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Practice comment

'Where has all the care gone?'


Caring for her mother during a hospital stay made Nadia Dossa realise that nurses do not have the time to provide fundamental care to patients. She expresses her concern over lack of staff leading to poor standards of care

I am a nurse, a senior lecturer but also a daughter. When my mother was admitted to hospital last year, she was very dependent – I would say equivalent to the care of five patients ­– but so were other patients on the ward. The nurses were extremely short-staffed, tired and frequently had no breaks. It took almost one nurse just to do intravenous medications on a shift. The 11pm drug round went on until 1am as each patient needed help and the nurse was called away many times. The newly qualified staff nurse needed guidance but he did not seem to be mentored.

There was no time to do what nurses should do – care.

Mum should have been on a pressure-relieving mattress from day one; she did not receive this until day seven. She developed a Grade 3 pressure ulcer on her sacrum and a Grade 1 ulcer on her heel.

Mrs H, the woman next to Mum, needed help too. When she had been left on a commode for 40 minutes, I asked her if I could help; she agreed. The nurses were none the wiser. Mum was very unwell and the nurses kindly let me stay the night. Mrs K, across from my mum, called out to me during the night, expressing how scared she was. I held her hand and eventually she fell asleep.

The nurses were kind, considerate, but totally overworked. They could not manage the activities of daily living for the patients as there were too few staff.

As a lecturer, I felt sad and disappointed. Are we preparing our students for nursing the rising number of patients with complex comorbidities? Are we correctly preparing them to not forget the basic fundamentals of care when trained with higher skills?

Training our nurses to care for carers was also a concern. Mrs H’s daughter also had a husband with a long-term condition to look after at home. She told me how unsupported she felt. A nurse who maybe could have sat with her, or just listened to her concerns, may have helped enormously at this difficult time. Basic nursing care is a right for patients so, as a nurse, healthcare assistant or student nurse, if we cannot meet basic standards of care, help must be sought.

My mum went into hospital with a fractured hip; she did not leave and eventually died. I do not hold anyone accountable, but standards of care are of great concern. I worked with the nurses to care for my beloved mum, washed her, fed her and saw her to what was hopefully a peaceful death – but not every patient is lucky enough to have a daughter, or indeed a daughter with my skills and expertise. Fundamental care cannot be properly provided to increasingly complex patients without an adequate number of staff who are properly supported.

The rationing of health resources is a persistent and worrying issue. With fewer nurses being trained, hospital closures and pay freezes, adding to cuts in funding while more and more people are living longer with more complex conditions is a combination for disaster – we must do something now.

Nadia Dossa is senior lecturer, University of West London.


Readers' comments (38)

  • A very similar situation happened with my Mum just over 2 years ago. My mum was very proud and was lucky enough to be able to control her bladder well. When I visited her words where always the same. ''Thank goodness you are here, I'm bursting" She was never offered a commode and no one went to her aid if she rang her bell! It made me ashamed to tell anyone that I was in the profession! I was also assisting other patients after already being at work all day. This was an Oncology Unit! Where are the nurses? They were often in the treatment room enjoying tea & biscuits! Do they have a conscience?

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  • excellent article which hopefully will help highlight the problem both patients, their families and ward staff face. it seems if demands are going to increase and qualified staff remain in short supply there needs to be a total rethink on the work they do, how it is organised, how it meets patient need and what training the need.

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  • just heard on WRS while i wrote the above comment of the developement of new pressure sensing technolgy used on beds to reduce risks of pressure sores.

    It sounds promising as it alerts staff to potential areas of excessive pressure and might be worth further exploration.

    Technology Tackles the Pressure Ulcer

    Scott Mace, for HealthLeaders Media, May 7, 2013

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  • Nadia Dossa

    Did it not occur to you to telephone the Director of Nursing during the night?

    Some interesting questions could have been asked about the lack of nurses.

    It would also have been possible to demand the Director of Nursing come to work and assist the struggling colleagues.

    Your Mother suffered" Institutional Neglect"

    The managers responsible for creating the short staffed environment in which neglect was inevitable should be held to account.

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  • Jenny Jones | 25-Aug-2013 7:36 am

    what a hard, self righteous nut you come across as in this and your other comments. you obviously always do the right thing and blame any shortcomings on anybody else.

    do you not think this nurse as a daughter had other preocupations at this time as a vulnerable service user rather than in her professionall role and that all of her mental and physical resources may have been used up focusing on the immediate needs of her mother?

    was interpersonal psychology and the reactions of individuals in health and disease not included in your training?

    no wonder there is a need for the six Cs and the fluffy stuff in nursing.

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  • I try to always have my wards fully staffed and often above my establishment by using agency or bank staff in additions, but for this am called to account for my staffing overspend, I am on the way out of my profession at this senior level so they can performance manage me all they like for failing the budget but they cannot ever point the finger for allowing low staffing. Even my actions do not always ensure enough on duty due to the dependency of our patients. Everyone seems to forget that the vacancies cannot just be filled or establishments increased as the nurses are not out there, we have cut the nurse training places and are going 'all degree'. Mmmmm work that one out..........we are in a mess, sitting holding a patients hand whilst we are being timed to answer a buzzer or enter the Brandon score in time for audit..........the dilemma many nurses make. I too have been on the receiving end when my mother was very ill earlier in the year, they were not short staffed just arrogant, poor communicators and saw her as an inconvenience, it all changed when I told them what I did and that I knew their chief nurse personally, my own recent personal experience was outstanding and they did not know what I did for a living in terms of my grade. They just did the job of caring 110%

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  • tinkerbell

    Anonymous | 25-Aug-2013 10:33 am

    Well done you for not following the herd mentality and doing the best you can for your nurses on the frontline delivering the care.

    When the next scandal hits at least you will have a clear conscience that you were doing the right thing.

    Coping is not the same as caring.

    Nurses who are regularly left without enough staff to do a quality job should unite and turn up en masse to their managers and show a united front on THEIR wards that we are not prepared to tolerate this. Either give us the staff to do the job properly or we're walking because we should not be participating in patients being neglected if we can't provide the care they need.

    If nurses are not prepared to take industrial action to shout out about about the neglect occurring then at least they can take a stand in their own work place as a team. We are all responsible and accountable practitioners in our own right and should say 'No'. We should not be 'hapless victims' that perpetuate this sorry sad state of affairs.

    On the other hand, in a culture, where nurses just sit around doing nothing whilst patients are left to their own devices then management should be dealing with them.

    We are there to do a job. We are there for the patients, they are not there for us. I am hopeful that these 'cultures' are dwindling. Senior nurses should be leading by example and out there on the floor with their staff providing hands on care and ensuring that staff are not sitting around in offices whilst patients suffer.

    The majority of hard working caring staff across the land are being let down on all fronts for various reasons but we should no longer tolerate these reasons being used as excuses.

    The good staff should no longer leave because they are worn down by the bad culture.

    Every person in healthcare should speak up if they find care falling below an acceptable standard where it causes distress and harm to a patient for whatever reason.

    The NT have tried to help with their speak out safely campaign. Along with the Francis report etc., there has never been a better time to SPEAK OUT, we just need to do it.
    Come on, we can do this. Let the bean counters count, our job is to nurse.

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  • Jenny Jones | 25-Aug-2013 7:36 am

    Well said Jenny. If we say nothing, then nothing will be done. The biggest problem is that so few seem to accept that.

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  • Anonymous | 25-Aug-2013 10:33 am

    The problem is that there aren't enough like you and the staff that you support don't offer any solidarity.

    tinkerbell | 25-Aug-2013 11:36 am

    See you at the barricades, Tink.

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  • tinkerbell | 25-Aug-2013 11:36 am

    Anonymous | 25-Aug-2013 10:33 am

    "Well done you for not following the herd mentality and doing the best you can for your nurses on the frontline delivering the care."

    so then you go on and wax lyrical about following the herd mentality ........?

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