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The job of basic care should be handed back to nurses

  • 5 Comments

I’d imagine it takes a lot to make Claire Rayner cross but nursing has done it. Not all of it, obviously. But some of it - a small but significant flake of it. And she has that look in her eye, like you’ve come round for tea and abused her hospitality by scoffing all the biscuits before everyone else has even been offered one. It’s a look that might make you melt with shame or at the very least rush out and buy some digestives.

A recent review by the Patients Association highlighted some “appalling” standards of care in NHS hospitals, and the ensuing debate led to many patients and relatives lining up to tell grim tales of thoughtlessness, neglect and cruelty. Some important people leapt to the defence of nursing. Bad care is unacceptable, but let’s not blame the whole profession for the poor standards of a small minority. Most nurses are great was the consensus.

But it’s too important to leave it at that.

I believe that if we asked 100 nurses “What do you think of the standards of basic care these days”, they would, after looking around suspiciously to make sure we haven’t smuggled anyone in, say that actually, for a whole host of reasons, things could and should be better. Of course, if there were any non-nurses, journalists or other outsiders at this imaginary meeting, those same nurses would defend both the standards of care and the circumstances in which they work.

‘When bad care is talked about, it is invariably good nurses who feel under attack - and who then feel the need to defend what they haven’t done’

In short, nurses know bad care happens. They know its causes (and these causes range from staffing numbers to some plainly poor nurses), and the ones I speak to feel a mix of rage, disappointment and contempt for poor care. But for a whole host of reasons, when bad care is talked about, it is invariably good nurses who feel attacked - and who then feel the need to defend what they haven’t done.

There are probably many reasons why it is difficult for nurses to openly acknowledge that they have seen bad nursing. Perhaps they feel traitorous or unsupportive if they speak out. Perhaps they understand why someone has become careless, and they somehow quietly accept it as part of working life.

However, I can’t help thinking that while government, civil servants or even professional organisations talking earnestly about nursing standards is inevitable, it isn’t going to help very much. In fact, if we genuinely want to acknowledge that standards are not what they could or should be - and that the act of caring (which is the essence of nursing) is being continuingly lost in the tasks of nursing science - we should hand the job to nurses.

Not the defensive ones. Not the tired ones. Not even the powerful ones. No, we should give it to the wise nurses, the “ordinary” nurses - the nurses who burn with anger when they hear of patients left to lay in wet beds.

If we really want to address standards of care - and let’s face it, it’s our responsibility to do so - then nurses should be the first line of response. Whether it be in addressing education and training curriculums, codes of conduct, protocol or policy. At their best, nurses can be their own harshest critics. And so they should be.

  • 5 Comments

Readers' comments (5)

  • When I first started nursing almost 30 years ago patients often told me that it was a 'vocation'. Something I didnt really understand at the time, but now realise that to be a good nurse you need to have empathy with patients and to go that extra mile to make sure that they get the good care that they deserve. The problem is now that instead of a 'calling' to help people. More nursing tasks are being handed to untrained staff and nurses are doing more roles traditionally done by doctors, taking them away from the sharp end of care. Those who are prepared to stick their neck on the line and say what needs doing are few and far between and inevitably suffer as a result. Its easier these days not to take responsibility for the care thats provided than to stand up and be counted.

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  • Having trained as a nurse between 1972 and 1975 the basis of training was on the wards. In the words of our sister tutor at the time "to enable you to learn how to care for all patients". The training did very well.
    I have progressed to the role of nurse practitioner in general practice but the standards of good nursing care is still present in my practice on a daily basis.
    At present I am caring for my father who is terminally ill at home. At 89 he has had you could say a good innings, but this does not excuse the lack of care provided by the NHS.
    Perhaps someone can tell me why a very able gentleman who fought for his country in the Royal Artillary between 1939 and 1946 has been left with the minimal of care from the state.
    I brought him to stay with me as the care he was receiving in West Sussex was appalling. His own doctor had just retired and he was seen by a doctor who did not know his history giving him pain relief that he is allergic to- thus making him ill.
    He had all the signs of a prostate problem for 2 years but his PSA was not tested as he had a TURPs in 2004/5 which was perceived to be benign. When a PSA was tested it was seen to be 16+ and he was admitted to hospital for a further protatectomy - the growth was biopsied, tested and was shown to be cancer. At the same time he had been complaining of pain in his right shoulder - we paid for physio as NHS physio was going to take 16 weeks to arrange. She sent a letter to his GP suggested my father should be seen by his urologist and have a bone scan.
    It took a further 2 months for the bone scan to be arranged and suprise suprise he had wide spread metastatic bone cancer.
    He is being cared for in Kent - as an ex District Nurse I cared on a daily basis for terminally ill in their own home. Where has this service gone. The Swale area of Kent had a second to none District Nursing Service, this is no longer present.
    I can only say that the size of the present PCT's has taken the local knowledge away from the services provided.
    I am disappointed that the care my father is receiving is from my daughter and my self. Both good nurses and proud to be in that profession. I am sorry for those who need care in the community now as it is no longer present!!!!!!

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  • Nurses have no one but themselves to blame. Too often a blind eye is turned - not only by colleagues but by managers. It is too much hassle to deal with a failing nurse, service etc and so it is allowed to perpetuate.

    Reporting bad care is seen as disployal and the reporter is punished rather than the culprit. Or worse, the manager to whom the report is made is so inexperienced they do not see the problem. An example of this is the Nurse Manager who could not understand the concerns of a relative when an infusion line which had been hanging in the wind with the end uncovered for several hours was going to be attached to a central venous catheter of seriously ill paerson who had already been given 3 different hospital aquired infections. The response was that the relative was being over demanding and that infusion lines were expensive had had to re-used for economy measures.

    Nurses deserve to be tarred with the same brush when bad practice is allowed, ignored and seemingly encouraged.

    Demand good care, report poor care and keep doing it because that is the only way anyone will listen.

    We all deserve the highest standards, indeed we expect it. Each nurse or one of our relatives may be a patient some day. Do we want sloppy, dangerous nurses caring for us or our loved ones?

    Act now - demand quality in education/training and continuing professional practice. Oh yes - and stop trying to be mini-doctors/surgeons and do the job you studied for. Remember what 'to nurse' actually means

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  • what happened to the role of the modern Matron? Surely as a chief Nurse it is their job to visibly monitor and support good practice, deal with the bad practice before it gets to be common practice. their job should in my view be to educate and support the nurses especially during difficult and pressured times made more difficult by NON clinical management being allowed to dictate clinical management.

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  • As a nurse I feel deflated by these awful reports. My experience as a frontline member of staff is that good basic nursing care would be provided to all my patients (which I always endeavour to do) if I could actually physically do it, but there is simply not enough staff to help me do it! I only have one pair of hands and find it impossible to keep on top of everything by myself. I feel a lack of support from management in this matter. More staff would definately improve standards of care and more support from management. I feel if the staff are looked after and supported that good standards of patient care will flourish. I am currently working through breaks to keep on top of the care of my patients which they deserve, and I get utterly exhausted. If management ensured that nurses and doctors got enough breaks and access to water (no thats not a joke) and enough colleagues on duty then this help ensure all patients are compassionately cared for, which is what I became a nurse to do.

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