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.

[Funtimewincies]

No I'm not sure. The point I'm trying to (possibly rather clumsily) make is that there were so many staff on the ward, all I'm sure doing important things, but no-one was able to simply move this woman's food closer so that she could eat. That's all the problem was. I couldn't as I could barely get to the loo unaided and I felt powerless as she went hungry. I'm not talking about one mealtime but many. Once I was mobile, I moved the table but this was after I'd watched from the other side of the room as she's missed 3 days of meals.

So many people, all too busy .

[Funtimewincies]

Actually, thinking forward to when I had ds1 (different ward), I also had a problem getting food. I'd labourered all night, was pushing at breakfast time, asleep at lunchtime (no-one woke me and no food left for me) and at tea-time (because no chit had been filled in from my bed the day before) all that was on offer was a small salad and a banana. Again at breakfast time (no chit) all that was left was 1 slice of toast and a fruit juice. I was famished and struggling to breastfeed.

We weren't allowed to bring anything more than snacks on to the post-natal ward for 'health and safety' reasons, nor could I wheel ds1 down to the cafe.

What is it with my hospital and food?

[Binfullofmaggotsonthe45]

I totally get it. I had to go to Salisbury with cluster migraines. I was in a ward with 15 or so elderly women. Very few had visitors. I was admitted in the evening after the dinner trolley. In the morning i went straight for a spinal so missed the breakfast trolley and they forgot to get me to fill out a menu for the rest of the day (had to be done the night before and i was in the admissions ward, then when moved to the womens ward no one asked. I didn't think to mention as i don't have much experience of NHS hospitals tbh.

I had a scan that afternoon so missed lunch and dinner, although as i hadn't filled out the form i wasn't sure i was getting any anyway!

Filled out a form for the next day. They ran out of toast and i didn't order porridge. Woman said she'd be back with more toast and never returned. I ws taking pain killers on an empty stomach. When i complained nurse just rolled her eyes, lunch trolley will be around soon. Lunch was totally inedible. And believe me i am not fussy. Ate half of it max even though i was starving.

They moved me to a corner of the l shaped ward that afternoon as the strip lighting was killing me . That evening the dinner trolley missed me as as i was round the corner and asleep! Seriously! So the form for the next day which was on this trolley wasn't filled out again.

My husband couldn't visit every night he was in the army and had our 2 yo to care for in the evenings plus the hospital was 50 minutes away from home.

By the time he got there i was in pieces, lost my dignity, a bit of my sanity, felt like a trouble maker and was bloody starving. He had to go to the shop and smuggle me a kit kat.

And i am a 36 yo woman, what if you are 70 and too weak to kick off?

When i felt a bit better and ask to be discharged i spent the entire afternoon helping these ladies with pillows, slippers, blankets, water from their jug as the auxillary nurses seemed to just ignore the buzzers after a while. Every request was like to much trouble. But i could look down the hall and see them all sat in the office.

You should have seen the face on one of them when i asked if it was my job to remove the faeces caked adult nappy on the floor of the bathroom before i could shower in there. It was as if i'd asked her to wipe my own backside!

[Newjobthankgod]

Lesley,

it is hugely important to understand who is who. Ask if you are not sure. Everytime an RN is caring for more than 5 patients at a time the mortality rates increase. Google Linda Aiken-nurse patient ratios. Right now in the UK it is at about one RN to 15 patients. Managment gets away with that because of the ignorance of the public. If you have one RN on a ward and a critically ill patient gets admitted that person will probably die regardless of how many untrained carers you have. But management and the public says this: "oh well who cares is there are two nurses on duty or one nurse and one carer? What is the difference?" There is a big difference.

If managment knows that they can staff the wards at dangerous levels because the public doesn't know any better then they will do it.

I have had patients report a worrying change in condition like chest pain to a care assistant thinking that they were speaking to a Nurse. The care assistant never told the Nurse and the patient became so unwell that she nearly became a failure to rescue statistic.

Funtimewincie3s- Nurses do think that they are responsible for feeding patients. They just cannot do it because of other things that are going on at mealtime. I hate when people make out that we are not feeding patients because we don't think it is our job. Everything is the Nurse's responsibility. But we only just about manage to get through the RN only tasks.

There are always lots of people chatting at the Nurse's station. Not likely the nurse though.

It is hard to be an Nurse, you have a lot of life and death responsibility. It sucks when someone who doesn't have the education to be a Nurse nor all the stress that goes along with it gets lumped right in with the Nurses. It takes a lot of education and training to legally be allowed to use the title Nurse. The word nurse is not a catch all title for anyone who works on a ward.

[Newjobthankgod]

Even though I consider nutrition my responsibility I can get shirty if someone gets at me at mealtime because they are unhappy with their tray or whatever. Sometime you have so many things going on like meds, deteriorating patients, orders etc that you feel like you are going to puke. It is hard to stay on top of the jobs that only an RN can do without having to take on the only jobs that the assistants can help with too. It's like for god sake's fuck off I have 100 drugs to get, the lady in 5 is bleeding out, 5 family members are waiting to speak to me so for christs sake get the care assistant if you want some mustard. It's not like she can help me with any of the other things that are happening.

In the UK many drugs are getting given lates and many mistakes are made because the patients will go to a Nurse with something that the care assistant could deal with. Look at it this way.

At any given time there are 10 things happening at once. On average 9 out of 10 of those things need to be handled by an RN. 1 of those 10 things is simple and can get handled by an assistant. The RN has a better chance of not fucking up if she can delegate the one simple job to the assistant rather than trying to do all 10 by herself.

[Newjobthankgod]

or look at it is way: Say i am the only nurse on duty and there are 300 drugs to give at 0800. If you do nothing else whilst giving those drugs it can still take hours.

I have 3 care assistants working with me. I have to do all the drugs myself because assistants cannot do meds. But they can take patients to the toilet.

While I am trying to get around with all those meds THAT HAVE TO BE GIVEN ON TIME patients are asking me for the toilet rather than asking the care assistant. If I stop and take everyone who asks to the toilet then all those meds will be given late and not only will I get written up for med errors but the patients will be mad that they had to wait so long for their IV pain meds.

I used to wonder why patients would ask me for the toilet when I was on the drug round...and then bitch about their meds being late!!! I guess they assume that those 4 other girls they see working on the ward are Nurse's and assume that they can continue with on with the drug round. But they can't continue on with it because they are care assistants. If I get stopped to do something a care assistant can do, then all the Nurse only tasks are frozen until I can carry on with them.

Nurse's do not think that they are above doing certain jobs. They just have to delegate. The only way a Nurse can stay on top of the RN only tasks and avoid errors that could be fatal

[Newjobthankgod]

You also have to remember that what the care assistants are doing or not doing is no indication of how busy the ward is for the Nurse on duty. <br />
I might have 300 drugs to give, an admission who needs blood, stat labs to draw, a patient who needs an RN escort for a procedure, a patient who cannot breathe and needs suctioning, another asking for pain meds, another coming back from theatre who needs an in depth assessment to prevent a post op complication that could kill him and ten family members waiting to talk to me all at the same time. It's a 20 bed ward and I am the only RN.

The care assistants cannot help me in any way shape or form with any of the above so they might sit at the Nurse's station and fill out menus, listen for call bells and have a chat with eachother while all this is going on.

In a situation like that I have to deal with the unwell patients first, then move into the pain meds. The patients waiting for the pain meds are going to have a long wait in a situation like that and there is nothing I can do about iot. These patients see the care assistants around and cannot understand why they are waiting so long for pain meds when there are so many "nurses" around, just sitting at the station. If only. Then the nursing profession, who has no control over skill mix and staffing, gets the big slag off. It's makes you bitter.

[StayingDavidTennantsGirl]

Just to underline what Newjob is saying, when I trained as a nurse, a typical weekday morning shift on a busy surgical ward would probably have a Sister, a staff nurse, maybe an enrolled nurse (nurses who did a 2 year, more practical qualification but were well trained, skilled and could do a lot of the stuff that a registered nurse could do), student nurses and perhaps an auxiliary too. The student nurses would be at varying stages of training - from their first ward to their final ward before qualification, and as they got further through their training, they were able to do increasingly more nursing tasks - giving the meds, changing IV fluid bags, putting up blood, doing dressings, doing the observations of temperature, pulse, bloodpressure, assessing patients' needs on admission and writing up the care plan.

All of this meant that the nursing jobs, the skilled ones, were shared amongst several people. Obviously the junior student nurses couldn't do very much, but they were learning every day, and a senior student nurse, who was near the end of her training and had done all her practical assessments was considered almost as skilled as a qualified nurse, and could be left in charge of the ward.

This spread the burden so much further, and meant it was much, much easier for the nurses to find the time to do basic care. In fact, there would be shifts where there were NO nursing auxilliaries on the ward, so all the work was being done either by nurses-in-training or qualified nurses. And even when the auxilliaries were on the ward, there was usually only one on a shift, and they were staff who had often been on the same ward for years - longer than the staff nurses and even the sisters in some cases, and they knew their job inside out - as Newjob said in an earlier post. But they cost too much, and have been replaced, as she said.

[Newjobthankgod]

To give you some perspective I'll tell you about my new job in the US. On a 32 bed medical ward we have 10 staff nurses on duty for a shift. In addition to that we have a Nurse in charge to deal with things like phone calls, and ward logistics. We can also go to her if we have a question or need help. In addition to all that we always have two ward clerks until 6PM and then one ward clerk from PM to 6 AM. In addition to that we have 3 full time case workers on the ward to organise discharges. Discharges are a complicated time consuming nightmare these days.

My hospital is non profit and takes uninsured and government medicare patients. I cant imagine what the for profit places are like.

On my 34 bed ward in the UK we had 1 or 2 nurses and 3 untrained care assistants for the duration of the shift. THAT WAS IT.

If we had 2 nursing students for the day then our care assistants were taken away. We went 5 years without even a part time ward clerk because the hospital didn't want to pay for it. We had no hospital social worker. So much of the caseworker job had to be done by the staff nurse. The ward staff nurse was not only the only nurse for the whole ward but community social workers would dump on us a lot.

[WhollyGhost]

"if that means their children have to put up with hardship and disruption to their life so be it, "

Even if that means their childrens' children have to be neglected?

[StayingDavidTennantsGirl]

I'm sorry, WhollyGhost - I must have missed that bit.

[ggirl]

Newjobthankgod -TEN staff nurses !!!!!! OMG
Sounds fantastic.

I am secinding all that newjob has said. The standard of care in hopsitals has gone down so much since I qualified in 1986 and that has to do with the staffing levels and abundance of unskilled cheap healthcare assistants and lack of trained.
You would never ever have been the sole nurse on a ward of patients yrs ago..
The ward I work on has jusst recently been allowed to have two trained on per shift. It makes all the difference but of course we have one less hca now.

[WhollyGhost]

SDTG - it was up near the start of the thread

While I think that it is right and proper that relatives help where they can, I worry about the pressure it puts on some. For example, my MIL is a saint. She devotes almost all the time she is not at work to caring, and advocating for her elderly Aunts. It means she never gets a break herself, and her own health is suffering. It also means that she was not in a position to help me when I was struggling (I don't resent that, the Aunts' needs were greater). It means that MIL has sacrificed getting to know her grandchildren.

I don't think that I could do what she does, and has done for years. Not least because my obligations to my DC come first. Most people have lots of competing demands on their resources, it is not reasonable to judge relatives for not providing care.

Personally, I would end it all if my loved ones were obliged to devote so much time to caring for me, but that has to be an individual choice. Advances in medicine enable us to linger ever longer. The reality is that means ever more resources are needed to care for those who can't look after themselves. I think inheritance tax should be drastically increased to help fund that.

[VivaLeBeaver]

Well as a health care professional I saw it from the other side yesterday. Had an op in the morning so nil by mouth from midnight. Came round in recovery in loads of pain, I had to use gas and air for three hours till it ran out and then they knocked me out with pethidine. Buzzer was out of reach for most of this time and I couldn't speak or sit up. So I missed lunch.
Then they decided I needed to be kept in and transferred me to another ward, at 8:oopm I asked if I could have something to eat but was told I,d missed meal time. Took my own cannulas out and came home.

[StayingDavidTennantsGirl]

Thankyou WhollyGhost - I did look back up the thread but couldn't find it. What you said has made me remember what my mum went through when her mum had a brain tumour, and she ended up caring for her at home whilst dsis and I were little - it was a huge strain for her, and has led to her saying that dsis and I are not to do that for her - we are to put her into a home, if she needs care. Not sure I'd be able to though...

[piprabbit]

When I was in very ill and in hospital for 6 weeks, I was considered ill enough by the hospital for me to have a side room. My family were therefore able to arrange a rota where they were with me from 9am to midnight every day (I think the hospital thought I was dying, so didn't kick up a fuss and by the time they realised I was getting better, they were faced with a fait accompli).

During that time my family fed me, gave me water, washed me and even had to clean the room.

It was my family who found my awful bedsores and asked for them to be treated, who trimmed the skin from my hands and feet as it all fell off, who held my hand when I cried from the pain of the IV antibiotics. It was my family who kept the records of my fluid intake for the staff, who fetched my special milk drinks from the fridge when the staff forgot/were too busy. They accompanied me as I began to walk again (up and down, back and forth along the corridors), so that I could become mobile enough to go home (I had to prove I could do stairs before I could be discharged).

I give the NHS full credit for my survival - without them I would be dead. But without my family I would have taken many, many more weeks to recover (and would have been tying up a bed all that time).

I was incredibly lucky to have a family who were able, and who wanted to care for me like this. I also feel that their care freed up the staff to look after other patients without families.

[SusanneLinder]

MY DH as a fairly newly qualified RMN had to "special" a patient in a busy Coronary Care Unit. Cos he trained mostly in mental health wards were the ratio of staff to patients was MUCH higher (although many qualified nurse jobs are downgraded), he was horrified to see that there were only 6 staff on, 3 were agency , 2 qualified nurses and an HCA. This was for a busy busy CCU ward where machines had to be checked all the time.

But then that health board had cut 1500 front line staff jobs. Why spend the bloody money using agency staff? Disgusting. And the nurses are overworked and underpaid.

[Funtimewincies]

So who on the ward is responsible for moving a table so that bed-ridden patients can reach their food? I still have no idea!

[VivaLeBeaver]

It should be every staff members responsibility. From the cleaner to the support worker, to the nurse and the sister. Even the dr on his ward round.

[Newjobthankgod]

It is everyone's responsibility. The lone Nurse on duty is the one who is the least likely to be able to check around and make sure trays are in position at mealtime. This is because of all the other stuff that is going on.

There are a few care assistants around at mealtime who really have nothing to do but answer lights and help with trays at that time. However, there are usually more patients ringing for the toilet during that 15 minute period when the trays get out and are collected back in than there are staff on duty.

If it is lunch time the evening shift may be coming on duty but they shouldnt really go near a patient until they have received handover. Otherwise they might feed someone who shouldnt be fed etc. The oncoming shift has to wait at the station until the current shift can get away to give report.

[StayingDavidTennantsGirl]

Are there practical things that could help, Newjob? Like the red tray system, spoken about earlier. Or a basic care plan on the end of each bed, so any member of staff can check and see whether MrsX can feed herself or whether Mr Y is nil by mouth or has a special diet, or if Ms Z has a choking problem.

[Newjobthankgod]

no stayingdavidtenantsgirl none of that helps and it has all been tried. Seriously, it's too chaotic on there. We just need a better system at mealtime and a better kitchen service. it would help if they sent up enough food too.

[SusanneLinder]

Nothing to do with this thread really, but DH got his first proper RMN post qualified permanent job. :) Working in a dementia unit (private),which he really wanted to do. Can't promise he will change the world,but do his best to make sure that he brings as much dignity to his patients as possible.Tried for NHS,but no jobs to apply for sadly.

Chuffed cos this has been a LONG hard 6 months of irregular agency work.