Today I have heard what can only be described as some depressing stories of nursing care being carried out in nursing homes and hospitals which seem to suggest a lack of care and an inability to want to know how to care. A colleague was recounting a story about how her husband was admitted to hospital recently having fractured his leg. He was admitted quickly, and smoothly and had surgery without problem, but afterwards when he and other patients around him needed care what was on offer seemed to be sadly lacking. At least she was able to help to wash her husband, and to bring him food that was appetising, other patients weren’t so lucky.

About 10 years ago there was felt to be a lack of nurses, this was essentially due to a fall in the numbers being trained, or indeed wanting to become nurses. Recruitment of both student nurses and trained nurses from abroad took place, and what can only be described as a lowering of entry requirements took place. This seems to have led to lower standards of care and also seems to have led to lower levels of leadership within the ward environment.

Thinking back, there have always been poor nurses around, but standards of care were determined by other nurses and to a large extent the nursing leadership i.e. the ward sister. We tended not to allow ourselves to be dragged down to the level of the lowest common denominator and we wanted to be able to provide the best for our patients. What then has gone wrong? Well if you import large numbers of nurses from other countries where they are here to earn money to send home, then they will bring with them their own standards of care, their own culture, and perhaps they will be performing their job as a means to an end. If you reduce the entry requirements for those commencing nurse training and then make it university based, something will have to give. If students are unable to be placed in a good learning environment, where care is good and people can question and challenge practice then perhaps the qualified nurses turned out at the other end will not be of the best quality. If you cannot retain your good nurses and you do not develop them into the ward sister of the future then the cycle of decline begins.

There has been much debate on Dr Crippen’s website about Essence of Care, a Department of Health Initiative started in the good intentioned but doomed attempt at improving standards of nursing (and other health) care. An essence of care folder, sitting nicely on the shelf in your office, which describes the required standards for say providing nutrition for patients will not actually make sure that someone takes the time to sit with an elderly man and help him to eat. People have to actually care about a person’s wellbeing, about whether they recover from their illness or accident without developing another one to make a difference and it is hard to see how this can be done in any other way than by good education, good role models and good leadership.

One of the reasons I left hospital nursing and became a district nurse was so that I could offer better care to people in their own home surroundings, I am bound to say that if I were to return to the front line that would be where I would do it. I really want no part in the delivery of poor care to people in large hospitals with poor management and who seem not to know how to make the necessary improvements.

The acute NHS trust in the area within which I work has 3 hospitals. It is no longer a single hospital with one set of problems it is a set of hospitals struggling to find its way through a whole lot of financial and care standard issues. Their answer will be to close 2 of the hospitals and centre care in one large sites, and mean time the PCT will take the less urgent work and provide it in small centres. This is an issue that will run on and on, and it makes me feel very sad that I feel unable to be proud of being a nurse!