'Nurses do not wake up each morning intent on delivering poor care...'

Today marks the end of Christina Patterson's investigation into the worrying state of British nursing. Throughout the week, readers' responses have been extraordinary – ranging from moving first-hand testimonies to thought-provoking suggestions for change

Poor care is due to systemic failings, not the nurses

When people discuss their experiences of poor care, there is little one can say in defence, it's their experience and no one else's. I can't deny for one moment that poor care happens. Every single instance is tragic and utterly unacceptable. However, when a problem is alleged to be systemic, as Christina Patterson appears to argue, one must look at the system and not simply the individuals at fault.

Despite political rhetoric to the contrary, deep budget cuts are being made right across the NHS. Tens of thousands of jobs are being stripped from the front line, and when nurses leave or retire, they aren't being replaced. What does this mean for the team working on an older people's ward that used to be staffed with five nurses, and now has to cope with three? It means that the 20 or so patients on the ward cannot physically get the attention they all need, that those who need help at mealtimes may not get it and that, despite the best intentions, standards slip.

The nurses of this country do not wake up each morning intent on delivering poor care – it just doesn't happen. What does happen is that systemic failings bring about individual cases of poor care. We need to openly discuss the factors that are currently making a nurse's life very difficult indeed.

Dr Peter Carter

Chief executive & general secretary, Royal College of Nursing

No wonder so many Brits come to work in Canada

After 30 years as a nurse, nothing surprises me and I know there will always be bad nurses, although happily at the hospital I work they are the exception. Part of the problem is the abysmal wages in the UK. When I saw the pay scale I understood why so many British nurses emigrate to Canada to work. The wages are appalling given the intensity and difficulty of the work and the educational requirements.

Jane McCall

Delta BC, Canada

I've had only superb care: is it because I live in a rural area?

I have been treated for two years for breast cancer by my local NHS Trust, and I have had superb care from all staff: oncologists, MacMillan nurses, nurses on the breast ward, radiotherapy centre and associated services such as X-ray, my GP, transport by ambulance or volunteer drivers, counselling, and appointment clerks.

So why is my experience so different from that reported? I believe it is because I am being treated in a rural area – Cumbria, with relatively small hospitals and clinics – not in a pressurised urban area where care is delivered via huge institutions. I don't want a Big Society, I want a Small Society, where people – professionals and patients – can foster genuine relationships in a caring environment.

Marj Waddecar

Ambleside, Cumbria

Let's build on what's good I will be retiring from the profession at the end of April after 42 years as a nurse ... It has been my privilege to have worked with nurses who are committed and compassionate, putting patient care at the heart of their decision-making. Please let's look at what's good about the profession and build upon that, instead of assuming that we all need to develop a new “culture of compassion”.

Sue Ward

Brighton

Missing managers and cliques of self-serving staff

Some practitioners have all the qualifications anyone could ask for, but lack any empathy. Some are even vindictive, as I can attest. In the vast majority of my contact with hospitals, the person in charge is never seen and does not supervise in any way. The main observation I have, though, is that most of the poor staff exhibit massively childish behaviour. My question is why these people are ever offered training in the first place, as they have no ability to deal with themselves let alone vulnerable patients. They form nasty, gossipy little self-serving cliques, and woe betide anyone who tries to enforce professional standards. I observe that hospital managers are paid handsomely. What for?

Carole Penhorwood

Bristol

A missed opportunity Christina Patterson's excellent series highlights the disaster of the abolition of State Enrolled Nurses. The NHS now relies on thousands of healthcare assistants to care for NHS patients under registered nurse supervision.

Many healthcare assistants do a great job but there is no uniform training. A healthcare assistant dismissed for poor standards in an NHS hospital one day, can turn up working in a private nursing home the next.

In the Lords, in debate on the Health and Social Care Bill, Labour Peers strongly supported the statutory regulation of healthcare assistants. This was voted down by Coalition Peers. A great pity and a real missed opportunity to boost standards.

Lord Philip Hunt

Shadow Deputy Leader, House of Lords

Care and practical skills must count for more than NVQs As a recently retired Charge Nurse, and having worked in the caring profession since the 1970s, I believe I can offer a perspective on the “crisis in British nursing” today.

When applying for a position within this field, I was able to say that I wanted the job because I enjoyed working with others, and actually wanted to help people, see their situations, and improve their recovery. More recently, individuals with career aspirations in the nursing sector are encouraged to place emphasis on the NVQ's or diplomas that they have, since managers and senior staff are primarily interested in what career paths the interviewee is pursuing.

I used to be an “enrolled nurse”, known in the profession as “the practical nurse”. Sadly, it seems that such skills are no longer valued in nursing. The culture needs to change again.

Alan Simpson

Southampton

Atomised care is a disaster Christina Patterson's series of articles this week illuminate a vital aspect of healthcare but it is a mistake to view healthcare and its problems in this compartmentalised way.

Healthcare is, or should be, an intimate commingling of disciplines and not an incoherent assemblage of entities, structures and processes. Atomised private healthcare is the perfect image of a disaster – clinically, practically, financially and ethically.

Unless and until we have a government truly committed to the welfare of the patients, the decline will continue. This excludes all three conventional parties who are united in their ambition to destroy the NHS.

Dr Steve Ford

Haydon Bridge

“A lot of nurses are scared to think outside the box”

“Nurses do care. When the press is constantly having a go, it does knock your spirits; everybody gets tarred with the same brush. I've seen bad care, but give a fair hearing to the remarkable things that are going on around the country. Knocking the NHS won't make it better. I've come across a lot of nurses who were scared to think outside the box. They were worried that if they did something off the wall, someone would clamp down on them. We need to get nurses fired up, get them to connect with patients more closely and thank them when they do a good job.”

Jill Fraser, a nurse of 30 years and co-founder of Kissing It Better, a charity that aims to improve patient care

And, from the many comments posted at independent.co.uk and on Twitter:

@witchynicky: As a nurse who trained in the 1980s I weep for my profession. Yes, there was much that was overly formal and task-orientated but we took pride in our work. I worked hard and I loved my work. As a patient six years ago, the nurses were cold and uncaring.

Robert: As a junior doctor working across a number of busy general and specialist medical wards I have been struck by the sheer volume of paperwork which nurses are obliged to complete in order to ensure their ward meets its CQC (Care Quality Commission) targets. Which seems to be a bizarre way to improve care.

Musabah67: I am a highly qualified nurse who has worked both in public and private hospitals and I was shocked by the poor standard of care when I was suddenly admitted into my local NHS hospital. The experience described in this article is similar to the one I endured and my life was only saved by the fact that I was a nurse and I knew exactly what to do.

@MariannaNodale: The point is that for one dodgy nurse, there are also 10 brilliant ones on the ward who are impeccable in their care, are sympathetic of patients needs, have an eye for detail and don't make any mistakes... Yet the 10 good apples don't negate the bad one.

@ajgaskin: Patients are only too often ready to complain but fail to acknowledge the good treatment they have received.

Martin West: I have had two operations for cancer in the last year, at different hospitals in the UK. In the first, the nurses were surprisingly brusque, unfriendly and, at times, bullies – to an extent that shocked me. In the second, they were warm, kind, compassionate and friendly, and I left feeling genuinely cared for. Two hospitals, same NHS.

Special report: A crisis in nursing

* Day One: Six operations, six stays in hospital – and six first-hand experiences of the care that doesn't care enough
* Christina Patterson: More nurses, better paid than ever – so why are standards going down?
* Leading article: What can and should be done about nursing
* Day Two: Reforms in the 1990s were supposed to make nursing care better. Instead, there's a widely shared sense that this was how today's compassion deficit began. How did we come to this?
* Day Three: How can a profession whose raison d'être is caring attract so much criticism for its perceived callousness? Does nursing need to be managed differently? Or is the answer to develop a new culture of compassion?
* Day Four: The nurses who taught an ailing hospital how to care
* Day Five: My 10-point plan for change by Christina Patterson
* 'Nurses do not wake up each morning intent on delivering poor care...'
* Anne Milton: 'We need to raise the bar'
* Leading article: Manifesto for better nursing

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