NHS - Blame the nurses?

#1
BBC News - Nurses to first train in basic care, ministers to say

Nurses will have to spend time as healthcare assistants as part of a measures to be unveiled by ministers in response to the Stafford hospital inquiry.
More compassionate care is needed in the NHS, ministers will concede.
It comes after the inquiry criticised the system for putting corporate interest ahead of patients.
Hundreds of people died needlessly because of neglect and abuse from 2005 to 2008.
Statistics at the time showed there were between 400 and 1,200 more deaths than would be expected.
The inquiry said failings from the top to the bottom of the NHS meant the public had been "betrayed".
In total the report made 290 recommendations for reforming the system.
Ministers are not expected to respond individually to each one.
Instead, they will spell out a series of steps they are taking to answer the main themes that arose from the inquiry.
Among these will be details about how compassion on the front line could be improved.
'Hands-on' Ministers believe placing student nurses on wards as healthcare assistants for up to a year will help them develop the caring skills required, before going on to do a degree.

It is unclear whether this time would count towards their degree however as nurse students currently have to spend half of their three years in training working on the front-line.
New minimum training standards and a code of conduct for healthcare assistants is also likely to be unveiled, although this looks like it will fall short of the registration scheme recommended by the public inquiry.
Speaking ahead of his announcement to Parliament, Health Secretary Jeremy Hunt said encouraging compassionate care needed to be more of a priority.

"Front-line, hands-on caring experience and values need to be equal with academic training," he said. "These measures are about recruiting all staff with the right values and giving them the training they need to do their job properly, so that patients are treated with compassion."

But Peter Walsh, of Action against Medical Accidents, said introducing a legal duty of candour, which was also demanded by the public inquiry, had the potential to have the biggest impact.

Such a duty would require the NHS to be honest when it makes a mistake.
Mr Walsh said: "For over 60 years the NHS has done no more than pay lip service to the fundamental principle that patients and their families should be told the truth when there has been an error which causes harm.
"Whilst frowning upon cover-ups, the system has effectively tolerated them.
"This culture of cover-up and denial is a cancer eating away at the NHS.
"The legally enforceable duty of candour will help change that culture and represents the biggest advance in patient safety and patients rights in the history of the NHS."
Are you a nurse or health worker? Will the proposals improve standards? Send us your comments and experiences using the form below.
Are they really trying to say that the core of the failures was a lack of compassion and empathy from nurses? They already do in-ward training as part of the degree as well as care in the community, surely that is enough? Throughout this saga the problems were always blamed in further up the ivory tower with stupid cost cutting and targets, why are they not getting targeted? Or if they are why not more severely? I had seriously hoped that such a scandal would finally lead to the real in depth no holds barred look at the system. Or am i missing something in all this?
 
#2
The professionalisation of nursing has (in my humble opinion) led to many nurses seeing the traditional facets of effective care as no longer their responsibility. They see themselves as demi-Doctors, with the 'dirt beneath the nails' work delegated to HCAs, who are paid barely above the minimum wage.

Of course I have met some good ones but most are dreadful and are given too much responsibility. The best ones know the limits of their skill set. The worst (an increasing number) think they know everything.
 
#3
You are probably missing something.
The Community Nurse turned up to see my Mum a few weeks ago to give her a anti-flu injection.The nurse was in a very bad mood.Her parting shot "I didn't do four years training to end up giving injections to old people"
Another occasion with a different nurse who eventually turned up four hours late to take a blood sample from my Mum.She stank of horses and horse shite,uniform was filthy,as were her hands.Mum asked her if she wanted to wash her hands the reply "It's ok - I washed them before I left home"
That's not right is it?
 
#4
The professionalisation of nursing has (in my humble opinion) led to many nurses seeing the traditional facets of effective care as no longer their responsibility. They see themselves as demi-Doctors, with the 'dirt beneath the nails' work delegated to HCAs, who are paid barely above the minimum wage.

Of course I have met some good ones but most are dreadful and are given too much responsibility. The best ones know the limits of their skill set. The worst (an increasing number) think they know everything.
I will take issue with that, as both a qualified nurse and the father of a student nurse. I appreciate what you are saying but I fear that is too simplistic. Nursing has been driven to become the degree based course it is. This resulted at the same time in a reduction of those coming into training. Oh No! said the NHS we are now short of nurses. So a recruiting drive in the commonwealth and other areas such as the Phillipines takes place. There is in those areas a different nursing ethic. At the same time there is a growth in Auxillary/care sassistant/HCA roles all filling what appears to be a second tier of nurse. AH, but you say we got rid of the "enroled" nurse. Now it seems to be returning by stealth. So now we also have the issue of junior docotrs hours and numbers fallling. The good idea? Let nurses "extend their role" for there will also be savings to be made. Now we come to the nub of the matter, MONEY, as it is always thus.
Nurses do care but in this ever money conscious world the care element is very expensive. Health policies that are money driven are not by their nature care driven, and if a caring attitude falls so it falls all over.
I appreciate there are many thoughts in there and believe me I could write a thousand more. this is not a dig at you but a dig at the never ending medleing into care that has got us to this point.
I'm going to stop now.
 
#5
It is easy to blame the nurses and technically correct but the reality is that they were failed by the massive shift in their training that occurred in the late 1980's.

Before then, nurses (like my wife) did a 3 year course that was almost entirely ward based. They did classroom periods as a group and the rest of the time they were split into 1's and 2's and put on different wards to get on the job training and experience of everything. This provided a fully rounded training and gave each nurse a look at each discipline and from that came the chance to decide on a specialty.

Project 2000 came in in 1987 (I think ..). This changed the emphasis from on the job training to Degree qualified nurses who didn't see a patient til they were already 'qualified'. This meant that nurses felt that as Degree holders that they didn't have to have to do the 'menial' but important tasks that also force nurses to have patient contact. Nurses still couldn't do the tasks that Doctors do but made them feel superior to the older SEN and RGN with who they worked. Imagine having a sergeant come in who has never served in the ranks or even been on a base !!

There was also the removal of the Matrons (belatedly reinstated) and the ethos of 'all-are-equal' and of risk avoidance and a lack of people willing to take responsibility as they realised that the bean counters and admin types who came to take over the running of the NHS wouldn't back them has meant that no-one is responsible for a thing.

A system that wasn't broken and worked well was replaced by some ill-thought out experiment designed by someone as far from nursing as could be found. It has failed but no-one wants to say so.

Nurses don't need to be graduates - they need to be knowledgable, interested in patient care and self-disciplined.
 
#6
sees daft, but bare with me.

many of the more, err... mature readers of this thread will remember during the 80's and 90's nurses being described in newspaper headlines as 'angels' - pay rise negotiations, NHS re-orgs etc... they could do no wrong, they were utterly caring, competent, altruistic, the embodiment of the values of the NHS.

add that to the change within the profession caused by the Degree requirement, and you could begin to see why a very obnoxious 'up-their-own-arse' attitude might emerge.

most here will be familiar with the spoilt brat who is never told 'no' by his adoring (and deluded) mummy and daddy, and who's every meagre achievment is met with fawning praise - think of your average premiership footballer - and who recieved constant gifts far in excess of either what his classmates would recieve, regardless of whether his behaviour deserved it, or whether his parents could afford it.

put it in a white coat, give it an underling (the HCA) whose job is the dirty, menial bits - and you'd not be that surprised at the results.
 
#7
It is easy to blame the nurses and technically correct but the reality is that they were failed by the massive shift in their training that occurred in the late 1980's.

Before then, nurses (like my wife) did a 3 year course that was almost entirely ward based. They did classroom periods as a group and the rest of the time they were split into 1's and 2's and put on different wards to get on the job training and experience of everything. This provided a fully rounded training and gave each nurse a look at each discipline and from that came the chance to decide on a specialty.

Project 2000 came in in 1987 (I think ..). This changed the emphasis from on the job training to Degree qualified nurses who didn't see a patient til they were already 'qualified'. This meant that nurses felt that as Degree holders that they didn't have to have to do the 'menial' but important tasks that also force nurses to have patient contact. Nurses still couldn't do the tasks that Doctors do but made them feel superior to the older SEN and RGN with who they worked. Imagine having a sergeant come in who has never served in the ranks or even been on a base !!

There was also the removal of the Matrons (belatedly reinstated) and the ethos of 'all-are-equal' and of risk avoidance and a lack of people willing to take responsibility as they realised that the bean counters and admin types who came to take over the running of the NHS wouldn't back them has meant that no-one is responsible for a thing.

A system that wasn't broken and worked well was replaced by some ill-thought out experiment designed by someone as far from nursing as could be found. It has failed but no-one wants to say so.

Nurses don't need to be graduates - they need to be knowledgable, interested in patient care and self-disciplined.
The description of nurse training contained within is completely incorrect unfortunately, and contains many untruths as pronounced by some nurses who qualified pre-Project 2000 and who really should know better.

Project 2000 has nothing at all to do with degrees. Project 2000 was a course that led up to a Diploma in nursing and involved roughly 50% of the time on the course on the ward on nursing placements. There are no nursing courses, nor have there been that I've ever been aware of where students 'didn't see a patient until they qualified'. Complete guff.

I did a nursing degree in the late 90's. This was a 4 year that had been course shoe-horned into 3, basically by us having only 5 weeks vacation a year, and we spent marginally more time on the wards than our diploma counterparts. The extra year had originally been intended for dissertation and elective placement work. We had to do dissertations at the same time as being on placement for 37hrs a week.

I've certainly never looked down on an SEN or a nurse with a diploma and I don't know any of my colleagues who have either. Having a degree doesn't make me a better or worse nurse than someone with a diploma or older qualification, it really only means that I've done a in depth research project and therefore bring a slightly different set of skills. Not better, just different.

I've never believed the Matron argument either, it's a convenient one that doesn't really stand up to any scrutiny. The re-introduction of 'modern matrons' hasn't changed much. As an example, the recent significant lowering of MRSA rates has nothing to do with modern matrons, who are really just an extra layer of operational management, and far more to do with bringing domestic arrangements back in house from contract or a significant tightening up of the KPIs for these contracts.

I think that many of the problems laid at the door of nurses are more to do with the ever increasing amount of paperwork and metrics they are instructed to complete and the gentle erosion in staffing numbers than any real hardening of their attitudes towards patients.
 
#8
sees daft, but bare with me.

many of the more, err... mature readers of this thread will remember during the 80's and 90's nurses being described in newspaper headlines as 'angels' - pay rise negotiations, NHS re-orgs etc... they could do no wrong, they were utterly caring, competent, altruistic, the embodiment of the values of the NHS.

add that to the change within the profession caused by the Degree requirement, and you could begin to see why a very obnoxious 'up-their-own-arse' attitude might emerge.

most here will be familiar with the spoilt brat who is never told 'no' by his adoring (and deluded) mummy and daddy, and who's every meagre achievment is met with fawning praise - think of your average premiership footballer - and who recieved constant gifts far in excess of either what his classmates would recieve, regardless of whether his behaviour deserved it, or whether his parents could afford it.

put it in a white coat, give it an underling (the HCA) whose job is the dirty, menial bits - and you'd not be that surprised at the results.
If you'd known the nurses of the pre Project 2000 generations then you would know that they were not arrogant and despite what the public may have thought of them, their workplace - and doctors in particular- made ****ing sure they were kept well in their place and made to feel the lowest of the low.

Your reasons, however, have put far more eloquently than i could the reason for the attitude of our Armed Forces. Always whinging about pay - despite knowing the pay before they joined -, spouting bollox about serving their country - when all they usually want is to do the minimum of work and maximum of tossing off and going on the piss and then whinging when their occasionally dangerous job sees them injured. And always playing the 'green card' at every opportunity. And you talk of nurses being arrogant !!
 
#9
The description of nurse training contained within is completely incorrect unfortunately, and contains many untruths as pronounced by some nurses who qualified pre-Project 2000 and who really should know better.

Project 2000 has nothing at all to do with degrees. Project 2000 was a course that led up to a Diploma in nursing and involved roughly 50% of the time on the course on the ward on nursing placements. There are no nursing courses, nor have there been that I've ever been aware of where students 'didn't see a patient until they qualified'. Complete guff.

I did a nursing degree in the late 90's. This was a 4 year that had been course shoe-horned into 3, basically by us having only 5 weeks vacation a year, and we spent marginally more time on the wards than our diploma counterparts. The extra year had originally been intended for dissertation and elective placement work. We had to do dissertations at the same time as being on placement for 37hrs a week.

I've certainly never looked down on an SEN or a nurse with a diploma and I don't know any of my colleagues who have either. Having a degree doesn't make me a better or worse nurse than someone with a diploma or older qualification, it really only means that I've done a in depth research project and therefore bring a slightly different set of skills. Not better, just different.
Spoken like a true post Project 2000 'graduate' . Albeit a bit more modest ;-)

As someone who qualified when you did, apart from knocking my post, a suggestion of the true problems and a solution might be useful .....
 
#10
They should kick all those overpaid and totally unnecessary 'managers' into touch and bring back the Matrons. They ran hospitals with a rod of iron & ensured they ran like a well oiled machine.
 
#11
They should kick all those overpaid and totally unnecessary 'managers' into touch and bring back the Matrons. They ran hospitals with a rod of iron & ensured they ran like a well oiled machine.
Oohh Matron, I hope you've warmed your rod of iron!
 
#12
Too many people reading fairy stories about ladies with lamps and 'angels of mercy'.
 
#13
So its a lack of compassion that has my wife in tears when a patient dies in her ward ?
Or a lack of compassion that changes the Dr's mind to not send a dying patient home for her last days as her last wish
Or a lack of compassion that brings her back to work on a day shift after four nights on ?

**** you bbc, **** you a lot.
 
#14
So its a lack of compassion that has my wife in tears when a patient dies in her ward ?
Or a lack of compassion that changes the Dr's mind to not send a dying patient home for her last days as her last wish
Or a lack of compassion that brings her back to work on a day shift after four nights on ?

**** you bbc, **** you a lot.
And your wife is not the only one. I'm in Occ Health and I dont have a day go by without a member of staff in my clinic breaking up as they can't do their job properly due to the current pressures on them. As for the manager knocking even that is not true. They are being culled left right and centre so much so that work they were very effective at is now not getting done, at all. Try speaking to payroll with a query and all you get is a messaging service.
 
#15
So its a lack of compassion that has my wife in tears when a patient dies in her ward ?
Or a lack of compassion that changes the Dr's mind to not send a dying patient home for her last days as her last wish
Or a lack of compassion that brings her back to work on a day shift after four nights on ?

**** you bbc, **** you a lot.
No, but it's probably reasonably good evidence that "compassion" (actually empathy) is neither a necessary, nor indeed a particularly desireable trait amongst those who would take up a 'caring' profession.
 
#16
Not getting into the whole 'to qualified to care' argument, but in the military there are some similarities.
Back in the late 80 in Germany when the IRA were knocking 10 bells out of morale in BFG I was based at HQ 1(BR) Corps.
Duties were good, and the average was one guard per month for a Dvr/Pte as with most units at the time.
Once the campaign started however we suddenly found ourselves doing almost 10-12 per month. This was due to the fact that as a unit there were only about 130 troops at that level who could stag on. All the others were JNCO/SNCO and officers (it was a very rank heavy unit as you can imagine). To make up the shortfall the order was given that JNCO's were to stag on as well. The guard commander went up to Sgt and the 2 i\c to Cpl with Cpls also stagging on. For many of the older JNCO's this was fine, it went with being a soldier and if there was a job to do you did it. Even the RSM stagged on for 2 weeks during a major exercise when everyone was out in the field!
The only NCO's who had any kind of a problem were the 'professionals'. Mainly Int Corps and those in technical trades where rank was granted like sweeties at the end of a children's party, and the same excuses came out. The 'I'm too qualified' and 'I didn't become a tech to do this sh*t' was quite common. The Int Corps guys were the biggest pain though. They even once all tried to get one man rooms in case they 'talked in their sleep'.
Anyway, back on track. My point is that perhaps it is not unusual for people to lose sight of their real purpose when in a role, and the more you raise them up on a pedestal the more they actually remove themselves from the base purpose of their job.
I have personal experience of this. Since leaving the army I have become moderately successful but almost threw it away a couple of years back when hubris set in. I'd lost track of the fact that what made me successful was doing all of the horrible little crappy jobs that kept my business ticking over nicely. It took a rather nasty shock to make me realise that I have to spend the first 2 hours of each day doing the business equivalent of sweeping the vehicle park and doing block jobs, and it was this activity that made me successful, not the 'other' stuff I'd began to believe was.
Perhaps the Stafford report is bringing this kind of behaviour to light in the NHS?
 

jarrod248

LE
Gallery Guru
#18
It is easy to blame the nurses and technically correct but the reality is that they were failed by the massive shift in their training that occurred in the late 1980's.

Before then, nurses (like my wife) did a 3 year course that was almost entirely ward based. They did classroom periods as a group and the rest of the time they were split into 1's and 2's and put on different wards to get on the job training and experience of everything. This provided a fully rounded training and gave each nurse a look at each discipline and from that came the chance to decide on a specialty.

Project 2000 came in in 1987 (I think ..). This changed the emphasis from on the job training to Degree qualified nurses who didn't see a patient til they were already 'qualified'. This meant that nurses felt that as Degree holders that they didn't have to have to do the 'menial' but important tasks that also force nurses to have patient contact. Nurses still couldn't do the tasks that Doctors do but made them feel superior to the older SEN and RGN with who they worked. Imagine having a sergeant come in who has never served in the ranks or even been on a base !!

There was also the removal of the Matrons (belatedly reinstated) and the ethos of 'all-are-equal' and of risk avoidance and a lack of people willing to take responsibility as they realised that the bean counters and admin types who came to take over the running of the NHS wouldn't back them has meant that no-one is responsible for a thing.

A system that wasn't broken and worked well was replaced by some ill-thought out experiment designed by someone as far from nursing as could be found. It has failed but no-one wants to say so.

Nurses don't need to be graduates - they need to be knowledgable, interested in patient care and self-disciplined.
Nurses were indeed very much ward based back then but everything was task orientated and there was very little machinery and little if any research or evidence in anything we did. We did quite a few things that made patients worse in fact but we didn't know it at the time.
Project 2000 did place more emphasis on education and research rather than learning a task and so they did indeed have gaps in their knowledge when it came to certain tasks. I think a lot were told lies by educators who believed they'd be the new tier of managers which wasn't true.
Matrons were of course looked back on fondly in the same way as you look back at the lovely CSM who had you doubling around the MT sheds with an SLR held high above your head until he got bored.

Nurses had to take on lots of extended roles when Doctors took on more extended roles, staffing got worse, pay didn't increase but the extended roles continued to increase.
So HCA's take on lesser skilled jobs, the Nurses do many jobs the doctors used to do, GP's do jobs that consultants used to do and so it will continue.
Ten years ago a consultant Psychiatrist did my job, eight years ago a GP did it, seven years ago I did it on my own. The time scale is approximate but just to give an idea.
So yes I think with more extended roles nurses probably do need to be graduates.
 

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