The Collins Dictionary defines a hierarchy as:
‘A system of organising people into different ranks or levels of importance, for example, in society or a company.’
Often, within a hospital, the medical consultants are seen as the most important people. However, I know that a hospital would be at a standstill without the hidden heroes who are often looked down upon or seen as ‘less’.
I have written previously about how some staff nurses can view student nurses as being ‘lower’ than them because we are not qualified. Then, on a few of my recent placements, I have seen that there are other people who are perceived as even ‘lower’ than me.
During my time at university, I was heavily involved in discussing hierarchies and how they can be detrimental to patient care. I had a whole unit on interprofessional working. By learning this, we understood the importance of the other members of the multidisciplinary team (MDT), not only those in the medical field but also those outside this area. But I don't think we discussed the importance of the ‘hidden’ members of this team; they often see things, hear things and spot things we don't have time to.
My parents always taught me to respect everyone. When discussing this, my mum said ‘Respect the people who look after you and how important they are. Without them, we can't get on with our jobs.’ My dad said, ‘Everybody deserves respect; at the end of the day, they provide a vital service.’
However, I have noticed that some staff and student nurses appear to take those people for granted and look down on them. I'm talking about the unsung heroes: the cleaners, maintenance people, porters, kitchen staff and housekeepers. Without these people looking after the hospital, our workplace – making sure our patients are fed, the spaces are clean and tidy, fixing things that break – the whole place would be a mess, and we, as staff, would be a mess. We couldn't do our jobs as nurses, doctors, and other MDT professionals to our full capabilities. We would be washing linen and making food and trying to fix a sink (in my case, really badly).
There is also a tendency among some staff to take healthcare assistants for granted too, but we also depend on them to care for patients - especially when the nurses' workload gets heavy.
On my placements, I will always shadow a healthcare assistant because they have skills in areas I can only dream of. They do certain things every day and have perfected their art.
And if the housekeeper asks for my help, I say yes; I am not above serving food, putting away washing, or helping take out the bins. Doing this helps my practice; I learn where and how things are stocked so that, in an emergency situation, I can find things. I know that if a vital person is off sick, I can step in and help. At the end of the day, these jobs still need to be done.
I was discussing this with a friend, and she reminded me, ‘There aren't fairies who restock the supplies cupboard; without those staff, I wouldn't know where to look!’
So, my point is, when you are working on placement, and you sit or stand waiting for your 4-hourly observations to be due, help someone and learn something else. It may help you in practice and give you food for thought for an assignment. You might learn a technique you never thought of using on a patient with complex needs; you might learn to fix a broken sink.
But you will also learn appreciation when a porter takes a little longer than you would like; you will understand that they came all the way from the other side of the hospital while also offering directions to those who look lost and confused (I wouldn't be able to, I only know my small area of the hospital). When the housekeeper needs help folding a bed sheet or making a bed, go and help and learn an efficient way of doing it.
These people are the foundation, the machine that keeps us running at the speed we need to. Please take a moment to thank them. Please take a moment to appreciate what they do and how much they help us. Do not look down on them.
Remember that when your patient goes home, you get the box of chocolates and the big thanks. You get told that ‘you're amazing’. But without those hidden heroes, you wouldn't have been amazing. You wouldn't have given them the patient-centred care we are taught about.
Finally, I will stop ranting at you! You don't like it when you are not spoken to with kindness and respect or when you are seen as less than others. As Paddington Bear says, ‘If we're kind and polite, the world will be right.’ Treat other people how you want to be treated.
‘Without these people looking after the hospital – making sure our patients are fed, the spaces are clean and tidy, fixing things that break – the whole place would be a mess’