A patient falls out of bed. A team of specialists – a mix of interns, senior house officers, a registrar, a clinical nurse specialist and a clinical nurse manager – are grouped close by. None of them moves to help.

In a ward that is always in flux, there is a strange cessation. Finally, one of the team gestures with a pen as if to say, “Oh nurse, that patient has fallen, please do something.”

The patient is big, solid, a former intercounty footballer. It takes me and two other nurses and all of our strength – and balance – to heft him on to his feet, and from there back into bed. The footballer is embarrassed. The specialists continue to discuss their life-saving work.

Silent communication

There is another silent communication, however. In it, the specialist team are saying: “We are not responsible for patients who fall out of bed. We are not here to lift, or heft. Next you’ll be asking us to empty bed-pans.” The specialists are saying nothing, but they are eloquent.

“We are more important than you,” they say. “We make the life or death decisions. We matter.”

I am so tired of all these roles, identities and boundaries. They serve no purpose but to further alienate and divide in a place where reality itself is fractured.

There are already enough HSE managers to sink the ship, thanks very much.

Among the nurses, some see themselves as too important to wash a patient. Fine. But this means they have not only ceased to value the hands-on work, but have also learned to distance themselves from the patient and, worse, have begun to act like management. There are already enough HSE managers to sink the ship, thanks very much.

In the hospital or outside it, when another human is vulnerable, or at risk, it is my instinct to help. I become confused when others fail to act in a similar way. Maybe I’m a dinosaur. Soon to be extinct. Maybe the fact that I live with a man who would be the first over to help raises the false hope.

Upstairs, a bed manager has a graph on a computer screen. You – the patient – are a dot on it. I – the nurse – am a dot on it.

There is a lot I don’t understand these days. I don’t understand why, when you become a patient in this hospital, you cease to have status or rights. You become a bed number, or a bed blocker. You are not listened to. You are factored into an equation slide-ruled by time and money.

Upstairs, away from the smells of death and sickness, a bed manager has a graph on a computer screen. You – the patient – are a dot on it. I – the nurse – am a dot on it. The bed manager earns easily €55,000. He or she works 9am-5pm, and you can be damn sure he or she gets to eat lunch. And has every single weekend off.

Decades of underinvestment and years of middle management eating greedily into money that should be dedicated to front-line services, equipment and supports have brought us to a place where people are dying in corners with makeshift curtains around them. Who is to blame? That is the wrong question.

What to do

What can we do? That is the question. We can get off our arses and lift the patient into bed. We can stop the “us and them” thinking. We can stop believing that some of us are worth more than others (because we “own” rather than rent?).

We can stop thinking that some of us are more essential (because we have designated car spaces?). We can stop thinking about status, privilege, money, time and “bed spaces”.

Instead, we can start to give patients back their dignity. Piece by piece. Room by room. We can make that the damn protocol the priority.

We can stop believing that a family who does not have private insurance deserves to watch their mother dying in A&E

We can start to see that nurses are always essential, not just when you are sick. We can stop the reductionist thinking that says if you spend four years studying, say, computer programming or chemical engineering, you are entitled to earn twice as much on start up, and three or four times as much after 10 years, as the deluded, vocational sap who spent the same number of years studying nursing.

We can stop believing that a family who does not have private insurance deserves to watch their mother dying, surrounded by strangers and the drink and drug-fuelled spillover from A&E.

Protocols

This public hospital is a mirror; a mirror of a broken system where protocols are more important than patients. Where planners, even those whose plans are to rearrange deckchairs on the Titanic are more important than nurses. Where something essential to our common humanity has been discarded.

Sometimes I think the cure is to hop on a plane. Go to Dubai, earn €60,000 tax free.

On the ward, you, the nurse, has to be vigilant in your thinking. A doctor, or a senior nurse, tells you that patient over there is an addict, an alcoholic or a prisoner, the inference being they are less deserving, they’re blocking a bed. Separatist thinking can be contagious.

The cure? Sometimes I think the cure is to hop on a plane. Go to Dubai, earn €60,000 tax free. But where does that get any of us? It gets me coming home with a deposit for a house that a nurse who didn’t emigrate also wants to buy.

The author’s identity to known to The IrishTimes.