How much 'caring' do nurses actually do nowadays?

[SLawsonB]

In a hospital ward and A&E etc

Because I have had the displeasure of being admitted twice in 2 months and noticed no caring at all from nurses

They were too busy with notes, ward round help, medication rounds, checking people over to assess them a lot

No bed changing or bed baths. Didn't help anyone with toileting at all, from what I saw

Is this usually the case now and it's all just down to HCAs?

Not a dig at nurses. I saw for myself that they were quite literally running from one task to the next

For someone who's not in the know though, it very much felt like being nursed was from the HCA ladies

I am interested in the job, a lot. But I wonder how accurate HCA work is to really get a feel for it - Because they're too different now and nurses pins are assumably at stake if they mess up etc? So the pressure is different

It's been like it for years, but definitely getting worse, more noticeable post covid. Such a lack of caring, I have been shocked by 4 recent instances where I've been in hospital myself, visiting my mum after her broken foot etc.

Also - I don't see why you say no caring from the nurses that's so negative. The HCAs do OBs , changes, washes , supervision, feeding frail patients etc - I think it's great

I’ve been admitted as an emergency to four hospitals around the country at one point nearly fortnightly and warded each time. I see nurses who do have too much to do (and particularly my ICU nurse seemed to have so much admin she couldn’t have dealt with more than one patient) but even if it takes a little while they are there to help with things like eating and toileting. I have anorexia and even the A&E nurses will pounce on me to help me walk to the loo or insist on getting a commode for example as I’m likely to collapse. At least in the hospital where I’ve been frequently admitted though it’s not helped because some older patients will just shout nurse! Hoarsely despite having been told what their care buttons are for and I often press my button for them after a while. Even the A&E nurses though are even quite strict as I’m often admitted vomiting blood and will be desperate for a drink and can at least take the time as they see me crawling for some water or squash to tell me off for drinking water.

Nurse in an acute med assessment ward. If we have all-care patients I try to assist my HCA before I start my meds round.
We try very hard to promote independence so will give bowls to those who can help themselves and just support where needed.
Unfortunately I have up to 12 (it's been more!!) people's meds to do including IV's, pumps, and on top of this....board round, discharges, referrals, speaking to family members, trying to take time to get to know my patients, MDT's, risk assessments, fluid input/output, cannulate, catheterise.
Yes there are many times I unfortunately have to prioritise my jobs over personal care, taking someone to the toilet etc. it's not a nice feeling but that's the nature of the modern nursing in a busy environment.

HCAs are all very much encouraged to do a care qualification and they cannot be a senior HCA without it.

It's called the Care Certificate

The thing is not all nurses were actually nurses.

There were registered nurses, enrolled nurses and auxiliary nurses. Auxiliary nurses were more or less the same as HCA now.

In addition wards were staffed by student nurses.

I've been in hospital a few times over the years, and worked in hospitals. Over the years my obs have been done by student nurses, auxiliary nurses, HCAs.

Makes perfect sense for HCA to do things like personal care bed changes and helping to the toilet

why would you waste a medical professional skill on that

Nursing isn't what people think it is.
It involves very little patient/client contact and lots of paperwork, delegating and managing HCAs/ support workers. Appraisals and supervisions. Chairing meetings and co ordinating care.
High levels of accountability and not much reward. I don't miss it one bit.

With the exception of elderly patients waiting for care packages, you’re only in hospital these days if you have complex needs and/or are acutely unwell. The registered nurses are busy prepping and giving IVI, oral meds, wound and catheter care, blood result and other monitoring, assessing and delivering interventions for deteriorating patients. The rest of the time they are liaising with other staff to advocate for the patient and organise treatment, taking calls, arranging discharge needs inc social care, giving info to or counselling patients and relatives, recording various monitoring or care plans, taking patients to other depts, chasing others to get certain jobs done, endless phone calls, bed management, sorting out staffing and rotas.
Some wards you might only have 1 nurse to between 8 and 15 patients- so of course the HCA has to deliver the personal care and feeding. Sadly these are the tasks most people see as the role of the nurse, hence why they’re still paid unskilled wages.

Agree. It makes sense for someone qualified and in high demand not to be helping someone go to the toilet surely??

It's actually ridiculous they even used to change bed tbh

My elderly mum has been in hospital three times this past year and the lack of care/caring was shocking. If basic care is now an HCA’s role, we need more of them and they need to be valued.

My mum worked as a care assistant for the elderly for decades (retiring past 70) and administering medication, applying dressings etc was part of her role. Sadly, care assistants are paid peanuts and their role is thought of as menial.

When mum was on one awful geriatric hospital ward, a member of staff admitted that no one wanted to work there. There seemed to be no one to do any actual care work and my mum (bedbound herself) witnessed one poor frail lady almost choke to death on food, as there was no one to assist her with eating. My mums’s legs were infected and only one young HCA ever applied her prescribed lotion. I fear for patients who have no relatives or friends to advocate/care for them.

One thing I also found shocking is how mum’s medication was not routinely given. Acute treatment was given (ie antibiotics) but the nurses did not give her daily medication (even anticoagulants). I brought her prescribed tablets to hospital but they were just taken away.

@Herbusyness sorry about your poor mum

My medication that's prescribed on repeat was never given to me either. It was very strange

I had to remind someone 3 times... I luckily had some in my bag anyway because it was never given

I think that it depends on the area. I’ve been in roles where I feel more like an office worker and have minimal patient contact but in other roles where I work have the same amount of paperwork but close contact with the patient and their families. I don’t feel comfortable writing reports about people that I’ve barely met.
I think that we are under more pressure now to complete work that would previously have been done by doctors, managers or discharge coordinators to name a few.
Obviously you are going to get nurses who just don’t care. I’ve met a few!

HCA’s are (mostly) bloody amazing though and I definitely couldn’t do my job without them. (Not what you were asking but wanted to get that in there).

My young son had a psychotic episode. We coped at home for days. He was then admitted to hospital for assessment..we all literally crawled onto the ward. We were more or less ignored. Nurses sat at computer stations which ran down the middle of the ward, a few health care assistants running around. All the care - helping to keep him in a bed, clearing up urine, going to find clean sheets, getting a doctor to find out when he might get some medication so he could get some sleep (the reason for the admission was sedation)....I am a big supporter of the NHS but quite honestly the staff on that ward didn't care. Not actually busy, just handling paper/sat at screens. Other wards were better (he was on 3 different wards over 3 days). Will be better prepared, ready to 'nurse' for the next admission.

Its so interesting how so many of you equate "caring" with hands on physical tasks ... i care immensely for my patients but never lay a finger on them and a lot of the caring is pure hard advocating for them sat at a computer or on the phone.

A HCA could not achieve what I have managed to achieve for my patients.

Before nurses had degrees, there were SRNs (state registered nurses) and SENs (state enrolled nurses). IIRC you needed A levels or equivalent to train as an SRN (a friend of mine did) and O levels (or GCSEs) to train as an SEN.

Presumably SENs did a lot of what HCAs do now, the more hands-on stuff not needing specialist knowledge (of which there is so much more needed now.)

I do know of someone who fairly recently started training as an HCA but lasted only a couple of days, since she was thrown in the deep end, so to speak - left to herself, nobody told her what to do or how to do it, she freaked out a bit - It did seem a shame, since she is a perfectly capable type.

Would just add that I was in hospital for 3 weeks last winter and maybe I was exceptionally lucky, but I could not fault the care I received from all the hospital staff.

HCAs do most of the general care, and nurses are now a lot more paperwork and admin.

HCAs do the caring, and general patient work.

Nurses sit at the station and complete 'paperwork '.

This was my experience too.

I was in hospital in September for 8 days and yes some of the nurses weren’t the most caring as they were so busy, but there were definitely more than a handful going above and beyond.

@MissDianaBarry sadly that’s how it is, rightly or wrongly. We have so much paperwork to do we can literally spend several hours on the computer. Because we are sat down doesn’t mean we are browsing Ebay. HCAs, again rightly or wrongly, do a lot of the care and report back to the qualified nurse in charge of that bay.
The solution is more staff actually on the ward, either to help with care or help with paperwork.
I work on crit care. The other night I had 2 level 2 patients. Both were ill but one was deteriorating with a heart rate of 180, needed observing, lots of IV meds. I was fully aware that I hadn’t given my other patient decent mouth care beyond mouthwash and only changed her position twice. It’s beyond frustrating.

I've been a qualified nurse for 20 years. A lot has changed in that time. I work in the community, so I feel I am still very hands-on. For example, if I am with a patient to assess a pressure area and they have been incontinent, then I will, of course, provide personal care. But I dont carry out the routine day to day washing of patients who we have on the caseload. (We provide care formsome CHC patients that aren't out sourced to care packages). I previously worked on an acute medical assessment unit, and that was very much paperwork and giving out medication. As you say, HCA do a lot of their personal care and observations, etc. In the community, they are beginning to administer insulin and carry out catheter changes, so the roles are changing and evolving there as well.

I agree my situation was possibly a staffing situation. However when asked questions only wanting to be signposted to a mop and clean sheets to be met with irritation and blank stares. True I hadn't slept myself for 3 days and was really worried about my son (who was writhing around being supported by his dad and a policeman) so I was less than patient. It was a bad experience.