Thursday, 16 April 2009
Dear Angry Relatives of Hospital Patients
Dear Angry Screaming Family Member,
You know who you are. You are the ones who rant and rage and accuse the staff nurses of being uncaring and oblivious without having any understanding of what is actually going on in that ward.
Those of you who think that elderly patients are being ignored and discriminated against by front line staff really need to walk a mile in a registered nurse's shoes. The registered nurses are being forced to take on a lot more patients than they can handle. Full stop.
You would not be able to do any better. Not at all. I know that to be a fact. If you were in the nurses shoes and working 14 hours non stop as they often do your patients would still be neglected and left unattended. The nurses have to make extremely tough decisions as to who gets care. We are not ignoring people nor are we oblivious. So many members of the public seem to think that we are oblivious to all the suffering around us. We are spread to thin. We do not hate elderly people. We do know when someone cannot feed himself and we understand that it is our responsibility to ensure that our patients do not starve.
You, however, have no understanding whatsoever of what a our job involves, how much responsibility we have on our shoulders or just how much we have going on at once. Over a decade of hospital nursing has clued me in to just how little the public knows. You do not understand the consequences of what happens when the nurse loses her focus. It's not 1970 anymore. The patients now are sicker, more complex. Things are moving a lot faster and every last detail of everything I do needs to be recorded for the solicitors. I can't fight this. Believe me when I say that you do not have the faintest idea. This is especially goes for those of you who have not nursed in a hospital since 1980. If you walked onto a ward in 2009 and tried to take on 12 patients + as I do every shift, you would be fucked. You would fail 100% even if you pushed yourself harder than you think you could be pushed. You would fail. Your patients would be neglected. Go on, give it a try or shut the fuck up. If there are 5 self caring well patients on the ward you get 2 nurses. If there are 35 totally dependent medically unstable wandering, confused crashing patients on the ward you still only get 2 nurses. The number of staff never change no matter what is happening.
Today's nurses did not invent complex interventions, polypharmacy, and the indignities of old age. We did not make your mum old. We do not have a say with the staffing levels. We did not give your dad dementia or a poor appetite. The doctors have each of my patients on pages and pages and pages of drugs and it takes them 20 minutes to swallow one pill, and sometimes they ALL are on 12 or more at least. They can take 20 minutes to swallow one pill as a result of cognitive problems rather than a physical swallowing problem. I might have 10 people like this, all due to have drugs at the same time at regular intervals throughout the day. It is an impossible time consuming task. If I get every pill into them I have neglected and harmed my other patients. If I don't get those drugs into these people than I have neglected and harmed them. It is a no win situation that I did not create. I am just responsible for any bad outcomes that occur.
When you experience what it is like being one nurse trying to feed five patients at once whilst being constantly interrupted as well as dealing with emergencies and admissions simultaneously then you will start understanding what is going on hospital wards and why people are being left with trays in front of them when they cannot feed themselves. How very dare you accuse a staff nurse of intentionally starving a patient without understanding what else she has on her shoulders at that moment in time.
You (as the nurse) will also have countless drugs and interventions due at this same time and at constant and fixed times throughout the day. The consequences for screwing any of this up are dire.
A simple assessment missed because I was running around making sure everyone was fed and toileted will probably lead to a life threatening situation later in the shift and a court date for me. Everything is always happening at once and nothing can wait. I am not god. I cannot astroproject and be 10 places at once. I cannot make patients disappear so that I can have a better chance of caring for my others. I cannot create an additional nurse out of thin air to help me. All I can do is aim to hit the to priority stuff, work hard, skip meal breaks, beg for mercy and a miracle.
My own beloved Uncle Richard was admitted to my ward once. I had 18 patients that day and he was in the other nurse's group of 17 patients. He never forgave me until the day he died for not getting into that room of his to check on him for 10 hours. If you understood what was going on with the 18 patients I was legally responsible for and how alone I was you would understand why I could not go and see to Uncle Rich. How every fucking dare you stand there and yell and say "you wouldn't treat my loved one like this if he was your dad". Fuck off. You have absolutely no idea about what is going on here do you?
Sometimes a miracle happens. There are days when I have less dependent patients than usual and my chances of getting everyone cared for properly are upped. I might even get them all cared for well and get a cup of tea. These rare types of shifts keep me going. Unfortunately the gods of nursing only allow this to happen once every few years or something.
You (as the nurse) have a million things to do. YOU HAVE to start with the things that could be lethal if they are not dealt with right away and then work your way down the list. Other than that you have absolutely no control. That list is top heavy and you won't have worked your way through the top priority stuff before the end of your shift. And things will be no better for the oncoming shift. You can't look stressed or the patients will panic. You (as the nurse) do not have the right to additional help but you are responsible, possibly at risk of criminal negligence if you fail.
If a childminder was forced to look after 12 or 20 children at once you can bet your bottom that she would bring additional help in or refuse to do it. A staff nurse does not have this right. We just have to move fast and do 10 things at once. This does not allow for hand holding and washing etc no matter how much the nurse wants to be doing those kinds things. Would you force a childminder to take on the care of 15 infants alone with 1 untrained helper only who is not allowed to do a lot of care? Would you interrupt her every 2 minutes while she was dealing with this? Would you then accuse her of being lazy and uncaring when one of those infants was left to cry, or left in a soiled nappy? Would you? It seems to be part of British culture to do this very kind of thing to staff nurses. It is sick.
I am a mother. At one time I had 4 children under the age of 6. One of those kids has special needs. The days I spent at home caring for them with no help while my husband worked long hours away would break most people. I found it easy. I was a nurse before I was a mother you see. It was easier than caring for 4 medical patients in a hospital that is for sure. I always have to take many many more than 4 medical patients when I go to work. Always.
If my own father was my patient on top of 10,15, 20 others he wouldn't see much of me either.
Seriously. You just need to fucking stop with the "You wouldn't treat him this way if it was your father" line. You have no idea what you are talking about. You are unable to see the big picture. You are only thinking of your loved one. I am aware of and responsible for the clinical picture for 25 people. What is happening with every single patient affects every single other patient. Whether or not you get that bedpan or painkiller in a reasonable amount of time is dependent on what is happening with the other patients. I couldn't control this situation if you put a gun to my head.
If another patient could not breathe and had a fast irregular heart rate and my father was asking for a pain killer at the same time I would HAVE to sort the short of breath heart patient first and then hopefully be able to get to my father. Hopefully. It would be entirely dependent on what is going on with all the other patients too.
I probably would not even be able to grab the o2 mask for the heart patient without being stopped for 5 commode requests....and the patient waiting for pain killers is still waiting.....and this is all happening during that 20 minute window I have to feed 7 people. The ambulance has just shown up to transfer a patient during this as well. The more patients I have to take, the more screwed everyone gets. Multiply this scenario I have just described by 5 times an hour for 12 hours straight. Then maybe you will start to understand what a shift is like for a staff nurse.
There is never a time during most of these shifts when the nurse is left alone, free of interruptions to go around and check on ALL his/her patients and make sure that they have everything that they need. Every single minute of many of these shifts are overbooked with multiple jobs that could get a nurse struck off and a patient harmed if they are missed. No matter how badly you (as the nurse) want to get around to everyone I can guarantee you that it isn't going to happen and that it will be out of your control. Most shifts are like this. And even though it is out of your control you are still responsible for any bad outcomes. All I can do is work hard, prioritize, skip meals and push push push myself. We are not oblivious, uncaring, and thick. We are overwhelmed. It is triage people. Triage. Not holistic care.
You also have to remember that most of the staff on the wards are not nurses. Most of the time at least half of the ward staff on any given shift are unqualified. They are usually hard working and caring people but not nurses. Most things can only be done by a nurse however. Yet the public seems to think that everyone walking around in uniform is a nurse. What the fuck is that all about?
The public need to be realising all of this rather than abusing overwhelmed nurses who are run off their feet most days. I know that you would do no better if you were in my shoes.
As a matter of fact I am also convinced that you would do a heck of a lot worse. I know you would.
If you have a problem or a question about your loved ones care that is absolutely fine. We are 100% cool with that and want to help. I may not be able to stop and talk to you for the duration of my shift but I will stay over at the end unpaid to speak to you. I do appreciate your concerns. I have received information off of relatives that have saved my arse on a number of occasions.
I never have a problem with people who are unhappy with the care they are getting because I know that their concerns are legit. I have never in all my years of nursing seen a patient intentionally neglected because of complaining. I have seen people who have praised the hospital over and over again in the local paper get neglected because someone else on the ward was sicker and there were too few nurses.
I also get that even the most reasonable person can lose it and lash out when their loved one is ill. But there is "lashing out due to grief" and then there is completely and utterly psycho. Lately we are overwhelmed with psychos. Make no mistake about it, these are daily mail reading nutters of the highest order.
Lately we are getting too many people that are running onto the ward screaming and calling pregnant nurses who have just worked a double shift with no break fucking whores, fucking niggers, stupid miserable uncaring fucking cunts. And these are the family of members of broken elderly medical patients that we got better and nursed back to health.......What brings on these outbursts? Call bell took more than 2 minutes to get answered (3 staff trying to answer 10 call bells). The tea trolley girl missed bed 4. We ran out of pillows and cannot get anymore. Medic is dealing with a cardiac arrest on another ward and also has 10 crashing people to see after that and cannot come and tell family of a patients x ray results right now.
You can only imagine what the relatives of the ones we can't help are like. I cannot even begin to describe their behaviour here. It is like they took their language classes at the militant medical nurse school of polite conversation.
This kind of abuse of staff is increasing like crazy lately. Is it something in the water?