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Maybe if nurses were allowed to nurse, not spend most of their shifts being clerks, recptionists,social workers, cleaners,junior doctors and being at the beck and call of every other profession who walks onto a ward things might improve. This is before they spend hours trying to answer the numerours calls from various family mambers about how their relative is. Spent a week in an NHS hospital watching one of the most put upon professions working themselves into the floor to meet the competing demands and expectations of patients, management and doctors and being constantly criticisied and blamed for everything thatr happens. A week in a hospital near the nurses station is most informative and some professions need to change their attitude towards the nursing staff. The most work shy group the ones who are ment to take blood but spend more time thinking of reasons not to was enlightening to overhear their conversations.
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Glad you are back Anne! You have been missed
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ReplyDeleteReading the Daily Mail/Telegraph comment threads again? Careful about that, it's not good for your soul. ;)
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ReplyDeleteHe missed out stuffing yer fat arse with choccies and trying to shag the Doctors.
ReplyDeleteBelieve me, none of the nurses/support staff/anyone with half a brain would be trying to shag a doctor where I work. It's nothing to do with being too busy, just that we're not slags, most of us are married AND the doctors are mainly unattractive (in personality). And we all hate getting chocolates on our unit; the receptionist takes the good ones and leave us the crappy ones nobody likes.
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ReplyDeleteBelieve me no one wants to shag a doctor. I have been a nurse for well over a decade and I have never fancied a doctor.
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ReplyDeleteDoes this finally mean you have quit the UK for the good old US of A? I am just waiting for a final date and then we are off to Canada and I can hardly wait.
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ReplyDeletemy sister-in-law's mother fell and broke her leg two weeks ago - she's 86 and fairly frail but independent - lives alone. Great first responder / ambulance, into shiny new NHS hospital, pinned and plated the following day, spinal anaesthetic rather than total, job well done.
A week on the ward at big shiny hospital, moved to local cottage hospital - where she's arrived with open pressure sores which they reckon will take 2 weeks to heal. They had her out in a chair within 2 days post-op, but presumably haven't been moving her often enough.
a) how does this happen ? Brilliant emergency treatment, lousy post-op care. Is it just staff shortage, or are they lazy sods ?
b) who should we be contacting ? - not so much to get someone's butt kicked, as to try and ensure it doesn't happen to the next patient.
Sorry to hear that Laban. Pressure sores are a big issue, especially with elderly patients. There are several things to consider here. Firstly the risk factors before the fall that would make it more likely that she might get a pressure sore...
ReplyDelete1) How mobile was your relative before the fall? Did she still walk to the shops, for example. Or did she spend most of her time sat in the house?
2) Skin integrity plays a big part- if you are frail or very overweight, you are more at risk of pressure sores.
3) How long after the fall wa she found?
4) What is her appetite like? Saying she is frail usually points to not eating very much.
5) Any medications she was on prior to admission to hospital.
>>>>>>
These are factors that should have been assessed when she was admitted in order to determine how at risk she was. Immobility following the operation will increase these risks (as well as the risk of clots or chest infections). Many of the risk factors cannot be got rid of once you are in hospital as they are out of our control ( your admission weight, skin integrity etc). What we can do is to try and minimise the risk...so mobilising you, getting the correct nutrition into you, having the right mattress etc...Many elderly ladies that have fallen at home become petrified of falling again and it takes alot of time and effort to build their confidence back up.
I can only speak for hospitals that I have worked in over the years. Elective and trauma orthopaedics used to be housed on the same units...elective patients are generally fitter and younger. Staff mixes on the units were better than today...more RNs/ENs per patient. We also had dayrooms rather than bedside tvs. Patients were encouraged to walk to the dayroom for meals as part of their recovery. Elective surgery is a money spinner and so current models separate out the two. Elective wards tend to have good staff ratios and trauma wards have poorer ones....trauma wards also tend to be full of elderly females with either fractured legs or hips. Many have complex medical histories to boot. Most need the assistance of at least one nurse to get dressed, fed, help with mobilising etc...most RNs on these wards will have 12-14 patients to care for...you can see where this is going....
How often did you or your relatives visit...what did you think of the staffing levels at the time? On a trauma ward I would expect there to be around 6 RNs and about half that number of HCAs...I'll put money on it being the other way around though. Incorrect skill mixes are the biggest problem...if an RN has to care for 12 patients with 3 HCAs, its the HCAs who will be doing most of the washes etc...this is when skin integrity can be checked. A good HCA will not just tell the RN, (s)he will show them if she finds evidence of the start of a pressure sore. There are a multitude of tools that RNs are required to fill out daily but these are no substitute for actually seeing the patients yourself...in my own trust, by the time the RNs have undertaken the morning medicine round and the iv round and the doctors round, it is already lunchtime, bearing in mind we start at 7am. The HCAs are the backbone on these wards but they are not RNs.
Rant over
I would suggest that you first contact the ward sister with your concerns. Ask her honestly about staffing levels. A good ward sister will already be aware of what has happened and why. If she or you feel that a lack of RNs is a big factor then you should put this in writing to the Surgical Services Director (title may vary in your particular trust). Problem will be that most trusts are well aware that lack of RNs is the real problem but they do not want to pay for a ratio of 1 RN to 4 patients...despite all the evidence to support this...google to see for yourself. The standard trust response will be to do nothing...
Anne, I've sent you an e-mail!
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