'Hiving off important responsibilities devalues nurses' skills'

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22 May, 2012

News that a West Midlands trust is to extend a scheme whereby unemployed people deliver patient care makes me deeply uncomfortable.

First there is the issue of whether it is right to be asking jobseekers to spend eight weeks doing unpaid work in an NHS that is shedding staff. I appreciate that many unemployed people need support in their search for work, and being able to show relevant work experience can make all the difference to job applications.

While Sandwell and West Birmingham Hospitals Trust may not be using unpaid workers to undertake work previously done by paid staff, there is certainly the possibility for trusts to consider this as a way of filling gaps left when staff numbers are cut.

I also have misgivings about the type of work the jobseekers are being allocated. While many of the tasks are uncontroversial - general tidying, welcoming visitors, running errands, and reading to patients – they are also being asked to serve drinks to patients and assist with feeding.

Ensuring patients receive adequate nutrition and fluid is a fundamental nursing role, and in the reports highlighting poor standards of care over the past couple of years, nurses have been repeatedly accused of failing their patients in this respect.

The profession has been accused of being more interested in academic qualifications than in core nursing responsibilities, yet fluid and nutrition are suddenly the domain of those undertaking unpaid work experience.

Hiving off these important responsibilities devalues nurses’ skills and puts patients at risk, yet nurses will still be held accountable if anything goes wrong, because they will be delegating the tasks to the unpaid workers.

Nursing has come in for a huge amount of flak recently, and the poor practice of the few has been used as a stick to beat the many. How is the profession ever to put its house in order if it is bombarded with mixed messages about its key responsibilities?

Readers' comments (21)

Amelia Swift | 22-May-2012 12:41 pm
Hear hear Ann, I find this incredibly frustrating. I spend my time teaching student nurses about the value of getting to know their patients, of finding out about them, spending time with them, using all their senses to always be doing more than the task at hand. When they get on the wards they find that more often than not the qualified staff have no time (or sadly sometimes no inclination) to work in this way. How much more do you find out about your patient if you are the one to do their vital signs, help them drink, wash them etc. How much more can you help them if you see this task as a vital part of the assessment, recovery and rehabilitation process. I am not against work experience, nor the vital assistance necessarily given by support workers and health care assistants but surely it is time that nurses got to be the ones to spend time with the patients and allowed to actually put to use the hard work they do in their training and beyond to understand not just how but why.
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Anonymous | 22-May-2012 1:10 pm
Where does confidentiality come into all this work experience? Do they have a code of conduct?
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Anonymous | 22-May-2012 1:36 pm
confidentiality could be a huge issue.
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redpaddys12 | 24-May-2012 8:29 am
It's a slippery slope nursing is on. Soon it'll be down to whoever is walking past the frontdoor getting dragged in for bedbaths, while the one nurse will give out the drugs in a never ending round.
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Anonymous | 24-May-2012 9:46 pm
redpaddys12 | 24-May-2012 8:29 am

not if she wears her red tabbard!
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Anonymous | 24-May-2012 9:51 pm
Anonymous | 24-May-2012 9:46 pm

sorry there should only be one 'b'.
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Anonymous | 25-May-2012 10:01 am
Confidentiality shouldn't be an issue, we have to trust our employees and volunteers and presumably they sign a contract. This is basically a volunteer role with the extra bit of helping to feed patients which many ward hostesses already do.

There are not enough nurses on the wards, that is a fact. Families are not always encouraged or willing to come in and help at mealtimes so I'd have thought this was a good compromise.

As long as they are trained in feeding patients, filling our food/fluid charts what is the problem. I used to help feed the old people in the day centre where my mum worked.

The only problem would be that they are abused, they should be shown respect and hopefully paid expenses for food and travel as they are really working for free, some people may be thinking about a career in nursing and this might be a good way in.

Presumably they are only on the wards for a few hours a day so fluid and nutrition will not 'become their domain' - they are not there to replace nurses, they are just there to help out.

With all respect, how many staff nurses sit idly talking to patients, help them with their food and serve the drinks or are they suddenly going to find the time to do these things now that there is a bit of competition.

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David Kitson | 25-May-2012 11:45 am
I wholeheartedly agree with the previous respondent (25-May-2012 10:01 am).

It would be wonderful if we suddenly had enough time to feed and provide drinks for our patients ourselves, but this isn't going to happen any time soon, especially given the apathy of the vast majority of our colleagues when it comes to trying to change the status quo.

Numerous studies and investigations have shown that we often fail badly in providing adequate nutrition and hydration to our patients. We can either choose to let this continue or embrace initiatives such as this one which might benefit both our patients and the unemployed.
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tinkerbell | 25-May-2012 12:31 pm
redpaddys12 | 24-May-2012 8:29 am

Exactly. My morning drug round starts at about 0800hrs and finishes at about mid day, if lucky.

Lunch meds start at 13.30hrs. In between i wash, change, feed and chat with the patients, complete an IRIS for being punched in the face. Mind me glasses. Do an admission. Write up notes, go into handover, come out, check controlled drugs with late shift nurse, to make sure i haven't pinched any during my shift. Do a supervison. Look dazed, go home. Walk through front door, go upstairs whilst having changed out of my uniform and into my pyjamas going up the stairs to bedroom. Quick change like superman. Collapse on bed.

Our poor old folk are on enough meds to sink a battleship most of which they don't want and tell me to shove them up my arse along with the meds trolley or to take them myself whilst giving a swift karate chop and i end up wearing them. Oh dear. I hate doing the meds.

My introduction of disposable tabbards has little impact on not disturbing me. Everyone mostly ignores it. I have resorted to becoming mute and giving them a funny look until they notice me pointing to it. Works much better.

I once asked some bloke hanging around watching me doing the drug round if he could work a late shift, he replied 'i'm a visitor'. I said ' can you do a late anyway?'.

There are so many bods walking up and down our ward at any given time asking me to look at the plumbing, take down the shower hose as it is a ligature risk, so walk around with a shower hose wrapped round my neck like a huge stethoscope, drippng water all over my shoes, whilst dispensing meds until i can find a safe home for the shower hose, expected to explain the complexities of the water pressure and what is required to get some water out of the shower, explain i could have been a plumber but i never bothered to the maintenance manager, whilst still wearing tabbard that says 'do not disturb' listen to staff squabbling about who's done what during the shift. Deep sigh, keep calm, carry on.

Meanwhile a drive by relative has left a loved one at our front door because they can't cope anymore and found there is not enough 'care in the community'.

Come on a late shift, pass nurse in corridor ask 'how's it been?'. No answer, just the look, say to them 'that bad eh?'.Yeah know exactly how you're feeling, no words required.

Any 'HELP' greatly welcome.

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Anonymous | 25-May-2012 3:22 pm
tinkerbell - I think you need a holiday.

Seriously though this can only be a good idea,as nurses I do think we can be a bit precious sometimes. We moan that we have too much to do and too little time but then when someone offers to help out we moan even more and accuse them of not offering the same amazing high level of care that only we can offer.

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Anonymous | 25-May-2012 3:24 pm
Why is it an issue that they are 'unemployed people', why does that make you feel uncomfortable. Volunteers are 'unemployed'. Would you be all for it if they were 'employed', if so, why.
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Anonymous | 25-May-2012 7:51 pm
Shouldn't we be grateful and respect anyone who is willing to come out and help us, especially those who are unemployed (probably through no fault of their own), and are not being paid.

This scheme is open to abuse, I admire anyone who wants to do this.

Those involved undertake 2 weeks training before coming to the wards, probably a lot more than some agency HCAs who have never worked in a hospital before but who nurses happily let offer really intimate care to.
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Anonymous | 26-May-2012 6:57 pm
I am An rn on a stupidly busy trauma and ortho ward! And our staff numbers have been reduced by 30% over the last couple of years, with no sign of them being reinstated. I am always highly delighted for any extra help with my patients, especially facilitating nutrition. A friend of mine is a volunteer " feeder" in a hospice, she described the training she received before helping out on the ward and it sounds like she received a far more In depth and comprehensive training on nutrition and feeding than ever I did as a trained nurse!!!
Tinker bell...I enjoyed your post!! Haha the first time I wore my red tab bard I had no less than 25 interruptions on my drug round....well it is red!
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Anonymous | 27-May-2012 1:22 pm
So the govt policy has caused stoppage in recruitment, nurses are losing their jobs, and people think it's OK to use the unemployed to fill the gaps?! For God's sake, get real! It is most definitely NOT OK!

Come on fellow nurses, you allowed HCAs to take-over much of what nurses previously did and now you are going to roll over and say yes to people coming in who are not even employed by the hospital you work in?! UNBELIEVABLE!!!
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Anonymous | 27-May-2012 3:21 pm
many hospital workers have started life helping out on the wards before entering training. it is a good way of seeing whether the career is for them and could help cut down wastage of those who drop out during training at even greater cost to tax payers.

From the point of view of those claiming benefits and the tax payers supporting them, they need to work. some need direction and a sense of purpose as well as work experience to get them more quickly into employment and we should not be paying for people just to sit at home.

What impact this has on patients, quality of care, privacy and data security is another matter which needs further study.

Nurses and ward staff do not have the monopoly of individuals requiring care as the post above suggests and this project must be embraced and seriously considered.
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tinkerbell | 27-May-2012 7:16 pm
perhaps when the helpers come in it would be a good opportunity to take some industrial action.
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Anonymous | 28-May-2012 7:57 am
tinkerbell | 27-May-2012 7:16 pm

not very helpful when job seekers need training, support and encouragement. Nurses understand only too well the difficulties associated with this so why subject others to the same treatment. At least give them a good chance in life and help to give the labour market a fresh kick start into productivity otherwise the country and its economy will continue to stagnate and nothing will ever improve. It requires everybody's participation.
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Anonymous | 28-May-2012 9:05 am
I hope that if anyone does come and help us out on the wards they are treated well, judging by some of the comments they will be bullied and mocked.

I am surprised that NT have written such a negative column, saying that this could put patients at risk. They are already at risk when they are not helped to eat and drink by the trained (and employed) staff. No-one complains about voluntary workers or ward hostesses serving food and drinks or helping people to eat.

Why would nurses be held accountable? if the hospital trains people to do these things for us then they are accountable.

Weren't two people given jobs at the end of their placement?
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Anonymous | 28-May-2012 9:14 am
tinkerbell | 27-May-2012 7:16 pm

"perhaps when the helpers come in it would be a good opportunity to take some industrial action."

instead of seeing all the advantages for all the different groups involved it is sad that some only see it as an opportunity to turn to their own advantage!
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Anonymous | 28-May-2012 10:31 am
"Haha the first time I wore my red tab bard I had no less than 25 interruptions on my drug round....well it is red!"

well, it shows that at least they draw attention, even though it is not the right sort or has the desired effect!
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