Friday, 27 February 2009

Safe Ratios Save Lives

Here I am repeating myself. Again. I have a million articles about nurse patient ratios saved. This one is getting posted on here because it is an easy read. If you want to see more research estimates, look back at the beginning of my blog or google nurse patient ratios.

The research that has been done into the effects of short staffed unit has shown that no patient on an acute ward is at all safe if his nurse has more than 5 other patients. In the UK his nurse has at least 10 to 12 or many many more other patients. That is why nursing care sucks here. It has nothing to do with nurse training, or nurse bitchiness, or bad attitudes ,or a lack of training. Even if it was, the piss poor ratios would still have a larger impact. "Dignity Training" can only help so much if the nurses are overwhelmed. Overwhelmed is an understatement for what British nurses are going through. Everyday in Britain, hardworking, well trained caring nurses are giving terrible care.

It's all about the ratios.

read this

Nursing ratios save money and lives
By Suzanne Gordon
July 9, 2008
BEFORE ITS legislative session ends in July, the Massachusetts Senate has an
opportunity to protect hospital patients as well as the nurses who care for them
by approving the Patient Safety Act that was passed overwhelmingly in the House
a month ago.

The ratios bill would require that the Massachusetts
Department of Public Health implement enforceable limits on the number of
patients a registered nurse can be assigned, thus providing patient protection
in all acute care hospitals. As the Senate debates this measure, it should
consider the positive effects that legally mandated nurse-patient ratios have
had where they've already been enacted - in California and Australia.

In California, since 2005, no nurse on medical surgical
floors can be assigned more than five patients at a time
. On equivalent
units in Victoria - the second largest state in Australia - the minimum required
staffing for every 20 patients is five RNs, backed up by a "charge nurse" who
has no patient load of her own and is thus free to assist other RNs.

both California and Victoria, ratios were originally introduced because
excessive RN workloads were putting both nurses and patients in jeopardy, while
adding to overall healthcare costs. More than 60 studies have documented
that hospital understaffing results in more patient deaths, plus more
preventable complications like pneumonia, urinary tract and catheter infections,
and medication errors
. A study done in 2005 by Michael B. Rothberg in
the journal Medical Care put a price tag on these problems, concluding that a
nurse who had time to prevent a case of pneumonia "saved $22,390 to $28,505, or
$4,225 to $5,279 per additional hospital day." When nurses prevent an adverse
drug event, they save the patient from an "added 2.2 hospital days at a cost of
$3,344." On the other hand, if understaffing leads to complications after
surgery, the resulting patient stay can be 8.1 days longer than normal, adding
nearly $11,000 to the total expense.

Unmanageable workloads have also
created an exodus of nurses into other fields or nonpatient-care jobs. According
to a study by L.J. Hayes that appeared in the Journal of International Nursing
Studies, hospital nurse turnover in 2006 - outside of California - ranged from
15 to 36 percent per year.

A study by economist Joanne Spetz, just
published in the nursing journal Politics, Policy, & Nursing Practice, finds
that ratios in California have increased RN job satisfaction and reduced
turnover. According to Spetz, nurses are happier at work because they now get to
spend more time at the bedside - particularly on patient education - which has a
positive impact on nurse turnover and thus on the quality of care.

Researchers at the University of Pennsylvania have compared nurses in
California with those in Pennsylvania and New Jersey - states without minimum
staffing requirements. California RNs reported greater job satisfaction, leading
to less burnout.

More nurse patient ratio research

The nurse patient ratio laws in California and Victoria are by no means perfect. They are relatively new and more research needs to be done. Like all new things there are a lot of bugs that need to be ironed out. How these ratios were implented by each different hospital makes has a huge impact on outcomes.

But it is a start. And we need these laws in Britain.

You certainly won't hear patients in California say that they were left hungry, cold, and in agony. They won't be left waiting for a bedpan or pain pills. They are clean, their nurse answers their call bell and spends time with them. Their nurse maintains their dignity and provides basic nursing care, she uses her knowledge and training to prevent complications and keep her patients safe. This is done without neglecting basic care. And all this care is done by highly educated nurses who only have 4- 6 patients at a time.

Now lets look at the current situation in the UK where the vast majority of the nursing staff on the wards were trained back in the "good old days" and have 15 patients at a time, sometimes more.............

Need I say more.

Nurses want no part of it!

This blog was written by a doc in the States. It discusses some issues regarding nurses vs primary care physicians across the pond. He knows that the money hungry and greedy powers that be want to see nurses taking over primary care and he also understands that nurses want no part of this. It's true, we don't. I'll post some of DrRich's quotes and then head off on a tangent.

Occasionally some of us will escape the hell that is ward nursing and go into advanced roles...but most of of are escaping healthcare and/or the country all together.

This blogging doctor has A POSITIVE attitude towards his nursing colleagues. That's the main reason I posted this. He also "gets" that many don't want to do the noctor thing. Seems as if he isn't quite as paranoid and misinformed as his British counterparts.

Some Excerpts:

"Much of what Gina (Code Blog), Strong One (My Strong Medicine), and Mother Jones (Nurse Ratched’s Place) have to say about the nursing profession is not all that surprising. That nurses are often disrespected and stereotyped by god-like doctors and poorly-informed patients is, sadly, an old story. But DrRich is struck by two things in Val’s podcast."

"Thanks to a) the growing nursing shortage, b) the inability to accommodate all the people who want to enter nursing, and c) the fact that those who have made it into the nursing profession are very smart people with “disturbingly” high ethical standards, we find that the healthcare system will soon need to re-evaluate its strategy in regard to primary care medicine."

Thanks. It is also very competitive and difficult to get into Nursing school in the UK. Too many applicants and not enough slots. A large number of the applicants have degrees in other fields and still are not getting in. The universities are able to pick the best applicants. Of course high quality people going into nursing is pointless if there is no jobs and they end up responsible for too many patients.

"First is that there is a long, long waiting list for entrance to nursing school. DrRich had no idea. He finds it uplifting that so many young Americans are lining up to enter this still-noble profession, especially at a time when nurses are so needed. It seems likely that at least some of this enthusiasm reflects the fact (and it is a fact) that the nursing profession is entering an era where the stereotypes and the disrespect seem ready to be torn down. While he has no special insight into the matter, DrRich finds it very likely that nursing school slots will be rapidly expanded (and nursing instructors will be adequately rewarded to staff these new slots), simply because there will be little other choice for our healthcare system.

Well that's a little naive but okay. The funding is not going to be there to train more nurses in the UK or the USA. Once they get onto the wards 2 out of 5 will burn out before their first year is up anyway. In the UK, managers think that 16 year old cadet nurses can just take over ward nursing while the ward nurses become pretend GPs. Yes we need more nurses but we are not going to get them or retain the ones we have in these hell hole wards. That's a fact here in the UK as well across the pond...............Anne

Second, it is striking that nurses seem to have figured out already that taking over primary care medicine from the rapidly-dwindling primary care physicians is a losing proposition. They are avoiding the opportunity in droves.

That, if nothing else, should tell us how smart nurses really are


"The healthcare system has done all this precisely to drive physicians out of the primary care business, for the explicit purpose of opening the primary-care doors to a profession it believes is more tractable than physicians - namely, the nurses."

Not only tractable but cheaper...........Anne

" The healthcare system sees nurses as professionals who (once they are duly certified in primary care medicine through respected testing organizations), will have just enough training to diagnose and treat the average patient (i.e., the ones with high blood, low blood, fat blood and sugar), and who will cheerfully, unquestioningly follow whatever guidelines are handed down to them from on high. And they will do all this for less pay and with less lip than the now-obsolete physician PCPs. These new practitioners of primary care medicine will be a perfect fit.
Except for one thing. The nurses want no part of it".

Ding Ding Ding. That is correct. We just want decently staffed wards, resources and a little back up so that we can do our jobs. If we don't get that we go, but not necessarily into the hell that is doctor land........Anne

The ultra paranoid british doc bloggers think that nurses want their jobs. This is bullshit. The truth is that even though we are being pushed that way by the powers that be the vast VAST VAST majority of us know that it is not a good idea. I am so happy that there is a doctor out there, somewhere who understands. How does DrRich know this? Go to his page.

The man is listening to and talking to real nurses.

Thursday, 26 February 2009

The Daily Express: WTF planet do they live on?

Just came across an article by Victoria Fletcher of the Daily Express.
I am so glad I don't take these "journalists" seriously. I really am. Ms. Fletcher is one of the better ones actually as far as "health" articles go. Sad isn't it.

Yes we know that patients are suffering horrifically. Nurse Anne and her loved ones also suffer a great deal when they are patients. Do they really think that patients are suffering because nurses and doctors don't understand these "commandments". Idiots. The NHS managers who think that dignity cards are going to improve things need to educated... or perhaps they need to be stopped from trying to pass the buck.

Here is an excerpt:

In some hospitals, investigations found that some patients too ill to feed themselves were ignored and then had the food taken away from them, causing them to become malnourished.

Last year an investigation into an outbreak of a hospital bug that claimed 90 lives in Maidstone and Tunbridge Wells NHS Trust revealed patients were told to soil their beds because staff would not take them to the toilet.

Last week it emerged that TV chatshow host Michael Parkinson, 73, will lead a new campaign to boost respect for elderly patients. He regularly visited his mother Freda in her last days in hospital before she died aged 95 last year.

He said: “I came across an extraordinary mixture of care – some nurses who were utterly dedicated and wonderful.

But there were others who treated it a bit like they were a jailer, treated people in their care as inmates. There were distressing signs of elderly people being left weeping who were still there half an hour later, and that’s not right.

“I used to worry about leaving her on her own.”


1. Have a zero tolerance of all forms of abuse.

2. Support people with the same respect you would want for yourself or a member of your family.

3. Treat each person as an individual by offering a personalised service.

4. Enable people to maintain the maximum possible level of independence, choice and control.

5. Listen and support people to express their needs and wants.

6. Respect people's right to privacy.

7. Ensure people feel able to complain without fear of retribution.

8. Engage with family members anDd carers as care partners.

9. Assist people to maintain confidence and a positive self-esteem.

10. Act to alleviate people's loneliness and isolation.

Well duh.

Not only am I concerned about the sanity of our NHS managers but I am also seriously concerned about Victoria Fletcher's. I have seen a few articles by her that were so way off base it is sickening. This one is obviously slanted to have a go at frontline staff and it's enough to send me over the edge.

I thought journalists were supposed to do research and commit to getting their facts straight. Vicki seems to think the the patients' dignity is being compromised and that cold trays are food are being left out of reach because the nurses are thick and lazy. Not one quote from a ward nurse. Vicky, my dear, you need a reality check and you need to start doing research. It would help to talk to people who work on the wards rather than people who only have a narrow simplistic view.

"Staff would not take them to the toilets causing them to soil their beds". Did it ever ever occur to Vicky that these nurses are in a position so precarious that they cannot always just stop and constantly toilet people? The nurses do not want things to be this way. They don't have a choice. If they are caught fucking up meds/orders or not noticing changes in condition because they are constantly toileting they are going to end up in front of a judge.

All we are constantly told is to prioritize prioritize and prioritize. The IV medication to stop that seizure comes first before the bedbath. The blood transfusion must be done before the commode. The man who can't breath must be sorted before the pain meds can be given. But the thing is, the top priority stuff never goes away long enough for us to do any basic care. If I am doing basic care someone else is not getting their blood, pain meds, or their hypoglycemic attack noticed and sorted. They die. Things move that fast.

Can you imagine my saying "sorry doc I cannot squeeze/infuse that gelofusion into your shocky patient or do anything else for him right now because 10 people need the commode. See you in about an 2 hours because I need to wash the commodes when I am done and then others will want it, and then I will wash it again".

That would go over like a lead balloon.

Vicky, we need more goddamn help and less of your ignorant bullshit.

Vicky would sue my ass off if I was caring for her loved one dying of sepsis and I left him to take someone to the toilet. What about when I am running up and down the ward trying to round up the supplies etc to implement the doc's plan to save Vicky's septic loved one? Should I stop during the course of that everytime someone asks for the loo? That would keep me away from Vicky's loved one for hours. Does Vicky think that another nurse would magically appear to help me out? Does Vicky think that those situations just disappear so that I can run around toileting everyone.

No one wishes for that more than we do.

Does Vicky think that the managers care and the nurses don't? Jesus Christ. How misinformed can a person be? The nurses and doctors care more than anyone. The "bad" ones may have just been caught up in the middle of something that they cannot control. This is what causes patients to wait. I have never seen a nurse make someone wait intentionally.

If anyone would listen to the nurses we would tell you why people aren't being fed and nursed.

Do your research. Visitors, etc see that the situation is damn bad but they have no insight into what the nurses are struggling against. They cannot see past their own grief enough to understand the situation on the ward as a whole.


I really think I need to go to anger management or something.

I nearly choked on my starbucks coffee when I went into specsavers the other day.

They had no less than 10 staff there, and 3 fit and well customers.

It will be a cold cold day in hell before management allows us to have 10 staff for a large ward full of ill, vulnerable people.

Just needed to get that off my chest, for my sake. My blood pressure is going sky high.

I feel better now.

Surrounded by Idiots: The Complaints Manager.

Received a phone call from a colleague fairly recently. I am going to document what she said on this blog.

She also works on the same ward that I am/did.

Not too long ago she was one of two RN's for the whole ward. She was the RN for one side and sister was the RN for the other side.

They were running their assess off, constantly interrupted and overwhelmed and by 11 AM everything was fucked up. Half the meds weren't given, gent levels etc weren't done, discharges weren't going anywhere because the nurses couldn't sort them out, patients were filthy, and no call lights were being answered. Their were 2 care assistants who were trying to bed bath everyone, and answer bells. Nightmare.

So around 11:30 AM this moron from the complaints department struts onto the ward and proceeds to glare at the nurses with complete contempt. She tells them that a another complaint came in about nurses not feeding patients.

This is a regular occurance:

Moron collars the sister, and pulls her into the office and demands that she sits there for 2 hours answering questions about the day the complaint when in, what staff members were on, do they not understand that nutrition is vital etc etc. She made sister formulate a response right there and then. Kept her in that office well past dinner time. Moron also had the nerve to roll her eyes at Sister when Sister declared that she needed to get back onto the ward ASAP. I don't even understand why moron bothered, her official response to the complaints will only be lies.

That left one RN and 2 care assistants to cope with all the patients, alone. We really, really needed Sister back on the ward. When she came out of the office, moron collared her again, insinuating that sister wasn't interested in the complaint or the situation.

The dinner trolley appeared at noon and the three staff were trying to feed 10 plus people themselves whilst managing care for the other 19. Moron would not get off Sister's back. People were not getting fed.

The staff nurse was in a blind panic because so many orders from docs that needed to get done stat were not getting done. She told me that she really thought someone was going to die. Listen people you can have the most brilliant doctor in the world but if you don't have a nurse that is able to implement and coordinate all these orders you are fucked.

Some visitors were on the ward at this time. We are not strict about visiting times when people are extremely ill and family cannot get there during the set hours. The lay out of the wards is such that they can see everything, even sister in the office engaged in discussion with moron.

While sister was being held in the office, and the 3 staff that were left on the ward were struggling to cope, two of the visitors walked downstairs to the patient complaint services office to complain about "oblivious" nurses not feeding patients. Never mind the guy with the pre-renal failure who hadn't even had any fluids started yet and that the staff nurse was trying to stop him from pulling his cannula out.

So at least 2 more complaints came in on that very day at that very lunchtime. If the people who were complaining or perhaps the managers were not completely fucking retarded maybe we would have been given more nurses instead.

If I hadn't witnessed these kinds of experiences myself all the time I would never believe it.

EDIT: I understand that the term retarded as used in context here is very offensive, crude and not at all politically correct. I apologise for that. I am even offending myself right now.

I am sitting here wondering if there is a better term to use to describe the behaviour of these people. There is not. They just have low IQ's. They retard the nurses efforts to care for the patients.

Monday, 23 February 2009

Productive Wards and Releasing Time to Care

Dr. Crippen (and many other bloggers) has written about this already. If you need details regarding what "Productive Wards" is then google it.

So when this bullshit came to my hospital they decided to make all the ward sisters attend a series of lectures about it.

A ward sister is an RN obviously and they will not pay more than 2 RN's to be on our large ward at any time. If we have 3, one gets sent away to staff a more "important" unit.

Ward sister was ordered to leave the ward to attend these lectures on "Releasing Time to Care" for the duration of her shift.

This left one junior RN in charge of the whole ward with 2-4 care assistants. The shift was 0700 to 1500 hours and the lecture thing that sister had to attend was pretty much the whole shift.

This is a 25 (sometimes 35 if the fuckers open the other wing even though they cannot staff it) bed acute medical ward where every patient needs constant support and just finding prescribed meds and/or setting them up to infuse for that many people can take 50 minutes out of every hour.

The hospital refused to pay for any nurses to cover the ward while the ward sister was at the lectures.

This meant that a junior RN was not only in charge of her 15 patients but sister's 15 patients as well plus charge nurse for the ward. Alone. The morning drug round alone takes 3 hours for that amount of people and that's if she doesn't stop everytime a patient shouts out for help or begs for a commode.

Even if she carries on without allowing herself to be interrupted, the patients will not get the drugs they need on time or anywhere near on time. It is just too much. Blood work gets fucked up as a result of these drug errors, people get hurt, people suffer etc. Time is extremely important with drugs. She will also get constantly interrupted by phone calls and doctors during this time, and they will not give a damn about the patients that they are not responosible for...

A consultant will show up (not at a set time but at a time it suits him, usually during our drug round) to see a patient in bed B.

The nurse will be getting pain meds out for bed A when doc decides to grace us with his presence. You would not believe how much of a long, time consuming process getting morphine up and out, ready to deliver is...

Doc will expect the nurse to drop what she is doing to shadow him on his visit to bed B. Immediately.

He does not care about the Nurse's patient in bed A because bed A is not his patient. Only bed B is his patient. He doesn't give a shit about the fact that the nurse would have to leave bed A in pain to attend his round. He doesn't give a fuck about the fact that there are no other nurses on the ward to help bed A. He probably doesn't know and he doesn't care either. He has other problems and the nurse's problems are the nurse's problems.

Either we end up with a screaming, tantruming consultant whinging about his precious time or a patient left to wait for pain medication. There is no other Nurse because she is at the "releasing time to care" lectures and management won't replace her on the ward. And yes she has to attend the lectures or management will fuck her up. There are only care assistants and they cannot attend rounds or infuse pain meds. The care assistants are struggling at this point just to get everyone fed, washed and answer bells without making them wait for hours, suffering in agony.

But no. Management will not get another nurse in to cover absences due to the productive ward lectures. The nurse not on the lecture that day will be left alone to be abused. the way if Nurse Anne was in that situation she would just tell the consultant to fuck off because someone she is responsible for is screaming in pain.

And yes, I do understand that ward rounds are extremely important and so is the consultant's time. I would still tell him to fuck off. Unless of course I had another nurse. Then one of us could get the pain meds and the other could be dutiful and attend rounds.

Too bad management doesn't think that way.

Sick sick bastards all of them.

Saturday, 21 February 2009

For the Docs (especially the junior docs: we like them better)

Just a few quick thoughts.

This blog was started so I could blow off steam. It is entirely nurse-centric. Nursing is all I really know.

I am always complaining about how tough nursing is right now. It's because I want things to get better. This does not mean that I do not understand how bad things are for other health care professionals. I am talking about the doctors mainly. Junior doctors especially. Consultants are just a mystery. I just try and avoid consultants 100%.

From what I can see it looks as if junior doctors are actually going through living hell. We do feel bad for them. We feel bad when we can't help them out. We feel bad when we have to keep bleeping them for stupid shit. But yeah, we have too. We feel bad when we find out something about a patient that needs a doctor review 8 hours into my shift rather than 2 hours ago when the doctor was actually on the ward. Now he/she has to come back here AGAIN when many other wards are trying to get him/her to see their patients. We haven't bleeped you 3 times an hour to be a bitch or make things harder for you. We are just constantly missing things because we have no time to read notes and assess people properly. It's bad. Honestly, we don't want to fuck up your orders or land you or ourselves in hot water.

We know that you had to be highly intelligent just to get into med school and that you have an extremely high IQ. We know this even if you just asked a silly question. We know that your hours are shit compared to ours. We know that you have more patients and are constantly dealing with acute stuff.

We actually worry about the junior docs...and take cash bets on which ones are going to keel over and die from stress before age 35. We get pissed off when we see consultants talking down to their juniors and yelling at them in front of everyone.

We think that it is a damn shame that you can't get anything done without that bleep going off. I would have thrown the fucking thing out the window. Obviously we respect the job you do. Even so, I am still going to run in the other direction and not make eye contact when you walk onto the ward. That's probably because I haven't yet been able to implement those orders you gave me over an hour ago. Yeah oops.

There is always going to be some nurses that hate doctors and give them a hard time. My experience is that the majority of us are not like this. The majority of us do not want to do your job either. No thanks. I really wanted to be a nurse, despite all the shit (literally and otherwise). I like the idea of nursing people, NOT spending my days diagnosing and prescribing. That doesn't sound like any fun to me. But that is just me. More power to those of you who choose to go down that road.

But the whole point of this blog is to explain things from the nurse's point of view, that's all.


You can thank the managers for this crap, the matrons for being indifferent, and the nurses for stupidly behaving like martyrs to try and keep the patients safe.

A bit of background. My trust got rid of float pool and bank nurses. The nurses who worked pool or bank were used to cover sick leave, maternity leave, short staffed wards etc.

Management fucking got rid of them over the last few years.

When a ward is short staffed they pull nurses from another ward.

What wards do they always pull staff away from? MEDICAL. GERIATRIC.

If anyone has read my blog you know that normal numbers on my ward. Sometimes we are 35 beds with 2 nurses and 2 healthcare assistants. When the ortho ward is short staffed, or a surgical ward is short staffed they will take our staff away to cover. When we are short we are told "sorry there is no help available". Can't expect those sick bastards to spend money and resources on medical patients can we.

Came into work one day last spring already stressed because I knew that there were only 3 RN's and 2 HCA's for the entire ward. This is better than usual but still shit. 5 minutes into the shift I got a call from the dreaded site manager.

"You need to send one RN to the surgical ward and one care assistant to the gynae ward".

Nurse Anne: "WTF that only leaves us with 2 nurses and 1 care assistant for 35 beds. We have elderly patients who need total care but also acutely ill patients"

Site Manager: "Tough it out. Prioritize. Do nothing but deal with emergencies and meds."

Nurse Anne: "No. I can prioritize but I also want to see my patients safe, clean, and pain free as well as fed".

Site Manager: "You have a house keeper. Put her to work as a nurse for today."

Nurse Anne: "Ummm she doesn't know how to be a nurse and who will clean and make food?"

Site Manager: "Not my problem. If your RN and HCA are not onto the surgical and gynae wards in the next 5 minutes you can consider yourself on final warning. Goodbye."

Nurse Anne: "Fuck you".

Okay I didn't say fuck you but I didn't send the staff either. He came down to the ward himself and collared them. I am not a good enough nurse to handle so many patients with so little. I don't know anyone who is that good.

So I decided to be real nosey and called the wards that I was ordered to float my staff to for the duration of the shift. The gynae ward (relatively well patients) had 3 nurses and 2 HCA's for 20 self caring young female patients ALREADY. But they didn't feel that they could manage on that so they asked for more.

The surgical ward was 30 beds and had 3RN's and 3 HCA's already. They also felt that this wasn't enough and they were probably correct but they should not have had my staff. I do understand that surgical patients require massively frequent monitoring.

I was left with 35 acute medical and geriatric patients with 2 nurses and one health care assistant.

So What happens when we call for help?

"Sorry no staff available to help you"


"just prioritize" (that means ignore the patients and do paperwork to cover your ass)

"Not my problem"

"Can't afford Agency".

"Deal with it".

They are damn focused on putting a show on for the younger patients in surgical/gynae/ short stay wards. But our patients are mostly confused and dying so fuck them say the managers. The nurses that are down there on medical and elderly wards busting their asses will take the blame right?

I had a chat with Matron about this situation. She shrugged her shoulders and looked at me in a very patronizing way and said "there is nothing I can do, you will just have to cope".

Almost every day that I went to work we ended up with less staff than my charge nurse had scheduled because they got floated elsewhere.

I don't know what I was expecting from her or any of those matrons really. She was the same twunt who left me as the only RN for 35 beds once. I was 25 weeks pregnant and when I got into hour 10 without being able to take a meal break safely I asked her for help. Not even a full break, just 5 minutes to get a drink. She literally turned her back on me without saying a word and went home for the day. That is an honest to god true story. That was the worst shift I had ever. Ever.

I may have been extremely short on nurses that day but the safety of patients required me to be able to do the job of 5+ people. I will never ever martyr myself like that again. And they say that if only the nurses took a little pride in their work things would be better. I got nothing out of that shift but a whole lot of patients that were really angry with me because they had to wait so long for things. They got terrible care that day even though I had pushed myself so hard.

And the modern matrons are supposed be teaching us about caring...

You can see why they will not bring back the old style matrons and sisters. The old style nursing superheroes would put an immediate stop to this bullshit. The modern managers , nursing leaders, and modern matrons would have to hire bodyguards and then go and crawl under a fucking rock. The old style nursing sisters and matrons would fuck. them. up.

Report/Too many patients/overwhelmed: Part 3

What to do?

If both of us (the only 2 RN's for a large ward) try and take handover on all the patients we are fucked. The sheer volume of information and the insane amount of time it takes to get through handover together with constant constant interruptions is a nightmare. It takes hours. Then it takes time away from the patients if we are constantly trying to meet up and hand over any changes/updates to each other. We try and we fight to pull it off but it just doesn't happen. We can't even wade through the top priority doctors' orders that will kill a patient if it doesn't get sorted immediately without fighting interruptions.

We do both feel responsible to every single patient on our large ward.

We have learned from repeated bad experiences that it just doesn't work for us both to keep constant track of all the patients. Accept it or fuck off.

So we each take a "side". I take team A which is beds 1-18. Carly takes beds 19-35. No it is not because we are thick, or lazy, or don't give a damn. We are working with what we are allowed to have, not what we want to have. We are coping the best that we can in a situation we have no control over.

Even though I only have a side I am still overwhelmed. Violently so. It becomes insanely impossible to nip over to the other side in a safe manner. It is impossible to keep track of my own side and get them everything they need even if I completely ignore Carly's patients.

Of course I won't ignore her patients if they need help and I am the only one around. But I won't lay a hand on them either without checking with Carly. Too many gods damn bad mistakes have happened because a nurse who wasn't up to date with another's patient answered a call light and patient request. They get real upset when I tell them I am not their nurse but that I will get her to deal with their request. Nine times out of 10 someone wants food when they are nil by mouth or a med that they are not allowed to have. It's not something I can sort out for them without throwing my own patients out the fucking window. Five minutes down can do that. Yeah. Really. It could take me a long time to chase Carly down, and in the meantime my own patients are falling out of bed and wondering where I am with that pain med.

So what do we get for trying to do our best in a difficult situation? Shit and constant abuse basically. That about sums it up.

Visitors and doctors especially are the worst. The walk onto the ward, grab the first person they see in a uniform and want immediate answers as to what is happening with their relative/patient. They take no notice of the information board that tells them who is who on shift and who is responsible for who. They take no notice of how few staff are actually there. They take no notice of the fact that I am running down the ward with an airway. They want what they want and they want it now. They don't seem to get that they really hurt patients by behaving like this.

They blow right past the info board and want to be babysat for the duration of their visit to the ward by the first person in uniform that they come across.

They don't give a flying fuck about what she is smack in the middle of either.

Not even a pleasant "are you the nurse looking after Mrs. Smith, and if not could you please point me into the direction of the nurse who does know her?". Oh fuck no. We cannot talk to nurses like they are human beings can we.

It's more like "Hey you! You are in a nurses uniform, stop what you are doing immediately and answer my questions, follow me around like a lapdog for as long as I want and no I am not concerned about the fact that you are in the middle of sorting out someone with a k+ of 6.7 with calcium gluconate and a little IV dextrose/insulin. I will not look for notes myself, or wait for the nurse who knows my loved to be able to safely leave her patients and speak to me. I want what I want and I want it now and damn the consequences to your other patients".

That's what we get about 6 + times an hour every hour. If you think that is an exaggeration than I invite you to shadow me at work for a shift and see just how damaging these visitors/doctors etc can be. The logical thing to do is help them quickly if they are inquiring about my patient or point them in the direction of Carly if they are asking about one of her patients. If I say that I cannot leave what I am doing to help them, they need to respect me as a professional and understand that I really cannot leave my patients to babysit doctors and visitors right this minute.

Tell visitors and doctors this and they throw temper tantrums. They insinuate that nurses "don't care", "can't be bothered" and all the usual shit. Fuck you. If I am saying "That isn't my patient" do not assume that I do not care about him, or that I don't want to be bothered. Never assume. It makes you out to be a twat.

Maybe I have been trying to hang blood on my GI bleed for an hour whilst fighting constant interruptions. I know that the blood takes absolute priority but I am still battling and upsetting people in order to actually hang it. GET. OUT. OF. MY. WAY.

Maybe I am already 20 minutes late checking that blood sugar on my patient with the insulin drip who isn't looking so good. I am 20 minutes late with it because a relative stopped to ask me a question, a patient then asked for a commode and I was too much of a pussy to say no to her and risk her anger by making her wait. And now you are in my face, and the woman with the insulin drip is going hypo and looks a gray colour!! There comes a time when the nurse has to draw a line and say NO. I need to prioritize and do what I need to do, YOU get off YOUR ass and go and find that patient's nurse to answer your questions and leave me alone !!!

Maybe I don't know the patient enough to answer your questions intelligently and I am so overwhelmed that I cannot hunt down his nurse or his notes to find out. I still haven't checked that blood sugar and the lady with the insulin drip isn't looking so good, nor have I hung that blood. Standing in front of me and refusing to let me pass until I answer all of your questions and hand you notes that you could easily find yoruself will not change this situation in the least. I will just push you out of my way.

Maybe I was finally on my way to get some pain meds for my cancer patient or investigate the guy who hasn't passed urine in 12 hours. Do not hold me up from that in order to make your life easier!!!! How very dare you, you fucktard!! If stop now to fuck around with visitor/doctor requests there is no one to take over my job. No one. Get it asshole? This is why nothing gets done around here.

These interruptions for my own patients and patients that I do not know cause it to be an uphill battle just to get someone a pain pill.

Maybe I am remembering that time I did answer a request from a patient I didn't know only to find out that I should have never touched him without knowing every bit of info about him. Bad outcome. Real bad. That situation happens a lot because we do want to help.

We don't want to say "It's not my side, I don't know about him" because we don't want to appear stupid and lazy and uncaring. WE also don't want to spend 20 minutes chasing down the other nurse when my own patient is going hypo, another is bleeding out both ends and the man with the potassium of 6.7 has probably arrested because I haven't got the stat meds his doctor ordered up yet etc. I usually have all this going on at once for the duration of my shift.

For the sake of safety and efficiency sometimes we have to say "I cannot" or "that's not my patient". It's not meant to be indifferent. Quite the opposite actually.

I have a license and a hell of a lot of accountability. If I say I cannot walk away from what I am doing right now then I fucking mean that I cannot allow myself to be interrupted right now without hurting patients. I am not ignoring you and I do understand that your needs are important.

Deal with it and shut the fuck up. I did not create this situation but I am trying to ensure that the patients on the ward survive it.

Monday, 16 February 2009

Taking report on too many patients PART 2

I am having a really tough time articulating this for people who are not nurses. I will try anyway because it is so important. If have ever wandered onto a ward expecting the first person you see in uniform to have the information you want, and then threw a tantrum about the "stupid nurses" you should read this. If you have ever become upset because a nurse responded with "that's not my patient" you should read this. You need a reality check.

I have had a few emails off of nurses about report and handovers. The American nurses are telling me that they arrive to work and take report on 4-12 patients on their 30 bed acute wards. That report alone takes 45 minutes due to the sheer volume of information one needs to know to be a primary nurse for those patients. Then there are the constant interruptions throughout handover. The idea of taking report on the whole ward and staying on top of everything for all of those people is generally understood (by those of us who do this everyday) to be "ludicrous". First of all it would take hours. You cannot be away from those patients for hours receiving handover.

However, the idea of getting involved with the patients that you haven't had handover on is understood to be dangerous. It is impossible to keep up with your own assignment let alone get involved with the other one. What if my patient gets labs drawn late, IV med late, or I miss a change in condition because I went to research a patient on my colleagues assignment so that I could answer a relative's question? I have harmed my patient if I do that. I want to help the family but it may take ages to hunt down that patients nurse and it will take ages to make my way to the notes and research and investigate the answers to their questions. it's doubtful that anyone has had the time to document everything anyway. I am constantly interrupted during the day, constantly with these queries.

It is a nice idea to think that all nurses on the ward during a shift have up to date knowledge about all the patients. But in practice it doesn't work at all. Yet having report only on one side of patients and not being aware of the situation with the other nurses patients is also a massive problem. This is what I am trying to reconcile.

If nurses decide to constantly try and update eachother about their patients so that everyone knows what is happening we end up with nothing but big fuck ups. First of all, any time spent away from patients trying to handover is dangerous. Who the heck is doing the work and watching the patient with a trained eye if we are constantly updating eachother? The teenage cadets? You would not believe the sheer volumes of information we are trying to keep track of and you would not believe how quickly things change and how unorganised it all is these days in acute care. You also wouldn't believe how easily a patient could be killed either because the nurses are constantly trying to handover to eachother, or because they weren't.

Nurses are of course encouraged to help out their colleagues and their colleagues patients when the need arises. But taking something on with a patient outside of your assignment when you do not have up to date info on them is a minefield. If another nurse's patients asks for something so simple like a glass of water or a pain med and you supply it without being updated you could seriously harm someone. It's more complex than this, but I am trying to keep it simple for the sake of clarity.

Our acute medical wards started moving from 4 nurses to 2. This what at a time when the patients were becoming more complicated, the work loads were tripling, and everything just started moving faster. Things will continue in this upwards spiral due to modern changes in healthcare.

We realised at this point that 2 nurses taking handover at the beginning of their shift on 35 patients was taking too long. We started work at 7:30 AM. The night nurse comes off the ward at 7:30 AM and starts giving us report on each patient: Name age, doctor, diagnosis, history, tests, assesments, treatments, social , physio, meds, problems, old issues, new issues etc etc. It was 9:00 before report ended and we hadn't even set eyes on the patient yet. You need a heads up on so much information your brain hurts when it is all over and you can barely process what you heard. It's likely that I haven't met any of these patients before.

Not only that but the care assistants would constantly be in and out during handover to tell us that someone had fallen, someone couldn't breathe, this patient needed morphine, another has just vomited a litre of blood. You can't leave that until the end of report. You also cannot touch a patient until you have had report. The phone rings constantly during report. No ward clerk present thanks to cutbacks.

The first thing all the relatives do when they wake up in the morning is ring to ward to find out what kind of night mother had and ask what time the docs are coming. Be damned if we nurses know when the consultants are going to grace us with their presence. If the night nurse is on the phone constantly answering questions we are not getting handover. We are sat there getting pissed off because we haven't started our shift yet. We (the day nurses) can't head out onto the ward and start anything if we don't actually know anything about the patients.

We do not learn what we need to know about them by osmosis or psychic ability. We are not there everyday and when you come back in after a day off everything has changed. We need time to learn about the patients' issues. That's why we have handover. This is not an issue in nursing homes and subacute units. They have the same patients there day after day and only need a quick handover to update.

I have often come in after 3 days off to find that I am the primary nurse for 15 + patients I have never laid eyes on before. And we can't even get through report or have a quick look at the notes before we start our shifts due to constant interruptions primarily in the form of phone calls from relatives. Jesus try keeping all the names straight in that situation let alone everything else. Just try it or shut the fuck up.

We know that you can't have the day nurses sat in a room for 2 hours at the beginning of their shift trying to get handover. The night nurses stopped being paid from 0800 onwards so they were there unpaid until 0900 or even 1000 trying to give us report. What is the solution to this? We no longer have a charge nurse/sister/matron there 5 days a week who knows the patients like the back of her hand. If we do have sister on duty, she is there instead of a staff nurse. That means she has to be a primary nurse doing care and cannot fart about with the doctors all day staying updated on patients. We tried taping report. That failed due to constant interruptions.

So our solution was this: There are 2 nurses for a 35 bed ward. Instead of both of us trying to listen to report on all those patients we will EACH TAKE A SIDE. Night Nurse Kate can handover patients in bed 1-18 to me. Night Nurse Beth can take the other day nurse aside and handover beds 19-35 to her. Then we are usually out of handover at 8:15. Then I can go and actually set eyes on my patients a lot earlier and get started. All 35 of them are due meds that have to be given on time before 0900. Otherwise they are written up as errors. We need to get started.

This is why nurses each have a "side" rather than updated info on all patients.

Are you guys following me so far? I hope so. This is really important even if you are bored.

I'm not done with this subject yet. The ranting and swearing is going to come in part 3.

Saturday, 14 February 2009

Nurses should not take report on all patients on the ward...PART ONE

I got a massive shock to the system when I stupidly returned to the UK following my training and working for a short time in the USA.

Over there I was working on a 36 bed general medical surgical unit. It was considered violently unsafe for a nurse to take any more than 6 patients...12 in an absolute staffing emergency. You could increase the ratios at night due to less interruptions.

We had "pods". Each 6 bed pod had its own nursing station, it's own phone and it's own nurse, it's own supply cupboard and it's own hand washing station. This staff nurse only had handover on those 6 patients. All the info she needed for those 6 patients was right there, not mixed up with the other 30 patients. The idea was that it is extremely dangerous to have handover and irresponsibility for more than your pod on busy day shifts. on nights there was one nurse to 12 so she had 2 pods.

Every single day we had a charge nurse (sister) who was in charge of the whole ward. She was there 5 days a week and knew about all 36 patients on the ward. That was good. She was our leader. It is stupid to expect a staff nurse to come in after days off and take report on 36 patients anyway. It takes forever to get handover on that many patients and it is way too much information to keep track of for any amount of time.

Things change so violently and quickly during the day that if you were trying to care for a group of patients and keep track of all the issues for the whole ward you would fail. This was understood by our managers and anyone else with a fucking braincell. That is why each staff nurse stayed in her own pod, only had handover on those patients. The charge nurse was the only one who had report on all 36 patients from the night charge nurse. She did not have a specific patient assignment. She went from pod to pod checking that the nurse and the patients there were doing okay.

Picture the shock to the system I had when I came to the UK to find that on a 35 bed ward there were only 2 staff nurses, no charge nurse and that we were supposed to listen to report on 35 patients we never saw before. How fucking stupid. On a 35 bed ward there would be 2 or 4 nurses listening to report on all the patients. Report at the beginning of the shift took hours. Now we don't even have four nurses, just two. All the notes for all 35 people are jumbled together at the nurses station and there is only one nurses station and one phone. It's fucktarded.

Let's back up a minute. Decades ago an NHS hospital ward had 35 beds and it worked out that you always had one nurse on duty to know about all of the patients. Matron or charge nurse was there every day without a specific patient assignment. First of all, the patients were no where near as complex as they are today on a general ward. General wards today are full of chronic people with complex problems who would not have lived very long back then.

Decades ago patients stayed in the hospital for a lot longer allowing the staff to get to know them. Things didn't move as fast or happen as fast. There were not as many targets, paperwork and changes throughout the day as there are now. I may do 11discharges in one day now. Things were at a slower pace back then. There were more nurses and everyday there was a charge nurse/sister/matron on the ward in charge. She was there every day and knew that ward like the back of her hand. She had staff nurses to care for the patients while she supervised and kept up with the information.

We don't have any of this going for us now. And it's not our fault.

They certainly won't pay for a charge nurse to be there everyday on top of two staff nurses. Most you get now is a charge nurse and a staff nurse or two staff nurses. Each will take a side of patients. If the charge nurse is the primary nurse for her 12-14 people than it becomes impossible for her to follow what is going on at the other side. We did try and have both nurses listen to both sides and get handover for the whole ward. We failed miserably. There was so much information to know for all those people that report was taking nearly 2 hours. There were so many changes during the day that we couldn't find time to catch each other up. Every time we tried we failed due to interruptions.

The other problem we have is this: Nurses are often working 14 hour shifts 3 days a week rather than being there 5 days a week. Saves the hospital some cash. To come in after 2 or 3 days off and listen to handover on 25 or 35 patients you don't know and then try and keep track of all the information is crazy. It's like begging for errors and mistakes. As a matter of fact we know for a fact that it will cause vital info to get missed out lead to mistakes. American nurses would be shocked at the idea of having all ward nurses know about all the patients on a 25-35+ bed ward. Actually anyone with a fucking brain would be shocked that people think that this could work nowadays.

I need to go now and will finish part 2 of this later.

Then I will have a holy motherfucking shit fit angry rant at the people who deem the ward nurses thick and lazy for not having up to date info on all the patients on their ward at all times.

If there are any nurses (especially outside of Britain) who are reading this I would like to know how many patients you get report on at the beginning of a shift. What would you think of sitting and listening to handover on 35 patients at the beginning of a day shift in acute med-surg? Maybe you'll decide for the only 2 staff nurses on duty to listen to report for both sides and work together. Do you think it would work? If you split it and each took 17 or 18 patients each how would you keep track of your 18 patients and your colleagues 17 patients as well? How can you keep track of all the minute details of 36 people with rapidly changing conditions and orders?

Please answer if you have time. British blog land is full of doctors and members of the public having a shit fit and calling the ward nurses stupid and lazy for not having up to date info or assessments of all 35 patients on a ward at all times.

Friday, 13 February 2009

Silly Complaints.

The lasix

the pillow on the maternity ward

the code

the code part 2

the pain killers were given patient didnt remember family pitched a fit

the confused lady who took off her clothes

the water jug

the commode

the commode part 2

the house keeper and the cups not a complaint but it just goes to show

the patient who punched the nurse and broke her arm and complained about his sore hand

the dead pregnant nurse

the other water jug complaint (doc on rounds reems nurse out about missing jugs)

the bedside md

the wanderer in USA long term care who got nurse fired.

one complaint about nurses being married women rather than nuns

Pregnant teen mum says nurses are slandering daughter

the dying patient seizure and the coke.

pharmacy not delivering med patient left in pain

care plan complaint.

the pre med missed and the emergency.

you killed my 101 year old grandma with multiple pathology.

Thursday, 12 February 2009

Some little jokes to cheer us up....

Hospital regulations require a wheel chair for patients being discharged. However, while working as a student nurse, I found one elderly gentleman already dressed and sitting on the bed with a suitcase at his feet, who insisted he! Didn't need my help to leave the hospital.

After a chat about rules being rules, he reluctantly let me wheel him to the elevator.

On the way down I asked him if his wife was meeting him.

'I don't know,' he said. 'She's still upstairs in the bathroom changing out of her hospital gown.'


Couple in their nineties are both having problems remembering things. During a check-up, the doctor tells them that they're physically okay, but they might want to start writing things down to help them remember

Later that night, while watching TV, the old man gets up from his chair. 'Want anything while I'm in the kitchen?' he asks.
'Will you get me a bowl of ice cream?'


'Don't you think you should write it down so you can remember it?' she asks.

'No, I can remember it.'

'Well, I'd like some strawberries on top, too. Maybe you should write it down, so as not to forget it?'

He says, 'I can remember that. You want a bowl of ice cream with strawberries.'

'I'd also like whipped cream. I'm certain you'll forget that, write it down?' she asks.

Irritated, he says, 'I don't need to write it down, I can remember it! Ice cream with strawberries and whipped cream - I got it, for goodness sake!'

Then he toddles into the kitchen. After about 20 minutes,

The old man returns from the kitchen and hands his wife a plate of bacon and eggs. She stares at the plate for a moment.

'Where's my toast ?'

AND the grand finale:

A little old widower, in his late 80's, finds love again with a widow of the same age.

One day he and his new sweetheart are sitting in the park. They are enjoying the scenery, the birds etc. Suddenly they see a young couple making out and getting pretty steamy!!

"You know what Edna...we can do that. Age is just a number, you know."

So the little old widower and his little old girlfriend make their way back to her place. Soon enough, things are really heating up and getting about as steamy as the young couple in the park.

Suddenly Edna starts becoming short of breath and clutches her now unclothed chest.

"Slow down Walter slow down, I have acute Angina you know" she gasps.

"Well Edna you better because your tits sure ain't nothing to look at!".

Tuesday, 10 February 2009

Why do Nurses always look like hell?

It's true. We look like slobs.

First problem is the uniforms. Right now I have only one that fits. I am not allowed to have anymore from the trust due to financial cutbacks. I am not allowed to buy my own uniforms outside of the trust. I sometimes leave work at 10PM at night and have to be back at 7AM the next day. I am a clean freak so that means that everytime I come home from work I wash the uniform and put it in the drier before I go to bed. I do this even if I left at 10PM and have to be back at 7AM the next day.

I get up at 5AM to get ready for my early shift and take the uniform out of the drier and iron it. Then it goes in a carrier bag and sits by the door while I get dressed. The uniform has been worn and washed so many times it looks like hell no matter what I do. If you get caught traveling to and from work in your uniform you are instantly dismissed. They have already made a few examples.

We are told that we need to change at work or else but there are no changing facilities. I think the other section of the hospital has them but we were not allowed to use them. There are portacabins outside (a 20 minute walk away)full of mice and we were told to use those but no one has given us a code to get into them.

Staff on my ward have to change in the domestics cupboard just outside the doors to the ward. It is very small and usually there are 2 of us in there getting changed. When someone else comes in and opens the door....anyone in the foyer can see us. This especially sucks during the 1PM start when countless visitors are standing around in that foyer.

Some of us started sneaking to the toilets to change but they were caught and told that this is unacceptable and to use the supply cupboard or the mice-a-cabin as I call it. The trust will NOT launder or store our uniforms, or give out new ones at this point. Other trusts do it, and they provide decent facilities for their staff as well.

So my worn out uniform has been carried to work in a sainsbury's bag and I have changed into while trying not to fall into an old cleaning bucket. My normal clothes get stored in the sainsbury's bag on the floor of the cleaning cupboard. There are 5 tiny lockers for everyone.

I am still meticulous about my appearance otherwise. I plait my long hair and wind it up in a coil for work. I pin every stray piece in place. I always shower before and after every shift. My nails are short and they get scrubbed and clipped again before work. I wear minimal natural make up so I don't scare the patients. I wear expensive shoes to work. They are very smart and comfortable. I'm a vain little shit.

10 hours into my shift without any sort of break the other day I caught a glimpse of myself in a mirror and nearly choked. Strands of hair all over the place, dry chapped peeling lips, bags under my eyes, stains on my face from crying after a death and a uniform that looks like it has seen heavy duty daily use since 1950.

This is actually very demoralizing because I am usually a snob about appearance and like to look good. I stay healthy and fit and take care of myself. I like expensive make up and beauty products and never wear the same outfit twice. I always take loads of time before work to try and look reasonable even if it means getting up at 5AM.

But that brief glimpse in the mirror showed me that during a long shift I look like the slovenly pig nurse that the public always complaints about.

If I could get a break during a shift I would redo my hair, apply some powder and lipgloss and clean my self up. Care assistants, secretaries, domestics and everyone else get time during the day to do this. I cannot even go pee without getting behind and making my patients angrier. Those of you who can take time during the work day for a makeup and hair check make me sick.

When I worked overseas the nurses bought their own uniforms from nursing stores. I never wore the same outfit to work twice. Like I said I am vain and can spend some serious money on clothes. I looked so much better. The uniforms I chose for myself were nicer with good labels and they were better quality and more professional than the shit the NHS gives us. I even bought uniforms made from bacterial resistant fabrics.

Older nurses that haven't worked in awhile may find this shocking as they were always supplied with fresh smart and clean uniforms every shift. They are also the ones who bitch the most about the appearance of todays nurses.

The Complaints Procedure in a Nutshell

I wanted to add this to my post about protected meal times but it just got to long. At university my english professors used to get on my back about rambling and run on sentences and you can see why!!!

Those of you have been reading my blog know that staff at my hospital have been complaining and pushing management to hire more nurses for years. Instead they have turned away scores of newly qualified nurses and told them that there are no jobs. Occasionally they hire a 17 year old care assistant on less than minimum wage and expect us to be very grateful for that. Teenagers that age with no experience cannot seem to grasp that if we say that a patient has swallowing problems and needs pureed diet you don't fucking give them sandwiches and biscuits. They leave pnuemonia patients lying flat and pyrexic patients (temp of 39.5) covered with 200 blankets because they are "shivering". I am rambling again.

I have written about feeding patients and how the nurses have pushed and pushed and sent numerous complaints into management about the clusterfuck that is meal time. The vast majority of these letters of complaint from staff came from my ward. We have the monopoly on patients that cannot feed themselves and we are also the most short staffed.

Between July and January we sent many letters. We begged. We pleaded. Management refused to speak to us and the matrons stated that they couldn't do a thing about it all. But we have our letters dated, copied and on file. All of them.

In March or thereabouts the complaints department received a complaint from the daughter of a patient from our ward. This woman was horrified about how much weight her loved lost while an inpatient on my ward. She was understandably angry about finding cold food left in front of her relative, out of reach. So she did the right thing and complained. She mistakenly believed that management doesn't realise what is going on. She wanted them to know so that the problems could be fixed so no one else suffers.

We saw the letter of complaint even though we never should have. Militant Medical Nurse has spies everywhere you know. We also saw the response from management which I have paraphrased here:

Dear Mrs. Jane Doe,

We are so sorry to hear about your relative's ordeal. We will deal with the nursing staff and make sure that they understand that it is their job to feed patients. They will have a ward meeting about this issue.

Okay, the last two sentences are pretty much word for word.

This letter went out from the same managers that had received the complaints from the nursing staff demanding protected meal times. They knew what the situation was.

Management and the good folks at the complaints department were questioned by a colleague of mine about this letter. They were asked why they just dumped this whole thing back on the nursing staff. Their response was "well sorry but we cannot admit liability on the part of management".

Oh the shame. Now this woman basically thinks that we are too stupid and lazy to help vulnerable people at mealtime. It finally dawned on me that our hardwork trying to cope at mealtimes and letters of complaint were meaningless. It's mortifying.

Sunday, 8 February 2009

Medical and Geriatric Wards PLEASE READ

I thought I would put this here so anyone who might read this can understand where I work and where I am coming from. I am going to try and keep this as simple as possible.

This blog is a portrayal of working on a 25 bed medical ward in the NHS. Medical wards take people with GI bleeds, Heart problems, Renal problems, Pneumonia, Lung disease, cancer, asthma, sepsis, general deterioration etc etc etc. This means that we are a mainly a geriatric ward. Most people who need to be hospitalized with these problems are elderly. The majority of my patients are completely unable to care for themselves due to extreme illness or dementia. Usually both together. The majority are confused. A severe medical illness will do that to you even if you were totally with it last week.

The opposite of this ward is a general surgical ward. These wards usually have younger patients who have a problem that needs sorting and that is the end of it. Think of the 26 year old male with a hernia. He goes in and has his hernia done. He has no other problems and is self caring. He goes home the same day. Sometimes surgical wards get really sick patients with severe problems but because the nurse's other patients are mainly self caring she can focus on the ill patient without leaving her other patients sat in shit for 4 hours.

The surgical ward is always better staffed than the medical wards. Always. Our hospital has a short stay surgical unit. They take easy cases. Young men like the one I described above are the norm down there. They will never take elderly medical patients as they are usually not suitable for an operation i.e. they'll probably die on the table. They have 15 self caring young patients who have no major medical problems. They get 3 nurses and 1 health care assistant for those 15 patients.

Cardiac wards are staffed in a similiar fashion but are also a lot busier. Even so, a nurse on a cardiac ward will often not have more than 5 patients some of whom are self caring and orientated. Compare this to a medical/elderly ward where the nurse has 15 patients and not one of them can feed themselves. Medical nurse will also have acutely unwell patients who could die if she leaves them long enough to help her more medically stable patients who are incontinant and struggling with basic hygeine.

Orthopedics is usually staffed well compared to medical/elderly and if one of their patients starts going down hill they are immediately sent to a medical ward where the nurse is caught between 20 elderly patients who need to be fed anc cleaned and the patient who came from the ortho ward who is now dying of heart failure because they overloaded him with IV fluids.

This blog is about working on a medical/elderly ward. It is an accurate represention of that without breaching confidentiality.

It is not an accurate representation of your nan's orthopedic ward where she had her hip done, or the surgical ward where you had your tonsils out, nor is it any kind of portrayal of cardiac wards. It is a whole different world from ITU and CCU where the nurse has 1 or 2 patients and massive back up.

My ward is a medical ward. This is the one your grandfather will go to after CCU stabilizes him, or maybe he isn't stable at all when he comes to me and I have to prioritize his care above hygeine care for other patients in order to ensure his survival. My ward is the one where nursing home patients go to when the nursing homes and their families cannot cope and there is no other place for them to go. They are medically stable when they come to me but are confused, malnourished, immobile, aggressive and incontinant and demand one to one care and so do their relatives. The relatives do not give a shit if I have a 30 year old mum down the bottom of the ward who can't breathe and needs a neb and a zillion other interventions to get even remotely comfortable. They don't care that I have a 63 year old who is raising her grandchildren and is now bleeding out due to a GI bleed and needs blood. They will tear me apart for leaving their elderly relative long enough to stablize the others. But the lawyers would tear me apart if I dared to leave an unstable medical patient to take another patient to the toilet. The nurses on my ward are in this position every minute of every shift they work. They are constantly caught between doing basic care for the elderly without harming someone is acutely medically ill. I cannot speak for nurses on surgical, ortho, cardiac, and intensive care wards.

I like caring for elderly people as challenging as it is. I see an old woman and I know that once she was someone's beautiful baby, someone's child who made mummy and daddy so proud. She was a gorgoeus, intelligent and vibrant young woman with plans for her life. She was someone's sweetheart and bride.

My elderly patient with dementia was someone's wife and the glowing mum to a new baby once. She was a shoulder to cry on for her older children and she probably busted her ass to care for her own aging parents as well as her own family. I know that if my own babies live a long time they are sure to end up like the old woman I see in front of me and I hope someone cares for them in their old age.

I know this and my colleagues know this. All of us.

So why does the public think that we hate old people? We don't hate old people. But society and our bosses certainly do.

Read the blog to see what shifts are like for nurses on these wards.

Protected meal times

Please check out my protected meal times blog below. The date on it says March. That might be when I started it but today I finished it.