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?

Want to be
Degree trained nurses spend 50% of their time working on wards. The rest is on biology lessons, the role of the nurse and how to assess plan implement and evaluate care. They dont sit reading all day for 3 yrs then let loose on a ward.
The nurses cow face was probably because whilst you were going on about his feet (quite rightly) she was overdue doing the meds round, hadnt had a break all day, had to complete an admission. One care assistant to the whole ward who cant do further than give wash bowls and take to the toilet. There would have been the expectation to drop all care and give meals and feed who needs feeding whilst answering telephones and taking someone for a poo who cant wait. All the time ots and physios and specialist nurses waltzing in and demanding updates on each patient referred to them. Ditto for consultants on ward round. Then doing repeat obs and bleeping doctors if at risk. And updating the bed manager. Whilst asking the sister if the off duty has been done because you have noone to watch the kids on a certain day. Then being given shifts with three days notice.
Within all that, as shit as it is, your dads feet being creamed were at the bottom of the list. I am sorry for that but the above is the reality of nhs nurses. It is not at all like America. I have known nurses cry on duty the way they are spoken to by patients and staff. And the worst part of the whole shitty lot, is that in working in the above conditions, if something is done wrong or not done-such as a pressure sore assessment, then management swoop in and scapegoat to protect the reputation of the hospital.
It is a thankless job and no wonder people are leaving the profession. Being degree or non degree trained makes no difference on the dangerous conditions and understaffing. They all go in it to care. Yet care is the one thing they cant do.

Lougie
Student nurses complaining they have to act as care assistants isnt that they believe it is below them. It is because whilst they are happy to help their role is supposed to be supernumery which means they have the opportunity to learn nursing tasks not just care tasks such as toileting feeding cleaning. These myst also be learned but they need to develop skills. Obs is one. Injections. Drips. Recording details. Doing a blood sugar measurement. Meds rounds ward rounds doing discharges and admissions. The role of speech and language and physios and when to record them. To learn the policies the sepsis pathway crash protocol. Dealing with families sensitively giving palliative care and last offices.
So if they are being care assistants all day how can they possibly learn the above???

Student nurses, have always been supernumerary, in principal. They’re not. Never have been, and imagine they ever will be.

bums I wasn't expecting the nurse to do it themselves but to make sure someone, a HCA or a volunteer, do it. Instead he ended up with a nasty infection caught by myself the next time I flew over. His legs from the knee down were bright red and hot to touch. I ended up hiring a lady to come in and do his feet myself. None of us live in the same continent as my father. He really is alone.

I know nurses spend a lot of time working during their degree. That is why I think the qualification needs to be looked at. We need nurses so why charge tuition fees and surely they should be paid at a reduced rate (i would think the same rate as a HCA) while working during their education.

Want of course you wanted care that is a basic right. But often there are way too few hands its totally shit.
Nurses once did work for a wage in an apprenticeship type trainibg in the 'good old days'. However they were not with rights or viewed as a serious profession which meant that the protections and benefits for nurses were few. Then other professions came in and overtook and nursing training was a diploma. This brought it into a new age where standards were determined by a government body-the UKCC. A code of conduct noy only demanded high standards of nursing but also protected the public. Pin numbers wrre and are awarded on completion of a course both dip and degree. The ukcc is now the nursing and midwifery council and these have on a database the details of every nurse and midwife in the uk. You can see who is fit to practise and who have been suspended etc. This means bad nurses cannot be employed. Totsl transparency has cone since Beverley Allitt the childrens nurse who killed mamy poor babies. Nurses are recorded down to when they work and where. Students as well.
The degree thing came into focus because every other hospital professtion had degrees. Even midwives as they felt a higher level of education was required to train soneone who is responsible for mothers and babies. Nursing followed this. If they didnt they were seen as having lower standards. If they did tgey were too pish to wash. The public view of nurses is as dogsbodies who clean up sick and mop brows. The thing is medicine has changed. As a nurse you need to k ow what a drug is why it is prescribed. What the interactions are with other drugs. If a doctor prescribes a wrong dose and the nurse gives it whos neck is on the line? The nurse. Yet they arent meant to be educated to the same level as an ot whose job doesmt involve life and death decisions?
Gone are the day of hospital corners. The nhs has changed. Nurses dont do what doctors say the are avcountable for everything. Not like on holby where nurses go off and get drips on a doctors say so. No. It needs prescribing. Serial numbers checking. Drip flow rate calculating. All of those are the nurses things to check.
Current evidence suggests mortality rates are reduced with higher educated nurses. It wont go back to where it was because it cant.
Up untill this yr the nhs paid students tuition fees and a bursary
Now students pay their own fees and take loans out to do things such as wash people and put on foot cream. These are basic and fundamental levels of care but nursing is so unsupported in comparison to every other profession except teaching, that care standards are and will be utterly shit. Its tragic.

Im genuinely sorry for your experiences xx

bums I wasn't expecting the nurse to do it themselves but to make sure someone, a HCA or a volunteer, do it

There isnt anyone to delegate to!
The HCAs are over stretched with THEIR role. Theres not enough of them to get meals out while they're hot. There's not enough of them to not leave someone lying in their own faeces while they change 4 other people who are lying on their own faeces.

They are over stretched in their OWN role yet they are expected to take on extra nursing roles on top like taking bloods, changing cannulas, doing ecgs, taking blood sugars, doing obs etc.

Many days you know your HCA is feeling broken and propping themselves up with painkillers because they're changing people alone who should take at least 2 or 3 people to roll but they do it because they know that it may be some time before anyone is free to help them...for me to then say "oh and by the way, cream mr Xs feet please" I think they would either cry or shout ir quit quite justifiably. Or if they're feeling particularly calm and level headed about it they might ask "so do you want me to not clean mrs Y who was just incontinenent and leave mr C who cant swallow well to choke on his lunch and go and do the feet instead?" (which HCAs shouldnt do anyway because if they cream the WHOLE foot they can do more harm than good. You need to take care to make sure none gets between the toes! Amongst other things) So its on me. And I wont WANT to leave it but if I also have a deteriorating patient that STILL hasnt been seen by a regustrar, 3 others Im worried about, porters showing up to take patients to proceedures that they need checklists for, a med round and a mountain of IV antibiotics, two patients having blood transfusions, no writing done and I actually DO need to leave on time today because there is nobody to collect the kids for me today and nobody to hand over to either because the late shift STILL isnt covered.

I hope I dont make catbum faces.
I try very hard to give relates my full attention as they often tell us valuable information, and I do try to impress upon them that their relatives care is important to us.

I would usually get round to doing the feet too at some point before I left. Somehow. So long as nobody else deteriorates. And then go pick my kids up with vacant eyes unable to really pay attention to how their day was. Crash out at home and only half listen to their homework problems. Because adrenaline is only supposed to be used for short fight or flight not whole shifts where you're condensing 3 hours worth of jobs into every hour.

I suspect you would have felt a bit more reassured if it had been me you spoke to. Over the years I have developed my poker face, my swan act (calm on outside & paddling furiously underneath). But I also suspect that catsbum face and me would have thought the exact same thing: "how? Just how?"

Of course its important to you and your dad and you are absolutely right to chase it up and keep chasing it up until its done. But maybe you are miss-reading desperation for reluctance?

Not that there isnt the odd bad egg, but most people I work with LOVE when they get time to do the basics and really make people comfortable.

^^
This this to staying after a shift until someone takes over. Can take hours. Glad im not a nurse. Its soul destroying.

Its not even as if we have a HCA "each". There isnt one per bay and theyre not our personal assistants who can pick up anything we dont do ourselves. There might only be 1 or 2 on the whole ward some shifts and they have a whole host of tasks of their own like making sure all the meals get ordered. Getting said meals out. Cleaning/changing water jugs. This are all really important jobs, if my patienta dont get food and water they wont get better! Thats in between toileting and washing and changing and answering bells.

Theyre not just there at my heels awaiting my command! They're just as busy as us.

The dry feet ARE on me

1. There is nobody else "free"
2. Feet are "tricky" and are a nurses job, not really deligatable anyway. Theres a lot to assess: sensation, vascularisation, skin integrety. I need to see them myself really. It's just got to go on the "list".

I have only been in the NHS for 16 years , the difference between working on a ward then and now is huge , there never seems to be any let up , the stress and pressure is almost constant for the entire shift , a long day is 7.15 until 20.15 , that's assuming you get off on time , which you rarely do . Some people do prefer these long days as it means they only work 3 a week . Personally I'm not so sure about them , I think that people are not at their best after working in that sort of environment for 13 hours , often with only one or two short breaks if you are lucky . People didn't seem as stressed when we worked the normal 8 hour shifts , although they did work a lot more days . I think there was better continuity for the patients and relatives tbh .

I think a lot also depends on the type of person in charge of the ward , there are those who listen to their staff complaining about the endless stress of it all and come out with some shit about time management and there are those who recognise the immense pressure their staff are under and fight their corner . I remember being sent to another ward and the ward manager doing the lunchtime drug round for the entire ward , so that her staff could get a break and so she could meet all the patients who were on the ward .

I would hand in my notice tomorrow if we went back to short shifts. It made stress so much worse when you never got a proper break from the place. Your 2 days off were NEVER together, doing late-day off-early doesnt recharge you much!

Late shifts finish later than long days do so its too late to eat and wind down etc

Earlies and lates are still about for those who like them, but I personally could not go back to working them. I felt like I never left the hospital!

I agree though with the "constant" aspect. They used to be busy times and lulls where you could catch up or do a bit of learning/teaching etc but now there is no quieter time of day.

And as for nights! Well! To think we used to bring books and magazines in with us when we used to do nights! Now nights are often BUSIER than days (except with less staff)

Bums HCA's at my local hospital can do a bit more than you described.

I did feeding (it was rare nurses did that as they were too busy), HCAs did all the obs and the blood sugars. We also did the skin checks and turns. Quite a bit of paperwork. Many also did bloods.

Many days you know your HCA is feeling broken and propping themselves up with painkillers because they're changing people alone who should take at least 2 or 3 people to roll but they do it because they know that it may be some time before anyone is free to help them..

Yep, I loved the job but could no longer put up with the shit conditions. I remember 3 patients needing to go to the toilet all at the same time, all 3 needed hoisting and not one person was free to help me. Two of them messed themselves. It was awful for them.

The turning people on my own and hurting my back was a regular occurrence. Some wards seemed to have a good amount of HCAs, others didn't have near enough. It was back breaking work and we didn't have time to do all of our own jobs, that's for sure.

I couldn't go back to it. I wanted to be a nurse for a long time, it was a big dream of mine. Working as an HCA and watching how over-worked they are and the patients not getting what they need in good time due to staffing issues knocked the dream out of me.

Gingerbread after posting that bit about long days , I remembered that when I was doing early and lates , I was also part time ! I can see that from a work /life balance long days suit most people . I do think that 13 hours of stress means you can only function optimally for some of that time though . Better staffing levels would be the answer , but would not solve the bed crisis , more social care step down beds would , unfortunately both require a long sighted approach and more money .

Something else I have been wondering about lately , in my local area there are large private residential care developments that have been built and are being built . Would it be possible as part of the planning stipulations to ensure that a small percentage of these beds are ringfenced for emergency social care provision , so could be used as step down beds or respite beds for instance ?

Do these developments pay commuted sums ? Could that money then be spent on social care provision, given they have increased the patient numbers to primary care providers in that area ?

Or do those commuted sums disappear and the NHS/social care never get a whiff of the money ? Since the change in the law re commuted sums , developments of 5 or less properties no longer have to pay these I believe or have to provide any affordable housing , a bit of a bone of contention in my local area

For large scale developments , for instance 3,000 properties , would it not make some sort of sense to get the developer to build a small scale unit with say 10 or less beds , economies of scale and all that , you could probably staff it with people from the development for the large part , but that probably sounds a bit too joined up thinking for this country !

Some nice supportive messages here, thanks all.
It drives me nuts when Theresa May says she's put more £ into the NHS. She hasn't compared to the increase in demand.

My area of the NHS will be £230K per year worse off by 2021 but patient demand as people live to an older age increases.

It will be privatised within 10 yrs, sadly, for all the fat cats.... And the poorest will suffer as usual

I have so much respect for all NHS nurses and HCAs working in such awful conditions. What successive governments have done the NHS is just criminal. The bottom line is there are less beds and less frontline staff and what we are seeing is the results of years of cuts and ‘cost saving’.