Right on Z.

Another refugee from Mental Nurse here

I graduated from University recently and I was lucky enough to count a few nurses as friends. Their course appeared anything but over-interlectualised. The suggestion is ludicrous.

They were the hardest working students i knew, long days of lectures and even longer ones on wards getting hands on expereince.

There are not many degrees where you spend an hour or two sitting with someone as they pass away, as happened to one of my friends. The work is hard, the hours are long and my friends assure me the pay is not very good. On top of this the one thing they always mentioned was how much they had to do and how poorly they were resourced to do it. Great post Zarathustra.

Sack at least half the administrators, stop paying management cosultants and spend the money saved on nurses, doctors and othr people the NHS needs. Labour has wasted much of the money raised since 1997 on pen pushers.

Absolutely. It’s a problem across most of the under-funded public services: nobody with power seems to realise that you cannot offer the same people the same service with fewer staff. And when you try, the staff you’ve got are driven mad by it, and go off sick, making it worse.

Thanks for an interesting piece. I would be interested to know whether in your experience shortages of nursing staff of the kind you mentioned are due to there being unfilled vacancies or just lack of money to pay for them, and also how widespread you think these problems are.
There are a lot of valid criticisms to be made of the way the extra billions which Labour has spent on the NHS have been utilised but one thing I did give them credit for was employing lots of extra nurses and increasing their pay to a level where they could attract and retain good staff, precisely to avoid the kind of situations you have described. That’s why I get irritated when people complain that x% of extra NHS money has gone on staff wages and why arguments about productivity are not always straight forward.
Did I get it wrong? Was I (perish the thought) wrong to take the government’s word about the extra numbers of nurses? Were the existing staff shortages worse than I imagined or are there wider reasons why these things are still happening even with increased staff numbers?

Hello Andrew,

I don’t understand the numbers that get quoted by the government. They seem to go on and on about all these new nurses etc. Well where are they? The complexity of patients, the workload, and the number of extremely dependent and chronically ill patients continues to increase exponentially. A general medical ward here in 2009 is very very different from a general medical ward in 1985. Today the patients are sicker and living longer, the way in which we delivery healthcare is more complex, the treatments and the drugs are more numerous and time consuming for the nurses. The consequences for failure and not moving at the speed of light are dire.

Years ago a medical ward had many patients on the mend, they had mobile and self caring patients who were simply waiting for tests. They had more trained staff actually on duty on the wards. The ward sister was able to be in charge, not running as the primary nurse between 12 patients. Everything moved at a slower pace. There was less documentation. I know everyone wants to slam the paperwork but let me tell you that when nurses do not document properly, information gets lost and patients die. A good nursing assessment is key to your safety in hospital. Some of the documentation is BS but most is very very necessary.

Today’s patients are chronicly sick and unstable. They would have died very quickly 20 or 30 years ago. The care that they require is extremely time consuming and complicated. And the nurse cannot miss a beat. Not for a minute.

So where are all these new nurses? Let me tell you a story. Years ago I worked in a facility in the USA. The facility was required to notify the State of their nurse staffing and patient numbers. If the numbers were too low they would have been shut down. But this facility was a business. They wanted to cram as many patients in as they could with as few paid staff as possible. On the 30 bed rehab floor there was 2 nurses and some assistants. But when the numbers were sent out to the state it showed that there were 13 nurses to those 30 patients. Was my boss lying? Yeah pretty much.

They counted the girl who failed out of nursing school and worked on the front desk downstairs into their registered nurse staffing numbers. They counted the director of nursing who never worked as a nurse in her life in with the nurse staffing numbers. They counted the human resources woman who let her nurse registration lapse years ago in with the nurse staffing numbers. They counted the retired nurse with the chronic back pain who worked in an office doing chart reviews all day in with the nurse staffing numbers etc etc, until it looked to the State as if we were well staffed. And that is how they passed inspection.

None of those people ever came near a patient or would ever dream of being able to function on a ward as a nurse. They did not get involved in patient care. But they were counted in with the numbers. Sneeky.

This is what the NHS is doing right now. But this isn’t just a rehab facility. The NHS hospitals have acutely ill patients. There are not more trained staff on the wards. And we probably need higher ratios of trained staff now than we ever did, as patient acuity is going through the roof.

Where are all the new nurses? I’d like to know because getting management to hire staff nurses to staff the wards is like pulling teeth. For years they have been losing people via natural wastage (retirement, immigration,career changes) and not replacing them. Yet patient acuity is sky rocketing.

It’s a situation that is going to continue to deteriorate for a long time before it gets better.

Militant Medical Nurse – I think, but I may be wrong, that the government counts the numbers of people on nursing courses when it bangs on about recruiting extra nurses. Seeing as about 30% of those will drop out, a small percentage won’t bother to register, some will go on to further study to do something other than nursing, some will return to their home countries and some will never work as nurses, then you can see how they get their figures wrong.

I think that they may be counting in cadets i.e. kids as well. …and of course NHS direct etc.

Thanks, that’s very interesting.

Read it.
Now what, boss?

Well it’s good to have my prejudice confirmed.

Where exactly has all the money gone? Wasted.

A great piece – although I’m not terribly surprised. Jenni Russell seems to have a lot of spite in her for public services – she recently wrote a fairly ill-informed vitriolic piece about social workers so I have a lot of sympathy.. and as a social worker, I can only empathise with nursing colleagues about the easy scapegoating oversimplifying the issues which are about micro-management and lack of staff and resources (and usually both).

If it’s any consolation I was told yesterday that at least if I were a nurse, I’d be doing something useful with my life! So it’s not quite the bottom of the food chain!

Hi all

Thanks for all your positive responses to this piece. I’ve attempted to make the same point on health blogs and been told to “bog off back to your bedpans, nursey”. Seriously, the likes of Harry’s Place and Lenny’s Tomb have nothing on the NHS Blog Doctor commentariat when it comes to vitriol and trolling.

Andrew, I’d give some feedback to your query, but I think Militant Medical Nurse has summed it all up quite nicely.