Something that really shocked me. DISCUSS!
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Original post by infairverona
I think you are overreacting personally. I don't think the point of this person was that you are above washing etc or that the nursing profession in general is above these tasks. I think they were saying when you are very low on the ground with staff, and you have HCAs there, they should be taking on these kinds of duties so that you are free to focus on the duties that differentiate you from an HCA - you are a band 5 (or higher), they are a band 3, there are tasks you are paid to do that they cannot do and you need to be doing those. If you are low staffed, while I appreciate you are trying to give good care always and that's great, it's probably not the best use of your time and the time of the ward for you to be doing duties that an HCA could be doing when you could be elsewhere doing a task that an HCA is not qualified to do. Obviously, the tasks you've mentioned such as washing, toileting etc are always going to be part of basic nursing care and no nurse should turn their nose up at doing these. But, things change when you are low on the ground and it makes sense to allow HCAs to get on with HCA level tasks and you to focus on the tasks that make you a nurse rather than an HCA. Your attitude to HCAs and general nursing is commendable, and I see where you're coming from, but I think being low staffed makes a difference. If the HCAs can't do the filling in paperwork and referrals etc and that is part of your job then you need to be doing that and let the HCAs get on with HCA work. I agree with the above poster that this way of working particularly when low staffed is more economical and effective, they aren't paying you a band 3 salary to wash and toilet when there's paperwork or other stuff commensurate with a band 5/6 to be doing and the HCAs can't do those tasks
Erm, I've just spent 3 long days being the only trained nurse for 11 heavy, elderly and complex male patients. Some of whom are very sick, some very confused and some who require complex treatments. I have still managed to fit in washes and PA care and actually talking to my patients as well as my other nursing duties which have included 3 meds rounds, 2 lots of visiting times, 2 lots of IV rounds, setting up IV fluids, multiple wound dressings (including bilateral leg ulcers), discharges, admissions, providing palliative care for dying patients, NG feeding and then caring for critically unwell patients, care planning, risk assessments etc. I haven't really had much choice in making sure my patients are turned and toileted as there has only been me and an HCA in the afternoon so we obviously worked together to get the job done. I am actually a Band 6 Sister, so when I Discharge Co-Ordinate, my entire job is making and chasing referrals and spending my entire life on the telephone. I obviously have very little patient contact when I do this role so I am not bitching about this part of nursing as it is necessary. I am also moving on to a role where I am going to have very little hands on contact with the patient as I am going to be focusing on quick and safe discharge for patients admitted to A&E and MAU so that they don't get admitted, and if they do get admitted that they have the appropriate assessments carried out and go to the correct speciality. It was just the general attitude of the Chief Nurse and Nursing Management. They are very out of touch with how wards actually run. They do not spend any time on the wards whatsoever, they are purely target driven.
Original post by ButterflyRN
Erm, I've just spent 3 long days being the only trained nurse for 11 heavy, elderly and complex male patients. Some of whom are very sick, some very confused and some who require complex treatments. I have still managed to fit in washes and PA care and actually talking to my patients as well as my other nursing duties which have included 3 meds rounds, 2 lots of visiting times, 2 lots of IV rounds, setting up IV fluids, multiple wound dressings (including bilateral leg ulcers), discharges, admissions, providing palliative care for dying patients, NG feeding and then caring for critically unwell patients, care planning, risk assessments etc. I haven't really had much choice in making sure my patients are turned and toileted as there has only been me and an HCA in the afternoon so we obviously worked together to get the job done. I am actually a Band 6 Sister, so when I Discharge Co-Ordinate, my entire job is making and chasing referrals and spending my entire life on the telephone. I obviously have very little patient contact when I do this role so I am not bitching about this part of nursing as it is necessary. I am also moving on to a role where I am going to have very little hands on contact with the patient as I am going to be focusing on quick and safe discharge for patients admitted to A&E and MAU so that they don't get admitted, and if they do get admitted that they have the appropriate assessments carried out and go to the correct speciality. It was just the general attitude of the Chief Nurse and Nursing Management. They are very out of touch with how wards actually run. They do not spend any time on the wards whatsoever, they are purely target driven.
Great, I already said I don't doubt your skills as a nurse. All I am saying is, if you are a CN or management in the NHS in its current state, you have to be economical. If HCAs can do X tasks, and nurses can do X+Y tasks, and you don't have enough staff, it makes complete sense that in theory HCAs do X tasks and nurses do Y tasks. That obviously should not be a clear cut divide and I'm not suggesting you stop caring for a patient just to call over an HCA to do an X task. All I'm saying is I think it makes sense why your management would prefer that, where possible, HCAs do X tasks and nurses do Y tasks.
I get where you're coming from completely - before I came to a band 6 role recently I was a band 5 with an assistant. I was frequently reprimanded for doing my own photocopying or filing if my assistant was really busy with tasks that had a more urgent deadline. Photocopying and filing, I was told, are not band 5 tasks, and I should've been leaving them for the assistant to do. I disagreed with this as I think any admin job in the NHS or out of it will at some point involve photocopying or filing and I'm not above doing those tasks, but having spoken with my manager about it I agreed that where possible I should be doing the higher level work. I would still even in my band 6 role happily do filing and photocopying, I agree with you that as a line manager I would never ask my staff to do a task I myself would not be happy doing, but if I can plan the workload of my team so that those who are paid to do X tasks can do X tasks and those who can do X but also Y are free to do Y, this is a better use of my team's time. They are on different bandings for a reason, because their jobs have different responsibilities, and when you don't have enough staff it can be the best use of everyone's time to allow higher level staff to get on with higher level tasks that lower level staff can't or aren't qualified to do. That's all I am saying, and I think this is all your CN was saying - not that nurses should never do basic care or should consider themselves above basic care because, as you quite rightly say, that would be wrong.
Original post by infairverona
Great, I already said I don't doubt your skills as a nurse. All I am saying is, if you are a CN or management in the NHS in its current state, you have to be economical. If HCAs can do X tasks, and nurses can do X+Y tasks, and you don't have enough staff, it makes complete sense that in theory HCAs do X tasks and nurses do Y tasks. That obviously should not be a clear cut divide and I'm not suggesting you stop caring for a patient just to call over an HCA to do an X task. All I'm saying is I think it makes sense why your management would prefer that, where possible, HCAs do X tasks and nurses do Y tasks.
I get where you're coming from completely - before I came to a band 6 role recently I was a band 5 with an assistant. I was frequently reprimanded for doing my own photocopying or filing if my assistant was really busy with tasks that had a more urgent deadline. Photocopying and filing, I was told, are not band 5 tasks, and I should've been leaving them for the assistant to do. I disagreed with this as I think any admin job in the NHS or out of it will at some point involve photocopying or filing and I'm not above doing those tasks, but having spoken with my manager about it I agreed that where possible I should be doing the higher level work. I would still even in my band 6 role happily do filing and photocopying, I agree with you that as a line manager I would never ask my staff to do a task I myself would not be happy doing, but if I can plan the workload of my team so that those who are paid to do X tasks can do X tasks and those who can do X but also Y are free to do Y, this is a better use of my team's time. They are on different bandings for a reason, because their jobs have different responsibilities, and when you don't have enough staff it can be the best use of everyone's time to allow higher level staff to get on with higher level tasks that lower level staff can't or aren't qualified to do. That's all I am saying, and I think this is all your CN was saying - not that nurses should never do basic care or should consider themselves above basic care because, as you quite rightly say, that would be wrong.
I get where you're coming from completely - before I came to a band 6 role recently I was a band 5 with an assistant. I was frequently reprimanded for doing my own photocopying or filing if my assistant was really busy with tasks that had a more urgent deadline. Photocopying and filing, I was told, are not band 5 tasks, and I should've been leaving them for the assistant to do. I disagreed with this as I think any admin job in the NHS or out of it will at some point involve photocopying or filing and I'm not above doing those tasks, but having spoken with my manager about it I agreed that where possible I should be doing the higher level work. I would still even in my band 6 role happily do filing and photocopying, I agree with you that as a line manager I would never ask my staff to do a task I myself would not be happy doing, but if I can plan the workload of my team so that those who are paid to do X tasks can do X tasks and those who can do X but also Y are free to do Y, this is a better use of my team's time. They are on different bandings for a reason, because their jobs have different responsibilities, and when you don't have enough staff it can be the best use of everyone's time to allow higher level staff to get on with higher level tasks that lower level staff can't or aren't qualified to do. That's all I am saying, and I think this is all your CN was saying - not that nurses should never do basic care or should consider themselves above basic care because, as you quite rightly say, that would be wrong.
No, she was actually surprised that RN's do actually provide basic care and was pretty appalled that they did. She also discussed other things as well (purely target driven) but my line manager stopped telling me and the rest of the Sister's on my ward about it because we were all feeling pretty peed off and demoralised by it all. Of course we should prioritise our workloads and delegate tasks accordingly. I'm not gonna go around doing the hourly rounds or cleaning if poor Joe in the corner is blue in the lips and short of breath. I'm also not gonna spend all morning doing my washes when I've got meds to do and need to plan my discharges and try to get them out before lunch. Then I'll have several admissions in the afternoon. There have been some shifts where I really do not feel like I have seen my patients all day, and I don't really think nursing should be heading in that direction because I cannot say that I feel like I have provided good patient care. I have provided the bare minimum by doing what is required of me but that doesn't make me feel good as a nurse.
There is a place for being economical for sure but solely relying on HCA's to do all the basic care is just asking for trouble in my opinion. If you are unlucky enough to be on shift with an inexperienced HCA, they are not as likely to tell you if someone's PA's are breaking down, they do not always communicate changes in obs and escalate warning signs to you, they are not experienced enough to let you know that someone hasn't passed urine all day and may not know the importance of collecting a stool sample when a patient develops diarrhoea. There are cost implications as you may well be aware the Trust gets fined for every grade 2, 3 or 4 sore developed in hospital and for every hospital acquired c-dif and other hospital acquired infections (if you don't get the sample in time, it's the hospital's fault). There are also cost implications on length of stay which could well be affected if EWS triggers are not picked up on early enough, they don't recognise patients with dysphagia when feeding them and it's just little things that can have a massive impact. And do you know who's responsibility it is? It's mine! I am the accountable practitioner. It's okay if I am on with an HCA who is very experienced who will escalate anything as soon as there is a problem, but if you are on shift with an HCA who is less experienced and cannot prioritise their own workload is makes the RN's job much more difficult and care does lapse. It happens, and it happens all the time, more than we'd like to believe. I am proud to say that I believe in general our Trust provides better care than our neighbours and we are statistically better than them in most areas. But things are starting to slip because they are so target orientated and I feel like they are forgetting that our job is to provide treatment to patients but instead see them as numbers.
Original post by infairverona
Do you think? I have to say, as much as I empathise with the OP of this thread (I work in the NHS also) I read part of it as she didn't want to be doing the tasks that make her a band 5 nurse over a band 2 or 3 HCA. The paperwork and referrals I'm guessing HCAs can't do, the basic washing, toileting, feeding etc a HCA can do. I'm sure in an ideal world or even an ideal NHS nurses would have the capacity to do both of these level tasks but I don't see much good in moaning about having to do tasks commensurate with your band. If you wanted to only do band 3 HCA jobs you could've just stayed a band 3 HCA, not become a band 5 nurse. Far from deskilling it sounded a bit to me like OP wants to be doing tasks that are generally commensurate only with a band 2/3 and is less keen on doing the band 5 tasks - yet she is being paid at a nurse level...
[Sorry for so many references to bands, a lot of people think they are just about pay but they are more about responsibilities also. I used to work in nursing/HCA recruitment in the NHS.]
[Sorry for so many references to bands, a lot of people think they are just about pay but they are more about responsibilities also. I used to work in nursing/HCA recruitment in the NHS.]
I read it as they were saying they felt basic patient care was important to help them actually complete the paperwork and provide the level of service needed to the patient and family. Presumably when a family comes in and asks for an update on their relative to have actually spent 10 minutes with said relative, spoken to them and got a genuine impression of their mobility/welfare and so on is fairly invaluable. Perhaps not every day but I personally think that patient contact can be an important part of providing good care. Otherwise the patient becomes a collection of obs and charts.
The problem (IMO) with sticking certain tasks into certain bands of responsibility is that on the basis of cost-effectiveness it gets done by job description. This makes sense most of the time but in places you do also lose out on things this way.
Original post by infairverona
Oh trust me, I've read all of it very carefully. I think you should take on board how your posts can come across. If you read my first post, I said your attitude towards it all is great, and I certainly don't doubt you're very skilled as a nurse. It just seems a bit odd to be saying you don't want to do paperwork and referrals all day, that is part of your job and if there are HCAs to do the basic caring then you as a qualified skilled nurse need to do the tasks commensurate with your banding. And I also said - which I reiterate in light of this post - I think you are blowing it up considerably. The CN was not saying 'basic nursing values should be lost', they are paying you to do a band 5 job when there are band 2s or 3s that can do the basic care on your ward. If they wanted someone just to do basic care all day they would not have requested the number of qualified nurses on your ward when they do service assessments and vacancy control. I think it's really great that you clearly enjoy basic care because myself and family have had nurses who clearly think this is above them but from your management's point of view they need to manage the workload on your ward in an economical way. That means, when understaffed, that HCAs do HCA work even if you as a nurse also are happy to do those tasks, and you are free to do the tasks in your banding that HCAs can't.
I have worked in 3 NHS Trusts and I've dealt with HR cases where nurses are complaining about stuff like this. If the tasks are in your banding and there are enough HCAs on your ward, it's a no-brainer for your management
I have worked in 3 NHS Trusts and I've dealt with HR cases where nurses are complaining about stuff like this. If the tasks are in your banding and there are enough HCAs on your ward, it's a no-brainer for your management
I think you've made some very fair points Inverona.
Butterfly RN, don't put DISCUSS in caps if you then don't like people's replies!
Original post by seaholme
I read it as they were saying they felt basic patient care was important to help them actually complete the paperwork and provide the level of service needed to the patient and family. Presumably when a family comes in and asks for an update on their relative to have actually spent 10 minutes with said relative, spoken to them and got a genuine impression of their mobility/welfare and so on is fairly invaluable. Perhaps not every day but I personally think that patient contact can be an important part of providing good care. Otherwise the patient becomes a collection of obs and charts.
The problem (IMO) with sticking certain tasks into certain bands of responsibility is that on the basis of cost-effectiveness it gets done by job description. This makes sense most of the time but in places you do also lose out on things this way.
The problem (IMO) with sticking certain tasks into certain bands of responsibility is that on the basis of cost-effectiveness it gets done by job description. This makes sense most of the time but in places you do also lose out on things this way.
That top paragraph is so on point.
Ok, so here's where I stand....
Although there is obviously variation in the quality of nurses, I find there is greater variation in the quality of HCAs. You don't know what they can/can't do or how well they do it.We have numerous new HCAs on my ward at the moment, who've been with us several months. To be honest, they can still only really do observations, and sometimes I find their assessments are not wholly accurate (Particularly with WOB which is SO critical in children). I'd let them do the paperwork, but I have to check it (Often correct it) and countersign it anyway, so there's little point in them doing that either. I try to teach them where I can; I love teaching and feel strongly that we, as a ward, should focus on their development more. This isn't a HCA bash though, as the slightly more experienced HCAs we have are AMAZING, and often I'll allocate them one, or even two simple patients to focus on. We'll do an initial assessment on them together, I'll inform the parents I am overseeing their care, and then I'll let the HCA crack on and notify me of any concerns or if they/the parents feel the child needs a PRN medicine. Every few hours we'll come together and have a catch up. I get the impression they all appreciate me teaching them things where I can, and that I am organised and regularly check in with them. (We have a max of 2 HCAs on per shift, so most of the time, I work alone).
As has already been pointed out, it must be remembered that if something happens to a patient, the responsibility is with the registered nurse allocated to look after that patient for the shift - HCAs are unregistered and therefore their career (Worst case scenario) does not rest on the line every time they come into work. The fact is, mine does. I am responsible for all aspects of care, whether I do itor a HCA does it for me, the buck stops with me.
What the Chief Nurse of @ButterflyRN's Trust implied is that basic care is not for nurses, and should be the HCAs primary responsibility.This is fundamentally wrong - especially given what I have already highlighted about responsibility and accountability. The ONLY time basic or personal care should be handed over to a HCA is when a nurse is prioritising care/tasks and has medicines to prepare/a sick patient to review or deal with/A.N. other task that a HCA is not competent to carry out which needs to be done at the same time. When I'm delegating a task, I always ensure the HCA understands why I’m delegating that task to them and that I’m not simply shirking my responsibilities, but I’m making a sensible use of our time and skills. E.g. “Are you ok to do patient A’s nappy change while I get patient B’s medicine?”. If we can both do both of the tasks, I give them the option of which they’d rather do.
I’m not sure how it works in the adult sector, but all this chat from other posters about “economical working” is, quite frankly, a load of rubbish from a paediatric perspective.All our Band 2s, 5s and 6s get as involved with basic personal care as each other, and as our patients require (Parents are sometimes there to carry this out for us, sometimes not). The only time this equal involvement may not happen, is if the ward is exceptionally busy or there is some kind of emergency which the nursing staff have to take control of. Excellent basic care mustn’t be lost from the qualified nursing workforce’s repertoire, and it will be lost if we do not regularly partake in it. How can we expect a HCA to do basic care if we, as qualified nurses, cannot effectively do it ourselves? We’ll lose the respect of our junior clinical support staff.
And let’s face it, what matters a lot to parents, friends and family of patients is basic care. I have heard countless stories of family members visiting people in hospital to see the basics not being done well, and they report how distressing that was for them. The first thing they see when they walk in the room to visit is not when the patient’s medicines were last given, but whether they are clean and in fresh clothes. If we can’t do that sort of care well, we’ll lose their trust. And at times like this, the NHS needs every ounce of trust we can get from the public. Additionally, a clean, comfortable, well positioned patient will likely have improved HR, RR, SpO2 and WOB.
I direct the ignorant posters among this thread to the Francis Report, where failings in the most basic care have the most horrendous of outcomes. It has taken the NHS a significant amount of time to recover from this report and we are still learning from it.
Enough said. I think my opinion, and rationale for such, is clear.
Although there is obviously variation in the quality of nurses, I find there is greater variation in the quality of HCAs. You don't know what they can/can't do or how well they do it.We have numerous new HCAs on my ward at the moment, who've been with us several months. To be honest, they can still only really do observations, and sometimes I find their assessments are not wholly accurate (Particularly with WOB which is SO critical in children). I'd let them do the paperwork, but I have to check it (Often correct it) and countersign it anyway, so there's little point in them doing that either. I try to teach them where I can; I love teaching and feel strongly that we, as a ward, should focus on their development more. This isn't a HCA bash though, as the slightly more experienced HCAs we have are AMAZING, and often I'll allocate them one, or even two simple patients to focus on. We'll do an initial assessment on them together, I'll inform the parents I am overseeing their care, and then I'll let the HCA crack on and notify me of any concerns or if they/the parents feel the child needs a PRN medicine. Every few hours we'll come together and have a catch up. I get the impression they all appreciate me teaching them things where I can, and that I am organised and regularly check in with them. (We have a max of 2 HCAs on per shift, so most of the time, I work alone).
As has already been pointed out, it must be remembered that if something happens to a patient, the responsibility is with the registered nurse allocated to look after that patient for the shift - HCAs are unregistered and therefore their career (Worst case scenario) does not rest on the line every time they come into work. The fact is, mine does. I am responsible for all aspects of care, whether I do itor a HCA does it for me, the buck stops with me.
What the Chief Nurse of @ButterflyRN's Trust implied is that basic care is not for nurses, and should be the HCAs primary responsibility.This is fundamentally wrong - especially given what I have already highlighted about responsibility and accountability. The ONLY time basic or personal care should be handed over to a HCA is when a nurse is prioritising care/tasks and has medicines to prepare/a sick patient to review or deal with/A.N. other task that a HCA is not competent to carry out which needs to be done at the same time. When I'm delegating a task, I always ensure the HCA understands why I’m delegating that task to them and that I’m not simply shirking my responsibilities, but I’m making a sensible use of our time and skills. E.g. “Are you ok to do patient A’s nappy change while I get patient B’s medicine?”. If we can both do both of the tasks, I give them the option of which they’d rather do.
I’m not sure how it works in the adult sector, but all this chat from other posters about “economical working” is, quite frankly, a load of rubbish from a paediatric perspective.All our Band 2s, 5s and 6s get as involved with basic personal care as each other, and as our patients require (Parents are sometimes there to carry this out for us, sometimes not). The only time this equal involvement may not happen, is if the ward is exceptionally busy or there is some kind of emergency which the nursing staff have to take control of. Excellent basic care mustn’t be lost from the qualified nursing workforce’s repertoire, and it will be lost if we do not regularly partake in it. How can we expect a HCA to do basic care if we, as qualified nurses, cannot effectively do it ourselves? We’ll lose the respect of our junior clinical support staff.
And let’s face it, what matters a lot to parents, friends and family of patients is basic care. I have heard countless stories of family members visiting people in hospital to see the basics not being done well, and they report how distressing that was for them. The first thing they see when they walk in the room to visit is not when the patient’s medicines were last given, but whether they are clean and in fresh clothes. If we can’t do that sort of care well, we’ll lose their trust. And at times like this, the NHS needs every ounce of trust we can get from the public. Additionally, a clean, comfortable, well positioned patient will likely have improved HR, RR, SpO2 and WOB.
I direct the ignorant posters among this thread to the Francis Report, where failings in the most basic care have the most horrendous of outcomes. It has taken the NHS a significant amount of time to recover from this report and we are still learning from it.
Enough said. I think my opinion, and rationale for such, is clear.
(edited 7 years ago)
Original post by seaholme
I read it as they were saying they felt basic patient care was important to help them actually complete the paperwork and provide the level of service needed to the patient and family. Presumably when a family comes in and asks for an update on their relative to have actually spent 10 minutes with said relative, spoken to them and got a genuine impression of their mobility/welfare and so on is fairly invaluable. Perhaps not every day but I personally think that patient contact can be an important part of providing good care. Otherwise the patient becomes a collection of obs and charts.
This 100%!!!
Original post by lilibet01
I think you've made some very fair points Inverona.
Butterfly RN, don't put DISCUSS in caps if you then don't like people's replies!
Butterfly RN, don't put DISCUSS in caps if you then don't like people's replies!
Just because I disagree with some of the replies doesn't mean that I don't respect them or take something from them. The point of a discussion is to discuss all points of view and of course people will offer different opinions and perspectives, which means inevitably that some people will disagree.
@PaediatricStN you are pretty spot on too and raise a good point about the Francis report.
Original post by ButterflyRN
@PaediatricStN you are pretty spot on too and raise a good point about the Francis report.
Were the findings in the Francis report because of nurses not wanting to deliver personal care though, or was it more because a trust so hellbent on foundation status cut staffing to the bone making anything other than doing the bare minimum impossible? Mid Staffs could easily happen again, anywhere, in fact there's a story in the news today where the inspectorate at a hospital in Scotland had to step in on the ward. I'll try find a link in a mo.
Edit: link here: http://www.bbc.co.uk/news/uk-scotland-36421159
(edited 7 years ago)
Original post by moonkatt
Were the findings in the Francis report because of nurses not wanting to deliver personal care though, or was it more because a trust so hellbent on foundation status cut staffing to the bone making anything other than doing the bare minimum impossible? Mid Staffs could easily happen again, anywhere, in fact there's a story in the news today where the inspectorate at a hospital in Scotland had to step in on the ward. I'll try find a link in a mo.
Edit: link here: http://www.bbc.co.uk/news/uk-scotland-36421159
Edit: link here: http://www.bbc.co.uk/news/uk-scotland-36421159
I never said nurses didn't want to deliver personal care, in fact I have been saying the opposite as have many other in this thread. We are running on fewer and fewer RN's and the Trust simply cannot recruit anymore. So whilst I appreciate that RN's do have to move away from doing a lot of the personal care to focus their other huge list of increasing priorities, the care the RN provides will suffer. You cannot adequately plan and evaluate a patients care if you have not even seen them all day. Yes, some days when I am the only RN on my team I do have to rely on what the paperwork and HCA's tell me and whilst I trust my HCA's, I am the one signing to say the patient has received that care. I feel like if we are heading in the direction of running on more HCA's and fewer RN's, although our HCA's work bloody hard and do a fantastic and commendable job, more hospitals will end up like Mid Staffs. Not because our HCA's don't do a good job because they do, but because they do not have the knowledge and skills to assess a patient and interpret what it all means.
Original post by ButterflyRN
I never said nurses didn't want to deliver personal care, in fact I have been saying the opposite as have many other in this thread. We are running on fewer and fewer RN's and the Trust simply cannot recruit anymore. So whilst I appreciate that RN's do have to move away from doing a lot of the personal care to focus their other huge list of increasing priorities, the care the RN provides will suffer. You cannot adequately plan and evaluate a patients care if you have not even seen them all day. Yes, some days when I am the only RN on my team I do have to rely on what the paperwork and HCA's tell me and whilst I trust my HCA's, I am the one signing to say the patient has received that care. I feel like if we are heading in the direction of running on more HCA's and fewer RN's, although our HCA's work bloody hard and do a fantastic and commendable job, more hospitals will end up like Mid Staffs. Not because our HCA's don't do a good job because they do, but because they do not have the knowledge and skills to assess a patient and interpret what it all means.
I will reply properly when I have the time to, which I don't at the moment. I agree we're sleepwalking into a situation where the HCAs are doing everything and it's something I disagree with, but I also think nursing has a bit of an identity crisis, which I'll expand on after my shift tomorrow.
I hope this thread is still about for me to comment on tomorrow, but I think people are getting a bit wound up. Can we all discuss this rationally and sensibly, I think it's good we're having a discussion about this and I want to start a thread on something similar in the future when I'm not buried under a mountain of work.
Original post by moonkatt
I will reply properly when I have the time to, which I don't at the moment. I agree we're sleepwalking into a situation where the HCAs are doing everything and it's something I disagree with, but I also think nursing has a bit of an identity crisis, which I'll expand on after my shift tomorrow.
I hope this thread is still about for me to comment on tomorrow, but I think people are getting a bit wound up. Can we all discuss this rationally and sensibly, I think it's good we're having a discussion about this and I want to start a thread on something similar in the future when I'm not buried under a mountain of work.
I hope this thread is still about for me to comment on tomorrow, but I think people are getting a bit wound up. Can we all discuss this rationally and sensibly, I think it's good we're having a discussion about this and I want to start a thread on something similar in the future when I'm not buried under a mountain of work.
Sure moonkatt
I don't really see anyone getting wound up, I just see people with strong feelings on the matter.Original post by ButterflyRN
I never said nurses didn't want to deliver personal care, in fact I have been saying the opposite as have many other in this thread. We are running on fewer and fewer RN's and the Trust simply cannot recruit anymore. So whilst I appreciate that RN's do have to move away from doing a lot of the personal care to focus their other huge list of increasing priorities, the care the RN provides will suffer. You cannot adequately plan and evaluate a patients care if you have not even seen them all day. Yes, some days when I am the only RN on my team I do have to rely on what the paperwork and HCA's tell me and whilst I trust my HCA's, I am the one signing to say the patient has received that care. I feel like if we are heading in the direction of running on more HCA's and fewer RN's, although our HCA's work bloody hard and do a fantastic and commendable job, more hospitals will end up like Mid Staffs. Not because our HCA's don't do a good job because they do, but because they do not have the knowledge and skills to assess a patient and interpret what it all means.
Isn't this exactly why there are calls to create a band 4 'associate practitioner' post between a band 3 HCA and a band 5 RN to help bridge that gap?
In relation to your reply to me above: I don't know how far your responsibility stretches with regards to your management of the HCAs but if you are having issues where they are not picking up things they should be picking up etc that needs to be identified as a management issue, a training issue, or potentially a poor work performance issue. I'm not clinical so I don't know all the ins and outs of the exact division between an HCA and a RN, so I don't know if some of the things you described are basic things HCAs should recognise and be able to do or if it's only 'good' HCAs who would be able to do those kinds of things. If they should be doing this and aren't, it's a training or work performance issue. If it's more that you wouldn't expect HCAs to be able to do that, then I would suggest those things fall under the kind of 'nurse work' category I was talking about in my earlier posts.
As I've said a few times, I'm glad there are nurses like people on this thread who do not feel they are above basic care. But with all due respect, your Chief Nurse DOES have to be aware of economical working - the NHS is skint. This is why she is Chief Nurse and part of nursing management rather than a staff nurse, and this kind of strategic planning with a limited budget is part of her job. It won't be popular, but when are service management decisions ever popular with clinicians, really?
Original post by PaediatricStN
I direct the ignorant posters among this thread to the Francis Report, where failings in the most basic care have the most horrendous of outcomes. It has taken the NHS a significant amount of time to recover from this report and we are still learning from it.
I direct the ignorant posters among this thread to the Francis Report, where failings in the most basic care have the most horrendous of outcomes. It has taken the NHS a significant amount of time to recover from this report and we are still learning from it.
I'm not sure if this is directed at me, as I have posted most aside from yourself and ButterflyRN - if it is, and you feel my views are ignorant, I wonder why you have repped one of my posts. Further, I'm not sure why you seem to have assumed other posters are not familiar with the Francis Report. I have had to study this in great detail and it doesn't change the fact that I can understand why the CN at Butterfly's Trust wants to plan HCA/RN workload in this way
Original post by infairverona
It won't be popular, but when are service management decisions ever popular with clinicians, really?
I appreciate what you are saying, but can't help feel that this attitude and accepting your statement as a given fact of life is why staff morale in the NHS is down the proverbial poo hole. Management assume all their decisions will be unpopular no matter what, and are under so much pressure to make endless savings, that things like quality and bringing staff on board (which potentially could actually lead to even more efficiency by engaging staff on the ground) are just dead in the water.
It makes for a rubbish work place and a management miles divorced from their staff.
(edited 7 years ago)
Original post by seaholme
I appreciate what you are saying, but can't help feel that this attitude and accepting your statement as a given fact of life is why staff morale in the NHS is down the proverbial poo hole.
I don't work in service management, but I have been involved in many HR complaints made as a result of service management. I think there is always going to be a stark divide between what makes a good staff clinician and what makes a good service manager. In an ideal world, there would be a good crossover and service management decisions would come out of good practice, but with the NHS in the state it is in right now and with all the limited resources I don't think any strategic management is going to be popular with staff. Staff quite rightly want to be able to work in conditions that allow them to do their job well and fully, and we don't seem to have the capacity for that anywhere now. Service managers have to try and manage this economically and effectively which is not going to always mean 'best practice' unfortunately. I don't agree with it and I certainly wouldn't want to do it - having been offered an ASM post and turned it down - but I think it's a pretty accurate description of what is going on in the NHS and until the government decides to give us the funds we need I can't see that changing any time soon
[e] Definitely agree with your last added sentence. My old Trust had a staff turnover of 60% per year (as in, over half the staff left a year and had to be replaced) and we always had nursing posts out for 6 ish months because we couldn't recruit to them. It's not easy by any means. I just also empathise with those making these hard management decisions because a lot of the time (in my experience) they don't PERSONALLY agree with what they have to do either, but at the end of the day it's their job. Most know full well what they have to implement is not going to go down well with their staff but they're stuck between a rock and a hard place - rock being the staff moaning because they don't like the changes, the hard place being pressure from senior management, targets, etc
(edited 7 years ago)
Original post by ButterflyRN
That's nice.
But if there are not enough RNs then something has to go. What are you suggesting as an alternative?
Original post by infairverona
Isn't this exactly why there are calls to create a band 4 'associate practitioner' post between a band 3 HCA and a band 5 RN to help bridge that gap?
In relation to your reply to me above: I don't know how far your responsibility stretches with regards to your management of the HCAs but if you are having issues where they are not picking up things they should be picking up etc that needs to be identified as a management issue, a training issue, or potentially a poor work performance issue. I'm not clinical so I don't know all the ins and outs of the exact division between an HCA and a RN, so I don't know if some of the things you described are basic things HCAs should recognise and be able to do or if it's only 'good' HCAs who would be able to do those kinds of things. If they should be doing this and aren't, it's a training or work performance issue. If it's more that you wouldn't expect HCAs to be able to do that, then I would suggest those things fall under the kind of 'nurse work' category I was talking about in my earlier posts.
As I've said a few times, I'm glad there are nurses like people on this thread who do not feel they are above basic care. But with all due respect, your Chief Nurse DOES have to be aware of economical working - the NHS is skint. This is why she is Chief Nurse and part of nursing management rather than a staff nurse, and this kind of strategic planning with a limited budget is part of her job. It won't be popular, but when are service management decisions ever popular with clinicians, really?
I'm not sure if this is directed at me, as I have posted most aside from yourself and ButterflyRN - if it is, and you feel my views are ignorant, I wonder why you have repped one of my posts. Further, I'm not sure why you seem to have assumed other posters are not familiar with the Francis Report. I have had to study this in great detail and it doesn't change the fact that I can understand why the CN at Butterfly's Trust wants to plan HCA/RN workload in this way
In relation to your reply to me above: I don't know how far your responsibility stretches with regards to your management of the HCAs but if you are having issues where they are not picking up things they should be picking up etc that needs to be identified as a management issue, a training issue, or potentially a poor work performance issue. I'm not clinical so I don't know all the ins and outs of the exact division between an HCA and a RN, so I don't know if some of the things you described are basic things HCAs should recognise and be able to do or if it's only 'good' HCAs who would be able to do those kinds of things. If they should be doing this and aren't, it's a training or work performance issue. If it's more that you wouldn't expect HCAs to be able to do that, then I would suggest those things fall under the kind of 'nurse work' category I was talking about in my earlier posts.
As I've said a few times, I'm glad there are nurses like people on this thread who do not feel they are above basic care. But with all due respect, your Chief Nurse DOES have to be aware of economical working - the NHS is skint. This is why she is Chief Nurse and part of nursing management rather than a staff nurse, and this kind of strategic planning with a limited budget is part of her job. It won't be popular, but when are service management decisions ever popular with clinicians, really?
I'm not sure if this is directed at me, as I have posted most aside from yourself and ButterflyRN - if it is, and you feel my views are ignorant, I wonder why you have repped one of my posts. Further, I'm not sure why you seem to have assumed other posters are not familiar with the Francis Report. I have had to study this in great detail and it doesn't change the fact that I can understand why the CN at Butterfly's Trust wants to plan HCA/RN workload in this way
The Band 4 role already exists, in the form of Associate Practitioners. In paeds we call them "Nursery Nurses", but the role is similar. We do need more APs. We've gone off on a real tangent in this discussion.
The reference to the Francis Report wasn't directed at you. I think we agree on the skill distribution between HCAs and RNs - that was why I repped the post. But that doesn't mean that a nurse's role is not to perform basic care.
The question was, effectively, should HCAs be the only ones (primarily responsible for) doing basic nursing care? The answer is a straight no. The second point in the NMC Code says to "Make sure you deliver the fundamentals of care effectively". This makes it plain and simple that a nurse's role is to perform basic care. That should be the end of that discussion.
There's that term again "Economical working". In general it is a good business principle but in the context of the current NHS, I'm afraid it is so wrong. The NHS is not in a position to be looking at being economical. When a business looks at how "Economical" it is, the implication is that they've got too much to go around and need to streamline things. Reality for the NHS is that we're so economical, we've overstepped it. We're stretched to the limit. To get anywhere near the optimum economy level, we need more staff. More nurses, more HCAs, more doctors. Not less staff. Not further delegation of skills to junior staff so we can make savings.
Original post by nexttime
That's nice.
But if there are not enough RNs then something has to go. What are you suggesting as an alternative?
But if there are not enough RNs then something has to go. What are you suggesting as an alternative?
I have to agree with this. I think too many Nurses or aspiring Nurses live in this world where the NHS has unlimited funds, and can happily pay nurses 25k a year to attend to the basic hygiene of patients, when a HCA can do it just as effectively and they're on far less money.
Its almost as if some Nurses don't respect the care assistants as being a fundamental part of the team and capable enough to communicate any potential issues to a Nurse.
Nurses get paid better money and require a 3 year degree because they have extra responsibilities, so its inevitable that the tasks that staff on less money can do should be doing them. I really don't understand the issue.
These Nurses who complain about management suggesting ways of lessening the workload so we can concentrate on things like IVs, meds, paperwork which the HCA cannot do. Will be the same Nurses complaining about understaffing and not having enough time to do this and that.
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