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Cuts must not threaten time for dignified care


Enabling our patients to feel comfortable, less vulnerable and dignified when in our care is an increasingly difficult challenge.

In recent years we have seen the necessity for campaigns to end the tolerance of indignity in health and social care settings. And all too often we see media accounts of nurses providing unacceptable standards in delivering health and nursing care.

These news stories are always extremely uncomfortable for everyone, but necessary, as they often inspire action to improve standards. However, they do not inspire confidence in nurses and nursing, and must also dramatically affect our current and future patients - as well as our current and future nurses. These negative stories are relatively small in number when compared with the total number of healthcare episodes, but they have a huge impact on the morale of those nurses who aspire to give excellent care to their patients.

Stories of abuse, neglect and poor standards in healthcare settings must also cause our patients unnecessary stress at a time when they are at their most vulnerable and often when they are most dependent on receiving high quality care with preservation of human dignity.

‘We need staffing levels that enable us to concentrate on the matter in hand. This would reduce multitasking and allow our patients to be cared for with dignity’

The effect that poor care has on the patient’s family is also distressing, especially when expectations are not met. A potential consequence for the professional is that they too become vulnerable, as the recipient of undignified behaviour when needing to manage difficult situations, exacerbated when expectations of patients and their families are not met.

Human dignity is about having respect for oneself as well as others. Being respectful at all times is a central element within the essence of nursing. I would argue that being respectful is also about ensuring we give sufficient time to our patients, giving time for them to communicate their needs. We need to give time to really listen to what patients have to say. In my opinion this is our most treasured commodity.

Time is one of the fundamental “dimensions of nursing” that is not readily explored or explained. We often talk about the fundamentals or essence of nursing care; yet fail to quantify the investment necessary to achieve the absolute ideals in terms of the outcomes. Time is often misleadingly defined by the quantity of events that occur in delivering nursing care. We rationalise the time taken to assess an individual’s care needs, or to undertake a nursing intervention, and suggest that the more experienced and expert we become, the more proficient we are in achieving the outcome and that less time is needed.

The operational way of describing a clinical intervention leaves aside that there is something more than simply counting activity measured against outcomes. It implies that the fundamentals of nursing are events that occur in sequence without variance. For example, when undertaking a nursing assessment this is a sequential event with measured outcomes, when we all know that because of demands on the nurse, rarely do we get the time to conduct any of our activities in isolation, and often we are interrupted and requested to attend to a multitude of events.

The process of assessing a patient during the admission is frequently interrupted because we need to assist others, answer telephones or speak with colleagues; consequently, this offers a less than dignified approach to patients, because we cannot always give the time needed to undertake each clinical event in a timely way and often think - but only if we had more staff. Or if we had the right skill mix of staff.

If we had sufficient staffing levels, with the required skill mix rather than grade mix, would that help us? Yes, most definitely. It would be wonderful: the interruptions for help would reduce, we would have sufficient staff to assist others as and when needed, and we would have time to discuss professional issues. But, most importantly, we would have time to care for our patients.

Is this too much to ask in this time of looming public sector cuts? It is, after all, what many of us came into nursing for. Nursing care is not simply a physical quantity to be measured, it encompasses the need to ensure the patient is the centre of gravity for the period of time that each nurse spends with them. We need “time to care”. We need staffing levels that enable us to concentrate on the matter in hand. This would reduce multitasking and allow our patients to be cared for with dignity.

So in this time of economic downturn, when nursing establishments are under review, when patient acuity is at an all time high and the demands to work within time constraints are also extremely high, we need to ensure that any delivery model of care, in any environment, ensures nurses have time to use their professional judgement in meeting the demands of current provision. For this to occur, it is vital that public sector cuts do not prevent nurses from providing dignified care.

As nurses we value self respect, we value our skills and we value our practice. To deny us time to care is to remove our self respect and threaten the way in which we plan to provide dignified care. We need that all too often scarce commodity - time.

Tina Donnelly is director for the Royal College of Nursing in Wales


Readers' comments (7)

  • What???
    Cuts are never likely to enhance care are they? Let's face it if yet further cuts are introduced the delivery of care will inevitably suffer despite the best efforts of front line staff.

    If we are able to see that there is a potential for the service to perform at a standard less than satisfactory then we should do something about changing the conditions that threaten patient satisfaction. Inevitably however, this threat like all others revolves around budgets and front line staffing levels. The obvious answer is to increase both and the threat will go away. No amount of 'belt tightening' will change the conditions now being faced daily by most care deliverers at ward level. No amount of new 'work harder and better' edicts from admin will allow staff to be in two places or do two jobs at the same time.

    But because the solution is simple it will never be applied in practice, it simply would not be cost effective to employ more carers....It is far easier to create or increase a litigation budget in the hope that potential complaints never go the distance.

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  • Oh please, this has got nothing to do with the cuts!!!! It is really starting to get on my nerves that everyone is now blaming the problems that we have been having for the past 5 years or more on the 'cuts'!!!! Yes the cuts are going to affect the NHS, and not always in positive ways, but lets be a bit sensible about this, the conditions that have forced us to spend less time with our patients/suffer poor working conditions/etc etc etc have existed for a long time. It is THOSE problems we need to focus on, and I still say cuts CAN be a positive thing IF they are used correctly (which I agree at the moment they are not).

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  • Hi mike,
    Over the last 20 odd years or more, staffing levels have fallen dramatically in most areas to, in some cases quite dangerous levels. This is, as I’m sure you are aware especially so at nights and weekends.

    This decline in numbers which does have an effect on time spent with each patient is reflective of budgetary restraints.

    Not enough staff to go round will and does create patient dissatisfaction and increased levels of complaints.

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  • Roger I totally agree, of course that is the case! But this is not as a direct result of the 'cuts' that are happening now. As you say they have been happening for 20 years or more! Yet all of a sudden everyone is blaming all the woes of the NHS on the new government and the cuts??!!?? It's ridiculous!

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  • It has been said before, but remains true: we have a price for everything and a value for nothing. Nursing care is, stage by stage, being reduced to priced actions. Eventually robots will perform some of these actions; it will not mean more time for nurses to "care", but less nurses! The forthcoming cuts will merely accelerate this trend.

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  • Working in the NHS is like flogging a dead horse.

    There is no patient care in this country, despite the best efforts of clinical staff. There's not even much point trying to fight it.

    Sod it, I'm off to better climes anyway.

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  • A very good but idealistic article. The problem is that only nurses fully understand what nurses actually do and how they manage their work. It is of little use employing managers, with all their new fangled jargon and higher salaries, to tell them how they should manage their time to do their job better as an significant part of nursing care is spending time with the patient and communicting with them (which means actually listening to them as well as talking to them on a social and a professional level - as both nurse and patient are in fact human beings and need this type of social and professional contact).
    In the day and age of multitasking, which some people for some reason actually boast about their ability to do, constant interruptions become an deeply ingrained habit and are anticipated even when they don't occur causing significant stress and pushing one to rush through everything just in case...
    This habit translates into nurses, even when they are not busy, perceived as often sitting around rather than doing the little extra tasks, and sometimes even more important ones, which are so important to their patients.
    Recently a friend's relative was severely reprimanded for wetting her bed even though my friend had gone to the dêsk where the nurses were chatting and examining their nails to request a bedpan which she would have willingly given herself if the nurses had deigned to get off their rumps to fetch her one. I have absolutely no reason to disbelieve this story as I have not only seen it happen on more than one occasion and have also heard and read other reports of patients left in similar circumstances.

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