Monday, 4 February 2008
Bring Back Matron you say? Oh they are back all right.
At my hospital we always had a saying..."Matrons are like ghosts...we know they exist but we never see them."
Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.
Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of "Nurse" onto one of these people*.
I have posted the stats regarding Nurse patient ratios. I have posted research into medical errors. I have posted about some of the insane practices that were happening on my ward and continue to occur almost daily. It doesn't take a rocket scientist to figure out that people do and can get hurt. At the very least is the little 90 year old man sat staring at a tray off food he cannot feed to himself..whilst his nurse is busy elsewhere. If anything makes me feel like going postal, it is that scenario. Staff nurses are not perfect and they do make mistakes, but many of the mistakes that happen are down to system errors that could have been prevented.
My ward was opened to another specialty and now takes 3 or 4 different specialties. We are the (now 40 bed) dumping ground for EVERYTHING. This was the result of a management decision that was not thought through. As usual we are left worse off than we were prior to said management decision. None of the RN's were cross trained and fuck up after fuck up occurs daily. The nurses are stuck with too many patients, no back up, no support in a specialty in which they have little or no experience.
The Matrons know the situation. There are many many highly paid matrons at my hospital. One for each specialty. Did any of them come to the ward to provide guidance and leadership or help out during the restructuring? HELL NO. They basically disappeared into thin air. Totally fucking AWOL.
Did they put on a pinny and come and help out on the ward? HELL NO.
Did any of them come anywhere near the ward or a patient? HELL NO.
Did they return our phone calls? Rarely.
Have we ever seen them act like a nurse? HELL NO.
Would any of them be able to name a patient on our ward? Nope.
Once, two years ago, a Matron did come to the ward to help us put because we were so short. This is the only time we recollect that this has happened. I was overwhelmed with really sick patients. Matron informs me that A. She does not remember how to do a drug round and will not do it. B. She is not comfortable with IV meds and will not help with that. C. She volunteered herself to answer the phone and call lights. So I got left with all the hard stuff, and supersuck (who makes double my salary) did fuck all.
That was the last time we saw a Matron (or a Nursing Leader) on the ward in a clinical capacity. They stay far far away and leave the staff nurses to suffer alone. We have written letter after letter about the conditions on these general wards and they are ignored, or Matron shrugs her shoulders and says "we feel so bad for you".
Don't feel bad for us...you are a highly paid nurse...get your arse to the floor and help us...be a goddamn nurse...provide some goddamn leadership by example. Come up with a plan for cross training the staff. Back us up when we are getting threatened by the chief nurse for complaining when we are one nurse to 24 patients. At the very least come and help us feed patients when YOU KNOW that we are 2 nurses to 15 feeds and everything else that is happening simultaneously. I have worked with bedside nurses who have masters degrees and chose to work at the bedside. The situation is so bad, it should be all hands on deck. Fuck whatever it is that you do all day. I have yet to see anything that you "do" benefit a patient.
I don't know what they do in that office all day. I don't know why they hate their nurses. I don't know why whatever the fuck they are up to in that office is so much more important than the patients and the staff.
I do know that despite the fact that they know how short we are working, they love to re-arrange our paperwork and make it more complex. Certain forms have gone from 5 pages to 20. I know that they are trying to redesign our care plans because the current ones are never filled in properly. I informed the Matron that it doesn't matter what structure our paper work takes...it is going to be FUCKED because of time constraints and overwhelming nurse patient ratios. I must not have got through.
When do we see Matrons? When there is an inevitable cock up. Then they are down to the ward like flies to a horses ass to ensure that all blame is directed onto the staff nurse and the hospital does not appear negligant or liable. Then the same error happens again with a different nurse because these are SYSTEM errors not NURSE errors. Once again Matron comes down hard on the individual member of staff without troubleshooting the problem. Fucking worthless whores. I saw it happen to too many of my colleagues and I got the hell out before the day came when it was my turn.
As far as I am concerned, most of our so called nursing leadership are traitors to nurses and patients alike. Don't even get me started on the NMC, the RCN or any of the other worthless pieces of crap who refuse to address the real issues. I'd like to see them all lined up and shot*.
*if there are any Matrons out there reading this that care about patients and support their nurses than I apologise to you personally. The rest of you are overpaid stupid worthless bitches.
*Nurse Anne is a non-violent pacifist and she does not believe in shooting our so called nurse leadership for their crimes. She just fantasizes about it.
Saturday, 2 February 2008
In the journal article, University of Pennsylvania researchers analyze why nursing care means more to hospitalized patients than pillow plumping and good cheer.
They culled data from more than 200,000 patients and 10,000 nurses to calculate that for every additional patient a nurse is assigned to care for, the odds of a patient's dying within a month of hospital admission rises 7 percent. In other words, when your nurse cares for seven other patients on a shift, your chances of dying from whatever ails you are about 30 percent higher than it would have been if your nurse had only three others.
Nurses in the UK average about anywhere from 1-10 to 1-20. It can be anything the managers want it to be and believe me, they want to divert as much money away from decent staffing as they can. When patients complain about waiting for a call bell to be answered, the managers forbid the nurses from talking about and explaining staffing levels because they "will not admit liability". They lay the blame with the nurses and nurses get a bad reputation. This is a fact.
May 30, 2002 -- In today's issue of the New England Journal of Medicine (NEJM), researchers Jack Needleman of the Harvard School of Public Health in Boston and Peter Buerhaus of Vanderbilt University’s School of Nursing in Nashville, Tennessee found that nurse short-staffing leads to deadly consequences for patients.
The study analyzed discharge data from 6 million patients and financial data and staffing surveys from 800 hospitals in 11 US states. When nurses were short-staffed, patients suffered up to 25% more life-threatening complications including infections, bleeding, pneumonia, shock, cardiac arrest, and "failure to rescue," all of which contributed to an increased length of hospital stay
78% of MDs believe RN staffing levels are too low, 82% believe quality is suffering, an alarming 1-in-5 doctors report patient deaths due to nurses caring for too many patients
(this article comes from the USA, where general ward nurses have 1-8 as opposed to the 1-10,20 etc that we have in the UK.)
AS RN to patient ratios decrease from 1:4 to 1:10, the number of post op surgical patient deaths climbs dramatically. (aiken, Clarke, Sloan,Solkalski and Silber 2002).
UK nurses average anywhere from 1:10 to 1:20 on general medical and surgical wards.
The Allnurses.com discussion forum cites numerous first-hand stories of how nurses have blamed themselves, or have been blamed by hospital administrators, for dangerous and sometimes fatal medical errors. In most cases, these incidents reflect far more on deficiencies in the systems in which nurses must work.
At least four out of five medical errors are probably due not to negligence or carelessness, but to deficiencies in the system in which doctors and nurses must work. The ISO 9001:2000 standard and its health care specific modification, IWA‑1, recognize that people work in a system, and that a deficient system cannot deliver good quality no matter how skilled or careful the workers might be.
It is a general rule in industry that only 15 to 20 percent of trouble comes from negligence, carelessness, and incompetence. The rest is due to deficient organizational systems that make trouble almost unavoidable. W. Edwards Deming's 85/15 rule says that 85 percent of all defects and errors are the fault of the system in which people must work, while 15 percent results from carelessness and negligence. Frank Gryna cites an 80:20 ratio, with 80 percent of errors and mistakes being "management-controllable" and only 20 being "worker-controllable." 
(i.e.organizational problems such as a NHS managers who have no clinical experience, a bad attitudes towards nurses and ignorance regarding nurse patient ratios. Total hospital wide system failures that cause the nurse to have to spend time away from patients i.e. chasing pharmacy up to do their jobs)
Recently conducted large scale research found that:
In a given unit the optimal workload for a nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission. A workload of 8 patients versus 4 was associated with a 31% increase in mortality. Higher nurse staffing levels resulted in reduced numbers of urinary tract infections, pneumonia, upper gastrointestinal bleeding and shock in medical patients and lower rates of "failure to rescue" and urinary track infections in major surgery patients
(What have I said regarding the ratios we are working with at my hospital? According to this research even 1:8 is bad on a general ward...let alone the 1:20 that happens on mine).
This paper from Harvard is an excellent explanation as to why working conditions and piss poor management causes nursing care to be so bad.