Wednesday, 25 March 2009

Why Are the Nurses Always Hanging around the Nurse's Station, the computer etc.

"Why are they always hanging around the computers and the nurses station"?

"Why are are they always filling in forms?"

"Does this mean that they don't want to nurse patients?"

Well, if you are even asking these questions, you are probably totally fucking ignorant. They ARE nursing patients by doing these things you moron. They are also trying to avoid harming patients, getting struck off by the nursing and fucktwittery council and ending up in a courtroom.

I'll get back to the CCU part 3 thing later.

Just look at these bizarre quotes from over at Dr. Crippen:

"I shall probably be shot for saying this, but the common factor in
very many of the horror stories seems to be nurses. Endless excuses are made -
not enough staff, too busy, not enough training etc etc. But I have personally
seen many instances where there is a clutch of nurses round the computers, but
none in the ward. Nurses all seem to want to be doctors, or at least look like
and be treated as doctors, and few of them want to nurse. Hence Nurse
Practitioners. Since the start of the ridiculous Project 2000 this has
escalated. (ducks down below the parapet)"

Yes you had better duck below the parapet you ignorant fucking shit. First off all, project 2000 died pretty soon after it was born. Most nurses working in the NHS right now did the traditional training. Lastly, just look over at America. Their nurses are highly educated at universities and you won't hear of patients over there starving to death. They also have much less ancillary staff on the wards than we do. Yet the patients get better care. They get basic care. Think about why this is the case. I will give you a hint. A 24 bed medical ward in the USA will have 7 trained nurses and 2 care assistants. In the UK the same ward would have 2 trained nurses and 3 care assistants. The nurses over there are highly educated, they graduated from highly competitive expensive schools, they get kicked out of school if they do not get top grades in their university science courses and the have a smaller number of patients. They can do the care and complete the other aspects of their work.

"A few years ago my wife was in two different hospitals in fairly quick
succession. In both I saw nurses routinely clustered around a computer screen,
chatting. In one, when I walked over with a question I found that they were
talking shop. So I walked over several times in the next few days; it was
shop-talk every time. In the other I had twice visited the nurses' cabal. Each
time the talk was mere gossip. Naturally, it was the gossipmongers' hospital
that was highly rated, internationally famous and so on."

First of all let me say this: I do not believe for a minute that either of the authors of these quotes are able to distinguish between a nurse and a cleaner, tech, auxiliary nurse, OT, dietitians, administrative staff, etc. I don't believe that they understand why nurses need to spend time on computers and form filing. I cannot believe that anyone would think that a nurse is trying to act like a doctor and avoid patients by hanging around on the computer or filling in a form. It is mindblowing that anyone in the 21st century could think like this.

Secondly I am suspicious of anyone who uses the terms "nurses" and "sisters". Many (not all) of these general wards will not pay nurses and sisters to all be on duty at the same time. Two "nurses" tops. If sister is on shift than it is "sister" and "nurse" and they are each the primary RN for a large number of patients. The rest of the staff kicking about are not nurses, or anything like a nurse. If you are going to use the term "nurse" you had better be damn sure that you know what you are talking about. People who use the term "nurses" plural whilst referring to general medical wards are probably talking shit.

Why do comments like those above piss me off?

1. Nurses stations are gathering places for all sorts of staff, all day long. These people may be in uniform but they greatly outnumber nursing staff. My ward is in a very central location. People love to use OUR fucking nurse's station as their own personal break room, meeting area etc. They tie up our phones, our computers etc. They are not nursing staff nor are they employees of my ward so it's not like they are going to answer a call bell or see a patient. The clinical techs are the worst. They work all over the hospital and they travel in groups. They are NOT ward based. When they are not busy you can bet your arse that they are feet up at MY nurse's station. If you look at the station at any random moment you will see occupational therapy, clinical techs, physios, dietitian, social workers, clinical techs sat on their arses, nurses from other wards who have stopped down to borrow something but are not allowed to touch a patient on my ward, clinical techs, clinical techs sat on their arses, pharmacy techs and more clinical techs. I have to fight my way through this crowd of people to get my work done at the station.

I know for a fact that relatives and visitors generally refer to this eclectic group as "nurses ignoring patients". We hear you say it, and we laugh at your fucking stupidity. This occurs on a daily basis and it gives me some much needed comic relief during a long and break less 12 hour shift. Thanks for that.

I had a little fun with this situation one day. There were 2 nurses and we were hours behind, patients were waiting and suffering. I could see visitors glaring at the nurse's station, giving each other knowing glances. I have been around long enough to know what they were thinking. So I acted like a bitch.

In a very loud assertive voice I shouted " Listen up, I want all non nursing staff who are hanging about the nurses station to stop using our ward as a break area. The patients and visitors think that you are actually nurses that you are ignoring patients. Can you not hang out in the cafe upstairs please?" All five techs who were having their break at the station got up and walked out, leaving the station empty of human beings. The visitors etc looked surprised. I know I sounded like a jerk but it was worth it. Nurses should do this kind of thing more often. I've done it more than once in order to make a point. It works and I haven't got told off for doing it yet.

I don't often get meal breaks and I don't want to see others get them if I can't. That was the other reason I threw them off my station.

2. Computer work and paperwork is nursing too and is absolutely essential to patient care. We violently hate this but it is a fact of life that we cannot control. They will string me up from great heights and deny my patients essential treatment if I fuck this up. If I was responsible for a small group of patients I could get through this stuff very quickly. But I am responsible for a large number of patients (12+) and the amount of computer and paperwork I HAVE to complete becomes extremely time consuming. Even if you ditch all the crap that is not essential and just focus on the absolute high priority stuff it is still very time consuming if you have a large number of patients. This is true if I have once care assistant or nursing student helping me out or 20 of them. This crap still has to be done only by the registered nurse. I'd rather be at the bedside.

The pharmacy won't give me the meds I need without filling in forms and placing orders on the computer. I had a patient who was about to arrest because he had a K+ of 7. I notified the doc of the blood results and he ordered the necessary intravenous meds. I had to jump through a million computer hoops to get the pump to deliver the meds. I had to had to jump through a million paper work hoops to obtain the drugs that needed to be given. I had to fight with equipment department and pharmacy. It took an hour to get the damn stuff and I ignored my other patients whilst I was trying to pull this together. I would have been responsible if he had died because I did not get the ordered treatment initiated.

Pharmacy will no longer stock us with half the stuff we need. Forms forms forms and arguing to get those ordered pain meds that your mother needs right now is the norm. Forms and fighting with pharmacy to get stat life saving medication is a regular occurrence. Obtaining routine medication is an even greater nightmare. I have to leave the patients and spend too much time on the phone, the computer etc arguing with these people just to do my job. They will not bring things to the ward so I have to leave my patients or send an HCA. We always have a large number of staff OFF the wards running after equipment and pharmacy.

If the paperwork isn't right the scan people and the blood people will not perform your test. Your skin may be a mess and what you need is an air mattress. It is like pulling teeth to get one. Back on the computer and the phone I go to obtain one.

Lab test results. For whatever reason our lab is not always phoning in critical blood results. This means that if I don't break away and run to the computer to check bloods something may get missed. I have found HB of 5 that they never called in. I have found screwed up electrolytes that they never phoned in. If I don't know about them how can I inform the doc? How can the patient get treated? How do I know if I can continue on with that K replacement or not? I frequently have to break away from the ward throughout my shift to run off and look this shit up.

Updating patient information for the next shit: This is crucial to patient safety but never gets done properly. I have seen incredibly bad patient outcomes occur as a result of this getting screwed up. It is extremely time consuming for the number of patients that I have. But every time I try and get near that computer visitors are on me like flies to shit, accusing me of ignoring the patients.

There is never going to be a time of day when I don't need to be at the computer or filling in forms to get my patients the things they need. This is constant throughout the shift. There is also never a time of day when I don't have 10 people that need basic nursing intervention immediately. Even if I saw to them previously they will need help all over again less than 15 minutes later.

Once I was on the computer trying to get something and a relative grabbed me to get her mum a pillow. She walked past 3 hca's who were making beds and came to me while I was trying to order a much needed item. She thought that the HCA's were busy and that I was doing nothing because I was on the computer. So she came to me. I went and did it myself rather than incur her disdain by making her wait or asking an HCA. On the way back to the computer a patient asked me for a commode. I got it right then and there and went back to the computer. Then I found out that I had missed the boat on obtaining what I needed for my patient by 5 minutes and now must wait until Monday morning to get it. Wards may be 24 hours but pharmacy, equipment, and path lab are NOT.

If I spent all day at the computer and pouring over paperwork I would not scratch the surface of getting all of it done. If I spent the whole day doing commodes I still would not get to all those patients in time. It is chaos and we are only able to do a little bit of each. Did I tell you that my childminder is charging me £1 a minute for each minute that I am out of work late and she has my child? I do push a lot of the computer work towards the end of my shift and complete it during unpaid hours to avoid ignoring the patients all shift. My childminder is making good money as a result of me getting out of work late and staying on unpaid. I have to pay her for time I did not get paid for. Nice huh. Next time I am going to get it all done while I am on duty and get the hell out of there as soon as my relief comes. If the patients and the visitors don't like me sitting at the computer all damn shift documenting and get things that they need then they can pay my childminder and I will stay over and do it at the end of my shift.

The amount of money I have spent on childcare for hours that I did not myself get paid for would buy me two new cars.

Look at this quote by Florence Nightengale:

"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

She is 100% right. The more we sacrifice, the more they want and the more they complain.

To hell with all this. I am just going to sit back and watch this ignorant country run every last nurse out of here with their impossible and ridiculous expectations and generalisations. America and Australia will be more than happy to have British nurses to help maintain their strict nurse patient ratios. They know that British nurses are damn good at their jobs and they are anxious to poach them.

Rant over. Back to the CCU part 3 now.


Staff Nurse Squabbly said...

I think I love you.

Found your blog via Random Acts Of Reality and I cannot tell you what a RELIEF it is to hear a voice like yours.

I am newly qualified - like, REALLY newly qualified - and I am feeling like I am working in Hell and a madhouse alternately (your basic London Trust, then), and that no one seems to speak the same language as me...

Am going to sit and read your entire archive.


Happy1 said...

I too have only just dicovered Nurse Anne's blog...and am part-way through reading the entire archive. I cannot believe that I am reading what my head has been screaming out for years!

Nurse Anne is a genius to be able to put the reality of it all into words...

Well done...keep up the good work (as in the nursing, and the blogging).

Keith said...

Hats! that's what we need!

Bring back caps :)

Anonymous said...

Why is it called the 'Nurse's Station' if anyone BUT the nurses hang around there? Do the doctor's have their own computers & writing space? Obviously the dieticians/technicians/physios/OTs don't. Where are they supposed to write up their stuff? Or should they take the notes back to their own departments?

Nurse Anne said...

I am cool with doctors, OT, and physio working at the station.

I am not cool with techs or anyone else sat there shooting the shit, belly laughing, and gossiping while shoving sandwiches in their mouths.

Some of my patients have just been told they have advanced cancer. They don't need to hear laughter and gossiping.

Dr Phil Yerboots said...

give them both barrels Sister!

Greatly enjoying your blog, in the same class as Dr Rant.

STAR said...

just wondering what clinical techs are? we don't have them in my hospital, or maybe we call them something different.

There is a move to get rid of nursing stations, and to go towards having mini stations around the wards. I still think that there will be a place where people will congregate.

And want to say I love your blog.

juli said...

This is something that I personally hate, but have no choice about. I'm an OT, and given the choice I'd much rather work somewhere else when I'm not actually seeing patients, but often I need to be at the nurses station as it's the only place on the ward to do the stuff I need to do. At the moment we keep seperate OT notes, so I can do most of my note writing in our office (which is not always easy, seeing as we have 15 OTs & physios sharing 6 desks) but we have to also document in the medical notes, so I need to do this on the ward. There's moves afoot in our trust to have all of the AHPs documenting purely just in the medical notes - I'll be spending even more time cluttering up your nurses station if this happens, as not only will I have to write all of my notes there, but because I won't have my own documentation to copy when I'm filling out care forms, equipment orders, etc, I'll have to at least complete the patient name & address etc bit of these forms on the ward instead of in my office! Yet the powers that be (even our own managers, which surprises me) think this is a good idea!

Also there are times when I'm waiting for something to happen that I simply can't leave the ward until it does - last week I was meeting with a social worker and the patient's family. I was on time, so discussed what I needed to with the patient & family, social worker was 30 minutes late, then when he finally turned up he insisted on speaking to the patinet & family alone, so I was left hanging around at the nurses station until he was ready to speak to me!

I know full well what it looks like when I'm at the nurses station. My patients can't even remember that I'm not a nurse, so their relatives have no chance of being able to differentiate between the professions. I hate it when the phone rings when I'm at the nurses station, as I'm damned if I do & damned if I don't - if I answer the phone I'm not going to know the answer to the question the person on the other end has, or be able to do anything with the info they have, so I need to run off and interrupt a very busy nurse to get them to take the call. So I stopped answering the phone, only to find I get dirty looks from relatives, managers and matrons who think I just can't be bothered! Tell me, would those of you who are nurses rather I answered the phone and had to interrupt you (I do enough interrupting already, but try to keep it to a bare minimum) or just ignore the phone and you have to rush across to answer it from the other side of the ward?

Nurse Anne said...

Juli honestly I don't mind OT's at the nurses station. Physio, OT and the dieticians are the only people in the hospital who treat the nurses like human beings.

Anonymous said...

Honestly...stop your wringing, get out & get another profession. As a long term patient I was absolutely sick of having this crap rammed down my throat every 5 minutes. Patients are your customers, if you were to enter a shop & the assistant moaned constantly about her employers, work conditions, pay etc etc, you would think it very in professional....same goes here. Your pay & conditions are far better than those for many who actually put their life on the line doing their job. You all enter the profession knowing the pay & conditions and you still chose to do it. Nurses have winged about pay & conditions since the beginning of time. Get into the outside world for a while & you might appreciate that actually your working conditions ARE better than most.

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