Wednesday, 2 September 2009

They want to cut clinical staff....still. Will they do it?

Here's an article that I found. It caused me to spit my coffee out all over my keyboard. But really I am not surprised.

NHS to Cut Staff.

Supposedly the health minister is publically denying that this is the way to go. God only knows what is being planned behind the scenes. I am not hopeful.

I really think we need to start helping the public to have a more realistic expectation of what kind of care can be given in hospitals. Let's see. We are 2 or 3 nurses to 30 patients now. I have always said that by the time I am old economic factors and changes in health care will have altered things so much that there will probably be one nurse covering 3 wards.

We'll see her maybe once a day for less than 2 minutes each if we are lucky - if all those patients of hers on all those wards are stable. If they are not stable, we will see her less. She'll fly past me while throwing super expensive medications that cure heart failure and diabetes at my 96 year old self. We'll know the nurse is on the ward when we hear the sonic boom, so fast will she be moving. We will barely have time to see her or catch our pills as she rushes past. Sound crazy? This is where we are heading. My angry patients say to me "well how would you like to wait hours for a commode". My official response is this: "when I am old, I will be waiting days for that kind of thing. Trust me"

Nurses are responsible for some pretty complex things now...even without taking on the role of Doctor. There is a large gray area that exists between diagnosing and treating a disease process and basic care. The docs have always done the diagnosing and treating part. The nurses do the basic care.

That gray area -for lack of a better term- includes things like implementing complex physicians orders, assessing and monitoring for changes in condition, and managing technology that keeps patients alive as well as coordinating lab results, medications, social problems, discharge planning etc. It's the nurse who gets nailed when this stuff gets screwed up. Indeed it is. And the nursing profession did not create this situation.

Medication administration is more complex now and it is the domain of the nurses. We are held liable for not catching doctors mistakes in prescribing. Seriously. That really pisses me off and is a whole 'nother blog post. If the freaks in charge want to hold nurses responsible for this shit then I can see why they are demanding that nurses all have degrees. I don't want a thick nurse coming near me or my ventilator , my IV drugs and lab results and I don't care how caring or warm hearted she is.....Being caring and warmhearted is necessary in a nurse but it won't stop her from getting somebody fucking killed.

Lab/diagnostic tests are more complex and getting more complex all the time. The doc may order the test but who is organising all the before and after care while coordinating all of the other things that needs to be taken into consideration for said test? The nurse. And it's a pain in the ass believe me. Doctors have no idea about what goes in to implementing their orders because they don't deal with that side of all exists in that gray area outside of diagnosing and prescribing and outside of basic nursing care.

This gray bubble that exists between diagnosing and treating illness (medicine) and providing basic care (nursing) will be a lot bigger when I am old. Much bigger than it is now. And the nurses are held responsible for the things that occur in this gray area. If this gray bubble was the size of a pinhead in 1970 it is the size of a football now. There will be less nurses, more patients, and a gigantic gray bubble the size of Jupitor in the future. The things that exist in that gray bubble cost money that no one has, and they will continue to cut clinical staff and other things that we take for granted to pay for it. Paying for a patient's basic medical and nursing care is expensive even now. It was not this expensive decades ago. Decades from now, the cost to provide what will then be considered the very basics i.e.tests and meds and technology will be so immense that we cannot fathom it. Say bye bye to having registered nurses around to hold hands and mop brows. Just get over it.

Anyway it seems that it is all going to go to hell in a handbasket a lot sooner than I thought it would. It's bad now, in a lot of places but not yet the disaster than I am predicting. I think we are on our merry fucking way thanks to the recession.

Here is the article with my comments in blue. I don't think I really need to say anything more.

NHS 'needs a 10% cut in staffing'

(UKPA) – 18 minutes ago
The NHS would need to slash its workforce by around 10% to help meet planned savings of £20 billion, it has been reported.

A study, commissioned from consultancy firm McKinsey and Company, said the workforce would need to be cut by 137,000 to meet efficiency savings by 2014.

It said clinical staff would have to go alongside administrators.

Christ we have no clinical staff as it is....I don't think that our RN to patient numbers wouldn't be legal in the shittiest parts of Mexico. Neither do the nurses have any kind of decent back up in the form of domestics, clerical.

The report, seen by the Health Service Journal (HSJ), recommends a range of possible actions such as a recruitment freeze starting in the next two years, a reduction in medical school places from October and an early retirement programme to encourage older GPs and community nurses to make way for "new blood/talent".

And we have no doctors doing ward work as it is...well there is one...for the whole FUCKING hospital outside of 9-5. Crap I can't even get a doctor to review a patient betwen 9-5 without jumping through flaming hoops. If I had a penny for every time one of these overwhelmed young doctors was flipping out and having a mental breakdown in my staff room I would be rich. Note to the junior docs...if you start crying your eyes and screaming "I cannot do this, I can't do this" while your pagers is going off 1000 times a minute The nurses will all be like awwww poor wee lad/lass and we'll make you tea and stuff.

"New blood and Talent". Hmm. That there is fuckwit talk for young, dumb, inexperienced and oblivious to what they do not know. New Nurses and Doctors need a hell of a lot of mentoring from the experienced. For years. Is this report really representative of the kind of shit that is being recommended to senior managers? Christ.

The report was presented to the Department of Health in March this year, the HSJ reported. It carries the department's logo and has been disseminated among senior NHS managers.
The study said £2.4 billion could be saved if hospitals with the lowest levels of staff productivity got up nearer the average.

Oh fuck. The small minded morons who happen to wield all the power have read the damn thing. These are the same bastards who want me to take responsibility for a lack of junior docs and the 16 year old untrained kid to take responsibility for nursing care.

And it said almost 40% of patients in a typical hospital do not need to be there at any one time.

True, many are not acutely ill but they cannot take care of themselves either, their families won't do it. Instead they want them waited on hand and foot by overwhelmed hospital staff who are up in their eyeballs dealing with acute patients. We do not have enough stepdown /sub acute /rehab facilities. There is your problem. If they build them, they will need to staff them.

The biggest causes are delays in patients receiving tests or therapies, and a lack of suitable care facilities in the patients' own home or community.
The report also said that if four million of the 29 million outpatient appointments each year could be cut this could save £600 million.

LOL. How about this- Instead of all these cuts we threaten them with having to pay for every funeral that they cause as a result of said cuts?

A further £700 million could be saved if procedures with limited clinical benefits - such as tonsillectomies, varicose vein removal and some hysterectomies - were no longer performed.
The analysis also suggests up to £8.3 billion of hospital estates could be "freed up".

I hope this is a joke. Take it for what you will.
I have been away so this post will have to do for this week's insane ramblings.


Happy1 said...

What always amazes me, is that on a weekend, the staff carparks are practically empty. We still have the same number of ward nurses on of a weekend, and admittedly a few less doctors.....but.....who the fuck are all these staff that fill up the carparks monday-friday 9-5?

Admin and managment staff are the ones who need to be slashed to bare minimum. Hospitals need MORE nurses, doctors and cleaners, not LESS!!

Geoff said...

I have just been redirected to this site re care of the elderly and possible cuts in the NHS.
I find your statement that families are not prepared to take care of thier loved ones offensive. I am not a doctor, so do not understand what is happening to my father. I am afraid for him.I cannot take care of him as I have to work. I have a family to support. I do not want him to be ill. He is not ill just purely to iritate you.

Nurse Anne said...

Geoff a nurse on a hospital ward with 20 acutely ill patients cannot do it either. Even when she really really feels for him and wants to care for him properly.

I know that many families are unable to do it. But lashing out at the staff in the way that they do (as a way to deal with their own guilt) is unacceptable.

And no, sick dependent people do not irritate me.

StudentODP said...

Been missing your blog, I'm glad you're back and I see you've joined Crippin in the Guardian, Good one! Though it won't be the same with toned down language.

Reading this post I think you need one of these:

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