Tuesday, 16 October 2007

It Just Gets Worse

Eight years ago when I started working at my current hospital I was hired to work on a general medical/care of the elderly ward that had 35 beds. Sister was there five days a week and a day shift (0730-1530) would have had 4 staff nurses and 4 HCA's on a good day. This meant that the 35 patients were divided up into 2 teams. On each team there was 2 staff nurses and 2 HCA's. We worked hard and we managed. The patients were cared for very well. Call bells were answered. The drug round/orders/ward round/discharges and admissions was done by one nurse on the team whilst the other nurse and the 2 HCA's helped patients, gave them breakfast and did bed baths as well as answering call lights. The two teams helped each other if one was struggling.

On many of our shifts the med nurse was able to lend a hand to the other nurse and HCA's. This is especially true if there was very little in the way of admissions/discharges/acute patients and short ward rounds on a particular day. We had bad days and we had short staffed days. But it wasn't the norm. We had a full time ward clerk who was excellent.

That ward was suddenly shut for refurbishing 6 years ago and opened again as a smaller specialty ward. Two months ago it was shut again and another specialty is planning on getting it but for now it is empty.

When it shut staff was dispersed. I went to a 15 bed short stay surgical ward. Lap chole patients/hernias/ENT etc etc. We also had a day surgery suite. It was brilliant. Very fast moving because of all of the patients coming in and out but excellent. I now had younger patients who were not chronically ill. They got better and went home. This 15 bed ward had one charge nurse in charge of the whole area. One staff nurse for bay one and 2 siderooms and 1 nurse for bay two and one sideroom. We had 1 or 2 HCA's and lots of students. Our patients raved about how excellent that place was. I loved it there and could have stayed. We always had excellent nurse patient ratios and zero complaints. We had lunch breaks because there was someone to cover our patients. We had 2 part time ward clerks.

More restructuring. That ward was taken over by another specialty and all of the staff were sent elsewhere to make way for their staff. Moved again. Lots of people were being moved to medical and they didn't know or want to work in medicine so they left as there were other jobs back then. They were not replaced. I went back to medicine.

Myself and the staff from my original ward were reunited on an older ward that was worse than the original ward. Once again we were doing medical and care of the elderly. This ward had a couple less beds and way way way less staff. Now we had 2 staff nurses and 2
HCA's for only 4 less beds than we had on our first ward. Most of us were the same nurses on the original ward yet care deteriorated. We had crap shift after crap shift. People left and were not replaced. Our manager is not allowed to hire. Our ward clerk became ill and retired. She was not replaced. The layout of the ward meant that the only phone was a long way away from the patients. Constant running back and forth. If I was doing a drug round and the phone started ringing I would run down to get it but by the time I got there the caller would have given up. I once again made my way down the ward and halfway down it would start again so I ran back up. Did this between 5 and 10 times an hour.

A year or two later this ward was shut along with some others. It was old and falling to bits. There is no money to refurbish. We were having bed crisis after bed crisis even before these wards were shut. Staff re-deployed again. People have quit. I am now on a bigger ward with more beds. This ward is medical/surgical/care of the elderly and a speciality that I know fuck all about. These patients should not be mixed together. It is becoming more and more medical day after day and goodness knows were the specialty and surgical patients are going. The specialty nurses this ward had are distraught. The staffing is so much worse than what we have ever had. It has been getting progressively worse for the last 6 months.

The nurses have reported what has been going on and taken action but it is falling on deaf ears. My heartbreaks when I see how our elderly patients are neglected and suffering. It is appalling. I can't even describe what I am seeing. It is hard when you are working your ass off because you give a damn, and so are your colleagues and yet the patients are basically getting left to rot. Important things are getting missed. Med errors are happening. People aren't getting fed. On that ward we may have 2 people who need to be fed or we may have 20 or anything in between. Staffing levels are not adjusted for this. We used to leave on time but now even if you are determined too you will have to go over your shift by one or two hours unpaid.

Nurses have legal obligations that we have to meet and "being short staffed" doesn't get us off the hook. Poor documentation is the number one thing that causes nurses to lose their registration. I have seen people die because something simple wasn't handed over or written down and it got missed. Some of that paperwork bullshit needs to get done. We often refuse to do the non-essential paperwork. Our manager has no say in anything that is going on. As a matter of fact our nurse managers often get themselves in serious hot water for speaking up.

I stopped into work on Sunday to check the off duty and they only had 4 members of staff on for the whole large ward. There was a 4th HCA who was doing a one to one with a elderly lady with dementia who was trying to pull our her central line and falling constantly. The third HCA was doing a one to one with another elderly Alzheimer's patient who was attacking other patients. She had thrown a water pitcher at one and wasn't going to be coaxed into stopping. The nurse and the other HCA were trying to hold down the fort alone. Luckily it was a Sunday. They had more patients than usual because storage cupboards and the day room have both had beds put in to accommodate patients.

People who want overtime are refused as it won't be paid. If you do work over you are unpaid but can take time back on another day. This is rarely possible because the ward is so short. Our uniforms are falling to bits and cannot be replaced due to budget cuts. We bring them to work in a bag and change in to them in a supply cupboard that doesn't lock and opens into a hallway were people are waiting. Our uniforms are in such a state that we are buying trousers on the high street and wearing those under our tunics.

With every week that goes by I start hoping that things will get better and improve but I am losing hope fast.

Targets have run these facilities into the ground. I hope that something changes soon. Can't take much more of this.

I went through a very competitive program and a top university to become a nurse. It was a lot tougher than your average bachelors degree. A growing body of research has shown that the more education a bedside nurse has the higher the survival rate is for his/her patients. Research is continuing to show that if nurse patient ratios are poor people suffer and die. As health care continues to become more complex and change dramatically the education level required of registered nurses will continue to rise. Not only do nurses of the 21st need to be better educated but we need a lot more of them.

This does not mean that nurses who are well educated think they are above cleaning up patients. Far from it. See my "which one is the nurse" post to see why well educated nurses should be doing basic care. The vast majority of us realise this already.

A high school drop out who works down the road at the Burger King has better working conditions than I do. Nursing care is vital. How are we going to get more recruits in if they require more and more education yet the pay and the conditions are deteriorating? Most of our new grad nurses cannot find jobs anyway. I don't see how things can continue to circle the drain like this.


DBA Dude said...

Reading this just made me feel so depressed for you.

I do not see how much longer you can continue working under these "Victorian" conditions without doing real damage to your mental/physical health.

Hope that things do change or that you manage to find a good way out.

Then I clicked on the Pirates and Emporers link - and that cheered me up (a wee bit).

Nursing Student said...

Thing is Anne, you don't NEED to work like this. There are a lot of qualified nurses who are left unemployed. I really do get so disheartened by things like what you discribe as clearly there is a demand for nurses which is deliberatly not being met. I remember last week some nurses in my ward discussing a recent round of applications made for a job where pedantic levels of nit-picking were being used to select the two people for the job.

Still, if around January time you need a staff nurse, I may be available for work.

However, in the meantime, just do what I do. Take a deep breath, smile sweetly and think about how you can rant and rave about all the things that have gone wrong on the blog. Hell, it's the only thing that keeps me going some days. Keep up the good work, and on a final note, thanks for giving advice which keeps this student nurse going on some shifts.

Garth Marenghi said...

it's a disgrace, good old fashioned proper nursing is not valued as it should be, while various nurses who don't like nursing rule the roost with their array of empowered roles that do very little good,

the same staffing problems are happening with doctors as regards night work, ie the infamous 'hospital at night'

Nurse Anne said...

Thanks for all of your comments guys. I keep trying to come up with posts that are more positive but I find it theraputic to let it all out on here.

Nursing student, If we were allowed to hire I would like to have you on board!! I think you would be excellent.

DBA Dude, I am working on a way out. There are no other hospitals and no jobs whatsover around here. My dad immigrated to the USA when I was a baby I spent every summer and did my nurse training there. I have an American nursing license as well. The husband is ready to go so we are working on getting visas and selling up. It should take between 6 and 18 months.

Gareth. Our matrons have abandoned us. We don't see them, they are not on the wards or involved with the patients in anyway. At least that's how it seems from down here. The specialist nurses got out because they flat out couldn't handle the bedside physically or emotionally.

Nurse Anne said...

I just wanted to add that not all bedside nurses are working in these conditions but it sure seems like most of us are from where I am standing. It seems that the general wards i.e general medicine especially are taking the worst beatings. Our patients aren't as likely to see what is going on.

It certainly wasn't this bad 5 years ago.

If there were jobs available I would head for CCU,ITU or Theatre.

Garth Marenghi said...


I thought this article summed up how things were going so badly wrong.

Hospitals were managed much better before governments started fiddling around with payment systems.

The NHS works much better if doctors and nurses work together and make decisions based on clinical indications.

Medicine goes to pot when run by idiots who know nothing clinical and only care for economics.

As you say, it's hard to be positive about things, however we are forced to complain because the government propaganda machine keep insists things are getting better, and they really are not, as you know!

Saad Amir said...

It has just worse has very nice and informative article for the peoples.The educated peoples who have sense of creating every things of his life.
regards, saad from

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