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?

I was doing a refresher of my ILS training a few months ago. The trainer said that when they evaluate in hospital cardiac arrests, it is most often the respiratory rate that gives the first clue that something is wrong with the patient. It is also the observation that is most often missed, and the observation that is most often short-cutted. Just how many patients can have a respiratory rate of exactly 16 BPM, each and every time they are observed? Well, 4x4 is 16, so it's nice and easy, and a normal rate is between 12 and 20, so.....

They found that the average time that the first signs that things were going badly wrong for these patients, who went into cardiac arrest in hospital, whose treating staff would always say "it was so out of the blue, it couldn't be predicted", was eight hours.

You can review on our ipads easily. But untrained staff (and a lot of students) dont.

To be fair they didnt when it was on paper either and the paper was worse because some people literally copied the previous one as it was right there! This isnt a tech issue, its a using untrained staff to do nursing things that nurses should do issue. The ipads are a great improvement. We also had score systems on paper..

clockwork. Believe me I have, numerous times. Anyway I left last week so guess it’s not my problem now!

"This isnt a tech issue, its a using untrained staff to do nursing things that nurses should do issue."

It's not only that, it's turning a vital part of nursing activity into an inconvenient, boring 'job' that has to be done, and quickly, so the real, exciting stuff can be done. That's why student nurses feel they're being ignored and 'treated like care assistants' if they are asked to do obs. Observations save lives, and they are the real reason people are in hospital. If they didn't need observation, they could go home with a cannula and pop back in for their IV antibiotics and painkillers a couple of times per day. But they aren't well enough to do that.

Anecdotally, it can often be cleaners who pick up on poorly patients in hospital. They go to the same bedspace several times per day, day in, day out, so they get to know patients. They notice when someone is looking unwell, or has collapsed, and raise the alarm. They aren't too busy looking for more interesting things to do.

@moreproseccoNow, thank you for that link to the BBC article, it explains clearly the different issues that have contributed to the current crisis. Clearly it's not due to immigrants or terrible management, but mainly the rising cost of people living longer, more expensive drug treatments, lack of social care funding and the government, especially the last seven years reducing funding proportionally. It's still rising each year but not as much as it has done.

The link is here as it didn't come up, worth reading www.bbc.co.uk/news/health-42572110

gingerbread I love reading your posts on nursing. With my father being so sick it's been the nurses caring for him that has greatly enabled him to recover. Poor nursing has such a huge impact on patients recovery which does impact the cost of care. I'm not in favour of nursing being so academic these days. It should be a vocational qualification recognized as a degree with no tuition charged.

Research has actually shown that degree nurses score higher in humanised care but for some reason people still think you cant be caring and book smart. They're not mutually exclusive.

But you've got your wish, nursing IS becoming less academic, with nurse associates training on the job, and so far the outcomes from initial reviews of non academically trained "nurses" are not looking good for patients!

gingerbread not to mention the fact that patient mortality decreases as the proportion of graduate nurses increased, as outlined in the RN4CAST study x

gingerbread I find that surprising. What I've seen is that graduate nurses don't want to do the basics like washing or observing as you mentioned above. My fathers feet were in terrible shape and I asked the nurse if they could make sure someone rubbed cream into his feet twice a day. I got a cats arse face. Later I went to clear the air with the nurse out of earshot of my father and she was offended because she thought I wanted her to spend half an hour rubbing cream into feet. First of all I expect a nurse to coordinate his care not do it themselves. Second of all she had no clue that I live in the US and bloody commute to the UK and was rushing in and out because I had a baby with my friend. I'd do his feet myself all the time if I didn't have 3DC ages 6 and under, worked FT and lived 3000 miles away.

I also think there is value to a degree course for nursing but it should be vocational based so no tuition. There should be Day release for attending lectures. The new scheme they have no rounded education. The best nurse my Dad has had is studying for their PhD. She is excellent and has really helped his mental health more than any other HCP involved with his care.

Are we back to nurses eating their young ?

Gingerbread no you are exactly still the mentor I would like. It's all this and more that I aspire to be as a nurse. Sometimes we just need reassurance and gentle explanation that just caring for someone is our job, but we see nurses doing so much that we worry we aren't learning enough and I'm getting nervous about qualifying. I never shy away from obs (I try and do at least one manual per shift) washes, assistance, toileting as you are right it's how you get to know your patients. I check skin in the morning and before bed. I've escalated a few times when I've noticed deterioration. At the same time I have had a bit of a head shake when I say I'm in 3rd year and haven't done a catheter. I've two grandparents in their 90s in a care home I care for my patients how I'd want a lived one to be cared for. I notice if a patient has dirty feet or dry legs. But yes many of my colleague students don't even want to care for the elderly, they were all scrapping to get into A&E and critical care in management. I really want to be a good nurse and am mostly just looking for my mentor to spend a bit of time with me, learning how they prioritise their days and why they are making the decisions they are. But you have reassured me that when I go back on placement I will continue to do what I am doing and not worry about the 'nursey' bits and that there will be time to learn the more technical bits.

OK going back over a few posts. My point (badly put) was that I'm aspiring to be a good nurse and to do that I need to be well trained and mentored. It wasn't until 2nd year that one of the nurses (who wasn't my mentor) said right stick by my side today. She went over obs with me and explained all of the above and related it to the medications the patient was on. She went through what she listens for in the handover and her priorities for the day and how that can change all the time. I was really grateful to her as I learned so much about applying the basic skills I was learning. I don't expect every shift to be like that but once in a while to get that appreciation. But my other point way back was that nurses are so stretched they often can't spend this time to train and explain fully what they are doing and why.

Anybody who thinks it would be better in the hands of private enterprise should have a look at social care and see how well it worked there.

Lack of decent social care is one of the things crippling the NHS.

True social care is in a total mess. The best home my GP was in was a council run one which has now closed. It was not glossy and could have done with a refurbishment. But the staff were amazing and had been there for years. When it became private it had a total refurbishment, but staff were on much worse conditions, and suddenly the staff started changing all the time and were much less good.

Frumpety

I don’t think we can stop nurses from eating their young....

I think it's an incredibly complex question that everybody will believe should be answered differently. But from my point of view ( as a nurse with more than 30 years experience in the NHS) here are some of my thoughts.
When I started training, the ethos was very much on caring for sick people. Now,it is geared towards 'reaching targets.'
Nurse training. You don't need a degree to learn how to care for people. You need a combination of intelligence,willingness to learn and common sense.
Both Labour and Conservative governments have made unpopular and blatantly ridiculous decisions regarding the NHS. Neither party pays more than lip service to it.
Finally,public expectations. We are now living linger with a far more complex set of medical problems than when the NHS was set up. Yet social care and the NHS cannot provide the care the population needs. It needs a whole new shake up - and soon.

Fruitcider thanks for the video, I enjoyed that and then fell down a TedTalks hole!

Gammel I LOVE ted talks. VERY off topic but this one really got me thinking too...

I know a paramedic who said that just after the London bombings in 2007 the ward sister in a busy A and E went into thr waiting room and asked that in light of a major incident could anyone who didnt have an absolutely urgent medical need please leave. She went back in 5 minutes and bar one couple the room was empty.
People take the piss. But they also expect too much. Nurses are on their knees expected to manage wards 3 months post qualification putting their own registration at risk due to the unsafe conditions.
It was created to keep people working. There are many wasyed resources

And so....Jeremy Hunt has Social Care added to his “management”.

I think it's pretty sensible to join up health & social care, as we have done here in Scotland.

However, Jeremy Hunt to oversee it? Nah. Couldn't think of a worse person.

So many people have spoken eloquently on this thread. The reasons have been explained very clearly.

Lack of nurses
Lack of Doctors
Lack of managers (this isn't a popular view, but the good leaders have left in droves. All studies have shown the NHS needs more, not fewer managers. But it's horrible: endless days and nights working all hours with no hope in sight, abuse from the public and the media, ill and depressed staff. Front line staff get horrific abuse and we try to protect them. Managers get abuse and tbh we all sort of feel we deserve it because we're NHS managers FFS!)

We will need to start closing hospital wards soon. They cannot be run safely with the current trajectory. It will be interesting to see how the public responds and whether that will trigger a bigger conversation.

This mess is bigger than one political party can sort out. It is in crisis and instead of Mr Hunt te al making a further mess, a cross party think tank should be in force. The back and forth sniping between parties in this matter is counterproductive to ever sorting it out.

Agree, Suki - there's another good article on the BBC website (which I can't seem to link to) asking if it's time to review the way the NHS is funded.

The government needs to clamp down on drugs companies massively overcharging for medications supplied for NHS prescriptions. One example is Liothyronine (a common thyroid medication) but there are many others. www.bbc.co.uk/news/business-42063274