It ain’t what you do, it’s the way that you do it…

It is rare that I get proper mad however this week the red mist descended.

It wasn’t the fact the whole nhs.net crashed on Monday due to some individuals hitting the ‘reply all’ button.  That actually turned out to be a lovely day of respite from the usual gazillion emails.

No, what made me mad was having to watch the total assassination of one of my senior nursing colleagues by external auditors and being unable to do anything about it.

The care of older people in hospital is regularly scrutinised.  It is something I have always fully supported. We’ve seen what happens when such safeguards are not in place (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf )

The care of older people takes a whole team of staff from housekeepers to therapists to doctors to nurses.  However it appeared that virtually none of these people were spoken to about their contribution except nursing staff.

Instead emphasis was placed on the paperwork and documentation.  I have a great deal of sympathy for my nursing colleagues in this respect.  When I do my documentation it is largely confined to one section in the case notes.  Nursing staff have page after page of documentation to complete.  This all to evidence the care they are trying to deliver. And try is the key word here.  Many wards in our hospitals run with nursing vacancies everyday.  I see my colleagues regularly in tears trying to keep up with the documentation which at times is sacrificed in order to deliver the all important care.

A report was published in the summer highlighting the problem of staff shortage. The RCN response made it clear that it is not about to get better anytime soon https://www.rcn.org.uk/news-and-events/news/urgent-action-needed-to-combat-major-uk-nursing-shortage-warns-rcn

Not all legal documentation falls to nurses to complete either.  In Scotland we have the Adults with Incapacity Act which safeguards the most vulnerable people who don’t have capacity to make their own decisions.  We as doctors will assess capacity and complete a certificate along with a treatment plan.  This treatment plan allows, amongst other things,   fundamental healthcare needs to be carried out.  These needs are defined as nutrition, hydration, hygiene, skin care and integrity, elimination, relief of pain and discomfort, mobility, communication, eyesight, hearing and simple oral hygiene.

The assessment and completion of the documentation is not something nurses can do however unless they have completed a module at Napier University (only small numbers have).

It therefore irked me even more to hear that our senior nursing staff were being held to account for this particular aspect of care without speaking to medical staff.

The visit did highlight many positives, in particular the care experienced by patients and relatives.

Afterwards I looked to remind myself of the definition of team work:

‘cooperative or coordinated effort on the part of a group of persons acting together as a team or in the interests of a common cause…’

Our common cause is excellent care for all our older people.  We do however need to reach a balance between written evidence and the kind of evidence that shines through just by looking at and talking to our patients.