I wrote yesterday about the worsening industrial situation in Victoria, but it’s not just here where Liberal governments are cutting services they ought to be protecting and building up – in NSW Premier Barry O’Farrell has responded to a WorkCover shortfall by deciding to limit payments to injured workers – there will be a protest tomorrow, which will include striking nurses – nurses constitute a high risk population, with both chronic and career-ending injuries.
This is an interesting contrast to the Victorian situation, where apparently we have so much money in the WorkCover coffers that the Premier’s in the process of passing a Bill allowing him to take $471.5 million dollars out of WorkCover over four years – money that is not a tax but paid in by employers to cover the medical and pension needs of injured workers – money that surely belongs to employers, injured workers, or both, and not to the government.
There is a perception in Australia (and I know we’re not unique in this) that the country – nay, the world – is filled with rip-off merchants from whom honest tax payers must be protected. It doesn’t matter what the facts are, we lock away innocent refugees in inhumane conditions because a minute percentage are not genuinely in fear for their lives, for example. And WorkCover authorities spend entirely too much time, energy and revenue on investigating people with long-term disability.
I’m not naive – hell, with my twenty-third year of acute, public sector nursing just behind me I’d have to be willfully blind and stupid not to know that some people are lazy, feckless layabouts eager to take anything they can get. I also know that these people constitute a tiny percentage of the population. I’m a tax-payer – I strongly suspect I’m not alone when I say that I’d rather subsidise some of these than penalise genuine victims – it’s the same principle that underlies our criminal justice system. But instead of focusing on how to manage with life post-injury, many work-injured employees spend their lives justifying and proving that they’re still impaired – even though we know less than 1% of WorkCover claimants are fradulent.
Although I knew that going in, reading this site, established by an injured ICU nurse, made me realise how much persecution these victims face. I was already aware of the role good luck has played in keeping me on the floor.
In the two decades I’ve been nursing manual handling has changed significantly – every single method of moving a patient that I was taught as a student is now illegal, and many of the intervening equipment and techniques have been superseded. My last significant work-related injury was over a decade ago (and was my fourth work-acquired back injury); despite annual competencies, education, improved techniques, and the prophylactic measures of regular massage and yoga, as long as I am involved with moving people I’m at risk of significant injury. People move unpredictably, particularly if they’re confused and/or aggressive; people fall and can take you down with them (and that’s assuming the instinct to grab them can be overridden, which is far easier said in theory than done when they’re going down before your eyes); maintaining a hold (like assisting a patient to curl for a spinal procedure) can require staying in one position far longer than is comfortable or recommended; and even if you take all precautions, there are all too often fluids deposited on the floor that weren’t there the last time you looked. Finally, there are emergencies – adrenaline can override discomfort, so an awkward position or wrench can go unnoticed, getting that tight bed head out of the way for an intubation seems like a bigger priority, or the patient arrested sitting in a chair or – surprisingly often – on the toilet, and resus on the floor isn’t ideal for anyone.
In an emergency, the patient is front and centre. We take precautions – check there’s nothing (like a live wire, knife-wielding maniac) that might harms us, too. That “clear” you see on TV is one of the few things about arrests that dramas actually get right – if you’re at the scene of defibrillation it’s your responsibility to both make sure you’re safe, and look out for idiots (most often junior doctors) who don’t realise that being in contact with the patient (or standing on liquid that’s also linked to the patient) means the electrical charge that we hope will jolt the patient out of a fatal rhythm could put them into one. And, however hectic things get, all sharps are flagged and safely disposed of and, since I saw a diminutive doctor slip on a piece of plastic while dashing toward the bed, only to disappear under it, I’m fanatical about keeping the area clear, too. But when that adrenaline’s flying, so are the staff.
Two emergencies particularly stand out for me. The first was only a few years ago – I was working with an excellent agency nurse who was so heavily pregnant that it was meant to be her last shift. The night was so quiet that I was sitting at the main desk, my feet up on the bench, talking with a friend visiting from another ward while idly colouring in my nails with whiteboard marker – I have not had a night like that in at least two years, and even then it was an aberration. Suddenly, the nurse appeared around the corner and said, “I think she’s dead!”
I knew exactly who she was talking about – a vasculopathic man in his mid thirties who’d been admitted with a myocardial infarction, then had a stroke. He was on a blood thinning drug, and had last been seen by the nurse just under half an hour earlier. I don’t even remember leaving my seat, and I took the corner up the corridor so fast that my pager flew off and I later found it under the window of the patient’s room at that intersection. I was thinking many things as I dashed up that passage, at time both contracted and elastically expanded with adrenaline – I thought of the Coroner, the family, the possibility of the nurse going in to labour, the ridiculous multihued nails I was sporting and, of course, the patient. I did not at all think about an obstruction being in the corridor when I took it at a faster turn than I’ve ever moved in my life, and it wasn’t until the next day that I felt the result of almost ten minutes of cardiac compressions that failed to yield a response.
I remember another arrest, very early on in my career, where nobody responded to my emergency buzzing – confronted with a woman in full arrest, I managed to get her literally dead weight (outmassing me by perhaps twenty kilos) from the chair in to her bed on my own. As soon as I got her flat on the bed her trache cleared and she started breathing again, but I have to admit that my back wasn’t even in the top ten things I was thinking about during that couple of minutes. And, fortunately for me, that wasn’t one of the incidents when I sustained an injury, nor even within a year of one.
But, as is so often the case with injuries of all kinds, and workplace ones in particular, that’s more down to good luck than anything else. We can put in safeguards, education, and alter policies in line with best practice – all these changes have made a real and measurable difference. But when you’re dealing with things that move – people and animals, who do not respond to manual handling with consistency or predictability – there is only so much intervention you can install. As long as those of us who work with people (and, I assume, livestock) prioritise the wellbeing of our charges as well as ourselves, there will be a possibility of harm. Manual handling techniques and equipment are brilliant, and have come a long way, but when the patient doesn’t move the way they’re supposed to, our choices can be limited.
One last anecdote – not so long ago I was caring for a person whose condition was rapidly deteriorating. In the space of only a couple of days he went from being able to transfer almost independently from bed to chair, to needing a standing lifter. This machine allows people who can partially weight-bear to stand, and it worked brilliantly. My patient, who I’ll call Dave, was in denial about his imminent death – his youth, his charisma and his circumstances meant all the staff had a lot of sympathy, and were prepared to cut him more slack than usual, which is why he was still allowed to go downstairs to smoke, even though he’d several times lost consciousness doing so (even though he was in a wheelchair). When I instigated using the standing lifter he was delighted – he told his partner that they should get one for when he went home, though going home was clearly never going to happen. But it meant we only needed two people to get him in or out of the chair, and having a smoke was pretty much his only outlet for what was becoming an increasingly repressive hospital regimen. Then, three days later, as I was transferring him from the chair to bed, he collapsed. I’ve never seen someone collapse in a standing lifter – I didn’t even know it was possible. But there he was, almost on his knees, with his arms extended above shoulder level because of the armrests and the hoist belt. He was in pain, he was contorted, he couldn’t breathe, and he was panicking. I couldn’t lower him to the ground because of the confined space and the size of the machine, and I only had his partner in the room helping me. I sent her out to get help, while I tried to release the belt yet not take all his weight myself. Help arrived within minutes, and we somehow got him back in to bed without injuring Dave or anyone else. But once again, that was more good luck than anything else.
Nurses are at high risk of occupational injury – injury that is often career ending. I know nurses who’ve sustained permanent disability reaching above shoulder height to hang a 2L bag of dialysis fluid. A physio I saw after my first (then) WorkCare injury told me she’s seen nurses crippled when they turned a door knob, because of the toll years of manual handling has taken. I first started seeing a massage therapist over a dozen years ago, after my fourth (and so far last) back injury – after a year or so of fortnightly massages he really started to hurt me. I stood it for a while, then asked why it hurt now. “Because,” he replied, “you had so much scar tissue you couldn’t feel it before.”
In two years, five months, two weeks and three days Victorians will head to the polls – and 119 days later our neighbours a little to the north will do the same. That’s not nearly long enough for me to forget, Mr Premier, and I know I’m not alone.