The Francis report on the Staffordshire hospital makes disturbing reading and sets
me wondering how nursing could have changed so much since I trained in the 1950s and 1960s.
As an outsider it is difficult to understand how things could have changed so much. I know that today’s nurses work in a very different environment (new drugs, hi-tech equipment, more advanced techniques etc.) from that we enjoyed, but surely the basic ethos of caring should still be there.
I think (as with many professions) that the chain of command has become far too complicated, so that it is much easier to “pass the buck” when things go wrong.
We had a simple, and easy to understand, structure. Matron was at the top and made sure she knew what was happening throughout the hospital. She and her deputy matron visited every ward every day. One day she would take the even numbered wards and the next the odd numbered wards. She went round every patient, and woe betide the nurses if a patient was in a soiled bed or had a genuine complaint.
We had one sister and just one staff nurse on most wards and they alternated their off duty. They were very much in evidence at all times. They went round as soon as they had received the report from the night staff, they did the medicine rounds and served the dinners and many of them rolled up their sleeves and worked on the ward. They somehow managed all this as well as mentoring the student nurses, ordering supplies, arranging the off-duty rotas and writing reports etc. They also accompanied the consultants on their rounds. Visiting times were more regulated then and either the sister or the staff nurse was available for any queries from the relatives.
When I was in hospital a few years ago the only time I ever saw the sister was when the lady in the next bed to me inadvertently pressed the emergency bell and the “crash team” rushed in through the door with all the equipment for resuscitation.
I think successive governments have had ministers with ideological missions, who have added more and more layers of authority, who have taken the authority from the clinical staff. Then in the 1980s Mrs Thatcher and Ken Clarke brought in the idea of “market forces” and put a price on everything and thought that patients would behave like commodities. Sorry MPs but patients are people and people behave differently! Some are textbook cases and “follow the rules” but many others don’t and cannot be put into groups and get all sorts of complications which go far beyond their “price range”
The other scheme in the 1980s was to privatise the domestic service. Before this we had an orderly and a ward maid on each ward. They took great pride in “their” ward and the wards were spotless. One of the orderley’s duties was to clean and refill the water jugs at least twice a day so no one had to drink water from a flower vase! They were accountable to the sister but now no one knows who is going to be doing the domestic work, this has also taken away the satisfaction the old domestic staff could take from looking after “their ward”
We have all seen how this cost cutting exercise was a false economy when the spread of secondary infection caused so much harm.
The reason sisters could manage with one staff nurse was that all the nursing staff, even the lowliest junior, had at least 12 weeks training before they set foot on the ward and most had had considerably more.
We ranged in experience from those just out of the preliminary training school in 3 month sets to those within 3 months of their final exams. There was a new intake of nurses “sets” every 3 months, so, as well as giving us a wealth of experience, the wards were well staffed.
I think one of the best piece of advice I got was, “However dirty, manic or disagreeble the patient may appear this may be part of the illness and you must treat them all with as much compassion as as you would like your own relatives to be treated”. This stood me in good stead when faced with a patient who wet the bed as soon as you had changed it, handed you a present of faeces, or tried to pinch or thump you!”
I have still to be convinced that a university degree is necessary for all nurses, could there not be a different title for those who would be quasi doctors and leave the nurses to do what they are best at, caring, keeping the patient comfortable, fed and hydrated and carrying out the apprpriate nursing procedure efficintly and professionally.
It should be mandatory for politicians, business managers and such individuals to actually work at the business end before they are allowed to make major changes.
As patients we should be more careful when complaining or taking legal action. Of course when there is a valid complaint it should be investigated, but not all patients will recover however dedicated and skillful the medical team, and every time frivolous complaints are made it gives the bureaucrats an excuse to add more paperwork. Very often all the patient wants is a polite and rational explanation. They just want to know that they have had the best care and attention.
Iknow that there are many younger people who will argue against our method of training, but the general consensus among those who trained this way is that we would have more cofidence being nursed by the old style nurses than by the new method. Judging from the presents of chocolates, tights, biscuits etc. left by the majority of patients, I would say that the patients were happy with their treatment.