‘Unknown’ nurses seek to be understood

The demand for community nurses is rapidly growing and their services are being stretched to the maximum but it is not more financial and human resources the Malta Memorial District Nursing Association is after. It just wants the public’s appreciation.

About 90 nurses, midwives and health carers, the equivalent of 72 full-time staff, pay about 1,000 visits to patients per day. From January to October, they clocked up 421,925 calls, including to schools to administer pills to pupils.

But the MMDNA, which has been around since 1945 and has a government contract to provide community nursing for free to housebound patients throughout the island, still feels somewhat “unknown”.

Over the years, the number of visits has been growing due to increased longevity, the fact that the elderly are staying in their homes longer and that most relatives work and cannot tend to them.

“Patients are requesting extended services but it is not easy to provide them. Many relatives cannot care for them because they are old themselves. A nappy change twice daily, the most the MMDNA can offer, is not enough for patients who want it four times a day,” said principal district nursing officer Carmen Cachia.

“We feel the public is not aware of the problems we face. They need to bear with us, especially in terms of time. Everyone wants a nurse between 8 and 9 a.m. But our staff complement cannot cater for 1,000 patients first thing in the morning.”

Each nurse visited 10 patients daily to wash them and change their nappies – a 30-minute job, Ms Cachia said.

The problem was people would not accept that their elderly relatives could have a saturated nappy but there was a limit to how much patients could ask for and it was time for a mentality change, she said.

The flu injection period was a particularly busy time for the nurses but it was the recent floods that put them to the test and really highlighted the pressure on them as well as their loyalty to the service.

“One nurse walked from Żabbar to Paola in the heavy rain to do her visits that day and a clerk caught a bus from Mellieħa to our premises in San Ġwann against her husband’s firm insistence not to go. It took her over three hours to arrive but she did, unwilling to miss work at all costs.

“A midwife from Balzan opted to cross the flooding valley despite being told she was crazy,” Ms Cachia recounted.

As the inclement weather stalled the nation, patients still called in to complain their nurse had not yet arrived by 8 a.m.

“Our nurses are out when the public is advised to stay in,” Ms Cachia said, adding they did their utmost in any condition. “But we do not fly!”

Doctors’ promises to patients did not help the association either and they had to bear in mind its tight constraints, she said, explaining they often requested a service that was not essential.

“They just sign a paper but the onus is then on us to figure out how to deliver. And if patients are told they need a service, they expect it and take it for granted.”

For example, the MMDNA carries out blood sugar tests for diabetics once a month but some doctors “please” their patients by requesting it be done daily so they can just put their minds at rest and be able to eat what they should not.

The burden was not just the extra visits but also the costs: “Some patients do not even want to buy the sticks and expect them from the government’s pocket.”

But it was not only patients and doctors who could complicate matters for the association. Parking was another obstacle and the wardens are on their case the whole time.

“We have police permits if we cannot find parking but the wardens consistently ignore them. That means we have to appeal and nurses have to attend the tribunals in their free time. The non-profitable association was midway to signing its contract for January 2011, said MMDNA management board chairman Major Stanley Clews.

“The government wants us to do more with less. To do so, it is not just a question of money and staff but also of reorganisation,” he said.

The country’s shortage of nurses meant it was not easy to recruit staff, he acknowledged, pointing out that the number of workers would drop next month and their replacement would be hard.