Throughout her time working undercover as a nurse (in the making of this Panorama programme), Margaret Haywood recorded a video diary of her experiences. She was working on Peel and Stewart ward at the Royal Sussex County Hospital in Brighton and described how it affected her personally. This is an edited version of her diary.
Margaret was a bank nurse during the months of November, December, April and May which meant that she was on the lowest grade and that her shifts were unpredictable.
3 December 2004
I've just finished a shift on the Stewart section of Peel and Stewart Ward. My general feeling about the ward is that the staff were really overworked. I think there were too many patients for the number of nursing staff.
There was only me and a senior staff nurse for eleven patients, some of whom were in need of a lot of nursing care. It was too much for two people.
There were no care plans (care plans are written by nurses and describe the patient's individual needs). There was no 'named nurse' who is specifically responsible for each patient, and I think patients would have found it hard to tell who was in charge of their care. Some of the patients hadn't had their blood pressure taken because, I think, basically, there was no time to do it. We just had to prioritise our care and do what we could and make the patients comfortable.
Generally the ward was untidy. The cleaning staff and the auxiliary staff should be doing that. I think the nurses have enough on their plates trying to care for the patients. It is such a small area as well and that makes it difficult to work. There were papers on the floor. The lockers were untidy. The bed tables were untidy. Some of the bed linen was dirty, so I went round and tried to change that.
It's a really difficult situation.
9 December 2004
Today I started at three and it was ten to ten when I finally got off the ward. I'm absolutely worn out. I've never worked so hard in all of my life.
In one bed there was a lady who had cancer of the liver and she seemed to be in an awful lot of pain. I checked her medicine kardex , (where details of a patient's medical care are noted) and discovered that she should be getting Oromorph (a powerful painkiller) every four hours. When I looked she had had some at half past one, but before that she'd not had it since six o'clock this morning which is a long time to leave someone in pain.
More seriously still, there was a lady who had no record written up of the fluids she was taking - how much water she was having. The lady was confused so she wasn't able to tell me herself. It's just basic chart filling, basic observations. I thought it was really lax that the qualified nursing staff who were on this morning hadn't filled that in. If she had got ill as a consequence it would have been serious.
I felt that the nursing standards I saw today were totally despicable. It made me feel ashamed of my profession. But I also think the hospital needs to look at their recruitment and their retention because they need more and better staff. I really can't blame nurses for not wanting to be there.
29 December 2004
In bed two today there was a lady called Jessie, who is 86 and has been in for a couple of weeks now. Her health is really deteriorating. She's got lung cancer which seems to be spreading.
What upset me about Jessie was that her mouth was really dry and sore. She had sores on her tongue which suggested that nobody had been giving her any mouth care. The corner of her mouth just started bleeding a little bit because it had cracked. When people are not eating and drinking orally that is what sometimes happens. They need what we call oral hygiene, so I had to organise that. I cleaned her tongue, with some sponge and water and then put some Vaseline on her lips and she looked a lot better then, once I'd done that.
I also helped her to have a nice wash and changed her gown as well. I changed her sheets, and combed her hair. Before that she looked unkempt as if nobody loved her and it was awful. I always think if you help people to have a nice wash and freshen them up; If you change their nightwear, change the sheets, turn the pillows over, perhaps try and get them to have a drink and have a chat to them then that helps. It can be as much as we can do for patients when they're not very well. Its basic care needs really. Her mouth being sore really did upset me. It just takes a few minutes to do that, just a few minutes of somebody's time and she even said thank you when I'd finished, so she appreciated it as well.
You know, what we've got to remember is that these poor old people are from a culture where they don't complain. They just get on with it, which makes it even more important to check on them and make sure that they're all right and just ask them. It certainly looked as if Jessie had not been cared for all day.
13 January 2005
First shift back on Peel and Stewart ward today after a fortnight's break and I can honestly say, I think it's the worst place I've ever, ever worked on in all my life and I've been nursing for 20 years now. It's terrible. Nothing's changed. There were no care plans. There were no named nurses. (The practise of appointing a 'named nurse' who will be in charge of overseeing the patient's care for the duration of their stay on a ward.)
I still don't think there are enough staff and the patients are simply not getting the care I think they deserve. Instead many were sitting in their beds most of the day in awful theatre gowns. They had no dignity, no self respect and no freedom of choice. Some who needed help to eat did not get it . Some of them were dehydrated.
I'm wondering whether I can face another shift there.
I arrived on the ward at quarter past seven this morning and found out that I was actually in charge of the ward. That meant that there was me (a bank nurse who hadn't been on duty for more than two weeks,) an agency nurse, who's new to the place and didn't know any of the patients and a student nurse who was on her first ward allocation.
The first thing which upset me was a lady who was quite poorly, named Ivy. It looked to me like nobody had been giving her anything to drink and her mouth was absolutely awful, really dry and sore. I gave her a beaker of water and she just swigged it back straightaway as if she hadn't had a drink for months and that upset me. I needed to go back every hour and make sure that she was getting fluids. I started a fluid chart, to keep account of how much she was drinking, just to keep an eye on that, and I hope it is continued on the late shift, after I had gone.
The lady in question told me that she wanted me to 'let her go'. I said: "Where do you want to go to Ivy?" and she said: "Heaven." That was an awful thing for her to say, so I just held her hand for a couple of minutes. I helped her have a drink. I helped her have a wash as well and changed her bed and sat her up a little bit, combed her hair. It was really upsetting.
14 April 2005
Before today I had been away for three months from Peel and Stewart ward. I had been told that there had been changes on the wards because of a new manager and so when I arrived I was keen to find out what these were.
However my first impression of the patient care was that nothing was very different from before. All I could do was sort of muck in and do the best I could for the patients.
One of the ladies who'd had a stroke had been given a fluid chart but all it had on it was the date. Nothing had been filled in at all. This poor lady couldn't speak because of her stroke, so sorting out the fluid recording was the first thing I had to do.
There was another elderly lady who'd been in the ward for three days now and nobody had bothered ordering her medication until this morning before I got in. Thankfully the lady was OK. But why wait for three days before you order her medication? I just couldn't believe that at all.
I sometimes just sat there talking to the patients, making them feel a little bit easier. It must be so difficult for them coming into hospital, in a strange environment, sometimes they're really frightened and it upsets me awfully, it's terrible.
I've been in a few hospitals where the care has been absolutely outstanding and what's made the difference in those places is that they've got good managers. I think it's all down to a good manager and a main nurse. Staffing levels do come into it a little bit and that is a problem here but even the good places where I've worked have had staff shortages and yet there the staff managed to deliver to patients the care which those patients deserved and needed at the appropriate times.
9 May 2005
I'm going for what could possibly be my last shift on the ward, today so I'm going to see if I can pin down the ward manager and ask her a few questions. I want to ask her what plan she's got for the changes that are needed on the wards. And I want to tell her about the bad practices that I have found - the lack of care plans, the lack of named nurses and patients' fluid charts and food charts not being filled in.
I had my chat with the new ward manager, Carol. It turns out she is well aware of the things going on there. She told me that she has been given six months to put all those things right. However she is a couple of months into that period and I think that I would have expected to see more improvements.
The fact that the hospital has taken action and appointed her and that she is aware of the problems are positive things but I think the changes, are taking far too long. At the end of the day we've got patients there who are suffering, whose needs are not being met and that should take priority.