While changes in healthcare needs require nurses to perform new roles, the ability to care is still the nursing skill patients value most, says Laura-Lee Leatherbarrow
The author of a recent opinion article concluded that nursing needed to change if a member of staff could not be relied on to place a glass of water within a patient’s reach (NT Opinion, 4 December 2007, p10).
In some ways I agree. ‘Fundamentals of care’ – or basic nursing care as we called it when I trained – was a key part of what a nurse was all about. We ‘cared’ for our patients. We tended their needs using a model of care (usually Roper, Logan and Tierney’s nursing process) to underpin our knowledge, and ensured our care met all the patient’s needs in a holistic way.
A bedbath was not just given to ensure patients were clean, it was also an opportunity to assess their condition. Skin integrity would be checked, wounds and pain levels monitored, IV lines observed and, best of all, mental state and anxiety levels assessed and acted upon. We kept up to date with research, continually enhancing our skills and knowledge but remembering that the patient always came first.
‘Times have changed, nursing has moved on,’ I can hear some of you mutter. But has it? If you ask a patient what they want from their nurse, they often say something along the lines of: ‘help with personal care, a friendly and approachable manner, and someone who will take time to explain what the doctor has just said.’
I have yet to hear a patient say: ‘I want someone who is trained to a minimum of degree standard and up to date with all the research and can perform the procedure for me to assess.’
I have seen students come and go, and wholeheartedly agree that they should be supernumerary and have a mentor who will work with them and give regular feedback.
Education is a vital part of nurse training and a level of academic rigour will always be required. However, I have noted that, for some students, patients have become merely part of their research essays, and that bedbaths and many elements of personal care are the sole duty of HCAs.
This attitude has become increasingly prevalent and we now seem to have a generation of nurses who do not perform many aspects of fundamental nursing care. Although they are present to supervise HCAs, they rarely help with basic care.
Fundamentals of care are extremely important to patients yet they are becoming less important to many nurses. Nursing was seen as a vocation in the past. Students who did not have the innate ability to care did not make it through. That cannot be said today. For some, nursing is just a degree course and then – if they complete it – just a job.
As levels of patient dependency grow higher and staffing levels fail to keep pace with changing healthcare needs, many nurses have no option other than to pass on basic nursing care.
This enables them to perform the equally vital extended roles required of them. However, it is vital that the people to whom that care is delegated are competent to provide it.
There is no reason why an HCA who has been educated, assessed and deemed competent should not be able to carry out ‘fundamental nursing care’ to an excellent standard. After all, we have extended our own roles to the extent that nurses of yesteryear would consider us ‘mini doctors’.
It is imperative, however, that nurses ensure HCAs are competent to undertake the tasks we ask them to perform. While HCAs may take on many tasks previously done by nurses, this does not mean nurses can ignore these tasks. Indeed, our code of conduct requires us to ensure that care carried out on our behalf is performed competently.
It is equally important to remember, even when rushed off our feet, that our patients are our priority and their needs are paramount. And that includes caring enough to ensure ‘basic’ tasks are undertaken properly, such as placing a glass of water within their reach. Anyone who cannot appreciate that, who sees nursing as just a job, should leave the profession.
Laura-Lee Leatherbarrow, is KSF nursing competency lead, The Royal Liverpool and Broadgreen Hospital Trust