You say that you have no problems with ward nurses and that you understand that they are in an impossible situation. You say that the ward nurses who do real nursing have your respect and that it is the noctors that you hold in contempt.
So why is it that the consultants only ever yell, scream at and abuse the ward nurses over lapses in care?
Anyone overhearing your rants would think that it is the ward nurses who believe that they are above basic care . Or they would be given the impression that the ward nurses don't want to be bothered staying on top of nutrition and hydration.
You know that it is impossible for them to stay on top of it for all of those people. You know that they only have untrained carers to help and that is why fluid balace charts, weights, and observations are not getting done properly. You know the nurse can't leave the carers on the ward while she attends ward rounds because that will lead to even more fuck ups and blunders that will cause the nurse to get a smack down. You know that the ward nurses are getting denied training to keep their skills up and are interrupted so frequently that they cannot even see their patients or read the charts.
If you want to let nursing profession have it, why not go for the throats of the noctors, the nurse managers, and the matrons who have not only accepted cuts in nurse staffing on the wards, but look the other way and refuse to go down there and give a hand? Why soley go for the staff nurses?
Explain it to me.
Noctors already get a regular kicking ;o)
ReplyDeleteI suspect harassment, and dare I say bullying, is probably related to ancient medical/nursing power hierarchies?
May I respectfully suggest that you encourage the nurses to bite back every once in a while?
A&E nurses are notorious for this - we have not earned the soubriquet 'rottweiler in lipstick' for nothing.
I must say, though, the relationship at our place between senior nurses and consultants is mutually appreciative, most of the time (providing they don't interfere too much) - perhaps this is predominantly a ward issue?
Even so, it sounds like a corrective feedback loop is long overdue in certain parts of the NHS - I don't think anyone would disagree that antics of this kind are only ever going to be counterproductive, for staff & patients alike?
Interesting question I'm a medreg myself and I'm not a shouty rangy sort of person. But I can see why doctors do it .
ReplyDelete1. It can be frustration. We can see our patient needs care, we can see it's not being given.
2. Some nurses manage with poor staffing better than others. You sound like you manage really well and get everything done the best you can. There's a hope that if you shout you can turn the non-copers into copers
3. Another part of it is our attitude to our own workload. Admitting you can't manage used to be a sign of failure. If there's more work than a doctor can manage it's seen by other drs as there fault for being inefficient. Just pull yourself together and get on with it.
I'm guilty of a this attitude myself. Last week i told the fy1 covering the wards to stop whinging and get on with it. Oh and I also told him that it was unproffesional to take two meal breaks in a twelve hour shift, even if he was entitled to them by some law. The only break I take on a 12 hour on call is the time it takes to physically eat a sandwich. Which can usually be done walking down the corridor
I agree with your comments doctorz, especially number 3. I think these kinds of attitudes get used against us and that is why we are working so short. The problem is that we get taken advantage of....
ReplyDeleteI'm not saying the macho attitude to hard work is a good thing. Quite the opposite. It means that patients continue to be put at risk by understaffing. Nursing or medical
ReplyDeleteI worked at one hospital that expected one doctor to cover 13 medical wards overnight. A task that was just possible if no one got ill! None of the doctors complained even though patients were at risk. This carried on until they tried to replace us with a noctor. The np's shadowed the dr for a couple of months for crossover and realised it was impossible so now they have two np's and a doctor and things are a lot safer.
The other point is that If you stand on a ward and watch it's quite tricky to see exactly how much the nurses have to do in a shift. It's only when I found your blog, showed it to nurses and asked if it was like that here that I realised.
becaues they are there....
ReplyDeleteYou're right.
ReplyDeleteI've never ranted at a ward nurse. Ever.
I've met with 3 Directors on the Trust Board this week alone, and it's only Wednesday, about their plans for "modernisation" and "workforce review" because they don't and can't appreciate the import of qualified staff of the right seniority in the right numbers to deliver the right care.
The only way to sort it out is for all clinicians to be shouting, together, that managers need to take responsibility for managing a responsibly resourced service.
As 'doctorz' comments below imply, it is because the tradition in medicine is for shit to roll downhill - nurses get shouted at because they are there and senior doctors can shout at them, they do exactly the same to the junior doctors.
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