I Wouldn’t Trust Them With My Dog

A couple of posts ago I gave a little rant about how I don't think that 'free market' systems result in a better health service. I have another example.
I was working in another area a little while ago, and while there got sent to a private nursing home. The patient was given to us as '80 year old female with difficulty in breathing'. We arrived and saw what looked to be two nurses having an animated discussion in the main foyer.

Grabbing our equipment we followed one of the nurses into the depths of the home, and were shown to the patient's room.

The patient was very much dead.

Also in the room were four nurses. They were standing around and they weren't doing CPR, they weren't breathing for the patient. They looked at me for guidance.

I immediately switched into commanding mode. “Why isn't anyone doing CPR?”, I asked.

“We were”, one of the nurses replied, “but I saw you coming in the mirror and stopped”.

The mirror was positioned so that if she had been doing CPR, she would have had to have eyes in the back of her head to see me coming.

When someone isn't breathing you have to breathe for them – this is the 'ambu-bag' that TV doctors put over someone's face and operate by squeezing the bag. It forces oxygen into your lungs. Unfortunately the patient had a normal oxygen mask on her, which would bathe her face with oxygen, but wouldn't get the oxygen into the lungs where it needed to be.

The patient was also lying on an air mattress, which would have meant that any CPR which may have been done would have been ineffectual because you need the patient on something hard so you have something to push against.

I felt the jaw of the patient – rigor mortis had already set in, so there was no point in attempting to continue any resuscitation attempt.

Someone had tried to take the patient's blood pressure, as there was still a BP cuff around her arm.

As is usual in these cases where we know or suspect that care has been…shall we say…lacking, we offer the services of the LAS to teach the nursing staff more effective resuscitation skills, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It's free to them although I don't think we get any extra money from the government to run it.

The nurse in charge (who was busy photocopying in the office while all this was happening) refused.

So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, run by staff who don't want their staff to improve. This despite a number of suppliers who are all in competition with each other – it's a lucrative market providing elderly care.

35 thoughts on “I Wouldn’t Trust Them With My Dog”

  1. You're right. I wouldn't trust them with my dog.I have had an almost identical situation. I walked into a job that was actually given as a Cardiac Arrest to find two nurses desperately trying to take a BP. When questioned why they said that it was the first thing that they did to any patient who was ill. However in the case above the patient would have had a chance if they had started CPR. They were not long down and were in VF.

    I despair at some of these “qualified” nurses I really do.

  2. The thing we need to know isn't so much who was running the care home, but who was paying for the care of this patient? Whoever it is needs to stop buying care from incompetent suppliers, if they don't then they're indicating that this 'service' is what they want; and they'll continue to get it.

  3. the problem is everywhere. having been in most, if not all, the homes in my area I cant think of one where i'd want my loved ones to end their days. It seems that employment criteria include the traits of apathey and neglect. Not once have i seen even the simplest of first aid procedures being done, other than the applicationof a bandage.A personal gripe is the way that they will leave an 80 something person on the floor and call a blue light responce rather than go down the hall for a hoist. I've actually been told “why should we, thats your job”. No its not!!

    Arrrgh, makes me mad!!

  4. My Nan ended up having to go in a home as unfortunately the family were no longer capable of giving her the level of care that she needed, even with good support from local social services and home visit nurses. They looked carefully at all the homes and found the best nursing home in the area (supposedly capable of providing medical care). She didn't last much longer. This may sound cruel but I'd rather risk loosing my parents sooner than force them to eek out a few more months in one of those places.

  5. From a completely different perspective (i.e. economics rather than health care), what you describe here and in your previous rant, which if I remember well was nicked by some newspaper (for good reason, cause it was a great piece), is really of great value in the debate over privatisation, over the assumed benefits of the private market, over the role of the State, etc. In economics, models attempt to describe reality, people get so focused on these models they fail to realise that they attempt to reresent reality, but are not reality in itself. Descriptions such as the ones you offer (at a 'micro level' as an economist would proably put it) shed light on aspects which constant wrangling over economic models will never address. Please continue giving us and the world outside more of this – would you consider an 'Open Letter' to the Secretary of Health (or whoever sits in the Parliamente who is responsible for health)? I think they would listen.

  6. There is a 'joke' that you can get a nursing certificate in South London markets for 40…It's a damn shame, and very much against the 'proactive/research based/reflective/advocate' role that the nursing profession tries to promote.

  7. The way I see it is this – if a 'client' is in a nursing home then the Social Services can cross them off their list of people who need a place. Hospitals can be as bad, for long term patients (the rather unflattering 'bed-blockers') there is often a big push to get the patient back in the community.There are a shortage of beds, so the purchasers are happy to buy beds off any supplier.

  8. It's not cruel – I also want my mum to live a good long and healthy life. I also want her to die quickly.I may have to arrange this.

    Though I'll have to wait until she isn't strong enough to lift the pillow off of her face…

    Mum reads this – Hi mum! Only joking…promise…

  9. Published in a paper…naughty naughty…as they never let me know, depends on 'fair use' though.There is a big difference between theory and reality – at least on our front line. But as I said in the earlier post – I am not an economist, I'm just a taxi driver.

    In a week or two I'll have a week off work, so I might do a couple of 'open letters' as a sort of theme. Good idea, thanks.

  10. Nurses have to reregister every three years – you have to prove that you have worked 'X' amount of hours and have undertaken 'Y' amount of further training/update.All you have to do is sign a piece of paper attesting to this fact.

    Note – this may have changed, when I get closer to re-registering my nursing I'll have to ask.

  11. I'm sure that's true, but the private care homes industry tends to lay the blame at the door of the public sector buyers not wanting to pay for a decent service. The best ref I can find in a couple of minutes is this one from BBC Wales.

    You can see the same problem more clearly in things like hospital cleaning and, moving off healthcare, school dinners. In each case the problem is that the public sector demands just 'cheap' rather than 'cheap as possible while still being good'; it's no surprise when that's all it gets.

    IMHO, of course 🙂

  12. I went on eBay and typed in 'nursing certificate and found a 'RED CROSS NURSING PATIENTS STAMP FDC CERTIFICATE CARD' from Taiwan for 4.57. Cheaper than the East End.

  13. It reminds me of the old Soviet Union, where the staff behind store counters would sit and read magazines while customers waited patiently in long lines. The staff were paid whether they waited on people or not, so why bother?It's the same here, isn't it? Profit says hire the cheapest staff. So long as the staff don't a) annoy the boss, b) do badly enough to cause lawsuits, c) cost money in the form of taking time to–what ARE you thinking!–learn stuff, so long as they don't do any of that, no problem. They get paid, they don't care. Given the atrocious work environment, only someone who doesn't care can work there.

    Interesting comment earlier about the difference between theory and practice. When there's a difference, theory is supposed to be adjusted to fit facts. Any economists listening?

  14. dog. i didn't know you had a dog, it's never been mentioned before i don't think – who looks after it while your on shift, whats its name?i'd report the f****rs to the NMC, the Nurse in Charge may not be struck off, but it would certainly make them think.

    (NMC = Nursing and Midwifery Council, who job it is to protect the public from Nurses like this, though it you talk to a lot of nurses them seem to be under the misguided though that its there for their benefit) you can visit the website, and check on someone registration details too, at http://www.nmc-uk.org.

    you could also report them to the Commission for Social Care Inspection at http://www.csci.org.uk

  15. Okay there were things incredibly wrong with this situation – such as why they lied about doing cpr, why they thought an oxygen mask was a good idea when the patient wasn't breathing – BUTtwo things I want to query: firstly, rigor starts within 3 to 12 hours of death – why *would* they be doing cpr? (this also raises questions about the 999 call, as I'm sure you didn't take three hours to get there!)

    Second, I wonder if it's less likely that a patient would be resuscitated in a nursing home, given that the home deals with old people dying all the time? I mean in the respect that people are dying of old age (sorry, I'm not managing to word this very well!).

    I'm not defending these nurses' actions, there were clearly some very bad mistakes made, but we do seem very quick to condemn them

  16. what i forgot to mention, is that not all “nurses” are Registered Nurses, and therefore covered by the rules and regulations of the NMC, but the Nurse in Charge, definately will be if its a Nursing home. Our code of Conduct places, firmly on the RN, to ensure that no act or omission on their part harms the patientThe Nurse in Charge if reported is in deep doo doo

  17. My mum just got her bumph through from the UKCC (or whoever it is now) She's retired, but can remain registered as long as she completes X number of hours 'education and training' and pays a fee.

  18. if you alledgedly “lie” about something like no doing CPR, but saying you did do it, what else are they lying aboutthe NMC code of conduct is very strict on lying, its a big no no, it does untold damage to the trusting relationship that an RN has with the public, and there is never any excuse

  19. that is a very good point – and in this case I really can't understand *why* they did it. If the patient was already starting with rigor, then cpr would be useless, and an RN would know that.*thinks about this for a moment*

    Yep, they're utterly useless.

  20. Well….The nursing staff told me that the patient had died in front of them, yet the jaw _was_ stiff. The patient was also in asystole.

    My guess as to what happened was that the patient died sometime before being discovered, and the nurses – not understanding rigor mortis would then start CPR.

    Or the jaw may have undergone a weird muscular spasm peri-death, as there wasn't a huge amount of gravitational pooling.

    Either way – I happen to think that the nurses didn't tell us the whole story and were trying to cover their backs.

    I've also left some details out of the post for confidentiality reasons.

  21. I don't have any pets – I used to own a dog, but the title of the post is just a phrase us Eastenders sometimes use.I'm fully aware of the NMC, I have to keep giving them 80 (or something) so I can remain registered as a nurse – but I didn't know about CSCI, so thanks for that info.

    The thing is…I'm not sure how impressed our management would be if we bypassed them and went straight to the regulatory people. I'd be doing our management out of a job and doing something involving another agency that they wouldn't be aware of.

    When I've put in complaints beforehand – our managers refer it on and I get a little feedback on what has been done to rectify the problem.

  22. A patient spilt a load of milk in the back of the ambulance (I didn't cry over it), so we got to go back to station to mop it out before it turned to cheese.I left all those comments while we were waiting for it to dry.

  23. Makes me FURIOUS.I was struck off from nursing for caring too much for my patients, whistleblowing and when I read about situations like this, which I have experienced and know it still happens, it makes my blood boil.

    'Nurses' should think long and hard about what the word, nursing ie: dedication, humanity and professionalism, in no particular order actually means.

    Well done Tom as always.

    Glenda

    gggggrrrrrrrrr

  24. i was being a bit tongue in cheek with the 1st comment.i has gone up matey, they will now sting you for $129 for 3 yrs, sorry US bought laptop, that i can't find the pound sign on. but if you have to re-register from now on, its payable on a yearly amount.

    it saddens me deeply, that these people are out there, it also frightens me even more, is that this isn't restricted to just nursing homes, there are hospitals with staff, i wouldn't allow to look after my shopping.

    there definately has to be more emphasis on training, and sadly the mind set in management is, well we'll react to it, not be proactive to it.

    *gets off soap box, and goes and has a cup of tea*

  25. same same, amazing the number of breathing/chest/confusion probs that are resolved, or the patient knew nothing about, by the time we get there. we're supposed to adopt, by law, the lifting policy of the home, but- i'm not going to leave someones granny on the floor while this is resolved, just wish the carers cared.

  26. ah, thanks for that, Tom. It's a strange situation, whatever happened. I'm guessing the coroner will need to be informed if it's a sudden death?

  27. So sad. So outrageous. So common. So wrong. The rigor is a thumping great clue isn't it?In addition to the CSCI there is also the Health Care Commission who could be made aware of things to pay attention to on their next visit / inspection.

    I'll be going for euthanasia if I make it to old age, rather than be surrounded by apathetic incompetents whose lack of social skills are only beaten by teenagers working in electronics superstores (no eye contact, boredom, insouciance). Grrrr indeed.

  28. Good great leaping gods. I am so glad I work in trauma hospitals in surgery. I would trust any of my fellow RNs to do CPR on me. I know because I have run codes with them.Although, if I were 80 and living in a “home” I would hope for a “slow code.” But preferably not out of incompetence and disinclination.

    You just can't force anyone to Care.

  29. I wouldn't trust 'em with a Gerbil, I got a job as “male unwell” in a nursing home to find a man in CCF lying flat on his back on the floor. None too impressed, I asked how long had he been like this, they told me over an hour! When i asked why they had n't called earlier, they told me the photocopier had broke so they had to write his notes by hand. I think I said a bad word (under my breath).

  30. I've been told by a GP that a number of patients in care homes starve to death; they're either physically unable to feed themselves, or too demented to remember. Staff put food in front of them. Patients do not feed themselves. Patients starve to death, because no-one has the time or inclination to feed them. And that cause of death is almost never listed as starvation because the acute cause of death is something different, but something that has been exacerbated by not being fed.My mother has proposed to jump off beachy head before being put in a care home.

  31. actually I know several teenagers/early 20s who, after getting very bored with their cashiers' jobs in Game or Dixons or wherever and being qualified for not much else, have gone into care work.The one who really bragged about having landed on his feet was a 21 year old lad who was getting paid 7 an hour plus expenses to “befriend” a 16 year old girl with cerebral palsy. Or in his terms – playing on the playstation, watching films, going down the seafront, to the cinema, whatever he felt like doing, as long as he included her. Don't get me wrong, she had a great time, in that respect it did everything it was meant to do. The job came to an end when her parents moved away from the area. But if there had been any sort of crisis or even minor problem, he would have been the biggest wet lettuce you ever did see. He'd have probably grabbed the nearest passerby and gone “help! can you do something about this?” and then run home to his mum.

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