What are *you* going to do about the poor standard of nursing care in hospitals?

Its also false economy to have such low levels of qualified nurses, many studies have proved that survival rates increase dramatically when the ratios are adequate and that for every patient a nurse has above 5 patients the death rate within 30 days of admission increases by approximately 7% for every patient she has.
These studies have been around for years yet no one acts on them and until litigation costs outweigh the cost of employing more nurses, nothing will be done.

The lack of qualified nurses on shift and the over use of HCA's who are untrained and poorly paid is a large part of what is wrong with the care in hospitals at the moment.
The ratio of qualified staff to patients is appallingly low in comparison with other countries, who have legal nurse patient ratio's of 1 to 5 whereas we have 1 to 12 or 15 on nights.
As a nurse I was taught how to assess and check my patients during basic care. This was an opportunity for me to assess nutrition, skin integrity, circulation etc, to have a little chat and see how my patients where feeling and to allay anxieties. HCA's are not trained for this and just go in and wash the patient.
Because the qualified nurse no longer does this, due to lack of time and management pressure, she misses a vitally important part of her patients care and its like nursing blindfolded. But to those outside nursing they don't value this basic care and think its 'just a wash' and any untrained person can do it.because its cheaper.
Currently poor care is dumped solely on nurses shoulders which suits managers, the government and the media as it makes a great story for them,and means their own management and cutting of staff is overlooked. what we need is people fighting for the right to qualified nurses having legal patient ratios and there are e petitions going, but its proving very hard to get the signatures needed as the media isn't interested in taking up this cause. and I think people honestly don't understand why care is so poor in hospitals at the moment. To them anyone in a uniform is a nurse, when often they are untrained HCA's.
If you or your relatives are getting poor care, ask first what the qualified staff ratio is and then take the managers to task over why its so low. They need to be held accoutnable for the decisions they make, instead of the nurse who is doing 13 hour shifts and 2 hours unpaid overtime, just trying to cope with the huge workload.

What can we do about it. We can lobby the government to introduce a legal qualified staff to patient ratio in hospitals.

Says a nurse with over 32 years experience.

But it won't happen because it will cost too much. So keep the present staffing levels and blame the lazy, uncaring nurses for bad care.

Yes hurriccanewyn you must continue to fight and correct the apathy in nursing. If people like you give up the NHS is doomed here speaks an old Registerd Sick Cildrens Nurse/SRN/SCM. Please don't give up.

I'm glad I've read this thread - it's a subject I was thinking about just last night. I'm a second year nursing student on placement & last night I spent an hour just holding the hand of a patient who was dying and talking to her while we waited for her family to arrive.
I spent half an hour reassuring a patient who has just found out her cancer has spread and is now having to think about palliative care. Yet more time with someone who needs to be given psychiatric care, but there's no space anywhere else for her so she's on a medical ward. In particular, she is being let down - not receiving the specialist care she needs, yet taking up so much of our time that other patients aren't getting the care they deserve either.
Yet, once I'm qualified I won't have this time. It's so disheartening - everyone I've worked with has cared. They never get out on time, never take enough breaks (none at all on night shifts, there's not enough staff), buy toiletries from their wages (or bursary, in my case) and still there isn't enough time.
I'm really questioning if I should continue.

Our area has a team of volunteers who go not hospitals in order to feed those who cannot feed themselves. Can't think of their name off the top of my head but know they exist.

I left nursing simply because I could no longer stand by and watch the erosion of basic care. When I started I had time on the wards to do nice things like foot baths and foot massages (important to keep an eye in feet...especially in those with diabetes), mow that simply would not happen as there is far less time.

The rot set in during the late 80s and early 90s (Conservative Govt) and continued into the late 90s and early 00s (Labour Govt). Conclusion is none of them gave a toss......

How we treat our sick is appalling...we have great medical care out there but it's worthless if we don't spend time ensuring basic needs are met. Patients on the whole welcome their medical care but its no good if they are not helped to be clean, nourished and to feel valued....and they would generally like that with a smile too. Not too much to ask in my opinion.

HCA's are supposed to go on training days. These study days are often cancelled because of a lack of staff on the ward's.

When I started 11 years ago, we were not allowed to start the job without completing the relevant study days.

Now we have new members of staff, who have been doing the job for about 8 months, who have yet to do a manual handling course.

About hospitals in Spain, the patients' relatives bring in their food, too.

My own family seems to have been so lucky. We've always received absolutely excellent care from NHS hospitals all over England and Scotland, for the last 50 years, the latest in March. That's cancer, a road accident, falling off a cliff, broken arm, brain surgery, meningitis, all sorts of gynae things, several babies ... When kids have been in hospital, parents have been allowed - encouraged - to stay.

My American friends think the NHS is amazing, and we are so lucky - and so mad to think of getting rid of it.

Great post, Badnurse. You really made me see how it must be for you all. What a shame.

From what you've said, all you need is more qualified nurses. Why isn't the government giving the hospitals enough money to employ as many as they need? And why can't HCAs be given more training - if necessary, on the job?

I think the government is deliberately running down the NHS in order to justify their decision to privatise it all. It costs so much they just want rid. And private companies certainly aren't going to sacrifice their profits by paying for qualified professionals.

from what i saw, the key thing lacking was management,

some staff did less than the bare minimum, leaving others to do twice as much consequentially.

if management enforced personal accountability - handovers (so if a staff member hadn't got sth done, they could be challenged on it, but also simply to ensure continuity of care), proper written communication (again, through good management making sure it happened)

management seem to rely too much on process without the necessary oversight to ensure the processes were followed.

and the culture of fear of litigation and negative press seemed to stymie proper investigations of wrongdoing - higher-ups didn't want to uncover staff wrongdoing because the hospital as a whole would be liable.

I havn't read the whole thread as I've been in hospital.
I can come in to help. I was thinking about the old ladies in the beds near me that couldn't manage eat.
Would a ward like volunteers? I'd be very happy to help.
I'm so annoyed that I can't find out 'how'.
Loads of leaflets all over for others eg. AgeUK but non for the hospital.

Well on my ward they have just redeployed 4 Qualified Nurses and replaced them with 4 HCA's.

Now we have an issue with covering sickness, annual leave and maternity with bank or agency Qualified staff.

We often run with 2 Q staff for 30 elderly, high dependant, confused and wandering patients. All with complex medical/nursing needs.
This is with 6 HCA's in the morning, 3 in the evening and 2 at night.

The pressure on all staff is unbelievable. Morale is at an all time low and everything now seems to be task focused. Got to get this done, that done and no, I don't have time to sit and chat with patients.

Even while giving personal care to a patient, we have to get it done asap because one or two patients are trying to climb over the bed rails, or the buzzers are going etc..

The answer is not cutting the amount of HCA's and replace with Q's. Extra pairs of hands are never a bad thing.

The answer is employing more Qualified Nurses. Increasing the amount of staff on the wards is the answer IMO.

Sadly it will never happen.

We are being told to try and adapt to the situation and get on with it. By people who have never worked on our ward!

27 years actually, typo.

I speak as one myself and I think that most HCAs are perfectly able to wash and dress a patient and do obs and other basic care.

I have been doing the job for 17 years now, so obviously know nothing!

Maybe instead of criticising, you could offer them your superior wisdom and train them to do it properly.

'One cousin is now in very bad shape with stomach cancer after being told for 3 whole years by his GP that his health concerns were 'all in the mind'.'

This is more common than you could imagine. My gran died of a heart attack on her bathroom floor. She had been in agony for such a long time. Turns out she did have stomach cancer, despite being sent to a psych for the imaginary pain. She didn't need to suffer like this at all.

I've talked about this a lot to a lot of people and have been VERY surprised to find out how many other people this has happened to. Absolutely awful :(

'honestly, would you rather that "basic care" took precedence over medications and surgery?'

There's little point in the latter without the former.

I know what you mean OP. The ONLY way a person in hospital gets cared for is if there is a family member/friend there all the time to do the caring and also be their advocate. Hospitals should be more honest and sort out the set up so it is the same as it is in India and other developing countries where it is overtly expected that family does the caring. It is so dishonest in this country as some people still expect care during hospital stays. Nobody who has had friends or family in during the last 10-15 years though I think.

Where I come from this patients can also have someone to stay with them if they wish to do so, however, in these cases patients will be in a room on their own with their own facilities as to not to disturb other patients.

Interesting article in the Observer here about how things are done in Spain. Do you think a campaign for the abolition of visiting hours, and better facilities for families (e.g. fold-out beds or reclining chairs) to stay with their relatives would help?

The first time I saw a British hospital was when I went to look at the local maternity ward to have my baby. I cried. I could not believe that hospitals like this still exist in the developed world. The care was so poor that I ended up with PND.

Last Christmas I ended up in hospital with Pneumonia and discharged myself. Had animals been treated in the same way the RSPCA would have been on the case. There seems to be a lot of criticism on those unqualified health care workers, but in my experience they cared a lot more for the patients than the nurses did. The caring profession seems to have stopped caring

I'm paying for private healthcare, I think is it is just a shame that it is not possible to have access to a private A&E.

I frankly don't understand why people want to keep the NHS going. Why not look at models such as Spain, Holland, France, Belgium etc...

Have to agree with everything said here by bednurse , tirednurse and nakerednurse.
I qualified in '86 and nursing care has changed so much in the yrs.
I now work in the community and find pts are sometimes traumatised by their stay on an acute ward.
Community care is also being squeezed ,caring for an elderly pts needs in the 30 mins I get allotted (including travel time) is difficult.I spend a large % of it doing documentation to cover my arse.
Also never ever finish work on time and rarely get a lunch break.

The problem boils down to £££ , not enough trained staff ,especially now that nurses do tasks that used to be done by docs taking us away from the basic care that pts need.

I left the ward because it was too stressfull not being able to deliver the care properly.

Matrons in my experience are often doing admin roles only. Waste of an experienced nurse .

We used to have state enrolled nurses who were usually excellent IME. But they were phased out.

Training costs money. Also you need to ensure a basic level of numeracy and literacy before you can train anybody...............................

I have worked with one or two really good HCAs, but however well intentioned people are, if they are untrained, it is never going to work.

We already do that. Many services are run by clinical nurse specialists, both in hospital and in the community. Think of chronic diseases such as diabetes, heart failure, arthritis, kidney disease for example. Long term management is now done by CNS, not doctors. CNS are cheaper than doctors.

We also have nurse practitioners in acute settings such as A&E, and minor illness practitioners in general practice and family planning. CNS are cheaper than doctors, but generally are very highly trained and give good care.

Where standards have fallen, IMO, is on the wards, especially WRT the care of elderly patients - i.e. medical wards. With an aging population, who have multiple health problems, and complex nursing needs, it is simply not good enough to have maybe one qualified nurse on duty and a few untrained people doing the actual care. But it is cheaper than paying qualified nurses.

So why not make highly qualified nurses into medics (ie, semi doctors) and give HCAs proper training so that they are proper nurses, in the old-fashioned sense. Perhaps not quite as cheap as HCAs, but less expensive than nurses are now?

badnurse - I agree with everything you have said.

The problem is that nursing care is now done by unqualified HCAs, because they are cheaper to employ than qualified nurses.

Qualified nurses now do an awful lot of jobs that used to be done by doctors. Medicine has moved on so much, nurses do need degrees, they need to be skilled with hardware and software, and much more besides.

What really annoys me is the fact that HCAs are dressed in nurse's uniforms and referred to as nurses, everyone thinks they are nurses, but they don't have the knowledge or understanding to actually nurse patients.

This is not their fault, but it is a national scandal.

As I said earlier, my mum died from starvation and neglect in an NHS ward. If she had been nursed by nurses, she would probably still be here. At the very least she might at least have got some care before she died.