Sunday, 27 June 2010
A Very Angry Patient
Many times on this blog I have posted about nursing cadets and apprentices. These are the untrained 16 year old kids without a shred of nursing knowledge that the hospitals are hiring these days instead of real Nurses. The real Nurses (the few of us that there are) are just running between too many patients because the cadets can do so little.
I have worked with a couple of cadets who are diamonds in a sea of shit. There is no knowledge there but they were mature for their ages, hellbent on becoming good nurses someday,and willing to learn.
The rest of them suck. And they don't care either. They don't want to become Nurses. They just want a few quid to go out with and the hospital pays them slightly more than McDonald's. The immaturity and attitude problems are unbelievable. They are not vetted properly. How I miss my older, experienced health care assistants who are mostly gone. How I miss all the experienced Real Nurses who have left and not been replaced by other Real Nurses. I could cry when I come onto shift with no one but inexperienced cadets who cannot do anything to "help". The public assumes that these kids are some kind of Nurse or something as they are wearing uniforms and handing out bedpans. Therefore the patients and visitors are not realising the true extant of the staffing problems.
One of these cadets really fucked off a patient and her husband. Let me tell you what happened. I wasn't on my usual ward but had been moved to another for the day as they had no staff. Neither did my ward but I was still taken from it for the day. *Details all changed as I comply with Hippa and always maintain confidentiality.
Older lady with congestive cardiac failure. Very swollen, very little output. Given massive amounts of Furosemide, a diuretic which makes a person wee for England. This drug helps their bodies get rid of all that excess fluid that is making it hard to breathe. Google congestive cardiac failure, fluid overload, and furosemide if you are confused. I don't want to explain it all on this post. We also keep these patients on fluid restrictions. Therefore they are not taking that much oral fluid.
The third time this nice lady rang her call bell for a commode to pass urine she expressed to me her worries that she was "being a pain, a right nuisance".
I reassured her that she most certainly was not a pain. I told her that it was an excellent thing that she was passing so much urine because it shows us that the drugs are working and her condition is improving. She had other medical problems in addition to failure that was making her short of breath. I also reassured her that she did right in ringing for a commode rather than trying to walk all the way down the hall to the toilets. I reinforced the need for the fluid restriction to keep her from any further overload. I was happy with the patient. She seemed happy with me. All good.
Lovely lady, no trouble at all. Not a bit.
I had 20 other patients and was caring for them when this nice lady rang again for a commode. Vikki Pollard, a 17 year old cadet (NOT A NURSE or even a trainee nurse) who was busted recently for 20 smoke breaks a shift answered her bell.
Vikki was the only other person I was working with for this group of 20 patients. Vikki did not want to be at work. She has no interest in nursing and never plans on becoming a nurse. She wants a paycheck. It was very easy for her to get a job at the hospital since the trust has decided to hire people like Vikki rather than actual Nurses. Vikki has no knowledge of CCF, diuretic medications, respiratory problems, congestive cardiac failure etc etc.
So Vikki answered this lady's call bell about 30 minutes after I was out of the room and said this to the patient:
"OMG I can't believe you are ringing again. Why can't you be bothered to get up and walk to the bathroom. Stop drinking so much if it makes you wee like that".
Vikki of course had sat through handover with me that morning. She heard that the patient was a CCFer on diuretics etc etc. That fluids were a bit restricted etc etc. But Vikki sleeps through handover and none of that information registers with her. There is so much of this information about all the patients that I am caring for that it is physically impossible for me to stay on top of Vikki's whereabouts and explain it all to her.
The next time I went into the patient's room she was quiet and didn't say very much. When her husband came into visit she unloaded to him. He cornered me and let loose wanting to know why some "young nurse" spoke to his wife that way 30 minutes after another nurse told her that passing urine so much and ringing for a commode was fine.
"You people don't know what you are doing"
"That young nurse as an abomination and should be struck off, so much for educating nurses at Uni"
"My wife is very hurt". (feelings)
Was he wrong? Only in the fact that he thought Vikki was a nurse and believed she could be struck off. She isn't actually a nurse so she isn't registered with any professional body to be struck off from. She certainly hasn't had nurse training or ever attended university. It takes an education to understand the situation of these patients and be truly compassionate. I will most likely take the heat for this as I am the one with the nurse registration. The trust doesn't want to lose the cheap untrained labour. But they want to lose qualified nurses.
What could I say to this man? Other than apologising and agreeing with him what could I say to make it better? I can't deflect all responsibility onto Vikki Pollard because I am the patient's nurse. I did try to explain to the husband that Vikki was an assistant and not a nurse and therefore she did not understand the situation. But there is no excuse for the way she spoke to the patient and I agreed with him on that. I spoke to the chief nurse about it all. Nothing has been done. They are still reducing the number of qualified nurses at ward level (both old and new trained) in favour of these young kids and novices. Both the older trained and new uni nurses are on their knees being so few in number and they cannot find jobs on the wards.
What to do what to do.
This is where the argument that nurses are "uncaring as a result of being university educated " Falls apart. I studied so much pathophysiology and pharmacology in nursing school that I understood this patient's situation completely (from a nursing, if not a medical perspective). Had this lady rang her bell 50 times an hour to pee my knowledge would have allowed me understand why and demonstrate compassion as a result of that understanding. Poorly educated and poorly trained carers are more likely to lose their rag with these patients as well as very demanding patients because of their lack of knowledge.
But thanks to the likes of Melanie Phillips, Frank Field, Iain Dale, and Minette Marin, the hospitals will continue to get away with poorly educated carers in the place of nurses. And not only that, but we will have poorly educated old fashioned trained nurses who cannot deal with the demands of modern patient acuity. * Edit They would be able to handle it if they had decades of experience under their belts. But new recruits to nursing will not have that, or the support that the nurse's who trained in the 70's had. This is due to poor staffing. If some of these self professed nursing and nurse education experts (who have never studied nursing , let alone understand what a nurse actually is) get their way and remove nurse training from university the hospitals will be even more full of Vikki Pollards as both qualified and unqualified staff in the future.
What to do what to do.