Why nurses are no angels

The public loves them. The Government wants to give them more power. If only you knew what nurses are really like, says Dr Lucy Chapman

"Sorry, Sister. Sister?" The nurse at the desk looks up reluctantly from her magazine and fixes me with a dead-eyed stare. I was paged to come urgently to this dark and unfamiliar ward, and have left a sick patient in casualty.

The telephone conversation had gone like this: "Hello, this is Lucy, the on-call doctor. You paged me." "Yes, we have a patient here, very anxious." "Right, is there anything else wrong with them?" "Very anxious, doctor. Bed 18 - you know her?" "No, I'm just the on-call doctor. What is the patient in hospital for?" "Just a minute, doctor..." [Sound of nurse wandering off, wait two minutes on phone.] "She had abdo pain. You are coming now?" "I'm a bit stuck with another patient down here. Are her pulse and blood pressure normal?" [Huffing sound as the receiver is clunked down on the desk again, wait another two minutes.] "BP low, 80/40, patient is anxious."

I go immediately upstairs to the ward and then wait, pressing the buzzer repeatedly for several minutes. I'm new here, and have not been issued with a swipe card. It's dark inside and I can see nobody through the glass door. Eventually, a patient limps slowly around the corner and lets me in. In her bed, I find an elderly lady who speaks no English, gasping for breath, distressed, in a cold sweat and critically unwell with heart failure. Her neck veins are bulging in time with her racing heart-beat and her lungs are water-logged. The pulse, blood pressure and oxygen saturations have been grossly abnormal since the beginning of the night shift, and have not been measured for two hours.

The most worrying explanation for this clinical picture is that the patient has had a heart attack at some point in the evening. I quickly site an intravenous line and take some blood, sit her up, put an oxygen mask over her nose and mouth and go in search of a nurse. Having found one, sitting at the other end of the ward with a copy of Heat and a cup of tea, I enquire after the nurse who originally called me. "She's on her break," says this nurse, and resumes reading.

By now I am struggling to keep my temper. "OK, is there anybody who can help me? I need the ECG machine, and someone to get some diamorphine, frusemide and GTN out of the drugs cupboard." In the end, I have to leave the patient to fetch the ECG machine from another ward myself, and it's another 10 minutes before the requisite two nurses can be found and organised to go through their checking protocol in order to get the drugs out of the locked cabinet.

It is an open secret that the standard of nursing in British hospitals is poor, at least in the inner cities. But nobody ever says so in public, and certainly not in print. To do so as a young female doctor is disastrous. Unsisterliness and medical arrogance, real or imagined, make an explosive combination.

I have worked with many excellent nurses: people who take pride in their work, who value the business of caring, and who are expert in the ward management of patients in their speciality. Mainly they are nurses of the old school who have declined the move into hospital management. Safety, cleanliness, comfort and dignity are the basics of proper patient care, and if they are not attended to then the medicine means, and can achieve, nothing.

Sadly, excellent nurses who choose to stay working on the ward are the exception rather than the rule. In my daily working life I encounter far too many unmotivated, off-hand people who seem to be unable to differentiate between life-threatening scenarios and simple patient requests, who vanish whenever a patient is incontinent, who spend their days bleeping the doctor with every little thing and then writing "Dr informed" in the notes, before going to tea, satisfied that their problem is now safely my problem. Worse, if the problem appears to be routine rather than life-threatening, even after a lengthy conversation I can never be confident of it, and have taken to getting them to put the patient on the phone instead.

At the other end of the spectrum are senior nurses who have become managers, pushing through government targets, harassing junior doctors into making hasty decisions inside a tight time-frame in A&E, managers who are in charge of which patients can and cannot be admitted because of bed shortages, and ultimately in charge of budget allocation in the hospital.

Experienced nurses have also been given extended clinical roles so that I frequently get officious calls from people who introduce themselves not as nurses but as practitioners with the outreach team, or the appropriately named pain team, to inform me that one of my patients has a fever and needs certain blood tests, or telling me what medicines I should prescribe and in what doses. Not having asked for their opinion and being rushed off my feet - doing my own job as well as trying to compensate for the deficits in basic ward care - I sometimes ask if they could possibly take the blood themselves. "No, that is not my job," is the stock response (Dr informed).

For a government keen on targets and paper achievements, supporting the political advancement of nurses makes sense. The Secretary of State for Health, Patricia Hewitt, announced earlier this year that nurses are to be given the power to prescribe all medicines, as well as full responsibility for diagnosis, treatment (including surgical operations) and discharge of patients without supervision from a medically qualified person.

A little knowledge is a dangerous thing - although, as the above scenario demonstrates, not quite as bad as no knowledge at all. You can see that this proposition does not fill me with confidence. Would you take a flight in hazardous conditions if you knew that the pilot was actually an air-hostess who had watched quite a lot of pilots at work?

The Government's current whirlwind of reform is producing a range of new managerial and specialist clinical roles for nurses. What is not being addressed is the real problem: a lack of competent senior nurses who can lead by example, educate their juniors and even maintain some standards of cleanliness and discipline on the wards; a lack of people willing to empty bedpans and to take old ladies to the toilet in time.

This continual drain of knowledge and experience from front-line care, allied with the rush to privatise and subcontract "services", means that patients are put at risk, and not always treated with the dignity they deserve. Routine patient care and monitoring are now delegated to healthcare assistants who have still less training and receive still less pay, reinforcing the notion that caring is a lowly occupation, that - unlike capering around with a stethoscope - caring is women's work, and unworthy of remuneration.

As a society we bear collective responsibility for disgracefully undervaluing the difficult and important work that nurses do. We have patronised them with a pittance for so long that we cannot be surprised if some of them take no care or pride in their jobs. But the solution is not to patronise them further by allowing them to pretend to be doctors without the requisite knowledge or training. It is to accord caring work its proper value and pay nurses accordingly.

Nurses with stethoscopes might be convenient for the Health Secretary - medicine on the cheap - but they are not safe. If nurses want to be doctors they can go to medical school, but if they are motivated, intelligent people who really care about patients, we need them to nurse.

Lucy Chapman is a pseudonym. The writer is a junior doctor working in an inner-city NHS hospital

Healing hands: doctors vs nurses

NURSES

* Nurses can become qualified within a minimum of three years' training.

* Newly qualified nurses begin on a starting salary of around £14,700, whereas nurses in the very highest brackets can earn up to £59,000 a year.

* Nurses usually work between 37 and 45 hours per week, often including weekends and nights.

* There are currently 682,220 registered nurses in the UK.

* Nurses' powers have recently been extended, giving 7,000 nurses the right to prescribe all but the strongest drugs to patients.

DOCTORS

* It takes five years to complete a medical degree, followed by two years as a house officer and then further specialist training.

* House officers (newly qualified doctors) start on a salary ranging between £20,295 and £22,907.

* Trainee doctors' hours are notoriously long and irregular, but employers are now legally prohibited from making them work more than 56 hours per week. These often include night shifts and weekend work.

* The UK currently has more than 150,000 doctors.

By Abigail Outhwaite