Dr Robin Youngson, Cofounder of Hearts in Healthcare, reflects on his recent stay in hospital.
There were no special privileges for this doctor-turned-patient, spending a week in a large pubic hospital in New Zealand. I was admitted for long-planned elective surgery. Many of the nurses never knew that I was a doctor, let alone a hospital specialist; they didn’t know I had previous worked in the same hospital and at one time was the corporate advisor for quality and safety.
I occupied a four-bed patient room on the surgical ward. My only view was the curtain around the bed but I could hear everything being said at the bedside of my three fellow patients.
My anaesthesia and surgery went wonderfully well. On the afternoon of a three-hour abdominal surgery I was eating, drinking and walking. I would have been discharged two days after surgery, were it not for a series of urinary complications involving multiple catheters and a bout of sepsis requiring readmission to hospital and iv antibiotics. All is well now.
During my seven days in hospital, I had opportunity to calibrate the quality of compassionate caring from a wide spectrum of nurses. The difference in the experience of care is remarkable: from apprehension to a profound feeling of safety and gratitude. There is nothing quite like being vulnerable, unwell or in pain to magnify this impact.
So I invite you to take this test, whether you are a nurse, therapist, doctors or midwife. Where does your practice fit on the spectrum of kindness and compassion?
1. Brusque care
This level is personified by one the nurses who inserted a urinary catheter. She was clinically competent and I couldn’t fault her technique. But she was rough and insensitive in a procedure that can either be painless or quite traumatic. She applied antiseptic skin prep to my genitals in a vigorous way, without thought to their sensitivity or tenderness. Then she forcibly squirted anaesthetic gel into my urethra, making me flinch, and without pausing she picked up the catheter to begin immediate insertion. At that point I intervened, gently asking her if she would mind waiting a minute for the anaesthetic gel to work before she inserted the catheter? She aquiesced to my request but never smiled.
2. Polite care
A minority of nurses fell into this category. They went about their work with brisk efficiency. They were polite, they smiled and they performed their nursing work with care. Some of the night-shift workers exemplified this mode of nursing. Their manner of doing patient observations ensure that every patient in the four-bed room was woken from sleep. Loud hurried footfalls with hard-soled shoes, clattering of equipment, bright lights, unthinking adherence to protocols. They smiled, but not with their eyes.
3. Kindly care
Most of the nurses I met were kindly. They greeted you as a person, anticipated your needs, came back to check on you, attended to small comforts and they smiled a lot. If you raised a question or concern, they would be sure to return with an answer. They bent the rules to do the right thing to care for you and to meet your individual needs. They obviously enjoyed their job and it was always a pleasure to see them at your bedside. One kindly nurse inserted a catheter; it was done with gentleness, sensitivity and empathy. The experience was painless.
4. Compassionate care
About one in five nurses fell into this category. They melted my heart and I felt such intense gratitude. When you are vulnerable, anxious, or in pain the impact of a truly compassionate nurse is immense. You just feel so comforted, safe and grateful. You forget about your pain. These wonderful nurses truly saw you as a person. They had a compassionate gaze that entered your soul. Their empathetic touch meant everything. I shamelessly held hands with these wonderful nurses and the pleasure and the smiles were mutual. These are the nurses who said, “I absolutely love my job.” They loved their patients too.
Which nurse did you identify with?
Think about your last week of patient care. Where does your practice sit? I feel sure that you care a lot about your patients but do you know how they experience your care?
I felt compassion for the nurses who were brusque or polite. I feel sure they entered their profession with a deep desire to care. But they have been brutalised by the system and they lost their vocation. They are just doing a job and a number of them are heading for burnout.
I could judge the character of each nurse within a minute or two of meeting, it was that obvious. The higher up the scale of kindness and compassion, the greater was the evident pleasure, satisfaction and joy of each nurse. Research supports this observation: empathy and compassion protect from burnout. Those who have lost the deeper meaning and purpose in their work are at the greatest risk.
The compassionate nurses quickly found out I was a doctor and it didn’t make a jot of difference to the care they offered – they gave the same quality of care to every patient, regardless of status. The brusque and polite nurses never saw me as a person, didn’t engage me in conversation, and didn’t find out that I was a doctor.
As we have amply documented in these pages, the quality of compassionate caring has a major impact on patient outcomes. The joyful nurses are literally helping their patients heal, the brusque ones are doing harm.
For individual practitioners, it’s a small step to elevate yourself from one grade in the kindness-compassion continuum to the next. The rewards for yourself and your patients are great. The wonderful thing is, you don’t need permission from your boss or anyone else to take this step. The brusque nurses and the deeply compassionate ones are working on the same wards with the same bosses. The quality of their care comes down to personal choice.
From our travels all around the world, we know that most healthcare workplaces are stressed and unsupportive. If you’d like to take the next step but feel overwhelmed, we have resources to help you. See my article, ‘Practising compassion in an uncompassionate health system‘ or else purchase a copy of my book, ‘TIME TO CARE – How to love your patients and your job‘ – it’s helped thousands of health workers transform their work experience. Those who live in Australia or New Zealand can get a signed copy of my book direct from our website.