I have just been reading a disturbing  website  about working on a medical ward in the NHS  (warning, contains bad language!)

If this is how things are generally now, I fear for the future . There seems to be no cohesion and nobody in overall charge. This seems like an army with no officers.

I know that we were probably too regimented when I trained, but it seemed to work better then. Cross infection was almost unheard of, patients were comfortable, well fed and clean. Relatives were treated courteously and with kindness. Nurses were respected.

To keep the army analogy, Matron was the C in C. She had a deputy Matron and one or other was on duty throughout the day shift, when they handed over to the Night Superintendant. There were 4 assistant Matrons each with her own sphere to supervise.

On the ward there was a Sister  and one or two Staff nurses. One of these was always on duty. The rest of the staff were Student Nurses at various stages of their training, from those  just out of training school to those about to take their final exams. We all assembled for report when we came on duty and then went off to perform our various duties  (according to our seniority)

The only other staff were a ward maid (who kept the ward sparkling clean!) and an orderly, who cleaned the lockers, helped with meal serving, took around the drinks trolley, provided clean water etc. These two were on the permanent staff and took a great pride in “their” wards

There were no care assistants, “hotel services” or any of the fancy titles dreamed up by civil servants.

Every morning and evening a report on each patient was written in a large report book. This included the general condition of the patient, any new or amended treatment, operations or tests performed or due etc. All medication, tests etc was also written up on the charts which hung on the end of the bed, so it was quite easy to check  on anything.

She also says that the report was constantly interrupted by relatives phoning to ask about the patients.  When I was nursing  the relatives were given times to ring, of course this was adaptable as circumstances warranted, but I don’t remember report times being unduly interrupted by the phone. 

The Consultants and medical students were also more organised and came round at regular times. As I said before we may have been too regimented but it seems to have worked better than the disorganised chaos she describes.

I left a comment suggesting that maybe the “apprentice style” training worked better and had a rather condescending reply that medicine has advanced so much that they need an academic training now because they have to understand the science etc. now not just practical nursing! Now they have to make life and death decisions!  I’m not sure who she thinks made those decisions before, after all the Sisters had had the same training as the rest of us!

I know that there is far more technology and different medication and treatment now but on the plus side the technology also makes life easier for many time consuming procedures in other parts. They do not have to deal with IV drips manually anymore a micro chip tells them when it is finished. They do not have to spend time boiling instruments and packing sterilising drums, they take down a disposable sterile pack. Temperatures etc. are not taken manually but by a machine, and of course the nurses no longer do cleaning.

I think one of the main changes now which causes so many difficulties is the rapid turnover of patients. It must be very difficult to keep up with the patients when they change so frequently.  Another change is probably the use of so many part timers. This would be alleviated by having student nurses on the ward again as they would be full time.

She also makes the comment that “the pace of life on the wards was slower in days gone by”  but I can assure her that it did not feel slower as we rushed around the wards!

When we spent the majority of our training on the wards, (contrary to modern belief we did have “academic” training too,  4-6 weeks of very intensive study every year  in the nursing school, where we had 6 lectures a day for 5 days a week), we were receiving not just practical training but also ward management and decision taking. After all we were the Sisters, Tutors and Matrons of the future. Indeed many of my colleagues held responsible positions around the world until they retired only a few years ago.

I suppose in the future some expensively convened “think tank” will have the bright idea that every ward should have a full time permanent Sister and nurse training should be based on the ward.

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