Every year we celebrate International Nurses Day on Florence Nightingale’s birthday. In our hospital it’s a time when nurses dress up in their best, renew their pledge to serve, collect awards, and put on a cultural program. For the third year in a row I was asked to say a few words. Last year I had discussed how our newly introduced Training Within Industry (TWI) program had helped reduce nursing complaints, increase our Net Promoter Score and win glowing comments from patients. But the program hadn’t been further expanded in the past year and I didn’t have anything new to say.
So I decided to learn more about Florence Nightingale and was amazed to discover how through astute observations, meticulous data collection, report writing and public effort, she created awareness of the role of hygiene in preventing infections and how her insights had transformed care of the sick in hospitals. As I was getting inspired by her story, I was also becoming increasingly conscious of how nursing in our environment failed to achieve its potential – in our hospital and more widely in the Indian health system.
Florence Nightingale was a “passionate statistician” and so I too began by asking Anitha, our human resource manager, to prepare some statistics on nurse turnover at Sitaram Bhartia – a problem that all private hospitals have come to accept as inevitable. In 2013 our hospital had 67 resignations from nurses. Given our approved strength of 86, this meant that we had a turnover of whooping 78%. We started 2015 with only 28 nurses who had been with us for two years or more. In most nursing departments like adult intensive care, neonatal intensive care and ward, only about a third of nurses had been with us for longer than two years!
“Nurses leave because they go to the Middle East or find a government job – we can’t compete with that!” is a common retort that I have heard all these years. But when we looked at the reason for nurses leaving us, the biggest group emerged as absconding, a term that is used for those nurses who leave without any notice and don’t respond to any correspondence from our side (29/67 resignations in 2013). When we compared the tenure of nurses who had absconded versus those who had left because of marriage, maternity, government jobs, or postings in the Middle East, it became clear that this was a very different group – a disproportionate number of absconding nurses had left under a year (27/29). These nurses were either not intending to stay long with us from the beginning or left because they found us to be unsatisfactory upon joining. Marriage and maternity were leading causes but typically these nurses had tenures of 1-3 years with us.
So inspired by Nightingale, we have gotten some clues as to where our problems may lie. Of course, we need to complete the picture by speaking to others and using common sense (which is unfortunately not so common). Most importantly, we need to decide whether we will accept status quo as inevitable, or following Nightingale’s example commit to improving the situation through analysis and systems thinking. Doing more of the same and expecting different results is insanity as Einstein had warned. And Thomas Edison could have written a book on hundreds of ways of not building a light bulb. We will have to be innovative and we will have to persevere. Luckily we don’t have to be as brilliant as Nightingale – the tools for understanding and finding solutions are largely well described in the quality improvement literature – but we have to embrace them.
The question is are we up for it? Individual nurses and organizations that succeed in doing so can expect better patient care, more joy and meaning at work, and more cost-effective healthcare delivery.
It may be easier to celebrate Nightingale’s birthday than live by her principles.