Eight out of 10 nurses say they have left work distressed because they have been unable to treat patients with the dignity they deserve, a poll suggests.
The Royal College of Nursing (RCN) poll of more than 2,000 UK nurses cited washing and privacy as key issues.
This probably won’t be news to a lot of nurses who have been too overwhelmed by workloads to ensure basic standards of care are met.
From the same report, a spokesperson from Patients Concern thinks she knows what the problem is:
“The perception of them has dropped and some of that is down to their own standards.
“In particular, they are being given more and more responsibility and I think there is a perception that nurses now feel they are above the basic care that is so important to patients and was always part of the nurse’s remit, things such as help at meal times and going to the toilet.”
That’s the perception, is it? That may be the perception, but that doesn’t necessarily make it actually true.
Could it be that those 8 out of 10 nurses who have left work feeling distressed at their inability to provide basic dignity have been thinking, “Oh no, I’m so distressed! I could have made sure that old lady with difficulty eating had adequate support during her meal, but I was just too busy having to think about a witty deconstruction of Marxist theory! And that chap who had to wait 15 minutes for someone to answer his call bell, I wish I didn’t believe that such things are the job of healthcare assistants and not for me to do! This is so distressing! I wish I wasn’t too posh to wash!”
I’m not suggesting there aren’t bad nurses out there - there’s good and bad in every profession. But I’d wager that the real reason for the problem comes from something like this:
My 35 bed (now 39 beds because the treatment rooms and day rooms are now patient rooms) ward considers itself lucky if we have 4 staff. We get on our knees thanking Jesus if at least 2 of those staff members are actual nurses. Our patients are acute, highly dependent,and many have dementia. They can die or have extremely bad complications because of one little fuck up or missed bit of information. I had 10 of them who needed to go off the ward for essential diagnostic tests the other day. At the same time. Why does god hate me?
All of them needed escorts because they were either on 02, they had dementia and would wander, fall and get lost if left alone in x-ray, or they were on drips that could not come down. All that stuff requires an escort from the ward staff to go with the Porter and stay with the patient.
We had 3 staff on duty. 10 patients needed to be off the ward with an escort (Nurse or HCA). No escort means no test basically. Radiology has a shit fit if they are asked to come to the ward to do a chest x-ray on someone who is too poorly to go down there and there are no escorts. The other departments constantly have shit fits because they want the nurses to revolve everything around their particular diagnositc department. Endoscopy is the worst for this by the way. Fuckers. Just kidding.
Does anyone else think that any of this is completely sick?
12 comments
April 27, 2008 at 11:13 am
seratonin sister
Well from my perspective, I doubt many of the nurses on my ward go home distressed, more frustrated ,if they do care.Come 3.00pm when the day shift buggers off they can’t wait to run down the ward corridor & get out.There’s too much in fighting & back biting going on.I would guess a lot of it is down to the poor ratio of nurse/HCA to patient.Then you get the odd one or two nurses/HCA’s who just cannot be bothered on the shift.It annoys me that when these ‘few’ have apparently finished their drugs trolley, obs, washes, they sit at the nurses station buggering about on the internet or reading magazines.If another nurse from the other side of the ward asks them for help they come out with “no I’m not working down that end of the ward today”.Yes luvvy you’re not actually working any part of the ward today are you ? The ward has 26 beds it is an acute one.Standards have fallen dreadfully in the 7 years I have been there, attitudes stink.It is not a hospital ward it’s a bloody war zone.
Apologies to the genuine nurses here.I agree that a lot of it’s to do with staffing.I’m just stressing the point it’s what I see.
April 27, 2008 at 11:40 am
accident and emergency charge nurse
The number of NHS beds has fallen by 40% over the last 40 years.
http://www.bmj.com/cgi/content.....2/1229/DC1
Unsuprisingy, bed occupancy rates in some hospitals runs at well over 90% (compared to the Dutch average of 60%) - rates of >85% are strongly associated with increased HAIs.
http://www.telegraph.co.uk/new.....mrsa25.xml
Incredibly occupancy rates in Lincolnshire = 99%
http://www.theitman.co.uk/gran.....pancy.html
The BBC item also highlights structural constraints such as lack of single sex accommodation, insufficient washing & toilet facilities, ill-fitting bed curtains and staff shortages (presumably associated with bankrupt hospital Trusts).
Predictably we get the usual platitudes from a nursing bod who is safely ensconced at the RCNs luxurious HQ .
I grow weary of “too posh to wash accusations” and I simply do not understand how certain blog-docs can propagate such rubbish.
Mind you the situation for psychiatric in-patient services in London is even more alarming - their rates have been put at 113% occupancy.
http://www.bmj.com/cgi/content/full/313/7050/166
April 27, 2008 at 1:51 pm
apple
Coming from the Netherlands, I’m surprised about the numbers of NA’s (or other not qualified nurses) that work in acute wards in the UK. With one or two qualified staff, how can you deliver quality care for the maost ill people? Maybe you need a Dr Crippen to question this dumbing down of your profession. Although, I doubt if it would help.
April 27, 2008 at 6:12 pm
beakie
Yeah yeah it’s all about staffing. Personally, I think there ARE some staff nurses who consider personal care to be beneath them, or who just don’t give that much of a shit.
When my mum was in hospital (and bear in mind this was a “centre of excellence” with plenty of staffing, no A&E and controlled admissions), most of the nurses’ time seemed to be spent hanging round the nurses station, reading Heat.
Oh, there were a few exceptions, yes, and I could always tell when they were on because my mum had had a wash and her nightie was clean. But they were by no means the norm.
I think when the government needs to wibble on to nurses about dignity, then there’s something seriously wrong and I don’t for one moment believe it’s all to do with staffing.
April 27, 2008 at 6:28 pm
zarathustra
I certainly wouldn’t deny that there exist nurses that are lazy or incompetent (though it’s also true that one can also find lazy, incompetent doctors, social workers, police officers, university lecturers - any profession).
But are nurses being trained to be too posh to wash? Well, I qualified via the honours degree route, getting a first. So I must be far too much of an up-my-own-arse academic to be willing to wipe a backside, right?
Well, I’m not currently working on an inpatient ward, but when I did I made a point of being willing to do personal care, feeding, close obs and all the other basic stuff whenever I got the opportunity in between the bits that had to be done by an RMN (administering meds, giving injections, updating notes, completing Mental Health Act documentation etc, etc) If I was on an early shift I’d make a point of getting involved with getting stuck into the morning personal care routine before things like meds and ward rounds would take me away from the hands-on stuff later in the morning. I certainly never got accused of being too posh to wash. Not by anyone who worked alongside me.
If a nurse is lazy or up themselves, it’s because they’re lazy and up themselves, not because they went to a fancy university.
I should also point out that for every lazy, incompetent RN I’ve met, I’ve also met a lazy, incompetent healthcare assistant. What’s their excuse?
April 27, 2008 at 8:01 pm
dazedandconfused
“What’s their excuse?”
Failed their nurse training but did manage to learn they should be too posh to wash?
April 27, 2008 at 9:10 pm
accident and emergency charge nurse
Beakie - any nurse worth their salt will feel angered and upset by the Heat reading nurses you describe.
The lack of care afforded your Mum is simply unacceptable - I wonder if you had a chance to speak to any of them about their unprofessional attitude, a conversation that might have started, ‘as a senior nurse lecturer, I couldn’t help noticing’………
Having said that the wards (at least where I work) are, by and large, incredibly tough places to work - there is no doubt that occupancy rates have reached unsafe levels, and the boom in HAIs seems to be strongly linked with untenable bed reductions.
In my view nurses with a strong moral compass, (like Zarathustra & OSB , dare I say) are just as much an influence on colleagues as the educational system they trained in, but sadly neither nurse leaders or academic framework can guarantee that a percentage of burnt out, or cynical colleagues will not make it on to the wards :o(
April 28, 2008 at 7:25 am
beakie
Like I said, there were some superb people on the ward, but they were far too few and far between and I could always tell when they were on because my mum was washed, dressed in clean clothes and had had her hair brushed. She was also considerably sunnier when they were around. It wasn’t a qualified/unqualified thing either - some of the best care she got was from an HCA.
I don’t think the educational system is to blame (well, I would say that wouldn’t I!) - I think it’s that the government has focussed on quantity of nurses instead of quality. Same as it has with care in general, to be frank. Targets, bed occupancy and crap students becoming crap nurses because all those extra nurses will make Gordo look good at the next election: these are the problems.
Me, after supporting and working in the NHS for most of my adult life, I’m getting private medical insurance because there is no way I want to go into a filthy, disease-ridden NHS hospital if I can help it.
April 28, 2008 at 5:14 pm
TheShrink
Oh come on, I mean, really?
I’ve worked, overall, with a couple thousand nurses now. Many have left nursing. I don’t think it’s ’cause of anything I did. Some had issues with how they had to work.
I can’t think of one who left just on a point of ethical delivery of care, around dignity.
Sure, many may cite this as woeful at an exit interview, but I’ll wager good coin that they’re leaving ’cause they’re undervalued, over worked, unsupported on understaffed shifts and chiefly ’cause they find their line manager to be an utter twat who’s no understanding of the reality on the shop floor, at all.
Or maybe that’s just in my neighbour hood. And in the dozen I trained in. And where I trained in General Practice. And in the county I did junior doctor posts in. And in the county where I did specialist training. Yeah, maybe I’ve just got a teeny view of it all.
Good grief, please, tell me this headline’s gibberish!
April 29, 2008 at 5:06 am
Mr Ian
Nurses leave nursing for a variety of reasons. One that will frequently be cited AMONGST OTHERS is poor patient care. For some it will rank 5th or 6th - for others maybe 3rd or 4th. I doubt it is the #1 reason. I agree with Shrinks comments on the many other primary reasons (tho my line managers are not so ‘twattish’ - just the senior managers).
Z’s comments are interesting - citing the stereotypical RMN role of medication and paperwork - whatever happened to those essential counselling skills and inter-personal relationships that are the main core of nursing? Tut on you for missing them out - as well as pool, tea ‘n’ biscuits.
Apple mentions the qualified/unqualifed ratio - this is a seriously interesting issue - somewhat tangetially - but I’ve noticed here in posh Oz - they won’t employ unqualified staff. They staff their units completely with EN or RN staff (neither of whom have any real MH training either). There is a major issue in this for global nursing shortage, economical diligence and also in the reason wards don’t run so well and staff leave in hoards.
I’m waiting on the common sense attitude to prevail - we need to get people into caring professions first then train them up afterwards on the job. One year (minimum) of that up to NVQ III standard then off to RN school if you so choose. One year of post grad preceptorship and two years of clinical development before becoming a senior staff nurse - or whatever grade thing that is now. 2 years senior staff nurse - then start the Practitioner training. It’s bloody simple.
May 5, 2008 at 10:18 am
OFMN
As a student nurse currently being ‘educated’ (for the want of a better term) I agree with z in saying that I am not taught to be too posh to wash. ‘Basic’ (what a terrible word) patient care is of major emphasis in my training, for which I am grateful.
May 5, 2008 at 2:33 pm
beakie
I’m waiting on the common sense attitude to prevail - we need to get people into caring professions first then train them up afterwards on the job.
I fail to see how this is “common sense” at all. Have hundreds of untrained staff running around hospitals and community teams? Who would run the bloody things for a start?
Have a word with yourself Mr Ian!