ALT-2 The Challenges of Bureaucracy in the Nursing Profession
I joined the NHS in Britain in 1980 as a wide eyed eighteen year old student nurse, full of enthusiasm and expectation. Twenty nine years later, after years of bureaucratic reform and dwindling standards of care, I have now turned my back on the NHS and work in the private sector.
The rot began to set in during the early Thatcher years, where in a drive to modernize the NHS, we were subjected to a series of reforms meant to improve efficiency and cut back on waste.
Matrons were replaced by managers, many of whom had no nursing experience. Domestic cleaning and catering were privatized and put out to tender, meaning our wards are now dirty and hospital acquired infection is now rampant. Many of our patients suffer from malnutrition as ward orderlies place meals at the bottom of a patients bed and in many cases remove it untouched when it is uneaten. The feeding of frail and bedridden patients used to be the nurses responsibility.
I lost count of the times I had to inform a patient, already prepped for surgery, that their operation had been canceled. The theaters were full as emergencies had come in during the night and there was no theater space for them that day.
Patients waiting for admission were sometimes left waiting in the corridor for many hours until a bed became available.
Unfortunately, many senior nurses spend much of their time completing paperwork or inputting data into computers instead of using their valuable skills in teaching and supervising junior staff and in direct patient care.
I left the hospital environment where I worked as a sister on a surgical ward in 1987 as staff shortages and financial cutbacks made it increasingly difficult to deliver a safe standard of care. I then worked in the community, responsible for a case load of approximately one hundred and twenty patients.
Time and study motions carried out in an effort to increase our efficiency showed that we were only spending about thirty five per cent of our time on direct patient care, as the rest of our time was spent on traveling and form filling.
The good old days of a central store where we could pick up equipment needed to care for our patients at home and deliver it to them, usually within an hour, was replaced by a requisition form which needed to be signed by the line manager and the supplies manager before being sent to the transport manager. This means many patients can now expect to wait up to ten days for a commode or pressure relieving mattress.
I did some agency work at my local hospital recently, as I thought it was a good way to update my skills. Standards had further declined in the few years since I left. I was left alone as the only nurse on a gynecological ward all night and although there were only two new emergency admissions that night, I could only find one IV stand in the store room. This had to be shared between both beds. Although I made a joke about this with these two ladies, saying I hoped that neither of them needed to answer a call of nature at the same time, it was yet another indication of a failing system. I spent forty five minutes on the phone trying to locate a spare one from another ward before giving up to carry out more urgent tasks. Half of the patients on this ward had a hospital acquired infection.
This hospital has recently paid out one hundred and thirty three thousand pounds to a new chief executive who resigned after three weeks. This was a severance fee or golden handshake. This same lady instigated a scheme to charge all hospital staff daily car parking charges and will be remembered fondly no doubt by many. The two point four percent pay rise awarded to the nurses this financial year is to be phased in during the year as this trust is overspent and cannot meet its wage bill.
I used to wear my uniform with pride, knowing that I could deliver a good standard of care and I know that the NHS was once considered highly by the rest of the world. Sadly, due to bureaucratic reform this is no longer the case.
