Thursday, 30 December 2010

Things I would love to say

Just once I would like to tell these patients and relatives how it is, without worrying about getting fired.

Why? You ask....

Because I get fed up with relatives who think that Nurses are in some kind of position to stop and chit chat.  The only people who have time for that are support workers and they can usually be found gossiping at the nurses station, wearing almost identical uniforms to Nurses. I am sick of the constant hammering we get from these people who don't seem to realise that we have a job to do or that there are people dying all around us.  We don't have time to explain things to them properly.  They don't have enough medical knowledge to understand what they are being told.  They stop every single random member of staff that they see (all of whom are going to view the patient's situation from a different angle-if they know the patient at all) and demand information. 

Then they accuse the Nursing staff of telling them "a different story".  It is a medical ward full of older patients.  These people are going to have one medical problem after another...sometimes the pneumonia is the biggest problem.  Sometimes renal failure is....Just because the patient was ?UTI on admission and we are now focused on her anemia does not mean that the staff is "lying" to you about "what is wrong".  She's a medical patient for Christ's sake.  They are never EVER simple, cut and dried. The diagnosis, prognosis, plan of treatment etc change faster than Tiger Wood's girlfriends. Most elderly people will be in their own waste, and in a real bad way of they are left unsupervised....leaving them to tend to other patients and duties is something every nurse has to do no matter how caring she happens to be.

For once I want to be direct and say exactly what I think in my sweetest little sarcastic baby doll voice. Or maybe just in a very matter of fact voice.

I take a big risk on the back of my patients by answering the phone at all.....many of my patients should not have been left for me to answer the phone.  I could get in big amounts of trouble if something happens to a patient and I don't catch it because I am answering relative enquiries.   Instead of being grateful to the Nurse for taking such a risk and leaving her patients to deal with stupid questions, all these relatives do is bitch about how long they waited to speak to someone.  Yes, there should be a member of staff who can update families without neglecting patients to do so....BUT THERE ISN'T.   And it isn't the fault of the Nursing profession.  We don't have any say in how to staff the ward.  No not even the sisters and the matrons get a say on that.

Thanks to hospital dramas the public has an unrealistic, ignorant and very unfair expectation of what they can expect in the hospital.  They don't understand what it means to share their doctor and nurse between multiple other patients.  They have no understanding of the true nature of prioritization. They don't understand why or how doctors and nurses prioritise as they do.  They refuse to acknowledge or accept that old age is a multi faceted  terminal illness that cannot be cured.  They refuse to accept that old age, sickness and death is crude, sad and ugly.  And they deal with it by lashing out at caregivers.

I had the most sympathy and empathy in the world when I started out. But the facts are this.  Even the most compassionate Nurses are having their caring natures sucked right out of them after more than a few months of Nursing.  I have seen some of the nicest people become Nurses.....only to become stone cold automatons after 6 months on the job.  It happens to most of them.   At times I have felt that I could walk past a bus full of children on fire and not bat an eyelash.  That is how bad burn out is.  When my grandmother died of the usual old age medical problems, in the usual old age medical way....I felt nothing Nothing.  I just shut down. And we were very close.  I think we survive working in health care by shutting off.

Sigh. Things I would love to say and get away with.  Management wouldn't back us up.  I have been told by managers "yes you are right and you did right but the relatives would never be capable of understanding this issue nor will we accept liability so we have to apologise and let you take the blame".

 I never would say these awful things because I constantly remind myself that patients and relatives DO NOT HAVE A CLUE and live in a fantasy world.  They mean well.  But their emotional state and ability to reason is usually not good. But at the end of a long day I cannot help thinking these things.

Here we go:

"I am so sorry you were on hold for 15 minutes when you phoned to call about your mother. This is an acute medical ward you see, there are sick people here. Actually, I was in your mother's room taking care of her when you called. She is having trouble breathing and we are trying to prevent her from getting re-intubated. I didn't think answering the phone was priority over that, but I know for next time that I should stop taking care of her, come to answer the phone and chit-chat with you for 15 minutes answering all the same questions I answered for your brother an hour ago  while she goes into respiratory failure and dies. I now know what is important here, thank you for reminding me. Oh and you called 15 min before and your were put on hold then as well.  Yes you are soooooo are right to imply that the patient I was taking care of at the time doesn't matter either.   My sincerest apologies. Next time I will know better.  Thank you for making me a better Nurse and showing me what is important."

I am sorry you do not like bariatric bed and feel the need to ring your call bell every 5 seconds to tell me this. I am sorry that you feel like your bariatric bed makes you stand out in the bay. Maybe you should have thought of this before you let yourself get to 30 stone thus requiring a bariatric bed.

You see honey, when you ask me for an blanket, water, whatever after I'm in the room, I am going to have to LEAVE the room to get the blanket, water, whatever. Trust me - I don't have one shoved down my cleavage just it case you want one. And management are not going to let us store them somewhere convenient or even allow us to have enough of those things for all the patients.  I am going to have to walk past 2 bays of people shouting for help just to get you more stuff.  If I stop to help them you will be waiting a long time. Yes, you miserable bitch, you are welcome.

Flashing your police badge at me will not make me let you up before visiting hours. Your wife is not dying, in severe pain, or a post op, she is sleeping.  Your constant demands and inane questions over and over again will seriously impair my ability to care for your wife and my 12 other patients. And from what I can tell she is probably happy to get away from you for a night seeing how rude, annoying, and belittling you are.

I'm sorry that sandwich the kitchen gave your husband expires today but I do have 7 other patients I want to at least eyeball to make sure they are alive and breathing before I hunt down some more food for him. No I'm not going to "just take a pudding" from the bereavement cart across the hall for you. Their family member is dying and you are absolutely ridiculous.

How could you not know that it is illegal, immoral and unethical for a health care professional to give you private information and test results about a patient over the phone?  Even if you are family, and the patient is out of it I can get fired for giving you private information.  Neither the hospitals, the doctors or the nurses make these rules.  We just have to follow them.  And my job isn't worth it.  What would posses anyone to call an ask the Nurses these things anyway?  Why would you do this rather than arranging a conference with the medical team?  You need a fucking psychiatric referral.  Unless you are brain dead you must know that we can lose our jobs for violating confidentiality.  Do you really think I am going to risk the loss of my job and home for you when you could get off of your fat ass and get the information you need just by contacting the medical team of doctors who will actually diagnose and treat you rather than harassing the Nurse and delaying the care given to other patients? I cannot read the doctors mind, or their handwriting.  And if I am at the nurses' station reading notes so that I can answer your queries I'll have like 50 dignity champions crawling up my ass accusing me of "ignoring patients and being too focused on paperwork".

To family members: Just because you call out and say, "Nan has to go RIGHT NOW," does not mean that I can come and help her to the bathroom RIGHT NOW. Believe it or not, I am not going to leave my new patient with chest pain, just because Nan needs to pee. If Nan were my only patient, I would be by her side helping her all day.  BUT SHE ISN'T MY ONLY PATIENT.   This doesn't mean that I don't care about your nan or do not like the idea of dealing with pee.  I do not know of a board of Nursing that exists in any country that wouldn't jump at the chance to strike off a nurse for leaving a chest pain patient to help another patient to the toilet.  They would fall all over themselves to strike off a Nurse who did that.  I am serious.  If Nurses don't prioritise people die.  Better to get in trouble for leaving someone in wee than to get done for manslaughter.  If you don't like this view, it may be time to consider hiring a one to one private duty nurse for your loved one.  And yes I am at the Nurse's filling in paperwork whilst your dad needs the loo!  You know why?  Because the patient in the next bed is bleeding to death.  The doctor has ordered a blood transfusion.  And the fucking path lab will not give me the blood unless they get their fucking paperwork.  I need to get it done and faxed before I take someone to the loo.  Otherwise I might find that my patient has bled to death because I delayed his paperwork and connsequently his blood transfusion by taking people to the toilet.  I don't want that on my shoulders. Yeah go ahead.  Jump up and down and scream because dad needs the toilet and his nurse is at the station faxing blood order forms.  Temper tantrums and nurse abuse are easier and more fun than thinking and understanding aren't they.

To the patient I discharged last week: Please don't call the ward to ask me for health advice. You are not under my care any more, and I am not allowed to give health advice over the phone FOR SAFETY REASONS.  Your notes were gone from this ward 10 minutes after you were out the door and I wasn't even on duty when you were here. Even if I know the answer to your question, the most I will say is "Go to your GP or to A&E," to cover myself. I'm sorry if that makes you angry....maybe you should have kept that follow up appointment with your doctor we made for you. 

To my angry patient: I'm truly sorry that you had to wait for two hours for pain medication last night. The Powers That Be at my hospital have decided that "no one will notice" if they cut staff at night. Sure you can complain about the nurse, but I know for a fact that she was doing the best she could. Maybe you should direct your complaints towards the management, instead of the nursing staff. Maybe if patients directed their anger towards management  in the first place our hospitals wouldn't be such a fucking mess and this kind of shit wouldn't keep happening. 

 STOP GETTING OUT OF BED. That annoying, high pitched loud beeping sound is going off because YOU'RE GETTING OUT OF BED.  If you fall I will have to do about 6 hours worth of paperwork, neurochecks, send you for a CT head etc.  That is going to really screw my other patients.  I wish I could be there to help you everytime you want to get out of bed. Unfortunately I am being forced to be responsible for 20 other patients that are too sick for a general ward all by myself.  No, the social workers, support workers, and phlebotomists cackling away at the Nurse's station are not "nurses who are ignoring you."  They are not nurses, and they aren't going to help you while I am tied up with the man across the hall who just pulled his dialysis tessio out and his bleeding profusely.

Stop bending your arm.  For the 500th time. That annoying high pitched beeping sound is going off because you are bending your arm causing your IV line to occlude.  No I cannot just "shut it off".  It is heparin for Christ's sake.  Do you want to die?  Just keep your arm straight.  That is all you have to do.  That is all you have to do.  If you keep bending that arm and then screaming at me because the IV pump alarm is beeping I am going to go into the treatment room and inject my veins with something that will kill me.  Then who are you going to bitch at?

 No, that person constantly with your roommate is not a private nurse the hospital is providing because we "like him better". It's security watching him at all times to make sure he doesn't try to kill himself or attack staff and other patients again.  He already gave a medical doctor a fractured skull when he was brought in for an overdose last night. And then he tried to jump on top of a patient and smother him in AAU. ( telling the patient this would violate the confidentiality of the combative patient, therefore I have to put up with the moaner complaining that he doesn't get a "private duty nurse" because " we don't like him").  The I have to put up with the family calling 10 times a day wanting to know why the other man in the bay gets a "private nurse" but not dad".

These are the drugs the doctor prescribed for you to make you better.  If I were really trying to poison you, you'd be dead already.

 If your pain is a 10/10 and you are asleep, or talking on the phone  complaining about the food. we need to clone your DNA for our race of superhumans we're working on down in the lab.

 Yes, it is your fault that your baby was born at 28 weeks. It had something to do with the crack you were smoking.

Yes, I did go to University to do this.  No that does not mean that I am "just like a wannabe doctor".  Degree nurses are prepared to work on the wards as a direct care Nurse.  They are not any closer to being a doctor than an old style training Nurse. A person needs to be pretty on the ball and knowledgeable to deliver the health care prescribed by doctors.  And that is what nurses do, we deliver health care. No, I do not think I should go back to school and become a doctor. Delivering health care is tough enough.  I have no interest in prescribing it.  If that makes a person stupid then so be it.

I will not get you another glass of water because you threw the last three cups I gave you at me.  Three strikes and you are out. You are not confused or suffering from dementia therefore you can't get away with it.  Yeah go ahead, call your daughter and tell her we are trying to kill you via dehydration. Remember when you pulled the central line out that we needed to infuse IV fluids into you?  Here is the phone.  You will look like a tit. She knows what you are like. And if you can go out to smoke every 10 minutes you can get your own water anyway.

If you are going to refuse to comply with any treatment recommendations given to you, you will keep getting sick, and I will continue having to deal with you. It's not a conspiracy against you, trust me, we're sick of you.

 You're crazy and so is your family. We can't wait for you to go home either. Unfortunately, the consultant decides that, not us.  And it is going to take him 8 hours to get here. Then it's going to take 4 hours for the junior doctor to prescribe your discharge meds.  Then it will take another 4 hours for pharmacy to actually dispense the meds.  And then I have to find time away from critically ill patients to go over your meds with you.  I cannot make this process go any faster.  Please stop bitching at me.  It makes me want to kill myself.  It is hard to have no control and yet have to listen to your constant whining for 12 hours.  So help me god, I'll hang myself in the treatment room if you don't shut the fuck up about how long it is taking for you to get discharged.

Get off your fucking mobile phone.  I have a grand 46 seconds with you to make sure that your blood glucose is stable and  get your prescribed drug regime that is due now into your system before I have to run back down the hall to make sure to implement the doctors' orders for that patient who is going downhill. I will be stuck at his bedside for hours once I get there and there is no one else to cover you or my 10 other patients from that point onwards .   Lets make sure that I use this 46 seconds to make sure that you and my other 10 patients are stable and alive because I won't get another chance to check on you.  And no I am not going to make you a cup of tea because that will take 30 seconds thus leaving only 16 seconds to eyeball and action my other patients before I head back down to the deteriorating one, who I never should have left in the first place.

If you're in here for "COPD exacerbation", getting regular ativan because you're "nervous" because you can't breathe, maybe you need to stop going outside to smoke a pack of cigs every day. I'll give you a nicotine patch, but I won't help you go kill yourself, so feel free to "report me to the doctor" for not taking you out to smoke at 3 in the morning -- and if you DO go out, I'm taking your  nicotine patch off, I don't want to have  you collapsed on the floor for no other reason than you wanted a buzz.

How can you be so nice when your family are so feral?  And my god, not only are they feral but they are stupid too.

This isn't a hotel and despite the uniforms we are not your maids/servants. We cannot wait on people and do our jobs at the same time.  And if I don't do my job people die. This is why I am NOT coming into your room every two minutes to change the TV channels. If I could do that for you I would.  But I can't.  If you think that this means I am mean and uncaring, you are a tit.  Anyway, if you can go outside to smoke every 6 minutes why do you need the nurse to change your TV channels? And no, I do not need a lecture about treating people like people and not numbers from someone who killed 3 people in two different accidents as a result of drunk driving.  If I can't get in here to change the channels for you then I can't get in here to change channels for you. Deal with it.  Maybe if you didn't watch so much damn TV you would not have such stupid ideas about what Nurses are here and able to do.

 Hell yes I took your father back to his room and shut the door in his face. I did, and I would do it again. He was looking in other pt's room's (females) while they were undressing.  He came in to a room to stare at a woman I was catheterizing.. He's alert and oriented, and able to walk and he knows how to use the call light, and he has no right to go into other pt's rooms and stare at them.

She accused me of making him feeling like a peeping tom..


But I didn't have the heart to tell her so.

Your complaints about 'the service' I am giving you aren't going to get you anywhere because I CAN'T HELP IT. There are 2 of us and 30 of you!  The goddman cadets sat at the station in their "just like a real nurse" uniforms aren't going to help! Here I am rushing around like crazy- you see me flying up and down the hall- and you, an alert, continent, and fairly able-bodied person, have the nerve to make whiny little passive-aggressive comments about how long you've been waiting for 'service'. All because you are jealous that the other man in your bay was getting constant attention!  He is a head injury requiring 15 minute neuro checks.  People like you are what is going to crash the NHS.  YOU. Not immigrants, single mothers and "overpaid" doctors.

To the adult son of the little old lady who just rolled onto the unit a little while ago....why no, there isn't a phone in this room, which I hadn't noticed because I've been too busy making sure your mother's pacemaker is capturing, that her incisions are WNL, that her observations are stable, that her pain is controlled, and that I can hear breath sounds on both sides. Sorry you were calling and calling and nobody was picking up...I guess I should get my priorities straight, huh?   I pity her for having you for a son.

I am a professional with a degree. Two of them, in fact. I am likely more educated than you and was also one of 70 accepted into a nursing school program with over 400 applicants.   I got you a blanket because you said you were cold and I had time to hunt one down.  I made some cups of tea for you guys because I lucked out this evening with all stable patients on very little drugs and drips. This does not mean that you should assume that I have nothing more than a high school education since I gave your good "service".  I actually am one of those degree nurses that you seem to detest. And I would love to tell you that. I would also like to tell you that you are a douchebag.

I am just the person who checks your blood sugar and administers your insulin according to the results. Why don't you get pissed off with yourself instead of me when I have to call the doctor about your blood sugar of 23 mmols.. I guess you think I have amnesia and don't remember that you already told me off earlier in the day when I tried to teach you that eating 10 burger king whoppers, with onion rings, while washing it all down with a liter of Coke might not be a good idea.  You also ignored me when I told you not to eat those donuts that your family brought in because it would raise your blood sugar.  And your family told me to fuck off when I reminded that that we were trying to keep your blood sugars under control.  And now that your blood sugar is so high that the meter cannot even give a reading you want to call me and your doctor "incompetents".  And still you are stuffing your face junk food.  And your doctor is now screaming at me because I had to call him about your high blood sugars and get orders  him from for insulin to treat you.  Thanks, asshole.

Is this some kind of a joke?  I actually think most of your family members possessions are gross and I have no interest in stealing any of their clothing or shoes. So please stop drilling me with questions regarding their missing underpants or socks that probably got carried away with the laundry. Trust me I don't want them!  And I am not leaving the post op bleeder in room 17 to hunt down your mother's nightdress. And 9 times out 10 the care assistants and I are moving way to fast to even consider worrying about a stray sock that may have been taken away with the bedding.  Your mother is in hospital....why they hell are you worrying about socks and nightdresses?  I will happily give you £40 out of my own pocket to replace them.  As long as you promise to fuck off and stop asking me stupid questions about lost items when I have blood to hang and doctors orders to catch up.  My purse is in the staff room, take it, use what you find in it to replace your mothers lost item and get the fuck out of my face.  Just get away from me.

Sir, let me tell you -- you are ONE nasty old man. Yes, we "forgot" your breakfast, and for that, I apologized up and down and sideways, even ran to the kitchen to personally see to it you got a lunch tray. And how did you reward me? You lit into me about every single injustice done to you at this hospital, including, :HORRORS: having to be "last in line" in the x-ray line because YOU had a sepsis infection.  Well you wouldn't want us to spread your infection to everyone else  via the xray machine would you?   I mean -- dude, you are getting out alive. Yes, little things were missed. There was probably a team of 100 or more taking care of you these last 3 weeks. Do you ever wonder that perhaps just everyday human error in a large organization COULD result in a few glitches in your care? Are YOU fricking perfect? You certainly expect everyone else to be.   I wish I could transport you back to the 19th century to receive their version of medical and nursing care.  They'll cut your throat and try to bleed you to cure you.  No costly xray machines, IV meds, or decent pain killers back then.  Have fun.

The truth is -- you were well taken care of in this hospital at a much higher cost than what you ever paid in. Most of the work that is done for you by the Nurses and Doctors goes unseen and happens out of your line of sight. People waited on you at your beck and call, every god damn 15 minutes. You have been nothing but nasty to everyone.  Well, I hope people like you get what you deserve - whatever that may be. You are nasty and rotten to the core. You see people in service to you and you simply choose to demean them. I hope where ever you're going, that it's not someplace good. You are evil to the core. You live a great country, get decent health care from a struggling and overburdened system free at the point of delivery, yet you continue to complain because the hospital doesn't revolve around you and your wants and needs. Ugh. You make me SICK.  Violently so.

To the relatives of patient in bed 60, I'm sorry but I cant give him back his call bell,dressing gown cord,belt or tie as he keeps trying to hang himself with them. No I also will not give him his shoes,book or flask back as he keeps throwing them at the nursing staff.  Don't fucking ask me again or accuse me of "taking his stuff" you are literally making me want to die.  

I'm sorry you got bumped for an emergent case, but the fact that you are not the emergency is a good thing to be grateful for, no?  I mean seriously...would you really want your hospital to refuse to give you a lifesaving operation right away when you have just been brought in from a car accident that ruptured your spleen because "the guy waiting for the hernia repair all day doesn't want to wait".  No you wouldn't.  So get a life. I just lost all respect for you.

I realise you don't want to care for your father because he's an incredible areshole. I don't blame you. However, I have a legal, ethical and moral duty  to take care of him, so stop with your guilt-driven inane complaints and requests, because unlike you, I have to actually make something happen for him and I can't go home and just blame everyone else when it gets too hard. Thanks.

Dude, honestly, do you really HAVE to drink over a GALLON of alcohol PER DAY? How do you do it? Do you also really have to smoke 2 packs a day on top of it? And, if you hate this place sooooooo much, and want to leave SOOOOO badly, why did you EVER present yourself to A&E in the first place??  Why do you keep doing this to yourself and then present yourself in A&E?  Why?  Why?  If the food is so bad and we are all stupid and worthless stop getting yourself admitted to hospital over and over and over again, sometimes 10 times in a month. We both know that there is nothing that the doctors can actually do for you and that you are only here for the free food, warm bed and morphine fix.

To my little old sweet lady in green bay you are SO sweet, SO well mannered. You were a joy today. And compared to the 3 rabble rousing drunks I had to deal with all day, you were like sugar and kittens. I thank you, and if the world had more like you, we'd all be so much better off.  I love you and I want to take you home with me.

I really don't care whether or not you take your damned pills. Do it or don't, but let's be quick about it because I have 8 more patients to see before I can pee.  No I can't leave pills here and walk away.  Sometimes I have too, but really leaving pills at the bedside is a very bad thing for me to do.

No, sir. I can completely understand why you don't want to do your treatments. Yes, sir. It does suck. Literally. And I'm tired of trying to talk you into doing it. After all, it's your health, not mine. I will try to talk you into it three times everytime I come around to you.  And after that I will document that you refused.  Then I am off the hook when you try to sue over your hospital acquired chest infection or some other complication. 

OK, sir. I absolutely understand that you don't want me bothering you overnight to cough and deep breath, use your incentive spirometer, check your glucose, put your oxygen back on or turn you on your other side. But if I went away and left you alone as you desire, you'd get pneumonia, be reintubated, become hypo (or hyperglycemic) and develop a bedsore.   Really, there is not need for calling me a bitch for disturbing you when I am just trying to prevent the above complications.  I hope your next nurse does get pissed off and ignore you and you get bedsores and pneumonia.  You will really be calling the Nurses some awful names then.  But she won't because we always try to do our jobs despite your nastiness. And I will continue to be in here over night to make sure you are okay even though you are a jerk.

No, I'm afraid I can't tell you anything more about Daddy's bowel movement that he had at 1 a.m. as I wasn't here and all that was documented by the night nurse was that he had one. I'm sorry I have no further information." Darling daughter went all the way up to the chief of nursing to complain about this. What I wanted to say was, "Are you SERIOUS?" Your father isn't having any GI problems and this has nothing to do with why he's here. I think you are one sick cookie to block my way in the hall and ask was it runny? How many cups was it? What color was it? Did he grunt when he had it? Get a life!! It's people like you that give the whole human race a bad name."

For God's sake, let your mother get some rest. The quality of the care I give will not be improved by you sitting there and GLARING at me all day. Yes, I do know what I'm doing. As a matter of fact, I KNOW HOW TO DO MY JOB BETTER THAN YOU KNOW HOW TO DO MY JOB. No, I'm not just going to let your mom die, unattended, without doing anything, because we are not of the same ethnicity. Let me do what I need to do for her, so that if I get tied up later at least I was able to see to her at some point in my shift.  If you can do better, take her home. Otherwise, get out of my way and stop asking the same stupid questions over and over again. And pass that on to your brothers and sisters while you're at it.

You have a pain rating of ten? Really? Wow, you must handle pain really well. The only time I had a pain of ten was during unmedicated childbirth, and during the height of that, there was no way I could have been talking on the phone, eating hamburgers or sleeping the way you are doing! Congratulations, you have a seriously high tolerance for pain!"

That's great that you'd like a diet black cherry vanilla coke with a little umbrella in it. I'd like a Martini after dealing with your fluid overload and high blood sugar that resulted from your non compliance with your doctors orders. . If wishes were horses, we'd all ride.

No, I don't know when the doctor is coming in. They don't answer to us. We are not in control of them. We do not have your consultant on GPS. Sorry that you only come in for ten minutes a day with Grandma Millie and want the physician here to answer your questions right away so you're not late for your nail appointment.  You are so right.  Nurses and Doctors should always drop what they are doing and come running so that you are not late for your nail appointment.  I am glad you brought this complaint to our attention.

I realize you are claiming that we never gave you your call bell, but the truth is that your call ball was lost in your abdominal skin folds. Yes, it might be time to think about weight reduction.

We always give your grandfather your call bell, and he always knocks it out of reach.  And there is no way it is physically possible for me to get around to him as soon as he knocks the bell onto the floor.

We did show your grandmother how to use the call bell but as her dementia causes her to forget everything within 5 fucking seconds SHE FORGETS. You know this. 

Hello, welcome to XYZ hospital: let's get three things straight off the bat: We don't control doctors, we don't control dietary, and we don't even know what is going to come through the door let alone what we will be doing 5 minutes from now.

Lets get realistic here. Supervisors and administration staff the place just well enough to keep people alive, that's it. Call bells are for "emergencies" and "immediate needs" only. Not for getting a tissue box moved to the other side of the table or having the temp. in the room changed.   Everyone loves the story "Little Boy who cried wolf" except when it applies to them. So many people abuse the bell so often for insignificant requests, when the request that actually justifies using the bell comes around they wonder why nurses aren't quick to respond.

For Christ's sake we still do not have fucking GPS tracking on the doctors. We didn't this morning, and we don't right now, and we never will.  They have scores of patients to see, all over the place and if we page them to ask when they are coming it will only slow them down.  If anyone asks me again when the doctor is coming I am going to kill myself by sticking my head into the macerator.

For Christ's sake the doctors have scores of patients on multiple wards with many different Nurses.  They do not have time to check in with is usually.  I can usually only find out their plans by abandoning the patients to bury my head in notes.  Then you will accuse me of abandoning patients to bury my head in "paperwork".

Lady, if you haven't noticed, hospitals are short staffed. I am ONE woman to at least 12 patients and NO help. You perhaps could have called in and reminded me -- that would have been courteous. But the immediate needs of survival, pain, meds, and immediate care of my other  patients trumps your husband's need to get a better pillow for now.  Why yes I AM on the computer while your husband is "waiting for his pillow".  How else do you think I am going to be able to order and obtain the life saving drugs for the patient who is going to die today without them?  I get one shot at ordering and obtaining this stuff for that patient and I am not going to blow it searching the ward for a pillow.  Sue me. 

I do not appreciate your glares and your short attitude with me. You should be grateful that your husband is receiving care at all in this hospital, that you have access to health care and that doctors are working SO hard to find out why he's having repetitive fevers. Your husband is wonderful and very appreciative -- you, however, are an ungrateful wretch of a woman who thinks the world must revolve around you. You and others like you are the reason for problems in health care, in my opinion. But go ahead and bitch.  I feel the days are numbered as to how long hospitals and this economy can support bending over backwards for folks like you. There's going to come a breaking point -- and mark my words, you will be on the wrong side of it.

No I cant get your dad home any quicker as we are waiting for transport to get back to us. There is 5 inches of snow on the roads and the county has a shortage of grit so I kind of doubt he will be coming home today. Ringing us every 5 minutes will not get him home any faster, if anything it slows things down as transport can't get through as you are on the blinking line!!!Trust us, we want him out of here as much as you do.   How the fuck could we possible know when the ambulance will get here when they don't have anyway of even knowing that themselves?  Why do you refuse to accept any kind of explanation? Get a life.

I have no idea where your doctor is at this moment, and No, I cannot "get him on the phone" for you to complain about your minor "back spasms" you all of a sudden decided you have in addition to the million pound workup you're getting to rule out your other issues. Your doc will round when all the other doctors round, and he will be in here eventually. One doctor does NOT report into each and every nurse who is taking care of his 80 patients -- he truly does not. He also does not sit around all day waiting for us to call him about your hangnail -- I mean -- it's about the WAIT. And don't worry, when the time comes, you WILL be routed OUT of this place, as soon as is humanly possible. So, why don't you just lay back, enjoy the free room, TV, food service and nurse, and just go with the flow. Honestly, I'd give ANYTHING to be able to lie there for 3 days and do absolutely nothing but watch TV, eat, and be waited on. Why can't you just enjoy that? I mean, dude, I'd give ANYTHING to be able to do that -- what is so wrong about it?

On treating patients like they are my own family members; I have already warned my family members that if they mistreat hospital staff, I will personally strangle them. When my aunt was in the hospital my dad interrupted her Nurse while she was doing drug calculations for another patient to ask a dumb question.  Nurse Anne ripped into her dad for that. 
So, if I were in a situation where I was taking care of a relative, I would hope I would not over prioritize their "personal" needs (TV turned off and on for them, two water pitchers kept full at all times, dialing the phone for them) over the "medical" needs of other patients my relative's Nurse was caring for.   

The doctor told me to get you walking.  I know that we need to get you walking.   We must get you walking.  So when I asked you to walk to the toilet 5 feet away I wasn't being mean and I do not need lectures on "what you deserve because you have friends on the board" and " lack of compassion in Nursing". If I fetch and deliver things for you rather than making you do it for yourself you will get a blood clot and die, or you will get pneumonia and die.   You won't get better if your don't grit your teeth and start trying to move around.  Yes, I know it isn't fun.  But you are not an elderly patient who really cannot do these things for herself. You are a 39 year old woman!!

I know your mother wants to go to bed. She already told me. There is no need to follow me down the hall. I am dealing with a man who just transferred himself to the toilet. That's why the alarm went off. I can't drop everything and leave him sitting here unattended just to put your mother to bed. He is confused, unsteady on his feet and he WILL fall... SHE understands that- why can't you? And don't you dare waddle down the nurses' station and start bugging them about it while they are in handover trying to ensure that all bases are covered with all the patients. The oncoming shift has ONE shot to get all the info they need to start their shift.  An omission thanks to interruptions could lead to a fatal error. GO HOME. Also, when i do put your mother to bed please don't stand there and watch me like a hawk. This room is small and every time I turn around you are standing directly in front of something I need. Again, GO HOOOOOOOOOME.

Are you really sure you want your 100 yr old grandma that you left in the nursing home for the last 20 years to be for full and active resuscitation? Even though she has a feeding tube,is getting dialysis everyday, has all four extremities contracted, a very large unstageable pressure ulcer on her bottom that requires a urostomy AND a colostomy, and hasn't been awake in 4 years?? So, You really want us to try and roll her to her back while her legs are curled up in the air and we can't pry her contracted arms away from her chest and then crack her ribs while we do CPR on her???  Okay then.  If my grandchildren do that to me rather than letting me go with dignity I will come back and haunt them to death.  I mean, my god........  What do your poor old grandmother ever do to you to you?  Why do you want to torture her with all this medical intervention?

Since you want us to call and ask permission for EVERY SINGLE thing that we do to your mom, I am just calling to ask you if we can put her on a bedpan now or would you like her to shit on herself in the bed? (this after daughter threw a fit when we took an emergency chest xray of her mom because she has pneumonia, copd, and chf and we didn't call her to ask permission) And YES you ARE allowed to come in every other day and throw a fit with the nurses and managers and DEMAND that the CEO come to the room RIGHT NOW to straighten out exactly WHYYYY your mom is getting omeprazole 40mg IV every morning. Please please talk to the managers and CEO right now actually. That way the managers and CEO will already know you are whacked out and crazy as a loon when you complain about me trying to reposition your mom every two hours.  There are patients and relatives making legit complaints and they don't get listened to because lunatics like yourself outnumber the people with genuine complaints 10 to 1.

If you can reach the call light that often, you can reach the

1. Kleenex

2. Water

3. Your magazine

4. Snacks

5. Blanket to pull up

6. Miscellaneous

since they are right next to the call light.

Seriously I have something like 8 minutes per patient per 12 hour shift.  And I need to cover about 1000 bases during those 8 minutes with you.Use your time wisely.

NO. This is actually YOUR job. There is nothing wrong with your hands. You are completely independent. The nurses help out people who can't do things for themselves. You can empty your own pouch. And when you leave here, who is going to do it for you at home? I understand you are frustrated but please don't blame it on me or the other nurses. It's an important part of your therapy that you be as independent as possible. I won't hesitate to help you but I won't do things for you that you perfectly capable of because it would only hurt you in the long run.

For relatives/visitors: we are not sitting here chatting, we are in handover. Would be nice if I could magically know all about my patients without it, but I can not. When you interrupt handover, it takes longer for me to get to your family member for their (non-urgent) request. When I tell you to go press the patient buzzer so the nurse looking after the patient can help you, the key phrase is nurse looking after the patient, who is not me - so don't come back in 5 minutes to give me an update.  If I am not assigned to a particular patient I cannot get involved for SAFETY reasons.  This isn't 1952.  I have enough liability and work on my shoulders just with my assigned patients. It has nothing to do with "not wanting to be bothered" you freak.

When I tell you that I can't make icepacks for you because we have an emergency with another patient, but you're welcome to make one up yourself:

1) don't tell me you don't know how - I worked it out and so can you; hint, they involve ice, a plastic bag and a pillowcase;

2) don't come wandering up to where all the drama is to have a look and get in the way - go back to your room;

3) don't buzz for me again 5 minutes later, I'm still trying to help this nearly dead girl by actioning her doctors orders.  Quickly.  At minimum it is going to be hours before I can get back to my other patients. This girl is ill. 
4) oh, she doesn't look that sick to you? I'll just tell the crash team that the patient in bed 24 thinks that the young girl with a blood sugar of  0.7mmol/L (27mg/dL) and a core temp of 31.4C (88.35F) is fine and they can leave.

All in a days work.  Sigh.

Thanks to for making this post possible.
Details have been changed to protect confidentiality.  You will not be able to identify anyone from these posts.  This post describes a days work, every freaking day.

Friday, 17 December 2010

A Letter from the RCN

From Peter Carter:

"Last week we wrote to you with news of an important proposal from the NHS in England.

Despite already imposing a two year pay freeze, the NHS in England has now told the RCN and other NHS trade unions that there isn't sufficient money to pay increments for any NHS staff for up to two years. In exchange for a total increment freeze, the NHS are offering a guarantee of no compulsory redundancies for some staff.

Yesterday, RCN Council held a meeting to discuss the proposal. This email is to tell you about that discussion and to set out the next steps.

RCN Council examined the proposal in great detail. We need to be clear that Council will not accept or reject the proposal until you and every other RCN member has had the opportunity to share your views. However, Council wanted me to share with you their initial thoughts.

Council were unanimous in their opinion that the proposal does not offer any kind of guarantee for nursing staff and that, if implemented, it could signal the end of national terms and conditions through Agenda for Change which the RCN fought so hard for.

Although the proposal sets out a guarantee of no compulsory redundancies for those on bands 1-6, this will only apply in trusts that decide to opt-in and will involve local discussions and agreement.

RCN Council also believe that, in reality, the vast majority of nurses are not facing this threat. Instead, the real danger to patients and services comes from the tens of thousands of posts which are set to be cut through recruitment freezes and deleting vacant posts.

To give up any prospect of career progression in exchange for a measure that does not guarantee staffing levels, not to mention job security for all nursing staff, will understandably anger many of you. We also know that an increment freeze will have a real financial impact at a time when VAT is set to rise, the cost of living is going up and pension contributions are increasing.

So what happens next?

Council have asked me to start the process of discussing the proposals with our sister unions in the NHS. We also need more information from the NHS in several key areas:

What is the funding gap that decision makers are trying to bridge?

What other savings are planned, and how will they be achieved?

If NHS staff are expected to accept yet another restriction on their pay, what else is being done to save money?

How many jobs are at risk, and how many would be avoided through the guarantee?

How can Foundation Trusts, who have autonomy over their own pay agreements, guarantee no compulsory redundancies?

The guarantee only extends to staff between bands 1-6, what about the thousands at bands 7-9?

Let me be clear. Asking for this information does not mean that we are 'negotiating' on the proposal at this stage. It simply means that we need to have all the information in order to share it with you, our members, so you can have all the facts before you tell us your views. I wish to assure you that, ultimately, it will be you, our members, who accept or reject this offer.

We are your union, your voice for nursing and we will act in your best interests and those of your patients.

Over the next few weeks we will be sharing news with you about our consultation process, in the meantime, please do carry on telling us your views through your branches and boards, your Council members, through the Frontline First website, via the the RCN's Facebook page or by emailing us at

Thank you to all those who have shared your thoughts already. We wish to assure you that we are listening to each and every comment.

Yours sincerely,

Dr Peter Carter

Chief Executive & General Secretary

P.S. You can find out more about the terms of these proposals by watching this video:"

Monday, 13 December 2010


Get a load of this.
Health campaigners have responded angrily to a suggestion from an NHS boss that staff could “donate” a portion of their annual leave as part of an effort to save £30m.  In a staff bulletin, Epsom and St Helier Trust chief executive Samantha Jones said that employees could play an important role in helping to save the money in the current financial year.
She wrote: “A number of you have said that you would be willing to sacrifice some of your annual leave allowance and come to work instead.“It might seem obvious, but each and every single day off in the organisation costs the Trust money. This is particularly true if a member of bank or agency staff has to be hired to cover for your post.
“I fully support this idea, and in fact I have decided to work on one of my annual leave days. If everybody agreed to work just one annual leave day, it would make a significant contribution in helping to achieve our goal.” Ms Jones explained that in many NHS trusts, staff were agreeing to reduce their contracted hours between now and the end of the financial year, in return for an appropriate reduction in pay

Militant medical nurse says no.  The last shift I worked was 12 hours long.  They deducted an hours worth of pay for a break that I could not take without risking patient safety.  Then I had to stay over another 2 hours unpaid to complete all the paperwork.  It's a legality.  But if I tried to do it during my shifts patients and visitors would accuse me of neglecting patients.  So I waited until I handed over to the night nurse and then I completed it.
Nurse's already work a lot of unpaid hours.  Even when we stay over late unpaid we still cannot accomplish everything.  On most days I hand over a list of patient needs that I never got to sort out to the next Nurse.  Chances are that she won't be able to do any better. Same with the next shift. And before you know it a patient waits three days before that sore they asked someone to look at is actually seen.
Last weekend I was asked to work an 8 hour shift because they only had one RN on the ward.  I felt bad for her.  I felt bad for the patients. So I went in.  It ended up being 10 hours with no break. And I WILL NOT be getting paid for any of that. I am supposed to take the time back as "time owing".  This is something I will not be able to do because the ward is short staffed and busy.  I will never get paid for those hours or get them back.   My childminder is getting paid for watching the kids for me during those hours! 
Never again will I pull an extra shift.
  No they are not getting anymore out of me. They need to find other ways of saving money.  

I like this suggestion from one of the commentators on the article:

If I was paid a decent wage for the work I do and was paid overtime for all the time I stay late then I might agree that it was a possibility. However I am not, so ask the CEO or your countless operations managers or a modern matron or 2 or 3 if they can help you out


Friday, 10 December 2010

Nursing in the NHS: A Comparison

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 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.

Great scott!
 In my 28 bed ward overseas in 1995 we had 24/7 housekeeping. If a patient got discharged I called the maid on her phone and she readied the room for the next patient. If I left a patient with a GI bleed to clean a room myself I would get struck off for sure. Oh sorry I let your dad bleed to death because we were getting a new patient and I needed to clean the room in order to prove that I am not above such work, Yeah right. That would go over real well. There is never a time in a Nurse's day when she isn't caring for someone that sick. The maids made sure that the Nurses were not dealing with that stuff in order to ensure that patient care was not compromised.   The housekeepers here will walk up to a Nurse whilst she is in the middle of clearing someone's airway and tell her that a room needs to be cleaned.

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.
 NHS Pharmacy. The bastards. They  are open 9-5 Monday through Friday. But they stop taking requests at 4:30 PM. It isn't until after 4PM that the junior medics get released from their rounds to prescribe stuff, review stuff, and write discharge drug orders. If I can get them to write stuff up in time I have to take the drug chart with me, leave my patients and leg it to pharmacy. If it is 4:31 pharmacy tells me too bad, that they will not fill the order. Then I have to search the hospital to get what I need. But I won't be doing that unless it is an emergency because I probably cannot leave my patients to go on a drug search yet again

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.

Thursday, 9 December 2010

Post from a disillusioned Nurse

I found this on allnurses and can understand everything this poor girl is saying.  It is all true.  Families and Patients behave this way because of their social conditioning about Nurses and because of unrealistic views they have as a result of media portrayals of Nurses, Doctors, and Hospitals.  A hundred years ago sick and dying patients were cared for at home.  Families understood first hand what illness and death actually look like. The sick and the terminal wasted away,developed sores and became delirious at home with their family members watching and doing everything possible.  No Nurses or Doctors were around to blame it all on.

I recently read an account of the death of Willie Lincoln, a 12 year old boy in 1862.  His father was the president of the United States.  Willie contracted Typhoid fever and screamed in agony as his bowel perfed.  This sickness and suffering went on for months.  He was treated at home, in his parents bed.  He wasted away to nothing and lost his mind through delirium.  His family had front row seats to the reality of sickness and death.   They had no Nurse around to blame it on.  If they had a Nurse I doubt they would have started screaming at her because pharmacy delivered medication late or because the x ray department couldn't fit Willie in for an xray that day.  They would have been grateful that those things existed. I doubt they would have accused her of Starving their son when he got past the point of being able to eat and digest food, a usual part of terminal illness.   I think they would have been  intelligent enough to realise that Nurses have no control over those things.

 People today have a very sanitised view of it all thanks to TV.  Therefore they cannot handle the realities of sickness and death.  The reality is that terminal sickness and death looks like hell, even with the best of modern medicine. When they are confronted with this reality they go absolutely apeshit on the very people killing themselves to try and help.  So very sad.  They are going to embitter every Nurse we ever train and run them the hell away from the bedside.  The following was written by a Nurse who has been in the profession for 5 years.

When I was in nursing school, I was so excited to get finished and get a job. I thought I would enjoy doing nursing tasks all day...meds, IVs, injections, dressing changes, catheters, assessments. I was so proud to tell people I was becoming a nurse.  My job would be exciting all day long. I would be working hard and  helping people. I would get respect...

But 5 years later, ha! What a joke! Don't get me wrong. I am grateful to have a job in this bad economy, but nursing sure turned out to be a disappointment. I never thought that I would be worked to death the way nurses are. I never thought I would be talked to like a dog the way I am by patients, their families, people from other departments, and some doctors. I never thought bosses would be so quick to stab you in the back and try to get you in trouble. I thought I would be a valued employee and appreciated for what I did because I am a nurse who truly has a heart, cares about my patients, likes to get along well with others, and work as a team.

Instead, as a nurse you are treated like a peon. You have a team of 15 patients and are running like a mad woman to take care of all of them properly while your manager sits on her butt looking for any one tiny thing you might miss (while not offering to lift a finger to help you). Families sit in the room watching you like a hawk assuming you are going to hurt their family member..... Griping because you have to turn people with skin issues or check for incontinence. Griping because you have to change an IV. The other day I had a family member sitting there watching me like a hawk as I had to change the patient's IV site. Mind you the patient was an obese lady with huge arms and had had to have deep lines in the past due to difficult access. She said to me very rudely, "You get ONE stick, then somebody else is gonna do it." Then proceeded to stand and watch me with her arms folded across her chest. Excuse me, since when does the family dictate my job? That really burnt me up. Fortunately I got her IV on the first stick, but I have to take crap like that from people or I would probably be written up by my manager. I never thought nursing would be like this. When I visited people in the hospital before I was a nurse I had respect for the medical staff and would never dream of talking to them the way I am talked to.

You are blamed for everything. Doctor comes in late today? Nurse is yelled at about it by family. Doctor changes a medicine and doesn't tell the family about it or the Nurse? Nurse is grilled about it. Lab wakes patient early for blood draw? Nurse is yelled at about it. Doc orders stat MRI at 5 pm on a Friday? Nurse is yelled at about it by Radiology. Assistant doesn't check patient for incontinence while nurse is trying to medicate a critically patient in the other room? Nurse is yelled at about it by family. Medicine is late from pharmacy? Nurse is yelled at about it. Dietary doesn't send up a food tray for a patient or send up what the patient ordered then refuses to communicate with the Nurse? Nurse is yelled at about it by patient and family. Family members interrupt you while you are trying to calculate a cardiac drips that the doctor ordered to stop your heart patient from dying to ask where mum's nightdress went.  Then they throw a tantrum because your won't stop what you are doing to look for it. What the hell makes these people think that a Nurse with multiple patients can provide them with service? Are they all mad? We can do nothing right. It has really been disheartening. We go into nursing to help people and instead are treated like crap. I can honestly say that nursing is the job I have felt I have been the least respected in of all the jobs I have ever had. It has just been very disappointing.  I WANT to like nursing because I spent all of this time getting trained and getting licensed but wow.

Wednesday, 8 December 2010

Minnesota Nurses tell it like it is

Please understand that this is very relavent to what is going on the UK. We may have national hospitals but we also have hospital chiefs earning 6 figure salaries whilst freezing vacancies for qualified nurses, denying wards the resources needed to function etc. The public doesn't want to hear about this. The only seem to want to walk onto a ward where one Nurse is caring for double digit numbers of patients and abuse her and accuse her of "lacking compassion". When she is calling a doctor or handing over critical information to other staff she is accused of "gossiping at the nurse's station". When she is looking in notes to try and find out what the hell is going on with her 15 patients she is accused of "ignoring patients in order to play with paperwork". When she has a crash during mealtime she is accused of "letting patients starve". And when pharmacy shuts up shop and leaves the wards without medication that they need the Nurse is accused of "not bothering to give dad his tablets". What the hell is wrong with you fucking people?  You want to leave your loved one on large wards where 5 staff are covering over 30 patients and you want instant responses to call bells and one to one care?  Fuck you.

It has got to stop. If you don't want to support safe staffing legislation then fine. But don't you dare abuse a Nurse because your family member waited hours for help. It is out of the Nurses' hands now and in yours.

Here is another excellent video...testimony from the President of Minnesota's nursing association. Everything she says is relevant to UK nursing.

This one below is just sad.

Save the nurses!

Why oh why is the RCN not doing stuff like this?

I love Australian Nurses

One2Four - The way to safe patient care

UK Nurses are one to 10 on a good day, 18 on a normal day and 35 on many days.

Tuesday, 7 December 2010

Need your Help: Daily Mail

They are really outdoing themselves this time.

I can't post on their site but if any of you can go here and post some comments I would be greatly obliged. If it isn't too late that is.  This post has been delayed as I have been trying to research some stats.

Most of the comments are just funny.  Many of them are from embittered older nurses who don't have a clue about what is going on these days.  As a matter of fact, most of them still seem to think that project 2000 is still in existence.  It hasn't been used to train nurses in about 15 years.

The Nurses who did train under project 2000 are less than a fraction of a percent of the workforce.

Nurses tend to be older. The vast majority of Nurses working in the NHS RIGHT THIS MINUTE trained under the old system.

Latest quotes I am getting are saying that less than 3% of Nurses in the NHS right NOW did NOT train under the old system.  That means that 97% of them did train under the old system.  But lets be conservative.  Let's say only 70 percent of current Nurses trained under the old system.  That still means that currently only 30% of our Nurses trained under the new system.  But I am still researching this so do not quote this as gospel.  It doesn't matter anyway, as the vast majority of staff on the wards are not nurses and didn't train under any kind of system.

So what is the deal with blaming poor standards of basic care educated nurses who critically think?   Nurses like that are a rarity in the NHS.  They are so rare, in fact, and so outnumbered by old fashioned trained Nurses that they cannot be the ones to blame for the current situation.  I don't blame the old fashioned Nurses either.  The vast majority of my RN colleagues are old fashioned trained.   They have been doing their jobs for decades, stayed current with their knowledge and know their stuff.

If the Daily Mail and the public really cared about in hospital care they would:
A.  Promote safe RN to patient ratios
B. push hospitals to invest money in the front lines of care
C. Invest in 24 hour in hospital services.

The problem is the way that these wards are run and the lack of support for Nurses.  I will do some comparisons of my time working as a Nurse in North America and as an NHS Nurse in order to demonstrate what I mean.  Next post.

Monday, 6 December 2010

Nurses we are not hiring

I am hearing disturbing things from new nurses who are looking for bedside nursing positions.  I am also hearing bad things from older, hospital trained nurses who are looking to get back into the workforce and or job hunting due to relocations etc.

They cannot find jobs.  This is the situation in the UK and also in the USA.

Hospitals will tell you that there is a nursing shortage.  There is, of course, no shortage of Nurses.  Hospitals simply do no want to hire all the Nurses that are needed to care for the critically ill and complicated patients that are on the wards these days,  End of.

I found this video that was created by a new graduate Nurse. The best part is when the hospital manager tells the Nurse that since there are no jobs at the hospital he should go into long term care (nursing homes) whilst describing the conditions in those hellholes perfectly.

Check it out if you want.