Friday, 29 October 2010
That title may sound a bit harsh. I know that our doctors are very intelligent when it comes to medicine.
But apart from that they seem to know sweet fuck all.
This is especially true when it comes to what is going on in the wards. It is true in regards to Nursing. If Nursing care goes bad medical orders do not get carried out and patients do not get monitored. In short the doctor's whole plan of care goes out the fucking window.
You would think that they would be a little more......well.....interested.
But no. They are delusional.
This is what I have learned about doctors in over a decade of Nursing.
1. They think all nurses are the same person or clones of the same person with a hive mind.
For example, if the Nurse on the shift before you missed something, it's your ass if you are the one on duty when doc graces your ward with his presence. If you are forced to float to a specialty you never worked or trained in before the doctors expect you to telepathically mind link with absent Nurses who have experience that area the minute you arrive on the ward They will not bother to write their orders or give you a heads up about things you need to know and wouldn't know unless you have experience there. They won't bother with any of that yet they'll go apeshit later when you forgot to remind them to prescribe something. Remember that they think Nurses are all the same drone with a hive mind who know each Doctors' individual ways.
2. They have no idea how to implement their own orders, or how time consuming and complex it is to implement their own orders.
Don't even get me started on the bullshit with the IV meds....both getting a hold of them and actually preparing them. Or fighting with pharmacy, equipment library and path lab. No Doctor they do not just keep everything on the ward for us. No they do not keep chest tube kits in a place where we can get them etc etc etc.
3. They have no idea how to work the system as a result of the Nurses doing it for them.
They don't understand why things don't happen instantly. For example, all RN's know it takes 6 weeks to get a patient into a Nursing home and that nothing can be done to speed this process up. Yet day after day the medical consultant walks in the very afternoon after he wrote that 90 year old Mabel can be discharged that morning and wants to know why she is still on the ward. Then he goes on a rant about how the Nurses can't be arsed to discharge patients. I could go on and on about this one, there are thousands of examples.
4. The saddest thing I learned about doctors and the crux of this post is that doctors are not able to distinguish between Nurses and ward assistants.
There are many times I am running my ass off trying to give a 150 IV meds all due now whilst the HCA's/cadets/auxiliaries are hanging out at the Nurse's station. The few jobs they can do are complete. They cannot help with the large proportion of the workload that only an RN can handle. Many doctors will walk onto a ward, take a look at the assistants hanging out at the station and exclaim "The Nurses don't seem to busy today". Dickhead. I am the only Nurse, and I am on my knees completely overwhelmed. What the assistants are doing (or not doing) is in no way indicative of how busy the Nurses are! Assistants are not Nurses.
Sometimes I will be 3 hours behind getting much needed drugs into patients and managing other patient problems and some young doctor will stroll onto the ward and ask me to hold an arm for him so that he can draw some ABGs. For god's sake, grab one of the assistants hanging around the Nurse's station for that. That is something they can actually do. Don't delay Mrs. Smith's pain relief any longer by causing me to stop and hold an arm!! It's not like the care assistants can give the meds and handle the Nurse stuff while I am tied up holding an arm for you!
A doctor walked onto my ward and wrote some orders for IV fluids and IV antibiotics for a patient with Pneumonia. As the only Nurse for all of those patients I was tied up and didn't see him arrive or know he wrote any orders. He handed the chart with his orders to a care assistant and left the ward. The care assistant has no idea about orders etc. She put the chart down on the station where it got immediately buried. And she said nothing to me. I had 25 patients that day (a staffing ratio no Nurse can function well with) and it was taking a hell of a lot of time to see everyone and process their orders. It was 3 hours before (by luck) I found the chart and the orders. Patient was in septic shock by that point. Doctors, you need to tell the actual Nurse about these things, not some underpaid teenage assistant that you have confused with Nursing staff.
Then there was the doctor who started yelling at me for having 4 bays full of patients rather than one!! "That is too many patients! You should have one bay per Registered Nurse". Yes Sherlock, no shit. I appreciate the fact that you have actually noticed that the RN ratios on NHS wards are horrible and dangerous and that this has a dire effect on patient care. But what the hell would possess you to think that they Nurses on the ground have any say in how we are staffed or how many patients we have? Even the ward Sisters are not allowed to have a say in how their wards are staffed. Duh.
I could go on and on. These doctors are clueless about what is going on with Nursing care and RN staffing on the wards. And frankly, I am getting sick of it.
My cousin in law is a doctor in the USA. He is not as dense as his colleagues here. If he finds out that his patients' RN's are being forced to take on more than 4-6 patients at a time he gets on the phone to MANAGEMENT and starts screaming. He tells management that he will have his patients pulled out of there by the end of the day and admitted somewhere else if they do not staff the facility properly.
He doesn't care how compassionate or knowledgeable or wonderful the Nurses are in that place. He knows that with poor staffing ratios that they cannot function even if they are wonderful. The facility would lose a ton of money if he pulled his patients out of there so they wouldn't dare short staff the place. They did it once, never again. Managers of hospitals all over the world think that intentional RN short staffing is the way to save cash.
He is a good doctor, and understands that without decent Nursing care delivered by RN's the patients are screwed. He understands that there will be nothing in the way of decent Nursing care in a place where Nurses are denied resources and safe staffing ratios. And he acts on it.
But it seems it is too much to ask for UK doctors to even understand what a Nurse is, let alone stand up for them. They haven't even grasped the notion that these Nurses are taking on too many patients to be able to care for anyone properly, and that they are being forced into a position where they cannot spend two minutes demonstrating compassion without risking a disciplinary for not filling in paperwork. Too bad.