Healthcare Assistant Raising a Concern: ERA

Experience

Over about two weeks on our elderly care ward, I noticed that an agency worker on regular shifts was recording food and fluid intake for patients I knew had not been helped to eat. Twice I found full meal trays returned untouched for a patient whose chart showed 'ate half'. This patient was on a nutrition care plan because of weight loss. I initially mentioned it indirectly to the worker, who said she must have mixed up the rooms. When it happened again, I told the nurse in charge exactly what I had seen, with dates, and showed her the trays and the chart from that lunchtime. She escalated it the same day. The charting was investigated, the agency worker did not return to the ward, and the patient's intake records were reviewed and corrected with the dietitian informed.

Reflection

What I have to be honest about is the two weeks. I saw the first mismatched chart and explained it away, partly because falsifying records felt like too big an accusation to hang on one meal tray, and partly because of who I am on the ward: agency or not, she was senior to me in banding culture if not on paper, and 'the HCA is questioning your documentation' felt like a conversation I was not entitled to start. What changed my mind was reframing what I was actually looking at. I had been thinking of it as a paperwork problem; the day I thought 'that chart is why nobody knows she's starving', it became impossible to sit on. I also realise my indirect first attempt was really about my comfort, not the patient's safety - I gave the worker a way to explain it away because that avoided conflict for me. The nurse in charge never once asked why I hadn't come sooner, but I asked myself, and the answer - status anxiety - is not one I want to be governed by again.

Action

I have learned to bring concerns as specific observations - what I saw, when, with what evidence - because facts gave me standing that my job title did not, and the conversation with the nurse in charge was easier than two weeks of dread had predicted. I will not use indirect hints again where a patient is at risk; they delay action and warn the person instead. I asked my ward manager to cover documentation honesty and escalation routes in our next HCA team meeting, because I doubt I am the only one who thought speaking up was above my station. And I now check charts against what I physically see at mealtimes for my patients as a matter of habit.