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Much can be learnt from going ‘back to the floor’ for a day


Gill Harris on the experience of working a shift as a healthcare assistant

As director of nursing and patient services at Wrightington, Wigan and Leigh NHS Foundation Trust, I recently went ‘back to the floor’ and spent a shift working as a healthcare assistant. The day was part of the trust’s efforts to enable senior and junior staff to mix in a less formal setting. I would like to share my thoughts on the experience.

My HCA uniform was ordered and delivered in advance, so that I was ready to turn up and perform my duties on the day in question. The shift I was scheduled to work ran from 8am through until 1.30pm on a medical ward at Wigan’s Royal Albert Edward Infirmary. I worked alongside another HCA and we were both supervised by a staff nurse. My main responsibilities for the day included washing, feeding and mobilising a group of patients in one of the bays on the ward.

My first impression was how good it felt to get back in direct touch with patients - they were very open and I was able to get their direct feedback on their experience through the numerous interactions and conversations that I had with them throughout the day.

The patients did not know who I was, although the staff did. However, they too seemed to relax and accept me in the role as the day progressed, especially as it was obvious that I was mucking in alongside them.

‘They seemed to relax and accept me, especially when it was obvious I was mucking in alongside them’

Spending more time on the ward in one session such as this, rather than the typical shorter senior management visits I had undertaken in the past, allowed me to observe in much more detail the typical daily activities within a ward.

One thing that was much more obvious was that the majority of interactions with patients were carried out by HCAs, junior nursing staff and domestics. This made me consider how I could influence this within my workforce and training strategies. It stressed the importance of people-facing skills and the impact these can have on a patient’s experience.

Although I did observe senior nursing staff performing key tasks with patients, they were also caught up in management issues and appeared to spend less time with patients. This is one area that we hope the implementation of the Productive Ward initiative will address, freeing up more time for all of our nursing staff to spend on direct patient care.

As the trust’s lead executive on infection control, it was very satisfying to see how spotlessly clean the ward was and the good practice relating to infection control. I did have one very interesting moment when, as an HCA, I challenged a consultant who did not fully comply with our trust’s dress code, which specifies ‘bare below the elbow’. I think he was very surprised to have this pointed out to him by an HCA, but quickly understood when someone explained who I was.

Throughout the day I was pleased at how open patients were about themselves and their care. They talked freely with me about their conditions and treatments, their families, any fears they felt and their personal observations about the daily activity on the ward. It was not surprising to hear that simply giving a patient a little time, listening to them and talking with them, can have such a significant impact on their perception of the service they are receiving.

The highlight of my day - or, perhaps, of the year so far - was when a patient said to me: ‘You are so kind and gentle. Why don’t you work here normally?’

The patient in question had mentioned to me earlier in the day that her hands were painful with arthritis and later, when I was washing her hands, I did take particular care. She commented on the relief she got from them being washed with such care.

Another memorable moment was being able to engage with a disorientated and distressed patient, and managing to get her to calm down through holding her hand and offering her an explanation of where she was and reassurance about what was happening to her. Both these examples demonstrated to me clearly the difference it can make when we can make time to listen to, engage with and respond to our patients.

I would certainly encourage my peers to take time to go ‘back to the floor’ themselves and see what the experience brings to light for them. I will do this again, although perhaps in a different role that can add further to my own personal experience.

Gill Harris is director of nursing and patient services at Wrightington, Wigan and Leigh NHS Foundation Trust


Readers' comments (3)

  • Good on you Gill for getting back to basics! A couple of points: It seems the doctor did not take the 'bare below the elbows' comment seriously until he was made aware of your seniority. This appears unprofessional and rather patronising of him. As a team, all members should feel able to 'remind' their colleagues of good practice without feeling unqualified by rank to do so. It's also disappointing that the patient you helped was not able to consistantly appreciate that level of care. You have obviously gained useful insights into the workings of the ward. Maybe all managers should keep-in-touch with reality in this way?

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  • Awesome Gill, and you're right the majority of interactions with patients are by HCAs, junior nursing staff, domestics and catering staff. Why is that then? Not only that, but from the patient's perspective, the majority of "care" comes from them too. And most patents often have no idea whether they are talking to an HCA or a Staff Nurse. Something to think about?

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  • The highlight of my day - or, perhaps, of the year so far - was when a patient said to me: ‘You are so kind and gentle. Why don’t you work here normally?’


    Quite. If only all you nurse administrators and nurse specialists left your desks behind and returned to hands-on nursing, the NHS would be a better place.

    Dr John Crippen

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