How does it keep getting worse? Total Insanity.

Our staffing levels and skill mix continue to be a joke- a sick fucking joke.

I thought that we were slated to get some new staff nurses.  I was wrong.  We  are getting more kids to replace the ones we are losing. They really are kids and they have no training or experience in a health care setting.  They will not be trained or orientated.  They will show up to work and just have to muck in, without knowing what they are doing.  No one has time to explain or teach anything.  The kids from last year are still fucking a lot of things up.  Goddammit I want RN's.  I can't handle being a nurse for this many patients whether I have 5 carers with me or fifty of them.  90% of what is going on in a ward is way over the care assistants heads.  They just don't realise it.

A nice little surprise awaited my arrival onto the ward to work a day shift recently.  I'm not talking about the staffing levels.  Those were as shitty as expected for the shift.  We were going to have 3 staff nurses and 2 carers.  But they sent our third staff nurse to cover another short ward.  So we had 2 staff nurses and 2 carers.  And then they sent us this agency carer who cannot speak a word of english and has been in the country a short time.  No previous experience in healthcare.  But she was wearing a nice pretty uniform that says "Nursing staff" on the front.  No wonder the patients and the visitors are confused.  I told her not to leave the cdiff mrsa patient's room without washing her hands.  I told her not to share equipment between those patients and other patients on the ward.  She gave me a beautiful smile and said "yes matron" to me and kept going.  She did the same thing again 2 minutes later.
 I think the only words the poor child knew were "yes matron" and "I happy to".  Not a clue about what we were saying to her.  Not a clue.  Sweet girl though.  I did complain to the site manager about it.  Her response was "you should be grateful for having an etc set of hands".  Uh, you took our trained nurse away and gave us a total novice.

Just for the record (in case any fucktwits are reading this) that girl is NOT a foreign nurse.  Foreign nurses have education, qualifications and registration with the NMC.  This girl was not a nurse and not registered with the NMC.  She was a foreign employee, not a nurse.

So those were our staffing levels.


Back to my surprise.  There was  a list of "orders" orders from management that greeted me when I arrived for duty.

They wanted us to take apart a whole lot of equipment and clean it all, on the floor on our hands and knees.  They wanted us to assess all these things for faults and fill in about ten forms for each item.  I am talking about large items like beds, mattresses, etc.  They wanted this from 2 staff nurses and three carers covering 25 patients who all require constant care.  They don't want to pay domestics, but they don't want another  Basildon.  They don't want to hire nurses or staff nor do they want to be in the papers.  I was told that threats had been made against the nursing staff if these things are not done.  Look at how basildon hospital responded to complaints about the care at their hospital.  They know what the situation is , but they blame the nurses.

In a letter to Mr Wood's family he wrote: "I am sorry that the standards of cleanliness were unacceptable during your father's hospital stay. All the clinical areas should be cleaned daily. There is no excuse for dirty bed linen to be left in the lavatory. The ward would like to apologise that the care they gave has left your family feeling that expected standards of care have not been met."

Now I am all into cleaning and stuff.  I quite enjoy the whole domestic goddess thing.  But what I couldn't figure out was this: who the fuck is going to take care of the patients?

We worked out how long it would take to knock out all the things on the list.  It would take 6.5 hours out of an 8 hour shift. They wanted it done on that shift. It takes about 6.5 fucking hours to get through the 8 AM drugs for a ward full of confused and acutely ill patients.  

We have many, many patients all sharing two toilets and management also demanded that we spend 8 minutes exactly scrubbing out each toilet between use.  Then they wanted a form filled in and signed after each and every cleaning session.  How? How?  At any given time we have more patients that need the toilet than there are toilets. And they get real nasty if they have to wait.  Really nasty.  We worked out that we would have to spend 50 minutes out of every hour just scrubbing toilets in order to do what tthe powers that be wanted.  It usually takes the care assistants (with the help of a nurse when she finishes the work that only a nurse can do) until about 1PM to finish all the AM hygiene etc for the patients when there are 6 of us on duty.

So they wanted this all from us without any additional staff. When RN's don't spend enough time with patients and focusing on the things that only a nurse can do patients die.  Those things are all encompassing and take more time than we have. What are these managers thinking?

Stupid us we tried to accomplish it.  My vote was to send an incident form to management saying "direct patient care and patient safety comes first, this is impossible so fuck you".  But the other staff nurse  on duty  outranks me and she is a Nerdy Nellie, always wants to please.   They had threatened us with a spot inspection that shift.  We had to make a go of it.  It was a disaster.

So by 10 AM I am 1/3 of the way through my 0800 drug round.  Half my patients are spitting their meds out on the floor or refusing to take them.   Half the beds are half dismantled. The phone is ringing nonstop and we are having to drop what we are doing to answer it, otherwise the public complains that we aren't "bothering" to answer the phone. And it's at this time that one of my patients goes bad.

The drug I need to stop the "bad" is always supposed to be kept in the fridge. It wasn't there.  This is happening almost every day.  Pharmacy has no staff either, and they are never open when we need them.  If something isn't there it is the nurse's problem.  Problem was, they left us without an emergency drug and they were closed.  My other staff nurse had an emergency on her side.  The two care assistants were half way through  bathing a patient who requires two people spending 20 minutes with her to get it all done.  The other staff member couldn't understand english, although she did show concern over the fact that I was standing in the medication room in a rage..  I had to ring 7 wards to find the drug and then walk my bottom down there to get it.  But I got it, and patient survived.

When I got back to the ward it was still chaos.  Patients were crying because they wanted to get back into bed.  But the beds were all apart waiting for the staff to check them over and  copy equipment numbers that are located in hard to find places.  It all was ordered to be done in the morning.  And there was so much going on that there was no way we were getting back to those beds.  I went to help Nellie with her poorly patient once mine was okay.  My drug trolley was just parked in the middle of the ward.   Patients were getting concerned that their drugs were so late and that they couldn't even crawl back into the bed to deal with the pain.  I reminded Nellie that the dismantled beds were her fault and that we should have gone with my incident form idea. Ha.

Nellie's patient now had a pulse of 200 but was alert and comfortable.  All other vitals were fine.  The phone rang.  I answered it hoping that it was the registrar (senior doctor) I had just paged about Nellie's patient.  I thought for sure it would be him calling back.  But it wasn't.  It was Mrs. Jones daughter screaming at me because her mother phoned her to tell her that she hasn't had her morning meds yet.   I told her that I was in the middle of an emergency and that I needed the phone line free NOW.  I told her that I would get her mother her tablets as soon as I could.  It went over her head.  She kept threatening me.  If the senior doc was ringing us back he wouldn't be able to get through because this woman was keeping the line engaged with "Don't you fucking tell me that you couldn't find time in the last two hours to give my mother her pills".   I had to hang up on her.  We have one working phone line. Then I heard a shout from Nellie and the next thing I knew I was putting the crash call out to get the cardiac arrest team to us immediately.  Her patient had just crashed. We didn't get her back.


Later on in the day I had more family fun with my patients relatives.  I had a patient on a drug that needs to be given at regular intervals through out the day.  I managed it but one of the doses was 10 minutes late.  No big deal.  Two hours late would be a problem but not ten minutes.  I have looked after thousands of people on this drug.  Her husband decided to give me a lecture and a computer print out from the internet about that particular drug because "you nurses are obviously too stupid to know that it needs to be given on time".  How he could think he understood WHY  that drug was late.  He didn't have a clue as to what was going on in that ward.  I should have got a fucking award for getting it to her when I did.  That on it's own, took a lot of manuevering.  If your loved one has a drug due at 0800 so do many of the nurses other patients.  Getting everyone everything on time is physically impossible.  I would have to be in 15 places at once literally.  If I have say, 10 patients all due a drug at 10 AM I will start at 9:30 with the first one and get to the last one at 10:30.  And run past people calling for help to accomplish that.  There is no other way.

It just got worse as the day progressed.

We had some fun with the doctors as well. .  Some of them are just creepy. The first thing that happened was a surgeon showed up onto the ward to see one of my patients. He wasn't her main doctor but he was asked by her doctor to see her.  He arrived on the ward unexpected shortly after the cardiac arrest.  The aftermath of one of those things is massive.  He went over to the patient and when she told them that she hasn't seen a nurse in hours he responded with "have you complained about anything-they'll be extra mean if you complain".  I wasn't surprised.  My patients have told me that many consultants tell their patients this.  In all my years of nursing I have never seen a patient get treated extra badly because they complained.  Never.  Everyone gets neglected whether you are nice to the nurses or not.

About a half an hour after the cardiac arrest a relative called me.  She asked me if I would give her mother a bath and wash her hair in the next hour, before visiting.  I looked at the ward in disarray and remembered that I was hours behind with about 1000 crucial jobs. She wanted her mother to have an hour soak in the bath.  This would require a member of staff staying with her for an hour as she cannot be left alone in there.  The other 4 members of staff were doing about 20 jobs per second, other patients were crying out for help and were being ignored.  The ward was a mess. No one could take the dirty linen away.The non english speaking staff member would not be able to get this woman in the bath safely as a hoist thing was required.  None of us had the time to show her.  I had this girl specialing a confused wanderer that was trying to get out. I told the caller that I would probably be unable to get it done today because of ward conditions.  She went onto tell me how important it is for patients to have simple things like their hair washed and how nice it is to do something like that for someone.  I was perplexed.  How could she think that I, a registered nurse, could not understand something like that. 

Ask any patient who has been in hospital unable to care for themselvs what meant the most to them while they were there.  They won't say it was the doctors or nurses, nor appreciate the meds or the treatments or the labwork we did.  They will tell you that the number one thing that they appreciated was a bath and a hair wash.  I have known this since 1992.  Of course it is a wonderful and important thing to do for patients. Things like that actually help patients heal because they feel positive when they feel that they look nice.  But the other other things going on at that time were all time consuming and higher priority.  It dawned on me that she didn't understand that.  She thought that I simply didn't want to be bothered washing her mother's hair.  She thought that nurses these days don't understand the importance of the simple things.  It is a triage situation on these wards, and the public have no idea.  And they are conditioned to think that nurses are uneducated slags who don't want to be bothered.  I have no chance of getting the reality of the situation across to her.  She has been socialised to have completely unrealistic expectations from the nurses.  I told her I would try my best (and I did ) but I didn't think I would be able to.  I left it at that. She wasn't happy. 

I got out of there over an hour and a half late, unpaid.  And not one job was completed properly.  I heard later on that it got even worse.

On my way out I was greeted by a nice person, the partner of a long term patient who is bedbound and unable to care for himself following a RTA (info changed to protect confidentiality).  This patient was medically stable but needed much in the way of total nursing care.  He has been with us a long time and comes in frequently.  We adore him and we adore the family.  We know them well. The spouse handed me some chocs and says " I just wanted to say thank you for everything you have done for soandso, you nurses are amazing".

Just what had I done for so and so? I hadn't laid eyes on him in 5 hours.  I spent about 2 minutes helping the care assistants wash him and had a quick look at his skin.  I resited his venflon.  I gave his IV meds an hour late.  I ordered an airmattress. That was all.  I didn't have time to spend with him and didn't do half of what I should have.  I was in and out of that room at the speed of light. It makes me sick.  The spouse knew this because she was there.  She knew we were having a rough time and was trying to build us up.  The tears were about to start so I walked away mumbling yeah thanks. 

So can see if you are mean to the nurses we get upset, and if you are nice, we get upset.  You are not going to win really.

What a mess.  Our staffing numbers look like crap over the next few months and management is hellbent on this cleaning regime and associated paperwork.  Some of the stuff they want done multiple times daily.  They won't even consider bringing more domestics in or giving us someone to answer the phone.  We have one shift that is set to be staffed really really well. And that means that a staff member on that shift will be sent elsewhere. 

I just have one question.  "How?"

I am hearing through the grapevine that frontline staff nurses are set to be scapegoated if anything goes wrong with the cleaning etc.  They are all ready all over us for the cleaning forms not being filled in.  It doesn't surprise me after reading this.- nurses being questioned by police.  The physical layout of the ward does not allow for patients to be isolated properly, we don't have enough handwashing stations etc etc, we cannot even wash our hands properly without getting told that we are not responding to patients quick enough.  Sometimes I will just turn on the water to wash my hands after finishing with one patient and the patient in the next bed will start shouting. "get over here now and get me the toilet"  "I am just need to clean the commode and wash my hands and I will be right there"  "Get over here now or I will wet the bed and it will be your fault".  Imagine if I took the time out to fill in the form saying that I cleaned the commode during that scenario.

We are not up to date with our knowledge.  Meanwhile David Cameron is running around like a twat worried about overeducated nurses not wanting to care for the patients.  The problem is no nurses David, not education of nurses.

Half my shift is spent at the nurses station sorting out systems problems or running around the hospital looking for drugs anyway.   Can't wait to get out of here.