Dangerous practice on mental health units ignored

Dangerous Practice and ‘whistleblowing’

Dangerous practice on our mental health unit was ignored on more than one hundred occasion. And that was just the incidents I knew about.

Take Perry, my former dangerous ward manager, from my previous post. He’d been working with a patient (Craig) who had schizophrenia and was struggling with telling his parents he was gay. Craig regularly told staff he was feeling lonely and really anxious, and we all knew how vulnerable he was. So what did Perry (our manager and Craig’s nurse) do?

After noticing that Craig had missed counselling twice a senior nurse, Mal called to see if he was okay. Craig said didn’t feel so good but he didn’t feel comfortable coming to the ward any more and asked to meet him elsewhere.

When Mal returned to the ward he informed the team that Craig had been on holiday with a member of staff but he didn’t want to say who. This member of staff had tried to engage him in some sort of relationship but Craig hadn’t been interested. There was a falling out after this and Craig reported spending the last three nights wandering the streets, afraid to return to the hotel.

It wasn’t difficult to put 2 and 2 together as Perry had returned to work a darker shade of pink than normal and his hair a paler shade of ginger.

Mal was the same grade as me so he should have been the person to speak with Perry or someone more senior but he refused to. So, now the whole team knew — yet nobody felt comfortable raising or reporting the incident.

Raising concerns

All NHS trusts and primary care organisations in England must have a raising concerns policy. This policy will include the type of concern you can raise, how you can raise it, who you can raise it with, and your organisation’s commitment to supporting you through the process.

Unfortunately, despite all the available policies, there was a culture of ignoring or dismissing concerns within our unit. And much of the time managers turned a blind eye. I know! I’d previously relayed concerns to my managers or modern matrons who chose to look away when:

• I mentioned one nurse’s regular drug errors and was told “Oh, look, she’s been here for years and that’s just the way way she does things sometimes.” Right, that makes it okay then?
• a male member of staff helped a patient back into bed one night after she’d fallen out, but didn’t call the doctor to assess the patient. In the morning, it was clear that the lady had actually broken her arm, and she’d been left in pain all night. When I mentioned it to our manager he shrugged his shoulders “she’ll live.”
• another manager would allow staff on night duty to sleep for 2-3 hours but I was instructed to “ignore it, he’s the manager and if it’s okay with him……” Really? Until there’s an serious untoward incident (SUI) or fatal accident.
• or when I told of my manager giving out whole boxes of unsubscribed medication, his boss (a Modern Matron) asked me “are you trying to get him sacked so you can have his job?”
• and when I eventually had to inform a senior Director of the above, he huffed “Look, now you’ve involved Daisy, the modern matron, it gets difficult….. Just leave it with me.”
• Eventually, during a counselling session (organised by the Director) between me and my manager, the therapist asked me “Why does all this bother you?”

Should we dismiss concerns

Look, we all make mistakes and I’ve made many. I made a drug error once but I noticed quickly and let my mentor know immediately. I followed the 5 rights of medication administration before completing my documentation and an incident form.

I’d given the patient the right medication but at lunchtime rather than in the evening. It was a minor mistake, in this instance, and easily rectified.

However, the above incidents were neither mistakes nor minor errors. Some would be classed as critical incidents or SUI’s and could have been fatal.

I was starting to think I was going mad. I couldn’t be the only one who had concerns about the above behaviours? Why did nobody want to deal with it? It seemed the further up I went, the more they tried to dismiss any concerns.

I mean we all knew who was sleeping with who on the unit, literally. Yes, some colleagues did have clandestine meetings in various offices on the wards. And, of course, some were married — to other people i.e. someone in or outside the unit. Where these people were having relations with their lovers colleagues, it made it difficult for them to address any concerns appropriately.

So, what should I do? Ignore it, don’t pass concerns on, and dismiss them as some sort of eccentric nursing foibles? Should I just allow vulnerable patients to be taken advantage of?

Shut me up already!

It was horrible. All I wanted was just to do my job. I didn’t want to have to deal with senior nurse’s poor practice or other people’s bloody extra-marital affairs.

These damn situations were making me anxious because I couldn’t ignore them and just couldn’t shut up. I wish I could have. But I loved working with patients and I cared about them and what happens to them. Why would I ignore poor practice?

It was wrong. So wrong. And it was unfair to expect me to turn a blind eye! It was unethical, immoral, unprofessional and not just poor but dreadful practice. Every time I witnessed bad practice, I completed electronic incident forms as soon as possible after the act, and before I was told not to. That way, at least there was a record of everything.

Understand when and how to escalate a concern

NHS Employers say “If you are unable to raise your concern within your organisation, or your employer has failed to adhere to policy requirements, or the issue you wish to raise is so serious that there is a wider risk to patient or public safety, you may need to escalate your concerns to a prescribed body.”

It goes on to say “Prescribed bodies do not have the power to investigate individual concerns but can hold organisations to account in meeting their legal responsibilities to address concerns appropriately.”

Heaven forbid I went down that route?

It’s not how it should be, but can you imagine if I’d escalated my concerns outside of the Trust? I wish I’d had the courage to report it to the newspapers — now there’s another post – honestly, it’s just reminded me of an incident!

Over to you

I’d be really interested to know what you think about any of the above incidents and how you might have dealt with them. Trust me though, it’s not as easy as the policies make it out to be. Would you want to be that person at work?