Monday, 7 February 2011

Wilful Neglect

Although a nurse - I am indeed lucky to work outside of the NHS - for if not, I would feel very threatened, undervalued and unprotected.

I would bring your attention to this statement from the DoH which was briefly reported in the media and has now disappeared into oblivion.  It states that doctors and nurses should be charged with a new crime of 'wilful neglect' if they fail to look after patients.  Sounds fair to me

It also states that ".... ensuring that providers have sufficient qualified, skilled and experienced staff and patients are protected from the risks of inadequate nutrition and hydration."

I can't speak for doctors, but if nurses such as Nurse Anne go home in near tears, as she is terrified that she has made a mistake or killed someone, as she is stretched to the limit by dangerous (qualified) staffing levels - how will nurses cope when this becomes more widespread?

Nurses in hospital are natural scapegoats.  If a doctor makes a drug error and the nurse carries out his/her orders, the nurse is responsible and accountable for carrying out said orders.  If a cadet/HCA fails to assist a patient with feeding, come 'wilful neglect' the nurse will be responsible and accountable - even though she will be unable to supervise as she is carrying out doctors orders, doing meds rounds, attending to patients in difficulty and completing the mass of required paperwork

The Conservative Health Manifesto stated "We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line."    Aint happening.

If nursing levels sink even lower - patients are going to starve and become dehydrated (outside conditions where a patient declines food and hydration at end stage illness) and yes it does happen now due to dire staffing levels  - nurses will pay the price for something that will become increasing beyond their control.

Can anyone speak up for the medical and nursing professions please?   We meed more - not less!  Why can you not imagine they are forests/woodlands and raise Cain?

Anna :o[

7 comments:

drphilyerboots said...

Dear Anna,

it is an interesting directive, but does not answer the question as to who is going to be prosecuted for wilful neglect, the staff nurse or the manager who understaffed the ward?

Dr Phil

HyperCRYPTICal said...

Hi Dr Phil.

Please read http://www.nursingtimes.net/5025186.article?referrer=e16
and then http://www.dh.gov.uk/en/MediaCentre/Statement/DH_124160
and it will be clear who will be prosecuted. Nobody, but nobody listens to nurse.

Anna :o[

Witch Doctor said...

Anna,

This is a welcome yet very serious development for nurses who are running wards that are not well resourced. They will be made scapegoats. In a care home, which is effectively the patient's "own home" then presumably the role of the doctor is similar to that of a GP visiting a patient at home, and so it could be said that a GP does not bear the brunt, or any, of the responsibility if nursing care is inadequate there. Although he/she will have a duty of care if he comes across what her sees as neglect of any patient.

However, the situation is very different in a hospital ward. A consultant, no matter how much he/she delegates, is the ultimate person in charge of the care of a patient and should see that patient often enough and know the ward circumstances well enough to know when neglect is occurring at basic nursing level for whatever reason. I put a post up some time ago referring to Nurse Anne's blog as to how this could be approached.

http://witchdoctor.wordpress.com/2009/11/21/nurse-anne-is-doing-her-nut/

In my view, if a nurse is getting no help whatever from her line manager, she should informally approach the consultants in the ward (they are still quite powerful people when they get the finger out). Hopefully they will start to notice things that have previously passed them by. If this repeatedly fails, she should bypass them all, and if necessary bypass all normal procedures too, and write carefully worded letters reporting specific serious incidents directly to the CE, sending copies to the Medical Director, The Director of Nursing, the consultants in the ward, and her immediate line manager.

Above all, it is important to have an extra copy called "cc file." This is the warning copy, which indicates to all concerned that you have every intention of bringing it out in court if a legal case should follow at any time.

Use paper copy, not e-mail. If you get e-mail responses to your letter, print them all off and keep them with the cc file copy of the original, but don’t respond by email except to say you will follow up with a letter. Use hard copy for all communications.

This needs to be done politely, calmly, accurately, stating concise facts without any embellishments, moans or rants. Serious, carefully selected incidents only should be reported. You may become unpopular, but it will work because at the end of the day CE's, Medical and Nursing Directors do not want to go to jail.

Sorry, my comments often turn into posts when its something to do with the very heart of the problems in the NHS just now.

WD

drphilyerboots said...

I agree with the Witch Doctor, it is vital to keep CC copies in your own files, what she does not say is that the files must be at home. If you are suspended you cannot access them at work, and cannot defend yourself.

Make sure that you do not keep confidential patient data at home.

HyperCRYPTICal said...

Thanks for your comments Witch Doctor and Dr Phil

Thanks for the info WD which I hope I am never in the position where I might have to follow it.
In 'my' home - I don't forsee it.

One thing I am almost certain of (and I am thinking more of a hospital setting here) is that if a doctor makes a prescribing error - wrong drug, wrong dose, etc) and the nurse administers that drug - she is then responsible and accountable for the error.

I have spent some time looking for a reference to a nurse losing her job (and registration) for this - but to no avail. But I know it has happened.

Only reading I could come up with are:
http://interuptions.net/literature/O_Shea_JClinNurs99.pdf and http;//www.ncbi.nlm.nih.gov/pubmed/11978334?dopt=Abstract but are not really what I am looking for.

Perhaps you could clarify?

Anna :o]

ned ludd carer said...

I have a lot of sympathy with hospital nurses. they're in an impossible position. For carers of people with disabilities, what this means is a massive retreat into 'nursing by numbers' so they don't lose their PIN number. The level of personal and individualized care deteriorates and everyone loses out. This is one of the major reasons we don't take my disabled son into hospital any more than we absolutely have to.

HyperCRYPTICal said...

Hi Ned

As said, I really am pleased that I am not a hospital nurse as I would not feel safe at all.
It is a sad state of affairs that nursing is taken up by so much box ticking.

The NMC must know the difficult situation that nurses find themselves in - but do nothing about it. I believe the GMC are just as useless in protecting doctors.

Sad state of affairs Ned. Sad state of affairs.

Anna :o]