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Neglect of older people: are nurses to blame?

Marilyn Eveleigh
Consultant Editor

The recent report on the care of older people from the health ombudsman outlined some shocking cases of mistreatment and neglect. Are nurses to blame? Or is the problem a result of more serious failings within the NHS?

This month I have had some scary mood swings. I've been angry and cried, I've been proud and ashamed at the same time, I've been shocked, saddened and irritable. Hormones, difficult teenagers or health service challenges you might think? No, not this time. The catalyst was my nursing colleagues whose care was described in the report of the health service ombudsman into NHS care of older people.1
I would be surprised if any reader was not aware of this report. On the day of release, synopses of the report were all over the media with in-depth interviews, commentary and opinions of how nursing standards have dropped - and strong implications that older patients are at risk under NHS care.

It was compiled by the Ombudsman, Ann Abraham, from 9,000 complaints received in 2009-10. She outlined 10 cases to illustrate that these were not isolated and that she had concerns about the recurring theme she was witnessing - a lack of basic humanity in the NHS. The culprit was nursing as nurses were the main carers, though two cases were about GP care.

This latest report makes difficult reading. I wondered how the stories were possible in this age and country - and wept. Patients unable to reach their food or unable to feed themselves, who had lost weight and/or become malnourished. Patients who had become dehydrated and confused because they had insufficient fluid intake. Pain relief being denied or delayed felt shocking and cruel. The burden and responsibilities on families to bring the plight of their loved one to the attention of nursing staff was hard and chilling.

Worst of all, it happened the under the care of the NHS to whom they had been referred. A deterioration in their condition as a consequence of poor standards of care was beyond belief. I was angry and saddened, recalling how reasonable and intelligent families have felt helpless against a system that did not hear them and made them feel others needs were more important. Shambolic discharge arrangement with thoughtless actions and poor communication with the patient and their carers made my blood boil.

Yet it did happen, and more stories have emerged to indicate there is a lack of compassion in our healthcare system. Nursing at the forefront of healthcare, expectations that nursing will advocate for patients and nursing as the constant in the patient's pathway means the finger of blame points at nurses. And it tarnishes all nurses. Reading that nurses are cross, dismissive and rude, and appear to resent being asked for painkillers, food and basic comforts, or stand around chatting makes me ashamed and frustrated at nurses that allow this to happen on their watch.

The immediate response from the Royal College of Nursing (RCN) on BBC Breakfast was that nurse training should be reviewed. Some elements in the press have picked up that the more educated nurses are, the lower their standards of care. 'In the old days' came out quite a bit - illustrating that all nurses rolled their sleeves up and got on with all the filthy challenging jobs they were faced with. The Daily Telegraph reported that a 'young nurse' apparently indicated that we "facilitate the patient through their illness and to say we 'look after them' was belittling". Headline-grabbing? But such stories are what the public reads.

I doubt any nurse thinks training is the problem. No one trains in isolation and a role model is powerful in moulding professionals - and people. As nurses and human beings, we are not less compassionate, less caring or less intelligent. We still believe in the principles of fairness, respect, dignity, equality and autonomy as outlined in the NHS constitution. Rightly, patients have been encouraged to expect more and better care that is evidenced based, safe and of high quality. That requires sufficient workforce to deliver it.

At the February Nursing in Practice Event in Belfast, the vast majority of the 300 nurses present felt poor staffing levels are to blame for falling nursing standards. Low morale, poor pay, bad management, lack of nurse leadership and training hardly factored in their reasoning. It is impossible to be attentive to all the clinical needs and comfort of totally dependent people when there are unfilled vacancies and the concomitant stress and workload this brings. A recent RCN online survey of 1,900 nurses, 80% said there were not enough staff to deliver safe patient care. Though the ombudsman believes extra resources are not the key, nurse leaders must review workforce capacity where stress has an impact on attitude.

I suggest all nurses review the dynamics and capability of their team, challenge rude, dismissive and uncaring attitudes in others, and put themselves in the place of the patient and carer. Sick, vulnerable, frightened, confused, in pain, with little energy, dignity or control - these are frailties that nursing recognises and should make good. This report is a reminder of the potential of nursing. Let it not be wasted.

Parliamentary and Health Service Ombudsman. Care and Compassion? London: TSO; 2010.

Your comments (terms and conditions apply):

"My daughter is just at the end of her degree in mental health training (for elderly). She had loads of practice before on wards etc before qualifying with this round the block experience and training; she is ready and willing to challenge bad practice - good luck to her" - Anona Bradbury, UK

"It was the nursing staff that me and my family had difficulties with when my mother was in hospital last year.  The lack of knowledge about underlying conditions relating to my mother was frightening and when a patient took my mother, a vulnerable patient, to the toilet having asked nursing staff to
help without getting any is unforgiveable. The nursing staff are there to nurse patients and to make sure that basic needs are met. They also had to be reminded that my mother required regular pain relief but by not being allowed to stay with her it was hit and miss she got the medication at the correct time.  When the nursing staff were confronted by our worries they were just ignored or dismissed rudely. I'm not saying that
all staff are the same as there are a lot of caring nurses out there and the idea of tackling the issues raised in the report by team members needs to start immediately and if the team members are not satisfied with the culprits then formal reporting should take place. Care of the elderly is an important part of the surgical and clinical side of any nursing considering we live in a world of an aging population" - Yvonne Gregory, Stockport

"Yes, I agree with the author about nurses challenging poor attitudes in their teams. But this requires leaders of those teams to be capable and prepared to tackle poor standards.  This was the message given by nurses in evidence submitted to the Prime Ministers' Commission on the Future of Nursing and Midwifery in England. Published just a year ago the
Commission's recommendations, if acted upon, would go a long way towards raising standards of care for patients" - Catherine Gleeson