When the NHS was born in 1948, I fell in love with it. I had been a cadet nurse for two years then and knew all too well how terrified some patients were, because of the cost of being ill. But we did our best to make their stay in hospital as safe and comfortable as it could be.
We worked incredibly hard to keep our hospital clean, using aseptic techniques as well as a great deal of elbow grease. We scrubbed everything. When a patient was discharged, the bed was scoured from top to bottom, including the mattress, to make it fit for the next patient.
And we scrubbed ourselves too. We washed our hands 40 or more times a day. We changed our uniforms if the slightest smear of blood or other body fluid marked it. We never left the hospital in uniform, never wore makeup and had to manicure our fingernails every week, without polish of course, for which sister inspected us each morning. And we never had any cross-infection among our patients.
And now? Nurses no longer scrub and clean patients' equipment and - dare I say it - themselves, as we used to. There are no longer scary sisters or all-powerful matrons with the power to insist on the rules of cleanliness for all, including ward maids and orderlies who did even more cleaning than we did. And now there is a great deal of cross-infection, some of it capable of killing patients.
The medical acronym MRSA, which once meant nothing to the average person, is now making people in this country even more terrified of going into hospital than they were in pre-NHS days. I caught the infection first when I had knee surgery a while ago, and was terrified I would lose my leg. Later, during a very severe illness due to a failed anaesthetic, I discovered by accident when I was transferred after four weeks in intensive care to a high-dependency room that my door was labelled MRSA, although I was never told I might have picked it up in intensive care.
I am now free of the infection (glory be, there is one remaining antibiotic that can deal with it), but all this has made me think. I now see why a bacterium that has inhabited this planet since well before we evolved, and will no doubt still be here long after we are extinct, has become so fearsome. It is partly because nursing has lost its way.
Nurses are now trained in universities, with occasional forays to hospitals where they only observe, never work. So new nurses with university degrees come on to the wards with much less training in bedside care and aseptic techniques than we had. I have lain in bed waiting for my dressing to be done and seen a nurse who has a BSc arrive with sterile packs of instruments and dressings carried in her bare hands, rather than on a spotless trolley. And then she put the packs down to be opened on my far-from-aseptic bed.
On one occasion when the surgeon came to remove the stitches from my knee, he was accompanied by a trained nurse and a nursing student there to watch. My soiled dressing was removed, the wound fully exposed, and he started to take out the clips. The pain made me thirsty and I asked the student for water.
"Certainly," she said, and passed a full to slopping-over glass directly between the surgeon and nurse across the supposed-to-be aseptic area of my wound. And neither of them said a word to correct her. So I did. I told her why what she had done was wrong, and she said: "Thank you. No one ever told me that."
These trainees and newly qualified nurses clearly need mentors to teach them the techniques that kept the hospitals of 50 years ago so clean and safe. Some of the healthcare assistants on the wards who do the bedside nursing, such as washing and feeding and dealing with lavatory needs, could also benefit.
Who is to give it? The answer is easy. Throughout the UK there are many nurses trained, as I was, to be scrupulous about asepsis, who gave up work to rear their children. They should be coaxed back to our hospitals to fill the yawning gap between academic nurses, who have to spend more time pen-pushing than giving patient care, and the less-informed healthcare assistants. They need to be given a grade and a salary commensurate with their value and an assurance they won't be snubbed or intimidated by people with degrees but a fraction of their know-how. The result will be happier patients, better trained nurses and assistants and, above all, a big decrease in hospital infections.
Beverly Malone, general secretary of the Royal College of Nursing, thinks it "a brilliant idea" and will support it in every way she can. What do readers, especially nurses trained in the pre-university days, think? Let me know and maybe we could start something that would at last remove MRSA from the fears too many patients suffer today.
· Claire Rayner is president of the Patients Association
clairerayner@harrowhill.demon.co.uk
