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.