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

I want to move to the European model where everyone is in single rooms and a family member is expected to stay with you to do basic care. I would love this and have put off hospital admissions due to knowing I won’t even have help to get more water when I run out and can’t move post anaesthetic.

I would hate this.

what if you didn’t have a family member to provide care? I mean, your husband would have to go to work wouldn’t he and what if he is the support system you rely on?

I think historically as well nurses really were doctors handmaidens; patients were unwell but not as acutely unwell as they are now.

Patients were admitted, often for many days or even weeks, with things that nowadays wouldn't get them near a hospital such as minor infections, being 'off legs', respite etc.

Surgery was simpler and patients were kept in for much longer, so not acutely unwell post-operatively for long at all and spent most of their time on the ward convalescing. Nowadays they're discharged within hours of surgery and the next lot are admitted. No time for cups of tea and chit chat.

Nursing care involved rounds, such as bed baths, back washes, teeth brushing, observations. Things were done by rote and routine, not necessarily because they were needed or requested!

My mum trained in the 60s and her nursing experience was hugely different to mine in the 90s - and its hugely different again now. EVERYTHING has to be recorded, risk assessed, documented according to protocols. If you don't write it down, it didn't happen. I rolled my eyes at a previous poster who put "paperwork" in inverted commas Nurses sit at the station and complete 'paperwork '. - well yeah, it's called care planning and delivery. Good nursing care doesn't just happen by accident. (I do think it's excessive though.)

We need to move away from the perception of registered nurses as the only people who can deliver care. We do care, enormously (well most of us) and it's just that our part in the team isn't what it was historically.

My partner's recent experience after ankle surgery was interesting. The basics were covered - obs, pain meds (eventually after much asking), food brought, but urine bottles sitting for hours, no attempt or suggestion of how to wash himself or for anyone to help with this, no help to arrange his leg comfortably - needed to be raised but he wasn't provided anything to do this with, ward was noisy and chaotic with patients playing music on phones etc.

Everyone that worked there was absolutely lovely but there was far too much to do for the number of staff.

If you couldn't advocate for yourself, or have someone to do it for you, god help you.

Same
And even if I wanted to do more hands on care there just wasn't the time.

There’s also the fact that nurses have to do things like detaching IV bags and even turning off the beeping machines when the IV is done.
I’m frequently admitted with dehydration and will often apologise if the nurse asks if they can do something and I ask for a glass of squash and will always apologise as it’s below their pay grade. I’m long-term sick but if I get back to work I considered nursing - they have extensive training and it would be a lot more complex than just turning up (might consider HCA although I’d have to be a lot more physically strong). But nowadays the clue is in the name - the HCAs are the carers, the nurses do the medical but sub-doctor stuff and the doctors do… the doctor stuff.

B6 on an (very) acute ward here. Trained nurses on my ward will roll sleeves up and get stuck in with washes, toiletting, turns, feeding, bed linen changes etc but when you have a ward to run (30+ patients), including a lot of level 2 patients (I had 5 on a shift last week and did not stop running between them, as we had less than 50% of the staff numbers we should have had and I was the only nurse who had the training to look after them), then the trained nurses sadly don’t have as much time to do the more hands on caring stuff.

I check all obs etc at start of shift, at each drug round and during hourly checks. I’ll also do additional obs. A lot of my patients are on cardiac monitors and very ill. A lot will have tracheostomies, NIV, HFNO, chest drains etc. some are confused and need specialling (but we don’t always get the staff to do this). I escalate things to doctors and the team. I check the plans from docs, physios, OT, dietitians etc etc and sort them. I’ll titrate meds and oxygen % accordingly and as needed, and then evaluate the patient’s progress. Drug rounds have to be done on time. I deal with staffing, referring patients to other specialities, making sure we have enough stock of things from the labs and pharmacy, admissions, discharges, and transfers. I escalate and report concerns, deal with complaints and update relatives. I often have to accompany very sick patients on transfers to different hospitals and wards. i support my manager and I support my colleagues in the lower bands. I give teaching to students, junior and new staff, and also the F1s. I document everything I have done re: patient care. It will look like I’m staring at a computer screen but our drug charts, notes etc are all on computers these days.

I rarely take a break and I never finish on time (I’ll handover to next shift and carry on). I also take time (out of work hours) to read up on latest studies etc to keep my knowledge current. My Fitbit shows that I do between 15k to 20k steps per shift. I often finish an hour or two later than I should because of low staffing.

Hopefully this shows that we do care an awful lot. I hear about awful care and it makes me so angry (and so sad). I think that a lot of what trained nurses do now is what doctors did many years back. And I think that what I’ve written is typical of most trained nurses in the UK. What would improve things would be higher staff numbers on the wards. I look after ten patients, but also am responsible for the whole ward (30+ patients) when I’m in charge or if my manager isn’t in. I will let the management side of things go if I need to be on the floor and our skill mix is down. But often I’m just spread too thin.

In paediatrics we still do it all. Or the parents will do it. (Always offer them assistance if they want it.) we only have one support worker on each shift and she does theatre runs and other things.

Having a degree makes absolutely no difference in practice. I've been a nurse for 20 years this year. I did the diploma. I am starting a top up degree this year. I really don't want to do it, And have. No interest in it. It will make no difference to my work or pay. But it's compulsory. If anything the standard of students has massively declined in the last few years.

I still love my job, and can't imagine doing anything else!

Spent most of last year in and out from 3 days to 3 weeks..
It's the nursing assistants that do bed change.. help to toilet/ shower etc.
Even PB / temperature etc.
They can't do medication or injections.
They can change catheters and drips.
They were Angels when l was in and got my bed changed every day.. would have helped me shower but my daughter did that every day.

@TicTac80 yeah, back in the day, so mid 2000s, I was a b6 on ICU. If I was in charge I had my own patient and had to sort out staffing and sickness, deal with issues on the unit, support junior staff. One of the things flagged up on CQC visits was the lack of a supernumerary shift leader but staffing wise we couldn’t do it.

I can totally believe this. The scope of all roles has increased hugely (and that’s a good thing, it means our staff have more training, and hopefully their jobs are more interesting, and they can do more from a medical perspective for patients). Trouble is that pay doesn’t reflect the increased knowledge, skill, and responsibility the professionals have to have.

I cannot abide the old biddies who think a nurse being ‘caring’ is more important than them being safe and knowledgeable, just because in their day it was all pillowcases opening away from the doorway and yes matron.

Notwithstanding that no one wants to pay more taxes to pay for public services.

I don't. Yet again women footing the word then. As that what happens

It'll be a good 80% plus that end up being women family members

The evolution of nursing and medicine in response to medical advancements has necessitated a shift in the role of nurses. With patients now being more critically ill, the education of nurses has transitioned from hospitals to universities, ensuring a comprehensive understanding of anatomy, physiology, pharmacology, and pathophysiology. This educational shift enables nurses to manage patient care effectively and contribute to safe discharges.

Contrary to the historical perception, nurses are highly trained and educated professionals. The outdated notion of nursing as a mere "calling" or being associated with angelic qualities is not only frustrating but also contributes to misconceptions about the profession. In reality, nurses play a crucial role in managing overall patient care, recognizing signs of patient deterioration, and responding appropriately. HCAs provide bedside care under the supervision of nurses.

Challenges such as the perception that nurses don't care and the persistent "angel" stereotype contribute to the undervaluation of the profession, impacting nurses' compensation. Addressing these misconceptions is crucial for recognizing the true expertise and dedication of nurses in the modern healthcare landscape.

Someone mentioned it not being that way in Paeds, and that they generally have just 1 HCA and the rest is nursing staff who will do all the cares if the parent isn't/cannot

I noticed with my daughter that nurses are still very much hands on in paediatrics (she spends a lot of time in hospitals).

Do they have a lower patient to nurse ratio?

I have friends who are nurses and the only happy one is the paeds nurse

I get that nurses should not be seen as just caring, that they are highly qualified professionals. But I think, like Doctors, there is a strong aspect of knowing how to reassure, calm frightened people in pain, even a good bedside manner. With all the talk of admin and paperwork, I still think there is a special quality to people who can do this job. Or I can't imagine a person being a nurse if they don't have this sort of high level empathy. Hands on care is where the empathy can usually be seen, so if nurses spend more time at a computer I suppose we don't see it as much.

There’s a flipside to this, with too much empathy you’d be a bad nurse or doctor. Sometimes in a medical situation you literally can’t do anything and if someone’s screaming in pain or actually screaming for any other reason and you can do nothing about it and are absorbing all the pain you’ll be paralysed and not much use.

Dd was in last year for 5 days and not once was her bed changed. She ate all her meals sitting in that bed with a saggy mattress with the sheets all sliding off and about, to spend 23.5 hours in there with all the food about in a hot sweaty ward when no one had told her when she could shower inbetween drips, I was just a bit 😱 and thought bed changing would be a regular occurrence.
As for the caring side, maybe they were caring when she was on her own I don’t know, certainly no one came round during my visits were a few hours long. I was just grateful that she was still alive tbh!

I had a week in a hospital with single rooms . I was seriously unwell and could barely get to the en-suite bathroom unless I had a visitor to assist . Bells went unanswered for 30+ minutes . I literally saw nobody except the boy doing the drinks rounds and someone to do the obs occasionally. No cleaners came into my room/ bathroom at all and the only reason I got clean sheets was because my visitors asked for them and did them .

@SLawsonB yes we do have a lower ratio. In my hospital and in ones I've worked In with agencies. It's generally 1:4. I as an inpatient in my own hospital a few years ago. And the nurse had 10 patients. Of which only two of us were self caring. If the girl in the bed opposite me, had been on my ward. We would have had her and one other very easy patient, and no one else.

This feels like I'm reading a uni assignment 😂

A Consultant told me the HCA are doing what SEN nurses used to do. Makes you wonder why they got rid of SENs.

yep, I was in a week with an infection. Very high temperature that would not come down for days, the consultant was very concerned and asked the nurses to make sure that I was given paracetamol very regularly, they did not. My drips were left to run dry. One nurse wrote in my records that she changed the antibiotic bag at 6pm, she left it on the table and did not attach it until 10.30pm so those records are wrong. My bed was not changed the whole week, apparently because my room was at the end , the bed linen ran out every time so there was no clean ones left for me. My room was next to the nurse station so I heard them all the time, just sitting around chatting about where they should go for their hols, about their boozy nights out, boyfriends, tv shows,🙄 anything but work or you know, patients

idle buggers the lot of them

So sorry