Tuesday, 15 June 2010

NHS Maternity Ward "Nurses"

Nurse Anne is grumpy and is feeling like being very picky this morning.

Over the last few years I have seen many news articles about maternity ward "nurses".  They are depicted as lazy and unhelpful.  This woman thinks she saw maternity ward "nurses" sat on facebook.   No doubt she saw staff on the computer.  Staff have to do lots of work on the computer, in real time rather than later when all the patients have had their needs met.  Otherwise they get their asses handed to them on a plate..  But rest assured that the staff in this situation were not nurses.  You must also realise that social networking sites are banned from hospital computers.

Head over to mumsnet type forums and you will often see mothers bitching about the "maternity ward nurses".

I find this very amusing as maternity wards in the NHS do not employ Nurses.

 There is not one maternity ward that I know of that has RN's on staff.  Not one.  Maybe some have RN's on staff but I have never seen it.  Feel free to correct me if I am wrong.

NHS maternity wards employ Midwives and health care assistants. That's it.  There are no generic nurses on staff there.  None.

Your average maternity ward will have too few midwives running between too many patients.  The only other staff involved with patient care are the health care assistants who cannot help with very much, who have no training and who might as well be sat on facebook for all that they are allowed to do.  

They are not Nurses as they have no training, and no registration.  They cannot answer a lot of your questions when the midwife is busy because healthcare assistants are not trained at all.  They cannot give you pain meds, sort out your drip, nor can they deliver a baby.   They are not given much in the way of information about your situation.  They probably aren't allowed to know anything about you because they are not registered professionals with training.  They are not allowed to get involved with your discharge.  And the overloaded midwife is running her ass off. It's not their fault that the trust is hiring these people instead of qualified staff.  It is not the overloaded midwives fault either.  For all the good health care assistants who are good there are 10 who are young, immature, and quick to give the two finger salute to the midwife if she tells them to get off facebook.  Management does nothing about the cheap labour with attitude.  If they piss off the cheap labour they might have to hire qualified staff! Gasp!

If I hear one more person bitching about maternity ward "nurses" and how stupid or lazy they are I will blow a fucking gasket.  Maybe if these "nurses" were actually NURSES they would have been able to deal with your questions/problems whatever.   Maybe if they were qualified professionals who knew your situation and were allowed to deal with stuff they wouldn't be sat on facebook.  Did it ever occur to you that your lack of care is down to a lack of midwives. No wonder these midwives are so damn grouchy.  I love maternity.  I love babies and I am fascinated with childbirth.  But I wouldn't walk a mile in the midwives shoes for all the money and gold in the world.   I would love a job on the maternity units assisting but I would never retrain as a Midwife.  The lives of all those precious mums and babes in my hands with no staff and no resources.  I'd flip out real fast and that would make me your run of the mill miserable midwife.

I think it would be quite helpful to the midwives to have professional registered nurses assisting them in the maternity suites.  I may not be a midwife but I had loads of maternity training in my nursing program.  I think I could assist the Midwives very well.  Too bad there is no chance of getting a job on maternity because THEY DON'T ACTUALLY HIRE FUCKING NURSES ON THE MATERNITY WARD.  Not in my neck of the woods anyway.

If anyone does know of a maternity unit that hires real nurses drop me a line a militantmedicalnurse@gmail.com

Maybe if the public and the media could actually get their semantics right they would have a clue about what is going on rather than that uninformed paranoid hysteria that they direct to frontline staff.  But they refuse to listen, and management takes advantage of their lack of understanding.  Same shit different specialty.

Rant over.


Dino-nurse said...

Oh so true. However, I do think that in some respects the midwives have made a rod for their own backs by insisting that childbirth is not a "medical" problem per se and (at least where I work) seem to be trying to push nurses and doctors out. About a year ago some bright spark decided to employ real nurses on the maternity HDU as it might reduce the numbers of mums who ended up being rushed over to ICU/HDU due to complications (PE, cardiac probs, low BP etc). It has worked pretty well and we had seen a real reduction. However the senior midwives were not happy as they felt we were medicalising the service too much. Now the nurses are being told to train up the midwives and go back to their own wards (as it was a seconment in the first place). They will not be getting any extra midwives to staff this HDU so I guess we will see more mums being rushed across site to us. No disrespect to the midwives but the seconded nurses were all from ICU/HDU/ED backgrounds with at least 3 years experience in these areas. This knid of experience comes with, well, EXPERIENCE.

Nurse Anne said...

I know exactly what you mean Dino.

I have heard of a maternity patient that ended up in ITU in fluid overload/heart failure because the midwives allegedly ran 4 liters fo saline in over a couple of ours and then didn't know what furosemide was.

You are right when you say that many of them resist medical intervention.

There are some midwives that I would like to say this to "Yeah, let's go back to the 19th century when a third of women were dying of childbirth and pregnancy related complications because "it is supposed to be a natural process". Whatever. Advances in medicine have stopped women dying needlessly. Medicalisation is a good thing.

If childbirth was simply a natural process why did a lack of advanced medical techniques kill so many? My great grandma was born in 1905 and she told me that in her day you had one foot in the grave when you fell pregnant. A simple natural process that medics should stay out of my arse. She told me that they wrote wills and prepared for their other children to be cared for when they fell pregnant since death is childbirth was the norm.

I read a lot of stuff from the
19th century and it was commonplace for a man to lose 4 or 5 wives in succession because of childbirth. I recently read one account of a young woman in 1830's Indiana who died horribly delivering her first baby. The "midwife" was her illiterate mother in law. It took two days for the nearest person calling himself a doctor to get there and when he arrived he was drunk and had to be put to bed. If it is natural process that doesn't need medical professionals why did we have those kinds of outcomes constantly years ago?

That is good that they have RN's in maternity HDU but I don't think they have them on the general maternity units at all. Not as far as I can tell.

Anonymous said...

Do you hate health care assitants or something? I have been working in care since I was 18 moved up to the hospital at 20 and left at 22 to do my training.

I do not belive I have ever been a immature HCA and find your comments offensive.

-Student Nurse and occasionally bank HCA.

Nurse Anne said...

I work with a lot of good health care assistants. Those are the real health care assistants. Some are so good I am about ready to fall to my knees in gratitude when I see them on duty.

The ones who are crap are the cadets and the apprentices who we are now getting instead of healthcare assistants. They are like little pre health care assistants. They often have an attitude problem to patients and staff a like. They are often young teenagers. They misrepresent Nursing. They can not do the job of a Nurse but they think that they can. Their idea of what nursing involves is very narrow.

I don't care how offensive I am. This stuff is true.

Nurse Anne said...

"I do not belive I have ever been a immature HCA and find your comments offensive."

So the fact that you are a good care assistant makes all of them good? I don't think that is a very "mature" point of view. No pun intended. Not.

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

I am an F1, and recently worked in obs&gynae. I could not agree more that maternity NEEDS good nurses as well as midwives, especially on the post-natal side. I am too junior to work on labour ward, so my job was split between the gynae ward, staffed by surgical nurses and HCAs, and the post-natal ward, staffed by midwives and MCAs.

The two were worlds apart, and I really do think that having some decent surgical/gynae nurses on the post-natal ward would have made an enormous difference. Midwives are generally great at what they do when it comes to delivering babies, but I always got the feeling that once the women (sorry, "clients") came to the PN ward, they stopped being interested. Some nurses who understand why an up-to-date obs chart is important; or that a patient who had a laparotomy (sorry, Caesarian) the day before, might need a bit more analgesia than the paracetamol they had 3 hours ago (when other medication is prescribed but not administered), would have been an absolute Godsend!

Please keep up the great work, both in hospital and on the blog!

ICUnurse said...

We do need a better solution to critical care of pregnant/recently delivered mothers. The current situation seems to be that when a mother becomes critically ill, they are rushed to ICU/HDU, at which point the midwives (and obstetricians) seem to think they are no longer responsible for any aspect of care. The nurses and anaesthetists can do a great job of providing critical care skills/knowledge but don't know anything about managing PPH, for example, and thus feel totally out of their depth and unsupported. This has been my experience as a critical care nurse in a number of hospitals.

I like the idea of a maternity HDU/ICU. Or even simply a pool of midwives who are dual trained as nurses/ODPs and have a background in critical care (or who can be given some experience in it). One hospital I do some work at occasionally is planning to house these patients in PACU when they arise, and a team of PACU ODPs/nurses has been identified. This team is undertaking rotations through ICU, HDU, L&D, obstetric theatres etc. to give them a background in all the relevant areas and they will then care for these patients when they come up.

A NURSE said...

Really? No RNs work in OB? As an RN that has worked 15 yrs in L&D in Canada and USA....I find that unbelievable.... =^@

Nurse Anne said...

Believe it.

In England you have to decide on what branch of nursing you want to work in before you do your training. You have to decide between becoming an RGN (Registered General Nurse)or Pediatrics or RMN (Psychiatric) or a learning disabilities nurse or Maternity (midwifery).

If you are a registered general nurse working on a medical ward and you decide you want to do psychiatric nursing then you must back to school and get your RMN. If you are an RMN and you decide that you want to work in med-surg then you have to go back to school and get your RGN.

I am an RGN and if I want to work in Maternity then I have to go back to nursing school and become a midwife. Or take a paycut and work as a nurse's aid.

This pisses me off. I trained in North America so I have had general training. But they will only allow me to be an RGN here.

The midwife program is 3 years and they are the people who run and staff the maternity wards. Your prenatal care, delivery, and post natal care is run by the midwives. If a midwife wants to work as an RN on a medical or surgical ward then she has to go back to nursing school.

You can only get a doctor involved in the process if you are high risk or there is a complication. The midwives handle your entire delivery without a doctor. But they can call an OBGYN in if you have a complication. But only if there is a problem. The midwives deliver the baby and stitch you up and all that.

After the birth your baby does not automatically get to register with a pediatrician. You don't get a say in that. The health visitors (registed children's nurses who work in the family doctors offices) at your family doctor's office take over your well baby check ups after the midwives turn you over to them.

If the health visitor notices a problem she will refer you to your family doctor and if he notices a problem then you might get to see a pediatrician.

You can't just chose a pediatrician over here and make an appointment with him like we do in North America. You only get to see one of their is a problem with the baby. To be honest when I had a baby here after years in North America I was pissed off about it all. I want to work in L&D but I do not want the scope of practice that a midwife on a maternity ward in the UK has. No thank you sir.

It is a way of controlling costs. Obamacare is your lot now so Americans are going to have to get to grips with this kind of care.

Frustrated Fairy said...

I had care during the birth of my stillborn baby last year mostly with RN's instead of midwives on a postnatal ward. Live babies all around you is really nice situation when you are delivering a stillborn. There was a special bereavement maternity suite in the hospital but there were not enough staff for me to go there. I had to deliver my own placenta as everyone was just too busy to be with me. I'd love to have a face to face with the management team about staffing levels, I really would.

Anonymous said...

,hello nurse anne im a student and i am currently in my last year in high school i would love to work in the maternity ward, i would just like some advice on what career i should be aiming at i would just like to know which is , well a good career to take. would you give me some advice if i should go on to be a midwife or a maternity ward nurse! i need some advice ? thank you nurse anne

Anonymous said...

I have to say, as senior student midwife, your "blog" is the most unprofessional thing i've ever seen.

Nurse Anne said...

Unforunately it is all true. And if truth is unprofessional then so be it.

Nurses have been asked to act like professionals for decades yet no one ever treats RNs like professionals. They use the whole "be professional" thing to use and abuse Nurses. Don't buy into it. I know how to act like a professional at work without eating shit and being a kicking bag.

Wait until you get out there and see what kind of rubbish you have to put up with...lucky for you maternity isn't as bad yet.

Nurse Anne said...

I found a lovely professioanl blog written by a British GP for you:


babymossycow said...

If you read through posts on mums forums you'll see thzat msot problems are due to lack of communciation - not surprisiong really that the semantics of the ward are misunderstood.

When I recently went into hospital for different reason the little book I was given said who everyone was and had a breif description of their duties etc. This seemed a good idea. Also, sorry but also: My own personal experience of post natal care with midwives has been that it has not been the difference in level of care that differentiated the HCA and MW - it was [and I hate to say it] that all but one midwife treated me like a trouble maker for being there and HCA smiled and treated me like a human,

Just my observations.

A lot of respect for NHS staff.

Anonymous said...

I am not a nurse but am a state registered allied healthcare professional, was working in private hospital.

After having repeatedly complained about one healthcare assistant being constantly glued to her mobile phone and never helping me, I quit.

I agree there are HCAs that are very good, and I too was so grateful when those were around but unfortunately the HCA I had problems with is a protected species and because she has been working there for 10 years she assumed managerial status and just because she had an NVQ, everything I asked her help for was beneath her.

I have spent years and made a lot of sacrifices to get my degree, and like you say, I am supposed to be responsible for this HCAs work. But I was run ragged as a result of managers using the KPIs (key performance indicators) and turning a blind eye simply because I always managed to get the job done. I even had surgeons stopping me from leaving theatres because they wanted me to stop jumping from one department to the next, telling me that I shouldn't be trying to cope with the workload alone; the said that if I managed, my seniors would always expect me to manage.

Quite often this specific HCA didn't bother to stick to her rota and didn't turn up, so instead of chastising her, the Radiology Manager (a Theatre Nurse by own trade herself) just used secretarial staff that's how dangerously stupid it has been.

Yet, if something had ever gone wrong, you are right, it would have been my head on the chopping block. They put my registration at risk yet I am powerless to refuse to work with her.

So I walked. I now have NO MONEY coming in whatsoever. AND,since the hospital has a bad retention and recruitment record in my department, my qualified colleagues that protected her will have to carry the workload now with one less professional around.

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