Every graduate nurse is the same aren’t they? So excited about finally being able to make a proper hospital bed, practise your skills on a real human and to see things that you couldn’t be taught in university. I was lucky enough to land my grad position in a large, busy public hospital on a surgical rotation – just what I wanted!
My ward was brand new – the facilities, equipment and surrounds were amazing. My team was large and supportive, readily welcoming six grad nurses with open arms and sharing their wealth of experience. I spent six months working in Theatre, rotating through the OR, anaesthetics and recovery. My naïve grad eyes saw more of the inside of the human body, and more things done to it than I thought were possible. I was in awe of this amazing new world I had found myself in.
The next six months were spent on a surgical post-op ward, where I revelled in dressing wounds, removing staples, inserting this tube, that tube, and more tubes, and mastering the art of cannulation. There was never a senior nurse far away when you were in need of help, and time-management was a breeze with our organised, well-staffed ward and relatively low-care patients. My favourite memory is the day I spent hours just sitting with a palliative patient and talking with him as the afternoon sunshine streamed in the windows.
I announced to my colleagues at the end of that year that I was moving to London for my next adventure to nurse, live and travel. I had a serious case of wanderlust; I was young, and I thought that i’d seen it all. Surely nursing was going to be just as incredible in the UK, but with the added bonus of being able to travel to Paris on my days off?
My colleagues warned me, “Nursing is not the same there! The conditions are terrible. Are you even registered with the NMC yet?” The last answer was a definitive no. The bureaucratic nightmare of having to convert my registration had been dragging on for months now, with no end in sight. It should have been my warning signal.
I landed in London on a beautifully sunny day in late January, and for the first few weeks relished being away from the constraints of parents, employment and responsibility. As my funds quickly diminished and I worked out that London was a very expensive place to live, I contacted the nursing agency I had registered with and started work as a Healthcare Assistant (HCA). My registration could not be converted due to my university course’s lack of paediatric and obstetric training, and so working as an HCA was the closest to nursing I was going to be able to get whilst in London.
My first shift was in private home-care, assisting the live-in nurse to care for an older gentleman with severe confusion, agitation and who was a high falls-risk. Transfers were done manually, with not a slide-sheet, hoist or pat-slide in sight. Our client had been incontinent overnight, and the nurse had clearly made no attempt to clean him, or even turn him, during the night.
One of my jobs was to assist with the showering, but the client became severely aggressive during this time. Everything was an immense struggle, and the sheer blasé nature of the live-in nurse astounded me. She showed absolutely no compassion, empathy or care towards her client, and the pressure areas and stale smell of human waste in the client’s room were indicative of a lack of caring on her behalf. When the client was finally settled downstairs for his routine of sitting in a chair and eating, the live-in nurse left for some respite, and it was my job to clean the house.
I vacuumed, polished silverware, scrubbed the bathroom and put the washing on. I was also ordered by the wife of my client to make tea and serve it to her at a certain time every morning, which very quickly became additional care as it was clear this woman was frail, confused and a falls risk also.
And so another day, another shift manually lifting, cleaning houses and dealing with pressure areas, confusion and aggression…
Coming on in the morning was always hard, as more often than not the live-in nurse had done little-to-no care overnight. It was always smelly, tiring and overwhelmingly upsetting to see the clients in the state (both physically and psychologically) that they were.
Aside from the private home-care, I also worked ten to twelve hour shifts in a variety of clinical settings, ranging from public and private hospitals, through to hospices and abortion clinics. I came onto a shift one morning in one of the major London hospitals to find that the majority of the patients had not been given their medications overnight due to insufficient staffing. The staff ratio was two Registered Nurses for over thirty patients. Several of my patients did not have any pillows due to a shortage, and had slept on rolled-up blankets – or nothing. My ward in Australia had pillows for every patient as a basic comfort, and enough staff to more than fulfil the one to four ratio. The differences were completely shocking to me.
I’m sure it couldn’t have been universal, but a lack of care always seemed to linger in the practice of the nurses I worked with. I just couldn’t understand why nurses in London just did not seem to have the same kind of values that had been so present in my colleagues in Melbourne.
The final straw for me came when I commenced a morning shift at another of the major hospitals in London, and saw something that would cement my opinion of nursing in the UK for good. An older lady, recovering from hip surgery, who could not speak English well, was desperately calling out for attention. Her daughter was there too, also trying to attract the response of the staff. As I approached the patient, the smell hit me like a train. It was clear that this woman was in need of personal care. Her daughter said, “Please, you must help us. My mother was incontinent last night and no one has come to clean her. I can’t move her on my own.” I rolled the woman over, and to my horror, she was completely covered in her own excrement, from the backs of her knees to her hair.
I asked the daughter, “How long has she been like this?”
“About ten hours,” was the reply.
Hilary Bush is a registered nurse who trained and works in Melbourne. She currently works as a Nurse Planner and the Online Education Manager at Ausmed Education. She enjoys actively contributing to the advancement of nursing professional development in Australia, as well as developing and evaluating engaging continuing education activities for nurses worldwide. Hilary is currently undertaking a Master of Education (Educational Management) at the University of Melbourne.