Sunday, 18 October 2009

Coming back to the bedside: Nurse Amnesia

I really like Nurse Ratchet and her most recent blog post really struck a chord with me.

Ok, so I've had a wake up call. Last night I worked on the "Assessment/admissions/somewhere you go so you don't break the 4 hour target" ward. It's the first time in years that I haven't done my overtime either in A&E or my own team. And strangely enough I really enjoyed it - and realised how far removed I've become from real life. Jeez - it took me 'till 0300 hrs to catch up - they'd had such a busy day that pretty much every one of my patients (and I only had 5) had fluids running behind, IV AB's not given,hourly urines not done - not to mention the very demanding patient who was in tears as her fan had broken.

I have to say that I neglected her, and her "lesser" needs to sort out the chap with neutropaenic sepsis, and the woman I had going to Theatre for a laparotomy, and the ALD with the pump that kept turning off, meaning her drug regime was about 6 hours behind. Bloody hell it's hard. I left the demanding patient for an unacceptable amount of time while I dealt with my poorly patients, but managed to catch up, as I said, by the morning.It's really really hard to work in these places, not helped, I am sure, by my lot telling you that you have to churn the patients out, and get them in. I saw some really good examples of good nursing last night, my hat is firmly off.I am eternally glad that I have done my time in these places, and that I actually don't need to spend every day going home handing over everything I haven't done anymore, because there hasn't been time.It's a scary old place, and it's only September.

Nurse Ratchet had 5 patients.

I am glad that Nurse Rachet enjoyed her shift and I am glad that she go her "wake up call". I think that many other senior decision makers in the NHS need to get a similiar wake up call.

It is damn hard to work on the frontlines. People do forget just how bad it is on the wards. It's similar to the kind of amnesia you get post childbirth. While you are in the throes of a 40 hour labour with a breech baby and no anaesthetist to do an epidural or c section ...well it is so bad that you want to die. You lose your mind from the pain and wonder just who the hell is doing all that screaming.

But a few months after the delivery you are telling your pregnant friends that "it's not that bad". And you cannot remember what it felt like. Your husband remembers and practically needs therapy and a shrink after watching you go through that, but you cannot remember much at all. Then when baby number two comes along and those intense contractions begin again you finally remember how bad it is and wonder what the hell made you do this again. "Oh shit here we go, what the fuck was I thinking? How could I forget this pain".

People who haven't been on the wards in awhile not only have nursing amnesia but they don't realise all the changes in healthcare delivery and pace that have taken place. Our site/bed /nurse managers have long forgotton just how hard it all is, and unlike Nurse Rachet, they will not be returning for a shift to find out. Site managers and bed managers are trying to work with what they have as far as staffing goes. It's the folks above them that are making all the bad decisions, and many of them are former nurses. They are all suffering from nurse amnesia. They are incapable of making intelligent staffing decisions. Their minds are on budgets.

I remember my last maternity leave. I stopped into work with my beautiful new baby to show him off while I collected my post. I looked around the ward and thought things like "this doesn't look to bad" "They don't look crazy busy " and "Why the hell was I so stressed when I did this".

I came back from maternity leave ready to go, ready to be supernurse and really believing that the little voice in my head who told me to brace myself was my mind playing tricks on won't be that bad!!! My first day back after 6 months was as the sole RN for 24 medical beds. And it got steadily worse from there. It wasn't until I came back that I actually remembered just how bad it truly is on a short staffed ward.

But we do not allow the bedside nurses (including sisters) to have any kind of say in how the wards are staffed and run even though they are the only ones who could do so intelligently. The only "nurses" who get to have a say are the ones who left bedside care years and years ago and whose main priority is making friends with the business managers.



Anonymous said...

Nurse Anne I share your irritation over nurse managers. The answer is generally the people in those positions know only how to take / implement orders.They often don't have the skills or nouse or will,to ruffle feathers upwards.Or perhaps they need to hang on to their jobs.

Eliza said...

Oh God, I can relate to this. When you try to tell them what its like the look at you as if you crawled out from the nearest rock, or your head is going to start spinning.

Nurse Anne said...

We had a matron like that Eliza.

She did a shift on the ward. She was the only good matron I ever knew. She covered shifts when we were short.

One day she worked an evening shift as the sole RN for 15 patients. At the end of the shift she was shaking her head and saying "this is impossible".

She was very outspoken on our behalf. She was one of three matrons. The powers that be decided to downgraded to two matrons and made them all reapply for their posts. Our good matron was the one who lost her job.

Nurse Anne said...

Oh wait. I said that totally wrong because I am on nights.

I should have started that with...Most of our matrons are like that but we had one good one.

Lisamqpd said...

Oh God, I can relate to this. When you try to tell them what its like the look at you as if you crawled out from the nearest rock, or your head is going to start spinning.

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