Sunday, 5 April 2009

Listen Up Lunatics: Well educated nurses care the most about basic nursing and hygiene needs!

And we are the best at delivering it. So there.

It is the old fashioned trained bunch that are running around with the protocal checklists. The degree educated nurses are younger and still finding their feet on the wards.

Let's look at my day between 8AM and 2PM.

When I come to work on a morning I will have anything from 12 to 20 patients as the only RN. A degree educated RN. The only help I have is the health care assistant (HCA).

I have 2 drug rounds to do. One before 0900 and one before 1300. The first one takes about 2 hours if I am not interrupted by the phone. We have no ward clerk most days. The reality is that I am interrupted on an average of every 2 minutes and 30 seconds. I actually timed it. I start at 0800 after a 30 minute handover. I eye up the sickest patients first and then I start the first drug round.

The second drug round at 1300 only takes about 30 minutes if I am not interrupted. But constantly interrupted I am.

I will average about 9 or 10 patients on IV antibiotics/meds. Sometimes none. Sometimes all of them are on IV meds. Staffing is not adjusted. Only one nurse if you have 3 patients on IV meds and only one nurse if all 20 are on IV meds.

These IV antibiotics are due every 4-6 hours. Or 2, 3 or 4 times a day. They take about 15-20 +minutes EACH to set up, check, mix, and administer to the patient. Again, I am constantly interrupted. So imagine that I have 10 of them to give and it takes a conservative estimate of 10 minutes each to set up and delivery every 4-6 hours. The realise that I am not getting more than 3 minutes without an interruption.

Are you doing the maths so far?

If it is a weekday I will spend about 2 hours or so on the morning doing doctors rounds when he decides to show up and demands that I stop what I am doing right now and attend the round. My group of patients have 6 different consultants. There are many of them showing up and demanding that I stop what I am doing and listen in on their ward round all morning.

Phone calls from families and social workers etc takes 20 minutes out of every hour. This is an all day thing.

Then there is always the critical patient thrown in there for good measure who requires 101 interventions ordered by the doctor and required now. I may have one doctor throwing stat orders at me for this patient simultaneously while 2 others are standing there demanding that I drop what I am doing and go on their ward rounds for the other patients.

I get admissions and must do complex discharges during this time frame. The discharges are extremely time consuming.

There are dressings to do, lab tests to look up, and deteriorating patients. If I do not catch onto the deteriorating patient quickly I am in deep deep trouble. If I mess up or miss any of these jobs I am talking about there will be hell to pay. Hell to pay. it's not like years ago when you just got a bollocking from the sister and the harmed patient got swept under the carpet. Now it is bollocking, loss of registration and possible criminal negligance charges.

This is what goes on between 8 AM and 2PM.

I carry this all alone and it is hell. It is all encompassing and overwhelming.

The only help I have through all this is an HCA and the only thing she can do is bedbath and toilet and the majority of the morning she is off the ward escorting patients for tests because the departments don't want to have to deal with the patients.

It takes about 5 hours non stop to see that all morning hygiene needs for this group of patients as they are so dependent. That means it takes her 5 hours to get to the last patient. The HCA tackles this alone between escorts and answering the constantly ringing call bells.

I need to be helping the HCA with all the hygiene needs and basic care but who can help me with the overwhelming numbers of medications due, phone calls, nursing interventions, and doctors rounds? Who is going to give the stat IV amiodarone to the guy with the pulse of 190 while I am helping the HCA bedbath? No one. Because there isn't anyone else. The patient gets worse and maybe dies because he didn't get his amiodarone and I go to coventry.

Does anyone want to tell me how I could possibly attend to basic care on a morning like this?

If I cannot wash my patient myself I am missing out on assessing them properly and let me tell you: It is like working blind. So much gets missed. The HCA is in a hurry too and she washes them as if they were on an assembly line. She doesn't really take note of changes in condition nor does she know what to look for. Things get missed. Patients have better outcomes when they are recieving total care by a well educated ward nurse with less than 4-6 patients. It is not debatable. These staffing numbers in the UK are a sick fucking joke and are the one and only reason behind poor care on the wards. I have absolutely no choice but to delegate all the basic care to the HCA. No choice. I hate it. It is the only side of things she can help me with on this all encompassing workload from hell.

Sometimes one of my old fashioned trained colleagues is on duty instead of me as the only RN. She is still a ward nurse and not graduated to freak with a protocal level. It's not like they will ever pay both of us to be there at the same time caring for the same group of patients. She carries this same patient load all alone with only an HCA to help. She cannot get anyone washed or attend to hygeine needs any more than I can. I have barely scratched the surface of describing all the things that the RN has to carry alone ALONE ALONE FUCKING ALONE during that time frame. And they say that I am being lazy for not helping the HCA with the basic care. Who the fuck is going to help me with all the doctor rounds, IV's, phone calls etc?

Any suggestions about how I could do the basic care myself in a situation like this? I would like to hear from all the nutjobs and psychopaths who say that degree nurses do not care about basic nursing care first. Dignity revolution, I am talking to you.

And no, they are not going to give us more staff. And yes the IV's etc are the nurses legal responsibilty. I cannot just ditch them because I don't want to do them. The doctors will never again do them.

The patients of degree educated nurses are proven to have lower mortality rates. I believe that if we went back to old fashioned training for nurses that the ward staffing numbers would get much worse. It would give the managers a massive excuse to not staff the wards with qualified staff. As a matter of fact I know they would think like this. I'll explain in the next blog post. Been up all night.


Nurse Ratchet said...

I really don't think it's got anything to do with how you're educated - you're either a good nurse or you're not. Staffing levels have nothing to do with level of education and everything to do with management, and caring more about hitting a target than actually caring for people. More education has to be good, but it doesn't matter a damn if you can't be bothered to get up off your arse and work hard. (not directed at you obviously Anne!)

STAR said...

Another great blog post, reminds me even more how great the past 3 days have been on my ward. You can read my blog about having good staffing levels and the difference it makes.
8 patients, 1 sister, 1 staff nurse and 1 HCA.

Anonymous said...

I still dont understand why you still work there....
I still dont understand why the press isnt in there doing an expose....
The whole situation is setting you up to fail - why dont you send every family member to the admin to complain about staffing levels?? I sure as hell would - every family member every day - until they fired me or changed something.

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