Practice team blog
One night you can manage but after a few nights short of sleep you feel jaded and don’t think and respond as well as you would like.
Sleep is important and even more so when you are ill. A recent study found that patients with heart failure who had a history of sleeping badly had a doubled risk of being admitted to hospital compared to those with a normal sleep pattern.
This Swedish study presented at the European Society of Cardiology meeting earlier this month concluded that we should be asking patients more about how they sleep as it is an important part of their recovery. Those identified as bad sleepers need to have the reasons explored and help with sleep hygiene including how they prepare to sleep. Otherwise poor sleeping may be linked to stress or worry or to medication, issues which can be addressed
As well as asking patients about their sleep history, nurses can help patients in hospital to sleep as well as they can with many small but effective measures. Making sure that wards are kept quiet, that staff talk and walk softly, that visitors to the ward are respectful of patients’ rest, and that patients are left to sleep in if they can and want to. Most people would not get up at 6am every morning so why would they want to do it in hospital? This study confirms that poor sleep hampers recovery. We all know the importance of sleep – let’s make sure we act on it.
After Mr Benn’s death was announced a few weeks ago I thought about that conversation and was struck by how my experience compared to so many others. Mr Benn had an amazing ability to listen, ask relevant questions and appear genuinely interested in my answers. When he got off the train I realised that he had said very little about himself and why he was on a train to Leicester but he had found out a lot about me.
This experience brings me to the NHS. I talk to a lot of nurses about their working lives and what I hear from them is that no one really listens to what they have to say. Many describe the board visit to the ward, the chief exec doing a walk round or staff meetings with managers as frustrating interaction. Staff are left with a feeling that people are going through the motions of appearing to be interested when they are in fact rushing to be elsewhere.
The only way managers can really know what is happening to patients is to talk to them but also to those who care for them. Engagement with clinical staff has to be more than popping in for a quick chat or rolling your sleeves up for the odd shift. It has to be continuous cycle of mindful listening and feedback. Until this happens staffing will continue to feel “done to”.
Tony Benn made a huge impact with his life and I wonder if part of this was due to his ability to listen and absorb information which he was able to assimilate and reflect back to his audience. I am sure that NHS managers could make good use of his listening skills to make proper use of the information that the staff on the frontline are feeding to them.
News that heavy drinkers are to be considered for liver transplants led to a predictable flurry of comments on national press websites. Many were along the lines of “it’s a waste of a liver”, “why should I fund surgery that just lets them carry on drinking”, or “the NHS shouldn’t offer this to people who have brought it on themselves”.
The less responsible media (yes you, Daily Mail) didn’t bother to mention that the NHS Blood and Transplant pilot scheme will involve only 20 patients and is designed to assess the benefits or otherwise of offering transplants to people with severe alcohol-associated hepatitis in some fairly tightly defined circumstances. But then, the image of hordes of rampaging drunks storming transplant centres across the UK and stealing livers from “deserving” recipients will attract more comments and clicks.
There are some aspects of healthcare that will raise debates about whether finite NHS resources should be spent on them – and treatments for conditions related to alcohol, tobacco or drug use top the list. But if you start making judgements about whether people “deserve” treatments, where do you draw the line?
Did I deserve a knee operation to repair damage sustained while skiing? Should someone who falls and sustains a fracture while drunk pay for their own treatment? And what about IVF – should the NHS fund that? It’s not like there’s a shortage of babies is there?
In a world of infinite demand for healthcare and finite resources, decisions about who receives treatment involve hard choices and inevitable losers. But these decisions should be based on evidence of costs and benefit rather than moral judgement.
Not wanting to miss out on the excitement, I took my laptop to reception and based myself there to meet our shortlist.
It wasn’t difficult to spot who was there to present to our judges. They all wore a uniform nervous smile and immediately reached for a copy of Nursing Times on seeing the strategically placed pile in the waiting area.
Within about an hour I suddenly became incredibly grateful that as a member of the Nursing Times team I have no say over who wins. Although I didn’t sit in on the actual judging, if the enthusiasm coming through the waiting area was anything to go by, the judges were not going to have an easy decision.
As nerve-wracking as the judging process can be, not one of the students, mentors or teams I spoke to failed to say how grateful they were to be shortlisted.
Student nurses work so hard and make an important contribution to the healthcare team. When they go above and beyond and show immense promise this needs to be recognised.
I’m not saying we should give an award to every student nurse who has gone out of their way to make a difference to a patient or taken initiative to bring something new to their placement area. Being noticed for working hard gives student nurses the motivation they need to get through what is undoubtedly an incredibly tough course.
Our way of saying thank you to student nurses is to run Student Nursing Times Awards, how do you thank your students?
As we know nursing is a 24-hour job. Patients that need care require it just as much at two o’clock in the morning as they do at three in the afternoon. And they need it as much at weekends as they do during the week.
The requirements for the nursing profession to deliver are relentless with increasing numbers of older and frailer patients with many comorbidities. Healthcare is becoming more and more complex as is the technology required to deliver it.
It is the relentlessness that makes it difficult for nurses to be able to take time out for training. Possible as individuals. As teams, well near impossible. Well one hospital has solved this conundrum in a very innovative way.
Barts Health has invested in a project which allowed teams from 14 older people’s ward to each take a week away. One after the other the ward teams spent a week together looking at how they could improve their care and their communication with each other. Each team returned to work with a supported action plan.
So what happened to the patients? For a six- month period the trust employed a shadow team to replace the ward team that was away. The shadow team included a matron and qualified staff – many of whom have now taken jobs on the same wards at the end of the project.
Most ward teams can only dream of spending a lunchtime meeting together. This was an amazing opportunity for these teams – let’s hope it can be replicated elsewhere.
How difficult can it be to take a glass of water, put it to a patient’s lips and get them to drink?
Most readers of Nursing Times know just how difficult it can be. It may be because the thickened fluids are unpalatable, or the water is too hot or too cold; perhaps someone forgot to put sugar in the tea or added too much but the patient can’t tell you.
Encouraging patients to drink can be a battle of wills, with the nurse desperate to record some intake on a fluid chart and avoid the need for an IV with the patient just not feeling up to it. All the while, family members are anxiously flipping through the charts and wondering why their loved one’s fluid intake is so poor.
When things get difficult it is up to nurses to rise to the challenge and think about how they can do things differently. For example, the author of an article in this week’s issue looked at types of thickener used in the care homes where she worked. She highlighted the importance of getting the right product and using it correctly to improve not only the texture and appearance of fluids but also patient safety.
Another nurse, Naomi Campbell who is hydration lead at Peninsula Community Health, has developed the “micro-straw”, a device that allows patients to independently sip fluids with minimal effort, in order to reduce reliance on nursing staff. She has received £15,000 from NHS Innovations Southwest to develop her idea.
We can’t all invent a new device but every nurse can do something to improve fluid and nutrition intake.
This is International Nutrition and Hydration Week and at Nursing Times we have organised a number of key activities throughout the week to help you to improve your practice, including free access to clinical articles, an ask-the-expert webchat, and on Wednesday you can complete our Nutrition Screening learning unit free of charge. To find out more, visit www.nursingtimes.net/nutrition
Full list of events on NT:
Monday 17 March:
We reveal this week’s free articles on the Nutrition and Hydration clinical zone.
Tuesday 18 March:
Throughout the day we will be tweeting facts and useful links, follow @NursingTimes to take part.
1pm: Ask the Expert Webchat – we’re joined by experts from the National Nurses Nutrition Group who will be answering your questions live on our webchat page. If you can’t join us at this time, you can email your questions to Eileen.firstname.lastname@example.org and we will ask them for you. A transcript will be available following the chat.
Wednesday 19 March:
Our Nutrition Screening learning unit will be FREE for 24 hours.
Thursday 20 March:
Pledge Day – tell us what you could do differently to improve nutrition and hydration in your area. Our favourite will win a nursing textbook from Sage Publishing.
Join in through twitter or on the Nutrition and Hydration page.
Friday 21 March:
Free CPD – These two learning units will be FREE to complete throughout the day:
- Dysphagia unit
- Obesity – an introduction to management in adults
Last week’s announcement that an apprenticeship route into nursing is to be developed has caused quite a stir.
Despite vociferous opposition from the “too posh to wash” brigade – who maintain nurses do little that requires the ability to think, this year nursing finally becomes an all-graduate-entry profession. And the benefits of having a highly educated nursing workforce have been confirmed by the authors of a huge Europe-wide study, who conclude that all-graduate nurses could reduce preventable deaths. It seems unfortunate timing, therefore, to announce a scheme whereby “the brightest and best” healthcare assistants can skip the requirement to go to university yet still gain a nursing degree.
Although we don’t have all the details yet, it’s difficult to see how it will be anything other than a “degree-lite” if there is no requirement to attend university. It’s also difficult to see how a 50:50 split between theory and practice can be achieved, or how NMC-approved education providers can deliver the apprenticeship – unless non-university institutions are to be approved.
I can see the logic behind a scheme supporting the brightest HCAs to become qualified nurses, but if the current system of access courses doesn’t work, surely that should be improved? We need to enable those capable of gaining a degree to do so, but this must not involve anything that devalues – or even just appears to devalue – existing nursing degree courses. Universities won’t attract the brightest and best prospective students onto nursing degree courses that are perceived to be equal to apprenticeships.
However, while the academic integrity of the nursing degree must be protected, all-graduate entry has widened the gap between HCAs and nurses. It leaves a huge group of HCAs who are capable of providing high-quality, compassionate care but who don’t have the academic capabilities to gain a degree with little opportunity to develop their careers and improve their incomes.
Some employers are addressing this issue by improving career pathways for HCAs. These HCAs are being trained to take on more responsibilities specific to their individual roles and capabilities, and employed at band 4; their role could be compared to that of the old enrolled nurse.
Surely it makes more sense to improve career opportunities for HCAs than to risk devaluing the nursing degrees the profession has spent decades fighting for?
I spent a day last week experiencing the adult student nurse programme at City University in London. The student nurses on that programme will be spending time on placement on the same wards that I trained on 35 years ago. Without a doubt I know who is getting a better deal – the patients now.
There is a myth that some hold that it was good to have trained as a nurse before Project 2000 which actually took place in 1986 not at the turn of the century. That it was better to have trained when you were based at a hospital, when after only 12 weeks of preliminary training school you went straight to work on the wards, not supernumerary but on the rota. And before long you found yourself as a second year in charge on nights.
And the often-touted belief that in those good old days you really learnt to nurse not like now when it’s all theory and no practice.Well on my visit it was very clear to me how well supported student nurses are today. And how better prepared they are to look after a patient then we ever were.
“it was very clear to me how well supported student nurses are today”
Their course includes experiencing patient care in a simulation lab where there is time to practice, reflect and think about how best to care. The lectures were interactive and stimulating and include the use of patient stories told by real patients. They will be many months into their training as a nurse before they are expected to look after a patient and their supernumerary status allows them time to grow and develop their skills.
So if I was a patient now and had to choose between being nursed by me as a student as I was 35 years ago or by one of the students prepared by the programme I witnessed last week. Well as a patient it’s an easy choice. And as a student nurse it’s the same answer.
If I could have my time again I would love to follow one of the programmes offered now.
Last week ITV aired the first of its new series looking into the lives of student nurses. The producers say ‘Student Nurses: Bedpans and Bandages’ will offer “insight into what it takes to become a nurse in the 21st century”.
What a huge responsibility for the group of student nurses featured, not to mention their tutors and the teams they’re working with. They’ve been given a unique opportunity to challenge the negative stereotypes about nursing and nurse training that have emerged in recent years, and I hope the producers allow them to do this.
When we asked student nurses on Twitter back in August what they would like to see included in a documentary about their training, the overwhelming response was that they wanted people to realise and appreciate just how much work they do and the role they play as members of the multidisciplinary team. Many voiced that they feel the general public think nursing is an easy degree, requiring little academic input.
The title “Bedpans and Bandages” does little to challenge this stereotype. Although, arguably, calling it “Coursework and Exams” would do even less for the cause as no one would watch it.
My worry was that the programme would be edited for entertainment, and feature a set of larger-than-life characters whose lives appear to alternate between embarrassing moments and heartbreaking scenarios that cause them to question themselves and grow as a person in the 10 minutes they are being filmed.
The first programme, however, felt accurate. Yes, there was motivating music, tears and spilt urine samples. But it also showed the levels of responsibility students are exposed to, it showed their need to be personable and the high levels of intelligence and initiative that are essential to becoming a nurse.
It featured an incredibly likeable student nurse sat at a desk voicing her surprise about how much work the course entailed, accompanied by close-ups of her crowded timetable. Nurses were shown leading healthcare, making quick decisions and challenging anyone who dares suggest the profession lacks compassion.
Have you been watching? What do you think?
I was shocked last week by the RCN’s decision to remove indemnity insurance from most nurses.
The RCN described this as a “small” change.
While it may seem a small change to the college I am sure many nurses will be astounded to hear that they will no longer benefit from this cover.
I joined the RCN in 1981 as a student nurse. The three main unions at the time RCN, COHSE and NUPE were eager to attract our membership and our fees. But the main attraction of the RCN was the offer of indemnity insurance. After all what would you do if someone sued you?
Even when I became aware that vicarious liability meant my employer would cover me in most circumstances I held onto my membership. In the back of my mind was an insecurity that if it indemnity insurance was offered by the RCN as a membership benefit then it must be important. Perhaps that just demonstrated my naivety, but throughout my clinical career I maintained my membership because it offered me this reassurance.
From 1 July 2014, work undertaken by RCN members who are employed – for example by the health service or an independent healthcare provider – will be excluded from the indemnity scheme’s coverage. Self-employed members will remain covered, but aesthetic practice will also be excluded from because of the high claims risk associated with this area of practice.
I appreciate the RCN needs to tidy up its policies and finances and has concerns that some employers were passing on claims relating to its members to the college, but it has failed to explain why it offered a benefit that was actually of no benefit to most members in the first place.
It seems to me that buying into union membership is a bit like choosing an energy supplier. You have to look at carefully at all the benefits before typing in your bank details.
If you want to know more about vicarious liability click here.