02 March 2008

Nobody wants to wipe bottoms

So says Alex Thomas, a medical student. Dr Grumble agrees. He has said as much himself. As Alex says, there is not much point in getting nurses to wash their hands if they will not deal with patients lying in their own excrement. Senior nurses of 20 years ago warned Dr Grumble of the the consequences of moving nursing away from basic nursing care and towards the technical. We didn't dream then it might move further towards the diagnostic - that would have been unthinkable. But very quickly the unthinkable has happened. The nurses of old were right and Dr Grumble was very wrong. If the government wants nurses to become doctors, then train them to be doctors. And then the logical thing would be to train the healthcare assistants to become good old-fashioned nurses. But this won't happen because this would cost too much. So let's have the nurses doing nursing. And let's reward them for doing the really difficult tough nursing. Why do you have to sit in an office to get paid well as a nurse? Or do the doctors job? It's much more difficult to run a busy ward well. And this job used to command respect. It really did.

This post was first published on 3rd December 2006. Dr Grumble has republished it now because the public is now becoming aware of how recent government policies have damaged the nursing profession. The govermnent failed to recognise the value of proper nursing. Partly as a consequence, the distinction between medicine and nursing has been eroded. Roles and responsibilities need clear definition. Tooke has recognised this. Without this you get chaos. Caring for the acutely ill is a bit like fighting a war; proper command and control at ward level are essential. But command and control on the wards is a thing of the past.

Some people seem doubtful as to the veracity of Lord Mancroft's allegations. Dr Grumble can tell you that, in response to questionnaires, reports of nurses talking over patients are commonplace. The managers react by sending out a round robin telling people to behave. But what you really need is proper nursing by proper nurses.


Anonymous said...

its the centralist state run money no object but the customer has no say services through and through

give the customer they buying decision, real ability to walk away and take their money elsewhere

let normal commercial dynamics force change in the way the chairman mao i mean brown never will be able to

Dr Grumble said...

It's been state run throughout my working lifetime. I can remember when British nursing was admired the world over. No blame cultures borrowed from the private sector and a move away from hierarchies and rigid professional groups abhorred by the private world and the substitution of cheap poorly trained staff for highly trained professionals has contributed to the decline.

Mousie said...

You're right Dr G, it is difficult to run a busy ward (or department) well. And it's just as difficult to nurse the infinite number of patients one has to care for under the increasingly intrusive, unecessary and misguided culture of targets, politics and protocol that has developed in the (ahem) fifteen years that I have been nursing.

Most of us are not too posh to wash; we're just ground down, day after day by poor skill mixes, dangerous under-staffing and overwhelming workloads.

It's hard to keep up standards when you don't have the time, the equipment or the support to do things properly. It's hard to keep the ward clean when the cleaners only work four hours a day and the nurses have enough paperwork to fill six hours of every shift. It's hard to keep on caring when it feels like you're the only one who gives a shit.

And then the colposcopy specialist nurse walks onto the ward and starts bragging about her three day week and her band 8c pay packet and revolt ensues. You can't blame us really... ;o)

Dr Grumble said...

Agreed Mousie. It's the policy makers that are to blame and not the nurses themselves.

Anonymous said...

Not only have the roles become confused, but in electronic medical records, physicians are being bypassed and nurses are becoming preferred for leading implementation projects.

Thus, you have the facilitators leading the enablers.