problems with care staff

Jade Baker 16/11/18 Dignity Champions forum

I have worked in care homes for more than 10 years and have felt the changes that person centered care; the CQC; the expoding, overstreached NHS and whistle blowing policies have brought. Overall person centered care and whistle blowing are great things but like the benefit and NHS systems these are open to abuse. Care Staff! the great backbone of the caring industry and there are some good ones but also those that will abuse the system. As a nurse running a unit, I want residents to have choices and get great care but 'some' care staff just dont want to provide it and Im not sure of my 'Nurse in Charge' role anymore. I have been, and am unable to get the bad carer's who want to sit, take exceptionally long breaks and disapear to provide the care expected. I have encountered many such staff and have been able to sort things out in the past but recently I have found myself in the firing line. I have needed to disipline a few staff only to find myself on the recieving end of serious allergations made against me. It seems to me that if you upset some care staff they invent a faulse story to get you back. This story seems to be taken seriously by the home manager and then nurses just let things 'go'; so as to avoid the issue; after all we are bound by a pin number which can be lost whereas care staff can just move to another position. I want to provide the care that people need but how when I dont seem to be allowed the leadership ability to run my shift. Surely there has to be limits on voices that do not have the qualification or authorisation to do so or there would not be things like the MCA and best interests policies.

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Carol Roughley 16/11/18

Hi Jade
I can empathise with you totally, as a student nurse I witnessed abuse in a care home, that previous to my arrival had been you could say 'accepted as the norm'. I was simply horrified that anyone could perceive these behaviours as 'the norm'. Sadly, the NMC only gave a suspension of 4 months, as no previous was noted. The big ask is, was there no previous, or was the previous not reported. Well, I will keep my thoughts on that one private. I have to be honest, I am three years post qualifying, and if i knew then what I know now I probably would never have taken this path. The stress of 'doing the right thing' has often taken its toll, and if you ask me was it all worth it, my answer would be 'I am not too sure, but I would hope so'.

Neil Purcell 16/11/18

Hi jade
Firstly you have my sympathy I've worked as a auxiliary nurse (remember them ) in hospitals for 15 years 1975 to 1990 and can really emphasise with your situation it made me angry with some attitudes of collegues I worked with .I then decided I'd get myself a care support workers role in the community which I've just retired from after the last 28 years working one to one with clients.
I know it's not the answer your looking for, and have seen bad practice out in the communityalso, but enjoyed my care role not relying on anybody else.
I wish you luck .Neil Purcell

chianta williams 16/11/18

Hi Jade

I’m saddened ,but also agree that there is still people ,that are in the care industry ,behaving like you have discussed . My mother has vascular dementia and is in later stage , I am a carer of 25 yrs and decided to care for mum at home . My mother looked after her mother who also had dementia and also was cared for at home . I love my job ,caring for young adults with learning disabilities but I’m fortunate to be working for a company that does not tolerate rude , uncaring employees,( that’s not to say ,that over the years I’ve worked with such people ) I am pleased you reported them as I would of done exactly the same . Unfortunately it’s an industry that struggles to get employees and that’s why they have no choice but to employ these people who just work because they have to , and not because they CARE The government doesn’t recognise how hard of a job it really is and the pay never reflects the work some people deserve. Management of some companies reward themselves greatly , don’t look after the good staff ,so the good staff move on ,and you are left with the staff that are there for the money ..That’s the reason my mother is at mine , some horror stories are true unfortunately. I’m so sorry you have had to go through what you have been through but there are places that value people like you , caring , thoughtful and want to do the right thing.... It’s a bout time the care industry started valuing them

L Allday 16/11/18

Hi I am now a HR, Training manger in a care home and I have seen it all in the last ten years. Yes, I am not a qualified nurse, but I have my level 5 in Health and Social care and currently studying my level 6 in dementia care. I have seen abuse and reported two managers both nurses for abusing residents. This didn't help my career one bit, as some large organisations won't touch me with a barge pole.
I have changed the way I recruit, it is purely values based and the residents do the first round of interviewing then I do the second round. I keep all emails and keep a journal if needed at times on everything important that has happened with dates and times. This is invaluable if allegations are made against you.
It is extremely tough to get good staff and keep them, I have flexibilty with staff shifts some do long days, others don't. All are trained to level 2 minimum, 3 or 4, as when I was a carer some employers don't care and dont train you.
You need to do 360 appraisals where every staff member has a say on the colleague that they work with this stamps out bullying, and identifies strengths and weaknesses which I can then find training for that individual.
HR and training and development need to spend on employees to get the return, have an open culture and weed out bullies and staff who don't pull their weight. I will continue to fight for my staff to be well trained but I do know I am unusual.
I wish I could be a care home manager but 90% of jobs are unavailable as I am not a nurse.
There are awful staff in both care and the NHS not all support workers are awful. In care we go by C.A.R.E cover a**e remain employed. Keep notes on all staff if you are in a position of authority, these can form patterns and then you have the proof with dates and times.Don't let your colleagues know and it does pay dividends, I have with my notes managed to get quite a few members of staff over the years to end up leaving organisations and going elsewhere. At the care home I work at we have won more awards than any other in Essex, we have an open and honest culture and staff come to me with anything that they are concerned with. Change the culture and keep the notes, value each other and let staff know they are valued, over time it changes the workplace. I have worked at my home for 2 and a half years now. I am no better than anyone else, we are cogs in a wheel, we don't function without each other. I have an extremely happy workforce. I have an open door and staff come to me all the time every day and at any time of the day. Sometimes I wish I could be in the NHS and have a much higher position but I am not valued in my industry as I am not a nurse. Wish me luck though as in December I have been recognised for training and development of the staff in the whole of the UK (second year running), but locally in Essex I have found it hard to get a job.......... Good luck in managing the staff, honesty and openess wins in the end.


mike stone 17/11/18

Hi Jade,

I 'got your thrust' - but I'm a little puzzled by where your closing sentence 'came from'?:

'Surely there has to be limits on voices that do not have the qualification or authorisation to do so or there would not be things like the MCA and best interests policies.'

Setting aside the issues I myself have with MCA interpretation and implementation, I'm wondering why you wrote that closing sentence?

Jayne Payne 17/11/18

Hi Jade, just to say you did the right thing, and as a first year student. It provides a positive and as I would say a good example to us students to speak up, as on placements we are aware of staff, not always their own faults, but as the norms, the things they shouldn't be doing, and as students feel you may not want or feel to say something . However, taking in consideration as a student to not only to learn but to care for the patients. There's only one thing to do, and that's speak up, as most of the patients either can't or feel they shouldn"t.
Jayne(1st year Student)

Jade Baker 18/11/18

Read in the content of the letter it simple means: if I have a position of authority due to my training and job role, I should be able to manage care staff on my shift rather than them disappearing, taking long breaks and not providing the care that people need. So with reference to the MCA, I should have the authorization to challenge care staff since I have the position of authority and they do not. In other words, I have the capacity to do so because they do not have the qualification to provide nursing care. I do not think I should be challenged by care staff in a Jeremy Kyle style and then be subjected to false allegations from the said carer by the Home Manager a day to two later. Staff appear to be aware of the implications such complaint have against someone with a PIN number.

Jade Baker 18/11/18

I did not post my concerns for a debate about why I wrote a certain sentence; (Although I hope I have answered this question) I posted my concerns since I want to provide good care, hydration and nursing needs but am challenged by unruly staff. I was hoping for some advice on how to deal with it because I love caring for people with dementia but the challenges are not with them its with care staff who appear to have the authorization to say how things should be which are not in the interests of nursing care.

mike stone 19/11/18

Thank you Jade, to be clear I absolutely agree that you should not be subjected to false allegations.

However - a clinical qualification, is not in fact directly relevant to MCA best-interests decision-making [although 'clinical seniority' might be relevant to a degree].

This is one of my main issues about 'clinicians and the MCA' - put simply 'any decision which can correctly be described as 'a clinical decision' is NOT 'a best-interests decision' (and, you can state it the other way as 'best-interests decisions are not clinical-decisions' - in fact, that is the obvious way to describe the situation).

I noticed the 'caring for people with dementia' in your 18/11/18 post - the MCA becomes almost nightmarishly complex, when individuals who are living with long-term [relatively severe] dementia are involved.

I suspect it wouldn't be useful for me to further analyse the difference between MCA best-interests and phrases such as 'the interests of nursing care' here, so I'll stop at this point with the comment that unless everyone is trying to work together in the interests of the residents/patients, 'care isn't going to work': and, discussion of seemingly reasonable concerns - raised by you or by anyone else - should not be prevented.

Tania Hudson 19/11/18

It's always sad to hear of staff being dis-interested in their role as a care / support worker or not working as a team, but I don't think it has anything to do with a lack of qualifications.

Back in 1990 I desperately wanted to become a nurse but didn't have the qualifications required and failed the maths entrance exam. I went onto be a support worker with adults with profound and multiple learning disabilities and have been lucky enough to have had a dream career where I have only come across one 'bad apple' colleague wise (that is one too many though).

I pride myself on being very good at my job despite not having the nursing qualifications. 28 years later I am still working in my local council, have built up qualifications and now work as a staff trainer. I come across many excellent staff working in older people and Learning Disability services but they often feel under valued, over-worked and under paid, with few opportunities to progress (I was one of the lucky ones)

Sadly care work attracts some people not suitable for the role - surely management hold some responsibility at the recruitment stage? Value based questioning should always be used so we can ensure the right people with the right values are being employed in this important role.

Once in employment, support workers need to feel valued in the contributions they make in order to continue to feel motivated in providing the best possible care.

I recently delivered person centred training to a private care home. The staff were a mix of ages and a few came across as immature in training - chatting, messing around, giggling... I did an exercise with them on putting together a 'one page profile' for a resident they know well. They really enjoyed it and produced some amazing profiles. It was clear that they knew their residents well, including history and likes and dislikes, but argued that they would never be given the opportunity to do this 'for real' with their clients as 'management' put together the care plans.

The staff were however excited after the session and were keen to show the manager what they had produced. I chatted to the manager afterwards and did a follow up session a month later. Thankfully the manager had given each support worker the role of producing a one page profile with a resident - these were all in residents bedrooms and being used on a daily basis. The staff had also done one page profiles for themselves and these were displayed proudly in the hallway. These were being used to help match staff interest to residents.

The change around in attitude was incredible. The staff commented on how they felt valued by being able to undertake this piece of work and that their knowledge of the residents needs was recognised.

This is an excellent new guide from Skills for Care that may be useful.

https://www.skillsforcare.org.uk/Documents/Standards-legislation/CQC/Safe-staffing/Safe-staffing-guide.pdf


mike stone 19/11/18

Hi Tania,

I really liked your comment at 19/11/18 above - if this were Twitter, 'then I would retweet it'. Lots of excellent points, well explained.

Kameliya Hristova 01/12/18

Hi all,

Reading the discussions and the experience I have make me so sad that it is ok for people who don't care but are there only for money to be in the industry. It is just not right.
I am a HCA and work with DU agencies who come to assists. Majority of them neglect and ignore the client. They cook for themselves, make a cup of tea and sit behind the client to enjoy it. But they don't offer anything to the client. They are rude and rough, having very poor hygiene standards etc. My agency does not support me at all. I had to find and changed 2 of those "care agencies", I had to deal with many institutions to try and help my client. On the other hand my own agency is sending the same type of carers to cover me for my week off (the package is live in 2 weeks on/1 week off ). My client is not happy and phones my agency afterwards to request another person for next time. They send a new person, but yet the same ignorant, neglectful and not skilled. This leads to my client been depressed, tearful and wanting to give up. On the last meeting at her home a clinical nurse made her cry and feel ussless a few times. In the end she said that their carers are trained and professional, but I have very high standards and it will be impossible to find her someone like me. But isn't the high standard a REQUIREMENT for a carer?! And now, last week they called me to let me know that they are removing me from the package and they informed her as well. I can only imagine how much they broke her heart as she told them many many times that if they remove me-she will simply give up, as no one looks after her as me.
I feel hopeless that the agencies who employ the carers are careless and abusive themself and I am expecting them to deal with this type of so called carers.
How can we change this? What can we do to influence and change the standards to be as they should be? I am affraid that we might need service at some point of our lives and I do not want to receive this service.

Susan Simmons 04/12/18

I cant understand why people do not want to enhance another persons life, not just in the care profession but in general, what has happened to our human kindness have people just become so selfish that they cant think of others and empower people who are vulnerable to be in control of their own lives.
I don't have a solution to it, its a sad day when services cant be the best as the norm and carers just don't care anymore.