Wednesday, 9 September 2009
Idiot Managers and Commodes.
We have a 20-30 bed ward. There is one toilet/showeroom. At any given time 99% of our patients are COMPLETELY UNABLE to walk there, even with assistance. Wheelchairs are often AWOL. Half the time we cannot even find one. We have 3 commodes for the whole ward.
The male patients are not a problem because they use bottles. The female patients are mostly large, unable to transfer out of bed onto a commode and require two staff to transfer them onto the commode. Either they have urinary frequency or dementia. Either way it won't be more than 5 minutes after they are assisted back to bed before they are again crying for the commode. They refuse bedpans. The damn things hurt, beleive me. With 3 commodes and 15 ladies crying for it all at once,all the time, you can see why we have problems. The dirty room is where the commodes are emptied and cleaned. This room is a long walk away from the patients.
So you are with the patient in bed 25. You have just assisted her back to bed. The lady in bed 24 sees you with the commode and demands it now. But in order to empty and clean it you need to walk all the way back to the dirty room. To get there you have to walk past at least 10 other people who shout for the commode as you walk by.
You clean the commode and head back to bed 24. On your way back the 10 people now inform you that they are pissing/shititng in their beds because you are not bringing that commode to them right now. 10 minutes later you finish assisting the lady in bed 24. She could not be left alone on the commode as she will almost certainly fall. Sometimes she does get left by the care assistants and nurses, because the others are screaming for the commode or you are in the middle of something that you cannot leave in order to do commode duty. For example, if you are caught leaving a deteriorating patient or being late with drugs because you were fucking about with commodes you could be looking at loss of registration and a lot more.
When you finish with the lady in bed 24 you need to push the commode full of piss and shit back down the looong hallway to the dirty room, past those initial 10 people who shouted for you to provide a commode over 10 minutes ago.
This is the setup. And of course it is the Nurse's fault when people are left in their own waste and commodes are not cleaned properly. Yeah right. What a fucking stupid ass set up this all is!!!! What a crock of fucking shit.
Remember that this goes on all day long. They will not allow us to have any more than 3 commodes. If we are lucky we have 3 or 4 or maybe 5 staff and most of them will be up in their eyeballs trying to keep people alive and painfree already.
We have 2 siderooms where MRSA and and CDIFF patients are isolated. Two of our commodes usually end up in there. One in each room. No, we cannot take them out and use them for a patient on the ward. 16 year old unthinking braindead agency untrained care assistants can't seem to grasp this by the way. You will not be able to clean the damn thing properly in the short amount of time you have. This means we are left with one other commode for the whole ward. It is a ward full of patients and visitors who wrongfully assume that if mum or gramps needs the toilet any member of staff walking by will immediately be able to provide one. They get angry when their unrealistic expectations are not met. Um. Ten people are in the que ahead of you dear, and some one is having a heart attack and the other 3 staff are tied up. What the fuck do you want me to do?
We are not allowed to have anymore commodes. They probably don't want to pay for it. If they did allow us to have more, there would be no room to store them anyway.
We have made management aware of what I have told you here. Their response has been silence. It's disturbing.
But what do we get to hear ten times a day from patients and visitors?
"You nurses are disgusting for making people wait for the toilet"
"You nurses are disgusting for only have 3 commodes and one toilet on this ward"
"You nurses are disgusting for the smell in this place" (the dirty room drain is often blocked)
"You nurses are disgusting for causing people to piss in the beds"
"You nurses are disgusting for not coming immediately with the commode"
"If I piss or shit the bed IT IS ENTIRELY YOUR FAULT YOU DISGUSTING NURSE"
"If mum or dad or auntie Gladys piss the bed IT IS ENTIRELY YOR FAULT YOU DISGUSTING NURSE"
Honestly, if I had a penny for everytime I heard one of these comments each shift I would be rich. These comments are what I listen to all day long. I listen to it as I am running between the dying and the suffering, when I am trying to talk to people who have just been told they have a death sentence and when I am running to people who are bleeding. I still have to listen to it when I leave those people to try and sort all of those who are desperate for a wee. I never hear "Thanks for leaving that dying patient to find me a commode". Instead I hear "What the hell took you so long to bring me that commode you fucking lazy bitch". Okay, since they probably don't know that I have other patients who are dying I guess I can let them off the hook for their shitty comments.
Everyone expects an immediate response from a nurse who is already in the middle of something that she cannot walk away from, even though there are ten other patients making the same demand, for the same piece of equipment all the time.
But of course the biggest problem is the filthy state of the commodes. The cleaners utterly refuse to touch the damn things. It is the job of the two nurses and two assistants for the entire ward to clean them. There is not enough time to clean them properly. They are in constant demand from impatient, needy people who need our help and their dignity maintained. There are not enough of us, there is a hell of a lot going on, and there are certainly not enough commodes and facilities.
One day we were left with two RN's and two untrained children to care for the whole ward. On that day a gaggle of overpaid worthless jobsworth infection control peeps showed up, and swabbed the commodes for germs. Now we are getting lectured about dirty commodes.
Why don't they staff the ward with nursing staff?
Why don't they staff it with cleaners who clean?
Why do nurses in these hospitals have so little in the way of domestic/housekeeping support?
Why do we have no say in any of this while having to always shoulder the blame, apologise, and listen to the verbal abuse.? Oh right. Management doesn't want to admit liability.
Why not deal with that? Why send overpaid worthless tits around with expensive swab kits to tell us what we all ready know?
So there you have it. Management cannot even fucking sort out the toileting facilities. They'll happily sit in their offices and let the frontline staff shoulder the blame however.
And what they hell can we do about these idiots who are running around with swab kits, who then lecture the hurried staff about "taking pride in their work".
Look, if any of you reading this are infection control or managers let me tell you something: Expecting nurses who are working with ratios that wouldn't even be legal in the shittiest part of Haiti to clean commodes properly is begging for failure. The idea of a nurse with 6 patients taking on cleaning duties is insane. IT WILL ALMOST CERTAINLY COMPROMISE PATIENT CARE. Nursing staff are so shafted these days that there is no way we can clean anything properly. We often have more than 12 patients per nurse here in the UK (a total abomination right on it's own). If you want to hit the nurses with these kinds of fucked up ratios, and then demand that they take on housekeeping duties as well you are a crazy fuck. You are smoking crack and even worse than that, you are not sharing it with the staff..
1.Increase the amount of cleaners/domestics on the ward.
2. Allow the cleaners to clean the commodes. Currently they are not supposed to.
3.Have domestics on the ward for more than 2 hours in the morning and 2 hours in the evening.
4.Allow us to have decent toileting facilities.
5.Have separate domestics for cleaning and food service. Duh.
Either do this exactly as I have directed here or shut the fuck up and go away for eternity. Those are your options. Make it so.
Rant over. The end.