BRITAIN’S biggest nursing agency is hiring out nurses to hospitals despite complaints that they are incompetent or even mentally unstable.
The British Nursing Agency last year earned £55.2 million from the National Health Service by supplying temporary staff to fill the gaps in rotas left by the increasing national shortage of full-time nurses.
The agency, which has 155 branches around the country, is the biggest player in a business which has boomed since the NHS was reorganised along market lines.
As the Guardian revealed last week, the service last year paid out £216 million to agencies such as the BNA . In 1993 the bill for this casual labour stood at £106 million.
Now, an investigation by the Guardian has uncovered alarming evidence that one of the BNA ’s biggest offices, in Leeds, has supplied unsuitable and unqualified staff and that patient care may have suffered as a result.
Our evidence shows that the agency:
Repeatedly took casual staff who had been rejected by one employer and then recycled them to other employers who were unaware of their track-record;
Supplied a care assistant who had given a bogus identity, making it impossible to check his background;
Gave work to a registered general nurse even though he was on its national list of personnel not to be given a job under any circumstances;
Supplied an auxiliary who falsely told colleagues he was a qualified nurse and who started administering drugs to patients.
An incident on the geriatric ward at Seacroft hospital in Leeds last year highlights the problem. The hospital contacted the agency for a nurse to work on the ward, which was short of staff. To begin with, the nurse tried to take a patient’s blood pressure, failed to get a reading but nevertheless recorded a figure on the patient’s chart. Then, as the sister in charge, Chris Smith, recorded in an official report: ‘She proceeded to spend the rest of the time preening herself in front of the mirror.’
The situation remained calm until the agency nurse announced that she needed to go to the toilet, whereupon she sat down on a patient’s bed and urinated on the bedclothes. Sister Smith recorded: ‘The patient noticed this and questioned the nurse, who ignored her.’
The nurse was seen later wandering around the ward in her petticoat while her soiled uniform dried on a radiator. Sister Smith sent her report to the agency with uncompromising advice: ‘I feel that this nurse should not be allowed to return to Seacroft hospital and leave it in your hands regarding her other areas of practice.’
The Guardian has established that the BNA continued to use this nurse and sent her out to nursing homes, where the complaints about her were not known.
The agency insists that it has not breached its procedures in any of the cases discovered by the Guardian. BNA staff say that the agency is highly commercialised and that administrative staff can earn bonuses by selling extra shifts to clients. The Leeds office was named recently as the agency’s best branch.
The Guardian has documented a catalogue of worrying incidents there. Many involve the ‘revolving door’ policy for staff who have been rejected by an employer.
For example, it is more than a year since the BNA in Leeds was warned of the problems of a casual worker we will call Staff Nurse X. She was variously described as unsuitable, not conscientious and lacking in motivation.
The BNA last week claimed that after receiving a complaint, it stopped sending Nurse X into hospitals. Our evidence shows it did so repeatedly.
Her behaviour included sleeping on duty, reading magazines instead of working, failing to help in a medical situation when asked, calling patients names, and refusing to give drugs.
After a series of complaints, Nurse X was barred from the Leeds Teaching Hospitals Trust. Yet the BNA kept finding her work. She is recently reported to have been working for the agency in nursing homes in the Leeds area.
The BNA last week told the Guardian that its internal quality standards ensured that staff guilty of questionable conduct were taken off its register and not allowed to work for it again. ‘We have a clear complaints procedure and if we find through the process of that investigation that there is some question in terms of professional conduct then we will not work that nurse again.’
The same point is made by national guidelines issued by the Department of Health. There is clear evidence, however, of a revolving door for rejected staff at the BNA ’s Leeds office.
The agency redeployed a nursing auxiliary even though St James’ Hospital described her attitude, reaction to constructive criticism, communication skills and relationship with colleagues as poor, adding that her work was very slow and that she had failed to warn nurses of a patient who was hypertensive. The BNA has since sent this auxiliary to work with frail and elderly patients at Seacroft hospital.
In another case, an auxiliary nurse sent for a BNA shift at Wharfedale hospital in Otley behaved so strangely that staff decided he must be drunk and sent him home after only an hour. The charge nurse reported that the auxiliary had ‘no clue: he seemed unable to understand instructions, said he had never made a bed before, pulled the covers off one bed and left them on the floor’. The BNA ’s Leeds manager, Jean Quayle, responded in writing: ‘I can assure you the person will not be sent into the trust again.” The Leeds office has since sent this person to work shifts at St James’ hospital, part of the other major health trust in the city.
Another BNA worker was said by her supervising sister to have been rude and aggressive, to have shown no motivation, to have produced poor work, displayed no skills and to have sat on the ward reading a Bible making bizarre comments about evil. The sister told the BNA not to send her back. The agency sent her to another ward at the same hospital.
Following the Guardian investigation, the BNA conducted an internal audit of decisions at its Leeds office.The agency acknowledged that it had recycled rejected staff but nevertheless concluded: ‘We are happy with the processes that happened in these cases.’ The agency argues that a worker who fails with one employer may nevertheless succeed with another.
In addition to the revolving door, BNA staff claim that new workers have on occasion been used without their references being checked. The BNA denies this. In the case of nurses sent to work with children, it is now a legal requirement that the police are asked to review their criminal records.
Staff say that there have been occasions, while waiting up to six weeks for the police reply, when they have sent nurses out to work, for example, with adolescents who have learning difficulties and who are deemed to be particularly vulnerable to abuse.
The difficulties in checking the background of temporary staff were highlighted by the case of an African care assistant who presented himself at the BNA with a Dutch passport. By the time that BNA staff recognised the man in a police photo release of people with false passports, there had been complaints about his work in hospitals. He disappeared.
The Guardian found a string of examples of the agency inadvertently supplying staff who were unable to do the job: a novice nurse who lasted only 20 minutes on a ward for the severely mentally ill; a young nurse who bullied elderly patients; a psychiatric nurse who was placed on a medical ward; an auxiliary who ’spent most of the shift standing around looking lost’ and who told staff she felt she had been sent by the BNA to ‘make up the numbers’.
The BNA does have internal systems which are supposed to protect hospitals against unsuitable workers. The most stringent of these is the ‘pink list’ which is circulated to every BNA office in the country, naming personnel barred from all BNA work. The Guardian has obtained details of two recent cases in which procedures appear to have collapsed with the result that workers who were supposed to have been barred permanently by the BNA were nevertheless booked on shifts by their Leeds office.
The pink list which was circulated last June named a registered general nurse as ‘a person not to be registered with BNA ‘. He had been the subject of a complaint about the wrongful administration of drugs.Nevertheless, in August, BNA ’s Leeds office booked him to work with elderly people in a nursing home in Douglas in the Isle of Man. Staff alerted Ms Quayle, who contacted the nursing home and sought a reference for the nurse from the people already employing him.
The nursing home matron provided one, adding, however: ‘I feel it pertinent to re-iterate that I have only known him for a very short period of time and, therefore, can only base my responses on what I have seen so far.’ The nurse who had been barred insisted that the complaint against him was a misunderstanding.On this basis, the nurse was removed from the pink list. Asked about this, the BNA denied the story, claiming that the nurse had not been ‘booked and paid’ by the BNA since March 1997.
This was misleading: the nursing home in the Isle of Man checked its records and confirmed that the barred nurse had been booked to it by the BNA in August 1998. Unsually, however, he had then been paid directly by the nursing home instead of his money being routed through the agency.
At about the same time, the Leeds office was dealing with a troublesome nursing auxiliary. Last May, he was accused of stealing £20 from the canteen till at Wharfedale hospital. He claimed it was all a misunderstanding and was allowed to continue working at the hospital.The next month, the health trust called in the police after discovering that the same BNA auxiliary had persuaded colleagues at Wharfedale that he was, in fact, a qualified nurse and not merely an auxiliary, and had been administering drugs to patients even though he was not qualified to do so.
At the BNA ’s Leeds office, Ms Quayle responded by writing to the trust to report that the auxiliary had admitted his actions. ‘I told him this was totally unacceptable and that I had no alternative but to take him off BNA ’s register immediately,’ she said. That letter was written on July 6 and yet, according to the auxiliary’s worksheets, less than three weeks later the BNA booked him to work a shift at St James’. The BNA last week claimed that the auxiliary had not worked this shift through it.
Health managers say the BNA has enjoyed a good reputation among agencies, joining national working parties to produce better practice. At the Royal College of Nursing, management adviser Sally Taber said she was surprised to hear of the Guardian’s discoveries.
‘It’s obviously unacceptable,’ she said. ‘We do not condone bad practice. The problem is that everybody is working under extreme pressure because the temporary workforce are providing more than the 999 cover that they were set up to provide. Because of the nursing shortage, they are actually providing more of a permanent workforce.’
