EDITOR’S VIEW

'It’s time to tell the public that nurses are not maids'

21 February, 2012 | By Jenni Middleton

The implications of the health bill, and the public mauling-by-media the profession seems to endure on a regular basis are putting nursing under a fair bit of pressure.

But the thing keeping most of you awake at night is the fear that you cannot meet the expectations of patients and carers using your existing resources. In our exclusive survey last week more than half of you (55%) said this was your biggest concern.

Workforce cuts are piling the pressure on an already stretched profession, but the public’s expectations are adding to that stress.

Let’s not suggest that any patient or carer should ever tolerate the poor care we saw documented in last year’s Care Quality Commission and ombudsman reports. Drinks and food left out of reach and blatant disregard of dignity are totally unacceptable. But some patients are unrealistic about what a nurse’s role really is.

Nurses have told me that some patients use their call bell to get them to change the television channel, pour water or recline their beds – all reasonable requests, except the patients in question were extremely mobile and well enough to do these tasks themselves.

There will always be awkward patients and nurses are usually resilient at dealing with them. But the lack of appreciation for nurses, respect or understanding for the job they are being paid to do is leading to increased frustration – among nurses and patients.

Buoyed by the review website culture, where the customer is always right, some seem to believe a stay in hospital should be like a stay in a hotel. While of course feedback should be analysed to make healthcare improvements, patients need to realise that nurses are not maids. They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description.

Readers' comments (46)

DH Agent - as if ! | 21-Feb-2012 11:01 am
'They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description.'

How many patients do think 'unquestioning servitude' is in the job description ? As opposed to wishing to be treated as an ill person, rather than as a collection of clinical problems ?

I don't know - has anybody got the evidence, in an 'evidence-based' sense, about how many patients do believe that nurses are 'room service' ?
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Anonymous | 21-Feb-2012 11:44 am
very little seems to be understood of the work of nurses and the wide range of skills required to do the job and all the health risks involved and there are many misperceptions. However, I also know very little of all the details of other jobs I have no experience of.
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Alice P | 21-Feb-2012 12:50 pm
In the States, the much of the public believes that you can't get a good CEO without throwing millions of dollars at them, but that nurses make too much money for what they do. Yes, I'd say we have an image problem.
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Anonymous | 21-Feb-2012 1:13 pm
Alice P | 21-Feb-2012 12:50 pm
from Anonymous | 21-Feb-2012 11:44 am

It's strange that if people get poor nursing and medical care they may not fare so well yet they do not put great store by nursing, which reflects in attitudes towards them and how they are treated and paid.

I have heard HCAs telling independent patients who expect to be served by them that they are not maids. Perhaps we should all be a bit firmer and make this perfectly clear.

The way some patients wish to offer tips also seems to show a lack of understanding.
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Anonymous | 21-Feb-2012 1:47 pm
Wow, tips? The only tips I hear about involved a lot of swearing and anatomically impossible instructions - usually given when they recieve £1.70 bus fare to get home from hospital instead of the generous taxi fare or train fare they hoped to get in cash! Either that or we are the visible target for their frustrations when they dont get the admission/scan/sick note they want. Doctors get the thanks, nurses often get the anger, it has been that way as long as I can remember but I also try and remember that it is only a small proportion of patients/public that do behave this way.
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Anonymous | 21-Feb-2012 1:48 pm
"They must learn that nursing requires a broad range of skills – and unquestioning servitude is not in the job description."

How are they going to learn this? Who is going to teach them? ...and how? Who is going to provide some effective suggestions and solutions?
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DH Agent - as if ! | 21-Feb-2012 2:37 pm
I have no doubt, at all, that nursing requires a broad range of skills. But I'm still unclear, if Jenni is quoting 'an evidence base' here ?

Asking nurses 'Do you think a lot of patients treat you as if you were 'room service' ?' could elicit a 'yes', but at the same time perhaps asking patients 'Do you think a lot of nurses ignore your needs ?' might also elicit a yes.

So, where is the evidence base for the assertion ? Is there one, or is this just based on a perception within nursing (I'm not saying that a lot of patients do not treat nurses as if they were 'maids' {I simply don't know} - I'm just saying, do we have the equivalent of 'a double blind methodology' here, or not ?).
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Little One | 21-Feb-2012 7:06 pm
I regularly find the attitude of patients is that I am there to do absolutely everything for them as they lie in bed 'getting better' and find myself telling patients that they will not 'get better' just by lying there, and whilst they have two good arms and legs they should use them.

I don't think it comes across as rude, it is about making the patient aware that we are promoting their independence, not being nasty, and that if they truly need help they will receive it but that I am not prepared to bend to their every whim and hold the glass to their mouth as they drink because they are too lazy to do it themselves, and they think that is entirely what my job consists of.
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DH Agent - as if ! | 22-Feb-2012 10:21 am
'and find myself telling patients that they will not 'get better' just by lying there, and whilst they have two good arms and legs they should use them.'

Little one, just to check something. So your hospital encourages patients who can walk, to walk around and do things for themselves, and to 'socialise with each other' if they wish to, etc ? I agree with what you say, but if you want patients to somehow 'be tied to their bed', that isn't true 'independence', is it ?
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redpaddys12 | 23-Feb-2012 4:40 am
Michael Stone:
Your use of quotation marks baffles me, are these your random musings or those you have heard spoken by nurses? Do you do the little" " motion with the fingers when you talk?
I'm a nurse, and was told that I was an arsehole by a patient because I wouldn't pull his blanket up over his feet when he was cold. He was cold after a walk outside for a fag...
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Little One | 23-Feb-2012 10:48 am
michael stone | 22-Feb-2012 10:21 am

If my patients can walk and talk they are encouraged to do so as long as they are safe. Be that getting up to have a shower, walking with the physios, or even walking up the corridor and getting a drink. As long as we are aware of where they are and what they are doing, and as long as they are not at risk of falling then they are encouraged to walk about the ward. If they want to socialise with each other then of course they can, they are in no way chained to their beds, they are however restricted in what they can do, as they are usually in hospital for a reason and not just for a holiday.
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tinkerbell | 23-Feb-2012 12:14 pm
Anonymous | 21-Feb-2012 1:47 pm

this is my experience also. If i have a patient who wants waiting on hand and foot i usually say 'i am here to help you help yourself'. I would hate to de-skill and make someone totally dependent on me whilst a patient. I try to discourage the sick role wherever possible but will do anything i can to help someone who can't do something for themselves rather than won't. It is all about 'recovery' wherever possible. We help no one when we make them dependent on us. I think it would help if the more independent patient wasn't lying around on a bed if they don't need to be and were able to wear day clothes instead of hospital gowns to remove this image of them being 'ill' and promote an image of them 'getting better'. Wherever possible we should not be encouraging the 'sick role of a passive receipient of care' but someone who is jointly responsible for their well being and recovery.
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tinkerbell | 23-Feb-2012 12:14 pm
Anonymous | 21-Feb-2012 1:47 pm

this is my experience also. If i have a patient who wants waiting on hand and foot i usually say 'i am here to help you help yourself'. I would hate to de-skill and make someone totally dependent on me whilst a patient. I try to discourage the sick role wherever possible but will do anything i can to help someone who can't do something for themselves rather than won't. It is all about 'recovery' wherever possible. We help no one when we make them dependent on us. I think it would help if the more independent patient wasn't lying around on a bed if they don't need to be and were able to wear day clothes instead of hospital gowns to remove this image of them being 'ill' and promote an image of them 'getting better'. Wherever possible we should not be encouraging the 'sick role of a passive receipient of care' but someone who is jointly responsible for their well being and recovery.
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Anonymous | 23-Feb-2012 12:37 pm
when i worked in a home for the care of the elderly my concept was not to take away their independence but to let them do what they were able with my support and then help them with the rest. however, strict time constraints did not permit this and other staff did not agree with me. as a result they were seen, particularly by the relatives, as the better carers, and I was seen as the bad one despite more years of successful work experience and higher qualifications, and was very quickly out of a job on the grounds given by the administrative head of the home that I was not accepted by the team. This was after just over three months in the job. I found this a shame for the residents as some could have done more, no matter how little or how much, and in my view is poor nursing practice.
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tinkerbell | 23-Feb-2012 2:43 pm
atrocious. Isn't this discrimination?
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tinkerbell | 23-Feb-2012 2:44 pm
Anonymous | 23-Feb-2012 12:37 pm

to you re above sorry forgot to copy/paste you.
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DH Agent - as if ! | 23-Feb-2012 3:00 pm
Little One | 23-Feb-2012 10:48 am

This will probably be removed by the moderator, who has already removed my reply to redpaddys12. This is a REPLY, moderator !

If you let patients do as you say, then I have no problem with nurses telling patients to be more independent, provided the patient is capable of doing things for him/herself. My only problem, is if your patients are getting confliciting 'advice/rules', or if patients who can't do things for themselves (for example, too ill to feed themself easily) are not being given any necessary help.
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Anonymous | 23-Feb-2012 3:16 pm
michael stone | 23-Feb-2012 3:00 pm

for crying out loud Michael. Nurses are trained to assess patients and evaluate what they can and cannot do and where they need help, and care plans are made to assist in this so that care is consistent and continuous as no one nurse is with the patient longer than the duration of their shift. Nurses are also highly trained in psychology and interpersonal relations and are more than capable of evaluating what patient needs are and what they are able and unable to do. If t certain restrictions because of their illness or surgery are imposed these will be prescribed by the doctors and nurses also work closely with the physiotherapists. this is part of a nurse's job and part of the nursing care process.

i can't help noticing the frequency with which you troll these sites wasting everybody's time and preventing some good discussions about important nursing issues where exchanges of other nurses is an important element in improving care although I have almost given up using these sites because of your constant remarks between other commentators and then projecting your trolling behaviour onto others.
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Anonymous | 23-Feb-2012 4:51 pm
There is an attitude problem towards the NHS - that we nurses know too well - and as someone rightly says we are trained and can [usually] differentiate between those who need help and those who demand and treat nurses as servants. These patients, like bad nurses are not the majority however their attitudes have an impact on nurses behaviour. Too much emphasis has been put on patients rights without the balance of patient responsibility. When you look at the 'sick role' there is a balance between receiving care and doing all you can to get better - it is when patients forget this that they seem to nurses to treat them as handmaidens. Unfortunately repeated treatment like this can lead to jaded nurses who tell the wrong people to self care - and that is not what anyone wants. This by the way is based on anecdotal evidence - all nurses will have examples of when they are treated as servants and this is quite distinct from the people who loose all sense of self care when they become patients and just need to be informed that they are still allowed to do things for themselves without it being detrimental to their recovery.
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tinkerbell | 23-Feb-2012 5:07 pm
michael stone | 23-Feb-2012 3:00 pm

I wouldn't tell someone without any legs to try and walk, we do assess our patients, observe, monitor and record regularly their strengths and needs.
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