It is patients who will end up losing out

Published in The Independent (November 13th, 2009)

Nurses are the lifeblood of the health service. Without good people on the medical front line, all the technological breakthroughs, genetic advances and brilliant doctors are meaningless if infections are allowed to spread, patients left in fouled bedding or their families treated in a callous manner.

Nurses also have an image problem. Those angelic stereotypes don’t necessarily match a job that can be very tough, with anti-social hours, sometimes degrading work and often difficult patients. And, until recently, the pay was lamentable. No one should be under any illusion that nursing is easy.

Women still make up 90 per cent of the nursing workforce, but they have many more career options than in the past. They are also more likely to take career breaks, work part-time and retire early. This partly explains why nursing is in crisis, with a fast-ageing workforce, high staff turnover and substantial decline in new applicants.

The Government’s solution, encouraged by the main nursing union, has been to turn it into a graduate profession, with some tasks taken over by nursing assistants. The hope is that improved status will attract more applicants from both sexes, and that they can handle more complex roles. But patients may well be the losers.

Already there is concern over falling standards of care. Good nurses – the vast majority – ease the trauma of an operation or coping with a sick relative. But like many people with a family member in long-term care, I have seen too many disturbing incidents. These range from the minor, such as nursing staff chatting away when patients are calling them, to the major, such as ignoring my daughter during a potentially life-threatening seizure despite her screaming and thrashing around in bed.

I have one friend who repeatedly found her disabled daughter left in soiled nappies and desperate for a drink after overnight stays in hospital. Another discovered his dying father covered in blood and faeces; the nurses had even forgotten to give him morphine that he desperately needed for pain relief.

In August, the Patients Association issued a damning report filled with cases that left Claire Rayner, its president and a former nurse, sickened by “cruel” nursing failures. Since then, the association has been inundated with harrowing new cases, and many of those suffering the worst neglect are the most vulnerable: the old, the disabled and the terminally ill. It fears there is too much emphasis on academic lessons for graduate nurses over practical training.

When I wrote about my family’s dismal experiences of the NHS three months ago, I received scores of emails from people complaining about nurses. Perhaps this was to be expected, since nurses have the most to do with patients. But the tales of filthy wards, of festering wounds, of elderly people left hungry, were awful all the same.

Less expected was the barrage of emails from nurses. Many said the introduction of Project 2000 in the early 1990s, which switched training from the bedside to the classroom, had led to an influx of well-educated nurses untrained – and sometimes uninterested – in basic everyday care for the sick.

“Nursing is a practical profession. It is not something that can be taught in a university. We had student nurses three months away from their final exams asking how to make a bed,” was a typical response. Another spoke of ambitious young nurses focused on senior specialisms “rather than bedside care supporting bereaved, sick, sad and often lonely people.”

It is not just personal testimonies. While most NHS patients receive good treatment, more than 160,000 people a year rate their care as poor. And the number of complaints against nurses is rising even as the number of graduate nurses increases. Last year there were nearly 20 per cent more referrals to the investigating committee of the Nursing and Midwifery Council than the previous year.

Additionally, many of the best nurses abandon the places they are most needed. Some move into private practice, others into management where the hours, pay and prestige are better. Despite recent efforts to improve the career structure for senior nurses, this will increase as more graduate nurses enter the profession saddled with heavy student debt.

But not all nurses need degrees; indeed, it makes little sense to exclude candidates for a profession facing shortages. We need a range of people entering nursing, well-trained and with differing ambitions. There are also wider questions to resolve about attitudes to the old and disabled, and the shortage of Britons willing to do vital caring jobs in an ageing society.

More immediately, the varying quality of nursing degree courses must be tackled. One email I received was from a student who quit after learning to write beautiful essays but little about patient care. “To this day, I don’t know how to do first-aid or put on a bandage – they whizzed through those two subjects on half-day courses,” he wrote. “It seemed that the powers that be were trying to change the nurse from being the doctor’s sidekick to being a profession. The casualties? Nurses and patients.”

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