You know the darker the day, the more you shine

Nurses and midwives accused of serious sexual, physical and racial abuse are being allowed to keep working on wards because whistleblowers are being ignored, a damning new report has found. Staff are too scared to report their concerns to the nursing regulator because of a “culture of fear” within the watchdog, documents seen by The Independent reveal. One whistleblower, speaking to this publication, drew parallels with the Lucy Letby case, accusing the Nursing and Midwifery Council (NMC) of being defensive and trying to protect their own reputation. They claim “deep-seated toxic conduct” within the NMC is leading to skewed and failed investigations. A review of NMC guidelines was launched after The Independent highlighted concerns earlier this year by speaking to staff who complained that the NMC was leaving nurses accused of sexual assault and domestic violence free to work unchecked.

Incivility is one of the most prevalent forms of interpersonal mistreatment. Although studies have examined the full range of experiences of incivility against nurses and other hospital personnel, very few studies examined the forms of incivility that patients face in a hospital. [...]

Participants most frequently reported experiencing insensitivity (38%) or affectively negative interactions. A majority explicitly used the word “rude” to describe their interaction. [...]

When the Doctor was a smart mouth and came in and said “congratulations you have a period” it ended up being a very serious infection. [Participant 290, 27 years old, Biracial, Woman]. Participant 290’s experience demonstrates some of the potential consequences of rudeness. In this case, the doctor was not only insensitive but gave an incorrect diagnosis. In addition, participants frequently indicated how insensitivity was also communicated through a “rough” touch when the doctor was examining them. The consensus was that insensitivity—verbal and physical forms—only made the participants feel worse when they are already in the hospital not feeling well. Participants (15%) indicated experiencing rudeness because of their identities. Many individuals explained how their socioeconomic status (SES)—specifically lack of health insurance—was a significant factor in shaping the treatment they received: I had a first time grand mal seizure and wrecked my vehicle. I do not have insurance, so the hospital I was taken to was so rude. I was brought in by an ambulance, they wouldn’t give me anything for the severe headache from the wreck and also from the seizure. They wouldn’t give me anything to keep me from throwing up. The only thing they did was give me an IV of Keppra to stop the seizures. After finding out I didn’t have insurance, they discharged me within 10 minutes. They took me to the bathroom to change clothes, they met me at the bathroom door, handed me my papers and pointed me to the door. I didn’t even get wheeled out after having a seizure and a wreck…[Participant 272: 28 years old, White, Woman]. [...]

…[I] was told in plain terms that those who don’t pay for their [insurance] have no right to complain about not receiving the best treatment [Participant 47: 34 years old, Latina/Hispanic, Woman]. [...]

Participants (26%) indicated what we categorized as containing elements similar to “gaslighting” or mistreatment in which participants’ experiences were minimized, doubted, questioned, second guessed, or denied by health-care professionals. [...] …I was told I was lying about being sick. I was told that I had lost 45 pounds in 2 months because of a mild cold, and that I was wasting their time. They tried to make me feel like I was a burden, and I was taking away from other patients who they implied were sick. Turns out I was sick, and I needed surgery. Going to a hospital out of town, they diagnosed my problem within 1 visit. [Participant 275: 34 years old, White Man]

Most research on aggression in health care relates to staff experiences about patient aggression. Research on patients’ perceptions of aggressive and transgressive behaviour in care relationships with nurses is limited. [...]

When it comes to competent care, some patients told stories of how expertise of care providers was questioned. One patient described a nurse provided pain-relieving medication while he is allergic to that product. In response, the patient’s daughter attached a list to her father’s bed listing products he is allergic to. Despite this list, every time her father asked for pain relief, that same product he is allergic to was brought to him. Another patient described a nurse accompanied him for an examination. He asked where she was taking him to and when she said it was to Nuclear Magnetic Resonance, he said he was not allowed to because of his pacemaker. He indicated the nurse had not gone through his medical file and was putting him in danger [...]

Patients told stories of being ignored by nurses or not treated as human beings. One woman described the nurse criticized her for not having to have worked a day in her life because of her long-term illness. Another man described dinner was put in front of him without a single word, no ‘good afternoon’ or ‘enjoy’. Patients also provided examples of a lack of gen- uine involvement of nurses in the nurse–patient contact. Various patients mentioned they felt like a number: . . .One thing that is very annoying is when two nurses are caring for you and they are conversing with each other over your head. That’s so annoying, you really feel like just a number. . . Furthermore, various patients indicated nurses are more concerned about the way care is organized than they are about the patient’s request. Patients mentioned nurses stick to their routine and are reluctant to deviate from it. One nurse distributes medication while another checks parameters of all patients. Patients describe they cannot approach the nurse about matters that are not part of his/her task at that moment [...]

Various patients gave examples of situations where they were not acknowledged or heard with regard to their own appraisal or expertise concerning their illness and health. Patients stated they themselves felt what they could or could not do, but nurses kept emphasizing and imposing things, according to guidelines and protocols, they should be able to do at a certain point in time. Several patients felt they were not heard: . . .I had two surgeries on my back. So the first day after the surgery, they said, ‘roll to the side and sit up’, of course that’s difficult. On the second day, they demand you get out of bed. But I felt worse, I couldn’t get out. And they didn’t believe me, the nurse didn’t believe it. ‘You’ve had surgery and according to the textbook, you should be able to get out of bed on the second day’. On the third day, they made a new scan and saw that those nerves had not been unblocked and on the fourth day I had another surgery. So they don’t listen, because that’s not possible, according to the ‘textbook’ you should be able to do this. . . [...]

When patients realize it is not self-evident to receive adequate care or do not feel in competent hands, they become more observant and vigilant. Patients describe they observe nurses carefully, check their medication and ask which examinations they are having and why. The care they receive is more outspokenly questioned: . . .They came to collect me for my hip. Ah, you’ve got a scanner appointment. She says: ‘it’s an MR scan’. I say: ‘an MR scan? I can’t do that because I’ve got a pacemaker.’ And she says ‘And now you tell me?’ ‘Listen here, missy, you walk in here and tell me to come.’ You’d be in there if you wouldn’t have said something, wouldn’t you! The battery can generate voltage which could burn your heart, destroying your pacemaker. If you’re not paying attention, you’re done for. You constantly have to be on your guard. . .