A question for NHS staff

[Glowinginthedark]

AIBU to think that no amount of money throw at the NHS in it current state will fix the issues? What is the real problem? Lack of funds or people completely abusing and misusing A&E or both?

Here's a good summary from the BBC website:

10 charts that show why the NHS is in troublewww.bbc.co.uk/news/health-42572110

£2,200 per person per year is what they aim to spend, it does not say they spend that. But it is very little as that includes building new hospitals and training Drs and other staff. When you pay for private health care in Britain you don't pay the real costs as the NHS has already trained the staff there. It also includes health prevention work. A friend had whooping cough, a notifiable disease. As well as treatment staff traced other people she had been in close contact with and tested them. There are lots of things this money pays for that private health care costs in Britain do not include.

"I have to constantly ask and pester to do more 'nursey' things".

The most nursey thing you can do is wash and talk to your patient. You will find that you gain the most knowledge about your patient during that time, than any other. Don't let anyone, ever, tell you that washing, talking, feeding or cleaning your patient isn't 'nursey'.

In Intensive Care, the most technical of all nursing environments, the Registered Nurse washes their own patient at all times. If they require help from another nurse, or care assistant, it is the nurse in charge of the patient who views the back of the patient, or the front, etc., so they can use that time to assess the integrity of the patient's skin and identify any vulnerable areas that are prone to breakdown.

Many a time, as a young care assistant and a student, before I qualified, I have admitted a patient and said 'have you ever had any surgery, sir?' "No, never!", they replied. The next morning, assisting with a wash: "What's this scar all about then, Mr x?" "Oh that would be my Cabbage [CABG - coronary artery bypass graft] in 1979!" Ahh....so you had an operation, then? "Oh yes, dear! Quite a big one at the time."

'Nursey stuff' is stuff that deals with patients. Even in intensive care, looking at the patient tells you more than looking at the machines. The machines just help to guide you as to why your patient looks the way they do.

I go back to my placement for 5 weeks in Feb and I just get left (not a bad way to learn certain aspects of the ward) and I have to constantly ask and pester to do more 'nursey' things.

I hope you don’t mean you are trying to shy away from doing the fundamentals of care eg washing dressing and feeding your patients? Because if I had a student nurse working with me who refused to assist an alcohol detox patient who had korsakoffs and had defecated himself to shower and change his clothes I would have a VERY dim view of this. The MOST important nursing task you can do is to be with your patients, wash them gently, dress them with fragility, feed them tenderly and hold their hand to comfort them. THAT is what makes a nurse, not how many pumps you can run in ICU or how quickly you can throw sutures into a scalp (though I do enjoy that part too )

£2200 per person is woefully inadequate as an annual budget. Given that everyone should have an annual physical that would probably cost about £150 to perform, it really does assume very limited treatment.

About two years ago I had my annual physical after the birth of DD2. I was in the obese category and the doctor had me come back weekly for a weigh in with the nurse (no charge for this). After two months I hadn't lost weight so she referred me to a weight management unit at NYU. I've been through a very expensive program where I see a therapist for a diagnosed eating disorder (emotional/binge consumption) and I'm now on weight watchers. The cost of this program has been about $10k which is expensive but long term it's cheap compared to the care needed if I had remained obese.

No want2b supermum there is no need for an ‘annual physical’ they’re there to make money out of healthy people!

I have a chronic illness and cost the NHS more than that. And that is not including the cost of training Drs etc.

An ordinary birth costs about £4k privately in the UK. That is without a caesarian or any additional care for the baby. It is easy to see how some births will cost the equivalent of 10 or even 20 years cost per person of the NHS amount.

Most people are unaware of how much different procedures actually cost so think that annual amount is generous, when it is not.

So my DP recently had a colonoscopy, common procedure. Looking at private healthcare and the costs, with pre appointment and follow up appointment, that alone costs £500. He had blood tests beforehand with another consultation, and is having further tests and another consultation. The whole thing could easily cost £1000 privately, and that is for a fairly simple and very common investigation that lots of people I know have had.

I've worked in the NHS for over 20 years & never seen it struggle this much before. I have never been so over-stretched, to the point of worrying about my registration. It's a horrible way to work.

If you click on the BBC link I posted earlier, it shows the percentage of the population above 60/65 & how this increasing at a faster rate than funding is rising.

Essentially, demand is outstripping supply.

I'd welcome an all-parliamentary group to examine funding issues & make recommendations- but politicians don't have the guts for that.

What on earth would happen if we had a major disaster? Major, coordinated terror attack for the UK? We are at breaking point now. It’d be a complete disaster.

Can I come and be your student Gingerbreadma. I go back to my placement for 5 weeks in Feb and I just get left (not a bad way to learn certain aspects of the ward) and I have to constantly ask and pester to do more 'nursey' things. I just keep getting told you don't learn to be a nurse until you qualify!!

Well then you wouldnt like me at all!!
How do you expecy to fill in the nursing assessments if you're not regularly seeing your patients skin? How do you complete a falls and frailty assessment if you've never helped them into/out of the chair/toilet?. That right there is nursing!
The students who get that and want to do the nursing basics will be plucked away to see advanced skills, because they're already "there". They get it! The skills and procedures are extras anyway you learn them on post registration courses/competencies.
The ones that only wanna see proceedures will be nudged in the direction of actual patients!
Taking obs is a NURSING job tha HCAs "help" with not the other way round, and I always try to do as many as I can myself because how much to you trust others to always count resps for a full 60 seconds? Or properly check if a pulse is irregular? These are the things that form the basis of your clinical decisions. They are the most important part of the job bar 1 single most important thing: LOOKING at your patients. Just looking at them. Knowing how they look normally so that you notice if something has changed and they "just dont look right". Not looking at whats being DONE to them, looking at THEM!

Definitely that ^^
I'm working as a carer and starting to notice when my regulars aren't right. Just because they don't smell right or they're quieter. Or a pressure sore changing because yesterday it was ok, today it smells odd
Who likes a good scrub and who wants washing more gently, how they want their food, their favourite plate/cup etc etc

1. Not enough staff to do the job
2. Staff burned out emotionally and physically
3. Staff constantly being told they're failing
4. Staff working on goodwill
5. No breaks...going to the loo is a luxury during a shift.

1. A more demanding society who have unrealistic expectations.....blows my mind!

Someone had a go at me about wheelchairs. Felt it was disgusting that the hospital didn't have a wheelchair to give them that fitted them better. Feet didn't touch footrests. They'd sprained they're ankle. That was 10 mins of abuse I got.

At my local Hospital...they're even offering staff cash incentives on top of pay to do overtime. But it's not having a massive effect because people have had enough.

Need more staff

So you've done washes before. But have you washed Mrs Jones? No? Well then whats the point in sending you to HER best interests meeting? I dont want you anywhere near her relatives if you're going to make them thing that the ward staff havent bothered to get to know their mum! Whats the point in letting you have a go at HER CHC check lists?

I'll send the student who spent the morning getting involved in washes and feeds, not the one who only wants to hover around the ward round being an extra intimidating face looming over the patient.

I'll gently explain all of this to you, Ill try and lead by example. But my patients come first and I wont have you in with me when Im catheterising a nervous patient if you're just going to gawp at their "business end" so you can "learn nursing things". Ill bring you in when Im confident that youll hold their hand and talk them through it and be able to tell me if they're suddenly squeezing your hand harder if its getting too much & they need me to stop!

Taking obs is a NURSING job tha HCAs "help" with not the other way round

YES! 🙌 sadly I’m the only nurse in my team that does observations. I like to observe my own patients and not rely on others all of the time.

It's so sad that 'obs' are seen as such a mechanical task now. In part, having MEWS, NEWS, ViEWS, or whatever acronym a particular trust has has lead to some of the complacency, I think, as well as making things superficially safer. Instead of nurses having it absolutely drummed into them that they must know their patients' observations, even if a HCA actually performs the task, it becomes a case of 'it's ok if they don't score above a 2 on NEWS....' or 'if they score a 4, there's a real problem!' The subtleties of observations are lost.

The patient whose overall respiratory rate (that is, number of breaths per minute, not per 15 seconds and times by 4!) is the same, but their work of breathing has increased, or they are frowning or wincing as they breathe, can be completely overlooked on an observations chart.

The patient whose overall heart rate is 'normal' but they are having runs of tachycardia (fast heart rate) in amongst a baseline of a slow heart rate. A thready pulse or a bounding pulse. None of that is recorded on an obs chart, but may well need to be noted in clinical notes.

Gaining the trust of a scared patient and/or relative is the single most useful nursing skill you will ever learn. It can overcome the biggest barriers to treatment, in fact more than many drugs.

I teach HCSW to take obs and I really do try to impress on them that it’s not just a case of filling out the boxes and saying what the overall score is......but it’s also about things like is breathing laboured, does something just not seem quite right, etc. Trust your instinct.

My biggest worry but I worry about it for registered staff as well as HCSW is that with electronic obs on an iPod you can’t see an overall trend like you could with old fashioned paper charts. Yes, you can go back on the main computer and see the trend but not in the iPod.....and you have to have a concern in order to do that. Someone could still be within normal parameters but if everything is just under scoring and have changed since last set of obs I’d be concerned.....but I might not notice!

Very good point from both PP, I had a HCA not tell me that a patients systolic had jumped from 127 to 180 and had stayed like that for days “because they scored 0

And even if patients do score, that’s not really surprising in my job. I would expect a patient with opiate withdrawals to be tachy with a higher resp rate and a raised BP. These symptoms are normal and will subside. I don’t need to be told about those, I need to be told about the patients that have been with us for 10+ days whose pulse is still 92, BP still 140/95. These are the ones I want to send for an ECG not the guy who is clearly clucking....

My DP died recently after a long, debilitating illness. DP flatly refused to be taken to hospital at the end because of all the terrible, terrible things that had gone wrong / been neglected on earlier multiple admissions. What is the point of being hooked up to machinery if no one comes when the alarms go off. I have PTS after all I witnessed and dread getting ill.

What worries me is often with serious complications, the body often compensates initially and obs stay fine even though the patient looks and feels "wrong"......
....so as the nurse you set the obs to 15 mins, put them in bed, grab a doc and let them know that somethings not quite right..... and only THEN on your 3rd set of obs the problem starts to show itself in numbers.

But where we're being replaced by 4s they often in these cases will see a score of 0 and set the obs to be done again in 6 hours time. And nothings done until the patient actually collapses.

Students need to learn from experience to doubt and second guess everything. So I do get them to do the obs. Even if some of them think thats being "used as a hca". Because I'll then ask them if they were okay, before reviewing them myself and pointing out the ones that actually are unacceptable changes even if the score has changed. You need to get it wrong in a "safe" way so that by the time you qualify its drummed into you to double tripple check and know your patients baselines and question the machines/scores.

Quilting I’m so sorry
It’s soul destroying for NHS staff when they know that their hospital is failing patients and they are unable to provide the high quality care that they want to.

mrscog As a patient I strongly disagree that annual physicals are not necessary. It's these checks that have identified that two of my DC have autism, DH has cardiovascular disease and I was at high risk of heart attack or stroke given my history.

In conjunction with my annual physical I have a full set of blood work which initially identified anemia. That is now under control. I also have an annual smear and have done since I first arrived here in the US. My insurance has never charged me for my annual check up. If you don't go you pay more. They have always checked my weight, my breasts, done a poop test and since having children they ask questions about how I'm coping.

It's a one hour appointment with the doctor which is booked after you come into the practice for blood work. It's a whole lot cheaper to manage health upfront than to pay on the back end.

Our ipads do have a section where you can view the last few days' of obs, and I think that's vital for timely bedside assessment. Might be worth raising with the team who manage your obs system?

We only have computer based recordings of obs too and not only does it list the last 20 readings but it can also show a graph and the baseline is recorded separately as a comparison tool (we use systmone)

My biggest concern about qualifying is whether I'll have the time to perform hands-on assessments of my patients, or whether I'll be expected to rely on reports from unqualified nursing staff. Things get missed when the people performing hands-on nursing lack the theory base to recognise problems. Yes, you can pull in anyone with a satisfactory DBS and teach them to wield a bedpan, but you have to invest time and money to teach them everything they should notice during fundamental care...