Today we have learned of the unannounced inspections by the Care Quality Commission (CQC) of one hundred hospitals and the disquieting news that one in five are neglecting elderly patients to the point of breaking the law. (The report is here).
We hear of unacceptable hospital cultures where unacceptable care has become the norm, where the elderly are treated with a lack of respect, stripped of their dignity, are ignored, are talked over (by doctors and nurses), where basic needs (eating and drinking and going to the toilet) are not met.
How many times have we heard something similar or seen ‘undercover’ reporting on TV documentaries of the disgraceful care of the elderly this year, last year and the years before? How many times will we hear and see it again – for we never seem to learn from it?
It appears to me that the blame culture firmly scapegoats nurses and fails to look at the real issues. Of course there are indeed bad nurses as there are bad doctors, bad politicians and bad governments and I have come across some cruel nurses and doctors in my time but would add that they are few and far between.
The report notes that care has been broken down into a task-based culture where doctors and nurses are held to account for every box they have or haven’t ticked and I would agree that this is indeed the case. Although not working in a hospital but a care setting there are so many boxes to tick (even the photocopier has to be risk assessed), so many authorities, agencies and professional bodies to which you are accountable, so much damn paperwork (often duplicated for aforementioned authorities, etc) that there is less time to offer patient/resident care. These boxes have to be ticked, no ifs or buts or it is your job down the swanny.
Of course staffing resources play a part and the report states: ‘Many people told us about the wonderful nurses in their hospital, and then said how hard pressed they were to deliver care. Having plenty of staff does not guarantee good care (we saw unacceptable care on well-staffed wards, and excellent care on understaffed ones) but not having enough is a sure path to poor care.’ (Bold type mine).
Understaffing does matter, more so when the patient group is more needing of staff input. If you really want to know why understaffing matters read this excellent and frightening post by Nurse Anne at Militant Medical Nurse. (It is important that you are aware that most of the nurses you think are nurses on wards are untrained healthcare assistants – that said there are many damned good healthcare assistants who cannot, I repeat cannot do the work of a qualified nurse).
I can only report honestly how understaffing affects the environment in which I work. We have excellent staffing levels which are above those legally required. If one member of staff has to accompany a resident to hospital during the night we are 20% down on staff and therefore 20% of residents will not receive the individualized input of that member of staff. (Hospitals tend to ‘hang on’ to our staff member for hours on end (anywhere from 2-10) and are quite reluctant to let them go (as in effect they increase the hospitals staffing levels). Staffing levels do affect care whether the DoH agrees with it or not. (Oh what fine meaningless statements the DoH make: “…. Ensuring that providers have sufficient qualified, skilled and experienced staff and patients are protected from the risks of inadequate nutrition and hydration.”)
However it would be foolish to pretend that all bad care is related to bad staffing for indeed there is a culture where bad care/practice is the accepted norm, that said if you work in an environment like this (and are good) it is almost impossible to effect change especially if bad practice is top-down. I worked in a care home such as this (owned by a hospital consultant) and as my ‘whistle blowing’ to management met with indifference I and a residents relative informed the JIU (which has morphed across time into the CQC) and I had to leave and the nurse in question kept her job.
This is the lot of a whistle blower who are regarded as troublemakers and at best ignored and at the worst vilified and lose their job.
So the question needs to be asked “How can change be affected if nothing changes in that wards remain under resourced, staffing levels are in the main made up of healthcare assistants, bad practice is allowed to continue and whistleblowers are vilified?”
What say you?