The Secret Struggle of Nursing -

Read Time:6 Minute, 59 Second

By Solomon Oswago

The business of saving human lives has always been held to a special standard, dating back to as early as 5 BC. Ancient Greek physicians recognized that saving human lives could not be treated as any other occupation and needed a specific set of rules.

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Thus, after much deliberation, the ancient physician Hippocrates established the Hippocratic Oath, a medical oath to the healing gods, taken by all physicians swearing that they would heal all patients fairly, equally, and to the best of their ability.

The importance of the oath lies not in the gods, but in what it stands for: a solid and non-negotiable code. All medical practitioners must recite the Hippocratic Oath to be allowed to practice, as a sort of ‘ceremonial representation’ that they will indeed work to Hippocrates’ standards, if not higher; all for the sake of the highest standards of medical care.

The Republic of Kenya is party to this as well, as all medical practitioners have their respective disciplinary codes. After the last review in 1999, practitioners established ‘The Code of Professional Conduct and Discipline’ with the latest revision being as recent as 2012. It can roughly be summarized into five major topics:

The structure and functions of the Medical Practitioners and Dentists’ Board.

Registration and licensing requirements.

Disciplinary proceedings and situations.

Conduct that would raise said disciplinary issues.

Professional ethics and recommended ethical conduct.

The Code in question is essentially a much more refined Hippocratic Oath, modified for the needs of the Medical Community of modern-day Kenya. This works towards ensuring the best possible treatment by Practitioners to the patients. Naturally, we cannot forget the essential cadre of medical staff, without which doctors cannot hope to function: the nurses.

Nurses have their own governing bodies and codes as well, mainly with the National Nurses Association of Kenya (NNAK) and the Nursing Council of Kenya (NCK). Yet again, we see that their code is more or less guidelines on how nurses are expected to carry themselves when interacting with each other and the patients under their care.

Yet in both these codes, there is one crucial third party overlooked: the patient. Particularly, the patient-nurse relationship dynamic. All codes stress the importance of treating the patient as caringly as possible, and straight-up bans any negativity against patients. On paper, this seems fine, but patients are the only party in this sphere that is left to their own devices, without any code to follow. They are basically untouchable. If ‘the customer is always right’, then ‘the patient is always God’.

Without a code, there are no guidelines. Without guidelines, there are no repercussions, and no repercussions mean that whatever the patients do, for better or worse, goes ignored and the subsequent responsibility gets pushed onto the hospital staff.

Now, this is not to say that all patients are evil. Far from it, most have common courtesy and sense, realizing that they should probably treat the people in charge of their health in at least a cordial manner. However, there is a small percentage of ill-mannered or rude patients who habitually abuse nurses mentally, physically, and even emotionally; to the point where the caregiver suffers real grief or real stress. Please remember that the caregiver is forbidden by the oath from any form of retaliation or pushback. Sometimes this aggression is not induced by illness but by some dark demons from within the patient. To put this into perspective, below are sample anecdotes from a certain hospital of patient grand misbehavior towards their ward and care nurses. Due to the nature of the Nursing Code, anonymity will be observed. The cited instances are, however, real and documented.

Nurse A was asked to bring some drinking water by her charge, which the nurse brought promptly. What the nurse did not expect was for the patient, upon touching the jug of water, to slap the said nurse in the face so hard that the nurse fell on the ground. The reason for this unprovoked outburst of random violence? The water was not room-temperature, but lukewarm. Since the code prohibits any manner of response from the nurses’ end, even if it is in self-defense, the nurse simply forced a smile, brought more water, finished their shift, and went home to cry in self-consolation. Unsurprisingly, Nurse A took a leave of absence for a month. The entire training of a nurse does not anticipate or conceive any circumstance in which such egregious violence unrelated to the disease or illness comes from a patient. And yet this is not an exceptional or rare occurrence, even if the average hospital-goer never witnesses such.

Nurse B had been wrapping up with a patient when the ‘Nurse Bell’ rang. The bell is a notification system that notifies nurses of a patient with any particular need. Nurse B had both the patient she had been dealing with at the time of the bell, and the bell-presser themselves as patients under her charge. Naturally, she chose to finish with the prior patient, then head to the patient with the request. Within 2-3 minutes she was already with the second patient, who was not pleased at all that they had not been tended to immediately. So, what did the patient do? Proceed to call her very abusive slurs, including ‘idiotic’, ‘failure that couldn’t make doctor’, and ‘incompetent’, among others. Being the professional that she was, Nurse B silently accepted all the slurs, waited for the abusive patient to finish, and just went to the nearest storeroom to cry her feelings out. To add salt to injury, the patient had pressed the bell just to have their bed height adjusted, an action that any patient with functional limbs, such as themselves, could easily accomplish on their own, as every hospital bed came equipped with a conspicuous panel for height adjustment.

Nurse C had been unfortunate enough to be assigned to be the private nurse of a patient who was the living embodiment of the term ‘filthy’. The patient themselves, far from having an untidy lifestyle, was actually doing all this intentionally. Why? Well, having paid for the most expensive ward, the Executive Wing, they felt entitled to do whatever they wanted as they had paid for everything, including intentionally pushing their private nurse to the limit, and report her for ‘misconduct’ if the nurse were to show any reaction that any other human would when dealing with such an insufferable person. Though annoying, this was nothing the nurse couldn’t handle. What broke the nurse was when this patient; a fully functional adult with no fecal incontinence; defecated in full hospital clothing while in his bed, soiling and stinking up the room like an infant. His reasoning? “I paid, now clean it up.”

I believe these three examples paint a sufficient picture of patient-nurse abuse. Unfortunately, a quick survey showed that these irregular patients accounted for roughly 35% of the total patient population, an unforgivably high amount. Now, while the protection of the patient by the Kenyan medical codes, as well as the Health Insurance Portability and Accountability Act (HIPAA in short), is valid, the ban on nurses reporting any sort of patient misconduct in spite of the situation is simply illogical. They may be nurses, but first and foremost they are human beings; prone to depression and mental degradation when emotionally taxed. It seems quite unfair that these hardworking citizens are expected to work with these hooligans and simply take it in their stride while functioning optimally. Clearly, medical guidelines in this respect are outdated and need to be carefully reviewed by the necessary authorities, as well as the establishment of a proper emotional and mental support system for nurses. Patients as well must be held responsible for any irregular acts they may commit.

So next time you end up in a hospital, be it for a simple check-up or a more serious reason, remember to at least say a “Thank you” to the hard-working staff in charge of your life, since at the end of the day, they are only human after all.

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