Positioning of Nursing in the Era of Change
Dr. LEONG Che-Hung
Chairman, Hospital Authority
Patron, Hong Kong Society for Nursing Education
(Keynote Speech at the Scientific Meeting of the 17th AGM on 28 March 2003)
Chairlady, distinguish guests, members of the Hong Kong Society for Nursing Education, ladies and gentlemen, can I begin by saying how grateful I am to be appointed your Patron and to receive a token of appreciation which I think I do not deserve. I also would like to thank your Chairlady and your Society for giving me honour to speak at your Annual General Meeting. Now, as you all know we are having a very hot topic at this point in time which is atypical pneumonia. I would use this particular disease as a means to exonerate the work and the role of nursing profession, at the same time express some of my thoughts on the needs for education future education or high education, of your profession in relation to the possible change in role of your profession in total.
As you know the world is in turmoil. War is raising in the Middle East and we don't know when it is going to stop. George Bush says it is going to end in days. But probably when it is going to end at all, in months or even longer. Tension as you all know is also rising in Korean Peninsula. While some world leaders, and politicians are instigating, segregation and raising war in the name of peace. I suppose we, as health care workers, must bring about peace through cooperation and promulgation of health for all in respective of sex, colour, race or creed. Now in Hong Kong, we are facing another kind of war. It is a war of men against virus, virus that brings on this formulating atypical pneumonia. I suppose you all agree that it is perhaps the biggest health care challenge. It's a crisis in Hong Kong ever since the day of bubonic plague which was dated back to the nineteen's century. Initially, this sickness seems to have preference in attacking us, the health care workers. But this may well be the beginning. Definitely, this is not all. Today, we are actually seeing the condition in the whole community and even on a global basis. Rightly or wrongly, it was reported, for example, in Toronto, that there are thousands of people that have to be somehow quarantined for the particular condition.
Now our colleagues in health care field both within the private and the public sectors in different professional level are facing immerse pressure: pressure from excessive workload, pressure from the fear that they themselves may ultimately fall victims of the disease, pressure of the possibility of bringing the illnesses home, and pressure, of course, of seeing their own colleagues falling sick one by one. Some of them are even very serious and critical. Yet our colleagues, I have to say, are braving this assault with complete professionalism and dedication. On behalf on the whole health care profession, and I would like to stress, the whole health care profession, we should solute to all of them.
But I have to say one thing too. They are not alone. In the last few days, I personally received numerous telephone calls from different members of the health care professions, ring up and say "I want to volunteer to help". We have seen in the media, big advertisement from different groups who previously were criticizing the medical health care professionals to come up to give their support. Money is actually pouring in to support our cost. I think we are winning the public hearts back.
Government too, was finally come to term that this crisis could bring on a debilitating consequence and it has proposed some active measures. Whether they are effective or not still needs to be seen, but at least they are proposing active measures including even a sizeable funding to help this epidemic. Whatever so, that the Government, especially those who hold the budgets would wake up to the fact that health care is always essential. Crisis only brings people to realise the importance of the health care professionals and that diseases are always round the corner. Yes, today Hong Kong is facing a financial turmoil. Yet, budgets for health care should never be drastically reduced with one single big slash. I do hope that, if anyone falls from this epidemic, this message that "Health care is essential. Health care is important as crisis would always be round the corner." This should be a clear message to the Government.
The fact that in the last few weeks you have seen there are proofs that this disease is caused by the coronavirus, for example, may indicate that they are, we might well be seeing light at the end of the tunnel. But it is for today, we are not sure who is going to win this battle, whether that is going to be virus or men. Yet I have to say to all of you. This war must be won, and I am sure it will. This could only be achieved through the wide vision of the policy makers, dedication of our frontline health care workers working in close partnership with sharp public health experts and swift health care administrators. We owe the victory to the public who relies completely on us. But, like it or not, the nursing colleagues would be the group that faces the biggest assault. You are constant contact and close contact too with those who acquired this disease. In short, you face the greatest challenge of catching the disease yourself. You are also responsible for prevention of disease spread inside the hospital setting. All these, and needless to say, you have a heavy responsibility.
The setting up of surveillance centres, imposing contact reporting and medical examinations for those who have been in contact, I think, to a certain extent, would be welcomed measures, and these will help contain the disease. Yet it would mean even bigger workload and greater responsibilities to the frontline nurses and doctors. The decision of the Hospital Authority is to meet all suspected cases under surveillance to the Princess Margaret Hospital, even those who go to private clinic. Now this would mean more nurses that will be needed to take care of cases of atypical pneumonia in the Princess Margaret Hospital. We need more ICU nurses to take care of those who somehow that are unfortunately goes into desaturation. It will also mean that we will need recruits who made themselves unfortunately fall victims of the disease, recruits who may worry of spreading the disease to their family members if they ever go home. Some of them may voluntarily decide to stay away from their family for a while. All these would be great sacrifice, a lot of headaches and heartaches, and tremendous psychological pressure. On the other hand, it would be a demonstration of professionalism, a pledge of devotion, and dedication for the world to witness.
Looking at this atypical pneumonia crisis brings me back to nostalgic feelings of Florence Nightingale. Born in Italy, Florence Nightingale became famous because of the Crimean war, a war between Britain, France, Turkey and Russia in 1850's, 19th century. The medical facilities for the military and wounded were poor then. In Britain, France, and Russia, hospitals were a fear to the patients. The description that I quote in one of the messages written by Florence Nightingale herself, "It is that hospitals are like a plague. More patients could be performed. Every cure stands still. Every wound become a sore, and every sore is apt to run into a gangrene." Hospitals then, were considered as a gateway to death. So anyone who goes into hospital may probably die or would probably die. Florence Nightingale was a saviour. She decided cross ventilation in hospitals believing that stagnant air breeds diseases. She believed in better nursing of the sick as an agent of improvement and nursing was the key weapon in a hygiene war where rightly showed a nurse could do much more and much better than a physician. Her success was tremendous, decreasing death rates from some 40% before to some 2% afterwards. Perhaps the most significant aspect of Florence Nightingale is that she believed that elevating nursing to high professional status owed much to members receiving thorough training in nursing theory and practice. What an insight, in the year 1859, in her "Note on nursing".
Ladies and gentlemen, nursing education is perhaps even more vital today, where nurses are seeing as it is not only a changing role but a diverse role. In Hospital Authority setting alone, we can see the following role that the nursing profession can, and should, participate in the future as a manager, and a budget holder, not only to organize nursing services but also to properly run a ward, a department, a unit or even a hospital. Medicine is advancing so rapidly that no one can be the "Jack of all trades". More and more would the nursing service and the public demand nurses with special skills and special expertise. Nurse practitioners who work in partnership with physicians in running follow-up clinics for stabilised chronically ill patients. And Hospital Authority will be promoting that. And also, to be vigilant, to refer this patient back to the doctors should any medical problems be suspected. Or, we are moving towards Tradition Chinese Medicine Clinics where require nurses, not only to act as an over-seer of this clinic, but also as a triage person to make sure that those who visit or those who are channelled to the Chinese Traditional Medicine Clinics, are actually suitable to be seen in the Traditional Chinese Medicine Clinic. In the year to come, in this year, if we have the money, will be starting three clinics of this nature and we will expand this to eighteen in the years to come, depending on, of course, the availability of money.
But even as a single caring nurse, continuous education is essential to bring everyone of you, everyone's knowledge to be in power with advancement of the medical sciences. Madame Chairlady, ladies and gentlemen, all these are essential and they need to be organised. I am very glad just now to hear from the Chairlady that the Academy of Nursing is being actively organised to cater for post-graduate nursing education specialisation. I am also very happy to see that you are amending your constitution to ensure that every single member of nursing professionals can participate so that they, irrespective they are nurse teachers or otherwise, could benefit or improve their nursing knowledge and nursing skills. Now I have no doubt that, when your Academy is established, and I do hope that could be very soon, it will work very closely with the Academy of Medicine which I am currently that I am still at the helm, to bring health care services standard to a new height for the benefit of Hong Kong people. With that, thank you very much for your attention.