No time! – Too busy!
How often do we think or hear these words in a day's work – perhaps in response to responsibilities not yet completed, a request to write something or join a committee, or being asked to try out a new approach designed to improve practice.
No time! – Too busy!
How often do those of us in clinical practice act on these sentiments in a day's work – perhaps with a response that involves little thought, or ears to hear or eyes to see; an indifferent moving on from the vulnerable, sick or injured person who silently hungers for a minute of our recognition and attentiveness.
No time? Too busy?
Well, yes and no. It depends on our perspective.
On the one hand, if our professional identity and worth are marked by how we measure up to the passing of clock time and if our interactions take place "in an objective time angst or with quick glances at clocks of all kinds" – as if a clock was time itself – then we would surely have no time because time would not exist (Bruneau, 1996, p.99).
Time is actually something of a mystery. Perception of time passing is a subjective, lived experience. It can pass slowing or quickly relative to a myriad of contextual factors. Clocks were invented to order and standardise our experience of time passing; to make it objective and measurable. Time quickly became 'time management' and the main measure of productivity. Inevitably, time became money.
Hmm, we might wonder does clock time remind us of something? managerialism, possibly? Increasingly, the educational and healthcare organisations within which we practice and teach operate according to a managerial ideology. A focus on organisational gains supersedes concern for the needs of individuals and the distinctive values and responsibilities of professional disciplines.
Efficiency becomes a byword in which clock time is translated into costs. The ultimate meaning that this ideology can have for healthcare organisations, particularly for the nursing profession, stalks us in the shocking details of the Francis Report (2013). If we are in the grip of managerialism, then it is very likely indeed that we have no time and are too busy.
On the other hand, if our professional identity and worth is marked by what we think is important; by our professional values; and if we believe deeply that our profession is worthwhile, then our perspective is different. While observing and manoeuvring within the conveyor-belt of managerialism that has been visited on us and, of course, keeping an eye on clocks of all kinds, we nonetheless value ourselves, our patients or students, and our colleagues as unique individuals who possess inherent dignity and worth.
In doing so, we stand by our professional values in the face of managerialism. Our inner world of subjective meaning and lived experience comes to the fore. Time becomes relative. A minute isn't a minute anymore. Our perception of time passing depends on what we are doing and the meaning it has for us. We know that our experience of time, and that of our patients or students, can slow down and expand.
Now we do have time and we are not too busy.
How might this work for us and our patients or students? Let us consider the proverb "a watched pot never boils". Its meaning is not so much concerned with the waiting interaction between the watching person and the pot but rather with the way the person is focusing attention on the pot (Zakay, 2012). Now, replace the pot with a patient or a student and we have a nurse-patient or teacher-student relationship.
In the case of the teacher, he or she is deeply committed to helping the student and engages with the student in a focused, attentive way searching for cues to how best to foster learning and providing targeted guidance. Meaning, attentiveness, kindness and patience are deepened and shared. The interaction may take only five minutes of clock time but its lived, subjective experience is likely to have seemed longer, especially to the student who may have continued to experience the 'heat' of it for some time, gradually blossoming with insight and enthusiasm.
Likewise, for the nurse who has seven or so very sick or vulnerable patients to care for on a busy hospital ward. Mostly, clock time is of overriding concern. It marks the time necessary for a couple of breaks and a meal over a 12-hour shift. It points to when scheduled patients' needs must be met. But despite the nurse's objective busyness, every nurse-patient interaction marked by clock time brings with it opportunities for minutes to become more than minutes. The mysterious, unitary, subjective worlds of nurse-patient interactions, unbounded by clock time, await the nurse's potential to make them a reality.
Consider a two-minute physical reassessment of a patient with several medical-nursing collaborative problems. During this assessment the nurse also has the opportunity to attend in a focused way to the patient as a unique human person with inherent dignity; to truly watch, hear, and listen with unreserved kindness. The relationship deepens. A chord of empathy sounds.
The subjective world and lived experience of the relationship expands and perceived time lengthens. Two minutes of clock time is no longer just two minutes, particularly in the memory of the sensitive and vulnerable patient. The nurse has time. The nurse notices new things about the patient; important insights into the patient's experience are gained. The nurse is energised and strengthened by the professional satisfaction of practicing well. Many other such experiences await the nurse over the 12-hour shift.
We have time, many times over. We are busy, but not too busy.
Bruneau, T. (1996) Subjective time, social interaction, and personal identity. In Interaction and Identity (Mokros, H.B. ed.) Transaction Publishers, New Brunswick, New Jersey.
Francis, R (2013) Independent Inquiry into Care Provided by Mid-Staffordshire NHS Foundation Trust January 2005-March 2009. London, Stationary Office.
Zakay, D. (2012) Experiencing time in daily life. Psychologist, 25, 578-581.
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