Practice team blog
All posts from: August 2012
She mentioned how she had been subpoenaed to appear in court as a witness in a false claim for work-related injury brought by a nurse on her ward.
Fortunately for the hospital, the nurse had failed to check her facts, and had claimed to have been left alone and forced to move an obese patient. Had she done her research she may not have chosen to cite a patient who had cachexia due to advanced cancer, or to claim the injury occurred on a day she was not on shift.
Of course the nurse received no compensation - but that was the end of the matter. Her union had funded her case, and the hospital took no action against her for making what was obviously a fraudulent claim so while she didn’t make any money, nor did she lose anything.
Many health professionals, but particularly nursing staff, incur serious work-related injuries for which they justly receive financial compensation - although most would probably prefer to give the money back if they could regain their health. But there are always a few bad apples in any barrel - and most of those who make fraudulent claims probably do their homework a little more thoroughly than this nurse. They also have access to unscrupulous ambulance-chasing legal services who will ensure they do not make elementary mistakes.
With budgets stretched to breaking point and jobs being axed to save money, the NHS cannot afford to spend thousands defending fraudulent claims. Perhaps it is time to hit back. In situations as blatant as this nurse’s, surely there is an argument for suing or pressing criminal charges rather than letting them go unpunished? It would not take too many frauds being made an example of to make the stakes high enough to deter others.
It’s a long time since I worked as a care assistant in a home for older women with dementia, and back then older people’s nursing (or geriatric nursing as it was known) was called the Cinderella service. It was seen as a backwater where nurses went if they had either no talent or no aspirations.
An episode of The Undercover Boss on Channel 4 recently featured the MD of a care home group going into her homes to see first-hand the challenges her staff faced. One manager spoke of the difficulties in recruiting qualified nurses - the stress of trying to cope without the continuity offered by nurses on staff was written all over her face. Despite her obvious dedication to her job and love for her residents she resigned while the programme was being filmed.
I don’t think anyone who understands the challenges of nursing older people would say it’s a specialty for people with no talent or aspirations, but it does still seem to be something of a backwater. I’ll admit to a personal interest here - my Mum is frail and confused and living in a nursing home, albeit one in which the care is excellent. However, it saddens me some elements of the Cinderella image prevail.
Nursing older people requires a range of clinical skills to manage comorbidities for which treatments often conflict. It also requires excellent communication skills to compensate for sensory or cognitive deterioration. But it is also a hugely rewarding specialty. Older people have so much life experience to share, and if you take the time to get to see beyond their health problems many are great company - and the long-term contact of nursing homes offers real opportunities to develop meaningful nurse-patient relationships.
Older people deserve the best - maybe it’s time for Cinderella to go to the ball and gain recognition as a career destination for the best and most ambitious patient-focused nurses.
When I was a student we used to ask patients to do the milky drinks rounds in the evenings.
Those were the days - when patients stayed in hospital until their stitches came out and we worked in predictable peaks and troughs with the occasional crisis. Life was less complicated 30 years ago. Patients trusted their nurses and there was never an expectation that anyone would complain.
The challenges faced by nurses today are so much more complex. Even if you had a patient well enough to do the hot drinks, they would probably not be allowed to help for health and safety reasons. The pace of change is rapid and it feels as if nursing has failed to keep up and engage the implications of this change.
We need to have that tricky conversation about what nursing is, what is driving its development and whether a direction is right for patients’ care. An example might be 12-hour shifts. They save money and might be good for staff arranging child care or social lives, but are they good for patient safety?
Marie Manthey, the advocate of primary nursing, gave some great advice that I always used when considering any change in practice: “Patients matter most but staff matter too.”
The new CNO of England, Jane Cummings, has laid out her vision for nursing and underpinned it with values: care, compassion, courage, commitment and communication. It is easy to be cynical but I think she has captured, in those five words, what nursing is.
She has started a dialogue about what nursing is and it is up to the profession, at all levels, to engage and take up the debate. This appears to be a real opportunity to talk about what nursing really means and define a philosophy for the future.
Imagine every nursing team across England sitting down for an hour and using the ‘five Cs’ to carve out their philosophy of care. An hour to write down what nursing means to them on their ward, unit or department and how they can achieve their goals. There is power in being able to articulate why your work is important, why it should be valued and to celebrate what you do well. It also helps to clarify when concerns should be raised and where change needs to happen.
Nursing has to change at grass roots level - anything else is merely cosmetic. So let’s stop talking audit and dashboards for a minute and think about what nursing should be. What is the value of empathy, compassion and care? How can nurses provide the best care all day, every day? What are the limits of nurses’ roles? What do patients actually need and want from nurses? When do nurses make a difference?
Being clear about what drives and motivates you and feeding this into the national debate is vital for patient care. With clear vision we can recapture public respect, but more importantly, their confidence in what we do.
An elderly woman said to me recently that she wore incontinence pads because it was easier for the nurses.
She needed to be hoisted in and out of bed so had to ask two nurses to use the hoist to put her on the commode or toilet. However, she said that she did know at least half of the time that she needed to use the toilet so with support and reassurance from the nurses could have maintained her dignity by using a commode or toilet.
Patients who are in hospital for a long time or who are being cared for in a nursing home can lose sight of their rights as an individual as part of being institutionalised. They start to put the nurses before themselves and try to do what they think the nurses find easier. Maybe it’s in some way like a prisoner trying to please their captors. And who wants to be unpopular with the people you depend on!
Ward and nursing home routines can rob the individual patient of their autonomy. However, nurses can try and find flexibility where they can to allow and encourage the patient to be an individual. If a patient likes to stay up late watching TV, nurses can position and settle them later rather than doing so just because the clock says that it is time.
Patients who have previously been independent do find it hard to accept that they need assistance and have to ask for help. Reassurance from nurses, that the assistance they offer is their job and that the patient is entitled to it, will need to be offered regularly. Nurse can help patients find their way by treating every patient differently because let’s face it, they are.