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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 25.06.07 - Nursing Standards PRESENTER: WINIFRED ROBINSON |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Now from Florence Nightingale through to the TV series Angels nurses tend to be regarded as the heroes of the wards; caring, considerate, willing to go that extra mile for sometimes scant material reward. But is the tide of public approval waning? The Patient's Association certainly thinks so, though the evidence from its calls to the helpline is largely anecdotal. Figures though, due to be published by the Nursing and Midwifery Council and revealed to You and Yours, show the number of complaints against nurses is up from 1,378 in 2005 to 2006 to 1,624 in 2006 to '07, that's a rise of just under 20%. This is what Katherine Murphy of the Patient's Association has to say. MURPHY Over the last six to nine months there has been a substantial increase in the amount of complaints that we have received around nursing duties, duties that should have been carried out by a nurse but the nurses refused. The most common complaint is about assisting patients with basic tasks; patients who are recovering from operations who need a little bit of assistance to get out of bed, to get dressed or maybe just to hand them their water or their food, nurses haven't got the time to do it. ROBINSON Katherine Murphy from the Patient's Association. Sarah Thewlis, is the Chief Executive of the Nursing and Midwifery Council, that's the regulatory body, and I asked her how worried she is about their increasing complaints that they have received. THREWLIS I think one of the things I'd want to say Winifred is to put this in context is this number of complaints that you're talking about is a very, very small percentage of the total register. We're actually talking about .3%, so that's a very, very small number of complaints. However, having said that, one of the things we do need to do is obviously our responsibility is to make sure that anybody on our register is capable of safe and effective care. So what we need to do is to make sure that people that come on to our register are able to deal with the difficult situations that nurses have to deal with. ROBINSON Do you think it's a trend or do you think it's just a blip? THREWLIS I think it's a blip. It's partly to do with as a regulatory body we were actually given more powers to deal with concerns that people had about nursing and I think it's also to do with, quite rightly so, patients are demanding high standards of care. ROBINSON Well your figures and their increase in complaints, whatever that means, perhaps it means nothing, perhaps as you believe it's simply a blip, it comes at the same time as two academics have written a paper called The Demise of Nursing and this has certainly caused waves in the profession. The paper was published in the Journal of the Royal Society of Medicine and it suggested that nursing standards have declined because nurses are routinely now handing over important nursing tasks to untrained people and it even suggests that patients, on occasion, are dying as a result of this. Earlier I was speaking to Peter Carter, the General Secretary of the Royal College of Nursing, and first though to Professor Linda Shields from Hull University who co-wrote the paper. SHIELDS Nurses, traditionally, are the ones who give all - what is commonly called the basic care, although there's a lot more than basic care. And a lot of this care is being given to the healthcare assistants who receive only the most basic of education. So that's things like carrying bedpans, doing washes, feeding people, looking after bed sores. This has always been such an important part of the nursing role and in countries where all nursing education has gone to degree level this sort of care is still very much an inherent part of what nurses are taught and certainly that is the case in the UK as well. The important part of this is that they give that so-called basic care but at the same time while they're doing that the nurses are doing things like communicating with the patient, assessing what is happening to them, where they are, how the illness is affecting their lives, they're looking for things like healthy skin; making sure there aren't bed sores forming, they're looking to see that they're feeding properly, that they're getting enough food, that they can swallow properly. All these many important things that are part of the nursing role, which remain hidden because people don't realise that this is what nurses do. Healthcare assistants are not trained and not educated to do those very complex parts of what is called the basic care. ROBINSON Peter Carter, from the Royal College of Nursing, are you concerned, are these roles that nurses should be trying to claw back? CARTER I don't disagree with many of the things that Linda has said. Nurses at this time in the NHS are under greater pressure now than they've ever been. We've had nearly two years of service cuts, a deficit crisis and so much of the impact of those cuts are being felt at ward level and it's unsurprising at times when relatives and patients feel unhappy with what's going on and that's because there are too few nurses who are now being asked to do so much more. ROBINSON Professor Shields, in your article you also make the point that at the same time as nurses have allowed key parts of their work to be passed to people who are unskilled they have made, what you see, as the mistake of agreeing to do the less skilled work that used to go to doctors. Can you tell me about that? SHIELDS These extended nurse roles. Some of them are really important, some of them are really good for nursing. People like diabetes nurses, cystic fibrosis specialist nurses who can extend their roles - and they're just two examples - they've extended their roles, they can provide a very valuable service that provides really holistic care for the people they're caring for. Our concern is about the nurses who are, we would say, conned into thinking that some of the things they're being asked to do are glamorous, things like doing parts of surgical operations that the doctors don't really want to do. This isn't nursing, we're concerned that nurses are giving up what is essentially nursing to take on these roles that really aren't what nurses should be doing. Our concern is for the profession itself and how nursing will disappear unless some of these new roles are thought through very carefully. ROBINSON You want all nurses to be educated to degree level. SHIELDS Yes. ROBINSON Why? SHIELDS Well in this - these days of really highly technological healthcare the ethics surrounding the highly technological healthcare, very complex management patterns of healthcare services, different expectat - very high expectations of patients of that care, only with a degree education can you gain all that knowledge that you need plus the critical thinking ability to be able to review the evidence, decide what's best for your patients, implement that, evaluate what you've done. This is the sort of knowledge that can only be given at degree level. ROBINSON Peter Carter? CARTER Well we too think that degree level education is important but I just want to come back, if I could, on a number of things. First of all, the term nurse is a generic title and nursing is such a disparate profession and you do have everything from at one end of the spectrum, what I would call core care, and Linda alluded to this, it is absolutely essential that nurses understand the need to look at hydration, fluid intake, output, mobility, skin care, pressure sore prevention and so on and so forth, these are core nursing skills which should never be lost. However, there is the very welcome development from the RCN's point of view over the past few decades of the extended role of the nurse and Linda's mentioned cystic fibrosis, diabetes. ROBINSON But only 4% of nurses are educated to degree standard in England, should that change? CARTER It should change and we think that should change and change quite rapidly but we don't move away from our basic premise that nursing is there to care and nursing will cover a huge wide range of skills and we don't see it as a backward step that nurses are taking on these specialist roles. ROBINSON One of the problems is the funding. If you do a nursing diploma your grant is not means tested and it is double that offered to nurses who are - to students who are studying for a degree. Also the degree grants are means tested. And I think the funding mechanisms definitely militate against anyone who wants to study for a degree. The other problem is once the students have graduated a nurse with a degree gets no better job or no more pay than a graduate starting a new job with a diploma. CARTER Well we think that there should be a non-means tested bursary of at least £10,000 to make it far more attractive for people to take degree courses. What I would also like to just briefly comment upon is that we believe that nursing - people training to be nurses must always have a significant component of hands on care, rather than have something that's far too academic you need a balance of something which you end up with a degree but it's almost like an apprenticeship system ... ROBINSON Well doctors manage to do it perfectly well. CARTER Well no actually there are plenty of examples whereby in medicine and civil engineering where you have a balance between a good academic programme and practical hands on experience and one of the things that we're concerned about is if you have far too much of an academic based programme to nursing you miss out on the very things that Linda's been talking about which I would go back to - some people call it - basic nursing skills, I call it core nursing skills and it's important that we don't lose them. ROBINSON What would you say to those people who say that however we are training our nurses nursing is in crisis, as this article says? CARTER Well look nursing, as such, isn't in crisis, the NHS is in a crisis and it's in a funding crisis and the effect of that crisis is being felt on nursing. If you take something like the Leeds group of teaching hospitals, the biggest conglomeration of teaching hospitals in Western Europe, they've announced this year that they're not going to be able to employ a single student nurse. Now what kind of message does that give to youngsters who may be thinking of a career in nursing when they hear something like that, that there's very few career prospects? ROBINSON So you don't accept that if families are complaining about what they see as neglect of patients on wards by nurses that that is anything to do with the way nurses are trained, the way their training is funded, you think it's simply down to a shortage of funding in the NHS? CARTER No, let's be realistic. With a workforce of nursing nearly 700,000 people and no one - not the RCN or anyone - is going to say that at all times everyone of those individuals are paragons of virtue. Of course there will be times when nurses fail and they do not behave in the way that reflects the spirit and the tradition of nursing. And certainly as a trust chief executive sadly there were occasions when I had to dismiss nurses. But I still maintain my primary point that the vast majority of nurses in this country, in the United Kingdom, give high quality nursing care, often under very taxing and trying circumstances. And what we've got to try to be clear about is when there's been a failure is that failure because of the individual nurse or is it because that individual nurse is working in a system where he or she is not given the proper resources and support in order to do their job properly? ROBINSON Peter Carter, General Secretary of the Royal College of Nursing and Professor Linda Shields. Well Sarah Thewlis, who's Chief Executive of the Nursing and Midwifery Council, the regulatory body, is still here. Where do you stand then on the central point in that article that nurses have given away some of their core role to unskilled people and have been fobbed off by taking, I suppose, the crumbs from the doctors' table, the jobs the doctors didn't want to do? THEWLIS We've got a very clear view on that and that is first of all nurses haven't given away some of the basic core tasks that people were talking about. ROBINSON Yeah but sometimes if you're in hospital and you call the nurse to do something - clean the floor or change a pad - they will call somebody else to do it. THEWLIS They may well do but if in that time when they're actually, what we call, delegating that task they need to be very clear that the person they've delegated it to is able to do it. And I think when you talk about things like basic washing and all the issues to do with that. ROBINSON Well they may be able to do it mechanically able to do it but are they able to do it in the way the nurse would do it? One of the points in the article is that when you change a pad you're also checking for bed sores and that in giving up that role nurses have given up a key - core - nursing task? THEWLIS A good nurse will actually ensure that she will do some of that herself and obviously she will delegate sometimes to somebody like a care assistant. So I think it is important to say that. At the other end of it to say whether or not they've taken up the crumbs from the doctor's table, I think that completely underestimates the fact that actually in fact nursing is a different profession from doctors and what you have got is nurses who are expanding their role but within that what they're bringing with them are the essential skills of nursing. ROBINSON But you do see nurses doing things nowadays don't you - putting in the things they call cannulas - the needles into the vein - putting up drips, they used to be the doctor's job. THEWLIS They did, but in many ways I think that's an example of how healthcare practice gets spread and there's different people doing different things. The important thing - anybody on our register if they're doing a task they need to make sure that they're competent to do it, if they delegate it to anybody they also need to make sure they're competent to do it. ROBINSON What about the other point in the article that more nurses, well in fact all nurses according to Professor Linda Shields, ought to be trained to degree standard? THEWLIS That's a debate where the Nursing and Midwifery Council's a regulatory body, we will obviously go out to consult on that later on this year. ROBINSON Because it's already happening in Scotland and Wales? THEWLIS That is indeed correct. What I think we will come back is a view that it needs to be a balance but obviously you've got those core caring skills which need to - every nurses needs to be able to do. But at the same time you've got to have, as Linda was talking about, nurses that are able to do some of the more analytical work that comes through. ROBINSON As well rather than instead? THEWLIS Correct. ROBINSON Now The Demise of Nursing, that was the title of the article, has, as I said, caused quite a stir in the nursing world, you're suggesting though that you don't believe there's a big cause for concern. THEWLIS No I don't because if you look at the numbers of people that are actually coming on to our register if you look at the sort of extended roles that nurses are doing I think nursing offers a very varied and full profession for a whole range of people. And at the bottom our responsibility is about patient safety and we think nurses do that very well. ROBINSON Sarah Thewlis, Chief Executive of the Nursing and Midwifery Council, the regulatory body for nursing. Do let us know what you think about the changing role of nurses. Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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