Month: February 2014

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Young Nurse Tending to Young Woman with Neck Brace and Arm Cast

 

“Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths”

This is not the only study to suggest this. Not only is the nurse to patient ratio an important factor in reducing patient mortality after surgery, their education they have is also a factor. Degree nurses have a positive impact on reducing mortality after surgery. This should finally nail the ‘you don’t need a degree to nurse’ nonsense. This is an argument that nurses have used when decrying poor standards of care.

 

Government, Society, Hospital Management and even nurses themselves need to realise their true worth as educated professionals. Care costs money, and if you scrimp on that and put pressure on staff, then you get worse mortality rates.

 

I often read comments by nurses that the problem with nursing today is education – ‘too posh to wash’ or ‘graduates lack compassion’ or ‘not enough clinical skills’ or a variant. This is nonsense and plays into the hands of those who want a cheaper workforce by increasing the care assistant to nurse ratio. If someone is too posh to wash or lacks clinical skills it is not because they are graduates. It is for other reasons, such as burn out, stress, lack of empathy or compassion per se. I’ve known many non graduate nurses who display lack of compassion, poor clinical skills and avoid washing patients. There was no ‘golden age’ of nursing when all you needed was ‘the right attitude’ and training by doctors.

Today, the evidence is stacking up – employ more RNs and get them educated!

Do you want to be nursed by someone who can take a blood pressure but can’t interpret it? No? Thought not. I once was told by a member of staff, after taking my blood pressure and being asked what it was, just a few hours after surgery,  “don’t ask me, I’m only a care assistant”.

On the same day that the Lancet study was published the Royal College of Nursing also published the result of a staff survey, now bearing mind the validity of self reported surveys, the findings do not sit well alongside the above study.

“Only 30 per cent of staff think there are enough staff to enable them to do their jobs properly and 82 per cent of nurses continue to work extra hours. 68 per cent of staff have attended work while not being well enough to perform their duties in the last three months alone.”

Another reading of that is the 70% of staff do think they have enough staff, but it is hard to spin the 82% reporting working extra hours. The issue regarding Mid Staffs reported in the media 26th February,  also highlighted the financial difficulties many Trusts are facing and following the Nicholson challenge, continue to do so. Although there are claims about the recruitment of more nurses into the NHS, the context is still one of pressure on the front line.

This directly affects nurse educators as we struggle to support mentors in practice to up the quality of students’ support and assessment. Our Placement Development Team colleagues who have the overview, can tell us both the hard data and soft metrics of the truth of clinical practice support – the areas where students can shine and feel supported and where they don’t.

We therefore still have a political battle to get results from studies such as this taken seriously by decision makers and key stakeholders. Evidence based policy on many health, social care, climate change, drugs and other issues is sadly lacking, instead we get policy driven evidence driven through by one of the most partisan, ideologically focused governments even since Thatcher. This Lancet paper will be of interest to us, but I wait without too much hope that Hunt et al will sit up and take any notice.

 Jane Salvage recently wrote “Nurse and scholar Jane Robinson and sociologist Phil Strong suggested (that nurses were invisible) in their study of the management of nursing following the introduction of general management. They suddenly realized, they said, that ‘despite the impressive statistics… nursing is relatively unimportant to government and to managers in comparison with medicine.’ They went on, ‘The tensions to which this situation gave rise – the nursing group locked into the gravitational force of its internal preoccupations, and the others, on the outside, unable or unwilling to look in and comprehend the nature of nursing’s dilemmas – seemed to us to be the social equivalent of an astronomical Black Hole’ (Robinson 1992)” .

1992. I don’t think much has changed.

 

Sunshine and drinking

To combat the air of doom and gloom caused by the wettest winter on records, the UK government is  discussing a new law which will allow workers to go home early to enjoy the sunshine. The green paper, called “Temperate meteorology and the relaxation of labour – exploring linear relationships between productivity, well-being and hop or other grain based products ” seeks to establish guidance for employers, backed by legislation, that will allow calculations regarding the number of hours of clement weather (defined by the % of cloud cover, temperature and sun visibility) to drive decision making regarding recreational practices. Dr Harry Brubaker of the Institute of Studies has called this ” groundbreaking legislation that will facilitate the drinking of ale in south facing beer gardens and enhance the UK birth rate through the reckless abandonment of morals, judgement and underwear. This is to be welcomed”. Critics say it is a charter for hedonism and sodomy, and the Scots won’t like it as they never will reach the required meteorological thresholds that will trigger said imbibulous revelry. My nan says “f*ck the sweaties, lets get pissed when the sun shines”. Australians have been barred from commentary because a) they have too much sunshine already, b) its not their country and c) no one would listen anyway.

Do we want any more drink?

At the weekend two key commentators have at last suggested a link between the current flooding and climate change. Ed Miliband and Sir Nicholas Stern have both again raised this as a political imperative. How many times must we remind people that weather is not climate and that the science cannot prove links such as this. That should not let us off the hook and we should not listen to those with vested interests who deny the obvious. The climate is measurably changing, the earth is getting hotter, see Berners-Lee and Clark ‘The Burning Question‘ published in 2013 in which Bill McKibben is quoted. Bill uses three numbers to ram home the message:

2  – for two degrees, the limit beyond which we should fear to go.

565 – the number of gigatonnes left that we could pout into the atmosphere by 2050 and still have some hope of keeping the warming down.

2795 – the number of gigatonnes of carbon left in our fossil fuel reserves. If 565 is 1 six pack of beer, then 2795 is 6 x six packs just waiting to be cracked open.

We are being asked by climate scientists to limit our drinking to that 1 six pack.

The fossil fuel lobby is the guy on the sofa in his vest and pants watching the football, knowing he has another 6 x six packs of beer in the fridge.

We are running an experiment with the globe and the risk is high. In 2015 we have a moment for democracy, a fleeting passing moment to register our concerns and ask leaders to develop a framework to address the issue, which so far they have singularly failed to do.

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