Thursday, 1 July 2010

Out of the mouths of babes

I feel really bad for the decent cadets and health care assistants for writing this.  But the fact it is that many of them are not so good and should not be employed instead of Nurses.  They fact is that they will continue to be employed instead of Nurses.  Neither job seeking RN's who trained in the 70's nor new graduate RN's can find jobs on the wards. 

Here is the latest one from  the ward next to mine:

Patient became unwell in the night with..... let's say sepsis, very weak and has gone from able to attend to her own hygiene needs to being totally helpless.  This has happened very quickly.

Enter the auxillary, who has sat with the Nurse and "listened" to handover and all the information on these patients at the beginning of the shift. She  goes into the room.  I put the word "listened" in quotes because many auxilliaries, cadets and the like sleep through handover.  They just just get on with baths and forget everything else.

"You could wipe your bum yesterday, why not today?" says the auxillary to the patient.

I cannot convey how nasty and condescending she sounded when she said it.  A blog just cannot convey that.

The Nurse didn't know that this happened.  She was up to her eyeballs in drugs, orders, doctors rounds, discharges, emergencies, and admissions for her 15 patients while the auxilliaries were doing all the basic care unsupervised.  This is why we want RN staffing ratios to improve.  RN's all know that RN's must be involved with basic care.  This is true whether the RN trained in the 1970's under the hospital programs or in the 1990's under the hospita/university training programs.  It is the managers that do not understand this.

She found out when the patient's daughter came at her screaming and wanting to know how any "Nurse" could be so stupid and rude to her mother.  The Nurse gently explained that the auxillary "is not a nurse and doesn't have the knowledge but that is no excuse for what she said".    We have to say this to relatives a hundred times a day.

To appease the patient and her daughter the patient was transferred to my ward.  This is how I know about it.  I grabbed the non nurses (the only people I was working with that day, no other qualifieds) and I made them listen to me as I explained the patient's condition.

But the non nurses who come on duty tomorrow will again have a mini sleep during handover and the same thing may happen again.

Does anyone think it is funny that all these complaints about nurses being "rude"seems to coincide with the hospitals replacing real nurses with untrained people?

33 comments:

Anonymous said...

Hey Anne,

Absolutely love your blog :) It is so refreshing to hear someone talk about the day to day issues that nurses face. I am a newly qualified currently trying to secure my first post, but to no avail. Apparently there are only 3 NQ positions at my local trust!

It is so disheartening! I am 25, have a biology degree and a nursing degree under my belt, yet I already feel as if I have been tossed on to the scrapheap in terms of employment!

I am working bank as a band 2 NA at my trust in the mean time. There are several jobs for bank and permanent NAs at the trust. Most of the wards are staffed by NAs and APs, with only 2/3 RNs.

It is nice to know that the NHS values its nurses!

Keep up the good work and just hope you are gradually getting through to the public (and hospital managers!)

Nurse Anne said...

My trust has no jobs at all for staff nurses (real nurses) whether they are RN's who trained in 1975 or RN's who trained in 2005. No jobs for RN's. None. Zilch.

Only auxilliaries and cadets.

capgras said...

well there you go! you see it comes full circle! they cant get enough people to do diploma and degree nurse training and when they do get graduates........well the graduates want Band 6 salaries and to do stuff like i.v. cannulation and diagnose new bundle branch block and suggest changing antibiotics and run A/Es as practitioners with No doctors. so who is left to do the "nursing"? e.g. feeding, washing, turning, taking down the TEDS, holding the hands of the dying, comforting the releatives, getting people out of bed into a chair, sorting out the social history ect ect? Well blow me down with a feather its the great british underclass with thier NVQ in health care or more likely its Big Black Bertha from Uganda and little tingtong from the phillapines who are the only available auxillaries on the bank. Oh an an Enrolled nurse from the 60s has been wheeled in to apply toothpaste to the patients wounds. it worked in her day.

UCL Med Student said...

Wait what's a cadet - student nurse?

Nikita said...

Anne.

I don't know whether you are aware that there is (since yesterday) an almost direct link to the goverment where you can air your views. It can be found at http://yourfreedom.hmg.gov.uk

I have already left a proposal there and left a link to your blog to enable members of the public - and hopefully the government - to be aware of 'real life' on the front line.

I would suggest that all of us who care about the NHS use this service.

Nurse Anne said...

No med student they are not even nursing students. They are not training to be nurses.

They are literally minimum wage workers hired instead of nurses. They have much less training and cope of practice than nurse's aids.

They can apply to nursing school someday if they want to. But most of them have no interest.

Nurse Anne said...

Thanks Nikita.

Nikita said...

Anne.

Sorry email address is: http://yourfreedom.hmg.gov.uk/

Dino-nurse said...

Oh Capgrass- I have missed your wit :0)
Just to point out that not all degree nurses want to leave the bedside. Most want to stay but there are no jobs. When this years batch of degree and diploma students qualify where I work, they will be fighting through clearing for around 40 jobs...for nearly 200 graduates. Nevermind that most wards are at least 5 trained nurses down before they even look. They will have no choice where they work, just have to fill in the application and see what happens. We are currently in the throws of downgrading many of the band 6s and 7s where I am also. Not touching any of the pointless management grades but forcing bedside nurses to take a permanent paycut by using the AfC grading as a weapon. Band 6s in ED, Admissions Units, ICU and HDU are to be put down to a Band 5 because the Trust has deemed that "senior staff nurses" do not exist and a Band 6 has to be a ward sister. So these excellent nurses will be paid less money but still expected to do the same job...you do not forget how to set up a dialysis machine or CVVHDF just because you have been forced to drop a grade. Ultimately many will leave and go to a nearby trust who will pay them the 6. So we lose the experience and the patients have a less safe environment. This has been happening for the past 7 years here. One of my colleagues has changed jobs/trusts every 18 months just to keep her grade. Its not fair.

Nurse Anne said...

Dino talks sense.

A new graduate staff nurse has to start out as a band 5 staff nurse.

She will probably stay a band 5 all her life.

If she becomes a band 6 she is a ward sister. We have one band 6, who trained in the 80's on my ward. All other real nurses are band 5 junior nurses whether they have a degree or whether they qualified the year armstrong went to the moon.

That one band 6 is our sister. When she and I are on duty she is the sole nurse for beds 1-15 and I (band 5)am the sole nurse for beds 16-30. We do the exact same job.

At my appraisal I got told I function like a very senior staff nurse. But to bad that they will not promote anyone and that I am a band 5 technically just like the new graduates and the dinosaurs.

A newly qualified degree nurse will be a band 5 staff nurse Capgrass.

They have chance of doing anything else nor choice where they work.
It does take a good education to handle a band 5 staff nurse job on a ward as you are the sole qualified nurse for an extremely large group of patients.

Dino, Why are people so misinformed? Why do they think that newly qualified degree nurses are jumping straight into manager, practioner, and super nurse roles?

Can people not see that it takes a good education to be a junior staff nurse on a ward? It's not like these youngins will be working with anyone more senior than they are. Can people not see that all these health care assistants and carers are not junior nurses but rather complete non nurses?

Arggggggggggghhhhhhhhhh

Anonymous said...

As the first poster, I would just like to say that my training was exactly the same as a diploma student. Both degree and diploma students do the same lectures, number of placement hours and have to achieve the same clinical competencies.

The only difference was that in the final year I had to write an 8000 word dissertation, while the diploma students wrote a 4000 word essay.

I do not consider myself to be above diploma students or experienced nurses who don't have degrees. At the end of the day experience is what counts! I am fully aware that I am a rookie nurse and have a lot to learn. I am no doctor nor am I a seasoned nurse.

I respect and admire experienced nurses and only hope that I get good support and can learn from one when/if I do get a staff nurse job. I wish to start on a general medical/surgical ward and believe that throwing newly qualifieds into the ED/ITU is a recipe for disaster.

I enjoy bedside nursing and am more than happy to wash, feed, take down TEDs, hold a dying patient's hand, talk to loved ones etc.

I'll admit my training had its flaws (not enough anatomy & physiology, pharmacology) but I like to think that I know a thing or two about CCF, diuretics, fluid restriction and monitoring the weight of these patients for fluid retention...

My knowledge is basic, but hopefully better than 17 year old Vicky Pollard!

Sorry to waffle on!

Nurse Anne said...

Absolutely. I would love to have you work on my ward anonymous. They are giving us more beds. They are also refusing to allow sister to hire any RN's. Help.

UCL Med Student said...

Went and spent a lot of time on the wards today.
Chatted to some RNs, who do feel they are understaffed by they take on about 10 patients each I think, which is still nicer than your 15 Anne.

Like to think I helped a little (hung up some drips and stuff) but mostly think the RNs enjoyed having a chat with me and being able to vent their frustrations.

One nice lady still took the time to help show me some stuff I needed for exams, so it still seems like all goodwill is not crushed dead and gone!

Dino-nurse said...

I'm not entirely sure where the idea that graduate nurses started higher up the payscale came from...maybe a bit of confusion with newly qualified midwives? They do start a bit higher up the Band 5 scale. I think the big problem is that many of the NHS managers who do have a clinical background, are my age. Unlike me, they haven't really set foot on a ward since the 1990s. They do not understand just how much sicker patients are on general wards, nevermind HDU/ICU. I blame all those adverts that show 90 somethings living it up on SAGA holidays. Very few are lucky enough to be this healthy. We currently have several 90+ year olds on the admissions unit. They are demented, incontinent, wheelchair bound and are still for resus (lol) as its a weekend. Last shift the HCAs were running around along with the one RN as three patients crashed...no help came from other units as they are just as badly off. My heart sank as I had the floorbleep this morning- 2 more RNs phoning in sick for tomorrows shifts. Plus several wards with only one RN. Agency ban means having to spend the day phoning staff at home to do a swap or an extra. Also will have to trawl my way through medicine and surgery to check IV drugs with the lone RNs and try to work out a way that they can get a break during the day. I so hate doing this. Means once again ICU will have minimal senior cover as I cannot split myself in two. Yet again a band 6 will be in charge. The same band 6 who is currently in danger of being made a band 5.

Nurse Anne said...

You are right Dino.

If my hospital was hiring 2 staff nurses and they hired a newly qualified university grad RN and an experienced RN who trained in the 80's......the old RN would start at a higher salary. Not much higher but higher nonetheless.

Anonymous said...

And that's a problem how?
Forget the degree part - if someone's experienced, it's the norm in most professions to start on a bit more salary...
Sounds like your problem is having RNs full stop, not whether they are degree/diploma/dinosaurs!!

ophelia bum said...

Dinos job sounds a bit of a nightmare: but perhaps thats why she does it: she enjoys a challange. bloody tough at the coal face like that though. it can really crucify you. but then again i always think someone like Dino is more like our consultants (doctors) they do do a lot of clinical no matter how emienent they become: they still touch patients. one such swaggered in today for a ward round: he drove in a BMW with a number plate that read "fanny 1" (he is a gynea) he wore a white suit and he acted like a real prat. but when the patient had a placental abruption he soon put on scrubs and done the business including all the nasy angry relatives bit. Whereas some of these Clinical nurse specialists or nurse managers or site managers ect.........when did they last do a long day? i mean some of them do work hard. but why do the infection control sisters go around in pairs? are they scared of us? after they ask us if we have any problems they go off and THEN the micro doctors turn up with same question!

ophelia balls said...

and to continue. its 11am on a monday morning. the pain nurse comes in. she only works part time. she wanders in in her pretty dress and sunny sandles and promptly fills in a critical incident form coz i didnt do my PCA obs at 2am on sunday morning. (patient was asleep). the she wonders around saying to the patients "push your button" she doesnt know the patients at all, but still takes up my time by patronisingly telling me to give paracetamol.........(I would if i could find the keys) and since it is now 11am and i havent even done one BM stick on a patient on I.v insulin ALL shift.....why doesnt she just go and get the bloody paracetamol and give it herself......cant she see i am busy? and as for the nutrition nurse..........going about writing with her special pen in the notes. never see her come feeding time though. She suggests and Ng tube.....but will she bind the patietns hands to stop him pulling it out? and as for the vulnerable adult deprivation of liberty nurse.......well she wont even let me use a cotside unless i fill in a form. UGH. (THANKS I FEEL BETTER NOW

Nurse Anne said...

Anonymous you misunderstand.

It is a good thing that the new degree nurses do not start on a higher wage than those with experience.

Dino and I were saying that the public seems to think that degree nurse grads are on a higher salary, higher band than an RN with 30 years experience.


We weren't saying that degree nurses should get more, we were saying that the public are fucktwits for believing that they do get more. Read the posts before you respond next time.

Nurse Anne said...

"Sounds like your problem is having RNs full stop, not whether they are degree/diploma/dinosaurs!!"

Exactly, we need RN's full stop.

But from here on in the young kids wanting to be RN's need degrees. Yes the nurses who trained 30 years ago are excellent. But the young kids today will not be excellent nurses without degrees.

Nurse Anne said...

And yes a new grad university RN and an RN with 30 years experience do the exact same job on a ward. They will only see eachother in passing, never be on duty together. This is because the hospitals will often not pay for anymore than one RN to cover a large group of patients per shift.

So they do the same job with the more experienced older trained RN getting slightly more pay.

The point of new nurses having degrees has never been about money, or about nurses wanting more money.

It is about RN's getting recognition and respect for the level of knowledge they need to do their job.

The general public seems to think that these new fangled degree nurses are going straight into practitioner, specialist, and management roles. This of course is not the case at all. The public are such a bunch of incorrigable fucktards.

Dino-nurse said...

I'm pretty sure that many of the specialist nurse roles will fall by the wayside as hospital trusts struggle to save money. As has been pointed out, with the exception of CCOT and ENPs most specialist roles are 9-5 weekdays only. So when your patient is rolling around the bed in agony at 2am because you cannot troubleshoot the epidural or PCAS pump, the "pain nurse" is tucked up in bed. My personal bugbear are the Infection Control nurses. Not one has any real understanding of basic microbiology let alone any ability to think outside of the tick-box. Currently we have 11 audits that are linked to this area...11! Everytime a CVC or venflon is inserted, everytime someone washes their hands, empties a catheter bag, touches their uniform (oh yes!)...its ridiculous. We recently had a very sick patient transferred from a smaller ICU for more specialist treatment. They arrived late on a friday on SIMV 80% fio2 with pretty high pressure settings. Very unwell. Infection control nazi insists that they are nursed in a sideroom on the ICU because they have been transferred from another hospital. (How does she manage to arrive every single time? Where are her spies?). They were screened for MRSA the day before by PCR and are negative...we screened on arrival but as its a weekend it will be 4 days before the result comes back negative. Consultant went apeshit as he righlty pointed out that someone this sick needs to be SEEN not in a room with a single nurse who will have to shout for help (no windows in the room that face onto the unit...well planned that). Nazi filled out an IR1 because we didn't put said patient in the room. Consultant gave her a blistering tirade of reasons why the patient was unlikely to be MRSA positive. Her only retort was that the policy states that all transfers must be isolated...so are we to believe that other hospitals would deliberately lie about MRSA status? More to the point the latest madness is that in-patient transfers are to be treated as though they are MRSA positive until we re-screen them...someone somewhere is laughing at us and I bet its whoever owns the patent on the PCR for MRSA. All because the government will FINE us for anymore MRSA bactereamias. Last in house day that I went to (for senior clinical staff) I had a run-in with said Nazi. I pointed out that all the wards that are reporting 100% compliance are just not doing the audits properly. She doesn't give a toss. As long as its 100% then she has nothing to follow up on.

Dino-nurse said...
This comment has been removed by the author.
Dino-nurse said...
This comment has been removed by the author.
Dino-nurse said...

Oops- not sure why 3 copies of the same post appeared! Have rectified hopefully. Come on, I am a dinosaur lol

Nurse Anne said...

Oh god how I hate the infection control bitches. One day I was alone on the ward with a 17 year old bank auxillary. A patient was dying, choking to death because the auxillary had fed him when he couldn't swallow.

The infection control bitches came onto the ward in the middle of this mayhem and started swabbing commodes to see if the nursing staff were cleaning them properly. And they wanted me to stand there and answer questions about whether or not we were spening at least 15 minutes cleaning the commodes after every use.

There is a special place in hell for those pigs.

UCL Med Student said...

I'm pretty sure you're overestimating the general public's knowledge. I can assure you most will not have a clue what a nurse practitioner is, and also have no idea whether nurses do degrees/is it vocational etc..

I fully support your campaign to improve the professional image, as good, competent nurses (seemingly like yourselves) are what save lives. But here I will be somewhat conetentious and feel free to try and shoot me down...

The professional image is not helped by the students I tend to see around who are quite often african obese females, who can barely speak English. I am no WASP, but I speak with good clear diction, some of these people cannot ask questions properly; don't understand when a patient might use any sort of advanced language, and just about manage a grunt back to patients.

Just as needs to be introduced with doctors, nurses need to be able to speak English properly!

Nurse Anne said...

UCL med student,

I do not believe that the women you are describing are nursing students.

I know the interview process to get into nursing school. It's rough, even for a lass with perfect english diction. There is no way that the women you describe (grunting at patients because they cannot speak english) would get into the nursing program.

Once again I think you are confusing nursing students with cadets/hca's.

ophelia said...

oh i love this post and all the comments. i really do! thankyou!!! i completely agree about the madnees of all the saving lives forms. MADNESS. i just fill in all the forms with a tick tick tick otherwise it creates MORE work. who is auditing the auditors that is what i want to know. meanwhile the cleaning just doesnt get gone. it is so LOW status. no one wants to do it! keep posting Dino and Anne and everyone else: its good that these things are out there. Fab therapy for me anyhow!

Anonymous said...

I was already a graduate (had studied for 4 years at Uni) when I decided to train as a nurse. I was at the very end of my 3 years training (so had done 7 years study at Uni in total). One evening after a long hard shift I was doing obs and noticed that one patient urgently needed oxygen. I asked him if I could put the mask on him and he nodded. (It was visiting time and many relatives were on the ward.) An auxiliary (just standing around flirting with one of the patients)trots across and says in an admonishing, 'ticking-off' tone of voice "I would ask the patient's permission before you do that". (This was a regular little trick she pulled whenever visitors were present and she would always back-answer when I gave her an instruction, a childish attempt to give the public the erroneous impression she was 'in charge'.) There was a lot I could have said to this youngster e.g. that there was no such document as The NMC Guide to 'Permission' but there was however a document approximately 19 pages in length entitled the NMC Guide to Consent and perhaps she ought to go and read up on it. I could have told her how much time students are obliged to spend learning about the legal ramifications re. the issue of Consent. If I hadn't been rushed off my feet I could have explained to her the difference between verbal, written and implied consent. On the other hand I could have just let rip and told her to quit showing off. As it was I was so irritated that I simply ordered her to move out of the way so I could get to the oxygen cylinder (because she was blocking my path). Later that evening one of the visitors came up to me and said to me "What are you? What exactly do you do?" You can't blame the public for being confused though can you because they don't have a clue what all the different uniforms mean.

Nurse Anne said...

We get the little 17 auxilliaries who think that they know everything a nurse does because they have been signed off on how to remove a venflon.

I tell them that until they have more than a high school education and a registration with the NMC that I am the boss. I listen to them if they are concerned about a patient that I haven't seen. And I will check it out right away. But I am the boss.

Two little shit auxilliaries lied to me about doing turns the other day. I was doing drug and ward rounds and all they had to do was turn the immobile patients. They said they turned a man when it was obvious that they had not. I asked them why and they replied that they didn't think he "needed" to be turned because he could use a call bell. WTF????

or how about "oh I didn't think those obs needed checking again even though you told me to do them, they were only done recently you know" The patient as a BP of 70/50!!!

This is why I want to to have a small number of patients and do everything myself instead of being overloaded and forced to delegate to young children who should be working at mcdonalds.

Anonymous said...

Yes Anne, the obs. The auxiliaries I was required to supervise were just 'cherry-picking' what to record on the patients' charts e.g. only the pulse and BP, or maybe just the pulse and the temp (but no BP or resps). I spoke to the little madam who kept back-answering me and told her to make sure she recorded ALL the obs and also sign the TPR chart (non-of the Aux/HCAs were bothering to put their initials on the bottom). How did she respond? Unbelievably she replied in a 'reprimanding' (!!!) tone of voice "Well it IS your responsibility". I lost it then and snapped at her, telling her in no uncertain terms that I was well aware it was my responsibility and that was the whole point of my speaking to her! I spoke about this problem of non-compliance to the Senior Nurse and what did he say? - Answer, "well they probably don't have time to sign the charts"!!!!! Well, no support from that quarter then!

Anonymous said...

The story of the Rampant Egos (or a cautionary tale of two 'loco' motions)

1) A second-year student was walking past a cubicle when she heard a patient cry out so she decided to investigate. The patient was lying supine and obviously in agony. Her back was contorted in a most unnatural position due to the fact that she had been told “push yourself up” following which a bedpan had been roughly shoved underneath her AND it was facing the wrong way! Beside the bed stood a new healthcare assistant (HCA) who had commenced working for the hospital only two weeks ago. To the patient’s immense relief the student swiftly removed the bedpan. She then proceeded a) to explain the correct way to place a patient on a bedpan and b) told the HCA that the bedpan was incorrectly positioned. Was the HCA a bit embarrassed? Was she apologetic? Was she grateful for this help? Not at all. In spite of her lack of experience she proceeded to argue vociferously with the student and insisted that she was in the right. The student tried again to convince her but she argued and would not accept the advice. The student felt exasperated. Obviously she could not allow the patient to be harmed so she had no alternative but to call over a staff nurse to intervene. Only when the qualified nurse confirmed that the student was correct did the HCA finally comply. As a matter of interest why had this particular patient been admitted to hospital? She had a spinal problem!

2) Don (pseudonym) had been an HCA for quite some time and considered himself very experienced. He had recently applied to the local University to do nurse training but unfortunately his application had been rejected. The nurses knew his pride was hurt so they were sympathetic and tolerant even when he showed-off and interrupted their conversations with new students. When a patient said she needed to use the toilet Don saw his opportunity to ‘teach’ and sprang proudly into action. Now watch me closely” he instructed the first year student “this is how to put someone on a commode”. He seized the female patient under the arms ready to swing her off the bed onto the nearby commode. The patient and the student both started to speak at the same time but he was so focussed on showing off that he didn’t bother to listen. He confidently swung the patient onto the commode. Suddenly he noticed that the student was looking horrified. Glancing at the patient Don was also horrified – he hadn’t even noticed that the patient had been wearing a nasal oxygen cannula – there were two rivulets of fresh blood trickling underneath the patient’s nostrils where the plastic tubes had been violently ripped out.