Tuesday, 25 January 2011

Had a Blast on the Surgical Ward. part 2

I just remembered one of the best things I experienced during my little shift on the short stay surgical ward.

His name was Sam.

No no no stop thinking like that.  Nurse Anne is a happily married woman.

Sam is an utterly fabulous health care assistant.  By the end of the day I called him Saint Sam.  Nurse Anne is a bit rusty with Surgical Nursing but I couldn't have failed with Sam on my team.

He was good with the patients.  He could do observations, blood sugars and he cared enough to let me know of any problems he felt were arising with a patient.  He even brought people back from theatre.

A good HCA is worth their weight in gold.  They may not be able to help with drugs and all that kind of stuff.  If I am the only Nurse on a medical ward for the shift I may have over 80 IV drugs to give.  That takes hours.  And Nurse's make drug errors and cannot get to their patients when they have that many IV's to do.  So even if I had a hundred Sam's working with me in a situation like that I would still be struggling and short staffed.

But if I  knew that Sam was keeping a careful, knowledgeable and watchful eye on my patients whilst I was tied up with Nursing stuff it would make me feel a whole lot better.  I wish we had people like Sam on our medical wards.  It would be a real help to know at least there was someone reliable to look at my patients whilst I was preparing over 80 IV meds and getting dragged on doctor's rounds and to the phone.  But we do not get Sam types on the medical wards.  We used to have Sam type HCA's but as they quit and retired they were not replaced.  And we got the kids instead. Sucks.  We have a couple excellent HCA's left in medicine but the rest of the care assistants are all kids/cadets/apprentices/auxillaries with serious knowledge and common sense deficits and a whole lot of attitude.

I asked Sam why he doesn't do his Nurse training.  He gave me a wry smile and laughed out loud.  " I am happy as I am.  From  my vantage point Nursing looks like a nightmare.   I used to work on a medical ward as an HCA and I know how the qualified nurses suffer.  As an HCA I don't have to fuck about with drugs, assessments, orders, doctors or take any responsibility.  And on the surgical wards things run more smoothly than on a medical ward. I just enjoy interacting with the patients and helping them out.  And it is great.  Why would I want to give up a job I love ?"

Our medical wards need to have good RN's and health care assistants.  I think the ideal ratio is 80% RN's to 20% health care assistants in the composition of ward staff.

But the current ratios we are working with are something like 30% of staff are RN's and 70% are cadets/kids/apprentices/axilliaries.  

The hospital lies and tells people that on any given shift their medical wards are staffed with 65% Nurses and 35% care assistants.  This is a lie. 

Anyway I tried to get Sam to beg for a transfer to my ward and he nearly fainted because he laughed so hard.

Forest Gump GPs and hospital Consultants all across the land are telling anyone who will listen that the problem is "degree nurses who don't want to work on the wards".  Bullshit.  Managers are turning away both older trained and newly qualified Nurses when they apply for jobs as bedside Nurses on the wards.  They would rather hire kids.  Cheapo cheapo productions.


Nursing Student said...

Great post. I know plenty of people like sam in my old trust, numbers were dwindling but I would hope once upon a time I was a "sam" myself but who really knows. Looking back now I wish I did what most HCA's do when they feel a need for change and moved elsewhere like when things in A&E got bad, because I enjoyed being a HCA. But I went to Nursing instead. But I woulden't have been able to keep up with it forever anyway... the pay is not brilliant and at 21 the outgoings were mounting... car, bills, rent, hospital parking permits, needy ex-boyfriends etc...

They haven't brought in cadets yet in my old trust or the one I work in now as a Student. The one I work in as a student prefer to just churn out mostly foreign HCA's from the bank who know very little english, or students doing bank HCA work, and hope for the best. They have no practical skills if they haven't done work like this before and they send them on two "supernumery shifts" as a bump before they do the real work, except they aren't really supernumery and they don't know really what work they are meant to do!

I took pity on this poor cow of a medical student who rocked up to my old stroke ward where I was a student one shift. She was doing HCA bank work part time and wound up spending her first "supernumery" shift with us. She was petrified and only just starting out in med school so didn't have any experience yet in a hospital environment. It was her luck that we had enough staff that day since all 3 of us students were on the same shift, that when it calmed down on the ward I was able to spend the rest of the evening shift showing her just about everything she needed to know. Obs charts, care plans, the computer system, then obs, blood sugar and even how to do a bed properly! She was eternally grateful and even sent me a card after, but I coulden't have done that every shift, she was very lucky. Nobody could do that with her usually, thats why HCA's suck so much these days. At least I had helped the cause by letting one back out into the wild with at least some knowledge.

Perhaps better regulating HCA's is the way forward, it is esentially our PINS (well, when I graduate) they work under. I don't know though. If there was regulation of HCA's then they would have to be trained properly, and that is another cost to the NHS. Who knows what the solution is at this point? Restaffing the wards again with RN's isn't going to happen in the next few years though thats for sure.

Nurse Anne said...

OMG Nursing student that is exactly what we were saying the other day. The shifts are so busy and short staffed that there is no one to show these new, untrained, and inexperienced kids the ropes.

Sue said...

our HCA training is actually sounding good. We spent 3 days learning to take and record obs, make beds, do a bed bath. Then we were let loose with on going training. I still remember my first, petrifying day on the ward.

I hope I am a "Sam". We don't have cadets, but there is talk of having "senior" HCA at band 3/4 and juniors at band 1 or 2, so I fear its coming.

Nursing Student said...

Yeah, there really is nobody to train these new HCA's to do the job. But then it's like, why should the wards do it anyway? They are already overwhelmed, it is the responsibility of the hospital to ensure that HCA's are fit for purpose. But they're not, because the training courses are being scrapped and they're just being thrown out there. It's futile.

Sue, I'm glad your HCA's are not so bad and you get the training. I have heared of the Senior HCA roles, it usually comes with being a fixed HCA on a ward for X amount of time and doing extra stuff like NVQ/Bloods etc. I imagine by giving a number of HCA's in the hospital a little pay rise, it will pave way for juniors at band 1 & 2 to surge in, another NHS cut in disguise.

Dino-nurse said...

I remember being a student nurse (back in the dark ages) and spending my first few ward shifts shadowing the excellent auxillary nurses (HCA of the day) to start to get to grips with basic care. Of course wards then had 6-8 trained (RN and EN) plus several HCAs and students. Seemed to work pretty well. Where did it all go wrong????

Nurse Anne said...

I remember when I first started in the NHS over a decade ago. We had 5 Trained Nurses on for a shift along with 4 experienced care assistants.

Now it is two trained Nurses and two brand new cadets their first day on the job and that is the grand total of your staffing for the shift much of the time.

uknurse said...


Interesting article on Staffords RN / HCA numbers. Speaks for itself really.

Sue Marsh said...

Funny, I had an amazing "Sam" on my surgical ward too. I remember his first week a few years ago. Wow has he come on!!

He sounds just like your Sam. Tonight's toast therefore, to the great HCAs !(Sams or otherwise)

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