I believe that under such a system we would still have "team nursing". Team nursing sucks. It worked great back in the 70's but there is too much information to keep track of as well as disorganised chaos now all thanks to medicine advancing and higher costs
Team nursing came about during WW2. It is the system in which our older, traditional trained nurses are familiar. It works properly only when ward structure is meticulous and well organised. I happen to believe in primary nursing. This doesn't mean that I am not a team player however. I will drop everything to help a colleague who has a patient in trouble, or is in trouble herself.
Have you ever wondered why you have noticed loads of staff in nursing uniforms hanging about when you visit your mum in hospital...yet no one seems to have a clue about what is going on....no one can give you any answers..... none of the patients are recieving their drugs on time.......and the only person who does supposedly know what is happening (mum's RN) didn't realise that your mum just had a dangerously low blood pressure reading 10 minutes ago? Does any of this sound familiar?
This all happens because Registered Nurses are running between too many patients, with less qualified staff to assist them. It is a system that doesn't work. Some people are saying that we should bring back enrolled nurses to help the RN's. EN's are an improvement over HCA's but a cost cutting NHS will just use them incorrectly, as they do with the HCA's.
I don't want enrolled nurses ( EN's as they were known) around unless the hospital is going to add them in addition to safe registered nurse staffing ratios .
They won't do that, they will only use them instead of registered nurses. Before you accuse me of knocking EN's please read on.
People generally seem to think that degree educated registered nurses don't do much in the way of ward training and that we need to bring back ward trained nurses (EN's) to improve care. That is a motherload of crap. We need to do lots of things to improve care, but not that.
Where do I begin.
The degree students have to do nearly 3000 hours of ward time/placements to qualify. The degree students are working shifts on the ward all the time.
During the weeks and weeks of their placements they are working full time shifts on the ward.
They are supposed to be supernumery but they ARE NOT actually supernumerary.
They are thrown right in at the deep end, doing all kinds of basic care. Take it from someone who is currently practicing as a staff nurse and who works with students. This is indeed how it is in 2010......... current nursing students spend thousands upon thousands of hours mucking in on the ward.
The idea of bringing back traditional trained nurses (or EN's) as well as degree nurses is a good idea on paper but it is a total fail in reality.
The reason for this is that TEAM NURSING DOES NOT WORK anymore.
Team nursing is what you are actually pushing by arguing that they should bring back EN's. Team nursing is when you have an RN's, EN's and auxillaries all caring for a large group of patients. It doesn't work. It fails because the RN has to be on top of everything that is going on for 30 people and no matter how many EN's or care assistants she has, the RN is overwhelmed.
Team nursing means the right hand does not know what the left hand is doing.
What we need is for a degree trained RN doing everything and having a small enough patient load to do EVERY aspect of her patients care herself. This is cost effective and it is the only thing that works. Giver her a care assistant to be used only in case she runs intro trouble but my god, leave basic care to the RN's primarily.
I don't want an EN or an auxillary sharing my patient load because I want to do everything myself for all the patients. The majority of RN's I talk to agree. Primary nursing is the only way to stay completely on top of everything that is going on.
If you throw more patients at me along with EN's and care assistants instead of Registered Nurses then fuck up after fuck up after fuck up occurs.
Yes, nurses having more technology, drugs, and medical stuff to do these days. We do indeed and staff nurses get held responisble for any screw ups with these things.
But in order to do those high tech things well, I also need to be doing basic care myself. Otherwise I am not seeing the whole picture. And neither are the EN's or the care assistants. When there isn't anyone at all seeing the big picture, all hell breaks loose.
If I am delegating the basics to an EN or HCA then that means that I am probably the only RN on shift and I am overwhelmed doing drugs for the entire ward , doctor orders and rounds, relative enquiries, and fire fighting for all 30 beds. This is overwhelming even if I have 100 care assistants/EN's to help with the basics.
Just the sheer number of relative enquires either in person or by phone is overwhelming when you are an RN with only 10 patients. The questions these people ask are usually only answerable by the RN. If I have 10 patients I have 10 families on back and I can barely get any patient care done. I can barely ge away from their phone calls and interruotions long enough to actually see any of my patients. There are just so many interruptions. Constantly.
Under the plan to bring back EN's, the RN will be the lone RN carrying all the the things that the EN's and HCA's cannot do . She will be overwhelmed. Meanwhile the EN's and HCA's will be merrily making beds and gossiping without a care in the world. Whenever a relative makes an inquiry or a patient becomes acutely unwell, the EN' s and HCA's will just dump that onto the RN and happily go on their jolly way making beds. And the RN will be managing 5 critically ill patients that she cannot even get to because she has the relatives of her other 25 patients on her back.
I want 4 acute patients or 6 non acute patients maximum and I want a charge nurse without a patient load on shift to back me up and organise the ward . I want to do EVERYTHING, EVERY nursing intervention for my patients myself. Myself. I cannot do this with 30 patients no matter how many EN's or HCA's you throw my way. Even if I have hundreds of EN's and HCA's with me doing the basics I am still going to have too much information to process, too many interuptions and total cognitive overload.
A growing body of evidence is showing that a well educated RN doing everything for a small number of patients is the only safe, effective, and cost effective way of doing things. The WW2 ward structure planning is still in effect now, just with less qualified staff.
What I am trying to say is this: If you throw EN's and HCAs at me instead of Registered Nurses then I have to keep track of everything for the entire ward as the lone RN. No can do. Not these days. It is impossible.
And that is the case if I am sharing my 30 bed ward with 1 EN or 100 EN's in a single day.
What they are doing right now in hospitals is essentially team nursing.
What we have now is the hospital managers saying this: "It's okay to stick one RN with 20 patients because we are throwing care assistants at her. She can medicate, all 20 patients, keep track of information for 20 patients, get interrupted to take questions from the families of 20 people with nothing in place to control the number if interruptions she is getting etc as long as she has a few less qualified staff around to make her beds and wash her patients. Do you really think that it would be any different if they brought EN's back?
They would probably have one EN in charge of a 40 bed ward with no RN and a few care assistants to help. That is how NHS management does things, the cheap fuckers. Not only do they currently have a world war 2 era ward structure in place on the wards ...... but they have it with less qualified staff at a time when patients are sicker and the stakes are higher. Even in the last ten years, patient acuity and costs have SKYROCKETED. Nurses in 2010 are dealing with sicker patients and have to do more for them in a shorter amount of time, with less qualified staff. Fallen angels my ass. I actually think that nurses today are much nicer than their yesteryear counterparts. The older nurses just had better ratios, resources, back up, and smaller workloads.
And this kind world war two era mentality by managment and dinosaurs is why things are so shit. The idea of bringing back EN's is a good one on paper but not actually implementable because team nursing is outdated. Let's move away from it entirely. Staff the wards with RN's, and when RN's have safe ratios then you can add in the assistants to assist with care rather than taking over care when they are not qualified to do so.