Monday, August 30, 2010

Nursing by numbers - sorry, wrong number

In a rare idle moment, I saw this article on the BBC news website It's all about fears that elderly people getting malnourished in hospital. I'm afraid it got me rather angry. This is simply a different manifestation of what Mencap found in their 'Death by Indiference' report on people with learning disabilities in hospital. What really got my ire up was the perennial assumption, seemingly by all concerned, that this could be solved by monitoring and procedures - introducing red trays etc. for people at risk.

Monitoring and procedures are not a substitute for care. People's conditions change, procedures don't always get implemented accurately, individuals fall through the gaps - and die. You'll be aware of my abhorrence of nursing by numbers and how hospitals are bad for people with disabilities. I don't blame the individual nurses - bless them, there are precious few around these days. The people visitors and patients take for nurses are actually nursing assistants in the main (or care staff in the community) who, because they have limited training, need the procedures to do their job. We've actually had one agency nurse say to us that she 'didn't do care - she had the nursing assistants for that' - she was only used to manning the nurses station, dispensing medication and ward/nursing home management. Our own package uses nurses precisely so that they have the skill and judgement to use their discretion, but they are now working under so many protocols, procedures and guidelines that we have to intervene when the rules work against his best interests.

Example - protocols state that if he has a fit lasting over 5 mins. give chloral hydrate. He almost always has a fit on waking. At present he has a chest infection. Result of chloral being given is that he was knocked out for over 12 hours - no coughing. Physio and PEP attempted by nurses but as it caused his O2 to fall initially, not proceeded with. He would have re-consolidated and ... draw your own conclusions. Upshot is that we had to go round and do physio and PEP ourselves, result lots of gunk removed from chest - all's well, (not quite all) with the world. Everyone knows the protocols don't work but they have to follow them or their nursing PIN number is at risk.

I know it's about resources - but that doesn't make it acceptable. There was another situation last century where the defence 'I was only following orders' was deemed unacceptable - it seems now to be the normal and only basis for action in this context. Mencap and others have raised this issue already. It isn't more rules that are needed - it's more people giving care. I wait in apprehension for the headline 'Old lady dies because she was given wrong colour tray.'

Rant not over - it's not over until the thin lady dies.


  1. Hi Ned,

    Procedures, protocols and guidelines are all fine and dandy in essence - but result in mountains of paperwork that become the priority, and actual patient care is relagated to second place.

    You correctly highlight that wards in hospital appear to be well staffed - but few will actually be nurses, and those that are will be spending their time filling in mountains of paperwork. Patient care then becomes secondary, not by choice - but by policies and procedures and the requirement to fill in the damned and often unecessary paperwork and it goes on and on and on...

    Your sons best interests are paramount and good on you for taking a stand.

    The agency nurse who stated that she "didn't do care....." should be shot - I hope you reported her!

    Keep on ranting Ned!

    Anna G.

  2. She didn't want the work - and we weren't unhappy about that. Most actually do want to do the care but they get prevented by having to follow the rules to the letter.