19 October 2008

Unforgivable, inexcusable and dangerous

‘I don’t think they care,’ was Hubby’s summation of the nurses' behaviour, 'I just think they are thick'.

Sadly, there are times when Dr Grumble has felt the same way. Read the story here.


Jobbing Doctor said...

This is quite scary, but it does seem to chime in with a fair number of stories that I hear each week from my patients, and read on various sites.

One on 18th October about the John Ratcliffe hospital in Oxford also points this out:-


It is a very far cry from the experience that I had as a junior doctor in the 1970s.

Elaine said...

It is also a very far cry from the care that we nurses gave back in the 70s. It is inexcusable and I do not seek to offer an excuse, but two things have caused the deterioration of nursing care, the first that the staffing levels are so much reduced from my days and the second (and probably worse)that nurses are "educated" to graduate level instead of being trained at a college of nursing with much of the three years being spent on the wards.

Never mind the loss of the matron, another great loss was the ward sister who knew all about the patients on her ward and delegated work to the rest of the team (keeping an eye out to see that it was done.)

This was changed to "team nursing" where nobody was in charge of the ward and a team leader knew only about the patients in her part of the ward.

Bring back matron, bring back the ward sister.

Dr Grumble said...

Things have changed JD. Older GPs have no idea just how much. Grumble once had a GP complain about the care of his father. He was clearly astonished at what had happened. He thought it was a one off and then realised that things in hospitals were no longer as he had remembered them. He decided to complain vigorously to help Grumble improve things. Of course it was really just a lot of work for Grumble dealing with a cumbersome complaints process that just sends out a lot of platitudes but generally results in no action that is likely prevent whatever happened from happening again. But that's not what Grumble told the well-meaning GP. Perhaps it did get logged somewhere. Certainly things are better than they were at the Grumble hospital.

These sorts of goings on are one of the reasons for Grumble's blog.

By the way the people who are most shocked at the changes in hospitals are older nurses with memories of how things used to be. These are the people who used to be ward sisters who really knew how a ward should be run. Running a ward is a difficult challenging job. It's tough. It's much easier to be a specialist nurse. That's the root of the problem: the best nurses leaving real nursing.

Incidentally some of these tales are why I need to maintain some anonymity. The problems are generic but my tales are local and that could spell trouble if I could be identified.

Dr Grumble said...

Wonderful! While Grumble was typing Elaine made his point and succinctly highlighted a few other extremely important factors with which Grumble wholeheartedly agrees.

GrumpyRN said...

This kind of ward environment would not have been tolerated even in the 80's. I knew every patient on the ward and I knew their diagnosis and what their treatment plan was. Unfortunately when you discuss these kind of things with ward nurses or with students they look at you as if you are mad or raving and tell you that things have moved on. I don't think it is anything to do with being a graduate but it has everything to do with the lack of hands on teaching of hands on skills. Having a degree should make for a better profession but unfortunately it does not make for better nurses or nursing.

Dr Grumble said...

"Things have moved on"

Dr Grumble has had this said to him several times. About nursing. About MMC. About experiential learning. Never real arguments. Just the implication you are an old fart ready to be put out to grass. The trouble is that it does silence the likes of Grumble. That's why he blogs.

The trouble with educating nurses to graduate level, as grumpyrn says, has been that the education has moved away from the wards to the lecture theatre. Junior doctors too are learning on plastic dummies instead of the real thing. The simulator may have a role but experiential learning is essential. But that's just the view of an old fart.

Anonymous said...

That is a truly awful story that you link to on Midwifemuses's blog.

And not just the nursing was at fault, if you ask me. It seems everyone involved failed the patient. You would think the surgeons - and possibly the anaesthetists if they were writing up the analgesia - had some questions to answer too.

In many ways it sounds like every single possible thing that could have been done badly, was done badly, starting with the "structural contraints" of organisation, training and ward staffing (inc. the things Elaine noted), and going on from there. Who, out of all the doctors and nurses, was actually taking responsibility for giving this poor man proper care?

The phrase it summons to my mind is "total systems failure". It certainly sounds like it needs the full air crash investigation-style critical incident / systems failure analysis.

Would something like this count as a "Critical Incident" and get reported and investigated, Dr G? Because it surely ought to be.

I wonder if Midwifemuse has a sympathetic MP?

Anonymous said...

Thank you Dr Grumble for linking to my posts, you never know, perhaps the more people read them, the more likely it is that change may happen. I'm an optomist!
Elaine and I trained in the same decade, when Matron, Nursing Officers and Sisters ruled 'their' wards. In the days when we learned through clinical experience, not through books, we didn't graduate, we qualified, but by the time we earned our buckle we knew that observation of the patient was one of the keystones to providing appropriate care and it is here that the nurses on son's ward fell down.
Dr Aust quite rightly suggested that it is not solely the nurses who have let their responsibilties slip, everyone involved has failed in their duty of care.

Dr Grumble said...

In the days of old when Sisters ruled their wards they would have insisted on the doctors doing their jobs properly as well as the nurses. Not, of course, that that excuses the doctors. But it does show how good nursing is the mainstay for quality care on the wards.

Dr Aust, when things go wrong they should be reported as a clinical incident but there are all sorts of reasons why this may not happen.

Midwifemuse, what you have related grieves us all. Many of us in our own little way with our blogs are trying to draw attention to these problems in the hope that somewhere somebody will notice and that improvements will result.

We all hope, midwifemuse, that things go better from now on. Dr G send his best wishes.

Anonymous said...

One of the Pavlovian theme's that emerges after an NHS horror story, is how things like this would not have happened in the past, a rather dubious contention in my book, certainly when I think back to a relatives cancer treatment.

There is an implied message that docs & nurses of yesterday were more caring somehow, or had greater clinical nous - well maybe they did, and maybe they didn't.
Of course, such terrible incidents beg questions about culpability, blame, and so on.

Well I can only speak as a I find - my nursing colleagues could not be working any harder [by and large, and accepting that all teams carry one or two passengers].
Yet in A&E we soon grow accustomed to predictable comments like "it's worse than a third world country" [a particular favourite amongst middle class punters], "I pay your wages" or "it's a disgrace I've had to wait 2hrs", etc.

In London nursing jobs are advertised all the time [because who in their right mind would put up with such unremitting pressure if they had another choice in life, but I digress].

So here's a challenge to the finger waggers - why don't YOU apply for a post in a failing service then perhaps you could instruct the nurses how to keep the managers, families, doctors, social workers and of course, patients, happier.

If nurses are so crushed that they are unable to provide basic needs [which we know is happening more and more frequently] - then the great and the good [Darzi & Co] need to vacate the board room and spend a bit more time witnessing the immediate effect of insane health policies.

Blaming the nurses only perpetuates the problem, in my opinion, most of us are decent enough, and only want reasonable conditions to do the job properly.
So, for starters, perhaps we could begin by reducing bed occupancy rates by 15% from nearly 100% in some Trusts to nearer 85% [the recommended safe upper limit].
Of course, this would have serious implications for the 15 million admissions the NHS deals with every year but we can't have both ways, can we ?

Anonymous said...

So, for starters, perhaps we could begin by reducing bed occupancy rates by 15% from nearly 100% in some Trusts to nearer 85% [the recommended safe upper limit].
Now that would be a target worth having. We are never going to have this unless it is made a target. The only way of saving money is to cut back on beds and, therefore, staff. It then follows that the only way of treating patients is to put two patients into some of the beds. Our trust specialises in this by getting patients sent to wait in the discharge lounge. How can you sort out discharge summaries, communication with relatives, making sure they understand their medicines etc with the patient getting fed up on the other side of the hospital!

Anonymous said...

The only way of saving money is to cut back on beds and, therefore, staff
I don't think the % reduction was aimed at saving money - more improving quality. But anyhow, I too acknowledge some places are crappier than others - yet also support A&E CN's notion that the source of the problem is not perhaps solely in bad nursing or the quality of those individuals.
The way some of the wards are not performing, a new grad nurse is likely to be flung onto a ward with less support and guidance into their new role than her/his predecessors were. The foundation base may be set in Uni or wherever, but the first few courses of brickwork laid over the first consolidating years will determine how stable the rest of the structure will be.
I'd argue the "too much paperwork" thing too - but since the fluid balance chart wasn't complete...

Too much patient care is measured by 'service episodes' and hours-per-patient-day. There needs to be less speed about bureaucratically derived 'health care' and more haste in (re)developing nursing as it should be caring about health - or it is all set to disappear up it's own bureaucratic sphincter.