To be or not to be. Is nursing more or less professional in 2012?

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I haven’t posted for a while because I have been determined to make this post tackle the subject of professionalism, which in my naivety I thought would be pretty easy and straightforward.

How wrong can you be!

When I was young and green I thought I was joining the nursing profession when I applied to train as a State Registered Nurse. So it came as a bit of a surprise to discover that there were some people within the er … trade, job, vocation … that believed that we weren’t a profession and as such weren’t taken seriously or respected sufficiently for our opinions. The answer to this apparently was to give all nurses a university degree thus putting us on a par with Doctors. I’m sure there were a number of nurses who were rather more interested in the increase in their personal status than the good of the profession.

Question : What defines a profession?

 The answer is that there is no specific definition (believe me I’ve researched until I’m blue in the face) There’s quite a lot of discussion out there and the most useful I found came from:

Larson – The Rise of Professionalism: a Sociological Analysis. Berkeley, California, University of California Press who states that there is considerable agreement about defining the characteristic features of a profession.

• professional association,
• cognitive base,
• institutionalized training,
• licensing,
• work autonomy,
• colleague control
• code of ethics
• high standards of professional and intellectual excellence
• self-regulation

So which of the above did the nursing profession already have before the universities took over the role of training nurses?

Professional Association

1887 – The first professional organisation for nurses in the world, The British Nurses’ Association was founded in 1887, to campaign for state registration. The lady-pupils, who saw a threat to their professional standing, sought to press for a set probationary period and rigorous training.

The BNA created their own register of trained nurses

1916 College of Nursing Ltd founded with 34 members and Mary S Rundle as Secretary. Standing Committees set up. Scottish Board established in Edinburgh.1917 Irish Board established in Dublin.

1919 the Nurses’ Act is passed establishing a state register for nurses for the first time.

Both the BNA and the College lay claim to being the successful campaigners for registration.

Institutionalized Training and Cognitive Base

1860 – The Nightingale Fund, set up as a result of the Crimean War, enabled the Nightingale Training School to be opened. By the end of the 19th century most of the larger, voluntary hospitals had their own nurse training schools, and you don’t get much more institutionalized than that. Please note there is no mention that the training must be done in a university and that the only acceptable qualification is that of a degree. The majority of medical schools were attached to hospitals rather than universities until the mid 1900’s!

Licensing and Self- Regulation

1919 – The Nurses Registration Act established The General Nursing Council (GNC) in conjunction with the GNCs of Scotland and Ireland. It was to compile and maintain a Register of qualified nurses, and to act as the disciplinary authority of the profession.

The GNC subsequently acquired responsibilities for advising, inspecting, or approving training courses, schools and syllabuses for State Registered Nurses (SRN) in England and Wales. The responsibilities of the GNC were extended by the Nurses Act 1943 to include a Roll for Assistant Nurses, renamed State Enrolled Nurses (SEN) by the Nurses (Amendment) Act 1961. SENs are admitted to training as pupil nurses and enrolled by assessment not examination.

Code of Ethics and High Standards of Professional and Intellectual Excellence

I am still researching when the first written code of ethics appeared in Britain and will amend this post accordingly. I don’t recall ever seeing a written code during my training but I did have to sign something called “Standing Orders” before taking up any post after qualifying which did contain many clauses that echo many in the 2008 NMC Code of ethics.

Colleague Control

Without having read Larsons book I’m not quite sure what this means. It is presumably different from self regulation. If it means regulation within a working environment i.e. appointment and disciplining by members of one’s own profession rather than administrators or lay managers then I think we can be assured that was most definitely happening prior to the 1980’s

So was nursing a profession before degrees were “de rigueur”?  I think by these criteria it certainly was.

The Australian Council of Professions made this attempt at defining a profession as:

‘A disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others.

Inherent in this definition is the concept that the responsibility for the welfare, health and safety of the community shall take precedence over other considerations.’

(Dr John Southwick, ‘Australian Council of Professions’ view’, during proceedings of a joint conference on competition law and the professions, Perth, April 1997)

Dr Southwick makes a very valid point here and that is, that society in general has a role to play in deciding what they will recognise as a profession and they will also make judgements as to what is professional behaviour. If a member of the public feels that an individual professional is not dressed appropriately for their profession, or breaches the ethical code or does not exhibit the necessary skills then trust can be severely damaged.

Despite so many nurses now holding degrees and therefore, in the eyes of some, more professional than ever before, the nursing profession is losing the trust of the public because in their eyes nurses no longer have the practical skills, the caring attitude, the smart appearance or the self discipline to be professionals.

Even as I write this I am aware that so many of the personnel that the public think are nurses on the wards are actually Health Care Assistants and are not professionals. Therefore none of the above applies to them but they are in large part the ones bringing the profession into disrepute and we professionals are doing very little about it. It is in the profession’s interest to bring HCA’s under the control of the NMC and to insist they have a formal training.

Patient, You are being processed not cared for.

Hands up anybody who knows what the Nursing Process is.

When did nursing practice begin to change? My feeling is that this began with something called “the nursing process” which was imported from the United States around 1974.

It should always be remembered that health care provision in the US has always been very different to the UK even before the inception of the NHS. The majority of US hospitals are private enterprises and like it or like it not that means being in it for profit. So it was in the financial interests of such hospitals to pass their training responsibilities to the universities. Therefore there have been departments of nursing studies offering degree courses in the US much longer than in Britain.

In the US, even today the professional relationship between medical and nursing staff is quite different to the UK. American nurses are much more the doctor’s hand-maiden than they ever have been in Britain. For instance American patients would be very upset if a nurse removed their stitches or clips, that is what they are paying their very expensive doctor to do! British nurses are far more autonomous and always have been.

So in a way American nurses had to justify their existence as something quite different from a doctor. Thus it was that Ida Jean Orlando developed a nursing theory called the nursing process which was introduced into British hospitals around 1974. I was working in Intensive Care at the time and it almost passed me by which only goes to show how badly it was explained to the qualified nurses who were expected to put it into practice. Suddenly tried and tested routines were labeled as “bad practice”, looking after a ward full of patients and treating them all the same was wrong, we were too task orientated apparently. Patients should be treated as individuals at all times.

I for one resented the fact that whoever it was in their wisdom was saying these things assumed that we couldn’t do both. I always treated my patients as individuals because they were. For all that they might be on a specialist ward they didn’t have identical medical conditions, identical backgrounds, ages etc etc. But in the same way as giving everyone on the ward their dinner at the same time was quicker and more efficient it was quicker and more efficient to do all the four hourly blood pressure and temperature measurements at the same time. That did not mean that if someone had missed lunch we didn’t save some for them or offer an alternative later. Nor did it mean that if someone was found to have a BP that caused concern we didn’t check it a few minutes later.

What’s more it meant that all patients were seen and spoken too more often than they are today. A bedpan round immediately after every meal prevented the unacceptable situation of patients begging to be taken to the toilet or for a bedpan, that seems to be a common complaint in today’s wards.

Whether we approved of it or not the nursing profession had the nursing process foisted upon it and nurses were expected to implement it without any proper training in its use. Amongst qualified nurses this caused a certain lack of confidence and as I say, some resentment. It was without a doubt the beginning of the avalanche of paperwork that currently threatens to overwhelm nurses and takes them from the bedside.

Question: What is the nursing process and is it still in use today?

 Good question and almost impossible to answer, so wrapped up in jargon has it become. I took this from the RCN website and will comment as we go

The Nursing Process

The nursing process is described as being cyclical, made up of four interconnecting elements and having a dynamic nature (Pearson et al, 1996). It has long been a feature of nursing care in the UK and when used in conjunction with a nursing model it facilitates consistent, evidenced-based nursing care, and necessitates accurate, up-to-date care documentation. The nursing process consists of four distinct phases, each having a discreet role in the process, whilst also being interdependent upon each other. The phases of the process are:

So it is still in use today.

The above statement seems to encapsulate what my entire training was about

Assess

In this phase the nurse makes an assessment of the patient/client as soon as possible following admission to hospital or first encounter in the community. Biographical details e.g. name, date of birth, age, address are noted and observations of blood pressure, pulse and respiration are taken. Relevant medical, personal and social details are noted. Although considered to be the starting point of the nursing process, the assessment phase is ongoing throughout the patient/clients period of care.

Yes, we old SRNs did that as well

Plan

This phase of the nursing process extends from the assessment and in conjunction with the patient/client wherever possible, family members/carers/significant others, determines how the individuals needs, wants and desires in relation to health are to be met.

This appears to be all about the patient and not his medical condition. The patient may want to be cured and that may not be possible. The patient may want to stay in bed, when in order to prevent immobility, DVT or pneumonia he needs to get up and get walking or vice versa his medical condition may dictate bedrest when all he wants to do is go home. What if another nurse comes along and disagrees with the assessment and plan of the first, where does the responsibility lie?

Implement

This part of the nursing process details explicitly the care given to and received by the patient. It is an accurate, up-to-date account and is signed by each nurse engaged in delivering the care as detailed in the care plan.

Funnily enough we always did this too, at least twice in 24 hours

Evaluate

Evaluation takes place at designated points during the patient/clients period of receiving health care. This is determined by the nursing assessment which identifies the specific needs of each individual and the subsequent plan for delivering the required nursing care. Evaluation is ongoing and leads directly back to the assessment phase of the nursing process, culminating in further planning of care or discontinuation of the need, want or desire for intervention.

Hmm. This is the part that worries me “evaluation at designated points” which is quite specific and “evaluation is ongoing” which is vague. Who is doing the evaluating? A specific nurse, a nurse manager or team leader. Named nurses can change day by day. With whom does the Buck Stop. It used to be the ward sister.

So that’s clear then ……. Isn’t it?

I am a little puzzled as to what the doctor’s role is in all this, assuming the nurse hasn’t taken over his job as diagnostician and instigator of treatment regimes!

 

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Apathy Kills

DISCLAIMER: WORDPRESS HAVE PLACED ADVERTS RANDOMLY ON MY POSTS WITHOUT MY KNOWLEDGE AND WITH NO PRIOR WARNING. I WOULD HAVE TO PAY TO HAVE THEM REMOVED (SO MUCH FOR A FREE SERVICE) I DO NOT ENDORSE ANY OF THE PRODUCTS OR SERVICES THUS ADVERTISED.

 

There are times when I feel I’ve said all that needs to be said about poor nursing, failing academic nurse education, untrained HCA’s and their lack of regulation. I’ve now said it so often, to so many people and in so many places I wonder if I’m wasting my breath, my time and my printer ink.

And yet.

At a recent W.I. dinner the subject of hospital care came up again and before I knew it I was back on my hobby-horse … again. I was talking to several ladies who were unaware just what the changes were to nurse training and that HCAs are untrained and unregulated. They were horrified to learn just how many work in the NHS and the scope of the tasks they are expected to undertake.

I have recently learnt that in one GP practice locally the Receptionist has changed role to that of Health Care Assistant and is to be sent on a course so she can run the diabetic clinic. Run, mind you, not assist at.

How can this be acceptable?

I urge everybody who is receiving health care of any description to ask the “practitioner” what their qualifications are to be doing that particular job. Do not worry about their feelings, your life could be at stake!

I digress. When I informed my companions that I was running a campaign to try to change things and asked for their help I received two startling replies, the first being.

“I’m not a nurse”

The second,

“I’ve got nothing to complain about. The NHS has always treated me OK”

To which I replied you don’t need to be a nurse to campaign for better and more appropriate training for nurses because one day you or your family will need the services of a nurse. Of course I’m delighted that a huge proportion of the population still think the NHS is wonderful and that they’ve received good care. I hope they told the staff so.

But, and it’s a big BUT, that’s fine until the day you don’t, then it’s dreadful.

•  Do you want to be the one left sitting in your own faeces?
•  Do you want to be the one feeling as if you’re dying and ringing the bell that no one answers?
•  Do you want to be the one developing one of the many complications of diabetes that is not picked up early and corrected?

We campaigners have been writing to our MPs trying to get this message across and the responses have been interesting.

Personal experiences make a huge difference regardless of the political allegiance of the MP. If they, or their families have had a bad experience they are all ears and agreement. If not, they couldn’t care less, regardless of complaints from their constituents.

Cameron and Gordon Brown showed the same trait some time ago when their children were poorly and needed emergency care. Paediatrics not being a speciality that thrives in the private sector they had to take their youngsters to NHS A & E Departments where they discovered that there are no separate facilities or paediatricians standing by ready to go into immediate action. So faced with a crisis in their own lives they wanted change and they wanted it to suit their needs and they wanted it yesterday.

Clinicians may have been saying for years that the country needs better paediatric services all round with dedicated Children’s areas etc etc, but paediatrics was never flavour of the month with politicians so nothing changed. Until it is their children who are affected.

So nurse training matters to each and everyone of us today because we do not know the moment when we are going to be at the mercy of the NHS and its staff.

•  You can be healthy today and screening may reveal you have cancer tomorrow.
•  You may be fit as a flea now and involved in a road traffic accident tonight.
•  You may be young and active but you will get old and infirm and you will die.

Do you want to be treated with care and compassion by well trained staff who can be held responsible for their actions?

Or does it not matter to you if you are neglected, misdiagnosed, disrespected and ignored in your hour of need?

Please don’t wait, write letters to all the individuals and organizations already mentioned. Become members of your local NHS Foundation Trust and ask questions. Join your local LINK.

 DO NOT DIE OF APATHY

Professional Nurses need a Professional Uniform not Pyjamas

A frequent but general complaint from the public is on the subject of uniforms.

The public do not like the fact that they cannot tell one grade of staff from another, that they can’t tell doctors from nurses or nurses from physiotherapists. The do not like the fact that they can’t see at a glance who is in charge.

They object very strongly to seeing nurses in uniform outside the hospital environment.

The public expect a standard of dress code from health professionals. They do not like seeing jewellery and piercings. They do not like hair flopping all over the place especially in their faces and their meals. Heavy make up and perfume is deemed inappropriate. Jumpers worn beneath tunic tops with sleeves at wrist length looks scruffy.

Patients trying to get peace and quiet or even to sleep do not appreciate noisy shoes clumping about the place.

The American practice of wearing “scrubs” in all departments of the hospital and not just theatres doesn’t go down well with the public who think they look like pyjamas.

Consider this,some years ago when the traditional cap and apron uniform was still the order of the day there was the sound of increasing discontent in the Casualty waiting area. Casualty Sister emerged from her office in her navy dress and starched frilled cap and apron, all she did was stand, arms folded and survey the scene. She said not a word. The hubbub died down and she returned to her office. That uniform carried authority.

It seems that now, everybody working in A & E wears pyjamas, sorry, theatre scrubs, apart from the different colours there is nothing to distinguish one profession or grade from another.

Question: Could the absence of anybody apparently in authority explain why a small number of individuals believe they can behave like hooligans within the department, demanding attention, threatening staff and upsetting fellow patients?

In 1973 the National Nurses Uniform was created.     (see http://dyk2.homestead.com/national.html)

It was hideous in every respect. The cotton apron was abolished and replaced by a shift dress in a fabric so unsuitable for purpose it was a joke. Apparently it was some sort of synthetic material that could be washed at 100 degrees, the weave was so open anything that was spilled on it went straight through and that means of course blood, urine, vomit and diarrhoea. Without an apron to catch the first onslaught the wearer was condemned to wearing underwear contaminated with body fluids for the rest of the shift. Remember sick people don’t always know when they are going to throw up or haemorrhage! The design of the dress itself was dire. The skirt, with no kick pleat, was so narrow that it was impossible to widen the legs sufficiently when lifting patients. (We still did that then.) The sleeves were too tight to be able to comfortably raise ones arms to reach high shelves. They were also fastened with buttons so any nurse reasonably endowed tended to burst out of the front. We still had caps but these were now made of paper and not cotton lawn.

Students and staff nurses wore the same pale blue with white lines, like a tiled floor! The Sisters was navy with the same style white lines, these latter were rapidly abandoned as they made the patient’s eyes go funny.

Not all hospitals adopted this National Uniform wanting to maintain their unique image but the apron had gone for good and within a short space of time the cap followed. Many nurses felt that due to the nature of the work and the fact that trouser suits were acceptable work wear for office workers by the 1980s that trousers and tunics would be a better uniform. Gradually this became the norm.

There are pros and cons to this change. Let’s consider the cap. The cap was deemed to be a throw back to the days when nurses were regarded as part of the servant classes. This was not an image to be encouraged. Except …… that’s precisely what we are, public servants, it does not mean one has to be servile. Look further back to the nurses of the early twentieth century and their caps which much more than a little top-knot, they were a full head covering more akin to a Nun’s wimple. What purpose did they serve? To my mind it was two fold, it kept the nurses hair tidy and out of the patient’s face; hairs could not fall in a patient’s wound or dinner, secondly it protected the nurse from unwelcome guests in the form of head lice. Make no mistake even in the twenty first century those little beasties are still about.

On the other hand the more usual cap, I think it was called a Sister Dora cap, could be a bit of a nuisance when lifting patients or around a patient with lots of IV lines as they did get knocked off.

Now lets consider aprons, again regarded as a throw back to servant days but they had their uses. Our aprons were heavily starched, as a result unless they were absolutely soaked, for a few minutes they were fairly impermeable. So if a patient threw up over you, you had time to take it off but still carry on caring for them. We covered our aprons with clean cotton gowns to carry out procedures not skimpy plastic aprons. They were also excellent impromptu notepads as turning over the hem and scribbling on the bottom with biro was a common practice. The note always washed off!

I admit this created a good deal of laundry and therefore expense, but how much do the hundreds of thousands of plastic aprons cost the NHS each week. Not to mention the cost of their disposal.

Question? How are they disposed of, covered in germs as they must often be?

Most germs are killed off when boiled.

Whilst I’m on the subject of plastic aprons has anybody asked patients how they feel about being nursed by someone in a plastic apron. Speaking for myself it feels more as if the staff are protecting themselves from me than the other way round. It’s an uncomfortable feeling.

The plastic aprons themselves leave a lot to be desired as they are definitely a case of one size fits all. Wrong. They fit where they touch and for a lot of larger members of staff that’s not a lot. They are often badly put on and make the wearer look as if they’ve donned a carrier bag.

I have attempted to find information as to the effectiveness of plastic aprons and have found no research as yet but masses of policy documents from every Trust in the country about PPE (Personal Protection Equipment) ie plastic aprons, gloves, goggles and gowns. Leeds NHS needed 5 people to produce a 9 page document and Manchester NHS needed 2 to produce a 14 page document. Most documents have been produced by an unnumbered “team” from infection control. This is where your money goes folks!

Question: Why is this not standard throughout the country? One document produced by the Department of Health for all Trusts.

There seems to be little understanding of the mobility of healthcare professionals who may work for many Trusts during their working life as they move around for training, experience and promotion. A bit of standardisation would be very very useful.

Back to uniforms however; one of the original purposes of a uniform is to distinguish the wearer from those around him, both in terms of profession and rank. That is understood by all human beings. Witch doctors wore a uniform of sorts!

It has been a disingenuous move on the part of Hospital Trusts all over the country to put all of their clinical staff in practically identical uniforms, usually white, with occasional coloured borders or epaulettes to demonstrate their role. The effect this has had is to make a ward or department look well staffed when it isn’t.

Not being able to identify each profession and their grade has created confusion for patients, visitors and staff alike but if it suits management’s purposes that is apparently all that is required.

In some parts of the country coloured tunics have been re introduced to designate different grades which is to be welcomed but I think all nurses in England need to be vigilant as I think the move yet again to a National uniform could be on the cards. See the Welsh National Nurses Uniform. Hideous scrubs for all.

Train to Nurse – the old fashioned way!

If I were asked to reform nurse education and training in the UK this is how I would set about it.

I would institute a practical nursing course run by hospitals that everybody wishing to nurse had to undertake. Its syllabus would focus on practical skills with just enough background theory to give the practitioner a sense of why they are doing something a certain way. It could be a modular course that others involved in caring for patients could tap into. For instance a “Moving and Handling” module could be available for porters, ODAs and medical students.

A record of achievement would be kept to demonstrate the amount of practice an individual had had. Then perhaps “learners” would be fighting to do bedbaths and practice aseptic techniques.

On achieving the required standard the individual would be awarded the qualification of Practical Nurse. Practical nurses would replace the Health Care Assistant and their names would be placed on a register with the NMC, who could then regulate them.

This qualification would be a requirement, along with the necessary GCSEs to go on to further training as a State Registered General Nurse. This should be hospital based with candidates interviewed and assessed by a Senior Clinical Nurse. The hospital should “buy” the services of the University of their choice to provide the theoretical education. Not the other way around. This would make the Universities look to their laurels and ensure they train nurses to the hospital’s  standards. The curriculum must regulated very closely by the NMC to ensure a national standard.

Once a nurse has qualified and nursed for at least a year, specialist training eg Midwifery, Children’s Nursing, Intensive Care, District Nursing etc could be undertaken including a degree in Nursing Studies for those most suited to it. Having a degree should not be a prerequisite to nurse.

The majority of nursing is nowhere near as technical as many academics make out and most nurses simply want to look after poorly people to the best of their ability. Whilst it is not related to training it is high time a proper career structure for clinical nurses was developed to recognize and reward adequately those nurses who want to stay at the bedside or in clinics.

No nurse should be allowed to move into management until she has done at least five years clinical work and there should definitely be a Nurse Managers course to train nurses in that role before they can apply.

Those are my ideas. Probably not perfect and open to debate

Redressing the balance

Today I went along to meet my friend the author and SRN Joan Woodcock at our local library. She was there to talk about her latest book Matron on Call the follow up to Matron Knows best. She had a good audience who were receptive to her stories from the days of hospital based training for SRNs. She reminded us of the days when Matron reigned supreme and was in charge of everything nursing related. Matron  recruited all nurses from cadets to Ward Sisters. Matron monitored  standards of nursing care, which were high, and she did this by visiting wards day and night. Matron was in charge of the cleanliness of the hospital. Cleaning that was carried out by domestic staff employed by the hospital, controlled by the ward sister. There was no refusing to clean up bodily fluids by cleaners in those days. Our domestics were as much part of the ward team as the staff nurses.

Question: What actually does a “modern” Matron do?

At the end of Joan’s interesting talk she opened the floor to questions and rather  than questions her audience were eager to share their more recent experiences of poor care in the modern NHS. This apparently happens wherever Joan gives her talks. Joan encourages these people to complain in writing as so often a complaint to the staff involved is treated with contempt. More than once I heard people say they didn’t complain at the time because they feared retribution from the staff.

This is appalling. Hospitals should be a place of sanctuary for the sick. Once upon a time people feared hospitals because of disease or pain or that they might be about to die but they didn’t fear the actions of the staff.

How dreadful that patients fear if they complain the staff will with hold medication or won’t come when you call for a bedpan or worse if they are feeling really poorly.

There were one or two stories of good care and Joan encouraged those people to write in praise of good practice too. I would echo that. Patients often send Thank You cards and chocolates which is always lovely but sometimes it might be good to add a note as to why that ward or that particular member of staff were good.

As a teacher once said to me ” A pat on the head is worth two on the bum”

Constant condemnation is hard to live with and hard working clinical NHS staff are rarely thanked by their bosses for the work they do and the extra hours they put in. It is rarely acknowledged that clinicians work in stressful situations and are human beings themselves with lives outside work.

Morale on many wards in many hospitals is at an all time low. A patient may be admitted and discharged within a few days and they may not have had a pleasant experience but they are now home. The permanent staff however have to go in day after day, week upon week it’s no wonder that sometimes caring wears a bit thin.

So it is as important for those caring, hardworking nurses and midwives who really want to do their best despite being overworked that everybody joins the campaign to bring back pride in nursing and supports efforts to improve their lot with better education and staffing levels.

 

Getting the Message Out There

I’ve had to take some time out to write to a few more people and create some leaflets and business cards to attract folk to my campaign. A friend has pointed out that many of the like minded souls I’d like to join me may well not be as computer savvy as I imagine they would be. Sad but true.

The leaflet will now be modified to include my contact details and I will perhaps have to create a Newsletter which could be both email and snail mail.

I have an indefatigable contact, Diana Carvalho, in Gloucester who used to be a community Midwife and she is a power house campaigner for improvements in nurse training and nursing standards and must surely be a thorn in the side of many government officials and nursing mover and shakers at the NMC and the RCN.

I was moved to start my own campaign after I had read Joan Woodcock’s first book “Matron knows Best” which was so in tune with my own experiences as an SRN and experiences as a patient following my retirement. I was so disenchanted with the care I received from one major hospital that after much soul searching I did write a letter of complaint mainly because I didn’t want other patients, who maybe didn’t know better, to have to put up with the poor standard of care I received.

It certainly generated a response as I was invited to a meeting with the Senior Nurse in charge of Quality and  one of the doctors who supposedly oversees the Out-patient department. I was given every opportunity to make my opinion and feelings known and they made suitable apologetic statements and then they left.

Did I get any follow-up? No

Did I get a letter apologising and stating how they were going to improve things? No

I’m ashamed to say that I didn’t follow it up myself.

In the meantime there has been the scandal at Stafford Hospital and countless letters to the press etc. recounting stories of  poor nursing care and practices. I read Joan’s book purely for the desire to take a trip down memory lane and I was unprepared for the final rant in which Joan compares nursing in the 70′s to Today. It was then I thought, someone’s got to do something, we can’t let this go on.

I began researching and my disquiet mounted. Through an online magazine I had contact with a Professor of Nursing and a lecturer in Nursing at two separate Universities. The most shocking thing was that neither thought that falling standards had anything to do with the way nurses are trained by Universities! Neither were prepared to take one iota of responsibility. Worse yet they didn’t appear to care.

Personally I’m mortified that the profession of which I used to be so proud has sunk so low. I want to know why. I want to know what can be done to rectify the situation. I want action before it is too late.

Soon it won’t matter what the politicians do with their Heath and Social Care Bill the NHS will implode because patients do not trust the staff providing the care.

(P.S. The situation is as bad in the Medical Schools too. Medical students no longer do dissections, go on ward rounds, practice the simplest practical tasks eg putting up I.V. infusions before they qualify, they don’t have lectures from practicing clinicians and they do a great deal of their studying via the Internet. Heaven help us all)

Does Anybody Care?

Naively perhaps I thought once I started blogging about poor nursing care, lack of training and unregulated Health Care Assistants I would have lots of hits and many comments.  I know  I have been looking for like-minded souls using those tags and not come up with much. So I have been a bit disappointed that this has not been the case – I can’t have much of a debate on my own. So I have been spending the last few days creating a “business card” and a pamphlet advertising my Blog that I can hand out to those people who have shown an interest.

Welcome to my Blog anybody who has followed that route. The details from the pamphlet are on my previous posts apart from the part that suggests what to do next.

When I began my campaign I composed a letter outlining my nursing experience and used examples from my own in-patient treatment to illustrate where I felt nursing care was going so horribly wrong. I compared the apprenticeship training with University education and I made some suggestions as to how things could be improved. Above all I made it clear that I believe nursing in the UK is headed for disaster and something needs to be done and done quickly before it is too late.

I then sent this letter to the following individuals or organisations:

1) Mr Andrew Lansley, Secretary of State for Health, Department of Health. Currently too busy privatising the NHS to reply personally to letters which are responded to in the most patronising manner by an Alistair Davie from Customer Service Centre

Question: Why has a Government Department got a Customer Service Centre? We are not customers! We are Tax-paying, National Insurance paying voters and should not be patronised by our elected representatives even if they have risen to the giddy heights of Secretary of State. They are still public servants reliant on their jobs from our votes.

2) Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN.  Replied with a standard reply indicating that the RCN is wedded to the idea of a totally degree based training without explanation other than nursing is so much more technical in the modern era. He believes (or the RCN believes) that HCAs should be regulated but he doesn’t mention that they should undergo any formal training. I know that this is a standard reply as a friend received an identical letter.

3) Professor Dickon Weir-Hughes,(since resigned 12.12011) Chief Executive and Registrar of the Nursing and Midwifery Council, 23, Portland Place, London . No reply at all

4) The Patients Association, PO Box 935, Harrow, Middlesex, HA1 3YJ. This was the first positive response and I was phoned and asked if I would mind if my name was put forward if the Press wanted to interview somebody on the topic of nursing care etc. As a result of which I gave an eight minute interview on Five Live. I later went on to local radio in Lancashire.

5) My Constituency M.P. -Ben Wallace. If you don’t know who yours is try this website  www.writetothem.com, it makes it so easy. The reply I received from Mr Wallace was very positive and he has said he will raise the matter with the Health Ministers

6) Ms Gill Robertson, Student Advisor RCN (address as before), No response.

7) Mr David Cameron No response as yet.

There are still further people and organisations to contact for instance:

a) The Care Quality  Commission, CQC National Customer Service Centre ,Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA  – www.cqc.org.uk/

The CQC check all hospitals in England to ensure they are meeting government standards, and  share the findings with the public.

When you look up a hospital on the website, they show you

• the latest report on whether government standards are being met
• how to help them by sharing your experience

b) The Nursing Standard an RCN Publication are running the Care Campaign, see:

http://nursingstandard.rcnpublishing.co.uk/campaigns/care-campaign

c) www.patientopinion.org.uk   a website where you can tell the world the care you had in any particular hospital or from a GP practice; good or ill. You may  even get a reply!

For wider concerns about the NHS and the latest Health Reforms try:

d) www.keepournhspublic.com a website for all who fear the NHS is about to crumble.

Some Relevant Facts and Figures

Having embarked on this campaign I have been trawling the internet for relevant facts and figures and although they are out there, they are not always easy to track down. Despite there being a Department of Health which demands an insatiable supply of data from clinicians on a weekly basis there is no coherent dissemination of the same to the public. Then of course since devolution, Scotland and Wales have to be treated separately. Northern Ireland apparently has no hospital beds! The Nursing and Midwifery Council remain the regulatory body for registering all nurses and midwives throughout the UK. Many of the statistics I have found are somewhat out of date which seems inexcusable in this computer age

Here are some interesting and worrying statistics:

Facts

• There are 138,714 overnight hospital beds available in England (Sept 2011 – Dept of Health)
• There are 12,149 overnight hospital beds available in Wales (2011 Welsh Government)
• There are 22,794 overnight hospital beds in Scotland (2010 Scottish Labour Party)
• Total (excluding Northern Ireland) 183,657 beds and falling.
• There are 660,000 nurses and midwives on the NMC Register. Not all may be working, some may be unemployed or on a career break. Not all will be in the NHS they may be in the private sector, nursing homes, teaching, school nursing or drug reps. Not all will be in the hospital environment as many, such as midwives, health visitors and district nurses are at work in the community. Some will be off sick.
• It is estimated that 300,000 qualified nurses work in hospitals but how many are fulfilling clinical roles on the wards as there are so many administrative positions such as Matrons and Nursing Officers as well as specialist nurses and consultant nurses
• 200,000 nurses and midwives approx. are aged 50 or over and will be retiring soon as they can retire at 55.
• 300,000 unregulated Health Care Assistants work in the NHS.
• 25% of student nurses do NOT complete their courses.
• Other than on paediatric wards there are no qualified nurse/patient staffing ratios yet the needs of the sick elderly are very similar to that of small children.

The population is getting older with a 61% projected increase in the number of people aged over 65 in the UK by 2032 (Office for National Statistics, 2008) and that’s only 20 years away. Unfortunately the older we get the more likely we are to need health services as the degenerative diseases kick in. The prospects for adequate essential nursing care appear very gloomy to me.

Question: To obtain a better salary many good clinical nurses are obliged to move into administrative posts. Why is clinical expertise so undervalued and underpaid? Why is there no decent career pathway for clinicians?

Many nurses I know just want to nurse the sick, injured and dying. They do not want to be responsible for budgets and staffing. These tasks are the very ones the “modern matron” should have taken over to allow Ward Managers to become Ward Sisters again, responsible only for the care of patients.

Question: Can someone please tell me precisely, what is the role of a Modern Matron?

I left my last post because the departmental manager left and nobody applied for the job so I was put under a great deal of pressure to accept the role. I did not want it. I wasn’t trained for it. I felt fulfilled in my role as clinician. I knew, that despite assurances from on high that I would still have a clinical role, the management aspect would take over and be very very stressful.  No training was offered. As I was within 18 months of being able to retire anyway why would they want to train me as a manager at some expense, so late in my career?

Back to the point of this Post!

Question:If 200,000 nurses are due to retire and 25% of potential nurses fail to qualify who is addressing the problem of the shortage of nurses in the not too distant future.

Nursing then … and Now

Before I proceed with this post there is something I must make clear. I truly believe that most young people today who want to make nursing their career are just as caring and idealistic as  my contemporaries and I were all those years ago. I believe many undergraduates and newly qualified nurses are disillusioned with their training and its manifest shortcomings. The system is failing them as much as it is failing the NHS and patients.

A newly qualified staff nurse told me how unprepared she felt on her first day as she was asked to do ten things during the morning that she had never done in her training. This is not only bad for her morale and confidence, it is dangerous for patients. She will eventually become a good nurse but she is going to have to do that on her own having already qualified.

In an effort to understand how and when it went so badly wrong I have made comparisons with the old and the new

The old apprenticeship system of training for State Registration was not perfect by any means but it had many merits, which were all swept aside when the Universities took over.

• Students should be supernumerary but should not be mere observers, during clinical placements students should have to achieve a set number of practical tasks be it bed-baths or drug rounds.

• Students should “work” all shifts including night duty. Three years at University leading a student life style does not create a good work ethic nor foster a team spirit.

• There is no substitute for contact with patients. 2,300 hours restricted contact is not the same as the 4700+ hours daily contact trainee SRN’s had.

• Boring though it may be, repetitive practice make perfect and this should occur before a practitioner has to take full responsibility for their actions.

• The emphasis was always on the patient first and foremost. Nurses were told they were the patient’s advocates and no matter who else was around, be they doctors, other health workers or relatives, the patient was their priority. The machinery was given higher priority than I was when I was last an in-patient!

I have been watching with fascinated horror the More 4 series “Confessions of a Nurse” and the nurses interviewed illustrate these points better than I can explain, for example, the attitude of one young staff nurse  who admitted on camera to regularly turning up late for her shifts and another whose complex family issues meant she had taken many days off sick, some without even letting the ward know she would not be on duty. The latter was a sacking offence in the 1970s, not that we would have dreamed of doing such a thing.

Question: Is professionalism not one of the topics covered by the academic syllabus?

I feel it can’t be as so many nurses on that programme and in hospitals I’ve worked in or visited recently do not care to look professional e.g. hair all over the place, excess make-up, ear rings and jewellery, long sleeved jumpers beneath their tunic tops and totally inappropriate foot wear. Could it be that because they don’t feel like professionals this is reflected by some nurses in their unprofessional behaviour?

The lack of practical skills was demonstrated by two fairly recently qualified staff nurses on “Confessions” who had to ask assistance from a charge nurse from another ward to help them with an intravenous line. I suppose we should be grateful that they knew their limitations and sought help.

Question: If undergraduates are at university to  receive a much more technological training than I had as an SRN, why had the management of intravenous infusions and the dangers associated therewith not been thoroughly covered so they were capable and confident to deal with a problem themselves?

The way I see it is that to qualify as an SRN we were trained to be nurses whereas to become an RN you study nursing, a subtle but fundamental difference.