It’s time to start looking after nurses to boost care
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After all, if they did understand the implications of diabetes insipidus they should have been able to give Kane the care he needed. If not, they had a responsibility to get the information they needed to ensure his care was safe and effective.
When a student, I was told never to give a drug unless I knew the indication, contra-indications, side effects and normal dose; the same went for understanding a patient’s diagnosis and treatment. Indeed, if you don’t truly understand what is wrong with your patient - the underlying anatomy, physiology and pathophysiology, then how can you look after them? Without this knowledge, nursing is nothing more than tasks - and tasks without understanding are dangerous things.
Which brings me to skill mix. Recent data from national nursing research unit suggests the average proportion of registered nursing staff - compared to unregistered healthcare assistants - on day shifts is 56%. This places the onus on the registered nurse to ensure that HCAs carrying out day to day care, such as fluid management, understand the significance of patient diagnosis. This is probably easy when staffing is stable and patients are on appropriate wards, but what happens to patients who have multiple and complex conditions?
It is often claimed in the media that anyone can give someone a drink but it’s not “simple” for someone with diabetes insipidus. Anyone can wash someone but it takes a bit more thought if a patient has a fractured neck of femur. Anyone can help someone to eat but not if they have dysphagia. Nothing in nursing is really simple which is why delegation has to be managed carefully and nurses given time to ensure those giving care, who often are not nurses themselves, understand the significance of what they are being asked to do.
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Readers' comments (49)
redpaddys12 | 30-Jul-2012 4:43 am
Very well put Eileen, you should forward this to the daily Fail.
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Anonymous | 30-Jul-2012 5:45 am
Eileen
Thanks. You post makes some good points. However, it fails to recognise that within the profession, we have some who need rooting out and striking off the register.
Amongst those I include
1) Those who cant be bothered to read clinical notes but construct elaborate "care plane" which don't reflect a patients needs, are never implemented and never reviewed !
2) Those who fail to ask the question "WHY", for example,why a young man should need a hip replacement - a very rare procedure which most(if not all), would never have experienced previously.
3)Those who fail to provide any care to sedated patients (and others) ie (no fluids, ( by any route), not undertaking clinical observation of LOC, B/P, Pulse etc.
4) Those who contribute to the emergence of "bad news" by the callous disregard of patients needs.
5) Those who attempt to deflect their personal failings on to others.
6) Those who assume Grand Job Titles, sit in offices and preside over skill/mix dilution and inadequate staffing levels
Clearly I could extend this list without difficulty but hope you will all understand the main thrust of my argument.
Until the "profession" takes collective responsibility for the eradication of poor practise, the results of which feed the news media and lead to enquiries such as took place in Stafford we will all suffer the consequences and continue to loose public support and confidence.
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Juggling Dog | 30-Jul-2012 3:47 pm
Life in general, turns out to be complicated - why should nursing be any different ?
The specific issue in the NHS, is how to deal with varying levels of expertise among staff - go for 'let them get on with it' and that breaks down if people are not sufficiently expert and well-trained, and go for 'everything is tick-box' and that annoys the competent, helps the less competent to not make serious mistakes, but also fails in unusual situations.
Having 100% expert and well-trained staff would be ideal, but in this world less expert staff cost less, and we can't have that perfect world, can we - working out where the best balance is, is very tricky !
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Anonymous | 30-Jul-2012 6:23 pm
excellent article and very valid comments.
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tinkerbell | 30-Jul-2012 7:10 pm
Anonymous | 30-Jul-2012 5:45 am
well said.
None of us are expert in everything obviously but if we can't seek advice when we are concerned about a patients condition then there's really not much point in us being there. Think it's called using your initiative.
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Anonymous | 2-Aug-2012 10:39 am
very well said.....as a nurse we have a responsibility to look after our patients. To keep them safe whilst in our care. It only takes common sense...when you are in doubt ..asked. I know we are all busy...staff are not sufficient at times..but still...i believe we could all spare a minute to help our patients. Not only the nurses..there are other members of the team who are involved with the patient care.
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Miriam Ventura | 2-Aug-2012 10:39 am
very well said.....as a nurse we have a responsibility to look after our patients. To keep them safe whilst in our care. It only takes common sense...when you are in doubt ..asked. I know we are all busy...staff are not sufficient at times..but still...i believe we could all spare a minute to help our patients. Not only the nurses..there are other members of the team who are involved with the patient care.
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Anonymous | 2-Aug-2012 11:01 am
Excellent article, which makes valid points and has prompted comments that expose the huge cultural issue to be overcome. There are nurses who despite the current challenges, remain passionate about the care they give and then there are those who prefer to put their energy in to critisising those who are trying to find solutions to those challenges.
This is an imperfect world and we are faced with some incredible challenges and nurses in senior positions trying to find ways to meet the demands placed on them to cut costs are in an impossible situation. There is no doubt it threatens the quality of care and patient safety when you dilute numbers or skill mix, but instead of complaining about this, we need to pull together as nurses and work together at all levels to see if there is a better and safer way to get through this. Only this will ensure we can protect those who are dependant on us for their care and to keep them safe.
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Anonymous | 3-Aug-2012 11:34 am
Thank you for a good article. However, the amount of work that has been delegated to HCAs now means that HCAs are effectively nurses. They go about their duties very little supervision. BUT as they are not nurses, if they do not highlight areas of concern to the registered nurse(s) on duty then patient care will be lacking. And of course they are not paid or trained to know about complex conditions such as diabetes insipidus. That is why nurses are needed and this issue highlights the fact that registered nurses are still needed, despite the govt drive to eradicate as many as possible. But us nurses and our union have done little if anything to support registered nurses, in fact the RCN have gone all out to try and register HCAs. To all HCAs reading this, please do not take umbrage as it is not a slur on your wonderful care of patients, I am simply highlighting the truth of the situation as I see it.
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Anonymous | 3-Aug-2012 11:47 am
There is no reason why an HCA cannot learn about complex medical conditions, A&P, diagnosis and treatment. Many I work with know loads of stuff because they are interested in what is wrong with their patients.
Qualified staff have a duty to share their knowledge with all the staff regardless of their grade. Managers have a duty to ensure all their staff know what they are doing.
When I was a student nurse I didn't know about diabetes but it was my responsibility to find out about it so that my patients were well looked after.
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Anonymous | 4-Aug-2012 2:53 pm
Excellent points made in the article and by many of the respondees. One point overlooked I think is the need to admit that 'I don't know .... (about the condition, the treatment, what to do etc)'. There is no shame in this - indeed there is greater shame in attempting to manage a patient's condition when we don't know what we're doing - other than our best. BUT it won't be our best without being willing to admit when we don't know.
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Juggling Dog | 4-Aug-2012 3:09 pm
Anonymous | 4-Aug-2012 2:53 pm
There is a paradox, about 'I don't know'.
The more competent and expert an individual is, the more they tend to be willing to admit 'I don't know/understand this' - presumably because if your reputation is already high, nobody else is likely to think 's/he should know it'. The less 'esteem' someone is already held in, the less likely the person is to admit to not knowing things, because (I suspect) of the 'that's because you are dim' response.
But it is remarkable, how often lots of others join in with 'me neither' after the first person has said 'I just can't get that'.
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Anonymous | 4-Aug-2012 4:17 pm
the only important thing is to understand what you need to or wish to know. ask until you do, it really doesn't matter how many times you need to ask or what others think of you for not knowing in the first place. remarks like don't you know that, you should know that, haven't you learned that yet, etc. are unhelpful and more a reflection of the shortcomings of those making the remarks!
there are many things we don't understand and never will, if these are unimportant to you and of no interest or value to you then it doesn't matter either and your time is better spent on finding out and getting answers to what matters to you and the safety and good care of everybody involved.
Remember, you know plenty that others don't know. shared knowledge is far better than giving or accepting destructive criticism or than the perceived fear of feeling a fool.
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Anonymous | 4-Aug-2012 9:17 pm
How I agree with the latter comment. I would much rather be viewed as 'stupid' or 'dim' (or whatever) than hurt a patient - surely most nurses would feel this way? Or would they ............................
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tinkerbell | 4-Aug-2012 9:55 pm
Anonymous | 4-Aug-2012 9:17 pm
Totally agree with you especially when peoples lives are at stake.
I will freely admit in front of my colleagues when i don't know something, even if they think i should know, sometimes just to give them the confidence to realise it's OK to say 'i don't know' regardless of seniority or how many years experience in post. That's how we learn. I will always defer to another nurse in a different speciality 'you know more about this than I do can you give me some advice'. There's no harm in it, the only harm comes to the patient and ourselves when we can't get over ourselves.
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King Vulture | 5-Aug-2012 12:19 pm
tinkerbell | 4-Aug-2012 9:55 pm
That's what the Dog said - you are relatively senior and experienced, so you don't feel threatened by admitting to not knowing everything:
'I will freely admit in front of my colleagues when i don't know something, even if they think i should know, sometimes just to give them the confidence to realise it's OK to say 'i don't know''
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tinkerbell | 5-Aug-2012 5:52 pm
King Vulture | 5-Aug-2012 12:19 pm
Yes i meant to mention that i totally agreed with The Dog, especially when he/she said
'But it is remarkable, how often lots of others join in with 'me neither' after the first person has said 'I just can't get that'
i find that happens a lot too.
What a lovely collection of animals we have on here.
They seem much more outspoken/assertive/confident than some of us humans.
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Anonymous | 5-Aug-2012 9:50 pm
I have enjoyed reading all the previous comments and feel that I must add my comments to the list. I finished my RN training back in 1964, in the days when there were no care plans etc. We did however try to understand for what and why, our patients needed treatment and how to nurse that particular patient. Despite having officially retired, I do work as a bank staff nurse in a small but busy day surgery unit. I make a point of looking up anything that I do not understand or cannot remember.A patient with Diabetes Insipidus was in for minor surgery just last week and I was able to look it up to refresh my memory and to explain the disease to the HCA with whom I was working.
If we all made time to pass on our knowledge to HCAs, and to explain the importance of communication within a team, perhaps these horrendous mistakes would not happen.
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Anonymous | 6-Aug-2012 3:25 am
Reference to my earlier post (Anonymous | 30-Jul-2012 5:45 am)
Here is just another example of neglect -- When is this going to end ??
The full storey can be read at:-
http://www.dailymail.co.uk/news/article-2183935/Parents-horror-finding-12-year-old-daughter-lying-NHS-hospital-bed-rigor-mortis.html
"Although Emma, who was wheelchair bound, should have been monitored every four hours, three nurses failed to look in on her during the night.
Evidence given to the hospital’s internal inquiry by the nurse who found Emma’s body suggested that rigor mortis had already set in. One nurse was suspended as a result of Emma’s death and later received a warning at an internal disciplinary hearing. Nobody has been dismissed."
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Anonymous | 6-Aug-2012 9:26 am
I must disagree with the title of this article.
The concept of nursing is simple and one of the problems in hopsitals these days is that people try to over complicate things.
Nurses need to observe their patients (if they aren't doing this then the patients may as well be at home), they need to administer medications correctly at the correct times and they need to coordinate other members of the MDT in the ward areas. They need to recognise when something is wrong (basic nurse training) and call for help in good time from appropriate team members when they have managed things to the best of their ability. They need to follow protocols and policies which are there to protect the patient, protect the nurse and protect the establishment.
This is nursing, not rocket science.
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