In 2013, it will be mandatory for all newly recruited nurses to have a degree. It will not be possible to enter the nursing profession by any other door. Suddenly it is upon us – health care assistants will be the most significant workforce in hospitals and care homes. At present, it is estimated that there are over 700,000 practising HCAs in the UK, but, as they are not registered or regulated, the number is not really known. Their training has been insufficient, to say the very least, yet they will be the ones who do the basic bedside nursing that is the foundation of nursing care, as anyone who has suffered long-term illness or debility will tell you. It is also, for this reason, the most noble.
Doctors come and go, but nurses or care assistants are always there. All the high-tech, multi-drug paraphernalia in the world is as nothing beside the human need for human touch and contact – which is what good bedside nursing is all about.
We can prolong life for decades, and resuscitation is fast becoming the norm, and all these people will have to be looked after. The decisions are made by government think tanks, by teams of professors at the British Medical Association, by ethics committees consisting of philosophers and theologians and senior judges. But having come to their conclusions, and issued their reports, they can walk away from the problem. They don’t have to do the work. The work is left to care assistants, who receive barely a living wage for work that is arduous and demanding, and for whom the strain can sometimes be insupportable.
We are a rich nation, and like all rich nations we need a subculture of underprivileged people to do the dirty work that we would not want to see our sons and daughters doing. Much of the work of care assistants falls into this category, and they are the ones who will look after us in our old age. It is worth remembering that, when our faculties, our senses, our mobility and our organs fail us, health care assistants will be more important to us, and have far more power over us than doctors.
Let me end this chapter by reproducing some of the NVQ introductory literature, which can be obtained online. It is addressed to prospective health care assistant candidates at the initial entry leveclass="underline"
NVQ Care Programme Information Pack
There are no academic qualifications needed to be a care assistant. All care assistants are expected to undergo a twelve-week induction programme [this is frequently not observed -author’s comment]. Direct experience is not necessarily required for the job, but it is useful to have some experience in working with people. Care Assistants are in high demand and it is relatively easy to get a job. The main employers are social services, hospitals, private or NHS nursing homes and agencies.
Personal skills: Care Assistants need to have excellent interpersonal skills and the ability to work with all kinds of people in situations which can be stressful or emotionally draining. More specifically they should have:
A friendly approach and the ability to put clients at ease, whatever their physical or social needs
The ability to be tactful; and sensitive at all times
A good sense of humour
A high level of patience as shifts can be long and often stressful
Excellent communication skills
The ability to deal with aggressive or anxious clients
A certain level of physical strength
Good stamina
The ability to stay calm under pressure
The ability to think quickly and solve problems as they arise.
Working Conditions: Care Assistants usually work shifts, which means their hours and days of work vary from week to week, and may include night shifts or weekend work. Shifts can be long and demanding, so care assistants need to have good stamina and both physical and emotional endurance.
The contempt with which this hedonistic society looks upon simple virtues is reflected in the pay reward. We offer care assistants £11,000 a year: that is £5.70 an hour, with no guaranteed sick pay, holiday pay or maternity leave, and no guaranteed pension.
Would you, the reader, do it? Could you? Would you advise your son or daughter to become a health care assistant?
Truly, truly, I say to you, when you were young you girded yourself and walked where you would; but when you are old, you will stretch out your hands, and another will gird you, and carry you where you do not wish to go.
— St John, ch.21, v. 18
1968
CONGESTIVE HEART FAILURE
The year was 1968, and I was night sister of a small provincial hospital. I walked into the ward, and there he was – Dr Conrad Hyem. We recognised each other instantly, though it had been many years since the night in Poplar when we parted. No doubt we had both changed. I was a married woman in my thirties with two children. And he? Well, he was very much changed. He looked frail, sitting up in a hospital bed, breathing with difficulty a bluish tinge around his nose and lips, and an anxious look in his eyes. The ward was quiet after the daytime bustle, and peaceful. A single light glowed above the bed of the frail old man suffering from congestive heart failure. I went over to him, sat on the edge of the bed, and took his hand. He squeezed it, and a crinkle in the corners of his eyes showed his pleasure.
‘Jenny Lee,’ he whispered, ‘after all these years … I have not forgotten you. How could I? And now you come to me when I am dying. You are thrice welcome. What a happy chance.’ He sighed with contentment, and squeezed my hand again, such a weak little squeeze. ‘A happy chance.’ He looked up and smiled once more.
The effort to speak had made him breathless, and he leaned back on the pillows panting, shallow breaths, his nostrils dilated with the effort to take in more air. An oxygen cylinder was beside his bed, and I turned it on and placed the mask over his face. He breathed the life-giving gas for a few minutes, and then pushed it away. I adjusted his pillows, and he leaned back comfortably and closed his eyes. I whispered: ‘I must go round the wards and see my other patients, but I will come back; be assured of that.’ He nodded and smiled and patted my hand. ‘Jenny Lee,’ he whispered, ‘a happy chance.’
A hospital is a lovely place to work in at night. Staff is reduced to about ten per cent of the number required during the day and there are no routine admissions or discharges, no routine surgery, no moving of patients to special departments for treatment, few telephone calls. All is quiet. I refer here to the general wards of a hospital, and not accident and emergency, where day can blend into night, and night is usually more hectic than day.
I went quietly around the hospital, taking the night report from each nurse in charge, seeing a patient here or there, checking a drug, adjusting some treatment, mentally noting this or that to be checked on the next night round, and then returned to the male medical ward, where I sat in the office reading Dr Hyem’s notes. Congestive heart failure was the diagnosis. Long-term diabetes, for which condition I had treated him in the first place, had caused generalised atheroma of the arterial circulation (atheroma – from the Greek for ‘porridge’). Just as a plumber may say, ‘Your central heating won’t work because the pipes are all furred up,’ so it is with the circulation. The arteries become congested and the heart, which is the central pump, gets weaker and cannot work properly.