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?


Nurse Anne said...

I wrote this on the beach after getting a text from a colleague. I can't even let go when I am away for god's sake. I haven't even unpacked yet.

Anonymous said...

what could help? I have had 3 relatives in different hospitals recently, one paediatric ward, no problems, really excellent (mind you parents mostly did the feeding and washing part), and two adult, not so good but you could tell that the nurses were run off their feet just coping. It was incredible, no point complaining, it felt we were all in the trenches together. But as a relative is there any way to complain or comment that would have any useful effect? We don't know about what staffing levels are or should be, we just see people rushing past doing several things at once. Shouldn't the nmc/gmc report on staffing levels and the dangers caused? People might listen at the moment. Sara

Anonymous said...

"I wrote this on the beach after getting a text from a colleague. I can't even let go when I am away for god's sake. I haven't even unpacked yet."

Yet another sign of unimaginable stress levels. Don't accept it, there other things you can do and still call yourself a good nurse. Talk to any member of staff in the icu or specialist areas and see how many would work on a ward again - they are not bad people but understand the system will not change until nurses stop just complaining and vote with their fucking feet.

SSS said...

If anyone needs a holiday it's you. So have it. Move away from the laptop.

And seriously, Anne, it's time for you to look for another job. It's killing you. I'd never, ever, ever work on a ward again and every time I read your blog I remember why. It's not worth your sanity.

Take care of yourself.

Anonymous said...

Hi Anne

I work in complaints for an acute trust and would so love to cut and paste your post as a response to some of the letters we receive! (Slight problem is there is no way our Chief Exec would sign it - because that would mean taking responsibility for the problems there are - shame)

Happy1 said...

Staff : patient ratio's decide whether patients get good care or not. Full Stop.

The general public do not understand the workload that rests on a Registered Nurse's shoulders on the majority of wards.

Nurse Anne - you define it very accurately, throughout all of your posts. The stress is evil. I moved to A&E where it is slightly better.

I recall an on-line petition to Downing Street a while back regarding safe ratio's,...

...the Prime Ministers Office responded that...

"The Government believe nurse leaders should have the freedom to determine their own staffing ratios according to local conditions"!?!?

There is a new, current petition on-line regarding safe ratio's. I urge EVERYONE to sign it.

(especially relatives with complaints who choose to hammer the nurses a little bit further)


Name: Bedpan Juggler said...

Amen to that. xxx

Nurse Anne said...

Many of the relatives are wonderful, helpful, and understanding. They are really sweet.

But the pyschos really make their present known. And the number of psychos seems to be increasing.

Methuselah said...

There's a lot of entitlement in the UK these days. Teachers, university lecturers and the rest are having to put up with the relatives of students and students themselves being very keen to exercise their "rights" without paying due attention to their obligations.

Anonymous said...

Today's nursing students are talked to as though they are children. As a student you are supposed to be 'supernumery' but of course in reality you are not. You must sign to say you are of 'good character' and be polite and courteous at all times or harsh punishment will follow (however other members of staff can be as rude, arrogant and sarcastic as they like to students without any fear of being similarly disciplined and boy don't some of them take advantage of that). As a student I was shouted and screamed at by various members of staff at all levels. I was asked extremely personal questions about sex and my private life. Are such individuals really suited to nursing? (You bet I refused to supply them with this information!) I was bullied, bawled at and ordered to stand to attention. I was forced to listen to my 'betters', who I was supposed to 'respect' indulging in crude and vulgar conversations - I was forbidden to spend quiet times revising so had no option but to listen to this juvenile drivel.) Oh I had plenty of obligations as a student but seemingly no rights at all. Like many of my peers I had previously had a good job where I was valued, respected and addressed like an adult but naively I believed nursing was a dignified and worthwhile profession and would be a way of giving something back to society. In the end I was so disgusted and disillusioned that I left, never to return.

Anonymous said...

I agree I am an RGN and I work for our trusts nurse bank I cover all wards including the A&E department within our trust. I have on a number of occasions had to look after 15 medical patients, two terminals (one with a syringe driver) two with PEG Feeds two with Hickman Lines and one with a PICC line, not to mention countless IV's to go up and other poorely patients. The Chief Executives response to cut backs within our trust was to state in a Local Newspaper that it would not compromise patient care, Bulls##t! Although I am a more than a competent Nurse, I feel that it is difficult to give the expected level of care when you have so many patients with so many needs to look after on my own. The trust thinks that if they tell the public what they want to hear then all will be well, WRONG it is patients care and possibly the nurses pin numbers that are being compromised due to being put in such a demanding and potentially dangerous position, But do the higher authority care? DO THEY HELL.

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