Monday, 11 January 2010

Glossary of Terms and Mythbusting: The Nurse Image




I always find it very difficult to get my points about nursing, staffing, and patient acuity across to your average Joe.  This is the case no matter how I present my point of view.

Why is this?  Let's look at what Joe thinks he knows about hospitals, nursing, and doctors.  If Joe has never worked as a real nurse  or spent an huge amount of time in an out of hospital just where the heck has he learned about nurses, doctors and hospital structures?

He has learned what he knows from the media.  Most likely from the entertainment industry.  This is absolutely tragic.  No  medical TV show, film or novel has ever even come close to depicting nurses in an accurate light.  Shows like ER, House, and Casualty stay stuck  on ancient and ridiculous stereotypes when they portray nurses and their professional relationships with doctors.  Children's books that introduce pre-schoolers to the concept of who is who at the hospital depict nurses as angels who hold your hand and doctors as the boss who is in charge and delivering every aspect of your hospital care. Again, this has no basis whatsoever in reality.   It merely promotes stereotypes.  Journalists and hospital administrators are a victim to this way of thinking.  They just really don't know any better. Nurses themselves have never been able to verbalise just what it is we are responsible for or what we do.  Probably one of the most important things that we could as a profession is let go of the angel stuff and focus on explaining that compassion is important but not anywhere near enough of what it takes to be an RN.  An RN needs knowledge, high level skills, analytical and critical thinking skills and further education all the time.  We know that a lack of these characteristics in an RN kills patients regardless of how caring he may be..

 So why do we never get these aspects of our jobs across  to the public?  Why do we merely focus on the angels with wings stuff when that describes such a small part of who we are and what we do.  I am going to throw together some ideas for educational posters and adverts that promote nursing in a realistic light later on.  Until people understand what an RN does we have no chance of getting them to understand why a person who has been an HCA for 20 years is nothing like a nurse, and why short staffing kills.

But for now I am going to add a glossery of terms for average Joes who are conditioned to have a poor view of nursing secondary to woefully inaccurate media portrayls of nurses and doctors.  No wonder they think the hospital nurses are mean and uncaring?  Casualty has taught them that nurses work for doctors, hold hands, and if they are not doing as they are told it is because they cannot be bothered! Joe has a poor image of nursing and then he comes into hospital and the nurses are not doing what he expects. Then Joe thinks that nurses are crap.  TV either depicts nurses as evil murderers,  poorly educated empty headed waitresses who give injections, or they go in a whole other direction and try to make out that nurses are smarter than doctors.  All of these things are extremely destructive to nurses image.  We are not stupid.  We are not smarter than doctors.  Further education in nursing does not equal "closer to becoming a doctor".  We are educated in nursing, not medicine no matter how far we go with our education.  We are not angels with 19th century notions of virtue to uphold who are above being held accountable.   We are highly educated and skilled professionals who also need to be caring. So are doctors and social workers.  We all just do different things in healthcare.  And if we screw up just this much they'll haul our behinds infront of the nursing boards and possibly a judge in a courtroom.  So we are most definitely not angels  with halos who exist in a realm of lovelyness way above censure and the law.

Back to the avertising ideas later.  I want to have a militant medical nurse glossary of terms.

Registered Nurse:

A highly educated professional who has completed three years of practical and theoretical training. Research has shown repeately that the more education a bedside nurse holds the better equipped she is to save the lives of her patients as a bedside nurse. Look up degree nurses at the bedside doing nursing care and patient mortality rates.  But nurses require vocational training as well.  Completing your training as a nurse at a well respected school of nursing is not enough to call yourself a registered nurse.  You have to cough up some serious money and become registered with your country's (or state/province) board of nursing. You must do this at regular intervals (annually in the UK and cough up some cash) or you are no longer a registered nurse and cannot work as one in any healthcare setting.  IF your registration lapses it doesn't matter how many degrees or certifications you have, you will completely be unable to do things such as administer medications etc in a healthcare setting. 

You have to do copious amounts of continuing education and prove it to the board to renew your registration. Your board of nursing can strike you off the register if you harm a patient or take an unsafe assignment and don't blow the whislte on staffing. This is regardless of the fact that your employer is utterly hell bent on not staffing and resourcing wards, forcing their RN's to take too many patients, and forcing other kinds of unsafe assignments on them.  Non Clinical managers cannot be struck off of any kind of register.  They are merely put on leave and paid large amounts of cash or they are put into another highly paid bullshit job.

Registered nurses take on a group pf patients when they arrive to work and are legally mandated not to abandon those patients until another RN relieves them of duty and receives a handover.   They are responsible for understanding enough about disease process and pharmacology to monitor for deterioration in condition.  They need to understand enough about disease and human anatomy to ensure that the ill patient does not get worse as a result of things like immobility and poor nutrition.  They need to ensure that the physicians plan of treament to diagnose and treat a disease process is implemented correctly and they need to be able to implement these things without killing patients.   That on it's own requires a lot of education.They need to know what drugs can do what damage and what to look out for in the unwell patient.  What happens if you push to much fluid into a congestive cardiac failure patient?  If your patient with an infection suddently crashes out his blood pressure and becomes tachycardic what needs to be done?  The RN is with the patient 8-12 hours a day.  The doctor is with the patient 5 minutes a day.  I can learn a 100 things about your and your nursing needs by walking you to the toilet or asking you about the weather or how you liked your dinner.  This has a huge effect on what I will need to do with your plan of care and what I need to communicate to the doctors.

Many patients have anywhere from 2 to 6 different doctors involved in their care and it is the responsibility of the nurse to coordinate and communicate between these doctors to ensure that the patient is getting the right care and that everyone knows the plan.  Many times (especially out of hours) we are communicating the patient situation to an on call doctor who has never before seen the patient and does not know that particular patient.  IF you are not able to grasp what is going on and cannot communicate this to the doctor your patient is screwed.  If you are worred about dehydration, cannot get the patient to drink and are calling the doctor for orders for fluids you must make sure that you mention that the patient has a history of CCF otherwise you could overload him with fluid and kill him.  If your patient is more hypoxic and short of breath than usual and your are calling the on call doctor your must be sure to tell him if the patient is a COPDer etc etc etc.  Otherwise you could make things worse by blowing 02 at the patient.  A nurse needs to know how drugs interact because she has multiple doctors prescribing things for one patient without looking at what the other guy is doing.  If a mistake happens with that, the RN gets nailed. Keeping on top of this stuff is not medicine it is nursing.

You need to know when to withold prescribed drugs due to an unexpected change in condition that causes the prescribed drug that was at one time necessary, to now be dangerous.  The RN is with the patient, not the doctor.  It is her job to catch this stuff and her ass if it all goes wrong. I could go on forever.  I am not doctor, a mini me doctor, a wannabe doctor, etc etc.  Nurses are hired and fired and discipline by the nursing directorate and NOT doctors.  Doctors are not ward based and although they are brilliant at what they do, they do not know enough about nursing to have a say about nursing.  We are not a subspecialty of medicine.  We are a different profession entirely.  We cannot function without doctors and they cannot function without us.

Doctor:


I am probably about as ignorant about doctors as they are about nurses (and believe me, they don't understand nursing at all).  But here we go.  A doctor is an extremely highly educated individual who has at minimum something like 5-6 years of training at school and than years of training after that.  They are 100% in charge of officially diagnosising a disease process and prescribing treatment.  The amount of stuff that they have to know to recognise and treat illness is insane,.  They are scientists of the human body.  They spend very little time with the patients, especially on general wards.  They do not know what goes into implementing the orders that they give or how a nurse stops a patient from getting worse or dying as a result of their illness and treatmentsjust  by using basic nursing care.  They do not know that nurses have responisbilies other than assisting them.  They think that the nurse is only caring for their patients and ignore the fact that she is handling 10 patients and 16 different physicians who are AWOL.  They are brilliant at medicine.  But diagnosing and prescribing is only one (large) peice of the puzzle that keeps you alive in hospital.  You can have a brilliant, perfect doctor but if your nurse is stupid you could die.  The nurse is at your bedside, monitoring you for change in condition,  ensuring that your diagnostic tests are performed and that the doctor is made aware of any results or changes.  If I ditch these things to spend my time mopping floors and holding hands I could get someone  hurt or killed.  This is the reality of how hospitals are set up.  I bet you thought that doctors were always with the patient managing all aspects of care with  nurse there to assist him and that the doctors hired and fired nurses!  You saw that on the TV show Scrubs didn't you? 

Doctors have, for years, pushed the stereotypical view of bedside nurses as being nothing but useless waitresses in order to inflate their own egos.  They have aided and encouraged the poor and misleading media portayals of nursing.  They were the first people to do this.  The situation has deterioted so badly, that even our own nurse leaders, who left the bedside years ago, are denying that bedside nurses are important.  Even our leaders are focusing on the angel crap and not educating the public about how important bedside nursing is and how knowledgable you need to be to do bedside nursing.  Everyone has been conditioned to have disdain and disrespect for bedside nursing.  Even nurses. Even nurse academics are pushing the idea of bedside nurses being "losers" and refusing the admit that it is indeed a difficult and challenging occupation that requires skill and knowledge  Nurse academia only seems to know how to "promote" nursing by portraying nurses as mini doctors.  Now people hate nurses even more.  Doctors have contributed heavily to this situation and now they are moaning and whining about nurses leaving the bedside to become noctors and penpushers.  Hey Doc, thanks to you leaving the bedside to practice a science that I am not qualified to practice is the only way to get a raise or a shred of respect from anyone. Why can't we all just admit that bedside nursing is crucial to patient safety, and that bedside nurses needed to be highly skilled and educated?  We, as a society, won't admit this and it has led to cost cutting hospitals denying the importance of real nurses at the bedside and replacing them with unskilled and uneducated care givers.  Make no mistake about it, this is lethal and it is not cost effective.  They savings they are making on labour costs go out the window when patients are experiencing expensive after expensive complication as a result of lack of RN input. It ruins the bedside nurses who are left with so many patients and information to work through that they cannot function and it harms and kills patients.  And that brings me to my next group of people who work in the hospital.

Healthcare assistants/ unlicensed assistive personnel/ care givers:

Hospital administration is no different than your average Joe..  They don't understand or value professional bedside nursing so they felt that there was really no need to keep paying all these nurses.  They lost nurses via natural wastage and replaced them with carers.  Now a nurse has 15 patients to keep track of and nurse rather than 5.  Health care assistants or nice,  often  hardworking, they do basic care and many of them are bright.  Some hold degrees in history or English lit etc and were never able to get a job in that field. Others are pre-med or pre-nursing students trying to earn some money.  Others can barely read or write and have no interest whatsoever in becoming a nurse.  They are simply there for the paycheck. If you walk onto a general ward these days and see 6 members of staff in Nurses uniforms, at least 4 of them will probably be care assistants.  They won't have had any nurse training.  They are not licensed and cannot be "struck off".  The RN takes the fall for anything that one of these carers does wrong.

 Healthcare assistants may now be staffing the wards instead of real nurses but they cannot take over for nurses.  They can only do small aspects of basic care.  This isn't even close to being a snapshot of the whole picture of what a nurse does.  Sometimes they bathe all the patients because their RN has critical patients.  They do some blood pressures and maybe change a dressing.  Then they declare "hey I am just like a nurse, I do most of what she does".  Not so kiddo.  Not so.  About 90% of what is going on in that ward is way over the heads of the care assistants, even if they have been a care assistant for 20 years. Most of the things that I, as the nurse, are responsible for or  am troubleshooting are things they have never even heard of nor do they understand what I am doing and why.  They don't get why I can help them with baths some days but not others.  They think it is because the nurses don't want to be bothered.  They see their jobs as 90% of what nurses do, even though it is really only 10% barely. I don't think some of them could even pronounce the word acuity.  They are doing basic care without the additional assessing and planning that goes with all that and not pulling the information together.  I do work with smart care assistants however and I do listen to them.

Lets look at the 30 bed ward I worked on years and years ago.  We might have 6 registered nurses and 2 auxillaries on duty for a day shift. Yeah really.  The most senior nurse took charge.  The other five of us staff nurses each took on 6 patients each.  I had 6 patients, to assess, monitor, medicate, care for, and keep track of.  The auxillaries helped out rather than taking charge of hygeine and basic care.   I was there also doing the bedbathing and basic care too.  I needed to in order to get a handle on my patients conditions.

Fast forward to a 30 bed medical ward in  2010.  Now if we are lucky we get 3 RN's.  99% of the time we have 2 RN's.  Sometimes (and this is getting worse) we have one RN.  Over the last decade hospital administrators have decided that nursing is so retarded that untrained people can do it.

Let's go with the typical staffing  these days of 2 RN's and 3 care assistants for a large general ward.  If there are two RN's we split the ward in half and take 15 patients each.   Now I have 15 patients to monitor, assesse, medicate, and keep track of with no charge nurse back up.  And patients are sicker these days and they are in and out of hospitals quicker so we have to do more with less time.  I am so over my head with all the drugs, information, monitoring, family member questions, multiple doctors for each patient etc etc that I am left completely unable to deal with the basics.  That side of things are getting left almost 100% to untrained and unregulated care assistants.  They can do a bedbath but they cannot extract the knowledge about the patient condition and act on it like a nurse can. Things get missed.  Some carers don't take things like pressure ulcer prevention and nutrition seriously because they don't understand the consequences nor can they be held accountable.  And they have too many patients to feed anyway.  We have more care assistants but they are still always going to be outnumbered by patients who need help.  I can't get on top of those basics eitherwhen I am the sole RN for so many patients.

This has been a fucking disaster.  It is a mess.  You walk onto a large general ward nowadays and you will not be able to find anyone who has a clue about what the hell is going on.  The care assistants are not really able to explain rationale for treatments, or drugs, nor do they read notes.  Most of what is said in shift handover goes completely over their heads.   They are merely concerned with who is allowed to eat and who is incontinant and telling anyone who will listen that they are the "real" nurses doing all the "real" work.  And  still there are more patients to feed and clean than there are nurses and care assistants.

It is a mess and until people start understanding the importance of knowledgable bedside nurses and why staffing is important  it is a situation that is going to deteriorate even further.


Mark my words.  If something isn't done the level of basic nursing care on the wards is going to get worse.  And no amount of magic red trays to "help nurses understand" that some people need help with meals or dignity lectures is going to help.

If by sheer luck anyone reading this is a member of the media or involved in the entertainment industry please realise that every time you depict nurses as nothing but compassionate brainless angels, handmaidens, servants,  or mini doctors you are contributing heavily to this problem and you are hurting patients.

If you want to learn more about this from a real writer/journalist who has been studying issues in nursing since the early 80's I suggest you check out any book ever written by Suzanne Gordon especially nursing against the odds.  She is the only non nurse I know who really gets it.  All I have done is this post is rehash a lot of what she is saying based on my personal experience.

24 comments:

Doc Doc said...

The best and most accurate TV medical show, at least from a doctor's perspective was Cardiac Arrest!

Some of you may not be old enough to remember this but the classic scene was when a catherter balloon was deflated and a pale brown liquid filled the syringe, the doctor took it and drank it as he'd used the patient's tea to fill the balloon.

There was also alot of nurses helping the junior doctors out when they first start working, and when I say helping them out I mean in more than the literary context!

Mark said...

Nurse Anne said about doctors "They have abetted and encouraged the poor and misleading media portayals of nursing".
Doc Doc, your comments further abet these misleading portrayals by suggesting that Jed Mercurio's satire was "accurate".

Nurse Anne said...

Bloody hell I can't type for shit. I need a proofreader.

Fuddled Medic said...

On the whole you are right that doctors don't appreciate nurses, which is a big shame. I'd like to think that the negative attitude will disapear towards nurses, most of my fellow medical students seem to appreciate and respect the work done by nurses.

The media like to portray nurses as evil scumbag, who cant be bothered to talk properly to patients or relatives, or who leave patients with food going cold. They never consider that the poor nurse would love to spend more time with patients (often the reason they went into nursing to start with), but they cant as there simply are'nt enough of them

Unfortunately a nurses job is only going to get harder, HCAs are going to be pushed more and more as they are cheaper and an ageing population means multiple drug regimes etc etc.

Clarinda said...

In my day the bad nurse stood out now it's the good nurse who does?

Sadly what there are more of than anything today is the indifferent nurse whether by nature or nurture.
The standard of many university nursing degree programmes is pretty poor (far too much emphasis on the soft 'sciences' and 'management' styles etc. rather than more concentration from able teachers with an understanding of the necessary and sufficient experience to enable and inspire their students to learn and apply their life sciences knowledge base)- with too many students struggling to string a sentence together or understand fundamental life science processes to the point where they can integrate the theory with the clinical nursing needs of the patient.

My training and education in the late 60s in Scotland would put many so called degree programmes today to shame - I should know as I was a Senior Charge Nurse in Critical Care, a Clinical Tutor in Critical Care before becoming a university lecturer and academic programme leader for post registration nursing degrees in a career lasting over some 40 years.

In that time the excellent relationship between the medics and nurses was destroyed by a load of codswallop from the new nursing hierarchy of frigid feminists determined to split nursing away into becoming an autonomous profession. This had the unfortunate side-effect (one of many) of demoting nursing in the eyes of the brave new world of management - where before nursing held sway with their medical colleagues in the board-rooms! The previous power, authority, goodwill and respect that nursing had to promote and assure maximal attention to the criteria to sustain patient nursing care was laughed out of the thickly carpeted NHS managerial suites.

Matron did not act alone - she (always!) had a robust coterie of Deputies, Assistants, the redoubtable Ward Sisters and Senior Staff Nurses (no letters of the alphabet then!)that acted as a co-ordinated nursing ethos and examplar throughout the hospital.
This power-base along with the medical power-base has been systematically razed by politico-managerialism. So in fact it was the new breed of nursing leaders who have caused most of the damage to nursing and it's little wonder that medics are regarded too frequently as the opposition rather than our professional partners.

For your information research (I could find the reference with more time)demonstrates that when you presume medics spent very little time in direct face to face contact with patients on the ward - nursing contact on an individual basis is frequntly even less - don't mix shift hours with contact time.

I must say I've only just found your blog but I will be reading it from now on as I agree - as a "dinosaur" with many of your points. Do remember dinosaurs could give many modern beasts today a good run for their money!

I agree with DocDoc that although the series Cardiac Arrest was pretty close to the actual bone - it was perhaps a little too raw for public viewing where it might have been taken too easily out of context and therefore did little to distinguish the nursing profession when it was also being attacked from within its own senior ranks.

Doc Doc said...

To some extent the nursing profession have brought this upon themselves, one teaching hospital I worked on the nursing staff wouldn't even reply to my cheery "good morning". Then came project 2000 and this type of attitude spilled over to the local DGH.

Cardiac Arrest was very "raw" as commented in the post above, but from a junior doctor's perspective, it was spot on. Written by a junior doctor about true stories, yes those things all actually happened, albeit his medical career was short lived.

In GP land we work very closely with our Practice Nurses who are invaluable and very respected part of the team, shame there isn't more teamwork in hospitals.

Nurse Anne said...

Project 2000 has nothing to do with anything. Universities do not turn out bad nurses. Quite the opposite actually.
If they have attitude it's because of the hellish working conditions that exist these days rather than some attitude they developed from university.

So Clarinda, I completely disagree with you. I don't think a nurse who hasn't practiced since the 70's could cope on the wards now. It's a lot different.

Nurses need to be trained in universities. But I do agree that their programs have too much in the way of soft sciences. However they have lots and lots of time on clinical placements too now. They do shift after shift on the ward but the quality of those placements are terrible because of the chaotic environment.

No the doctors did not respect you back in the day.

And I work with many many new grad nurses who are excellent.

Nurse Anne said...

Most of the nurses I work with are pre-project 2000. And they can't cope with the current environment either.

capgrass said...

sorry but i am not even going to read the above post. Its just too long!
Anne you have an important message to blog about. However you got to get the art of saying it is about 120 words. like India Knight on Twitter.
big long speils are just too off putting to anyone who works at the coal face like i do also why you never ever mention the quiet hard working "you say jump i say how high" Filapino nurses. who are obedient to the point of cruelty sometimes. (got the inappropriate use of non-invasive ventilation (cpap and bipap) is a terrible way to die for many medical patients with copd on poorly staffed wards.

Nurse Anne said...

Yes I am definitely long winded.

Have I not mentioned Filipino nurses before? I have only ever worked with two of them but they were fantastic.

Nurse Anne said...

Capgrass, I mean this in the nicest way: Why don't you do a guest post for this blog. Show me how it should be done! ;)

capgrass said...

anne that is nice of you.........but i cant spell or use grammer and anyhow i am drunk a lot of the time so would be a liability.
i like you posts though i am just tired due to a stretch of long days.
will read it on nights (if i can get some zopiclone prescribed for the patients).

Clarinda said...

Nurse Anne - I was in direct active clincal work from mid-60's until 2003 - and I therefore have the direct perspective of being subjected to a myriad of change, reform, 'modernisation' and too many other ravages of politico-managerialism that has obliterated the previous complimentary intra-professional working relationships of nurses, doctors and PAMS. You are, I'm afraid, incorrect in stating that doctors and nurses did not have a mutual respect for each other - I was there!
- as student nurses our Nemesis was more often the occasional Ward Sister whose charisma had been excised at birth.

I note your RN career started in 1995?- I must inform you that the decline of nursing authority and leadership began in the mid-70's reaching terminal velocity in the mid-80s. It was utterly frustrating and demoralising to see nursing leadership and control handed to layers of non-clinical managers with our professional bodies stupefied in silent acceptance.

I agree with you that it is totally unacceptable that to be a good nurse today depends more on determination, commitment and luck rather than design! I still maintain that university education in nursing ought to be more influential in the clinical area - it is hypocritical to prepare students for slaughter at the workface and relinquish responsibility on their graduation. In Scotland we have had nursing degree education for many years and although there will always be some disparity between pre and post registration education and employment, the patient is too important to be left in the tenuous hands of chance.

John the Manager said...

Hi Anne you should be so lucky try working in a Path Lab nobody knows what we do, the only recognition in the media is 'get me a full blood count, U&Es and 6 units stat'

Nurse Anne said...

That's an interesting perspective. You are one of the first older nurses to tell me that doctors were more respectful of nurses. What I have been hearing from relatives and friends who were nurses (and journalists who write about this stuff) is that the doctors were not respectful and could often be abusive towards the nurses. My godmother was a nurse in the 60's and 70's and she often tells story of physical violence she saw directed at nurses from doctors.

But then again, you were there and I was not so I am MORE than interested in what you have to say.

I have ragged on the medics on this blog just for kicks but I have insane amounts of respect for physicians. They have an extraordinarily difficult job and decisions to make. I'd hate medicine.

Nurse Anne said...

John,

That is a good point. All I know about path lab is that they have long hours and multiple science degrees.

I took micro at uni and we did some labwork--like staining and testing bacteria to see what it was....that was a long time ago and all I remember was that it was difficult!! Point is that I am indeed ignorant about path lab. I wouldn't want to work down there and make a mistake!!

John the Manager said...

Hi Anne

I agree that at the moment all that people care about is how to take the next 5% out of my budget. I have managed oncology, womens health and palliative care wards and what was needed on all of them was the correct skill mix not the cheapest. There are many efficiencies still to be made but non filling of vacancies is a crude and dangerous tool. Why is it that all the wrong people leave?
Good luck

Glamorganist said...

I'm with Clarinda. My nursing career began in 1970 (Nursing Auxiliary). I became a Student Nurse in 1971, and qualified in 1974. At no time in my clinical nursing career did I see anything but mutual respect between doctors and nurses (incidents happened but in general that was true). I will never forget the evening when a consultant arrived on the ward to see a patient, found me (2nd year student, all alone on the ward, the staff nurse had gone to supper), behind the screens, washing an incontinent patient and changing his bed, and helped me to finish my patient before he went on to see his patient. I remember junior doctors as being responsive to requests for help and equally responsive to suggestions. As for now, well I expect appropriate behaviour from everyone I work with and I suppose I benefit from "age-related" authority!

bampot said...

Clarinda makes many accurate and pertinent points.I would suggest that the split (or should that be vast chasm?) that we now have between the universities and practice areas is not condusive to the provision of high quality nurse education. Unless there is a high degree of congruence between what is taught in the classroom and what they may experience in reality, then we are failing our student nurses. As Clarinda put it,"preparing students for slaughter at the workface". I have known many students who, after three years of training and through no fault of their own could tell you all you'd ever want to know about the menstrual habits of yak breeders in the Hindu Kush and yet hardly know one end of a patient from the other

Anonymous said...

One of the main issues you mention throughout your blog explains some of the issues between medical and nursing staff. That is staffing. Doctors, certainly in the junior grades would like to spend more time of the ward, would like to manage patients and would like to have a good nurse who knows the patient with them. Unfortunately, with the many patients we have we spend a great deal of time on "clerical" tasks be they making endless phone calls (usually engaged or not answered), writing TTOs and filling out endless blood request forms. This limits the time we can spend getting to know what's going on with a patient. Add this to the fact that on call we have to cover wards and patients who may have been in hospital for weeks with many developments but who we have never met and who the nurse knows exist, but even with the best will in the world cannot keep up with and you have conflict. And I can't believe I'm saying this, but spare a thought for the Consultants. While they're moaning and whinging at juniors and the nursing team a lot of the time it is because some mysterious office person has their balls in a vice (those balls have been too crushed to stand up for us btw). Being still relatively junior I started work just before European Work Time, but I do have (providing it is sensibly regulated) some fantasy that nurses would be able to call "their" doctors and doctors would be able to rely on "their" nurses.

I've been an a***hole to some nurses before and I'd say the majority of times it has been because both of us are rushed off our feet and damn frustrated that neither of us can do our job as well as we would like. Working (for a short time) in a non ward branch of medicine has led me too be so much nicer to people. Unfortunately, the work on the medical ward it what really excites me.

Nurse Anne said...

Oh believe me anonymous I know that a junior doc's life is chaotic hell. Bleep going off every 3 seconds for stupid shit that we have to call you for and all that.

Bampot, I work with older nurses who trained when you did that don't know one end of the patient from another. It's not just new nurses. The new nurses I meet seem pretty on the ball, as much as anyone can be working in these hellish chaotic conditions.

Nurse Anne said...

What Bampot, Are you suggesting that nursing education should teach the students how to take shortcuts and do everything in the 5 seconds you have between interruptions....or how to break every rule of nursing just to get your drug round done in less than 10 hours?

Because it is so bad on the wards that is what you would have to teach them to prepare them for reality. In order for the universities to really tach "reality" they would have to teach the students some very bad things indeed. Things that are big no no's.

People (university students included) become nurses because they want to care for patients not because they want to run around like a headless chicken barely accomplishing anything for 10 hours. Management is concerned about "productivity" they want the nurse to see 30 patients a second. That is what they see as efficient and cost effective.

It's quite the opposite really.

bampot said...

Anne, in your passion you always seem bite the wrong end of the bone. I wasn't for a second suggesting that bad practice should be taught. All I was trying to suggest was that what is taught should be really relevant to the practice of nursing,- not some fashionable waffle that will never aid a nurses practice. ( If you want to see a student nurses eyes roll, just try mentioning "models of nursing" or "the nursing process" ). As we all know, until ward based practice is improved(in all the ways you have very clearly elucidated ), patients will not receive the care they deserve and student nurses will contiue to experience extreme cognative dissonance between the classroom and the wards. Clarinda made a very good point regarding University involvement in clinical areas. We are told that practice should be based on evidence. Every time student nurses "report back to" ( or what ever term is current ) their university after some completely nightmarish placement their reports will add to what must surely be an already vast amount of evidence regarding the very poor standards of care they have experienced. It has long been taught that nursing must function according to professional, legal and philosophical priciples. If these principles are to have any meaning, is the university therefore not duty bound to attempt to influence the quality of care in the clinical areas? If a large part of the profession (ie. those preparing the registered nurses of the future) are indeed well aware of the problems we're discussing,why aren't they trying to do something about it? Is it not tragic that the "victims" of the current situation are the very patients our profession is meant to serve?

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Please email me back with your URl in subject line to take a step ahead and also to avoid spam.

Thank you,
Anna Huges
editorial.physician@gmail.com
www.physician.com