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REFLECTIONS ON PRACTICE

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I recently completed the Overseas Nurses Programme as part of my application for registration with the NMC, and despite being the equivalent of an F-grade RGN back in Australia, was employed as an HCA until my PIN was available

HCAs do the real nursing
As an HCA here in the UK, I experienced the NHS from probably the lowest level of healthcare professional. I was usually allocated nine to 10 patients for a 12-hour shift and did not receive any help from the RGN.
A 12-hour shift requires three meals to be arranged, collected, served, fed to patients and cleaned up. Toileting nine to 10 patients without help – patients who are confused, at risk of falls, in pain and incontinent, not to mention infected with Clostridium difficile – as an independent assistant, is a challenge to say the least.
Manual handling of these patients usually requires two staff, which is difficult to obtain if you are an HCA. The only other healthcare staff who will assist are other HCAs. At the end of the day, the RGN has not washed the patient, so is not able to assess skin integrity, bed mobility, consciousness level or other alterations in the patient’s status.
The RGN has not helped any of the patients to use the toilet and so must ask about urinary output and bowel function, requiring a non-trained HCA to comment on output versus input, offensive (infected) urine, catheter blockage and bypassing, bowel sounds versus no bowel action.
The RGN has not fed a patient so is unable to comment on appetite, caloric intake, swallowing difficulties, nausea and vomiting and oral disease. Nor has the RGN taken a vital sign, so is unable to ascertain an impending situation, where a patient may look febrile, but temperature is 36ºC or less, and the patient may have been admitted for febrile investigations. (You do not need to be physically febrile to be septic.)
I did all this and reported it to an RGN who appeared to disregard my comments.
I have managed to work in a few trusts and have come to understand that they are not all the same – just as not all RGNs are the same. However, I am saddened to see such a brilliant profession as nursing reduced to a pill round and a collation of information at the end of a 12-hour shift without any active nursing being undertaken by professional RGNs.
I also believe that within the NHS there is a push to employ a higher percentage of HCAs than RGNs. This will not only increase the level of concern for nursing at the bedside but also, in the long run, will add expense to the NHS rather than help.
Finally, to all those HCAs out there, whether they are really RGNs in disguise or just fantastic workers dedicated to performing the nursing tasks that have underpinned the concept of care since Florence walked the corridors, I take my hat off to you.

Suzanne Oakley, staff nurse, The Royal Marsden, Sutton, Surrey

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