Militant Medical Nurse

Is the NHS recruiting senior managers from the sam...

2010-01-05T23:18:34.013-08:00

Is the NHS recruiting senior managers from the same pool as the police? Perhaps there was actually a sort of `day of the triffids` moment when, one night, a fuse blew somewhere and the next day we woke up to a world of pillocks. I watched the common sense `leaders` rapidly vanish throughout the 80's. Oh how I haven't missed them these past few years of my `life, part 2`. And if you haven't had the chance to watch the new series, "Nurse Jackie", record it. `Thank you` to you and your colleagues.

Oh and Capgrass one late shift when we had one nur...

2010-01-05T10:48:49.316-08:00

Oh and Capgrass one late shift when we had one nurse and one HCA and two fullblown medical emergencies as well as NO other staff we got disciplined for not answering the phone. A family member complained that "no one could be bothered to answer the phone or tell her anything".

My vote goes for George Michael. He has shown supp...

2010-01-05T10:42:16.024-08:00

My vote goes for George Michael. He has shown support for nurses in the past. But if you contact celebrities they just think you want money so pointless there.

I allow the mobiles as well. I just tell the pati...

2010-01-05T10:41:20.146-08:00

I allow the mobiles as well. I just tell the patients not to get caught!!

It is a worry that they will film someone with dementia hanging out of bed to accuse the staff of neglect.

The kind of patient that no matter what you do or how much time you spend with them they will be hanging out of bed shouting help.

And even if you go to them and get them toileted and clean and comfortable in the bed and give them paid meds every 5 minutes of every hour they will still be hanging out of the bed screaming for help. That is dementia. They will not remember what they were told 5 minutes ago. They won't even remember that they were shouting for help and deny that they did. They cannot remember or make sense out of anything you are telling them. No matter what you, that person will hang out of the bed screaming for "Bobby" and "Help". They cannot make sense of their world and it is traumatic.

There is absolutely nothing the nurse can do with a patient such as this. But people will film it and whinge on about shitty nurses."Oh how could they leave her like that?"

But I still allow the mobiles. I would get real upset if I couldn't have mine with me if I were a patient.

i work on such a ward: this is my survival strater...

2010-01-05T10:14:08.074-08:00

i work on such a ward: this is my survival stratergy. people kept ringing "just to send my love". sometimes whole family trees ring.........despite the fact that i ask them to create a "telephone tree" and pass the message on.
my two coping stratergies are 1)unplug the outside line, 2) allow all patients to use their mobiles ( i love to see a 90 year old with an i-phone............and they do know how to use it and it warms my heart to see them texting away. although i suppose equally they could be vidoeing me........but i love it when you hear they are on face book and stuff: meeting such people makes me remember why i still sometimes love nursing. 3) get the doctors mobile number and give him mine.........so we can comminicate independantly. and 4) ignore the phone.
However Anne is bang on as usual. i love her writing. wish we could launch a NATIONAL CAMPAIGN like the "go to work on an egg" campaign. methinks we need a celebrity to start this up. why not ask Dr Crippen?

Capgrass, The NHS has depended on that angel fema...

2010-01-05T02:34:20.144-08:00

Capgrass,

The NHS has depended on that angel female self sacrifice shit in order to keep costs down.

The public better hope and pray that nurses never become anything other than bitter self sacrificing martyrs.

Because if we do leave all that behind and they have to start paying us for all the hours we work, treating us as something other than a battered wife who takes the blame and a beating for everything under the sun, giving us the resources we need to do our jobs other than the "make do without or take the blame for failure-you ARE an ANGEL aren't you" culture that we have now..................the nhs would shut down. They balance the books on the backs of frontline nurses.

keep up your posting grumpy. personally i reckon y...

2010-01-05T02:28:49.480-08:00

keep up your posting grumpy. personally i reckon you are Charlie Fairhead. in nursing EXPERIENCE is EVEYRTHING...........EN`s were invaluable and many of the ward managers and sisters you see on the wards now, and the "lifers" in A/E ICU and theaters........were once ENs who got the RGNs, their children, their spouces and their nurse tutors to help them write their essays and thus past their "conversion courses". Also I am so Glad Grumpy is a pervy old male nurse. He probably brings a delicous black humour into the most tragic of situations that we encounter in hospital. I always love the male nurse who acts as a balast against the dreadful atmosphere of female self sacrifice...........which comes from the likes of Anne, Nellie, Dyno nurse, student nurse and a whole lot of other worthies.

The reason I choose that school was because I alre...

2010-01-05T00:08:48.058-08:00

The reason I choose that school was because I already had years of uni under my belt majoring in something else and because they had a 100% pass rate for the state nursing board exams among their students. Even if I had not done the BSN afterward I still would have been able to do every single thing and ASN or BSN could.

The state I was in really screwed the LPN's I'll never forget what they did to them. Glad I went straight for the RN.

We also had to keep top grades in science and math...

2010-01-05T00:05:33.199-08:00

We also had to keep top grades in science and math and all of our other university courses that were providided by the university or we got kicked out of nursing school.

It was a half and half thing. Our nursing courses and placements were done via the school of nursing but our university courses were done via the university that was liased with the old school of nursing. You could either get all the university stuff out of the way before attending the diploma program or do it simultaneously.

It was good but gone now.

EN's are LPN's. The diploma nurses in the USA are...

2010-01-05T00:02:09.051-08:00

EN's are LPN's.

The diploma nurses in the USA are RN's and have to take a lot of university courses to graduate. They do university level microbiology, anatomy, pharmacology, English,maths etc.

I know because I did my diploma first, at one of the last diploma schools. They were in the process of transitioning to a BSN program so after qualifying I didn't have to take very much more to get a BSN.

The EN sounds like the equivalent of our diploma n...

2010-01-04T23:39:16.572-08:00

The EN sounds like the equivalent of our diploma nurses here. I an RN who had gone the diploma track before it was phased out. She had years of experience on her and taught me a lot. She had what I call "horse sense", meaning she had good judgment. I work with a LPN who is one of the best nurses on our unit. She does not do IV pushes or piggybacks or hang blood. She also cannot do admission assessments. It would be a nightmare having to be the only RN on my unit (it's happened), but this LPN is really good.They are a good adjunct to the RN staff, if you can utilize what they are trained to do and can legally do appropriately - appropriately being the operative word.

When I was an EN we were exactly the same as the S...

2010-01-04T12:33:19.832-08:00

When I was an EN we were exactly the same as the Staff Nurses except they were always going to be in charge of the ward. I wrote my own documentation and called a doctor if I felt it was necessary.
If there was no RGN on duty then I was boss.
In the 80's nurses did not do IV's except in places like CCU, ICU Renal Dyalisis etc. slowly over the 90's we somehow decided this was our job so less time to do the drug round. If the EN was free at drug round time s/he did it with a student - and was expected to teach the student while doing this. After I converted to RGN they stopped EN's doing the drugs unless they had done a competency test, but this was not that difficult and most of them just carried on as before.

So yes, used properly a good EN can be worth their weight in gold.

Oh they forced them all right.Or so I was told by ...

2010-01-04T11:51:20.527-08:00

Oh they forced them all right.Or so I was told by the EN's. Maybe they just said that though I don't know. I thought it was the NMC doing it.

I have only ever seen LPN's and EN's work under the direction of a nurse mostly. For example lets take ward with a 12 patient zone staffed by an LPN and an RN. 6 patients belonged to the RN and 6 patients to the LPN (EN). The RN had to do the assessments, charting, IV drugs and doc calling on the LPN's 6 patients in addition to her own.

Did EN's do IV's and care planning?

If so, I want one. I'd rather die than mix up another batch of BenPen2.4 grams. What a PITA.

You are right though, anything we do will fail right now.

Anne, I'm glad you read Nursing Against the Odds. ...

2010-01-04T11:41:35.589-08:00

Anne, I'm glad you read Nursing Against the Odds. I am a ADN RN in the USA though I'm now in school for my BSN.

I know the UK press has done a huge number on the degree educated nurse and it's still banging on about Flo but I never see anyone harking back to the days of surgeons hacking off limbs with rusty saws or wishing they could just have a course of leeches instead of modern medicine.

I realize the public doesn't realize that with technology comes a lot more education, workload and monitoring than Flo had to do.

But you'd think they'd be clued in after a spell in hospital...........

It's pretty sad to realize that nursings biggest advocate isn't a nurse at all - she's a journalist and her name is Suzanne Gordon.

Diane in USA

I take your point Anne but if they are not going t...

2010-01-04T10:43:19.124-08:00

I take your point Anne but if they are not going to staff the wards properly it does not matter what you do you will fail.

"I will then miss a critical part of my patient's picture" - What you have to remember in this is that they would be the EN's patients not yours, they are registered nurses too. Would you go behind another RN checking their work? I would have been mightily pissed off if a staff nurse had come behind me to make sure the patients were all right without good reason. EN's were trained nurses who did the same job as a staff nurse but were junior to the staff nurse - yes. yes, I know that things have changed and patients are sicker and there are more technical things requiring doing but for good basic care of a patient you cannot beat a good experienced Enrolled Nurse.

I sound as if I am advocating the return of the EN, I am not I am trying to point out in my illiterate manner that EN's were not just trained HCA's.

I'm not convinced that your hospital were allowed to force EN's to change as I am fairly sure that is against RCN and the NMC rules. Obviously if they did it they did it. My hospital still has one or two EN's running about and I have already told you about the Band 6 EN - she had been in that post for 15 months and was actually looking for advice on how to become a level 1 nurse without going to university full time. You can find her letter here and my answer. Look for katogirl.
http://careers.guardian.co.uk/forums?plckForumPage=ForumDiscussion&plckDiscussionId=Cat%3afbe1954f-19a7-4006-82a3-08b5319f4c1dForum%3a7296f258-6ce7-4743-b359-795e7661e245Discussion%3a732ab509-9f55-49ef-a7a7-7b594df567ae&plckCurrentPage=0

My hospital made all the EN's get their RN, otherw...

2010-01-04T10:15:53.919-08:00

My hospital made all the EN's get their RN, otherwise they were made into HCA's.

"BUT it will not beat having proper degree trained...

2010-01-04T10:15:24.937-08:00

"BUT it will not beat having proper degree trained nurses on the wards especially as they still have to be paid the same as a degree trained nurse."

and that is why it will fail. They will leave an EN in charge of a ward with nothing but 16 year old untrained kids to help.

I am familiar with LPN's and EN's and they were for the most part very knowledgable and secure as nurses. However I don't want an EN doing all my drugs for me because I will then miss a critical part of my patient's picture. And I don't want EN's used as an excuse to stop RN's from being hired as ward nurses.

As an ex Enrolled Nurse I am well aware of what th...

2010-01-04T10:11:29.380-08:00

As an ex Enrolled Nurse I am well aware of what the role entailed and I don’t think you appreciate what the EN actually did Anne.

You talk of "delegating the basics" to an EN, this did not happen. An EN is, or should be, a valuable member of your team who is a registered nurse in their own right and any delegation is done in the same way that the Charge Nurse/Senior Charge Nurse delegates to you. As an EN I looked after my own patients including the sick ones. I could and would do a drug round for the whole ward – in fairness doctors did IV’s in those days but I still had to know and understand drugs. I would on occasion be the nurse in charge of a ward, I mean completely in charge as the only trained nurse there working with a couple of students and an HCA. As part of my training I learned the basics at the same time as the RN students – on the wards at the bedside. EN’s are trained to be ‘bedside’, ‘hands on’ nurses NOT glorified HCA’s. We were trained to understand illness and the disease process and also to interact with our patients and with their relatives – I was well able to talk to patients relatives either on the phone or face to face. I also on many occasions did the ward round with the consultant. The difference between me and an RN? I did not do as much depth as the RN students and I was not prepared for management. I still had to pass exams and I gained a registerable qualification which I will still on occasion write down.

Now having said all that, would I like them back? To be honest I’m not sure, it will not be a cheap option as you think as EN’s are registered as second level nurses and as they are registered they automatically become Band 5 nurses. I recently corresponded with a Band 6 Enrolled nurse. Where EN’s do come into their own is in giving people who only wish to get into nursing a chance to do it with training, registration and accountability without having to go to university.

It strikes me that if the plan as you are stating it is to make EN’s super HCA’s this will definitely not work. However, if EN’s have a similar type of role to what they used to then yes there could be some merit in it BUT it will not beat having proper degree trained nurses on the wards especially as they still have to be paid the same as a degree trained nurse.

I should add that in that situation I tell the nex...

2010-01-04T05:55:35.448-08:00

I should add that in that situation I tell the next of kin only to ring anytime. The next of kin is the person listed on the hospital admissions form as designated next of kin. I am not legally allowed to give any info out to anyone else.

But the next of kin never calls and everyone else in the family does. Repeatedly.

That sounds like a good hospital. We don't have t...

2010-01-04T05:48:25.215-08:00

That sounds like a good hospital.

We don't have those aprons anymore because the public just ignored them.

From what I know about high dependency they have less beds, and more registered nurses.

Each nurse on high dependency should only have a couple of patients. They will also have the back up of a ward clerk to answer the phone. That makes it easy to communicate with the families.

My ward is general medicine. That is a whole different world from high dependency.

We are more like 2 nurses to 25 or 30 beds. No ward clerk to answer a phone which rings constantly.

Sometimes multiple members of the same family ring all day long and many of our patients are not critical.

I can easily spend 40 minutes out of every hour answering phone calls from relatives with questions like "is mother wearing a hospital gown or one of her own?" and "when will she be discharged". There is really no way to answer the discharge one. There is no set time frame for anything in general medicine (there is in surgery however).

I will get a call like the ones I just described from Mr. Smith's neice, then the same question from Mr. Smiths brother in another phone call 10 minutes later. 20 minutes after that Mr. Smith's daughter will phone and ask the same questions. They don't speak to eachother you see. Then when Mr. Smith's wife comes in during visitors she asks the same questions again.

I get this constantly from the families of all 30 of the patients on my ward. With no let up. It would be different if I had only 3 patients in high dependency.

IF we cannot come to the phone right away, or if we ask them to designate one family member as the caller who shall them disseminate info to the rest of the family they fly into a rage.

If I have a critically ill patient because there are no beds in high dependency I also tell the families to ring anytime.

A family member was in hospital recently, big cris...

2010-01-04T05:26:57.482-08:00

A family member was in hospital recently, big crisis, high dependency unit, heart problems - anyway we asked at the nurses station if we could phone and ask how she was (limited visiting hours) - they said yes, of course, phone any time. We would not have realised it might be a nuisance from anything they said. (Also noticed people doing drug rounds on the main ward had aprons saying 'DRUG ROUND - DO NOT DISTURB' on, in big letters).

pscychiatry is a black cat - I saw Doc Crippens po...

2010-01-03T14:24:39.910-08:00

pscychiatry is a black cat - I saw Doc Crippens post, but in this case I agree with him, I have said in the past I only really disagree with him about nurse education and career progression and if he ever calls me 'nursey' I will stick a bed pan so far up it will give him a second adams apple.
Also, I do work in A&E, but I very rarely do catheters and the only time I have seen an 18 go in was in urology.

Anne, what do you mean am I saying I am a perv? I positively revel in it ;-) hehehe(dirty laugh). Actually, due to an unfortunate incident involving a nurse with a large chest and ongoing CPR my colleagues have accused me of having a boob fixation.
Like most mature adults in a mixed work place we have a fair bit of sexual innuendo going on, mostly at my and the other males expense. No offence taken and no harm done.

I don't work in a&e but we never seem to have any ...

2010-01-03T13:33:57.211-08:00

I don't work in a&e but we never seem to have any 12, 14 ch catheters in stock. Have to leave my patients for ages to run around and try and track them down. It's not like we have anyone to sort our stock out nor do we have time to do it.

But ouch, I'd rather leave someone in retention than put an 18 in.

hello Grumpy and a/e charge and Anne...........gue...

2010-01-03T13:15:46.986-08:00

hello Grumpy and a/e charge and Anne...........guess what i just found out the nhs blog doctor has decided to post. (he is slagging off charles again). will one of you post him a comment to wind him up? the only thing that seems to wind him up is poor grammer.
p.s. i hope grumpy that you are not the nurse down in a/e who keeps putting size 18 catheters into men. we have had a run of them recently. i cant help thinking its because you are out of stock of the smaller ones.

OMG Grumpy are you saying you're a Perv??? LOL.

2010-01-03T06:47:10.112-08:00

OMG Grumpy are you saying you're a Perv??? LOL.