Having worked both abroad and in the NHS I noticed a few things. Man oh man have I noticed a few things.
Nurses in British hospitals do not have the support or resources to do their jobs. No amount of caring, compassion and old fashioned training can fix that. The are constantly put upon by pharmacy, porters, secretaries, housekeeping and supply departments in order to make the working lives of those people easier. I spent 3 hours out of my shift yesterday running around the hospital in a frantic search for the drugs my patients were prescribed. This left my patients nurse-less and un monitored.. It can take up to 8 hours to find and obtain common drugs that Boots could dispense in 5 minutes.
I want to go back in time...back to my old job in a setting that seems futuristic compared to the setting I am working in now. I decided to ask Doc Brown and Marty Mcfly for some help with this. They will loan me the DeLorean or Darth Vader from the planet Vulcan melts their brains. Their choice.
In 1995 I was working in as a qualified Nurse in another country. I worked on a 28 bed ward. There were 8 RNs on duty for a shift. One of those RN's was in charge. One RN floated between teams and covered lunch breaks. We had 3 ward clerks from 7AM to 3 PM and two ward clerks from 3PM to 11PM. This was essential to keep notes and information organised and deal with all the phone calls and enquiries. If my patients' doctors ordered some IV antibiotics I wrote the order on the drug chart or entered it into the computer. The ward clerk then faxed it to pharmacy. If she didn't do that immediately she was in trouble. Hundreds of orders like this are flying at qualified Nurses every hour and we need support to stay on top of it. Otherwise patient care gets completely neglected.
Pharmacy had a duty to get that drug to me when it was due, prepped and ready to go. If it was a STAT med, they had 5 minutes to get it to me or they were disciplined. Pharmacy was open 24 hours and they assigned a pharmacy tech to each ward. It was THEIR JOB to ensure that the Nurse had the drugs she needed at her disposal and ready to go as soon as they were due. There was an individual medication drawer for each patient and when you opened it you would find what you needed for the upcoming drug round as well as prescribed as needed medications for that patient. If you didn't find it and had to go and chase around looking for stuff, you wrote up pharmacy for a disciplinary. Pharmacy had faxes of all the patients drug charts. Every time that drug chart was updated with a new order the ward clerk faxed it to them immediately. Or else.
Each Nurse and support worker in that place carried a hospital mobile phone clipped to her pocket. I could stay with a patient whilst calling a doctor. I could stay with a patient whilst calling another Nurse for assistance. If a family member, pathology lab or a doctor called for me the ward clerk would transfer the call to my phone. That way I didn't have to leave what I was doing to answer a call. In the NHS I have to abandon the patient and walk past a score of them crying for help just to get to the ward phone. Then I have to stand there and que for the phone. Then I bleep the doctor. Then I have to stand there looking like an idle simpleton and wait for him to call back. Then I can walk back past scores of people crying for help and go back to what I was doing. If stop to help the people shouting for it, I may not get back to the man on the sliding scale fast enough to stop him from developing hypoglycemia and going into a coma.
We had hospital social workers to organise discharges and care. We had security.
These people were very well aware not to interrupt the Nurses unless it was an emergency. Most of the time they complied. In the NHS these people do not have a clue. If a social worker, a phlebotomist, or a porter etc interrupted Nurse during her drug round to ask a stupid question (i.e are you the Nurse looking after Mr Jones) they would have been disciplined. If they want that question answered they could look at the big board that had the room assignments, the patients name and the name of the Nurse written next to it, or they could ask a ward clerk or a tech. In the NHS people constantly walk onto the ward, right past the board that shows what Nurse is assigned to who and asks if I am looking after so and so. I get interrupted on average every 2.5 minutes with this shit all day long in the NHS. There is no respect for the Nurses here, they are not left alone to do their jobs even for a minute. The supporting departments in NHS hospitals think that the ward Nurses work for them.
I shit you not. In the NHS these people walk up to a staff Nurse whilst she is with a patient, concentrating on drug calculations, medicating a dying patient and holding the hand of a distraught relative......to give her "instructions" about what THEY need to make THEIR job easier. Porters do it. Pharmacy does it. Kitchen does it. House keeping does it. Our pharmacists started screaming at one of my colleagues the other day. He came onto the ward with some CD's (a miracle in itself, usually we have to fetch them). The only Nurse there was unable to stop what she was doing and check those meds in because she was with a patient so he had to wait 5 minutes. He went apeshit and tore her apart. While she was still with the patient. Our domestics go mad if the night nurses haven't started the domestics AM duties for them. On nights there is only three enough and I am NOT going to release the HCA,myself or the other Nurse from patient care to collect and wash cups and jugs. Nursing management knows about this, and they seem more keen to side with the domestic managers.
Only next of kin is legally allowed to get info about the patient in both North America and the UK. Any relative who rang that hospital had to give the next of kin password to the switchboard operator before they were put through to the ward. This helped the Nurse to avoid getting into a long winded conversation with someone who isn't allowed to have information. Patient care comes first before relatives. A legit caller could also be put through to the charge Nurse for information while I continued on with my job. The switchboard operators here do not even attempt to protect the Nurses from unnecessary interruptions. They just put the drunk and belligerant caller through.
In the NHS there is no charge Nurse free of a patient assignment who can talk to these people. All day long I have multiple neighbours, friends and extended relatives calling constantly demanding test results etc. When the Nurse is running to the phone every 2 minutes, it leads to a whole lot of patient neglect. Management should be protecting Nurses from unnecessary interruptions.
1995. Since then patients are even more ill, more complicated and there is increased throughput. And in the NHS we are working with a lot less than we had when I worked in North America in 1995.
Let's talk more about working in the NHS in 2010. It sure is a step backward from 1995 in North America.
Here in the backwards future In the NHS we are often 30 beds with 2 Nurses and three care assistants. That is all. No charge nurse. One of the staff nurses who is the most experienced has to take charge even though she is the sole nurse for a team of patients. Fail. It cannot be done. Every time she gets stopped to answer relatives' questions and answer their phone calls her patients go without a Nurse and are neglected.
We get a ward clerk for 0900 until 2:30 from Monday until Thursday and that is all.
The ward clerk can't even handle all the numerous calls coming in for all those patients. If we have 5 relatives calling multiple times for 30 patients all day long it gets to be too much. We cannot even get a free phone line out to call a doctor in an emergency.
So she gets stressed and goes for a coffee break and the Nurse has to cover the phone whilst doing her job Nursing patients. The NHS ward clerk will ask the Nurses who are 3 hours behind on their drug rounds to file paperwork for her as one ward clerk for 30 beds is too much. It is too much. But I am in no position to help her. She also spends half her day looking for notes because doctors do not even have the decency to put notes back where they found them. This causes things to get lost. She cries a lot and disappears off the ward. Sometimes she is covering two wards.
If a family member phones the ward clerk walks over to me whilst I am in the middle of inserting a catheter and trying to maintain a sterile field and tells me that Mr. Smith's daughter is on the phone. Then the ward clerk walks away.
This leaves Mr. Smith's daughter on hold until I can get to the phone, really pissing her off. Or I can just stop what I am doing in the middle of a procedure to answer the phone. 9/10 it is an enquiry that the ward clerk could have answered if she would have bothered to ask what the caller wanted. These kinds of interruptions are constant for the Nurse in the NHS. With less staff and poor management and almost zero modern gadgets to help us out with today's increasingly ill patients we are fucked the minute we walked onto the ward.
We have two phones on the 30 bed NHS ward here in 2010. They are at the Nurse's station. There is no such thing as hospital mobile phones or pagers for the Nursing staff. It is a long walk past lots of needy patients to get to the phone. I have to stop what I am doing and answer a whole lot of phone enquiries whilst trying to Nurse my patients. I have to stop what I am doing and abandon patients to make calls to doctors or to fight with pharmacy and supplies to get what I need.
I have to leave the patients and go looking around for another member of staff if I need assistance. It was faster and more efficient to be able to ring the Nurse on the other end of the ward directly. A phone call from the little phone clipped to my pocket direct to the little phone clipped on her pocket. But not in the NHS. I have to hunt her down. Then I get delayed as patients shout for help as I walk past. Or I can ignore them, hunt down a colleague for assistance, ignore them again as we head back to the patient I just left etc. Call bells are worthless as no one has time to answer them. I spend so much time walking to and fro looking for staff and stuff, and then getting shouted down for help by patients as I am walking past, that I never can get on with anything. Patients and relatives stop you as you are walking past, show no regard or consideration about what you might be in the middle of for another patient and expect you to attend to them immediately. It isn't fair on the other patients or the Nurse.
|Holy Shit Doc. This is heavy. This sounds worse than 1955. Who in their right minds would expect Nurses to be able to be there for patients and not make mistakes in these conditions.|
Pharmacy also closes for an hour between 12-1PM. That means if I need a STAT med at that time I am stuffed unless I abandon my patients during lunchtime to go on a search throughout the hospital.
NHS pharmacy does not stock us up properly. Basic common medical drugs that a BOOTS could dispense in 30 seconds are AWOL on my ward. Each of my 15 patients are each on 10 drugs each due at 8AM and four other times throughout the day. Of these ten drugs for each patient: three of them will usually be in the drug cart or the patients locker. 3 of them will be completely AWOL and I will have to order them from pharmacy and the rest might be obtainable if I leave the ward to go on a drug hunt.
I can usually figure out what I need by 10 AM and I order them at that time. I do not get the drug chart back or the drugs until about 5PM when pharmacy goes home and cannot answer any questions. Right before they go they send out the packets to each ward with all the stuff we ordered. They do not dispense anything ordered that day until after 4:30 unless you walk down there constantly and beg. They barely answer their phone either. The other 4 drugs I will usually be able to locate if I ring other wards and walk down there to get them. This is very time consuming and an 8AM drug round that should take an hour takes about 4 hours. Pharmacy in the NHS DOES NOT prepare IV drugs for the Nurses. Nurses here have to dilute the powdered med and prepare the infusions. This is very time consuming. I may have 9 patients prescribed to have IV BenPen 2.4 grams 4 times a day. That means that at 8 AM,12 noon, 6 PM, and 10 PM I have to spend well over an hour diluting,mixing, and preparing each one for infusion. In decent hospitals pharmacy does this for the Nurses and sends up the bag ready to hang.
The constant interruptions from patients asking where their drugs are and relatives phoning slow me down even more. If I stop to help those shouting for help it slows me down even more than that. And still there will be ordered drugs not given despite doing my best. In order to even order the need drugs, pharmacy has paperwork for the Nurse to fill in. Then we have to run said paperwork down to pharmacy ourselves. For each and every drug. If pharmacy even thinks that the drug may be someone on your ward or on another ward in the hospital then refuse to supply it. And send a nasty message suggesting 6 or 7 places where you should look or it. Sorry but I am too busy getting screamed at by patient's relatives over late drugs and other things I cannot control.
|Great Scott Marty. England's hospital pharmacies of the future fucking suck. Are you sure this is 2010 and not 1910?|
NHS Hospital Pharmacy's favourite lines are "It is the Nurses job" and "We are going home at 5 and it is 4:31 so we will not help you" and "Did you search other wards for it first before you bothered us".
Woe to the patient who is waiting for their discharge drugs. Woe.
The doctor will tell them that they can go home during his round at 9AM. He will be unable to come back to the ward until about 4PM and then he has to write and prescribe all those discharge drugs, as long as he doesn't have really sick patients elsewhere who need to see him again. No way he has time to do it during the day while on rounds. And in the preceding days writing discharge orders just isn't priority. Then we have to beg pharmacy to accept the orders that late in the day. Then they fuck it up but by the time we realise they are closed and have gone home.
NHS housekeeping. We have two domestics from 7-2. Then one from 5-8. No 24 hour domestics here. in the NHS we just have part time domestics who think that the Nurses work for them. They don't give a rats ass of the Nurse gets struck off for neglecting her own duties.
If a patient gets discharged the bed is now free. AAU is chomping at the bit to get one of their patients into my bed. Domestics will not sort the room. I have to stop my endless search for drugs and do it, or pull the care assistants away from trying to do basic care to do it. This has to be done right away or we get held accountable for any breaches in A&E. The domestics are too busy trying to clean the floors and toilets and serving tea. They will often interrupt the Nurses in the middle of emergencies to ask for help collecting in cups and jugs for washing. They will walk past a care assistant on commode duty to tell a Nurse that someone needs the toilet. While the Nurse is in the middle of calculating a drip. Great now my concentration is gone and I need to start over. And the patient's treatment is delayed. We have a 15 minute window to feed 30 patients or we inconvenience the domestics. They just go and collect the plates in whether or not we have been able to get the patients fed. We have resorted to begging them not to do this but if they delay the collecting of the dinner plates back in then they are slowed down with their work. I don't think that they have any concept of the difference between HCAs and Nurses.
The NHS Equipment library expects the Nurse to clean and tag any equipment we have used before we send it back to them. The Nurses haven't been doing this properly because we have so many patients that need help, so many things to do and we are so behind....and scared for our registration and our patients lives. If I haven't seen crying incontinent patients for 7 hours because I am hunting for medications and trying to keep the acutely ill alive I am sure as hell not going to fuck around cleaning and tagging equipment. So it wasn't getting done properly or at all.
Equipment library made us a nice little poster showing step by step (at least 10 steps in all) how to clean and package an air mattress for them etc. They hung this little poster on our ward wall. They also made us a nice little instruction booklet regarding how to label and tag said equipment. *Every line has to be filled in for the equipment library, and this is the responsibility of the ward staff.*booklet. I can't speak for every hospital in North America. But I do know that the support staff in mine would have never dreamed of asking the Nurse to disregard patient care to do their job for them.
That equipment still isn't getting cleaned, tagged and packed up properly or at all. So equipment library made us another nice poster with pictures so that we can understand how to clean and tag their equipment properly. One of their staff even modeled for it and they showed her doing each of the 20 things that needs to be done to clean and repack and tag and air mattress. I hope someday that fucking bitch dies because her Nurse is elsewhere packaging up an air mattress nice and neat.
Fucking drug carts and keys in the NHS. In 1995 in North America I had a drawer in a pyxis device for each patient. My hospital was one of the first to trial this kind of device. This drawer had every possible drug I could need for this patient as ordered by the doctor. I was able to access and unlock the drawer by keying in my personal identification number.
Don't even get me started on kitchen staff, IT, social services or bed managers in the NHS. Just don't.
Nursing is tough enough without having to search for drugs, staff, answer the phone and package equipment for staff who do nothing but work 9-5 Monday through Friday and take lunch breaks every day. Lazy bastards.
If I have 10 patients that means I get 6 minutes with each patient every hour. Now take into account the answering of the constant stream of phone calls, the drug hunts, the relatives etc. The one patient going poorly who needs 40 minutes out of every hour.......
Anyway it seems that Doc Brown has the DeLorean up and running! And if that doesn't work I will just keep on trying to get abroad.
|Pyxis drug machines,24 hour pharmacy and housekeeping, multiple ward clerks, ward staff mobile phones, supportive support staff.....hell yes when this baby hits 88 miles per hour Nurse Anne is going to see some serious shit.|