culture and care


My husband was admitted to the hospital last week.   I have much to say about the system issues like bed utilization and the practice of hallway medicine.  But these problems are so big that I want to put my head down on the table in defeat whenever I think about them.

But the culture issues?  These are more in reach.

As the wife of a patient, I’ve been keeping vigil at bedside.  I can hear everything, for flimsy curtains in a four-person ward mask no sound.

The patient, who I love very much, has been bumped around the hospital from Emergency to the hallway to nursing unit to nursing unit.  The nursing units have offered up stark lessons in the differences in workplace culture.

On both units, the care has been competent.  Of course, the nurses are all educated and licensed, so nuts and bolts of assessment, medication administration, wound care, etc. have been similar.  The difference between the units is not what treatment has been done but how it has been administered.

On Unit A, my husband’s nurse introduced herself when she came on shift. If another nurse was covering for break, that nurse explained that when she came in. ‘I am here to take care of you,’ they all said by way of introduction.

I listened as my husband’s nurse chatted with the other patients as she went about her tasks.  She called the patient by name and lightly joked with them.  Even when I knew she was busy, she did not appear busy in the moment.  There was no edge of impatience to her voice.

All the nurses used the white board beside the bed to update the date and their names. This careful care was consistent shift after shift.  This was not the case of having one exceptional nurse.  This was the way this unit went about their business – with a smile and not a frown.

I could hear the nurses chatting about their days off in the hallway.  This gave me comfort that they liked each other and worked well as a team.  And that they did.  When a call bell went off, any available nurse would respond to it, even if it wasn’t their patient.  I was astounded at one point as four nurses responded to one call bell.  They often popped in to ask if their colleague needed help with what they were doing.  They said thank you to one another.

The nurses on this unit were, in a word, collegial.  They cared about each other so they could care for their patients.

I don’t know exactly how this happens.  So many factors come into play with workplace culture:  The nurse manager’s leadership style.  Hiring practices. Performance reviews. How mistakes are handled.  Whether staff see their jobs as a merely a job or as a calling.

My husband was moved after two days on Unit A.  I’m sad to report that Unit B had little of Unit A’s secret sauce.  Unit B was like opposite-land.  This was in the exact same hospital, so I can’t blame hospital leadership for this contrast.  The differences must have stemmed from the local level.

On Unit B, staff openly argued with each other at the nursing station.  There was rarely a smile. Staff came and went conducting their tasks in silence, without introduction.  There was no chit-chat with patients.  Two staff gossiped loudly about a patient in the hall.  Often times I was not even sure who my husband’s nurse even was.

I felt for these folks.  I knew the workplace culture was totally different here.  Everybody seemed unhappy.  Misery was a low-hanging cloud over the entire unit.

People scurried about with their head down, not making eye contact.  The corridors were crammed with so much equipment and garbage that you could barely squeeze by.  The sound of unanswered call bells echoed in the hallways.

While sometimes I despair that the emphasis on staff morale can overshadow patient-centred care, I fully acknowledge that positive staff engagement in their work is directly related to the patient experience.  Kind health care means that everybody must be kind to each other. This thread of kindness must run through all staff, physicians to unit clerks to housekeeping staff to porters to nurses. Full stop.

How could the patient and staff experience be so different in the exact same hospital, a few floors apart?  The answer is culture.  Staff culture eats patient care for breakfast.  Happy staff equals happy patients.  It’s as simple as that.

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