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Cleverness is not better than kindness

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Amid all the hoo-ha about whether nurses should have a year of healthcare assistant work built into their contract, an important thing seems to have been forgotten.

I won’t pretend to know the first thing about how nurses should be trained, though it seems a little hasty to imply - as the government seems to - that a whole profession have lost their drive to care for patients. I’ve known some brilliant nurses, representatives from every stage of the career ladder. The era that they trained in seems irrelevant to their ability to exercise their humanity and to make sick people feel safe and well cared for.

What’s worst in all of the debate is the pejorative way that healthcare assistants’ roles are often viewed. I seem to be harping back to my hospital days a lot recently but I have to say that working on a stroke unit taught me never to underestimate the good that a healthcare assistant can do.

A lot of what we did as doctors was a percentage game – there’s an x% chance that Mrs Smith, with her AF-induced embolism, will benefit from starting warfarin. The risk of bleeds (and the hassle of the blood tests) amount to quite a bit less than x%, according to the best available evidence. So you explain this to her and her family, and if everyone agrees, she goes onto warfarin. But you never get a chance for a 100% gain.

Once, whilst standing at the nurses’ station tinkering with a drug chart, I overheard a conversation that wafted through the Ångstrom-thick privacy curtains. A healthcare assistant was attending to a gent who had suffered a massive stroke two days previously. On Monday he had walked five miles but Wednesday saw him wake up in a pool of faeces that he was unaware he had passed.

Weeping with shame, he was gulping and pleading with the HCA, ‘Please, you shouldn’t have to, it’s too disgusting, don’t. Please, leave me.’ She was calming him, saying quietly, ‘It’s OK, it’s OK, it’s what I’m here for. It’s OK.’ Gradually, the tears were subsiding as she cleaned him.

I wish I could have done something as unequivocally good as that. Perhaps I did and perhaps some of the decisions I made did stop future strokes, or lessened the impact of those that had already happened.

But healthcare assistants are not skivvies and if a task is technically simple, that doesn’t mean it wasn’t valuable beyond measure. However much our technical capabilities grow, cleverness is not better than kindness.

Dr Nick Ramscar is a GP in Bracknell, Berkshire

Readers' comments (7)

  • Well said Dr Ramscar! The majority of Health care assistants and nurses are dedicated, kind and compassionate people. Nurses and carers- post francis inquiry have had a lot of bad press. Listen to student nurse Molly Case at RCN conference, to restore your faith in human nature.

    http://www.youtube.com/watch?v=XOCda6OiYpg

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  • without going to extremes o examples, i can remember 2 very intelligent girls who worked at HCA's at the practices i worked or. One HCA would make notes relating to patients concerns and emotional state, this would greatly help all of us treat the patient holistically, especially knowing that they have seen the HCA for longer duration both over the years and on each appointment. The other i came accross was so inclusive in her practice, was ready to pick up where other doctors and nurses have left and deal with issues correctly. I think intelligence and compassion is not determined by the position you hold in health care system.

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  • At the same time I know of many secondary care nurses (especially as my wife is a nurse!) who thinks dirty jobs are beyond them (one even said she didn't achieve a degree to wipe Pt's bum), time should be spent on nursing notes rather than patient's needs, and their breaks should over ride everything else.

    Thankfully practice nurses have not yet gone through this change. Making student nurses do HCA work will not change this attitude, the whole ethos of nursing occupation will have to change. Perhaps start off by getting rid of "nurse consultants" who seems to be beyond any form of nursing work or clinical responsibility?

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  • The task of assisting someone with personal care is not "technically" simple.

    It requires a level of emotional intelligence that many doctors simply don't possess.

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  • The issue is not about compassion or the training of healthcare staff - its quite simply about dwindling resources and bulging demand.

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  • I agree that majority of nurses and HCAs do a fantastic job. However, I have personally witnessed some abhorrent behaviour of nurses whilst working in secondary care. I once walked into a ward and an elderly gentleman with diarrhoea came running to me with his IV still attached to his arm, stools running down his legs. He was pleading the nurses to clean him up. One staff nurse, right in front of the charge nurse, very aggressively yelled at him and said that her drug round takes priority over cleaning his bum. I was shellshocked.

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  • Quote from Florence Nightingale's "Notes on Nursing"
    "Women should have the true nurse calling, the good of the sick first the second only the consideration of what is their ‘place’ to do – and that women who want for a housemaid to do this or the charwomen to do that, when the patient is suffering, have not the making of a nurse in them.’

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