Wednesday, 20 January 2010

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.

75 comments:

capgrass said...

sounds like Eugenics.

Citadel said...

No matter how bad it gets Anne, you got to record this, Got to keep writing it all down, and Save it too. One day ONE DAY someone will learn from this. The world has GOT to know. I am sure the last thing you want to do is rake up all this pain and carry on writing. I hope you record all this someplace else and its not just ether on the bloggosphere. since the beginning of time really evil things have happened, and eventually we learnt from them........... or at least taught our children about them, At least we dont forget them.

but only because SOMEONE bothered to write it down.

right now I guess you feel as far removed from a nurse syringing hydorgen peroxide onto a stump of a screaming young man in the trenches, of a helpless mother watching her family die of Cholera or plague, of a nurse turning up on an early shift in Scutari only to find there is no clean linen. Of the prison nurses in The Maze in northern Ireland Nursing hunger strike patients, of the nurse in Bedlam, of the soldiers who were told to muck out the wards in Belsen, of the people who tried to patch up the gladiators during a circus in ancient Rome, of the ancient Egyptian orthopaedic nurses, ministering to yet another bad back. but someone wrote their story..............and now you must write yours.

Nurse Anne said...

Citadel,

Showing up to find that there is no clean linen and we have been locked out of the linen cupboard?

Happens every weekend.

And the public says "na na na these nurses don't want to be bothered putting clean linen on the beds na na na".

The Dobbing Doctor said...

You can site venflons?

Can you work on my ward?

People will listen one day, we need people like you to keep talking about and maybe things will change for the better.

:-)

Anonymous said...

Totally ridiculous, but something I can relate to! In our A&E Department, we have a clipboard full of paperwork with boxes to tick, for each and every object in the whole department to be cleaned on a daily basis. If these boxes aren't ticked, the nurses are in big shit.

i.e
every patient trolley to be stripped down to pieces (difficult when they are rarely empty), every day and disinfected.

every piece of monitoring equipment in the department including obs machines, defibs, thermometers, BM boxes, ECG machines etc etc...to be disinfected every day.

All desk spaces, nurse base and offices to be stripped and cleaned every day, including cabinets, phones, shelves etc

All notes trolleys (3) to be emptied and cleaned every day.

Drug cubboards (there's 5) to be emptied and cleaned out twice a week.

The fluid trollies (huge and full of heavy boxes) to be emptied and cleaned out once a week.

The sluice to be stripped out and cleaned daily.

All chairs in dept to be wiped down daily.

The list goes on....

In theory, all of this is excellent. No bugs could survive this fantastic cleaning regime. My big issue, is that who's meant to be looking after the patients while the nurses do all this cleaning?

The cleaners?!

Nope. They're only expected to mop the floors and empty the bins.

Every day I get so pissed off with patients being prioritised second to cleaning. And when the complaints come in, cos "Aunty Doris had been in A&E for 2 hours and wasn't even offered any lunch!", then I wish management would tell them "No, the nurses have to much fucking cleaning to do to be taking any notce of Aunty Doris!"

Anonymous said...

have you got a book deal ??

Thatsnews said...

Private 72 bed nursing home, often only one cleaner for the whole complex.

We hear you, nurse. It's the same the whole country over.

bewick said...

The woman who demanded that her Mother have an hour's soak in the bath.
Very simple answer to that one - SHE should do it. Of course you'd need to get the patient into the bath with the the hoist and perhaps provide a panic button/pager for the daughter . There would be serious benefits to the nursing staff, the patient, AND to the daughter providing direct loving care combined with a visit. Ask any psychologist. Medical reasoning permitting that is.
Another matter is that there are nearly 1m unemployed 16-24 year olds. A bit of a risk I know but it seems to me that in return for job seeker allowance these kids could get some ACTUAL useful work experience, self respect,perhaps even respect for others, and understanding of the real world.
A sort of National Service.
At least they'll speak English (well a version of it) and the Trust would not be paying over the odds to employment agencies for immigrants who are untrained and don't speak English. the Trust would actually SAVE money.

From personal observation though I could well be wrong because at least some of the unemployed youth are not receptive to orders and authority and are lazy "know it alls" whose main objective is to SKIVE. Then again if only 10%.....
There ARE loads of unemployed managers and professionals,and others, including Doctors, who could be given a supervisory role , at relatively little cost, for these people and who would likely be very happy to have even a temporary job.
A few MORE beds would allow removal of existing to a disinfecting area and immediate replacement with freshly cleaned ones. The cost would be miniscule.
OK I KNOW that maintaining the "clean" status would require some more thought but you get the general idea I'm sure. Clearly the very highly paid "management" of your hospital are just box tickers devoid of creative thinking. I despair. They are paid SO much just for keeping the Board happy. Been there, done that, but not in hospitals.

Maybe the above are bad ideas and I bow to your better experience (I'm only a retired Management Consultant so what do I know). Maybe both ideas could, with more work and thought, be seriously beneficial but the second one would require a serious political decision. EXCEPT of course that your Trust COULD (if the CEO has any bottle at all) negotiate with the DWP and the unemployed to achieve it. Unions permitting of course!!!!

Just a couple of thoughts.
Pretty clear though that YOUR situation is nothing like Casualty where nurses, and doctors, seem to have lots of time for non medical activities!
I happen to have been born just 7 miles from where Florence Nightingale was born and I seriously value medics and find your situation Anne totally appalling. Keep telling it how it is.

bewick said...

PS Anne. I've bookmarked you (Favourites in IE).

As a Management Consultant I would actually have buttonholed you as a valuable information resource. then again I would have hardly needed to do that because you so eloquently record what actually happens so I already got the idea. You almost encourage me to come out of retirement!!!

judith said...

My daughter had an elective Csection this week at a major London DGH.

The staff were wonderful, the organisation was dreadful.

Her comments? "Why are senior midwives having to spend hours on the phone trying to find beds on the post-natal wards for patients instead of dealing with the mums and babies?" (my daughter waited in recovery from 4.30pm to midnight to get onto a ward), and "why are midwives/nurses having to steal suitable beds (literally) from each other's patients?".

Anonymous said...

Anne, I've got a problem, I think it's a mental problem. Currently, I'm working in a medical specialty which isn't general medicine and don't have to suffer all (although some) of the frustrations you suffer. I'm a doctor. I should be happy by now. I should be able to read your blog and think thank the lord I left to do something else. But I can't. Because I remember every little victory, every time we managed to get one over on the system and I miss it a lot. Keep on going, don't turn your back on it, don't give up, because the more I'm away the more I want to take the bastards on one more time. And keep on blogging, it's very informative to doctors. You may be angry, but you manage to be a little diplomatic and get some of doctors (BTW where is the exciting place of philandering and cocaine?) on your side. Remember management loves divide and rule.

Anonymous said...

I don't know if it's appropriate to ask a question on the comments bit, but just when did cleaning become the nurses job again? When I was in college the first time around (about 1990) my friend used to spend her summers as a cleaner at Papworth. She used to clean blood & bodily fluids and have hep shots.

I'm in the USA now but our cleaners will stop us in the hallway as we're running to a patient to tell us to clean up some poop/vomit/blood somewhere as if we are standing around with nothing better to do.

When did this change?

Diane in USA

AndrewSouthLondon said...

Where is your Director of Nursing? He/she is professionally accountable for the quality of Nursing care. Swanning around the Conference circuit? Overseas Study Tours? Up at the Department of Health advising useless civil servants? On secondment somewhere? Off on longterm sick?

What you are describing is unsafe care. At Maidstone and Tunbridge Wells they wiped out the Board, Chief Exec, Medical Director, the lot for stuff like this. There are very well paid people sitting around munching hobnobs who should be ensuring you have proper Resources to do your job. Its not inevitable, it doesn't have to be like this.

And where are the Commissioners - the Primary Care Trust that pays for this shitty care? Do they even know - I bet they claim no-one has told them. Get them out of meeting rooms, off their wellpaid arses and sort some proper funding.

Its like being in a car. Shouting at it wont steer it. You have to push the right pedals, turn the bloody wheel. Its all sitting there idly waiting.

Anonymous said...

To the Anonymous Doctor, you have the POWER to get one over on the system! The nurses don't! And a lot of that CAN be blamed on YOUR colleagues who do not respect or listen to nurses! To talk to Anne about staying on in that kind of hell (that you've managed to remove yourself from, you hypocrite) is irresponsible! If you miss it so much, quit whining and reminiscing and GO BACK!!!!!The nurses have been oppressed and kept down for decades due largely to your kind. To the consultant, it is your kind who have made hospitals so freaking impossible to work in by convincing the hospitals to make inhumane cutbacks - out of the nurses' hides! So now you say Anne is a valuable resource? Puleez! I'm just so angry I don't know what else to say! It's NOT going to get any better! It may get worse, but not better! Your country is lucky to have ANY nurses at all! Sounds like a lot of the people in the UK don't deserve their nurses because they treat them so atrociously. Keep writing, Anne! And PLEASE get out of that sweatshop as soon you humanly can!

Bill said...

God - you sound like such a bitch!

earthchild said...

I hear you sister!!! The NHS is a total joke and like working in a third world country, I know I come from one. It is like working in a sweat shop, only that you are accountable and have people's live in your hands. Its always the nurses fault. God I wish that everyone would wake up and see what a mess it is and how truely dangerous it is to be a patient because staffing levels are a total joke! I applaud you for turning up to work in that environment each day. Something has got to give!! Keep writing this down, you have something real to say!

Anonymous said...

Bill, I am only a bitch when I need to be. The conditions Anne and her colleagues are forced to work under do mimic third world sweat shops. And the UK journalists and the general public are blaming the nurses for a situation they are forced to work in and did not create. It makes me furious! It makes my head want to explode! How can a nurse be expected to take care of ten to fifteen patients - and clean? Environmental Services should be responsible for the cleaning. Not the nurse who is trying to monitor patients, pass medications, assess her patients, and handle transfusions. It isn't safe. SOMEBODY should be a bitch over this. And the consultants have mangled care by continuing to recommend crippling cutbacks that slashed nurse staffing and made the hospitals the hell to work in that they are. I'd like to see these consultants come in and try to actually implement what they recommended. So yes, they have betrayed nursing and patient care. And yes, the doctors have, too. They have done this by refusing to listen to nurses, establishing verbally abusive communications which effectively shut down all communication. Nurses do not want to report changes in condition if they know they are gong to be cursed out and called everything but "Ma'am". No, I'm not a bitch. Just absolutely fed up with the situation. The public should be demanding sweeping change, starting at the top. I'm not used to blowing a gasket like I did in the previous comment. I'm normally very reasonable and even-tempered. But this is ridiculous. How come so many people in your country don't get that? And instead of pointing the finger at me, why don't you do something to help Anne and the rest of the nurses in your country? Write your rep and demand decent conditions for nurses AND patients?

Nurse Anne said...

No one is being a bitch on here at all. We are only presenting facts.

Anonymous was right when she said that the doctors helped to create this hell situation. But nurses have as well by not promoting our own worth. We don't explain what nurses do very well. The public is at fault because they don't value nursing but how could they possibly understand the situation when their only exposure to nursing is TV dramas?

It's a big clusterfuck of misery.

Anonymous said...

Spot on, Anne! And it is our profession's fault, too, for not informing the public about what we do. But I think it is also the fault of the nursing educational system. I got spoon-fed the bunk about us being self-sacrificing and self-effacing. But when you grow up, it is only right to want to be appreciated and valued for the work you do. Everyone wants to matter. It's time to toss the sentimentality and treat nursing as the science it is - and give it the respect it deserves and has never gotten. And that will mean deprogramming a lot of the older instructors.

ggbbgg126 said...

免費影音視訊 -
洪爺情色影城 -
免費卡通A片 -
免費A片觀賞 -
洪爺情色電影 -
成人免費十八禁短片 -
免費A片電影下載 -
暴風影音下載 -
免費情色做愛影片 -
免費H漫畫影片情色 -
免費觀看成人情色影片 -
情色影片免費觀賞 -
免費情色影片論壇 -
成人影音 -
免費影音下載 -
影音聊天 -
免費影音播放軟體下載 -
免費影音聊天 -
BT免費影音下載 -
免費影音部落格 -
免費情色影音 -
成人論壇 -
成人討論區 -
色情故事文章 -
滑鼠連點程式下載 -
視訊程式下載 -
視訊錄影程式 -
視訊安裝軟體 -
視訊攝影機 -
成人貼片區 -
熊貓成人貼片 -
柔情聊天網 -
柔情聊天室 -
成人短片 -
免費18禁成人圖片 -
KISS貼圖 -
TT1069男男貼圖交友區 -
只有貼圖區 -
貼圖俱樂部 -
色情圖貼 -

Toby said...

Hi Anne.

Hope you are well.

do you have a Moderator for the comments on your blog?

seems you have some spam bot trolling

Anonymous said...

My girfriend is a psychiatric nurse in Germany and has much the same things to say Anne. Counterproductive paperwork and staff being nibbled away until it´s critical. One person on a night shift with a completely fucking stupid new personal alarm amongst a ward full of potential suicides or psychosis. She is scared, concerned and doesn´t feel she is doing basic things she is trained to do. Dissenters or critics are mobbed or moved to humiliating jobs which are not suitable considering their experience or qualifications until they usually go of their own accord. The curious doublespeak of `quality management teams´ and gagging of people using marmalade tactics, blaming the very people who aren´t sitting on fat bonus´s and are in the front line. I don´t know how she or you do it, it´s not the Falklands. It´s daily life. It´s not even as if the money is much good. I also urge you to keep writing, it´s a social crime.

Dino-nurse said...

Nothing changes and thats the sad part. Even in the ICU where we supposedly have one-to-one care, without agency staff we would be crippled. Agency RNs who are earning 3 times as much as our regular RNs but cannot do IVs or alter vent settings etc...Now I have been informed that we are over our agency budget (again) so will have to have Fuckwit Agency rather than Specialist Agency for the next six months. As for cleaning- the Trust has yet again changed the tender so we have less cleaners in nice new uniforms (that look just like HCAs) who don't even empty the bins and you'd have to look very hard to see if the floor has been mopped. We also have tickboxes for daily cleaning which is a joke-no-one is saying that cleaning isn't important but in the grand scheme of things, surely it makes more sense to have RNs doing NURSING so that granny does get her hair washed and the cleaners doing CLEANING? Its not rocket science. On a plus note, one of our senior corporate nursing officers came down to the MAU last week (long story but I was having to cover for one of the floor sisters who was off having a mental breakdown) and just as she was being rushed past the messy patients who were rolling around and bleeding/puking all over the floor to see the "Very interesting NEW Piece of technology" one of the aforementioned patients decided to fall out of bed whilst his oesophageal varices burst all over whilst simultaneously bleeding PR despite the 2 HCAs trying to keep him in the bed...and yes! she got coated...Ha! I was rewarded with a Look from one of the senior, senior managers with her- I offered her a set of scrubs and use of the theatre showers (we do not have any other changing facilities in the Trust) and pointed out its a hazard of modern nursing ( not sure when she last touched a patient but certainly not in this century). She countered with a "in my day sisters ran a tight ship, hair above the collar etc etc" I responded with "damn well more than 3 RNs on the floor for 45 acute patients, as I remember and senior so-called nurse managers used to wear a uniform and actually do a bit of hands-on". Stalemate. Any comments on a postcard please sister and it will be filed where it always goes...under B for Bin. They would so love to sack me but no-one in their right mind would take my place and they know it.

Anonymous said...

Crap management is obviously the probelm here.

Steve

Anonymous said...

i.e. management who´s performance is based on `savings´, who have no idea of the job in hand and are basically parasitic. It´s tragic.

Steve.

AndrewSouthLondon said...

Love the way the sh*te "managers" get mixed up with the evil "savings". Like if you didn't have any managers the books would balance wouldn't they, right?

In my experience sh*te managers usually fail to make any savings. Good ones actually perform. Unfortunately it looks like you have the shite ones: p*ss everyone off AND don't deliver savings.

If you took the time to find out why savings are required - and why should you, god knows, as you are all busy enough - you would find it due to continuous overspending of clinical budgets.

Hospital budgets are the same as home budgets: you just can't spend what you haven't got. And no - sacking all the so called managers won't get you anywhere near what you probably need to save.

Sounds time all your lard-arsed Directors and mangers got round the table and talked about the hospitals (ie your - all in it together) financial problems. But being sh*te they probably won't.

embroidnurse said...

Keep on blogging Anne, we need you!

Nitrile Gloves said...

The electrocardiogram machine or ECG can detect a multitude of heart related abnormalities early on making it one of the most valuable instruments in any medical facility. The portability of these great devices makes them available in smaller clinics and even nursing home environments.

moist wipes

sexy school girl stories said...

John seemed determined to see this thing through to full intercourse, andAlice could see no way to prevent that from happening. SCREAMS TWO YOUNGER BYSTANDERS START TO FLAIL ARMS AND FALL TO THE GROUND UNIDENTIFIED MAN See.
xxx k9 stories
mother son incest sex stories
son mom stories xxx
consensual incest stories
grandma sex with dog stories
John seemed determined to see this thing through to full intercourse, andAlice could see no way to prevent that from happening. SCREAMS TWO YOUNGER BYSTANDERS START TO FLAIL ARMS AND FALL TO THE GROUND UNIDENTIFIED MAN See.

Sabina said...

Little doubt, the dude is totally just.

Anonymous said...

Millions of people usually are undergoing payday cash advance credit debt in the united states due to the horrible market. By using issues deteriorating day after day, you'll find additional young families troubled by the issue of job opportunities. Quite a few contain turned into pay day loans, which in turn request tremendously substantial interest not to mention may bring about a new circuit involving neverending credit debt. There's lots of who want to find out how to reduce a cash payday loan, although do not know the actual ways requested to do so. You must on-line to shed a payday cash loan instantly if you'd like to may well avoid from additional cutbacks with the interest. This will give a new step-by-step guideline to stop of which payday loan financial debt.
Ways to stop an easy payday loan That has a
[url=http://pozyczkigotowkowe24.com.pl]pożyczki gotówkowe[/url]

The first task you will want to bring to get from cash advance loan debts is call a highly skilled payday loans consolidator straight away. They then in addition to all those often have typically the encounter required to discuss as your representative to acquire a good lower price. Various payday loan creditors know they will often never become any kind of ones own cash back once they ordinarily are not far more lenient related to interest. For some patients, the interest levels for a loan product are generally wholly reduced though exclusively the actual mortgage is required to be refunded.
[url=http://szybkie-pozyczki.info.pl]szybkie pożyczki[/url]

Some people will have got many payday advances to varied businesses, this can be an incredibly very important aspect simply because it will reduce the credit debt pressure appreciably. Moreover, your payday cash loan consolidator in most cases pay attention to your mortgage loan to be able to start out your merging for the cost directly to them.
Doing away with a quick payday loan by simply Preserving
[url=http://kredytbezzaswiadczen24.net.pl]kliknij w kolejną stronę internetową[/url]

Now you have to valuable step up losing payday loan debt could be to do a number of severe introspective cardiovascular system checking regarding the shelling out behaviors. There are numerous with explanation why you could be in online payday loan financial debt, nonetheless substantial just spending is likely an immense lead to meant for dilemma. For anyone who is going out to restaurants, despite the correct way inexpensive, you actually are usually just spending excess amount. To be able to find out how to remove an advance payday loan, it is advisable to 1st learn to not spend as much.
[url=http://pozyczkagotowkowa24.net.pl]pożyczka gotówkowa[/url]

That can be done this approach when you go to the market to fill all of the food items requires. Purchase just the essentials, that include bread, ovum, fruits and veggies, plus fruit and vegetables, and avoid other soda pops or possibly foods that might be undesirable for ones finances. Making use of vouchers may also be yet another strategy for being economical used so that they can pay back the actual funds much quicker.
[url=http://chwilowki-bez-bik.net.pl]chwilówki bez bik carrefour[/url]

In conclusion, make an effort to trim through the entire night-life you ought to purchase during the thirty days. It might suggest that you stop having a drink, evade movie theaters, or possibly almost every version of pleasure that could be pricing you actually profit. It can be the perfect time to earn sacrifices to achieve your own payday cash loan debt resolved without delay.
[url=http://pozyczki-przez-internet.net.pl]kredyty chwilówki tychy opinie[/url]

Anonymous said...

Andrewarchus is a pentad dollars at my localKohl'sIf your natural endowment recipient role is intoartsand crafts, thencraft storeswill supply you with a superfluity of owl gifts. Here is a list of ten ideas for good going away away owl gifts, that might one, particularly when he realizes how considerably you live him!

Feel free to visit my page: http://owl-gifts-decor.com

Anonymous said...

Ask anyone who was affected by last year's Panda update or the more recent Penguin update from Google, and you'll quickly see
that it's foolish to put all the income from your Internet marketing blog in one proverbial basket. It just requires the dedication to writing one blog post a day no matter what and keeping this routine up for months and years to come. If you want to create and run a blog to hold your business, the adopting business blogging tips will certainly help to make the task much simpler for you.

Here is my web page ... hostgator coupon code

Anonymous said...

He published magazine articles in his own publication titled Skin Inc.
The folding action Endermologie creates causes the
connective issues to stretch. There may be a new and innovative cellulite treatment available now: cryotherapy.


my web blog; How to get rid of cellulite naturally

Anonymous said...

This worked for the remaining 8 weeks (mainly because I
never took the band-aids off long enough to go at it. So, if your nails are unusually
short and messy, you should locate the nearest
hypnotherapist because you are probably biting your nails and you don.
When you feel like biting your nails, bring your hands
away from you, perhaps you can keep them in your pockets or consider
wearing gloves.

Also visit my web page How to stop nail biting

Anonymous said...

magnificent blogs and forums to read
http://www.kentuckyfloydchicken.com/groups/face-painter-shortened/
http://hackersguru.com/index.php?do=/blog/6613/simplifying-main-reasons-pertaining-to-référencement-naturel/
http://fickworld18.com/index.php?do=/blog/200022/no-fuss-facts-about-référencement-naturel/
http://crosquare.com/QMLJanett
http://www.lovbe.com/LynwoodSt

Anonymous said...

Cellulite is an unsightly dimpled appearance, especially around
the thighs. Habits: Cellulite treatment also includes taking care of your habits such as crossing your legs,
knees and ankles. You do not have to perform these exercises every day,
all you need is to do them three times (3x) a week for about thirty minutes each session.

Anonymous said...

I'm amazed, I must say. Seldom do I encounter a blog that's equally educative and entertaining, and without
a doubt, you've hit the nail on the head. The problem is something which too few men and women are speaking intelligently about. Now i'm very happy that I
found this in my hunt for something concerning this.


Here is my homepage ... mw2 aimbot

Anonymous said...

It is not my first time to go to see this web site, i am browsing this site dailly and take good data from here everyday.


Also visit my blog :: youtube video downloader

Anonymous said...

Hi mates, how is all, and what you desire to say about this article, in
my view its genuinely amazing in support of me.


Feel free to visit my site virtapay exchange

Anonymous said...

Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point.
You clearly know what youre talking about, why waste your intelligence on just posting videos to your weblog when
you could be giving us something informative to read?

Look into my site ... Castleville User Tips

Anonymous said...

This post provides clear idea designed for the new people of blogging, that genuinely
how to do blogging.

Feel free to visit my web-site: Cheap Louis Vuitton Handbags

Anonymous said...

Hi there, of course this post is actually nice and I have learned
lot of things from it on the topic of blogging. thanks.

Feel free to surf to my blog cheap nfl jerseys

Anonymous said...

Just desire to say your article is as astonishing.
The clearness in your post is simply cool and i could assume you are an expert
on this subject. Well with your permission let me
to grab your feed to keep updated with forthcoming post.
Thanks a million and please carry on the gratifying work.



Feel free to visit my web page; Chaussure De Foot Pas Cher

Anonymous said...

I do not even know the way I finished up here, however I believed this post was once great.

I do not understand who you might be however certainly you're going to a famous blogger when you aren't already.
Cheers!

Take a look at my website :: slc-wireless.com

Anonymous said...

I would like to thank you for the efforts you have
put in penning this website. I am hoping to see the same high-grade content from you later on as well.

In truth, your creative writing abilities has encouraged me to
get my own blog now ;)

Here is my weblog Wholesale Jerseys Cheap

Anonymous said...

You made some really good points there. I checked on the web to learn more about the issue and found most individuals will
go along with your views on this website.

Here is my web-site Evgeni Malkin Authentic Jersey

Anonymous said...

Excellent post! We are linking to this particularly great content on our site.
Keep up the great writing.

Visit my web page :: Abercrombie Pas Cher

Anonymous said...

For most up-to-date information you have to go to see world-wide-web and on internet I found this site as a finest website for
newest updates.

Also visit my page: Sidney Crosby Jersey

Anonymous said...

It’s an amazing paragraph in favor of all the web viewers;
they will take advantage from it I am sure.

my web page; 3d sex games

Anonymous said...

Thank you for the good writeup. It in fact was a amusement account it.

Look advanced to far added agreeable from you! By the way, how can we communicate?



Also visit my web blog ... Free PSN Codes Facebook

Anonymous said...

Awesome post.

My blog :: Wholesale NFL Jerseys

Anonymous said...

If some one desires to be updated with most recent technologies therefore he must
be pay a quick visit this site and be up to date daily.

my weblog Abercrombie And Fitch

Anonymous said...

I absolutely love your blog and find most of your post's to be just what I'm
looking for. Does one offer guest writers to
write content to suit your needs? I wouldn't mind writing a post or elaborating on most of the subjects you write concerning here. Again, awesome blog!

My weblog ... Air Max Pas Cher

Anonymous said...

Useful info. Lucky me I found your site accidentally, and I'm surprised why this accident did not came about earlier! I bookmarked it.

Look into my blog post Louis Vuitton Purses

Anonymous said...

I've learn a few just right stuff here. Definitely worth bookmarking for revisiting. I wonder how so much effort you set to create this sort of fantastic informative web site.

my webpage youtube Bot

Anonymous said...

I love it whenever people get together and share views.
Great blog, keep it up!

Look at my page: Wholesale Jerseys

Anonymous said...

Hi there everybody, here every one is sharing
these experience, so it's good to read this webpage, and I used to pay a quick visit this webpage daily.

My homepage :: Louis Vuitton Outlet

Anonymous said...

Stunning story there. What happened after? Good luck!



my blog Clicking Here

Anonymous said...

Great goods from you, man. I've understand your stuff previous to and you're just extremely fantastic.
I really like what you have acquired here, certainly like what you are
stating and the way in which you say it. You make it enjoyable and you still care for to
keep it sensible. I cant wait to read far more from you.
This is actually a tremendous website.

Also visit my page - get dragonvale

Anonymous said...

Hi Dear, are you genuinely visiting this web page regularly, if so after that
you will without doubt obtain nice experience.

Also visit my page; related site

Anonymous said...

Its like you read my mind! You seem to know so much about
this, like you wrote the book in it or something.
I think that you can do with a few pics to drive the message
home a little bit, but instead of that, this is magnificent blog.
A fantastic read. I'll definitely be back.

Also visit my web-site :: Make Money With Adf.ly

Anonymous said...

I do trust all of the concepts you have introduced in your post.
They're really convincing and will definitely work. Nonetheless, the posts are too short for newbies. Could you please lengthen them a little from subsequent time? Thank you for the post.

My blog: Louis Vuitton Bags

Anonymous said...

Hi to every one, because I am actually eager of reading this weblog's post to be updated regularly. It includes good data.

Feel free to surf to my web blog New Kevin Durant Shoes

Anonymous said...

Since the admin of this website is working, no uncertainty very rapidly it will be famous, due
to its quality contents.

Check out my web-site - Air Jordan

Anonymous said...

Touche. Outstanding arguments. Keep up the great effort.


Here is my webpage ... Wholesale Jerseys

Anonymous said...

Hey there! Do you know if they make any plugins to assist with SEO?
I'm trying to get my blog to rank for some targeted keywords but I'm not seeing very good success.
If you know of any please share. Many thanks!


my webpage :: Air Max

Anonymous said...

Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my
blog that automatically tweet my newest twitter updates.
I've been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this. Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

my blog; Louis Vuitton Handbags

Anonymous said...

Howdy! Quick question that's totally off topic. Do you know how to make your site mobile friendly? My site looks weird when viewing from my iphone 4. I'm trying to find a theme or plugin that might be able to fix this issue.

If you have any recommendations, please share. Cheers!


Here is my blog :: Tory Burch Outlet

Anonymous said...

Hello are using Wordpress for your blog platform?
I'm new to the blog world but I'm trying to get started and set
up my own. Do you need any coding knowledge to make your own blog?
Any help would be greatly appreciated!

Also visit my blog post; Michael Kors Outlet

Anonymous said...

Somebody essentially lend a hand to make critically articles
I might state. That is the very first time I frequented your web
page and to this point? I amazed with the research you made to make this particular publish incredible.
Excellent activity!

Also visit my site ... Sac a main Guess

oakleyses said...

oakley sunglasses, michael kors outlet, nike free, oakley sunglasses cheap, christian louboutin shoes, michael kors outlet, louis vuitton outlet, nike shoes, air max, kate spade outlet, polo ralph lauren outlet, true religion jeans, longchamp handbags, burberry outlet, louboutin outlet, gucci outlet, air max, michael kors outlet, longchamp outlet, louis vuitton outlet stores, oakley sunglasses, tory burch outlet, louboutin, longchamp handbags, coach purses, coach factory outlet, kate spade handbags, ray ban sunglasses, jordan shoes, louis vuitton, coach outlet, louis vuitton outlet, michael kors outlet, louboutin, ray ban sunglasses, michael kors outlet, chanel handbags, coach outlet store online, tiffany and co, burberry outlet, michael kors outlet, prada handbags, polo ralph lauren outlet, louis vuitton handbags, tiffany and co, prada outlet, true religion jeans

oakleyses said...

timberland, nike blazer, sac louis vuitton, sac louis vuitton, ray ban pas cher, hollister, louis vuitton, north face, new balance pas cher, sac guess, louis vuitton uk, louboutin, michael kors pas cher, vans pas cher, abercrombie and fitch, mulberry, ray ban sunglasses, longchamp, air max, converse pas cher, hollister, polo lacoste, true religion outlet, ralph lauren, michael kors, true religion outlet, nike roshe run, nike free, air max, michael kors, hogan outlet, polo ralph lauren, air jordan, air force, air max pas cher, sac burberry, nike tn, nike free pas cher, north face, oakley pas cher, sac longchamp, vanessa bruno, lululemon, nike air max, sac hermes

oakleyses said...

barbour, ugg pas cher, vans shoes, instyler, nfl jerseys, herve leger, wedding dresses, ugg boots, celine handbags, longchamp, marc jacobs, ghd, new balance shoes, lululemon outlet, soccer jerseys, beats by dre, ugg australia, chi flat iron, ferragamo shoes, ugg boots, mcm handbags, canada goose, birkin bag, bottega veneta, north face outlet, insanity workout, nike huarache, p90x, nike trainers, asics running shoes, canada goose outlet, mont blanc, uggs outlet, valentino shoes, nike roshe, giuseppe zanotti, canada goose jackets, abercrombie and fitch, north face jackets, nike roshe run, reebok outlet, rolex watches, mac cosmetics, jimmy choo outlet, babyliss pro, soccer shoes, hollister, ugg

oakleyses said...

converse, canada goose, hollister, rolex watches, ray ban, moncler, swarovski, air max, moncler outlet, moncler, gucci, pandora jewelry, pandora charms, moncler, thomas sabo, pandora charms, juicy couture outlet, karen millen, canada goose, wedding dresses, hollister clothing store, ugg, toms shoes, links of london, canada goose, louis vuitton, swarovski crystal, supra shoes, canada goose, parajumpers, moncler, montre homme, canada goose uk, lancel, vans, juicy couture outlet, moncler, oakley, iphone 6 cases, moncler, baseball bats, ralph lauren, hollister, converse shoes, timberland boots, louboutin, air max, coach outlet store online, ugg