Monday, 30 March 2009

Here come the kids. God help us.


Yeah it just gets worse and worse and worse. The photo above pretty much depicts the only new staff members we have had over the last few years.

Once a upon a time there was some dickhead worthless manager with a large salary and too much time on his hands He had a determination to justify his existence and job title. So he came up with a plan to staff the wards in a cost effective way.

It is anything but cost effective. Costly and begging for a million pound lawsuit is a better way to describe this crap.
They actually started hiring ward staff at one point before now. But these people were not nurses or health care assistants (who at least have of a bit of a clue). What we got was something called cadets and trainees. Once upon a time I was bitching about health care assistants. Now I want my experienced health care assistants back.

On paper it looks good. Replace all the leaving HCA's and nurses with cadets and trainees. In some places they are called apprentices. They are on minimum wage and do not get shift differentials to work unsocial hours. The 16 year old kids are on less than minimum wage. They will be an extra set of hands on the wards. They will learn about nursing. The trust can get away with paying them less for a myriad of reasons. They are on less than a healthcare assistant. But it is an extra set of hands on the ward in a nurse's uniform. Hopefully someday they will want to go to nursing school.

The idea is supposed to be that (in the beginning of their career as nhs employees) these kids work along side knowledgeable staff and learn and help out. I am just going to refer to these people (apprentices, cadets, juniors, trainees) as kids since most of them are barely out of high school. They are completely untrained and have no prior experience in healthcare.

Occasionally we get a good one. You know what I mean. The ones who are aiming for medical school and nursing school and want to learn all they can are great. But even so they are still dangerous. This is not their fault. I'll explain why in a minute.

Others have no interest in nursing and just want a paycheck. Macdonalds would be much easier love. Some figure this out after about 2 weeks and leave.

Others cannot even spell their names, have no chance of getting into nursing school BUT think that they are already nurses simply because they have a job on the ward caring for patients.

Their confusion is understandable. First of all, their uniform is identical to a nurse's uniform except for one tiny little detail. They have a dark green stripe on the sleeve. Nurses have a light green stripe. The patients and relatives think that every woman in uniform on a ward caring for patients is a nurse and addresses all of them this way. God, does that piss me off. "Nurse" is my hard earned title. Most staff on the ward are nothing like a nurse and this includes healthcare assistants. Sob. I miss the healthcare assistants. I just want someone who knows what they are doing around. Now I have "kids" instead.
And not one of these "kids" has any idea of just what they are walking into. Not one. This job is a little different than selling ice cream cones like they did last summer.

The first few weeks that these untrained kids with no nursing knowledge and no understanding of consequences came onto the ward they were not supposed to be counted in with the staffing numbers. Instead they were supposed to shadow the existing staff and learn how to do the few things that they are actually allowed to do. They cannot even take observations or do blood sugars at this point. They certainly cannot fill in a fluid balance chart. If they know how to do it they certainly hide it well because they never fucking do it. Ever.

What happened on the very first day we had "the kids" starting on our ward (the very beginning of their orientation period)? That shift we had 2 nurses and 3 health care assistants. When the site manager saw that we had 2 new cadets on for that shift in addition to the 5 of us they immediately floated our 3 health care assistants somewhere else. That left only 2 registered nurses and two purple haired, tattooed brand new cadets.

They do this every fucking time we have someone new start. From the first day on the job when new staff are supposed to be on orientation and supernumerary the staff that is supposed to be training them is floated off the ward to cover extreme short staffing on another ward. They do this to new graduate nurses their first week on the job. They do this when we have student nurses on the wards. They float away some of the regular staff to cover dangerously short other wards because we have an extra set of hands in the form of nursing students. The nursing students spend all day running after call bells and never fucking learn anything.

When yours truly started as a brand new nhs staff nurse, having never worked in an NHS hospital before because I lived with my dad for awhile and trained abroad; I had 2 days being supernumerary and then on the 3rd day I was left in charge of the ward whilst my mentor was sent to cover sickness on the ward downstairs. New nurses should be on a 6 month preceptorship as new nurses. And please, none of this BS about how this is due to academic nurse training not preparing people. That has nothing to do with this.


The university trained nurses are getting plenty of time on the wards as student nurses. PLENTY. It is the quality of that time that is the problem. THE FUCKING QUALITY.


Almost immediately after the kids started we were finding that the experienced staff were outnumbered by the kids on most shifts. But they are still being paid as "apprentices". They were never trained properly to do the few things that they are allowed to do because they were never there in addition to a well staffed ward. If we had 2 staff nurses and 3 kids we were grateful. A fucking supercuts salon has more goddamn trained staff than that. And they only have to deal with one person at a time.


I said earlier that it was the idea that these kids would gain vocational experience and go on to nursing school later. Ha ha ha ha. They see the nurses getting screamed at, blamed for everything, working like dogs 14 hour shifts with no breaks while the kids themselves have multiple tea breaks and hide in the toilets on their mobiles. If I say anything to them management will get real upset with me for upsetting the cheap labour.

None of them want to be nurses anymore. If anything they have been talked out of it. Right now they get to prance around in nurse's uniforms, get addressed as "nurse" by the patients and visitors, all the while taking lots of breaks and not being accountable for any of their actions. They don't have a registration. Everything they do is on my registration. They are happy right where they are.


Our HCA's are becoming a thing of the past. The ones that are leaving are not being replaced by anything except kids. I feel like I am spending 99% of my time babysitting these new dangerous brats. At least the HCA's were goddamn trained to do their goddamn jobs.


That's cruel of me. There are a few of them who work hard and at one time wanted to continue into nursing. Many of them are doing way better than I would have done thrown into a ward like this at age 16.


But it is still a really fucked up situation. And all this time qualified nurses with years of experience who moved into the area are getting told "sorry, no jobs". That hopefully will change now that the Staffordshire story broke. We are holding our breath, desperate for a miracle and some trained staff.


I need to run now but I will do a blog post all about cadet horror stories and explain just how much this situation screws with patient care.


Friday, 27 March 2009

Ensuring that we have Compassionate nurses.

We need compassion in nursing. We need our patients to receive wonderful and dignified treatment.


But forcing ward nurses to take a ridiculously high number of patients, working 8-14 hours without a break in addition to massive amounts of unpaid time in a vain attempt to avoid being struck off hardens people. They become numb. Some nurses are just crap. Most are working themselves into an early grave trying to do their job well. The bad ones and the good ones are both working in insane conditions. Let's improve the conditions and weed out the crap.

This country is collectively mentally ill. We give nurses outrageous numbers of patients and expect one to one care. If she can't do it we call her lazy and uncaring. Sick sick sick.

If you want the nurse to be there every single time your loved one is wet, in pain, or needing his medications then you want one to one care. You don't want your nurse to have any other patients. This is not something he/she can control. Yet you say nothing when the wards are intentionally short staffed. You bitch about sloppy nursing care but want the nurse to take on insane numbers of patients in order to save you some money. You don't care if she works a 14 hour day with nothing to eat and that only allows for the bare minimum to get done. You complain about her and close your eyes to the situation.


If my grandma goes into hospital and I find out that her nurse has more than 4 other patients the shit hits the fan. I will tear into the boss. I want my grandma cared for. Stopping her nurse from seeing her other patients by complaining and harassing and stalking her over something she cannot control only makes things worse for all of them, including my grandma. If grandma's nurse has a bleeder in the next bay then no she can't take my grandma to the toilet right now, or for a long time. I can abuse this nurse to death but it won't change the situation. If I bully the nurse into putting my grandma's toileting needs first then the bleeder dies because he didn't get what the doctor ordered.

Daily mail readers and Dr. Crippen think that the overwrought nurses will be so much nicer if society ensures that they are poorly educated and chased around by an old fashioned matron carrying a stick to beat them with when they crash and burn. Uh yeah, problem solved.

Read this article. This is how you begin to get good, compassionate nurses who respect dignity.

You should treat them with dignity and you should not abuse them day after day.

You should admit that their job is tougher than most others rather than subscribing to old fashioned and incorrect views of nursing that lead you to believe that a moron with a good heart would make a wonderful nurse. Have you any idea of just how much an RN needs to know to be a safe nurse?

You should respect them and help them to cope. I don't think for a minute that listening to soothing music and doing push ups is going to improve things all that much. The point here is that someone is actually recognising that poor conditions for nurses means poor conditions for patients and they are trying to do something about it.

Would you beat a dog every day and then leave them alone with a child? No? But you want to treat nurses like shit, working in overwhelming 3rd world conditions where they have to go 8 or 12 hours without eating, work unpaid hours to boot and then you expect them to be compassionate and stay at the bedside?

Anyway I'll quote some of the article here. Edit :no I won't now because blockquotes are evil. Just click on the links.





Wednesday, 25 March 2009

Why Are the Nurses Always Hanging around the Nurse's Station, the computer etc.




"Why are they always hanging around the computers and the nurses station"?



"Why are are they always filling in forms?"



"Does this mean that they don't want to nurse patients?"





Well, if you are even asking these questions, you are probably totally fucking ignorant. They ARE nursing patients by doing these things you moron. They are also trying to avoid harming patients, getting struck off by the nursing and fucktwittery council and ending up in a courtroom.



I'll get back to the CCU part 3 thing later.



Just look at these bizarre quotes from over at Dr. Crippen:



"I shall probably be shot for saying this, but the common factor in
very many of the horror stories seems to be nurses. Endless excuses are made -
not enough staff, too busy, not enough training etc etc. But I have personally
seen many instances where there is a clutch of nurses round the computers, but
none in the ward. Nurses all seem to want to be doctors, or at least look like
and be treated as doctors, and few of them want to nurse. Hence Nurse
Practitioners. Since the start of the ridiculous Project 2000 this has
escalated. (ducks down below the parapet)"


Yes you had better duck below the parapet you ignorant fucking shit. First off all, project 2000 died pretty soon after it was born. Most nurses working in the NHS right now did the traditional training. Lastly, just look over at America. Their nurses are highly educated at universities and you won't hear of patients over there starving to death. They also have much less ancillary staff on the wards than we do. Yet the patients get better care. They get basic care. Think about why this is the case. I will give you a hint. A 24 bed medical ward in the USA will have 7 trained nurses and 2 care assistants. In the UK the same ward would have 2 trained nurses and 3 care assistants. The nurses over there are highly educated, they graduated from highly competitive expensive schools, they get kicked out of school if they do not get top grades in their university science courses and the have a smaller number of patients. They can do the care and complete the other aspects of their work.


"A few years ago my wife was in two different hospitals in fairly quick
succession. In both I saw nurses routinely clustered around a computer screen,
chatting. In one, when I walked over with a question I found that they were
talking shop. So I walked over several times in the next few days; it was
shop-talk every time. In the other I had twice visited the nurses' cabal. Each
time the talk was mere gossip. Naturally, it was the gossipmongers' hospital
that was highly rated, internationally famous and so on."


First of all let me say this: I do not believe for a minute that either of the authors of these quotes are able to distinguish between a nurse and a cleaner, tech, auxiliary nurse, OT, dietitians, administrative staff, etc. I don't believe that they understand why nurses need to spend time on computers and form filing. I cannot believe that anyone would think that a nurse is trying to act like a doctor and avoid patients by hanging around on the computer or filling in a form. It is mindblowing that anyone in the 21st century could think like this.


Secondly I am suspicious of anyone who uses the terms "nurses" and "sisters". Many (not all) of these general wards will not pay nurses and sisters to all be on duty at the same time. Two "nurses" tops. If sister is on shift than it is "sister" and "nurse" and they are each the primary RN for a large number of patients. The rest of the staff kicking about are not nurses, or anything like a nurse. If you are going to use the term "nurse" you had better be damn sure that you know what you are talking about. People who use the term "nurses" plural whilst referring to general medical wards are probably talking shit.


Why do comments like those above piss me off?


1. Nurses stations are gathering places for all sorts of staff, all day long. These people may be in uniform but they greatly outnumber nursing staff. My ward is in a very central location. People love to use OUR fucking nurse's station as their own personal break room, meeting area etc. They tie up our phones, our computers etc. They are not nursing staff nor are they employees of my ward so it's not like they are going to answer a call bell or see a patient. The clinical techs are the worst. They work all over the hospital and they travel in groups. They are NOT ward based. When they are not busy you can bet your arse that they are feet up at MY nurse's station. If you look at the station at any random moment you will see occupational therapy, clinical techs, physios, dietitian, social workers, clinical techs sat on their arses, nurses from other wards who have stopped down to borrow something but are not allowed to touch a patient on my ward, clinical techs, clinical techs sat on their arses, pharmacy techs and more clinical techs. I have to fight my way through this crowd of people to get my work done at the station.


I know for a fact that relatives and visitors generally refer to this eclectic group as "nurses ignoring patients". We hear you say it, and we laugh at your fucking stupidity. This occurs on a daily basis and it gives me some much needed comic relief during a long and break less 12 hour shift. Thanks for that.



I had a little fun with this situation one day. There were 2 nurses and we were hours behind, patients were waiting and suffering. I could see visitors glaring at the nurse's station, giving each other knowing glances. I have been around long enough to know what they were thinking. So I acted like a bitch.


In a very loud assertive voice I shouted " Listen up, I want all non nursing staff who are hanging about the nurses station to stop using our ward as a break area. The patients and visitors think that you are actually nurses that you are ignoring patients. Can you not hang out in the cafe upstairs please?" All five techs who were having their break at the station got up and walked out, leaving the station empty of human beings. The visitors etc looked surprised. I know I sounded like a jerk but it was worth it. Nurses should do this kind of thing more often. I've done it more than once in order to make a point. It works and I haven't got told off for doing it yet.


I don't often get meal breaks and I don't want to see others get them if I can't. That was the other reason I threw them off my station.


2. Computer work and paperwork is nursing too and is absolutely essential to patient care. We violently hate this but it is a fact of life that we cannot control. They will string me up from great heights and deny my patients essential treatment if I fuck this up. If I was responsible for a small group of patients I could get through this stuff very quickly. But I am responsible for a large number of patients (12+) and the amount of computer and paperwork I HAVE to complete becomes extremely time consuming. Even if you ditch all the crap that is not essential and just focus on the absolute high priority stuff it is still very time consuming if you have a large number of patients. This is true if I have once care assistant or nursing student helping me out or 20 of them. This crap still has to be done only by the registered nurse. I'd rather be at the bedside.


The pharmacy won't give me the meds I need without filling in forms and placing orders on the computer. I had a patient who was about to arrest because he had a K+ of 7. I notified the doc of the blood results and he ordered the necessary intravenous meds. I had to jump through a million computer hoops to get the pump to deliver the meds. I had to had to jump through a million paper work hoops to obtain the drugs that needed to be given. I had to fight with equipment department and pharmacy. It took an hour to get the damn stuff and I ignored my other patients whilst I was trying to pull this together. I would have been responsible if he had died because I did not get the ordered treatment initiated.


Pharmacy will no longer stock us with half the stuff we need. Forms forms forms and arguing to get those ordered pain meds that your mother needs right now is the norm. Forms and fighting with pharmacy to get stat life saving medication is a regular occurrence. Obtaining routine medication is an even greater nightmare. I have to leave the patients and spend too much time on the phone, the computer etc arguing with these people just to do my job. They will not bring things to the ward so I have to leave my patients or send an HCA. We always have a large number of staff OFF the wards running after equipment and pharmacy.


If the paperwork isn't right the scan people and the blood people will not perform your test. Your skin may be a mess and what you need is an air mattress. It is like pulling teeth to get one. Back on the computer and the phone I go to obtain one.


Lab test results. For whatever reason our lab is not always phoning in critical blood results. This means that if I don't break away and run to the computer to check bloods something may get missed. I have found HB of 5 that they never called in. I have found screwed up electrolytes that they never phoned in. If I don't know about them how can I inform the doc? How can the patient get treated? How do I know if I can continue on with that K replacement or not? I frequently have to break away from the ward throughout my shift to run off and look this shit up.


Updating patient information for the next shit: This is crucial to patient safety but never gets done properly. I have seen incredibly bad patient outcomes occur as a result of this getting screwed up. It is extremely time consuming for the number of patients that I have. But every time I try and get near that computer visitors are on me like flies to shit, accusing me of ignoring the patients.


There is never going to be a time of day when I don't need to be at the computer or filling in forms to get my patients the things they need. This is constant throughout the shift. There is also never a time of day when I don't have 10 people that need basic nursing intervention immediately. Even if I saw to them previously they will need help all over again less than 15 minutes later.


Once I was on the computer trying to get something and a relative grabbed me to get her mum a pillow. She walked past 3 hca's who were making beds and came to me while I was trying to order a much needed item. She thought that the HCA's were busy and that I was doing nothing because I was on the computer. So she came to me. I went and did it myself rather than incur her disdain by making her wait or asking an HCA. On the way back to the computer a patient asked me for a commode. I got it right then and there and went back to the computer. Then I found out that I had missed the boat on obtaining what I needed for my patient by 5 minutes and now must wait until Monday morning to get it. Wards may be 24 hours but pharmacy, equipment, and path lab are NOT.

If I spent all day at the computer and pouring over paperwork I would not scratch the surface of getting all of it done. If I spent the whole day doing commodes I still would not get to all those patients in time. It is chaos and we are only able to do a little bit of each. Did I tell you that my childminder is charging me £1 a minute for each minute that I am out of work late and she has my child? I do push a lot of the computer work towards the end of my shift and complete it during unpaid hours to avoid ignoring the patients all shift. My childminder is making good money as a result of me getting out of work late and staying on unpaid. I have to pay her for time I did not get paid for. Nice huh. Next time I am going to get it all done while I am on duty and get the hell out of there as soon as my relief comes. If the patients and the visitors don't like me sitting at the computer all damn shift documenting and get things that they need then they can pay my childminder and I will stay over and do it at the end of my shift.

The amount of money I have spent on childcare for hours that I did not myself get paid for would buy me two new cars.

Look at this quote by Florence Nightengale:


"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

She is 100% right. The more we sacrifice, the more they want and the more they complain.

To hell with all this. I am just going to sit back and watch this ignorant country run every last nurse out of here with their impossible and ridiculous expectations and generalisations. America and Australia will be more than happy to have British nurses to help maintain their strict nurse patient ratios. They know that British nurses are damn good at their jobs and they are anxious to poach them.



Rant over. Back to the CCU part 3 now.

Sunday, 22 March 2009

Nurses and Stress

I found this over at allnurses and thought I would post it here. Nurses are stressed and we hold so much of it in. Non-nurses have such massive disconnect between the realities of nursing (education, responsibility, workload, legal issues) and their stereotypical view of the profession that we can't really unload on them. It would be like trying to teaching a donkey algebra.

The NMC and our employers have drilled it into us that we should never talk about any of this because it puts patient confidentiality at risk. It makes the patients "scared". It looks unprofessional. So we stay silent.

The only people we are really protecting with our silence are evil organisations like the NMC, useless organisations like the RCN and money obsessed hospital managers.

Nursing is crazy because we have a hell of a lot of responsibility and no control. Doctors have insane amounts responsibility but they also have a hell of a lot more control too. They also command respect.

Anyway here are some tips:

http://allnurses.com/nursing-articles/warning-nurses-holding-292974.html

Have you ever wondered what the stress of nursing is doing to you? We know that stress causes cortisol levels to rise which raise our blood pressure, raise our blood sugar levels, increase our lipids, etc. Blah, Blah, Blah. The point of this article is not to teach you something you already learned in pathophysiology class.We know that high stress levels can cause weight gain and we know that obesity complicates every disease there is. Obesity has been linked to higher cases of breast cancer, etc. As nurses, we KNOW all this stuff.Let’s not go there right now.

Instead the message of this article is to talk about the emotional price of high nursing-related stress in your life. Nursing stress is so unique. It’s practically impossible to explain to non-nurses…that’s for sure!How do you explain what it feels like to have your pager go off for two different patients at the same time? One is in severe pain and one is throwing up. Add to that scenario “a transport tech” arriving on the floor asking if your pre-surgical patient is ready to go to surgery because the anesthesiologist and surgeon are waiting downstairs. Yikes! You didn’t get the checklist done yet! Multiply that scenario several times an hour for 12+ hours at a time and you've got nursing stress.

Nursing stress mounts so quickly that it leaves you speechless with friends and family. The thought of describing what you go through during your work day becomes so exhausting that you just don’t do it. You don’t tell your friends. You don’t tell your family. You may find yourself becoming emotionally shut down to a certain extent because you start to hold stuff in.Have you ever wondered, “Am I depressed and I don’t even know it?” You may find the answer to that question by examining what you do on your days off. After a brutally stressful day at work, it is not uncommon to hear a nurse describe her day off like this, “All morning, I could still hear my pager going off and the monitors too. I stayed in my pajamas until the afternoon. All I had energy to do was zone out on TV and eat.”It’s a matter of life and death to find healthy outlets for the nursing stress in your life!

When the thought of picking up the phone and talking to a dear trusted friend to “relieve some pressure” becomes too much for you to handle, there may be a problem. Perhaps you used to refer to it as a “mental health” day, but when all your days off look like this, there may be a problem.

more here

Thursday, 19 March 2009

Clipboard Carrying Wastes of Space

They make me weep.


Heard a story from a colleague recently. She works at our sister hospital.

On her 36 bed medical ward one Tuesday morning there were only 2 nurses and 3 care assistants on a day shift. As usual they complained to management, wrote incident forms etc.

The first care assistant had to do a one to one with a patient who was licking the floors, hitting other patients, screaming the place down, arguing with a toilet and beating the staff. He could not be controlled. Psyche wouldn't see him and the doctors were hesitant to prescribe sedative type medication due to certain issues. The medics said his problems were psyche and the psychiatric people said that his problems were medical. No one was taking ownership. The ward nurses were left to manage him. RGN's are not RMN's. We are not trained to deal with this shit nor can we restrain people etc. This is a whole 'nother blog post right here.

The second care assistant had to escort a patient to a procedure off ward. The patient was confused and incontinant. The people in the procedures department will not deal with this and refused to carry out the said test unless patient was escorted by ward staff. This test was paramount. The nurse would have been in deep shit if she tried to keep the care assistant on the ward and patient missed the test. They were gone for 3 hours in the morning.

The third care assistant was trying to bed bath, toilet, and assist 36 patients herself. Most of these people cannot be cleaned or even get onto a bed pan or commode unless you have at least two staff lifting. It is physically impossible.

The 2 nurses each had 18 patients with more drugs, and orders that they could handle. The nurses alerted the powers that be to the fact that they needed help and they needed it now.

The 2 nurses flew through the drug round in an unsafe manner. They did a 10 second assessment of each patient to ensure that they were stable. Then they had to decide what to "ditch".

All the patients were stable and the most important meds/interventions were mostly caught up at this point. The next priority on the nurses' list was helping the lone care assistant. They grabbed pinnys and went off to bed bath and toilet and feed. Otherwise those patients would have been left for hours and hours and hours. Even with all 3 staff on board working like dogs those patients still would have been left for too long.

Yes, the nurses decided that once the patients were stable and the most important interventions were out of the way that they would make BASIC CARE the top priority. But something had to be "ditched" in order to pull this off.

They ditched the discharges (clogging up a&e as a result), all paperwork, phone calls, and doctors rounds and lots of other stuff. Discharging patients is very very time consuming these days. It keeps you away from your other patients for a long time. They had to ditch the discharges etc. Otherwise the other patients and their lone care assistant would have been fucked.

2PM rolls around. These nurses started their shift at 0700. By 2Pm they were finishing the bed baths. They had not had any kind of break, the ward was in pandemonium due to phone calls, doctors rounds, discharges and other jobs being ditched. Meals barely got out, and now lunchtime meds were late. These nurses were in big big trouble.

But the patients were safe and clean.

At 2:30 the 2 nurses were cleaning, dressing and changing the 5 day old dressings on their last patient. They were hungry and feeling faint. The awesome and hardworking lone care assistant was walking someone to the toilet. This patient walks so slowly that it takes a long time to get her to the toilets. So many call bells were ringing at this moment in time. Patients were crying for help.

It was at this time that a gaggle clipboard carrying fuckhead modern matron type "nurses" who are not ward based walked onto the ward and stopped just outside the curtain where our two hero nurses were busting their asses.

The gaggle (there was about 5 of them) commented about the fact that the paperwork was a mess on the ward and that the nurses needed to be "spoken to harshly".

They commented about the colour of the curtains and whether they matched the floor. This was the main topic of conversation.

They discussed the fact that there were no coloured magnets on the board to identify which patients could be moved so that targets could be met. Then they left. They just left.

What is the point of this very true anecdote?

Our 2 superhero ward nurses took a big risk and worked hard to make sure the patients had basic care. These two ward nurses are modern degree educated nurses. Both of them are about 28 years old.

The gaggle of clipboard carrying fuckhead matron type "nurses" who abandoned our heros and walked off the ward discussing curtains were all trained before 1985. Most of them trained in the 1970's. Yours truly is too young to even remember the 70's. The whole goddamn group of them were old school trained. They didn't talk to a patient or offer to help our two heroes. They all just walked away. They discussed curtains and punishing the nurses for not doing paperwork and then they walked away. Fucking whores. What the hell kind of fucking sociopathic sickos did these old time hospital based nursing schools churn out? These 5 people knew the situation on that ward with the staffing and the mental health patient. They absolutely did. They were the ones who told the ward nurses that no help was available.

Things may be far from perfect now but at least they have standards for people to qualify as nurses today. Jesus Christ.

The old school nurses who are still on the wards are fabulous.

The nasty evil horrible ones who hate nursing get given clipboards and big salaries. And we know which ones shag the managers.

These nutters are the ones who bleat on about "today's nurses". You won't often hear that shit coming from the old school nurses who are actually still on the wards. Those comments usually only comes from those who haven't done ward nursing since 1983.


I see this stuff all the time myself. That is why I believe it. This is why I will not tolerate this bullshit about degree educated nurses not caring about basic care and patient dignity. The vast majority of nurses are old school trained. The vast minority are degree trained. Those clipboard carrying worthless twits that you see walking around hospitals these days are OLD SCHOOL TRAINED.

Tuesday, 17 March 2009

Hell in Staffordshire

I am not the least bit surprised. I have seen the effects that targets have on patient care FIRST HAND.

They admit too many patients for the staffing levels to cope with and then everyone acts all surprised when people suffer and die. I have been overwhelmed and tried to refuse admissions to my ward. They came anyway. They dump them anywhere. The make us wake stable patients up at 4AM to move beds so that they can admit an acute patient from a&e onto my ward. Targets might get breached otherwise!!! Bastards.

Listen. Staffordshire is not the only place where this stuff is happening.

Read this excerpt:

A hospital's "appalling" emergency care resulted in patients dying needlessly, the NHS watchdog has said.
About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the Healthcare Commission said.
It said there were deficiencies at "virtually every stage" of emergency care and said managers pursued targets at the detriment of patient care.
Health Secretary Alan Johnson has apologised and launched an inquiry.
One of the worst examples of care cited in the watchdog's report was the use of receptionists to carry out initial checks on patients.
'Complete failure'
Mr Johnson said a review of Mid Staffordshire NHS Foundation Trust, which runs the hospital, would be carried out, focusing on the years 2002 to 2007.
He said there would also be an independent review of the trust's emergency care and that he had asked the National Quality Board to ensure the early warning systems for underperformance across the whole NHS were working properly


Read more here

This is also very sad.

"Every single day for four months, myself, my brother or my dad, we visited. We fed her, we tried to clean her when she was left in her own faeces and her own urine.
It was her dignity really. She was left on a bed-pan in agony one day, when I walked into the ward and I could hear her screaming - the nurses were so busy, they'd actually forgotten.
I'm so disappointed that my mum went in there just to be helped.
She'd beaten cancer, she just needed help with her physiotherapy and I trusted them and they let me down bitterly. They let my mum down, they let my family down.
She so wanted to live, at one point she grabbed hold of my hand and said: 'Please, Deb, don't let me die in here."

Read more here


Christ. It actually sounds a hell of a lot worse than my hospital if you can believe that. I have yet to see someone drinking from vases or left on a bedpan for 10 hours.

"The interim chief executive, Eric Morton, said lessons had been learned and that staffing levels had been increased"

What does this asshole mean when he says that staffing levels will be increased? The son of a bitch means that they will recruit a bunch of less than minimum wage paid untrained "nursing cadets" who are not allowed to DO ANYTHING. They will put them in nurses uniforms in nearly the same colour as the qualified nurses. The public will think that the wards are staffed well. That is what this asshole means. These fuckwads NEVER learn their lessons. A cadet is not even near the level of an HCA but that is what we are getting.

At my hospital the nurses' uniform colour is like this and the cadets' uniform colour is like this. And it is only a stripe on otherwise white uniform. Yes they are different colours.

Jessica's Letter

Jessica is a staff nurse and the conditions on her ward are horrendous. No this is not about me or my ward or even my hospital. Jessica is a real nurse I know with a name change.

Her ward is so short staffed and dangerous that she started writing letters. She wrote to the NMC and demanded action in the interest of patient safety. They told her to go to her line manager. For real.

Her line manager told her that he sympathised and couldn't do a thing. So she wrote to the director of nursing, risk management, and the chief executive of the trust. The chief executive ignored her and refused to meet with her. The other two expressed sympathy and told her to talk to her line manager. Her line manager told her to talk to the NMC and the chief nurse. She wrote to the unions. They responded and received a letter back from the trust promising to hire the next round of nursing graduates. They backed off and so did the trust with their promise to hire enough nurses. The matrons also said that they "sympathised" but were powerless.

Jess was pissed off. She wrote to her MP. He told her to go to the unions, the NMC and her line manager etc. He also "sympathised" but said he was powerless. She even wrote to Tony Blair when this first started and then Gordon Brown outlining the suffering on her ward. She received a stock letter back from the Prime Minister thanking her for her support and telling her to go to the PCT. The PCT responded to her letter by telling her that she needed to send her letter to the managers at the hospital instead.


And the public thinks that they get fucked over by the complaints procedures.


For how much longer are the managers and politicians going to stand around playing hot potato with people's lives?

And you can bet your ass that if anything happens to one of Jessica's patients and it goes to the NMC, she will get struck off.

Goodwill/ Working for Free/Documentation Hell

Why do nurses work long hours and then stay on unpaid?

To protect our patients from harm and thus protect the professional registration that we worked so hard for. That's why.

I have blogged about 8,12, and 14 hour shifts without breaks. I have also blogged about the fact that I may stay over at the end of these shifts another 1 or 2 hours unpaid.

I am no martyr and I do not want to work these kinds of hours any more than you do. I like to eat and sit on my ass and I like coffee. A lot.

If you have been reading this blog you know that we are short staffed and that I do not have another RN to fall back on if I need to eat, wee, my back hurts etc. My work load can be so insane that I often cannot stop and eat. I am insanely behind on interventions that could get someone hurt if they are not performed. I am hours behind and I cannot catch up due to interruptions. I can't go to the patients who are suffering from a lack of basic care until I catch that other stuff up. How the hell can you take a "break" in the middle of that? Even without taking a break and staying over unpaid to boot my nursing registration is at risk. If that goes I lose my ability to support my family.

Night shifts and weekend shifts are great because I can eat and sit for about 10- 30 minutes as long as all the patients are stable. There are less interruptions and I have a shot at getting everything done and getting out on time. I love those shifts.

But weekday day shifts? Forget it. They are just clusterfucks of total chaos. And they are not staffed any better than the weekend shifts.

At the end of the day, if a patient gets harmed the NMC will pull my license with pleasure. They don't care if we are short staffed or if I needed to stay over the end of my 8 hour shift by 3 unpaid hours to get finished. There are things that I can hand over to the oncoming nurse and things that I cannot hand over.

Documentation

The main thing that holds me over at the end of a shift is documentation. There is no time to do it during the shift (unless I ignore the patients).

The documentation that nurses are required to do is taken very seriously. I have known nurses who have lost their licenses over this.

Every move a nurse makes, everything she says, every conversation with every person she talks to about patient care, every test a patient has and every action of the doctor, social worker, physio, OT, dietitians etc has to be documented in at least 3 different places. God forbid a patient's change in condition or general assessment isn't documented in all these different places as well. They (Lawyers, NMC, management) also expect it all to be done as it is happening, not at the end of the day.

That is impossible. I would have to ignore the patients all day to pull this off as it is ordered and legally required to be accomplished.

I barely get time during my shift to actually take care of the patients and do anything but the most important forms. For example a life saving test may not get performed if I do not chase certain paperwork. Then it is my fault if said test does not get done.

Social services will not send carers to care for my elderly patient on discharge if I do not leave my other patients alone and fill in hundreds of forms and make about 10 phone calls. We no longer have a hospital social worker to sort this shit out and god knows what the clipboard carrying discharge nurse managers actually fucking do. God only knows.

Pharmacy will not send the drugs I need without many forms being filled in. Lab tests will not get done if forms are not sorted. Some of these forms I have to do an others have to be chased.

The other stuff gets left until the end of the day. So I stay over to do them. It is a legal requirement to complete this stuff regardless of the nurses' own personal situation.

Management says " if you nurses would organise your time better, then you will not have to stay over. No we will not pay you for staying late, just get yourself organised". But they won't give us any help or additional staff. It is my registration that gets pulled by the NMC if something doesn't get done. Not theirs. I could get called to testify in court if a patient sues and if my documentation was messy and half done the barristers will easily have me for lunch. No one cares how overwhelmed I was that day.

But getting it all done during my shift would mean ignoring the patients all day. Can't do that can I?

So other than documentation why do I have to stay over?

Self Preservation

Sometimes I hand over to the oncoming nurse and I realise that she is going to be in one hell of a mess.

At the end of my shift and the beginning of hers she has: two crashing patients that need one to one nursing support to implement medical interventions, 5 confused wanderers heading for the stairwell that cannot be reorientated, 10 patients who are demanding a commode and their nightime meds, 8 families lining up demanding to speak to the nurse because "mum has the wrong colour nightdress on" and a drug round that usually takes 2 hours all happening and due RIGHT NOW.

You have to focus hard on the drug round and you have to do it as quick as possible so that you don't make mistakes or get written up because prescribed meds were given late. Fuck it up and /or get them out late and you are in deep. Drug rounds are complex and Medication errors kill and maim and the majority of them occur because nurses get interrupted on drug rounds.

She also has to have all of her patients assessed within the first hour of her shift. What happens if someone has no urine output and she doesn't catch it until 3 hours into her shift? The phone is ringing off the hook. Then there is everything else as well. So I stay on unpaid to special the critical patients so she can finish her drug round and deal with the other crap. She will do the same for me next time when I come on duty after her. It's not about being a caring martyr or loving my colleagues so much that I like to stay on to help them. It is about self preservation.

"Goodwill"? How about "totally fucking scared".

We have brittle diabetic nurses bottoming out all the time on duty because they cannot get a snack. When I was pregnant I swore that I would force myself to take a meal break and sit down. It didn't always happen. As hungry as I was I could not put my patients well being and THUS MY NURSING LICENSE at risk. I often worked very long shifts without breaks while heavily pregnant even when my preeclampsia started to kick off.

A nurse may be a brittle diabetic, or have asthma and back problems, or she may be pregnant. Management will not pay an additional RN to be on the ward so that these nurses can look after themselves for 30 minutes out of a 12 hour shift. And if anything happens to a patient, it will be the nurse herself who is punished and loses her ability to work as a nurse. At the very least, she will be the one that the patients and relatives complain about if something doesn't get done.

We have families to support. This goes out the window if I get struck off or I piss somebody off.

Patient Abandonment

Abandonment of patients by the RN responsible for their care is very illegal. They will strike me off for this and possibly prosecute me in a court of law. Once I take report I am responsible for my patients until I hand over their care to another RN. This is a good law. It stops me from walking off the ward because I am overwhelmed, crying, just been punched by a patient, etc. It is designed to protect the patients. It is a good law. If I leave those patients without handing over their care someone could get hurt and I am in deep shit. Managers love to take advantage of this to get free overtime out of us.

So what happens if there is no nurse coming on duty after me? I have to stay on and keep going until management decides to get/ pay another nurse to take over. I have unwillingly pulled many unplanned double shifts this way. Childminders sure know not to work for hospital nurses. Believe me. Once they find out you are a nurse they say no way. They know that when they look after nurses' kids that they end up keeping that child hours longer than they were asked too.

What happens if my child gets sick at school and there is no RN for me to hand over to so I can go and get him? I can't legally leave if there is not another nurse even if there are 10 care assistants. My husband has to ditch work in the middle of the day and get our child. He misses a lot of work due to the fact that he is married to a nurse. If I am one of two RN's for the whole ward and I really have to leave due to an emergency than I hand over to the other nurse. That leaves her legally responsible for 25 patients herself. She is now liable if anything happens, not management for not replacing me for the duration of the shift.

How's all that for rambling? Would love to go back and edit for grammar and spelling but it's just too long.

Saturday, 14 March 2009

Stupid People




Not all that long ago I was working a shift as one of two RN's. It was a day shift and we had just had a cardiac arrest.


Another patient on the ward was probably going to arrest. The other RN was at her side with a team of doctors who were fighting to save her.


She was there and I attended and nursed the first patient who arrested and died. Because we were both tied up the cadets and the care assistant were caring for the other patients themselves. They were getting on great with the bed baths and the basic care. But many of those patients were also desperate for medications, interventions, and assessments that can only be done by the nurse.


But we were both tied up.


After the first cardiac arrest the crash trolley was in a hell of a state. If it is not well stocked and organised and an arrest occurs we are totally screwed. I knew that my colleagues patient was about to go.


A few months prior to this on another ward there was a cardiac arrest. The trolley had not been stocked up properly. The patient had a bad outcome. The police took the the list of RN's who were on duty during that shift and the ones prior, ever since the last time it should have been stocked. This trolley is checked over every day by an RN now, much to the chagrin of patients who don't understand what we are doing and think that they are being ignored. It is actually very time consuming.


I knew my colleagues patient was going downhill. I knew the trolley was in a hell of a state and missing vital equipment. I was 10 hours into a shift with no break. I was behind on the work which meant that I was going to have to stay over unpaid to protect my license to practice. The HCA's cannot help me with any of this, other than answering call lights and providing urinals.


AS soon as I dealt with the fallout from my patient who arrested (family etc). My very first job was to sort that crash trolley. My colleague's patient had very seriously started to circle the drain at this point.


There were more call bells ringing than there were people answering them at this point. I tuned that out and went on with stocking the crash trolley.


I was standing in front of the crash trolley figuring out what supplies I needed and was replacing the ambu bag and making sure everything was working when a patient that was watching me decided to put her two cents in.


"In my day, nurses didn't ignore patients and they washed the windows when they had down time" she said.


I didn't have time to reply to her because I heard my colleague shout for the crash trolley. Off to another arrest. Lucky for us there was already a team of doctors and critical care nurses on the ward. I just had to make sure that they had everything that they needed. Seconds count in an arrest situation.


As I was running with the crash trolley to the bedside of the dying patient the patient in the next bed chimed in with her take on the situation.


"I have been here for 2 weeks and never got that kind of attention. I don't think these nurses like me".


When my colleague shouted for the crash trolley I ran to her and the team with it. I had only just got most of it stocked and ready and had to run like Forest Gump to grab items. What I did do is I left some garbage on a table next to the trolley...the wrappers for the supplies etc. I was going to throw them away but then the cardiac arrest call went and I went running with the trolley.


One of the care assistants overheard the first patient comment on that:


"In my day a nurse would have never left a mess like that! Where is the Matron to knock these people into line? In my day matron would have clipped her ear. And look at all these unmade beds. Bring back matron I say".



Hmmm. Maybe I should have washed the windows and made the beds and thrown away the mask packaging before I assisted the crash team.


This is all true. I wish it wasn't.


Does anyone want to speculate on just what the hell is the matter with these people?


The sad thing is, this is the usual attitude of the patients.

Friday, 13 March 2009

The Urology Ward vs The Medical Ward

Once upon a time I came to work on my medical ward to find that 3 staff nurses were scheduled to work the shift for 24 beds. Isn't that how every post on here begins?

That is a hell of a lot better than what we usually get. But it is still not safe especially when you look at research that shows what the numbers should be in order to protect the patients from harm.

We didn't rejoice because everytime we have more than 2 actual nurses at least one will get floated away to staff another ward.



Two minutes exactly prior to the start of the shift the phone rang. It was the supervisor. "You have 3 staff nurses, one of you must go downstairs to staff the urology unit because they only have one nurse and one hca on duty". As usual we made our case to him explaining why we cannot cope with only 2 nurses on our ward. As usual our cries fell on deaf ears. The fact was they only had one trained nurse and one assistant for 12 beds and you can never have only one trained. It was my turn to "float" so I went downstairs. I left my 24 full dependent and acutely ill patients with 2 nurses and 2 care assistants.



I arrived onto the urology ward and introduced myself to the only nurse. She explained that she would take the "heavier" 6 bed bay and I would take the lighter 6 bed bay. This was fine because I don't know much about urology.



It was so easy. I was responsible for 6 men. Nothing acute. They were mobile, and alert and orientated. They were self caring with their hygiene needs and wanted it that way. Not one of these chaps was over the age of 60. Not one of them had complex medical histories. Three of them were simple trials without catheters. 2 were going to theatre and sorting them out for that was a piece of cake. The procedures they were going for were simple. They were nice to me. They were polite. I had a basic nursing assessment done on all of them very quickly. I realised that my work was done here and the nurses back on my floor weren't even out of report yet. I walked around and around and asked these chaps if there was anything I could do for them. They smiled and told me to get myself a drink. I just couldn't believe it. At the end of the shift they complimented me and again thanked me for looking after them so well.


So I popped into the other nurse's bay and asked her if she needed anything. She had her 6 patients under control. She gave me some teaching about urology procedures and terms etc. She had some post ops and we assessed them together. It has been a long time since nursing school so I was glad to be updated a bit.



I had everything done on time. I had no problems getting patients to and from theatre because my other patients were fine, stable, and sensible. I didn't have to worry about anyone with dementia falling on the floor or throwing themselves onto the floor because I was tied up with someone else. I had no admissions. The discharge I did was a piece of cake since the patient had no social problems or care needs at home. I had a full 30 minute lunch break in an 8 hour shift. I left on time. I could not believe I got paid to have it so good. They even had a nice break room with a microwave and a fridge for staff.



Yes it can get really busy on that unit when they have more patients coming in for procedures than they have beds. Occasionally they get poorly patients.



But my god, did I have a fab shift that day. I told the nurse down there about what goes on upstairs and she said "yeah, that's why everyone needs to get the hell out of medical wards, I got out 5 years ago". She also told me that on days they have 3 nurses and a healthcare assistant for their 12 beds, and that the majority of their patients are younger and self caring. We are lucky if we get that for 24 patients upstairs. And my patients are medical trainwrecks. Sad but true.



Okay so I should escape but if everyone gets the hell out who is going to take care of acutely ill "oh my god they might fucking die if they if they don't get this intervention 5 minutes ago" patients as well as the chronic patients with complex needs, the elderly and the infirm, the social admissions etc.



Not all hospital units are created equal!!!!!



The general medical wards are under resourced, short staffed and treated like the ginger haired step children of the NHS.

Our most vulnerable patients suffer so much because of this. The medical nurses kill themselves on those wards day after day. The job we have on our ward is tough because we deal with so many different kinds of patients and they are so ill and dependent. Medical nurses are no less clever than other nurses but they are much more overwhelmed at times. I found units that are more homogenous in their patient populations to be so much easier. This isn't the first time I floated to another unit. I have perspective.

General medicine is nothing but a dumping ground. If a patient goes bad on this urology unit guess where they immediately get sent? They go upstairs to the medical ward.

If there are no beds at the psychiatric facility for the paranoid aggressive patient...they come to us. No beds in hospice and dying cancer patient needs pain control? Send her to the medical ward!

Admitted to a&e with a GI bleed? Send him to the medical ward!

100 year old patient found on the floor at home, cannot take care of herself and it is a 3 month wait for nursing home care? Send her to the medical ward. "The nursed down there are thick and do nothing but bedpans anyway".

Diabetic emergency requiring close monitering and sliding scale insulin drip? Go to general medicine.

Surgical ward patient overloaded with IV fluids now in heart failure? Send him straight to medical.

75 year old confused incontinant man whose family have abandoned him in A&E because he hits and wanders away and spreads faeces everywhere and falls? To the medical ward where 2 nurses are looking after 24+ similiar patients!!

Respiratory failure/pancreatitis/MI and no beds in the intensive and cardiac units: "Send them to the medical wards..... But we won't increase staffing levels just because there is a fucking ITU patient there who needs one to one" says the fucktwit managers.

Patient on a surgical ward cannot walk and needs the bedpan? "Send him to medicine, all the nurses do up there is bedpans anyway" says the surgical nurses. These surgical wards and homogenous units will also refuse to admit the kinds of patients I am describing above. They are also better staffed.

Dying cancer patient who is neutropenic? "Send her to medicine with the wandering, confused, MRSA patients and then sit back with a tub of popcorn and watch her daughter lay into the medical nurses and ask them if they "think it is funny" that her dying mum is having to be on a ward with "those types". Grab a beer and watch same daughter call the medical nurses every name in the book. Refuse the nurses request to move the lady a better unit or to give them more staff" says the managers with a grin.



I really want to fight for our medical patients but let me tell you: Job postings are few and far between at my trust anymore. But if they EVER advertise for a job on that urology unit I am going to make a play for it.

Disclaimer: I do know urology nurses who work on short staffed heavy units that also take vascular surgery, short stay surgery and the occasional medical patient. I know that they bust their asses. This post is not a dig at urology nurses in any way shape or form. I just wanted to spout off about my awesome shift.

Thursday, 12 March 2009

Feedback? Oh Please.

A friend of mine recently left nursing after 25 years in the profession. One day she came to work on an evening shift on a busy surgical ward.

She was to be on her own with 14 patients, half of whom were major post ops who arrived back on the ward as she was in handover. MAJOR POST OP PATIENTS MUST HAVE CONSTANT MONITERING OR THEY COULD EASILY DIE.

As soon as she escaped from handover she knew she needed to get to those post op patients who hadn't been assessed properly upon return from theatre. She already knew of two who were going severely down hill. Others could have been bleeding to death. Others were crying for pain meds, as you would do if you just had your uterus removed and no one put you on a pca. Administering and preparing this type of analgesia is very time consuming.

For the first 45 minutes of her shift she was constantly obstructed by relatives who were stalking her for information. They were relatives of stable patients who were waiting for discharge. I think there were 5 people waiting for discharge. All of their families descended upon this nurse as soon as she was out of handover. She wasn't even going to think of starting the time consuming discharge paperwork until her post ops were sorted.

First she was nice to them. She explained that she could only give them a few minutes of her time due to ill patients. They wanted more. They demanded that she answer 100's questions right then and there and immediatedly arrange the discharge orders, paperwork etc. The relatives didn't give a flying fuck about those other patients. At minimum it would have taken the nurse hours and hours to sort them out, and even then she would not be able to leave them and spend hours on discharge bullshit. This is why a&e can never get people into beds.

She started to panic because she wasn't able to get past the relatives to get to her nurseless post op patients. Finally (after about 3 minutes of this shit...too long for a deteriorating post op patient) she got very firm told these dangerous assholes that she had other priorities and explained that she needed to get to her patients and she pushed past them. They spent the next 40 minutes or so her so stalking her around the ward. She carried on with what she needed to do.

She wanted to say: Stable patients will never be a priority in this situation. Deal with that. During a situation like this we don't care if your parking meter expired an hour ago and you want your wife discharged so you can go. We just want to avoid needless deaths and suffering. Deal with it and shut the hell up.

But she didn't say that at all, she is too professional. She just kept going while explaining that she was very busy.

She took damn good care of those post op patients and got two bleeders back to theatre. But this incident lead to an official complaint about her being a "sour faced bitch" who was "very unhelpful". She's left nursing as a result of this incident. I think she did the right thing. She was an excellent, hardworking and caring nurse and it is a massive loss to that ward.

Why didn't she have other nurses working with her looking after those 14 patients? Management decision.

No one is going to explain these situations to patients yet they are going to have them grade us and provide feedback. Great.


nurses to be rated for being nice

They are pulling the same shit with doctors.

feedback for GP's

I once had a patient with a blood sugar of 26mmols (high sugar reading in british measurements) officially complain about me for not going downstairs and getting her a dairy milk chocolate bar.

Simultaneously with this her family was putting in an official complaint about the nurses and doctors not controlling her blood sugar. Family was also bringing her mcdonald's milkshakes in daily and refusing to comply with the fluid restriction that she was on. They were smuggling in bottles of lucazade. They go smart and started hiding the bottles under the bed. This was after they were given educational sessions by the diabetes specialists and tons of literature. They also gave us hell because her chronic leg ulcers were not healing. Well fuck me, I wonder why?

These people are going to be rating me on how well I do my job?

Wednesday, 11 March 2009

VIBES

I have had many people ask me why nurses don't explain the staffing situation to the patients.



I have never told a patient that I am short staffed and I never ever will. It is the last thing that vulnerable, sensitive, suffering, people need to hear. It is not their problem. It has nothing to do with them. It is 100% the fault of greedy managers and poor working conditions.



That doesn't mean that I haven't been tempted to open my mouth. Sometimes when patients and relatives become very angry and abusive and have unrealistic expectations that I cannot deliver I do want to tell them what is happening. But in all reality it would only make a bad situation worse. There are times when I have to be extremely firm without breaching the confidentialty of other patients. The anger and abuse from the patients/families is mostly a result of fear, anxiety and loss of control. The majority of people who act out like this when dealing with ill health are not bad people. Telling them that I am overwhelmed only exacerbates the problem. It creates more fear, anxiety and anger. Anger is really only an extension of frustration, hurt and fear anyway.



Nurses know this and we do allow ourselves to be used as kicking bags. Management also knows this as well and uses it against us in many ways.



I will not tell you that I have more patients than I can handle and I will not tell you that I cannot come right now because the man in the next bay is dying. I won't do it. Nurses who do this really piss me off. The patient doesn't need to hear about our problems. I will just say "as soon as I can". Scaring my patients and their families on top of their illness stressors is just wrong. My managers know that many of us think like this. Isn't it obvious?



When I was back in nursing school we were given lectures about body language, attitude, and "vibes". No matter how bad things get you can never let the patients see it. If they are stressed they will not heal. If you look angry and rushed they will react to it in a negative way. They might think that you don't want to care for them. Some patients may even think that they are "disliked" by the nursing staff or that they have done something wrong. Patients are very very in tune with the body language of their care givers. More so than even they realise. The last thing any decent nurse wants is for the little old man in the corner to not tell anyone when he is having pain because "those poor girls look so busy".



So I always pace myself and try to be incredibly positive even when I want to lock myself in a room and sob. I often feel really manic and also a bit panicked at work so I make an effort to slow down and smile.



I learned the hard way when I was a young stupid nurse about how important this is. During a particularly gruelling shift I forgot myself and must have had a face like thunder. I was not upset at the patients, nor did I think they were a "nuisance". I had witnessed a horrific death of a "regular" patient of ours and was positively broken hearted. I was also in a rage because we were supremely short staffed that day and my other patients were getting nothing in the way of nursing input.



After about 45 minutes or so of CPR and everything else the resus efforts were stopped for our regular. He was more like a friend than a patient. I then went out of the room and over to the nurses station. I had to call the family in. I felt sick. It was an inevitable death and they were told that this would very likely be the outcome. But they were also in extreme denial regarding the deterioration and ultimate prognosis of their loved one. Even at this early point in my career I had seen relatives of dead patients screaming with grief, pulling their hair out, losing control of their bladder (yeah) and collapsing. At 24 years old I could not handle it at all. Now I don't miss a beat and keep going.



I am giving a lot of background here because a few minutes after the death of my patient I acted like a complete dick. I can't justify it but I'll try anyway :)



On my way to the nurses station all I could think about was the dreaded phone call. Just as I was turning the corner out of the bay of hell another patient shouted me and asked for pain killers. My shoulders were slumped, my footfall was heavy, and I must have had a really horrible look on my face. I grunted and pivoted around to get the pain killers. I came back into the room and barely said a word. I wasn't thinking about the lady in front of me with the osteoarthritis from hell. My mind was still on the dead guy and his family. I handed her the tablets and grunted again and walked out. I know now that my body language was positively vicious. Some patients would just think "that nurse is just a cow" and they would give me the 2 finger salute as I walked away and forget about it or complain. But this lady reacted the way most patients would. She was extremely hurt by my behaviour.



It didn't hit me until about an hour later. I made my way back to the lady's room where she was sitting on her bed crying her eyes out. I apologised for being so out of it when I gave her the pain meds and explained that I had just seen something very bad and was still thinking about that when I walked into her room earlier. She let out a sigh of relief and said "I am so glad you told me that, I thought that you were angry with me for asking for pain killers again, I hate being a nuisance". I apologised and grovelled. I explained that I would never ever think that anyone is a nuisance for requesting pain medication! I told her that it is never ever good to sit there in pain, suffering in silence and that she should always ask for pain killers, just as she did. I am lucky that she was a very nice woman and very understanding.

From then on I made it a number one priority to watch the body language and the attitude. I sometimes slip and I think most nurses do forget this at times. I think it leads to a lot of complaints about gruff sour faced nurses. When patients pick up on negative vibes and energy of nurses they often take it personally. They should never be made to feel that way. Maintaining a good working environment for care givers is paramount to good patient care. Abused people who are being constantly stripped of their dignity are not going to come off as "caring" people. Would you beat the crap out of a dog day after day and then leave it alone with a child? We abuse the hell out of our nurses then we want them to be as caring as a saint with no human needs or feelings. Most (not all, there is always a bad apple) nurses do not try and upset patients intentionally. Most nurses just leave.







Any health care professional will tell you that you never forget a lesson learned the hard way. I certainly learned the importance of pulling myself together and keeping my emotions in check that day. It's not something I will ever forget even if it means that others don't quite understand the pressure I am under.

Sunday, 8 March 2009

Ward Nursing and Whistle blowing: Some quick comments

Med-Surg means general medical and general surgical wards.

These are the large dumping grounds with more acutely ill patients than ever before and horrific nurse : patient ratios. These are also the wards that get the most elderly people and the most complaints that nurses are uncaring and abusive. I have posted a thread for you to read from over at all nurses. It is mostly American but these hospital wards sound like mine and I haven't even contributed to that thread at the time of posting this. We can never get pharmacy or supplies to send us what we need. We spend hours on the phone arguing with the various departments. Radiology wants me to leave my patients without a nurse for 2 hours so I can escort one of my patients down there. The radiology department doesn't want to deal with patients! These departments will refuse to perform the tests unless the ward staff will abandon the ward to act as an escort. This in house fighting goes on all day long.



Just have a little read here over at allnurses.



http://allnurses.com/general-nursing-discussion/i-cant-take-375764.html



I have about 5 blog posts in the works right now. I am still working on the dignity card group and also writing one about how the new whistleblower legislation doesn't mean shit. I also have one in the works about the "help" we have had from the unions. If you want to read a bit about the farce that is whistleblower protection head over to the jobbing doctor and spend some time.

If there are any NHS nurses who want to weigh in about whistleblowing, short staffing etc please let me know. We can all be anonymous here. So please, share your stories.

If you really want to get pissed off then read about what happened to Graham Pink when he whistleblew years ago. Years after he lost his job he was giving a talk to nurses and a nurse manager was overheard saying something like "I would have got rid of him a long time ago".

I have had communication from two different groups that have basically said that they don't hear any nurses complaining of deliberate short staffing on the wards and that if only we whistleblew on these situations everything would be fine and dandy. All that new legislation and protection and everything would protect us and just make everything as sweet as sugar and easy as cake. Right.

You can also read up on what has happened to Karen Reissman

Got to run. I hope everyone is having a nice weekend.

Thursday, 5 March 2009

Another fine example: Overworked nurses leave the bedside.

Their managers love it because they can replace them with untrained staff. I am still working on my letter to "Dignity Revolution" and I will print it here soon. Kids, dogs, work, and decorating the house are keeping me on my toes.

I found this short little article. It's American but it could have been written about an NHS nurse. Roll on the day when our journos do some real articles about nursing.


http://detnews.com/specialreports/2001/nursing/sunlead/sunlead.htm

Stressed nurses quit, hurting patient care
Poor pay, conditions leave hospitals strapped for help

Emily Minard, 23, graduated from the University of Michigan School of Nursing in April 2000. She got a job at a hospital but quickly burned out, overwhelmed by the chaotic environment. She now works in home health care.By Sarah A. Webster / The Detroit News

DETROIT — Kelly Stimac says that if she had been allowed to do the job properly, she would still be working as a nurse.
But what she once saw as a dream career became a nightmare. Every day became a race with too little time to treat too many patients.
One day still haunts her. Stimac struggled to give one patient blood, while another began having a heart attack and yet another strained to breathe on a respirator.
“It was just impossible,” said Stimac, who now reviews medical records for a Berkley law firm. “You couldn’t take care of people as needed. Staffing was terrible. I would come home and cry for hours.”

I bet that the relatives lined up to complain about the fact that their family members didn't get their teeth brushed properly while this poor nurse was in the middle of this situation. I bet they also slammed her as some miserable bitch who felt that basic care was beneath her. Fucktwits...............Anne

Her solution was painful but simple: she quit.

She is not alone. Thousands of other nurses are abandoning the once highly regarded profession.
The exodus is aggravating a nationwide shortage of nurses and compromising patient care in many health care facilities nationwide.

and in the UK...........Anne

Many nurses openly say they are demoralized. They complain of low pay, long hours, large patient loads and being treated condescendingly. In the era of managed care, they say hospital administrators are putting profits over people — both workers and patients.


Hospitals are struggling to keep nurses at the bedside and find new recruits. But services are quietly being reduced or restructured for lack of workers. Many nurses who remain on the job say they are being pushed to do more than ever — more than is safe.

And the relatives and patients way of dealing with this is to call the nurses lazy and uncaring for not being able to treat each patient as if they are the only one on the ward. Their solution is to give the nurses "dignity cards" and fire nurses. I'll refer to that as "The fucktwit solution"....................................Anne

“Quality is impacted,” said Ada Sue Hinshaw, dean of the University of Michigan School of Nursing. “When the ratio of nurses drops below a certain level, more people die, there are more errors. I think patients need to know what they are walking into.”

Tuesday, 3 March 2009

A Dignified Revolution: WHAT. THE. HELL?





I trained at a top school to earn my nursing qualifications. It was very academic but also very hands on.




We were taught that it is 100% the job of the registered nurse to provide hands on basic care.




We were taught that we should push hospitals to do away with most ancillary staff and that a patient is only safe with a registered nurse providing all of his total care. This can only happen if each nurse has a smaller number of patients. Our instructors were well educated and old fashioned. They foresaw the trend of more ancillary staff than registered nurses being used to staff a ward.




We were also taught that if we so much as miss a deteriorating patient, or infuse a drug late resulting in harm to a patient because we were giving out commodes ...then we would be facing serious legal action. It is a fact.




So what the hell happened? Why are patients starving to death in their own waste? We all know it is happening.




Hospital management has deliberately short staffed the wards in favour of trying to make a profit. On general wards, where patients are the most vulnerable, the nurses are overloaded with way to many patients. Providing basic care becomes so dangerous. The nurses are forced to make tough decisions about who gets care. The wrong decision could mean permanent harm, death, lawsuits and banishment from the nursing profession.




I am so alone. I am overwhelmed. I only have care assistants to help, and all they can do is basic care. I want to through all the other stuff at THEM and have a pleasant day bed bathing and feeding patients.




I have been a qualified nurse for 12 years. I know nurses. I know degree educated nurses and old fashioned nurses. The vast majority enjoy providing basic and feel that it is the best way to assess a patient properly and head off problems. THE VAST MAJORITY FEEL THIS WAY. The other .02% who don't feel this way are just nasty. Give me a baseball bat and some tar and feathers and I'll sort those few out myself. Throw the managers and the modern matrons in with them and I might sort several problems out with one swing of my trusty bat.




Look at what this silly nurse did. Silly right? What they hell are they teaching them up in Yorkshire?








Stupid and crazy actually...and insane and deadly?




She was an idiot. It is easy to see that she screwed up. But she was also under insane pressure. If I immediately stopped to fetch a commode every time someone asked for one, I would be in silly nurse's shoes. Every minute of every shift their are multiple people begging for the commode and multiple people deteriorating before my eyes. I have to make a choice. It sucks. If I get lucky and get a shift with stable patients and more nurses ......... my patients get great care including their basic needs met. It happens once in a blue moon that I get that kind of shift. That is my version of "getting lucky".

If she had ignored the commodes they would have complained about her and slammed her. If she had sent the care assistant to get the commode and went to the unwell patient then they would say that she is "too posh to wash". If she had left her patient on the commode to attend to the dying man and that patient fell of the commode because she left him unattended she would also have been struck off.


All you have to do is go to any of Britain's newspapers online. Type in "Nurses" and "too Posh to Wash". Look at the articles. I did a take on a few of these articles earlier in my blog:
You will be bombarded with comments from the public stating that any nurse who doesn't immediately stop to hand out a commode when asked "doesn't want to be bothered" and "should be struck off". No one asks how many other patients she has and what is going on with them. If I did nothing but commodes all day and ignored every single other thing I STILL wouldn't get around to all my patients in a timely fashion.




What the fuck is wrong with the public? Why are they not concerned about what is really happening on these wards?




First off all, you get people like this:








I like what they are trying to accomplish.




I want to see patients get dignified, excellent treatment no matter how old or infirm they might be. I want to provide all of their nursing care and do a great job and be super nurse. My colleagues are the same. We all want to be the nurse with the most thank you cards on the staff room wall. We all have elderly and ill loved ones who are in and out of hospital. We know....




But how these people are going about achieving their goals and how they are trying to "inform the public" is atrocious. Have a look at that link.




I accept that there are bad nurses. I have worked with nurses who were as ugly on the inside as they were on the outside (which is saying A LOT). They are not the majority. I have worked with 3 nurses who "don't care" out of the hundreds of nurses I have worked with in hospitals over more than a decade. I have met about 5 HCA's who were pure evil. This is out of hundreds that I know. No amount of dignity training will sort people like this out. They need to be fired. Give control back to the ward staff. We will sort them out.




But nothing will be achieved if we cannot do our jobs. Good nurses will continue to fail on an under resourced short staffed ward. If that is the case, how can we possibly sort out the few and far between bad ones?




Got to run now. I will lay into dignified revolution in my next post.


Sunday, 1 March 2009

Is there anything I can do? I have the time.





Check this out!!


http://donurseshavethetime.blogspot.com/

Excellent excellent blog post. I wish this nurse would continue blogging!! He/she managed to explain in one post what I have been trying explain over 58 posts! If you read any thing on my blog please read this non militant medical nurse post. If you think that the issues she is talking about are unique to the US states that are not enforcing ratios, then think again. A British Nurse could have written much of this. Anyway, what the Americans do today, we do tomorrow. The nurses understand the deal and are fully aware that unless we wake the public up things are going to get worse. A lot worse. I'll paste some excerpts below in coloured text.

The new trend in hospital satisfaction is called “scripting.” Hospitals seemed to have paid some company to do a survey on patient satisfaction and it seems that people have stated that they feel that the nurse doesn’t have time for them. The answer to the problem? Nurses are now mandated to script to patients with the last sentence being “Is there anything else I can do for you? I have the time.” Some institutions have even changed policies to force the nurses to all wear the same color for example a drab boring dark blue. This was in response to other complaints that people do not know who the nurses are. Hospitals have become competitive within the realm of “customer service” and actual patient care is a vintage act. Instead of focusing on safe patient care, they are more concerned with images.

Patients and families are fully aware that nurses spend very little time at the bedside doing patient care. Some people are under the impression that it is because of the new wave of computer technology. They see nurses at the computers charting and they believe that is what is taking them away from time with the patient. Other people may be convinced that their nurse is lazy and is off reading a magazine somewhere. While every job classification may have the “magazine reader,” this is not the problem.

The truth behind this scene is that patient care has become more complex and the resources have decreased equally if not more for nurses. Hospital settings have become a revolving door for employment with a new concept revolving called “Magnet Status” which means that employees are happy so the care will be better. Basically, this is another administrative forced expectation that encourages employees to vote to help their hospital receive this “Magnet Status” when in all reality there are still underlying issues within employment and job satisfaction.

Nurses have a wide multitude of expected tasks throughout an eight or twelve hour shift. They are expected to exchange report on their patients, check patient’s orders, medications and labs, sometimes immediately start their shift following up on a task that was passed on to them by the previous shift. They are supposed to start their shift off by checking on, meeting and assessing their patients. If everything is going well, they begin to pass medications which requires applying experience, skills and training because specific laboratory results or patient conditions may require a change in any given medication. Throughout the day there will be expected and scheduled treatments which include dressing changes or repetitive assessments to keep a patient stable. The reality of nursing is that on a “medical/surgical” unit with a nurse being responsible for 5 patients, her tasks alone can easily consume an eight or twelve hour shift. Now add interruptions with phone calls, water, blankets, bed changes, assisting patients to the bathroom and even waiting on families and visitors who seem to think that nurse is another word for “waitress.” In a regular eight to twelve hour day the nurse finds herself behind on the important tasks of patient care trying to maintain “customer satisfaction” with a smile while addressing interruptions. Using the words; “I do not have the time right now” can send the nurse right to the unemployment line with absolutely no reference for any time spent on the job.



AND

http://thevalueofhumanlife.blogspot.com/

While these corporations insist that there is no money in their budget for your direct care such as nursing, they have many other “services” or merchandise to offer you in exchange for profits. They will go so far as to put up new buildings with new d├ęcor, new televisions and offer you more treatment options and diagnostic services to get your business. Over the years, the area of direct personal care such as nurses, case managers, social workers, assistive personnel and other departments are working with limited resources including the number of employees needed to assure that you receive the skilled and specialized care that will actually promote a better recovery. They insist that the funds are not available for this “merchandise.”

Statistics have proven that medical errors result in an average of countless thousands of deaths with many of the errors not being reported and that number being hard to determine. It is also proven that the new terminology referred to as “short staffing” has a direct relation to this number of fatal events.


Short staffing is a term used in the field of direct patient care that is deceiving. It leads the public on into believing that corporations are not able to find the correct number of staff to provide one of the most important parts of care that you should receive as a “customer” of their services. That is not the case. Their “staffing models” are set up for profits with your care and safety being at risk. Nurse to patient ratios are at unsafe levels while corporations are raking in the profits for salaries and more “merchandise” to lure you in. Professionals that speak up for your welfare and better working conditions are faced with being slandered and tarnished as “bad employees.” Not only do these corporations have the money to decorate, build and purchase, they have the money to employ large legal firms to protect their actions in proving that these employees were released for justifiable reasons as stories are developed or twisted and supplied within their personal files. The fear of such actions keeps professional caregivers under control to participate in the vicious circle of profits for health care while trying to feed their families and pay their bills.

The terms “short staffing” and “nursing shortage” are used as generic “titles” for this dilemma but in all reality neither of those terms are appropriate because “short staffing” implies that they are actually missing the number of nurses needed to completely staff a unit in order for the appropriate care to be provided and “nursing shortage” implies that we actually have a shortage of nurses in the field. In all reality, “short staffing” is a term that nurses have began using in their every day life of explaining why they have more patients they can handle.
Over the years, expectations, tasks and documentation have increased along with the number of patients a nurse will manage. The mix of the expectations, tasks and documentation is more than an eight or twelve-hour shift can handle. Safe nurse to patient ratios have been mentioned for years as the “nursing shortage” increases and nothing is being done to actually address “safe patient care.” There are hundreds of thousands of licensed inactive nurses that are not working with over 50% specifically stating that it is because of the unsafe conditions. There isn’t much data to report the number of nurses that are actively working in patient care but are unhappy with the unsafe conditions. This is partly due to the repercussions of administration – if you get caught speaking up, you will find yourself one of many nurses looking for employment without a reference.Unfortunately, the public seems to be fairly educated about the conditions for nurses but in their attempts to speak up, more demands fall upon the nurses to hush the public and hide the problem within the facilities.
No wonder nursing care is getting shittier by the minute.