An article about the Kids from The Sunday Times.

This article is better than the usual rubbish that we get about nurses.  But the headline pisses me off;

Novices do Nurse's Job

They did hit on a lot of good points.  Then they fucked it all up by implying that nurses brought novices into the hospital to avoid hands on care.  Nurse have no control over hiring, firing, staffing matrixs, or skill mix of ward staff at any given time.

It is true that our hospitals hire people off the street and throw them onto a ward dressed in a nurse's uniform.  They are not even training them to be health care assistants  anymore.

These people are thrown right onto a ward instead of trained and experienced staff.  Absolutely.

The problem I have with the article is the headline really.

"Novices do Nurse's job"

Oh no they are not.  They are incapable of doing a nurse's job.  They are there on the ward.  They may wash patients and make beds if they feel like it.  But these things are a far cry from an accurate description of a real nurse's job.

If I am working on a ward as a nurse and the only other staff I have with me are two or three apprentices/care assistants then there is ONE nurse on duty.  This article makes out that it is the nurses who are wanting to dump all this work onto the novices and that really leaves a bitter taste in my mouth.  The lone nurse simply cannot attend to everything by herself.  She knows what needs to be done, she knows what the consequences are.   She starts out doing the things that only she can do (this is the stuff that makes a huge impact on patient survival) and she delegates the easy stuff to the novices. There is no other way to do things if you are the only nurse.

As the only nurse I am on my own with all the:

Medications  (40 minutes out of every hour of my time for much of the day)
Drips/calculations and monitoring
NG tubes,
Diagnostic tests organisation and preparation
admissions
discharges (complicated and time consuming)
communication with doctors, physios, pharmacy, path lab, specialists (they all go through the nurse rather than talk to eachother)
assessments to avoid "failure to rescue"
wound care
Peg feeds (I have never seen a care assistant change any kind of a drip bag)
suction/trach care
02 delivery and management
post procedure management and care
communication with family members (I cannot get 2 minutes straight free of this to see my patients)
specialing the critically ill patient but not leaving that bedside except to grab supplies and fast bleep the reg.
documenting every single thing that has been ordered for or is happening with every patient
managing and implementing blood transfusions
pressure area care

The novices don't even really know what any of that stuff is.  I singlehandedly have to stay on top of all that for 20 people whilst getting interrupted literally every two minutes.  When the heck can I do a bedbath?  I should be doing it for assessment reasons but something has got to give.

And in addition to all that I need to do basic care so I can see my patients general condition and bring any problems to the attention of the doctor.  But certain aspects of basic care are about the only things that novices can help me with.  I need to beg the novices to please clean and turn my patients when I am tied up with blood transfusions and doctors rounds.  I need to be apologetic towards them for not doing it myself.  Everyone just thinks that the nurse wants to dump the basics onto the kids rather than get her hands dirty. Nurses will sometimes abandon things that should not be abandoned in order to assist the apprentices with basic care, trying to prove that she is not "too posh to wash".  Then blood transfusion reactions do not get picked up quickly enough.

Recently I was 2 hours into my shift and still hadn't even seen most of my patients at all.  One of them took a turn for the worst and was dying before our eyes.  I was tied up with that, trying to ring his family to come in.  After that was over I made a series of attempts to check on my other patients.  Notice I said attempts.  Everytime I headed down the ward, phone calls came in and I had to backtrack to the phone. Their drips were empty, dressings were on the floor, cannulas were tissued, catheters were pulled out, people were in retention.  The apprentices were on the ward, but they don't get involved in that stuff.  They just come to tell me it needs to be done.

Finally after an hour of fighting, I got to the bedside of my first patient out of 20 who looked like she has been cooking a nice hospital acquired chest infection or had possibly aspirated.  She was laying flat and sounding pretty bad chest wise.  The apprentices would have bed bathed her and left her flat. God knows what they fed her but I doubt it was pureed enough. Her oxygen sats were low, 72% and her only past medical history is dementia.  I had just put the 02 on her face and sat her upright.  I needed to get some obs, could tell she was pyrexic.  She isn't on antibiotics as she originally was admitted for a collapse ? CVA.  She hasn't seen a doctor since 9AM Monday morning.  It is 4PM on Tuesday.  I think I need to get her seen. 

Smack in the middle of this two apprentices come into the room.  "Anna, there is a phone call at the station for you, it sounds urgent.  The ward clerk told us to come and get you".   Once we had a good but very part time ward clerk but she is away and has been replaced with shite.

I left my patient and walked all the way back to the nurse's station.  It was ambulance control.  They wanted the birthdate of a patient they had transferred out that morning.

Does anyone want to tell me why the ward clerk or the apprentices could not look through the discharge book or the notes and give the birthdate out to ambulance control?

This kind of shit happens every time I make an attempt to see a patient. All I am doing is backtracking to the phone, and praying that my patients are okay in the hands of the apprentices.

No.  The novices are not helping the nurses or doing a nurse's job.  We work for them I think.

A man who commented on The Times article wrote this:

As for the DofH quoting a rise in qualified nurses since 2007 of 8,563; it means nothing if they are passing their responsibilities to healthcare assistants. The increase in nurse numbers is just adding insult to injury.

Those DoH stats are a lie.  The few RN's on the ward are left with no choice but to delegate because the tasks that only they can do are overwhelming.  And it isn't the paperwork, unless you count the ten forms I have to fill in 20 times an hour to obtain life saving drugs ordered by a doctor.  The rest of the paperwork gets completely blown off to the point that we get in trouble over it.

When the apprentices and care assistants  are pissing and moaning and whining about being ordered to do bed baths on their own you have to remember this:  These kids have absolutely no idea about what the nurse has on her shoulders, nor do they understand how complex and time consuming it all is, nor do they understand the consequences of her not delegating tasks to the untrained staff.   It is the mere simple minds  who look at this situation and  say "the nurse doesn't want to get her hands dirty"