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PLACEMENT EXPERIENCES

Is it safe for student nurses to speak up about poor care?

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Meet Poppy, a student nurse who bravely spoke out about poor care on placement twice, and experienced a different reaction each time

*Poppy’s name has been changed and details of her university and placements have been left undisclosed in order to protect her privacy.

 

The patient is a 50-year-old male. He had a bowel resection and underwent stoma surgery after suffering long term from diverticular disease. Due to post-op complications he was returned for another bout of surgery to drain a pelvic abscess and left with an Exudrain. The following day he had an anastomotic leak and his bad luck continued in this fashion as he was prepared for surgery number three in the space of four days.

“When she pulled him over, she didn’t even check to see whether he had any drain sites and therefore when she yanked him over she pulled the Exudrain and it nearly came out which is incredibly painful.

“The patient was telling her to stop and let him do it on his own slowly as he was in pain from previous surgeries. She said ‘we don’t have time for that, I need to get him ready for surgery’ and yanked him right over pulling on the drain and catheter.”

Nursing student Poppy Green* explains how she felt complete shock and then utter anger towards the agency staff nurse working on her placement ward after she witnessed the nurse “yank” the patient from his bed. Followed by what Poppy describes as a compulsion, she asked the nurse to leave the room.

“I was so angry that I was literally like, ‘get away from the patient’. I didn’t care about the hierarchy thing and the fact I’m a student and I’m the bottom of the pit and she’s a staff nurse. That didn’t matter to me at the time.”

It wasn’t until after the incident that Poppy realised the nurse would be heading to speak to her placement mentor or the ward sister. It was then that she began to feel nervous. Once the patient had been taken safely down to surgery, she recalls worrying about the implications of her behaviour and questioning whether she had gone too far.

Poppy revealed that she has been actively encouraged at university to speak up and report incorrect practice. But following recent news, where the likes of Dr Raj Mattu has come forward with claims that managers bullied him for more than a decade after he chose to blow the whistle on avoidable deaths at University Hospital Coventry, it bodes the question whether it is safe for students to do so.

NHS whistleblower, David Drew said: “If [students] see things that are wrong they ought to report it in a factual way in their place of work or if appropriate to their tutor, mentor etc. This should not be seen as whistleblowing but normal professional behaviour. We all see things like this all the time. The safe care of our patients depends on these conversations.”

Poppy details the formal procedure her university has put in place to follow in case of incidents like these.

“You inform your mentor firstly or the manager or sister. You talk about the situation and then you contact your university and you have interviews and things. The more serious it gets the more it progresses.

“The negative thing about it is you have to stay on that placement during the whole time this is happening. So when there is an investigation and you’ve whilstleblowed you still have to remain on that placement which is really difficult because obviously the staff will have a negative attitude towards you and it’s not a very good learning environment.”

Poppy describes how the agency nurse involved in her situation had already had several complaints made about her. She states that this meant other members of staff, including her mentor commended her courage for acting as the patients advocate.

“They were praising the fact I stood up for this patient and for myself.”

However, this is not always the case.

During another placement where Poppy was placed into a nursing home she was so outraged at what she was witnessing that she complained on her first day.

She describes refusing to cooperate on moving the elderly patients as they were using illegal manual handling techniques such as the drag lift.

“That can break an old person’s shoulders. It’s actually illegal and it’s a form of abuse that was being used on a regular basis.”

Poppy had already picked up on vibes that her mentor and the matron of the nursing home weren’t particularly approachable so took her worries straight to her placement mentor asking to be removed from the organisation rather than following the usual procedure. She was told to remain on the placement as it was not possible to remove her.

 The following day, Poppy was called into a meeting at her organisation after they had been contacted by the placement mentor. She was advised to contact her university confirming the situation had been resolved.

“If a complaint goes far enough it can go to the Care Quality Commission, they can get involved and there will be inspections and stuff like that and if it’s bad enough then the nursing home will get closed down. So, she told me ring the university and say I’ve sorted it out, and their way of sorting it out was, I had to leave the room and not take part…

“She used almost emotional, I wouldn’t say blackmail but she made me feel like I had done something wrong and then influenced me to take back what I said, almost. But she made me feel like a really bad person because I had complained and this is people’s home and I could get it shut down. She turned it into my fault that this was going on.”

As a result, Poppy decided not to take the complaint further.

Although the Care Quality Commission were unable to determine how many students had contacted them they did reveal in 2013/14, they were contacted 956 times by whistleblowers working in the NHS compared to 601 in 2012/13.

A CQC spokesperson said: “In assessing health services, CQC asks: is the organisation well-led? An organisation that is well-led will listen to and act on information from staff, particularly when staff report poor care.

“It takes great courage to be a whistleblower and staff need to know that when they do come forward with concerns they will not suffer as a result.   

“In 2013/14, CQC received 956 contacts from NHS whistleblowers. This information is vitally important in helping us decide where and when to inspect.”

Mr Drew suggests that the responsibility lies with student’s universities. He said: “It is more important for universities to ensure that their students are placed in organisations where advocacy for patients is the professional norm. If students are taught the basic professional obligations to their patients they will understand advocacy.”

Poppy highlights that although it may be difficult as a student to express concerns about the standard of care in the organisations she is placed, the patients are her priority and acting as their advocate is a basic principle of being a good nurse.

“It is a difficult situation because to make your placement a nice placement and for it to go quickly and to learn, you want to develop these relationships with carers and nurses, but if it comes in the way of proper patient care, you have to make a decision and think.

“If you don’t decided to tell people when you see bad things you shouldn’t be a nurse, because you are there to protect the patient at the end of the day.”

Is the problem lack of time?

Staff Nurse Leanne Savage, recalls times when she felt that patients could have received a higher standard of care but blames this on lack of time.

“I do remember a few times where I have felt that patients could have been treated better, however, that isn’t to say I felt these patients were maltreated or received sub standard care, just that the nurses I have worked with have admitted that they would love to have more time to spend with their patients doing the little things.”

Poppy agrees with this stating that she sees witnesses’ nurses not having enough time due to staffing pressures everyday she goes onto the ward.

“There is not enough staff. For every nurse there are two bays of six patients plus three side rooms. That’s 15 patients to one staff nurse and a healthcare assistance. That’s too much. The Francis report came out and said if there are more than eight patients per nurse it’s dangerously unsafe.”

The Francis Inquiry report was published February 6 2013 and investigated the causes of the failings in the standard of care at Mid Staffordshire NHS Foundation Trust. The report looked at incidents throughout 2005-2009.

The report recommended openness, transparency and honestly through the healthcare system as well as improving support to allow for compassionate and committed care.

Miss Savage describes alike Poppy how she was actively encouraged to speak up as a student and educated on procedures regarding whistleblowing whilst on placement.

“We had regular teaching sessions on safeguarding patients and whistleblowing procedures and this was reinforced through the publishing of the Francis report. We also had to attend a trust induction at each placement which would explain their procedures for safeguarding and whistleblowing.”                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

Miss Savage believes that if a student spoke up in a ward environment it could improve the standard of care patients receive. However, she highlights that change would only occur in the masses.

“I think it would take more than one student speaking up to change the NHS however if everyone spoke up about bad practice then I do think that this would improve patient care.”

 

Laura Richards is a final year journalism student at Falmouth University

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Readers' comments (1)

  • dichotomy ....

    On the one hand we have to practise duty of candour versus managerial political organisational skull duggery. Interesting and potentially challenging question for students let alone nurses .Matching up your own values with organisational values and priorities is challenging but it can also be rewarding as well. There are non toxic employment environments out there. Its a matter of finding them

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