So I am back. I think we finally have a fully functional PC now. Fingers crossed. We had built one recently and had problems with that so finally we bought one.
To be honest I have also been having a bit of blogger block. I think have about 30 half finished posts.
I don't have a lot of time today but I thought I would check in anyway. A couple of work related incidents have made me laugh out loud this week.
A large medical ward such as mine takes a large number of elderly patients at any give me time. This means that we often take patients who have hearing loss. It also means we have a large number of extremely grumpy and self centered people. I don't care if that last sentence sounds offensive. It's true. You and I will more than likely be self centered, miserable and easily stressed over nothing when we are elderly as well. Reality. Deal with it. I don't do politically correct on this blog. The fact of the matter is that old age sucks and that it will come to most of us someday.
Let's start with the hearing loss. We obviously have more than a few patients with some type of hearing impairment. Their hearing aids are usually lost somewhere between Casualty and the medical express units. By the time they get to the ward we have a serious barrier to communication. Whiteboards and notebooks don't always work out too well due to additional problems with eyesight, crippling arthritis etc. Most of these patients have only suffered from hearing loss recently and do not use sign language. If the hearing aid is awol we will try and get audiology to sort it out. If we are lucky they will come and the see the patient about 800 years after the initial referral. That's deemed quick.
So my patient cannot hear me. I am going a mile a minute and can usually only spend 10 seconds with any patient at any given time. This is bad. The patient has no understanding of what I have on my shoulders and thinks that I am running in and out of the room without taking the time to explain things because I am an inconsiderate bitch. Yes, we know that this is what you think. I do try to explain things in the few seconds I have between dealing with the transfusion reaction in bed 4 and the fall in bed 28. Sometimes I will fly into your room to give you a much needed pain killer when I am in the middle of an emergency elsewhere. I shouldn't leave the emergencies to give a pain killer. Not ever. But if I don't use the 2 seconds I have right now to do it, before the bleeder really starts to crash, then you may not see me again for 2 hours.
Multiply this situation by about 12. Realise that often the nurses are in this situation almost at all times. due to short staffing. Then you will see why we fly in and out of the rooms to fast. We are not trying to be rude or inconsiderate. If you think I can control how long I spend with a patient your are completely crazy.
Often we are trying to communicate with our hearing impaired patients by just talking loudly and trying to help them to lip read. Sometimes it works. Sometimes I just cannot work it all out due to time constraints. Most of the time the patients in near beds will complain about the nurses "talking to loudly and disturbing them". This is especially a problem at night.
Example: Patient with hearing impairment rings bell because they have started having pain. Nurse has to ask questions. If things like notebooks etc are out of the question ...then the nurse has to speak loudly and clearly. It's not a good solution but what else can your do at 3 AM if all other options are out of the question. The rest of the patients on the ward go ballistic and threaten to "strangle that deaf bitch and the nurse". We are often trying to communicate with patients who have difficulty hearing during the night. Unfortunately you are not all in private rooms. This is not a situation that was created by the Nurse so fuck off.
On the other hand, and often at the exact same time...we get complaints about the nursing staff from hearing impaired patients. The nurses offended them by "talking too softly and quickly when she knew I was deaf" and "not taking all the time that was needed etc". The former occurs because we have multiple other patients on the ward who complain about the lack of quiet on the wards. The latter occurs because we are always rushed due to factors out of our control.
Patients in general: We are not talking loudly to piss you off. Patients with hearing impairments: we know that there are mega barriers to communication and we are really doing the best we can with the resources and time that we have. We are not being "insensitive" the the fact that you have hearing loss. Nor are we insensitive to the fact that patients really need peace and quiet. We do get that. Yes, really.
But sometimes there is just going to be a lot of noise.
I'll never forget the night that my colleague found a young patient in full respiratory arrest (but with a pulse) during her rounds at about 2 AM. I was the only other nurse and was on the complete other side of the ward. ANNNNNNNNNNNE!!!!!! The way my junior colleague screamed my name made me go cold. It was an unexpected arrest and a young patient. Then there was the chaos of the cardiac arrest, the senior docs and ITU team shouting orders. The patient survived. The next day multiple other patients complained all day long to anyone who would listen about the horrendous noise they were subjected to at 2 AM. They complained about how much they suffered and how dreadful the nurses were for disturbing them like that.
Why is there always this bad attitude and towards the nurses? Why all the assumptions that all these bad things happen because the nurses are being cruel, insensitive, inconsiderate, thick etc. The answers to those questions can be found if one studies the history of the nursing profession and the subconscious images that people have of nurses. I'll get around to finishing that post.
My children were promised a day out today. I'll try and add to this in another post later.
Sunday, 5 July 2009
Wednesday, 17 June 2009
A Journalist Becomes A Nurse: repost
I am probably committing a major blogger no no but I just feel the need to repost this article.
It was written by an editor of The Wall Street Journal. He made a career change into nursing at age 40. Long story short he had only 3 patients and he found it difficult. He says he felt like a moron compared to the other nurses at times. He couldn't cope with the physical or mental demands. He needed cash. He got the hell out and went back to journalism.
Why am I re posting this: I recently read a comment where someone (possibly a journalist) made a comment about nurses being intellectually incapable of handling a debate. Nurse at my university (overseas)were held to higher standards than other students academically. We were told that we had to be better than your average student because of all the life and death responsibility in difficult conditions that we would have. When we graduated we had higher starting salaries than most other new grads started on after 3-4 years of Uni. Other countries do not hold the same kind of contempt for people that go into nursing that Britain does. The class system here has a lot to answer for in my opinion. Many people with degrees in other fields flunked right out of nursing school.
What is my response to non-medical people who are horrified at the idea of their bright child wanting to become a nurse?
Your child can be bright and academic and go to nursing school. The school won't take you if you can't hack it. Your child may even find it difficult. When they qualify they can go to the USA or Australia and make lots more money than you do. They are certainly going to have to use their brain on the job more than you ever did.
Bedside nursing is not a job for stupid people. Really it isn't.Walking onto the ward as an uneducated simpleton who cannot think with the responsibility that an RN has in the 21st century is insane. And it is a good way to get you in a lot of trouble with the law. If you kill a patient and then try to defend yourself by saying "oops I didn't know because I am just a stupid nurse incapable of doing anything but mopping brows" you are not getting off the hook.
Anyway I am rambling. Read on if you can stand it.
http://online.wsj.com/article_email/SB117738203850080018-lMyQjAxMDE3NzI3NTMyODUyWj.html
This is the kind of stuff we need to see from British Journalists. Unfortunately they do not have the gonads, the brains, or the work ethic and integrity to handle nursing.
Here are some excerpts.
It was written by an editor of The Wall Street Journal. He made a career change into nursing at age 40. Long story short he had only 3 patients and he found it difficult. He says he felt like a moron compared to the other nurses at times. He couldn't cope with the physical or mental demands. He needed cash. He got the hell out and went back to journalism.
Why am I re posting this: I recently read a comment where someone (possibly a journalist) made a comment about nurses being intellectually incapable of handling a debate. Nurse at my university (overseas)were held to higher standards than other students academically. We were told that we had to be better than your average student because of all the life and death responsibility in difficult conditions that we would have. When we graduated we had higher starting salaries than most other new grads started on after 3-4 years of Uni. Other countries do not hold the same kind of contempt for people that go into nursing that Britain does. The class system here has a lot to answer for in my opinion. Many people with degrees in other fields flunked right out of nursing school.
What is my response to non-medical people who are horrified at the idea of their bright child wanting to become a nurse?
Your child can be bright and academic and go to nursing school. The school won't take you if you can't hack it. Your child may even find it difficult. When they qualify they can go to the USA or Australia and make lots more money than you do. They are certainly going to have to use their brain on the job more than you ever did.
Bedside nursing is not a job for stupid people. Really it isn't.Walking onto the ward as an uneducated simpleton who cannot think with the responsibility that an RN has in the 21st century is insane. And it is a good way to get you in a lot of trouble with the law. If you kill a patient and then try to defend yourself by saying "oops I didn't know because I am just a stupid nurse incapable of doing anything but mopping brows" you are not getting off the hook.
Anyway I am rambling. Read on if you can stand it.
http://online.wsj.com/article_email/SB117738203850080018-lMyQjAxMDE3NzI3NTMyODUyWj.html
This is the kind of stuff we need to see from British Journalists. Unfortunately they do not have the gonads, the brains, or the work ethic and integrity to handle nursing.
Here are some excerpts.
Good lord, this man only had 3 patients and some of them were no where near as sick as my 10-15. Please please please read the whole article."In 2002, at age 40, I left my job as a page-one editor at The Wall Street
Journal, my professional home of 15 years, to take a giant leap of faith -- in
myself. Like a lot of people, I questioned my purpose after Sept. 11, 2001.
Jolted from the complacency of a comfortable career, I became convinced that I
could achieve selfish fulfillment through devotion to service -- to the
individual, to the community, to the vulnerable.I considered teaching. I
considered law, medicine, pure science and research. But my thinking always
returned to the nurses I had watched care for my mother a few years earlier,
when she lay in an intensive-care unit in her final illness. I marveled at the
way they melded an aloof, precise professionalism with a mysterious human (and
humane) instinct. They seemed to operate in a purer space, beyond worldly
distractions. I would be a nurse."
"My skills were those of any new nurse. With easily shattered confidence, I
could start an IV, administer medications, bathe a bed-bound patient and change
linens, change dressings, insert all sorts of catheters and tubes, read lab
results and electrocardiograms. I knew to be vigilant against infection,
pneumonia, pressure ulcers, medication errors and the many other lurking threats
to hospital patients. On the burn unit, pain control loomed large. I also knew,
as both executor of treatment plans and patient advocate, to keep a close eye on
what doctors ordered. They make mistakes, too.
But in those first months, I felt stupid and slow, and thus dangerous. I
hadn't yet mastered the ruthless efficiency of thought and motion that lent
veteran nurses the appearance, at least, of enviable ease. Next to my crazed
back-and-forthing, they floated around the unit, maintaining a cool composure no
matter what crisis erupted.
.Basic nursing duties were enough to keep me on my feet until dawn: initial
head-to-toe physical assessments; hourly vital signs and other monitoring tasks;
medications; bed baths and dressing changes; regular suctioning.
There could be no skimping, no coasting through a shift because of a
headache or trouble at home. For 12 hours, I belonged to people whose survival
was at stake. A sloppy physical assessment could later explode in disaster if a
potential problem -- a bum IV, an incipient pressure ulcer, abnormal lung sounds
-- went unnoticed. Rooms required meticulous inspection, too, to ensure that
vital equipment was present and functioning: A missing bag mask -- attached to
those blue vinyl footballs you see TV doctors and nurses rhythmically squeezing
in emergencies -- could cause lethal delays.
Tuesday, 16 June 2009
Good God, we had a nice week.
A couple of really good things happened this week. First of all I have earned a hell of a lot of comp time for working unpaid hours over the end of my shift. The hospital cannot pay overtime and has demanded that we take the time back. I did a couple of 8 hour shifts. It's not like being at work at all. I loved the 8 hour shifts. I was able to come home and still have part of my day.
I cannot go into to much detail on here but between restructuring at the hospital etc we not only ended up with a few closed beds but extra staff from another unit. Usually we get their patients but not their nurses. It's really true, sometimes managers do not fuck up and the gods of nursing shine down on us. I am sure that the closed beds etc wrecked havoc in the rest of the hospital but on my ward, things were smooth.
Not only did I only do an 8 hour day but I had only 5 patients. Only 2 of them were acutely ill. That's right. A non nursing colleague of mine came onto our ward, looked at the numbers and said "Whew, Annie is going to put her feet up today". No chance my friend. I wanted to see if I could still nurse patients properly when I have a controllable work load and time on my side.
I immediately set out doing everything as it was meant to be done, my patients got a thorough nursing assessment and I caught onto a lot of stuff that was a bit worrying. It scared me to think about how much we miss on our usual rush days. When the consultants came for their rounds I was ready with any info they needed about the patients. I knew those patients inside and out. I knew every drug they were on, everything that happened since admission, every test result, what their normal level of orientation and mobility was like, social circumstances etc. I had a chance to read all their notes. It doesn't take a lot of doing to read up on a handful of people.
Usually the medics can barely find one of us to do the ward round and if they do, we are barely able to answer a simple question about the patient "John Smith? Oh. Is he my patient? Let me look through my handover sheet. You ask if he has passed urine yet......Um I don't even know what he looks like". It's no wonder that they think the nurses are all retarded.
The rounds went well. My patients were happy. I felt like they were getting the safest care I can provide. The drug rounds took 15 minutes rather than the usual 2 hours. Less patients means less people phoning and less time running to the phone.
Not only did we have a 1 to 5 ratio but we had an extra nurse to coordinate. She wasn't from our unit and there wasn't much happening so she busied herself with the important jobs that never get done basically.
I had one extremely sick woman who needed many interventions. The family made a point of thanking me for taking such good care of her, and they told me that knowing that she is getting good nursing care makes their sad situation bearable. They said that they thought that I had worked really hard and that they appreciated it, especially considering the horror stories that they heard about the place.
Of my 5 patients only one needed to be fed and the HCA and I fought over who was going to do it.
5 patients isn't always going to be easy. Had they been critically ill I would have been run off my feet. It's not always the number of patients you have but the acuity as well. I was lucky in the fact that I had a smaller than normal number of patients who were not very acute. Woo hoo.
And that's it. Soon the new units/beds etc open, all the beds will fill at lightening speed and the nurses we have will all be spread out even more thin than we are now. I got a letter from management addressing my concerns about the usual state of the staffing ( I last wrote to them months ago). He was pleased to inform me that we are getting 0.5 of a cadet. Uh uh.
I cannot go into to much detail on here but between restructuring at the hospital etc we not only ended up with a few closed beds but extra staff from another unit. Usually we get their patients but not their nurses. It's really true, sometimes managers do not fuck up and the gods of nursing shine down on us. I am sure that the closed beds etc wrecked havoc in the rest of the hospital but on my ward, things were smooth.
Not only did I only do an 8 hour day but I had only 5 patients. Only 2 of them were acutely ill. That's right. A non nursing colleague of mine came onto our ward, looked at the numbers and said "Whew, Annie is going to put her feet up today". No chance my friend. I wanted to see if I could still nurse patients properly when I have a controllable work load and time on my side.
I immediately set out doing everything as it was meant to be done, my patients got a thorough nursing assessment and I caught onto a lot of stuff that was a bit worrying. It scared me to think about how much we miss on our usual rush days. When the consultants came for their rounds I was ready with any info they needed about the patients. I knew those patients inside and out. I knew every drug they were on, everything that happened since admission, every test result, what their normal level of orientation and mobility was like, social circumstances etc. I had a chance to read all their notes. It doesn't take a lot of doing to read up on a handful of people.
Usually the medics can barely find one of us to do the ward round and if they do, we are barely able to answer a simple question about the patient "John Smith? Oh. Is he my patient? Let me look through my handover sheet. You ask if he has passed urine yet......Um I don't even know what he looks like". It's no wonder that they think the nurses are all retarded.
The rounds went well. My patients were happy. I felt like they were getting the safest care I can provide. The drug rounds took 15 minutes rather than the usual 2 hours. Less patients means less people phoning and less time running to the phone.
Not only did we have a 1 to 5 ratio but we had an extra nurse to coordinate. She wasn't from our unit and there wasn't much happening so she busied herself with the important jobs that never get done basically.
I had one extremely sick woman who needed many interventions. The family made a point of thanking me for taking such good care of her, and they told me that knowing that she is getting good nursing care makes their sad situation bearable. They said that they thought that I had worked really hard and that they appreciated it, especially considering the horror stories that they heard about the place.
Of my 5 patients only one needed to be fed and the HCA and I fought over who was going to do it.
5 patients isn't always going to be easy. Had they been critically ill I would have been run off my feet. It's not always the number of patients you have but the acuity as well. I was lucky in the fact that I had a smaller than normal number of patients who were not very acute. Woo hoo.
And that's it. Soon the new units/beds etc open, all the beds will fill at lightening speed and the nurses we have will all be spread out even more thin than we are now. I got a letter from management addressing my concerns about the usual state of the staffing ( I last wrote to them months ago). He was pleased to inform me that we are getting 0.5 of a cadet. Uh uh.
Monday, 15 June 2009
A Powerful Comment
I believe every word of this comment that I am going to post below. These problems are more common than you think. A young male patient attacked my charge nurse and gave him a fracture and the judge let the lad off the hook. He attacked the charge nurse because it was "taking to long" to get discharged. The nurse was tied up giving IV meds to an unwell patient. What was management's response? "What did you do to make the patient so angry that he needed to do that?" Came from the same people who don't understand about staffing the wards properly. They don't see nurses as human beings....kind of like the members of the general public who walk onto a short staffed ward and start raving about the fact that grampa hasn't had his 8AM antibiotic yet (it is 8:03). "Are you nurses too stupid to understand that drugs need to be given on time?"
This comment was placed on this blog under the Why don't nurses smile? post.
This comment was placed on this blog under the Why don't nurses smile? post.
Nurse Nancy said...15 June 2009 06:21
I used to work in A&E in a very busy city
centre hospital. (I had 15 years experience of working in A&E.)There used to
be 2 hospitals with A&E depts but it was decided that the city really only
needed one. They therefore closed one down and now all the patients had to go to
one department. Same number of staff on duty though.
Who would have thought that waiting times would get longer, that patient
care would suffer, that the staff turnover would increase as people could not
cope and left and that the general level of violence towards staff (due to long
waits etc)would double. I particularly recall one shift where I was the nurse in
charge with 5 other staff nurses working with me. We had four critically
injurred patients from an RTA each requiring their own individaul nurse and Dr.
This meant that there was just me and another staff nurse and a HCA to care for
all of the walking wounded who now had an even longer wait because all of the
medical staff were tied up in resus with the RTA.
The two if us also had 17 other trolley patients to care for, all of who
were acutely ill or injured, as well as trying to carry out dressings etc for
the walking wounded who actually did get seen. On top of all this we had to try
to get patients to x-ray - some of who were unsafe to be left on their own - eg
patients with dementia who had fallen and fractured things and had no relative
or care home staff with them.
Whilst i was running round the department with a broom up my arse sweeping
the floors as well i was approached by a woman who was concerned that her son
who had been brought in by ambulance had still not been seen by a dr having been
there for 3 hours (he was drunk and agressive). I have to admit that she did not
think that i was taking her concerns very seriously decided that the best course
of action was to shout at me that I was a fucking blonde haired cunt and punched
me in the throat causing me to fall back through a curtained trolley bay onto
the lap of some poor old man. Her and her son decided not to hang around after
that so at least we were one patient down.
I remember standing in the middle of this heaving and chaotic department
and thinking would anyone notice if i just sat in the middle of the floor and
had a nervous breakdown. What happened to the nice lady who assaulted me? She
got a conditional discharge for 6 months (let off in other words) and had to pay
me £50 compensation at a rate of £2 a week. What happened to me. I now
work in the civilised realm of a primary care trust as an advanced nurse
pracitioner for the elderly - nice work if you can get it!!
Direct Quote from an NHS Pen Pusher.
No, I am not going to post the identity or link or any such thing. If you don't want to believe it then that is fine with me. This is a direct quote word for word from an NHS pen pusher.
Militant medical nurse is not at all shocked. This person is not a nurse manager by the way (for those of you who want to blame all the problems we have on the ward on different factions in nursing). The author of this quote is just a pen pusher.
Isn't it nice to know that when we are running our asses off , not taking breaks in order to up the chances of getting around to all of our patients and getting interrupted every 30 seconds for 14 hours straight ......that some pen pushers are getting paid to do sweet fuck all..................
"I have worked in the NHS for nearly 10 years. I am one of
those non-clinical, overpaid bureaucrats who are regularly slated in the press.
I totally agree. I got into the job by accident, stayed because of the
security/salary/maternity pay/benefits . I'm desperate to
do something more useful than sitting at a desk, sending the occasional email
and trying not to fall asleep at meetings.The trouble being that there are NO
part-time jobs ANYWHERE.So I should be grateful for my job, I suppose.But some
days I want to phone up The Sun and tell them how scandalous it is that people
like me get paid to do nothing but push paper around, --make up-- write business
cases and go to meetings 'for information'.
Militant medical nurse is not at all shocked. This person is not a nurse manager by the way (for those of you who want to blame all the problems we have on the ward on different factions in nursing). The author of this quote is just a pen pusher.
Isn't it nice to know that when we are running our asses off , not taking breaks in order to up the chances of getting around to all of our patients and getting interrupted every 30 seconds for 14 hours straight ......that some pen pushers are getting paid to do sweet fuck all..................
Thursday, 21 May 2009
Why does caring burn us out?
Found this over at Nurse Ratched's Place.
"Before I sign off, one of my readers asked me to help him out. Edward J Gordon, RN is doing some research for a book and he wants to hear from you. The book is about burnout. I’m sure most of you know what that is. Here’s what Edward said:
I sure would like to understand what’s at the heart of burnout. What is it that kills us about nursing? What is it that makes us so unhappy? Almost everyone I work with is either trying to get into NP school, or CRNA school, or is already taking classes-as if there were some unlimited amount of jobs away from the bedside. I think if I were younger and wanted to leave the bedside, I’d leave nursing altogether, become an IRS agent or something (I like numbers.). It seems like caring kills. It kills us personally to care for others. It turns us into something we are not. But is that a bad thing or a good thing? And is it this kind-of spiritual suicide that’s at the heart of burnout? I’m just wondering.
Please send Edward an email at EdGordonRN@cableone.net if you can help him out."
Nurse Anne decided to email Ed. I basically summed up the reason for this blog and made my usual amount of typos due to the fact that I am always in a rush. I know I simply told him things that he already knows, and I doubt that my email is really what he is looking for, but I sent the email anyway.
It went something like this:
Dear Ed,
Why do nurses burn out?
Nurses are expected to take on a ridiculous number of patients. At the same time they are expected to treat each and every patient as if they are the only patient on the floor. It is an impossible task and that is what burns nurses out.
We get the most wicked abuse when we are unable to provide this level of care from patients, families, our managers, the media etc. Here in the UK they will staff a 25- 35 acute medical ward that has a significantly high number of elderly, dependent patients with dementia with 2 RN's only. If we are lucky we may get 2 or 3 care assistants to help. We don't even get a ward clerk to answer the phones anymore as management does not want to pay for it. This is getting normal for general medical surgical floors in the NHS. It is definitely the norm for wards that have a high number of elderly patients.
I cannot remember the last time we had more than 2 RN's on duty for the whole floor.
If you open the newspapers here in England you will read countless articles about the suffering of patients in hospital. They claim that the nurses are uncaring and lazy and that this the whole cause of the problem. They claim that the whole problem is that nurses are better educated these days, and that we think we are above mopping the floors and caring for patient's basic needs. They claim that this is the reason MRSA and cdiff are rampant. This is what people think.
We are often left with critically ill patients during mealtime and 2 nurses and 2 care assistants to feed 18 people. We get a 20 minute window at mealtime to get all the food out and feed the patients. The critically ill patients do not go away at this time. What to do? What to do?
The press and various patient rights groups are claiming that nurses these days think that they are "too clever to do something so menial as feed patients" and say that this is the reason that patients are starving. They hit us up with these insane patient loads and then they say that if we are not sitting at bedsides mopping brows and holding hands it is because we are all cruel. We often work 14 hour days without a break and without stopping and still cannot get anything done. let alone done well.
People do not realise that nurses have life and death responsibility on their shoulders and that every second counts. They place unrealistic and unfair demands on the nurses, and then they lauch direct attacks towards the nurses when their unrealistic demands are not met. This is why "caring" burns us all out. This is why our nurses are running away from the bedside.
I blog about this if you ever want to have a read. I'll just warn you about my language. I do tend to swear like a sailor at times. I don't swear normally, bad language just seems to rear it's ugly head when I blog.
Anne
"Before I sign off, one of my readers asked me to help him out. Edward J Gordon, RN is doing some research for a book and he wants to hear from you. The book is about burnout. I’m sure most of you know what that is. Here’s what Edward said:
I sure would like to understand what’s at the heart of burnout. What is it that kills us about nursing? What is it that makes us so unhappy? Almost everyone I work with is either trying to get into NP school, or CRNA school, or is already taking classes-as if there were some unlimited amount of jobs away from the bedside. I think if I were younger and wanted to leave the bedside, I’d leave nursing altogether, become an IRS agent or something (I like numbers.). It seems like caring kills. It kills us personally to care for others. It turns us into something we are not. But is that a bad thing or a good thing? And is it this kind-of spiritual suicide that’s at the heart of burnout? I’m just wondering.
Please send Edward an email at EdGordonRN@cableone.net if you can help him out."
Nurse Anne decided to email Ed. I basically summed up the reason for this blog and made my usual amount of typos due to the fact that I am always in a rush. I know I simply told him things that he already knows, and I doubt that my email is really what he is looking for, but I sent the email anyway.
It went something like this:
Dear Ed,
Why do nurses burn out?
Nurses are expected to take on a ridiculous number of patients. At the same time they are expected to treat each and every patient as if they are the only patient on the floor. It is an impossible task and that is what burns nurses out.
We get the most wicked abuse when we are unable to provide this level of care from patients, families, our managers, the media etc. Here in the UK they will staff a 25- 35 acute medical ward that has a significantly high number of elderly, dependent patients with dementia with 2 RN's only. If we are lucky we may get 2 or 3 care assistants to help. We don't even get a ward clerk to answer the phones anymore as management does not want to pay for it. This is getting normal for general medical surgical floors in the NHS. It is definitely the norm for wards that have a high number of elderly patients.
I cannot remember the last time we had more than 2 RN's on duty for the whole floor.
If you open the newspapers here in England you will read countless articles about the suffering of patients in hospital. They claim that the nurses are uncaring and lazy and that this the whole cause of the problem. They claim that the whole problem is that nurses are better educated these days, and that we think we are above mopping the floors and caring for patient's basic needs. They claim that this is the reason MRSA and cdiff are rampant. This is what people think.
We are often left with critically ill patients during mealtime and 2 nurses and 2 care assistants to feed 18 people. We get a 20 minute window at mealtime to get all the food out and feed the patients. The critically ill patients do not go away at this time. What to do? What to do?
The press and various patient rights groups are claiming that nurses these days think that they are "too clever to do something so menial as feed patients" and say that this is the reason that patients are starving. They hit us up with these insane patient loads and then they say that if we are not sitting at bedsides mopping brows and holding hands it is because we are all cruel. We often work 14 hour days without a break and without stopping and still cannot get anything done. let alone done well.
People do not realise that nurses have life and death responsibility on their shoulders and that every second counts. They place unrealistic and unfair demands on the nurses, and then they lauch direct attacks towards the nurses when their unrealistic demands are not met. This is why "caring" burns us all out. This is why our nurses are running away from the bedside.
I blog about this if you ever want to have a read. I'll just warn you about my language. I do tend to swear like a sailor at times. I don't swear normally, bad language just seems to rear it's ugly head when I blog.
Anne
Saturday, 16 May 2009
Coloured Coded Uniforms? They won't change a thing.
The BBC came out with this little article recently.
"Colour-coded nurses' uniforms to help patients in Wales recognise who is in charge on hospital wards are being unveiled.
The assembly government said the new unisex scrubs would clear up confusion about who does what.
Ward sisters will wear navy blue, clinical specialist nurses royal blue, staff nurses sky blue and healthcare support workers will wear green."
It's a waste of time. Patients and visitors think that anyone walking around the ward in uniform is some kind of nurse. The fact is that the nurse is massively outnumbered by untrained staff and those who are at a level above staff nurse do not come near the wards. Our uniforms are currently colour coded with a different coloured stripe designating our rank so to speak. I do believe that we need better uniforms and laundry facilities and changing rooms. But I do not have any confidence in the fact that the public understands what a nurse is or understands the difference between a nurse and a care assistant.
When patients need a bedpan or a drink they think the ask for the "Nurse". I would like to be doing those things for people, as I know that they appreciate it and are grateful for any help. But the fact is that if I am in the middle of the drug round, ward rounds, emergencies and I am the only nurse with a few care assistants then I HAVE to delegate these things to the care assistants.
The 3 hour drug round to get everyone their 8 AM medications will turn into a 6 hour drug round if I do not delegate all the simultaneous requests for the commode that I get while focusing on the drugs etc to the care assistants. It's not like the care assistants can carry on with my work while I stop to help with toileting. The vast majority of errors etc that I have seen during the course of my career occurred because of nurses being interrupted for these kinds of things. I am already going to be getting interrupted constantly for things like phone calls, visitors, doctors orders, admissions etc anyway. The care assistants cannot help me with that either.
This leads to patients saying things like "That nurse (the care assistant) was kind enough to stop and help me wash my back but that mean nurse (the lone RN doing the drug round for 15 people while managing someone who needs constant monitoring) couldn't be bothered.
Even if the patients can differentiate between a nurse and the care assistants they are still going to ask for the "nurse" when they want something relatively minor. The nurse is usually up to her eyeballs with constant problems and cannot always get that commode. Nurses have to make quick decisions as to where they can go and when.
Janelle was a colleague of mine who got written up over something like this. She was a lone nurse for the ward with only care assistants to help. It was 7PM and she was still doing the drugs that should have been out at 5PM. She was running between a GI bleed and a COPD (infected excab) patient who was really kicking off as well, very short of breath and looking septic too. She had visitors of other patients up her backside wanting immediate answers. Sitting down with them and giving them those answers would have taken her away from the GI bleed and the COPD patient for too long. She was the nurse and had to deal with it all alone. The care assistants cannot help with things like this.
At one point she was drawing up some antibiotics and getting IV fluids reading for the COPD patient when the care assistant burst into the treatment room. "The woman in bed 3 says she must have a nurse right away. I told her that I am a care assistant and I can help but she says she wanted a nurse straight away". The patient in question often gets chest pain and Janelle thought that this must be why she wanted a nurse. So she legged it to bed 3. "I want a commode, that is why I demanded a nurse" says the woman in bed 3. "I am going to let Lena the care assistant to help with you with that right now because I have a situation with another patient who needs some medications" says Janelle. Cue the patient getting pissed off and complaining as a result of not understanding the situation. Cue Janelle being stupid and getting her a commode to appease her. Cue the medic showing up and pitching a fit because the IV antibiotics and IV fluids were not yet started on the copd patient and Janelle, the only RN, was handing out a commode while the care assistants twiddled their thumbs.. Janelle was complained about by both the patient asking for the commode and the medic of the poorly patient.
Nurses do not mind giving out commodes, cups of tea etc. But we are rarely in the position to do so. We did not create this situation, it is out of our hands. There is a lot of work that can only be done by a nurse and we are severely outnumbered by untrained staff who can really only help with basic care.
Colour coded uniforms are not going to change much. Nurses who are trying to concentrate and focus and get from one sick patient to another with drugs and treatments are still going to get interrupted constantly and asked to deal with things that the care assistants could handle. And we will continue to have mistakes and omissions as a result. I have seen severe mistakes occur because of it.
We are taught to prioritize but we have all walked away from things that we should NEVER have walked away from in order to prove that we are not "to posh to wash". And problems have occurred. I have seen patients harmed because their nurse was off helping other patients to get commodes. They are sensitive to the fact that people are accussing them of being "to clever to care" and then they do something stupid. I have seen more patients hurt by this rather than harmed by uncaring nurses.
Please realise that the nurses are professionals who are overwhelmed with their workload and understand that horrendous consequences can occur if they are not allow to focus and delegate. Please realise this rather than accusing them of being shirkers who are trying to get out of getting their hands dirty.
"Colour-coded nurses' uniforms to help patients in Wales recognise who is in charge on hospital wards are being unveiled.
The assembly government said the new unisex scrubs would clear up confusion about who does what.
Ward sisters will wear navy blue, clinical specialist nurses royal blue, staff nurses sky blue and healthcare support workers will wear green."
It's a waste of time. Patients and visitors think that anyone walking around the ward in uniform is some kind of nurse. The fact is that the nurse is massively outnumbered by untrained staff and those who are at a level above staff nurse do not come near the wards. Our uniforms are currently colour coded with a different coloured stripe designating our rank so to speak. I do believe that we need better uniforms and laundry facilities and changing rooms. But I do not have any confidence in the fact that the public understands what a nurse is or understands the difference between a nurse and a care assistant.
When patients need a bedpan or a drink they think the ask for the "Nurse". I would like to be doing those things for people, as I know that they appreciate it and are grateful for any help. But the fact is that if I am in the middle of the drug round, ward rounds, emergencies and I am the only nurse with a few care assistants then I HAVE to delegate these things to the care assistants.
The 3 hour drug round to get everyone their 8 AM medications will turn into a 6 hour drug round if I do not delegate all the simultaneous requests for the commode that I get while focusing on the drugs etc to the care assistants. It's not like the care assistants can carry on with my work while I stop to help with toileting. The vast majority of errors etc that I have seen during the course of my career occurred because of nurses being interrupted for these kinds of things. I am already going to be getting interrupted constantly for things like phone calls, visitors, doctors orders, admissions etc anyway. The care assistants cannot help me with that either.
This leads to patients saying things like "That nurse (the care assistant) was kind enough to stop and help me wash my back but that mean nurse (the lone RN doing the drug round for 15 people while managing someone who needs constant monitoring) couldn't be bothered.
Even if the patients can differentiate between a nurse and the care assistants they are still going to ask for the "nurse" when they want something relatively minor. The nurse is usually up to her eyeballs with constant problems and cannot always get that commode. Nurses have to make quick decisions as to where they can go and when.
Janelle was a colleague of mine who got written up over something like this. She was a lone nurse for the ward with only care assistants to help. It was 7PM and she was still doing the drugs that should have been out at 5PM. She was running between a GI bleed and a COPD (infected excab) patient who was really kicking off as well, very short of breath and looking septic too. She had visitors of other patients up her backside wanting immediate answers. Sitting down with them and giving them those answers would have taken her away from the GI bleed and the COPD patient for too long. She was the nurse and had to deal with it all alone. The care assistants cannot help with things like this.
At one point she was drawing up some antibiotics and getting IV fluids reading for the COPD patient when the care assistant burst into the treatment room. "The woman in bed 3 says she must have a nurse right away. I told her that I am a care assistant and I can help but she says she wanted a nurse straight away". The patient in question often gets chest pain and Janelle thought that this must be why she wanted a nurse. So she legged it to bed 3. "I want a commode, that is why I demanded a nurse" says the woman in bed 3. "I am going to let Lena the care assistant to help with you with that right now because I have a situation with another patient who needs some medications" says Janelle. Cue the patient getting pissed off and complaining as a result of not understanding the situation. Cue Janelle being stupid and getting her a commode to appease her. Cue the medic showing up and pitching a fit because the IV antibiotics and IV fluids were not yet started on the copd patient and Janelle, the only RN, was handing out a commode while the care assistants twiddled their thumbs.. Janelle was complained about by both the patient asking for the commode and the medic of the poorly patient.
Nurses do not mind giving out commodes, cups of tea etc. But we are rarely in the position to do so. We did not create this situation, it is out of our hands. There is a lot of work that can only be done by a nurse and we are severely outnumbered by untrained staff who can really only help with basic care.
Colour coded uniforms are not going to change much. Nurses who are trying to concentrate and focus and get from one sick patient to another with drugs and treatments are still going to get interrupted constantly and asked to deal with things that the care assistants could handle. And we will continue to have mistakes and omissions as a result. I have seen severe mistakes occur because of it.
We are taught to prioritize but we have all walked away from things that we should NEVER have walked away from in order to prove that we are not "to posh to wash". And problems have occurred. I have seen patients harmed because their nurse was off helping other patients to get commodes. They are sensitive to the fact that people are accussing them of being "to clever to care" and then they do something stupid. I have seen more patients hurt by this rather than harmed by uncaring nurses.
Please realise that the nurses are professionals who are overwhelmed with their workload and understand that horrendous consequences can occur if they are not allow to focus and delegate. Please realise this rather than accusing them of being shirkers who are trying to get out of getting their hands dirty.
Subscribe to:
Posts (Atom)
Posts
