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'Basic' nursing care requires more than basic skills


When wards are busy, nurses have to cut corners. Persistent lack of staff and heavy workloads mean nurses have to make difficult decisions every day about what they do and don’t do.

When staffing shortages become chronic the numbers of cut corners can lead to ingrained poor practice that puts patients at risk. We learnt all these lessons from the Francis report four years ago but last week a leading nurse staffing expert Peter Griffiths, warned that the “lessons of Francis” are starting to be “forgotten” as the focus again shifts to finances over safe nurse staffing levels.

It is vital that nurses monitor the effect this is having on patient care and remind themselves of importance of essential skills such as mouth, skin and continence care and what the gold standards should be.

“This week’s archive issue looks at essential care skills and focuses on hygiene”

This week’s archive issue looks at essential care skills and focuses on hygiene which is often delegated to unregistered staff. Our first article on how to provide effective oral care reminds us that oral care is a fundamental part of nursing and is a skill that requires practice. If you would like to explore the topic in more detail a Health Education England programme called Mouth Care Matters has produced a comprehensive guide.

Our second article looks at foot care and older people and highlights that poor foot care can have a profound effect on mobility and lead to social isolation. It explains how to care for people’s feet and describes how the routine activity of washing feet can be transformed into a pleasurable experience for both the patient and their nurse.

Our final article looks at the complex problem of caring for patients whose hands have tightened by spasticity after stroke, brain injury or other neurological conditions. Good hand hygiene is essential for this group of patients to prevent skin soreness, breakdown and infection but patients often experience pain and are reluctant for their hands to be handled. The authors describe how to overcome these problems and ensure patient safety is maintained. As with anything described as ’a basic nursing task‘ it is clear that considerable skill is required to provide this care effectively every day.

“As with anything described as ’a basic nursing task‘ it is clear that considerable skill is required”

What is clear from these three articles is that essential nursing care is highly skilled and nurses need to consider the assessment skills and practical training of unregistered staff before delegating care to them. Omissions of care, such as failing to attend to patients’ feet, is poor practice and failing to provide care because of lack of time should be documented and reported.

It is important that those who make decisions about staffing appreciate fully the impact that poor staffing levels have on all aspects of patient care and what needs to be cut when workload exceeds pairs of hands.’


Readers' comments (13)

  • Well said Eileen

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  • As a staff nurse I was often concerned at the level of engagement in basic skills by Students, who saw it the remit of the HCA to provide themselves skills. Most I spoke to about it appeared unphased by the fact that unless they too were well versed in the basic skills, how could they delegate once qualified. As a ward sister, with almost all my staff imported, trying to engage staff nurses in basic skills leading by example was almost impossible as many saw washing a patient 'beneath them' and was not part of their 'role'. I am probably going to be labelled a dinosaur for my views, but how can a New Staff Nurse safely delegate if they do not appreciate the needs of individual patients and the capabilities of their HCA's. I am sure HCAs would be more than happy to see their RN colleagues roll up their sleeves. Being a nurse is far more than just paperwork.
    The information gleaned from and about a patient while making a bed or helping with toilet or hygiene needs is all part of the care planning process. How can a staff nurse plan care from behind a desk!
    The move to university training has lost far more than it has gained. I am there for any HC needs for my family, I am not sure who will be there for me

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  • Well said Sister, i have been saying this for years.

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  • Too often HCAs are delegated jobs where they are not competent in the entirety of the jobs. Every day at work I am working alongside HCAs doing almost the same jobs as myself and yet we have difference in the way which we do the jobs. I do feel frustrated about this, and more and more I see nurses and HCAs jobs entwining without the same knowledge entwining.
    I know mostly they are doing their best and it is not their fault, but that does not help how I feel about nursing now. I just want to get out as soon as I can.

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  • Well said SML60. I have been saying this for years. The knowledge you can gain by being with patients, talking to them and observing them while giving basic Nursing care as well as things like bed making can tell you much more than the same patient will admit to i many cases, sadly skills which seem to be undervalued and forgotten. I heard a newly qualified Staff Nurse reply to a colleague who asked her to help make a bed that she didn't go to University to make beds and feed people. Not all Nursing is about the "high power technology" which seems to be consistently forgotten it seems to me now a days. I give Student Nurses and others new to Health Care the same piece of advice I was given on my first ward over 35 years ago; "treat everybody how you expect you and your family to be treated and you wont go far wrong". Dinosaur I maybe but I think it is still as pertinent today as it was then. I count myself lucky I trained when I did as I learnt so much by being a member of the team, expected to pull my weight and to learn from everybody from the Ward Domestic up both professional and life skills.

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  • I qualified in the last five years and I would love to be able to do 'basic' care more often!!

    Instead I am bogged down with paperwork, enhanced clinical skills such as cannulation, iv abx, venepuncture, endless paperwork, care plans, liasing with doctors, OTS, social workers, nursing homes, pharmacists. Dealing with relatives, delegating to staff, looking after 12 acutely sick patients at a time and managing students. So I'm sorry but I'm proud of my university training, but that isn't where the problem lies. And it makes me very cross when I see that insinuated. Personally, from my experience I find it difficult to delegate to HCAs, especially as they move into doing tasks such as ECGs and some are less keen to assist in the 'dirty' jobs.

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  • I am sure my 'Dinosaur colleagues' will have simthing to say about being bogged down with paperwork. The increase is linked with the need to advance the professional status. My career was saved by the Kardex system when daily paperwork on a surgical ward was kardex, observation, fluid and drug chart. They were completed to a high standard. When nurses were nursing not taking on Dr and technicians jobs. Nurses are not nurses anymore. Too many are becoming Jack of all trades. Finding any excuse to hide behind paperwork generated for paperwork sake. The more you have the less time with patients. Incidents have a habit of generating more addressing risk resulting in more risk events happening. Stuck in a spiral of decline. As for HCAs only wanting to do ECGs have you ever thought about what will happen when they bring AP's (SENs) into the mix? The patient is no longer the focus and P2K had the cheek to suggest GNC trained nurses were not good enough!

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  • I suppose you could say I am old school, I have been in nursing for many years and started as a cadet nurse,during those two years we learnt a lot about basic care which is seen as not essential these days due to the short hospital stay.As a student and once qualified we spent time on a daily basis at the bedside where I learnt so much about the individual patient and gained a lot of information relevant to their individual needs and health problems that they hadn't been able to discuss, which I feel made me a much more experienced senior nurse and diagnostician ,we were able to help the doctors with their jobs not do them .Life skills and common sense goes a long way into being a good nurse.Patients have not changed they still come in to hospital frightened and needing support and reassurance and good explanation of what to expect, this all takes time and time is what everyone seems to lack hence complaints and problems, all this leads to good experienced nurses leaving the profession .

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  • SML60 I do not disagree with what you are saying, but university trained nurses are not where the problem lies. Working on a busy colorectal surgery ward I personally mucked in where I could, I found a lot of older nurses not washing or feeding patients or answering call bells. I think it's a culture in certain areas, I've not found students to have that attitude but they will likely only be following what they see from trained staff. Unfortunately you are not always able to give all your patients bed baths in the morning, when you have a whole host of medications and IV abx to give, alongside obs, ward rounds. My mother was a nurse before me and she said that doctors used to give IV meds and when I tell her the things we have to do now she is shocked. Basic care is our bread and butter, but it's no longer the be and end all of nursing. In Australia the nurses are able to do everything for their patient because they only have 4. If I have 12-16 patients to myself on a shift, then you can bet your bottom dollar I won't have any time to do bed baths or toileting and I'll need to delegate to my hcas while I try and keep my head afloat. But if you give me 4 with a floating hca, then I'll be able to do all those tasks.

    I hate how in nursing we just snipe and bite at each other, 'the young ones don't do bed baths' 'the old ones are stuck in their ways' how about we are all understaffed, undervalued and underpaid and therefore unable to do the tasks we went into nursing in the first place!

    I'm now in the process of leaving nursing to be a midwife. There are a lot of same issues, but midwives seem to advocate and appreciate each other a lot more then we do.

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  • I am very shocked at how the apprenticeship roles are being rolled out. I have seen an advert for a Band 3 A & E Technician. The word 'Nursing' is not in the job title which implies this is an admin/clerical post. However, the job summary specifies :
    To work under the direct/indirect supervision of and in support of the registered nurse, carrying out delegated nursing and non-nursing duties to promote patient centred care.
    To assist the registered nurse in the delivery of direct and indirect patient care within all areas of the emergency department.

    This seems to me to be bordering on dangerous for patients and the technician. I cannot imagine how anyone without healthcare training of some sort could possibly be prepared for the impact of being plunged in to a busy emergency environment, witness horrific scenes and be exposed to the high levels of fear and anxiety involved and know what it feels like to care for terrified and vulnerable patients in extreme pain and fear of their lives. The amount of support likely to be available from the trained nurses, who are likely to be run off their feet, is highly unlikely to be sufficient to ensure this post is safe for anyone. I have seen other posts like this springing up which are crossing the boundaries of clinical and non clinical roles in ways that are extremely lacking in insight and entirely unprofessional. Is it really legal to include highly skilled nursing tasks in task orientated roles being advertised as admin or clerical, which clearly put both patients and staff at high risk?

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