Sunday, 20 January 2008

Connecting Some Dots

Staffing issues/Bed Occupancy/ Fucktwit politicans/ Superbugs

HAVE A LOOK AT THIS:

http://www.blackpoolgazette.co.uk/blackpoolnews/Worries-over-shortages-in-wards.1959230.jp

INCONSISTENCY and mismanagement threaten a critical shortage of GPs and nurses, warn two Fylde coast MPs.
Ben Wallace, MP for Lancaster and Wyre, and Michael Jack, MP for Fylde, said a leaked document on cuts to the NHS wage bill showed bad personnel management.
The document, part of the draft version of the NHS pay and workforce strategy for 2008 to 2011 in England, predicted that within four years the NHS will have a shortage of 1,200 GPs, 14,000 nurses and 1,100 doctors.
It also revealed an extra 3,200 consultants the NHS cannot afford to pay and an excess of 1,600 allied professionals, health scientists and technicians.
The Government has announced that more than 900 NHS staff are to be made redundant across the country as part of hospitals reorganisation.
Mr Wallace said: "The whole thing shows the Government's incompetency when it comes to workforce planning.
"It has encouraged people to join the NHS but now is laying people off and, in my own constituency, I hear of health professionals, for example, midwives, who cannot find a job.



AND THIS:

From a recently qualified Graduate Nurse

http://nursingstudentmuseing.blogspot.com/

Well, a few day's on the ward and I have neglected to really mention much of what I have been doing. There is still no job, though there have thankfully been a handful more job's posted on the NHS jobs site for my hospital. It would seem that the reason I was not shortlisted for the job on the ward was that there were 47 other student nurses who applied for the post. Yes, 47 students without jobs. I am not making this up, as I saw the pile of application forms. There were over 100 applications made when you add in the registered Nurse's that applied for the post. Good news is that they are going to keep my application if anything else turns up.


AND THIS:

http://www.sciencedaily.com/releases/2007/07/070719115825.htm

St├ęphane Hugonnet and colleagues from the University of Geneva Hospitals, Switzerland, investigated the number of patients admitted to the ICU who developed ventilator-associated pneumonia (VAP), over a four-year period. They then compared this to the number of nurses on duty for each patient in the preceding days. VAP affected over a fifth of the 936 patients who received mechanical ventilation during the study.

The team found that when there were lower numbers of nurses, patients were more likely to catch pneumonia six days or more after being placed on a ventilator. This suggests that bacteria are transferred between patients, or from one site to another in the same patient. This could be due to short-staffed nurses having less time to follow hand hygiene recommendations and proper isolation procedures or being unable to provide adequate care to the ventilated patient. The nurses' training level had no effect on infection rates.


Plus This:

http://www.sciencedaily.com/releases/2007/01/070116094235.htm

ScienceDaily (Jan. 16, 2007) — Hospital death rates can be reduced by employing more Registered Nurses and the routine use of care maps or protocols, according to a study in the latest UK-based Journal of Advanced Nursing.

A ten per cent increase in the proportion of Registered Nurses employed was associated with six fewer deaths per 1000 discharged patients.
The death rate also went down by nine per 1000 discharged patients when the number of Baccalaureate-prepared (university graduate rather than diploma qualified) nurses went up by ten per cent.
A ten per cent increase in adequate staffing and resources (as reported by nurses) was associated with 17 fewer deaths per 1,000 discharged patients.
:


PLUS THIS:
http://www.theitman.co.uk/granthamhospital/bed_occupancy.html

Hospital acquired infections such as MRSA and C.Diff. are on the rise. There is much evidence to suggest this is mostly down to two main factors, poor hygiene standards and bed occupancy.

Bed occupancy rates within Lincolnshire are high, very high. 99.2% !!! (Apr 05-Apr 06) The govt. target is 85%.

Several times a year the whole United Lincolnshire Hospitals Trust is on red alert. This refers to the trust having no available beds whatsoever. On 25th November 2006 Lincoln hospital had to close wards as 10 patients had the c.diff bug. One patient died.


Before any more beds and services are cut at our hospital we should ask the Trust board how they can justify further cuts to bed numbers at a time when we have already had one major outbreak at Lincoln and the bed occupancy numbers are massively over government requirements of 85% occupancy.

Quotes from around the press :

"People with MRSA should be treated in isolation, but that does not happen because bed occupancy is running at almost 100 per cent. We have heard of hospitals pulling the curtains around a bed and pinning a note on it to say "isolation".
Katharine Murphy, of the Patients' Association
http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2006/11/21/nhs19.xml

"Good infection control is being thwarted by high bed occupancy levels, a lack of isolation facilities and too many patients with different conditions being placed together in wards."
Edward Leigh. Public Account Committee
http://society.guardian.co.uk/nhsperformance/story/0,,1260861,00.html


And This:


http://www.cdc.gov/ncidod/EID/vol10no11/04-0253.htm

Staffing patterns and nurses' working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals' ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed.

A recent evidence-based practice report sponsored by the Agency for Healthcare Quality and Research concluded that a relationship exists between lower levels of nurse staffing and higher incidence of adverse patient outcomes (14). Nurses' working conditions have been associated with medication errors and falls, increased deaths, and spread of infection (15–30) (Table). RN staffing levels have been associated with the spread of disease during outbreaks (17,22,23,25,28). However, increasing nurse-to-patient ratios alone is not adequate; more complex staffing issues appear to be at work. Many studies have found that the times of higher ratios of "pool staff" (i.e., nursing staff who were members of the hospital pool service or agency nurses) to "regular staff" (i.e., nurses permanently assigned to the unit) were independently associated with healthcare-associated infections (16,17,21,27). The skill mix of the staff, that is, the ratio of RNs to total nursing personnel (RNs plus nurses' aides), is also related to healthcare-associated infections; increased RN skill mix decreases the incidence of healthcare-associated infections (20,29,30). In a recent comprehensive review of the literature, the authors concluded that evidence of the relationship between nurses' working environment and patient safety outcomes, including healthcare-associated infections is growing. They also concluded that stability, skill mix, and experience of the nurse workforce in specific settings are emerging as important factors in that relationship (31).


Anyone see where I am going with this?


And Gordon Brown is going to spend millions on supposed "deep cleaning" instead of creating jobs for front line staff, and redesigning hospitals and creating beds.
http://news.bbc.co.uk/1/hi/health/7008775.stm

I do not need to create a link to my posts about the staffing at my trust or managements attitude towards this problem. Randomly select any of my previous posts and read about it. We do not have enough beds to cope. New nurses cannot find employment anywhere. WE have 3 closed wards at our hospital. They are nightingale wards so cannot be used (as per government orders) but there is no money to refurbish (as per government penny pinching). I know of trusts that have the lowest staff to patient ratios in the country. They have superbug problems. They want rid of hundreds of frontline staff but they advertising for new management consultants.

Gordon, you ignorant slut.

Our domestics are only working 4 hour days and in that time they must serve breakfast and dinner. They are only hiring part timers as domestics. There are 2 domestics to do this in 4 hours and clean the ward as well in that time. The ward is at 100% bed occupancy and is totally overcrowded. They could not clean it properly if you had a gun to their heads.

Everyone understands this and has already connected the dots...everyone except the fucktwits in charge....

Thursday, 10 January 2008

Temper Tantrums




I think I am really losing it as a Nurse. I am still very compassionate but a hardened shell made of diamond has formed around every compassionate and empathetic bone in my body. I want to stand in the middle of my ward and shriek, scream at the top of my lungs: THIS IS REALITY. IT SUCKS BUT THIS IS HOW IT IS AND I CANNOT CHANGE IT. THIS IS NOT HOW THINGS ARE SUPPOSED TO BE AND I CANNOT CHANGE IT. NOW PUT ON YOUR BIG GIRL PANTIES, AND DEAL WITH IT LIKE A FUCKING GROWN UP.

The things some of these people bitch about...Their unrealistic expectations for one to one care....The belief that you are going to get one to one care in hospital.....the belief that the nurse you are sharing 35 patients with can revolve the world around you and your families schedule without fucking killing someone.......

I'm just a nurse who wants to do my job well and take care of my patients.

My assignment of patients wasn't so bad, that turned out to be a blessing later. My colleagues day sucked. It was her and myself for 28 patients. My 14 were in good shape. They were mostly walking wounded. One poorly patient went to ITU. No upcoming discharges. I was able to get in and do a good assessment on everyone at the beginning of my shift and get a good handle on everything. I was able to do this because I went into work early. Only 2 of them were on IV meds. No confused wanderers that day. It was good. I enjoy days like this because they are so rare. I recently got a couple of beautiful thank you notes from patients. The cards were waiting for me when I went into work. I feel bad because I know the care could be so much better.

My colleague had the other 14 patients who were tougher. She ended up with a death, 3 critically ill patients and 4 palliative care patients whose families were angry and inconsolable. I was able to spend most of my shift helping her out since my assignment was so good.

We have no free beds on the ward but are slated to get an admission at 3PM for minor surgery the next morning. The admission comes in and we sit her in lounge. She appears to be a very well lady. She is raging because there is not a bed yet. I told her it is okay as long as she is here and we can sort out her stuff and prepare her for theatre la de da. Called the bed manager and said please find this lady a bed.

Well a bed did become free around half past 3. We knew it would really. A patient in the side room died. The family was there. They were hysterical.

A relative of the dead patient was so distressed we nearly sent her to A&E..She was a young adult and when told that her dad died she lost control of her bladder. The rest of the family was no better. More family came in to say goodbye. We couldn't lay out the body and get it moved to the morgue because the family was laying on top of the corpse and couldn't bear to leave him. This went on for hours and hours. I was so heartbroken for them. It's not cool to say "look we have a new admit that needs this room, please leave". We gently tried to tell them that they could see him in the chapel of rest and encouraged them to get a cuppa while we sorted out dad and prepared him to leave the ward. They were having none of it. They would not budge. They would not converse with us. I don't think their English skills were great. This was the only bed we were going to have. There were no other beds free, or that could be made free.

Bed manager was aware of the situation there were no beds anywhere else. That's what she said anyway but she is also a well known liar.

Meanwhile the new admission in the lounge was getting increasingly PISSED OFF. WE were not going to tell her that there was a body in her upcoming bed
that we couldn't move. I could tell that she was the kind of person who would completely flip out about that.

By 5PM she was in the lounge crying because she was told to come into hospital for her op and expected to come into a bed and see her doctor straight away. She was to have a hernia repair the next day. I left 28 patients to hook her up with magazines, food, a TV some blankets to get comfortable and apologized profusely regarding the bed situation. I told her she wouldn't see her doc until tomorrow morning anyway even if she was in a bed. It did no good. Every 5 minutes she came out of the room to berate us, call us useless for not getting her bed ready. Then she called her husband and he came in ranting and swearing. Then she called her sons and they rang the ward every 5 minutes ranting swearing and threatening us. So did her sister. I guess they thought that this would get her in a bed faster.

This went on until 9PM. She had to go into the bed where the body was, there was nothing else we could do. We couldn't throw the recently bereaved family out. There was 7 of them and 2 of us. Site manager was aware and said his hands were tied. Thanks for the help you fucker. It was 9PM when we finally were able to lay the body out, get him transported to the morgue and clean the room for the new admit.

If you want to know why your nurse isn't answering your call bell, spending time with you etc etc....it is because they are messing around with this stuff.

This woman was crying and cursing saying that having to wait for a bed like this was the worst thing that ever happened to her in her life. I had to try so hard not to laugh at her. I brought her a dinner tray in the lounge and she threw it on the floor. I am sorry. The lounge she was in was nicer than the room itself. She had comfortable chairs etc. She wasn't ill. She had food, water, TV and a phone. She was coming in and out to smoke.

My colleague suggested that we should give her full responsibility of 3 bays by herself, then she could have something to really whine about.

By 8PM I came so close to grabbing her by the hair, digging my nails into the back of her head and dragging her to the room with the corpse in it so that I could point to it and the grieving relatives and say "NOW THAT IS A REAL FUCKING PROBLEM". "NOW THAT WOULD BE SOMETHING TO GET UPSET ABOUT".

I came damn close. Maybe it's time for sick leave.

Thank god my 14 patients were all right. They saw me for about 2 seconds each. If one of them had deteriorated, it would have been missed. If any of them peed the bed they sat in it for the duration of my shift.

Edited to Add: I just made a few phone calls and have an appointment with my GP tomorrow. I am now off sick. I hate complaining to my GP, since she probably has too deal with 100x more bullshit at work. I hate feeling this way.

I have had close relatives die horribly. I have had medical problems myself and as stressful as that was I feel ten times worse and more anxious about going into work. I can't handle the abuse and getting sworn at all the time. I don't get to throw tantrums and cry when I am feeling like that. I'll get complained about if I so much as forget to smile. Maybe if they just offer me a chocolate cookie that will make it all better and force me to smile.

http://www.timesonline.co.uk/article/0,,2087-2450166,00.html

I am not going to follow my own advice and put on my big girl panties and suck it up anymore. I am still job hunting so maybe something will turn up. I will even go and work at Asda if they are hiring. If the house sells first we are out of here.

Monday, 7 January 2008

Beauty Salon VS. General Medical/Surgical Ward

Okay guys check this out.

I was talking to my little sister yesterday. She is a hairdresser in the States. She works from 0900 to 1500 daily and makes WAY more money than I do because of the tips she gets. We had a conversation the other day.


Nurse Anne: So how many chairs do you have at your hair salon?

Little Sister: uuuuum like 10 chairs.

Anne: How many staff do you have on a normal day?

Little Sister: Um... like.... never any less than 4 or 5. Um like we take one hour lunches. And if customers don't like waiting it's tough titties. Um like and oh yeah we sit in the back and like smoke and shit and make them wait longer if they complain.

They can leave if they don't like it like okay? Yesterday Kiki and Emilio did my hair and my nails because it was like a totally slow day. We closed down the shop for an hour or 5 and had a little party. Like I think I am going blonde at work tomorrow. Emilio will fix it for me.


Jesus Christ where is their manager and/or owner?

But I digress...


Okay so let's go back and analyze this. They have 10 chairs. The maximum number of people being seen to at once is 10. They may also have customers waiting in the lounge. No harm comes to them as a result of waiting for awhile. They have 10 chairs and 4 to 5 staff.

My 35 bed (now 39 beds because the treatment rooms and day rooms are now patient rooms) ward considers itself lucky if we have 4 staff. We get on our knees thanking Jesus if at least 2 of those staff members are actual nurses. Our patients are acute, highly dependent,and many have dementia. They can die or have extremely bad complications because of one little fuck up or missed bit of information. I had 10 of them who needed to go off the ward for essential diagnostic tests the other day. At the same time. Why does god hate me?

All of them needed escorts because they were either on 02, they had dementia and would wander, fall and get lost if left alone in x-ray, or they were on drips that could not come down. All that stuff requires an escort from the ward staff to go with the Porter and stay with the patient.

We had 3 staff on duty. 10 patients needed to be off the ward with an escort (Nurse or HCA). No escort means no test basically. Radiology has a shit fit if they are asked to come to the ward to do a chest x-ray on someone who is too poorly to go down there and there are no escorts. The other departments constantly have shit fits because they want the nurses to revolve everything around their particular diagnositc department. Endoscopy is the worst for this by the way. Fuckers. Just kidding. ;)



Does anyone else think that any of this is completely sick?


We have been harassing the managers and matrons for months trying to get them to meet with us. The only response we have got from the powers that be recently went something like this "You are well staffed as far as we are concerned. Deal with it and cope".

Wednesday, 2 January 2008

Sorry

Between a destroyed computer and a sick kid I haven't been able to get on and post for awhile and for that I apologise!! I hope you all (if anyone still comes over here) had a Merry Christmas!!