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The care gap that cheats nurses and patients alike

Posted by:

10 December, 2012

As the news focuses again on the dangers of going into hospital and the pressure I wonder if we are missing something fundamental.

I know from my own experience how quickly things can go wrong when the bed pressures take precedence over safety. Some years ago I worked a night shift on a ward with seven empty beds.

Within 15 minutes of starting work we had four patients arrive, three at the same time. The admissions ward refused to hold off on the next three patients who arrived in short succession. At 2am we were still completing assessments, trying desperately to get through the work.

Then the cardiac arrest buzzer went off. One of the new patients had arrested and by the time we confirmed she was not for resuscitation, CPR was well under way and the team had been called. No-one remembered the transfer nurse handing the DNR over and the admitting nurse had not had a chance to look in the patient’s notes.

The patient didn’t survive, she died alone and she didn’t get the end of life her family had been promised.

We wrote an incident report but like many nurses we finished a shift feeling we had worked really hard but let our patients down.

I seems to me that just as the Beveridge Report could not have anticipated the effect of modern pharmaceuticals and medical advances on longevity, neither have we really got to grips with the demand that an ageing population is putting on our health care system.

There is endless talk about the need to provide more care in the community but while there is a shift in that direction, these developments are not keeping pace with demand.

Without adequate community services is it surprising that pressure on beds and pressure on staff is increasing and mistakes happen?

Currently we have hospitals with too few beds and community services that are not sufficiently developed to provide acute care at home. Between the two is a huge gap that no one wants to take responsibility for.

The people who suffer most are the old and vulnerable who end up in a system that is not designed to meet their needs being cared for by people who care but simply don’t have time. That is not good for anyone.

Readers' comments (27)

  • what's an 85% bed occupancy rate - our beds are never empty, we have had patients sitting out in chairs waiting to be discharged whilst the new patient is put into their bed.

    everyone is suffering, not just the elderly, it's time to get real about the state of the nhs. there are not enough beds in any speciality - operations are frequently cancelled, ITU are always on red alert, A&E departments close because there aren't enough beds.

    doesn't anyone actually listen to what health staff are saying.

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  • Anonymous

    'We wrote an incident report but like many nurses we finished a shift feeling we had worked really hard but let our patients down.'

    Bad for morale, isn't it ?

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  • Anonymous | 10-Dec-2012 11:53 am

    "doesn't anyone actually listen to what health staff are saying."

    No. Because nurses neither say it loudly enough nor insistently enough.

    Many of those who comment here will be the exceptions, because they often write about all the actions they take in their own areas. However, they are very much in the minority.

    Most nurses are very good at seeing what is wrong and what it would take to put it right. They are also extremely poor at articulating these facts effectively or actually doing anything constructive about it. In fact, they usually add to the problems and make them worse by accepting every mad policy and patient-endangering scheme introduced by the muppets at the top. None of this will stop until we stop it. Having been in that minority for 30-odd years, I have come to the conclusion that nurses are incapable of doing the best for their patients, because they are too busy being victims. They complain that they are too busy to do anything about the NHS. When will they see that changing the NHS and making it work for the patients and staff, will give them back that time and transform their ability to do their job in the way we all want to see it done?

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  • michael stone

    Anonymous | 10-Dec-2012 3:55 pm

    Yes, you make good points - but without having been a nurse myself, I have seen many media reports, and various posts on NT, that reveal that 'bad managments/bad cultures' treat 'critical feedback' from nurses, and indeed from doctors, as something to be silenced rather than as something that could lead to an improvement if thought about properly.

    Sorting that issue out, has got to be a major part of the solution to this problem, surely ?

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  • DH Agent - as if ! | 11-Dec-2012 2:41 pm

    "Sorting that issue out, has got to be a major part of the solution to this problem, surely ?"

    I agree. And the way to do that, is by being loud and insistent. And the way to do do that, is to take united and effective action, and not stop until we have achieved the solution. 'Feedback' isn't going to do anything.....it never has. Not enough incident reporting occurs. The vast majority of issues and incidents actually go unreported. Changing bad management and culures simply will not happen on its own, and nurses need to stop waiting for it to happen.

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  • As long as Patients and Care are measured in "pounds shillings and pence" by the Muppets who decide which of the hospitals/ GP surgeries and all the other care providers can have money to run, Nurses will have to learn the pounds shillings and pence language to communicate effectively with them.

    As I say, they are Muppets, so can only speak one language, filthy lucre or "how much of it can we save, so that our jobs are secure, because we are tighter than Scrooge and the goal is to be cost effective". To be sure, they will not be putting themselves or their loved ones into the NHS system if they can help it, if they need hospital/ primary care, so they won't know what first hand experience of their policies have done to good people - both patients, Nurses and other types of carer.

    Sadly, also, it is pretty well impossible to transcend the philosophical gap between the psycho-social world of care, compassion or even just dignity. So try as we do( and some of us do with ear piercing/heart rending shrieks), our pleas fall on tuned-out ears of the Muppets who hold the purse strings.

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  • Penny Nibbs | 11-Dec-2012 7:46 pm

    "Sadly, also, it is pretty well impossible to transcend the philosophical gap between the psycho-social world of care, compassion or even just dignity. So try as we do( and some of us do with ear piercing/heart rending shrieks), our pleas fall on tuned-out ears of the Muppets who hold the purse strings."

    Because not nearly enough of us try. UK NHS nurses are the largest single workforce in Europe. It doesn't take a rocket scientist to figure out that, working together, we would indeed be a force that it would be impossible to ignore. But we don't work together. Our patients suffer and so do we. That isn't going to change any time soon....

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  • michael stone

    Anonymous | 11-Dec-2012 9:10 pm

    Mark posted a piece about, loosely, 'why do nurses seem to lack power and get ignored ?' and it didn't attract many replies.

    But there is something, it seems (perhaps something hierarchical, perhaps some consequence of nursing being female dominated - I'm not sure) that does seem to result in nursing having a much 'quiter voice' than its numbers would suggest it could have. So perhaps the solution is to convince the people at the very top that the voice of nursing needs to be heard, but will not be heard unless they establish 'an enviroment that encourages reluctant nurses to speak out' ?

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  • It's all very depressing.

    My hospital has been criticised for putting patients into 'escalation areas', essentially window-less rooms intended for storage or short procedures. In the meantime, the PCT has closed community beds, sold off the hospitals and subsequently opened 'de-mountable wards', better known as porta-cabins, for stroke patients.

    The other day, my manager said there was good news - we are getting extra nurses to look after patients in the corridor....

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  • Anonymous | 11-Dec-2012 9:10 pm

    "Because not nearly enough of us try. UK NHS nurses are the largest single workforce in Europe. It doesn't take a rocket scientist to figure out that, working together, we would indeed be a force that it would be impossible to ignore. But we don't work together. Our patients suffer and so do we. That isn't going to change any time soon...."

    Unfortunately, very true.




    DH Agent - as if ! | 12-Dec-2012 11:20 am

    'why do nurses seem to lack power and get ignored ?'

    I didn't catch Mark's article, but I am sure the answer to that is fairly complex and I could never do it justice in these little NT boxes.

    I know that I came into Nursing to care for people. It was never my wish or expectation that, in trying to be an advocate for decent care for my patients, I would come to believe that industrial action and even striking would be the only way to achieve that. I can't even begin to describe how alien that is to a nurse. Some agree with me, but many don't take the same view.

    I agree that the female-dominant nature of the profession is also a factor. Nursing is a physically, mentally and emotionally challenging job and, in spite of this age of so-called equality, women for the most part, carry the responsibility for being the main carers at home. This doesn't leave much time or energy for a fight against the government or other such muppets. With some exceptions, women generally lack that competitiveness and killer-instinct that more men possess. So we don't fight in the same direct way that men do.

    I also read some research (I must try to dig it up and post a link) a couple of years ago, that there is a mentality within some nurses where they almost enjoy being in the position of martyrs. (That, of course, could be generalised to the population at large). It wasn't comfortable reading, but it was hard to disagree with some of the conclusions. It is easier to moan and be a victim (you'll get lots of sympathy and people telling you that you are 'an angel'), than it is to stand up on a box and shout "enough is enough, let's strike and get this sorted" (you'll get lots of people telling you that you are 'unprofessional' and will be accused of putting your patients at risk.

    Patients (and staff) are more risk now than they have ever been since the inception of the NHS. Yet those who carry out the largest part of their care are standing by, and even accepting the blame, whilst it all deteriorates around our ears.

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  • Anonymous | 11-Dec-2012 9:10 pm

    "Because not nearly enough of us try. UK NHS nurses are the largest single workforce in Europe. It doesn't take a rocket scientist to figure out that, working together, we would indeed be a force that it would be impossible to ignore. But we don't work together. Our patients suffer and so do we. That isn't going to change any time soon...."

    Unfortunately, very true.




    DH Agent - as if ! | 12-Dec-2012 11:20 am

    'why do nurses seem to lack power and get ignored ?'

    I didn't catch Mark's article, but I am sure the answer to that is fairly complex and I could never do it justice in these little NT boxes.

    I know that I came into Nursing to care for people. It was never my wish or expectation that, in trying to be an advocate for decent care for my patients, I would come to believe that industrial action and even striking would be the only way to achieve that. I can't even begin to describe how alien that is to a nurse. Some agree with me, but many don't take the same view.

    I agree that the female-dominant nature of the profession is also a factor. Nursing is a physically, mentally and emotionally challenging job and, in spite of this age of so-called equality, women for the most part, carry the responsibility for being the main carers at home. This doesn't leave much time or energy for a fight against the government or other such muppets. With some exceptions, women generally lack that competitiveness and killer-instinct that more men possess. So we don't fight in the same direct way that men do.

    I also read some research (I must try to dig it up and post a link) a couple of years ago, that there is a mentality within some nurses where they almost enjoy being in the position of martyrs. (That, of course, could be generalised to the population at large). It wasn't comfortable reading, but it was hard to disagree with some of the conclusions. It is easier to moan and be a victim (you'll get lots of sympathy and people telling you that you are 'an angel'), than it is to stand up on a box and shout "enough is enough, let's strike and get this sorted" (you'll get lots of people telling you that you are 'unprofessional' and will be accused of putting your patients at risk.

    Patients (and staff) are more risk now than they have ever been since the inception of the NHS. Yet those who carry out the largest part of their care are standing by, and even accepting the blame, whilst it all deteriorates around our ears.

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  • I don't know why the first submit posted anonymously! Gremlins!

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  • michael stone

    Mags,

    I agree with your comments, and in particular I agree that women tend to have to act as the glue holding families together, and sometimes are consequently less single-minded (and perhaps have less time) in pushing things (you could argue, 'are less selfish in their actions').

    Mark's piece was essentially 'are nurses not listened to seriously because of sexism ?' and it is probbaly partly sexism, but there are other issues.

    But moaning and complaining are on the same range of activities, and it does seem to me that nurses do a lot of moaning to each other - that isn't going to change much. I complain directly to the people who might have an effect - for example, Chris Cox at the RCN has commented on a 'possibly perverse consequence' of this new 'openness requirement'. There is already some perverse guidance because of a misunderstanding by clinicians of a law, and when I re-find his e-mail address (I contacted Chris a couple of years ago) I'll be sending an e-mail to Chris about that, because the RCN sign up to this bit of 'rubbish guidance' and Chris is their legal guy. It probably won't work - but it doesn't take any longer than moaning to colleagues, and it might effect a change.

    You need to get the strategy and tactics right, to change things.

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  • mags | 13-Dec-2012 8:31 am

    "I don't know why the first submit posted anonymously! Gremlins!"

    probably for exactly the same reason as you post as "mags"! Hobgoblins, pixies, etc.?

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  • Anonymous | 13-Dec-2012 9:36 pm

    The reason I post as 'mags' is for clarity in attribution of comments, whilst maintaining my own anonymity. It's easier to continue discussion with an 'assigned name' than it is to debate with an 'anonymous', because there are so many. I totally understand the reasons why people choose to post as 'anonymous', but it would be easier if more used a pseudonym.
    Looking back at the original post, I notice that it only states the time that I posted the comment. It doesn't list either my pseudonym or anonymous. Gremlins indeed.

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  • michael stone

    mags | 14-Dec-2012 12:05 pm

    I had this unwanted anonymous posting thing, I think without even 'anonymous' (just the time), a couple of months ago - it seems to be a glitch that sometimes crops up.

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  • NT currently offers the free choice to post anonymously or under a pseudonym or other. Please respect the freedom of others to exercise this choice without coercion or criticism. thank you. It is the content of the comments which should be the focus of attention.

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  • Anonymous | 14-Dec-2012 9:00 pm
    Did I miss something? I don't think that anyone is being disrespectful here. Who is your comment aimed at?

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  • Anonymous | 14-Dec-2012 10:26 pm

    i thought i was the only one who was puzzled by that comment. i don't see anything wrong with what has been written.

    DH Agent - as if ! | 13-Dec-2012 11:49 am

    i always try to complain up the way. don't always get the answers i want but its no reason not to try. sometimes they give in if only to get rid of you!

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  • DH Agent - as if ! | 13-Dec-2012 11:49 am

    "But moaning and complaining are on the same range of activities, and it does seem to me that nurses do a lot of moaning to each other - that isn't going to change much. I complain directly to the people who might have an effect..."

    Mike

    That's it exactly. I'm with Anonymous | 14-Dec-2012 10:47 pm. The best way to complain is upwards. I, of course, wish that the complaining would also be done in a more effective manner. Nurses need to back up their concerns with action.

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