What are *you* going to do about the poor standard of nursing care in hospitals?

[tirednurse]

I've changed my nickname to hide my identity I post on other areas. I am a nurse with nearly 30 years experience. Everybody needs to be aware that the standard of nursing that your family will receive if they are admitted to hospital is is at best sub standard and at worst life threatening. If something is not done soon then the situation will only get worse. Nurses have never been angels but now they are in many cases actually putting patient lives at risk. YOU the general public need to speak out because it could be your mother/father/son in hospital receiving this so called care,

I know what you mean OP. The ONLY way a person in hospital gets cared for is if there is a family member/friend there all the time to do the caring and also be their advocate. Hospitals should be more honest and sort out the set up so it is the same as it is in India and other developing countries where it is overtly expected that family does the caring. It is so dishonest in this country as some people still expect care during hospital stays. Nobody who has had friends or family in during the last 10-15 years though I think.

'honestly, would you rather that "basic care" took precedence over medications and surgery?'

There's little point in the latter without the former.

'One cousin is now in very bad shape with stomach cancer after being told for 3 whole years by his GP that his health concerns were 'all in the mind'.'

This is more common than you could imagine. My gran died of a heart attack on her bathroom floor. She had been in agony for such a long time. Turns out she did have stomach cancer, despite being sent to a psych for the imaginary pain. She didn't need to suffer like this at all.

I've talked about this a lot to a lot of people and have been VERY surprised to find out how many other people this has happened to. Absolutely awful :(

I speak as one myself and I think that most HCAs are perfectly able to wash and dress a patient and do obs and other basic care.

I have been doing the job for 17 years now, so obviously know nothing!

Maybe instead of criticising, you could offer them your superior wisdom and train them to do it properly.

27 years actually, typo.

Well on my ward they have just redeployed 4 Qualified Nurses and replaced them with 4 HCA's.

Now we have an issue with covering sickness, annual leave and maternity with bank or agency Qualified staff.

We often run with 2 Q staff for 30 elderly, high dependant, confused and wandering patients. All with complex medical/nursing needs.
This is with 6 HCA's in the morning, 3 in the evening and 2 at night.

The pressure on all staff is unbelievable. Morale is at an all time low and everything now seems to be task focused. Got to get this done, that done and no, I don't have time to sit and chat with patients.

Even while giving personal care to a patient, we have to get it done asap because one or two patients are trying to climb over the bed rails, or the buzzers are going etc..

The answer is not cutting the amount of HCA's and replace with Q's. Extra pairs of hands are never a bad thing.

The answer is employing more Qualified Nurses. Increasing the amount of staff on the wards is the answer IMO.

Sadly it will never happen.

We are being told to try and adapt to the situation and get on with it. By people who have never worked on our ward!

I havn't read the whole thread as I've been in hospital.
I can come in to help. I was thinking about the old ladies in the beds near me that couldn't manage eat.
Would a ward like volunteers? I'd be very happy to help.
I'm so annoyed that I can't find out 'how'.
Loads of leaflets all over for others eg. AgeUK but non for the hospital.

from what i saw, the key thing lacking was management,

some staff did less than the bare minimum, leaving others to do twice as much consequentially.

if management enforced personal accountability - handovers (so if a staff member hadn't got sth done, they could be challenged on it, but also simply to ensure continuity of care), proper written communication (again, through good management making sure it happened)

management seem to rely too much on process without the necessary oversight to ensure the processes were followed.

and the culture of fear of litigation and negative press seemed to stymie proper investigations of wrongdoing - higher-ups didn't want to uncover staff wrongdoing because the hospital as a whole would be liable.

Great post, Badnurse. You really made me see how it must be for you all. What a shame.

From what you've said, all you need is more qualified nurses. Why isn't the government giving the hospitals enough money to employ as many as they need? And why can't HCAs be given more training - if necessary, on the job?

I think the government is deliberately running down the NHS in order to justify their decision to privatise it all. It costs so much they just want rid. And private companies certainly aren't going to sacrifice their profits by paying for qualified professionals.

About hospitals in Spain, the patients' relatives bring in their food, too.

My own family seems to have been so lucky. We've always received absolutely excellent care from NHS hospitals all over England and Scotland, for the last 50 years, the latest in March. That's cancer, a road accident, falling off a cliff, broken arm, brain surgery, meningitis, all sorts of gynae things, several babies ... When kids have been in hospital, parents have been allowed - encouraged - to stay.

My American friends think the NHS is amazing, and we are so lucky - and so mad to think of getting rid of it.

HCA's are supposed to go on training days. These study days are often cancelled because of a lack of staff on the ward's.

When I started 11 years ago, we were not allowed to start the job without completing the relevant study days.

Now we have new members of staff, who have been doing the job for about 8 months, who have yet to do a manual handling course.

Our area has a team of volunteers who go not hospitals in order to feed those who cannot feed themselves. Can't think of their name off the top of my head but know they exist.

I left nursing simply because I could no longer stand by and watch the erosion of basic care. When I started I had time on the wards to do nice things like foot baths and foot massages (important to keep an eye in feet...especially in those with diabetes), mow that simply would not happen as there is far less time.

The rot set in during the late 80s and early 90s (Conservative Govt) and continued into the late 90s and early 00s (Labour Govt). Conclusion is none of them gave a toss......

How we treat our sick is appalling...we have great medical care out there but it's worthless if we don't spend time ensuring basic needs are met. Patients on the whole welcome their medical care but its no good if they are not helped to be clean, nourished and to feel valued....and they would generally like that with a smile too. Not too much to ask in my opinion.

I'm glad I've read this thread - it's a subject I was thinking about just last night. I'm a second year nursing student on placement & last night I spent an hour just holding the hand of a patient who was dying and talking to her while we waited for her family to arrive.
I spent half an hour reassuring a patient who has just found out her cancer has spread and is now having to think about palliative care. Yet more time with someone who needs to be given psychiatric care, but there's no space anywhere else for her so she's on a medical ward. In particular, she is being let down - not receiving the specialist care she needs, yet taking up so much of our time that other patients aren't getting the care they deserve either.
Yet, once I'm qualified I won't have this time. It's so disheartening - everyone I've worked with has cared. They never get out on time, never take enough breaks (none at all on night shifts, there's not enough staff), buy toiletries from their wages (or bursary, in my case) and still there isn't enough time.
I'm really questioning if I should continue.

Yes hurriccanewyn you must continue to fight and correct the apathy in nursing. If people like you give up the NHS is doomed here speaks an old Registerd Sick Cildrens Nurse/SRN/SCM. Please don't give up.

What can we do about it. We can lobby the government to introduce a legal qualified staff to patient ratio in hospitals.

Says a nurse with over 32 years experience.

But it won't happen because it will cost too much. So keep the present staffing levels and blame the lazy, uncaring nurses for bad care.

The lack of qualified nurses on shift and the over use of HCA's who are untrained and poorly paid is a large part of what is wrong with the care in hospitals at the moment.
The ratio of qualified staff to patients is appallingly low in comparison with other countries, who have legal nurse patient ratio's of 1 to 5 whereas we have 1 to 12 or 15 on nights.
As a nurse I was taught how to assess and check my patients during basic care. This was an opportunity for me to assess nutrition, skin integrity, circulation etc, to have a little chat and see how my patients where feeling and to allay anxieties. HCA's are not trained for this and just go in and wash the patient.
Because the qualified nurse no longer does this, due to lack of time and management pressure, she misses a vitally important part of her patients care and its like nursing blindfolded. But to those outside nursing they don't value this basic care and think its 'just a wash' and any untrained person can do it.because its cheaper.
Currently poor care is dumped solely on nurses shoulders which suits managers, the government and the media as it makes a great story for them,and means their own management and cutting of staff is overlooked. what we need is people fighting for the right to qualified nurses having legal patient ratios and there are e petitions going, but its proving very hard to get the signatures needed as the media isn't interested in taking up this cause. and I think people honestly don't understand why care is so poor in hospitals at the moment. To them anyone in a uniform is a nurse, when often they are untrained HCA's.
If you or your relatives are getting poor care, ask first what the qualified staff ratio is and then take the managers to task over why its so low. They need to be held accoutnable for the decisions they make, instead of the nurse who is doing 13 hour shifts and 2 hours unpaid overtime, just trying to cope with the huge workload.

Its also false economy to have such low levels of qualified nurses, many studies have proved that survival rates increase dramatically when the ratios are adequate and that for every patient a nurse has above 5 patients the death rate within 30 days of admission increases by approximately 7% for every patient she has.
These studies have been around for years yet no one acts on them and until litigation costs outweigh the cost of employing more nurses, nothing will be done.

Meddie, I think we are singing from the same song sheet. Agree with every word you have written.

Even worse-there are many newly qualified nurses who cant get sodding jobs!

I've been an in-patient in 3 separate hospitals within the same city over the past 3 years. On each occasion I have not had friends or family with me to help/visit.

1. Major NHS hospital. Gall bladder removal. Operation that had been postponed from the previous week when I had been fully prepared for theatre but op had then been cancelled as they had run out of operating instruments. I was left in severe pain. Nurse removed cannula incorrectly so my blood spurted on the sheets. I was left to sleep in these bloodied sheets. Actually, I couldn't sleep for the pain and the fact that there were only 2 nurses on night duty for a ward of about 20 people and one nurse spent the whole night trying to deal with a dementia patient who insisted on walking around, screaming and disturbing the rest of the ward. No follow-up appointment. Discharged to GP care.

2. Private hospital. GA for orthapaedic operation. Own room, TV, newspapers, psyiotherapy consultation immediately prior to operation, meal ready for me when I came round. No pain. Left hospital with a set of follow-up appointments.

3. Major NHS hospital. Biopsy. Superb treatment with care and compassion from real nursing professionals who took time to listen, put me at ease, took obs every 30 minutes and shared their own tea and biscuits with me after my procedure. They were wonderful. I felt they took extra care with me because I was alone.

Now facing an imminent and major 4th operation in yet another hospital within the same city and am terrified.

Good post bad nurse. Interesting to read about a 'normal' day for a nurse. Evens out the argument.

I just want to add my support to what badnurse said.

I really couldn't agree more with her description of a day on an average ward. She has summed it up brilliantly.

I should add, I am not a nurse, but I am HCP, but I see exactly, precisely what today's nurses are up against. I think the point of abandoning 'the drugs trolley' in favour of 'basic care' was very well made. There simply isn't time to do both well, and the simple fact remains, whilst a patient left lying in their own dirt for far longer than is 'acceptable' is bad, that has considerably fewer 'long term consequences' than giving the wrong drug, the wrong dose or even none at all to that patient.

We simply cannot afford the Florence Nightingale 'image' of nursing we all treasure in our folk memory; far more people are living into an until very recently unimaginable old age; many live alone; the NHS cannot legally (and wouldn't morally) practice 'age discrimination' (which, as an aside, leads to the situation I witness on a daily basis where very elderly, bed bound, utterly confused and frightened (if they're conscious at all) Alzheimer-suffering people are as kindly and carefully as possible, manhandled into the xray department, onto the CT scanners, into the MRI scanners having scans (some of which involve injections that really can compromise failing kidneys yet further) all to rule out that possible cancer that just might be a causative factor of that elderley patient's condition. No one's going to 'treat' it in such a frail and elderly person (often with co-morbidities, ie other more immediately 'threatening' illnesses that really will kill them); they're not fit for anaesthetic thus won't be operated on- all it does is add a sentence to the post-mortem report... why? because if we don't, we stand a risk of being sued for age-discrimination for choosing not to put that person through that pointless, maybe humiliating, often frightening ordeal.)

DH was in an ENT ward in a large DGH for 2 nights and 3 days last week on IV antibiotics. He was in a 6 bedder. Of the other 5, one was a young thug recovering from a pub beating; one was a middle aged self-caring man with a sinus infection, the other 3 were very old and bed bound, requiring all their needs to be met for them. One of them was bed-blocking (awaiting a social services report). Now, this was an ENT ward, not a geriatric or medical ward, yet 50% of the patients were in need of a far higher input of care than the one nurse there could possibly provide. So even ENT is now moving towards a branch of 'elderly care'- but the staffing model just hasn't kept up because it can't afford to.

If we want to carry on with our current 'model', we either need to accept we have to pay far more into our National Insurance, or we have to ration 'free' health care, or we have to pay for it through private schemes. Or we need to put limits on compensation payouts, accepting that honest mistakes happen, and that to scan 50,000 people so as to ensure we don't miss that condition in one isn't cost effective. I think you would be stunned by a) how many 'just in case/cover my arse' examinations and tests are done within the NHS these days, and how much money is spent either defending actions or just paying them out prior to court as Trusts can't afford the possibility of losing.

What we don't need to do is bash those poor people struggling at the coalface of our stressed, creaking system as it currently stands. Or limps.

About to start work as a HCA, I am keen, caring, well educated, have common sense and am told I am going to be trained very well to carry out basic care need, this is the role of a HCA, I am a little upset to read how badly thought of they are, if nurses dont go into it for the money then surely that can be said even more so for the HCA's. I am going into this job becasue I want to care for people and free up nurszes to do their role.

I was a HCA working in acute wards until very recently.

I am educated in health care, as were many of my colleagues.

I have been asked a few times recently if I miss my old job. I miss the times I got it right, when you knew you had made a patient more comfortable, when patients thanked you, when you felt like you had made a difference, however small.

I don't miss the sense of dread I got during handover. When every single patient, out of 30, needed all cares and I knew that it was just me and the other HCA who had to do it all because the patients were so unwell the qualified would be busy all night with meds, obs etc. I don't miss finally getting to someone at midnight who had been waiting since 7pm because I had not had a minute until then to help them. I don't miss coming on to a ward at 8pm and having to pick up and clean every single cup that was out on the ward before I can even offer people a cup of tea because the catering staff finish at 5pm and the day staff had have no time to do it. I don't miss announcing 2 hour waits at the outpatient clinic because the doctors didn't turn up on time for clinic. I don't miss running out of clean sheets, towels, soap, gloves, pillow cases and having to beg other wards for spares. And all the while I am doing this I know that patients are waiting for me. I don't miss the times that three buzzers were going off and the staff nurses were busy and I had to decide which person to take to toilet first, and then dealing with the aftermath. I don't miss mopping up dirty bathrooms at 3am because the cleaner forgot to do them, and as I do it I know people are waiting for my care. I don't miss being sworn at, spat on, assaulted at work. I don't miss checking patients and realising that the person before me didn't change their dirty (dried on) sheets. I don't miss arguing with colleagues about how someone really doesn't need to get up at 7am, we can make them toast when they wake up! I don't miss not sitting down all shift and going home feeling guilty because I didn't have time to do everything that needed doing.

This is controversial, but nursing seems to be one of the few professions that seems to think that people cannot both care and be well educated. Nobody judges teachers, occupational therapists, physiotherapists for being too educated to care or make a difference, but they all have degrees.

The answer is more staff, more qualified, more unqualifieds.

Indeed, lazeybones