On Short-sighted Executives

February 28, 2013 at 1:29 pm | Posted in Nursing, Politics | Leave a comment

Nurses in Britain will probably have at least some peripheral awareness that national negotiations are currently in progress to determine our Agenda for Change terms and conditions (i.e. what we get paid).

What a lot will not be aware of, however, is that our colleagues working for 19 NHS trusts in the South West of England are facing real terms cuts to their pay and conditions, thanks to the South West Pay Cartel – Basically, 19 trusts in the South West have banded together in an attempt to adopt a regional pay structure. This despite the Health Minister telling the Cartel that regional pay is a terrible idea, and they have no legal right to leave the Agenda for Change T&Cs.

Well, this is depressing.

I think I need to address the people who live in the South West of England at this point. It’s an older population than most parts of England, because many people retire there, and the economy is not vibrant, so many young people leave to work elsewhere. In other words, it is disproportionately dependant on the NHS, because older people = more use of healthcare.

So to the people of the South West: Let me tell you what is going to happen where you live, if regional pay is adopted there, and pay is cut as a result (it will be, that’s been the transparent goal of the Cartel from day one).

Medical schools, nursing schools and schools for allied practitioners such as physiotherapists, occupational therapists, radiologists, turn out a class of fresh, eager new professionals every year. And those professionals look for jobs. Do they look for work in a part of the country they know to be more expensive than average in terms of living cost, and where they know they’ll get paid less? No. They do not.

Existing healthcare professionals in the South West will suddenly be faced with a choice: Stay and get paid less, or go and get paid more. What happens? Those who can move away, move away. It’s not hard to get a job as a qualified healthcare professional. Really. I get sounded out or asked to apply for one at least once a month. We can work anywhere; our qualifications are universal, and our professional registrations are good enough for the whole world.

So at this point, no newly qualified professionals will be moving to the South West, and a lot will have left, leaving hospitals desperately short-staffed. What do they do? The only thing they can do; they’re legally obliged to maintain safe staffing levels, so they get agency staff at an average cost of £146 per hour to cover the shortfall.

So what do you, the patient, get? You get inconsistent care, where you rarely see the same nurse twice during your hospital stay. You get a lack of continuity because the nurses looking after you are not a part of the team, and they have no real incentive to make sure your needs and requirements are handed over to the next nurse on shift.

What do the trusts get? Well, let’s just look at nursing a minute, because that’s what I know: A newly qualified nurse on Agenda for Change terms costs employers around £11 per hour in all. That’s about £125 for a twelve hour shift (note: That’s not what the nurse takes home, that’s what they cost the employer including pay). An agency nurse, on the other hand, costs £146 per hour (the best paying agency offers a flat rate of £32 per hour, the rest goes to them), or around £1750 for a twelve hour shift.

In other words, by cutting pay for nurses the South West Pay Cartel will ensure that everybody, including themselves, loses out financially. The only people who win will be nursing agencies and their very well paid employees.

And let’s not forget the bigger picture: We need newly qualified staff, who’ve been trained in the newest and best ways of doing things, to come and tell us when we’re doing something in an old-fashioned way. Medicine should be evidence based, and evidence improves and changes. We don’t all have the benefit of being able to sit down and plough through the journals every day to stay up to date, so those new staff are a crucial part of keeping our practice up-to-date.

I think what scares me the most is how very obvious this all is. Executives at those trusts are in dire need of opening their eyes, taking off their financial blinkers, use whatever metaphor you like. They’re going to bankrupt their trusts, and they’re going to do real harm to patients in the process.

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On Stafford, and Judgementalism

February 13, 2013 at 10:56 am | Posted in Media, Nursing, Politics | 2 Comments

I guess I can’t really blog about nursing and not mention the Stafford Hospital report. For anybody who’s been living under a rock, the tl;dr version is: Care was not good enough at the Stafford Hospital, and unnecessary deaths resulted.

Ouch. I can only imagine how nurses at that hospital feel right now. Frightened. Embarrassed. Defensive. Angry. Probably a cocktail of all those and more. But that report has been pored over and analysed and quote-mined to death; the only thing that I want to say about it directly is: The report’s author has already admitted that he was wrong to name the whole hospital as the problem, when in point of fact the issue was isolated to two wards – And he even narrowed it down to specific staff on those two wards.

And yet, on the basis of this report, nursing in Britain is going through what feels like a witch hunt. This isn’t a nice time to be living through, speaking as a nurse. The media cannot wait for us to screw up and sell more papers for them, and the government are eager to push any agenda which makes the NHS as-is look inferior, because they’re ploughing ahead with privatisation by stealth (if you doubt that, read the full text of the Health and Social Care Act, then come back to me) and want to minimise resistance from the general public.

What’s worse is, nursing can’t get a mention on social media without a barrage of comments from uninvolved lay-persons who think they know how to fix all of nursing’s woes. From dead reckoning, at least ninety percent of the people making such comments can be summed up as “Bring back Matron!”, even though Matron never actually went away in the first place. Personally I think that there is a small but very vocal minority of sexually deviant people who fantasise nightly about Hattie Jakes in a white tabard and starched cardboard hat, and who want to populate our hospitals with her.

My point here is this: Nursing is a profession that people have so little respect for (until they actually see us in action) that they feel perfectly comfortable with telling us how to do our work, in spite of their own absolute ignorance. Dunning-Kruger effect – They’re too stupid to know that they’re stupid.

Of course, in amongst the Hattie Jakes fans, there are always one or two comments along the lines of “my mum laid in her own faeces for hours!”. Actually, that’s a really good example to use because it’s so common and yet usually such obvious tosh. How would you know that your mother had been laying in faeces for hours unless you were actually there to see it? And if you were there to see it, why didn’t you nag somebody until they came and cleaned your mother up? Now, I’m not saying that anybody visiting a hospitalised relative should ever be in a position to have to provide care, but honestly? If I was visiting my elderly grandmother in hospital and nobody had cleaned her up after a few minutes and repeated requests? I would just do it myself. And I know that’s not really a fair generalisation, because I am a nurse, and cleaning poo from elderly people is very much in my job description, but I think the point remains valid.

People in general don’t seem to provide care for elderly relatives as much as they used to. There is a very sad tendency to expect the NHS and/or Social Services to do everything. And that really isn’t the point of socialised health and social care.

I have encountered my share of families who pick up on every single detail of their relative’s care, and get angry and upset and claim that it isn’t good enough even when it’s absolute gold standard. They’ve all had one common feature: Guilt. In general, it’s often the family of an end-stage terminal patient who’s been an inpatient for weeks or months, but whose family have never been to visit until the day they’re phoned and told that their relative is fading fast and now would be a good time to come and say goodbye. That’s the point when you know as a nurse that you’re in for a challenge, because the family are justifiably upset that their relative is dying, and they’re feeling guilty about not visiting while he/she was still actually conscious and able to interact with them. They lash out at staff, and it’s our job to take it and to never, ever judge them. We don’t know why they never visited, and it’s not our business.

It’s also our job to deal with patients who are confused and/or demented. I personally know four or five nurses and auxiliaries in the last year alone, who have been assaulted severely enough by dementia patients, to have needed time off work to recover. This is something that is poorly understood: If a person has dementia so advanced that they form no new memories and have few or no original memories, then as far as that person is concerned, they are always in a strange place, surrounded by strange people. A lot of they time they won’t even know who they are, let alone the people in blue who want to come and give them a wash. Fear and anger are natural responses to that, so sometimes as nurses we get physically assaulted. I’ll leave aside the issue of people who assault us because they’re just plain horrible people, because that is rare outside of the ED.

Now, I don’t want to play the martyr here. Honestly, I don’t; I think that’s a terrible and manipulative thing to do. Everybody who ever trained as a nurse knew very well that they were getting into a hard, physical job which comes with a lot of responsibility and very little financial reward. We all knew from the outset that we’d be working twelve hours without a break, often followed by four hours of unpaid overtime. We all knew that our home life would suffer for our choice of profession. We knew that we were going to get insulted, spat at, berated and punched.

We knew all of that. But we never agreed to be whipping boys and girls for every politician and bored journalist in Britain. And that, sadly, is what we are becoming.

If I get any message across in this post, I hope it’s this: On the basis of a report about specifically identified staff on two wards in one hospital, the government and media now seem to be on a mission to destroy the working reputations of more than a million clinical staff working across almost four hundred NHS trusts. They’ve totally ignored patient’s opinions (the last CQC survey showed that 91% of patients who responded rated the care that they received as excellent, very good or good), and they’re completely blanking the vast majority of clinical staff, particularly nurses, who deliver that excellent care against stacked odds.

So if you’re a nurse or an HCA or an NA or an AP or even (whisper it) a doctor, then hold your head up. The vast majority of your patients think that the vast majority of you are brilliant. And really, do any of us care what anybody else thinks?

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