Sunday, 30 August 2009

Novices do nurses’ job after week’s training

HEALTHCARE assistants in the National Health Service with as little as one week’s training are performing technical nursing tasks on patients, including heart tests, blood checks and changing dripfeeding bags.

The service is also relying on unqualified nursing staff to carry out basic duties such as washing patients and taking them to the toilet.

Despite being responsible for such intimate treatment, the 150,000 healthcare assistants and nursing auxiliaries working in the NHS are not registered with any professional body.

The unregulated staff have been brought into hospitals partly to cut costs. However, criticism has also been levelled at ambitious nurses who perceive more menial tasks to be “beneath them”.
Peter Carter, general secretary of the Royal College of Nursing, said that supermarket shelf-stackers receive more instruction than healthcare assistants. Now he is demanding a substantial minimum training period, as well as the introduction of a code of conduct.

“Hospitals take well-meaning people off the street, give them a uniform and put them on a ward,” said Carter.

“Supermarkets give all of their staff training. They wouldn’t dream of taking someone on, not even someone stacking the shelves, by just saying ‘find your way around’.”

One healthcare assistant, who received only a week’s training before starting work at an Essex hospital, told The Sunday Times how unqualified nurses are being relied on to wash and feed patients.

They are also used to adjust the amount of food that patients receive through a nasal tube and can even be asked to carry out echocardiograms (ECGs), which test the function of the heart.

The whistleblower, who did not want to be named, said she often felt inadequately trained for the tasks she performs.

“You only get about a week’s training and that is to train you how to take blood pressure and to take blood sugar levels,” she said. “You are shown how to wash patients, how to manually handle the patients and how to use a hoist.

“There are things I come up against that I am very unsure of. I did not get trained in how to carry out ECGs.

“We are supposed to put the patients onto the ECG machine and get a [heart] tracing. The other day I was asked to do one and I wasn’t up to doing it because I haven’t been trained. I didn’t want to do it wrong.”

Last week the Patients Association published a report detailing the lack of basic nursing care received by NHS patients. It revealed how patients were often being left in soiled bedclothes, deprived of sufficient food and drink and having repeated falls.

Katherine Murphy, director of the association, said it had received calls from healthcare assistants and auxiliaries complaining that they are being left to carry out duties they are not qualified to perform.

“Healthcare assistants are being asked to do a lot of the work that trained nurses should be doing,” she said. “We had healthcare assistants phoning us up who were put on a high-dependency unit with no introduction to the technology and no understanding of what they were meant to do.”

Unison, the public services union, claims the training of healthcare assistants and nursing auxiliaries is “patchy”. Many opt to complete national vocational qualifications, but this is not obligatory.

The union is concerned that nurses and healthcare assistants do not have standard uniforms across the NHS, leading to confusion among patients about whether or not they are being cared for by a qualified professional. One nurse, writing on the Nursing Times website, said that even she has found it difficult to distinguish between qualified and unqualified nurses.

The nurse wrote: “I may be being cynical, but the reason why employers are going to resist this is so that they can continue to confuse patients and relatives about the true staffing levels on wards.

“Even though I am a nurse, when I have visited relatives in hospital I have found it extremely difficult to identify the qualified from the unqualified staff.”

The healthcare assistant who spoke to The Sunday Times said qualified nurses fill out paperwork while healthcare assistants wash and feed patients. She explained that on one occasion, when a qualified nurse had been assisting with the washing of patients, she was called away to sign paperwork by another nurse who said: “Washing isn’t your job, that is not part of your job description.”

Claire Rayner, president of the Patients Association and a former nurse and newspaper agony aunt, admitted that such views were widely held by nurses. “It is an appalling attitude to say it is not your job to wash patients. I am afraid this is spreading widely and I disapprove of it strongly. Unfortunately, today’s nurses think it is too menial,” Rayner said.

Frank Field, the former Labour welfare reform minister, said: “It is a terrible indictment if the most qualified nurses on the ward are filling in the paperwork and the least qualified are doing the nursing.

“Cleaning people is an essential nursing function. At the same time nurses are talking to the patients and finding out what the patients’ worries are.”

On his blog, Field recalls how he had resorted to feeding the patient in the bed next to his mother, who had had a stroke, because nurses had failed to help her. He wrote: “The woman was paralysed and unable to reach her food. It was regularly placed there at meal times and then simply taken away uneaten. The nurses commented how kind it was of me to feed the old lady.

“I didn’t have the courage to tell them that it was their job; and that they had stood in a group gossiping, watching what I was doing. I was fearful that they would take it out on my mother if I did so.”

Department of Health spokesperson said: "The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas. Since 2007 we have seen a rise of 8,563 more qualified nurses.

"Local NHS organisations need to plan and develop their workforce to deliver the right staff with the right skills to meet the needs of their local populations and ensure high quality care for patients."

Source : The Times

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