The nurses too busy to save a life: In this shocking – and revealing – diary, a nurse on a typical hospital ward says a lack of basic care and compassion by overworked staff is costing patients' lives
08:39 GMT, 19 June 2012
The NHS at its best is brilliant, but a new book by a male nurse claims that too often it lets patients down, not through direct negligence, but due to small omissions and a lack of care and time that, added up, can have devastating results.
Here, Michael Alexander (not his real name), describes a busy week in the large London hospital where he worked…
Like many nurses, I now find myself increasingly overburdened and do not have the time to do what I know I am capable of – and what is needed
Mr Benson shouldn’t be on my surgical ward — he has a bad case of pneumonia — but there is nowhere else for him to go.
All the wards are at full capacity. The nurse I take over from explains Mr Benson is normally independent and only needs intravenous antibiotics, so he should be straightforward to look after.
I look down at Mr Benson, who is slumped against his pillows, his chin resting on his chest. He might normally be independent and healthy, but the foul infection nestled at the base of his left lung has sapped his strength.
Mr Benson, who is 79, probably doesn’t realise he shouldn’t be here; that he should be somewhere less hurried, with the time to give him the care he needs.
‘I can’t thank you enough,’ he says to me later, as I administer his antibiotics.
‘You’re all so good to me.’
Though I am touched, I hope none of the other patients on the ward catch Mr Benson’s chest infection or, even worse, get a wound infection from him coughing and spluttering.
For not only would this be bad news for all the patients, it would stretch our already thin staff.
I am often responsible for ten to 12 patients, with just one nursing assistant to help me. Back in New Zealand, where I trained, I would usually be responsible for six.
Today, I have three patients for theatre and nine other patients in varying stages of post-surgery recovery. It is all a bit much.
The lack of nurses means medication isn’t always on time and patients aren’t always ready for their operation, irritating the surgeon by making them wait for ten minutes.
Patient hygiene isn't always as it could be: we have only two showers and neither is accessible for a wheelchair
Patient hygiene isn’t always as it could be: we have only two showers and neither is accessible for a wheelchair.
Feeding patients, walking them, sitting and talking with them are often left to my one nursing assistant, while I deal with tasks that only registered nurses can do, such as giving medication.
‘I haven’t had a decent wash in over a week,’ one of my patients, Mrs Jones, complains as I walk past. ‘When are you going to take me to the shower’
Mrs Jones is on bed rest for leg ulcers and is desperate to get out and about.
‘Maybe later this morning,’ I reply, though I know I will disappoint her. ‘It’s pretty busy.’
‘You’re supposed to change my dressing four times a day,’ Mr Smith declares. ‘It’s 11am and nothing’s been done.’
‘Sorry, Mr Smith, I’ll try to get to you soon. My patient from theatre is not very well.’
His face softens.
The patient I am talking about is Mrs Wright, who has lost quite a bit of blood and is being given a transfusion. I am supposed to check on her every half an hour, but sometimes it is nearly an hour before I can make it back.
‘My mother has been sitting on the commode for 20 minutes. This place is a disgrace,’ says the daughter of Mrs Blake, who is in for a hip operation.
‘What sort of establishment is this I’m going to write a complaint.’
‘Please do,’ I reply, as I help Mrs Blake off the commode.
There is not much else I can say — and perhaps it will help get us more staff on the ward.
I look in on Mr Benson at the start of my shift. It’s nearly lunchtime and he is still in bed. He has slid down and is hunched in a ball, his shoulders up by his ears and his head on his chest.
Why hasn’t anyone thought to get him out I suppose because no one is around to do so.
Sitting at his bedside holding his hand is another hunched figure, Mrs Benson.
‘Good morning, Mr Benson.’ He lifts his head and gives me a smile.
‘Oh, good morning . . .’
He breaks off into a bout of coughing that racks his whole body. I have a peep at his drug chart.
Sure enough, his 10 am antibiotics haven’t been given. I don’t have time to give them to him because I am overdue to check on another patient, but there is no other nurse in sight.
Back on my own side of the ward, I am running ten minutes late having decided to administer Mr Benson’s antibiotics after all.
Though I never really planned on being a nurse — at 17 I went into it because it would be a guaranteed job — I soon discovered it was so much more than just a way to make a living.
Everyone likes that feeling they get when they help someone, but I really liked it.
However, like many nurses, I now find myself increasingly overburdened and do not have the time to do what I know I am capable of — and what is needed.
Mrs Wright needs a fresh unit of blood. I notice that her pain relief, which is being delivered straight into her arm, is nearly empty and will need changing. Plus her antibiotics are an hour overdue — though an hour isn’t too bad, at least for this place.
Forty minutes later, Mrs Wright is back on track and everything is up to date.
‘Any chance you can do my dressing now’ Mr Smith asks.
No longer angry, he sounds almost resigned to his fate.
Today I have the afternoon shift, with a total of 14 patients, none of whom are Mr Benson, but I still want to keep an eye on him.
‘Can you please take Mrs Blake off the commode’ I ask Trixie, the nursing assistant.
Trixie is only 19 and in her second year of nursing school, and seems overwhelmed. I can’t help but wonder if this will put her off nursing for good.
‘Hello, Mr Benson,’ I say, as I enter his bay.
He is in a chair, but he has slipped so far down it is only a matter of time before he is on the floor. I try to lift him but he’s too heavy.
He is not a particularly big man, but he has no strength to help me.
‘I’m stuck,’ Mr Benson manages to say, before bursting into a round of coughing. He slips further down.
Today I have the afternoon shift, with a total of 14 patients, none of whom are Mr Benson, but I still want to keep an eye on him
There are no medical staff around, so I ask the lady cleaning the floors to help. She remains silent, but follows me into the bay.
‘I’m not allowed to help you lift him,’ she says. ‘I’m not trained.’
I have an ongoing battle with the cleaners in London hospitals: they aren’t allowed to clean up vomit or body fluids, and I am not allowed to use their tools (mop and bucket) — so I usually end up having to wipe up vomit with a towel.
I remember trying to open the cleaning cupboard and finding it locked, with the cleaner refusing to open it for me. I don’t know how much hospitals save by outsourcing their cleaners, but the ones I meet don’t seem to take pride in their work.
I say firmly: ‘I just need a quick lift. It’ll only take a moment. I won’t tell.’
She eventually obliges and apologises afterwards for not helping straight away.
‘The boss says we shouldn’t get involved with the patients. Legal reasons and stuff.’
When the cleaner leaves, Mr Benson clasps my hand.
‘You’re good to me,’ is all he says, succumbing to another bout of coughing.
At the start of the shift, I make a plea to the nurses to keep an eye on Mr Benson.
Everyone agrees to make an extra effort. One of them even puts in a request for extra physio.
But this patient needs more than physiotherapy. He needs to be mobilised regularly — to be got up out of bed and not to be left slumped in his chair for hours on end.
He needs his antibiotics on time. He needs to be encouraged to eat and drink. He needs what time won’t allow us to give — though we are capable of giving it — and that is basic nursing care.
In New Zealand, I developed some habits in the care of my post-operative patients that I struggle to keep up with in British hospitals.
I am used to all patients having a complete bed-wash, linen and gown change when they come back from surgery — but here, with such low staffing, I can’t always find the time, and I find other nurses feel the same.
A lot of the older nurses confide in me that they don’t get the time to do all the basic things they have been taught to do.
I suggest Mr Benson be transferred to a medical ward where things happen at a slower speed — there’s not the hurried rush to get someone to or from theatre, none of the intensive immediate post-op care.
Later, I find Mrs Benson at her husband’s bedside again, her head bowed, holding her husband’s hand in silence.
She can’t make it every day because she is unable to drive and is reluctant to use the bus because a year ago she had a fall getting off one.
She can’t afford a taxi. She has to rely on the warden from the supervised accommodation where she and her husband live to give her a lift. The warden tries to make a trip to hospital every day, but this is not always possible.
‘I’ve never seen him so frail,’ she says.
I sit down on the side of the bed.
‘We’re doing all we can,’ I tell her. ‘Can I get you anything’ ‘Tea would be nice.’
I hurry away and get Mr and Mrs Benson cups of tea.
It is the first time I have managed to sit down with Mr Benson and not be interrupted. There is work I should be doing, but it will have to wait.
Mr Benson is wheeled past me on his way back from X-ray.
He doesn’t notice me, but I grab his charts and am disappointed to see there is still a large white area at the base of his lung. The antibiotics aren’t doing their job.
Meanwhile I have to deal with Dr Hitchcock, who is straight out of Cambridge and doesn’t listen to nurses. Junior doctors like this are a danger to their patients and nursing staff.
Mrs Thornton needs antibiotics for a painful skin infection — and Dr Hitchcock has prescribed a deep injection into the thigh.
But the antibiotics can also be given via a vein: Mrs Thornton already has a line into a vein in her arm, and using this would mean there is no risk of infection or an abscess. It will also be much less painful.
Correcting the error will take Dr Hitchcock 30 seconds.
Instead, he scowls and tells me it will have to wait. ‘I’m sorry to interrupt,’ I say, as he chats to his colleagues, and point out the error.
‘If a doctor has prescribed it that way, then it has to be given that way,’ he replies.
Half an hour later, a senior doctor changes the order in an instant — and strides off to give the junior doctor a ferocious ticking off.
Hospitals have budgets to balance, though I do wonder if they've ever calculated the long-term costs… How much of that would be saved if we employed more staff and reduced workloads
Now Mr Benson has been moved to a single room near the nurses’ station. During the night he developed a high temperature.
Even before I enter his room, I hear the rattling noises coming from his chest. He is drifting in and out of consciousness.
Mrs Benson is sitting at her husband’s bedside.
‘He’s very ill,’ I say, as sensitively as I can. ‘I know,’ she replies.
She’s not crying, but the expression on her face says it all.
‘What do you really think Please.’
I can feel a lump in my throat. ‘It’s not looking good,’ I begin. ‘He could get better, but the infection seems to have spread. His whole body is battling it.’
‘Is he suffering’ she asks.
Mr Benson’s eyes are closed. His temperature is down and even though he looks horrendous, at the moment he is not suffering.
‘He’s not in pain,’ I say.
I’d like to stay with her, but I’m needed at the end of the ward.
It isn’t always like this, with vast numbers of patients to a single nurse, but it has not been an uncommon experience for me in the UK.
Hospitals have budgets to balance, though I do wonder if they’ve ever calculated the long-term costs.
I hear that billions of pounds are set aside by the Government to provide compensation for legal cases brought against hospitals by patients and their families, but how much of that would be saved if we employed more staff and reduced workloads
I often think back to a patient I treated in New Zealand.
At 69, Mr Henderson should have still had some good years in front of him, but he had a bad case of pneumonia that antibiotics couldn’t shift.
He was deteriorating fast. Colleen, the nurse who had mostly been in charge of him, was pretty upset — she was just out of nursing school. She thought maybe a change of scene would help, so we moved him into room five — the ‘room with a view’, where you could see into the local gardens and playground.
Then Colleen had an idea — take Mr Henderson, bed and all, into the garden. It was a hell of a risk to take. If anything happened while we were out of the environment of the controlled ward, we could lose our jobs.
‘Look, guys, he’s going to die anyway and he doesn’t have any family,’ she said.
‘Plus we’re not exactly busy. Imagine if it was your father or grandfather in there.’
This clinched it. So four of us — two nurses and two porters — wheeled him out.
I don’t know if it was the feeling of wind on his face, the smell of freshly cut grass or the sound of children playing, but Mr Henderson seemed to come alive.
It was amazing to watch his progress over the coming week. Before long he was sitting up, the grey pallor left his skin and his breathing became less strained.
When he was discharged, the team of doctors congratulated themselves on a job well done— but we knew it was Colleen who had made the difference.
Mr Benson isn’t so lucky. On the seventh day of his stay, he is alive, but no longer conscious.
The nurse assistant and I go to turn him onto his other side, but when we start to move him, she gasps: ‘He’s stopped breathing.’
I order her to press the alarm. I don’t want to. Mr Benson should be left to die in peace, but the choice isn’t mine to make. I begin to do chest compressions and have to clench my stomach as I feel the familiar crack of his ribs.
Two doctors arrive, plus two specialist arrest nurses. It is ironic that Mr Benson is receiving all this intense attention from so many people now when all he needed was a little attention to begin with.
It feels like for ever, but finally everything is over: the doctors are defeated and Mr Benson is pronounced dead.
Maybe he would have died regardless of the level of care. Maybe it was his time. The painful thing is that we never gave him a chance. What would have helped during his hospital stay is another registered nurse — it might have been enough to give Mr Benson a chance at survival.
It’s not always a single error that kills. Sometimes it’s a collection of problems or conditions that combine, with devastating results.
The story of Mr Benson is one of these combinations, and the story of his last week of life highlights how a health service — unrivalled in its brilliance when it works at its best — can, at its worst, result in the avoidable death of patient.
Adapted from Confessions Of A Male Nurse, available now as an ebook from The Friday Project at 2.99. The paperback version will be published in August.