Wednesday, 28 October 2009

The Nursing Times : Where have they been for the last few years?

Can you believe this shit. How can this be news to these people? Bear with me. I have just complete two shifts from hell so I am in a bad mood. I started at 0700 and by 10 AM I hadn't even set eyes on half my patients. The healthcare assistants were missing the fact that people were obviously going into septic shock, they forgot to check the blood sugar on the lady that goes hypo. I was up to my ears in meds etc. I couldn't go 5 minutes without consultants showing up and interrupting me. Every time they did so it pushed me back from carrying out an initial assessment on my patients by another 15 minutes. It got so bad that by 10AM I hadn't even seen half of them and was afraid of walking into a room and finding a corpse.

If a trained nursed has the recommended ratio of 6 patients she can get to all of them and see all of them and get to grips with their situation within the first hour of her shift. But with 21? No way. By 10AM I had no idea what was happening with half of these people and the 4 care assistants that were with me were no help to any of this whatsoever. A registered nurse does not walk onto a ward of 20 people and suddenly "know" everything about the patients by some kind of psychic phenomenon or information osmosis. We get a brief report on 20 people...that takes 45 minutes and then we don't know much until we assess the patient, look at their observations, fluid balances, their doctors notes, talk to the patient, look at the nursing notes etc. It takes about 20 minutes per each patient to do this kind of assessment so I that know what is happening with them. The written info is kept in about 4 different places throughout the ward.

Anyway back to the Nursing Time Article.

This has already been going on for years. This is why nursing care these days is shit. Everyone knows (except the fucktwits who run hospitals) that the decreasing the number of registered nurses and replacing them with untrained kids is a big fat fail. The reasons that RN's cannot function is because we are spread to thin among to many patients and forced to delegate to care assistants who don't know what they don't know and don't care either.

I told you that it was management moving nurses away from the bedside not an over academic nursing profession. Nurses need to be highly educated, they need to be at the bedside, and they are not too posh to wash. University educated nurses are taught that they need to provide basic care in order to assess their patients properly. Assessment is the first step of the nursing process.

These hospitals are saying that there is a shortage of band 5's (registered nurses). This is bullshit. They are not advertising to hire them on the wards. They are only posting ward jobs for care assistants and many newly qualified nurses are on the scrapheap, unable to find jobs.

I told you that this shortage of RN's working at the bedside is down to economics rather than arrogant nurses who supposedly think that they are above caring.

I told you that the "shortage of trained nurses" is/was manufactured by greedy hospital chiefs.

In every post on this goddamn blog I explain how care fails when an RN runs between too many patients and is so swamped handling drugs, assessments, and orders by herself that the care assistants are doing all the actual care, and totally fucking it up. They cannot assess patients, electronic monitoring does not help. The care assistants go through the motions of providing care like it is factory work. Too much gets done incorrectly and or completely missed until it is too late. This is called failure to rescue. The few actual nurses are to swamped to actually assess and plan and implement care. Our hospital patients are getting nothing in the way of nursing input.

It's a total fucking fail and it will kill more people and cost more money if it continues.

I said it here.

I explained it here and in pretty much every other post.

How dare they devalue proper ward nursing and say that someone who isn't trained and registered can take over?

IF this is a good idea then why does research show that a smaller proportion of qualified nurses in the ward skill mix causes higher mortality rates and increased costs?

IF this is a good idea then why do patients of hospitals that employ a higher number if highly educated RN's to work at the bedside have much lower mortality rates.

When they say that they are not creating band 4 protocol based posts to save money....THEY ARE LYING.

And yes RN's do report that we have to do many things that are "beneath our level of training". We have to wash mattresses when we have 3 patients crashing because the care assistants cannot be bothered and we are getting an admission in 5 minutes. You don't look at that and think "Okay, then let's have less real nurses and more irresponsible untrained people who don't have a registration to maintain and don't care on the ward then". You are supposed to look at this and you hire domestics to avoid a multi million pound damages payout when a patient dies because his nurse is washing mattresses.

I am heading into another shift from hell today. Bear with me.


Anonymous said...

The UK's health care system is totally screwed! You should try to get out. I hate suggesting that because I know you care, but they are asking you to do the physically and humanly impossible. You should have a pharmacist in that hospital AT ALL TIMES. You should have a pneumatic tube system to tube your meds to a tube station on your ward. The overpaid pharmacist who has plenty of time to ass-sit and talk badly to the nurses should be calculating your damn dosages and mixing them. That's what he got all the damn education for, right? There should be a full-time staff of housekeepers to clean beds between patients and wash mattresses and empty trash. There should be a staff of dietary aides to distribute trays and snacks. You should be able to NURSE, and that's it. And you should have the staff to do it safely. Patients are sicker now. Your whole system is antiquated and dangerous to you and your patients. Your entire profession should be up in arms and banging on your Prime Minister's door and demanding that someone get up off their ass, unstick their head from said ass, and totally wipe the slate clean and start over. That is how screwed up your system is. I would not work in an NHS hospital. I'd serve fries at a fast-food restaurant before I'd go face what you face every day. The powers that be in your organization do not want you. This blog is wonderful, but the people who are not nurses DO NOT CARE. It isn't happening to them, and they don't have to face that nightmare every day. And your nursing leadership DOES NOT CARE. They're not blind to what is happening, Anne. They are simply evil. They see just fine. I am so thankful I am not a nurse living in the UK. I am so angry for all of you. I read your blog all the time, and I say this as someone who cares about your wellbeing. I am deeply concerned for you and all the nurses in your situation. I hope this does not make you mad. But I know you are not being listened to. Nurses are finally being treated half-decent here in the states (still a long way to go though). Nothing changed until there was mass exodus from the profession. And we are not out of danger yet over here. The powers that be will not listen until all of you make them listen.

Nurse Anne said...

A pharmacist in hospital 24/7? HA HA HA HA. It would be a cold day in hell before anyone mixed our IV antibiotics for us.

I had several patients on IV Benpen 2.4 gram, IV flucox 1 gram, and IV metronidazole. The Metronidazole comes bagged already and was only 3 times a day but that was lucky.

But the Benpen and the flucox was 4 times a day and OMG. The benpen alone comes in little bottles of 600mg in powder form that you have to dilute with sterile water and mix and add to an IV bag of saline. It takes AGES and AGES. I feel like I spend most of my time mixing drugs.

Many doses get missed because the nurses can't always screw around mixing them when we have 20 patients all screaming "nurse".

Granted that giving the IV meds are priority because the patient is not getting their doctors' ordered treatment without it and therefore won't get better BUT try explaining that the all the screaming relatives that don't understand why we are not sat at the bedside changing mama's gown the second she spills a drop of juice on it. We get no back up from management with these ignorant people complain. No one explains to them the reality of the situation.

And we don't have anyone to answer the phone either.

Dr Grumble said...

I read this post first just after doing a ward round. The nurse in charge apologised that nobody was going to be able to come with me despite the fact that I was going to be making decisions on every single patient as they were recent acute medical admissions. I asked what the problem was and she told me that they were short staffed. "Not enough money?" I asked. "Not enough nurses," was the reply. The money is there but nobody wants to do the job any more. There are no nurses to be hired.

If you press people too hard they will eventually walk away and they are already walking.

Meanwhile the managers wonder why mistakes are made and the patients are not discharged as quickly as they would like.

Nurse Anne said...

There is a huge shortage of nurses willing to work on hospital wards because the bullshit.

When california hospitals were forced to staff their hospitals with one RN to 5 patients the hospital chiefs FREAKED OUT.

"We will never be able to find all those nurses, we will have to close wards" they said.

A year after the ratio laws went into effect thousands upon thousands of RN's came back to the bedside, RN's also left other states to make a beeline to Cali. The number of their nursing school applicants went up by something like 144%.

They have so many job applicants for RN positions they are able to pick and choose the "cream of the cop" apparantly.

But prior to the ratios going into effect the hospitals were all bitching about the "nursing shortage". Yeah, there was a shortage of RN's willing to have that level of responsibility with all the abuse and lack of control.

And it's not just about the shitty pay. Many many bedside RN's leave nursing and go into much lower paying jobs just to get out of nursing. More nurses are doing this than heading down quacktitioner route.

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