Why digitisation harms nursing. #respectnurses

This text is an article published in Mabuse magazine in summer 2020

In the midst of the debate about the shortage of skilled nursing staff, which is now also being discussed in public, in the midst of the daily hustle and bustle and in view of the dramatic figures of the Health Report 2019, which proves that „Germany’s nurses are worse off than average“, it is hard to believe in retrospect: Not long ago, in the mid-1970s, some colleagues in the profession were doing fabulously well. A model ward was set up at the University Hospital of Ulm, which was oriented towards internal medicine and psychosomatics. Anyone who wants to take a look at the blatant differences to today’s concentration of work can watch the film „Wer will schon krank sein auf der Welt“ (Who wants to be sick in the world) from 1975 on the Internet, which documented the work of the ward. Today’s viewer is overcome with restlessness as he experiences the protracted conversations between the nurses and their patients. Spending so much time in one conversation seems to be a utopia today. Yet Peplau had already defined nursing as relationship work in 1965.

For many, digitisation today seems to be a solution to relieve nurses of work and create time resources for other tasks. According to the results of an INQUA study, nurses want to work with people and are not so technologically inclined, this is just a common opinion. Nurses are very curious about new technologies. The fear that the relationship work in nursing could suffer through the use of digital technologies should be taken into account in any implementation. The health report of the health insurance companies in Germany also recommends the use of digital technologies to relieve the burden of nurses. After all, they are more often incapacitated for work due to mental stress than people in other professions. It is not surprising that the interviewees of the INQUA study particularly endanger marriages, because they are professional carers. However, in the praised relief provided by digital systems, an essential aspect was forgotten. The health of the nurses themselves.

Neuroscientist Joachim Bauer examines the creation of the human self on the basis of resonance. Resonance, i.e. the interaction between the I and the YOU, which is evident from infancy onwards in the interaction between the individual and the outside world, helps the human being to develop a self. According to Bauer, work in particular is connected to the self in a special way. Through social esteem, a positive resonance of the social environment and interpersonal resonance, the worker receives recognition. This addresses motivation and reward systems in the brain. If the resonance fails to materialise, a mental and physical breakdown will soon occur. Burnout and depression can also result from altered or absent resonances. This is especially true for „workaholics“ who derive their benefit from the positive resonance of an overfulfilled work performance.

According to Bauer, the increasing density of work and the arrival of digital technology in the world of work pose a major threat. Bauer by no means writes explicitly about nursing. However, the parallels are significant. For years, the increasing concentration of work in nursing has been lamented. The lack of social esteem that nurses experience and communicate is a widespread criticism. The gap between expected and experienced reality also became clear in January 2020 in the discussion under the hashtag #respectnurses. There, nurses reported on the shocking disrespect they have been experiencing at work for years. For years now, sexualised violence has also been a recurring theme.

Nurses do not seem to experience positive feedback in lived reality. And it fits in with Bauer’s theory of alienation from the self that nurses in particular are mentally ill. There is simply a lack of resonance spaces in the ever-denser everyday working life, which can lead to a positive self. This reduction to a barely working existence without a resonating space approaches in a threatening way what Hannah Arendt defined in her book „Vita Active“ as „animal laborans“ as a work animal. „Since humans are subject to the need of life, they can only become free by subjugating others and forcing them by force to bear the need of life for them. If the life of nurses, which also isolates them socially, revolves only around their profession, the step to social deprivation is not far away. If institutions do not succeed in creating spare wheels for the increasing digitalisation and we lead nurses with laptops, digital files and floor sensors further and further away from their possibilities of resonance. Then it would only be logical if they continued to fall ill despite the alleged relief. Surely that cannot be the claim.

Technology per se is not the problem. The nurses at an ICU, for example, are offered a continuous resonance by the handling of technology and the auditory feedback through alarms. This shows them that they are doing their job excellently as long as the patient’s stability is proven. This may also be a reason for the popularity of ICUs.
Violence among colleagues, bullying, #nurseseattheyryoung can also be illuminated differently as a call for recognition against this background.

Digitisation offers opportunities, but apparently also risks. Without a significant change in thinking on the part of employers, structural changes in the field of politics, without social resonance (and I mean more than gossiping on the balcony) and without appreciation, digitisation is just a patch on a carpet that nobody can walk on.

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