Q: What do wearing gloves, using lifting machines, legislating ratios and clinical supervision have in common?
A: They’re all measures that protect nurses and their patients.
Back in ye olde days when I started nursing (the 1980s) the concept of “universal precautions” was introduced (source). In short, suddenly all body fluids were to be treated as potentially infectious. It didn’t matter if you arrived in hospital as a needle-sharing, sexually promiscuous, pus-and-rash stricken bleeding wreck, or a saintly and demure sex, drug and rock-and-roll avoidant 80 year old nun, we treated your body fluids the same. Amongst the changes this heralded was that gloves were to be worn whenever there was a risk of coming into contact with body fluids. It was a new way of working for older nurses and doctors. For newbies it was just standard practice: so much so, that in the mid 1990s the term “universal precautions” was replaced by “standard precautions” in Australia (source).
My first (short lived, temporary) job as a RN was in a nursing home. I had to argue for gloves to be made readily available for the AINs, ENs and RNs. The initial response was along the lines of:  using disposable gloves for every encounter with body fluids will be expensive,  nurses can wash their hands if they come into contact with urine or faeces, and  do you REALLY think that any of these elderly people have been sharing needles or having unprotected anal sex to contract HIV? They came around, but at first the management just did not understand that universal/standard precautions were not just a nuisance cost, but actually an investment in protecting staff and residents/patients.
When I was a student nurse I was often made to feel very warm and fuzzy inside. Not because of my sparkling wit and ruggedly handsome looks (🙄), not because of my enthusiastic and self-motivated approach to work, not because of my knowledge or skill, but because I was able to lift people easier than some of my more petite colleagues. Big boofy blokey nurses were handy to have around when patients need to hoisted up a bed, onto a barouche, or transferred between bed and chair.
In the hospital I trained in there were a few lifting machines. The way I remember* it, there were about 3 of them for a 900 bed hospital. So, I was a bit incredulous when I first heard of a “No Lift Policy” in the mid-1990s. “As if!”, I thought, “It will be too slow and too expensive to be practical. It’ll never happen.” Anyway, I was wrong. The No Lift Policy was implemented, and has since been renamed and reframed as Safe Patient Handling. The change has been endorsed by employers and the nurses’ union alike. Nurses of my age/era often have back pain, but younger/newer nurses are now better protected. The purchase of safe patient handling equipment and expense of training is not just a nuisance cost, but actually an investment in protecting staff and patients.
When I was a student nurse it would be usual to be allocated 6-8 patients on either a morning or afternoon shift, and up to 16ish on night shift. On a ward of over 30 patients in a surgical or medical ward in a large acute hospital, it was pretty standard for one RN and 2 student nurses to run the whole thing overnight. #scarynostalgia
In Australia the states of Victoria and Queensland have legislated nurse:patient ratios. Since July 2016 Queensland nurse:patient ratios have been credited with avoiding 145 deaths, 255 readmissions, and 29 200 hospital bed-days. Amazingly, ratios have been evaluated to save up to $81 million (source). Implementing ratios to stop nurses from burning-out over workloads and to improve quality of care is not just a nuisance cost, but actually an investment in protecting staff and patients.
In April 2019 a joint position statement was issued by the Australian College of Nursing, the Australian College of Mental Health Nurses and the Australian College of Midwives that Clinical Supervision is recommended for all nurses and midwives irrespective of their specific role, area of practice and years of experience (source).
As articulated in the joint statement, there is consistent evidence that effective clinical supervision impacts positively on professional development, and retention of a healthy and sustainable workforce. There is also evidence that clinical supervision of health-care staff impacts positively on outcomes for service-users.
I expect to be still working full time in 5 years time, but not in 10. I hope that by the time I pull-up stumps clinical supervision becomes embedded in nursing practice. Clinical supervision is not just a nuisance cost, but actually an investment in protecting staff and patients.
#qnmuconf @qnmuofficial improving the occupational health and safety of Queensland Nurses and Midwives = improving quality of patient care:
1980s universal precautions ✅
1990s no lift policy ✅
2010s ratios ✅
2020s clinical supervision❓(I hope so) https://t.co/bUJZsGVSTn
— Paul McNamara (@meta4RN) July 19, 2019
*not a reliable source: I have the memory of a stoned goldfish
Thanks for reading this far. As always, feedback is welcomed via the comments section below.
Thanks to Stella Green for giving permission to share our nearly-funny SMS.
Paul McNamara, 31 August 2019
Short URL meta4RN.com/protect
Great blog Paul and bring it on! Clinical supervision for all nurses will take our profession to the next level.
Hi, as a resource the following material may help promote CS for MH nurses around the country (and possibly ALL nurses!) Scroll down the page.
Excellent work! The recent DHHS CS guidelines for Victoria’s mental health nurses may also be useful, not just for MH nurses!