Monday, 22 March 2010

So Where is Anne?

I am job hunting.

And working a lot.  I was hoping that working double shifts would get me some extra cash but they are back to not paying overtime and we are getting extra time off instead.  Which, of course, leaves the wards even more short staffed.

I had the fright of my life yesterday.  Have to change details to protect confidentiality and all that.

I was on duty with one other RN and an an inexperienced auxilliary who did not know how to make a bed.  For the whole floor.

One of my patients was having a procedure downstairs and the department demanded, DEMANDED that the patient get transported back to my ward with an RN escort.  That means I had to go down there and bring him back. They are, of course, better staffed with less patients but for whatever reason the department staff always refuses to bring patients back.  We went back and forth for some time.  I told them that there was no way I could leave the ward to dick around down there waiting for porters and such.  But I got sick of them ringing me constantly and accusing me of messing up their list thus delaying patient procedures in their department.  I knew I wasn't going to win.  I know they don't understand nor do they want to hear about the short staffing on the wards.

Against my better judgement I went. And I got stuck down there waiting for them to get it together and then waiting for the porter.  I harassed them and reminded them that I really really needed to get back to the ward.

When I got upstairs I was wheeling this patient who immediately needed post procedure observations taken into his bay.  I peered into the bay across from his to see a young patient of mine looking very funny.  I ran to this person and it was obvious that this patient was in respiratory arrest. Was not breathing.  Still had a pulse though.  I dumped the post procedure patient (distressed that I was leaving him on a trolley in the middle of the bay--he didn't understand what was happening) and put the resus call out.

Holy shit.  This person has a history and was probably in the throes of a seizure while I was getting dicked about by recovery who couldn't be bothered to bring the patient back to the ward.  Following the fit, he stopped breathing.  And a I suppose it was several minutes later that I saw him.  I have no doubt if I had been on the ward, or if there was 1 RN per bay it would have been dealt with immediately.  The auxilliary didn't even understand that the patient wasn't breathing.

We have more patients going for diagnostics and procedures every hour that require nurse escorts than we have nurses to escort them.  The ward is almost always increasingly short staffed as a result.  So basically if we have 2 nurses and 2 auxillaries on shifts we are often left with two staff on the ward because of escorting.

I really fucking hate the people I work for.

I went to this study day/ meeting where we had our (old fashioned trained not been on a ward in 30 years) leaders telling us to read the reports on Staffordshire and cry for the suffering that was dished out by our colleagues.   They wanted suggestions about how to "improve" care and efficiency.  They want more with less but patient care will not be harmed and we will not be a staffordshire. They told us over and over that 20 billion is getting cut out of the NHS budget and that the current system is unsustainable.  They shut down and refused to discuss RN staffing when we mentioned it.  The even chortled. Sadly, they don't understand that it is cost effective to have more RN's at the bedside. 

Other head managers were at this thing saying things like "we are listening to our nurses".  He shocked me when he said it. Then I saw a journo and a photographer from our local paper  at the back of the room.   As soon as the journos split so did the chiefs. But they had a nice little photo in the paper with a "We are listening to our Nurses" headline.



Hayley said...

One of the things I learnt relatively early in my NHS career: the higher up they are, the less likely they are to listen.

I'm not clinical, but it doesn't take a genius to work out that there are problems with the NHS as is. That said, I'm always horrified when I read your posts about just how short staffed you are, and I wonder 'is it like this at my hospital?' I don't think it's quite that bad, but I know we're short staffed on the wards. We're short staffed everywhere, actually, except on the management corridor...

The thing that angers me the most is that the managers don't seem to understand - we're doing our best. I'm actually very lucky - my manager is a nurse who's worked his way up, and is very proactive if I ask for tools to facilitate my job. That said, I've been managed in the past by someone who, when told morale was low, informed the department that there was none in the cupboard. This manager also started out as a nurse.

I don't know what the solution is. I'm fairly sure cutting back on frontline staff is not the solution, though. Sadly, the hospital hierarchy has yet to realise this...

Anonymous said...

Our A&E dept (like Stafford) is often short-staffed. Yesterday I had to attend to someone who was having a seizure - an obvious priority, but I had to abandon someone who was having chest pain to do it.

All the while that I was tending to the fitter (ongoing seizure, blue, clammy, losing her airway etc) I was stressing about the patient with chest pain. Was she having an MI? I haven't had chance to do her ECG, was she stable...she looked a bit grey but I had to abandon her for the fitting lady. No-one else around to take over. (Apart from a bunch of managers hanging around the office stressing about 4 hour breaches coming up, looking rather annoyed at the lack of nurses to shift breaching pts to the wards.)

Once lady had stopped fitting I got yelled at by a colleague for some HELP NOW PLEASE(!) with a LVF patient drowning in his own secretions - SUCTION QUICK!

So...lady with chest pain was then abandoned, along with post-ictal fitting lady. Sorted out the crashing LVF, headed back to the fitter, who had vomited all over herself whilst semi-conscious.
THANK GOD I'D LEFT HER ON HER SIDE because she would have been vomiting into her airway completely unnoticed otherwise.

Eventually got back to the chest pain, who thank goodness was not having an MI. Bastard managers all stood watching us running round, giving us evils because by this time, patients had breached 4 hours.

I can't stand it anymore, this is NOT what i went into nursing for :(

(Which I suspect is exactly how the Stafford nurses felt, and those poor sods are now taking the blame)

Anonymous said...

Nurse Anne said...

Hi Anonymous,

And I bet you had 10 others bitching and calling you evil and "lacking in compassion" because you weren't bringing them a bedpan during all that.

Running down the ward with a bag of phenytoin for my arrest patient who came around and then started fitting again I yelled at the only other staff nurse who I was working with to get observations on my post procedure patient who was still sitting on a trolley in the middle of the bay in god knows what kind of condition. The only other staff other than the other nurse was an auxilliary who couldn't take obs.

I shouted to this other nurse to check on my post procedure patient on my way down the ward back to seizure man. This led to the crash team who was still with the fitting patient to yell at me and say "stop chatting to your colleagues and move it along". I had to spend ages hunting for more anti seizure drugs because there were none on the ward.

the a&e charge nurse said...

He hee, anonymous (2:14) it's only taken 7 years to wake up to the concerns highlighted in the BBC item you link to;

The RCN arrived at similar conclusions about A&E some time ago;

Sadly, nobody is listening.
Speak up about it and risk being marginalised, or worse.

My mortgage provider would be unlikely to advocate such a reckless course of action - many honourable NHS whistle blowers will understand (from bitter experience) why this is the case?

Anonymous said...

omg Anne, I can't believe you said this

"And I bet you had 10 others bitching and calling you evil and "lacking in compassion" because you weren't bringing them a bedpan during all that."

Because thats exactly what happened! A relative asked me for a bedpan during all this, and I said "i'll be with you as soon as i can" Obviously 20 minutes later I still hadn't got there, and she poked her head out of the door and glared at me like i was a piece of shit as i ran past. When i did eventually get there with the bedpan she completely ignored my attempt at apology, staring at me with evil eyes and absolute disgust. I was gutted :(

shijuro said...

keep smiling Millie... we love you...

Dino-nurse said...

The 4 hour "target" is what drove me out of ED in the first place. I am very aware of just how coddled we are in ICU and have made a bit of a name for myself amongst manager types because I do stick up for my colleagues...I have been called the "IR1 queen" and several far less complimentary things. The NHS today sucks and it is only going to get worse. Jump forward 20 years and we will have an insurance based system because its the only workable one...even Obama shied away from the idea of "free" healthcare for the poorest...instead all will be required to take out insurance. Thats where we are heading...massive ICU hubs staffed by RNs and general wards staffed by APs and HCAs that will care for those with poor insurance...most days the ICU cares for 75% patients who would be 1)uninsurable due to age/health or 2)never contributed to NI so would still be uninsurable...upshot being that most of our patients would no longer make it onto the ICU in the first place.Managers would love nasty patients overstaying their welcome on the ICU and then dying despite all that cash that was thrown at them.

Nurse Anne said...

You are right Dino. It isn't workable. So many dumb americans think that under Obama they are getting a system like the UK's or Canada. Ha ha ha ha ha. That is not what they are getting at all.

Nurse Anne said...

Free market has never been tried. Not even in the USA where the whole show is controlled by government/corporate co-ops. I don't think that insurance is so great either. There is an alternative.

Anonymous said...

Hey Anne,
It's Casey. I am so glad you are looking for another job! You can't keep working there. I am ambivalent about the Obama legislation. I hope it works out, but I just don't know. I know I don't want to work under the conditions you are subjected to in the UK. And I don't want a cut in pay. I am wondering what exactly this legislation is going to do to me and my colleagues financially. I was not for the bill in its present form. But that's what we're getting. I guess I'll say a prayer and hope for the best. We need reform. I'm just not crazy about mandated insurance as a solution. But it's a great day for Big Insurance here in the states. They just gained a captive customer base.
Casey in the USA

delcatto said...

As ever the 'proposed'(already happening) cuts will hit frontline services.

Dino-nurse said...

My Trust is in the red, so we have been told to stop agency and bank shifts. Also there will be few jobs for students qualifying this summer (again). My husband has been offered a job in I have a bit of a dilemma. Children would be able to take GCSE results and slot into final year for A level equivalents, it seems. Any ideas as to what its like to nurse there?

Nurse Anne said...

Nursing is tough and harsh everywhere. But Canada is beautiful. Especially Vancouver area and Toronto area. You will have a lot more in the way of job options if you are unhappy in one place.

I would run from the UK. I would be gone now if I could sell the house. Things are going to get a lot worse. When I went to this meeting recently where they were going on and on about the system being unsustainable and cuts cuts cuts my heart sank.

Anonymous said...

Over here, we also add the public and all media to the list of Dicks. All of the Dicks are guilty of mismanaging Health Care everywhere. I need to stop watching Dexter, it isn't healthy for me or the Dicks. Oh when nurses go rogue!

Anonymous said...

Dino-Nurse, come to Canada. It's still not as bad as it is in other parts of the world as far as nursing goes. With an ICU background you will have no problem getting a job. We have such a shortage here. Avoid Toronto though, way too big. Avoid anything in Quebec (nice place to visit but you don't want to work there). Alberta is fine except for the bigger cities. Vancouver or Victoria or Ottawa or any of the smaller towns and cities are fine.

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