Saturday, 21 February 2009


You can thank the managers for this crap, the matrons for being indifferent, and the nurses for stupidly behaving like martyrs to try and keep the patients safe.

A bit of background. My trust got rid of float pool and bank nurses. The nurses who worked pool or bank were used to cover sick leave, maternity leave, short staffed wards etc.

Management fucking got rid of them over the last few years.

When a ward is short staffed they pull nurses from another ward.

What wards do they always pull staff away from? MEDICAL. GERIATRIC.

If anyone has read my blog you know that normal numbers on my ward. Sometimes we are 35 beds with 2 nurses and 2 healthcare assistants. When the ortho ward is short staffed, or a surgical ward is short staffed they will take our staff away to cover. When we are short we are told "sorry there is no help available". Can't expect those sick bastards to spend money and resources on medical patients can we.

Came into work one day last spring already stressed because I knew that there were only 3 RN's and 2 HCA's for the entire ward. This is better than usual but still shit. 5 minutes into the shift I got a call from the dreaded site manager.

"You need to send one RN to the surgical ward and one care assistant to the gynae ward".

Nurse Anne: "WTF that only leaves us with 2 nurses and 1 care assistant for 35 beds. We have elderly patients who need total care but also acutely ill patients"

Site Manager: "Tough it out. Prioritize. Do nothing but deal with emergencies and meds."

Nurse Anne: "No. I can prioritize but I also want to see my patients safe, clean, and pain free as well as fed".

Site Manager: "You have a house keeper. Put her to work as a nurse for today."

Nurse Anne: "Ummm she doesn't know how to be a nurse and who will clean and make food?"

Site Manager: "Not my problem. If your RN and HCA are not onto the surgical and gynae wards in the next 5 minutes you can consider yourself on final warning. Goodbye."

Nurse Anne: "Fuck you".

Okay I didn't say fuck you but I didn't send the staff either. He came down to the ward himself and collared them. I am not a good enough nurse to handle so many patients with so little. I don't know anyone who is that good.

So I decided to be real nosey and called the wards that I was ordered to float my staff to for the duration of the shift. The gynae ward (relatively well patients) had 3 nurses and 2 HCA's for 20 self caring young female patients ALREADY. But they didn't feel that they could manage on that so they asked for more.

The surgical ward was 30 beds and had 3RN's and 3 HCA's already. They also felt that this wasn't enough and they were probably correct but they should not have had my staff. I do understand that surgical patients require massively frequent monitoring.

I was left with 35 acute medical and geriatric patients with 2 nurses and one health care assistant.

So What happens when we call for help?

"Sorry no staff available to help you"


"just prioritize" (that means ignore the patients and do paperwork to cover your ass)

"Not my problem"

"Can't afford Agency".

"Deal with it".

They are damn focused on putting a show on for the younger patients in surgical/gynae/ short stay wards. But our patients are mostly confused and dying so fuck them say the managers. The nurses that are down there on medical and elderly wards busting their asses will take the blame right?

I had a chat with Matron about this situation. She shrugged her shoulders and looked at me in a very patronizing way and said "there is nothing I can do, you will just have to cope".

Almost every day that I went to work we ended up with less staff than my charge nurse had scheduled because they got floated elsewhere.

I don't know what I was expecting from her or any of those matrons really. She was the same twunt who left me as the only RN for 35 beds once. I was 25 weeks pregnant and when I got into hour 10 without being able to take a meal break safely I asked her for help. Not even a full break, just 5 minutes to get a drink. She literally turned her back on me without saying a word and went home for the day. That is an honest to god true story. That was the worst shift I had ever. Ever.

I may have been extremely short on nurses that day but the safety of patients required me to be able to do the job of 5+ people. I will never ever martyr myself like that again. And they say that if only the nurses took a little pride in their work things would be better. I got nothing out of that shift but a whole lot of patients that were really angry with me because they had to wait so long for things. They got terrible care that day even though I had pushed myself so hard.

And the modern matrons are supposed be teaching us about caring...

You can see why they will not bring back the old style matrons and sisters. The old style nursing superheroes would put an immediate stop to this bullshit. The modern managers , nursing leaders, and modern matrons would have to hire bodyguards and then go and crawl under a fucking rock. The old style nursing sisters and matrons would fuck. them. up.


Gus said...

Great post.

Wait till the laying-off starts. It will be like the Crimean War on the wards.

Nurse Anne said...


You think there is going to be more lay offs? Of nursing staff? They can't possibly.....

Anonymous said...

What would the Department of Health say about the imbalance between the nursing care offered to medical and surgical patients? They would tell you about:






But there is this awful unfairness, lack of respect, poor quality, loss of dignity and absent autonomy on medical wards as opposed to surgical wards. The surgical patients mostly come in well, they arrive fit, if they die its the hospital's fault. Managers will have backs to cover. The geriatric patients are seen by the cost cutters as dying anyway. A death in the geriatric ward will not be noticed. Nobody will attribute the C diff outbreak to lack of nurses to clean patients up promptly. I could go on. These patients are much more difficult to nurse than the surgical patients and nursing input is likely to make more of a difference between them living and dying than nursing input on the surgical ward where most of the patients will do alright anyway.

Nurse Anne said...

It's not just about cleaning people up an hygiene though. A lot of these people have multiple pathology, they need their furosemide and their digoxin, and a nurse who spends enough time with them to notice a change in condition. They need someone to moniter their lab results and get intervention sorted when the furosemide drops their K to low. The doctors cover multiple wards, they cannot possibly be around all the time babysitting the nursing staff and the patients.

They are diabetics who need insulin and their blood sugars monitered. They need their hypertensive medications and their BP observed. They need someone who can keep an eye on them when that aminophylline is infusing, and ensures that levels are drawn. They need someone who knows how to give IV meds and infusions and blood without killing them.

They need someone who can do all that and keep them clean and dry and fed.

norwich12 said...

when ased to run the ward below what i consider to be safe staffing levels i filled in a
risk assessment and sent it to the powers that be.
i work in a community hospital 28 beds older peoples rehab we are the only ward, so theoretically they cannot pinch my staff but they have cut my staffing levels. i have the same amount of staff for 28 beds as i did for 22.
10 of those patients can be strokes all others either orthopaedic or general medicine with multiple pathologies, hard going.
i agree with everything said but you can fight it.even go to the unions.
we are at present setting up our own nurse bank as the acute unit who does the bank of course think their needs come first and they cannot always supply staff we request.
i feel nurses think it is the norm to work short. as a group we have or could have a mighty voice, it is getting up the courage to use it.
i am an old school trained nurse and have not got long before retirement but i'm not frightened anymore to speak out.
i thought in the late 60's we slogged hard but today in 2009 it is quite appauling what some nurses have to put up with.

Nurse Anne said...

What we have learned is that if you use your voice you are made out to be a liar. The unions and the nmc are aware of the situation.

Thanks for reading.

MrAngryman said...

Anne its the same at my hospital. The modern matrons are just glorified bed managers who make sure that theu go home on time. If i had the space i could tell you horror stories about how ineffectual and almost clinically negligent these guys are but im sure you have similar stories yourself. The maxim of the new NHS is dont rock the boat, do as your betters tell you and remember YOU ARE NOT IMPORTANT, PATIENTS ARE NOT IMPORTANT, THEY ARE ALL JUST NUMBERS. It helps if you repeat this twice a day george Orwell style in front of the mirror!

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