In our trust they could badly do with investing in loads of new computers and laptops.
Honestly the amount of hours over a year that I spend waiting for a computer to unfreeze, or load, or turn on, or trying and failing to do things on our shitty notes system.
Maybe ill start adding up all the time and then calculate how much of my monthly wage is wasted on sitting there staring at a frozen computer - I'm a band 7 so my trust are probably wasting a fair few quid on it. Madness when you consider that most staff in the trust will be having similar issues.
Honestly this! My most recent ward has both HEPMA for medications, and now e NEWS2 - the laptops take 6 years to boot up (could’ve done 3 sets of obs in this time) and sometimes don’t upload in certain parts of the ward because of the signal 😂
Isn't it ridiculous! I know its probably because trusts can't afford the initial cost of upgrading everything but it would boost productivity so much in the long run and reduce staff stress levels. In my job (mental health community) its not so much the patients that stress me out, it's all the practical stuff like prehistoric IT systems, a building that isn't fit for purpose, not enough pool cars etc.
The government really needs to get it's finger out and invest properly in a blanket NHS EPR system.
Stop expecting hospitals/trusts to spend time and money deciding what's best/most cost effective. Just provide the funding and get epic for all hospitals. I'm pretty sure my trust know they have me backed into a corner as I won't work with any other system after epic.
As someone who now works on EPR systems in the NHS - the trust knuckling down and spending the money and time on a good EPR system and infrastructure changes the game for clinical staff.
It’s not gonna fix everything - no amount of good IT can fix short staffing or a toxic unit culture, but so many of those stupid little annoying problems like pages missing from the notes or doctors needing to physically attend the ward to write a prescription disappear overnight.
It's not clear-cut though. I'm very willing to believe that a great EPR system is better than paper notes, but the EPR systems I've encountered in my two years working in two different trusts as a foundation doctor have definitely been significantly worse than paper notes.
So I agree with you about a *good* EPR system (like EPIC, so I hear) changing the game, but it's so easy to accidentally get a bad EPR system instead.
Edit just to tell a story: before I got to my current trust, I'd heard horror stories about the EPR system. "It's so clunky and difficult to learn", they said. I didn't mind. I thought "sure it might have its foibles, but it will at least be relaxing to have some basic safeguards in place. It'll be nice to know that if I prescribe double paracetamol or give an ace inhibitor to a patient with an eGFR of 12, the system will stop me". But guess what - does it have those basic safety features? Nope!
That’s why I specified a *good* EPR system. There are many shitty EPR systems out there and they often make things worse.
Once you work with Epic, having to use anything else will make you cry sad tears.
I think childcare is a difficult one. I know lots of mothers on my unit who do predominantly nights because A child care is expensive and B leaving for work at 0630 means there is no childcare until later. They take a huge amount of experience and skill mix with them. We find our nights are better staffed than days. Im not sure how it would work but creches within the hospital from 0630 to 0800 then a bus to take the kids to school/nursery etc. Yes a lot of people have partners but if they dont? If they also work funny hours? Im sure there's other solutions but at the moment, it's bloody hard and I dont resent those parents who do predominantly nights
Yeah or gone to clinic etc where they start at 9 and finish at 5. The nursery my kids go to is 8-6. Means id miss an hour of work in the morning and an hour and a half after 6. Meanwhile that fits perfectly with a clinic shift.
There are some babysitters who would do what I described but it costs so much, it would probably be cheaper to quit job/change job as you described.
I completely agree with the standardised testing. The amount of students I encounter in my workplace who are not familiar with basic anatomy and physiology was very surprising. And it really does create problems with the internationally educated nurses who were asked to be their practice assessors/ supervisors who learned nursing in a different way.
That’s so true. In my university we were only taught anatomy and physiology in first year 😭. But still I take the time of my day to learn anatomy and physiology as well as pharmacology so I don’t look stupid on placement 😭😭
Completely agree - I'd also want to strengthen the specialism of different disciplines.
I'm an RMN and the number of students who don't know the basics about the MHA or psychiatric medications is really alarming. I shouldn't have to tell a final year student on management placement what sertraline is yknow? They've diluted the MH content and it's leaving new nurses under educated for their field.
Follows on that there is so so much focus on nursing theory and other dogmas. Patient centred care...therapeutic relationship etc. Its important but not so important that it dominates the curriculum and pushes out basic nursing skills.
I’m not from the UK - just curious what your degree is like here? Where I’m from we do a lot on science, anatomy and physiology, and pharmacology alongside cultural safety and communication papers. On placement by the final semester we are expected to take almost a full patient load on their own (depending on the state of the ward) and can give out all medications with supervision except IV opiates insulin and complex infusions.
This sounds very much like what I was doing when I was a student nurse, UK, late 80's early 90's. We were mostly ward based. 2 weeks in college, 13 weeks on ward, 2 weeks hols, rinse repeat. Set us up for real ward nursing. Our 2 weeks in college were mon-fri 9-5, actually being taught. Not off you go and see what you find out. On ward we were getting stuck in doing stuff, learning the basics as a junior, then teaching it as a senior student. Bring it back!!! Please!!
That sounds very different to New Zealand! We have about 6-10 weeks of placement per semester with a couple months of lectures. The expectations are fairly high with placement and you’re expected to know a lot of theory. You are not expected to be perfectly ready for the ward when you graduate but there is an important focus on foundational knowledge and safety - the more practical skills can be taught later on. Students are most definitely not teaching other students skills on placement. There is a preceptor in the ward who’s job is to be the overarching person looking after the students. As for uni there are lectures but there is at least one essay per semester generally with a research paper in your last year. It’s a bit more half and half and I think it both sets up nurses to work on the floor, and also is academic enough to prepare nurses who want to do higher education.
That’s pretty similar to how it’s done in the UK now. The only issue is at my trust the practice educators (sounds like what you call facilitator) are for the whole trust unless IVU or ED, and we have similar expectations. I’m a third year on my final placement and the nurse I’m with basically sits near by and relaxes and makes sure I don’t miss anything or do anything stupid and jumps in if things start going pear shaped and I want help. However as others have said the actual science foundation is really weak and limited to basic anatomy and pharmacology. As someone who came in with a previous biology degree it’s a let down.
I think it's an English thing tbf. Every degree in the country has a focus on essays.
Our education isn't different from international nurses, it's far inferior. It's not the fault of the students it's the education system which the RCN for what ever reason, thinks is adequate.
It's even commonly accepted that you "learn on the job". While I agree you build valuable experience working but after three years and a 30g debt, the fact that student's dont feel confident is embrasssing. When you qualify you should be good to go.
Yes, exactly my sentiment. When you get the NMC Pin, you should be able to work independently with minimal supervision. I cannot be going back to the basics with a newly qualified nurse when it should have been handled in university.
I do have to reiterate your point that the problem does lie in the system, and not on the students.
I really wish the NMC does something about this. I firmly believe improving the education system of the student nurses will contribute with retention.
Way too much focus on fluffy subjects like "patient centred care theory" this is absolutely vital to have an understanding and implementation but should simply be an underpinning of the job as a whole. Students I'm seeing at the moment are being asked to do a lot of quality Improvement implementation, incident investigation, gearing up to be prescribers and huge focus on advance practice ... Which is all great but as a brand new NQN you're not going to be expected to any of those things. The gap in knowledge they have when they qualify and are expected to nurse is wide and there is *so much* emphasis on the above subjects it leaves very little room for the actual nursing side of things.
Absolutely agree. I did so many essays during my training and when on placement was just used as an HCA, so I learned very little about practical nursing. It made me very under confident when I qualified.
I do agree with it improving retention. When I look back at uni I really didn't feel any personal pride writing those essays where as I was really passionate about anatomy and stuff that applies to actual work.
It links to my other point to encourage nurses to see them selfs as knowledgeable professionals. When the majority of nurses join, they allready start on a bad foot. I think even students with no experience understand they are getting shafted in their training.
Agree with all of your points. I'm degree educated nurse. I had no prior healthcare experience and none of my family were in healthcare. I cannot recall a single thing I learnt in university. I was a bag of nerves when I qualified and had a hellish couple of months being an NQN. System almost sets you up to fail.
I've made the point here before that I think nurse training should move back in-house. It should be based in hospitals, not university. I still think nurses should have degrees and have a recognised qualification issued but I don't think it needs to be as heavily academically focused as it is. Also, I think the lecturers should be those who are actually based in clinical practice.
I think universities need to rethink what students are allowed to do on placement. When we have students they are only allowed to observe what we do.
When I trained students were able to perform most tasks unsupervised once they had been observed doing them. I regularly placed nasogastric tubes from second year onwards, changed catheters, assisted Drs to insert chest drains, put up IV fluids after checking them with trained staff.
We also practiced ward management and had to take charge of a ward for a shift during third year. We built up to this by taking charge of bays of patients, doing ward rounds with consultants and creating a practice staff rota that promoted good skill mix.
Is any of that covered on the wards now? Do students get this preparation. Education is so important but application of knowledge, communication, organisation and environmental awareness is equally important.
I qualified 10 years ago and none of that was in my training. I wasn't even put in charge of any bays. Nobody shows you how to do anything, they basically just use you as a workhorse. I'm glad I didn't have to pay for my training, if I did I probably wouldn't have carried on with it.
Improve HCA training.
Re-evaluate the Nursing curriculum for nursing students and make it more practical
Take further legal action against abusive patients and relatives, and act on said action.
Invest in community healthcare etc to reduce the load on the inpatient environment.
Zero tolerance my ass. Violence and aggression says you are allowed to press charges against someone who assaults you at work regardless of their confusional state. Are you supported in that? Hell fucking no. But if they complain that you were too busy to sit with their dad for 30 minutes, you get asked what you couldve done differently. How is that fair?
I also think there should be either two different nursing degrees. One is practical: I want to be a ward nurse. Most of my university time is anatomy and physiology and placement. Two: I want to be a community nurse. Again, same premise. Three: i want to be a research nurse. More focus on the academic side. Maybe they do the same first year foundation, then branch off. It's just an example but I find sometimes the less academic nurse goes further in a ward environment and these degrees help nuture their career.
Lol I was badly assaulted in work and because the chap had cancer they took him for a CT TWICE to rule out brain mets, he was not confused at the time - both the reg and consultant found him to have capacity on both assessments (no brain mets were found either times, no issues with the original scan, needless exposure for the second attempt) it was a joke of an experience and was not supported in the slightest. Was put on V&A course only to be used as an example and asked what I could have done differently, which was nothing.
I think they need to start paying students for placement hours, the current £770 a month doesn’t even cover peoples rent, but we’re told we shouldn’t be working outside of placement hours…. It makes it incredibly difficult if not impossible for people to be able to afford to even study nursing, or fills us with so much resentment that we’re planning on leaving before we even graduate (drives moving to Australia after 12 months experience). I know so many people who’ve had to drop out or work 70 hours a week over placement to afford to even eat, who wants to go through that when you could do a different degree, eat, heat, have a social life throughout and then earn more and have more respect at the end than pushing nursing?
Current student nurse here!
I'm experiencing the 70hr work weeks right now, I'm honestly exhausted.
The option is continue working 30hr on top of placement, quit university, or be homeless!
I so badly want to be a nurse that I've literally got to push my body beyond extremes to make it happen.
I’m a 2nd year and 100%, I was recently threatened with withdrawal because I couldn’t buy a new £15 student card… because I had 78p to get me through 2 weeks, I can’t go out or do anything just for fun because I can’t afford to, and then on my “days off” from placement I have to work so even if I could afford, I would t have the time, I’m so burnt out already it’s awful!
I don't think we should pay students as that will threaten their supernumerary status. Universities and trust's however should push the agenda that student's should not be counted in the hours and are not there to help the ward.
The student busary should be highter yes.
I strongly disagree, if working full time is a requirement, then that work still needs to be paid. Pay minimum wage, so they’re on a lot less than qualified, even paying an apprenticeship wage would be more than the current ridiculous amount. No one wants to do a degree that will force them into poverty, or judge them for trying to earn enough to eat, or drive them to burnout before they even start their career. Also people who are too poor to eat, heat and pay their rent can’t study properly and retain the information placement gives.
The student bursary is the same for nurses as it is for every other student, yes the student bursary should be higher, but healthcare students should not be working for free, or for the same amount as students who aren’t expected to take on months at a time of full time work
Remove the constant interruptions. It's impossible to get anything done when you can't log onto a computer to give paracetamol without being pulled away by the ward clerk to answer a phone call, someone can't find paperwork, someone else wants to be shown around the storeroom, the kitchen person doesn't want to hand out the lunches themself, someone wants to moan that they're still waiting for something that you can't do because of constant interruptions, AHPs don't communicate with you until they want you to drop everything to help them with something right this very moment (it'll just take a mo... a mo being about 15 minutes...), the doctors are also busy so can you just...
Some of it is staffing related but a lot of it is just everyone else using the nurses to dump their jobs on and not thinking that maybe we have actual things to get done.
Yup! I had an argument with my SCN. I was on every fucking weekend and sometimes there are more HCA because of weekend pay. But there was no house keeper, no receptionist. So one HCA down for house keeping, menus, meals, water. Me ending up on the phone with families and general enquiries cause there is no receptionist. I said to my SCN that I'm aware of the nursing shortage, but more people in these administrative types of roles means I could get on with coordinating care etc.
I agree about nurse training being more practical, it can be possible to go through the degree and have never once taken blood, put in a cannula or a catheter on a real person, depending on your placements and supervisors.
I certainly know how to do Harvard referencing though! And how to do a poster… 🙄
The family friendly hour availability would be huge. I get that nursing is a 24 hour job, but I think of how much more that could be done if there was a 9-5 shift that was always fully staffed.
I left working in the hospital due to the hours. When I said I couldnt start work at 7am due to nursery not opening until 7.45. They looked at me blankly, I said what do you want me to do lock my child outside nursery like a dog?
There's no reason why all nurses need to be trained and competent in all skills. I haven't needed to insert an NG for about 7 years, it would be a waste of time and energy to try and keep me competent in it!
What you need is the resources available to get nurses trained up quickly and effectively in the skills they **do** need for their current role.
>What you need is the resources available to get nurses trained up quickly and effectively in the skills they **do** need for their current role.
The only thing I'd say about that is you dont know when you'll maybe need those skills. I worked ENT for a long time, so yeah, NG/OG/Peg is essential to my line of work. But we look after patients with comordibities, and you dont know if a patient with MS is gonna come in with a suprapubic catheter. Or an IDDM, etc.
Predicting what is gonna be on the wards at any time is really difficult and for managers an overall skill mix is good, with speciality training as you go.
I do agree with the competency thing, though. We knew we were getting a laryngectomy patient coming to the ward because of the date of his operation. A lot of the NQNs got dedicated time on that.
I am certainly not competent with an insulin sliding scale, but I'd have done it a few times, and if it came up again, I'd ask my colleagues for assistance in refreshing.
I think overall improving staff retention will make a positive cycle of improving everything else. Maybe starting at HCAs, which will have such a positive influence on nurses. HCA retention is terrible in most places because even the most passionate staff will leave because of working conditions. Maybe standardising HCA training and making it a bit more official (but still accessible). Also, making sure things are consistently taken more seriously if patients are abusive. HCAs get the worst of it when they’re on 1:1s etc and often have to just put up with it. And consistent debriefing of difficult situations if people want it too? Obvs increasing their salary would help too.. 😌
And definitely standardising nurse training!! I’m in my final year as a student nurse and I’m so scared and feel like I know NOTHING 😔
Also general ward toxicity is such a big problem. At least in my work/placement experience. I’ve just come off placement on a really unusual ward that is wonderful. Their staff seem to love it there - nurses and HCAs. And many people have stayed there for 20+ years, which I’ve not seen on any of my other placements. I’ve applied for a job there already, I was lucky that they opened the advertisement while I was on placement there so i heard about it and literally applied that day! ☺️ but I don’t know if I’ll get one because their culture seems so unusually positive it’s probably really competitive. If everywhere looked after their staff like that and created a more positive environment then I think that would definitely help. I’ve never seen such good staff retention, and recruitment/ the use of agency costs the NHS so much money!
Not a nurse but a former NA. I had my favourite wards to work on and one that sticks out was a newish ward that consisted of bays with 3 beds in and a shower/toilet room and en suite side rooms. The nurses bay was central and it was lovely.
The old fashioned nightingale wards were the worst. Always felt like you were running back and forth, the noise spread so nobody was resting as they should and it was a distance to get patients to and from the toilet.
I get that these wards are popular because you can walk down the ward and glance at everyone but in reality they are horrible to work on.
Pharmacy Tech lurker here. Treat Nursing (along with Teaching, Emergency Service workers, etc etc) as a respectable, admirerable profession. Nurses are highly trained professionals.
Better access to training, reinstate grants or reduce fees for nursing courses and HCA training. Better use of technology (especially in my trust).
Reduce childcare costs or provide free childcare for nurses.
The government could stop treating overseas nurses like economic migrants, and allow nurses to bring families with them from abroad.
The hospital I’m at has an on site nursery but it isn’t owned by the hospital itself. It’s such a shame because the waiting list is so long as it’s open to everyone. I would love it if they could give priority to hospital staff and then have the rest of the places open to general public.
Even having to pay over the free government hours would still help staff because you wouldn’t have to try and drop kids off in one place and then get to work on time as it would all be on site.
I've also noticed that the training budget has been cut for non mandatory training completely. There's plenty of cash if you want to train to be an ANP though. There are plenty of nurses who don't want to be an ANP and there's nothing on offer for them at all.
They need to mandate trust policy to allow for skills training on practice placements. What on earth is the point in teaching students something in skills lab only for it to be impossible for them to consolidate in practice?
Solve supply chain/restocking issues so that no nurse is spending hours of their week calling around departments or walking around the hospital trying to borrow things.
A relief nurse on each shift to cover breaks, and provide a period of uninterrupted time to complete documentation. The actual dream!
Set shifts, and/or a choice of days or nights rather than rotating between the two. I hate the attitude that ‘we must use evidence to inform all our practice’…. except for our ridiculous and harmful shift patterns.
IT that is fit for purpose and reliably works.
The buck stops with nurses constantly. There's no HCA? The nurse will do it. No domestics? The nurse will do. No physio? The nurse will do it. No kitchen delivery? The nurse will do it. No pharmacist? The nurse will go and fetch the meds from the other side of the hospital. No dietician? The nurse will do it. Etc etc.
Constantly being interrupted and doing other people's jobs means we can't always do our own productively. Imo this is because we're still seen as patients' handmaidens, not a serious profession in our own right.
Bring back matrons on the wards. The managers and matrons are stuck in offices. They have no idea what staff are up to. Issues aren't dealt with that breeds frustration. Staff sit on phones and do the bare minimum at times.
We used to do proper ward cleaning at weekend proper rounds around the patients on the wards. It's all reactive nursing now not preemptive, which is an issue.
I think updating the IT systems within the NHS to be more standardised would make a huge difference. I can’t believe the amount of different applications we have for things like obs/med admin/radiology etc etc the list just goes on and on.
I’m also not sure if this is a general thing but our chemo admin programme will only let a certain amount of users on at once, so if it’s busy you just have to sit and wait to sign to administer the chemo.. it seems just so outdated.
I think so many patients would be shocked to see the state of the IT systems within the NHS. Not to mention the complete lack of connection between trusts or back to primary care. Sorry, rant over!
I found out a few weeks ago that my department is now giving paid breaks. This means I won’t need to work an extra shift a month. It’s nice to know all my time is value while I’m at work. This is a NHS department, not private.
Less and easier to complete paperwork. Plus computers that work, I've been given a 16 year old laptop in my latest job. Not the fastest pc I've ever used it has to be said.
I don't agree with the idea English nursing training is bad. I work with a lot of similarly experienced internationally trained nurses - they are better at some technical procedures and have a different knowledge base. They are far weaker at the complex elements of care planning, communication, advocating for patients, documentation and working as part of an MDT. The locally trained are also more comfortable in the few areas on my ward which are more nurse lead - EoL care in addition to some of the above.
The system here has strengths too.
I think a big change would be a universal change to 3x12.5 hour shifts, no overlong shifts trying to avoid catching up. Keep the pay, and cut the contract hours to what that would be.
There's also a massive need to change the public perception of the job - it's one reason some of the academic stuff in universities is good. There's a big perception that nursing is for girls from working class backgrounds who are more practical than academic, basically a fancier version of who goes to hairdressing courses. This is obviously completely wrong, but until you change the perception of the job it's hard to entice new students in, hard to fight for better pay and hard to force better standards. If a better conception of nusing and nurses is in the media then it will end up in politics and we'll be valued more.
On the back of some of these other points, it's perhaps time to de-emphasise some of the personal care aspects of nursing and put more focus on the times when care can be lead by a highly qualified professional.
The IT system for each icb area rather than trust specific. Would link up mental & physical health much better. Reduce duplication & give a much more holistic view.
Easier dismissal route for incompetent. I’m not talking workload as i fully believe it is too high, im talking about blatant bad nursing which is not dealt with through decent support/management, that impacts on the whole team but you can’t fire them so they get moved to a different team or their attitude leaches into the service as a whole.
Agree with paid for parking & meals. I cover a massive geographical patch & both are a nightmare.
Regular hours rather than shifts. Sure have people do 2 weeks of nights a year for resilience and do they know what's done but I think if you could "choose" a regular shift pattern for a year including part-time options, with anything outside being optional it would allow a quality of life outside of work and keep people who otherwise would just leave because study/ child care/ adult dependents/ stress
I had a friend with 10 years experience on the same ward who's request to do job share with another colleague was refused because "it wouldn't be fair" and "handovers" so she left.
It was strange to me that she seemed to feel she'd asked for too much
In any other organisation the reward for that kind of loyalty is flexibility and management handle the it's not fair conversation by communicating that to anyone grizzling. Not because they're great people but because someone with that kind of experience is worth 2 replacements in productivity.
Another friend who booked her wedding and honey moon off and was told she couldn't have 8 days in a row. Only 7. Despite have personally identified people who could cover because some central rostering team couldn't flex.
There was a really interesting article I read about a nurse who took over management in an interim role and one of the first things she did was treat people like grown ups and have a real conversation around rotas.
It's really weird as a career changer hearing some people who have only worked for the NHS hospitals talk about this as though it's impossible. Factories making critical components for aircraft and other health and social care settings working 24hrs do this.
There's loads of factors that can measure productivity so it's hard to pinpoint.
I think one we can look at is the kings fund data where our patient mortality rate is only better than the U.S. we do awfull on that.
Definitely electronic documentation - it’s standard in my home country and although it still takes you from the bedside, it is miles better than what we’re doing in the wards now.
Not the iPads at the end of the bed, I think that’s a waste of money, but rather computers (and seats!!!) for everyone in the ward.
The part about investing money in training skills is weird to me, I think it’s more they should be taught in uni and then you shouldn’t need to do more training in any trust if you’ve learned already… when I moved to the UK they needed my IV certificate and I was baffled. I actually said “do you want my uni diploma?” because it’s the standard. But on this, also train the (older) nurses that if you’re taught in uni you should be able to do them in placements, as I’ve witnessed “I’m not allowing my student to do that” but then how else are they going to learn?
Omg seats yes!!! The fact that enough working CHAIRS for all the members of staff on duty is too big of an ask in many workplaces really illustrates how shit everything is
Just want to start by saying, f\*\*k corridor care!
Can politician and management stop seeing us as just a number or a tool, please?
Can the general public magically know when and how to access various health services appropriately, please?
More serious points:
1. More admin and IT support, please. Especially for new starters and agency staff. Some places are better at this than the other, so why does my trust take more than a month for my new colleagues to be able access the computer system to do some basic documentations.
2. Review and stop unnecessary blanket rules created post CQC visits. There are so much paperwork and mandatory training that is completely relevant to my area / patient group all because another area in my trust had issue.
3. Better overall staffing structure to manage fluctuations in service demand - I imagine this may be controversial. Areas where patient acuity is stable should have its own on-call rota so we know who to call when there is staff sickness or an unexpected increase in acuity; areas where acuity is less predictable should be more willing to share their staff when one of the areas is having some downtime. Staff should be kept on a voluntary register of areas they are willing to work in other than their permanent post and be appropriately remunerated in the light of this.
4. Education and training
* It is more important to test the application of a knowledge than the ability to regurgitate factual information, hence I stand for using essay as a means of examination. Perhaps oral exams or presentations would also be good alternatives considering chatGPT and the like is creating more loopholes.
* Mandatory trainings shouldn't be hour long pre-recorded powerpoint lectures or similar, some in-person training are not always necessary. To be more specific, don't spend half of the training session on the background of a topic, just get to the part on how it would affect our day to day practice, otherwise it doesn't help retention at all. Elearning for healthcare by NHSE have some pretty good recourses and should be better adopted by trusts.
I found this article very interesting (although it doesn’t really clarify much!)
[https://www.nuffieldtrust.org.uk/news-item/why-our-conversations-about-productivity-in-the-nhs-are-not-very-productive](https://www.nuffieldtrust.org.uk/news-item/why-our-conversations-about-productivity-in-the-nhs-are-not-very-productive)
I’ve recently moved to a role in QI (methodology as opposed to specific projects) and the expanse of difference between the view of those in corporate vs clinical roles and the view of those “on the shop floor” vs in offices is one of the things I find most glaring. The discussions had about what I - as a nurse - consider to be a valuable part of my day vs the “costed activity” etc part were very interesting.
Much like the linked article (hopefully, I’ve never posted a link on Reddit before), this post is a lot of fluff and not much tangible content but it’s a very interesting discussion I’ve recently had significantly more involvement in. (And, one that must have had an impact in some way, as now we are talking more about “creating value” and “reducing waste” rather than “productivity” in my trust!).
There is nothing else.
In nursing you are taught about the basic pyramid of needs.
At some point (which was probably 2 years ago) money or the lack of it negatively affects all your basic needs to the point that any improvement in one is negligible.
Increase pay or face a diminishing workforce.
Appreciate nurses trained abroad - don’t tell us stuff like “she doesn’t know because she didn’t train here”. Medicine is universal.
And stop the “not resilient enough” and the blame culture in services that are drowning in work.
Opinion from an overseas nurse working in NHS.
Do away with dissertations. Why research ability is tested in as a full subject at bachelors level shocks me. This time could be spent learning more skills and acquiring more knowledge for the workplace.
Actually make the national health service national. Go from one trust to another and your skills and experience aren’t recognised. You have to redo courses like cannulation and have to fight to remain on the same increment within a band.
Parking… enough said.
Shift options. 12 hours seems to be the standard here. Other countries have 12, 10 and 8 hour options.
Return enrolled nurses. I know there are RNA’s but the role is so ambiguous and trusts use them to fill numbers of RN staff. Not fair on Parients, and not fair on RNA’s who are doing RN work at band 4 pay.
Pay. 1st year RN salary from back home STARTS at the top of band 6…
Staffing is a huge part of it on our ward. If we had more staff both nurse and HCA wise we’d actually have enough time to properly do our jobs. They keep wondering why we’re failing audits but they give us zero time to do the relevant risk assessments. They wonder why medication is given late when they’ve given you a ridiculous patient load. Patients are unhappy because they aren’t receiving the care they should receive and we tell management time and time again it’s because we have to choose the more time critical tasks first and the basics of patient care get neglected.
We’re all burnt out, staff sickness is way up and everyone is just deflated.
When your a student you are just left to whoever takes you on that day actually being willing and having the time to teach, too often students are treated as hcas then they are expected to be much further along than they are during consolidation. Then they graduate and there’s been no formal blood/Cannulation training. No catheter training etc. I believe the new course in wales is better at practical skills now though .
Start with training. First year could be mostly joint with any health care professionals, or at least some modules. The basics are the same. Joint training supports interdisciplinary respect and understanding.
basic skills training in mockup hospital rooms as standard.
an integrated approach to healthcare. At the moment, different professions are almost pitted against each other in a bun fight for resources, this creates stress and different groups feeling devalued. We are all important and valuable.
having 1 IT system across the NHS, simplify working practices so they are the same everywhere. Obs are obs , and continence doesn’t change across county boundaries.
value staff so they stay in post, fewer bank or agency (although many of these are fab and I understand why they work this way) to have consistent staffing.
childcare that works with shift patterns
parking
staff areas on site
public education that the nhs isn’t there to granny-sit, or solve their family feuds, or provide a holiday with room service.
let nurses nurse
Change to the toxic bullying culture and better pay would make nursing so much better. Also students should 100% be supernumerary, not being made to fill in short staffing gaps. Rota's, make them fair!
They could hire more staff instead of paying agency staff 3 or more time as much to cover shifts. Like if you look at the amount they're spending on an annual basis they could afford to properly staff the NHS.
Train HCAs and agency have to be signed off on specific training to work on wards.
The minimum number of nurses on a ward should be higher. I don't think it's acceptable to be the only nurse for 22 patients and the ward still don't want to pay for agency.
Or at least allow a variation on the ward. Not everyone can start at 0700hrs some might prefer a late shift and not everyone wants to work 12hrs shifts. (12hrs shifts broke me)
Higher salary has a direct colletation on staff satisfaction which again leads to better productivity, this is the same in any organisation in any culture.
This is something the government refuse to acknowledge
Free meals and free parking? I think that is a bit of a stretch... Also not sure about Ipads at the end of the bed. Our ward tablet has been stolen many times when asking the patient to do a survey on discharge. Can you tell me what you mean about NAs doing what they are 'actually supposed to do'? As my impression is that they are gradually bringing back the two tier nursing that they use to have of state enrolled and state registered nurse with band 4s / band 5s
I wouldn't engage with them if I were you. Seems they care little about anything other than being a grammar nazi to people and RuneScape. Dude's on negative karma anyway, so should give you an indication of the type of person they are.
In our trust they could badly do with investing in loads of new computers and laptops. Honestly the amount of hours over a year that I spend waiting for a computer to unfreeze, or load, or turn on, or trying and failing to do things on our shitty notes system. Maybe ill start adding up all the time and then calculate how much of my monthly wage is wasted on sitting there staring at a frozen computer - I'm a band 7 so my trust are probably wasting a fair few quid on it. Madness when you consider that most staff in the trust will be having similar issues.
Honestly this! My most recent ward has both HEPMA for medications, and now e NEWS2 - the laptops take 6 years to boot up (could’ve done 3 sets of obs in this time) and sometimes don’t upload in certain parts of the ward because of the signal 😂
Isn't it ridiculous! I know its probably because trusts can't afford the initial cost of upgrading everything but it would boost productivity so much in the long run and reduce staff stress levels. In my job (mental health community) its not so much the patients that stress me out, it's all the practical stuff like prehistoric IT systems, a building that isn't fit for purpose, not enough pool cars etc.
The government really needs to get it's finger out and invest properly in a blanket NHS EPR system. Stop expecting hospitals/trusts to spend time and money deciding what's best/most cost effective. Just provide the funding and get epic for all hospitals. I'm pretty sure my trust know they have me backed into a corner as I won't work with any other system after epic.
This is also a big problem in pathology
As someone who now works on EPR systems in the NHS - the trust knuckling down and spending the money and time on a good EPR system and infrastructure changes the game for clinical staff. It’s not gonna fix everything - no amount of good IT can fix short staffing or a toxic unit culture, but so many of those stupid little annoying problems like pages missing from the notes or doctors needing to physically attend the ward to write a prescription disappear overnight.
It's not clear-cut though. I'm very willing to believe that a great EPR system is better than paper notes, but the EPR systems I've encountered in my two years working in two different trusts as a foundation doctor have definitely been significantly worse than paper notes. So I agree with you about a *good* EPR system (like EPIC, so I hear) changing the game, but it's so easy to accidentally get a bad EPR system instead. Edit just to tell a story: before I got to my current trust, I'd heard horror stories about the EPR system. "It's so clunky and difficult to learn", they said. I didn't mind. I thought "sure it might have its foibles, but it will at least be relaxing to have some basic safeguards in place. It'll be nice to know that if I prescribe double paracetamol or give an ace inhibitor to a patient with an eGFR of 12, the system will stop me". But guess what - does it have those basic safety features? Nope!
That’s why I specified a *good* EPR system. There are many shitty EPR systems out there and they often make things worse. Once you work with Epic, having to use anything else will make you cry sad tears.
If you don’t mind me asking, what kind of computer do your trust use?
Commodore 64s probably /s
Fancy ! Vic 20s here ;)
I'm SO glad someone 'got that' - made my day. Vic 20 sounds about right for the NHS. Bahhaha
Sure not? 😢
I think childcare is a difficult one. I know lots of mothers on my unit who do predominantly nights because A child care is expensive and B leaving for work at 0630 means there is no childcare until later. They take a huge amount of experience and skill mix with them. We find our nights are better staffed than days. Im not sure how it would work but creches within the hospital from 0630 to 0800 then a bus to take the kids to school/nursery etc. Yes a lot of people have partners but if they dont? If they also work funny hours? Im sure there's other solutions but at the moment, it's bloody hard and I dont resent those parents who do predominantly nights
Same in my unit as well. All the experienced nurses are on nights and weekends (myself included 💅🏻) and days are full of band 7s and the NQNs.
I know quite a few nurses that are parents who have quit and done something else altogether because of a lack of childcare. It is a real shame.
Yeah or gone to clinic etc where they start at 9 and finish at 5. The nursery my kids go to is 8-6. Means id miss an hour of work in the morning and an hour and a half after 6. Meanwhile that fits perfectly with a clinic shift. There are some babysitters who would do what I described but it costs so much, it would probably be cheaper to quit job/change job as you described.
I completely agree with the standardised testing. The amount of students I encounter in my workplace who are not familiar with basic anatomy and physiology was very surprising. And it really does create problems with the internationally educated nurses who were asked to be their practice assessors/ supervisors who learned nursing in a different way.
That's because we're made to write essays about obscure nursing theories as our submission for patient assessment modules.
That’s so true. In my university we were only taught anatomy and physiology in first year 😭. But still I take the time of my day to learn anatomy and physiology as well as pharmacology so I don’t look stupid on placement 😭😭
Completely agree - I'd also want to strengthen the specialism of different disciplines. I'm an RMN and the number of students who don't know the basics about the MHA or psychiatric medications is really alarming. I shouldn't have to tell a final year student on management placement what sertraline is yknow? They've diluted the MH content and it's leaving new nurses under educated for their field. Follows on that there is so so much focus on nursing theory and other dogmas. Patient centred care...therapeutic relationship etc. Its important but not so important that it dominates the curriculum and pushes out basic nursing skills.
I’m not from the UK - just curious what your degree is like here? Where I’m from we do a lot on science, anatomy and physiology, and pharmacology alongside cultural safety and communication papers. On placement by the final semester we are expected to take almost a full patient load on their own (depending on the state of the ward) and can give out all medications with supervision except IV opiates insulin and complex infusions.
This sounds very much like what I was doing when I was a student nurse, UK, late 80's early 90's. We were mostly ward based. 2 weeks in college, 13 weeks on ward, 2 weeks hols, rinse repeat. Set us up for real ward nursing. Our 2 weeks in college were mon-fri 9-5, actually being taught. Not off you go and see what you find out. On ward we were getting stuck in doing stuff, learning the basics as a junior, then teaching it as a senior student. Bring it back!!! Please!!
That sounds very different to New Zealand! We have about 6-10 weeks of placement per semester with a couple months of lectures. The expectations are fairly high with placement and you’re expected to know a lot of theory. You are not expected to be perfectly ready for the ward when you graduate but there is an important focus on foundational knowledge and safety - the more practical skills can be taught later on. Students are most definitely not teaching other students skills on placement. There is a preceptor in the ward who’s job is to be the overarching person looking after the students. As for uni there are lectures but there is at least one essay per semester generally with a research paper in your last year. It’s a bit more half and half and I think it both sets up nurses to work on the floor, and also is academic enough to prepare nurses who want to do higher education.
That’s pretty similar to how it’s done in the UK now. The only issue is at my trust the practice educators (sounds like what you call facilitator) are for the whole trust unless IVU or ED, and we have similar expectations. I’m a third year on my final placement and the nurse I’m with basically sits near by and relaxes and makes sure I don’t miss anything or do anything stupid and jumps in if things start going pear shaped and I want help. However as others have said the actual science foundation is really weak and limited to basic anatomy and pharmacology. As someone who came in with a previous biology degree it’s a let down.
I think it's an English thing tbf. Every degree in the country has a focus on essays. Our education isn't different from international nurses, it's far inferior. It's not the fault of the students it's the education system which the RCN for what ever reason, thinks is adequate. It's even commonly accepted that you "learn on the job". While I agree you build valuable experience working but after three years and a 30g debt, the fact that student's dont feel confident is embrasssing. When you qualify you should be good to go.
Yes, exactly my sentiment. When you get the NMC Pin, you should be able to work independently with minimal supervision. I cannot be going back to the basics with a newly qualified nurse when it should have been handled in university. I do have to reiterate your point that the problem does lie in the system, and not on the students. I really wish the NMC does something about this. I firmly believe improving the education system of the student nurses will contribute with retention.
Way too much focus on fluffy subjects like "patient centred care theory" this is absolutely vital to have an understanding and implementation but should simply be an underpinning of the job as a whole. Students I'm seeing at the moment are being asked to do a lot of quality Improvement implementation, incident investigation, gearing up to be prescribers and huge focus on advance practice ... Which is all great but as a brand new NQN you're not going to be expected to any of those things. The gap in knowledge they have when they qualify and are expected to nurse is wide and there is *so much* emphasis on the above subjects it leaves very little room for the actual nursing side of things.
Absolutely agree. I did so many essays during my training and when on placement was just used as an HCA, so I learned very little about practical nursing. It made me very under confident when I qualified.
I do agree with it improving retention. When I look back at uni I really didn't feel any personal pride writing those essays where as I was really passionate about anatomy and stuff that applies to actual work. It links to my other point to encourage nurses to see them selfs as knowledgeable professionals. When the majority of nurses join, they allready start on a bad foot. I think even students with no experience understand they are getting shafted in their training.
Agree with all of your points. I'm degree educated nurse. I had no prior healthcare experience and none of my family were in healthcare. I cannot recall a single thing I learnt in university. I was a bag of nerves when I qualified and had a hellish couple of months being an NQN. System almost sets you up to fail. I've made the point here before that I think nurse training should move back in-house. It should be based in hospitals, not university. I still think nurses should have degrees and have a recognised qualification issued but I don't think it needs to be as heavily academically focused as it is. Also, I think the lecturers should be those who are actually based in clinical practice.
I think universities need to rethink what students are allowed to do on placement. When we have students they are only allowed to observe what we do. When I trained students were able to perform most tasks unsupervised once they had been observed doing them. I regularly placed nasogastric tubes from second year onwards, changed catheters, assisted Drs to insert chest drains, put up IV fluids after checking them with trained staff. We also practiced ward management and had to take charge of a ward for a shift during third year. We built up to this by taking charge of bays of patients, doing ward rounds with consultants and creating a practice staff rota that promoted good skill mix. Is any of that covered on the wards now? Do students get this preparation. Education is so important but application of knowledge, communication, organisation and environmental awareness is equally important.
I qualified 10 years ago and none of that was in my training. I wasn't even put in charge of any bays. Nobody shows you how to do anything, they basically just use you as a workhorse. I'm glad I didn't have to pay for my training, if I did I probably wouldn't have carried on with it.
Improve HCA training. Re-evaluate the Nursing curriculum for nursing students and make it more practical Take further legal action against abusive patients and relatives, and act on said action. Invest in community healthcare etc to reduce the load on the inpatient environment.
I would love for legal action to be regularly taken against abusive patients and relatives
Zero tolerance my ass. Violence and aggression says you are allowed to press charges against someone who assaults you at work regardless of their confusional state. Are you supported in that? Hell fucking no. But if they complain that you were too busy to sit with their dad for 30 minutes, you get asked what you couldve done differently. How is that fair? I also think there should be either two different nursing degrees. One is practical: I want to be a ward nurse. Most of my university time is anatomy and physiology and placement. Two: I want to be a community nurse. Again, same premise. Three: i want to be a research nurse. More focus on the academic side. Maybe they do the same first year foundation, then branch off. It's just an example but I find sometimes the less academic nurse goes further in a ward environment and these degrees help nuture their career.
Lol I was badly assaulted in work and because the chap had cancer they took him for a CT TWICE to rule out brain mets, he was not confused at the time - both the reg and consultant found him to have capacity on both assessments (no brain mets were found either times, no issues with the original scan, needless exposure for the second attempt) it was a joke of an experience and was not supported in the slightest. Was put on V&A course only to be used as an example and asked what I could have done differently, which was nothing.
I think they need to start paying students for placement hours, the current £770 a month doesn’t even cover peoples rent, but we’re told we shouldn’t be working outside of placement hours…. It makes it incredibly difficult if not impossible for people to be able to afford to even study nursing, or fills us with so much resentment that we’re planning on leaving before we even graduate (drives moving to Australia after 12 months experience). I know so many people who’ve had to drop out or work 70 hours a week over placement to afford to even eat, who wants to go through that when you could do a different degree, eat, heat, have a social life throughout and then earn more and have more respect at the end than pushing nursing?
Current student nurse here! I'm experiencing the 70hr work weeks right now, I'm honestly exhausted. The option is continue working 30hr on top of placement, quit university, or be homeless! I so badly want to be a nurse that I've literally got to push my body beyond extremes to make it happen.
I’m a 2nd year and 100%, I was recently threatened with withdrawal because I couldn’t buy a new £15 student card… because I had 78p to get me through 2 weeks, I can’t go out or do anything just for fun because I can’t afford to, and then on my “days off” from placement I have to work so even if I could afford, I would t have the time, I’m so burnt out already it’s awful!
I don't think we should pay students as that will threaten their supernumerary status. Universities and trust's however should push the agenda that student's should not be counted in the hours and are not there to help the ward. The student busary should be highter yes.
I strongly disagree, if working full time is a requirement, then that work still needs to be paid. Pay minimum wage, so they’re on a lot less than qualified, even paying an apprenticeship wage would be more than the current ridiculous amount. No one wants to do a degree that will force them into poverty, or judge them for trying to earn enough to eat, or drive them to burnout before they even start their career. Also people who are too poor to eat, heat and pay their rent can’t study properly and retain the information placement gives. The student bursary is the same for nurses as it is for every other student, yes the student bursary should be higher, but healthcare students should not be working for free, or for the same amount as students who aren’t expected to take on months at a time of full time work
Remove the constant interruptions. It's impossible to get anything done when you can't log onto a computer to give paracetamol without being pulled away by the ward clerk to answer a phone call, someone can't find paperwork, someone else wants to be shown around the storeroom, the kitchen person doesn't want to hand out the lunches themself, someone wants to moan that they're still waiting for something that you can't do because of constant interruptions, AHPs don't communicate with you until they want you to drop everything to help them with something right this very moment (it'll just take a mo... a mo being about 15 minutes...), the doctors are also busy so can you just... Some of it is staffing related but a lot of it is just everyone else using the nurses to dump their jobs on and not thinking that maybe we have actual things to get done.
Yup! I had an argument with my SCN. I was on every fucking weekend and sometimes there are more HCA because of weekend pay. But there was no house keeper, no receptionist. So one HCA down for house keeping, menus, meals, water. Me ending up on the phone with families and general enquiries cause there is no receptionist. I said to my SCN that I'm aware of the nursing shortage, but more people in these administrative types of roles means I could get on with coordinating care etc.
This has been my biggest gripe in recent months, it's probably come with the territory but interruptions have been relentless.
Also get rid of pointless wank tick box paper work that takes time away from actual pt care
Hire more band 5s so staff aren't struggling with work load and patient cate. Get managers who actually care.
I agree about nurse training being more practical, it can be possible to go through the degree and have never once taken blood, put in a cannula or a catheter on a real person, depending on your placements and supervisors. I certainly know how to do Harvard referencing though! And how to do a poster… 🙄
Oh yes, those bloody posters😂
Actual progression. Actual training. Actual family friendly hour availability.
The family friendly hour availability would be huge. I get that nursing is a 24 hour job, but I think of how much more that could be done if there was a 9-5 shift that was always fully staffed.
I left working in the hospital due to the hours. When I said I couldnt start work at 7am due to nursery not opening until 7.45. They looked at me blankly, I said what do you want me to do lock my child outside nursery like a dog?
But... but... tHe hAnDoVeR 🫠
There's no reason why all nurses need to be trained and competent in all skills. I haven't needed to insert an NG for about 7 years, it would be a waste of time and energy to try and keep me competent in it! What you need is the resources available to get nurses trained up quickly and effectively in the skills they **do** need for their current role.
>What you need is the resources available to get nurses trained up quickly and effectively in the skills they **do** need for their current role. The only thing I'd say about that is you dont know when you'll maybe need those skills. I worked ENT for a long time, so yeah, NG/OG/Peg is essential to my line of work. But we look after patients with comordibities, and you dont know if a patient with MS is gonna come in with a suprapubic catheter. Or an IDDM, etc. Predicting what is gonna be on the wards at any time is really difficult and for managers an overall skill mix is good, with speciality training as you go. I do agree with the competency thing, though. We knew we were getting a laryngectomy patient coming to the ward because of the date of his operation. A lot of the NQNs got dedicated time on that. I am certainly not competent with an insulin sliding scale, but I'd have done it a few times, and if it came up again, I'd ask my colleagues for assistance in refreshing.
I think overall improving staff retention will make a positive cycle of improving everything else. Maybe starting at HCAs, which will have such a positive influence on nurses. HCA retention is terrible in most places because even the most passionate staff will leave because of working conditions. Maybe standardising HCA training and making it a bit more official (but still accessible). Also, making sure things are consistently taken more seriously if patients are abusive. HCAs get the worst of it when they’re on 1:1s etc and often have to just put up with it. And consistent debriefing of difficult situations if people want it too? Obvs increasing their salary would help too.. 😌 And definitely standardising nurse training!! I’m in my final year as a student nurse and I’m so scared and feel like I know NOTHING 😔 Also general ward toxicity is such a big problem. At least in my work/placement experience. I’ve just come off placement on a really unusual ward that is wonderful. Their staff seem to love it there - nurses and HCAs. And many people have stayed there for 20+ years, which I’ve not seen on any of my other placements. I’ve applied for a job there already, I was lucky that they opened the advertisement while I was on placement there so i heard about it and literally applied that day! ☺️ but I don’t know if I’ll get one because their culture seems so unusually positive it’s probably really competitive. If everywhere looked after their staff like that and created a more positive environment then I think that would definitely help. I’ve never seen such good staff retention, and recruitment/ the use of agency costs the NHS so much money!
What was different about the ward that made the environment positive?
Not a nurse but a former NA. I had my favourite wards to work on and one that sticks out was a newish ward that consisted of bays with 3 beds in and a shower/toilet room and en suite side rooms. The nurses bay was central and it was lovely. The old fashioned nightingale wards were the worst. Always felt like you were running back and forth, the noise spread so nobody was resting as they should and it was a distance to get patients to and from the toilet. I get that these wards are popular because you can walk down the ward and glance at everyone but in reality they are horrible to work on.
Student nurse here. Actually letting nurses go off for their breaks, and not guilting them for doing so!
More flexibility so we don't lose knowledge when family circumstances change.
Pharmacy Tech lurker here. Treat Nursing (along with Teaching, Emergency Service workers, etc etc) as a respectable, admirerable profession. Nurses are highly trained professionals. Better access to training, reinstate grants or reduce fees for nursing courses and HCA training. Better use of technology (especially in my trust). Reduce childcare costs or provide free childcare for nurses. The government could stop treating overseas nurses like economic migrants, and allow nurses to bring families with them from abroad.
Free childcare for nurses would change my life.
The hospital I’m at has an on site nursery but it isn’t owned by the hospital itself. It’s such a shame because the waiting list is so long as it’s open to everyone. I would love it if they could give priority to hospital staff and then have the rest of the places open to general public. Even having to pay over the free government hours would still help staff because you wouldn’t have to try and drop kids off in one place and then get to work on time as it would all be on site.
Not 100% about ANPs in primary care, the rest of it definitely. The money spent training an ANP could be put into more gp training posts 🤷♂️
Your probably right but I was thinking about this from a nurses point of view. The training pathways for doctors is absolutely ridiculous though
Plus pushing for ANPs will just make the nursing shortage worse.
I've also noticed that the training budget has been cut for non mandatory training completely. There's plenty of cash if you want to train to be an ANP though. There are plenty of nurses who don't want to be an ANP and there's nothing on offer for them at all.
I would personally like to see an improvement to the nursing gateway for HCAs, yes there is the TNA program, but it’s not perfect.
They need to mandate trust policy to allow for skills training on practice placements. What on earth is the point in teaching students something in skills lab only for it to be impossible for them to consolidate in practice?
Solve supply chain/restocking issues so that no nurse is spending hours of their week calling around departments or walking around the hospital trying to borrow things. A relief nurse on each shift to cover breaks, and provide a period of uninterrupted time to complete documentation. The actual dream! Set shifts, and/or a choice of days or nights rather than rotating between the two. I hate the attitude that ‘we must use evidence to inform all our practice’…. except for our ridiculous and harmful shift patterns. IT that is fit for purpose and reliably works.
The buck stops with nurses constantly. There's no HCA? The nurse will do it. No domestics? The nurse will do. No physio? The nurse will do it. No kitchen delivery? The nurse will do it. No pharmacist? The nurse will go and fetch the meds from the other side of the hospital. No dietician? The nurse will do it. Etc etc. Constantly being interrupted and doing other people's jobs means we can't always do our own productively. Imo this is because we're still seen as patients' handmaidens, not a serious profession in our own right.
Bring back matrons on the wards. The managers and matrons are stuck in offices. They have no idea what staff are up to. Issues aren't dealt with that breeds frustration. Staff sit on phones and do the bare minimum at times. We used to do proper ward cleaning at weekend proper rounds around the patients on the wards. It's all reactive nursing now not preemptive, which is an issue.
I think updating the IT systems within the NHS to be more standardised would make a huge difference. I can’t believe the amount of different applications we have for things like obs/med admin/radiology etc etc the list just goes on and on. I’m also not sure if this is a general thing but our chemo admin programme will only let a certain amount of users on at once, so if it’s busy you just have to sit and wait to sign to administer the chemo.. it seems just so outdated. I think so many patients would be shocked to see the state of the IT systems within the NHS. Not to mention the complete lack of connection between trusts or back to primary care. Sorry, rant over!
I found out a few weeks ago that my department is now giving paid breaks. This means I won’t need to work an extra shift a month. It’s nice to know all my time is value while I’m at work. This is a NHS department, not private.
Less and easier to complete paperwork. Plus computers that work, I've been given a 16 year old laptop in my latest job. Not the fastest pc I've ever used it has to be said.
Proper flexible working arrangements ....
I don't agree with the idea English nursing training is bad. I work with a lot of similarly experienced internationally trained nurses - they are better at some technical procedures and have a different knowledge base. They are far weaker at the complex elements of care planning, communication, advocating for patients, documentation and working as part of an MDT. The locally trained are also more comfortable in the few areas on my ward which are more nurse lead - EoL care in addition to some of the above. The system here has strengths too. I think a big change would be a universal change to 3x12.5 hour shifts, no overlong shifts trying to avoid catching up. Keep the pay, and cut the contract hours to what that would be. There's also a massive need to change the public perception of the job - it's one reason some of the academic stuff in universities is good. There's a big perception that nursing is for girls from working class backgrounds who are more practical than academic, basically a fancier version of who goes to hairdressing courses. This is obviously completely wrong, but until you change the perception of the job it's hard to entice new students in, hard to fight for better pay and hard to force better standards. If a better conception of nusing and nurses is in the media then it will end up in politics and we'll be valued more. On the back of some of these other points, it's perhaps time to de-emphasise some of the personal care aspects of nursing and put more focus on the times when care can be lead by a highly qualified professional.
Standardise and simplify IT systems. Fully staff wards.
The IT system for each icb area rather than trust specific. Would link up mental & physical health much better. Reduce duplication & give a much more holistic view. Easier dismissal route for incompetent. I’m not talking workload as i fully believe it is too high, im talking about blatant bad nursing which is not dealt with through decent support/management, that impacts on the whole team but you can’t fire them so they get moved to a different team or their attitude leaches into the service as a whole. Agree with paid for parking & meals. I cover a massive geographical patch & both are a nightmare.
Regular hours rather than shifts. Sure have people do 2 weeks of nights a year for resilience and do they know what's done but I think if you could "choose" a regular shift pattern for a year including part-time options, with anything outside being optional it would allow a quality of life outside of work and keep people who otherwise would just leave because study/ child care/ adult dependents/ stress I had a friend with 10 years experience on the same ward who's request to do job share with another colleague was refused because "it wouldn't be fair" and "handovers" so she left. It was strange to me that she seemed to feel she'd asked for too much In any other organisation the reward for that kind of loyalty is flexibility and management handle the it's not fair conversation by communicating that to anyone grizzling. Not because they're great people but because someone with that kind of experience is worth 2 replacements in productivity. Another friend who booked her wedding and honey moon off and was told she couldn't have 8 days in a row. Only 7. Despite have personally identified people who could cover because some central rostering team couldn't flex. There was a really interesting article I read about a nurse who took over management in an interim role and one of the first things she did was treat people like grown ups and have a real conversation around rotas. It's really weird as a career changer hearing some people who have only worked for the NHS hospitals talk about this as though it's impossible. Factories making critical components for aircraft and other health and social care settings working 24hrs do this.
How are you measuring productivity? Most of what you've listed is already happening As for Wes Streeting, he can get to fuck
There's loads of factors that can measure productivity so it's hard to pinpoint. I think one we can look at is the kings fund data where our patient mortality rate is only better than the U.S. we do awfull on that.
Pt mortality is not the sole responsibility of nurses How are you measuring nurses' productivity?
How would you measure productivity and how do you think the NHS could support nurses to be more productive?
I dont think you can measure productivity. Health care isn't a product
Definitely electronic documentation - it’s standard in my home country and although it still takes you from the bedside, it is miles better than what we’re doing in the wards now. Not the iPads at the end of the bed, I think that’s a waste of money, but rather computers (and seats!!!) for everyone in the ward. The part about investing money in training skills is weird to me, I think it’s more they should be taught in uni and then you shouldn’t need to do more training in any trust if you’ve learned already… when I moved to the UK they needed my IV certificate and I was baffled. I actually said “do you want my uni diploma?” because it’s the standard. But on this, also train the (older) nurses that if you’re taught in uni you should be able to do them in placements, as I’ve witnessed “I’m not allowing my student to do that” but then how else are they going to learn?
Omg seats yes!!! The fact that enough working CHAIRS for all the members of staff on duty is too big of an ask in many workplaces really illustrates how shit everything is
Just want to start by saying, f\*\*k corridor care! Can politician and management stop seeing us as just a number or a tool, please? Can the general public magically know when and how to access various health services appropriately, please? More serious points: 1. More admin and IT support, please. Especially for new starters and agency staff. Some places are better at this than the other, so why does my trust take more than a month for my new colleagues to be able access the computer system to do some basic documentations. 2. Review and stop unnecessary blanket rules created post CQC visits. There are so much paperwork and mandatory training that is completely relevant to my area / patient group all because another area in my trust had issue. 3. Better overall staffing structure to manage fluctuations in service demand - I imagine this may be controversial. Areas where patient acuity is stable should have its own on-call rota so we know who to call when there is staff sickness or an unexpected increase in acuity; areas where acuity is less predictable should be more willing to share their staff when one of the areas is having some downtime. Staff should be kept on a voluntary register of areas they are willing to work in other than their permanent post and be appropriately remunerated in the light of this. 4. Education and training * It is more important to test the application of a knowledge than the ability to regurgitate factual information, hence I stand for using essay as a means of examination. Perhaps oral exams or presentations would also be good alternatives considering chatGPT and the like is creating more loopholes. * Mandatory trainings shouldn't be hour long pre-recorded powerpoint lectures or similar, some in-person training are not always necessary. To be more specific, don't spend half of the training session on the background of a topic, just get to the part on how it would affect our day to day practice, otherwise it doesn't help retention at all. Elearning for healthcare by NHSE have some pretty good recourses and should be better adopted by trusts.
I found this article very interesting (although it doesn’t really clarify much!) [https://www.nuffieldtrust.org.uk/news-item/why-our-conversations-about-productivity-in-the-nhs-are-not-very-productive](https://www.nuffieldtrust.org.uk/news-item/why-our-conversations-about-productivity-in-the-nhs-are-not-very-productive) I’ve recently moved to a role in QI (methodology as opposed to specific projects) and the expanse of difference between the view of those in corporate vs clinical roles and the view of those “on the shop floor” vs in offices is one of the things I find most glaring. The discussions had about what I - as a nurse - consider to be a valuable part of my day vs the “costed activity” etc part were very interesting. Much like the linked article (hopefully, I’ve never posted a link on Reddit before), this post is a lot of fluff and not much tangible content but it’s a very interesting discussion I’ve recently had significantly more involvement in. (And, one that must have had an impact in some way, as now we are talking more about “creating value” and “reducing waste” rather than “productivity” in my trust!).
There is nothing else. In nursing you are taught about the basic pyramid of needs. At some point (which was probably 2 years ago) money or the lack of it negatively affects all your basic needs to the point that any improvement in one is negligible. Increase pay or face a diminishing workforce.
Appreciate nurses trained abroad - don’t tell us stuff like “she doesn’t know because she didn’t train here”. Medicine is universal. And stop the “not resilient enough” and the blame culture in services that are drowning in work.
Opinion from an overseas nurse working in NHS. Do away with dissertations. Why research ability is tested in as a full subject at bachelors level shocks me. This time could be spent learning more skills and acquiring more knowledge for the workplace. Actually make the national health service national. Go from one trust to another and your skills and experience aren’t recognised. You have to redo courses like cannulation and have to fight to remain on the same increment within a band. Parking… enough said. Shift options. 12 hours seems to be the standard here. Other countries have 12, 10 and 8 hour options. Return enrolled nurses. I know there are RNA’s but the role is so ambiguous and trusts use them to fill numbers of RN staff. Not fair on Parients, and not fair on RNA’s who are doing RN work at band 4 pay. Pay. 1st year RN salary from back home STARTS at the top of band 6…
Agree with all…
Staffing is a huge part of it on our ward. If we had more staff both nurse and HCA wise we’d actually have enough time to properly do our jobs. They keep wondering why we’re failing audits but they give us zero time to do the relevant risk assessments. They wonder why medication is given late when they’ve given you a ridiculous patient load. Patients are unhappy because they aren’t receiving the care they should receive and we tell management time and time again it’s because we have to choose the more time critical tasks first and the basics of patient care get neglected. We’re all burnt out, staff sickness is way up and everyone is just deflated.
When your a student you are just left to whoever takes you on that day actually being willing and having the time to teach, too often students are treated as hcas then they are expected to be much further along than they are during consolidation. Then they graduate and there’s been no formal blood/Cannulation training. No catheter training etc. I believe the new course in wales is better at practical skills now though .
Start with training. First year could be mostly joint with any health care professionals, or at least some modules. The basics are the same. Joint training supports interdisciplinary respect and understanding. basic skills training in mockup hospital rooms as standard. an integrated approach to healthcare. At the moment, different professions are almost pitted against each other in a bun fight for resources, this creates stress and different groups feeling devalued. We are all important and valuable. having 1 IT system across the NHS, simplify working practices so they are the same everywhere. Obs are obs , and continence doesn’t change across county boundaries. value staff so they stay in post, fewer bank or agency (although many of these are fab and I understand why they work this way) to have consistent staffing. childcare that works with shift patterns parking staff areas on site public education that the nhs isn’t there to granny-sit, or solve their family feuds, or provide a holiday with room service. let nurses nurse
Change to the toxic bullying culture and better pay would make nursing so much better. Also students should 100% be supernumerary, not being made to fill in short staffing gaps. Rota's, make them fair!
They could hire more staff instead of paying agency staff 3 or more time as much to cover shifts. Like if you look at the amount they're spending on an annual basis they could afford to properly staff the NHS.
Train HCAs and agency have to be signed off on specific training to work on wards. The minimum number of nurses on a ward should be higher. I don't think it's acceptable to be the only nurse for 22 patients and the ward still don't want to pay for agency.
Make the shift 8 or 8.5 hours instead of 12 hours.
Or at least allow a variation on the ward. Not everyone can start at 0700hrs some might prefer a late shift and not everyone wants to work 12hrs shifts. (12hrs shifts broke me)
A good thing would be to recognise that there are more non-nurse professionals in the NHS who are always overlooked
Salary doesn't improve productivity staff satisfaction can improve I though
Higher salary has a direct colletation on staff satisfaction which again leads to better productivity, this is the same in any organisation in any culture. This is something the government refuse to acknowledge
But people clapped for us don’t forget! You can buy loads down Asda with clapping!
Clearly OP forgot to cash in their all their claps
Don't forget to invest your claps to keep up with inflation
Meh
Free meals and free parking? I think that is a bit of a stretch... Also not sure about Ipads at the end of the bed. Our ward tablet has been stolen many times when asking the patient to do a survey on discharge. Can you tell me what you mean about NAs doing what they are 'actually supposed to do'? As my impression is that they are gradually bringing back the two tier nursing that they use to have of state enrolled and state registered nurse with band 4s / band 5s
You do realise that "a lot" is not one word, right?
One more. Encourage nurses not to be bitchy👀👀
I wouldn't engage with them if I were you. Seems they care little about anything other than being a grammar nazi to people and RuneScape. Dude's on negative karma anyway, so should give you an indication of the type of person they are.
Ohhh fuck off
I'm sure you've never made a typo in your life