Tuesday, 20 April 2010

Mixed Sex Wards.

The government has maintained that these wards must be disposed of as soon as possible. The Nurses must do more to prevent patients from being admitted onto wards where their dignity will be compromised by sharing facilities with members of the opposite sex. 

Yesterday I had 5 male patients who were ready to go down to stepdown beds (the few that exist, we don't have enough) that were available at the tiny cottage hospital up the road. 

The consultant for these five patients determined that they were medically fit (they were) and that they needed further rehab and care while social services sorted out their home care/residential homes.   The acutely ill patients MUST to come to my hospital to get the care they need.  The cottage hospital is merely stepdown.  So we try to get stable patients who need looking after up to there.

I rang the bed manager to let him know that we have 5 men who could go to  Daisy Cottage hospital. 

"Excellent" he says.  Medical admissions is bursting at the seams with patients for you to take.  And Green ward over at Daisy has 5 beds!"

Too good to be true I thought.

So I rang Green Ward at Daisy Cottage Hospital to handover the 5 male stepdown patients.

As I started to handover the first patient, John Doe,  the Green ward Staff nurse informed me that they are nightingale and only have female beds and one bathroom.

They are under pressure to not mix up gender-designated accomadation.  The male ward at the cottage hospital was closed to admissions.

We got off the phone and I called the bed manager as the staff Nurse at the cottage hospital did not want to accept my 5 male patients. Or, at the very least, she wanted time to shuffle things about to get appropriate beds somewhere else for either her females or my males. There are only three wards there.

The bed manager was livid.  "Goddamn them, they will take those patients, and they will take them now, A&E is breaching.  I'll ring them.".

And 2 minutes later the cottage hospital nurse called me back to accept handover on my male stepdown patients. 

And my 5 male stepdown patients went to an open plan female ward.  The Nurse there told me that they are threatened with discipline for mix sexed wards and that whenever this happens they fill in incident forms but nothing ever gets done.

The government says that the ward nurses are responsible for maintaining dignity.  And that ward nurses are to take the blame when patient dignity is compromised.  They say that ward nurses must take the lead in avoiding mixed sex wards. 

I know that the bed manager sounds like the bad guy here, but he didn't have a choice.

The problem here is lack of facilites, poorly designed wards, and a health service that has been slashing the  number of acute and stepdown beds for years.   

If they want to avoid mix sex accomodation they need to start re-designing and building and they had better get off the Nurse's backs while they are at it.

Sunday, 18 April 2010

Thank You Dr. Pena

The Nursing Times as recently published an article highlighting the issue of the UK's obscene Nurse to Patient ratios on general wards.  It is decidedly helpful when the Medics go to bat for their Nursing colleagues.

As is often the case, the comments posted by Nurses under the article are much more revealing than the article itself.


Wednesday, 14 April 2010

The Onus is on the Nursing Staff

45 minutes to dismantle, clean and rebuild a bed.

This is the trust's latest trick in fighting infection control. 

They continue to ignore the issues of safe staffing while scoffing at any suggestions made by the professional nursing staff regarding this matter.  They are unable to address the issue of high bed occupancy as a result of being forced to meet targets.  In a nutshell, this means that the ward is always to full to clean properly.  We continue to get slammed with admissions we cannot handle at mealtimes, during rounds, change of shift, and when we are struggling to care for the patients we already have.   We don't have enough domestics.  We have no right to have an uninterrupted block of time at any point in our shifts to do our jobs.  We are doing so many things at once that nothing, NOTHING gets done well.

None of this gets addressed.  Ever.

But the trust behaves as if it is  quaking in their boots at the thought of getting busted over poor hygiene, super bugs and poor care.  They cannot deal with the real issues that lead to these problems so they are covering their assess and putting the onus on the Nursing Staff.

I attended a study update the other day to learn about the trusts requirements for the cleaning of all 30 beds on the ward.  The process that we were instructed upon is to be implemented daily and between every discharge and admission.  They want each bed completely dismanted and every part cleaned in a certain way, every single day and between each patient.  It is heavy work that requires at least 2 members of staff.  It takes at least 45 minutes to do one bed.

There are 30 beds. We have between 5 and 15 discharges and admissions per day.  There are 2 nurses and 2 assistants for a 12 hour shift during the day who cannot even attend to all the Nursing care that needs to be accomplished. 

Do the Math.

We cannot even get around to everyone fast enough to prevent pressure sores, dehydration, notice changes in condition quickly enough or medicate properly.  Here's a newsflash for the doctors:  you know those IV antibiotics that you prescribe to be given 4 times a day?  They are getting given two times a day max because the nurse has so damn many of them to mix and give that it takes hours.  Yeah, doses get missed regulary.

Now you need to take into account that in addition to this we must clean and dismantle 30 beds that take 45 minutes each to clean every day.  And in addition to that we have to dismantle and clean them between each patient.

They won't bring more staff on board.  They don't want the domestics doing the beds and there are not enough of them anyway.

During the course of the study update we did explain that we will be unable to follow this bed policy due to a lack of time and staff.

This statement was met with ridicule of the Nursing Staff in the form of eye rolling and the inferred notion that Nurses are too thick and lazy to do their job properly.

And I quote:  " The trust is implementing this policy to prevent the spread of infection.  There will be spot checks to ensure that these actions are being carried out.  If they are not, the blame is on the professional Nursing staff."

Did I tell you that they want us to spend 11 minutes exactly in a cramped room cleaning and dismantling commodes and documenting it between each patient use.  Four commodes are being used over 15 times an hour on some days. They are swabbing them to ensure that this is done.  The swabs are never clear.  And infection control is up our asses over it.  They have devised even more cleaning checklists and paperwork.  Same with pressure sore audits etc.

And they want to know why we have so many pressure ulcers, and drug errors as well.  And they have demanded that the RN on duty drop what she is doing as soon as the consultants arrive (we don't know when they are coming and cannot plan for it) and attend every ward round, following the medical teams around the ward for hours while they see their patients.

And if my patient suffers harm because I am off on a ward round or dismantling a bed I must take full responsibility.  It's tough shit really.

Fuck them.  I am going to Nurse my patients starting with the high priority actions and working my way down.  I will turn the patient and if that doesn't leave time to document that I have turned them it is too bad.  The trust wants documentation that it is done more than they want it to actually get done.

Monday, 5 April 2010

Sunday, 4 April 2010

Too many untrained staff.

I lost my mojo with writing a wee bit.  But I thought I would update you on any new developments.

Awhile ago I explained that my trust was replacing real nurses with care assistants.  And then they started replacing care assistants with untrained 17 year on "nursing cadets" who I like to refer to as "kids".  Most of these kids have no interest in nursing.  They take the job because it pays a little more than McDonald's and because they like to play around in the nurse uniforms.  The few that do have an interest in nursing would be wondeful to have in addition to a well staffed ward.  But instead they are all we have instead of a well staffed ward.

6 years ago we had 4 or 5 registered nurses and 3 or 4 healthcare assistants on a day shift for a large ward.

4 years ago it went down to 3 staff nurses and 3 care assistants.

Now we have 2 staff nurses and two cadets per shift on a good day.  That means that they only people who can handle most of what is going on are the staff nurses.  The cadets can do very little outside of bed pans.  And many are not willing to even do that.

The health care assistants are leaving.  The qualified nurses are leaving and they are all being replaced with untrained cadets.  Being untrained (and young) means that even though they are counted in the staffing numbers, there is very little that they can do or understand about what is happening on the ward.

The cadets call off sick constantly.  We are talking at least twice a week..  Weekend call offs are a given because teenagers like to get drunk. 

They walk up and down the ward with mobiles.  They talk to the patients like idiots.  Some try  to copy the staff nurses in their interactions with patients but they don't really know what they are on about.  I once stood outside of a room eavesdropping on a patient telling a cadet that she thought she had a UTI as it burned when she passed urine.  The patient probably assumed that the cadet was a nurse.  "Is your pain radiating anywhere?  Like to your left arm?" asks the cadet.  At that point I went into the room, trying to keep a straight face.  When I get student nurses on the wards I need to use them to babysit the cadets rather than teach them how to be a nurse. 

We have to remember that the patients assume that these kids are some kind of Nurse.  Most are not even wannabee nurses.  They have had NO training.  The few in number qualified nurses are so on their knees that we cannot watch these kids or avoid delegating the basic care to them.  It gives me nightmares.  I have not a minute free to teach them.  This is why the cadets are only great in addition to real staff, not instead of real staff.   The qualified nurses are unable to find jobs.  But we are getting batch after batch of cadets.  And the trust tells the world "oh yes indeed we are increasing our nursing numbers".  There should be some kind of law that says that an NHS trust is only allowed to use the term nurse when they are actually talking about qualified nurses.  That would bring stats down.

It is getting pretty obvious that these kids are not being vetted properly.  We have had kids caught red-handed stealing drugs after asking for the keys to  "get some sudocrem".  We have had kids who have been found out to have a criminal record when they were once again arrested for assault.  We have kids who are coming to work hungover.  All sorts of alleged social problems stop these kids showing up for work much of the time.    One kid's boyfriend showed up on the ward and got into a physical altercation with her.  We have 16 year old pregnant kids who refuse to lift-the only thing that they are allowed to do anyway.

Thank god for the one or two cadets who are planning on nursing or medical school.  They are there for the right reasons and take pride in their work.  The rest of them are crap.

We have 4 decent health care assistants left.  Three of them handed in their notice along with a qualified nurse who has had enough.  In their place, we care getting 4 of these cadets.  The experienced health care assistant that is left has told the managers in no uncertain terms that she has had enough of the cadets and is refusing to work with them from now on.  The qualified nurses feel the same.

One of our qualified nurses was the sole RN for 30 beds with 2 cadets on a monday morning.  It was hell on and she was ringing and ringing and begging for more help.  They kept sending her more cadets and acting like the nurse would be fine as long as she had a "few more sets of hands".  This is how badly management devalues nurses.  They think that untrained chavs can do the job and help the nurses.  The qualified nurse broke down completely and resigned. And she is getting replaced with a cadet.  And the public thinks that these cadets are their new "modern nurses" who have been "ruined by university".   Wrong.  Most of these cadets probably never even finished high school.  And they are of no help to us when we are low on qualified nurses. The real new and modern nurses are stocking shelves as Asda because they cannot find a job.