Are modern nurses uncaring and slovenly?

Nursing has always been a trusted profession, strongly associated with caring. Doctors also register high in dependability, topping Ipsos Mori’s ‘most trusted’ poll once again this year (funnily enough, journalists languish at the bottom, only beaten by politicians in the least trustworthy stakes); however it is nurses who tend to be considered most empathetic, most approachable and most likely to see the human side of a patient’s condition.

Doctors might argue that nurses have time on their side thanks to their longer consultations, but nurses feel that ‘caring’ is integral to their profession which embraces an holistic ethos of patient care and is all about treating the person and not the illness.

Working for several years on Independent Nurse has shown me first-hand how closely nurses identify with their patients: it can be harder to ascertain nurses’ views on their own pay and conditions than their concerns about patients. When they do consider their own needs, it is often in relation to the potential impact on the people for whom they care. For example, the knock on effects of insufficient training or understaffing on essential services or opportunities to innovate.

However, criticisms of nursing have been gathering momentum: in yesterday’s Daily Mail, an article appeared entitled ‘Uncaring. Slovenly. Some of our nurses are a disgrace.’ Written by lecturer in nursing Lorraine Morgan, this outlines Ms Morgan’s outraged account of the treatment of her elderly aunt at the hands of hospital nurses, between 2005 -2006.

She describes the ‘neglectful care’ experienced by her aunt due to inattentive staff who ‘consistently failed to wash her for months, feed her or give her anything to drink’. Lack of fluids and nutrition left her aunt frailer, weaker and suffering kidney failure and she contracted cellulitis, followed by MRSA. She also fractured an arm falling out of bed (no protective cot sides having been attached to her bed) and her condition generally deteriorated.

On one occasion, Ms Morgan found her aunt dressed in a gown four sizes too big for her; this had fallen off her right shoulder, exposing her naked chest to the elderly man in the nextdoor bed.

This is not just a one-off case of Daily Mail hyperbole; earlier this year, nurses were branded ‘grubby, drunken and promiscuous’ by Tory peer Lord Mancroft, during a debate in the House of Lords.

He insisted that it was ‘a miracle’ he was still alive after his experience of filthy wards and ‘slipshod and lazy’ nurses, when admitted to the Royal United Hospital in Bath.

Lord Mancroft particularly objected to nurses talking over his bed, as if he wasn’t there, so that he knew ‘exactly what they had got up to the night before, how much they drank, and exactly what they were planning to do the next night.’

In light of such experiences, patient representative organisation, Patient Concern, has accused nurses of losing touch with the job by ignoring patients’ basic needs as they take on more responsibility in their specialist roles.

The perception is that reductions in ‘care’ are directly proportional to medical advances, with the focus now being on new drugs and treatments rather than on the quality of care and attention provided to patients; nurses are becoming increasingly trusted as experienced professionals, taking on advanced roles and prescribing from the full formulary, but less trusted by their patients, who value the human touch they used to receive.

Not all nurses should be tarred with this brush (criticisms are generally aimed at the younger, less experienced nurses working in hospitals, and at agency staff); nor are pressures on time, money or hospital beds the fault of the nursing profession.

However, mud sticks.

Let’s hope that this shift of image can be swiftly nipped in the bud. After all, much lip-service is paid by ministers to the concepts of ‘patient-centred care’ and ‘patient choice’ and most nurses generally are attentive and caring.

Helpful initiatives include the RCN’s recently launched campaign to ‘put dignity at the heart of health and social care’. This provides a complete package of resources created by nurses, for nurses, to help put dignity at the heart of everything they do.

As RCN chief executive and general secretary Dr Peter Carter makes clear: ‘Dignity should not be an after thought or an optional extra. Each and every patient – whether they are in a hospital, a GP’s surgery, in the community or in a care home – deserves to be treated with dignity and respect. Dignity should be integral to nursing care and this campaign is a big step in the right direction.’

  • Steve Hards

    I doubt that community nurses have this reputation, so what is it in the hospital culture that breeds such impressions?

    Leaving aside the ‘No Angels’ series on TV which, whilst highly entertaining, helped contribute to this impression, the real rot surely set in when hospitals became dominated by doctors rather than nurses. What I mean is that there was a point, probably a long time ago, when hospitals changed from being places where you went to be nursed (= nourished and cared for) to where you went to be cured.

  • rosie_lee

    The ethos of nursing had definitely changed. Some changes have been for the better, but some not.

    Nurses are now expected to be more academically minded, and this is fine if this is why you took up the profession, but for many, they are inundated by paper work, computing etc and this means less actual time spent with the patient.

    As for patient care, most of this is done by underpaid undervalued health care assistants, or other such assistants who do the feeding, bathing etc, while nurses are busy specialising and trying to compete with the medical profession.

    The caring profession is not very compassioante, and in extreme cases, we have seen them turn into killers.

    The constant need for more qualifications so you can advance up the pay scale is something which enables nurses to care less about patients, and more about the latest course.

    It is very sad indeed, but hey, that’s what change is all about. I am glad I am not nursing these days, because it would make me very unhappy to spend more time on paper work, than with patients

  • queenievenus

    There is nothing new about nurses being uncaring as in other walks of like there is a cross section of individuals with differing skills and characteristics.I have worked in the health service now too long and unfortunately it has always been the same, one person will take the patience to feed a difficult patient slowly whilst another will give up at the first sign problems. Young people today are far more self assured and find it harder to adhere to some rules especially some idiotic rules such as being unable to wear black tights with an pattern on, this to me is ridiculous. does this in any hurt or impede a patients health.To speak in a derisory manner about health care assistants is both unfair and guess what– uncaring . Nurses seem to be getting fatter including high ranking members of the RCN AND NMC, similar to the rest of the population,what a slovenly look ,there is also another strange phenomenon every photo or new clipping I see with nurses in, it including Peter Carter there is this irritating habit of laughing like Hyena, WHY ? Also the desire to dress up in pink like some clown in a circus I suppose they think its funny I think how the hell can the public take us seriously when we gad about in this attire with no insight into the impression we are having.We all are only caring with our work colleagues only as long as they turn up for work sadly out of site out of mind. We harden for survival we constantly make short term friendships never perhaps to see the same person twice. No psychological support for us just get on with the next task. .Many patients died in our care so it constant small losses no wonder we are as hard as nails at times .Although patients may be ill and indeed very ill for the short period in our care. they can and will leach enormous amounts of physical and emotion care out of us, given there is not enough staff on any one day to ever be ever be able to give proper care to any one of them especially on a general ward, time is valuable and must be allotted to a million things in one shift which is why many of our day staff are still on the wards hours after the should have left for home Does anyone care the most that will be said is some derisory remarks such as she or he can’t manage there time well,never any care once a person leaves the ward flor for some higher post with no patienet contact . Some relatives seem to have no insight into hospital life at all and can attempt to spend all visiting time discussing care, especially to exclude family from any responsibility. Why we dont encourage relative to come into hospital to wash and feed there family member this rule puzzles me we can’t feed them yet we don’t like the relative to help WHY?? There are some uncaring nires and health care assistants this has got to due to poor initiation training and poor standards must be addressed as in telling the person with no waffle what is acceptable and what is not.
    To see some poor old girl sit in a chair with only a gown no dressing gown not even a blanket around oon the legs is still seen getting patients up at 5am to sit in a chair to help the day staff is still in common practice even today not feeding not giving drinks Oh another stumbling block not wanting to give a cup of tea to a patient during the night is a complete no-noon nearly ever ward I have worked on this to me is a disgrace!!Still practiced up to 05/12/08.Having given justifiable criticism the majority of the young nurse work there socks off and I admire the professionalism I see amongst them .We need more nurses otherwise care will only continue to deteriorate.there is only so much a person can do in one day.

  • Alan Fisher

    We had the right idea many years ago – “one number for all” except that it was in the guise of 999 to access any emergency service. It worked well!. This does not mean that the same idea will work well again.

    The concept is sound but, as Dr Arasu has pointed out, add in commoner-garden members of the public and it all goes to pot. It has been increasingly obvious that people can no longer manage simple injuries or illness. I have experienced at first hand the young man who called an emergency ambulance for a cut finger – he demonstrated that the simple paper cut would not stop bleeding by squeezing the finger (twice) to make it bleed. Equally I have had the elderly lady that was quite rude when told that the Out-of Hours doctor was not the best person to help her husband who’s varicose vein had ruptured and was flooding the bathroom floor with blood. Even when I pointed out they did not carry dressings, were a 30 minute drive away and that I would arrange an emergency ambulance who would be there much quicker and with all the right equipment, she was not happy and hung up.

    How then can we expect these people to decide between urgent and emergency?

    Add to this the confusion of services that currently exist. A minor injury unit often turns patients away when they attend with a sore throat or cough “We don’t do illness so you need to see your GP. But you saw my child with a temeperature the other week. That was the weekend when we do the Out-of hours service as well as minor injuries, this is Tuesday so I’ve turned back into Minor injuries only mode”!!

    Admitedly patient are often trying to bypass the system because it is easier to walk in and get seen at a time that suits them than trying to get an appointment when they are due to get their hair done, or as I often hear, because they work away from home during the week.

    Expectations, priorities and demands on peoples time have all changed over the years. The NHS has to change along with them. The ideal situation would be to have the facility to have suitable quilaified and experienced staff triage a call and direct it to the appropriate call handler – take the descision making from the public. Many ambulance services already have a facility for streaming off calls to an adviser. This is essentialy what happens in an A&E department and has generally worked well for years.

    Perhaps on the back of this we need to reconfigure our A&Es into 3 sections – at triage the patient can be given an appointment to see a GP, streamed into a minor injury area or dealt with by the A&E side (many already have something like this). Equaly, MIUs and walk-in centres could have something similar. Problem is that they all need to be staffed appropriately – of course that costs money!

  • Anuradha Arasu

    so true. reconfiguring A and E makes a lot more sense than having these places in different buildings where disasters are bound to happen

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