Last night’s movie, Jiro Dreams of Sushi, featured an 85 year old Japanese sushi chef who was absolutely passionate about his craft.
Not once did I see anyone in his kitchen filling out a form. Each day he created a new menu using Japanese calligraphy on rice paper. People in his kitchen started their day by going to the fish market to buy the very best fish, and shell fish available. If what they found was inferior they took that dish off the menu. They worked ceaselessly all day preparing the fish, shell fish, and rice to be made into unique, delicious, sushi.
What does this have to do with nursing? Sadly, not much at all.
I just finished reading a new interview transcript in which a nurse describes starting her day earlier and staying later than scheduled in order to document all that is required. Throughout the interview she voiced frustration about mountains of paperwork, forms, policies, and regulations which take her away from caring for her patients (her craft). This nurse did not work ceaselessly caring for her patient. Rather, she worked overtime creating a paper trail which satisfied managers, accountants, executives, and others external to the institution. She was not free to develop a “new menu” each day. She described constraints arising from rigid scheduling of tasks, predetermined patterns of care, and the need to squeeze her nursing around the schedules of other providers of care (Doctors, physiotherapists, etc).
The nurse in the interview had worked for 30 years in her field. Yet, her expertise, her practiced hands, and critical mind were not determining what to do for her patients, how to do it, or when.
As I think about Jiro and his life of perfecting his craft I see little in common with the work of nurses. There is no one department, level of management, payer, or regulator to blame. Everyone connected to health care in any way is as burdened as the nurse in the interview. It seems the industry (yes I used industry deliberately) has put its faith in managing risk through the use of prescribed action meticulously recorded. As with many “good ideas” this seemingly careful approach brings with it serious unintended consequences. Perhaps the saddest is seeing how much more attention can be given to making sushi than to caring for our patients.