I hope you had a good weekend.
I can guess, some of you won’t have had much of a weekend… especially if you were working. One day must seem much like another.
Twelve, sometimes fourteen hours, back-to-back. Short of staff and more often than not, no breaks
Dare I point out; a lorry driver can only drive a lorry for nine hours a day, with an obligatory 45 minutes break after 4.5 hours driving.
Nurses are tougher than lorry drivers… they have to be.
Airline pilots can only fly up to 8 hours per 24hr period and are required to rest a minimum of 16 hours post-flight. No more than 75hrs per month, flying.
Nurses work harder than airline pilots… they have to.
They fly through back-to-back shifts and many, to make up their money, will do an extra shift on the bank, or a care home. There’re no limits.
Tired lorry drivers cause accidents. Sleepy airline pilots kill people. Knackered nurses just soldier on.
Over the weekend, this appeared on Twitter, from a nurse;
‘… I came into a 1:32 patient ratio. One [patient] acutely unwell. One (the description is redacted) and 2 (again the description is redacted, for confidentiality purposes).
I paged the site manager, who replied “I know… and?” They tried to pressure the nightshift nurse to stay…’
Faced with a situation that is at best risky and at worse dangerous, what’s a nurse supposed to do?
I’ve read the NMC code of conduct. There are a lot of things it obliges nurses to do but precious little that is of any help. It’s all froth and no beer.
The best I can find is;
16.1 raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace… use the channels available to you, in line with our guidance and your local working practices.
That means contact the manager, who, in this case hasn’t got a clue what to do. The NMC do not keep patients safe.
Who is keeping patients safe? The NMC don’t. The nurse can’t. The manager can’t and the Trust can’t… we don’t have enough people.
If the nurse were a lorry driver, the load wouldn’t be delivered.
If the nurse were a pilot, the plane would stay on the tarmac.
Because the nurse is a nurse, they’ll keep going until they’re frazzled, make a mistake and someone is harmed. Then…
… someone will complain. The CQC will fandango. The roof will come-in. Management will blame the nurse. The Board will run for cover. NHSE will look the other way and we have Mid-Staff’s all over again.
As a simple member of the public, I’d like to think someone was looking out for me? Not the manager, not the Trusts, not the NMC, not the CQC. No one is… part from the nurse, doing their best.
In other parts of the world, nurse to patient ratios are a matter for the law.
The world authority in nurse-to-patient ratio research Professor Linda Aiken found;
‘… for every extra patient over four patients per nurse, in a general medical or surgical ward, there is a direct impact on a patient’s recovery, the risk of serious complications and or death.’
Here, when ratios were raised, the management and nursing hierarchy obfuscated, fiddled and wrote complex reports about the right nurse in the right place. NICE ducked the question;
‘…The guidance states: “There is no single nursing staff-to-patient ratio that can be applied across the wide range of wards to safely or adequately meet the nursing care needs of patients.”
But, they advise…
… a “red-flag” indicator, 1:8 is recognised as a level that may pose increased risk of harm to patients.’
This, is rubbish.
It was written in 2014, when it was widely known, HMG didn’t want to pay to train enough nurses. ‘Ring the duty manager and wave a red flag’… we know what they’ll say.
The NHS is not safe in their hands and the NHS has more red-flags than the Kremlin.
The answer?
Give every nurse a credit-card-style bar-code. Let them swipe on and off duty. Collect the data and publish it live, for every ward, in every hospital, every shift and plonk a dashboard on No21’s desk.
Would it create more nurses?
No… but the public would see what’s going on. We’d see variation, learn from the best, understand retention, ensure we have exit interviews, see the full picture and make meaningful plans. And, it would create…
… transparency, the most important word in the lexicon of safety.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
