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Practice Comment

'When tasks overwhelm, the human touch will be missing'


I am not sure there has ever been a golden era of nursing. Certainly, I would be the first to criticise my own training with its flaws and inadequacies, but it did teach me fundamental skills, which I have always thought were pivotal to being a nurse

I am drawn to the present by my personal experience of being an NHS inpatient and wonder if we are any further forward a year on from Francis. A recently perforated appendix and some postoperative complications have given me time to reflect on the state of nursing.

I was a patient in two surgical wards and a visitor to many different departments for investigation. Once the effects of the morphine had subsided, I became aware of what was going on around me and was saddened by the plight of qualified ward staff.

It’s no secret that nurses are regularly and relentlessly vilified for not attending to basic patient needs in a timely manner or with the dignity and empathy perhaps of a previous generation of nurses.

However, I would argue that nurse training does identify and highlight all the features a good nurse should have. I believe we do understand the importance of fundamental aspects of care. What training does not perhaps account for nowadays is low staffing levels on acute wards.

Jane Cummings, chief nursing officer for England, has recently addressed staffing levels with some vigour stating that we have clear evidence of a link between appropriate staffing and the outcomes of our patients. Yet I witnessed two trained nurses and one support worker on night duty for a busy surgical ward with 28 patients, a few of whom were older and frail, confused or incontinent. We have to questions how much high-quality nursing care can be wedged into one shift with such limited resources.

Nurses juggle. I witnessed a nurse attempt to reassure a patient who had been to theatre while checking their observations and giving intravenous therapy, and helping to take a confused patient off the commode in the next bay. At the same time, the nurse was caring for a third patient who was terrified postoperatively and a fourth who hadn’t eaten any supper and had been sitting in the same position for the last four hours.

Staff were clearly overwhelmed by the amount of technical tasks needing completion. These were done with astonishing efficiency, I noted, but what perhaps was missing was the human touch and attention to detail.

Staffing guidance published in November by the National Quality Board last year calls for “greater transparency” on staffing levels at ward level and outlines expectations for providers and commissioners relating to staffing numbers. Its aim is to give clear advice on how these expectations can be met and takes into consideration local differences to rule out a one-size-fits-all solution.

But is this another welcome document - or nothing more than rearranging deck chairs on the Titanic?

Jules Davidson Carr is senior dermatology nurse specialist at Sheffield Children’s Hospital.

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Readers' comments (4)

  • It is about time that hospital staffing was rearranged a little to reflect the needs at different times of the day. It has long been observed that there are frequently inadequate numbers of nurses on a ward on the night shift; but who decides on what constitutes a night shift?
    In these days of flexi-time, surely a shift taking in the hours until 10.30 or 11pm, (when the ward can be extremely busy - and after which, many patients have been settled for the night)? In this day and age, night nurses should not arrive for their shift, knowing that there are too many patients for them to cope with adequately. The same could be said for early mornings.
    Many nurses would welcome more flexibility in the existing shifts - which have changed little in aeons - and patients could only benefit,

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  • The issue revolves around having adequate numbers of nurses to meet the needs of patients at any time during 24 hours.

    Two nurses being expected to care for 28 surgical patients is clearly inadequate.

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  • i have just embarked on my mentor training, so i will be able to teach and assess the nurses of tomorrow, this has been an eye opener, it is scary as these young people do not seem to have any initiative and want to be taught every thing. How am i going to fair i wonder with all the shortages of staff, the work load i have and still having to take a student, making sure she is well supervised and covering the their programme of education

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  • There has never been a 'golden age' period. Nursing has always been tough. People think it was better in the 1950s, complete rubbish! More people are living into very old age than at any time in history.

    The NHS has done so well in keeping people alive. We have a geriatric tsunami slowly descending upon the service. Infact,now, the period we are in, might be the nearest to a 'golden age'.

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