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.


murse said...

So, what do we do? Maybe you could get a regular spot in the Guardian now that nhsblogdino has apparently expired? Doesn't change the fact that nobody (including our pathetic simpering 'unions' gives a shite about nurses unless they are one (or married to one and tired of the moaning). When we do tell people how it really is they don't fucking believe it anyway. Still planning on voting with your feet?

the a&e charge nurse said...

In the theory your hospital should have a 'policy' that deals with harassment & bullying.

Might be worth dusting down ......... it will probably give you a bit of laugh, if nothing else?

Crippo said...

It would be a good idea if you took Crippen's place on the Guardian. These posts need a wider audience!

Dino-nurse said...

Your Trust sounds an awful place to work. I know that the NHS has a bad reputation regarding whistleblowers but it may well be the only thing left to do. As a group, nurses are piss poor at standing up for themselves in this country- problem ingrained within the public sector. Its about time that we actually did something constructive and went on strike. I'm not advocating that we walk of the wards but leaving on time at the end of a shift, not doing overtime to save money on agency, working to your job description...would do for starters.

TonyF said...

I think it's about high time that some of our so called 'leaders' were shown the truth of their incompetence. If only one ore two could get their faces out of the trough, and actually visit some of the places and things that that they have ruined. Without SMT hanging around. I suggest enlisting Guy Fawkes (or similar) to create some er, customers...

TonyF said...

I think it's about high time that some of our so called 'leaders' were shown the truth of their incompetence. If only one ore two could get their faces out of the trough, and actually visit some of the places and things that that they have ruined. Without SMT hanging around. I suggest enlisting Guy Fawkes (or similar) to create some er, customers...

TonyF said...

I have an echo...

Anonymous said...

Dear Anne
those managers are nicompoops and don't understand their job is to FACILITATE clinical staff. Be real sweet and ask them for a demonstration in the ward ? just to be real sure as to how it's done and whilst someone is dismantling ask them to take over some nursing eg iv medication or get a bedpan for a patient. Bet u they won't bother. Is this coming from infection control people ? I get so mad on your behalf.

Nikita said...


Have you seen www.nursingtimesnet/5013601.article Perhaps your message is getting through at last?

The Shrink said...

"And they have demanded that the RN on duty drop what she is doing as soon as the consultants arrive "

Quite right too, and mop my fevered brow, and make me a nice hot cup of tea, in fine bone china, with a doily and a nice biccie on the side, too ;-)

You really do work in a shithole of a police state, don't you :(

Anonymous said...

I just found your blog and am liking it.

Just wondered where you are from though? I know you work in the UK, but a lot of what you write sounds like it was written by an American because of the phrases and words (e.g. "You do the Math", "up our asses" etc).

Keep up the good work :)

Nurse Anne said...

Hi Anonymous,

I spent years and years in the US and Canada.

Anonymous said...

I am a student nurse on community placements and I love it, its way better than on a ward.

Maybe Nurse Ann should hang up her pinny and go to the community, one to one patient care, time to teach students, its great!

Anonymous said...

Our trust had a similar little directive to the on-call doctors recently - apparently there has been a problem with on-call jobs and patient reviews not being done in a timely enough fashion, on a completely unrelated note doctors are not documenting in the notes with enough detail when they see patients on-call.

Fortunately the solution is quite simple, the doctors will spend more time writing in the notes and also see more patients - problem solved.

When it was suggested that perhaps these were conflicting priorities and that maybe the problems highlighted a need for more on-call staff it was made quite clear that these recommendations will be implemented, there will be no more staff, and it will be a 'professional misconduct' issue if doctors are not able to comply.

A similar issue was seen with medical staffing where they did not attempt at all to find locum cover for known abscences, then at the last minute they ring up the rest of the doctors to inform them that they are obliged to cover the shifts* between themselves and failure to do so would again be 'professional misconduct'.

What is interesting is that there is apparently no concept of professional misconduct for these admin and management arseholes who get to tell everyone else what to do while going home early and apparently taking no responsibility for the mess they leave preside over.

* Of course the ensuing failure to meet European Working Time Directive limits is, funnily enough, the responsibility of the individual doctors and can be subject to 'disciplinary action' for working too many hours!


Hallo Anne,

I am new to blogland and am still not quite sure of what I am doing. I have mentioned this post in my third blog. If I have infringed blog etiquette - I apologise and would ask that you advise me of same.


Nurse Anne said...

No breach of etiquette whatsover my dear. I appreciate the link.

Eileen said...

Watched a programme the other day on German TV about the new super-hospital in Nuremburg which opened a couple of years ago. It has a "dishwasher" for beds - between patients every bed is pushed into a room which is like the dishwasher you see in pubs for the glasses. It's washed with high-pressure jets, subjected to a disinfection cycle and dried. All automatically, just pushed in by the technician running it, doors closed, push the button and hey presto!
As far as I remember, the patient is picked up from wherever they are admitted in the bed so 1 patient equals 1 bed reducing cross-contamination - they do have the advantage of a new purpose-built building which allows enough space for a bed rather than having to put your patient onto a trolley just so they fit in the space and of course there is also a reduction in the risks to backs of moving patients back and forth.

Anonymous said...

Great Blog. Glad to see nurses talking about how broken the system (s) is (are), not just where I work but everywhere. Not only that, but from what you describe at your work, I will be a bit more cognizant of how good my job is. Not to ignore that we do also have problems galore, but nothing on the level of what you endure.

Anonymous said...

Hah. Infection Control. You gotta love their poor nitpicking little hearts.

Our lot recently came up with the genius idea of attaching checklists in little plastic pockets to all the dripstands so that instead of doing anything remotely useful we nurses could fill in these checklists every time we cleaned a dripstand.

They were quite proud of their little notion until I said "But who is going to clean the plastic pockets attached to the dripstands? Don't we need a second checklist for that?"

Awww I think I rained on the parade.

JSAbetterthanMRSA said...

I am so glad to have found this blog. WTF is going on? How can these baw bags get away with this? The NHS was never perfect but it did at one time strive to deliver quality care. I left 2 yrs ago mid shift after working for 16yrs and it just seems to be getting more cynical. It seems to be the people that give a shit that are being isolated and burned out. They keep on putting posters up about violence against nurses not being tolerated. But keep on putting violent patients alongside very ill patients and we have to jump in like fukkin super heroes to stop some poor bastard getting a hospital acquired facial injury to accompany their o/a presentation.The worst part of it is that the person who needs restrained is wired to the fukkin moon and is not responsible for what they are doing and have usually been banged up with benzos for so long that when paradoxical aggression kicks in the whole thing is fukkin chaos. I am going to leave it there but it gets me so fukkin angry they can stick their posters and benzos up there arse. We need proper units with appropriate staffing to meet the very complex needs of potentially aggressive patients.

Anonymous said...

Your place sounds like mine.... we know have weekly cleaning lists, including toilets, changing rooms, visitors rooms, overnight accomodation and staff rooms added to our list of things we are supposed to clean,thats on top of the beds, multiple equipment and stock trolleys and rooms, oh and lets not forget the hour long computer assessment on clunky old NHS software that is worse than useless.
all the while working a 13 and a half hour day.. and looking after our Intensive care patient.
If I see another 'tick list' from management for some target they want us to reach so they get a fancy logo to stick on their letterhead I think I,m going to scream.

Anonymous said...

With reference to Ulrike's comments it isn't the good HCA's that are a problem it's the bad ones. I could kiss the good ones, I really could. Also, am a bit surprised you are not allowed to write in notes. Hell, even the lowest level support staff on our ward were allowed to write in the patient's care plans. One snitch used to monitor what the nurses did and write down comments on whether they had done things well or not in her opinion. She was 'bestest fwiends' with the ward sister, they were like siamese twins - if she had got any closer at handover she would have been perched on the sister's lap! You can't fight this set-up. Why was an auxiliary (with only a couple of years experience) allowed to behave this way? One day when I was with a consultant doing the ward round I told her to clean up a patient who had just messed himself and she actually refused and started arguing with me (and it wasn't the first time this had happened. Management just let her get away with this sort of thing. How I longed to kick her up her fat lazy little backside. How can nurses do a proper job with support staff who indulge in challenging behaviour like this? A hospital ward is no place for a worker who acts like a primary school child, it just isn't fair to the patients, it really isn't.

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