Which One is the Nurse? Does It Matter?

Yes it does actually.

Time to go off on a few tangents and let off steam. It's theraputic for me even if no one reads this longwinded crap.

Before I start I would like to deal with a misconception about highly educated nurses. People think that we think we are above bedpans and cleaning. This is just not true.

I have always said that the major problem with Nursing is this: People don't understand what a nurse is, what nurses do, how much they have to know, the amount of liability and accountability they take on, the amount of education they need to do their jobs, and the unbelievable amount of responsibility they have. They cannot differentiate between a Registered Nurse and a Nursery "nurse" and probably think they have the same level of education.

How do I know that the public is so freaking clueless? Because I read doctor blogs and then I hear people refer to their 17 year old niece who gets a job working in the hospital as an auxillary as "a junior nurse". Yeah. A Nurse. Yep. People think that employee who comes into their room to take a blood pressure is a nurse. Why did I work so hard to get the initials RN behind my name if people think that the trolley girl who serves tea is a nurse? Any female walking around the hospital in uniform is a "nurse". This is totally unnacceptable. If you analyze this further you can see some of the serious problems that can arise as a result of ignorance. Attitudes can Kill.

You think I am being petty? Walk into an airport and call an airline pilot "stewardess". Hell they all work in the same place so whatever right? Walk into a solicitors office and refer to the legal secretary as "solicitor"..why not they all work in the same place. Walk into a hospital and call the doctor "nurse". You all know not to do this yet you refer to an untrained but well meaning kid who simply makes beds and walks people to the toilet as "nurse" which is my legal title and I'm not supposed to get annoyed? If an HCA or an auxillary had to go through what I went through in nursing school they would probably flunk out. Yes I know I sound too much like Dr.Crippen when he is having one of his quacktitioner vs Doctor tantrums.

They (support staff) know that real nursing is a total bitch. Why do you think so many of them won't go off and become nurses even though their education would be free (in the UK) and they would make slightly more money? Why do all that work when one can have an easier (although backbreaking) job with no accountability and still get called "nurse". They are only on very slightly less than an actual nurse salary wise. The job is lightyears less demanding...even if they are breaking their backs doing all of the lifting, bathing, turning etc. I was an HCA once so I know the score. I used to think that HCA's did all the work and now I look back on that knowing what I know now and realise that I was just ignorant.

I worked my ass off through a rigorous 4 years at university where I was in lectures 8-12 hours a day and clinical placements on top of thaton the same damn day. I had to take university level chemistry, microbiology, anatomy and physiology 1 and 2, statistics, the pharmacology course from hell, and much more as well as nursing theory. The other students at this university could get shit grades barely above passing and still graduate but the nursing majors were kicked out if their final grade for any class went below an 80%. Two fuck-ups in clinical and you were gone and you didn't get your $40,000 a year tuition refunded. Okay I was on a full scholarship but I was still under an insane amount of pressure. While I was doing 8 hours of clinical a day on top of 8 hours of lectures in a single day the media studies majors were getting drunk and fucking around. Bastards make more money than me too.

We were going to be nurses and had to be better than the others. This is what we were told. Nurses have life and death responsibility and even small mistakes kill. Most other Uni grads won't have to deal with that or work in such a chaotic environment. They won't have to think as fast etc etc.

Nursing in the UK is no piece of cake either. There are two ways of becoming a registered nurse. One can either do a 3 year diploma AT UNIVERISTY, or a 3-4 year degree AT UNIVERSITY. Let me tell you something. The 3 year diploma is a lot tougher in many ways than your typical 4 year degree for non-healthcare staff at university. Any starting new grad RN walks into a job where he will have triple the responsibility and workload and accountability that a teacher, english major, or business major etc. will have. I have lost count of the number of people I know who have done nursing as a second degree and said it was shockingly harder than their first degree. They don't last long.

I have lost count of the people I know who have Bachelors degrees in other fields who have flunked out of diploma nursing. In places like the USA where an RN has a highter starting salary than most new grads we see engineers, teachers, accountants, computer majors and others going back to Nursing school because they want a higher paying job and they want to help people. In the UK we see people who go through some kind of mid-life and decide to switch careers into nursing because they feel that they have done nothing worthwhile with their other degree and they want a job that means something...they want to help people.

What do all of these people have in common? The vast majority feel that nursing school was the toughest thing they ever did yet it was cake compared to actually trying to function as a staff nurse on a general ward. I know 5 school teachers (2 with a masters degree who went back to nursing school. Three were located in the USA where nurses make more money and 2 were located in the UK where nurses make less money than a teacher. Only 2 of them actually made it through nursing school and none of them lasted more than a year as nurses. They were soon back to teaching and it wasn't because they have an aversion to shit and puke. They couldn't handle the information overload and the life and death responsibility, the nightmarish hours. The ones in the US took the pay cut and went back to teaching.

Sure nursing education is lacking in a lot of ways but it's a lot harder than you think believe me. Just because it isn't as hard and as long as medical school doesn't mean it is cake. Nurses need a good academic foundation as well as massive amounts of hands on training done IN THE RIGHT WAY. Years ago we had the latter and not the former. People died. Now we have the former but not the latter. People die. My belief is that nurses do need to have a 4 year degree as entry level BUT that doesn't mean shit without decent placements and mentoring and interships. You just can't have one without the other. You need both. But who wants to go to school that long to get paid less than a policeman?

In spite of these problems with nurse education, people who can legally call themselves nurses have worked hard to earn it. The 19 year old HCA who makes your bed has no idea what it takes to be a nurse. They have no accountability and don't have to make difficult decisions. They don't take responsibility for anything. They are working on my license. They do not understand all of the ins and outs of what I am doing and why. They hear in report that we have a patient with an HB that dropped fairly quickly who is still on 2 kinds of anti-coagulants for that clot and he now has maleena. He is in the bed next to the NBM guy who now has no IV access and a K+ of 1.9. I have to change some info here to comply with confidentiality but you get my drift. They hear these things but they don't know what that means or what's involved and they don't understand why I make a run for those guys as soon as I get out of report rather than "helping us" serve breakfast.

Even after completely 4 years of hell at Uni and graduating with a degree in Nursing I was STILL NOT LEGALLY ALLOWED TO CALL MY SELF A NURSE. I had to take a miserable hellish state board exam. I passed on the first go and then I was allowed to use the term nurse to describe myself without breaking the law for the first time. All this qualified me to apply for a job as a Junior D grade staff nurse in the UK. I paid my dues to the state board of nursing for my license and than the NMC. It costs money to maintain a license. Not an issue for support staff.

This unfuckingbelievable amount of ignorance regarding nurses, their legal responsibilities and their education leads to many things. Indirectly it leads to people suffering and getting shitty care.

First of all it's very easy for the powers that be to cull back the number of registered nurses and bring in untrained kids with nose rings, give them a uniform and teach them how to make a bed. The public doesn't really understand the difference between these employees and a "nurse". Their opinion of nursing as a profession goes out the bloody window. I have heard comments such as "an HCA does everything a nurse can do except give meds". You have got to be shitting me. I'll be writing about a day in the life of an RN in a later post and we'll discuss this.

This increase in non-professional staff and decrease in actual nurses is occuring at a time when patients are sicker and more complex due to advances in health care that SAVE THEIR LIVES, as well as increasing targets that cause us to have to run around like chickens with our heads cut off rather than focus on the task at hand. The liability and the litigation against nurses is increasing causing us to spend more time than anything covering our asses via documentation. If you didn't document it...than you DIDN'T DO IT. That is the rule and if you don't adhere to that you GET BUSTED.

Meanwhile the HCA's are spending most of the time doing patient care (i.e assistance with activities of daily living). I don't have a choice but to let that happen because I am so overwhelmed but it scares the living fuck out of me. If I bathed my own patients, fed them, and walked them to the loo I can do a hell of a good holistic nursing assesment during that time and decrease the risk of getting fucking slaughtered by the NMC. I will notice how you are breathing while bathing you. An HCA will not or may not connect any dots. I will notice if you are showing signs of internal bleeding, shock, neurological changes, drug reactions, dehydration, pneumonia, hypoxia, infection, etc etc etc ad nauseum. I will catch problems during this time and sort them. An HCA will bath you and go onto the next patient because she doesn't know any better. Does the term "Failure to rescue" sound familiar? Most HCA's are lovely and hardworking but they do not have a license or professional accountability. If they fuck up I am fully responsible. They can't connect the dots between your appearance on a good head to toe assesment and your meds, labs, etc.

Am I able to provide basic care and do a good nursing assesment of each of my patients during this basic daily activity? NO.

Am I forced to dump things like bed baths on the HCA's? Yes.

Does that mean that my patients problems are not getting noticed quick enough? Yes.

Are nurses happy about this? Hell No.

We are scared shitless. Doing simple bedbaths allows me to do a thorough assesment that can help a patient, catch trouble brewing and keep my cute little bottom out of trouble. We are not "too posh to wash". We are "pulled in too many directions at once to wash" and we hate this because we can't get a good handle on our patients general condition which leaves us open to litigation, as well as a lifetime of guilt. Plus you just look fucking stupid when you don't know that your patient has sore heals. a sacral sore and a cellulitic looking leg and you have been "caring" for him 2 shifts in a row.

In later posts I will talk about nursing assesments how much I learn about your general condition during a 2 minute chat and a bedbath, or a simple walk to the toilet. That assesment at the beginning of my shift can make or break you (and me). I believe that all care should be carried out by an RN with a small number of patients. I believe that I should have a smaller number of patients and do everything for them from hanging IV meds, assesments, care-planning, to wound care, and to cleaning their damn feet. Pedal pulses anyone? This is how I feel and yet I have no choice but to leave the bathing and the mobilizing and the talking to my patients to the HCA's. No choice whatsoever.


Where are the signs of horror regarding low patient ratios and a mass exodus of actual nurses from the bedside? Why doesn't the public care? Why aren't they worried and crying out regarding the dangers of short staffing? Because to them a nurse is simply the hospitals version of waitressing staff, and doctors (who are rarely ever on the wards) are somehow watching the nurses' every move and the patient's condition. Therefore nursing care is really no big deal.
This is what sets the stage for poor care in hospitals. Nurses are an easy target for managers, and we are one of the first things to get culled back when they need to balance the books. Until people realize just how important nursing care is and that we need lots of actual nurses around care will continue to deteriorate.