Month: May 2013

The NHS needs Registered Nurses. Patients need Registered Nurses


First let’s deal with the title ‘Nurse’. In the UK it is illegal to call yourself a nurse if you are not on the register, Nurse is a legally protected title…this is a fact which gets lost in media talks about poor ‘nursing’.

Too much ‘nursing’ is in fact done by care assistants.

Too many student nurses are being supervised by care assistants.

Care assistants often are good people trying their best but they are not always supported, trained or supervised enough. They need to support nurses in their roles rather than replace them, which is in fact what is happening.

In ‘Skill mix and the effectiveness of nursing care’ Carr-Hill (1992) argued that ‘grade mix had an effect on the quality of care in so far as the quality of care was better the higher the grade (and skill) of the nurses who provided it’. In other words skilled nurses reduce poor quality care.

In the United States a Philadelphia hospital (2012) adopted an all RN care model, they eliminated the use of care assistants and patient outcomes improved and costs reduced.

This comes on the back of another 2006 in the US  study indicating that increasing the ratio of nursing by RNs reduces stay, adverse outcomes and patient deaths.

Finally as published on the a UK study suggests:

“There is a link between higher death rates and the number of healthcare assistants employed in NHS hospitals”.

A study by the University of Southampton found trusts with a higher number of unregulated HCAs also had a higher mortality rate.

A higher HCA-to-bed ratio increased the mortality rate up to a maximum of 5.4% more than would be expected, the new study found.

The study also identified a clear link between the number of registered nurses and mortality. It found there were fewer deaths the more nurses were employed. For every 10% increase in the number of registered nurses the odds of patients dying dropped by almost 7%.

Based on hospital admissions in 2010-11, the study found a 10% increase in the number of nurses would result in 2,600 fewer deaths.

Lead study author Professor Peter Griffiths told Nursing Times the findings on HCAs needed further investigation, but said: “It certainly calls into question a workforce strategy that moves registered nurses further away from the bedside and replaces them with assistants.

“This echoes some of the findings of the [Mid Staffordshire Public Inquiry] report, which expressed concern over the lack of regulation for this workforce.”

Professor Griffiths added: “The fewer registered nurses a hospital has, the more patients die. So the significance of nurse staffing levels seems to be well established both in the research and in the tradition of the profession.”

He added that, while the government appeared “dead set” against introducing mandatory staffing levels, “there is surely a level at which we can be clear it cannot be safe under any circumstances.”

He suggested a ratio of eight patients per nurse, saying in his study 60% of shifts were at this level or better.

“The findings taken as a whole point to the need for more qualified nurses at the bed side,” Professor Griffiths said. “It is hard to conclude from this evidence that the solution lies in downgrading the training of the nursing workforce as a whole and reducing the number of registered nurses.”

On Graduate nursing: ?

Reference Aiken et al (2003) Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA 290(12):1617-1623

June Girvin argues:  The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.

‘Nuff said.

Why do they hate us?

There are currently over 83 British citizens being detained in a foreign jail, without charge, without being convicted, so far for a period of between 12-18 months. The regime has also a larger detention centre where it has been holding many western citizens for years without trial, often in the face of international condemnation.The regime holding the men supports armed interventions in Western nations aimed at removing Western military bases from their locality and is developing nuclear weapons to “defend our way of life” from US and UK incursions onto their continent in the search for oil and precious rare earth elements. When challenged, the prison authorities state that what they are doing is legal under their military law. There is no trial date.

One young local man (of white British descent) in protest at this detention, assaulted and killed a local policeman. This incident was broadcast on the TV news. The perpetrator was described as ‘white/christian’ and as a result, in the first five days, 10 local churches were attacked culminating in a triple petrol bomb attack on one church. A nun had her cross ripped from her and was knocked unconcious, and a 75 year old churchgoer was stabbed to death. One local group referred to the churches as foreign to their culture, as infidels, and accused them of prosletyisng in an attempt to turn their country into a christian country “just like the British did when they built their empire”.

Local christian groups, largely made up of third generation expat Brits who have had a community there since the 1950’s after oil was dicovered nearby, have reported to MI5 that a few of their own younger, more angry men have been overheard planning ‘reprisals’.

Back in the UK it has been discovered that the English Defence League aided by the British National Party, have also been secretly planning bomb attacks in the town where the citizens are held “to send a message”. Following an investigation into internet communication and websites preaching anti muslim sentiments, it was found that local sympathisers in that country, who feel their Christian and their western freedoms are under threat, had also been planning car bomb attacks. There is no formal link between the EDL, the BNP and the locals – they merely share the same ideals.

None of this is true, I merely wish to understand why we hate. Imagine.

This is true: Camp Bastion is where Afghans are being detained without trial, Gitmo we all know about, for the policeman read Drummer Rigby. This week, mosques have been attacked in the UK, a muslim woman had her veil ripped from her, and a 75 yr old man has been stabbed in Birmingham.

The US led invasion of Iraq resulted in over 100,000 Iraqi civilian deaths.

It is claimed that US mega corporations such as Halliburton made $39.5 billion from the war.

The US has declared that the war on terror is a war without borders and also targets unarmed and unidentified people in foreign lands. If you are a friend of the US , and I am, this is disturbing.

Violence begets violence. We need empathy first, understanding second, then negotiation. Islamism and Wahaabism are not Islam, The Real IRA is not Catholicism, the UVF is not Protestantism, the EDL is not ‘English’. They are extremists which will be defeated only through empathic understanding and negotiation. All terror groups are defeated by undermining their sympathetic civilian support aided by good intelligence. Stooping to illegal detentions, breaking our own fought for rights and freedoms, fuels misunderstanding and hatred. Illigal detention is a recruiting sergeant, foreign occupation is a recruiting sergeant, petrol bombing mosques is a recruiting sergeant, stabbing off duty soldiers is a recruiting sergeant, setting off bombs on London buses is a recruiting sergeant. This is not about being right or wrong in your perceptions of others, it is about trying to understand what the others are saying. I am also not saying that freeing the detainees will now make it all better, that Islamist terrorism will stop. It is too late for that, but we had better start building empathic understanding in our communities or else we are doomed to repeat the mistakes of the past.

You may say I’m a dreamer, but I’m not the only one.

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