Too posh to wash?

Biker - What a good post. The essence of nursing.

Well put biker

Hello Biker good to see you back . This issue is a biggest topic of conversation amongst my son's cohort of final year nursing students, and they say the same as you - they want to do those patient-contact tasks that allow them those opportunities. A couple of days ago, they had this discussion with a uni tutor who had told them that, on an average shift, a qualified nurse on a general medical ward will get four minutes contact with each patient. The students are angry that a) uni courses are geared to 'help' students manage this lack of contact, b) ward managers go along with the status quo, and c) there is no comparitive shortage of senior managers and administrators, whilst support workers are being brought in from agencies.

The psych unit my son works on at weekends has persuaded managers to prioritise staff and bank workers over agency (there's only been one agency worker in the last month), after the staff group petitioned a temporary ward manager who was put in place to cover for their suspended manager during an investigation. Disgraceful that complaints and deaths have to occur before managers will listen.

I seem to remember there used to be nurses that wore beige , that seemed to do the basic caring stuff, plus every ward had it sown FT cleaner.... those were the days..pre 1979

Those would be the State Enrolled Nurses, susie. Nowadays, Health Care Assistants do the same job, presumably for lower pay.

Hello Biker - good to hear from you - an eloquent post. There are two threads running on this topic. I feel that I could participate in this debate on the "nurses need to roll their sleeves up" side. But there are plenty of voices raised on that side so I have been trying to think about the issue and gain a wider understanding by looking at other viewpoints. This includes talking to my DIL who has wide experience of the UK system and the Australian system.
I doubt biker that there are many nurses who would disagree with you. However the political and financial pressures on the NHS, including the increasingly technical workload and the increasingly serious condition (on average) of those who are occupying hospital beds would seem to preclude any quick or easy solutions such as making nurses do a year of nursing assistant work or saying work harder. Nursing has always had high absence rates and very high levels of trained staff being lost to the profession. I fear this will only get worse as budgets are further tightened.

Good morning Jess, you are right in many ways. The whole culture of nursing has changed beyond recognition in the almost 50 years I have been in the trade.
To meet both government and financial targets our patients are placed on a conveyor belt of care that shovels them through the system very quickly indeed. There is little or no time for nurses to get to know their patients as they used to and actually need to if they are going to provide top quality care.
8 weeks ago I had my second new hip hammered in on a friday morning. Saturday afternoon I was sent home. I live alone. I remember nothing of the first week and to be frank it both shocks and frightens me that this could happen. Yes, colleagues and friends called in and apparently got food ready for me but I was so much at risk of falls and injury that I still don't like to think of it.
This pressure to treat and discharge is one of the major reasons for the high absence and attrition rates that you mention.
An old American TV series used to mention 'Treat and Street' - that cry seems to be the ethos of modern health care in the UK. It both saddens and sickens me.

My DD is due to have a hysterectomy this week - should have had it done a couple of months ago but shortage of beds in SWales means that the January ladies have not yet been done - cancelled several times. I was horrified to learn that it is now routinely done with an epidural and the ladies are kept in hospital for 36 hours!
DD has been having hormone injections in her abdomen on a monthly basis to shrink fibroids. I understand these injections cost hundreds of pounds each and a maximum of six can be administered. Usually a hysterectomy is done after a couple of injections but DD has now had five with no sight of when she might get the operation. They cannot/will not tell her what to expect when these injections end, but research on Google would suggest the fibroids grow back at a fast rate and maybe the dreadful bleeding will return.
All this is very worrying so we said she should look at the situation if she goes privately - same surgeon - yes she could be done within a couple of weeks. So she is booked in to have it done this week at a BUPA hospital and will be in three days - she has had to pay the bill already!!!
As a family we have sorted the cost out but many people would not have this option. We have been told that on one occasion at least both surgeon and patients were ready for the operation but it was cancelled at the last minute due to no beds being available. What is happening in UK - or Wales in particular?
In March it was decided that DH needed an op here in France and all was sorted within a fortnight including having lots of checkups prior to the op to ensure there were no other underlying problems - this is normal procedure here. The operation was done at the beginning of April. So far we have nothing but praise for the quality of service received.
We are returning to UK this week to be on hand to assist DD when she gets home.

Bez - could I suggest that your DD does as much research as possible on the surgeon and the hospital. My daughter had an operation in The Chaucer BUPA hospital in Canterbury, which should have been routine, but when the surgeon punctured her stomach and she was deperately ill there was no consultant on call in the hospital.
Any surgeon should be willing to tell a prospective patients his success/failure rate in any particular type of operation.

Thank you GN for that advice but early on in this process - last November - she went to have a second opinion from a private Gynae Dr - suggested by the GP surgery - and he said the two people she had been referred to were extremely good and he had worked with them. The NHS hospital he works at tends to be a bit specialist for women. Also she knows a number of women operated on by him and they had nothing but praise. This particular surgeon does seem to have an extremely good reputation - we shall see!!

That all sounds good, Bez. My daughter had had her gall bladder removed by the same surgeon some years previously and was very happy. Unfortunately, something must have happened to his own physical or mental health in the interim and he cost the NHS millions in damages as he had butchered more than a dozen women, and had 75 separate complaints against him, before he was suspended. He asked for voluntary deregistration (which was not granted) on the grounds that he did not want his own health problems to be made public.
No whistleblowers around - he was a very popular consultant at the hospital. I wonder if any of his colleagues suffer pangs of conscience.

The rot started in the year 2000, when project 2K was introduced. Some of you are no doubt familiar with this project?
Combine some practical nursing with a lot of classroom study, move them around to various specialities, don't pay them a wage, give them a bursary, guarantee they become staff nurses on completion of the course. gives rise to the accusation of "Too posh to wash" (for many, not all) They feel they are staff nurses, above the mundane things like washing, combing hair, feeding, talking to patients, almost on their first day when they know nothing at all.
HCSW, on the whole do a good job, they replaced the auxiliary nurses, but we had more of them,they were the carers, the washers, the hair combers,the feeders, the ones that would find the time to talk to you, see that you had water to drink,(within reach)see that your food was as ordered and was palatable.
Too many chiefs and not enough indians, as is common elsewhere.

blimey biker that is quite terrifying. Years ago you would have been in hospital for about 10 days I guess. Hip replacement is hardly minor surgery. Only advantage of such early discharge is that you are less likely to pick up something in hospital.
Bez - misreable. My cousin's OH is a chest consultant. He tells me that there is huge pressure from the ministry to reduce the number of beds. In surgery this would have the effect of longer waits for surgery. In his specialism it is not realistic as he cannot spread workload over the year - heavier demand in winter of course, and there is nothing he can do about this. We should complain to our MPs.

Deserving Project 2000 was started around 1991.

Biker. Your post makes abundantly clear that rather than constantly being described as basic or low grade tasks personal care is vital to the wellbeing of the patient as well as providing important information about status changes. There should be patient /nurse interaction while the patient is being made comfortable and this also contributes to the mental wellbeing and confidence of the patient . It is well documented that appropriate touch promotes wellbeing so in my opinion we need to re evaluate the idea that this is not important to patient care and to learn a lesson in humility in the face of great suffering and fear and when people and their families are at their most vulnerable.

Biker That really was frightening and should not have happened. I had a TKR done recently and i was operated on the Friday pm and was discharged a week on the Saturday. It did not end end there because "hospital at home" kicked in and a physio and nurse visited me on the Sunday. The physio came I think for around 2-3 more days until he thought that I was competent on crutches, could "do" stairs etc. The nurse visited daily I think for a week, checking my temperature, BP and that there was no leakage from my wound. This was a private service bought by my local health authority so that folk did not occupy hospital beds unnecessarily. I also live on my own and still found it difficult to cope because I could not carry anything eg cups of coffee while using crutches. My experience was totally different from yours and has given me faith to have the other knee operated on.

"The rot started in the year 2000, when project 2K was introduced. Some of you are no doubt familiar with this project?
Combine some practical nursing with a lot of classroom study, move them around to various specialities, don't pay them a wage, give them a bursary, guarantee they become staff nurses on completion of the course. gives rise to the accusation of "Too posh to wash" (for many, not all) They feel they are staff nurses, above the mundane things like washing, combing hair, feeding, talking to patients, almost on their first day when they know nothing at all"
Dear Deserving - where have you been? P2K was finished as a course by 2003 and replaced by the current incarnation which, for Wales, I was happy to write. Wales has always paid a bursary up to this year England started by paying a bursary but when they went onto a four year course (to allow for university holidays) they stopped. Wales has stuck to the three year course. The original diploma level has been upgraded to a degree level course and this is not to allow nurses to preen or become less practical it is purely for parity. All the other professions within the multi-disciplinary team were degree qualified so it was felt that nurses should at least be equal to that. They are trained in research led practice rather than the condition led training that I had and now have far more understanding at qualification than any previous generations.
My own experience with the students (and as a patient) is that the Nurses themselves would LOVE to spend more time with the patient group; unfortunately shortages of staff and the waiting list conveyor belt prevent this.
The problems lie not with the Nurses as a group but are systemic. Central Government demands allied to silly and unrealistic targets plus of course all us creakies living too long pile pressure onto the clinical areas that they just cannot meet. Ward sisters can no longer work weekends (they cost too much) Nurses now work 3 long days per week instead of 5 shifts, there are moratoria on recruitment and the use of bank staff - the numbers of staff required are simply not there.

I think it comes down to the competence and efficiency of those incredibly well-paid managers in appointing supervisors and enough other staff who are also competent and efficient and letting them get on with it without interference. I've just had a really excellent experience in a local hospital; I couldn't fault any of it. On the other hand, my poor old mum was neglected in another hospital, same speciality in the same Trust where it was hard to find a nurse to talk to. One department can be wonderful and another awful, in the same hospital.

Blinding flash of light on the subject while talking to DIL this morning.
:
In the private hospital she worked in recently in Sydney area there was a system for managing the response rates to call buttons. Ward managers could see daily rates of answering calls on their ward, even response rates for individual patients. This enabled them to praise staff for response rates, identify problems and solve issues around individual patients (the man at the end of the corridor who was very grumpy for instance was waiting longer than others...)
Staff are a lot more aware with this system is operating and tend to prioritise calls from patients.
This obviously involves investment in an IT system but as "they" rightly say - if you cannot measure something you cannot manage it.
Because it was a private hospital this was a key "customer satisfaction" measure.
Of course they also need enough staff to do the answering which is the other part of the equation.

That sounds like something worth implementing, Jess , even if it does cost money. It documents their response time and compares it with national levels, and can be observed and improved with obvious and immediate results. Gold stars on the classroom wall. Plus, it does not depend on individual patients and their relatives raising hell and becoming unpopular.

I would love to be able to say that every nurse I have encountered was kind and efficient, and when my daughter came close to death they were very sympathetic - some were in tears because they could not find a consultant to come and stop her internal bleeding (it was a Friday evening in an NHS hospital).
However, in the long weeks when she was 'recovering' she saw some things which appalled her. One young man in his 20s had terminal stomach cancer - she was in a mixed ward. He called out for more pain relief and the young nurse who came said to him 'If you keep making a fuss it will take even longer to get your morphine'. She herself had to get up, shuffling along with her drip bottle, to give a drink of water to the old lady in the opposite bed who was pleading for a drink.
I visited every evening, and there was often a gaggle of nurses around the nursing station, apparently just gossiping about their social life.
I think a strict old-style ward sister would soon have sorted them out.
This was the same hospital where her sister started nursing training and was told that if she reported the appalling attitude of an anaesthetist she could 'kiss her career goodbye'. It was also the hospital where the surgeon who almost killed her by his negligence was allowed to continue operating when it must have been obvious by his failures that he was no longer competent.

biker, where have I been?
I've been in the hospital,as part of the patient "group" as you refer to them.When P2k ended is irrelevant, the corollary relates to when it started,and its continuance,irrespective to the changes that have been made. Changes that from the patient groups aspect,appears to be worse.Granted insufficient staff exacerbate the problem, and ill people are a nuisance when you are working towards a degree. Do not regard this as calumny you appear to have had/have,a medical leaning, which can make you too close to the wood.Chacum a son gout, many have had very good experiences,and would not excoriate or even dream of doing so,nevertheless the exigency of the services are far from being met. If I want a wash ,or my hair combing, or cannot reach my food, I have no ambivalence regarding your possession of a degree,or otherwise.

Leadership comes from the top, and individual nurses tend to fit in with the existing ethos of the unit where they work. If they don't like it, they vote with their feet. If they absorb it, they reinforce it.

I like the system that Jess describes - an emphasis on patient care with a concrete measurement of how well it is doing - the time-to-response element at least. Less paperchasing, more nurses and better deployment of them could do a lot.