Poor care in nursing- or any other care professions- in all establishments, has always existed (Dimon 2013) and will always be a potential problem that all staff need to know how to address. This is due to several factors including socio-political, neoliberalism, attitudes, low staffing and poor resources. Poor care exists on a continuum from unintentional to intentional. This is evidenced by blogs, research, NMC or coroner cases. Unintentional refers to errors such as drug errors, or well meaning staff who oppose the rights of the patient for outcomes determined by the professional. Intentional includes such as physical abuse- slapping, or verbal-swearing. The occurrence of this does vary between types of care. For example in specialist units such as ICU, there may be clinical errors rather than such as, leaving patients in wet beds or shouting at them. Reasons for this may be various, such as the higher attention paid to ICU patients, rather than continuing care of vulnerable patients including old people or mentally ill. There are of course, higher staff levels on specialist units with more qualified staff. Of course such units may face short staffing, if people are sick for example, but they are usually given the priority when moving staff from other units.
This is all regardless of who owns the establishments. However, there is evidence of deliberate shorter staff levels within private equity owned care homes (Fernandez 2012) . Indeed there is also a higher use of overseas staff within the private sector who are cheaper and complain less (Duell in Dimon 2013)
The training of overseas staff when arriving in the UK, is another factor. Indications are that it is inadequate (Dimon 2013) and cultural attitudes do of course differ (Jewkes et al 1996). Whilst this is an early reference, few authors write about this issue but it is supported by several blogs. There are a few articles highlighting further attitude differences, such as (RCN ) attitudes to pain relief between cultures (2003 in Dimon 2013) . Also attitudes towards older people , or restraint are addressed within other articles.
Mee (2013) discusses well, the issue that nurses need to take responsibility for their own actions , describing the situation of two adjacent wards, being very different regarding quality of care. This situation has been described to the authors, by several care assistants, who also are aware of possible reasons why. He also discusses attitudes of staff, and the willingness, or ability to oppose authority. Mee begins to do what is required- an analysis of the actual major incidents and why they occurred- not a whitewash of short staffing.
The excuse of “short staffing” is used as a smoke screen for poor care; primarily triggered by the RCN who aim to maintain nurse and HCA members, and avoid upsetting the profession. “We must only write about good care” they declare.
Of course we cannot dispute in anyway, that low staffing (which may occur unplanned), DOES cause poor care by for example, omitted aspects of care such as baths. It does not excuse however, swearing at a dying patient who was incontinent in bed (just one reported case). Nor does it excuse locking patients in a care home, in a “dungeon” (Gregory 2013).
There are so many factors involved. We really need to look at the issue of why we fail to accept that poor care in essence, does occur, even without short staffing. This tells us a lot about the issue. Is it fear of admitting? Loss of professional reputation? Loss of business? Guilt? Or is it the difficulty of the aspects- that so differs between cultures regarding expectations and acceptance? This has vast implications if people will address it- far wider than the issue of care or the NHS hospital ward. Indeed, unless there is a research reference for the existence of poor care, despite blogs and complaints, many fail to accept it.
This is a plea to focus upon “poor care” as the issue- and not “low staffing”.
Lenin Nightingale. Carol Dimon
Dimon C (2013) The commodity of care Cloister House Press
Fernandez E (2012) Low staffing and poor Quality of Care at Nations For Profit Nursing Homes UCSF Nov 29
Gregory A (2013) 7 workers ‘arrested’ after dungeon found in care home. mirror.co.uk 23.10
Jewkes R, Abrahams N, Mvo Z (1998) Why do nurses abuse patients? Soc Sci and Med v47n11 p1781-1795
Mee S (2013) Is workplace culture an excuse for poor care? Nursing Times 109;14-16 5 April