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Nurse denies falsifying records

A former accident and emergency nurse in the hospital at the centre of the Stafford care scandal has denied fiddling records of patient waiting times to fulfil management’s “draconian” demands to meet targets, accusing managers of falsifying documents, a tribunal heard.

Sharon Turner said management would only alter times by “a couple of minutes” but that the demands of senior staff to get 98% of patients in and out of A&E in the four-hour government target were sometimes impossible to achieve as capacity at Stafford General Hospital dwindled.

Earlier in the tribunal, the NMC heard that there was a “culture of bullying” among senior management at Stafford who “made a spectacle” of nurses for breaching waiting time limits and shouted at them.

The allegations came at a misconduct hearing into the standard of care provided by Turner and another nurse at the hospital at the centre of the Francis Report into care at the Mid-Staffordshire Trust, where hundreds of patients are said to have died unnecessarily.

Tracy White faces five charges of misconduct relating to patient care and falsifying waiting times, and Turner faces six, including falsifying waiting times, patient care and racist conduct, relating to their time in charge of the A&E department in 2007.

But Turner denied telling another nurse, Helene Donnelly, “my advice is to lie about the breach time”, when she rang through from the minor injuries section saying they had patients who were about to clock up four hours in A&E.

Last Monday Mrs Donnelly told the hearing that patient records were “routinely” doctored in the “chaotic” department, which lacked a permanent manager at the time, to hide breaches in waiting time limits.

Turner admitted the targets were a “bone of contention” among staff but that it was management who falsified waiting times on patient records as nurses were “too busy doing their jobs”.

James Townsend, representing the nurse, asked her: “Was there any general practice for nurses on the unit to fiddle the times by a small amount in order to prevent breaches?”

She replied: “Not nurses on the unit.”

He went on: “By anyone else?”

Mrs Turner replied: “Because you get the breaches (reports) through the following day I think we acknowledge that minutes were taken off - a couple of minutes here and there by managers.”

The following day the lower-level managers had to take breach reports up to senior management and explain if the limit had been broken.

She went on: “I think it was probably something subsequently done by management - I don’t think there were excessive times taken off.”

She said it was “just a couple of minutes, the time to walk down a corridor.”

“I think they just thought ‘what is the point in declaring a breach if it is only a couple of minutes?’”

Turner said the only time she altered records was when night staff got confused by a 24-hour clock.

“They used to get confused by the 24 hour clock and you would get breaches by thousands of minutes.

“Obviously that was not the case so I had to change that and sign to say we had changed that,” she said.

She also said that when the targets were introduced in 2004 under Labour, there was not a problem with waiting times at Stafford.

“There were no specific protocols but I think it was seen that a patient should be processed effectively through the department,” she said.

“We were only a smaller general hospital so the horror stories we were hearing about at other hospitals didn’t happen at Stafford.

“I don’t think there was a major capacity problem back then. People sometimes waited longer than you would have liked them to but I don’t think there was an instance that I thought they waited longer than what was acceptable.”

“Initially 98% seemed to be adequate. However, as demands on A&E grew and you no longer had the capacity and you were waiting for discharges before getting people in the front door so that 98% target gradually became harder to achieve.”

Turner added that as staff left the A&E department they were not replaced, making the targets tighter.

She also said management at the hospital would not accept the 98% target and actually wanted every patient to be dealt with during the four hour time limit, saying A&E staff were “held to account for any breach”.

Turner said sometimes this was impossible due to a patient’s condition but that managers did not listen to A&E staff when they tried to explain.

The nurse, who now works at the Royal Shrewsbury Hospitals Trust, also denied making racist comments, including likening an Asian junior doctor to a suicide bomber.

She denied referring to a doctor derogatorily as “him in the turban” and a female gynaecologist as “her in the yashmak”, saying she used to say “the doctor in the turban” to easily identify him.

She said she never used the word yashmak, but may have referred to the other doctor’s hijab.

White, who is expected to give evidence tomorrow, is accused of calling a seriously ill elderly patient a “naughty little monkey” and refusing to lift her from a wheelchair to a bed.

The patient died the following day.

White is also accused of saying “she can wait if you can do that to your baby” when a woman came into A&E suffering from bleeding after having an abortion.

White and Turner contest the charges. The hearing continues.

Readers' comments (15)

  • michael stone

    ' I think we acknowledge that minutes were taken off - a couple of minutes here and there by managers.”'

    Sorry - the time, is the time !

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  • I worked as staff nurse in Queens Hsp, Romford A&E (formerly Oldchurch Hsp) for years and any patient who was going to breach the 4 hour in A&E time was falsely taken off the computer system. Sometimes this was an hour before they left the dept. Sometimes you had to guess whether they would be admitted or discharged and change the computer accordingly, The main priority of the nurse in charge would be to continually pressurise staff to move patients to wards before you had a chance to write up notes properly or sometimes administer drugs that had been prescribed. It was hell working in that environment, one nurse looking after up to 10 patients at times. When a patient needed a bed pan it was at times impossible to find another member of staff to help. I hated working there and frequently used to think I would not want my friends or family to go there.
    None of the senior nursing staff seemed to have any back bone to argue against the hospital managers on these 4 hour target times. I left because I could not stand giving such a poor service. The younger nurses do not know any different it seems and the older nurses can't wait to retire.
    I do not believe that this is the only a&e unit that has to resort to falsifying the times. It was made clear to all nurses that it was a very serious matter for a patient to breach. Sometimes when left in charge for example in Childrens A&E whilst trying to administer important treatment to very ill children I was having to answer phone calls from the Bed Manager and Nurse in Charge to explain why other patients were still on my computer. Very frustrating and hardly patient centred care. Cant blame Tories as New Labour introduced these targets.
    We need more trained nurses on the shop floor.....it's not rocket science.

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  • Anonymous | 11-Mar-2013 10:45 pm

    is there an issue with what is on the computer system as long as the patient is getting the care and treatment they need? surely this can be prioritised over administrative work and managerial staff can be asked to phone back later or get down to the department to see how busy it is or to lend a hand or provide the staff needed.

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  • I know that nurses are expected to see and treat patients in a timely manner, but the targets do not take into account that the patient is a unique individual with their own needs and not a tin of bean on a shelf!!
    I retired from nursing early 2 years ago and one of the reasons was not being able to treat patients as individuals!! If patients are going to the ward from a/e soiled then the poor overworked ward nurses have to sort it out and the a/e nurses are left feeling guilty because that have been pressurised into moving the patient on.I am glad my mother who was a nurse is not alive to see the sate of affairs in some hospitals

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  • The pressure on the nurses commence the minute a patient enters A&E.
    The senior sisters pressurise every nurse along the way to make a bed available for this new patient.
    The effects reaches the discharging of patients. It has a big ripple effect on pharmacy, discharge lounge and hospital transport. Many times transport is booked, the patient is still waiting for medicine from pharmacy the amuulance arrive then leave because they cannot wait. Transport has to be booked again. The nurse has to do a task that she had done before.
    The nurse is pushed every step of the way, with the senior sisters not caring nil about the nurse having other patients to care for. In fact even the other patients suffer as less care can be afforded to them, the nurse becomes fustrated and the pressure continues for the bed.
    The nurse in her pressurised state forgets something. I have heard about patients being discharged with venflon still in their arm.
    The job is very difficult because of targets and tick boxes.
    God help us nurses.

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  • The problem with targets is the negative way they are dealt with. The hospital administration do not look say at A&E waiting times and when they are outside of targets look at ways of reducing them [more staff] they simply bully staff to reduce them. The staff have no means to reduce the recorded waiting times other than thinking of creative ways of recording things. In this environment targets do not help patient care. If they were used as a means to look at improving things to meet the target we would surely love them.

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  • I don't mean to sound negative but we keep on hearing about Mid Staffs and the problems there, we don't hear anything about what goes on in other hospitals.

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  • Anonymous | 12-Mar-2013 7:09 pm

    The illegal deaths of potentially hundreds of innocent patients at the hands of the NHS getting boring for you?! Jeez.

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  • it's not getting boring but unfortunately there are times when the public get fed up and stop listening. do you think poor care goes on anywhere else? do you think that should warrant equal reporting?

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  • When we start to get get fed up of hearing such horrible stuff, it is blxxxy well time we do something about it, or demand that something be done. We are supposed to be living in a civilised country yet we are more concern about watching hospital drama on TV, where it never shows even close to the true picture of what really goes on in hospitals.
    It is true, horrible stuff is happening in many hospitals where there is not enough staff to deliver safe care to patients, and where managers are concerned only with one or two targets. We should have targets for every single part of caring, with sufficient resources in place for ALL targets to be met.
    What about a target for waiting time for a bed pan. What is wrong for that.

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  • This is a fact. Since I'm a nurse myself and it's a shame since some of our fellow nurses cover their mistakes. We must do something about this issue since its rampant these days.

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  • "What about a target for waiting time for a bed pan. What is wrong for that."

    I doubt Mother Nature understands targets, especially among the sick!

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  • Anonymous | 13-Mar-2013 6:37 pm

    I see no evidence to support that assertion. The public are most certainly listening to what is going on! Pick up any paper and you'll see any number of articles which cause great anxiety.

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  • I wonder what will happen now Jeremy Hunt says anyone fiddling figures will be sacked. Where does it stop? The culture of fear is so pervasive. What infuriates me is that the original Tory plans were to get rid of targets like these, and replace them with outcomes. There was a consultation with clinicians and it all sounded very sensible. Not quite waiting times for bedpans, but far more patient centred. I know the old thinking behind 4h waits was to get rid of the idea of someone on a trolley for 18h but what we've replaced it with is worse. And so much policy is written by people who've never set foot in ED. all the rhetoric about care outside hospitals and the best bed is your own at home and elderly people shouldn't be in an acute trust ..... If we had the investment and staffing yes, but it's gone in the wrong place. I would hate to be old and ill with no family to care for me. God help us, this couldn't be further from what Nye Bevan tried to create.

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  • The Nobody | 17-Mar-2013 11:33 pm

    does this mean the elderly have no right to be in an acute trust even if they have an acute illness?

    I am 66 still live the same active and sporting life I lived when I was 56 (and nobody believes my age and yet I am a geriatric and would be subjected to a mental health status and goodness knows what prophylactic treatments and screening tests if ever I went to see a doctor) but if I was ill and without any family and my friends scattered around the world who will look after me?

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