Conversation with a Moron

http://www.nursingtimes.net/nursing-practice/clinical-specialisms/management/the-case-of-the-disappearing-staff-nurses/5023027.article#commentsubmitted

I recently had a bit of dialogue with a rare specimen of a human being on the comments page of the article linked above.

I decided to post about here because people who think like this are 100% responsible for the decline in Nursing care that we see today.

This person (I think it is a woman) seems to think that a Nurse can be overloaded with patients with no limits on numbers and acuity, and still function.

She thinks that most NHS nurses are incompetent because of the following list.  (keep in mind that most NHS general ward RN's are taking on 15 patients each and that years of intense research have shown that the maximum number even the best nurse can take and not make mistakes is 4-6 on a general floor). 

" I am often involved in investigating untoward clinical incidents. The majority of times they arise from a chain of small mistakes which when put together cause a very serious situation, much like the well know “Swiss cheese” model.



Many of these small mistakes are made by “experienced nurses” many that have good academic qualifications. Examples of these mistakes include:


• Omitting to administer prescribed medication


• Administering the wrong dose


• Failing to administer medication at the appropriate time


• Failing to report that medication has not been administered


• Administering medications to the wrong patient


• Leaving drugs potted up on bedside tables


• Failing to recognise a deteriorating patient


• Failure to record observations


• Failure to report a deterioration in patients condition


• Failure to rescue deteriorating patients


• Poor documentation

None of the above “require the person who is delivering the treatment to be extremely on the ball” and being “short staffed” or “underpaid” is not an excuse for failing to carry out basic duties which are what the above are.

To her it is as simple as "Nurses are crap and incompetent and no  omissions and errors should occur matter how many patients have"

It is physically impossible to document, catch onto changes in condition  and administer drugs on time and correctly when an RN has a patient load that is too high.  I have worked enough 14 hour shifts without a break to know this is 100% true.  I do not believe that a person is capable of investigating "untoward clinical errors" on a general ward properly or devising schemes to avoid future mistakes UNLESS HE/SHE HAS RECENT AND FREQUENT EXPERIENCE WORKING ON SAID WARD FOR FULL SHIFTS AS THE ONLY RN FOR 15 PATIENTS. This person is an example of why I feel that way.

Let's review the research once again.




This had some alarming conclusions. It showed that when a nurse is assigned more than four patients, the risk of death goes up by 7% for each additional patient. So if the risk of death for each patient is 7% when a nurse is taking care of five patients at a time, that risk goes up to 42% for each patient when that nurse’s workload goes up to ten patients.



http://mnnurses.files.wordpress.com/2010/03/staffing-ratios-fact-sheet.pdf

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s3491is.txt.pdf

http://nursingadvocacy.org/faq/short-staffed.html#freq

There is so much more if you want to google this issue further.

Most hospitals in Britain have dangerous RN to patient staffing on their general wards.  The formula that management uses to determine staffing levels is flawed.  I have heard our chief exec, our nursing director, our matrons etc say that a ward is "sufficiently staffed" when it has one RN to 10 patients.   This is, of course, wrong.   That Nurse is going to make mistakes an fail. Throwing more apprentices and care assistants at the problem doesn't help when I am in the middle of a drug round and getting interrupted constantly during it to deal with things that only an RN can handle.

The thing about the NHS is that they overload their frontline RN's and put them in situations that no one could handle no matter how compassionate, intelligent, caring, or hardworking they happen to be.   When untoward incidents occur they use it as an excuse to disrespect Nurses even more and cut them off from even more resources.  It is a catch 22.  Pretty soon we will have one RN running between five 30 bed wards and they will say that the bad care and omissions in care are down to her "laziness".

Do you see what kind of fucking clueless morons we have running the show.  I have never seen a general medical ward in the NHS where the RN has less than 10 patients.  Most of us have up to 20 patients per RN at a time.  The powers that be have never even heard of safe staffing studies and they won't bother to look at them because they think all the problems are down to "bad nurses".  And as a result they will continue to deny us the resources we need to do our jobs. 

Nothing will ever improve until the dinosaurs working in the NHS that hold these ridiculous opinions start to die out.  Until they do Nurses will not win and patient care will continue to deteriote despite Nurses working harder than ever.

When I tell colleagues abroad that over here in the NHS the RN takes 8,10,12,20 patients on a general medical ward without 24 hour pharmacy and other back up etc etc they want to know "how the hell are you people getting out of there at the end of the day without making 150 drug errors in one shift".  The Nurses who have said this to me are award winners for bedside clinical excellence.  Yet they would refuse to work in the NHS because they KNOW that they would make mistakes working in these kinds of conditions.

But our little commentator over at Nursing Times thinks that these mistakes and omissions are merely occuring because Nurses cannot be bothered with basic nursing or are uncaring. She is wrong on both accounts.