Nursing no longer a caring profession?

[Lucio]

http://www.telegraph.co.uk/health/87...rofession.html

This article made me stop and think, at one point in the past I was training to be a nurse and know a little about how challenging it is to look after several people on a daily basis.

For what it's worth, I think the author is wrong in their conclusion, the assumption is that nurses no longer care is a bad one to make because it skips over other causes. For starters, her ideal of care was based on one to one whereas budgets dictate a typical nurse plus care assisstant combo covers 6 to 12 patients

Also, the paperwork mentioned, she has no idea of what it's like to be responaible for people in a day and age where even a hint of a cock up forces a lawsuit. It's drummed into you that you have to document everything, from fluids given, drugs taken, various measurements recorded etc. Even at 10 minutes per patient, that represents at least an hour of work.

There's also the issue of how long it takes to perform a task, feeding someone 5 to 60 minutes (yes some patients take 1 hour to eat a meal), commode visits take 10 minutes once you've cleaned it out, even fetching water can take 5 minutes, longer if someone needs help drinking. Multiply that by the number of patients and you've got most of your day accounted for and you've only met these needs a couple of times per patient.

I don't disagree that a nurses role is changing but ask yourself this if a nurse, who is trained, doesn't oversee drugs and observations, who will? Can't get a doctor to do it as they're better used dealing with even more complex medical issues, a care assistant could but isn't trained so would blindly follow instructions.

My conclusion is that the issues raised by the article shows a need to increase budgets available for staffing on the wards, but also raises the inherant problems with caring for more than one person at once.

[megah0]

I'm a qualified nurse, my overall response to that article is unprintable I'm afraid.

My hospital does not use the tabard system mentioned in the article but I can understand why some do, what is more important: Mrs Jones has a chat with a nurse OR the rest of the patients get their antibiotics or painkillers on time? Especially since missed antibiotic doses are recorded as drug errors - something that can get you suspended as a nurse. I'm fairly sure the author would prefer a nurse to prepare her mother's drugs uninterrupted, rather than risk a mistake creeping in due to the nurse being distracted.

"form filling and box ticking" If it were up to me the paperwork we have to fill in would mostly get chucked away, but sadly we live in a litigious society and everything must be documented in full lest some unhappy person decide to sue us 5 years down the line. We have to complete many audits during the day, time consuming but important to monitor progress and quality etc.

I'm not sure where she gets the idea that we all want to get behind a desk, I like looking after patients, and my seniors who do end up with an administrative role try and remain as clinically based as they can.

Number of patients dying of neglect rising? Citation needed.

I'd break down my shift today but as an intensive care nurse my workload is somewhat different to the ward staff.

[Alex]

I'm a doctor in the NHS, and have to agree with megah0 on this.

Anyone who slags off ideas like these 'do not disturb, nurse on drug round' has very clearly not worked in the NHS. The NHS is not set up to be aiming for 'customer satisfaction' - it's not a business but a health service. It's fundamental premise is to make people better from illness, not to make sure people have a nice time there. I'm not saying that medical staff shouldn't care about people's happiness - obviously that's important - but making sure people's medical care is as good as it can be is the main aim. If, as megah0 says, nurses are unable to even give all the patient's their medication then clearly this is being compromised. This initiative was fairly obviously set up to try to solve a specific problem - and not that nurses just can't be bothered with talking to their patients. If you want staff to have more time for their patients then you need more staff. There are only a certain amount of person-hours in a day - and if I was in hospital I'd rather that time was spent on getting good medical care than chatting.

Not that anyone pays any attention to the 'do not disturb' aprons anyway.

EDIT: Please, by the way, don't take this to mean that I don't care about personal interactions between staff and patients, or to mean that I don't think communication is vital. Just like any other busy job with loads of small jobs - you need to be able to plan to get things done and being able to do a ward round in one go without being disturbed means you have more time later, when you can plan, to do all the other important jobs - making sure people get the drugs/CT scan/operation/discharge from hospital on time. If you can sort these out in a much more organised fashion you then have more time to go and discuss things with patients and relatives later in the afternoon.

[chuckskull]

Cheapshot because a nurse got arrested over the saline deaths and picking on cops(the perennial favourite) has gone out of fashion in recent weeks, as far as I can see.

[Saracen]

My view is that if you take both the views of Mega and Alex, but add in a touch of the thrust of that article, you'll be somewhere near the truth, which is that as human beings, nurses vary. Some are good, some not so much. Mostly good, in my experience, but not uniformly so.

But I'd also say that if nurses are so busy filling in forms and conducting audits that they can't ensure patients have water, food and commode visits, then they aren't doing their job properly, the primary thrust of which is supposed to be care for patients, not administrative cover your ass. However necessary they that administration may be, and whatever the reasons for it, it comes second, in my opinion, to ensuring basic patient care.

I would agree, though, that interrupting "do not disturb" nurses on drug rounds should only happen in cases where immediate attention is required and nobody else is around. "Excuse me, but Mrs Jones over there is having a heart attack" is a bit different from "nice weather today, and aren't Man United doing well", and outweighs a drug round. But that kind of situation ought to be very few and far between.

I have come across nurses with a very surly attitude, and from whom you can't get a smile or a nice word, even while they're attending you, but the majority (in my experience) are friendly and helpful, at least as much as time permits.

I don't agree with the overall tone of that article, but it does raise some valid points. And most of it comes down to staffing levels and budgets. But not all.

[santa claus]

What a load of unmitigated tripe that Telegraph article is. There can't be anything more useless than some gormless hack thinking up stories to fill paper. I wouldn't even use that rag to wipe my backside.

But I'd also say that if nurses are so busy filling in forms and conducting audits that they can't ensure patients have water, food and commode visits, then they aren't doing their job properly, the primary thrust of which is supposed to be care for patients, not administrative cover your ass. However necessary they that administration may be, and whatever the reasons for it, it comes second, in my opinion, to ensuring basic patient care.

Do me a favour. Hospitals are full of whining old dears who expect personal attention from nurses for their every waking moment and they're not even happy when they get it.

Nurses have the patience of Job. They astonish me with their skill and attitude; they are under-valued, underpaid and now insulted by a crummy article in tomorrow's fish and chip paper.

Everyone working in the NHS deserves a medal; the pressure is intense. Do you really think that people who have chosen the profession want to be filling in forms all day? Sure, there will be people who have 'a surly attitude'. I get like that myself now and then; we all do.

Walk a mile in their shoes.

[Saracen]

....

Do me a favour. Hospitals are full of whining old dears who expect personal attention from nurses for their every waking moment and they're not even happy when they get it.

I'm sure there are, and I'm sure they'd try the patience of a saint, but that's not what I said, or was talking about, is it?

....

Nurses have the patience of Job. They astonish me with their skill and attitude;

And most astonish me, too. But not all.

....

Everyone working in the NHS deserves a medal; the pressure is intense. Do you really think that people who have chosen the profession want to be filling in forms all day? Sure, there will be people who have 'a surly attitude'. I get like that myself now and then; we all do.

I'm sure they don't want to be filling in forms. And I agree many, most even, are dedicated, professional and competent carers. But not all. That category may be small, but it does exist. I know that from personal experience.

One instance. My father had just had a major operation to remove a stomach cancer that resulted in the removal of most of his small intestine. A nurse decided to "freshen" his bed and tuck the edges in. Great, in as far as it goes. So she did one side, then lent across him to do the far side from where she was, rather than walk round, and in doing so, lent right on the 14" inch wound, less than 24 hours after the surgery. She did NOT deserve a medal for that piece of stupidity and thoughtlessness.

So no, not everyone deserves a medal, and they're not all saints. They're human, have 'feet of clay' and, like every other human, they have good days and bad days, and there are good staff, mediocre staff and downright poor staff. The difference is, if you get poor staff in a shop or restaurant, for instance, you can walk out and go elsewhere. If you're seriously ill in hospital, you don't have that choice, and may well not be able to get food or water, or a loo break, without help. And if you aren't getting it, it's an utter disgrace, and inexcusable.

None of this detracts from the job that most staff do, most of the time, but good though it is, the NHS is not perfect, and neither are all staff. Mistakes happen, but thankfully, most of them aren't terminal. Some, though, are.

As I said, I don't agree with the overall tone of that article, which reads like a hatchet job. But nonetheless, it's not entirely without foundation, either.

[Saracen]

....

Walk a mile in their shoes.

Not a chance. I have neither the temperament, training, expertise nor inclination.

Nor would I wish me as a carer on my worst enemy, let alone some innocent bystander. Though, thinking about it, perhaps there are a few I would wish my 'tender ministrations' on. They'd probably wish they'd spent their time with a Ghaddafi torture squad instead, though.

[santa claus]

My apologies, I am steaming after reading that article.

You are right to say that the NHS is not perfect. The NHS is a patient with the lifeblood being drained from its system. Its defence mechanisms are working day and night to save it but it is an organisation that is unwell not because of those in it but because of those who withhold the medicine it needs. It doesn't help when hack bystanders twist the knife in the wound.

And no, I couldn't do their job either for the same reasons as you. They are special people; I know that when the time comes that I need them, they will be there.

[Saracen]

So if we accept that the system is imperfect, there are a couple of obvious questions. What things are wrong with it? What can be done to fix them?

Of course, that's a BIG topic.

Take the "audits", and general paperwork. It's easy to say "scrap it all", but if you do that, you have no way to monitor what's going on, and to perhaps catch problems before they kill someone. There have to be procedures, record-keeping and to some extent, form-filling. But if you do too much of it, you end up with a hide-bound bureaucracy. The trick is getting the balance right.

For instance, if you don't keep detailed accurate records of drugs given to patients, I'd imagine you'd end up with either some patients not getting necessary medication, or others getting double (or more) dosed. I'm not a doctor or nurse but I'm sure there are some here that could confirm that at the least, that kind of record-keeping is necessary.

But from what I've been told (by friends within the NHS) there is a fair bit that is felt to be about, for instance, meeting government targets than about clinical needs of patients.

Just like other aspects of the public sector, such as police, perhaps in these times of austerity, we need to take a long, hard look at not just what services like police and the NHS are doing, but how they're doing it. Are all the forms that get filled necessary? If not, it's using staff time better spent on service provision than time-filling paperwork invented by a government more concerned with micro-managing than service provision.

[santa claus]

Taking a long, hard look at the NHS against a backdrop of austerity will lead to the inevitable 'solution' of cutting public services or screwing more out of already over-worked staff. I don't much fancy slash and burn tactics; that's the way this Government would like us to be thinking. Oh no nee no nee no Mr Cameron.

A huge Organisation like the NHS has to have structure and accountability; this penny pinching mob don't want to fund the required administrative back up (they prefer to fund bonuses for the overpaid instead) and the consequence is that doctors and nurses are having to plug the gap with duties that were never supposed to be part of their function let alone a greater percentage of it.

The Telegraph article targets the wrong people. No surprises there.

That said, if the NHS could somehow rid itself of the middle class moaners who think the raison d'etre of the hard-working staff is to fawn around them all day plumping up their pillows and getting fresh water for their false teeth it would help .

[Saracen]

....

A huge Organisation like the NHS has to have structure and accountability; this penny pinching mob don't want to fund the required administrative back up (they prefer to fund bonuses for the overpaid instead) and the consequence is that doctors and nurses are having to plug the gap with duties that were never supposed to be part of their function let alone a greater percentage of it.

....

It has to have structure and accountability, but that doesn't mean it needs all the current paperwork. As I said, the tricky thing is getting the balance right.

I've certainly had friends working in the NHS moaning about the massive increase in bureaucracy, and for that matter, it's not just the NHS, it's schools, the police, and so so on.

[badass]

A large part of the problem is the fact that patient facing staff are having more work thrust upon them than they are able to do effectively in many hospitals.
Part of the problem is the previous government, part of the problem is the government previous to them and part of the problem is the current governemnt.

The previous conservative government cut the NHS back almost as far as it could before completely collapsing. They were stupid enough to have targets of 99% bed occupancy in hospitals for example. Which ever idiot came up with that one deserves a medal for stupidity and to suffer a bout of seasonal flu to understand how absurd that is. Then because of Gordon Browns pretending to be prudent, they decided that inctead of buying hospitals outright, to save on upfront cost, they would instead rent the new ones from private businesses which costs 3 times the price of buying outright every 25 years. If they hadn't done that, most of those hospitals would have paid for themselves by now.
Then the Labour government came is and hugely increased NHS spending, but attached so many strings to the new money that an army of bureaucrat were needed by hospitals individually in order to make sure they got all of the money from the government that they could.
Then they decided that whinging londoners and business owners were a more important group for the NHS to service than those genuinly in need of treatment. They decided that making sure commuters didn't have to take time off work for an arranged doctors appointment was a good way of spending a limited pool of money. This group of moaners were both complaining about taking time off work. To the worker: That's what sick pay is for. To the business owner: You knew this when you decided to start a business. Organise around it
Instead of telling this bunch of whiners to shut up, they decided to spend more public money offering the service.

Now the current government are expecting the army of bureaucrats that shift pointless paperwork around the NHS to decide where to make the cuts. Those cuts will be on front line staff and the fat will be left behind.
What they really need to do is manage peoples expectations. Cut back on the convenience and focus on the important. Get shot of the stupid targets and get shot of all of those people employed to make sure hospitals reach those targets. Cut back on centralised management (costing 25% of the NHS budget) and allow clinical staff to decide what's best for patients on a case by case basis. Suitable inspection/auditing is far cheaper and less invasive than endless pointless targets.
Spend more money on training and sort out some of the archaic IT/lack of IT where it should be. This does not mean starting from the top down building huge behemoth projects that end up costing £12.9 billion and being about as much use as a small MS access database.

[Saracen]

.... Good post....

More or less what I was getting at, but better said. Much better said.

[santa claus]

Yep, good one. I think that we're all pretty much agreed that the medical staff like Dr Alex and Nurse Megah0 are finding themselves in an impossible situation. If they fill in the forms, the patients get the hump and if they don't fill in the forms, the Government will have their guts for garters. It's an unenviable position and testimony to their dedication.

Sometimes it seems like the Government NHS 'experts' get their ideas from an episode of Holby City.

Not to get too far away from thread topic, the article in the Telegraph shows that contrary to nursing no longer being a caring profession it is the couldn't-care-less profession of newspaper reporting that deserves the spotlight.

The NHS may have its ills; press reporting is out and out sick when it prints tripe like that.

[badass]

More or less what I was getting at, but better said. Much better said.

A rare accolade

Yep, good one. I think that we're all pretty much agreed that the medical staff like Dr Alex and Nurse Megah0 are finding themselves in an impossible situation. If they fill in the forms, the patients get the hump and if they don't fill in the forms, the Government will have their guts for garters. It's an unenviable position and testimony to their dedication.

For further evidence of the dedication of staff - particularly doctors - in the NHS - you just need to see the hours they actually do. In many hospitals they work obscene hours and only get paid for the official hours they do. This is endemic.

Sometimes it seems like the Government NHS 'experts' get their ideas from an episode of Holby City.

Not to get too far away from thread topic, the article in the Telegraph shows that contrary to nursing no longer being a caring profession it is the couldn't-care-less profession of newspaper reporting that deserves the spotlight.

The NHS may have its ills; press reporting is out and out sick when it prints tripe like that.

I couldn't agree more. If there's one thing worse than the state of management of the NHS, its the morals and quality of journalism in this country.