Wednesday

The nursing crisis goes on

For those who think the nursing crisis is over, some anecdotal evidence:

A hospital consultant put his career on the line yesterday by warning publicly that a desparate shortge of nurses is putting patients’ lives at risk….
Mr [Milton] Pena, an orthopaedic specialist, is a surgeon of more than 30 years’ experience.
He revealed the crisis at Tameside General Hospital, Ashton-under-Lyne, Greater Manchester, after warning for two years that nursing levels on three wards which deal with his patients as well as some with acute chest pain or head injuries were dangerously low.
Yesterday he said he feared that someone would die. His concerns were echoed by the Royal College of Surgeons who warned of a severe shortage of nurses in the NHS nationally….
…he could now face disciplinary action for making his fears public…
Tameside General Hospital had the 11th worst nurse-to-patient ratio in England in 2003 at 102.8 staff per 100 beds, compared to the national average of 131.7.
Mr Pena alerted bosses in 2003 after 14 separate occasions when there was just one qualified member of staff on duty to cover 28 patients.
Yesterday he said he had decided to release the confidential nursing logs from the wards because the situation had not improved two years on.
“…I felt I had no choice but to speak out on behalf of my patients and I’m prepared to take the consequences – if they suspend me then so be it.”
“When I retire, I don’t want to feel that I knew about the problems here but did nothing about them.”

Some of the comments from the hospital in reply to the story which appear in the Daily Mail (not online as far as I can find, unfortunately) are most revealing:

“Last year we employed external consultants who recommended that we increased staffing levels on the orthopaedic wards. This was done and we do not currently have any nursing vacancies.”
“Unfortuantely we have recently been affected by sickness and that has made it difficult to meet those levels”.

The comments reveal that the hospital:
a) needs external consultants to realise it needs extra nurses, even when one of its own consultants has been telling it this for two years.
b) spends some of its budget on consultants that might better be spent on the extra nurses needed.
c) is unprepared for the eventuality that sometimes nurses become ill.
The hospital, according to the Daily Mail, has not ruled out disciplinary action for Mr Milton Pena.
The public does not understand the true level of the inadequacy of the National Health Service partly because doctors and nurses are contractually bound not to speak out about it. Like Mr Pena, they fear they might be disciplined.
Here are a few of the 2005 nursing records publishing by Mr Pena:

January 27 2005: Two trainees, three qualified staff on duty: ’28 very dependent patients. Unable to carry out basic needs for patients; pressure care, nutritional needs, continence care, observation, unable to carry out four-hourly observations. Complaints from relatives. Will put in letter of concern.’
February 12: Trainee absent. Three qualified nurses, two trainees on duty: ‘Patient care, drinks, toileting, medications late. Wound care and care plans not done.’
March 17: One qualified nurse sick. Two qualified and three trainee nurses: ‘Unable to take patients to toilet. Nutrition needs not properly met.’

Not being a nurse or doctor, I cannot properly describe the health implications of what is described. But it sounds as though people who are very seriously unwell have not been fed properly. They have even gone without fluids to drink. They have, perhaps, lived with unemptied bags of urine. They have not been given the drugs they need which, presumably, have been prescribed to reduce their pain, to prevent them getting dangerous infections or to help cure them.
It is appalling for those who may depend on this hospital to think that they or perhaps their elderly loved ones might be treated in this way.

  1. Why nurses leave the NHS
  2. What really happened at Epsom Hospital
  3. Why has Great Ormond Street Hospital run out of money?
  4. Overcrowding and infection risk
  5. More manipulation of hospital waiting times
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One Response to The nursing crisis goes on

  1. The most worrying thing that I can see is the lack of “pressure care”. When I wirked as an Aux. Nurse in a (private) care home (where we were also severely understaffed; still, what can you do when Aux Staff go on their lunch break on their first day, leaving their resignation letter behind them, eh?), we had a number of patients with severe pressure sores. In all cases, these pressure sores had ocurred at home, when the patients were being cared for by relatives who were unaware of the danger.
    They usually start off looking like a watermark on the skin, usually on bone protrusions such as the hips or buttocks and are, obviously enough, formed on pressure areas, e.g. usually when a patient is sitting on them for a large amount of time.
    Within a very short space of time, they suddenly become revealed for what they are: severe destruction of the fatty and epidermal tissue. In essence, they suddenly break through the skin, and you are left with a hole straight through to the exposed muscle, and sometimes bone.
    Our patient with the most severe pressure sores had two, one on each hip, which were roughly 10 cm in diameter. They required dressing at least every morning and evening, and sometimes even more frequently. Through extensive pressure care management (which myself and another Aux. mainly used our breaks for), we managed, over the course of a year, to reduce them by about 1 cm each side. However, he had them until he died a year later.
    Can you imagine the potential for infection? Leaving aside the issue of hospital “superbugs” such a Methicillin Resistant Staphylococcus Aureus (MRSA), a slightly leaky catheter–and they are always slightly leaky–occasionally soaked the dressings (anyone with a catheter is prone to urinary tract infections anyway). Plus, of course, there’s the (not insubstantial) cost of the dressings and the time taken to dress each wound (each sore took about 15 minutes to dress properly).
    Pressure wounds on supine patients can form horribly quickly and are almost impossible to mend. This particular patient had them–almost unchanged in size–until the day he died, about 18 months after I left the Care Home.

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