recently formed Nursing and Care Quality Forum, chaired by Sally Brearley. http://cno.dh.gov.uk/2012/01/31/nursing-and-care-quality-forum/
.The suggestion was made that the recruitment of student nurses should include
an assessment of the student nurse's ability to be caring and have 'the right
sort of values'. In an article today on BBC Health http://www.bbc.co.uk/news/health-17195679 mention was
made that 'dignity was "the essence of proper nursing"'. Whilst I believe this
to be true, it is almost one of those sayings which 'goes without saying'.
This morning, I also listened to the Today programme on BBC4 where the issue
of care of the elderly in our hospitals was discussed. There seems to be a lack
of appreciation of the difficulties faced by nurses and HCAs to provide
compassionate care to a ward which is often full of predominantly elderly and
very elderly patients and the lack of safe staffing levels which will allow this
I have recently nursed in wards which are a mix of six-bed bays and side
rooms (for isolation) where most of the patients are not in their 80s,they are
in their 90s. This is another phenomenon which is not being discussed. The very
elderly are often very frail and frequently have an overlay of dementia.
Measures like Intentional Rounding (the deliberate visiting of a patient
every hour or two hours to check on their needs) were introduced to ensure that
good nursing care is provided. However, with the best will in the world. this
can only happen if staffing levels are maintained at a safe level.
Many nurses and HCAs work long shifts; 13 and 1/2 hour shifts are not
uncommon. I have worked with nurses on these shifts who say things like 'well,
no break for me this afternoon!' or 'I think I went to the toilet at 9 am this
morning' (said at 8pm).
These factors will not change in the future;in fact they will get worse. The
elderly continue to live longer, there are fewer intact families to provide the
additional care (support at home, visiting in hospital) and staff levels are
difficult to maintain as more and more nurses and HCAs decide they can earn more
for less work in almost any other job. The fact that many remain is a testament
to their caring natures.
The NHS and private hospitals will have to continue to draw on overseas
nurses to fill the void. At the recent Nursing and Care Quality Forum session, I
asked what focus there would be on language skills testing of all nurses who
come into the country to work and language support for those nurses who struggle
with English for Medical Purposes. This need appeared to be a focus which had
not been thought of or indeed known much about.
I spoke on Teacher Training in EMP last Saturday at the Oxford International Study Centre, Oxford and before that at the Wimbledon School of English . It was heartening to see the beginnings of a groundswell in the awareness of English for Medical Purposes as a specialty course which overseas doctors and nurses ,and other heathcare professionals,need to undertake to ensure safe practice and an understanding of the UK hospital culture.
During the radio programme today I heard the word 'communication' and related
expressions several times: talking to the elderly in a way which shows dignity,
spending a few minutes to chat to the elderly to understand their needs for the
day, effective communication and so on.
It gets back to the heart of nursing. I am about to return to Australia for a
reunion of my nursing group, Royal Prince Alfred Hospital, Sydney 1979-1982. We
are celebrating the anniversary of the end of our training as we celebrated the
anniversary of the start of our training in 2009. We were taught how to care,
that's true, but it was in a different environment. The Baby Boomers still
staffed the wards, technology was minimal compared to today and paperwork? I
think I remember a communication book and the patient record.
I firmly believe that a certain amount of paperwork is essential to ensure
checks and balances. As nursing in the UK moves towards a degree course in 2013
there will be changes,changes which I see as essential for nursing in the UK to
join the ranks of other countries which see nursing as a legitimate profession
standing at the same level as other healthcare professionals.
Having a caring nature or the willingness to show compassion is only one
aspect of good nursing care. Registered Nurses need to be able to nurse their
patients as a whole; managing physical, emotional,spiritual and cultural needs.
Healthcare Assistants need and often receive, training in basic nursing care and
training in the observation of risk factors. There is,however, a need to
standardise the training and ensure that competency assessment is undertaken
before HCAs commence their work on the ward. The current practice of allowing
HCAs to start work and then 'train' ,sometimes by distance education, is not
Similarly, the training of carers ,or lack of it, in the Aged Care sector is
a scandal and makes me think of the situation I remembered in Australia in the
1970's and 1980's. In Australia today, any Carer (called Personal Care
Assistant) must undertake a 12 month Aged Care Certificate III and be signed off
as competent before starting employment in any Aged Care Facility, private or
government run. This acts as a safeguard for the elderly and also a sifting of
unsuitable workers. Aged Care is a complex area especially dementia care and
requires skills in communication and awareness of the changing physical needs of
the elderly. As in the UK, the Australian Aged Care sector is made up of a large
number of overseas workers who need language support to be able to deal with the
complex communication scenarios they will encounter.
Recruiting for values is important but offering future nurses the environment
where they can care for their patients in a caring way is just as important. If
we cannot offer student nurses the vision of a career path in nursing where they
can invisage making a difference to the lives of their patients, who will we
attract to the profession?