Friday, 24 September 2010

Another Classic Quote from High Level Nurse

We already had a previous comments post. This new comment wins hands down. 

I cannot tell you if the person who said the following is a Matron, a Clinical Lead, a Nurse Specialist, a non ward based Nurse manager etc etc.  But she is one of the above.

Like most of the silly commentators mentioned in my previous post she is an older nurse, trained under the old system; she hasn't worked on a ward since 1982 and she HATES Nurses who choose to stay at the front lines providing direct patient care.  She sees them as "Nurse Failures".  Thank god that us University educated Nurses don't think like that. We are going to be on the wards providing direct patient care until we retire anyway.  It is where you start out when you graduate Nursing school and these days it is where you stay as there is NO PROMOTION and recruitment freezes.

She has given the frontline staff nurses even more scores to do.  Not content with having them down twice a week she now wants us to do them on all  35 patients every day (irregardless of risk factors) and document the results in 4 different places. Each sheet of paper of course requires the nurse to write the patients name, date of birth, 9000 digit long NHS number on both front and back.  There is the waterlow score for pressure areas, the nutrition score, the fall risk score. Blah blah blah.  If a patient deteriorates and moves from a low waterlow score to a high one then obviously there is higher risk of pressure area damage and certain actions we will then need to implement. As if we wouldn't realise without the score....eye roll.

We told Nurse Ancient that this amount of writing is ridiculous, physically impossible etc etc.  She called on us to ask why her scores were not being done.

When we told her we had too many patients, too many things going on at once and  that doing this insane amount of redundant paperwork was impossible and pointless she called us "whingers".  And then she said:

"You don't really have to score them every day if you are busy.....just copy down what the last person wrote or make it up...guesstimate....just make DAMN SURE THAT THE DOCUMENTATION IS COMPLETED".

Um.  Well what is the point then?  If I am going to write all these names, patient info, scores and numbers on 4 different worksheets back and front for 35 people I need to know that it is actually going to benefit the patients.

Still not going to do it.  She can bite us.  They just had 5 RN's quit simultaneously off the 40 bed even more short staffed hellhole ward below mine.  Let's see if we all get sacked for refusing.

Our younger  RNs are scared of the Queen Bee "Nurse" quoted on this post. There they are running around, trying to get all this stupid paperwork done so that they are seen as "good nurses" by their "superiors". 

Militant Medical Nurse knows that being a good nurse is inversely proportional to being a good employee.  Fuck the non essential paperwork, I have patients to nurse.  I am trying to teach this notion to the youngsters.  Safe patient care first: fucktwittery last...Of course if the hospital gets sued and the paperwork is not 100% complete (including scores) a barrister will use that to nail the trust (and clinicians responsible for patient) to a wall.

will continue


Prisoner of Hope said...

Brings to mind 2 related experiences. The 1st in Leicester, the 2nd in Sheffield.

As a health service director of information (and Review!) - 20 years ago - I was asked to help a Nurse Researcher who had difficulty applying an accuity score, to nurse staffing calculations for care of the elderly, as they did not seem to make any sense. After asking a Maths graduate and public health doctor, in my department, to see if he could see why this might be... and getting nowhere, I ran a series of calculations to test the sensitivity of the formulae being used and found that 100% of the difference in required staffing levels - that resulted - could be explained by one variable.

When I asked the researcher what this factor was, she said it was the "correction" that the Chief Nurse said should be applied to acute ward accuity scores for care of the elderly. On closer examination this correction factor was not based on evidence of any kind. As a result I (unhelpfully!) concluded that the Nurse Researcher did not need to collect any future data and should just apply the chief nurse's subjective assessment! This was obviously not practical as the Chief Nurse expected the data to be collected and calculated performed to confirm her judgements - just smoke and mirrors!

A year or so later as a patient on an acute ward in Sheffield I remarked that there seemed to be a lot more nurses on the ward than the previous day. I was told that the previous day everyone was too busy to fill in the forms and as a result staff were moved elsewhere in the hospital, which is why they were all so very busy. So the next day they made sure that the forms were filled in and to their surprise were "rewarded" with more staff when they were not really needed. SO they had time to talk to me about the nonsense of it all.

That is when I truly became aware of the utter futility in trying to score the effect of patient demand on nursing workload as an inverse law operated in getting accurate raw data. This problem is of course exacerbated by fools with an absolute faith in a black box calculation which disguises the fact that it is all subjective guess work masquerading as rational management.

This is a problem that has been allowed to fester for too long and ends up with the situation you have describe. Sadly I can not suggest anything that can be done to bring the fools to their senses..... just don't let them grind you down ...please!

Anonymous said...

Documentation is the bain of my life!

Take a grade 2 sacral ulcer for example. I know that a dressing is required, air mattress & cushion needs to be ordered, patient to have regular positional changes, good nutrition, monitor for infection etc etc...

What I can't stand is the added extras i.e

-complete tissue viability form and fax to TV nurse, bleep TV nurse who won't get round to reviewing pt for weeks or else tells me what I already know. Document in notes have done above. Incident form (of which nothing ever happens), Log ulcer on trust system (prone to crashing), complete latest audit on pressures ulcers, colour in productive ward chart with green crayon. Reassess waterlow etc

After all this the patient barely gets a look in!

Anonymous said...

Anonymous 04:07: It's better (and easier too), to prevent the pressure sore occurring in the first place. After all, to prevent a pressure sore you have to take preventive measures, and you list some of them in your post, but once a sore has occurred you have to take preventive measures plus you have to treat it as well, possibly doubling your work-load. It makes sense to identify patients at risk early and institute preventive care immediately.

Nurse Anne said...


My trust refuses to allow the staff nurses to order airbeds and aircushions for the patient unless the patient already has a grade 2.

Many patients all ready come into hospital malnourished.

It can take all 4 of us (two nurses and two health assistants) to turn and reposition everyone that needs it.

That means one move in 4 hours and that is if we ignore every thing else that is going on. Otherwise with will take longer. Remember that acute medicine and care of elderly has been combined so you have both types on patient together.

Dino-nurse said...

Documentation is there for one purpose only- to cover your ass. Does filling in the paperwork make you a better nurse? I think most of us would agree that prevention is the best option when talking about pressure sores. Prevention means having enough nurses to ensure that patients are washed and assessed by an RN, assisted with meals as needed and equipment provided as asked for. NOT being fobbed off with the fact that the equipment library does not have any more mattresses (I kid you not) or that MAU should be able to function with 6 trained RNs and a few HCAs/APs for 45 patients. This is the reality of frontline care in the NHS today...a timebomb waiting to go off as more and more RNs leave and head to other countries. Most of our senior nurse managers would not know what to do if a patient was put in front of them and this is what needs addressing. The NMC needs to make it COMPULSORY that to keep your PIN you need to remain clinically active...that goes for nurse educators as well.

Nurse Anne said...

True about equipment library and their "oh sorry no mattresses" shit.

Nurse Anne said...

and of course everything else you say is true as well

Anonymous said...

Anonymous (6:51) I completely agree that pressure sores should be prevented rather than developing in the first place. I think every nurse knows that pressure sores are caused by poor nursing and I personally find it very shameful when a patient under my care gets one.

Pressure sores can easily be prevented by early identification, adequate staffing and simple measures.

Unfortunately adequate staffing simply does not exist on most wards and as a result patients do not get repositioned as often as they should. Also many patients have pressure sores prior to admission and what about patients who refuse to be turned, despite explanation of the risks?

I guess the point I was originally trying to make is that there is far too much documentation and that my time would be better spent with the patient.

Nurse Neil said...

What I would like to know and no one important has ever explained it to me is that, why, when Drs are probably the most litigated against profession in the country do they manage to defend themselves from often one line in a pts notes whereas we are expected to write the equivalent of war and peace in triplicate each time a pt farts. Fuckwittery of the first degree

Anonymous said...

To Anonymous 06:51:

Is there REALLY a nurse anywhere who needs to do a waterlow, a nutrition assessment, a mobility assessment, etc, etc to be able to recognise which patients are at risk for pressure damage?? Is there REALLY a nurse anywhere who doesn't know this just by looking at the patient??? For God's sake, just give me the time and the staff to look after my patients properly and give me the authority to order an air mattress when I see fit.

I honestly can only remember ONE time when I was surprised that a particular patient developed a pressure ulcer, and this patient did not score as "high risk" using all the wonderful screening and assessment tools that the powers that be require us to fill out endlessly.

Anonymous said...

Anonymous 16:14, this is Anonymous 06:51 replying to your question.

You ask: "Is there REALLY a nurse anywhere who needs to do a waterlow, a nutrition assessment, a mobility assessment, etc, etc to be able to recognise which patients are at risk for pressure damage??"

I reply, of course not. Or, more specifically, I reply that any nurse who NEEDS to use these methods should probably consider looking for another job, preferably one that requires no mental effort. I would say that, in my opinion, the whole assessment tool industry is more or less useless.

If you read my post again you may note that I made no reference to Waterlow or any other such assessment system. On the other hand, I hope you would not disagree with my statement that early identification of patients at risk of suffering complications is essential. I would agree with you that a nurse should not need to fill in forms to identify such patients. Once identified, as you say, such patients should be cared for appropriately.

As far as I am concerned the only documentation necessary should be a simple expression of professional judgement on the lines of "This patient is at risk of ... because of... and requires the following care/ nursing equipment."

Nurse Anne said...

"statement that early identification of patients at risk of suffering complications is essential"

It is essential and it is of course in our heads and on our minds. Yet early identifaction isn't helping.

Early identification works when you have enough uninterrupted time to assess and get to grips with a patients situation, enough boots on the ground to position people, provide nutrition and it works when the Trust allows you to have the equipment that you need (i.e. airbeds).

We have none of the above going for us.

Anonymous said...

I am a Clinical Lead somewhere in Englandshire. I find this blog informative, funny but worryingly true.
I would never leave my ward understaffed, and frequently attend to deal hands on with clinical issues that arise. The paperwork comments I can see both sides of, from a personal perspective (excellent documentation saving my ass) to the other side - having to conduct investigations and seeing piss poor standards leaving nurse wide open.
We do not support each other as we should, too bothered earning brownie points and pretending we are doctors.... The NMC and RCN are both wastes of time that drain our finances and offer little in the realms of support or solidarity to our plight.
Trusts have frozen posts, to find 'surplus cash' to be spent on pictures and prettt chairs. I would rather employ the excellent student nurses whom have qualified but we are loosing to the private sector.
We can't / don't strike.
I wonder if the worm will ever turn and we develop a little more chutzpah like our American counterparts.
It disappoints me that as you climb the ladder there is a real distancing from what happens on the shop floor. Whilst I feel desperately for your plight, not all senior nurses behave in this way (I have refused to conduct useless audits and do not attend useless meetings).
I have introduced your blog to many of my collegues. Keep up the excellent work - from a non - degree trained back in the arc nurse...

Anonymous said...

The NMC is run by a bunch of hysterical lesbians who rather than defending our profession in return for the ridiculous amounts of money they charge us each year are more content with stabbing us in the back

Nurse Anne said...

Damn straight about the hysterical harpies.

I like the quotes on here but degree nurses are most certainly NOT pretending to be doctors. They are new, and on the shop floor.

The weasals who trained in 1968 and haven't been on the floor since the 80's on the other hand......

I think the old training taught Nurses to look down on those who stay on the front lines. Therein lies the problem.

Anonymous said...

Hi anonymous 06:51 and 04:00, Thanks for that, you're quite right, you didn't suggest that formal assessment tools are needed. My apologies.

If only it were the case that we could write that one line you propose: "This patient is at risk of ... because of... and requires the following care/ nursing equipment."

I also agree with the poster who pointed out that the busier (and more understaffed) we are, the poorer the documentation is - we're so busy actually caring for the patient that we don't have the time to prove we cared for the patient. I can see where this is a problem but it's also true, as Nurse Neil said, that doctors can write "improving" and everyone will accept that the patient is improving. I wonder why it's different for us?

Anonymous said...

I have never suggested degree trained nurses pretend to be doctors, my comment was aimed at those who climb the corporate ladder and distance themselves from the art and science of nursing. I know many old style and new style who fit this unfortunately. I most certainly agree that non-clinically based staff should spend at least a week per year on the shop floor to maintain registration....

Dino-nurse said...

Oh for the days when you could write "care as planned" and it was taken as read that you had done just that. As a senior nurse myself ( manager really but I don't like the title as many of my managerial colleagues stay away from the wards) I am also fighting against the tide of useless audit. We will also have yet another set of students who qualify and have to look elsewhere for jobs as the Trust wants to save money. Staffing levels are a joke and I am sick and tired of trying to make the egits understand just why Mrs X or Mr Y needs a particular dressing/piece of equipment/drug that is not normally on our unit (so will have to be ordered and PAID for). Every shift that I opt to work on the floor is a shift that is used as a weapon by the powers that be to try and undermine me. They do not want managers that stay clinically active as then we get to see first hand where things are going wrong. As for the NMC and the RCN...I cannot think of a single positive thing to say about them- so, as my mother used to say...if you can't say anything good....

Anonymous said...

Dino Nurse,
Nice to know there are a few of us left on the shop floor attempting to fight the tirade of sh** !!
Anonymous clinicla lead from Englandshire

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