Just another £1.2 Billion to fix the NHS?

Just another £1.2 Billion to fix the NHS?

Poll: Just another £1.2 Billion to fix the NHS?

Total Members Polled: 237

The NHS just needs a bit more money: 3%
The NHS needs LOTS more money: 15%
No more money, just radical reform: 66%
The NHS should be privatised: 5%
The NHS is beyond repair - let it die: 7%
The NHS is fine as it is: 3%
Author
Discussion

g3org3y

20,606 posts

190 months

Sunday 23rd November 2014
quotequote all
LucreLout said:
andymadmak said:
Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.
I never thought I'd say this as long as I lived, but the disgusting attitudes shown by NHS staff on this thread have finally convinced me. The only answer is to shut it down. All of it.
Start again with a clean sheet of paper, no standing army of paper pushers or jobsworths (for that is the attitude being shown however well camouflaged), and design a new organisation focussed around patient care. That may or may not need some privatised elements, but what it so definitely doesn't need is any unionisation.
Would like to know which part of my post you found 'disgusting'.

andymadmak said:
V8 Fettler said:
Management issues. I'm sure you complained about the pool of mixed ingredients (with photographs as evidence), what was the outcome?
Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.
Sorry to hear of your experience Andy. frown

I'd wager (hope!) the nursing staff you encountered were bank/agency nurses. They don't work there permanently and have no allegiance to the ward. Hired per shift, unfortunately a "it's not my problem" attitude is encountered all too commonly with many doing the minimum just to get through the shift. It's a poor attitude and can also make the lives of doctors very difficult when we need their help and they are not forthcoming.

I remember an instance on a busy night shift (when we were struggling anyway) asking a bank nurse (never saw her on the ward before and never again) to help me attend to a patient relatively urgently as I needed some medication administered. The response - no I can't, I'm going on break.

The vast majority of nurses I meet are conscientious, caring and go the extra mile for their patients. They under tremendous pressure, especially on high intensity work wards (such as Care of the Elderly) where often you can have 2 or 3 bays of patients (each bay containing 6 patients) per nurse. I could not do their job.

As I said earlier, I genuinely believe the return of old school style matrons is the way forward. A well run ward is a clean ward and a proud ward. When individuals have pride for their ward they will do all they can to maintain standards and will take pleasure in working together to do the best they can for patients and themselves.

Edited by g3org3y on Sunday 23 November 12:32

V8 Fettler

7,019 posts

131 months

Sunday 23rd November 2014
quotequote all
andymadmak said:
V8 Fettler said:
Management issues. I'm sure you complained about the pool of mixed ingredients (with photographs as evidence), what was the outcome?
Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.
Good management changes attitudes.

V8 Fettler

7,019 posts

131 months

Sunday 23rd November 2014
quotequote all
LucreLout said:
andymadmak said:
Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.
I never thought I'd say this as long as I lived, but the disgusting attitudes shown by NHS staff on this thread have finally convinced me. The only answer is to shut it down. All of it.
Start again with a clean sheet of paper, no standing army of paper pushers or jobsworths (for that is the attitude being shown however well camouflaged), and design a new organisation focussed around patient care. That may or may not need some privatised elements, but what it so definitely doesn't need is any unionisation.
Set a fixed percentage of gdp beyond which spending on health cannot rise, and create legally binding contracts to drive the best outcomes based on that money. It'd force the new nhs to stay modern and look to efficiency in all it does. And yes, if a bunch of nurses have an hour to chat about shagging during their shift, then they have time to mop the ps off the floor while chatting. Better for the patient you see.
I can see descriptions of "jobsworths" in this thread, but none of posters could be described as "jobsworths", or have I missed a post or two when skimming through?

Edit: missing word


Edited by V8 Fettler on Sunday 23 November 13:14

gruffalo

7,509 posts

225 months

Sunday 23rd November 2014
quotequote all
g3org3y said:
Sorry to hear of your experience Andy. frown

I'd wager (hope!) the nursing staff you encountered were bank/agency nurses. They don't work there permanently and have no allegiance to the ward. Hired per shift, unfortunately a "it's not my problem" attitude is encountered all too commonly with many doing the minimum just to get through the shift. It's a poor attitude and can also make the lives of doctors very difficult when we need their help and they are not forthcoming.

I remember an instance on a busy night shift (when we were struggling anyway) asking a bank nurse (never saw her on the ward before and never again) to help me attend to a patient relatively urgently as I needed some medication administered. The response - no I can't, I'm going on break.

The vast majority of nurses I meet are conscientious, caring and go the extra mile for their patients. They under tremendous pressure, especially on high intensity work wards (such as Care of the Elderly) where often you can have 2 or 3 bays of patients (each bay containing 6 patients) per nurse. I could not do their job.

As I said earlier, I genuinely believe the return of old school style matrons is the way forward. A well run ward is a clean ward and a proud ward. When individuals have pride for their ward they will do all they can to maintain standards and will take pleasure in working together to do the best they can for patients and themselves.

Edited by g3org3y on Sunday 23 November 12:32
The wife of a friend of mine decided to return to nursing once her children all had started full time school, she lasted 6 months before resigning.

Her problem was with the attitude of her fellow nurses, most of who has done their nursing qualifications at a university and not at a teaching hospital. Their attitude was very much along the lines of " I didn't get a degree to empty and clean bed pans" she tried to explain that it was just a part of caring but to no avail so she left, she described the system as completely broken due to nursing becoming just another job and not a vocation any more.

There is only one concept of the NHS that has to be kept and that is treatment free at the point of delivery, all other concepts and practises should be rebuilt to suite a modern health service not a concept from 1948.



spaximus

4,230 posts

252 months

Sunday 23rd November 2014
quotequote all
gruffalo said:
The wife of a friend of mine decided to return to nursing once her children all had started full time school, she lasted 6 months before resigning.

Her problem was with the attitude of her fellow nurses, most of who has done their nursing qualifications at a university and not at a teaching hospital. Their attitude was very much along the lines of " I didn't get a degree to empty and clean bed pans" she tried to explain that it was just a part of caring but to no avail so she left, she described the system as completely broken due to nursing becoming just another job and not a vocation any more.

There is only one concept of the NHS that has to be kept and that is treatment free at the point of delivery, all other concepts and practises should be rebuilt to suite a modern health service not a concept from 1948.
I have a few friends in Nursing who have said the same thing. They call these new type of nurses Noctors, nurses who really think they are Doctors. Apparently it is the role of a care assistant to do the mucky bits not nurses with degrees.

mrpurple

2,624 posts

187 months

Sunday 23rd November 2014
quotequote all
spaximus said:
gruffalo said:
The wife of a friend of mine decided to return to nursing once her children all had started full time school, she lasted 6 months before resigning.

Her problem was with the attitude of her fellow nurses, most of who has done their nursing qualifications at a university and not at a teaching hospital. Their attitude was very much along the lines of " I didn't get a degree to empty and clean bed pans" she tried to explain that it was just a part of caring but to no avail so she left, she described the system as completely broken due to nursing becoming just another job and not a vocation any more.

There is only one concept of the NHS that has to be kept and that is treatment free at the point of delivery, all other concepts and practises should be rebuilt to suite a modern health service not a concept from 1948.
I have a few friends in Nursing who have said the same thing. They call these new type of nurses Noctors, nurses who really think they are Doctors. Apparently it is the role of a care assistant to do the mucky bits not nurses with degrees.
As a 40 yr served very senior nurse I would love to get my OH's opinions on this but having retired 6 months ago, and having been recently lured back in, I am not sure she is ready for a busman's holiday just yet.... Not saying it isn't an issue but I must say that "Noctors" is not something I remember having heard her complain about.

ETA Having just cooked her a Sunday roast I have dared to ask and got chapter and verse

Summary as follows:

Nursing via degrees does have negatives, partly around not having spent as much time within a hospital while training (even getting school hols)so yes it is an aspect that needs addressing. She does have a degree but obtained long after her training. However in the scheme of things not something that is anywhere near the top of her list for things to address to cure the ills of the NHS.

In her mind dealing with medics that can be a rule unto themselves (some not all obviously) may be more beneficial.

Now where did I put my hardhat? getmecoat



Edited by mrpurple on Sunday 23 November 20:59

mph1977

12,467 posts

167 months

Sunday 23rd November 2014
quotequote all
spaximus said:
gruffalo said:
The wife of a friend of mine decided to return to nursing once her children all had started full time school, she lasted 6 months before resigning.

Her problem was with the attitude of her fellow nurses, most of who has done their nursing qualifications at a university and not at a teaching hospital. Their attitude was very much along the lines of " I didn't get a degree to empty and clean bed pans" she tried to explain that it was just a part of caring but to no avail so she left, she described the system as completely broken due to nursing becoming just another job and not a vocation any more.

There is only one concept of the NHS that has to be kept and that is treatment free at the point of delivery, all other concepts and practises should be rebuilt to suite a modern health service not a concept from 1948.
I have a few friends in Nursing who have said the same thing. They call these new type of nurses Noctors, nurses who really think they are Doctors. Apparently it is the role of a care assistant to do the mucky bits not nurses with degrees.
Here we have the biggest problems in modern Nursing ,

1. Those left behind by developments attacking those who threaten them becasue of their greater knowledge - many of the traditionally trained Nurses attacking Degree educated Nurses fall into this group. the irony of course is that these same people are the ones who sign of Students as havign met their practice placement outcomes ( 2300 hours worth of working in clinical areas under the supervision of and assessed by Registered Nurses)

2. Care assistants who do not know how little they know and who refuse to accept direction from Staff Nurses despite their job description clearing stating that they report to the Nurse they are allocated to work with / for on each shift.

3. the Public not listening when they are told about the role of the Registered Nurse -
Many people seem to assume that the role of the RN is the role of the Care Assistant and Nurses cannot act without the orders of a Doctor, rather than the reality which is Nurses guiding junior Doctors into safe decision making and using their own assessment skills and clinical acumen.

Instead at the behest ofthe media the public are listening to 'experts' who in one very notable case had been out of clinical practice for 40 years ( Clare Rayner - yes she had been an SRN and SCM but her total time in the professions was 10 years , 4 -5 of which would have been as a Student 3 for SRN and 18 months + for Madwifery) also wanting to bring back poorly trained, un(der)educated dried up old lesbian bullies aka Old fashioned Matron...

4. the whole 'Noctor' thing based on out dated assumptions of what is and isn't the role of the Registered Nurse - assessing a patinet includes physical examination and basic investigations such as 12 lead ecg and blood tests, not just doing a set of obs and ringing the houseman. Another crazy assumption from those in the hospital sector is that Nurses who work in the community (whether distrcit nursing services or in care homes) 'lose skills' - despite the fact they are relied upon to make clinical decisions without hot and cold running housemen and registrars



pre-Francis report it was typical for a Registered Nurse working on a ward to be accountable for the care of between 8-16 patients each shift, and although thereare figures suggesting 8:1 was the typical figure this was often hospital wide or inpatient units wide meaning that staff numbers away from critical care were much poorer, these numbers may also include office dwellers such as Ward Managers and 'Matrons'

The acutiy in both the hospital sector and care homes has risen substantially over the past 30 years and staffing ratios have been an ongoing topic for many years, the same issues that showed up in Francis etc where well known and documented prior to Mid Staffs kicking off but were often dismissed by lay management and out -of -touch with clinical practice Senior Nurse Managers ( some of whom may not have regularly worked on the wards in the last 20 -30 years having taken Clinical Nurse Manager posts in their late 30s / early 40s )


I', sure many of the readers with a scientific / engineering education or an understanding of audit beyond accountancy will be aware of various descriptions of how work is dome

Assess- Plan - Implement- Evaluate

most jobs in any business have additional staff to do the 'implement' part of it all

Nurses are not just there to implement the plans the Doctors write ...

Nurses have their own assessments , planning and evaluation to do ,

while medicine has got rather better at holistic care ( and various specialities are lampooned for their supposed lack of skill - ( https://www.youtube.com/watch?v=q0S5EN7-RtI ) , the integration of biological , social and psychological factors in care is the responsibility of the Nurse - as they are the constant presence in the in patient environment


some reading

http://www.rcn.org.uk/__data/assets/pdf_file/0005/...

http://www.nice.org.uk/news/article/nice-unveils-s...

http://www.nhsmanagers.net/wp-content/uploads/2013...


I also apologise to any female junior doctors for referring to them as 'housemen' in this post but the lay audience really struggles with the differences between FY1 Doctor ( house officer in the old scheme), FY2 Doctor and Core trainee / ST1+2 (Senior House Officer in the old scheme)


Another point for anyone reading from a logistics background - how long can you sustain running your warehouse or network at average 97 % capacity ?

Sway

26,070 posts

193 months

Sunday 23rd November 2014
quotequote all
mph1977 said:
<Snipped out some interesting points - thank you. >

Another point for anyone reading from a logistics background - how long can you sustain running your warehouse or network at average 97 % capacity ?
Not just logistics/warehousing, but manufacturing and service industries experience - indefinitely.

It's not easy to create the structures, systems, processes, environment etc. to do so (and it's immensely easier starting from a blank slate), but it is by no means impossible. The biggest challenge/enabler is to ensure your 'average' (by which I assume is the mean) is within a very tight range of demand. High demand variation causes massive challenges - regardless of mean utilisation requirements.

By capacity, what exactly are you referring to? Genuinely interested as measures of operational capacity are (in my experience) often very poorly understood/calculated.

For example, if we're talking bed utilisation, then I'd argue that this isn't a full picture - as bed utilisation is made up of no. of patients multiplied by length of use - where there are opportunities to increase capacity by reducing the number of people requiring a bed or implementing mechanisms to reduce the length of time a patient needs a bed.

Data understanding throughput capacity potential would be more useful, and would highlight areas where this could be improved - some of the potential improvement mechanisms will reduce costs, some increase them. As always there's a balance to be had (which is where the fun part lies!)...

mph1977

12,467 posts

167 months

Sunday 23rd November 2014
quotequote all
Sway said:
mph1977 said:
<Snipped out some interesting points - thank you. >

Another point for anyone reading from a logistics background - how long can you sustain running your warehouse or network at average 97 % capacity ?
Not just logistics/warehousing, but manufacturing and service industries experience - indefinitely.

It's not easy to create the structures, systems, processes, environment etc. to do so (and it's immensely easier starting from a blank slate), but it is by no means impossible. The biggest challenge/enabler is to ensure your 'average' (by which I assume is the mean) is within a very tight range of demand. High demand variation causes massive challenges - regardless of mean utilisation requirements.
I'm not sure what the figure of 97% occupancy as an average is , your points aobut infrastructure are very valid and controlling demand and variance

the answer in industry is centralisation and consolidation , which isn't entirely applicable to healthcare , while you can place a less acute patient into a bed designed for higher acuity it's rather hharder to do the reverse ...

Geographical availability is also a big issue - especially with the reverse NIMBYs and formation shroud waving teams who don't or won't understand the clinical drivers for centralisation of some services and the crazy expectations of acceptable distances to travel - such as the claims surrounding A+E rationalisation in London where people are horrified they have to travel 5 miles to an A+E department , where in the shires you'll be lucky to have to travel as little as 5 miles to find a pharmacy or go to the GPs


Sway said:
By capacity, what exactly are you referring to? Genuinely interested as measures of operational capacity are (in my experience) often very poorly understood/calculated.

For example, if we're talking bed utilisation, then I'd argue that this isn't a full picture - as bed utilisation is made up of no. of patients multiplied by length of use - where there are opportunities to increase capacity by reducing the number of people requiring a bed or implementing mechanisms to reduce the length of time a patient needs a bed.

Data understanding throughput capacity potential would be more useful, and would highlight areas where this could be improved - some of the potential improvement mechanisms will reduce costs, some increase them. As always there's a balance to be had (which is where the fun part lies!)...
oh yes , hence the fun with Clinical (in)Decision Units when the A+E 4 hour target came in - admit people who are likely to be discharged following a set of tests or a short period of observation under the care of an Emergency Medicine Consultant and have Emergency Medicine minded Nursing staff care for them , rather than them getting swept into the 24 -48 hour process of the acute medical take .

as for throughput , you'll get the fuming over Mental health and social w**kers who don't see the issues with blocking up A+E/ CDU / Acute Medical beds with people who are 'medically fit' from a physical health point of view but require mental health and/or social care input and aren't safe to be discharged or transferred until these assessments have taken place.

Edited by mph1977 on Sunday 23 November 22:39


Edited by mph1977 on Sunday 23 November 22:44

Sway

26,070 posts

193 months

Sunday 23rd November 2014
quotequote all
Whilst I have no idea what half the clinical terms you're using mean, I'm fairly sure I understand the principles of what you're saying!

Agree with almost all of your points - although centralisation is not always a good way to increase throughput/efficiency.

The real challenge here is (trying) to remove the 'human' element. Talking about admitted patients as 'inventory' wouldn't go down to well I'd have thought, and yet it's a perfectly valid description of a patient's 'impact' on the service provision. True understanding of the potential against defined (and simple!) requirements would irrefutably show the ability to provide more effective care (in every definition of the word) for far less money, with better experiences for all staff - a complete paradigm shift in national healthcare delivery in the same vein as that in manufacturing following the industrial revolution.

The vast majority of data, metrics and targets are counterproductive in reality. Targets are the biggest limiter in the effectiveness of any operation. 'Systems Thinking', with effective understanding and definition of service requirements and achievement are key. However, as I've said before on this thread, it's impossible for politicians to step back enough to allow this to happen, for that matter it's impossible to influence the organisational thinking to effect meaningful change...

So, unfortunately for guys like me it's an abstract mental exercise, rather than the most exciting project I (and those truly world class guys and gals I've worked with over the years) could conceive getting involved in. Which is a pity, if I can make such a huge understatement.

If wishes were dreams and all that.

V8 Fettler

7,019 posts

131 months

Monday 24th November 2014
quotequote all
gruffalo said:
g3org3y said:
Sorry to hear of your experience Andy. frown

I'd wager (hope!) the nursing staff you encountered were bank/agency nurses. They don't work there permanently and have no allegiance to the ward. Hired per shift, unfortunately a "it's not my problem" attitude is encountered all too commonly with many doing the minimum just to get through the shift. It's a poor attitude and can also make the lives of doctors very difficult when we need their help and they are not forthcoming.

I remember an instance on a busy night shift (when we were struggling anyway) asking a bank nurse (never saw her on the ward before and never again) to help me attend to a patient relatively urgently as I needed some medication administered. The response - no I can't, I'm going on break.

The vast majority of nurses I meet are conscientious, caring and go the extra mile for their patients. They under tremendous pressure, especially on high intensity work wards (such as Care of the Elderly) where often you can have 2 or 3 bays of patients (each bay containing 6 patients) per nurse. I could not do their job.

As I said earlier, I genuinely believe the return of old school style matrons is the way forward. A well run ward is a clean ward and a proud ward. When individuals have pride for their ward they will do all they can to maintain standards and will take pleasure in working together to do the best they can for patients and themselves.

Edited by g3org3y on Sunday 23 November 12:32
The wife of a friend of mine decided to return to nursing once her children all had started full time school, she lasted 6 months before resigning.

Her problem was with the attitude of her fellow nurses, most of who has done their nursing qualifications at a university and not at a teaching hospital. Their attitude was very much along the lines of " I didn't get a degree to empty and clean bed pans" she tried to explain that it was just a part of caring but to no avail so she left, she described the system as completely broken due to nursing becoming just another job and not a vocation any more.

There is only one concept of the NHS that has to be kept and that is treatment free at the point of delivery, all other concepts and practises should be rebuilt to suite a modern health service not a concept from 1948.
The duties of nurses/noctors/doctors/care assistants should be clearly defined within their respective terms and conditions of employment. Good management should ensure that these T&Cs are adhered to for the elimination of confusion.

mph1977

12,467 posts

167 months

Monday 24th November 2014
quotequote all
V8 Fettler said:
The duties of nurses/noctors/doctors/care assistants should be clearly defined within their respective terms and conditions of employment. Good management should ensure that these T&Cs are adhered to for the elimination of confusion.
There is No such thing as a 'Noctor' , this is a term used by Nurses who are lacking in insight into the needs of their patients and either jealous or threatened by those colleagues who have developed their role to include b roader assessment roles and who make full use of their authorisations ot request tests and investigations or provide treatment options.

The Job Descriptions are clearly defined, the problem comes when the expectation of others does not match the reality of practice. As an exampleo f this is where Care Assistants expect Registered Nurses to do 50 % of the 'any person' work in addition to 100 % of the RN only work , meaning that 70 -80% of the total workload within Unit falls on the RNs. Much of what is Health Professional only / *specific* Health Professional only / *prescriber only* cannot be delegated, so unfortunately for HCAs this often means the stty end of the business of care.

Further complications arise when care assistants do not realise what they do not know, and consequently RNs 'sat on their arses behind the nurses Station' are not relaxing or taking an unofficial break (although no doubt the usual knockers will be along with anecdotes ). so do not like following the 'legitmate management request' from the RN ...

Funnily enough, I disbeleive those who allege that Nurses are on face book on Hospital computers as in the trusts i'm aware of social media sites, various shopping sites , you tube etc are blocked on on the 'clinical areas' parts of the network ... the block on you tube can be an issue sometimes if you want to show someone ( staff, patient or visitor) video of a procedure or technique ( but that is a side show to the actual topic at hand here)

spaximus

4,230 posts

252 months

Monday 24th November 2014
quotequote all
mph1977 said:
There is No such thing as a 'Noctor' , this is a term used by Nurses who are lacking in insight into the needs of their patients and either jealous or threatened by those colleagues who have developed their role to include b roader assessment roles and who make full use of their authorisations ot request tests and investigations or provide treatment options.

The Job Descriptions are clearly defined, the problem comes when the expectation of others does not match the reality of practice. As an exampleo f this is where Care Assistants expect Registered Nurses to do 50 % of the 'any person' work in addition to 100 % of the RN only work , meaning that 70 -80% of the total workload within Unit falls on the RNs. Much of what is Health Professional only / *specific* Health Professional only / *prescriber only* cannot be delegated, so unfortunately for HCAs this often means the stty end of the business of care.

Further complications arise when care assistants do not realise what they do not know, and consequently RNs 'sat on their arses behind the nurses Station' are not relaxing or taking an unofficial break (although no doubt the usual knockers will be along with anecdotes ). so do not like following the 'legitmate management request' from the RN ...

Funnily enough, I disbeleive those who allege that Nurses are on face book on Hospital computers as in the trusts i'm aware of social media sites, various shopping sites , you tube etc are blocked on on the 'clinical areas' parts of the network ... the block on you tube can be an issue sometimes if you want to show someone ( staff, patient or visitor) video of a procedure or technique ( but that is a side show to the actual topic at hand here)
I personally have no issue with well trained nurses doing extra jobs, but I do have a problem with attitudes.
How is a patient who is in hospital know what the people there do? They know a Dr is in charge of their treatment after years of study and should instruct those under them to do what is asked. But how does a patient know that some nurse's will not do certain things because that is not their role? All they see is a person walking past obvious things, those people ignoring requests from patients.
I was in A&E in Torquay recently, an old man was in a wheel chair and asked three different people to take him to the toilet. He was clearly in discomfort and alone, waiting sat opposite a nurse station. In the end I went over and asked who was in charge as this man needed help, I offered to take him but this was not allowed. They got a care assistant to take him eventually. At that moment I know they were busy but they lost a bit of humanity at that point because they lost sight of the person in the chair. These are the "annecdotes" that come too often. Perhaps because the people do not understand, but is that their fault?
There are too many tales of nurses discussing sex lives and other things they should not, for them all to be made up. Yes the public can be wrong, yes they can exaggerate but they have paid for something and too many times feel let down.
I don't think there is fear of other educated nurse's. Many of the older nurses probably are happy to do what they are asked, but others on here have told tales of nurses being upset by the lack of care demonstrated by some out of university?
If things go wrong with job sharing in a ward, it is the fault of who is in charge of the nurse's and care assistants whatever they are called this week, it is not the responsibility of the patient.

mph1977

12,467 posts

167 months

Monday 24th November 2014
quotequote all
spaximus said:
I personally have no issue with well trained nurses doing extra jobs, but I do have a problem with attitudes.
How is a patient who is in hospital know what the people there do? They know a Dr is in charge of their treatment after years of study and should instruct those under them to do what is asked.
your reply lacks credibility because of the above comment. This ties in with comment in previous replies aobut how the public willfully ignores what Health Professionals and their regualtors say aobut the scopes of Professional Practice.

Doctors are not line Managers , other Professionals are not 'under' Doctors unless that Doctor also happens to be a Manager whose management responsibilities include the 'general' Management of the clinical area.

With regard to Hospital in-patient treatment the named Consultant holds responsibility and accountability for the overall conduct of your Medical care. The Ward Manager / Senior Sister / Senior Charge Nurse holds overall accountability for the Nursing care you recieve on their unit.

In both cases accountability and responsibility is delegated to the individual Registered Practitioners who actually do things for/ to you (and in the case of Nurses the nurse who looks after you among others as a cohort on each shift - unless you are in a level 3 critical care bed when you get 1:1 Nursing ) , responsibility, but not accountability may be delegated to non-registered Staff

spaximus said:
But how does a patient know that some nurse's will not do certain things because that is not their role? All they see is a person walking past obvious things, those people ignoring requests from patients.
you need to define 'ignore' here and relate how the needs and/or wants of one individual may have to be ballanced against the needs and wants of the other 7 patients that individual is looking after and the othe 20 -30 patients o nthe ward ...


spaximus said:
I was in A&E in Torquay recently, an old man was in a wheel chair and asked three different people to take him to the toilet. He was clearly in discomfort and alone, waiting sat opposite a nurse station. In the end I went over and asked who was in charge as this man needed help, I offered to take him but this was not allowed. They got a care assistant to take him eventually. At that moment I know they were busy but they lost a bit of humanity at that point because they lost sight of the person in the chair. These are the "annecdotes" that come too often. Perhaps because the people do not understand, but is that their fault?
see above ref the needs and wants of one vs the needs and wants of others in their care

assisitign with basic care is the role of the HCA , it is a small part of the role of the RN - primarily becasue the RNs responsibilities are broader ... it is very easy to presume from a poition of ignorance about the duties of the Registered Nurse, especially when you have the likes of the late and (un)lamented Clare Rayner waxing lyrical with their 50 year out of date stories.

spaximus said:
There are too many tales of nurses discussing sex lives and other things they should not, for them all to be made up. Yes the public can be wrong, yes they can exaggerate but they have paid for something and too many times feel let down.
'nurses' or 'Nurses' ... there is a difference all too foten the great unwashed assume anyone in a hospital in a uniform is a 'nurse' , disregarding that these staff include Care Assistants working for 'nursing', porters of various flavoursn cleaners / housekeeprs and catering staff, Other Health Professionals ( physios, OTs, etc etc) and their assistant grades ( although AHPs are subject ot their own code of conduct via the HCPC


spaximus said:
I don't think there is fear of other educated nurse's. Many of the older nurses probably are happy to do what they are asked, but others on here have told tales of nurses being upset by the lack of care demonstrated by some out of university?
There is fear it;s rather harder to bully and intimidate a Graduate, who may well have had work experience elsewhere into following the poor practices of the past than it is to do that with someone who has been socialised into the ways straight from school.

There also seems to be an iussue with some older Trained Nurses over the way that Educated Nurses do not demure to Doctors or those ina Navy frock just becasue


spaximus said:
If things go wrong with job sharing in a ward, it is the fault of who is in charge of the nurse's and care assistants whatever they are called this week, it is not the responsibility of the patient.
the majority of Ward Managers and 'Matrons' are Trained Nurses , not Educated ones, Senior Nursing Management is almost universally Trained Nurses - especially as they are often in the the un-redundable period of their career (aged 50 -60) ( because the Trust that makes them redundant will have to pay the NHSPA a sum equivalaent to the annual employee and employer contributions to pension to take the indiviaul to a full pension or the pension they would have at 65 so could be a sume in excess of 100k as well as paying Notice and redundancy to the individual )


spaximus

4,230 posts

252 months

Monday 24th November 2014
quotequote all
mph1977 said:
spaximus said:
I personally have no issue with well trained nurses doing extra jobs, but I do have a problem with attitudes.
How is a patient who is in hospital know what the people there do? They know a Dr is in charge of their treatment after years of study and should instruct those under them to do what is asked.
your reply lacks credibility because of the above comment. This ties in with comment in previous replies aobut how the public willfully ignores what Health Professionals and their regualtors say aobut the scopes of Professional Practice.

Doctors are not line Managers , other Professionals are not 'under' Doctors unless that Doctor also happens to be a Manager whose management responsibilities include the 'general' Management of the clinical area.

I would prefer they were, call me old fashioned.

With regard to Hospital in-patient treatment the named Consultant holds responsibility and accountability for the overall conduct of your Medical care. The Ward Manager / Senior Sister / Senior Charge Nurse holds overall accountability for the Nursing care you recieve on their unit.

In both cases accountability and responsibility is delegated to the individual Registered Practitioners who actually do things for/ to you (and in the case of Nurses the nurse who looks after you among others as a cohort on each shift - unless you are in a level 3 critical care bed when you get 1:1 Nursing ) , responsibility, but not accountability may be delegated to non-registered Staff.

All for delegation of duties to suitable persons as defined by clinical need, so long as that is fully explained and understood.

spaximus said:
But how does a patient know that some nurse's will not do certain things because that is not their role? All they see is a person walking past obvious things, those people ignoring requests from patients.
you need to define 'ignore' here and relate how the needs and/or wants of one individual may have to be ballanced against the needs and wants of the other 7 patients that individual is looking after and the othe 20 -30 patients o nthe ward ...

I understand, however for the individual their needs are what matters and if there are insufficient to meet reasonable needs something is wrong. Clearly there is a world of difference between someone wanting something fetching and someone with no water wanting a drink before they die of dehydration.


spaximus said:
I was in A&E in Torquay recently, an old man was in a wheel chair and asked three different people to take him to the toilet. He was clearly in discomfort and alone, waiting sat opposite a nurse station. In the end I went over and asked who was in charge as this man needed help, I offered to take him but this was not allowed. They got a care assistant to take him eventually. At that moment I know they were busy but they lost a bit of humanity at that point because they lost sight of the person in the chair. These are the "annecdotes" that come too often. Perhaps because the people do not understand, but is that their fault?
see above ref the needs and wants of one vs the needs and wants of others in their care

assisitign with basic care is the role of the HCA , it is a small part of the role of the RN - primarily becasue the RNs responsibilities are broader ... it is very easy to presume from a poition of ignorance about the duties of the Registered Nurse, especially when you have the likes of the late and (un)lamented Clare Rayner waxing lyrical with their 50 year out of date stories.

She may be unlamented to you but to others her ideals for the care of people is still relevant

spaximus said:
There are too many tales of nurses discussing sex lives and other things they should not, for them all to be made up. Yes the public can be wrong, yes they can exaggerate but they have paid for something and too many times feel let down.
'nurses' or 'Nurses' ... there is a difference all too foten the great unwashed assume anyone in a hospital in a uniform is a 'nurse' , disregarding that these staff include Care Assistants working for 'nursing', porters of various flavoursn cleaners / housekeeprs and catering staff, Other Health Professionals ( physios, OTs, etc etc) and their assistant grades ( although AHPs are subject ot their own code of conduct via the HCPC

I do not consider the people who pay for the NHS as "the great unwashed" perhaps if someone gave thought to explaining the roles of each staff member to the patient and their family might help


spaximus said:
I don't think there is fear of other educated nurse's. Many of the older nurses probably are happy to do what they are asked, but others on here have told tales of nurses being upset by the lack of care demonstrated by some out of university?
There is fear it;s rather harder to bully and intimidate a Graduate, who may well have had work experience elsewhere into following the poor practices of the past than it is to do that with someone who has been socialised into the ways straight from school.

Caring for people would seem to be good practice to me

There also seems to be an iussue with some older Trained Nurses over the way that Educated Nurses do not demure to Doctors or those ina Navy frock just becasue

If they wanted to not demure to doctors perhaps they should have trained as one.

spaximus said:
If things go wrong with job sharing in a ward, it is the fault of who is in charge of the nurse's and care assistants whatever they are called this week, it is not the responsibility of the patient.
the majority of Ward Managers and 'Matrons' are Trained Nurses , not Educated ones, Senior Nursing Management is almost universally Trained Nurses - especially as they are often in the the un-redundable period of their career (aged 50 -60) ( because the Trust that makes them redundant will have to pay the NHSPA a sum equivalaent to the annual employee and employer contributions to pension to take the indiviaul to a full pension or the pension they would have at 65 so could be a sume in excess of 100k as well as paying Notice and redundancy to the individual )
redundancies are made when there is no job to do, regardless of cost. The NHS has never been afraid to cut staff loose if that was thought right, many then coming back as agency.

I have read everything you have written and through it all you never seem to really consider the patient. They are frightened, confused and need reassurance that they count especially the old who fear being left to die as they are a burden. We can never go back to the old days as things progress, but if the progression is to ignore the giving of care not just medical then something really has gone astray

I have cocked up the quoting bit but read my answers in the main body

V8 Fettler

7,019 posts

131 months

Monday 24th November 2014
quotequote all
mph1977 said:
V8 Fettler said:
The duties of nurses/noctors/doctors/care assistants should be clearly defined within their respective terms and conditions of employment. Good management should ensure that these T&Cs are adhered to for the elimination of confusion.
There is No such thing as a 'Noctor' ,
I know, it appeared further up the thread but seemed to be an apt description.

mph1977

12,467 posts

167 months

Monday 24th November 2014
quotequote all
Spaximus doctors have never Managed Nurses and Other Health Professionals in Hospital.

Nurses are managed by;
Team leaders (Sister/ Charge Nurse ) who are lead by First Line Managers ( Senior Sister/ Senior CN / Ward manager )

who are in turn managed by 'Matrons' / Clinical Nurse Managers ,
who are managed by the Assistant Directors of nursing who report to Divisional Directors Of Nursing (or Deputy Chief Nurse) who reports to the Executive Director of Nursing who is a full board member

similar patterns apply to Midwifery and Other Health professionals ( Radiographers / Physio / OT and so on ) to the dividional director level , as generally on the overly lay manager heavy Executive Board ofthe average NHS trust there are two clinician posts - the Executive Medical Director and the Executive Nursing Director ( who may have a slightly different title ) .

The biggest problem with delegation is where none registered Staff do not accept that they are directed by Clinicians of Band 5 and upwards and that these directions are to be followed and that they should be questioned only where patient safety is compromised by carrying them out.

Claire Rayner is unlamented becasue her 'expert' opinions on Nursing practice were based on practice 40 -50 years ago, that is why she is unlamented as shewas being viewed by the media and various pressure groups as a valid source of evidence,

People's roles are explained but generally it goes straight over their heads regardless of how simply it is explained. The Media ( both fact and fiction ) and even the health sector Unions do not help in this.

why should someone demure to a Medical Practitioner just becasue that person is a Medical Practitioner ?
the majority of Registered Nurses have far more experience and speciality knowledge than Foundation and Junior Specialist Trainees.

In terms of clinician redundancies the NHS will cut the people it is cheapest to lose or who can be scapegoated. It isd amazing how many posts are magically found at the same banding when budgetry pressures mean that band 7 - 8b Nursing and AHP roles are being 'reduced' ... or of course acting down into a hard to fill band 7 post for short period ... I've seen a reduction in Matron posts actually end up with more 8a posts after the reduction than before ... sudden need to have 'night matrons' discovered ...

it is interesting that people always assume that becasue the high quality patient care deelivered to 99.99999% of NHS paitients isn't constantly mentioned in reply to answers aobut management systems that it is not being done ... but like the SP&L police hate squad , just becasue the very rare instances of poor care make the national news it must be happening all the time up anddown the country. the fact these incidents make the national news indicates the actual rarity of the incidents ...


V8 Fettler

7,019 posts

131 months

Tuesday 25th November 2014
quotequote all
mph1977 said:
People's roles are explained but generally it goes straight over their heads regardless of how simply it is explained.
Then it's not being explained very well, maximum 10 bullet points normally works. Don't comply and you're out of the door.

Croutons

9,807 posts

165 months

Sunday 30th November 2014
quotequote all
Convenient pre-Autumn statement leak (or perhaps briefing) to the Telegraph says George will give em £2bn more next year. Nice Labour outflank, no info on which money tree is dropping it for him.

NicD

3,281 posts

256 months

Sunday 30th November 2014
quotequote all
borrowing more billions to add to that frittered away on foreign aid et al.