Are patients not washed any more in hospital?

[Shortkiwi]

I am a nurse of over 40yrs plus. My 93 yr old father has been in hospital for a week. We have visited every day and had to wash and shave him in the afternoon or evening because it hasn’t been done. When I asked if he could be showered one evening, for the next day, I think they showered him but without using soap or shampoo, basically hosed him down from what he reported. His hair was definitely not washed. His teeth have not been cleaned without us doing them. Shaving is definitely not on the agenda. When I was a young nurse it was a given that patients were bathed each day, either in the bathroom or in bed. Teeth/dentures were cleaned and male patients shaved. We were admonished if these things weren’t done. Dad’s ward was very quiet today with several nurses chatting at the nurses station. They were very happy to get us any personal items we didn’t have. I just think if it wasn’t for us he wouldn’t be clean. He actually said, through his dementia, how much better he felt today after we showered him and washed his hair and said it would last him for a while! Which it won’t of course!
We had a list, in the old days, in terms of total patient care, in which we had to tick off items of personal hygiene for every patient in both our theory and practice. I’m sad for those that might not have relatives to attend to personal hygiene these days. It has never been discussed that we would do it, it’s just not been done. Basically, we have had to take the initiative. Years ago there were charts and care plans at the end of the bed, now it’s all computerised. I can excuse the 3 days of hell in A&E but not these last 4 days on the ward. My Dad is not mobile unless he has a lot of help and he is confused.

Sorry for the numerous typos in my last post, I have to rush but thank you for your post beseen I found it very informative and helpful.

@Swissmountains sorry about my typos! Was on nightshift last night.

The current model of care doesn't work mostly because of the vast need. Junior doctors and completely burnt out with the jobs that they have too and most give an extra 10/15hours unpaid to NHS a week. My friend had to get her lip stitched in ED last week after being assaulted by a patient then went right back to reviewing patients. However I am on forums with RNs in the US and they are facing the same issue of increased patient workload and acuity even in private care. It is an ageing population that are so much more medically complex than before because of scientific advancements that we can keep people alive longer but not always healthy longer.

One problem with increased single rooms (although absolutely amazing for comfort and dignity of patients) is that patients have no idea what is happening with my other patients. So you are in visiting your lovely mum and she's been sick and her gown is dirty so you head to nurses station and there is never anyone there so you find someone and they are rushing about and say "I'm just with someone at the moment ill be in as soon as I can". Now your mum of course is your number 1 priority and of course you are righteously angry that she has been left so undignified. But you don't see that we are all down in the room down the hall dealing with an unexpected major hemmorhage in a 50 year old trying to keep him alive long enough to get his wife and daughters in to see him. When someone is deteriorating quickly time just flies and that cuppa I promised 40 minutes ago is still steeping in the kitchen but for the patient desperate for a cup of tea and some human interaction it feels like I've abandoned them so no matter what I do their experience is a negative one.

That is not to say that there is not lazy nurses sitting at desks with their phones, or discussing patients inappropriately or making comments when someone is at their most vulnerable. And you are completely right, ward culture is a big factor in this. The night ward sister can make all the difference. And yes we need to call out this poor behaviour and lack of compassion for patients going through the toughest time of their life. I 100% agree with that.

@Swissmountains 'does a HCP need a degree ?' Physios, OTs and pharmacists all have degrees. Would you want a HCP to be able to flag up abnormal blood results, realise independently that a patient needs an urgent ECG, recognise that your patient is anuric/hypotensive and may need fluid or that you are witnessing the signs/symptoms of hypoglycaemia and need to take a blood sugar. If so a degree level training is essential to understand why those things are happening as well as the treatment. I really cannot think of any profession that would want to downgrade the education of its members ! I qualified years ago and didn't really have any preparation for that. Student nurses are learning venepuncture, catheterisation and NG insertion before they qualify now which is great and are being exposed to so many different learning situations to help them preapare hence things like the aims course etc

Thank you for spelling it out so clearly beseen because it has made a big difference to me on this thread, and I am sure others too.

I didn't know the extent of the differences of job roles between nurses and HCAs etc and how few qualified nurses there are on wards. Nor the long list of clinical care they are now expected to give to patients on top of the usual work.

As a patient I see lots of people in uniform and assume they are doing the same thing. I have spent many years in and out of hospitals, so it is not like it is new to me either. It is no wonder you are so stretched if this is how it is now set up...and almost designed to fail if there is no oversight or limited oversight of HCAs, which I am assuming do not have access to the same level of training?

When I was in hospital I was aware of the need around me, and I knew the nurses would be attending to people sicker than myself, and I was glad about that and I most definitely made allowances of course. I was in a private room and it was the worst place to be, because I couldn't alert anyone when I needed help. The wards are better in the sense you can catch someone's attention faster if you are in trouble.
There did come a point when my own suffering was at such a level, I could not continue to solider on hoping that at some point I could go to the loo/have a drink/ have a sick bowl/have some pain relief. Being bedbound, as a healthy person is hellish experience anyway, it made me feel panicky because I literally couldn't get out of bed in a fire, I was scared when no one came, when I couldn't hold on any longer for the loo. When such major pain kicked in and there were no meds, and I was pleading for them, even once you have them they take half an hour to work. I became aware of just how dirty I felt, but unable to wash. It was all so difficult to endure with the surgery I had had.

Of course your job will always be there to prioritise the greatest need as it should be, and saving lives, but as the list of your patients grow longer so does the suffering due to a lack of staff to help.
You are right this could be fixed with ratios, but if you have never been treated outside a private hospital it probably means very little to a politician to understand what this means and the difference it can make to the patients.

I would now never go to a hospital, I suspect even with a heart attack or a stroke I couldn't be confident that the same or worse wouldn't happen again. It was very traumatic to overdose alone in the dark (an innocent accident of being given drugs twice) and I don't know how I am still alive today, but as I am still here I would be happy to devote my time to campaigning for change and support for nursing. I do also volunteer in a slightly different role. Volunteers are great but we need more staff, more investment, more incentives to go into nursing and a social care system that is paid for by those that can afford it, and plan for our days as an older and frail person because it will happen to us all one day. The infrastructure of our countries is stretched and fraying, and it is happening in every western society. I find it odd no one actually planned for this, the spreadsheets have been predicting this situation for decades.

One other thing that has worked well at two hospitals I've been in is to have the tea and snacks served by catering, as well as lunches, in one I had a hydration person who came every few hours to change and top up water and check people were drinking. This then means teas/coffees, drinks, all food is not the responsibility of nurses at all. The HCA's help patient eat. Catering does everything else. Again, it comes down to organization. Of course it makes sense for a nurse to be doing an important medical procedure over a cup of tea, that's why it doesn't make sense for them to be doing it.

The best care is when everyone understands their role, it's specialized and there's enough staff, then standards are set around the culture. I arrived on the ward at 3am and settled in- the next morning, the nurse noticed that I hadn't got fresh water provided at that point and the HCA responsible was given a quick note about that (to do it in future). That's how you set standards constantly. So no bells ringing more than 1 min, beds changed daily, hydration at all times, food assistance at every meal. It wasn't better staffed than other places, but held high standards and if they were breached, it was apologies all round and everyone resetting them (e.g. if someone was wet in bed and left for more than 5 min).

The best care is when everyone understands their role

And the patients understand everyone's role too, and aren't expecting 'the nurse' to do everything because that is how it used to work, and they can't tell the difference between a HCP, a HCA, a catering lady and an actual nurse senior or otherwise.

Exactly, not all jobs are the same. Someone might be ringing the buzzer for help onto the toilet or a cup of tea while I'm trying to bring up a hypoglycemic patient who's scoring 2.8 and very drowsy. The cup of tea and toilet is very important but making sure someone doesn't go into a diabetic coma is more important.

@Swissmountains in the hospital I was in, they all wear different colours so it's actually quite easy, plus the catering staff are the ones pushing the trolley! HCAs all wear the same. Nurses easy to distinguish as they wear different colours and only come around twice a shift to give medicines and do notes. Plus all of them introduce themselves and say their role on entering the ward or starting with a new patient or at a shift change, so they say 'Hi I'm Gabby, and I'm the person looking after you today'. They also show you the bell, and it has to be by the patient's hand at all times (they get told off if it isn't). Honestly, the more I think about it, the more I think this ward should make a video or something to train others!

Every hospital I have been in or visited family or friends in the last few years has water jugs and glass by each patient filled up at least once a day automatically, and regular tea/coffee rounds that includes biscuits, fruit, cake, sandwiches (varies dependent on hospital).
I know this is not the case in maternity, but it is in all other wards.

I am aware of the different uniforms, but I couldn't tell who was who, and how to find out. Everyone was rushing around, and no one had time for formal introductions or anything.
Everyone was called 'Nurse' by the patients, regardless of their job role.

I was only ever fully aware of the senior nurse and that is because she made it very clear to me by telling me, and she was taking things from here kind of thing. Then the consultant turned up, and suddenly I had everyone with me at once. For a patient, particularly a very ill one it would be helpful to know more clearly who is who as up to now before reading this thread, I had believed that it was always a 'nurse' taking care of me, when in fact she was probably the only one that I didn't see much of apart from drugs rounds and emergencies!

I also think there might be a general public misconception about what nurses actually do now. I believe most people still have their perception of a 'nurse' firmly rooted in the 1950s with starched sheets and bed making and that kind of thing, when modern medicine has clearly moved on - and this is very far from what they do now - even though I am sure they do it all at times!

Oh and everyone is 'nurse', which clearly isn't the case, and is rarely corrected.

@Swissmountains Standardised uniforms in Scotland, NI and Wales. Hopefully that happens in England soon, it definitely does make things a lot easier for staff and patients alike

The misconception might also be the reason why the pay increases that you should be getting given the clinical responsibilities you now have are not forthcoming or in line with the work you do.

If the public truly understood what a real nurse does now, I think it would alter the way people see the whole profession, and how it is viewed and the salaries awarded. Many more professions including postal workers/train drivers/taxi drivers for instance, can pay more to their staff than someone saving lives each day. Just saying. I think this thread has exposed the misunderstanding - or maybe it is just me, and I should have cut back on the morphine faster than I did at the time!

This is a picture of my dad a month before he died. At this point he had an infection in his kidneys (went to sepsis three times) that they were trying to get rid of. They said they needed him to drink a lot and pee a lot. But every day that I came in his pee bottles and his buzzer were always put out of his reach (he couldn’t walk at this point), so he tried to drink less so he wouldn’t have the indignity of wetting himself and having to be cleaned up. Often drinks were left out of his reach too. Nobody listened and nothing changed when I mentioned it. I could cry when I thinking how he was often treated in there. Some of the nurses were amazing, but 2/3 were truly dreadful and couldn’t give a stuff.

It is coming soon in England :)

The role of a nurse has changed so much that most don't have the time to wash patients, absolutely there should be more investment in healthcare assistants and the like- adequate staffing is the first step towards improving standards and care. I worked on a ward as a NQN but used to find it so horrible knowing patients had gone without washing, hadn't been changed as often as ideal, and I cried on the way home after one shift as I said I'd make a cup of tea for a patient and got distracted and didn't get round to it; sounds ridiculous but I think it was the straw that broke the camels back. I work in the community now and although workload is always increasing and its hugely stressful still I love it. When I go to someone's home I know I have x amount of time to do what I need to do, and building a rapport is such a privilege. I miss working in a hospital in many ways but won't go back unless things change.

@Honeyroar That's terrible. I feel so sorry for your father 💐

Sorry for your loss, I lost my dad recently and absolutely heartbreaking- miss him every day. Its so sad that this is the case for so many patients now and it is absolutely unacceptable, really hoping things change but I don't know if the government is bothered sadly.

I left nursing because I was not happy with the quality of care that was being provided. Intensive care was the only ward I worked in, where this was not the case. The reason being nurses only have 1 to 2 patients to care for due to the instability of the patient's condition.

Unfortunately, there are no statutory minimum safe staffing levels for wards in the UK - and it can vary from 6 to 12+ plus patients depending on what area of the country you work in.

I frequently worked with agency nurses from London who would tell me that 6 to 7 patients were the norm there. I was often looking after 14.

When I left my first nursing job, which I had only been in for seven months, I was asked by the ward manager why I was leaving. I told her that the ward was 'unsafe' and I feared for the patients and my professional registration. Her response to me, which I found pretty shocking, was, 'well, it was the same when I qualfied' - as if that is a good reason to carry on with the same shit show.

I complained to senior staff members about poor care and practices, but no action was ever taken, and it changed nothing.

I know of a few nurses who were very vocal about unsafe care and were victimised and bullied out of their jobs.

I am so glad I left adulting nursing. It's one thing being bullied, unsupported and not listened to by your managers, but now the general public are in on it too.

If you have not already I suggest you read the following report.

www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry

These are the All Wales uniforms. We wear scrubs which are so comfortable.

Thanks Chibbers and Wookiebowl I’m sorry you went through it too.😞

If you read my post, it makes the point that a lot can be missed if personal care isn’t properly attended to. My elderly mother was left unwashed and in the same nightdress after being admitted to our local hospital. A long standing tumour in her breast had a growth spurt while she was in hospital and it went unnoticed - partly because she wasn’t regularly washed and her nightdress changed, and partly because basic care is left to care assistants who don’t have medical training.

Surely the wards must stink with all these unwashed people in them?

@Felix01 it's nuts - I remember in the 80s as a student nurse on a ward of around 22 women we would have around 7 staff , 3 staff nurses , 2 SENs and 2 HCAs .

*@Lovelysausagedogscrumpy
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partly because basic care is left to care assistants who don’t have medical training.

That's incorrect. Auxiliary nurses aren't medically trained in that they don't have a degree, but they do receive training.

Each patient has a body so completed on admission, and this is regularly updated if there are any changes. Auxiliaries can complete and update these, not just registered nurses.

It's just the fact that your poor mum wasn't checked, and this is proven by the fact she was still in the same nightdress.

It's not because 'care assistants' were left with the task.

Please don't minimise the role of the nursing auxiliary.

-*body map

Sorry for predictive text and NM not allowing to edit once posted

When my 5 year old was on a ward for a week i was very sad at the low standard of nursing im afraid. Nothing against individual lovely nurses but they did nothing beyond medical checks