Sunday, 19 October 2008

Nursing

I came across this post by a midwife today which has me worried, is this normal? Does this really go on in our hospitals? I have been a patient a few times recently and I have had on the whole a good experience. I realise that as soon as nurses in wards find out that I am a Charge Nurse, my wife is a Staff Nurse and my mother is a retired Sister I am going to get good care as at the very least they do not want us carrying tales around the hospital about 'that awful ward' and in all fairness, I think my hospital is pretty good anyway. But it started me thinking, is there a lack of knowledge in today's nurses about basic things? I have a degree in Nursing, my colleagues all have degrees in Nursing and I must assume that most of the nurses in the hospital have a degree in Nursing. So, does this make us better nurses than those nurses who have retired or are my age and heading rapidly towards retirement? In other words, am I a better nurse for having a degree than I was before I got it? The answer in my case is that it has really made no difference, but mainly because I got my degree fairly recently and managed fine for years without it. Having all nurses with degrees should make us a better profession but it does not make us better nurses. What does make a difference is training and having a pride in what you do. When I started training I worked with an old fashioned ward sister, everybody was afraid of her but her patients loved her. Why? Because she knew every patient on her ward, she knew what was wrong with them, she knew what drugs they were on, she knew their families and she knew what was going to happen to them. She ran her ward with a rod of iron, it was her way and her way only, the nursing process, team nursing and patient allocation were only words to her. If any nurse on her ward had dared to say to a relative "he's not my patient I'll find his nurse" she would have shouted and screamed at the offender so much that they would never, ever say that again (every patient was yours). I had worked in construction and in factories and she terrified me. So if she was such a tyrant why do I think very fondly of her? Why does everyone I speak to who remembers her speak fondly of her? Because she taught us our jobs, no excuses were tolerated, if a patient was sick that was our priority. Now we have recording sheets with colour coded areas which give 'scores', the higher the score, the sicker you are, she would have thrown them out - she knew when a patient was sick.
So what was the difference between then and now? Firstly, the college of nursing taught us what we needed to know, we learned about diseases and the disease process and how to nurse someone with those diseases, you learned hands on nursing on the wards. Secondly, student nurses were not 'supernumerary' they were there to do a days work and to learn while doing (we were paid a wage for this, not a bursary). Thirdly, there was less paperwork to complete and there was not the same pressure to document every little thing (OK I appreciate that this was perhaps wrong and documentation is important but paperwork is very time consuming). Lastly, there were more staff on the wards, even if those staff were students they had a lot more responsibility then, often caring for up to 6 patients with an auxiliary nurse (Health Care Assistant). So can we move back to those days? Probably not, but we can at least try to make our nurses proud to do the job, take pride in having done the best for everyone in our care, but can we please get the tools to do the job we are trained to do. A few more staff on the wards would go a long way, government actually giving a c**p about the NHS and can we please get rid of some of the managers. I read in a blog somewhere this comment - "If half the managers in the NHS did not turn up for work tomorrow, would we notice"? Now substitute managers for any other job title and ask the question.

6 comments:

Elaine said...

I left a comment in the same vein on Doctor Grumble's blog yesterday. I had left bedside nursing to work in the community just as nursing degrees were coming to the fore.

I think you are so right about about the sister (you weren't on Ward 9 at the time?, but I had forgotten about student nurses not being supernumerary, which makes a bibg difference to staffing levels.

midwifemuse said...

When you and I trained we didn't just have RNs (SRNs) and Auxilliaries, we also had ward orderlies and SENs, plus the student and pupil nurses. There were a whole throng of people dedicated to differing tasks, no one was jack of all trades and, I hesitate to say it, master of none. Ward life was a far more ordered affair, even when the sister wasn't on-duty. I had never heard of a 'hierachy of needs' but still managed to provide individualised care. From what I am witnessing at the moment the staff may have all the buzz words but don't know how to put them into practise, they are not even trying.
This may be an isolated example, although I doubt it from reading the papers etc.. I have always staunchly defended front-line staff, generally citing staff shortages, however there was no shortage of staff when I encountered the lack of basic care given to patients on son's ward.

grumpyoldwoman said...

During my last stay in hospital the 'nurse' came to take my BP - as it had registered high at the pre-op it was very important that it was correct so that my op could go ahead. In the event the cuff inflated without disturbing my arm as she had put it on back-to-front. When I queried my lack of BP she said that it was the first time that she had done it and no-one had shown her how!!!!!!!

Mike said...

In answer to your question a degree doesn't make you a better nurse. Here in the U.S. this topic is very polarized and in some circles it would start wars. There are many things in nursing education that in my opinion are truly worthless, such as nursing diagnosis. While many will disagree with me no one comes to an ER saying they have an alteration in comfort.

A good nurse is one that knows the clinical side of medicine, one that is technically smart, applies knowledge well, can multitask well, demonstrates good clinical judgment, can prioritize, identify a sick patient just by looking at them and maintains their cool in an emergency. There are other attributes. Most of these are not taught in any nursing program any where that I know of.

Finally, the one thing that seems to be always missing in nursing is the internal support for less experienced nurses. Senior nurses tend to be over critical instead of just teaching someone a new skill. I could go on and on but in the end you are not a better nurse because of a degree. You are a better nurse because you want to learn your craft well and you do it.

Paula said...

I am a nurse in the USA and we have the same problems in nursing here....part of it is that no one really cares about the patient...only how much money he will make or lose for us

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