Thursday, 30 April 2009

Attitudes Towards Nursing. Part2 : The British Media

Part one is the post just below this one.

Now let's look at the rubbish that comes from British journalists. This article was written by a woman named Jenni Russell. She is supporting Margaret Haywood and defending nurse whistleblowers. Great. I thank her for that. Jenni does not talk about why nursing care is so terrible. She lays into nurses. "We need more Margaret Haywoods to deal with these horrible nurses". Read the article. That is pretty much what she is saying. What we need is help. Margaret tried to help. She may have been the only nurse down there with a camera but I doubt she was the only one who cared.

As usual, a British journalist doesn't miss an opportunity to ignore the real issues behind terrible care and lays straight into nurses.. There is no talk about unsafe ratios, increasingly complexity, sicker patients, and stonewalling by management when the nurses try and resolve these issues. Jenni turned what could have been a decent article into an emotive piece against nurses. She displays the usual ignorance of the situation.

In Jenni's world, all patient suffering is caused my lazy, uncaring nurses. I have worked with about 2 lazy nurses out of hundreds and yet I have never seen anyone intentionally leave a patient in a bad way. Ever. Even a lazy nurse has to be on her toes more than your average person. There are a small number of bad nurses. They are not the number one problem. Excellent, hardworking nurses are failing every single shift due to a situation that is way out of their control. Jenni doesn't want to talk about that. It's more fun to be a lying shill, a government tool, and an ignorant bitch isn't it love?

Here is the article.

Look at this quote:

"Imagine that you are a frail, elderly person, perhaps in the last days or weeks of your life. You are so sick that you have been admitted to a hospital ward for care. But care is rarely what you get. Instead you have entered a nightmare world in which weakness is punished and misery ignored...............Jenni Russell.

Yes Jenni. We like to pick on weak and frail patients. That's why we went into nursing. You are so full of shit. Just go and crawl back under whatever rock you came out from.

You are lying in bed, gaunt and almost breathless, the bones in your pale face etched against the pillow. You are whispering because the pain is so acute. You tell the nurses - delicately, almost apologetically - that you are in agony. You do not know that it is because the drugs for your terminal cancer are being wrongly administered, and that you are suffering needlessly as you die. All you know is that no one cares....Jenni Russell

Of course they care, and they bust their arses to get there. One person having pain is not going to make everything else go away. If you don't understand how one patient could be harmed or even killed because the nurses are only focused on managing pain for another patient then you shouldn't be doing articles on health care. This is why too few nurses results in crap care. No amount of caring is going to make a nurse be 100 places simultaneously. Don't you dare accuse the nurses of not caring. They are the only ones that do. But caring is not enough, and caring and working hard is not going to solve this clusterfuck of a situation.

Oh, and if they were administering that kind of medication incorrectly the patient would probably be dead. You don't fuck with controlled drugs and at least 2 nurses always check. Always. If I am the lone nurse on a ward then I have to call a nurse from another ward to check that kind of medicine with me, and then we both walk to the patients bed with it and she observes me give it. The patient waits as long as it takes for the nurse from the other ward to get there. It is always done this way. Always at least 2 nurses for every step of the process with controlled drugs. Always. Jenni is ignorant..............Anne

Around you, you see other elderly patients, unable to walk alone, crying because nurses won't help them get to toilets on time. Old people are left to sit or lie in their own urine. One old woman is left in her soaking bed for almost nine hours because nurses won't fix her catheter. Some patients are too sick or shaky or confused to feed themselves. They go hungry, while some of the nurses eat the patients' food in the ward kitchens. Patients die alone and unnoticed...........Jenni Russell

I really cannot even respond to this. How could she even begin to say that these people are left like this because the nurses "won't" help them, or that we are leaving them like that on purpose.

Ah, the old nurse on the lunch break and the disconnected catheter story. Catheters disconnect. All the time. The ones used in the NHS are cheap crap. Re-attaching the thing is one of the only damn things that the carers can help with.

A nurse sits down for 5 minutes to grab a sandwich after 9 hours non stop. She has 5 more hours to go and then she will handover to the oncoming shift. Then she will stay on to document. She just got her critical patient transferred to ITU after 3 solid hours straight of having to one to one him to ensure his survival. She is behind with so much for her other patients. She has been 9 hours with a break and cannot think straight. She knows that if she doesn't stuff her face now, she won't get another chance today. The carer comes along and asks her to attach the catheter bag again. The nurse is perplexed. This is one of the things a carer can actually do to help. She knows that if she doesn't grab some food now she won't get another chance. She knows if she walks down that ward to deal with the bag, that a million different things will keep her there. She is hungry and she can't concentrate. She just needs 5 minutes to inhale this sandwich. The carer can attach the bag. The damn carers never have to go without breaks. They cannot help with most of the things that the nurse is overwhelmed with. This scenario is more likely than the edited garbage that you saw on panorama. I may have done the same thing as the nurse in the video. Sometimes I know that I have between 13:55 and 14:10 to grab a bite to eat and if I don't I won't get another chance at all until 11PM. A catheter bag that can be dealt with by an available carer wouldn't take that away from me. A crash or pain meds or, sudden change in condition might take it away from me but not a catheter bag, if there is a carer available.

Jenni is sounds a little bit retarded. The only time I have ever seen a member of staff take food from the trolley is after everyone has been fed and helped as much as possible and immediately before the food is about to be thrown away. We often work 12-14 hour shifts. We do not have a fridge for staff or a place to store our own food, there is a small overcrowded one for patients. This is a fact of life on my unit.

There is no fucking way we can leave the ward to walk all the way to the cafe on most days. No fucking way. No time for that. The canteen is often shut when we are working anyway. Sometimes the only way the nurse is going to get a morsel of food is to grab something that is going to be thrown away off of the trolley. This is a fact of life for us. They used to provide nurses with meals years ago, and provide time away from the ward uninterrupted to eat. Not now. I have never ever seen a member of staff eat anything that wasn't about to go in the bin. Ever. Ever. They might inhale something that is going to get thrown away anyway in their 5 minute break time. They are getting docked pay for taking a 30 minute meal break that they cannot take without harming their patients. Do you really want to crucify them for taking 5 minutes to eat waste that is getting thrown between doing ten million different things? No one wants to eat that rubbish hospital food anyway. You have to be ravenous and desperate. This is a fact of life for hospital nurses. Our metabolisms are getting totally fucked up. The best we can hope for as far as healthy meals during work goes is constant handfuls of chocolate on the run. It's crap.

Seriously Jenni. Just fuck off with all your stereotypical ignorant bullshit about nurses. You want to know why patients suffer. Really? Read this blog. You probably cannot be bothered. Thanks for standing up for Ms. Haywood, but did you really need to sensationalise with your ignorant garbage in order to take a cheap shot in at nurses? If you feel so sorry for these patients why the hell don't you write about the real issues surrounding patient care in our hospitals? Yeah, that's what I thought. Hear that? That is the sound of silence.

This is why I am trying so hard to raise my children with integrity. The world doesn't need anymore journalists.

Attitudes towards Nursing. Part one: The American Media

I found this today and it made me very happy.

It is sensible. It is not ignorant, inflammatory or insulting. It is a straightforward feature article on about nursing. It is American. The author did not use it as a jibe against nurses. The author did his research and spoke to real live nurses who are currently working in frontline care.

My favourite quotes are below. My own thoughts are in purple.

California's 2004 patient-nurse ratio law has helped with the workload in hospitals. But the sick have gotten sicker.

"Fifteen years ago, with a six- or seven-patient assignment, probably four of them could get up and about. A typical patient [today] has totally restricted movement, so we have to keep turning them as much as possible [to prevent] blood clots.

At the same time, this person can require IV medications every six hours and can be taking three different antibiotics every two to three hours and pain medicine every two hours. We are monitoring all of their lab results, making sure any tests that have been ordered have been followed through, and prepping patients for tests.That's just one patient -- and I can have up to five

It would be a good day if I had one patient who could get up and walk around and get to the bathroom and take care of washing up [on their own]. More often than not, I have at least three that require total care, meaning that everything has to be done for them.It's pretty hefty -- a day with four patients is OK, five is pushing it. It only takes one extra person to push you over the edge in terms of trying to manage your day".

Yes things are changing and moving faster. Patients are sicker and more complex. Here in the UK a nurse would be happy to have 6 patients. 6 Patients is the least I have ever had and it happened twice. My normal load can be anywhere between 6 and 35. And I have to perform just as well whether I have 6 patients or 35 patients...........................Anne

"As a new nurse in the 1980s, my patient load was probably three to four patients, which is what it is currently in pediatrics, but the patients were not as sick as they are now. There's been a definite change over time to a higher acuity [sicker] patient, requiring more technology, more paperwork, more intensive monitoring. If you had a patient assignment in the past, you might have one sick patient and several patients on the mend. But that has changed

I [used to] go home and be falling asleep and would wake myself up thinking, "Oh my God! Did I do such and such? Did I tell the next nurse about this or that?" Because you're so rushed you would be continually questioning, "Did I get everything done, was everybody safe?"

It's scary as hell. Come to England and have no control over how many patients you have and end up with 12 or 17 or 35 people to look after. People who probably need a one to one to get the kind of care they imagine that hospitals provide. See how that fucks with your serenity................Anne

"There are all kinds of complicated procedures and technology that the nurse is responsible for monitoring that didn't exist 10 years ago. A lot of patients are on continuous dialysis with machines. A lot of labs and drugs have to be given on an hourly basis. There are very critical IV drips, and you're titrating the drugs up and down based on the patients' clinical picture, and there is constant bedside decision-making with each patient.We also have [many more] patients who are on isolation precautions [because of infectious diseases] than we used to, which means gowning and gloving every time you walk into their room. That's very time-consuming, but very, very necessary. There is a much greater risk factor for people who work in healthcare now and it makes the care more complicated. There are a lot of things that have changed over the years that make the delivery of care a lot more complicated."

This is also the case in the UK, and these prehistoric long retired dinosaurs refuse to understand this fact. We now have more untrained staff now in proportion to trained staff. That means that there are very few people on the ward who can actually deal with this very complicated stuff. They are overwhelmed with it all. The patient loads that the RN's are forced to take on are horrendous. The nurses may have no control but they are still liable. The total care elderly patients are mixed in with acutely unwell medical patients. One acutely ill medical patient can keep a nurse on her toes for hours, constantly. But she still has 10 other total care elderly patients. Patients such as this really do need one to one care to have their dignity maintained and remain clean, hydrated etc. They do. They need that.

I walk away from a 90 year old dementia patient for 5 minutes to check on my bleeding patient and the 90 year old ends up covered head to toe in feces, and falls out of bed trying to help himself. Multiply this scenario by 10 and that is my normal patient load. This is the indignity of old age. Nurses did not create and can not cure old age. The families of these patients and the hospital managers do not want to lend a hand or pay for more of us. No one cares either...............................Anne

Reading a straightforward feature article about nursing is like taking in a breath of fresh air. The author of this article talked to nurses who have been nursing a long time, and are currently nursing.

Wednesday, 29 April 2009

Neat Little Quote

I found this in the comments section of nursing times. The person who posted it was anonymous but I don't think he/she owns it. It is supposedly a nursing mantra from long ago. Sounds like a quote from Mother Theresa or something.


Can modern nurses add to this at all or does it pretty much sum things up nicely as it is? If I wrote it then I would add a few words onto the end.


Ahh, I'm no poet.

Tuesday, 28 April 2009

Don't be afraid of me!

I have been having some random thoughts and since I use this as a diary type thing I thought I would post it. There is a pile of ironing I really don't want to tackle right now.

I know that I post a lot about angry ranting screaming relatives who have unrealistic expectations. Their view of nursing and what the nurses are able to do is very far away from reality. They can get very aggressive and nasty. They have not yet realised that the situation on acute medical wards (which is where elderly patients go nowadays, to get mixed in with acutely ill patients) is one of triage rather than holistic care. The nurses do not have a choice or any control as to how long they spend with the patients on most shifts. These angry screaming people bother me a lot, even though I should just learn to shrug it off.

I do not, however, have a problem with complaints and questions. No half decent nurse would. As long as you can do it without calling me a fucking lazy bitch and implying that I hate old people it's all okay. I want to hear your concerns, questions, etc. It helps me care for you better.

It always seems to be a case of extremes rather than a gray area.

For every single ranting and raving lunatic we have 10 people who are scared shitless of the nurses, doctors and hospitals in general. I have come across many patients and relatives who are bloody terrified of "upsetting" or "offending" or "questioning" the nurse etc. There is no need to feel that way. We get yelled at a lot and get called some pretty foul names by people. I can put that aside and give them the best nursing care that I am capable of giving. We are trained to do that. If I can handle that I can easily handle hearing your questions, concerns and complaints. sometimes really nice, reasonable people lose it and flip out and we understand that. It won't get held against you.

When I see patients afraid to speak out it really saddens me. I always try and make my patients feel like I am approachable. I think the nurses that I work this also try and make themselves approachable.

One day I saw one of the patients looking really worried. I asked Mrs. P. what the problem was and she said "nothing" in a way that told me that something was really wrong. So I asked her again.

Finally she told me that she did not understand why she was given a certain new tablet rather than her old ones. She said that she was afraid to ask because she did not want to appear to be questioning the nurses or complaining. I totally reassured that we are happy for her to ask and that we think it is better if she understands her plan of treatment. I explained why the tablet she was on at home was stopped by the doctors and the new one commenced.

We should be explaining each and every drug to the patient anyway during the drug round anyway but the fact is we are too rushed.

There are lots of patients like Mrs. P. They are so afraid of "rocking the boat" or upsetting someone that they stay silent. They are afraid that we will be cruel intentionally if they "offend" us by asking a question or complaining. This is so sad.

The nurses and the doctors are on your side. I know we seem rushed and everything else but seriously we are there to do our best for you whether you are nice or nasty, bright or not so bright, pleasant or abusive etc.

Not that long ago I had a relative approach me because he was concerned about some aspect of his mother's care. The information he gave me really helped me to understand the patient better and I was duly grateful to him for saying something. He mentioned that he was afraid to "complain" because he didn't want the nurses to take anything out on mother.

In my 13 years of nursing I have never seen a nurse take a complaint out on a patient. I have seen people who have praised the hospital repeatedly to the press and people who have complained violently both get neglected because there was someone sicker on the ward. But I have never seen a nurse intentionally treat someone like crap. Have the places I worked been so unique?

This kind of abuse must happen though. You hear people mention it all the time. I know that there are wards out there with negative vibes and a bullying culture. But is it really so widespread?

I can't imagine sitting in handover and hearing someone say "Mr. R's daughter wrote a letter complaining about the nursing care, let's get him!" The worst we would ever say is "they don't understand" or "oh crap, we missed the boat". Then we will walk on eggshells around them. I have made stupid mistakes and I have admitted them and apologised. Honesty goes a long way with most people. Being brutally honest, showing remorse, and sincerely apologising goes a long way to avoiding an official complaint. I once made a communication error to a relative and had no one to blame but myself. I wasn't even busy.

If any nurse on my ward was running around being mean to all the patients the rest of us would have her for lunch. Instantly. We would be in the managers office tattling on the nasty nurse like a bunch of high school girls. You can't work with someone like that. We do not do bullying on my ward. If a member of staffed is deemed dangerous and rude then we deal with it. We nip it in the bud. It happened once with a new HCA who talked down to patients. We spoke to her and things didn't improve and we got rid of her. If a patient is getting really nasty we are firm but professional and he still gets his care. We do support each other if one of us is struggling. We also compete with each other in a friendly way.

We have egos the size of Texas, but we also have integrity. We all want to be supernurse with all the thank you cards. We often fail, and get a lot of complaints. But we keep going. We are way too professional to go around bullying people and being mean because they are complaining and or asking questions. Our noses are too high in the air for that kind of stuff. It's not like we don't understand why they are complaining. We do.

I once had a patient who greeted every nurse who walked into the room with some of the most foul epitaphs you ever heard. His family was no better. Complained about everything and every nurse everyday with very colourful language. We continued to care for him everyday. That's our job. I don't have time to decide on my personal feelings towards you and even if I do it doesn't matter anyway. If you are sicker than the lovely patient in bed 5 then I deal with you first. You are always going to get the best care I can give considering I have other patients who may be sicker. Lots of people go from lovely to vicious in 0.3 seconds due to disease processes anyway.

On the day this man started to deteriorate we took care of him very well. Well , one nurse that was on duty for him and 13 other patients took care of him very well. She had to neglect much nicer, easier, and more pleasant patients in order to do what she needed to do for grumpy. But he survived.

We get many little old ladies who are worried that the nurses "don't like them" or that they are being a "bad" patient. No chance. You don't need to apologise for throwing up on my shoes, or ringing for the commode when your diuretics start to kick him. If your pain is making you grumpy we understand. If I seem a bit rushed I apologise. It's only because the mean guy in the next bay is sicker and I have to run over to him, but really I'd rather be hanging out with a nice medically stable elderly lady like you. Believe me.

I had one very elderly lady age 98 who would cry and wail whenever she threw up or passed urine "The nurses are going to go mad, they will let me have it!! She didn't have dementia and she lived at home with her son so she wasn't around nurses a lot., otherwise I may have suspected the nursing home. She was just terrified and nothing we said or did reassured the lady. Of course we weren't angry!! We got this a lot with very elderly people. We think that they had stern victorian/edwardian parents and grandparents who beat the crap out them when they were potty training or something. But my god, some of these very elderly people are TERRIFIED of the nurses. It is so heartbreaking. I think a lot of it reflects more on the way things were in their day than the way nurses are now. Images of smallpox hospitals that were like jails for children springs to mind.

Complaining is fine. We understand. Tell us now, not 2 weeks after discharge because you are afraid of repercussions. If you tell us now then maybe we can fix the problem. Sometimes there are things we cannot control. We have no laundry facilities and no place to wash out and hang up soiled garments. It's going to go in a carrier bag in your locker. Sorry. Asking questions about your care, drugs, etc is absolutely fine. If I seem a little rushed it has nothing to do with you and everything to do with what is happening on the ward. I only resent that I can't do more in the way of individualised holistic care.

I don't want anyone to read my blog posts about all the relative rage and think that we label anyone who gets angry, complains, or asks questions as a nutter. Complaining and questioning is one thing. Acting like a raving lunatic every single day while swinging cans of lager at the staff is quite another.

We completely understand where people are coming from with most of the complaints. We also understand that the stress of a hospitalisation will make even the most reasonable people completely lose it. We agree with you that it is completely shit that your mother has not had an immersion bath (only a bed bath instead) for the last few days, and that her soiled nightie is in a carrier bag. Give me a second and I'll run and get you a complaint form and help you write it!!

What do you guys think? Are there many wards where the nurses are dishing out punishment because people are complaining? Whether someone complains or not has never determined how much time I spend with them, the clinical picture for all my patients determines where I go and when. It's been that way every place I have ever worked. God forbid if you were intentionally cruel to a patient because they complained or for any reason.

Are people unaware the fact that their nurse is to busy to give them one to one care and thinking that they are being intentionally neglected? Or are there lots of bully nurses out there? I think this was more of a problem in the past.

I don't know. I am just rambling away on here to avoid housework.

Monday, 27 April 2009

The Matron who actually worked a shift

I can barely type this or drink my coffee because I am laughing so hard. I did hear this secondhand. I have seen similar situations first hand and I have no doubt that the following occurred.

Let's set the scene. Not my hospital but I wish it was. Really I do. I would have had fun with this. A certain very large very acute medical ward at a hospital nearby with 30 beds was short one RN for the shift. This left one RN for 30 patients. She kicked off and their highly paid and god knows what she actually does Matron got roped in to work an 8 hour evening shift.

So Matron was to have 15 patients and the other RN was to have 15. It takes forever to do a drug round for 15 patients, let alone 30. So each nurse takes a side in order to maximise the chances of patients getting their medications on time and reducing the amount of errors. Once you finish your drug round (after about 2 hours)you are pretty much locked into being the primary nurse for that side only and you really are not up to date about the other side. That is why nurses have "sides".

Now keep in mind that highly paid modern Matrons never come near the wards. Ever. This is the case even when we are in way over our ears and we actually beg. If a mistake occurs they rip you get this mock trial thing where they all sit around you and destroy your character like high level judges in a kangaroo court. And you are guilty until proven innocent. If you really are innocent and just outspoken they will make something up to punish you for rocking the medical shitboat. I am surprised that they don't give them wigs, robes, gavels and iron maidens.

How this matron got roped in I don't know but she agreed to work a late shift.

When she arrived on the ward she informed the ward registered nurse that was going to be on duty with her that: "I will be working as an HCA because I have been away from nursing too long". Remember that today's matrons may be qualified nurses from a long time ago but really they are an extension of management rather than nursing staff. They are focused on management aims and goals.

The ward nurse wasn't having this. The matron has something like double the ward nurse's salary. She knew that it is impossible to be a primary nurse and do all drugs, interventions, and assessments for 30 acute medical patients. Matron had to take a side.

Andy by 9PM when night staff came in Matron was at the nurse's station in tears. "This is impossible, this is impossible" "This is ridiculous". "There's not enough time". "The interruptions are constant and unending" Blubber blubber blubber.

Really, Matron. No shit. Why don't you get your ass down to the ward a bit more often?

She gave a fractured and weak handover to the night staff and left. She really had no idea what was going on with her patients. Night staff said that there were so many unsigned for/ not given drugs on her side that it wasn't even funny. Nothing got done. It was like she just gave up.

The nurse who worked with her said that at mealtime she brought a diabetic patient some chocolate cake and nearly gave a confused who was on clear free fluids and plate of chips. She just couldn't keep up with it all. The drugs that got given were given late. A few warfarins and IV antibiotics were missed totally. It took nightshift the first few hours of their shift to sort out all the problems.

No wonder Matrons don't come near the wards. This one never came back to do a shift. They are not completely stupid you know.

Sunday, 26 April 2009

More fun with the kids part 2

If you don't know what I mean about "kids" go here.

So it's Nurse Anne and Tara the Kid on duty for approximately 13 patients.

Tara is about 17 and thought she wanted to be a nurse. Two days on the ward made her realise that nursing in real life is not like Holby City. After her second or third day she decided that everything was either too disgusting or upsetting and she refused to do anything involving patient care. Management was immediately made aware of the situation and surprisingly they came through for us fairly quickly and got rid of this little Tara.

But there were a few days where things got so bad that we tried to send her home in the middle of the shift.

1. Tara refused to do anything.

2. As long as Tara was on the ward counted in with the numbers the bed manager could not justify sending us another set of hands.

3.Tara would not leave because she wanted a paycheck.

The day I nearly lost it was a double shift. My wonderful health care assistant started vomiting and I immediately sent her home. This left Tara and me to care for 13 patients. As usual I was over run with all the stuff that I go on about in every other post on here. I tried to think of something that Tara would do to help. I showed her how to do mouth care and asked her if she could help the patients with that while I was tied up on the drug round, with doctors, orders, and relatives. I explained that when people are nil by mouth and unable to see to their own hygiene that their mouths get dry and uncomfortable. A little thing like good mouth care to moisten and clean their mouths is lovely for them and if it is not done, they suffer. Nurse Anne is a stickler for mouth care.

"Oh that is disgusting, I am not doing that."

Well why don't you go home you little bitch thinks Nurse Anne. Actually I said something to that effect, although nicer, but the hospital wouldn't have it. They had no one else to send and I thought maybe I could coax Tara into being useful somehow. They did give her a firm lecture. Repeatedly.

At one point I was inserting an NG tube into a patient with an obstruction and the person in the next bed asked for a commode. Tara was standing outside the bay. I asked her really nicely if she would help the patient. She walked away. I firmly told her about it and her response was "this is all too depressing for me and my mum told me that if anything makes me uncomfortable I don't have to do it, it's all the nurses job anyway".

True true Tara. It is the nurse's job. But if the nurse is tied up with inserting an NG tube (and everything else) into a patient going downhill with an obstruction, then you can help get someone a commode. It is why you are here and what you are paid for. I am one RN to 13 patients and I really need help so we can give them the best care possible. You little bitch, and by the way your mum is a dumbass who should stop babying you.

This went on and on. I tried to coax Tara into doing something, but anything that involved going near a patient caused her to bolt. Any nurse will tell you that if she has too many patients without a good care assistant or another nurse helping out she is up shit's creek without a paddle. Big time. If the nurse is up shit's creek, so are the patients. So are the doctors because if the stuff they are ordering is not getting implemented then........

Things had not improved by evening time and deteriorated rapidly after the meal as I had feed my patients rather than deal with the drugs. That is bad. A good nurse would have prioritized the meds etc over the feeds. It sounds mean but they expect us to prioritise for a reason. I fed the patients that were near the obstruction patient so I could monitor him. 20 minutes later my obstruction patient was going downhill and I had surgeons barking orders for me. I had people who needed insulin. The drug round due at that time was not happening and people needed pain killers. Tara doesn't like to feed people. Obviously she cannot deal with all the drugs and other things either.

In the middle of doing a million things for my now deteriorating patient and getting him ready for the surgeons, panicking about the pain meds and the insulins, and panicking about all the other shit that was not getting done something happened.

A woman walked up to me and asked me to make her loved one a cup of tea.

Aha!!! That is something Tara can help me with!! It doesn't involve actual patient care. So as I was heading back down to my "holy fuck he looks like he is going to die" obstruction patient I asked Tara nicely if she could get the woman's loved one a cup of tea.

"Okay"....says Tara.

And she made the patient a really nice cup of tea.

And 5 minutes later the tea patient's relative hunted me down and came out with a nice little gem of a statement.

She looks at me, as if I am a piece of dog shit and she says " Well, maybe you couldn't be bothered to get my loved one a simple cup of tea, but at least that nice nurse over there (points to Tara) managed to find the time".

Yep. True Story. But you know what? Nurses are used to this kind of shit.

Tara was kicked off the next shift she was on and told to never come back with the complete support of management. Can't tell you what specifically happened but it went beyond refusing to do anyway work.

Thank god most of the kids are hardworking and do their best. I would have hung myself by now if that wasn't the case. It's fun to watch the ones who want to be nurses really taking it all in and learning the ropes. Hopefully we won't get any more Taras. A few of our apprentice types are now care assistants and they are quite good!! I know it sounds like I have a chip on shoulder regarding unqualified staff but really, I don't. I just have a chip on my shoulder towards life in general.

Friday, 24 April 2009

My Machines

I'm a Scrubs addict and a youtube addict. Deal with it. I have always thought that the TV comedy Scrubs was the most realistic medical drama on television. Sad I know, especially considering that it is nothing but a silly sitcom.

I have posted the link below so you can see what I mean. The video is a short scene from Scrubs where the nurse and doctors are busting their arses to get a CT scan for an unwell patient as soon as possible. But there is a problem. It is late Friday evening and the radiology folks are home for the weekend. The patient can't bear to wait until Monday for the test. Have you ever dealt with radiology out of hours?

MY Machines

I'm telling you, it is so much like real life that it is scary.

Too funny.

More funny stuff from scrubs here: The Dermatologist

Thursday, 23 April 2009

More fun with the kids Part 1

The patients and visitors think that anyone walking around the ward in uniform is a "nurse". How wrong they are.

A nurse in the UK trains for about 3-4 years at uni. I think I doctor is 5-6 years initially. Untrained cadets and carers have zero years of training. Some have NVQ's. I did 4 years at university and then took a licensing exam to qualify as a nurse. I was taught about how to nurse a patient with diseases and treatment plans diagnosed and ordered by doctors. I took microbiology, anatomy and physiology etc to help me understand what I need to know. I have a professional registration and accountability.

First of all, the cadets are not allowed to do the majority of things that need to be done during the course of a shift. They do not have a professional license and cannot be held responsible for any errors. Everything they do is on the registration of the RN that they are working with that day.

They do not have knowledge behind patient conditions, treatments, drugs, doctors orders etc. On my general ward, and many general medical wards throughout the country (hell the world even), the majority of staff on duty are indeed kid types rather than actual nurses. The actual nurses cannot even remember the names of all their patients because they are so overloaded. This is not an NHS only phenomenon.

The kids can do a few things. They can bedbath a patient. They do this as quick as they can. The do not notice changes in condition or plan nursing care around the patients needs.

"Ah", says Nurse Anne as she is bathing a patient "His mobility is impaired, his skin integrity is at risk he needs to be repositioned frequently. His sacrum is breaking down already. He needs an airmattress. Oh look, His left side is showing a dense weakness and there was no weakness yesterday, no history if a stroke. The doctors have been treating him something else entirely.
The doctors might want to know about this now instead of 2 days from now when they do rounds. Can he swallow without choking? I need to make sure he eats safe foods and that he can swallow safely first! He doesn't need aspiration pneumonia on top of everything. He is due to have medications this morning and damn is he tachycardic. O2 sats and temperature are fine. Hmm. He just failed the safe swallow test I gave him using a teaspoon of water. Really fucking failed it, but he is alert. Left side of his face is droopy. He is hypertensive and tachy and cannot swallow his little digoxin pill, or any other meds. He might need a cannula to have his meds/fluids IV since he cannot swallow so I will get that sorted as I call the medic etc etc etc". Shit, I better put a Nil by Mouth sign above his bed so that the tea lady doesn't give him any. He'll fucking inhale that stuff right into his lungs. I could go on for 3 pages about that guy alone. There are many nursing care tangents that I could branch out onto about this fictional patient of mine. It's not my job to diagnose what has happened to this guy, even though it is pretty obvious. I am here to notice changes in condition, make medics aware of changes in condition, and plan nursing care around all that.

But when kids bath all the patients they just do it quickly and run to the next patient. They don't pick up on this stuff. They would bathe a patient as I described above and then throw sandwiches that are hard to chew and swallow at him for lunch and run to the next patient. I am so tied up with all the constant bullshit that I have no choice but to delegate basic care to kids. It fucking sucks. It is like working blind when I don't provide basic care to my own patients. I cannot relay to you here how scary this is for me.

I spend the whole morning with drugs and ward rounds, and phone calls from relatives and at about 12:30 a medic comes across one of my patients with a one sided weakness, facial droop, no history of stroke and a plate of hard sandwiches and half drunk cuppa on the table at the far side of the bed. He sounds chesty too. "When did he get like this?" says the medic. Damned if I know says Anne. I had so many meds to give this morning (took 2 hours), so many rounds (1 hour), discharges (very complicated, angry screaming daughter who wanted her dad out now so the whole thing took forever), constant phone calls from relatives, social workers etc etc (every 10 minutes for 4 hours) and one emergency over the last 4 hours that the kids bathed the patient. The cadets and I walked onto the ward at 0800 into all this plus 15 patients who needed full assistance with morning hygiene and each one takes 10-25 minutes each to do the bare minimum. The morning hygiene and 10 bed baths were the only thing the kids could help me with. Now Anne looks like a tit.

The kids can fill in intake and output charts. If someone has a cup of tea then you record the amount on the intake section. If they pee, you record the amount on the output section. It ain't rocket science and it sounds lame but it is extremely important. People are on fluid restrictions because their NA level is fucked. They may be in heart failure. They may be going into pre renal failure due to dehydration. I need to know their Intake and output and more importantly, the doctors need to know.

But try getting a kid to remember to fill in these charts after they have handed out drinks or taken a bedpan away. It's like pulling fucking teeth.They are in such a rush to get onto the next patient (and avoid complaints from prima donnas who take it as a personal insult when they are made to wait) that they do not document the one thing that they are allowed to document. I want to do it all myself. I do not have eyes on the back of my head. If I did all the care myself I would know if someone has passed urine etc. But I cannot be there every time someone needs to pass urine. It's physically impossible. The kids can be there, it is one of the only things they are allowed to do. But they don't really understand why we are measuring and recording, so it's not all that important in their minds.

I am tied up with too many IV drugs that need to be mixed and given, 3 angry relatives on the phone, a new admission who says she cannot breathe and a patient discharge as well. The kids cannot help me with any of that. But the weights need to be done now. That is something that they can do. They can weigh a patient and write down the number. I have asked them to do it. It's important. They are not going to do it. They don't seem to understand why weighing patients is important. Heart failure patients are weighed. It is always the last thing on the cadet's short list of jobs. Granted that the kids have many call bells ringing all the time, the nurse is tied up with bullshit and the cadets don't want to get bitchslapped by patients who think that they are being made to wait on purpose.

Here comes a consultant showing up on the ward round, seeing the incomplete charts and asking the registered nurse if she is to stupid to fill in a fluid balance chart or a weight chart. "Are these nurses to retarded to document whether or not someone has a wee" he whispers to his junior medic in a gentle yet astonished tone with a posh accent. We heard him. LOL.

Some kids can take blood pressure, heart rates and temperature (obs). They have been asked by me to check obs on all 15 of my patients please. They did 8 of them only. I didn't find out that they only took obs on 8 patients until hours later. They didn't tell me about the pyrexia in bed 31.

"Why did you not take obs on all the patients" says Nurse Anne. "Well the other patients were already done on the last obs round 4 hours ago so we skipped them". Nurse Anne slams her head into a wall. The obs are done every 4 hours to look for changes in condition!!!!

Why didn't I do my obs myself? I wanted too. Again, it is a chance at assessment missed and I feel blind. If I stop at the end of a bed to look at the obs chart all the other patients in the bay start shouting "nuuurse". I need to rely on shitty obs being flagged up for me sometimes. I don't have a fucking choice. At the time that this set of observations were due I was knee deep in bringing a rare surgical patient back from theatre (rare because we don't get a lot of surgical patients), arranging pain meds for a dying cancer patient, taking an admission, and was outnumbered by angry relatives wanting to speak to a nurse. The surgical patient was so hypotensive that I cannot believe they let him out of recovery.... and this is with IVF running fast, and that was taking my time and causing the hospice patient to wait and wait and wait for her next prn dose of pain killers. The kids couldn't help me with anything that was happening during that moment in time....except for that set of observations, bedpans and intake and output charts.

Enter Tara. She's the new kid in town and she is about 17. She is my latest ward kid and she really really doesn't want to be here. Most of the kids work hard and try hard even if they fuck up occasionally. Tara refuses to do things because "it is too disgusting". Tara has no interest in going to nursing school. Maybe she did when she first started, but once she got on the ward and reality set in she changed her mind. But she won't quit. She stands in the middle of the ward and refuses to do anything. We had to get management to get rid and get rid they did (they do come through for us sometimes). But there were a few weeks when things were rough. I was on shift with Tara many times with a full on load of 10-15 patients and only little Tara and maybe another cadet or HCA to help. .

I need to go now. I'll put part one in the title and finish the story about Tara later. I don't know how these get so long.

Monday, 20 April 2009

A Nurse from Staffordshire talks

My tears at 'appalling' A&E ward

An inquiry into the Mid-Staffordshire Hospitals Trust is due to report back to the government next week.

A damning report by the NHS watchdog the Healthcare Commission has already said patients died due to the "appalling" state of emergency care at Stafford Hospital.

Angie said working on A&E was heartbreaking

One former nurse practitioner turned whistle-blower claims the warning signs were obvious long before the commission's involvement as she told Simon Cox, of Radio 4's, The Report.
Angie (not her real name) has no doubt what caused the crisis at the hospital, part of the Mid Staffordshire trust: chronic staff shortages, an obsession with targets and the drive for foundation status.

The hospital's problems took a heavy toll on staff and patients alike.

"I would come home literally in tears sometimes because I felt I couldn't deliver the standard of nursing care that I wanted and that patients should be getting and indeed have the right to expect," she told The Report.

"There just physically wasn't enough nursing staff available to go and attend to them and get a commode, help them get changed, change the bed - anything like that - and patients would be left for any amount of time before that was seen to.

"It used to literally break my heart."

Staff shortages

Angie left Stafford Hospital last year. She was there for six years, with the last four spent in the accident and emergency department.

Throughout this time the shortage of doctors and nurses was a major problem, according to Angie.

"The nursing levels were extremely low, dangerously low.

"This issue was flagged up many, many times by myself and other colleagues through the internal incident reporting system and very little was done about it."

Bullying claims

But these issues were compounded by a target that patients should spend no more than four hours waiting in A&E.

"In principle it's a good idea," she said. "However the onus was solely on the four hour target - it was not about patient care, the comfort of a patient or the delivery of treatment."

If you said as a nurse, 'I'm not prepared to lie about this', you would be bullied and threatened.

I understand Angie. When you take on those kinds of patients loads you are so up to your neck in drugs,IV's, assessments, troubleshooting, doctors orders , and emergencies that you cannot possibly provide anything approaching decent, basic, nursing care. It is impossible. Incident forms are getting used as toilet tissue by managment. Being caring and hardworking is just not enough. If I am in one bay I cannot see what is going on in another. People might fall. Their relatives accuse you of not caring and being lazy. I hate it. Love nursing, adore the patients but hate the bullshit.

Sunday, 19 April 2009

Why Doesn't Nurse Anne and her Crew Work Somewhere else?

Let's see.

Okay let's start with my hospital.

First of all there are not a lot of jobs being advertised around here. Once upon a time a few years back a practice nurse job came up in the community. There were hundreds of applicants for that one post.

There have not been any staff nurse jobs advertised at this hospital for a long long time. The very few that do come up are on wards like mine and they are merely replacing people who are retiring, rather than increasing the staffing numbers. They are not even replacing all the people who leave, just a few. No change there then. I have covered shifts on these very same wards and would have to be dragged back kicking and screaming. It can get worse than Nurse Anne's ward. A lot worse.

The specialty areas such as CCU, and ITU etc are not hiring at the moment. When they do, I will be putting an application in along with many many others.

A&E. Ours is violently short staffed. I do not see any job postings for that department, and haven't seen any in years. James (an excellent newish qualified staff nurse on my ward) kissed some arse a few years ago and managed to get a job in our A&E dept.

From the very first day (with no nursing experience except 6 months adult medicine) he was in charge of bays down there with no induction, no named mentor, and no one willing to help him. There were traumas, paediatric cases, gynae cases etc. He was lost. He got real scared. He was really looking forward to working there. After a week he realised that he was never going to get any kind of orientation or a named mentor. If he asked a question the doctors complained that he was slowing them down. The nurses were like a freaking blur, running past at top speeds. He got yelled at more that week than he did in 6 months on my ward. He begged to come back to my ward. Is has to be pretty bad to want to come back.

There is so much that one needs to learn to be a nurse and you cannot learn everything that you need to know for every specialty during your school years and clinical placements. This has nothing to do with nurse training and everything to do with medicine and health care becoming more complex. And A&E is rough for people who do know what they are doing. The A&E charge nurse was no help to James. She was spending her days getting yelled at because of target breaches. James and I know that the real problem with waiting times in A&E are the lack of beds and staff over on the wards.......the delayed discharges.

James is back on my ward and thank goodness for that. I am so glad that they let him come back. He is a hard worker and very caring.

But this story illustrates the problem I have with just leaving the wards ( which is all I know) and pissing off to some specialty unit where I have no experience. I know for a fact that at my hospital that they will just throw someone like me (or James) in to the fray with very little in the way of orientation. The specialty units at my hospital also struggle with staffing. All it would take is one person to be off sick to find myself in charge of patients on a new unit my third day there. I would just be told to cope. I would just be thrown in to sink or swim.

It's like the day they covered sickness on my ward with a newborn nurse and expected her to take charge of 12 adult medical patients. So even if a job came up in the few specialty units that we have, I doubt I would apply. And to those of you who say "back in my day when you came out of training you could run any kind of ward anywhere" can piss right off. It's different now. The nurses today need to know more than you ever did in order to function and they have a lot more liability these days. They are working in a more chaotic environment then you ever did. Come back into the hospital and give it a try yourself my dear, otherwise you can shut up. Seriously, I want to see some of these retired old dears come to work on today's wards and take on 16 medical patients alone, taking on full liability for not getting paperwork done, med errors, missed assessments etc. I will grab a box of popcorn and observe them walking a mile in my shoes. It would be more fun than a night at the cinema.

There are nice units like the 12 bedded urology ward or the 8 bedded gynae unit. I'd like to try ortho. I would be there in a heartbeat if they posted a job. I check every day. I am going to die waiting I think.

When jobs come up at the city's private hospital everyone applies. Those jobs don't seem to be too forthcoming either.

Let's look at the other hospitals in the trust/area. I have looked. The answer is no way. The staffing levels are worse. The decent units are not posting jobs, I cannot afford the commute anyway. A couple of my nurses are refugees from those hospitals. We are talking 35 bed medical/elderly units with 1 or 2 nurses and 1 care assistant. ..left alone with an occasionally violent psyche patient who no one would transfer out...FOR A FUCKING YEAR. The two staff would spend the shift trying to keep this guy from hurting another patient. They did everything they could possibly do. Medics said he was a mental health patient and turned around and walked away. Mental health said he was a medical patient and turned then around and walked away. Yes, a couple of my nurses are refugees who escaped from there. That place nearly killed these women. They do not mind the cost of the commute to work on my ward. This hospital isn't posting any jobs that I am aware of anyway. I do look every day just out of curiosity. The person in charge of that trust will look you straight in the eye and deny that there is an issue with staffing and say that they are hiring.

Right so next nearest hospitals in other trusts are at least 2 hours away. Spouse will not consider moving or commuting. He has a stable job but the market is shit in his field. The housing market is fucked. My older children are nearly teenagers and do not want to be uprooted. These other hospitals don't have great reports coming from former staff. And they aren't posting any jobs for staff nurses, not as of the last time I checked anyway. When I look at the options around me I am thankful for what I have and where I work even though it is a hell job. At least I work with good people?

Does bedside ward nursing really need to be this horrible? Does it have to be? As long as it is, we will keep haemorraging nurses, and things will get worse, and we will lose more and it goes on and on and on.

We have newly qualified nurses at my hospital who have only been nursing a year and they are already starting the process to go to Australia. Some just quit. They are young, live with mum and dad and do not have kids and mortages yet. They can just throw in the towel and quit. Ask anyone what is the worst thing about it the 14 hour shifts? The life and death responsi bility? The fear of liability? Those things get us close to the edge. But the unrealistic expectations and abuse from the relatives of the patients is pretty much what sends you over.

I am still always looking around for other options. I am sure I will figure out an escape route soon enough. Something will come up. In the meantime I will do my best to take care of my patients, write letters to the powers that be, fill in incident forms and blog on here and vent away. The blogging makes me feel better anyway.

Thursday, 16 April 2009

So why are staff afraid to blow the whistle?

Because it doesn't help the patients and the whistleblower just gets bent over and screwed. I am working as the editor in chief for No Shit Sherlock Magazine today and that is my headline.

First of all I think that Margaret Haywood was set up.

I also believe that she did what she did because she cared about her patients. I think she should have known that the powers that be would use the fact that she was walking around the ward with a camera as an excuse to ignore the actual problem and shut her up. Confidentiality is indeed a big deal. This nurse knew that but she wanted to help those patients. Panorama chewed her up and spat her out and then the NMC gnawed on what was left.

"A nurse who secretly filmed for the BBC to reveal the neglect of elderly patients at a hospital has been struck off for misconduct.
Margaret Haywood, 58, filmed at the Royal Sussex Hospital in Brighton for a BBC Panorama programme in July 2005.
She was struck off by the Nursing and Midwifery Council which said she failed to "follow her obligations as a nurse".
Ms Haywood, a nurse for over 20 years, said she thought she had been treated harshly and had put patients first."

My understanding is that patients gave permission to be filmed on that ward.
The pricks at the NMC are behaving like but a bunch of worthless bastards. No change there then. They do not care about patients. They go on and on about protecting the public. The number one thing they could do to protect the public from shit nursing care is to ensure that their nurses are not being forced to take on a ridiculous number of patients. It's the number one thing that they could do.
These people have been away from bedside nursing for years. Their version of nursing is so far removed from real life it's like it isn't even the same thing. It is the same deal with some of these nursing university lecturers who have been away from the bedside for years. They are smoking crack somewhere a million miles away on planet goofy and not at all aware of reality here on planet earth.
I have a nephew who has started at nursing school. He tells me stories that are unbelievable. He was a care assistant for 4 years so he knows the wards. He thinks his lecturers come from a different solar system entirely. I did warn him. But I am going off topic now.
A 35 bed medical ward that is being staffed some shifts with 2 RN's and one care assistant has recently been brought to my attention. Six patients on a ward like that is a hell of a lot for a nurse to handle and would keep her going.
The Nursing and Midwifery council doesn't care.....

until a nurse makes a serious error than they will be all over her. They can get us for not whistleblowing ( failing to protect patients) and they can also get us for whistleblowing ( breach of confidentiality). If you whistleblow by using the correct channels and not doing anything drastic and illegal then nothing changes. If you do something drastic that grabs every one's attention then they nail you for that. You don't have to bring a camera into the ward. If they want to get you they will find something. We are overwhelmed and our work is sloppy. If they wanted to get anyone of us all they would have to do is look back at our nursing notes on patients we have cared for over the last few years. There is enough there for them to strike every single one of us off. Poor documentation is the number one thing that nurses are struck off for by the NMC.
(edited to add If it wasn't documented then it wasn't done. Messy documentation can and does lead to legal gray areas. Poor documentation also leads to lapses in communication that harm patients. It is probably not the number one strike off in the UK at this time so I made a mistake by saying that it was. The state boards of nursing are probably de-registering nurses for this more than the NMC does. Point is that if they want to get you they will get you. It gives them something to do all day. I move so fast and have so much to write that my documentation looks like it was written by a 2 year old with learning disabilities. I am sure that the NMC would have a field day with that)
Yet if I even make an attempt at documentation I am accused of neglecting patients and focusing my evil uncaring self on worthless paperwork.

Nurses all over the country are filling in incident forms about staffing and poor care etc. Constantly. I think that hospital bosses, the government and organisations like the NMC are sitting around, having a big fat happy circle jerk together and using the incident forms and letters from nurses to clean up when they are done.
How I hate having to give those sociopaths at the NMC 70 something pounds a bloody year just to stay registered and be allowed to work and I cannot believe what the doctors are forced to pay to their professional body every fund smear campaigns against heroes like Dr. Rita Pal.

It's a disgrace.

Dear Angry Relatives of Hospital Patients

Dear Angry Screaming Family Member,

You know who you are. You are the ones who rant and rage and accuse the staff nurses of being uncaring and oblivious without having any understanding of what is actually going on in that ward.

Those of you who think that elderly patients are being ignored and discriminated against by front line staff really need to walk a mile in a registered nurse's shoes. The registered nurses are being forced to take on a lot more patients than they can handle. Full stop.

You would not be able to do any better. Not at all. I know that to be a fact. If you were in the nurses shoes and working 14 hours non stop as they often do your patients would still be neglected and left unattended. The nurses have to make extremely tough decisions as to who gets care. We are not ignoring people nor are we oblivious. So many members of the public seem to think that we are oblivious to all the suffering around us. We are spread to thin. We do not hate elderly people. We do know when someone cannot feed himself and we understand that it is our responsibility to ensure that our patients do not starve.

You, however, have no understanding whatsoever of what a our job involves, how much responsibility we have on our shoulders or just how much we have going on at once. Over a decade of hospital nursing has clued me in to just how little the public knows. You do not understand the consequences of what happens when the nurse loses her focus. It's not 1970 anymore. The patients now are sicker, more complex. Things are moving a lot faster and every last detail of everything I do needs to be recorded for the solicitors. I can't fight this. Believe me when I say that you do not have the faintest idea. This is especially goes for those of you who have not nursed in a hospital since 1980. If you walked onto a ward in 2009 and tried to take on 12 patients + as I do every shift, you would be fucked. You would fail 100% even if you pushed yourself harder than you think you could be pushed. You would fail. Your patients would be neglected. Go on, give it a try or shut the fuck up. If there are 5 self caring well patients on the ward you get 2 nurses. If there are 35 totally dependent medically unstable wandering, confused crashing patients on the ward you still only get 2 nurses. The number of staff never change no matter what is happening.

Today's nurses did not invent complex interventions, polypharmacy, and the indignities of old age. We did not make your mum old. We do not have a say with the staffing levels. We did not give your dad dementia or a poor appetite. The doctors have each of my patients on pages and pages and pages of drugs and it takes them 20 minutes to swallow one pill, and sometimes they ALL are on 12 or more at least. They can take 20 minutes to swallow one pill as a result of cognitive problems rather than a physical swallowing problem. I might have 10 people like this, all due to have drugs at the same time at regular intervals throughout the day. It is an impossible time consuming task. If I get every pill into them I have neglected and harmed my other patients. If I don't get those drugs into these people than I have neglected and harmed them. It is a no win situation that I did not create. I am just responsible for any bad outcomes that occur.

When you experience what it is like being one nurse trying to feed five patients at once whilst being constantly interrupted as well as dealing with emergencies and admissions simultaneously then you will start understanding what is going on hospital wards and why people are being left with trays in front of them when they cannot feed themselves. How very dare you accuse a staff nurse of intentionally starving a patient without understanding what else she has on her shoulders at that moment in time.

You (as the nurse) will also have countless drugs and interventions due at this same time and at constant and fixed times throughout the day. The consequences for screwing any of this up are dire.

A simple assessment missed because I was running around making sure everyone was fed and toileted will probably lead to a life threatening situation later in the shift and a court date for me. Everything is always happening at once and nothing can wait. I am not god. I cannot astroproject and be 10 places at once. I cannot make patients disappear so that I can have a better chance of caring for my others. I cannot create an additional nurse out of thin air to help me. All I can do is aim to hit the to priority stuff, work hard, skip meal breaks, beg for mercy and a miracle.

My own beloved Uncle Richard was admitted to my ward once. I had 18 patients that day and he was in the other nurse's group of 17 patients. He never forgave me until the day he died for not getting into that room of his to check on him for 10 hours. If you understood what was going on with the 18 patients I was legally responsible for and how alone I was you would understand why I could not go and see to Uncle Rich. How every fucking dare you stand there and yell and say "you wouldn't treat my loved one like this if he was your dad". Fuck off. You have absolutely no idea about what is going on here do you?

Sometimes a miracle happens. There are days when I have less dependent patients than usual and my chances of getting everyone cared for properly are upped. I might even get them all cared for well and get a cup of tea. These rare types of shifts keep me going. Unfortunately the gods of nursing only allow this to happen once every few years or something.

You (as the nurse) have a million things to do. YOU HAVE to start with the things that could be lethal if they are not dealt with right away and then work your way down the list. Other than that you have absolutely no control. That list is top heavy and you won't have worked your way through the top priority stuff before the end of your shift. And things will be no better for the oncoming shift. You can't look stressed or the patients will panic. You (as the nurse) do not have the right to additional help but you are responsible, possibly at risk of criminal negligence if you fail.

If a childminder was forced to look after 12 or 20 children at once you can bet your bottom that she would bring additional help in or refuse to do it. A staff nurse does not have this right. We just have to move fast and do 10 things at once. This does not allow for hand holding and washing etc no matter how much the nurse wants to be doing those kinds things. Would you force a childminder to take on the care of 15 infants alone with 1 untrained helper only who is not allowed to do a lot of care? Would you interrupt her every 2 minutes while she was dealing with this? Would you then accuse her of being lazy and uncaring when one of those infants was left to cry, or left in a soiled nappy? Would you? It seems to be part of British culture to do this very kind of thing to staff nurses. It is sick.

I am a mother. At one time I had 4 children under the age of 6. One of those kids has special needs. The days I spent at home caring for them with no help while my husband worked long hours away would break most people. I found it easy. I was a nurse before I was a mother you see. It was easier than caring for 4 medical patients in a hospital that is for sure. I always have to take many many more than 4 medical patients when I go to work. Always.

If my own father was my patient on top of 10,15, 20 others he wouldn't see much of me either.

Seriously. You just need to fucking stop with the "You wouldn't treat him this way if it was your father" line. You have no idea what you are talking about. You are unable to see the big picture. You are only thinking of your loved one. I am aware of and responsible for the clinical picture for 25 people. What is happening with every single patient affects every single other patient. Whether or not you get that bedpan or painkiller in a reasonable amount of time is dependent on what is happening with the other patients. I couldn't control this situation if you put a gun to my head.

If another patient could not breathe and had a fast irregular heart rate and my father was asking for a pain killer at the same time I would HAVE to sort the short of breath heart patient first and then hopefully be able to get to my father. Hopefully. It would be entirely dependent on what is going on with all the other patients too.

I probably would not even be able to grab the o2 mask for the heart patient without being stopped for 5 commode requests....and the patient waiting for pain killers is still waiting.....and this is all happening during that 20 minute window I have to feed 7 people. The ambulance has just shown up to transfer a patient during this as well. The more patients I have to take, the more screwed everyone gets. Multiply this scenario I have just described by 5 times an hour for 12 hours straight. Then maybe you will start to understand what a shift is like for a staff nurse.

There is never a time during most of these shifts when the nurse is left alone, free of interruptions to go around and check on ALL his/her patients and make sure that they have everything that they need. Every single minute of many of these shifts are overbooked with multiple jobs that could get a nurse struck off and a patient harmed if they are missed. No matter how badly you (as the nurse) want to get around to everyone I can guarantee you that it isn't going to happen and that it will be out of your control. Most shifts are like this. And even though it is out of your control you are still responsible for any bad outcomes. All I can do is work hard, prioritize, skip meals and push push push myself. We are not oblivious, uncaring, and thick. We are overwhelmed. It is triage people. Triage. Not holistic care.

You also have to remember that most of the staff on the wards are not nurses. Most of the time at least half of the ward staff on any given shift are unqualified. They are usually hard working and caring people but not nurses. Most things can only be done by a nurse however. Yet the public seems to think that everyone walking around in uniform is a nurse. What the fuck is that all about?

The public need to be realising all of this rather than abusing overwhelmed nurses who are run off their feet most days. I know that you would do no better if you were in my shoes.

As a matter of fact I am also convinced that you would do a heck of a lot worse. I know you would.

If you have a problem or a question about your loved ones care that is absolutely fine. We are 100% cool with that and want to help. I may not be able to stop and talk to you for the duration of my shift but I will stay over at the end unpaid to speak to you. I do appreciate your concerns. I have received information off of relatives that have saved my arse on a number of occasions.

I never have a problem with people who are unhappy with the care they are getting because I know that their concerns are legit. I have never in all my years of nursing seen a patient intentionally neglected because of complaining. I have seen people who have praised the hospital over and over again in the local paper get neglected because someone else on the ward was sicker and there were too few nurses.

I also get that even the most reasonable person can lose it and lash out when their loved one is ill. But there is "lashing out due to grief" and then there is completely and utterly psycho. Lately we are overwhelmed with psychos. Make no mistake about it, these are daily mail reading nutters of the highest order.

Lately we are getting too many people that are running onto the ward screaming and calling pregnant nurses who have just worked a double shift with no break fucking whores, fucking niggers, stupid miserable uncaring fucking cunts. And these are the family of members of broken elderly medical patients that we got better and nursed back to health.......What brings on these outbursts? Call bell took more than 2 minutes to get answered (3 staff trying to answer 10 call bells). The tea trolley girl missed bed 4. We ran out of pillows and cannot get anymore. Medic is dealing with a cardiac arrest on another ward and also has 10 crashing people to see after that and cannot come and tell family of a patients x ray results right now.

You can only imagine what the relatives of the ones we can't help are like. I cannot even begin to describe their behaviour here. It is like they took their language classes at the militant medical nurse school of polite conversation.

This kind of abuse of staff is increasing like crazy lately. Is it something in the water?

Friday, 10 April 2009

Going on Holiday

Anne is leaving on a jet plane and going to place that has sun, sand, gorgeous Spanish speaking men and swimming pools with bars in the middle of them.

See you in about a week.

Thursday, 9 April 2009

More on Traditional Trained Nurses

The majority of nurses working in today's NHS are traditionally trained.

The majority of nurses working on my ward are older women or are traditionally trained. They are excellent. Caring, hardworking, clever and excellent doesn't even come close to describing these people.

We have traditionally trained nurses on my ward pushing 60 years of age. God knows how they do it. They work 14 hour days without stopping and then they go home and beat themselves up over all the things that they didn't get accomplished for their patients. They beat themselves up over all the care they never have time to give. They miss the good old days when the matrons are managers weren't totally fucking retarded and the relatives were not so selfish,demanding and unrealistic. Not all relatives/visitors are like that. Just some.

Sometimes these visitors (not all, MANY OF THEM ARE SAINTS)want you to neglect all your other patients so that their loved one can get one to one care and they can get free parking. This is how they behave anyway. They don't care that there is one nurse running between 15 patients who are sicker than mum or dad. They just want mum or dad to have one to one care and damn the consequences to the nurse or the other patients. These kinds relatives are more of a danger to your loved ones than a nurse in my humble opinion. Management will not get the situation under control or back up the nurses. They are more interested in customer service and illusions of care.

You only ever get one RN for a large group of patients. This RN may either be traditionally trained or newly trained. Most likely they are traditionally trained as these older nurses make up most of the RN workforce.

These older and more traditionally trained nurses are no more successful during the course of their shift than the younger nurses who did more recent training. We are all struggling. The care on my ward would be much worse if we weren't ALL busting our asses into an early grave. I think we do okay with what resources we have. But still the care leaves a lot to be desired.

Both the traditional trained and the newly trained have something in common other than the initials RN. They go home after a 8, 10, 12, or 14 hour day where they have worked unpaid time and they curse themselves for not being able to be 100 places at once.

The matrons and specialists who never come near the ward EVER or see patients EVER are all women over the age of 50 who are traditionally trained originally. That is a fact. Their main function in life seems to be to do as the managers and governments want them to do. Their second function in life to increase the paperwork to dramatic levels and hang the nurses when it doesn't get completed. This is what they live for. Again, these are older women who trained before I was out of nappies.

Student nurses are still spending at least 50% of their learning time on the wards. When they qualify they will have a lot more responsibility than the nurses who trained years ago ever did. This is down to changes and advances in healthcare. It is down to the lawyers as well. As Shakespeare said "kill all the lawyers". I am with Billy on that one. It's not like a newly qualifed RN nowadays will have many other nurses working with her EVER or a decent matron to provide leadership by example. I don't think that the newly qualified nurse today will ever have the same kind of support or structure that newly qualified nurses had yesterday.

Simply blaming the appalling situation on the wards on modern nurse training is a mistake. It's mostly about the staffing and management failures. Nurses aren't perfect and their training is by no means perfect. But most of them are people who are doing their best and working harder with more responsibility and longer hours than most other professions.

And as of right now, most of these wonderful people did indeed qualify in the good old days.

Tuesday, 7 April 2009

Research and Degree Educated Bedside Nurses

IF YOU WANT TO GET STRAIGHT TO THE RESEARCH BIT THEN PLEASE SCROLL DOWN.Before you read the research below let me say something. I have worked with many traditional trained nurses who were intelligent, excellent and talented nurses. But their method of training allowed a lot of crap into the profession. I don't believe that the research below is the whole story. There are many factors at play here. For decades hospital bosses have used that fact that most nurses do not have degrees to shit all over the nursing profession and kill patients. For decades.

Hospital bosses have asked why they should have more nurses on the wards than health care assistants. "What does it matter as long as you have staff on the ward who is physically able to wipe ass? It's not like nurses need a degree to be qualified anyway" the bosses have always said.

And now we have research that proves that patients have better chances of survival when there are more qualified staff on the ward than untrained kiddies. HCA's and kids are okay in addition to enough nurses, not instead of god damn it. I am forced to delegate way to much to them and I don't like that.

When the nurses told the bosses that putting c-diff and MRSA patients on crowded wards with poor hygiene facilities the bosses said "why should we listen to you? It's not like you need to hold a degree to be a nurse in the way that an OT or a physio does". I have heard that line directly.

And we have this.

And when the nurses tell the bosses that the numbers of qualified nurses on the ward improves patient survival the bosses said" why should we listen to you, it's not like your professional is all degree qualified?"

How many die on wards where the usual is 1-12, 1-15,1-20 as is the norm on general wards?

When the nurses told the bosses that patients have increased complications, that they starve, that they deteriorate leading to delayed discharges and increased length expensive hospital stays when staffing levels are low the bosses said "why should we listen to you, it isn't like one needs a degree to do your job".

And we have this.

When the nurses told the hospital bosses that newly qualified staff need mentoring and assistance and cannot just be thrown straight in the bosses replied with this: "But they had 3 years at nursing school to learn how to bed bath. Why can't they just get thrown in to sink or swim. What could possibly go wrong with a newly qualified over stressed nurse? It's not like you gals are a profession that requires a degree or something".

And we have this.

The nurses have been telling their bosses these things for decades. And for decades the response from hospital management has always been the same.

Countless, countless patients have died needlessly on the wards because of these attitudes. Nursing was not respected in the least when they were all hospital trained. Not in the least. These old fashioned docs and retired nurses view the old days via rose tinted glasses. Nurses were seen and not heard. They were not seen as educated and were ignored. There were more needless deaths back in the "good ole days". I have heard stories from people who trained in the 70's that would make your toes curl. Green students left in charge of wards etc. But back then it was all swept under the rug and the devastated families accepted the BS they were told by hospital bosses.

They are not learning their lesson. Now increasingly complex 21st century patients are getting cared for by untrained kids as a direct result of cost cutting by the hospitals and an ignorant public who cannot differentiate between kiddie carers with green hair and nurses.

I think that it is good for a bedside nurse to be well educated. I think it helps her to problem solve. That essay may not be worth shit but it got the nurse thinking. The statistics class I took in nursing school is long forgotten and I do not use that knowledge on the ward. But damn did it teach me how to think and problem solve. Nurses who don't think kill. Nurses who do not understand the reasons behind what they are doing can kill.

But I also think that the bosses of hospitals that have a higher percentage of degree educated nurses staffing the wards cannot get away with the "You girlies are not degree educated like the OT's, docs, social workers and therefore we don't have to listen to you" line.

This is a very important factor. The hospitals with a higher percentage of degree educated bedside nurses also have better ratios, better working conditions for nurses etc etc.

All that plays into patient mortality rates. Dramatically so. I am not slamming older nurses with this research.

The research below is not promoting nurse practitioners. When they are talking about degree educated nurses they are talking about degree educated nurses at the fucking bedside...not in advanced roles.

Now you can look at the research.

Recognizing Differences Among Nursing Program Graduates. There is a growing body of evidence that shows that BSN graduates bring unique skills to their work as nursing clinicians and play an important role in the delivery of safe patient care.

In an article published in Health Services Research in August 2008 that examined the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes.

Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-rescue rates. The authors conclude that “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”

In a study released in the May/June 2008 issue of the Journal of Nursing Administration, Dr. Linda Aiken and her colleagues confirmed the findings from their landmark 2003 study (see below) which show a strong link between RN education level and patient outcomes. Titled “Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes,” these leading nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death.

In the January 2007 issue of the Journal of Advanced Nursing, a new study is titled “Impact of Hospital Nursing Care on 30-day Mortality for Acute Medical Patients” found that baccalaureate-prepared nurses have a positive impact on lowering mortality rates. Led by Dr. Ann E. Tourangeau, a research team from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to the hospital with heart attacks, strokes, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."

In a study published in the March/April 2005 issue of Nursing Research, Dr. Carole Estabrooks and her colleagues at the University of Alberta found that baccalaureate prepared nurses have a positive impact on mortality rates following an examination of more than 18,000 patient outcomes at 49 Canadian hospitals. This study, titled The Impact of Hospital Nursing Characteristics on 30-Day Mortality, confirms the findings from Dr. Linda Aiken's landmark study in September 2003.

In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5 percent. The study authors further recommend that public financing of nursing education should aim at shaping a workforce best prepared to meet the needs of the population. They also call for renewed support and incentives from nurse employers to encourage registered nurses to pursue education at the baccalaureate and higher degree levels.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level. These findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine that references studies conducted in Arizona, Colorado, Louisiana, Ohio and Tennessee that also found that nurses prepared at the associate degree and diploma levels make the majority of practice-related violations.

Chief nurse officers (CNO) in university hospitals prefer to hire nurses who have baccalaureate degrees, and nurse administrators recognize distinct differences in competencies based on education. In a 2001 survey published in the Journal of Nursing Administration, 72% of these directors identified differences in practice between BSN-prepared nurses and those who have an associate degree or hospital diploma, citing stronger critical thinking and leadership skills.
Studies have also found that nurses prepared at the baccalaureate level have stronger communication and problem solving skills (Johnson, 1988) and a higher proficiency in their ability to make nursing diagnoses and evaluate nursing interventions (Giger & Davidhizar, 1990).

Research shows that RNs prepared at the associate degree and diploma levels develop stronger professional-level skills after completing a BSN program. In a study of RN-to-BSN graduates from 1995 to 1998 (Phillips, et al., 2002), these students demonstrated higher competency in nursing practice, communication, leadership, professional integration, and research/evaluation.

associate degree doesn't exist in England. It is a 2 year junior college qualification...Anne

Data show that health care facilities with higher percentages of BSN nurses enjoy better patient outcomes and significantly lower mortality rates. Magnet hospitals are model patient care facilities that typically employ a higher proportion of baccalaureate prepared nurses, 59% BSN as compared to 34% BSN at other hospitals. In several research studies, Drs. Marlene Kramer, Linda Aiken and others have demonstrated that a strong relationship exists between organizational characteristics and patient outcomes.

Baccalaureate-Prepared Nurses are Key to Patient Safety, Preventing Deaths
WASHINGTON, D.C., September 23, 2003 The American Association of Colleges of Nursing (AACN) applauds a landmark new study released today which finds that surgical patients have a ''substantial survival advantage'' if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In the study, Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Wooohoooo..............Nurse Anne

''Dr. Aiken's research clearly shows that baccalaureate nursing education has a direct impact on patient outcomes and saving lives,'' said Dr. Kathleen Ann Long, president of AACN. ''Nurses with baccalaureate and higher degrees are particularly well-suited to meeting the demands of today's complex health system, reducing patient risk, and lowering mortality rates.''

The study, titled ''Educational Levels of Hospital Nurses and Surgical Patient Mortality,'' is published in this week's issue of the Journal of the American Medical Association. Key findings include:

In hospitals, a 10 percent increase in the proportion of nurses holding Bachelor of Science in Nursing (BSN) degrees decreased the risk of patient death and failure to rescue by 5 percent.. Patient mortality and failure to rescue would be 19 percent lower in hospitals where 60 percent of nurses had BSNs or higher degrees than in hospitals where only 20 percent of nurses were educated at that level..

If the proportion of BSN nurses in all hospitals was 60 percent rather than 20 percent, 17.8 fewer deaths per 1,000 surgical patients would be expected..

At least 1,700 deaths could have been prevented in Pennsylvania hospitals alone if BSN prepared nurses had comprised 60 percent of the nursing staff and the nurse to patient ratios had been set at 4 to 1..

(They mean one qualified degree educated nurse to every 4 patients. HCA's and kiddies do not improve survival rates. Just thought I would add that in for those who still do not get it.)

(And I thought that I would again remind you that these studies are talking about degree educated nurses at the bedside, NOT in advanced practice roles)