Wednesday 19 May 2010

Acute Wards

I do work on medical and surgical wards, covering liaison psychiatry for older adults in the acute hospital.

Things ain't great.

Medication is accidentally omitted (oddly, never reported to the NPSA despite their alert on this issue).

People are left lying in urine.

People are left unfed.

This happens every day.

Rather than plan person centred care, Wellness Recovery Action Plans, sophisticated dementia care and the like, basics need to improve. They're not poor because the wards are poor. The nurses and HCAs aren't turning up to work full of wickedness, intending to do a bad day's work. The crunch is that they're understaffed.

As an outsider seeing this, and not someone they can sack, it's been easy for me to raise this with their management structure. Which I did. They took note of the serious concerns raised, the unacceptable standards of care, care at variance with national guidance and the risk generated for their Trust through suboptimal care. Excellent. So what's happened?

They now have Modern Matrons charged to make it better, but they've no resources (at all, no extra time, no teaching time, no money, no staff, nothing). But because it's such an important issue, the Modern Matrons must ensure that Dementia Champions are trained. They don't have a view on what these Champions will do, but the Trust needs to have some, so staff have to be removed from the ward for training (but there's neither cover nor a training budget for this training). Failure will therefore be a ward level failure, with the managers having given strategic direction and solutions. Hmmm.

How will the Trust be sure that things are in place? Nurses will check. Except the senior nurses, who 2 years ago were seeing patients, now don't. They now "support the governance framework" through checking things on clipboards are ticked off and done. This drives them to distraction, they're band 8 nurses, not band 3 clerical support, but that's what the Trust requires of them. Tick, tick, tick.

So when there's a clinical problem, the solution was remove nursing time from the ward and remove senior nurses to do surveys/tick boxes, compounding the problem of a lack of hands on ward time.

My, how my colleagues in the acute Trust live in interesting times.


XE said...

Oh dear oh dear oh dear.

Spirit of 1976 said...

It's a depressing, but all too familiar account. As thought these managers really believe that woeful understaffing can be addressed with more tick-box checklists.

I wonder how many extra nurses could be employed to provide more boots on the ground if these processes were just ditched and the nurses were just allowed to get on with their jobs.

Cockroach Catcher said...

Quoted you on my latest post, thanks.

Nurse Anne said...

It's so hellish at the moment I cannot even blog.

The Shrink said...

Sorry to hear that Nurse Anne . . . it's so so grim that understaffing of clinicians and overstaffing of management is completely routine, it's happening every day and so is accepted as normal, so accepted as acceptable. Much badness.