Saturday, 19 December 2009

Unsafe Staffing: Time to Jump Ship.

I have a meeting with our chief nurse next week.  Again.  Let's hope he shows up this time.  I am going to ensure that my words ruin his christmas.

I am sick of nurse leadership.  They don't have a clue.  They don't know what to do.

I'd like to organise something like this for as long as I stay here.

Recently worked a 12 hour shift.  There were two staff for over 20 beds.  That was it.  Twenty heavy medical patients that mostly required two to transfer, multiple IV's, patients with dementia constantly falling out of bed, 10 or 12 of them crying and screaming for a nurse all at once all shift.  WE couldn't even physically get to any of them 90% of the shift.The shift after us had one nurse.

Our sister ward had one member of staff.-an RN and that was it.  A 35 bed surgical-ortho ward had 1 nurse and 1 care assistant.  Express medical admissions had 2 people staffing it for 12 hours.  So basically I had it good.  My patients are a lot more stable and there were 2 RN's.  Horrendous but better than other wards.  I have never had so much back pain in my life.  I am in agony and can barely sit still while I type this.  Merry fucking Christmas.  Decent hospital management is supposed to invest in frontline staff and regular staff pools as well as on call staff.  They cannot invest enough in this kind of thing and it would save them money in the long run.  But instead they let everyone go, and try to band aid everything with agency care assistants (NOT NURSES).  Then they refuse to allow us to call agency anyway.

A couple of Patients were on the phone (mobiles) to their families about the lack of care.... who then got all upset and tried to ring the ward and speak to the "nurses" to find out what was going on.  The constant ringing phone just took us away from those patients even more.  They complained about us if we didn't answer the phone, but when we did leave the area where we could see the patients to answer the phone our patients got hurt.  Not one of those family members rang management to complain about staffing levels.  They just laid into the nurse who was trying to get away from the phone and get back to the patient area.

The site manager (nurse supervisor on duty) did what he could.  There was no staff anywhere in the hospital to pull from.  He tried to come to each ward for some minutes and take over to give each staff member a quick break. He did this all night.  No stopping for him.  Twelve hours is a long time to go without food and water and constant cognitive overload.

A teacher, office worker, etc would have lost their rag after 10 minutes. Imagine a teacher's reaction to having to work 12-14 hours non stop in an area of education that they were not used to teaching.  Then give them 30 kids they never met before. Then set it up in such a way that they are having to leave their classroom every 2 minutes to answer the phone and speak to families members of their pupils.  When I call my kids' school I leave a message for the teacher and she rings me back in the next day or two.  And it's not like she has life and death situations to walk away from in order to answer the phone!  Imagine if a classroom teacher had to run to the office and answer the phone every two minutes and imagine if this action could get one of her pupils killed.  Then imagine that her headteacher was threatening her with disciplinary action every time the phone didn't get answered while refusing to hire admin staff. Teachers would run a mile in this situation.  Run a mile.

My patient had a reaction to a drug.  Scared me enough to really make me tremble and get nauseous.  The drug I needed to stop the reaction was not on the ward.  Pharmacy was closed.  I had to leave him and my other patients and ring around until I found a ward that had the drug.  The only other member of staff had a bleeder and we were dealing with that as well.  Could not leave the ward. My patient was not crashing out but very unwell.  Believe me when I say we could not leave that ward. Add a dozen 90 year old patients to the mix screaming for their mamas over and over again and you can get a feel for the situation.

But then I had to ring around and find a ward that had the drug and enough staff on duty for one to leave and bring it to us.  Couldn't leave my ward with only one person.  God knows what the porter was doing.  He said he couldn't get the drug and bring it. I asked him what he was possibly doing that was more important!  They are fucking porters for christ sake not professionals with accountability.  Rather than waste time arguing I went back to ringing wards and found one with 3 people on duty and my drug.  They legged it up to me.  It took me way too much time on the phone to obtain this drug in an emergency situation. 

When the ringing relatives managed to get their call answered they pissed and moaned about the line being busy for so long, the phone not being answered right away....keeping me away from the patients even longer to give me an over the phone bollocking.  These people must have some level of mental retardation.  Morons probably think I was on the phone chatting to one of my boyfriends.  Remember that everything these idiots ever learned about Nursing comes from the Daily Fail and No Angels.

We are getting no help from the NMC, the unions etc.  

Make no mistake about it, nurses and senior nurses have been reporting these issues and believe me the NMC will to go after frontline staff.  If the NMC, the RCN, and Unison say that we haven't been whistleblowing  then they have confused me completely. Those in a position of power will not even acknowledge the staffing issues and the antiquated system/layouts/and ward set up nor will they acknowledge other management failures.  Our incident and grievance forms are probably being used to light some administrators oven.  Too many NHS nurses cannot function at all in their working conditions, not even the good ones.

They are only focused on going after individual nurses.And like the public they are blind to the real issues.  They just don't want to face it.  It's more fun to go after the frontline nurses who are trapped in a situation where they cannot function.

It's time to jump ship.  I have said this for a long time but have not been pro-active about it.  But the housing market is improving.  Had a long talk with the other half recently. He hasn't got a transfer back overseas yet that we have been waiting for.  We are not waiting any longer.  I hate to mess up his career in this economy but he is packing it in and we are getting out. It's a big thing to ask.  But he understands and is supportive.  At least someone (who is not a nurse) is understanding and supportive.  I am sure that somewhere in the NHS there are wards functioning well...but they probably won't be for long and I am not going to risk it.


murse said...

Get out, out, out Anne, if you can. The NMC are a bunch of fuckwit poodle stooges. Good luck.

Nurse Anne said...

I am really hating the NMC and their £76 registration yearly fee.

When I get settled overseas I will not be renewing with the NMC. Instead I will, however, be sending a singing telegram complete with profanity and a little diddy with lyrics that tell them exactly how I feel to their headquarters in London.

I think I will title it fucktwit poodle stooges.

We need a nurses march on London. We should be picketing right outside their headquarters..and the government.

Let's be honest, we can harass the RCN etc but what can they actually do about staffing levels? What can the NMC do? They cannot make management invest in trying to improve ratios.

They could,however, back us up and educate the public rather than jumping on the ridiculous and incorrect too posh to wash bandwagon.

We are going to have to educate people.

Anonymous said...

Hi. It's Casey. So very sorry that it's come to this. It's the only sane choice you have left. I am glad you have a spouse who understands and "gets it". It's going to take mass implosion for the NHS to make real changes for the better. You are doing the right thing. Someone is going to get killed before things really come to a head; and you don't need to be anywhere near such a potential mess. ANY nurse with the ability to take another job or just quit altogether and lie low for awhile should do so now. One nurse for thirty-five patients in any condition is absolutely insane! It cannot physically be done. A ratio of one to ten is still extremely unsafe! I have said it before and I will say it again: It is insane to close pharmacy in a hospital at night! Insane and unsafe! It is also an antiquated practice. In the States, we have pharmacists in the hospital 24/7. It is safer and patients get medicines in a timely manner. It is insane to expect nurses to answer the phone in addition to trying to take care of ten patients. I have said it before, and I'll say it again: The nurses need to turn out at Parliament and at the Prime Minister's door and demand a seat at the table and a bigger say in how the hospitals are run! Of course, I put it a little more crudely the last time I said it...Forget educating the public! They are having way too much fun jumping on the We Hate Nurses bandwagon created by your irresponsible media. I am not familiar with your laws, but nurses should definitely contact an attorney regarding the sensationalism that is creating an even more hostile work environment for you - not to mention causing patients further harm. Forget trying to gently educate the public. You have tried and failed. It is time to retaliate. Of course, nobody can make this decision for the nurses in your country. It is much easier said than done, I know. I do not blame you and your colleagues for not retaliating. I am not working in this system, and I do not have to suffer the consequences. But I do think as long as your colleagues suffer in silence, your continued exploitation and oppression is guaranteed. Women tried to wait patiently for men to give them the right to vote and got nowhere. It was only when they began misbehaving (having hunger strikes, picketing, turning out en masse to demand their right to vote) that they got results. There were casualties, of course. Women went to jail. But here we all are; and we can vote. All because someone decided that the right to vote was worth imprisonment, defamation, and loss of approval. Either direction your colleagues decide to go will be difficult. I feel for you and your fellow nurses. I am not a religious woman, but I am a believer in a Higher Power. You and your colleagues are in my prayers. May God bless and keep all of you.

Dr No said...

Nurse Anne - Well spoken. One of the problems - at least for me - is the dilemma between our short term duty to look after today's patients and our longer term duty to tomorrow's patients. By staying today, by not jumping ship, we prop up an already dangerous system - to the point where it is now so dangerous it is failing today's patients. So, by staying, we end up failing both today and tomorrow's patients. Not good. So it is the right thing to jump ship now, not only to save your own life, but also to hasten the implosion of the system.

We have before us many months, if not years, of hardship. NHS funding is set to collapse, morale is at an all time low, and our unions, associations and political masters have no interest in the survival of the NHS.

The answer, for me, is obvious: shoot the managers, and return to consensus management and the primacy of the clinician. It works - we know that. It is also the only thing that will work. When I qualified, the wards were full of real nurses, and patients got cared for not just safely, but well. Today when I go on a ward, I see your opposite number (if I'm lucky), harassed and struggling, and a bevy of charming but useless HCAs. In the not so distant background I hear the wailing of distressed and uncared for patients. It makes me deeply ashamed.

Not so long ago I was talking to a service manager. He gushed that he had a "passion" for his service. Bullshit. The service was falling apart as he said it. The only passion he had was for his own importance. That is why I say "shoot the bastards - simple, but effective!".

Prisoner of Hope said...

I'm sure your decision is the right one. So what can we, who have followed your plight and "get it" do? Perhaps your decision will be a call to arms.

It is one thing to "get it" its another to do something about it! In a way "getting it"- is too easy and can breed a smugness while walking by on the other side content that at least the problem is being aired and kept alive . In a way your postings act as a safety valve.

Maybe what "we" can do now is to ensure that in the next 6 months - in national and local elections - that candidates for office are a) acquainted with the true facts and b) asked whether they are satisfied and if not what "they" will promise to do about it.

Maybe what is needed to get there is a co-ordinated series of requests - under the Freedom of Information Act - for Nurse Staffing : Patient Ratios by shift, ward, Nurse grade and qualification.

These requests could be made to individual acute hospitals and to the Local PCTs and need to be at least daily or 6 hourly figures (if that makes sense). These figures should then be compared to what happens elsewhere and what is considered to be "safe", "acceptable" and "excellent".

Before you go - do you or any of your followers want to suggest how such a request should be worded so that it gets at the truth?

I would be willing to set up and maintain a web site to act as a rallying point to help co-ordinate matters, if that would help.

Nurse Anne said...

Thanks Casey. As usual you are spot on. This is why I titled this blog militant medical nurse. I am about ready to don army greens and chain myself to something until this situation gets addressed ha ha.

Dr. No, Our service managers gush as well. One of them was openly saying publically that he knows nothing about any staffing problems and wanted to know what was wrong with 2 nurses on a 30 bed ward. But during the day when this post happened multiple calls were put out to chiefs-management-chief nurse etc. They did not respond and they certainly did not come into work. You would have thought that the matrons would have been on their wards that were down to 1 RN. They did not even respond to the calls that were made to them.

POH, I won't stop blogging yet, things are going to take some time to organise. You have some briliant ideas. I was going to get another petition going. The last one failed. I am going to try and word this one better. Using the freedom of info act and posting the numbers next to reasearch would be grand if we can get honest stats. Will work on the wording.

Anonymous said...

Glad you have an out Nurse Anne.

I'm a Mental Health Nurse who loves your blog.

Tragically, Casey, people are already dying preventable deaths due to the current NHS situation. I know this is the case in my area. As in Nurse Anne's experience, I have seen nurses blamed for incidents caused by lack of resources/staffing due to decisions made by long since gone managements consultants who have moved on to get another big fat cheque for their "innovations" in some other NHS trust.

I feel helpless and powerless, except to do my best for my patients in increasingly demanding, even impossible, situations. Propping up the dangerous system and delaying the inevitable implosion, as Dr.No suggests.

What to do?

Nurse Armadillo

Anonymous said...

Well of course they dont respond or show up (sr management) because then they might have to do something and that would be bad (for them) as they have a) no idea b) no desire to make changes c) dont want to admit there is a problem - so they will blame it on the nurses saying that they "cant cope" or "are disorganized" etc so it makes them look good. If I wa s the chief nurse I would put these fuckwits on duty in exactly the same circumstances you work in now and see how long they last. Im guessing 10 minutes. (being generous) Ann if you come back to USA check out careers at

Nurse Anne said...

Thanks. We are looking at a place in the North/Midwest (job for hubby) and possibly Canada. That gets me nearer to my brothers and their families.

Prisoner of Hope said...

Check your email if you want to get in touch at all about ways I may be able to help.

capgrass said...

yes but in the
uk we dont ususally tie our patients to the bed when they are confused. we use chemical restraint rather than physical. isnt it in america they do and are allowed to use restraints. dont get me wrong, i often want to put "boxing gloves"(bandages) on a patient who has pulled out their i.v. line, trache and ng tube unpteem times..........but the point is we dont: we "special them" in the US........they do tie them up............or am i wrong?

Nurse Anne said...

We don't "special" them Capgrass because there are two of us to 30 of them.

US hospitals are much more likely to bring in an extra member of staff or agency to simply do a one to one or special. Even a patient who came in with an intentional overdose was automatically placed on a one to one. They always brought a nurse or carer in just to sit with that single patient.

If they have to use restraints they do so carefully not on a whim. My experience was a doctor had to review the patient and restraints every few hours or so.

Such was my experience over there anyway.

We would have a lot less banged up heads and broken hips if we used them in the UK.

In the UK they leave two nurses to 30 demented patients and orders for rubbish like Haldol. Useless. Benzos are just plain scary in old people. I do not sedate elderly people unless I have too. They can react really badly. The worst ones are the detoxers and they docs won't prescribe benzos for them and haldol, of course, just makes a person worse.

I hope that if I am ever suffering from dementia or combative that I either get a one to one or go into restraints if a one to one is unavailable. Preferably a one to one though. My 25 year old sister had an op and ended up in restraints in recovery after she went cuckoo from the anaesthetic. Ha ha. And no one took any bloody pics for me! She understood and was cool with what they did.
and why

I think it is completely idiotic to leave two nurses to 30 demented constantly falling patients as well as refuse to bring in one to one staff and then NOT use geri-chairs and restraints.

How are we supposed to keep these people from falling when we cannot even get anywhere near them because there are so many of them?

Anonymous said...

We are not allowed one-to-one at my hospital, most of the time. Even if they came in as an intentional overdose.This is in the USA. Of course, I work in one of those wonderful "right to work" states that has managed to effectively crush any effort at unionization. DO NOT come to the southern part of the United States, Anne! You just might find yourself in the same situation you escaped from! Stay in union states, if possible. But don't go anywhere near Mississippi, Louisiana, or Florida right now.

Nurse Anne said...

Hi Anonymous. I heard that about the South. It's a shame because there are other positives about living in Dixie. But as far as nursing goes it has a rep as a no go area. I think I would be jumping out of the frying pan into the fire.

Prisoner of Hope said...

When the time comes to submit one or (hopefully) more requests under the Freedom of Information Act you - and others perhaps - might find the What Do They Know web site is a useful way to get results and alert others to the current status of any responses.

Nursing Student said...

GOOD FOR YOU! Can't say I'm not at least dissapointed or saddend that the NHS is losing yet another great Nurse though. When will it ever end? I hope things change by the time I qualify, but will they really though? It remains to be seen. But I hope you will still keep this blog going right? When you are far away on another continent, make sure you think of us aswell!

Dr. Liz Miller said...

For what it is worth, this has to come from everyone, doctors, nurses and patients.

I cringe at the way many doctors talk about nurses, especially on Doctors Net uK - (which should be shut down) I do not know how many NHS managers dare come to work in the morning

There has to be change. At the moment the NHS is soaking up millions and not giving value for money. It has gone from being cheap and inefficient to expensive and inefficient with no stage in between. I preferred cheap and inefficient

Change has to come from the grassroots. No one gives up power voluntarily. Not least the overpaid, fat cats appointed to keep the gravy train running.

In the meantime, if our relatives are in hospital and we care about them, we need to physically role up our sleeves and help the nurses look after them. These are our relatives and the UK is a third world economy. It is a waste of time complaining, better to spend the energy looking after your own and those around you.

I love your blog and trust you will keep us updated with your experiences!

Nurse Anne said...

Dr Liz,

I had a doc telling a nurse who was running between 35 patients singlehandedly that if only nurses weren't so thick and knew how to prioritise properly that there would be no problems with patient care.

Also had this same type of attitude from a surgeon. He showed up on a ward where one RN had 15 patients. Two were critically ill as in sepsis with a BP of 50/20 critically ill. She and the medical junior were dealing with that patient. The other critically ill patient had pancreatitis---no beds in ITU_---- and his medical doc had given her a million orders to implement on that patient and then walked away because he had to see another critically ill patient on another ward.

So the surgeon walks up smack in the middle of all this and demands that she stop what she is doing and attend his ward rounds. Sometimes we are half medical patients and half surgical patients. We get no say in this stuff.

It was 10 AM at this point and she was still right in the middle of running between these two critical patients and she hadn't even started her 8 AM drugs yet WHICH MEANS that she had not even set eyes on her 13 other patients yet during the 3 hours she had been on duty----only health care assistants had.

That is a good way for a nurse to get struck off i.e. not seeing your patients for over 3 hours.

Surgeon walks right up to her in the middle of all this, demands that she attend his ward round NOW and she refused. His round would have pulled her away from those other patients and left them nurseless and dead because their docs orders would not get started in time if she went off on a round for over an hour.

So he goes on a rant about how nurses don't know how to prioritise properly and she better not ring his team later with stupid questions as a result of her "non-attendence" on his ward round.

Why oh why are they such ignorant dicks? Go ahead and post that on

You can also tell them that no competent doc would admit his patients to a ward where there is more than 6 patients to one RN.

My cousin is a doc overseas and he will not admit patients to wards that have poor ratios. Only an idiot would expect a nurse to manage such high patient loads.

Can't type this morning holding wiggly new puppy.

Prisoner of Hope I got your email and have tons of questions so I will get back to you when I can sit and focus. Thanks for such a great idea.

Anonymous said...

Ooo! Wriggly puppy! :)
Happy news.

Having cheered myself with that thought, I'm now tempted to peek at doctors net and upset myself before heading for the late shift.

Nurse Armadillo

Nikita said...

Hi Anne,

Saddened to hear that you intend to jump ship, but I can totally understand the reasons why. The USA's or Canada's gain will be the UK's loss.

With regards to your statement regarding the RCN and the NMC. The NMC could and should inform the NHS that it is its intention to order its members to withdraw from wards where they are operating within dangerous staffing levels as they are in breach of their Code of Conduct. But I guess they will not as it is easier to jump on the publc bandwagon and not offer support to those they supposedly serve.

Recently, I toyed with the idea of a mass petition to the government from ALL health professionals concerned with the steady demise of the NHS. I emailed two 'feelers' to blogging docs, asking advice of how to approach or where to start with the medics to get this of the ground. However, no response! Nothing! Not even the courtesy of saying "Sorry, can't help here." All talk and no action, Anne.

I did suggest they could canvas Doctors Net uk to drum up support, but after reading Dr. Liz Millers comment, I think I am rather naive as I did not realise it was used to slag nurses off.

Whatever you decide to do after receiving advice from the Prisoner of Hope - count me in! I will email you sometime within the holiday period. Until then, Happy Christmas and hopefully a Happier New Year. Give the pup a hug from me.

Mags. xxx

india K said...

how does someone work on a medical ward, have a husband, children and a wiggly puppy? r u related to Sarah Palin? do your admire her?
how do you juggle all these balls in the air and have time to write with so much conviction and passion about such important topics. your blog is very popular

Nurse Anne said...

You busted me. I am actually Sarah Palin and I can see Russia from my house.

Now I am off to do some shooten since we don't have any wolf meat in for christmas dinner.

Todd, Trig,Trip,Twig and someotherstupidname, will only have fresh kill wolf meat on christmas day.

You don't happen to know what the Bush doctrine is do you?

Have A Merry Christmas Ya' all!!

Anonymous said...

I ca
me across this blog recently:

I reckon that this is the only hope for the UK. Now that the US seems to be following the successful European model of socialised healthcare Britain with its failing nationalised system will be left out in the cold.

satish said...

Well, I agree with you, Job of nurse is not easy, it as a lot of responsibility and i m sure your are taking right decision

Nurse Anne said...

Hi Anonymous,

I stay away from politics on this blog but as someone who believes that all government is bad,both major political parties are evil,all politicians are useless, and the reason that the US system is such a messed up failure is because of the government controlled corporate monopoly on health care rather than free market I actually really LIKE nurses for reform.

Many similiarities between what the NFR is saying and my hero here:


Nurse Anne said...

and Saint Obama's plan will fail.

Nurse Anne said...

But I do stay away from politics on this blog because I simply do not have all the answers.

Saad Amir said...

The good planning has been very great for the hospital.So because of this the great management has very good for any company.
regards, saad from

Safety Manager said...

Safety staffing should be done on the basis of the skilled as well as professional should be hire to take responsibility of the safety .

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