The moral crisis in nursing: voices from the wards
Published in: Daily Mail
Last Monday, I wrote a column in the Daily Mail about the moral crisis in nursing which was causing untold distress to many patients, particularly the elderly and incapable. I blamed this on a seminal change in the way nursing viewed itself at the root of which lay an extreme form of feminism.
Not for the first time on this particular subject, I have received a deluge of emails the vast majority of which are passionately in support of what I wrote. These messages have come not only from former patients and their deeply distressed loved ones, but also from many nurses who are even more distressed by what has happened to their profession.
Many of these messages are deeply painful and poignant, and I thank everyone for sending them. I reproduce here three (edited) messages from the nursing point of view and one from the perspective of a patient and relative, in the hope that this will further inform debate and bring about very necessary change. As I said previously, many nurses do a magnificent job, often in very trying circumstances. Nevertheless, the attitudes illustrated here reveal a moral sickness in the professional ethic of nursing, and more particularly nurse training, which urgently needs to be addressed.
1) I wanted to thank you for your article this morning .I speak as a nurse with 30 years experience in nurse management both in hospital, community and the independent sector in the speciality of care of the elderly.
I have a very heavy heart these days because I no longer recognise my profession. The profession I was so proud to be part of when I qualified in 1980 following three years training. The uniform represented status. The buckle that my parents were so proud to see me wearing.
As students we worked on the wards in rotation with the school of Nursing. We were supervised at all times by senior nurses, ward sister or the clinical tutor, a role that no longer exists and mores the pity for that clinical tutor was key to the foundations of developing my nursing skills which lasted throughout my career. The achievement of passing the four compulsory practical exams. 1. Aseptic technique. ( sterile dressing procedure )2. Drug round assessment.3.Total patient care.4.Ward management. Followed by a written exam. That certificate was the beginning of what I considered to be the most rewarding job anyone could have.
I mention this as I believe this is what nurses in training lack today ('first principles' as you put it).I am not alone because when I met up earlier this year with some of the girls I trained with we were all saying the same thing.
It is hard to get to the crux of why nurses have changed so much. You articulated some of the reasons so well. I also think that men in nursing have had a big influence on the changes in status as well as the changing female attitudes .And of course changing culture has to come into it I think to some degree.
Speaking of degrees, I have achieved all that I have without a degree. Indeed, my educational qualifications are such that I would not be accepted for nurse training today!!! Isn't that ironic?
2) I despair; I trained at Stoke Mandeville Aylesbury, 1970. I have seen the decline in nursing since the inception of Project 2000 [a seminal training initiative]. As you say the idea that nurses should virtually compete and be the equal of doctors was the idea of senior ex-nurses at the UKCC, who decreed that we couldn't call ourselves professionals unless we have a degree.
The abolition of the SEN qualification, bringing in an unqualified tier of nursing assistants, combined with political correctness, meaning so called Matrons are unable to admonish a student nurse for anything, means there appears to be no control over standards at all. God, we were terrified if Matron appeared on the ward, but it made sure we kept up standards.
I went on a course in 1999 re Project 2000. I remember commenting to the young male nurse running the course that if things changed drastically the profession would lose many experienced nurses; his reply was “good!”
On a personal level, I was rushed into hospital with a rectal haemorrhage five years ago. Having been examined, lying on the trolley with a thin blanket covering me, I was in shock and freezing. I managed to catch the eye of a young staff nurse; she rolled her eyes, approached and said “What!”...being told I was freezing I was told to stick my arms under the covers!
Please, please use your immense influence to change things...I have had a couple of articles printed in nursing journals, and have been accused of betraying my profession!
3) I commenced training in 1965 aged 18 in Barnet General Hospital. I was proud of my profession and at that time we trained hard and diligently. The standards of care were well established and unshakeable. The trained staff, knowledgeable, respectful, honourable and disciplined. We all knew our place and tasks, boundaries were well known.
It was common place for all the staff to provide care to be given as a fact of our everyday working life. We were constantly monitored by the ward Sister, visiting Deputy and Assistant Matrons several times a day. We were expected to do a “round”, know every patient by name, diagnosis, treatment, medications, admission date and expected discharge date. We had to hand-write a full report at the end of each shift, no matter how busy we were, which was sent to the Matron's office.
This was as well as writing in each patient’s cardex file. In our first year we were doing things that the fully trained staff of today have just begun. The second year were put in charge of wards. Third years ran wards and conducted consultants’ rounds with the Sister or in place of her at times.
We took a mock exam at the end of each year and were not allowed to take the state exams if we failed the mocks. These were two whole days of written work (8-6) and half a day in practical exams. In addition to all this we were constantly engaged in “nursing care” of all kinds. Fluid and food intake, hygiene and toileting were standard. We had to keep written charts of all the intakes, care and nursing management which were examined by the ward Sister BEFORE you were allowed to go home. We earned a wage, and learned on the job.
I don’t agree with you that nurses got too big for their boots, or that they felt that the tasks were undermining them. Certainly feminism in my experience had little or nothing to do with the Project 2000 changes, which transferred the teaching to university classrooms. It had more to do with cost cutting in that nurses now have a bursary (far less then what we earned). The organisers of PK2 did not have the foresight to imagine what their disastrous management schemes would unfold. It is better that nurses are seen as academically learned, the price we have paid is the basic connectivity of humans who care for humans who need care.
In my experience many new staff are bewildered by BP monitoring machines, how to take a temperature, bathe or clean patients, understand how much is a normal amount of fluid, to actually talk to patients and are more focussed on reading patients’ case notes and chatting to doctors. This is not true of all trainees, of course not, but I see the breakdown in the intuitiveness of nursing staff, which became inherent and became a natural part of our instinctive thinking.
I feel sorry for many trainees who enter a ward after qualifying and faced with running a ward with academic knowledge as 90 per cent of their learning and 10 per cent intuition and natural care. The ratio of academic training and nursing “hands on” routines is in favour of class room learning. We had students who spent eight weeks in the university classroom for every two weeks in a ward, with the district nurse or in out-patients. It is now six weeks on a ward, well it still isn’t enough. Many, many students top up their learning by working extra hours as bank staff on the ward they are assigned to, or others, gaining experience whilst earning, which is precisely what we did all along. Whilst the come to work as a bank nurse they cast off the 'student cape' and cast on a nursing cape.
I and my colleagues NEVER felt low class or used because of the hands on and intimate nature of our work. I retired in March 2008. During my last 15 years of training staff from university and otherwise, I always told the staff -
"Be honoured to be able to share intimate moments of such delicacy and sensitivity with human beings in need, where care cannot ever, never, ever be compromised, diluted or damaged. You are serving a human being at a time when they are in the greatest need, the trust they place in you at this time cannot ever be dishonoured, if it is you dishonour your patient and you dishonour your colleagues and you dishonour your profession and you dishonour me."
The poor quality seen today is a result of the fragmentation of the core values of what being a nurse is all about. It has been a slow decline and nursing as the job I knew it to be is in its death throes.
4) I'm 64 and have huge experience of hospitals and agree with everything you said.
I knew things were going wrong when I was admitted to hospital for a hysterectomy in 1989. Some days after my operation I was due to have my drip removed - I was on my way to the WC and had to pass the nurses’ desk. The nurse there at the time was in the middle of a private call (laughing, gossiping) but beckoned me over and proceeded to remove the needle from my arm with the hand that wasn't on the phone.
Was she surprised when the blood pumped out of my arm? Who knows? She put the phone on the desk while she found a plaster and then just carried on talking.
Both my parents were incarcerated in the same geriatric ward - my father died there in June 1996 and my mother was a patient until a week before her death in December 1997.
Every day that each of them was on the ward was a battle. My father wasn't showered for weeks even though he was mobile -- I won’t bore you with all the details, just to say that my mother tried to sue the hospital but died before the action got anywhere.
On the day my father died we visited as usual and the sister told me he wouldn't eat and I was allowed to have a go at him to make him eat. Also I should walk him up the corridor as he needed to get moving. I tried to walk him but he was too weak and I had to get a wheelchair to take him back to bed.
About an hour after we left him he told a nurse “I think I'm dying”. He died. She went off duty and left the nightshift to deal with it.
It transpired that he had heart failure and I now know that he couldn’t eat as his lungs were full of fluid and compressing his stomach. The last walk I took him on probably served their purpose well as they didn't have him bed-blocking anymore - they encouraged me to finish off my own father.
I’ll NEVER get over it.
When we went in the next day the sister saw us from a distance and hid.
My mother’s stay in hospital is memorable for my sister and I checking in with her every day before going to the ward desk to complain about something. For instance one day I arrived to find her sitting on a pillow soiled with faeces, upset and embarrassed because she’d been that way for a long time, but frightened to say anything unless “something happens.
Of course - she was on the ward covered by the geriatrician she was suing! (He's still there now.)
She spent her last week in a local nursing home - she had lung and brain cancer and was paralysed down one side so I couldn’t look after her at home. On her last day she was severely depressed but was taken out in the morning by one of the assistants. She was wheeled around in a chair wearing just a skirt and sleeveless top - in December - and she had a chest infection. Apparently she said “I’ve had enough”.
A relative saw her later in the morning and said, although not well, she seemed otherwise fine. She died within hours from the infection. So that got her out of the way. Bed empty - next please!!
I've got a daughter and daughter-in-law involved in the care industry so I know I have someone to fight for me, but what of those who have no-one?
Conversely - my husband’s uncle became ill and was admitted to a geriatric hospital in County Kerry, Southern Ireland a few years after the deaths of my parents. The wing he was in was full of old Irish men, most of whom hadn’t been strangers to a drop of the hard stuff.
The care they had was just as in the old days, although the building was a bit old and run down. They were looked after by Irish nurses and nuns and I doubt there was a degree to share between the lot of them. They were brilliant and, of course, the nuns weren’t in it for the equality, the money or the career advancement - they were there to CARE and to NURSE.