Let's get something straight: The Chicken or the Egg.

All over the Internet I see posts that try and blame nurse education and nurse "snobbery" for the state of things on the wards. It's true that the wards are violently short staffed. It's true that many registered nurses are no longer ward based. The fact that many nurses are no longer ward based has nothing to do with the situation on the actual wards. Short staffed wards are that way as a result of business managers.

Let me tell you what I know after over 13 years of nursing in multiple countries and an obsession with issues surrounding nursing care.

We'll be real simplistic in case any daily mail readers are looking at this blog (doubt it but I'll endeavour to keep things on a year two reading level anyway, just in case).

The wards did not suddenly become short staffed overnight when health care delivery became more complex and the role of a ward nurse changed. Having a caring heart and a strong stomach are not enough to make a good staff nurse anymore. I often hear comments from people on seem to think that degree educated nurses do not want to be at the bedside. Complete rubbish.

They are educated to work at the bedside, they need years of bedside experience before they can change jobs into specialist roles. The abusive conditions at the bedside drive them away time and time again. These working conditions drove the 1972 grads with certificates away and it is driving degree/diploma grads from the class of 2009 away too. People who like to look down on nurses just cannot STAND the fact that nurses of the class of 2009 have more escape routes from this hell than the class of 1972 ever did. They want to keep it hellish for nurses and ensure that nurses have no escape routes. It allows them to put money towards things that give the illusion of decent patient care without ever really providing it.

The wards have always been pitifully staffed by greedy managers. This has always resulted in an abusive work environment for nurses. Their experiences were so harsh that they will never return. For these people, working a 40 hour work week with lunch breaks minus life and death responsibility is like a permanent vacation with a paycheck. Most escaping nurses do not go into practitioner jobs within health care. They go into everything from teaching to theology to working at GAP. And you wouldn't get them back into health care as a nurse if you offered them double the pay, so atrocious were their experiences.

Many people seem to think that if specialist and managerial nurses were forced back to the wards then we would magically have enough nurses to do the job. This is bullshit. Ward staffing by registered nurses does not follow the rules of normal supply and demand. "Supply and demand" of RN's is very tightly controlled by twats with a financial agenda which does not benefit nurses or patients. Do you know how many new grads are still looking for jobs, and feel that they have very little in the way of options?

Most of the time we only ever have 2 RN's per shift. This number seems to remain constant no matter how many new staff we hire, no matter how many leave, no matter how many are off sick, no matter how many want to work over time. If we have 3 + nurses for the shift, one gets sent away for the shift to staff another unit. If we only have 1 for a shift either she attempts to cope alone or they take from another unit to ensure that we have 2 RN's. 2 RN's for the whole ward seems to be the minimum number that management can get away with, without they themselves looking like the bad guys. The number 2 is the magic number and usually constant no matter what. We have 20 something beds. The medical ward downstairs has over 35. Neither ward ever really seems to have more than 2 RN's per shift even when they hire new people and have staff begging for overtime.

The ward budgets as designed by business managers do not allow for the wards to be staffed well with much needed RN's. They just don't allow for it. The specialist nurses and the managerial nurses will never be brought back to the ward for this reason. Ask any one of them, they would come back if they knew for certain that they would not get shafted i.e. have a manageable number of patients rather than ratios from hell. But even if they all came back, we would still be heaving with only 2 RN's per shift.

If we ever, god forbid, get 4 RN's for a shift, one gets sent to staff another ward and the other gets sent on a study day that she should have gone on two years ago (legal requirement) but could never go because the ward would be left too short. No matter what happens we always end up with 2 RN's per shift.

If all the nurse practitioners, nurse specialists, and practitioners came back and begged to be ward based we would still only have 2 RN's per shift.

IF every nurse who left health care came back, re-qualified, and begged for a job as a staff nurse on the wards as well...we would still only have 2 nurses per shift.

If every British nurse who left the UK for pastures anew came back to Blighty and begged and begged to be put to work in an NHS hospital as a staff nurse....we still would only have 2 RN's per shift.

And, if in addition to all that, every single dead nurse arose from their graves like something out of Thriller, and came along dancing with Michael Jackson towards the wards looking for jobs....we still would only have 2 RN's per shift most days.

Being only one of 2 RN's for a whole ward is hell on earth. This blog does not even begin to touch on how much a nurse in the position is crucified and made to suffer. When I was a kid I shoveled horse shit and worked as a sales assistant. When I was at Uni I worked in a bank and a museum. I know I take on more work and abuse in 5 minutes as a staff than I ever did in all of those jobs combined.

If you think that the normal rules of supply and demand apply to nursing then you are batshit fucking crazy.

The nurses who have long ago left the bedside know this. See, they know a lot more about the situation than the likes of NHS blog doctor. Doctors may be highly intelligent and brilliant at diagnosing an illness and prescribing a course of treatment. But they don't know shit about nursing. My 5 year old understands nursing and nursing issues better than any doctor ever could.

The AWOL nurses who left the bedside know that even if they come back, and all their friends who left came back and they all got jobs on the ward......the business managers would find ways of shedding other RN's through what they call "natural wastage".

All nurse managers and nurse practitioners know that if they come back, and everyone else comes back to the ward, that they will end up getting overloaded with too many patients. They know that they will be in the exact same position that Nurse Anne is in right now. They see us working 12 hour shifts without being able to eat drink and pee, getting crucified and screamed over things out of our control, slamming our heads into the wall with stress etc etc. If they all come back, the staffing numbers STILL would not change one fucking iota...and these returning nurses will be straight into our shoes.

It's a classic chicken and egg scenario with a bit of catch 22 thrown in for good measure to deflect blame from the real culprits who are responsible for shit nursing care. Did the wards become horrific and short staffed because of nurses being too snotty to work at the bedside, or did the nurses leave because the wards were horrific and short staffed? Make no mistake about the fact that the latter statement is correct while the former is complete and utter bullshit.

Never forget the golden rule of nursing. There is no shortage of RN's. There is merely a shortage of RN's willing to put up with appalling conditions. Appalling working conditions for nurses saves money....well that's how the business managers see it anyway. The reason that people cannot stand a well educated nurse is the fact that she has more options to escape than older nurses ever did. People resent that.