Monday, 8 February 2010
What is going on? What happened to respect?
How I miss our experienced Health care assistants. Now we get apprentices as they are called. They are thrown onto the ward with no training and no experience in the place of experienced staff.
They wander around in nurse's uniforms and refuse to answer bells and help with turns. They are unable to do observations. "That is all the nurse's job" they say. Well yes everything is actually the nurse's job, but I have a 150 drugs due in the next 45 minutes, the consultants are here to do their rounds, and family members are queing up to lay into me. My blood transfusion is here and I need to do 10 things to get it started, and monitor the patient.
Consultants are constantly yelling at the nurses for observation charts not being done and intake and output charts not getting filled in. They know damn well that it is physically impossible for the lone Nurse to attend to all of those things. But they yell anyway. I have no choice but to rely on the apprentices. But I don't know how to get them to understand the importance of recording how much fluid a patient is drinking and how much they are voiding...without that information we could send someone into pulmonary oedema or miss pre-renal failure. Just keeping those charts accurate for all those people would be a full time job on it's own. They just refuse to do it an I can't be there to do it for all those people. The apprentices know that the consultants will lay into the nurses over it. It's not the apprentices problem. They do as they like.
The domestics are leaving lists of jobs for the nurse to do so that the domestic can leave on time. The nurse is already staying over 2 hours past the end of her shift just to accomplish the things that only and nurse can do, and that is before you take into account all the things she is having to pick up because the apprentices do nothing.
The clinical techs are bullying the doctors. Clinical techs are people who are hired and trained to draw blood and insert cannulas. They have no further education or registration. You do not need any kind of schooling or anything to do this job. The clinical techs often worked at tescos prior to being clinical techs. They just do venflons and bloods to take the load off the docs a bit. Here is another group of people who have no real responsibility or consequences because they are not professionals, dumping on already overstretched professionals with no personal consequences to themselves. The problem is, they are sat in the cafe telling the doctors to do their own cannulas. They tell the junior doctor who is running between multiple wards with all that life and death responsibility off for asking them to do a venflon.
The clinical tech's favourite line is "Tell the doctor I am to busy, so he has to draw the labs himself". OMG you fucking slacker do you have any idea about what the doc has on his shoulders? He has a list of jobs on mulitple wards. IF he is telling you that he cannot take the time to draw blood, THEN HE REALLY CANNOT FUCKING TAKE THE TIME TO DRAW BLOOD.
The clinical techs are either answering pages to do venflons or they are kicking it in the cafe upstairs. If they are asked to come and insert a cannula they want to know why the junior doc is being to "lazy" to do it himself. Hey, if it doesn't get done it's the doctor's and nurse's ass isn't it? The unregistered staff never has to suffer any consequences. They don't. They just keep on passing the buck which stops with the few of us who can be held accountable for our actions or omissions.
Recently I saw a clinical tech screaming at a junior doctor for paging her to draw some blood. The clinical tech was annoyed because the doctor was already on the ward that required the blood draw. She didn't see why the doc couldn't just do it herself. The stupid little shit doesn't want to realise that the doctors have patients all over the fucking place and they they need to do what they can for the patients they are with, delegate anything that they can, and then run off so that they can get to the next patients.
The housekeeper takes 20 minutes worth of break time every hour and follows the 2 nurses around reminding them to clean the toilets properly. "Remember you have to fill in the cleaning forms, they are so important because management says they are". Then she castigates the nurses as lazy. Thick as pigshit she is.
If a doctor points out that an alcohol handgel cannister is empty to the housekeeper, she turns around and points to the storage cupboard where the re-fills are kept. Which means that it gets left empty because doctors are running their asses off trying to keep patients alive and really shouldn't be re-filling stock.
I had a domestic order me (when I was in the middle of a 2 hour late long and complicated drug round from hell) to empty the waste bins and collect in the dinner plates for her so she could leave on time. I was already slated to be there 2 hours at least past the end of my shift just doing nursing stuff. And that is before you take into account that my patients were sitting in pee soaked chairs for the last 8 hours because the apprentices, the only help I have, are refusing to lift the patients. Out of everything that is going on, it is one of the only things the apprentices could do to help out.
When we try and tell these people that the nurses and doctors are already overwhelmed and patient's are suffering we are told "Well, everyone is stressed". Really. And how the fuck are you people stressed when you are doing nothing and don't have any accountability to the law or a professional body? Serioulsy. If a care assistant or an apprentice causes harm to a patient the RN responsible for that patient takes the fall. They are working on my license.
Pretty soon the domestics are going to be bleeping the doctors to empty the rubbish bins, so that the domestics can have their breaks. Staff nurses rarely get breaks, and doctors never get them. I am waiting for the apprentices to start asking the doctors to empty the catheters for them. They are already refusing to assist the nurse's with anything. "You are the nurse, do it yourself, don't dump your job on me, it's time for my tea break". So the patient gets left sitting in pee for another hour until I can finish getting the guy with chest pain sorted out.
What happens when we try and knock these people into line? They get all upset and cry that they are being bullied. And management does not want the professionals pissing off the easily controllable and cheap labour. We are told that they are "stressed too" and that we should help them more. Yeah it must be stressful spending the day on your mobile and going out for fag breaks.
What the fuck?
Where is the respect and autonomy for professionals in this place?
It should go like this:
The rest of you... Including management with a non clinical background.
That looks harsh doesn't it. I did not make that list because I am some snob who thinks I am better. I may quite happily hand in my registration and proudly start working as an HCA or a tech again. I made that list because if the shit hits the fan with patients, it is the doctors who have the most to lose. The nurse comes in second with the most to lose. That is why we delegate. It isn't because we are lazy or snobby. Now show some fucking respect and give us a hand.