Want to fly into a violent rage? Or bang your head into a wall over the fact that some people have no clue? Read some of the comments here.
There was one good comment.
I haven't yet had the balls to look at the daily mail and their readers take on all this.
Thursday, 19 November 2009
Thursday, 12 November 2009
You will Need a Degree to become a Nurse
We just had a death in the family of the canine type, I have been reading BBC have your say, and I am in a real bad mood.
When I was overseas many patients would throw their registered nurse out of the room if she didn't prove on the spot that she had a university education. "Are you a BSN" "No sir I trained under the old diploma program" "Then get the fuck out of my room lady". Sad but true. Our older nurses are some of the best simply because they have decades of experience behind then and have proven that they have the tenacity to hang on in this hell profession. But people over there seem more switched on and seemed to have more of an understanding of what a nurse actually is. People in the UK do not understand what a nurse is.....
The old ways of training turned out good nurses for their time. The nurses that trained that way who are still practicing are excellent. They have decades of experience behind them and have grown with the changes. If you tried to train today's nurses like that however you would increase hospital mortality rates. The old training would not suffice now. As someone who has a strong desire to live and who will be a patient some day I have thought about this a lot.
I would thr0w a caring and empathetic nurse who couldn't get through pharma maths at Uni out of my hospital room . I don't give a goddamn about how caring or empathetic you are. I want to stay alive. If you are a caring and empathetic but not that bright I have less chance of surviving my hospital stay. I hope you are caring but first and foremost I want you to be on the ball because I know how much information you will be analyzing and how fast you will be moving and it is scary. I say this as someone who has been a nurse for well over a decade. I say this as someone who has seen patients die because their caring nurse was off helping hand out commodes. I say this as someone who wants to live.
Let me link to it again in case ignorant sickos like Jeremy "But what about the caring"Vine happen to be reading. It's all in the link...just scroll down. Or google nurse education and mortality rates.
Research has shown over and over and over again that hospitals that have a higher proportion of well educated nurses on staff providing direct patient care have higher survival rates.
If I had a registered nurse caring for me who didn't catch onto the fact that I was going into renal failure or was pre -arrest because she was lovingly off somewhere else bathing and making cups of tea for her other patients I would get her sacked and get her license revoked. I would also have a strong desire to beat her to death with a hammer.
Actually I suppose my next of kin would be handling that because I would be either in ITU as a result of failure to rescue before the problem got to big...or I would be in the morgue. If my nice caring but not so bright nurse doesn't catch onto my deterioration in condition who will? Anyone who is an RN will find himself alone with a large group of patients and no back up other than untrained carers. The carers won't catch onto my change in condition unless it is blatantly obvious. When it is blatantly obvious it is too late. This is why the nurses need to stay on task with assessments, labs etc. The docs are NOT around to do it, they won't do it and the nurse will take the heat over any failure to rescue screw ups. This is real life not television where the docs are always around the patients and the nurse is just their assisting. That is not real life.
I swear to god that if I , as a patient, caught my RN making tea and making beds rather than dealing with the things that the carers cannot help her with I would be on her ass like flies to shit. I want to live. So should you. The older trained nurses we have now have been around the block about a 1000 time and done a lot of continuing education. They certainly know what they are doing. Don't worry about them. What I am afraid of is a 19 year old here in 2009 who wants to be a nurse getting trained like they did in 1972 and then getting thrown onto the wards in the current situation.
Here is the BBC article you have all probably read. I have been in mourning so I am behind with all this.
Here are the fucktwits on have your say.
I am in two minds about nurses being required to have a degree to qualify.
Let's talk about the pros first.
First of all a hell of a lot of research has shown that the patients of well educated bedside nurses have higher survival rates. Anyone who qualifies as a nurse will be thrown into a situation where he is own his own dealing with complex stuff, making life and death decisions and having to think fast on his feet with no second chances almost immediately upon qualifying. He will have to handle all this whilst getting interrupted on every 30 seconds or so throughout a 12 hour shift. Support? What a fucking joke. He will be the lone RN for a large number of patients with only untrained care assistants to help. This is how it's been for years. The matrons sure as hell won't come any where near the wards and it will be rare for our newly qualified hero to be on duty sharing a patient load with another qualified nurse to guide him. This is how it has been for years and it is getting worse.
Why are people in this country so silly? Why do they seem to have a death wish? If you don't think that your RN needs to be well educated as well as have a manageable number of patients you must have a death wish. You must want to die. You certainly don't really understand what a nurse actually is.
When I was overseas many patients would throw their registered nurse out of the room if she didn't prove on the spot that she had a university education. "Are you a BSN" "No sir I trained under the old diploma program" "Then get the fuck out of my room lady". Sad but true. Our older nurses are some of the best simply because they have decades of experience behind then and have proven that they have the tenacity to hang on in this hell profession. But people over there seem more switched on and seemed to have more of an understanding of what a nurse actually is. People in the UK do not understand what a nurse is.....
The old ways of training turned out good nurses for their time. The nurses that trained that way who are still practicing are excellent. They have decades of experience behind them and have grown with the changes. If you tried to train today's nurses like that however you would increase hospital mortality rates. The old training would not suffice now. As someone who has a strong desire to live and who will be a patient some day I have thought about this a lot.
I would thr0w a caring and empathetic nurse who couldn't get through pharma maths at Uni out of my hospital room . I don't give a goddamn about how caring or empathetic you are. I want to stay alive. If you are a caring and empathetic but not that bright I have less chance of surviving my hospital stay. I hope you are caring but first and foremost I want you to be on the ball because I know how much information you will be analyzing and how fast you will be moving and it is scary. I say this as someone who has been a nurse for well over a decade. I say this as someone who has seen patients die because their caring nurse was off helping hand out commodes. I say this as someone who wants to live.
Let me link to it again in case ignorant sickos like Jeremy "But what about the caring"Vine happen to be reading. It's all in the link...just scroll down. Or google nurse education and mortality rates.
Research has shown over and over and over again that hospitals that have a higher proportion of well educated nurses on staff providing direct patient care have higher survival rates.
If I had a registered nurse caring for me who didn't catch onto the fact that I was going into renal failure or was pre -arrest because she was lovingly off somewhere else bathing and making cups of tea for her other patients I would get her sacked and get her license revoked. I would also have a strong desire to beat her to death with a hammer.
Actually I suppose my next of kin would be handling that because I would be either in ITU as a result of failure to rescue before the problem got to big...or I would be in the morgue. If my nice caring but not so bright nurse doesn't catch onto my deterioration in condition who will? Anyone who is an RN will find himself alone with a large group of patients and no back up other than untrained carers. The carers won't catch onto my change in condition unless it is blatantly obvious. When it is blatantly obvious it is too late. This is why the nurses need to stay on task with assessments, labs etc. The docs are NOT around to do it, they won't do it and the nurse will take the heat over any failure to rescue screw ups. This is real life not television where the docs are always around the patients and the nurse is just their assisting. That is not real life.
I swear to god that if I , as a patient, caught my RN making tea and making beds rather than dealing with the things that the carers cannot help her with I would be on her ass like flies to shit. I want to live. So should you. The older trained nurses we have now have been around the block about a 1000 time and done a lot of continuing education. They certainly know what they are doing. Don't worry about them. What I am afraid of is a 19 year old here in 2009 who wants to be a nurse getting trained like they did in 1972 and then getting thrown onto the wards in the current situation.
Now that I said all that about dying and needing intelligent nurses let me explain why I think that the all degree qualification for nurses rule is stupid and pointless.
Management does not actually want to staff the wards with trained nurses. On any given shift the majority of staff are untrained carers who do not understand your diagnosis, history, complications, the way your symptoms present and your drugs. The knowledge of all these things is extremely important to nurse a patient properly.
Currently, most of our actual nurses are NOT degree trained. There are 3 kinds of nurses. There are the ones that trained long ago under the old system (most of our current nurses fit into this group), there are nurses who trained in 3 years at uni and obtained a diploma, and there are nurses who trained in 3 years and got a degree (the latter is the smallest group).
I have a degree, my ward sister has a diploma. We are both RN's. We will rarely ever work together because of management. They are dicks. When I am on duty I have a large number of patients with only carers to help and when she is on duty she is also in that situation. They won't ever pay for any more than one RN to be on duty for the same large number of patients whether that RN is old fashioned trained or university trained. Management only wants to hire untrained carers and they want to have as few actual nurses as they can get away with.
This is why nursing care is so bad and a degree won't mean much if they are going to continue to staff the wards in this manner. I want my nurse to be smart, but if she is on her own with 15 patients we are both fucked.
It wasn't too posh to wash registered nurses who wanted these untrained carers brought in to the hospitals. Registered nurses are left with no choice but to delegate all basic care to untrained people. We hate this. It screws things up for me. It screws things up for the patients.
Hope that your nurse is smart enough to get a degree, and hope that she has a manageable number of patients so that she can stay on top of basic care as well as everything else. This is what the nurses want. It is all linked. When this becomes the norm staffing wise, nursing care in our hospitals will improve. Until then, no expensive quick fix band aid will succeed.
Monday, 2 November 2009
Happy.
It's not all bad. There is that .1% of the time that my job is great.
We lucked out times two the other day. First of all we had 3 staff nurses on duty. Usually that would not be enough. But something else happened that was lucky.
The same random force that can throw all critically patients at you when you are more short staffed than usual can also throw all stable patients at you when you are well staffed.
Actually there was a third lucky thing that happened. The bed manager will usually float a nurse away to another unit if we have more than 2 on duty. But she didn't on this day.
Only two people were on IV meds. No one was acutely ill.
Since there were three staff nurses we decided to put one staff nurse for each group of 14 patients with yours truly in charge and coordinating.
This allowed the staff nurses to get on with the care uninterrupted while I sorted the doctors rounds, the phone calls and intercepted any interruptions before they got to the primary nurses. I answered call bells, assisted the HCA's and made sure that the primary staff nurses were left alone to concentrate on their drugs and the rest of their job. I got their insulins and IV's out of the way for them to save them time. I helped the HCA's with daily care.
I babysat a confused and wandering patient to keep her from escaping to the motorway on foot and half naked yet again. The previous day when there were only 2 staff nurses on it took them until 11:30 AM to get all the 8 AM meds out. On this day because I was there to intercept interrutpions and deal with problems they were done at 09:15 AM.
When our main consultant showed up for his round I approached him, introduced myself as the nurse in charge and told him that I would be attending the ward round for the whole ward and I knew all the patients very well. I had done two night shifts recently and had time to read all the notes etc. He looked surprised. I explained that I was an extra nurse today so we are coping well, and that there would be two staff nurses on the ward attending the patients while I was on the round (which takes 1.5 hours). He was really pleased.
I like going on the ward rounds. It's easy to trail after the docs and answer questions and take notes. I won't even consider attending if it means I have to abandon my patients for hours without having another RN keeping on top of their care. That is just hasking to get hauled before the NMC. I always learn a lot from ward rounds and it helps me get a better handle of what is going on.
Not only did we get everything done but we got it all done well. The patients were happy and the next day a relative gave us a beautiful thank you later. We even had lunch midway through the shift. That was cool.
Just one extra staff nurse and lower acuity allowed for this!
We have approached management asking if we can always have a senior nurse in charge and coordinating every shift just for this reason. Two words: Shot down.
We lucked out times two the other day. First of all we had 3 staff nurses on duty. Usually that would not be enough. But something else happened that was lucky.
The same random force that can throw all critically patients at you when you are more short staffed than usual can also throw all stable patients at you when you are well staffed.
Actually there was a third lucky thing that happened. The bed manager will usually float a nurse away to another unit if we have more than 2 on duty. But she didn't on this day.
Only two people were on IV meds. No one was acutely ill.
Since there were three staff nurses we decided to put one staff nurse for each group of 14 patients with yours truly in charge and coordinating.
This allowed the staff nurses to get on with the care uninterrupted while I sorted the doctors rounds, the phone calls and intercepted any interruptions before they got to the primary nurses. I answered call bells, assisted the HCA's and made sure that the primary staff nurses were left alone to concentrate on their drugs and the rest of their job. I got their insulins and IV's out of the way for them to save them time. I helped the HCA's with daily care.
I babysat a confused and wandering patient to keep her from escaping to the motorway on foot and half naked yet again. The previous day when there were only 2 staff nurses on it took them until 11:30 AM to get all the 8 AM meds out. On this day because I was there to intercept interrutpions and deal with problems they were done at 09:15 AM.
When our main consultant showed up for his round I approached him, introduced myself as the nurse in charge and told him that I would be attending the ward round for the whole ward and I knew all the patients very well. I had done two night shifts recently and had time to read all the notes etc. He looked surprised. I explained that I was an extra nurse today so we are coping well, and that there would be two staff nurses on the ward attending the patients while I was on the round (which takes 1.5 hours). He was really pleased.
I like going on the ward rounds. It's easy to trail after the docs and answer questions and take notes. I won't even consider attending if it means I have to abandon my patients for hours without having another RN keeping on top of their care. That is just hasking to get hauled before the NMC. I always learn a lot from ward rounds and it helps me get a better handle of what is going on.
Not only did we get everything done but we got it all done well. The patients were happy and the next day a relative gave us a beautiful thank you later. We even had lunch midway through the shift. That was cool.
Just one extra staff nurse and lower acuity allowed for this!
We have approached management asking if we can always have a senior nurse in charge and coordinating every shift just for this reason. Two words: Shot down.
But I will enjoy these rare days when they occur. On these days I am glad that I am a nurse.
Saturday, 31 October 2009
Paranormal Ward
So once upon a time I was one nurse to 80 million patients and.....
I just had to start off with that line because that is how every damn post on this blog starts.
But this post has nothing to do with all that.
I had the idea to blog about possible paranormal experiences of health care workers but I put it off for months. I felt like most of the readers on here seem sensible and probably wouldn't care for supernatural stuff.
But what the hell. It's Halloween. Let's rock out with the ghost stuff. Grab your sweets and let's go.
Some of these things really happened to me and some have happened to colleagues and friends. I know I know: Dying brains hallucinate and so do tired nurses.
1.I was a brand new graduate nurse on a cardiac unit once. Didn't know my arse from a hole in the ground nor did I believe in anything stupid like ghosts and supernatural happenings. The older nurses who precepted me set me straight and made me a half decent nurse. They also nearly made me goddamn believer in the paranormal.
Peggy was my mentor and we were on duty together one evening. She had been a nurse for 40 years and was cool as a cucumber. We were looking after a man called John. He had some cardiac problems. John, a 48 year old man, was one bad dude during his life. Real bad. He had been in and out of prison for everything from drugs to rape to violent attacks on innocent people. Nurses always went into that room two at a time and security was outside.
John got better. He was discharged home by his very competent doctor. He was waiting for transport back to maximum security. He may have been an evil dick but he was orientated and with it times 3 normally. No confusion whatsoever.
But all of the sudden we heard him start screaming his head off "Help Help Help". Peggy and I legged it to his room.
"You goddamn bitches better get that motherfucker in black out of my room" says John.
"We don't see anyone in your room John so calm down and tell us what is happening. Are you feeling unwell? Are you have chest pain?" says I.
" NO i AIN'T GOT NO PAIN. Listen to me you fucking whores. That dude is standing right over there in the goddamn corner. He is wearing black and he is looking at me. GET HIM THE FUCK OUT OF MY ROOM." says John.
Peggy and I went through the motions of looking behind the curtains, in the bathroom etc. No dude in black was seen. John, however, thought he saw him and was getting really angry...fearful I think. We tried to reassure him as much as possible and stepped back in the doorway. He had denied any pain etc.
"Anna get the crash trolley" says Peggy quietly.
I couldn't believe what she just said. "He's fine, maybe he has developed an infection and he is confused. Why do you want the crash trolley?"...I giggled.
"Anna that man is seeing the angel of death, the bad one. Get the trolley and put the crash call out." says Peggy. She said this in a very serious tone she gave me a little shove in the direction of the crash trolley we use for resuscitation.
Now I am laughing at Peggy and saying "You are nuts..he's not gonna....
And as I was in mid sentence John's eyes went real wide and he collapsed in his bed. I may have been a newbie but I knew a sudden cardiac arrest as soon as I saw one.
Now I ran for the crash trolley. John did indeed pass away.
2. I looked after a lady named Jane once. She was about 96 and had supposedly been mostly non verbal and immobile following a stroke a year ago. Now she was in the hospital with something else and she was dying. I never heard her speak. One day I was walking by her room. I heard a weak female voice saying "Milly, Milly, come here my love how I missed you"! Hand over my heart I went into that room and she was sat on the end of her bed arms outstretched...a look of pure joy on her face. Her eyes looked like they were watching someone move about the room. I had never seen this woman move let alone speak so after my initial shock faded I asked her Milly was. She didn't answer. She just laid down on the bed and went back to sleep with a smile of contentment.
This happened a few more times and other nurses saw it. I never saw a look of such pure joy on any person's face. As Jane deteriorated, the Milly sightings increased. The medics didn't believe us. Finally I asked Jane's grandson who Milly was. He gave me a strange look and told me that Milly was Jane's little 2 year old daughter, the apple of her eye.
Milly was the only daughter after 4 sons. Milly died at age 2 when she fell out of a second story window while Jane wasn't paying attention. This was decades and decades ago. Jane never got over it and refused to speak about it. She blamed herself. The grandson was shocked that I even knew the name since Jane was no longer verbal. Hell even when she could talk she could not mention Milly without violently weeping.
This is when I started to get that maybe there is something out there that we cannot see. I do not believe that anyone ever dies alone. They come for them. As a nurse you soon realise that when a patient is dying it is like a family reunion of all their deceased loved ones around that bed. The closer they get to death..the more we the living seem like a fuzzy dream, and dad who died in 1930 seems like total reality as he stands over the bed with a smile and a reassuring wink.
On a number of occasions I have walked into a patient's room to see her smiling from ear to ear "My brother Paul who died in the big war was just here visiting me".
This kind of statement always perks my ears up and I take a close look at my patient because 9 times out of 10.......
Sometimes out of the corner of your eye you will kind of see or sense others in the room of an extremely sick patient. It's weird.
I was caring for a dying 87 year old woman not so long ago. She was dying in a really awful manner. The care assistant and I were changing her gown (haemoptysis and maleena). The patient was not really aware of us but my god, she was having a beautiful conversation with someone we couldn't see. I felt like I was intruding on a very emotive but happy family reunion. From what she was saying, it sounded like she was talking her to mother and auntie.
Of course of course...dying brains hallucinate and all that.
Some people claim that the wards are haunted. I have only ever seen things out of the corner of my eye and such. I walked out of the drug room and then walked back in quickly because I forgot a syringe. The room was tidy when I left it but 10 seconds later when I walked back the room every drawer was emptied onto the floor. The staff at that place were convinced it was haunted.
I took care of a little old man who used to pull my ponytail all the time and laugh. He died on my ward. Every time I walked past his bay for a few nights someone yanked on my ponytail.
I worked with a care assistant who swore that she would have reoccurring dreams about an old fashioned horse drawn hearse. Whenever she dreamt this before work there would be a death on the ward.
A very anxious lady named Helen died on the ward downstairs. They took her body away and then the room was empty. But the call bell kept ringing and ringing over and over again. The room was indeed empty!! Maintenance was called in...but they could find no fault with the call bell system. Finally one of the older nurses shouted "for god's sake Helen you're dead, just cross over and stop messing with that bell". It stopped.
There was the nursing home built over the site of a Victorian orphanage where all the Alzheimer's residents saw the same thing: A little boy in a navy suit and a little girl in a green dress running around the facility acting up and being silly and naughty. The nurse's got sick and tired of the residents asking them to deal with those brats in the old fashioned clothes who were jumping on the bed. How could the nurses deal with children they couldn't even see?
There's more but my children are raiding the sweets that I thought I had hidden so well. Happy Halloween everyone.
A Comment That Says It All. Awesome.
I received this comment on the post below this one. WELL SAID ANONYMOUS!!
Anne,
The UK's health care system is totally screwed! You should try to get out. I hate suggesting that because I know you care, but they are asking you to do the physically and humanly impossible. You should have a pharmacist in that hospital AT ALL TIMES. You should have a pneumatic tube system to tube your meds to a tube station on your ward. The overpaid pharmacist who has plenty of time to ass-sit and talk badly to the nurses should be calculating your damn dosages and mixing them. That's what he got all the damn education for, right? There should be a full-time staff of housekeepers to clean beds between patients and wash mattresses and empty trash. There should be a staff of dietary aides to distribute trays and snacks. You should be able to NURSE, and that's it. And you should have the staff to do it safely. Patients are sicker now. Your whole system is antiquated and dangerous to you and your patients.
Your entire profession should be up in arms and banging on your Prime Minister's door and demanding that someone get up off their ass, unstick their head from said ass, and totally wipe the slate clean and start over. That is how screwed up your system is. I would not work in an NHS hospital. I'd serve fries at a fast-food restaurant before I'd go face what you face every day. The powers that be in your organization do not want you. This blog is wonderful, but the people who are not nurses DO NOT CARE. It isn't happening to them, and they don't have to face that nightmare every day. And your nursing leadership DOES NOT CARE. They're not blind to what is happening, Anne. They are simply evil. They see just fine.
I am so thankful I am not a nurse living in the UK. I am so angry for all of you. I read your blog all the time, and I say this as someone who cares about your wellbeing. I am deeply concerned for you and all the nurses in your situation. I hope this does not make you mad. But I know you are not being listened to. Nurses are finally being treated half-decent here in the states (still a long way to go though). Nothing changed until there was mass exodus from the profession. And we are not out of danger yet over here. The powers that be will not listen until all of you make them listen.
I wrote a little bit below Anonymous's comment and I will post that here as well as add some more thoughts:
A pharmacist in hospital 24/7? HA HA HA HA. It would be a cold day in hell before anyone mixed our IV antibiotics for us. A cold and frigid day in hell.
I had several patients on IV Benzlpenicillin 2.4 grams, IV Flucloxacillin 1 gram, and IV metronidazole all at the same time. The Metronidazole comes bagged already (the only IV antibiotic that is ready to go) and was only 3 times a day. So we were lucky with that one. But yeah, holy massive amounts of antibiotics.
But the Benpen and the fluclox was 4 times a day and oh my god..... The benpen alone comes in little bottles of 600mg in powder form that you have to dilute with sterile water and mix and add to an IV bag of saline. It takes AGES and AGES. I feel like I spend most of my time mixing drugs.
Many doses get missed because the nurses can't always screw around mixing them when we have 20 patients all screaming "nurse".
Granted that giving the IV meds are priority because the patient is not getting their doctors' ordered treatment without it and therefore won't get better BUT try explaining that the all the screaming relatives that don't understand why we are not sat at the bedside changing mama's gown the second she spills a drop of juice on it. We get no back up from management with these
people complain. No one explains to them the reality of the situation.
And we don't have anyone to answer the phone either.
Not to long ago I was working on a shift with 2 RN's and 2 kids for over twenty patients. The phone rang non stop. We always tried to answer the phone when we could. Most of the calls are from relatives asking questions we cannot answer. Instead of accepting that they just get someone else in the family to try. They don't seem to get that giving any kind of info over the phone is illegal.
But the one phone is a long way away from the patients. If you think about the logistics of walking away from the patients every 2 minutes to answer the phone you will see what I mean. We already had a least 6 patients who required one to one care, one because he was acutely ill and the others were just extremely confused as well as very mobile. So just those 6 people outnumbered the staff already. One was so confused and mobile that he ended up leaving the ward and was wandering in the street nearby. Had to call the cops.
During all this we were only managing to answer the phone about a third of the time. It was ringing constantly. Lo and behold one caller got real pissed off that he couldn't get through and called management ranting and raving about the nurses not bothering to answer the phone. Management (the same fuckers who decided that we can't have a unit clerk anymore than half day weekdays) apologised profusely to the ignorant man and let us have it. The man (a relative of a stable long term patient) came up later during visiting hours sneering at us because "the chief promised that you girlies will be knocked into line if you don't bother answering the phone".
So yeah. That is how it is. You are right that it is all beyond the grasp of non nurses and that people do not care because they do not live it day after day. Striking isn't the answer because an ignorant public who does not understand the situation would not back us up...they would turn on us even more. They would be bored to tears with this blog and not read very far so a wake up call for them isn't happening in the foreseeable future.
This blog does have a purpose and an ending...I'm just not there yet.
Wednesday, 28 October 2009
The Nursing Times : Where have they been for the last few years?
Can you believe this shit. How can this be news to these people? Bear with me. I have just complete two shifts from hell so I am in a bad mood. I started at 0700 and by 10 AM I hadn't even set eyes on half my patients. The healthcare assistants were missing the fact that people were obviously going into septic shock, they forgot to check the blood sugar on the lady that goes hypo. I was up to my ears in meds etc. I couldn't go 5 minutes without consultants showing up and interrupting me. Every time they did so it pushed me back from carrying out an initial assessment on my patients by another 15 minutes. It got so bad that by 10AM I hadn't even seen half of them and was afraid of walking into a room and finding a corpse.
If a trained nursed has the recommended ratio of 6 patients she can get to all of them and see all of them and get to grips with their situation within the first hour of her shift. But with 21? No way. By 10AM I had no idea what was happening with half of these people and the 4 care assistants that were with me were no help to any of this whatsoever. A registered nurse does not walk onto a ward of 20 people and suddenly "know" everything about the patients by some kind of psychic phenomenon or information osmosis. We get a brief report on 20 people...that takes 45 minutes and then we don't know much until we assess the patient, look at their observations, fluid balances, their doctors notes, talk to the patient, look at the nursing notes etc. It takes about 20 minutes per each patient to do this kind of assessment so I that know what is happening with them. The written info is kept in about 4 different places throughout the ward.
Anyway back to the Nursing Time Article.
This has already been going on for years. This is why nursing care these days is shit. Everyone knows (except the fucktwits who run hospitals) that the decreasing the number of registered nurses and replacing them with untrained kids is a big fat fail. The reasons that RN's cannot function is because we are spread to thin among to many patients and forced to delegate to care assistants who don't know what they don't know and don't care either.
I told you that it was management moving nurses away from the bedside not an over academic nursing profession. Nurses need to be highly educated, they need to be at the bedside, and they are not too posh to wash. University educated nurses are taught that they need to provide basic care in order to assess their patients properly. Assessment is the first step of the nursing process.
These hospitals are saying that there is a shortage of band 5's (registered nurses). This is bullshit. They are not advertising to hire them on the wards. They are only posting ward jobs for care assistants and many newly qualified nurses are on the scrapheap, unable to find jobs.
I told you that this shortage of RN's working at the bedside is down to economics rather than arrogant nurses who supposedly think that they are above caring.
I told you that the "shortage of trained nurses" is/was manufactured by greedy hospital chiefs.
In every post on this goddamn blog I explain how care fails when an RN runs between too many patients and is so swamped handling drugs, assessments, and orders by herself that the care assistants are doing all the actual care, and totally fucking it up. They cannot assess patients, electronic monitoring does not help. The care assistants go through the motions of providing care like it is factory work. Too much gets done incorrectly and or completely missed until it is too late. This is called failure to rescue. The few actual nurses are to swamped to actually assess and plan and implement care. Our hospital patients are getting nothing in the way of nursing input.
It's a total fucking fail and it will kill more people and cost more money if it continues.
I said it here.
I explained it here and in pretty much every other post.
How dare they devalue proper ward nursing and say that someone who isn't trained and registered can take over?
IF this is a good idea then why does research show that a smaller proportion of qualified nurses in the ward skill mix causes higher mortality rates and increased costs?
IF this is a good idea then why do patients of hospitals that employ a higher number if highly educated RN's to work at the bedside have much lower mortality rates.
When they say that they are not creating band 4 protocol based posts to save money....THEY ARE LYING.
And yes RN's do report that we have to do many things that are "beneath our level of training". We have to wash mattresses when we have 3 patients crashing because the care assistants cannot be bothered and we are getting an admission in 5 minutes. You don't look at that and think "Okay, then let's have less real nurses and more irresponsible untrained people who don't have a registration to maintain and don't care on the ward then". You are supposed to look at this and you hire domestics to avoid a multi million pound damages payout when a patient dies because his nurse is washing mattresses.
I am heading into another shift from hell today. Bear with me.
If a trained nursed has the recommended ratio of 6 patients she can get to all of them and see all of them and get to grips with their situation within the first hour of her shift. But with 21? No way. By 10AM I had no idea what was happening with half of these people and the 4 care assistants that were with me were no help to any of this whatsoever. A registered nurse does not walk onto a ward of 20 people and suddenly "know" everything about the patients by some kind of psychic phenomenon or information osmosis. We get a brief report on 20 people...that takes 45 minutes and then we don't know much until we assess the patient, look at their observations, fluid balances, their doctors notes, talk to the patient, look at the nursing notes etc. It takes about 20 minutes per each patient to do this kind of assessment so I that know what is happening with them. The written info is kept in about 4 different places throughout the ward.
Anyway back to the Nursing Time Article.
This has already been going on for years. This is why nursing care these days is shit. Everyone knows (except the fucktwits who run hospitals) that the decreasing the number of registered nurses and replacing them with untrained kids is a big fat fail. The reasons that RN's cannot function is because we are spread to thin among to many patients and forced to delegate to care assistants who don't know what they don't know and don't care either.
I told you that it was management moving nurses away from the bedside not an over academic nursing profession. Nurses need to be highly educated, they need to be at the bedside, and they are not too posh to wash. University educated nurses are taught that they need to provide basic care in order to assess their patients properly. Assessment is the first step of the nursing process.
These hospitals are saying that there is a shortage of band 5's (registered nurses). This is bullshit. They are not advertising to hire them on the wards. They are only posting ward jobs for care assistants and many newly qualified nurses are on the scrapheap, unable to find jobs.
I told you that this shortage of RN's working at the bedside is down to economics rather than arrogant nurses who supposedly think that they are above caring.
I told you that the "shortage of trained nurses" is/was manufactured by greedy hospital chiefs.
In every post on this goddamn blog I explain how care fails when an RN runs between too many patients and is so swamped handling drugs, assessments, and orders by herself that the care assistants are doing all the actual care, and totally fucking it up. They cannot assess patients, electronic monitoring does not help. The care assistants go through the motions of providing care like it is factory work. Too much gets done incorrectly and or completely missed until it is too late. This is called failure to rescue. The few actual nurses are to swamped to actually assess and plan and implement care. Our hospital patients are getting nothing in the way of nursing input.
It's a total fucking fail and it will kill more people and cost more money if it continues.
I said it here.
I explained it here and in pretty much every other post.
How dare they devalue proper ward nursing and say that someone who isn't trained and registered can take over?
IF this is a good idea then why does research show that a smaller proportion of qualified nurses in the ward skill mix causes higher mortality rates and increased costs?
IF this is a good idea then why do patients of hospitals that employ a higher number if highly educated RN's to work at the bedside have much lower mortality rates.
When they say that they are not creating band 4 protocol based posts to save money....THEY ARE LYING.
And yes RN's do report that we have to do many things that are "beneath our level of training". We have to wash mattresses when we have 3 patients crashing because the care assistants cannot be bothered and we are getting an admission in 5 minutes. You don't look at that and think "Okay, then let's have less real nurses and more irresponsible untrained people who don't have a registration to maintain and don't care on the ward then". You are supposed to look at this and you hire domestics to avoid a multi million pound damages payout when a patient dies because his nurse is washing mattresses.
I am heading into another shift from hell today. Bear with me.
Tuesday, 27 October 2009
Productive ward. Again. Kill me please.
Productive ward: releasing time to care is back in full swing on my unit.
Apparently the ward would run as smooth as silk if only nurses understood how to tidy cupboards and work more efficiently.
The physical ward layout (appalling), the chaos, the constant interruptions and the massive lack of qualified staff make the idea of working efficiently a joke. The closest we can come to being efficient is taking dangerous short cuts just to ensure that we can actually assess everyone and get all the drugs out and administered without a fatality. All registered nurses are forced to do this on a daily basis because of the working conditions that they cannot control. Anyone who says that this isn't true is a liar.
Even if we could tidy and reorganise the cupboards we would still be up and down that ward constantly, wasting precious minutes. The thing needs to be redesigned and rebuilt to be truly workable. Half our supplies are always missing and require the ward staff to abandon patient care to obtain things constantly throughout the shift. Productive ward isn't going to fix this mess, it just puts more culpability onto the nurses. Pharmacy, and equipment /central supply are 9-5 Monday to Friday. And even during 9-5 they are fucking useless. They cause is more work than any patient ever did. Their worldview is that the lone RN on a ward with 20 something patients is there to make their job easier. God how I hate them.
Let me give you an example of something that happens about 100 times during an 8 hour shift. The lab calls me at 4PM and tells me that my patient's most recent blood results are barely compatible with life. My job is to inform the doctor who is covering. He orders a medicine. Of course pharmacy won't allow us to keep it in stock. To get the medicine I have to ring pharmacy, leave a message, wait for them to call back and then argue with them for about 15 minutes. They are pissy because they are supposed to finish work for the day at 5PM. They stomp their feet and say that they will not bring said drug to the ward. I have to walk the written doctor's order for the drug to pharmacy.
I get there and they ignore me for another 15 minutes while I bang on the glass. I. am. Serious.
They say that they will ring me as soon as the drug is ready. I reiterate the fact that I need this drug NOW. I cannot sit there however. I have many other things going on with my other patients that are almost as high a priority.. 30 minutes sat in pharmacy could seriously harm my patients who are now nurseless. Pharmacy promises me that they will bring the drug to me asap. If I send a care assistant rather than go down there myself it is bound to get all fucked up. 99% of the time we cannot get through to them via phone as they have it permanently on voicemail.
Back to the ward now. I need a special pump to deliver this med that we also are not allowed to keep on the ward as per central supply's dumbassness. I call central supply. A grumpy man who is obviously eating something chewy answers the phone. I tell him what I need. Very slowly he responds with "Well you will just have to come down here and get it".
But I cannot. I am hoping to get this drug administered ASAP as soon as that slut from pharmacy gets her ass here (and she had better hurry I swear to god).
I tell Dick from Central Supply that I am in no position to leave the ward (yet again) and my care assistant is trying to stop my alcohol detoxer from attacking the other patients (so am I while I am on the phone).
He chews whatever the fuck he is eating and slowly responds with "sigh sigh siiiigghhh. I will bring it up if I must. You had better go around your ward and find every piece of equipment that belongs to central supply. Clean it and label it before I get there and put it on a trolley so I can bring it back with me. I don't wanna make two trips. I'll be there in 15 minutes so have it ready for then."
Yeah right Dick. I am chasing pharmacy right now. There is now only myself and a care assistant on the ward. The other RN is now in recovery picking up her post op patient and the other care assistant had to escort a dementia patient to the CT scanner because the staff down there don't want to deal with it. I have a patient who has blood results that show that she needs this drug infusing via this particular pump NOW. I have an alcohol detoxer who is beating the care assistant, trying to beat other patients and myself and we cannot get her doctor to come up here and prescribe sedation. I have 20 other patients as well. I had over 15 IV antibiotics due in the last hour that I haven't even begun to mix. I have a que of angry relatives that want to know exactly what it is we are doing for their loved one. I will certainly be ignoring Dick from Central Supply's request.
And pharmacy still is not here. I ring them. I get voicemail. I can't go down there and neither can my care assistant.
You leave one person on the ward and a crash occurs you are fired.
Now the doctor who prescribed the drug for the patient with scary blood results is on the ward. He looks at his patient. His face turns the colour of a tomato. He glares at me. "Why the hell hasn't the drug I ordered been started yet? What the hell are you doing? Do you not understand that it is priority?" he screams.
Yes I do doc. But I cannot give what I don't have or pull syringe pumps out of my ass. I have already been ignoring many sick people over the last hour trying to pull this together. By the way...do you see that patient over there beating the healthcare assistant? See the scratches on my arm? Her doctor is tied up somewhere...will you prescribe her some sedation? Benzos not appropriate I know...how about haldol...anything?
"No. Not my patient. Get the anti -scary- blood- results- drug up now and call security for your combative patient."
The he left. We did call security actually. Those are the porters. They informed us that they are too busy.
OMG where the fuck is that slut from pharmacy. Their phone is still engaged. I cannot leave the ward. Dick from central supply showed up with the pump, took one look at the alcohol detoxer who was licking the floor and trying to hit anyone who came near and left quickly.
Now I have my pump. But where oh were is that slut from pharmacy.
I run to the end of the ward and peer down the hallway. There is the slut from pharmacy. She is holding what looks like the box containing the drug I need. She is stood talking with her friend from medical records that she has obviously run into on her way here. I walk over to her. I grab the box out of her hands. "Is this for ward R" I say. "Yes" she says whilst looking shocked that I just grabbed something out of her hands roughly. And off I go back to my ward whilst shouting "I needed this an hour ago".
"Those nurses really have an attitude don't they" she says to her friend.
Now I move at the speed o0f light getting the drug out mixed, ,measured, drawn up and doing my maths calculations. My other RN is back from theatre and quickly she checks my arithmetic. I get the drug up and grab a set of obs on my patient. Finally after over an hour of bullshit she is getting the treatment that the doctor ordered. What if I had dropped the ball on this an hour ago? What if I hadn't notified her doctor of her blood results or stayed on pharmacy's ass, multitasked, moved quickly and ignored my other patients calls for help to get this patient her treatment? The brilliant doctor and his brilliant treatment orders go nowhere if they are not implemented. And implementation of treatments is totally the domain of the registered nurses. It takes knowledge and you have to fight! Diagnosing and prescribing (the doctors domain) is only the first step of a very complex process of caring for hospital patients.
Now I brace myself to settle down this detoxer (she has already taken a chunk out of my upper arm) so we can get back to caring for all the patients...but in 10 minutes it will all start again and we will be looking for things.
This is how bad things are during 9-5 hours. You should see what it is like trying to get what you need out of hours.
But they want us to understand that if we tidy cupboards on the ward all will be well. Productive ward will not in any way shape or form deal with the bullshit from central supply and pharmacy. It will not address the fact that we are running these wards with so little staff that we can barely address 1% of what we should be doing. But this is their "solution" to problems that they do not understand.
Now that productive ward is back in full swing our ward sister has been forced to put a cork board up at the nurse's station. On it she has been forced to put little motivational messages. We are supposed to add to these messages by writing our feelings onto the board. The messages say things like:
Releasing time to care: I will understand that I am here for the patients
Working more efficiently so every shift will be a joy!.
Helping the ward to be more organised so that we can spend time with the patients.
Every single member of ward staff is supposed to grab a colourful marker, some nice paper and add their happy visions about the productive ward to this board. I haven't added mine yet. Do you guys have any suggestions for me?
I was thinking about stealing this from mental nurse and posting it on the happy happy joy joy board.
Apparently the ward would run as smooth as silk if only nurses understood how to tidy cupboards and work more efficiently.
The physical ward layout (appalling), the chaos, the constant interruptions and the massive lack of qualified staff make the idea of working efficiently a joke. The closest we can come to being efficient is taking dangerous short cuts just to ensure that we can actually assess everyone and get all the drugs out and administered without a fatality. All registered nurses are forced to do this on a daily basis because of the working conditions that they cannot control. Anyone who says that this isn't true is a liar.
Even if we could tidy and reorganise the cupboards we would still be up and down that ward constantly, wasting precious minutes. The thing needs to be redesigned and rebuilt to be truly workable. Half our supplies are always missing and require the ward staff to abandon patient care to obtain things constantly throughout the shift. Productive ward isn't going to fix this mess, it just puts more culpability onto the nurses. Pharmacy, and equipment /central supply are 9-5 Monday to Friday. And even during 9-5 they are fucking useless. They cause is more work than any patient ever did. Their worldview is that the lone RN on a ward with 20 something patients is there to make their job easier. God how I hate them.
Let me give you an example of something that happens about 100 times during an 8 hour shift. The lab calls me at 4PM and tells me that my patient's most recent blood results are barely compatible with life. My job is to inform the doctor who is covering. He orders a medicine. Of course pharmacy won't allow us to keep it in stock. To get the medicine I have to ring pharmacy, leave a message, wait for them to call back and then argue with them for about 15 minutes. They are pissy because they are supposed to finish work for the day at 5PM. They stomp their feet and say that they will not bring said drug to the ward. I have to walk the written doctor's order for the drug to pharmacy.
I get there and they ignore me for another 15 minutes while I bang on the glass. I. am. Serious.
They say that they will ring me as soon as the drug is ready. I reiterate the fact that I need this drug NOW. I cannot sit there however. I have many other things going on with my other patients that are almost as high a priority.. 30 minutes sat in pharmacy could seriously harm my patients who are now nurseless. Pharmacy promises me that they will bring the drug to me asap. If I send a care assistant rather than go down there myself it is bound to get all fucked up. 99% of the time we cannot get through to them via phone as they have it permanently on voicemail.
Back to the ward now. I need a special pump to deliver this med that we also are not allowed to keep on the ward as per central supply's dumbassness. I call central supply. A grumpy man who is obviously eating something chewy answers the phone. I tell him what I need. Very slowly he responds with "Well you will just have to come down here and get it".
But I cannot. I am hoping to get this drug administered ASAP as soon as that slut from pharmacy gets her ass here (and she had better hurry I swear to god).
I tell Dick from Central Supply that I am in no position to leave the ward (yet again) and my care assistant is trying to stop my alcohol detoxer from attacking the other patients (so am I while I am on the phone).
He chews whatever the fuck he is eating and slowly responds with "sigh sigh siiiigghhh. I will bring it up if I must. You had better go around your ward and find every piece of equipment that belongs to central supply. Clean it and label it before I get there and put it on a trolley so I can bring it back with me. I don't wanna make two trips. I'll be there in 15 minutes so have it ready for then."
Yeah right Dick. I am chasing pharmacy right now. There is now only myself and a care assistant on the ward. The other RN is now in recovery picking up her post op patient and the other care assistant had to escort a dementia patient to the CT scanner because the staff down there don't want to deal with it. I have a patient who has blood results that show that she needs this drug infusing via this particular pump NOW. I have an alcohol detoxer who is beating the care assistant, trying to beat other patients and myself and we cannot get her doctor to come up here and prescribe sedation. I have 20 other patients as well. I had over 15 IV antibiotics due in the last hour that I haven't even begun to mix. I have a que of angry relatives that want to know exactly what it is we are doing for their loved one. I will certainly be ignoring Dick from Central Supply's request.
And pharmacy still is not here. I ring them. I get voicemail. I can't go down there and neither can my care assistant.
You leave one person on the ward and a crash occurs you are fired.
Now the doctor who prescribed the drug for the patient with scary blood results is on the ward. He looks at his patient. His face turns the colour of a tomato. He glares at me. "Why the hell hasn't the drug I ordered been started yet? What the hell are you doing? Do you not understand that it is priority?" he screams.
Yes I do doc. But I cannot give what I don't have or pull syringe pumps out of my ass. I have already been ignoring many sick people over the last hour trying to pull this together. By the way...do you see that patient over there beating the healthcare assistant? See the scratches on my arm? Her doctor is tied up somewhere...will you prescribe her some sedation? Benzos not appropriate I know...how about haldol...anything?
"No. Not my patient. Get the anti -scary- blood- results- drug up now and call security for your combative patient."
The he left. We did call security actually. Those are the porters. They informed us that they are too busy.
OMG where the fuck is that slut from pharmacy. Their phone is still engaged. I cannot leave the ward. Dick from central supply showed up with the pump, took one look at the alcohol detoxer who was licking the floor and trying to hit anyone who came near and left quickly.
Now I have my pump. But where oh were is that slut from pharmacy.
I run to the end of the ward and peer down the hallway. There is the slut from pharmacy. She is holding what looks like the box containing the drug I need. She is stood talking with her friend from medical records that she has obviously run into on her way here. I walk over to her. I grab the box out of her hands. "Is this for ward R" I say. "Yes" she says whilst looking shocked that I just grabbed something out of her hands roughly. And off I go back to my ward whilst shouting "I needed this an hour ago".
"Those nurses really have an attitude don't they" she says to her friend.
Now I move at the speed o0f light getting the drug out mixed, ,measured, drawn up and doing my maths calculations. My other RN is back from theatre and quickly she checks my arithmetic. I get the drug up and grab a set of obs on my patient. Finally after over an hour of bullshit she is getting the treatment that the doctor ordered. What if I had dropped the ball on this an hour ago? What if I hadn't notified her doctor of her blood results or stayed on pharmacy's ass, multitasked, moved quickly and ignored my other patients calls for help to get this patient her treatment? The brilliant doctor and his brilliant treatment orders go nowhere if they are not implemented. And implementation of treatments is totally the domain of the registered nurses. It takes knowledge and you have to fight! Diagnosing and prescribing (the doctors domain) is only the first step of a very complex process of caring for hospital patients.
Now I brace myself to settle down this detoxer (she has already taken a chunk out of my upper arm) so we can get back to caring for all the patients...but in 10 minutes it will all start again and we will be looking for things.
This is how bad things are during 9-5 hours. You should see what it is like trying to get what you need out of hours.
But they want us to understand that if we tidy cupboards on the ward all will be well. Productive ward will not in any way shape or form deal with the bullshit from central supply and pharmacy. It will not address the fact that we are running these wards with so little staff that we can barely address 1% of what we should be doing. But this is their "solution" to problems that they do not understand.
Now that productive ward is back in full swing our ward sister has been forced to put a cork board up at the nurse's station. On it she has been forced to put little motivational messages. We are supposed to add to these messages by writing our feelings onto the board. The messages say things like:
Releasing time to care: I will understand that I am here for the patients
Working more efficiently so every shift will be a joy!.
Helping the ward to be more organised so that we can spend time with the patients.
Every single member of ward staff is supposed to grab a colourful marker, some nice paper and add their happy visions about the productive ward to this board. I haven't added mine yet. Do you guys have any suggestions for me?
I was thinking about stealing this from mental nurse and posting it on the happy happy joy joy board.
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