Saturday, 6 February 2010
I see Creepy People.
Or crazy, stupid creepy people who watch to much TV perhaps.
People are generally ignorant about things in which they have no personal experience.
Even the most open minded person who is aware of his own limitations will lay into medical and nursing staff like a rabid dog. I put this down to fear, the inability to deal with their mortality, their loved ones mortality, and the loss of control that all these things bring. Most people have no understanding about what a nurse is, or what she does, or what she has on her shoulders. But that does not stop them from being a monday morning quarterback, ready to tear her to pieces. The mental guidlines they use to measure their nurses (and doctors) by come from years of fictional and incorrect medical dramas that they have viewed on TV.
On TV even the dying patient looks lovely and calm...because the nice nurses and doctors made her look that way.
On TV nurses and doctors have lots of breaks to chat. On TV a confused patient can be settled down with a kind word. On TV the patient has his own crew of multiple nurses and doctors, around him at all times. On TV the nurse will stop and attend to you as soon as you shout nurse because that is what she is there for, it's not like she'll have other patients sicker than you. On TV the hospital provides that staff with enough linen to change the beds every day.
On TV a trauma patient looks beautiful after falling out of a plane and survives horrific injuries because the doctors and nurses decide to make her look beautiful and make her survive. On TV elderly people are never violent or aggressive. They never attack other patients or rip their tubes and lines out, as well as the tubes and lines out of other patients. If they do behave like that, the nurse (or the doctor) is shown sat at their bedside, holding their hands, because on TV doctors and nurses are not being rushed between multiple patients as if they are working on an assembly line. On TV if a patient dies it is because the doctors and nurses are crap, incompetent or evil.
Now de- program yourself.
We deal with these kinds of attitudes on a day to day basis. You wouldn't think that people are so stupid but they are indeed. Everyone has stereotypes about lawyers, stock brokers, and McDonald's burger flippers. But that is nothing compared to the bullshit they believe about medical care.
Last week I took over from another RN on the shift after hers. On her day shift her youngish patient crashed and survived but she needed to one to one him for 6 hours until he went to another facility. In real life these things occur all the time, and the nurse is not given another nurse to care for her other patients. That means that they are without a nurse until the their nurse dumps her critical patient on someone else. As she is walking back and forth to the medication room to get additional supplies for her patients she cannot, under any circumstances stop and get commodes or do a drug round or any such thing. The healthcare assistants are around, trying to help out the best they can. But they cannot do meds, or doctors orders, assessments, dressing changes, discharges etc. This means that the other patients are without that stuff for as many hours as it takes for the nurse to lose her critical patient. The nurse cannot control this in any way shape or form.
I took over from Rachel and my first job was to run to her other patients who hadn't actually seen a nurse all day. The critical patient was now gone. I caught up on the other patients care etc etc. All I got from them was
"oh you are so nice compared to that horrible Rachel this morning, who ignored us completely"
"Oh you are so nice, that Rachel hates old people"
"That incompetent Rachel didn't bother to bring my tablets on time"
"That horrible nurse Rachel didn't change my dressings"
"Thank god for nice nurses like you Anne, that horrible Rachel has no compassion"
"I am going to report that horrible Rachel, I shouted out for her to bring a commode and she ran right past me and told another girl to do it (Rachel was running for a bag of geloinfusion and the other girl was a health care assistant who could not help out with the critical patient).
It didn't matter how many times I explained that Rachel is actually an excellent nurse who was tied up with a critically ill patient that she could not allow to die. It didn't matter how many times I explained that the reason I was able to care for them right now was because there was no longer a critically ill patient on the ward. It went right over their heads.
Now I can certainly understand these patients being distressed by their lack of care. I would be distressed as well, and angry. But why would they assume that a nurse with multiple patients would be able to meet all of their needs instantaneously, at the drop of a hat? What causes them to classify a nurse who doesn't do this as "lacking in compassion". Even when they are told that their nurse has 15 other patients, that one of them is trying to die on her, and that management refuses to staff the ward with actual nurses as they did years ago even though the patients are sicker now............the average lay person still does not get it.
This is why we lose nurses.
The next day I was working with a lovely health care assistant. She is 19 weeks pregnant and was scheduled to work an 8 hour shift. We had no care assistant for the afternoon so she stayed on and in total did 14 hours. Bless her heart. But even so we were struggling. The afternoon shift for 30 patients consisted of myself, another RN and this pregnant care assistant for 30 heavy and complicated patients.
Their families don't want to be bothered pushing their service providers to hire nurses, they don't want to understand what intentional short staffing by management does, they don't want to be bothered backing the nurses up when they blow the whistle on short staffing but boy oh boy do they love to lay in to the nurses for not providing one to one care.
If you want someone to always stay with your mother while she is on the commode, or always have her pain medicine on time, or be there instantly when she needs the loo then what you want is indeed one to one care. You don't want your mother's nurse to have any other patients. The nurse has no right to control how many patients she has nor can she control what is going on with them. She cannot even control how long she spends with them at a time, as all that depends on her other patients. To you, this seems to mean that the nurse "lacks in compassion". I don't think it's the nurse who lacks in compassion, not by a long shot. I think it is the public. Mentally, they cannot deal with the reality of sickness, death and health care economics, so they lash out at the soft targets. Nice.
Ellen, the lovely pregnant health care assistant went to hour 11 without a break of any kind or food and fluids. At hour 11 I told her to sit her ass down and have a break. There were lots of things going on in the ward, we are always outnumbered by call bells and patients needing help. But I didn't need a collapsed pregnant health care assistant on my hands as well. The hospital will deduct 1.5 hours out of her pay for breaks whether or not she takes those breaks. She was not going to take it. I made her take one. As I said before, I wasn't in the mood to deal with a collapsed and pregnant member of staff. She finished what she was doing and went to the office with a mug of tap water and some dry crackers. She didn't feel that there was anytime for her to disappear off the canteen.
Enter Simon. He is the son of a frequent flyer patient of ours. He likes to follow the staff around taking pictures on his phone. If a patient is ringing a call bell he stands there with his watch and counts how long it takes for the bell to be answered, then he goes apeshit on the staff.. He doesn't bother to think about what the staff are actually right in the middle of at that moment. He jots everything down in the notebook and shouts at the nurses. To Simon, anyone in uniform is a "nurse" and she is a nurse who doesn't want to take care of patients. He tries to take pictures of patients so he can sent them to the papers and "shop us" for neglecting everyone. If he sees a confused patient shouting out he demands that the staff "do something to stop her confusion and help the poor woman right now dammit". Simon, there is absolutely nothing that a nurse can do to stop a patient from being demented and shouting out. Nothing. Nothing. Nothing. Nothing. Even if I didn't have other patients who need things at this moment. Simon is like our wards own little daily mail police officer. We don't have security or anything, we can't kick him out, we just have to put up with it.
As soon as Simon saw Ellen head into the office with her crackers he was straight there, camera in her face, taking pictures of the "lazy nurse who is stuffing her gob whilst patients need help". I had words with him, explained that Ellen was not a nurse, that she has put in a long day trying to help these patients and that she is expecting and needed to stop and eat. He laughed at me and shook his head.
Simon is not just one guy, he is many. We are getting more and more of this. Simon himself is unemployed. I doubt he ever went as long without food, working his tail off, as Ellen was doing. Pregnant Ellen took a grand total of 10 minutes out of a 14 hour shift to stuff some crackers and tap water into her mouth. And she was called lazy. Only nurses and health care assistants could work a 14 hour day in horrendous conditions where they can barely function and still get called lazy by an unemployed 40 year old healthy (physically) male. The other nurse and I skipped our breaks completely but even that did not get us off of Simon's hook, nor were we able to feed any patients or answer call bells quickly.
We are getting bombarded with Simon types and I don't really know what to do. He wouldn't behave this way in a supermarket, or a bank. If he did he would get kicked out.
What can we do about people such as Simon?
What can we say to people who think that there elderly mother was left on a commode because the nurse is "cruel".
Why do they not think about what else might be going on?
It's fucking creepy if you ask me.
I always find it very offensive that people will make these kinds of judgement calls about nurses without having any kind of idea what other things the nurse has on her shoulders at that moment in time. We know that lay people have no idea of the function of a nurse.
What about people who shout out a nurse whilst she is in the middle of slowing bolusing an IV drug and demand that she stops what she is doing and bring granny a bedpan?
Visitors do this and then run down to complaints whining about being ignored by the mean nurse who left crying granny without a bedpan. I know if I am bolusing a drug I will blank anyone speaking to me until I am done with what I am doing. I made a mistake once because relative rushed me. They show no respect for the nurse, or the patient receiving the drug that will kill them if pushed in too quickly by a rushed nurse. It is truly diabolical to start yelling nurse at anyone walking past in uniform and expect them to be able to stop what they are doing immediately and attend to you. They are in no position whatsover to just drop the ball like that.
How can we make these people understand why these things happen?
Why do we get no back up from the Hospital chiefs?
Or the Media?
Or our Nurse leadership?
Or the Doctors?
They have all jumped on the "The nurse can do everything perfectly at all times for 30 patients all by herself and give them all one to to one care on another person's terms and timescales...and if she doesn't, she is "lacking in compassion" bandwagon.
The terms and timescales of the patients, visitors, managers, doctors etc are a mute point anyway because they don't understand what else is going on in that ward. No nurse on a large short staffed ward can take all the time with one patient that he needs, without bringing harm to another.
I don't get it. But I know it has a lot to do with people not being able to deal with the fear and loss of control that a hospitalisation brings. I used to have sympathy. Now I am sick and tired of being the kicking bag for their dysfunctional coping mechanisms and their inability to deal with the realities of sickness and death.
It's never pretty. Sickness and death, old age, ischemic legs, loss of independence, infected wounds, sepsis, pulmonary oedema, death etc etc is always UGLY and HARSH. Even with the best staff on the case. Two litttle 5 foot tall nurses are never going to be able to move a 15 stone combative patient gracefully. We cannot stop people from falling. We cannot force people to eat.
It is never going to be pleasant or pretty.
So what can we do?