Nursing in need of care

On the eve of the Royal College of Nursing Congress in Harrogate, Melissa Jackson spoke to a nurse to find out what life is really like in the frontline of patient care.

Derek Ramsay, a staff nurse in the Intensive Care Unit (ICU) at London's St George's hospital, describes a good day as being able to look after the patients without any problems.

But all too often he has a bad day, which he defines as having to move people out of ICU before they are ready, to free up beds for other patients queuing to come in.

Mr Ramsay, 30, qualified five years ago, and worked full time up until the beginning of this year - taking home £1300 a month.

He now earns £800 a month working part-time, while he studies for a law degree and makes up the rest with highly lucrative agency work.

One might assume that he is disenchanted with the nursing profession and is studying for a new career, but that is not his intention.

He loves his job and is totally committed.

Although he often feels angry and frustrated at the pressures under which staff have to work, he believes conditions are gradually changing for the better in the health service, even if the pace is too slow.

He said: "In the past we have had to move people around from hospital to hospital because of a shortage of nurses, rather than beds.

"But now if we need more agency staff we phone up and get them, whereas in the past we couldn't."

But this only plugs the hole temporarily and Mr Ramsay's great concern is that everyone on the wards is taking on more work because of chronic staff shortages.

"We are taking on more and more jobs, but we are not being financially rewarded," he said.

In the worst incidents, Mr Ramsay has seen a nurse to patient ratio of 1 to 12 on the wards at St George's.

He said: "You just don't have time to do the basics, and St George's is not the worst by far."

He added: "Staff are getting tired at work and making errors."

Weakening morale

Staff morale is also weakened by long hours. Nurses regularly working over shift without the reward of overtime payments.

They also worry about the cleanliness of their surroundings.

Mr Ramsay said some cleaning contractors are not meeting the minimum standards required, which leads to nurses taking on cleaning tasks.

He said: "There are definitely problems with cleanliness at St George's.

"We have to clean the beds down even though it's not part of our job."

Such extra tasks are diverting them from patient care, and blurring the definition of their job.

Mr Ramsay said: "The patients complain because you don't have time to talk to them and it's true, you don't have time to chat."

Anger and frustration among patients and their relatives is a growing problem as their patience is tested by the inadequacies of the health system.

Ward rage

Mr Ramsay said: "The number of assaults on staff has gone up. The attitude of relatives of patients is far more aggressive and they get angry because their mother or father has been waiting 15 hours in casualty.

"I suppose you could call it ward rage, but you can understand why they're angry."

"The government needs to look at ways of dealing with the funding problem.

"I don't have a problem with private hospitals doing work and the NHS paying, but what worries me is that they might start charging people for their food in hospital.

"And who is going to deal with the reactions? It will be nurses on the ward. The front line staff."

"There are already £2 an hour car park charges at St George's and that can mount up for relatives of a patient who needs long-term care.

"That amounts to charges by the back door."

Another concern is whether recruiting trained nurses from abroad is counter productive.

Mr Ramsay said: "I think they have to look at who's training for the health service.

"A lot of foreign nurses are coming in and they're great to work with but I wonder how long they're staying in the NHS. Is it short term?

Mr Ramsay said he would never be tempted by a job in the private sector because it would compromise his standards, but he knows of others who would.

He said: "I think morale is very low and staff feel like they're being uses as a political football."

And his advice to the politicians?

"Increase the pay. It's the only way to encourage more people into nursing.

"No-one expects to earn a fortune in public service but if they want to recruit people they have got to make a significant pay rise, comparable with other degree professions."