A conversation with a nurse revealed the dire state of care for elderly patients on her ward.Jayne Lingard wonders why she feels she can do nothing about it

It was lunchtime at the conference and I asked my neighbour where she was from. 'Oh, I am just local, ' she said, and explained she was a nurse working on a general elderly ward. She was attending the conference on dementia because her manager could not make it.

I asked if the ward practised person-centred care. 'No, ' she replied. 'In fact we do not really practise anything.'

The ward had 29 beds, and patients of all different ages and needs. The patients just did not get a good deal and she often did not get a break.

'Things have changed in the past few years, ' she continued. 'A man used to come round with papers, but he's stopped coming. Occupational therapists used to visit the ward and go in the kitchen with the patients, and a lady used to come and do a little bit of keep-fit with them.

'But That is all stopped now. What upsets me is that the families of the patients get angry with us because they can't see what benefit their relative is getting. One lady - she was 50 - was admitted to us after a stroke. They told her she would get intensive physio. Intensive physio? We have one physiotherapist to 29 patients. She'll be lucky if she gets 10 minutes a day.'

I asked the nurse why she thought things were so bad and whether the senior nurses were to blame.

She didn't really know.

'Our G-grade sister - she does everything she can, but the problem is beyond her. Even the I-grade can't sort it out. The bed manager just keeps on sending all these different people to us. You see, they are closing the hospital down.'

But that was not until 2004 and this nurse was worried about the people coming for care now. She had much to say that would help to improve things.

She thought there should be some way people could express how they felt - especially if they were feeling like leaving.

But if you said anything you were seen as a trouble-maker. She had seen it happen: 'Everyone agreed that something needed to happen, then everyone kept quiet except one person, and they made mincemeat out of her. It is not worth it. People are frightened for their jobs.'

'Who is this 'they'?' I asked.

'Well - the management, I suppose. There used to be a Mrs Widget. She and I did not see eye-to-eye.

She was quite a dragon. But she used to come on the wards and knew us all by name. This new manager - the one who didn't come today - you never see her. She's always in this or that meeting.'

The nurse herself was thinking of leaving: 'I love being a nurse. I think I know what it means to really nurse people properly, but here you can't. You just have no time for the patients and there is nothing else for them. Before, about four or five years ago, you could think: 'Oh well, the newspaper man will be round soon, or the keep-fit lady will be here to cheer them up this afternoon, or the OTs will come and do some crafts.' But now, nothing.

'The thing is, It is all written down. If you read what we are meant to be doing, you would think it sounded great. But It is not happening. It is not getting to the patient.'

I asked who would care about what was happening if she left. 'Caring doesn't make any difference, ' she replied, 'It just makes you ill. You have to shut off. But I hate it. I wake up in the morning and I do not look forward to work at all. I used to really enjoy my work, but now they just say there is no money for anything.'

The healthcare assistants had asked for promotion to a higher grade, but had been turned down, she said. They were getting towards retirement and should be feeling that they had done a good job and might come back to do the odd shift.

'But they just can't wait to finish. They say they will never set foot in the place again.'

The nurse sighed and stirred her unlovely lunch. I asked her who the chief executive of her trust was.

She knotted her eyebrows in concentration, and admitted she didn't know.

I said I felt she should be using her knowledge and experience to improve the situation.

Nodding in agreement, she slumped back in her seat: 'Yes, but what can I do? What can I do without risking my job?'

Well, what can she do? Answers on a postcard please. Avoid any use of trite words such as Investors in People, strategy, matrix management, or staff involvement.