to understand how it is possible for a patient to starve on a NHS ward?

[GastonTheLadybird]

I don't have much experience of the NHS and I was shocked to read this blog:

here

If this is true, and I guess you have to assume it is, of course peoplemare going to starve on hospital wards. Logistically it just doesn't work.

Surely it could be arranged so that family member could feed the patients? I know I would be happy to do that if my Mum or Grandmother were in hospital. Although I guess it might not be possible for everyone.

I totally believe you happy2bhomely.

They would have to train you up in the kinds of things I am explaining on this thread i.e. not leaving trays where a disorientated patient can reach it, not giving too much water to a hyponatremic patient, not giving a renal patient potatoes and bananas because of the high potassium etc etc etc. This stuff has all been explained to these patients but it doesn't sink in and they will ask any new face to help them get what they want.

I think it is mean to deny people things but having seen of the shitstorms and poor outcomes that have occured as a result of letting them have what they want I can see why there is such a thing as restrictions.

we had a patient who was on a fluid restriction for congestic cardiac and kidney failure. We must have explained the reason for the fluid restriction verbally and with pamphlets 1000x. Family was NOT happy and were still convinced that we weren't giving mama the litre bottle of pepsi that she wanted every hour because we were meanies who didn't care about hydrating patients.

We explained over and over again that she would not get dehyrdated on the 1000ml a day restricton that we were giving her but that fluid overload would kill her FAST. We got no where. They snuck in huge bottles of cola to her and thought they were real smart hiding it from the Nurse. We could not figure out why she was gaining so much water weight and getting oedematous and short of breath when her Nurses were sticking to the 1000 ml a day fluid restriction ordered by her doctor. We had no idea that the family was sneaking so much shit into her. She got overloaded and died as a result. And that family still tell anyone that will listen that the Nurses killed her by not letting her have enough drinks. She literally had so much fluid around her heart that it stopped.

That is a good idea about the biochem students. I can seem managment shooting it down though. That is how they are. Hundreds and hundreds and hundred of the qualified nurses who have graduated from nursing schools since 2005 have not been able to find jobs on the wards. They could hire them. But they won't. When I first started in the NHS there were 5 qualified nurses on duty for a 25 bedded ward per shift. That was in 1999.

In 2010 there was one RN and 4 untrained carers on duty for the same ward per shift. This isn't down to a lack of nurses, or a lack of nurses who want to work at the bedside, it is down to managment not wanting to hire. The untrained care assistants are given very similiar uniforms as a Nurse. Visitors see 5 people in uniform working on the ward and they think that there are 5 nurses on duty. In 1999 if I had one patient having and emergency and another patient needing pain meds two of us would deal with the emergency and the other nurse would get the pain med for the other patient. Now I don't have that other Nurse. I have care assistants who cannot deal with an emergency or hand out medication. So if I have that situation nowadays the patient who needed the pain med could easily wait an hour.

I'm sorry, but I haven't had time to read the whole thread, but I trained as a nurse in the 1980s, and we would have been in the worst possible trouble if this had happened to a patient in our care. I am imagining what my first Ward Sister would have said to us if we'd left a patient's food in front of them and taken it away untouched, and it's not pretty!

A few things that I think helped, back then.

Firstly - ward design - most of the wards I worked on were the long, Nightingale-style wards, so all the staff could see if someone wasn't eating their meal or was having difficulties - that is not possible now with lots of small rooms - staff just cannot be in more than one place at once.

Secondly, whilst patients did fill in menu cards, the food didn't come up individually plated, it came up on big serving trolleys, which were plugged in on the ward, and the nurse in charge dished up the food - this meant that if someone was admitted after the menu cards went round, or was off the ward in theatre or x-ray or whatever when the menus were done, they could still have a meal, albeit maybe not their first choice of food.

Thirdly, as others have said, there was less paperwork for the nurses to do, and they had not yet taken on as many medical roles as they have today, so they did have more time for the basics of care - plus there were student nurses on every ward, and they were a full part of the ward staff, not supernumary staff, and they had responsibilities for patient care which I don't think nursing students have nowadays.

I've just looked back up the thread a bit and zipzap's idea of red trays for patients who can't feed themselves is pure genius.

we have a red tray system at our hospital, our hospital has just started a new position which is funded intially for a year i believe. We go in for three hours over lunchtime and evening meals. We are first and foremost there to feed patients. Fill in feeding charts, we also have more time to spend to listen to people, take time to sit with people etc It is frustrating though as we cant help as much as we would like as they wont train us to healthcare assistant level as then they have to pay us more. I like to think that if we are making up/stripping beds and feeding etc it frees up the HA's to attend to nursing needs of the patient.

@SDTG students still have responsibility for patient care. it's one of the core things that we are assessed on during each placement and failure in this one section is enough to fail you for the placement. despite the well bandied supernumery status most of us (at least on my course) have to work a minimum of 50% of shifts with your mentor, meaning that we work the shifts that they do, be that day or night. mentors are supposed to be keeping an eye that the student performs as a part of the team and pull them up if they don't. working as an effective member of the nursing team is part of the NMC requirements that we have to fulfill.

i can't speak for other uni's but mine keeps a close eye on the students while they are out on placement and there have been a few who have been put off the course for failing in basic patient care. the course i'm on runs over 2 campuses and out of the 70 odd people that started on my campus 3yrs ago there are now just under 50 left. the other campus has a larger number of students as it also offers mental health nursing but has similar attrition rates.

Stayingdavidtenantsgirl, you really should have read the thread before you commented. Now you look like a jerk.

I really cannot tolerate Nurses who have been off the wards for years and do not understand what is happening. The nurses who are working on the wards these days are working in very different conditions due to increasing costs of healthcare and decreasing reimbursements to hospitals. That's nice if there were tons of you on the ward and you were able to dish out food and feed people but the Nurses today don't have that option no matter how bad they want it.

You also have to remember that the reasons RNs have to take on more medical roles is down to COSTS. The level of healthcare that everyone expects is a hell of a lot more expensive than what they are even going to pay in. So the NHS is desperate to save money in order for the free at the point of delivery healthcare to remain sustainable. So they force medical roles on RNs and Nursing roles on untrained carers who never attended nursing school. It makes me violently ill when people say things like "overeducated nurses dont want to do basic care blah blah blah".

if you came back onto a ward today as an RN this is how it would be: you would be forced to be the only RN on the ward for all those patients and you would HAVE to take on medical tasks that could get you done for manslaughter if you screwed them up. And this would be the case for you whether you liked it or not. Older trained RNs who still work on the wards are put into this position every time they go to work. So are the new grads. The only way to get away from having so many medical tasks dumped on you to the point that you cannot do basic care is to get the hell out of nursing.

It really makes me ill when people say that modern nurses dont want to be bothered with basic care. that isnt the case at all. Basic care is easy and pleasant.

Patients on the wards today are more ill, more complicated. You would not have seen these kinds of patients on the wards 10 years ago. They would have only been in ITU. But with an aging population and chronic illness with acute excarbation out of control and rising there is no room in ITU so they are out on the wards. And there are less RNs on the wards than there was 10 years ago. Knock it off with the "back when I was nursing we would have never done that" shit. You have no idea.

And yes university nursing student have to work nearly 4000 hours on the wards doing all kinds of long shifts delivering basic nursing care or they get failed out of uni and do not graduate.

So now that we all know that we can knock it off with the "nursing students dont work on the wards because they are at university trying to be a doctor" bullshit comments as well.

Nursing students are not supernumery. They are supposed to be but we are too short staffed for that so they get sucked right in. Do to liability they are not allowed to just disappear off with the medications and give them out. They have to have an RN right there with them to do that. But the RN cannot be right there with them because she is the only RN on duty. The students end up working as auxilliaries.

Any care assistants/ auxilliaries that were supposed to be on duty get sent away to cover other wards that are even more short staffed when the staffing office finds out that we will have nursing students on the wards. So that means that the nursing students have to do their job instead of working with the RN and learning from her. So they still get a lot of free labour from nursing students. And those girls and boys are really doing the hands on dirty work.

Newjobthankgod - I did not say that modern nurses don't want to be bothered with basic care. Implying that makes you look like a jerk. My post was intended to demonstrate that, in my day, nurses didn't have the demands on them that RGNs today do, hence it being so much harder for them to find time for things like feeding the patients. I mentioned the medical tasks that nurses now have to do, which take their time away from nursing (as does all the paperwork).

My post was intended to be supportive - pointing out the things that now make work so much harder for today's nurses/the things that made it easier for nurses to nurse in my day.

I am angry about the fact that you have read such nastiness into my post, and treated it with such rudeness. Yes, I did say that, in my day, we wouldn't have got away with letting a patient go hungry, and it's the truth - but I went on to point out the things that made that way of nursing possible.

Perhaps you should reread my post and lose the martyrdom.

When my wonderful grandmother was in hospital we went in to feed her. The nurses were run off their feet and were grateful for the help.

Really sorry StayingDavidTenantsgirl I though you were pulling a Claire Raynor on me. Yeah, you're right I was the jerk there sorry. :)

It's OK, Newjob - don't worry about it at all.

I think there are good and bad things about nursing today and about how I learned to nurse and your mum learned to nurse, MadamDeathstare. As I said - simple things like ward design made it easier for us to keep an eye on our patients - the sister dishing out the meals at the meal trolley in the centre of the ward could see almost all the patients (apart from one or two in sidewards) and if they were having problems, either she or another member of staff could spot it easily and help out. Plus we didn't have the kitchen staff arriving so quickly to collect the trays - as people have said on this thread, there can be little or no time for staff to get to the patients who need help before the tray is taken away again - by someone who doesn't have to tell anyone if a meal is eaten or not (I assume).

But when I trained, we were used as workforce on the wards first and foremost, and our learning experience was nowhere near as good as the students get nowadays - I believe they get more study time, away from the wards and in the university atmosphere. We used to get 2 weeks out of every 12 (approximately) in the school of nursing.

We didn't have half as much paperwork either - though it was starting its inexorable rise when I was training - admission sheets with careplans that we had to fill in for each patient were a relatively new thing, and checklists for patients going to theatre were unknown when I started my training, but had appeared by the time I left nursing. Operating theatre (where I specialised) saw its own increase in paperwork too - from a single, leatherbound register to a register that was supposed to go on computer, plus patient care checklists. Interestingly, the new registers were supposed to make collating data much easier. In the old days, if a surgeon wanted to know how many hernia repairs he had done in a three month period, a person with a pencil went through the registers and counted up. The new registers were designed to make entering the data on computer much easier - but sadly we didn't actually have the computers - so data collation was still done by a person with a pencil!

There has to be a way of combining the best of all training methods, and nursing styles/work practices to ensure the best care for patients and much greater job satisfaction for nurses - but I suspect it would involve more staff and more money, so is not going to happen. Much better to spend the money on changing how the NHS is run.

Madamdeathstare, in your mum's day there was more than one Nurse on duty at a time!! That was probably what allowed them to stay on top of nutrition like they did. I would have given anything to have a charge nurse on duty with me. In your mum's day there was a charge nurse and several nurses on duty to share the qualified nurse wordload between them.

Now there is one Nurse with no other nurses to help her. She only has untrained carers to help her. She is the charge nurse automatically because if she has completed nursing school she is the most senior member of staff on duty at that time. She is the medicication nurse for the entire ward because care assistants cannot give drugs. She is the discharge/admissions nurse because the care assistants cannot do that either. She has to stay on top of all orders and assessments for the entire ward herself because care assistants cannot do that either. Etc etc ad nauseum.

In your mother's day it was a little easier. I would like to see her walk onto an acute medical ward now and handle all the by herself and NOT make a fatal error. No Nurse from your mother's day could do it now. They would run away screaming. They were too used to having other Nurses on duty with them to share the workload and a head nurse to organise everything for the ward so that the nurses could get on with nursing. Management will not pay for that level of staffing these days because health care costs are soaring.

Your mum was never left as the only qualified nurse on a ward full of cardiac drips, insulin drips, telemetry that has to be read by a Nurse, 30 patients on 20 drugs each every 4 hours and 10 complicated discharges and admissions. She never handled a situation like that all by herself without having other nurses around. And that is why she was able to get her patients fed.

When i left the NHS in January we had only one actual nurse and 3 care assistants for the duration of a shift.

I think the author of that blog is an American - i recognise many, many phrases / words.

Davidtenantsgirl, you are right. Nursing is now data entry. In America the Nurse has to click through 17 different computer screens and fill in loads of information online on the hospital wide medical system before the medication machine (a pyxis) will unlock and allow her to take a one freaking paracetamol tablet out. No keys. When I have been in a hurry because a patient is angry with me and waiting I have tried to pry and smack the damn thing open. There are marks are all over the machine from Nurses flying into a rage and punching it.

Thank god I have only 4 patients. It pretty much has to be done for each and every med. The douchebags behind this little enterprise are none other than risk management.

This is coming to the UK. What the hell are NHS nurses going to do when they have 20 patients each and they have to do this for every med that needs to be given?

Imagine going through all those click screens at 8 AM when you have 20 patients each on 15 different drugs due just at that time.

And still these little old witches who nursed in the 1950's will be saying "back in my day I gave my patients their drugs immediately, shame on these modern Nurses".

You just figured that out Nice? I am the author. I am a dual national. Born in the UK, raised and educated in the USA. Came back to the UK at age 23. Ran away screaming again back to the USA age 34.

Newjob: i havent read this thread, just the blog post, but you write just like i do :) (american expat myself)

Are you from the North East? I grew up in New Jersey. When I went back to the UK after not being there since infancy I was so sure I would pick up an English accent eventually. Never happened. Sucks. I sound like fucking Snookie and probably write like that as well. I think that the italian american way of communication just comes off as nasty and obnoxious to most people, especially Brits.

stayingdavidtenatsgirl....you must have done the "traditional training" like me then! 13 weeks per ward, 2 weeks in school...happy days

I am a critical care nurse now, and so we have very very few patiets that eat, so when there is one, it warms the cockles of my heart to sit and feed them and proudly write on their diet sheet what they have managed, no matter how much or how little. It means that they are defo on the road to recovery when they are able to eat in my dept.
Me & my colleagues jump around with joy if we get a spoon full of mashed spuds down them!!

sad sad folk

must acknowledge how absolutely lucky and privaledged i am working on critical care, 1:1 ....supposedly...
i did a shift on Saterday, we had 15 patients and 10 nurses, which is well below recomendations.
Had to take painkillers when i got home, my feet and legs were actually painful to walk...i had had half a cup of coffe all day, stared my shift at 7am, finished at 9pm. Half a cup of coffee, nothing to eat till a kindly relative brought us a tin of roses, that was our nutirtional intake for that day!

oh and managed to squeeze on quick wee in !!!!!

newjob: nah, from hillbilly-land, me. i spent a few yrs in Detroit though. you write just like i would speak.