Thursday, 17 February 2011

Stopping in to say Hi.

Hello everyone!

I just thought I would put in a quick update in order to let you know I am still alive.  I have been flying in and out of the country sorting out all kinds of things.

I have indeed seen the recent reports into the poor care of elderly patients.  I have also seen Dr. Grumble's post on starving patients. Yawn.

Dr. Grumble's post reminds me of an old old story that I once heard whilst on holiday in the United States.  We were driving through Kentucky and met some interesting people.  Here's the story:

Once upon a time an old farmer with a young son and a teenage daughter was at work in his fields.  His little boy came running towards him.  "Papa Papa!  Sissy and your hired man are in the barn.  They climbed up into the hay loft and took their clothes off !  Dang it Papa they are going to pee on the hay!".   "Son" says the old farmer "It would appear that you have your facts right and your conclusions wrong."
And it is just so with Nursing care in this country.  The media and the public are getting some facts right i.e. malnourishment and elderly patients not getting the care that they want.  But their conclusions as to why these things are happening (blaming nurses and nurse education) are way off base.

In the meantime I just want to make a few things clear.

The vast majority of staff on your average NHS ward are not Nurses.  The are carers.  They have never attended any kind of Nursing school either hospital based or university based.  On your average shift 3 out of 5 staff are non nurses.  My 6 chair hair salon has more than 5 staff on duty at any given time.  My 35 bed ward?  Never more than 5.

There are no ward jobs for real Nurses.  New nurses are signing on or leaving the country.  You really don't have any degree Nurses working on the wards or in NHS management.  They are rare birds in the UK.

The vast majority of Nurses in the NHS both in high level management positions (chief nurse, matrons, nurse specialists) ARE INDEED OLDER NURSES WHO TRAINED UNDER THE OLD SYSTEM. 

Of the few Nurses on the wards, the VAST MAJORITY are older nurses who trained under the old system.  My ward has no degree nurses unless you count me (and I had old fashioned hospital training as well as the degree I did abroad).  The ward upstairs?  No degree nurses.  The ward downstairs?  No degree nurses.   The matrons?  Nurses who trained in the 70's who got degrees later.  The Sisters?  Ancient hospital trained certificate nurses, older than Methulusah.  And so on and so forth.

Where people are getting the idea that there are all these degree nurses running around NHS hospitals from I have no idea.  Our newer Nurses are mostly in Australia doing direct patient care with a 4 to 1 ratio.  What is left in the NHS? Ancient nurses who trained decades ago and are too old to immigrate.  But of course an NHS ward only has two of them a shift (sometimes one for an entire ward). The rest of the staff is comprised of untrained uneducated unlicensed carers.  The few new nurses we have taken on are absolutely disgusted.  They hate being the only qualified on shift and being so snowed with drugs, orders, etc that they have to leave patient contact to carers who cannot connect the dots between general condition and plan of care. They are quitting.

Even if a new Nurse qualifies with a degree  and gets a job she cannot just go straight into management or clipboarding.  She has to get years of experience as a bedside arse wiping drug giving sheet changing  Nurse before she can even think about moving on.  And as there is no promotion or jobs she isn't going to be moving on into anything.   She sure has hell cannot even look at specialist nursing until she has years and years of old fashioned nursing experience under her belt.

Tick boxes?  Well yes we have been told we have to do that.  But there is no time during the shift to do it so we stay over unpaid to do it and avoid discipline.  Why do we have to do it?  Is it because some fancy degree nurse says we should?  NO.  Our senior nurses are not that dumb.  It is because the DoH/ CQC will fine the fucking shit out of the hospitals if we don't.  And my hospital has no money anyway.  They cannot get fined.    When the CQC came in I was happy.  I thought someone was finally doing something. All they were concerned about was whether the box ticking was done.  And if it wasn't done they wanted BLOOD.  These people are AUDITORS AND BUREAUCRATS  not nurses/doctors/ or god forbid educated Nurses.  I expressed my shock over their attitude to my ward sister.  "Why do they only care about forms?" says I.  "They are not clinical.  They are business people" says she.  I thought they were going to sort the place out.  But they just want the damn audits and tickboxing.

If you see a Nurse filling in forms at mealtime it is because she just got orders for a blood transfusion for a patient who is bleeding to death and haematology wants the Nurse to fill in 100 forms to actually get the blood.  If she feeds the patients and then fills in the forms to get the blood her patient will be dead.  And so is she.  Pharmacy, path lab, equipment library and social services are the true cause of lots of form filing.  The hoops that they make us jump through to get what we need and avoid a medical crisis are insane.

Matrons, chief nurses and Sisters are figure heads with no authority.  Never forget that.  They have no say in staffing or how many Nurses they are allowed to hire.  They have no say in whether or not we get carers rather than Nurses.  They have no say about cleaners or how many hours they can work.  They have no say about whether or not we can have a ward clerk, or if broken equipment on the ward can be replaced or fixed.   Everything is controlled by the folks who hold the purse strings. The ones who really try to push the issue are out of a job.  The rest just ask for things and get told No.

What is happening at my trust recently?

We certainly don't have enough cleaners.  And they have a very short amount of time to do their jobs.  It isn't enough for a 35 bed ward.  The powers that be are reducing them further.  Now we will have one cleaner for 3 hours a day to do about a 100 jobs.  Everything will be half assed and you know what?  She can't help it.  IF you think you could keep a ward clean in that time frame on your own you are crazy.  If you think that a lone qualified Nurse with acutely ill patients and over 1500 drugs to give 3 times a shift can clean you are also crazy. If you think a strict Sister or Matron who "runs a tight ship" is going to fix this you can go fuck yourself.  Sisters and Matrons and Nurses have NO SAY IN THIS.  

Kitchen never sends up enough food at mealtime so even if we did have time to get meals out and feed people we would run out pretty quick. 

No equipment.  Can't find anything in an emergency. No one to do stock. 

Shall I go on?  I was going to and then I decided to stop myself.  I am not out of the woods yet.

Anyway I hope to go into some of this stuff in more detail later.  Some of it is kind of delicate and I don't want to be in the country anymore when I let loose.



Robert Munro said...

Another great post Anne. Thanks for telling it like it is ,,,as always!

Anonymous said...

Good to hear you're still there. Best wishes for your move!

Anonymous said...

Excellent post Anne. People have got to understand they get what they pay for, and if they don't want their hard-earned taxes to pay for a decent level of properly trained nursing staff granny's going to suffer. And those nurses left are going to suffer too. We need more righteous anger like this, thanks.

Sue said...

I wondered where you had gone to! I'm glad everything is kind of falling into place for you. I was fuming reading the daily mail this week.

I have to run but I will be back to comment later.

Anonymous said...

well said Anne, Guess the government think the NHS can be run as a car factory. BUT they're NOT LISTENING.
Wishing you well

Dino-nurse said...

ConDems think robots would be cheaper than nurses, I fear. They do not care about the poor as they have never had to sit for hours in ED, or in the dole office, or wander around a town centre in the middle of the day trying to keep warm....
Unfortunately the great british public believe the lies and will get the NHS they real nurses and docs working under duress to pay off student loans...sound familiar? welcome to the good ship NHS County hospitals...

Anonymous said...

You underestimate HCAs. Shame on you.

Anonymous said...

Carers do a fabulous job, we may not be University trained but we do have training and the wards would be sinking far faster without us... I for one would have trained as a nurse but would lose the client contact, the reason I chose this job in the first place.

Anonymous said...

Thank you very useful post

bryboy said...

Wow! What an education that has been for me. I arrived here via Grumpy RN and you have explained so much that was troubling me about care for the elderly in hospital. I do not support the militant unions but I do like honesty. I guess I am a bit late but better late than never!

Nurse Anne said...


Please do not see the word militant in the title of this blog and think that we are pro-union.

Frontline clinical hospital nurses understand better than ANYONE that unions are worthless, evil extortion machines that care nothing for the people that they are supposed to represent.

Most Nurses are in the RCN for the liability insurance they provide. We need this to practice.

It would be very easy for any hospital nurse to get distracted by one of her 12 patients and their relatives long enough to make a fatal error. Long enough for this to happen is two minutes. That is the sole reason the RCN gets my money.

Unions show no interest in and can do nothing about the short staffing, poor skill mix, shit working conditions, and unsafe patient care. They know they can't do a thing about it. They are only interested in making money for themselves.

When I, at 26 weeks pregnant, was left as the only RN on a 21 bed ward for 14.5 hours unable to eat, drink, sit down or pee during all that time without risking a manslaughter charge the RCN did not want to hear about it.

The other staff I had working with me that day were untrained care assistants and they could not help me with drugs, orders, assessments, monitoring and information management for all those patients. They were parked at the Nurse's station. You can see how it looks to the patients and visitors. On that day there were so many patients on IV drugs that it took me 50 minutes out of every hour to just mix and prepare, and administer the damn things. And on average I was getting them to the patients about 3 hours late.

The care assistants cannot help me with that, nor can they give information about the patient's care to relatives who were queing up at the nurse's station to get inforation------wondering why all the "nurses" were sat at the desk ignoring them whilst mum's IV meds were late.

What I am militant about on militant medical nurse is that fact that unions are shitty, arse wipe extortion machines that make it easy for management to starve the frontlines (especially nursing) of resources and funding.

Please do not believe this bullshit that goes around about NHS nurses having an easy time of it compared to the public sector because they are unionsed public servants.

The unions get our money because I need liability insurance. I know that they won't do shit about working conditions and patient safety.

I am now abroad. My hospital is non unionised. I am so happy now I weep for joy. I now love my work. I am so happy to be back in the private sector that I cannot stop smiling.

Nurse Anne said...

sorry that should have said "having it easy compared to the PRIVATE SECTOR"

Anonymous said...

Hi from Melbourne Australia

Nurse Anne

Fantastic post! You are a great writer!

I notice you use an example of the Victorian 1:4 ratio as an example of the way Nursing could be!

Unhappily, our state government is going to abolish the compulsory ratios and introduce Nursing Assistants to replace registered nurses!

Our union, the ANF, is fighting hard to maintain our ratios, along with other conditions we have!

Having being an admirer of yours for a while, I am well aware of what you think about Unions, so i was wondering if you would allow me to give the link to this post and put it on the ANF RESPECT OUR WORK Facebook page!

I'm sure a lot of the members would be fascinated to get a first hand account of what it would be like to work with nursing assistants and to catch a glimpse into the wonderful new world our loathsome state government has in store for us!

Yours In solidarity

Ernie Ward

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