Category Archives: Clinical Practice

Blogs about patient care and related issues

The Job of a Nurse and the Nursing Function

The Job of a Nurse and the Nursing Function

I have, for a long time, wished to write an entire article on this subject. May be a short post can be a start.

Nursing is an activity performed by all members of the community. We talk/hear about a mother nursing her child, daughters nursing their parents in their old age and wives nursing their debilitated husbands. Nor is nursing confined to women. We read about husbands nursing their wives back to health. In fact, stories had been written of a whole a community nursing an injured soldier. In Malay the word ‘rawat’ means ‘to take care of’. A synonym is ‘menjaga’ which means to do a day and night vigil to look after a sick person. It includes performing tasks to provide comfort, to assist in the performance of basic activities of daily living and to give hope.
At a certain point in history, groups of women take on the task of nursing as a defined activity which later became important enough to be recognized as a profession. The nurse then becomes a member of the healthcare team, joining other healthcare professionals and complementing them by providing ‘nursing’.

Yet, today, the job of a nurse has evolved in such a way as to expand beyond her/his role to include those tasks other than nursing. She/he has taken on or has been given additional tasks in the care of sick persons as well as in health promotion, disease prevention, early detection of diseases/illnesses/health problems and in rehabilitation. Currently, she/he is expected to perform parts of the tasks of the doctor, the pharmacist, the rehabilitation professional, the phlebotomist and other professions not to mention that of porters/orderlies. Included in these is the recording of data. On top of that, they are also saddled with administrative and managerial tasks.
Why does the job of the nurse encompass so much responsibilities? This stems from the tradition of the nurse being on a 24-hour vigil (‘berjaga’ means ‘not to sleep’). The healthcare service has been designed so that (more so in in-patient care) the nurse is there by the side of the patient and within the location allocated to her/him all the time. To achieve this, nurses work in continuous shifts. Somehow, it is thought that at night there is less work and the nurse can work a longer shift (to keep a vigil is after all a sacrifice expected of a carer).

Much of the work that is not necessarily ‘nursing’ in nature is given to the nurse because she is always there. The first of this is observation and monitoring which, by nature, are continual. Dispensing medication is her/her role because we do not expect pharmacists to come in at night, do we? Who is more appropriate to teach, observe and cajole patients to do various physiotherapy exercises than a nurse? After all it is simple and within their capability. If the nurse can withdraw blood, who needs a phlebotomist. Somehow, porters are always short in supply, it is not beneath the nurse to push a patient. It is better because she/he can keep watch on the patient. The list goes on and on.
To be part of the health-care team effectively, the nursing profession need to reconcile with these needs and arrangements. They should be proud to take on the responsibility of executing the key components of the overall care plan instead of complaining of being the ‘hand-maiden of the doctor’. Looking at it that way means that they are servants also of all other health care professionals mentioned above. They must also acquire sufficient knowledge and skills to do so.

On the other hand, health care service managers must recognize the importance and gravity of the nursing job. Numbers of staff assigned to various services must commiserate with the amount and complexity of the tasks to be performed. The contribution of nurses must be compensated equitably.
In modern healthcare practice, the role of the nurse goes beyond ‘nursing’. The difference between the job of a nurse and the function of nursing needs to be understood.

The Basis of Patient Care

The subject of clinical work process and total patient care is not covered well in most textbooks dealing with clinical methods or medicine in general. Medical students somehow acquire an understanding of the approach to patient care despite (in my opinion) an incoherent exposition to the subject.

A search via the internet result in a fairly long list of articles  and posts but few if any describe exactly the processes of patient care. It would appear that understanding of it is assumed.  The term process as applied in other industrial endeavors is seldom used in medical circles except when discussing quality management and clinical information systems.

Actually, clinical work processes in the guise of Nursing Process is very familiar to nurses. Unfortunately, it is considered as a special technique rather than something more fundamental. The current feeling is that “Nursing Process” has been superceded by “Nursing Care Plan”.

In practice, the method of caring for patients and their disease guided by a standard sequence of clinical processes is used by all direct care providers (clinicians) be they doctors, nurses, physiotherapists, occupational therapists, speech therapists, nutritionists, counselors, and clinical psychologists. Currently in some instances, optometrists and audiometrists are also care practitioners (manage some patients on their own) and would therefore be guided by the same processes.

You can read my article about this subject entitled “Overview of Clinical Care“.

Abdollah Salleh