Tuesday, 6 November 2012

David Cameron's Hourly Rounding Sheets


I had been planning to post about this years ago. Oh well. Better late then Never.

I read with astonishment David Cameron's comments on Nursing awhile back. His ignorance is incomprehensible. He clearly doesn't understand just why there is such nation wide poor nursing care in the UK. http://www.youtube.com/watch?v=fseCsrq2Lsw. Sorry I just can't be arsed with the video links.

 Mr, Cameron, NHS is nursing care is terrible because you and your hospital chief underlings are not willing to pay for RN's to staff your wards. Simple as. And no amount of hourly rounding paperwork, dignity classes and hospital training rather than university training is going to change that. General ward patients are 10x more complicated than they were in the 1970's, throughput is higher, and the pressure on the RNs is immense and constant. There are fewer RNs per patient now than there was decades ago.  Don't be fucktarded enough to by into DoH stats and shit. The population has aged and are living with chronic illnesses that wards did not deal with years ago (hint these kinds of patients just died in the past). And instead of increasing beds and RNs to keep up with it all the system has done the opposite.

I was still working in the NHS when I first read about Cameron's suggestion for hourly nursing round sheets.  These are pieces of paper located on each patient's bed.  The nurse is supposed to round on everyone of her patients every hour and sign and time the form each time.  

At the time I laughed. On my NHS ward I would often be the only nurse for 19 patients. Many of these people are so sick that they would have been in the intensive care unit with one to one nursing 15 years ago.  Now there are so many of them that they come to the wards with complicated drips, meds, orders, tubes and etc.....and they share their RN with at least 12 other patients.

I wondered how I would manage to sign those sheets and see all 19 patients within the hour. If  I spent 3 minutes with each patient it would have taken me 57 minutes to see them all once. But how would I manage all of the other things going on and still manage to see everyone and sign those sheets.

 Many of my patients were each on meds etc that took 15 minutes at least out of every hour to prepare and give.  Family members of just ONE of my patients could take up 20 minutes out of EVERY hour and many patients had families who tried to do just that. Labs, diagnostics, patients returning from theatre, chasing meds, dealing with changes in condition, doctors orders. Nurses are doing like 20 jobs per second.

Now that I am in a place that actually has hourly rounding sheets I laugh even harder at Cameron.  Not only because it is impossible even with 6 patients but because Cameron obviously stole his idea from somewhere else.

On a bad day here (blizzards, tornados, etc) I have 6 patients MAXIMUM.  If I am the designated charge Nurse for that shift then I get no patients or two patients depending on staffing and acuity. As charge I need to organise the ward and  help the RNs who each have 6.  This is why charge has a smaller assignment.

Filling in those sheets for just 6 patients is nuts.  You want to get to all 6 of them within the hour as well as dealing with all of the other things that cannot be ignored. Yet each patient (or their family) tries to keep you in the room for 20 minutes. Interruptions continue (this is a constant thing for Nurses, we usually average about 30 seconds between interruption for 12 hours).  People deteriorate, admissions come, families on the phone, pharmacy and lab want you, the insulin, heparin and cardizem drip that needs to be started and monitored, the IV antibiotics that need to be prepared by the Nurse and given all at the same time.  These things are all constant and never stop.

It takes each RN at my american hospital (and I work with fabulous ass hauling nurses) about 3 hours to get in and sign those hourly rounding sheets once for each patient. And they each have only 6 patients.

What the hell was Cameron thinking when he wanted to add these sheets to the workload of a Nurse with 20 or 30 patients?   I have never EVER seen him mention safe RN ratios at the BEDSIDE. The boy doesn't have a clue.

The problem down to a couple of issues.....Cameron is one of these morons who thinks that RNs are hospital orderlies who are there to wait on patients and have nothing else to do.  He shares that view with most people. His view of Nurses has been shaped by media such as TV, movies and books that have never in the history of their existence depicted Nurses doing what they actually do.  I've never seen a tv show depict a nurse managing a gazzillion doctors orders for 20 patients at once, dealing with lab and pharmacy to initiate a heparin drip as per doctors orders whilst being expected simultaneously to constantly assess all this stuff to notice changes in patient conditions. These shows do however show nurses acting as maids, switchboard operators and secretaries for doctors. 

The other possibility is that he has no intention of staffing those hospitals safely or he knows it is unaffordable but of course is NEVER going to communicate that to the public.  Neither will labour, the libdems, the american political shits or anyone else who wants to win an election.

I think it is a combination of the two.  As the population ages and we have people living with all these complicated treatments and disease processes like dementia, immobility, airway support, regular blood transfusions, parenteral nutrition, organ transplants, second organ transplants when they drink their way through yet another liver etc etc etc and the system knows that it needs to reduce qualified staffing costs to pay for all this stuff.  Costs are going up and basic care is going down.  And it will continue to do so.

In  1946 if you had anything that I described above you DIED. Quickly. You did not live with these things. 21st century healthcare is advanced and costly and the systems are going nuts trying to pay for it all. Their solution is to decrease qualified staffing and beds and increase throughput.  This is what they started doing about 15 years ago when they realised that the whole system would collapse if they didn't.

I hope they find another way.  I think they could, if they weren't so crooked. And I would like to tell David Cameron to eat shit.  Seriously dude:  Eat. Fucking. Shit.


Anonymous said...

I doubt that he even cares. I am sure he has private health insurance and if he doesn't, he'll be "given" a 1:1 nurse and a nice quiet side room in an NHS hospital

Nurse Anne said...

Yeah I know that he doesn't care but it would be nice if he stopped laying blame on the people who have no control.

murse said...

Cameron's ultimate 'fuck you' to the workers in the Health Service was replacing the loathsome Andrew Lansley with the even more reptilian Jeremy 'Cunt' Hunt. Bunch of bourgeoisie wankers laughing at the plebs while their mates mop up the steadily increasing pickings from the NHS table. We're fucking doomed.

uknurse said...

Have missed you Anne! :)

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Nicky said...

Alternative #3 Nurses save their whine to go with cheese in the evening and join the real world.

I live in the UK have had frequent reason to visit hospitals (amongst other things, my husband had terminal cancer)and have yet to find a nurse who didn't have time to chat about their private life whilst on duty.

I also work in a professional capacity and instead of 20-30 cases at a time, am expected to work with something like 150-250...OK, so if I made a mistake there is no-one's life at risk but even so the workload is huge in comparison.

One day I complained at the noise and laughter coming out of the staff-room during our FIVE HOUR wait for chemotherapy administration only to be told that the nurses were "entitled" to have a break. My retort was that my terminally ill husband was "entitled" not to have to wait for hours for scheduled treatment...the response was that we were threatened with being kicked out of the hospital for abusive behaviour!

Anonymous said...

Agreed that in principal the 'hourly rounding sheets' would appear to add another paperwork burden. But why don't we take charge of this and decide to eliminate the 'crap' that does not add value to patient care. The only downside is that you require a committed clinical lead to achieve this-have people read Dr Caldwell's papers (google it now!)?
Yes it would be nice to have more staff as emergency admissions are on the increase, but actually take a look around you and stop doing 'the crap'. Then you will have more time to provide proper nursing care. We are very task focused and constantly document the same information in multiple places compounded by the fact that NHS IT is decades behind, we do not have useful handovers because people cannot think about rearranging tasks to make sure they are in the correct place or give the correct info because we are too busy to work as a team. Help! Culture and proactive attitude change needed!!!

Anonymous said...

Jesus Anne, where have you been all my life?! I've just found this blog and swear to God I could've written it myself! Don't hate me though, I'm not a nurse, but then again I'm not a doctor either....no, I'm another one of those under appreciated, over worked, demoralised, front line NHS saps.

I hate the system, I hate the politics, I hate my managers - hell sometimes I hate my patients! (But only the ones with pyjama-related paralysis - you know the sort. Reach me that, help me up, I can't walk - well how the fuck did you do all those things 2 hours ago when you were at home, and how do you plan to manage at home tonight when I'm not there to fucking do it for you?!) I know I'm having a bad day when my patients irritate me.

All I want to do is do the job I thought I was applying for 15 years ago but now my managers would prefer I spent the vast majority of my day auditing stupid things, reviewing protocols that haven't changed in 20 years because they don't need to, filling in spreadsheets and ticking checklists. I mean, I spend 20 minutes every morning doing a fire check where I go around checking every soddin door, every window, every extinguisher - in my ultra modern, well equipped, reasonably small outpatient department. In the 15 years in the NHS I have never seen a fire, smelt one or even dreamed about one. But I'll check that extinguisher hasn't expired since I checked it FUCKING YESTERDAY. Honestly, it would be preferable to burn to death.

My managers don't give a shit about my patients. We have no disabled access. Let me repeat - this is a modern, nah ULTRA modern, department. Our patients who come along in their own wheelchairs can't get in the sodding door. One lady got trapped between the door and the wall and couldn't go forward or back. Our receptionist rescued her. I plead on a daily basis to my managers begging for automatic doors, but they are too expensive and we don't need them because the receptionist can help the patients in. Except she has to answer the 4 phones she mans by herself, book appointments, complete numerous stupid audits herself, and keep track of how close we are to needing to fudge our waiting list stats. Very occasionally she needs to use the bathroom and perhaps have a bite to eat at lunchtime, but I'm hoping she will learn to multitask and pee and eat at the same time so she has more time to help our patients through our front door!!

God, it feels good to rant! I can see how this started for you!

Good luck with the fight to stay sane, I'm losing it completely.

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"One day I complained at the noise and laughter coming out of the staff-room during our FIVE HOUR wait for chemotherapy administration only to be told that the nurses were "entitled" to have a break. My retort was that my terminally ill husband was "entitled" not to have to wait for hours for scheduled treatment...the response was that we were threatened with being kicked out of the hospital for abusive behaviour!"

Jesus Christ, I've just read this comment. So now staff are not entitled to breaks because you don't want to sit waiting for that chemotherapy treatment?! Take a look around you love, you're sitting in a fucking chemo clinic surrounded by other patients with cancer! What makes your relative so special?! We bust our balls getting patients into the clinic only to find they're not prepped right, maybe their script isn't written up, maybe they were late because their appointment is too fucking early for them to drag themselves across town. Chemo isn't something we pick off a shelf in a cupboard. It's prescribed by those special people you swoon over - the fucking doctors. And then we have to wait for the bloody stuff to get dispensed from pharmacy and delivered to us. And just maybe you have no fucking veins left and its not my fault I'm struggling to find one. Do you think I'm doing it deliberately?! So its not my fucking fault youre sitting waiting! im entitled to a break and entitled to laugh during it! you might think this is the worst place in the fucking world but its my workplace, i dont have to be fucking depressed and sombre every working minute im there!

Meantime I'm sweating like a hog and squeezing my ass in between the entourage of hand-holders you've brought with you. Do you really need 3 people to sit beside you the whole time? I can't get near you, and I'm sorry I have to keep inconveniencing you by moving you out of the way.

Jesus, the NHS would be easier to tolerate without fucking whining patients. You are getting this FOR FREE. Take yourself to fucking Somalia and see how much better their health service is.

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