To bring about closer collaboration between the medical and social sectors, the Hospital Authority (HA) of Hong Kong, which manages all public hospitals in Hong Kong, has announced, after a three-year pilot project, that it is ready to implement an integrative care model for helping at-risk elderly people who are discharged from hospitals meet their immediate transitional needs. Under the guidance of the HA, non-governmental organizations (NGOs) will have a social worker from the collaborating NGO stationed in the hospital to assess patient needs.
When I learnt about the initiative, I realized it was already a lost cause for community nurses to be champions of community support and care. I worked as a community nurse for a year in the mid-1980s. Back then, there was not much emphasis on community services and care, but now it is entirely different, with governments and health authorities all over the world realizing the importance of keeping patients in the community.
To me, nurses can also be brokers of community services as long as they have knowledge of the service agencies and support services available in the community. It intrigues me as to why we need another professional—a social worker—to come and be stationed in a hospital. Many community nursing centers are an integral part of hospital services. Community nurses go to the wards to assess patients prior to discharge when they receive a referral from the attending doctor. Now, a social worker will be stationed in the hospital and visit the unit to conduct patient assessments. It is a duplication of health resources.
Given the nursing shortage, nurses are ever so cautious when it comes to taking up new roles and responsibilities. Yet, when we focus only on what we cannot do because we believe we are overloaded, we do not see the possibility of what we can do. We need to show stakeholders that we are willing to take on new responsibilities for the purpose of providing holistic care to our patients.
At one time, nurses could have been the champions of community care. We could have done so much more for our patients. But we stayed in our comfort zone of defined practices. We would only see patients who had a referral—to dress a wound, give an injection or teach self-administration of injections, supervise walking exercises or change a catheter. Anything that was to be done had to come with a physician’s order.
Why would health education or patient counseling need a doctor’s referral? Charging for services is, of course, an issue. That is understandable. However, what is stopping nurses from going the extra mile to do the liaison work, to find out the needs of patients and families, and refer patients to the community support services they need, instead of asking them to seek a referral at their next doctor visit?
We need to wake up to the call of our nursing vocation and make ourselves visible and accessible.
