Saturday, 6 March 2010

Are They Hiring?

I just had a look at my Trust's current vacancies.

There are jobs for managers and administrators, purchasing officers, and HR.

Lots of them.

No Staff Nurse posts are being advertised.

They are advertising for more "apprentices" and aiming the adverts at teenagers.

It still makes me laugh when people say that the University education of Nursing is what has destroyed Nursing care.

You idiot.

If we actually had university educated nurses staffing the wards I would agree with you.  But the university educated nurses are stacking shelves at Asda while they try to find a job at the bedside.  Even if they only want to do noctoring and managerial stuff they cannot even dream of it, if they do not have years of experience as a bedside nurse first.

The vast majority of staff on the wards at any given time these days are untrained, uneducated but mostly nice if a little dippy carers who have never been to university and do not want to become Nurses.  It is getting to the point where we rarely have more than 1 RN per shift.  The Nurses are an aging workforce.  Most of the time that one nurse per shift is someone who trained back in the "good old days".  The majority of NHS staff who are actually qualified nurses trained pre project 2000.  Carers cannot help with drugs, treatments, orders, information organisation and action etc etc.  The lone nurse carries that on her own.  There are more drugs that need to be prepared and given than you can possibly, physically give.  That's the case even with the threat of getting sacked for a med error and getting struck off as a nurse at the forefront of your thoughts.  Even if your stomach is doing flip flops, due to fear that you are going to kill someone due to medication problesm, you still cannot do it.

In Victoria, Australia and California, USA the hospitals must staff their wards with degree nurses so well that no degree nurse is to have any more than 5 patients at a time. This is law.  The hospitals tried to resist these laws but patients were dying.  The law went into effect around the year 2001.  If one of her 5 patients gets unwell, she gets another real nurse to help out with her other 4. In the UK I start my shift with more patients than I can handle, then I get more and I have so many constant and unrelenting interruptions that I cannot accomplish a thing.  The only way to survive, and ensure my patients survive is to stay focused.  This makes me look hard---as if I am lacking in compassion.
 The  degree RN in California has a small number of patients which allows her to do everything for them.  Care assistants are few and far between. This is what they have over there, rather than untrained kids running around and one real Nurse trying to do it all for 30 patients like we have in the UK.  On a 30 bed ward in California you would have 7 real Nurses  at least (One in Charge), maybe one care assistant who is merely helping out rather than taking charge of the basic care, admin staff to answer the phone, domestics, dietary staff for a shift..   In the UK  you will have one real Nurse and 3 untrained kids on a 30 bed ward per shift and that is all. This is getting to be the norm.

You won't hear of any patients getting starved, neglected, and left in their own filth in Victoria or California.   And their staff nurses are ALL degree nurses. 

You think it costs too much to pay all that well educated staff?  Wrong again, they actually have lowered their costs by improving patient outcomes as a result of having strict, legistlated nurse patient ratios. If hospitals weren't so busy fucking around with government initiatives and interference this stuff would probably be automatic.

http://nurseactioncenter.org/campaign/Staffing_Ratios/explanation

http://www.haponline.org/downloads/HAP_Summary_HB_147_SB_689_Nurse_Staffing_Levels_Sept2009.pdf

The second link is fabulous.  The hospitals would not be able to include care assistants and non direct care providing nurses in their ratio declarations.

25 comments:

Anonymous said...

I was at a 'hospital at night' meeting today where the night nurse practitioner and the night matron were laughing at the silly little ward nurses who thought they had too many patients and not enough staff - apparently it was so much worse in their day and the ward nurses should just pull their socks up and stop complaining (note that none of these nurses now worked on the wards).

The parallels between nursing and medicine are so striking it isn't funny.

Nurse Ratchet said...

Lord that makes me cross. I spend my life trying to get more staff for the wards, God help me if I ever turn into them.

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

It doesn't surprise me at all. They think it is funny.

They forget that when they were on the wards there was less throughput, patients were not as sick, frail, and complicated. The nursing students were legally allowed to do more, mistakes were swept under the carpet.

They had more support in the form of hospital social workers who did the job rather than community social workers who dump on the ward nurse. They had visible matrons who supported the staff, ran the wards, and saw the patients.

There were more doctors and they were there more.

They were protected from constant interruptions.

They had a higher ratio of trained (RN's and EN's) to untrained staff.

Why don't you show them this blog anonymous?

Anonymous said...

I was trained in the the good old days Anne. And yes, things were different then. As you say, more qualified staff and more support, but I would argue that "mistakes were swept under the carpet." What do you base this on?

In is interesting that you feel patients were not as "sick, frail or complicated" then. How come?

I was a science graduate, but after two years in the research field, decided that I would do what I really always had wanted to do - become a nurse.

Of course, as I was not a graduate nurse, I decided after qualifying to leave my brain on hold. Since then, I have not taken on board any new procedures - refuse to do them! Novel meds after that time - refuse to dispense them! The list is endless. I prefer to squark on about the good old days.

Get real Anne and stop attacking your colleagues!

Nevertheless, I do enjoy your blog, for in the most part, you report as is.

Dino-nurse said...

Staffing levels on general wards were far better 30 years ago. Fact. Students were apprentices. I can remember doing drug rounds with another student, putting up drips, doing the paperwork and even being the teamlead for a shift- all as a student. Like most, my first ward as a staff nurse was the last ward I had worked on as a senior student, hence not too big a culture shock. Yes the responsibility was hard to get used to but at least I felt at home. Now whenever I attend directorate meetings I have to gag myself. Our matron is pretty good the sticks up for the unit. Same goes for the ED matron. Unfortunately the others are a waste of space. Any hint that staffing is a problem is glossed over with glib comments about lack of resources and targets being the most important things. Most meetings are merely there to introduce the latest batch of pointless audits. Most of the surgical consultants no longer even turn up.

Toby said...

I see Iain Dale posted a letter to a MP today about a generic ward problem andd nothing like as horrific as your 12 patients to 1 RN story earlier.

Perhaps, if you get time, head on over explain in a post. TBH if more RN people were willing to speak out on larger media sources (guest blog on larger readerships or even comment on these issues on those blogs the we might graually start to see some better awarenes perpetuated via the MSM as its becoming increasingly obviouss that the MSM no longer generat their own content and trawl for stories off blogs.)


The problem, of course, that all blogging done about life at the coal face on public services are done by people who a: don't want too much attention and B: are constanly on the job and just don't have time to surf and discuss on other forums/blogs.

But Dale's post along with other articles you mentioned before are starting to point to 'near truths'

DespairingLiberal said...

Toby, I think Iain Dale is doing what he so often does, eg, pick on one rather narrow aspect of the problems that the NHS is having as part of an ongoing anti-public healthcare campaign that he and his fellow travellers of the New Right so ardently follow - their goal is complete privatisation and removal of healthcare from the majority.

Nurse Anne, I am glad to see your blog, very informative and revealing.

pj said...

That incident does sound pretty bad but I was much amused by this line:

"Between my wife and I we survived the week but it certainly was not without incident! I have total admiration for many of the staff but there are fundamental issues that need to be addressed and in my view a starting point would be to listen to the Matrons etc who I am sure can see ways for improvement and who are doing their best with the resources provided."

Yeah right, the Matrons, they're clearly the ones who know how to sort everything out - all that time they spend at the coalface.

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anne...where are you???

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