Militant Medical Nurse

Horrible things that Doctors do to Nurses

2012-02-01T22:35:00.000-08:00

In my last post prior to this one I talked about my sincere respect for Junior Doctors and all they go through. And that wasn't bullshit. I do respect and admire them.   But for the sake of balance let's talk about all the horrible things that doctors do to nurses. The number one thing that causes Registered Nurses to run away from the ward and frontline care is their Physician colleagues. Number one. Numero Uno. We don't hate cleaning up body fluids, or dealing with bedpans and death and dying. We don't mind washing patients, doing dressings or getting our hands dirty as well as all the skilled jobs that Nurses have to do. We leave the wards and healthcare in general because we want to get the hell away from Physicians. The junior ones are still pretty human towards the Nurses. They work hard, take a lot of crap and we respect them. But once they get past the level of "junior" I just want nothing to do with them. Not personally or professionally. Not anymore.

The abuse of Nurses by their medical colleagues is nothing new. Even Claire Raynor reported a surgeon throwing instruments at her decades ago. My godmother, an RN in the 1960's and 1970's, tried desperately to talk me out of Nursing school. "Doctors are mad at the world and it's the Nurses that they lash out at; you never want to work with one of these people" she told me. At that time I pictured my friendly family doctor and just laughed her off. I had only ever had experience with doctors as a patient. Working with these people is a whole different experience. The medical profession has a cruel streak and it is directed at Nurses. Always, always has been.

I don't even go to the doctor when I am sick. I try to tough it out unless I become convinced that I am going to die. He might find out that I am an RN. I told him that I am a homemaker, but he might find out that I am really a Nurse. Then he'll act like a creepy bastard towards me. It's no better with female doctors. They hate Nurses even more I think. The word is 'hate'. Make no mistake about it.   And it has nothing to do with the bad nursing care on the wards (docs don't give a shit about nurse staffing), or the grumpy nurse who was mean to them when they were struggling students.   Doctors need to decompress and registered nurses are not only an easy target but the only target. If they treated anyone the way they treated RNs they would probably be in jail.

I have seen many a Nurse fired for a physicians' mistakes. Too many to recollect all. Doctors are valuable and an RN is easy to blame and cheaper to sack.   Doctors will lie through their teeth in order to pass the blame onto an RN.   They lie about orders they gave or did not give. A lot. If a treatment goes bad they can pass the blame onto the scummy, incompetent Nurse. It's very, very easy for them to do.

As an NHS staff nurse I once had a new patient admitted to my ward. He has necrotic toes and was in agony. I looked on his drug chart and no pain medicine had been prescribed. I cannot give pain medication without a hospital doctor's order and approval from pharmacy. This is a time consuming process. I phoned the doctor on duty to get the order. His reply was "fuck off" and he hung up on me. I called him back. He told me to tell the patient to "deal with it" and hung up. I called him back at which time I got about 15 minutes of abuse and name calling. Then he refused to call me back. I finally got a doctor to prescribe for my patient. But that time the patient had been in agony for way too long. On the ward round the next day the abusive doctor says to the patient "You poor thing, your nurse never bothered to give you pain medicine, I will deal with her" and then he actually smirked at me. I've come to expect this kind of behaviour. If I told the patient what really happened I would lose my job.

Path lab once called me to tell me that my patient had a hgb of 7. I looked at yesterday's results. Yesterday her Hgb was 11. She was weak and short of breath. I took her obs and her blood pressure had dropped. My job in this situation is to look for signs of bleeding and notify the doctor of my findings. I called to notify the doctor of the critical lab value "I'm too busy for this crap, so just fuck right off" was the response I had from this patient's doctor. Then he hung up on me. Later on during the ward round the consultant wanted to know why a blood transfusion had not been prescribed yet. "The nurse never reported the low Hgb to me" replies the doctor who had hung up on me nearly 4 hours before. That got me a long lecture from the consultant explaining (yelling at me in the middle of the ward) to me why a sudden drop in hgb is something that needs to be reported to the attending doctor. Well, Duh. I did try.

Natalie was a nurse on my ward. She had a patient with a really complicated dressing change. The dressings that needed to be used were expensive and much more specialised than simple gauze. The damn things had to be ordered from pharmacy which is a mission itself. The patient had waited 5 hours for a dressing change by the time Natalie obtained the necessary materials. She set them up on a trolley and was on her way out of the treatment room and down the ward to the patient when a doctor saw her. He wanted a trolley for his notes and couldn't find one. So he grabbed the trolley from Natalie, dumped all of her materials onto the floor, did a little dance on them, piled his notes onto the trolley and walked down the ward.   At that point pharmacy was out of the stuff and the patient had to wait days for more. Which of course got blamed on "lazy, neglectful Nurses'.

Report these Physicians at your own risk, Nurse.

I had a patient express a desire to have a sleeping tablet prescribed. I cannot prescribe, obviously, so I called the doctor on duty to get an order for something. "Tell her that this isn't a hotel" was the response of the doctor just before he hung up on me.   Then he never returned my calls.   The senior doctors above him consider it beneath them to take calls for this kind of stuff. She never got her sleeping tablet. The patient complained the next day about the Nurse not bothering to give her a sleeping tablet. The doctor told her that "no one had asked him". Liar.

When a doctor refuses to return our calls, hangs up, tells us to fuck off, insults that patient, lies etc etc we are not allowed to document it that way. We have to write " notified doctor of patient's request, awaiting orders". Not "doctor told me to to fuck off, that Gladys is a pain in the arse, and hung up on me". If the doctor lies and says "but the nurse never told me......" There is nothing that the Nurse can do. The doctor's word is the doctor's word. And that is the case even if their are other Nurse witnesses to his behaviour.

In a sudden emergency a doctor gave a strong verbal order to one of my Nurse colleagues. "Nurse give this patient 10 mg of dangerdrugacin" he shouted. The rule is that we are not allowed to give anything without a doctor's order in writing. But an emergency is an emergency and if you ask a doctor to write out an order in the middle of one he will rip your head off and kick it down the ward. The Nurse gave the drug that the doctor verbally ordered. The patient had a terrible reaction and died. The Nurse got fired. They had to blame someone to appease the family so they used the fact that the Nurse gave the drug "without a doctors order". As the doctor never put anything in writing, he was off the hook. Two other people heard the doctor give the order to the Nurse and said so. She still got fired.

I had a 30 stone patient admitted to my ward with respiratory distress. While I was admitting her I noticed that she had a stage 3 pressure ulcer on her sacrum. Her husband informed me that even though she can walk she refuses, and rarely moves at home. She sleeps, eats and does everything in her mobility scooter. I asked if she had been in hospital or under the care of nurses in the last year and he said no. The doctor came into see her. I told him that she had a pressure ulcer that looked infected. "Well that is the fault of the Nursing profession, you Nurses don't turn people" he shouts in front of the patient. I calmly informed him that the patient came into hospital with the ulcer. "Well it's still your fault" he says. At that point I asked the patient if she could stand up. She did so and asked her husband to bring her scooter up to the ward so that she could go out for a fag. When she was outside I asked the doctor if a pressure ulcer in a fully mobile patient who has not been in hospital under the care of Nurses was still the Nurse's fault. "Oh Fuck off, she has a pressure ulcer because she is a fat pig" he said.   I then asked him why he told the patient and her husband that it was the fault of the nursing profession that she had a pressure ulcer. "Because I can" he said.

Doctor came to see the patient and told her that she could go home. Then he left the ward for 10 hours. He did not write her discharge orders or her drug prescriptions before he left. It took me 10 hours to get him back to the ward to do this. I am unable to discharge the patient without it.   When I called him I was told "I'm busy, tell the patient to fuck off about her discharge" etc etc. When he finally came back to the ward the patient said to him "Doctor, you told me that I could go home this morning , why have the nurses made me sit here all this time".   "Because the Nurses on this ward don't have it together" he told her.

How many times have doctors left orders for meds on the drug chart that should not have been there, only for the Nurse to get blamed when the drug was given? Seen that more times than I can count.

Nursing homes and social workers take 6 weeks to arrange a place for patients who need one. At least. The hospital nurse has no power over this. But that doesn't stop consultants for screaming at Nurses because "that patient is still here, don't you understand that she could get an infection because you fucking nurses didn't get her out of here, it is YOUR FAULT IF SHE DIES, YOUR FAULT". Usually this kind of stuff is said within ear shot of all the patients.

I once saw a doctor scream "You dirty pig" at a housekeeper (A HOUSEKEEPER) who dropped some cups on the floor. He then turned to the husband of a patient he was chatting with and said "We have to keep these dirty pig nurses in line or they would hand out the filthy cups that landed on the floor to the patients". The husband just nodded.   The doctor knew that she was a housekeeper and that she was heading back towards the dishwasher with the cups. He was just being an asshole, because he can.

If a doctor forgets to order lasix cover between units of blood it is "the nurse's fault, because she should have reminded me". If a doctor order's something incorrectly "it is the Nurse's fault for not catching it".

If a doctor doesn't come and see a patient for hours and hours despite repeated calls from the Nursing staff it is also "the nurse's fault". If a ward nurse is forced by management to take care of 30 patients on her own, it is also her fault if the patients get neglected or an order gets missed, according to the doctors.    If kitchen sends up the wrong food: doctor screams at the Nurse. CT department can't fit that scan in today: doctor screams at the Nurse. Social services delays nursing home placement: Doctor screams at the Nurse. Patient who has been ordered to be nil by mouth sneaks food behind the Nurse's back: Doctor screams at the Nurse. Patient refuses prescribed treatment or medication: Doctor screams at the Nurse. Pharmacy takes forever to dispense drug and refuses to stock the ward: Doctor screams at the Nurse. Patient decides to be noncomplaint with his fluid restriction nd renal diet and sneaks 10 litres of cherry fucking coke behind the Nurse's back: Doctor screams at the Nurse. You know damn well that neither can we watch your patients constantly nor get them to listen to us! Physio and OT avoid patient: Doctor screams at the Nurse. And he usually does this in front of patients to undermine the Nurse and make himself look like the hero.

Fuck this shit, Doctor. I am not a babysitter. I am not some self sacrificing angel who exists to take the fall for you. And neither am I a punching bag because your are frustrated with your job.  Nurses CANNOT control your crazy, noncompliant patients, the allied health professionals, the waiting times in the GI department, nor pharmacy, nor social services nor blood bank nor relatives nor transport.

It's no better in the United States. The doctors here don't do shit. We Nurses have been told that if a doctor wants to prescribe a med that HE has to enter the order into the system. But he doesn't want to 99% of the time. He says "enter it yourself or your patient doesn't get it".   And then he hangs up. If I enter it wrong or the patient has a bad reaction I will get the blame because I entered it.   Or the doctor can say "I told her 2mg not 4 mg" even though he really did say "4 mg". They can basically change their order after the fact this way and pass the blame onto the Nurse.   Thank god I only have 6 patients here. The doctors throw so many orders out at the Nurses but they refuse to enter them into the system. If I had 15+ patients like I do in the UK I would have to spend the entire day on the computer entering their orders for them. If the patient is actually going to get the treatment, the order has to be in the system. If the Nurse doesn't do it for them, and the patient doesn't get their treatment, the Nurse gets blamed. I can feel the eyes of the patients and relatives burning holes through the back of my head while I am on the computer. They probably think I am on facebook or something.

Oh my, I could go on for 100 pages with these kinds of stories. 100 pages easy. But you get the gist.

If a Nurse leaves general ward nursing, she gets away from this. Full stop. Well usually. You might want to read this: http://torontoemerg.wordpress.com/2012/01/25/the-persecution-of-amanda-trujillo/#comments

It always kills me when doctors say that Nurses leave ward nursing because we don't want to be bothered with bedpans. The truth is that we want to get away from Physicians.

Respect the Junior Doctors

2012-01-28T11:22:00.000-08:00

I had some real bad days as an NHS staff nurse. I felt like the stress and frustration would kill me. But there was a never a day where I felt like I would rather be a Junior Doctor. Those kids run their asses off.

They often carry the pager for the whole hospital. They are dealing with incredibly complex cases at the same time as routine stuff with nothing more than 5 seconds between bleeps from yet another staff nurse on another ward. We nurses have to call them for a lot of stupid shit as well, because of dumb rules. Some nurses forget that the medic is trying to be 1000 places at once and get impatient and demanding.

I have seen junior doctors collapse in crying fits at the nurse's station, breaking down to the point where they couldn't answer their bleeps. We tried to help the best we could by answering the bleep and telling the caller that the doctor was busy and would get back as soon as he could. We knew that the consultant would show the juniors no mercy and we tried to protect them. Well some of us did. Others were so worn out and mired down in the bullshit clusterfuck that is ward Nursing that they just lashed out as a way to cope. It's like they enjoyed watching other health care professionals squirm and suffer.

Junior doctors would lash out too. But I found that, as a group, they were more of a friend to Registered Nurses than any other health care professional group out there.

Once I made a mistake as a newish nurse (thank god no harm came to the patient). When I realised the mistake, the first thing I did was call the junior doctor on call, who was already very busy I'm sure. He was very kind and reassuring on the phone. He came to my ward straight away and reviewed the patient and then he calmed my anxieties, wiped away my tears and reassured me that everything was fine. He said that he thought what I did may have been good for the patient rather than bad. Those words of encouragement from him helped me to get through the rest of my shift.

In turn I always tried to encourage and reassure the junior doctors whenever I could.

I saw this blog this morning and it reminded me of so many things I saw at work. It's a great read. Have a look at it.

Must be mental...my time as a young doctor: Running like a mad man: When a crash bleep goes off on your first day you know there is only one explanation. You’ve been cursed. That’s it, must be the only op...

Worry grows as second senior nurse leaves NMC | News | Nursing Times

2012-01-26T19:04:00.000-08:00

Worry grows as second senior nurse leaves NMC News Nursing Times

My god. I hadn't actually realised that the Nursing and Midwifery Council has so few actual Nurses on staff. According to this article, they practically have none. The Nursing and Midwifery council is the organisation in the UK that licenses and regulates RNs. In order to work as an RN we have to by law be registered with these people. And they are expensive.

I always knew that they were brain dead and living in a fantasy world but I just put that down to the fact that they were older Nurses who haven't worked clinically in years.

But the truth is that they are not Nurses at all. There is not one person in that organisation that is able to grasp what a Registered Nurse actually is and neither are they able to grasp the idea of Nurse vs unlicensed assistive personel.

If they haven't worked on a ward as an RN responsible for a large number of critically ill patients, they simply won't be able to comprehend the situation. No one can unless they have done it. It is too complicated. Even RNs who left the wards in the 80s cannot comprehend the situation. At all.

This sure explains a lot about why the NMC is so useless. And it sounds like they are "divided" over the licensing of health care assistants.

If they license the health care assistants, then health care assistants will be counted as "Nurses".   Your local trust will use this as a way to decrease the number if Nurses working at the bedside.

Health care assistants cannot give meds, action and evaluate doctors orders, respond to emergencies, communicate with physicians regarding consults, hang IV infusions, assess for changes in condition, notice a potential emergency arising or plan nursing care around priortizing in a chaotic ward.

They simply change beds and do skills without thinking. It would never occur to a health care assistant to notice that the black tarry stools you are passing whilst on a heparin drip may signify the need to contact a doctor, get a PTT ordered, maybe get the drip held and watch closely.

Doctors, I hope you are getting ready to action your own orders, medicate your own patients, titrate your own drips, drop your own NG tubes, program your patient's IV pumps, watch for a million one possibilities for each patient (everything from pre renal failure to hypoglycemia and changes in LOC), do your own ward admissions and discharge planning, escort patients to tests in case they crash in the lift on the way, mix and administer all the IV antibiotics you order, and chase down pharmacy and fight to get the meds you want your patients to have. The care assistants cannot do this. You will have to do it when the RNs are gone.

Doctors, I really hope you are getting ready to handle all of that as well as your own jobs.  See the writing on the wall.   The RNs are being whittled away. They are going to license health care assistants so that they can get away with replacing Nurses with cheaper alternatives.

People think that all you need for a nurse is a kind heart and a willingness to clean up shit. You'll have that in the HCAs, but that is all you will have.   Those wards will have nothing but health care assistants. Health care assistants cannot and will not get involved with any of the things I have suggested that you get ready to do. You poor bastards are going to have to do the job of a ward RN as well as your own job.   There are so many real nurses unemployed right now and desperate to work on the wards, but they are unable to find jobs.   This will get worse when health care assistants are licensed.

And once the health care assistants are licensed the Hospitals will legally be able to say "but we have 6 nurses on the ward" when really there are only 6 health care assistants and no Nurse.

Hospital Doctors, if I were you I would hunt down the ward nurses to find out how to program an IV pump, do a drug round, mix iv meds, do trach care, peritoneal dialysis and the quickest route to pharmacy. All these things that you order (and expect to be done instantaneously) are going to have to be done by you when the RN posts are lost. I am sure that the RNs will show you the ropes before they are all made redundant.

The Nurse's Lament

2012-01-26T00:34:00.000-08:00

What does Bill Paxton's performance in the movie Alien have to do with NHS Nurses, you ask?

In this clip he sounds just like an NHS general ward RN at the START of her shift. She is going to sound worse after it ends.

When I arrived to work (when I worked in the UK) and found out:
1. That I am going to be forced to take on way more patients that I can handle
2. I'll be the only qualified Nurse for 16 patients who are already either pissed off, or dying, or both.
3. The patients I am assigned are way too critically ill and complicated to be on my general ward, but there they will stay......
4. Bed management is going to slam us with admissions and take staff away even though we are already fucked.
5. The only staff I will have with me are useless clerical types and allied health professionals who will sit at the Nurse's station gossiping all day, really pissing me off.
6. The phone calls from angry relatives will all be directed towards me all day long.
7. The mean doctor who never calls back and just hangs up on us if he does is the one holding the bleep today.
8. The realisation dawns on me that I will be held accountable for anything and everything that goes wrong, happens, gets omitted etc, even though I have no control.
9. In addition to all this, 4 or 5 patients are going to be going off the ward EVERY hour for tests and procedures requiring a Nurse escort. We have two nurses for the entire day.

I come out of handover sounding just like Bill Paxton in the movie Alien. We all sound like this. "Game over, man, game over. What the fuck are we supposed to do now". And then it goes downhill from there.

It's really the most realistic portrayal of medical-surgical RNs talking that I ever saw from the movie industry, and they weren't even trying to depict us. Both pre and post project 2000 nurses who work on the wards currently sound just like Bill Paxton's alien charactor. Can you feel his state of mind as he screams "game over man, game over"? Now picture someone in that state of mind acting "loving, caring, patient, and empathetic".

The Violence

2012-01-25T23:31:00.000-08:00

Once upon a time in the spring of 2010 ( I think) I was scheduled to work a night shift from 8 at night until 8 in the morning.   This wasn't unusual because all staff nurses have to work night shifts once in a while. Sometimes we work a whole week of nights. Other times our night shifts are mixed into the same week as day shifts. Our work schedules have no regular pattern and we get very little notice of what we are going to be scheduled to work.

On this particular night I came into work at 7:40 PM to start getting my report sheets with my patients' info together so I could be organised and not miss anything. I learned that on this particular shift I was going to be the Nurse for beds 1 to 15. Beds 16 to 30 were going to be covered by Jenny.

Jenny is a wonderful Nurse. She is about 60 years old, trained in the old days, and had been doing this job since before I was born. We just love her.

The staffing for the shift consisted of myself (a younger RN), Jenny (an old fashioned trained RN), and Kayla a care assistant.

Jenny and I are both RNs. We both do the same job for the same pay despite our backgrounds.

In my section I had beds 4, 8, and 11 empty. They had been empty for about 45 minutes as three patients were discharged around 7PM. I know that A&E is always full and at anytime I would be getting a phone call that admissions were coming into those beds.    I was going to have to handle that as well as handle the other patients I already had. Predicting when those new admissions were going to come in is impossible. All I knew is that I had to rush meds, assessments, infusions and everything else that needs to be done for my already present patients as fast as possible so that I could deal with the admissions. I hoped that they wouldn't come until after I saw all my patients.

Jenny was taking over beds 16 -30. In her section beds 19 and 28 were empty. There had been a death in bed 19. Bed 28 had become critically ill around teatime and the day nurse had just arrived back from transferring her to ITU. The patients in beds 16-30 had no care for about 3 hours at this point. The day nurse had to deal with the critically ill patient and then transfer him to ITU. So Jenny also was going to be getting admissions at some point too. And she also was going to have to catch up many things. The nurse who had my soon to be team of patients tried to help out with beds 16-30 but it wasn't enough.

I dread admissions. Admissions are pretty complicated and require an hour or two of focused attention to ensure that you don't miss something important i.e. a doctors order for blood, an allergy, etc. There are thousands of things that the Nurse has to think about with an admission. Usually when admissions come to the ward it is very unclear what is going on with them and what they require. It takes a bit of detective work on the part of the Nurse to find out and act on it. Has this patient had the IV bolus that the admitting doc ordered? Why are no pain meds prescribed? I can see in the history that he has chronic back pain and takes meds at home..but no pain meds are prescribed? His hgb is 5 but no one has prescribed blood. Call the doctor and see if he wants it given otherwise get yelled at for not asking. And on and so forth. Too make a long story short, admissions are a bitch.

Jenny found the day nurse who was caring for patients 16-30 and started getting handover from her. I found the day nurse who was caring for beds 1-15 and started getting handover in a different room from Jenny. If both of us listened to the information on all 30 patients we would be in report forever and that would just slow us down even more.

Straight in the middle of report (handover). The bed management people phone. "Your two new admissions are coming within 10 minutes, we have yet to assign your other empty beds but A&E is full, so we soon will be." she says.

"We only have two staff nurses (me and jenny) and one care assistant (kayla), can we please have more staff" I ask. "No, dear" she says, and hangs up on me.
"Great" I say. I haven't even got through report on my other patients yet, let alone seen them. But new patients are sent when it is necessary for the sending department and not when it is safe for the ward nurse to take an admission.

At that moment Jenny comes flying into the room where I am getting report. She looks white as a ghost.

"OMG, what just happened" says me. The look on her face made me assume that someone either just died or fell or was in the process of crashing.

"My new admission for bed 19 is here. It's Jimmy".

Oh no no no no noooooooooooo . Jimmy has been here before. Many times. He's an alcoholic with a massive psychiatric history and he tends to kick the shit out of people. Jenny informs me that he is getting admitted into her bed 19 for detox and a possible GI bleed.

Jenny and I run onto the ward. Bed 19 is in a bay with 5 other patients. And that is the bed that bed management has assigned to Jimmy. Bed 20 has a man dying of cancer. Bed 18 has an elderly man with confusion and fall history who has been diagnosed with a blood clot and is on a heparin drip that needs to be closely monitored. Bed 17 is a brittle and non complaint diabetic on an insulin drip. Both heparin drips and insulin drips require close monitoring by the staff nurse. Bed 16 has a young man recovering from pnuemonia. Bed 15 was a renal patient. And of course there are still my 15 patients and Jenny's other patients in the bed 16-30 assignment as well.

The porters dumped Jimmy into bed 19 and walked away. Thank god in heaven he looked asleep. Jenny and I checked him over quietly to ensure that he was breathing. Then I flew to the phone and called bed management. "how can you dump a violent patient onto a ward with frail, vulnerable, medically unstable patients and hardly any staff" I yell. "Look Anne, stop whining, put on your big girl knickers and deal with it" says bed management. And then they hung up on me before I got another word in.

Now Jenny and I were raging. We called the nursing supervisor on call for the hospital. While we waited for him to call us back we finished getting report on our other patients so day shift could go home. They had been there for over 14 hours at that point.

Now it is 9PM and no patient has had any care from the last few hours of day shift and the first hour of night shift.

The nursing supervisor comes to the floor. Jenny and I explain the situation. "What do you want me to do about it" he says as he shrugs his shoulders.

Now I am breaking out into a cold sweat. My hospital has no security team. Jenny, Kayla the carer, and myself were on our own.

I asked the supervisor just what the heck we were supposed to do when Jimmy wakes the hell up and starts beating patients and smashing the place.

"RUN. Go to the nearest ward and call 999". he says.

And then he continues with the following statement "Jimmy already broke bones in the ED about a month ago when he was last here, it took 7 members of staff to hold him down. He is sleeping now because they gave him stuff but yes, it is going to wear off. He spent time in jail for holding an ex partner hostage and torturing her for about a week. This is the kind of bloke you are dealing with. Just run. RUN"

I then ask him what I am going to to if Jimmy starts attacking the other patients in that bay. This is a very likely scenario with an alcohol detoxer because they go nuts. And Jimmy is a violent thug on top of being a detoxer. "I'll have to try and tackle him I guess" I say.

The supervisor shook his head at me. "Come on Anna, he'll kick your head in. If you see him start to stir and wake up, just run off the ward and call 999. I am sorry, I tried to stop them from admitting him to your ward. I did. Im sorry. Bed management overruled me and the hospital manager on call has refused to pay for any kind of security. I can't help you any further. I'm sorry you have to deal with this".

And with that statement the supervisor turned around and walked away. He had to deal with worse things going on in A&E. I'm serious.

"Let's pray that he doesn't wake up till morning when day staff comes in" whispers Jenny.

I still had 15 patients to attend to and by 10 PM all of the new admissions were rolling onto the ward simultaneously.   Jenny started with her lot by seeing to her patients on heparin and insulin drips. Those kinds of drips are not something you fuck around with and neglect. That's right, she had to go into the bay that Jimmy was in. We should have gone in together but I was so concerned about my other 15 patients and the new admits that I just didn't go with her.

And bed management, those rotten sons of bitches. They still sent new admissions to the ward and denied us additional staff even though they were very well aware of what the situation was.

At about half past 10 I was with my patient in bed 1. I had gone to her first because she had something going on that needs to be checked every 15 minutes. It is a med ordered by her doctor. I was listening to her bitch about "not being cared for during the past hour by you lazy nurses and didn't get my pain meds" when I hear a dull sound. It sounds like a thud, like a body hitting the floor. Then total silence. Then I heard a shout and a door slam.

Oh shit. He woke up. I guess I should add at this point that we had earlier called the physician and asked him to prescribe additional sedatives for Jimmy so that we could administer them if the shit hits the fan. He never called me back.

So I hear this dull sound and I go running towards bed 19. As I ran out of my bay one of my patients shouts this at me "I'll have your job if you don't give me my meds and tuck me into bed in the next 30 seconds. I ignored her and just ran while thinking "God I don't even know if my new admission who is bleeding out is even still breathing, and you want me to tuck you into bed, you crazy bitch" and "god why do I have these nasty thoughts, guess I'm burned out"

I run to room 19. Jenny is on the floor, propped up against a wall. She had been punched so hard in the face she is insensible.  She is conscious though. Jimmy and the young pneumonia patient are locked in a full on fight. I learned later that Jimmy had got out of bed and got Jenny from behind. The patient witnessed this and tackled him. Jimmy got away from him, grabbed Kayla and started heading for the door. I took off to the nearest phone to call 999. Jimmy had dragged Kayla into a bathroom and locked the door. Then he came back out and headed towards me on the phone. When he left the bathroom, Kayla re-locked the door for her own safety. I ran out the door over to the nearest ward. It happened to be an ITU that was locked. I banged on the door. A staff member opened it. I could barely talk.

I just said "detoxer. beating staff. please call 999". She ran to the phone and and called the cops and someone else came back down to the ward with me. I was so afraid for the frail patients in that bay, especially the man dying of cancer. I think the unit I ran too  must have called the supervisor and the medical doctor on call because they were on the ward within minutes. The medical doctor took one look, mumbled about not wanting to prescribe benzos to someone with liver problems and needing to call his consultant, and then ran off. The pussy.

The sup and the staff member from the unit had tracked Jimmy to the treatment room where he was sitting on the floor weakened and vomiting blood. It isn't uncommon for alcohol detox patients to have gastrointestinal bleeds. Now I knew that he would need a blood tranfusion, that psychiatry would not see him because of his medical issues, and that he would be staying here on my ward. Fuck.

The police came quickly. I was seriously impressed at their response time. Like 5 of them showed up. At least something in that town was well staffed and able to handle an emergency. The hospital wasn't.

Kayla sat with Jenny. While the police and the nursing sup were with Jimmy I quickly checked on the most unstable, unwell patients (paying particular attention to those with potentionally dangerous meds infusing).   Bed management called at this time and wanted to know if they could send another admission.   "The hospital is on alert as there are no beds anywhere and lots of patients in A&E."

"I haven't even seen the last admissions that you sent to me, nor my other patients. We have no more beds, and a nutcase smashing the place up, I am down a nurse because she got punched in the head. Do not send me another admission. My ward is closed" I yelled. The fuckers sent one up anyway. A&E was busy, people were on trollies and targets were being breached. When targets are breached the government fines the hospital, thus taking vital funds away for things like...ummmm...SECURITY AND NURSING STAFF.

But they sent her up anyway. The people in bed management are not nurses or doctors, they don't care.  New patient was a precious 70 year old with an even more precious daughter who arrived on the ward yelling at me about the wait in A&E and demanding food for herself and her poor starving mum. Neither of the two of them looked like they were malnourished. Believe me. God, if they are yelling about lack of food now, just what the hell are they going to do to me when they find out that A. there are no beds to put mam into and B. There's an out of control violent person on this ward. That daughter is going to kill me. Unless Jimmy kills me first.

And it was around that time that the police told me that they had to leave.

Jimmy, however, was staying.

Do you guys want to hear the rest or is it all too insane? This is the reason I never posted this back in 2010.

disclaimer. If you think you know any of the people involved with this, you are mistaken. Names and info have been changed to protect confidentiality.

A New Start

2012-01-18T10:25:00.000-08:00

Hello!

Well I have been in the States for months now and still haven't bought a PC. Blogging from a crappy tiny laptop notebook thing would probably cause me to loose my hair. So I am finally going to buy a real desktop computer.

Is anyone even still interested in this Blog? Should I let it die because I am no longer in the UK? Or do you want to hear some stories from the NHS frontlines that I never dared to post while I was actually physically present in England?

To be honest I was going to let it go. But then David Cameron's comments about Nurse's doing hourly rounds nearly caused me to choke to death on my own vomit.

He doesn't seem to grasp that one qualified nurse to 15+ patients is not going to be able to get around to everyone she is responsible for in a 12 hour shift.   The only things she is going to be physically capable of handling are the most high priority doctors orders and tasks and emergencies. Those things are not going to go away at any point in her shift so that she can round.

What Cameron won't admit is that the government has had hiring freezes on qualified nurses for years, decades even, and that the trusts are refusing to pay for more than one or two qualified nurses to staff 40 bedded wards for a 12 hour shift.   The acute medical wards have the sickest most complicated patients outside of critical care and also have the lowest staffing levels of qualified nurses in the hospital. In addition to that acute medical wards are also bombarded with elderly patients who need one to one care in order to survive and be treated with dignity. Bombarded is an understatement. The system simply cannot cope with the growing population of dependment, medically complicated elderly. It is the same here in the USA.

When qualified Nurses such as myself would call management crying and asking for help because patients were suffering we were told "tough" "not managements problem" "not within budget" "you aren't getting any help, deal with it" "grow up" "put on your big girl knickers" etc etc etc.

When we would tell management that forcing qualified nurses to fill in hundreds of forms in order to obtain emergency transfusions, medications, labwork, diagnostics, and equipment stopped us from getting near our patients, we were told "tough". If I had refused to fill in the forms in order to do a Cameron round on my patients I would have been held 100% responsible for any deaths that occured due to missed transfusions, medications, labwork, diagnostics and lack of equipment. David Cameron knows that this is the situation. He is not going to admit that government is NEVER going to finance the hospitals properly or force local managers to staff wards with enough qualified Nurses. So he is trying to pass on the blame for neglect of patients and save his own skin by depicting Nurses as people who just don't care.    I would hope that the public isn't dumb enough to drink that Kool aid but comments I see in the papers make me despair.

In the early 90's hospitals had the bright idea of trying to control costs by reducing the number of qualified Nurses at the bedside. The managers who control staffing and budgets are people with backgrounds in finance. They are not people with a background in health care. They do not understand how crucial qualified Nurses at the bedside are to patient outcomes. These people also do not hold a license to practice in the way that a doctor or a qualified nurse does. Therefore they cannot get held responsible for the lapses in care that are caused by their refusal to staff hospitals with enough qualified people. They make a lot of money from forcing doctors and nurses to take on uncontrollable workloads and by replacing qualified staff with unqualified people. And they are not the ones who get labelled as uncaring and incompetent by the papers, even though they have total and sole control. They even make it so bad that as a qualified nurse I cannot even control how long I spend with each patient, except to keep the time to less than a minute. Junior doctors have it a lot worse when they are carrying the bleep for medicine.

We do care.  But patients sure aren't going to see that side of us when we are prioritizing, overwhelmed, full of anxiety, hungry, exhausted, panicked and scared shitless. And angry. We ARE ANGRY. We are not angels, or superhumans or demons or anything else. We are just plain people trying to do our best. Granted that health care professionals can handle a lot more than most people. But we are by no means magical, perfect or superman.

When these finance cunts are told that patients are suffering and dying their response to the health care professionals is often "tough" "deal with it" and "sucks to be you, nursey".

Now who is uncaring? The Nurses and the Doctors? Don't think so.

Caring with no control over the situation equals no care at all. Your doctors and nurses care. But they are simply cut off from time, resources, control and support from budget driven cunts with MBAs.

By the way, if you walk onto a ward and see support workers and secretaries sitting at the Nurse's station gossiping and cackling .......it is no indication of how busy the Nurses and Doctors are at that moment. Unqualified staff cannot help us with most tasks. Just an FYI.

So yeah I was pretty sick over David Cameron's comments, enough to want to start blogging again.

My readers have probably all grown old and died by now ;). But if anyone out there has looked at this, thanks for reading!

Anne

New job new life!!

2011-05-25T18:30:00.000-07:00

Nurse Anne is pretty happy right now.

My new hospital really seems to have the right idea!!

I now have 4-6 patients. If any of them are acute then I get less. I have help. Pharmacy bends over backwards to ensure that the Nurse on the floor has what she needs. They know (and he said this) that patients suffer and wait too long for pain meds and other ordered drugs when pharmacy takes too long to verify orders. In the UK the Nurse would be left on the floor with patients screaming in pain and screaming at the Nurse because they didn't get their drugs. The reason their drugs weren't available wasn't because the doctor didn't prescribe it. It wasn't because the Nurse was mean and lazy and didn't want to give the drug. It was because the Nurse could not get her hands on the drugs until pharmacy did their thing. And it would take hours and hours and hours to get pharmacy to comply.

In the meantime the UK nurse deals with orders and care for her other patients-tasks that cannot be abandoned so she can sit with the man in pain. The visitors and the patients stare at her and they say"that man is screaming over there, why is the nurse ignoring him and not helping him". Well, she called the doctor 4 times over the last 5 hours to get an order for something to help the patient. The doctor was finally able to come to the ward to prescribe something, And now the Nurse is waiting on pharmacy. 9 hours total. That is how long this process can take in the UK.

Now, these things happen instantaneously for me. If I have a patient that needs something I can get a doctor on the case and his order verified and dispensed by pharmacy almost instantly. They work hard at this hospital so that the Nurse can have that.

Food. I am now in a place where kitchen sends up enough food to feed the patients. No matter how ward staff in the UK filled out those menus, the bastards in kitchen never sent up enough. And they only gave the Nurse a 15 minute window to get trays dished out and an entire ward fed. In England, the ward staff had to run out with the trays, and put them near the patient. They had to leave elderly patient's trays out of reach and continue on dishing out trays to the next patients. Elderly patients trays were left out of reach to stop them from burning themselves on hot food or dumping bowls of soup over themselves. The staff would run out with all the trays, hand them all out, deal with a 101 interruptions during this process and within 15 minute those goddamn fucking bastards from kitchen would be collecting those trays back in because "they had to take pots etc back down to kitchen and wash them because they wanted to get home on time".

I actually asked kitchen staff in England if they knew that Nurses were getting blamed for starving patients. I also asked them if they understand that we cannot help all those people and dish out food for an entire ward in 15 minutes. They shrugged their shoulders and said yeah so what.

And people blame Nurses starving patients? WTF? Nurses are the last people who have any kind of control over this process. English nurses get smirked at and sneered at when they bring these issues up to managers. And I am not talking about nursing managers. I am talking about the non clinical managers who control everything,

In my current job I not only get enough food for my patients but the hospital understands that Nurses have sick patients with multiple orders and constant tasks that do not disappear at mealtime. We get trained helpers from the diet department at mealtimes. If I want an elderly patient to have a carer to stay with them at all times I simply have to ask. Lets face reality. Elderly patients need someone who can stay at their side all day in order to get hydrated, fed, and help with movement to prevent pressure sores. If his Nurse has a full patient load and hundreds to drugs to give all day long she cannot do that for him. Can we please face up to this fact rather than labelling Nurses as cruel witches who intentionally neglect people?

Now, when I am on days I always have multiple secretaries on the floor who answer the phone and protect the Nurses from unnecessary interruptions. In the UK I did not have that. We were told we had to answer the phone or else. The phone rang constantly and a lot of time was taken away from the patients as a result.

I now have cleaners on the floor, lots of them! And they are given time to clean rather than having to condense an entire day's worth of tasks into two hours because our managers don't want to pay for any more than two hours a day of cleaning,

No more having too leave the ward and run 3 floors down to restock the crash trolley after a crash.

I now work on a med-surg floor and it is still tough, this kind of nursing always is, but WHAT A DIFFERENCE IT MAKES WHEN THE WARDS ARE RESOURCED PROPERLY. And what a difference it makes when the people who run the hospitals understand that Nurses need to be with the patients, not doing every other profession's (social worker, pharmacy, lab. etc) job,

I have time with my patients now. The amount of real time documenting we have to do (governement rules, yes government does regulate and accredidate US hospitals and fine them if the Nurses don't document the far end of a fart) is still immense and the penalty for failure to document is of course, termination. But they are always looking for ways to make all this documentation as quick and as painless for the Nurse as possible without violating government policy. Government policy in the UK dictates a lot of paperwork and data entry for ward based Nurses too (CQC and audits anyone?), but the system they use to do it is much more time consuming and the UK nurse has to do it all for 12+ patients rather than 4. And she has less in the way of help.

I have become 100% sure of something.

Having well trained, skillful, kind, caring and hardworking nurses isn't enough. It is only 50% of the equation. If that is all you have, nursing care will -to put it bluntly- be shit. Nurses need efficient work environments, manageable patient assignments, resources, and back up as well. If you don't have both of these things in a hospital at the exact same time, nursing care will be shit.

Regarding Unions:

2011-05-10T18:38:00.000-07:00

This post is going to be about ~~those fucked up, leftist, evil, worthless extortion machines~~ unions.

I hate them.  In the late 19th and early 20th century they were necessary. They brought into being good policies that are now enshrined in law.    Now they just exist to make themselves money and scoff at people who actually take on responsibility and work for a living.

I recently read a comment on this blog that concerned me. I am afraid that the author of the comment saw the word "militant" in the title of this blog and mistook me for some pro union communist bitch. He didn't say that but that is what people think of Nurses isn' it. So lets clear things up. We may have to be hard bitches to stop people from getting hurt and dying in hospital but I think most nurses realise that unions are nothing but a really, really bad joke.

This is the quick, quick version of Nurse Anne's take on unions:

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 15 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 got my money. If that happened to me they would help me with the legal stuff. Supposedly.

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 RCN rep told me that I should have "left the patients and gone for a lie down if it was so bad". Those were my days as an NHS Staff Nurse.

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 having a natter. 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. That includes all the time I had to spend chasing pharmacy to get the fucking things. And on average I was getting them to the patients about 3 hours late. That is because there were so many other things going on simultaneously to those drugs that on an RN could handle. And I was the only RN.

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 information------wondering why all the "nurses" were sat at the desk ignoring them whilst mum's IV meds were late.

Had the NHS hired all those new grad nurses that they trained; days like that never would have happened to me. I would have had other trained nurses working with me. You all bitch about new nurse training causing standards to slip. Standards have actually slipped because trained nurses have been replaced on the wards with people who have never attended nursing school. The one RN on duty gets overwhelmed and things get delayed. Mistakes get made. One hundred hardworking, good care assistants working with the RN cannot prevent that. That is why standards are slipping.

What I am militant about on militant medical nurse is that fact that unions are bastard extortion machines that make it easy for management to starve the frontlines (especially nursing) of resources and funding. Unions care about unions. The end.

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

The RCN got my money every fucking month because I need liability insurance. I know that they won't do shit about working conditions and patient safety.

I am now abroad. My new hospital is non unionised.   The folks that run my new hospital have won awards for treating their nursing staff so well. These people understand that when RN's have manageable patient loads, are well resourced, respected, and supported, our patients get better care. It is cash well invested and makes the hospital money that gets put back into even better care for the patients. We are non profit but not government. It is a good cycle.

All those expensive unions in the UK have never, ever made an attempt to get NHS managers and UK politicians to understand this. Unions are just extortion machines that are interested in making money for themselves. The doctors have the same problems with their union in the UK. Even if these unions gave a shit, they would still be powerless to change anything at this point, unless they were completely restructured. Maybe if NHS nurses had decent unions who were simply about protecting the worker things would be okay. But they are far from okay.

So I am non unionised now and can buy my own malpractice insurance. I am so happy these days 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. Yes I am non unionsed, and if I make a mistake my new employer can fire me at will. So what? If I fuck up that badly with only 4 patients,and much in the way of 24/7 back up and support then I deserve to get the sack.   I don't always get a lunch break in a 12 hour shift. But I get them a lot more now than I did when I was a unionised NHS ~~whipping boy sacrificial lamb slave~~ Nurse

Australia: One RN (an RN is a person who has attended Nursing school) to 4 patients on a general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

USA: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

Singapore: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need. This is what singamore nurses tell me anyway. I've never been there.

England One RN to 12, 15 or 30 patients on a 30-ish bed medical ward. She might have several untrained carers that assist with basic care only. Pharmacy, clerks, and housekeeping are 9-5 and dump on the RN. If the RN doesn't do their bidding, the patient doesn't get what he needs and the Nurse gets the blame. The RCN is oblivious.

And I think the UK is more heavily unionised. What does that tell you?

On a Break

2011-04-23T09:43:00.000-07:00

As you may have noticed MMN is on a break at the moment. Sorry that I haven't updated in awhile. I should have more posts coming your way by summer.

Take Care!
Anne

An intelligent comment from Daily Mail reader

2011-03-17T10:15:00.000-07:00

I read this comment. Then I collapsed. And when I came around I thought I would post it to my blog.

Alan from York I don't know who you are but I love you!!

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.

http://www.dailymail.co.uk/health/article-1366832/One-NHS-workers-NOT-recommend-hospital-treatment.html#ixzz1GsSmZqkj

Dr. Rant is back Ya all!

2011-02-21T00:12:00.000-08:00

I am their number one fangirl. I want the t- shirt, the autograph, everything.

http://www.drrant.net/

More job cuts

2011-02-18T11:52:00.000-08:00

Mental Nurse beat me to it but here you go:

http://www.guardian.co.uk/society/2011/feb/17/nhs-hospitals-axeing-frontline-staff

and remember........

http://www.guardian.co.uk/society/2010/jul/07/nhs-jobs-cuts-coalition

Notice the line about the Royal College of Nursing "confirming" that nearly 10,000 posts (qualified Nurses) have been cut due to vacancy freezes.

Nurse Anne told you so.

And I have an inkling that their number is only the tip of the iceberg. My trust alone has got rid of nearly 60 District Nursing posts. Our hospital is appalling for not replacing Nurses.

As they say over at Mental Nurse: And so it begins......

You think the care in the hospital is shit now? Just wait.

Epic Win...Kind of....

2011-02-18T07:53:00.000-08:00

Somebody posted a link to my blog and it actually made it into the comments section of the Daily Mail.

Not that their readers will give a crap or ever understand the situation. But you know, it is something worth celebrating anyway I think.

Stopping in to say Hi.

2011-02-17T04:17:00.000-08:00

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.

Chow!

What it is like.

2011-01-28T10:25:00.000-08:00

Back to the Medical Ward. Yay.

NOT.

My 13 hour night shift was due to end at 0700; at which time I have to be ready to give report to the oncoming Nurse.

Starting at 5AM I had to:

Start a magnesium infusion, give calcium gluconate and start an IVI with K then an addiphos infusion and take off a whole load of other doctors orders for a patient with deranged U+E's. The addiphos probably won't go up till day shift. He could have crashed at any moment with a K that low and I didn't want to leave him. He had bloods done over night and the results came back at 04:30. The doc wrote the new orders just afterward. I had to run around like a nut just to find some magnesium to start and of course document every aspect of all of this. All had to go through a central line. As you know this is time consuming.

I needed to get vital signs and obs on all 19 of my patients by 7 AM. If you wake the patients up before 6 to start getting all their obs they get angry. If I didn't start before 6 they would never got done and we would potentially miss the signs of a deteriorating patient.

I had to IV fluids on someone with renal failure.  I had noticed his rubbish output at midnight but it took until 04:30 to get the doctor as he was the only doc on for multiple wards. Bloods hadn't been done for days on this patient and I needed to draw them.

I was also trying to keep the 02 on another patient, a confused patient who was desaturating without it and kept taking it off his face. He has disorientation secondary to sepsis so he could not understand me when I asked him to keep it on. He needed a mask rather than a nasal cannula.

At this time I also had to obtain,, mix, and administer 15 (yes fifteen) IV antibiotics for 8 patients that were prescribed them. This has to be done by 0800. Day shift starts at 0700 but doesn't even get out of handover until nearly 0800 so they can't do it. I had to do them and finish them by 07:30 AM.

I had 5 patients ask for controlled analgesia during this two hour window. This again is very time consuming. The system for obtaining and administering controlled drugs is a joke.

During this window I also had to be up to date on the current status of all my 19 patients. For example any little thing that changed with them on my shift I need to be onto right away. Examples of this include changes in observations, neuro observations. fluid balance, blood sugars etc. I had 5 diabetics. I need to act on every little thing and document it and it all needs to be done right now.
I had to act on the fact that I just noticed that my patient who is being treated for a UTI is completely unresponsive with a low BP. Had to call the doctor and wait for him to get around to calling me back. Fast IV fluids ordered as well as a million other things that needed to be done ASAP.
Two patients who needed IV antibiotics woke up and pulled their IV cannulas out. Two others pulled out their urinary catheters. It was like a blood bath for all 4.

I needed to monitor the patient on the IV insulin infusion closely. His blood glucose still isn't right. Something is wrong about this. Her consultant wanted her to stay on this infusion over the weekend. All night long I had told the house officer that the insulin infusion and the iv fluids that get hung with them were running out and that he needed to prescribe more so that I could hang more on the patient. The only time the doctor came was at 4:30 in the morning. I handed him the chart but he put it down and "forgot" to prescribe it before he got bleeped away somewhere else. Called him again and he said that he couldn't "come back to your ward" for awhile.

I had to deal with the fact that a patient woke up in agony with a blocked catheter. It needs irrigating. It was draining a few hours ago.

Remember all this is what got thrown my way between 5 AM and 7 AM. I was the only RN for double digit patients.

There were two lots of IV frusemide to give. 80mg. They need to be set through a pump. Got to watch those BPs because even though they are borderline (and I wouldn't give it if they were a smidge lower) these two chaps really need it.

I didn't want to leave the side of any one of these patients. But my god. Just standing in the treatment room mixing and preparing all these IV drugs is extremely time consuming.

I had to leave a few of the antibiotics for day shift. Day shift was so busy that they didn't give the 8AM meds that I didn't give until nearly noon.

I got a phone call at 0600 to take a direct admission from A+E as there are no beds anywhere else. The A&E nurse gave me report on my new patient. He is a drunk and combative alcohol patient who fell and hit his head. They want neuro obs every 15 minutes. He is sleepy but when he wakes up he knocks stuff over and hits. I didn't want to take this patient because the only empty bed I have is in a bay with 5 nice but frail confused elderly men. He will need a lot of admission stuff doing as soon as he gets to the ward i.e. paperwork to get his admission orders sorted.. The rest of the admission paperwork and all other legally required documentation I will knock out after my shift ends by staying over unpaid.

And that is just some of it. If I went into all the knowledge I have to have to manage those things we would be here all day. If I fucked any of that up just this much I could be held responsible for someone's death.   Nurses are legally responsible for delivering the orders given by a doctor and monitoring patients. And my list reflects my doing just that.

That was my lot to carry and carry alone. I was the only qualified Nurse for those 19 20 patients There is no way that I can articulate on this blog how long it takes to prepare and mix and infuse and flush etc etc all those IV meds that were prescribed and due. It takes a lot of time away from the patients. Real hospitals have 24 hour pharmacies that make it their job to stay on top of new orders and mix and prepare and get to the Nurse these IV meds when they are do to be given. My NHS hospital DOES NOT have this. Even during the 9-5 hours that they are open they do not do that. They just develop more paperwork for the Nurses to fill in so that we can actually get the drugs and not get fired for a med error by omission (not giving a prescribed drug to a patient on time).

The only help I had was a teenage cadet called Beth.  There was nothing in the above list that she could help me with. Nothing. She cannot even do observations/vital signs or check blood sugars. She is not a Health care assistant or a Nurse. I wish I had that lovely HCA from the surgical ward with me. He was mint. Beth refused to empty the catheters so that we could monitor an accurate fluid balance because "that's gross".

Between 5AM and 7AM this is what Beth had to do:

Change a few beds
Help people to the toilet.
Answer call lights and tell patients that the Nurse will be there as soon as possible. This confuses them since they think that she is a Nurse. She is wearing the same uniform as me after all.
Serve hot drinks at 7AM (she puts a trolley together and just blows past anyone who appears to be asleep rather than waking them up and encouraging fluids).

I would rather just do the drinks myself but....you have seen my list of jobs happening at this time.
If anyone pees or drinks she needs to measure it and write the value on the fluid balance chart. She didn't bother because she doesn't understand the point. As a matter of fact I asked her to do just that whilst my arms were loaded with IV meds, vital signs equipment, and new admission orders.   She just rolled her eyes at me and said she was "too busy" because she was "serving drinks".Doctors and Nurses could kill a patient if they don't have an accurate fluid balance. Serving drinks took her all of 5 minutes since she ran past any patient who was sleeping or quiet. Then she sat at the station on her mobile.

Beth cannot help me with anything on my list as she is not a Nurse.  But I must help her change those beds on top of everything else otherwise we get the cries of "those damn new fangled to posh to wash RN's leave all the real work to the care assistants". And I just don't want to fucking hear it.

And at 07:30 she will be out the door on her way home regardless of what is going on in that ward.   She is not a Nurse, she is not licensed. What does she care? I will still be giving report. Giving report on 20 patients takes a long time. Who is looking out for my patients while I am handing over? Beth will be on the Bus. She doesn't understand what I have on my shoulders with those patients...she doesn't even understand what addiphos, deranged U+Es, hypoglycemia and sliding scale insulin means. She has no idea what a Nurse does she just sees me flying in and out of rooms.   She tells the patients that she is a "real nurse" and a "nice nurse" because she is the one who serves them tea. And they suck it up. Most of what I am doing for them goes unseen by them.

Cadet Beth is real pissed off because she had to do the bed changes on her own mostly. She will piss and moan to anyone she who will listen about how she was left to do all the real work (8 out of 14 bed changes; I managed to assist with 6 of them) because the Nurse "wouldn't help her". The patients will tell her that she is the "nice nurse" who was kind enough to provide them with a drink and say "some others cannot be bothered with that because they think they are so high and mighty". And the patients will say this too Beth whilst looking daggers at me. They have absolutely no fucking clue what needs to be done to keep them alive and who is doing it.; They get that the doctors are the brains who prescribe treatment. And they get that nice ~~nurses~~ staff like Beth "care" enough to give them a drink. But they totally miss the knowledge bus on everything that is smack in between of that. The bus took off and the patients are still at the station.

Beth was on her way home at 07:30. I was still there on the ward tying up legally required loose ends at 9:30. They stopped paying me at 07:30. I think that without the new admission I may have made it out of there by 8:30 but nevermind. My daughter was late for school. Again.

Fuck this shit. I want a clipboard job. And when I leave I will be replaced with another cadet. And when that happens there will be one RN to 40 beds rather than one RN to  20 beds.

I love bedside Nursing but this is just too damn much. It isn't Nursing that is the problems it is the working conditions. The day shift nurse will be in for it. When the consultants come in and see that the fluid balance charts are blank from the night shift (thanks Beth, you worthless slut) they will smackdown on the Nurse who happens to be standing the closest to them.

Imagine how different things would have been if this was the scenario: Instead of just Beth and I for those 20 patients IMAGINE IF we had the recommended ratio of one nurse to 4 patients. Imagine if each of those 4 patients were sharing one Nurse rather than all 20 sharing one Nurse and one cadet? Imagine if each Nurse was able to do total care for her 4 patients......everything from dealing with IV infusions to changing their beds and encouraging a drink of tea.

I would stay in the job if that was the case. But it will never be the case here. NHS hospitals do not want to hire qualified Nurses to work at the bedside. They do not want to pay for that.

When I finally left the ward at 09:30 I was near tears. I was so rushed during those hours I was terrified that I made a mistake and killed somebody. I was afraid that maybe I hung the wrong meds on the wrong patients. I was afraid I missed somethingm like a low BP or a patient who had stopped fucking breathing. OMG I hope that patient finally kept his 02 mask on.   I was afraid that one of the patients would go down to PALS and tell them about how I was the mean nurse who ran past them as they were shouting for help (I had to). Oh but that Beth, she was lovely and made us tea....

Had a Blast on the Surgical Ward. part 2

2011-01-25T11:05:00.000-08:00

I just remembered one of the best things I experienced during my little shift on the short stay surgical ward.

His name was Sam.

No no no stop thinking like that. Nurse Anne is a happily married woman.

Sam is an utterly fabulous health care assistant. By the end of the day I called him Saint Sam. Nurse Anne is a bit rusty with Surgical Nursing but I couldn't have failed with Sam on my team.

He was good with the patients. He could do observations, blood sugars and he cared enough to let me know of any problems he felt were arising with a patient. He even brought people back from theatre.

A good HCA is worth their weight in gold. They may not be able to help with drugs and all that kind of stuff. If I am the only Nurse on a medical ward for the shift I may have over 80 IV drugs to give. That takes hours. And Nurse's make drug errors and cannot get to their patients when they have that many IV's to do. So even if I had a hundred Sam's working with me in a situation like that I would still be struggling and short staffed.

But if I knew that Sam was keeping a careful, knowledgeable and watchful eye on my patients whilst I was tied up with Nursing stuff it would make me feel a whole lot better. I wish we had people like Sam on our medical wards. It would be a real help to know at least there was someone reliable to look at my patients whilst I was preparing over 80 IV meds and getting dragged on doctor's rounds and to the phone. But we do not get Sam types on the medical wards. We used to have Sam type HCA's but as they quit and retired they were not replaced. And we got the kids instead. Sucks. We have a couple excellent HCA's left in medicine but the rest of the care assistants are all kids/cadets/apprentices/auxillaries with serious knowledge and common sense deficits and a whole lot of attitude.

I asked Sam why he doesn't do his Nurse training. He gave me a wry smile and laughed out loud. " I am happy as I am. From my vantage point Nursing looks like a nightmare. I used to work on a medical ward as an HCA and I know how the qualified nurses suffer. As an HCA I don't have to fuck about with drugs, assessments, orders, doctors or take any responsibility. And on the surgical wards things run more smoothly than on a medical ward. I just enjoy interacting with the patients and helping them out. And it is great. Why would I want to give up a job I love ?"

Our medical wards need to have good RN's and health care assistants. I think the ideal ratio is 80% RN's to 20% health care assistants in the composition of ward staff.

But the current ratios we are working with are something like 30% of staff are RN's and 70% are cadets/kids/apprentices/axilliaries.

The hospital lies and tells people that on any given shift their medical wards are staffed with 65% Nurses and 35% care assistants. This is a lie.

Anyway I tried to get Sam to beg for a transfer to my ward and he nearly fainted because he laughed so hard.

Forest Gump GPs and hospital Consultants all across the land are telling anyone who will listen that the problem is "degree nurses who don't want to work on the wards". Bullshit. Managers are turning away both older trained and newly qualified Nurses when they apply for jobs as bedside Nurses on the wards. They would rather hire kids. Cheapo cheapo productions.

Had a Blast on the Surgical Ward.

2011-01-25T03:08:00.000-08:00

When Gladys is admitted to hospital she ends up on a medical ward due to her chronic COPD, diabetes, and Anemia. She is sick and tired of the way these general wards are underesourced and has decided to make her feelings known to management with a nice hand gesture.

Lucky lucky LUCKY me. I showed up to work a shift on my usual medical ward last week.

But the surgical ward downstairs was short staffed. And we had 3 RN's. They had one. And it was my turn to "float". So I was ordered by the bed manager to work on the surgical ward. He didn't have to order me to go there. I ran away from my ward and ran down there skipping and laughing, so full of glee and joy was I.

It was I thought it would be. Bloody fantastic.

Surgical wards are fantastic compared to medical wards. Less patients, less drugs, virtually no confused and total care patients.....all in all it means that the Nurse is more in control of her workload on a surgical ward and can do the job better. Surgical ward Nurses are not as destroyed emotionally, physically and mentally as Medical ward nurses.

We recently discussed this over on a fantastic blog called Diary of Benefit Scrounger. The author of that blog is a woman named Sue. She had recently had experience of an incompent medical ward. Not long after she was admitted to a surgical ward and was shocked at the difference in care. She felt secure and happy on the surgical ward.

I weighed in on Sue's comment section with my opinion on why the surgical ward Nurses have it together so much more than medical nurses:

Again this doesn't surprise me in the least.

We have talked a lot on militant medical nurse about medical wards vs surgical wards.

I once worked on a surgical ward. Never was I so happy. I was one RN to 6 young, sensible, reasonably healthy stable patients having minor to moderate surgery and we had all the equipment and to resources we needed. We had a charge nurse without an assignment to back us up and we always had clerical support.

Then that unit was shut and my colleagues and I were moved to medical wards. That is when I began blogging.

On surgical wards not only do the nurses have less patients but their patients are less confused, less ill and less demanding. If the surgical ward nurse with only 5 easy patients gets an admission of a demented elderly patient pulling out his lines and tubes and spreading shit everywhere she sends him to a medical ward where the Nurse already has 20 such patients.

Medical ward nurses are NOT allowed to dump a patient somewhere else because they cannot handle him.

If a patient becomes medically unwell on a surgical ward he immediately gets sent over to the overwhelmed already medical nurse who already has more patients and more difficult patients than the surgical nurse has.

There is a lot that surgical nurses don't have to deal with.

A drug round on a surg ward is simple since most of the patients are not as acute or chronically ill as medical patients. It took me 15 minutes to get through the 8AM drugs on my 6 patients in the surgical ward. It takes me over an hour to get through the 8AM meds for 6 patients on a medical ward. And I have about 16 of them.

Surgical patients bring money into the hospital. Medical patients cause the hospital to lose money. It was explained to me that this is the reason for the discrepencies. This is why medical wards are so underesourced causing medical nurses to struggle.

Surgical ward nurses also think that they are superior to medical nurses since they get better patient feedback and make less mistakes.

I thought this too when I was a surgical nurse. My eyes were really opened when I went to work on a medical ward.

Once another surgical ward at my hospital was shut and their nurses were sent to my ward to work. They were making wisecracks about "now we are on a medical ward we will do nothing but babysit and hand out commodes" and "It will be like a nursing home".

I came in for a night shift the next day and two surgical nurses had been on for the entire medical ward alone during the afternoon and evening. They were in tears. They couldn't manage the demented, the high patient load. One of the patients deteriorated with a severe medical condition and they didn't know what to do. They couldn't figure out a lot of what needed to be done and patients really suffered.

The wisecracks soon stopped after they got a taste of general medicine.

Care assistants on a surgical ward have a smaller easier work load and get paid at band 3. Care assistants on a medical ward break their backs and get paid at a lower rate on band 2.

There are no geriatric wards anymore. Geriatric patients go to general medical where they are mixed up with critically ill patients, psych patients, hospice patients,surgical patients who had a medical emergency on the surgical ward and social admissions for lack of coping at home etc etc. The staffing levels of Nurses on these wards would shame a third world country. The real Nurses are few. The untrained care assistants are many.

In short there is less chaos in surgery and what chaos that exists is easy to control. The surgeons round twice a day on the surgical wards. The medical consultants twice a week.

So you perceptions are very accurate.

and I should add to this that surgical wards deal with the same thing and over again with little variation. They refuse to accept patients that dont fit into a criteria that they don't want or do not feel like they can handle. Medical nurses are unable to do this and have to take anything and everything no matter how overwhelmed they all ready are.

Surgical ward nursing was fun but general medicine has made me burn out and lose my mind.

Then DinoNurse, an ITU Sister who often comments on Militant Medical Nurse, gave her tuppence worth. As usual, Dino was right on the money and did a better job of explaining it all than I ever could:

Medicine is the blackhole of well, medicine lol.

On a more serious note- google "medical ward" and "foundation trust" and the number of closed wards seems to be growing. My own foundation trust lost an entire ward when the former hospitals merged. Last winter we had to open 2 entire wards to cope with the influx- pushed our agency budget through the roof. This year, had the powers that be learned anything? Of course not- yet again medical wards are full to bursting and the backlog is impacting on everything else. Our admissions units are warzones, quite literally.

This is the same UK wide. If you really want to raise awareness Sue, you need to be pointing out that in general surgical patients are younger, fitter and spend on average a week or less in an NHS hospital bed. If you have a chronic condition, by and large you will be treated on a medical ward unless you need surgery. Our ICU emergency admissions are generally medical in origin- chest infections, GI bleeds, DKAs, epilepsy complications- the list is endless.

Most surgical admissions are either elective ( because they have need for 24-48 hours ventilationn) or due to unpredicted bleeding (although obviously life threatening, fluid resus normally sorts this out quite quickly and they come to us for monitoring and inotropes.)Surgical wards do not do inotropes...however medical wards are expected to manage.

Any surgical patient who develops a "medical problem" will be turfed to medicine...the chest infections, UTIs- generally elderly and mostly leading to confusion and agression... Generally speaking, medical patients take longer to recover and require more input from nurses, physios, social services etc...Surgery can make money for a trust and medicine cannot.

Medical wards literally suck the life out of you ( staff and patients). What we need is guaranteed SAFE RN TO PATIENT RATIOS. I cannot stress this enough. 1 RN to 6 patients would be a step in the right direction. Ideally this should be reduced to 4 in an acute setting. A little story happening in an average trust every day- allegedly...28 bedded medical ward has 3 RNs on duty along with 2 HCAs. So each RN gets just over half an HCA and 9 and a bit patients. Ward has 6 bays of 4 beds and the rest are siderooms. So each RN has 2 bays and the siderooms are shared, so to speak.

In one bay we have a confused old man who keeps climbing out of bed, the trust have helpfully provided a buzzing mat that goes off everytime he does this. There is also a very sick young diabetic in DKA in the next bed with multiple drips, sliding scale insulin and he should be on half hourly observations (minimum). Thats just one bay. The RN for this bay will should basically never have to leave the bay. In the other bay she is responsible for we have a GI bleed who is actively bleeding, having transfusions and has just been started on inotropes. He also needs a MINIMUM of half hourly observations. So the RN will bust her tail trying to keep up to date with the GI bleed and the DKA and hope that the old guy doesn't fall out of bed. As for the other 6 or so patients she is responsible for, well....need I go on?

Oh, and halfway through the shift the ward will lose an RN and an HCA to "help out" on a medical ward with even worse ratios. In the "bad" old days we would have created an "obs" bay and put all the medically unstable patients here, next to the nurses station- and we would have had 6 RNs/ENs on duty ( alot more trained staff than we have now). The DKA patient would most likely have been transferred to the ICU. This is the biggest problem today- patients are older, sicker and more complex. Many of those on medical wards would have been in the ICU 20 years ao. Unless we get safe ratios we are heading for the biggest fall imaginable. The NHS will dissolve into "social enterprises" that are still private in nature...and if you were the CEO would you want to waste all your resources on the medical blackhole? Didn't think so....

My day at the surgical ward was fantastic. I had 8 patients. All of whom were stable. I had two post op lap chole patients who were doing great. I was able to spend a lot of time with them talking about post op care and ensuring that they were safe and comfortable. I had several pre op patients and admissions who were healthy and compus mentus. This allowed me to spend time making sure that everything was in order for their procedures and also explaining to them what they could expect. The drug round took 10 minutes.

I couldn't help noticing the wall behind the Nurse's station on the newly redecorated, modern and refurbished surgical ward. They had trust awards for "best at completing careplans" and "best at completing risk assessments" and all that. They even had an award for "least falls". Probably because all of their patients are youngish, not confused and have no mobility problems. Yes, managment actually gave the short stay surgical ward an award for "least falls". No wonder they don't have any falls. They have no fall risk patients and lots more staff.

My medical ward has no awards. Our confused elderly patients outnumber the staff 20 to 1 and there are lots of falls. And we sure do not have time to complete care plans or risk assessments because we have critically ill patients that need 150 IV meds mixed up and given whilst we are trying to stop the confused elderly ones from falling, peeing on the floor and attacking other patients. My ward looks exactly like something out of 1950's Russia except that it is a whole lot dirtier. The cleaners on my ward like to flip off the Nurses and go for tea breaks.

God, I hope that when I am old and confused that I have saved enough money for my family to hire a one to one carer to stay with me when I am in hospital. Lord knows that my poor ward RN, with a 150 IV meds to give and more patients than she can keep track of won't be able to help me. I do have a savings account set up for that you know.

General medical wards: The red haired step child of the NHS.

Judith Potts is at it again

2011-01-23T12:54:00.001-08:00

I am actually really embarrassed for her. She really isn't doing her research before she writes these pieces. Her ignorance is astounding.

http://blogs.telegraph.co.uk/news/judithpotts/100073144/do-hospice-nurses-show-more-empathy-than-general-nhs-nurses/

Managers who support the pay freeze:

2011-01-23T05:19:00.000-08:00

From this wonderful blog.

Salaries of NHS bosses who back increment freeze

Twelve senior NHS managers wrote to the Health Service Journal on Tuesday saying that staff should have their annual increments frozen for two years as part of a government cost-cutting programme.

The deal offered is that in exchange for the increment freeze, there will be no redundancies at Pay Band 6 or lower.

There is no such guarantee on offer for those on higher grades.

In effect this means that anyone on Pay Band 7 which starts at just £30,460 will be at risk of redundancy.

The increment freeze will come in addition to a two year pay freeze already imposed on NHS staff.

The managers say in their letter: ‘it is important that there is a considered debate about the issues based upon accurate information and we are seeking to encourage employers to have that debate with their staff and their staff sides’.

In the interests of providing accurate information and to encourage just such debate, here are the current salaries of all 12 signatories.

Maggie Boyle, Leeds Teaching Hospitals

£220 - 225,000

(Source: Annual report2009/2010)

Sir Robert Naylor, University College Hospital foundation trust

£260-265,000

(Source: Annual Report 2009/2010)

Jo Cubbon, Taunton and Somerset Hospital foundation trust

£165-170,000

(Source: Annual Report 2009/2010)

Peter Cubbon, West London mental health trust

£135-140,000

(Source: Annual Report 2009/2010)

David Dalton, Salford Royal hospital foundation trust

£220-225,000

(Source: Annual report 2009/2010)

Stephen Eames, County Durham and Darlington hospital foundation trust

£185-190,000

(Source: Annual Report 2009/2010)

Mike Farrar, north west strategic health authority

£200-205,000

(Source: Annual Report 2009/2010)

Andrew Foster, Wrightington, Wigan and Leigh hospital foundation trust

£160-165,000

(Source: Annual Report 2009/2010)

Julian Hartley, University Hospital of South Manchester foundation trust

£180-185,000

(Source: Annual Report 2009/2010)

Simon Pleydell, South Tees Hospitals foundation trust

£185-190,000

(Source: Annual Report 2009/2010)

John Rostill, Worcestershire Acute Hospitals

£165-170,000

(Source: Annual Report 2009/2010)

Chris Sharratt, Sheffield Children's hospital foundation trust

£145-150,000

(Source: Annual Report 2009/2010)

Keep in mind that we have already had a pay freeze in effect. Keep in mind that we are already paid a lot less than Nurses in other first world countries. Keep in mind that we have a much heavier workload than Nurses in other first world countries because of poor RN to patient ratios. You wouldn't believe how many thousands of pounds I have had to pay out to childminders during the course of my career to watch my children during hours I worked that I never got paid for. Keep all this in mind. What kind of state would the NHS be in if they didn't exploit their frontline professionals?

Ward Nurse Suspended...

2011-01-22T06:15:00.000-08:00

I received a cry for help in my email inbox this week.

It was from the husband of a registered nurse who has been qualified and working on the frontlines as a direct care Nurse for 30 years.

Recently she was left as the only experienced/qualified nurse for a very large number of ill patients on her ward. Like my hospital, her hospital as probably ignored the Nurses' complaints about short staffing of real nurses on the wards.

Her least ill patient was a man having minor surgery. He was fine. Never complained to her or about her. He recovered well and went home. All of you who work as acute care nurses and find yourselves as the only RN on a large ward know that you cannot give time to well patients without killing your sickest ones.

After this patient was discharged his wife wrote a nasty note to the hospital complaining about the fact that she did not feel that her husband received enough one to one care.

The Nurse who was on duty that day (my correspondant's wife) was suspended because of the complaint. She has had over 30 years as a Nurse without a mark against her. Sounds to me like she is at the top of her pay band as a bedside Nurse and they want her gone to replace her with a totally green and inexperienced newly qualified or a kid. They are on lower salaries. You see a lot of this in Nursing. I had a good friend (and mentor) who was qualified for 40 years. She was top of her pay band as a bedside Nurse. They got rid of her over something completely made up and replaced her with a newly qualified Nurse on a much lower pay band. Hospitals have been playing these games with bedside RN's since the late 80's when they decided that professional Nursing at the bedside wasn't worth spending money on anymore. Once they decided that it has been nothing but cut cut cut. Not only do they get rid of their most experienced bedside RN's but they don't replace those who quit or retire with staff of equal value, training or experience. Many will blame well educated Nurses for the shitstorm that is hospital nursing care these days. But the truth is that well educated qualified Nurses KNOW that they need to be at the bedside with their hands getting dirty in all aspects of patient care. Hospital management does not ~~give a shit~~ know this.

I have seen this kind of thing in my hospital. Management won't accept liability and they won't deal head on with problems at ward level (lack of qualified staff). And a Nurse or a Doctor becomes a sacrificial lamb. I have no doubt that this Nurse will be reported by her hospital to the board of Nursing that she is licensed with for patient neglect. In which case she is guilty until proven innocent and gagged from talking about how her ward was staffed and what was going on with her multiple other patients. I have seen it happen. I hope this Nurse has a lot of money put aside for legal fees.

Even though I detest Unions and think that they are worthless for health care professionals I do hope that this lady is unionised. But then again, what will the union do about it? Hospital chiefs laugh at the Nursing Unions. We have absolutely no leverage and cannot strike. I don't know how to advise the husband of this Nurse. I hope that they can afford a good lawyer.

This post makes me think of a fantastic book by a journalist named Suzanne Gordon. She is not a nurse but she studies Nurses and has spent years shadowing qualified Nurses at work on hell wards. She understands what is going on. Her book is called Nursing Against the Odds but I think a better title would be "Oh My God what the FUCK has happened to Nursing care on the Wards" or perhaps "Don't Blame the Nursing Profession, asshole".

Great book if you get a chance to read it.

Another article on Hospital care.

2011-01-18T02:02:00.000-08:00

Should we bother writing to this woman and explaining how unrealistic her expectations were and how greatly she misunderstood the situation? She is right about hospital care. But yet she completely misinterpreted the situation.

Do you think she actually wants to know and understand or do you think she just wants to moan?

http://blogs.telegraph.co.uk/news/judithpotts/100070484/my-mother-in-laws-shocking-experience-at-scarborough-hospital-and-what-it-says-about-the-nhs/

As I work in medicine at a district general hospital I know how long it takes to get new patients sorted. I know how difficult it is to do the right thing with elderly people and how slow the system is to act. But I think this woman just has it in for the frontline professionals. She lacks insight and sense and takes it out on the Nurses and Doctors rather than the shitty system they work in.

The GP had been called to the residential care home in which she lives – Sylvia has severe dementia – because she had not been eating or, more importantly, drinking for 24 hours and was virtually comatose. The GP diagnosed possible pneumonia and asked that Sylvia should be put on a re-hydration and anti-biotic drip within two hours

The GP had to know that there was no way that she could be admitted and started on those orders within two hours. He must have been covering his ass. Tests have to be done in hospital and the hospital consultant has to see the patient in AAU long before anything can be started. A lot of ducks have to be line up in a row for a diagnosis to happen and the right treatment to be initiated.

Unfortunately, no assessing of Sylvia’s condition was carried out for several hours. I understand that recent policy in the NHS requires patients to be held for no longer than 4 hours in Casualty. Clearly, this does not apply to the “assessment” ward.

That is of course why they have assessment wards (AAU). There are not enough beds, staff (the right kind of staff) or facilities to meet the targets and avoid the hospital getting fined. Management did this.

After waiting three hours, I approached a female nurse and explained about the GP’s wishes. Standing under a poster warning patients and their families not to abuse hospital staff, the nurse sarcastically answered me. “With all due respect, darling, it is for the hospital doctor to decide on diagnosis and treatment not the GP.”

That is 100% true. No hospital Nurse or hospital doctor can act on orders by a GP. The GP did not make a definite diagnosis. He did not have the diagnostic tests at his disposal to do that. It would hurt patients even more if the hospital staff did what this author believed that they should do. Hanging the wrong IV fluids or IV antibiotics could kill a patient very fast and a doctor's rule is "first do no harm". The Nurse of course can NOT hang IV fluids or IV antibiotics until the consultant has seen the patient and one of his doctors has prescribed the darn things. These places are so short of qualified staff (not unqualified staff ....lots of them hanging around) that I think they did well to get it sorted within 24 hours.

Eventually a doctor appeared. He was perfectly polite and, after examining Sylvia, took us to one side, explained that there were “quite a few things going on with Sylvia” and asked for our decision on resuscitation. Not having realised Sylvia’s condition was that serious, we were very shocked – not least because she had been left untreated

That is a bit silly. An elderly woman with severe dementia who has stopped eating and drinking could be at death's door regardless of pneumonia, IV fluids and IV antibiotics. Those treatments might have worked or they might have sent another organ system in her body totally screwy. Doctors are clinicians not psychic mediums. Medicine is not a cut and dried science that always follows a logical planned and steady algorithm. I bet her renal function was also a mess. Anyone (me, you, etc) could drop over dead at any time. An elderly person who is sick enough to get admitted to hospital is very likely to just crash at anytime regardless of anything the doctors and nurses are or are not doing.

He was correct to ask about rescus status. At this point there was no way for the medic to know how things would turn out for Sylvia. I once worked with a young healthy nurse who fell over and died of a stroke in the middle of the shift. If that can happen to her it can happen to an elderly lady at anytime, regardless of IV antibiotics and fluids.

The whereabouts of the consultant was a mystery. Neither he nor his team were in attendance, despite the fact that there were two other elderly ladies with chronic dementia on the ward.

Believe me when I tell you that this consultant would have had over a 100 patients with confusion, dementia and multiple other medical problems on many, many, different wards all over the hospital. It takes these guys something like 10 hours in a day to see all of these people just one time. Plus they have clinics and everything else. It is offensive for you to imply that he was bunking off and ignoring his patients. If you tried to keep pace with his work day just once you would collapse.

Next morning I rang again – quite prepared for Sylvia to have died in the night – to be told that she was absolutely fine and could go home.

This is how it is with elderly people who have dementia. It is never cut and dried and you don't know what will happen. If they sent her home the next day it is highly unlikely that she had pneumonia, as the GP led you to believe. Older people with dementia often stop eating and drinking and have alterations in levels of consciousness. It may be an acute medical problem that needs IVs and other treatments or it may just be the kind of quick deterioration that happens to all older people as their bodies start to shut down. They often seem to rally, then get worse, then rally again. Not eating and drinking etc is normal for people when they get to end stage of life. And all elderly people are at the end stage of life and their bodies are going haywire and shutting down. Fixing one problem causes another to start. If some IV fluids helped her come around this time then that is great. But it doesn't mean that she is "cured".

Pleased though we were, we wanted an explanation. Nothing tallied.

She is elderly. And elderly patients are complicated. There is no cure for old age. She was admitted to hospital. They did some tests. She came around and they determined that she was medically stable and they sent her home.

There is nothing else to tell. You are wanting instant answers and diagnostics and a cut and dried plan of care instantly. This is impossible in general medicine especially with elderly patients. In other words, nothing tallies because you have no experience or education in health care. If the hospital doctor and nurses explained this to you as I am explaining it to you would not have liked it.

However, Sylvia was not sent home that day because she became unwell again.

Yep. Elderly patients go up and down like this because they are at the end of their lives. Doctors are brilliant but there are two things that they cannot do. They cannot cure old age or stop us from being mortals with bodies that give out.

I would imagine that she will deteriorate, rally, deteriorate, rally, deteriorate, rally many more times before she passes. All without a concrete diagnosis. That is normal. It is no different for elderly people in the United States, Canada, Australia etc.

I have numerous questions including – was Sylvia apparently ignored? Why is there no communication between the GP and the ward staff – and is this nurse’s opinion, of the GP’s ability to diagnose, commonly found in NHS wards?

It wasn't the Nurse's opinion. The Nurse was telling you a fact. A fact that should be obvious. Even if the GP had wrote out orders (which he did not) and faxed them the Hospital nurse still would NOT have been able to act on them. The hospital doctor has to write the orders. The GP did not have the information to give safe orders. A doctor cannot prescribe IVs etc without blood tests and xrays. The hospital doctor will prescribe what needs to be prescribed when he has all of his ducks in a row. If Nurses are to give IV fluids or IV antbiotics the order has to be written on a hospital drug chart by hospital doctors. Otherwise it is an illegal order and cannot be given. Sylvia was not ignored. She was under the care of Nurses and Doctors who were already 4-5 hours behind on doing what needed to be done for the patients that they already had when Sylvia came through the door.

Why was there no polite, informed communication between the ward staff and me – I was not the only person sitting beside an elderly relative’s bed, not knowing what to do?

Did it very occur to you that:

A. An RN cannot delay treatment for the 15 people she is responsible for to chat with relatives
B. The five unqualifed staff sitting at the Nurse's station cannot help me implement doctors orders or communicate with relatives. A Nurse has to handle that all by herself all at the same time. And there is only one Nurse for a large team of patients despite how many techs you see hanging around.
C..That there was nothing to tell? It gets very frustrating when relatives sit around with nothing to do obsessing over every little detail and inventing these paranoid scenarios where everyone is trying to neglect and kill grandma and hide information from them. Open your eyes a little.

there was no evidence of shortness of staff; indeed a lot of eating and chatting was going on at the nurses’ station.

From what I hear, Shitborough has some of the worst direct RN to patient ratios in the galaxy. It is lack of RN's that are the problem, not lack of techs and unqualified staff.
You know not what you see. I know how wards are staffed in these places. Many of the staff you see at the station are not Nurses and Doctors. They are care assistants and techs. And even if I had a hundred of them working with me I would still be too short of nurses and doctors to get things done in a timely fashion. I once had a bag of IV fluids run out on a patient and it took me 5 hours to chase down a doctor to get him to prescribe more so that I could hang a new bag A few techs sat at the nurse's station drinking tea and chatting does not change how long it takes the doctor to get results of diagnostic tests so that he can order the correct treatment. I could have a thousand techs working with me on a shift. But whether they look busy or are sitting around at the station does not change how long it takes to get orders written by the doctor and implemented by the Nurse.

I think you are either very unrealistic or are simply shit stirring. And please keep in mind that no hospital Nurse can act on orders or start any kind of IV therapy unless it has been prescribed onto the hospital system by the hospital doctors. Not under any circumstances ever.

I am also surprised that a medic told her that someone would ring from the ward with an update! As a ward Nurse I am almost never in a position when I can abandon those IV fluids and meds that I am hours and hours behind on starting on all those people to call relatives. The only help I have are techs and assistants and they cannot make calls to relatives NOR can they continue with my workload as I am sat around ringing the relatives of 15 different people to give an "update".

And that's probably all there is to tell Mrs. Potts. Hope that helps.

.

Hold me Back

2011-01-17T04:49:00.000-08:00

Well at least Journalists are allowed to have their little temper tantrums. If I even look tired at the end of a 14 hour day of watching people die and about 10 relatives will go down to PALS calling me a sour faced bitch who needs smile lessons. Imagine if a Nurse or Doctor shouted "fuck it" or threw something down and shouted "fuck this I am not doing anymore"? The camera never turns off for us, the loss of temper or frustration never gets edited out and we are always seen. And compared to journalists we actually have a good reason to lose our cool.

I very nearly lost my temper with some visitors the other day. To the point that I had to lock myself in a toilet to ensure that I kept my mouth shut.

It wasn't anything more than the usual nasty ignorant crap we get from them DAY AFTER DAY AFTER DAY over an over again. But it was like the straw that broke the camel's back.

I work with a Nurse called Amanda. She works 3 shifts a week from 7AM to 9PM when she isn't doing night shifts.

Amanda is super. At the end of every shift she stays over unpaid by hours to sort things like necessary paperwork and order checks to give the next shift a helping hand. No one has asked her to do this. She does it because she cares. Can you imagine working a 14 hour day and then staying on by a couple of hours unpaid?

What she does is really helpful. When I come on duty after her I am more able to get on with direct patient care because her extra work allows me to do so. If she didn't stay over to do these things I would have to do it rather than getting straight to my patients. Then they would accuse me of neglecting them.....

Last night at 9PM Amanda handed over to me as I was taking over from her. She stayed on and did a whole bunch of stuff (answered the phone, checked orders, went downstairs to get me some blood etc etc). This allowed me to get started with the bedtime drug round and check in on my patients simulatneously. It was a big help as I also had a really unwell patient on top of all the other stuff that needs to get dealt with minutes into a new shift.

At 11PM, two hours after the end of her shift, Amanda was still at the Nurse's station. She was doing some computer work for us Night shift girls that needed to be sorted at that exact time. New patients had been admitted 10:45 PM and their details need to be entered into the computer as soon as they arrive onto the ward. Amanda kindly did this for me (I didn't ask her to) and it allowed me to continue with eyeballing all 19 of my patients, drugs for all of them, assessments for all of them, and deal with unwell patient's new orders.

Had Amanda not hung around at the end of her shift I might have been so tied up dealing with all that shit that I might have missed something with a patient that could have turned into a mega catastrophe later on. Thank you Amanda.

As Amanda was at the station at 11PM two visitors who had stayed late walked by her and spat "there is another 'angel' sat on her ass at the desk ignoring patients".   Pretty harsh words coming from a couple of cunts who probably don't work at all or ONLY work 8 hour days 5 days a week.

Amanda is a saint but she is stupid too. Never make the kind of sacrifices that she is making. The public just throws it back in your face. I very nearly told those two visitors exactly what I thought of them.

I was already in a foul mood that day. Earlier in the week I had a patient go into congestive cardiac failure secondary to fluid overload. Her IV fluids had to be STOPPED. Or she would have died. We gave her some IV furosemide and she improved.

Cue the family seeing her IV fluids stopped and marching up to me. "Why are my mother's fluids not running?". I explained about the fluid over load and the CCF but I wasn't getting through. These people had already decided that I was trying to dehydrate their mother to death long before they spoke to me. So they walked away from me and went up to a cadet nurse (thinking she was a nurse) and asked her. Of course a cadet doesn't even know what CCF and fluid overload even is. Then the family marched up to the Nurse's station where a doctor (who didn't even know the patient in question) was sitting trying to review some notes on a patient that was referred to him.

"Those two Nurses (pointing at me and the cadet as if we are criminals) are trying to kill my mother by refusing to hang another bag of IV fluids".

I thought this was pretty funny considering that we need an order from a doctor to hang more IV fluids and we CANNOT just hang them because we think a patient needs them.    And of course the order to stop IV fluids had come from the doctors anyway.

The doctor looked like a deer trapped in the headlights. He didn't know the patient but here he had some crazy family member who assumed that he was responsible for all patients on the ward and that he was also the "supervisor"of the Nurses. I don't think I have ever been hired, fired, or supervised by a doctor in 14 years of Nursing. This relative was looking at me real smug, as if she thought she was going to get me in big trouble with the boss. The meaner she got, the nicer I was and that really made her go mad.

I explained the patient's situation to the doctor. He told the visitor the exact same thing I did. And she was happy with his explanation.

WTF?

This has more to do with visitors having a prejudiced and 19th century view of Nurses than it had to with any concern they had for their mother.

In the old days criminals and prostitutes were pressed into Nursing when they didn't want to be there. They needed close supervision and threats to ensure that they didn't harm the patients. During the American Civil War (1861-1865) woman were considered out of place as Nurses and soldiers who misbehaved were put on "nursing duty" as a punishment. That was your Nurse workforce.

Fast forward to today. Medical care is so complicated that even the Nurses need a good education to deliver it.   I had to work my butt off to get into Nursing school overseas. I had to have top grades and be in the top percentage of my class. I had to pay a lot of money out to qualify and take an expensive state board exam. I have to pay a lot of money out every year to stay qualified and continue to update my education. If I didn't do all that I couldn't be a Nurse.

I never would have made it if I didn't want to do it and take it seriously.

But members of the public still think that Nursing is a "terrible" job that losers are forced into doing. Therefore they think they have to stay on top of us. The viewpoint is also exacerbated by the fact that Registered Nurses are the lowest paid of the public sector professionals in the UK.   This isn't because they actually deserve less. A hospital RN has a lot more on his shoulders than a teacher or a cop does. Nurses  are undervalued in a system that is forced to make financial cuts on the frontlines of health care.

In countries like the USA a bedside direct care Registered Nurse earns far more than a police officer and a teacher. They earn more than most 3-4 year graduates upon the start of employment. I was out earning my stepsister ( who holds a master's degree in journalism from Medill) immediately upon my first job as a bedside  RN in the USA. I provided direct patient care (all aspects of care from cannulation, to orders to shit cleaning) to a team of 7 patients. I think that gives people over there the idea that maybe just maybe Nurses are a bit skilled, important, and serious about their work.

These negative views held by the British public are all the more inflamed and reinforced by the terrible state our hospitals and patients are in as a result of poor RN staffing, resourcing, incompetent management etc.

I hope that this blog has helped people to see that there is more going on here than the simple "Oh the Nurses are just a bunch of pigs who don't want to be bothered" scenario.

But I don't know I don't know if it is even possible to educate people about what is going on in our hospitals. They just want someone to blame when the idea that their loved ones and themselves are not immortal. They want someone to blame when they cannot accept that sickness and old age are ugly horrible things and that medical science doesn't have all the answers.

Reminding myself of all this helped me to keep my mouth shut and not go into smackdown mode when those people insulted Amanda.

Let's watch Bill O'Reilly meltdown one more time. Isn't it just so stressful to be sat a desk reading for a teleprompter? Christ if anyone at my hospital acted like this ever we would be gone. Immediately.

Imagine this little princess having to deal with constant interruptions whilst she was trying to calculate a drip to stop someone from dying and getting blamed for their death.

Here is another one. Aren't these reporters so professional? These guys would be the first one on the story if a Nurse panicked and shouted "oh shit" when she realised that her 16 year old patient stopped breathing. I am sure that the patients and relatives would be running to PALS and the papers if they heard an explective come out of the mouth of a Nurse. Makes me laugh. He doesn't look like he is having a tough day at work to me. None of them do.

Housekeeper hell

2011-01-15T07:13:00.000-08:00

I recently posted a comment in the comments section on my Wow, Peter post about the housekeeper re arranging everything on the ward so that equipment was impossible to find in an emergency. This was done because the previous set up was an inconvience to her.

Now I can top that story. Or just add to it really.

Another housekeeper who works about 5 hours a day 4 days a week recently insulted a medical doctor of ours.

He was preparing a tray to draw some bloods on a patient. Just as he got it all together his pager beeped and a voice came through it : " CARDIAC ARREST WARD 15, CARDIAC ARREST WARD 15". His patient on a ward 3 floors away had just stopped breathing. He dropped the tray on the counter top and ran down there, as is his duty. He ran like an athelete to get down there and help his patient.

The housekeeper came into the treatment room a minute later, saw his phlebotomy tray, and went nuts because the doctor "didn't clean up after himself". She went on and on about his "laziness" and "lack of consideration". He did not leave any kind of mess, just a tray with a syringe and blood tubes and some gauze. He would need that later when he came back from the emergency to draw bloods on my patient (a very difficult person to get bloods from).

She began to put all the equipment back. I told her that he would need it all again in about an hour or so and to leave it. She continued with the "lazy bastard" stuff. I let her have it. I couldn't help it. This medic was probably going to be working a 12+ hour day and he should not be worried about tidying things up to make like easier for the housekeeper. None of us should, I tried to explain to her that unlike her he has real responsibility and cannot delay treating a patient to make life easier for her. But I didn't get through that thick skull of hers. She was still pissing and moaning about it an hour later.

Shocking isn't it. And it happens all the time.

If you want to read more about lack of respect for Nurses and Doctors from the supposed "support staff" go here:

We have a hell of a lot of lazy and crap staff in the NHS who need to be disciplined and fired. But you won't find this amongst the professional nurses and doctors. We have a registration to protect. We take our jobs seriously. It is the low paid crap that we depend on that let us down constantly and are never dealt with that is the problem.

At 6 in the morning I had a patient deteriorate and as I was dealing with him all the other patients were ringing and shouting for help. Where was my health care assistant (the only other member of staff I had with me)? In the kitchen washing jugs and setting up for breakfast because the domestics would give her a smackdown if they came into work at 7AM and stuff wasn't done for them. She was actually afraid of them. I told the HCA not to worry about those slags and to give me a hand on the ward instead. The domestics came into to work and started on the HCA for not doing jobs for them and I told them off. Then they complain that they are being "bullied".

These people are untouchable. They are never disciplined or dealt with. The trust wouldn't hesitate to get rid of a Nurse or Doctor if something goes wrong but it seems as if everyone that we depend on just fucks around.
I had a ward clerk sat on the computer telling me that it wasn't her problem if the phone was ringing and that the Nurse should answer it.

WTF?

I could go on.

No unsocial hours pay.

2011-01-14T06:38:00.000-08:00

I just received a worrying email. I have promised the author that I will not give out the details of his/her trust location.

The trust that this person works for as a Nurse is trying to stop unsocial hours pay. The pay rate for nights, days, weekends etc will all be the same basic rate.

The unions are getting involved but if Nurses cannot strike how much power will they have to really fight it?

If this goes through in one trust it will go happen in others.

All staff Nurses work a mix of day shift, night shift, weekday shifts and weekend shifts every single month. Currently they get paid a slightly higher rate for working unsocial hours.

Our shifts are different every week. We work on no kind of pattern . The working week goes something like this for a staff nurse..

Monday 7AM to 3 PM.
Tuesday 2PM to 10 PM
Wednesday 7AM to 3PM.
Thursday day off.
Friday 8PM to 9AM saturday morning.
Saturday off.
Sunday 7AM to 3 PM.

The following week:

Tuesday 8PM to 9 AM
Wednesday 8 PM to 9AM
Thursday off
Friday 7AM to 9PM.

Ridiculous isn't it. My body clock is messed up. Every week has that kind of mix of shifts. But the fact that we get a slightly higher rate for doing nights keeps my monthly wage at a certain level.

If this goes through they will see their wages fall by hundreds of pounds a month. I know I would. I do lots of nights and weekends. And there is no opting out of them even if they refuse to pay unsocial hours.

This is not a good thing to happen at a time when cost of living is skyrocketing.

More staff nurses will quit. Hospitals are having to close beds because of lack of staff. That is how extreme the nursing shortage (which results from nurses refusing to work at the bedside because of poor conditions) is getting. The staffing has become so bad that even management knows that the situation is bad. Usually they will just keep beds open and make 2 RN's take 30 patients and then 6 more admissions. But when the best you can get is one RN for 36 beds then beds close.

Lets hope that the plan to cut unsocial hours pay is all talk.

Wow Peter.....

2011-01-13T10:55:00.000-08:00

I think Dr. Peter Carter has actually possibly grown a pair. I think I am turned on. Well, not really.

I wanted to inform you of a very important development relating to the proposals to freeze the incremental pay for all NHS staff in England in exchange for a "no compulsory redundancy" guarantee for some staff.

Today, the RCN rejected the proposals, calling them "illogical" and said they were an "attack upon hard-working nurses". This decision is due to be ratified by Council next week.

The RCN took this decision after hearing the strength of feeling from members who have contacted us by email, via our Facebook page and by post and phone.

Over the past few weeks you've told us how angry you are, you've told us what impact the proposals would have on you and you've said that you want to see the proposals rejected. We listened.

Today, I'm asking you to tell decision makers why your increment matters to you. You can tell us what you think by uploading your thoughts to the new Frontline First video wall.

http://www.rcn.org.uk/frontlinefirstvideowall

Asking you to give up your increments when in return only some would have a guarantee of no compulsory redundancy is, frankly, just not on.

We are also highly sceptical that the Employers would be able to deliver on job security. After all, the RCN's Frontline First campaign has already identified 27,000 jobs earmarked to be cut in the NHS.

Tell decision-makers why your increments are so important and why this proposal was so unacceptable, both to you and the future of patient care. Record your short film today on a mobile phone or webcam.

http://www.rcn.org.uk/frontlinefirstvideowall

The proposals also coincide with the increase in VAT and continuing anger over bankers' bonuses. Nurses and healthcare assistants did not argue against the two-year pay freeze announced last year as you accepted the argument that 'we're all in it together'. However, we fail to see how this is true when bankers are walking away with bonuses (when you bailed them out) and nursing staff are being asked to take yet another pay cut.

Enough is enough.

Yours sincerely,

Dr Peter Carter

Chief Executive & General Secretary

The RCN will be correct if they reject the proposals. We are already working for free much of the time........ in horrid conditions that a private sector employee could never imagine. I am counting the minutes until I return to the private sector myself. Jobs have been going for years unofficially(via natural wastage i.e not replacing retiring, immigrating, sectioned under the mental health act staff nurses).

Not matter how much cash they save it will NEVER EVER HIT THE FRONTLINES. The NHS could have a windfall of 100 trillion pounds. Not one penny would trickle down to the frontlines. Not one. Even if they did save a ton of cash via pay cuts and redundancies we all know that our patients will never see any benefit from that, and neither will we. We will not only be impoverished but we will be the scapegoat for all the patient complaints. We can't function as it is.....

Government is untrustworthy. And we should all be giving the finger to them. They take a lot of money off of us, have always artificially suppressed our wages and do not deliver what they promise for our patients.

Memories

2011-01-07T02:14:00.000-08:00

For some reason I woke up this morning thinking about something that happened years and years ago.

It was around the time I first went to a medical ward. The nu-labour targets hadn't messed up everything yet. And our staffing was pretty good.

I worked a late shift on a 25 bed ward and there was 4 of us staff nurses and 2 care assistants for the ward.

One of my patients started with maleena and massive amounts of coffee ground vomit. She was only in her 40's or 50's. We swung into action. She was becoming unresponsive. This is a GI bleed and it is life threatening.

Two of us (staff nurses) focused on her. The other two staff nurses managed the rest of the ward and deal with all the other patients. The medic was straight on the job and after he took one look at her the reg was there as well. This happened right before visiting hours. Her family arrived to see her in a hell of a state. I briefly and gently explained to them what was happening. One of the HCAs took the family down to the day room and made them tea,coffee and comfort food and stayed with them.

The doctors were throwing out orders left and right. And the other staff nurse and I dealt with it quickly and efficiently. Diagmostic tests, blood, IV's you name it we sorted it. And we managed to keep her clean and comfortable despite the fact that she had a massive gastrointestinal bleed that was causing bloody shit to poor out of her bottom and bloody puke to come out of her mouth constantly.

She survived. As a matter off fact she walked out of the hospital a week or so later.

I was so proud of the doctors, the nurses and how well everyone dealt with the situation.

I miss those days.

Conversation with a Moron

2011-01-06T04:15:00.000-08:00

http://www.nursingtimes.net/nursing-practice/clinical-specialisms/management/the-case-of-the-disappearing-staff-nurses/5023027.article#commentsubmitted

I recently had a bit of dialogue with a rare specimen of a human being on the comments page of the article linked above.

I decided to post about here because people who think like this are 100% responsible for the decline in Nursing care that we see today.

This person (I think it is a woman) seems to think that a Nurse can be overloaded with patients with no limits on numbers and acuity, and still function.

She thinks that most NHS nurses are incompetent because of the following list. (keep in mind that most NHS general ward RN's are taking on 15 patients each and that years of intense research have shown that the maximum number even the best nurse can take and not make mistakes is 4-6 on a general floor).

" I am often involved in investigating untoward clinical incidents. The majority of times they arise from a chain of small mistakes which when put together cause a very serious situation, much like the well know “Swiss cheese” model.

Many of these small mistakes are made by “experienced nurses” many that have good academic qualifications. Examples of these mistakes include:

• Omitting to administer prescribed medication

• Administering the wrong dose

• Failing to administer medication at the appropriate time

• Failing to report that medication has not been administered

• Administering medications to the wrong patient

• Leaving drugs potted up on bedside tables

• Failing to recognise a deteriorating patient

• Failure to record observations

• Failure to report a deterioration in patients condition

• Failure to rescue deteriorating patients

• Poor documentation

None of the above “require the person who is delivering the treatment to be extremely on the ball” and being “short staffed” or “underpaid” is not an excuse for failing to carry out basic duties which are what the above are.

To her it is as simple as "Nurses are crap and incompetent and no omissions and errors should occur matter how many patients have"

It is physically impossible to document, catch onto changes in condition and administer drugs on time and correctly when an RN has a patient load that is too high. I have worked enough 14 hour shifts without a break to know this is 100% true. I do not believe that a person is capable of investigating "untoward clinical errors" on a general ward properly or devising schemes to avoid future mistakes UNLESS HE/SHE HAS RECENT AND FREQUENT EXPERIENCE WORKING ON SAID WARD FOR FULL SHIFTS AS THE ONLY RN FOR 15 PATIENTS. This person is an example of why I feel that way.

Let's review the research once again.

This had some alarming conclusions. It showed that when a nurse is assigned more than four patients, the risk of death goes up by 7% for each additional patient. So if the risk of death for each patient is 7% when a nurse is taking care of five patients at a time, that risk goes up to 42% for each patient when that nurse’s workload goes up to ten patients.

http://mnnurses.files.wordpress.com/2010/03/staffing-ratios-fact-sheet.pdf

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s3491is.txt.pdf

http://nursingadvocacy.org/faq/short-staffed.html#freq

There is so much more if you want to google this issue further.

Most hospitals in Britain have dangerous RN to patient staffing on their general wards. The formula that management uses to determine staffing levels is flawed. I have heard our chief exec, our nursing director, our matrons etc say that a ward is "sufficiently staffed" when it has one RN to 10 patients. This is, of course, wrong. That Nurse is going to make mistakes an fail. Throwing more apprentices and care assistants at the problem doesn't help when I am in the middle of a drug round and getting interrupted constantly during it to deal with things that only an RN can handle.

The thing about the NHS is that they overload their frontline RN's and put them in situations that no one could handle no matter how compassionate, intelligent, caring, or hardworking they happen to be. When untoward incidents occur they use it as an excuse to disrespect Nurses even more and cut them off from even more resources. It is a catch 22. Pretty soon we will have one RN running between five 30 bed wards and they will say that the bad care and omissions in care are down to her "laziness".

Do you see what kind of fucking clueless morons we have running the show. I have never seen a general medical ward in the NHS where the RN has less than 10 patients. Most of us have up to 20 patients per RN at a time. The powers that be have never even heard of safe staffing studies and they won't bother to look at them because they think all the problems are down to "bad nurses". And as a result they will continue to deny us the resources we need to do our jobs.

Nothing will ever improve until the dinosaurs working in the NHS that hold these ridiculous opinions start to die out. Until they do Nurses will not win and patient care will continue to deteriote despite Nurses working harder than ever.

When I tell colleagues abroad that over here in the NHS the RN takes 8,10,12,20 patients on a general medical ward without 24 hour pharmacy and other back up etc etc they want to know "how the hell are you people getting out of there at the end of the day without making 150 drug errors in one shift". The Nurses who have said this to me are award winners for bedside clinical excellence. Yet they would refuse to work in the NHS because they KNOW that they would make mistakes working in these kinds of conditions.

But our little commentator over at Nursing Times thinks that these mistakes and omissions are merely occuring because Nurses cannot be bothered with basic nursing or are uncaring. She is wrong on both accounts.

Poor Child.

2011-01-04T03:55:00.000-08:00

Hospitals need to bring back old fashioned Matrons to kick some ass and knock certain people into line. And I am not talking about Nurses and Doctors.

What happens when:

Hospitals cut back on staff and beds when demand is increasing?

What happens when wards are full of patients who cannot be discharged for social reasons thus slowing down the flow through A&E?

What happens when drug seekers/ addicts and people with minor illnesses are overwhelming A&E's and demanding urgent attention?

What happens when Nurses and Doctors cannot even triage and assess really sick patients properly because of out of control drunks smashing the place up (a constant thing in A&E) and patients arriving with chronic back pain harassing the staff and making ridiculous demand after ridiculous demand?

What happens when a family brings great grandma into A&E for abdo pain and by the time they complete all of her tests it is 0200 AM. The tests show that she is fine and can go home. Just has wind. There are no beds in the hospital anyway and A&E is backed up with critically ill people waiting to be seen. But all this family can do is piss and moan about how unfair it is to send their medically stable and precious grandma home at 2AM and they demand she stays the night in the A&E cubicle. Then granny makes demand after demand overnight, expecting to be waited on because she is elderly thus stopping the staff from assessing, triaging, and dealing with the potentially critically ill people.

It is an accident and emergency department for christ sakes!! It is not a place for you to go because you ran out of pain meds for your bad knee or you feel nauseous and your GP is closed. ARGHHHHH.

It is not a place for your elderly relative to get babysat because she is too precious to have to deal with being discharged and driven home at 2AM and you really don't want to deal with her anyway.

It is not a place to go for a pregnancy test and then scream the place down because you are not getting seen to first (duh, the damn things are £5.99 at Boots).

It is not a place for you to go for a morphine fix and stab yourself in the finger and drip the blood in your urine so that we think you have kidney stones. It is not the place to go because you have been constipated for 2 days. It is not a place to go because you are mad at your GP for not giving you antibiotics for your viral cold. It is not a place to throw a temper tantrum because things are not going your way. It is not the place you should go to demand junk food and snacks from a Nurse that is running around trying to hang blood and implement docs orders for the critically ill. Especially if you walked yourself into the place.

Oh yes we are SO sorry that the patient with chest pain and shortness of breath was taken in first despite the fact that he came in after you and your sore thumb. Eye roll.

ER's and A&E's are so overwhelmed with this kind of SHIT that they cannot function. When the hell are we going to get over this "customer service" crap and start being strict hospitals again where matrons demand that the patients and visitors compose themselves and follow some rules? If you are not as sick as the others you are not first priority! Let me tell you what happens when the public abuses the ER's of the United States and the A&E's of the UK.

This happens.

Important things get missed. Really sick people wait to long. The quiet patients who complain the least are usually sicker than the fat twat who walked himself into A&E with a "stomach ache" demanding a chocolate bar and some Pepsi..
Poor little thing. It was an extremely rare illness that strikes quickly and is easily missed with all the coughs, colds and flu out there. But I would think that if she had urgent attention she might have been luckier. Why didn't a sick child like her get immediate attention? Because of Emergency room abusers. This dying little girls father had to fight his way past hordes of drunks and ER abusers to get his kid seen. He was right to shout loudly. Had he not done, the staff never would have heard him over the tantrums and moaning of the people who merely have minor illness and the rowdy drunks trashing the place and beating up on staff.

Five hours she waited. Five hours of the Nurses and doctors dealing with drunks, and people with minor illnesses who think they are entitled to be seen first and then scream the place down.

If you have ever worked in A&E, you'll know what I mean. If you haven't worked in A&E you will probably not have a clue...

Great Post over at Mental Nurse...

2011-01-03T13:31:00.000-08:00

of course all the posts are great at Mental Nurse....but this one is just good enough to eat.

Typical nursing care is coming in to a job that you don’t like and doing your very best to help people.

Typical nursing care is trying to do the seemingly impossible.

Typical nursing care is doing your utmost to work with a smile, while working somewhere that isn’t your chosen branch of nursing because there were less than 100 HCA/support worker/nursing assistant posts across the entire country last you checked, and you don’t want to leave your family/partner/social networks and move cross country for one of the few jobs available which hundreds of people are applying for.

Typical nursing care is providing the best care you can, when management are changing perfectly good consumables for inferior products creating potential infection risks, all because it will save a pittance over the course of a year but improve their financial management stats for the CQC.

Typical nursing care is trying not to grumble when your expected to do the same job for £3,500 less a year, despite the government saying people earning under £21,000 won’t face pay freezes or pay cuts.

Typical nursing care is having to courteously listen to people espousing their little stink nuggets of wisdom, despite their obvious lack of medical/nursing training or any experience WHAT SO EVER.

Typical nursing care is having to face patients despite wanting to cry, because you know you can’t give them the standard of care you know they have a right to.

Typical nursing care is looking patients to apologise, because unfortunately, accidents happen, as is the nature of being acutely ill.

Typical nursing care is not telling ungrateful patients to go fuck themselves, despite them making underhanded, disparaging comments like “that’s not [insert reason here] typical nursing care“, when your that tired, that thirsty, that sore, that sick of working on orthopaedic wards without proper manual handling equipment that you don’t care if the roof caves in on your head, you just want the shift to end ASAP.

These things shouldn’t be part of typical nursing care, but they are. And I hope the government, management or what ever all powerful deity is in charge of the NHS pulls their heads out of their collective arse before nurses get so hacked off that they get politicised.

All in all I’m pretty frustrated!

As am I.

How Sweet

2011-01-01T09:03:00.000-08:00

http://well.blogs.nytimes.com/2010/12/29/in-praise-of-nurses/?src=me&ref=health

I love and admire nurses.

Oncology nurses and ostomy nurses. Radiation nurses and post-op nurses. And those essential, always-there-when-you-need-them, round-the-clock nurses. (And though most of my experience is with female nurses, I admire male nurses, too.)

Now this isn’t some abstract infatuation, based on seeing “South Pacific” one too many times. I’ve been hospitalized six times in my life, and the medical personnel I came to know best — and like best — were the nurses.

To generalize: Nurses are warm, whereas doctors are cool. Nurses act like real people; doctors often act like aristocrats. Nurses look you in the eye; doctors stare slightly above and to the right of your shoulder. (Maybe they’re taught to do that in medical school?)

My most recent dependence on nurses came in 2008 and early 2009 as I was treated for an aggressive Stage 3 prostate cancer. But more about that later.

My first vivid nurse memory comes from the summer of 1970 at Exeter Hospital in New Hampshire. I was 12 years old — almost 13 — and a benign tumor in my right knee needed to be cut out.

Read the rest here.

Things I would love to say

2010-12-30T02:48:00.000-08:00

Just once I would like to tell these patients and relatives how it is, without worrying about getting fired.

Why? You ask....

Because I get fed up with relatives who think that Nurses are in some kind of position to stop and chit chat.  The only people who have time for that are support workers and they can usually be found gossiping at the nurses station, wearing almost identical uniforms to Nurses. I am sick of the constant hammering we get from these people who don't seem to realise that we have a job to do or that there are people dying all around us. We don't have time to explain things to them properly. They don't have enough medical knowledge to understand what they are being told. They stop every single random member of staff that they see (all of whom are going to view the patient's situation from a different angle-if they know the patient at all) and demand information.

Then they accuse the Nursing staff of telling them "a different story". It is a medical ward full of older patients. These people are going to have one medical problem after another...sometimes the pneumonia is the biggest problem. Sometimes renal failure is....Just because the patient was ?UTI on admission and we are now focused on her anemia does not mean that the staff is "lying" to you about "what is wrong". She's a medical patient for Christ's sake. They are never EVER simple, cut and dried. The diagnosis, prognosis, plan of treatment etc change faster than Tiger Wood's girlfriends. Most elderly people will be in their own waste, and in a real bad way of they are left unsupervised....leaving them to tend to other patients and duties is something every nurse has to do no matter how caring she happens to be.

For once I want to be direct and say exactly what I think in my sweetest little sarcastic baby doll voice. Or maybe just in a very matter of fact voice.

I take a big risk on the back of my patients by answering the phone at all.....many of my patients should not have been left for me to answer the phone. I could get in big amounts of trouble if something happens to a patient and I don't catch it because I am answering relative enquiries.   Instead of being grateful to the Nurse for taking such a risk and leaving her patients to deal with stupid questions, all these relatives do is bitch about how long they waited to speak to someone. Yes, there should be a member of staff who can update families without neglecting patients to do so....BUT THERE ISN'T.   And it isn't the fault of the Nursing profession. We don't have any say in how to staff the ward. No not even the sisters and the matrons get a say on that.

Thanks to hospital dramas the public has an unrealistic, ignorant and very unfair expectation of what they can expect in the hospital. They don't understand what it means to share their doctor and nurse between multiple other patients. They have no understanding of the true nature of prioritization. They don't understand why or how doctors and nurses prioritise as they do. They refuse to acknowledge or accept that old age is a multi faceted terminal illness that cannot be cured. They refuse to accept that old age, sickness and death is crude, sad and ugly. And they deal with it by lashing out at caregivers.

I had the most sympathy and empathy in the world when I started out. But the facts are this. Even the most compassionate Nurses are having their caring natures sucked right out of them after more than a few months of Nursing. I have seen some of the nicest people become Nurses.....only to become stone cold automatons after 6 months on the job. It happens to most of them.   At times I have felt that I could walk past a bus full of children on fire and not bat an eyelash. That is how bad burn out is. When my grandmother died of the usual old age medical problems, in the usual old age medical way....I felt nothing Nothing. I just shut down. And we were very close. I think we survive working in health care by shutting off.

Sigh. Things I would love to say and get away with. Management wouldn't back us up. I have been told by managers "yes you are right and you did right but the relatives would never be capable of understanding this issue nor will we accept liability so we have to apologise and let you take the blame".

I never would say these awful things because I constantly remind myself that patients and relatives DO NOT HAVE A CLUE and live in a fantasy world. They mean well. But their emotional state and ability to reason is usually not good. But at the end of a long day I cannot help thinking these things.

Here we go:

"I am so sorry you were on hold for 15 minutes when you phoned to call about your mother. This is an acute medical ward you see, there are sick people here. Actually, I was in your mother's room taking care of her when you called. She is having trouble breathing and we are trying to prevent her from getting re-intubated. I didn't think answering the phone was priority over that, but I know for next time that I should stop taking care of her, come to answer the phone and chit-chat with you for 15 minutes answering all the same questions I answered for your brother an hour ago while she goes into respiratory failure and dies. I now know what is important here, thank you for reminding me. Oh and you called 15 min before and your were put on hold then as well.  Yes you are soooooo are right to imply that the patient I was taking care of at the time doesn't matter either.   My sincerest apologies. Next time I will know better. Thank you for making me a better Nurse and showing me what is important."

I am sorry you do not like bariatric bed and feel the need to ring your call bell every 5 seconds to tell me this. I am sorry that you feel like your bariatric bed makes you stand out in the bay. Maybe you should have thought of this before you let yourself get to 30 stone thus requiring a bariatric bed.

You see honey, when you ask me for an blanket, water, whatever after I'm in the room, I am going to have to LEAVE the room to get the blanket, water, whatever. Trust me - I don't have one shoved down my cleavage just it case you want one. And management are not going to let us store them somewhere convenient or even allow us to have enough of those things for all the patients. I am going to have to walk past 2 bays of people shouting for help just to get you more stuff. If I stop to help them you will be waiting a long time. Yes, you miserable bitch, you are welcome.

Flashing your police badge at me will not make me let you up before visiting hours. Your wife is not dying, in severe pain, or a post op, she is sleeping. Your constant demands and inane questions over and over again will seriously impair my ability to care for your wife and my 12 other patients. And from what I can tell she is probably happy to get away from you for a night seeing how rude, annoying, and belittling you are.

I'm sorry that sandwich the kitchen gave your husband expires today but I do have 7 other patients I want to at least eyeball to make sure they are alive and breathing before I hunt down some more food for him. No I'm not going to "just take a pudding" from the bereavement cart across the hall for you. Their family member is dying and you are absolutely ridiculous.

How could you not know that it is illegal, immoral and unethical for a health care professional to give you private information and test results about a patient over the phone? Even if you are family, and the patient is out of it I can get fired for giving you private information. Neither the hospitals, the doctors or the nurses make these rules. We just have to follow them. And my job isn't worth it. What would posses anyone to call an ask the Nurses these things anyway? Why would you do this rather than arranging a conference with the medical team? You need a fucking psychiatric referral. Unless you are brain dead you must know that we can lose our jobs for violating confidentiality. Do you really think I am going to risk the loss of my job and home for you when you could get off of your fat ass and get the information you need just by contacting the medical team of doctors who will actually diagnose and treat you rather than harassing the Nurse and delaying the care given to other patients? I cannot read the doctors mind, or their handwriting. And if I am at the nurses' station reading notes so that I can answer your queries I'll have like 50 dignity champions crawling up my ass accusing me of "ignoring patients and being too focused on paperwork".

To family members: Just because you call out and say, "Nan has to go RIGHT NOW," does not mean that I can come and help her to the bathroom RIGHT NOW. Believe it or not, I am not going to leave my new patient with chest pain, just because Nan needs to pee. If Nan were my only patient, I would be by her side helping her all day. BUT SHE ISN'T MY ONLY PATIENT.   This doesn't mean that I don't care about your nan or do not like the idea of dealing with pee. I do not know of a board of Nursing that exists in any country that wouldn't jump at the chance to strike off a nurse for leaving a chest pain patient to help another patient to the toilet. They would fall all over themselves to strike off a Nurse who did that. I am serious. If Nurses don't prioritise people die. Better to get in trouble for leaving someone in wee than to get done for manslaughter. If you don't like this view, it may be time to consider hiring a one to one private duty nurse for your loved one. And yes I am at the Nurse's filling in paperwork whilst your dad needs the loo! You know why? Because the patient in the next bed is bleeding to death. The doctor has ordered a blood transfusion. And the fucking path lab will not give me the blood unless they get their fucking paperwork. I need to get it done and faxed before I take someone to the loo. Otherwise I might find that my patient has bled to death because I delayed his paperwork and connsequently his blood transfusion by taking people to the toilet. I don't want that on my shoulders. Yeah go ahead. Jump up and down and scream because dad needs the toilet and his nurse is at the station faxing blood order forms.  Temper tantrums and nurse abuse are easier and more fun than thinking and understanding aren't they.

To the patient I discharged last week: Please don't call the ward to ask me for health advice. You are not under my care any more, and I am not allowed to give health advice over the phone FOR SAFETY REASONS. Your notes were gone from this ward 10 minutes after you were out the door and I wasn't even on duty when you were here. Even if I know the answer to your question, the most I will say is "Go to your GP or to A&E," to cover myself. I'm sorry if that makes you angry....maybe you should have kept that follow up appointment with your doctor we made for you.

To my angry patient: I'm truly sorry that you had to wait for two hours for pain medication last night. The Powers That Be at my hospital have decided that "no one will notice" if they cut staff at night. Sure you can complain about the nurse, but I know for a fact that she was doing the best she could. Maybe you should direct your complaints towards the management, instead of the nursing staff. Maybe if patients directed their anger towards management  in the first place our hospitals wouldn't be such a fucking mess and this kind of shit wouldn't keep happening.

STOP GETTING OUT OF BED. That annoying, high pitched loud beeping sound is going off because YOU'RE GETTING OUT OF BED. If you fall I will have to do about 6 hours worth of paperwork, neurochecks, send you for a CT head etc. That is going to really screw my other patients. I wish I could be there to help you everytime you want to get out of bed. Unfortunately I am being forced to be responsible for 20 other patients that are too sick for a general ward all by myself. No, the social workers, support workers, and phlebotomists cackling away at the Nurse's station are not "nurses who are ignoring you." They are not nurses, and they aren't going to help you while I am tied up with the man across the hall who just pulled his dialysis tessio out and his bleeding profusely.

Stop bending your arm. For the 500th time. That annoying high pitched beeping sound is going off because you are bending your arm causing your IV line to occlude. No I cannot just "shut it off". It is heparin for Christ's sake. Do you want to die? Just keep your arm straight. That is all you have to do. That is all you have to do. If you keep bending that arm and then screaming at me because the IV pump alarm is beeping I am going to go into the treatment room and inject my veins with something that will kill me. Then who are you going to bitch at?

No, that person constantly with your roommate is not a private nurse the hospital is providing because we "like him better". It's security watching him at all times to make sure he doesn't try to kill himself or attack staff and other patients again. He already gave a medical doctor a fractured skull when he was brought in for an overdose last night. And then he tried to jump on top of a patient and smother him in AAU. ( telling the patient this would violate the confidentiality of the combative patient, therefore I have to put up with the moaner complaining that he doesn't get a "private duty nurse" because " we don't like him").  The I have to put up with the family calling 10 times a day wanting to know why the other man in the bay gets a "private nurse" but not dad".

These are the drugs the doctor prescribed for you to make you better. If I were really trying to poison you, you'd be dead already.

If your pain is a 10/10 and you are asleep, or talking on the phone complaining about the food. we need to clone your DNA for our race of superhumans we're working on down in the lab.

Yes, it is your fault that your baby was born at 28 weeks. It had something to do with the crack you were smoking.

Yes, I did go to University to do this.  No that does not mean that I am "just like a wannabe doctor". Degree nurses are prepared to work on the wards as a direct care Nurse. They are not any closer to being a doctor than an old style training Nurse. A person needs to be pretty on the ball and knowledgeable to deliver the health care prescribed by doctors. And that is what nurses do, we deliver health care. No, I do not think I should go back to school and become a doctor. Delivering health care is tough enough. I have no interest in prescribing it. If that makes a person stupid then so be it.

I will not get you another glass of water because you threw the last three cups I gave you at me. Three strikes and you are out. You are not confused or suffering from dementia therefore you can't get away with it. Yeah go ahead, call your daughter and tell her we are trying to kill you via dehydration. Remember when you pulled the central line out that we needed to infuse IV fluids into you? Here is the phone. You will look like a tit. She knows what you are like. And if you can go out to smoke every 10 minutes you can get your own water anyway.

If you are going to refuse to comply with any treatment recommendations given to you, you will keep getting sick, and I will continue having to deal with you. It's not a conspiracy against you, trust me, we're sick of you.

You're crazy and so is your family. We can't wait for you to go home either. Unfortunately, the consultant decides that, not us. And it is going to take him 8 hours to get here. Then it's going to take 4 hours for the junior doctor to prescribe your discharge meds. Then it will take another 4 hours for pharmacy to actually dispense the meds. And then I have to find time away from critically ill patients to go over your meds with you. I cannot make this process go any faster. Please stop bitching at me. It makes me want to kill myself. It is hard to have no control and yet have to listen to your constant whining for 12 hours. So help me god, I'll hang myself in the treatment room if you don't shut the fuck up about how long it is taking for you to get discharged.

Get off your fucking mobile phone. I have a grand 46 seconds with you to make sure that your blood glucose is stable and get your prescribed drug regime that is due now into your system before I have to run back down the hall to make sure to implement the doctors' orders for that patient who is going downhill. I will be stuck at his bedside for hours once I get there and there is no one else to cover you or my 10 other patients from that point onwards .   Lets make sure that I use this 46 seconds to make sure that you and my other 10 patients are stable and alive because I won't get another chance to check on you. And no I am not going to make you a cup of tea because that will take 30 seconds thus leaving only 16 seconds to eyeball and action my other patients before I head back down to the deteriorating one, who I never should have left in the first place.

If you're in here for "COPD exacerbation", getting regular ativan because you're "nervous" because you can't breathe, maybe you need to stop going outside to smoke a pack of cigs every day. I'll give you a nicotine patch, but I won't help you go kill yourself, so feel free to "report me to the doctor" for not taking you out to smoke at 3 in the morning -- and if you DO go out, I'm taking your nicotine patch off, I don't want to have  you collapsed on the floor for no other reason than you wanted a buzz.

How can you be so nice when your family are so feral? And my god, not only are they feral but they are stupid too.

This isn't a hotel and despite the uniforms we are not your maids/servants. We cannot wait on people and do our jobs at the same time. And if I don't do my job people die. This is why I am NOT coming into your room every two minutes to change the TV channels. If I could do that for you I would. But I can't. If you think that this means I am mean and uncaring, you are a tit. Anyway, if you can go outside to smoke every 6 minutes why do you need the nurse to change your TV channels? And no, I do not need a lecture about treating people like people and not numbers from someone who killed 3 people in two different accidents as a result of drunk driving. If I can't get in here to change the channels for you then I can't get in here to change channels for you. Deal with it. Maybe if you didn't watch so much damn TV you would not have such stupid ideas about what Nurses are here and able to do.

Hell yes I took your father back to his room and shut the door in his face. I did, and I would do it again. He was looking in other pt's room's (females) while they were undressing. He came in to a room to stare at a woman I was catheterizing.. He's alert and oriented, and able to walk and he knows how to use the call light, and he has no right to go into other pt's rooms and stare at them.

She accused me of making him feeling like a peeping tom..

THAT'S BECAUSE HE IS ONE!!!!

But I didn't have the heart to tell her so.

Your complaints about 'the service' I am giving you aren't going to get you anywhere because I CAN'T HELP IT. There are 2 of us and 30 of you! The goddman cadets sat at the station in their "just like a real nurse" uniforms aren't going to help! Here I am rushing around like crazy- you see me flying up and down the hall- and you, an alert, continent, and fairly able-bodied person, have the nerve to make whiny little passive-aggressive comments about how long you've been waiting for 'service'. All because you are jealous that the other man in your bay was getting constant attention! He is a head injury requiring 15 minute neuro checks.  People like you are what is going to crash the NHS. YOU. Not immigrants, single mothers and "overpaid" doctors.

To the adult son of the little old lady who just rolled onto the unit a little while ago....why no, there isn't a phone in this room, which I hadn't noticed because I've been too busy making sure your mother's pacemaker is capturing, that her incisions are WNL, that her observations are stable, that her pain is controlled, and that I can hear breath sounds on both sides. Sorry you were calling and calling and nobody was picking up...I guess I should get my priorities straight, huh?   I pity her for having you for a son.

I am a professional with a degree. Two of them, in fact. I am likely more educated than you and was also one of 70 accepted into a nursing school program with over 400 applicants.   I got you a blanket because you said you were cold and I had time to hunt one down. I made some cups of tea for you guys because I lucked out this evening with all stable patients on very little drugs and drips. This does not mean that you should assume that I have nothing more than a high school education since I gave your good "service". I actually am one of those degree nurses that you seem to detest. And I would love to tell you that. I would also like to tell you that you are a douchebag.

I am just the person who checks your blood sugar and administers your insulin according to the results. Why don't you get pissed off with yourself instead of me when I have to call the doctor about your blood sugar of 23 mmols.. I guess you think I have amnesia and don't remember that you already told me off earlier in the day when I tried to teach you that eating 10 burger king whoppers, with onion rings, while washing it all down with a liter of Coke might not be a good idea. You also ignored me when I told you not to eat those donuts that your family brought in because it would raise your blood sugar. And your family told me to fuck off when I reminded that that we were trying to keep your blood sugars under control. And now that your blood sugar is so high that the meter cannot even give a reading you want to call me and your doctor "incompetents". And still you are stuffing your face junk food. And your doctor is now screaming at me because I had to call him about your high blood sugars and get orders him from for insulin to treat you. Thanks, asshole.

Is this some kind of a joke? I actually think most of your family members possessions are gross and I have no interest in stealing any of their clothing or shoes. So please stop drilling me with questions regarding their missing underpants or socks that probably got carried away with the laundry. Trust me I don't want them! And I am not leaving the post op bleeder in room 17 to hunt down your mother's nightdress. And 9 times out 10 the care assistants and I are moving way to fast to even consider worrying about a stray sock that may have been taken away with the bedding. Your mother is in hospital....why they hell are you worrying about socks and nightdresses? I will happily give you £40 out of my own pocket to replace them. As long as you promise to fuck off and stop asking me stupid questions about lost items when I have blood to hang and doctors orders to catch up. My purse is in the staff room, take it, use what you find in it to replace your mothers lost item and get the fuck out of my face. Just get away from me.

Sir, let me tell you -- you are ONE nasty old man. Yes, we "forgot" your breakfast, and for that, I apologized up and down and sideways, even ran to the kitchen to personally see to it you got a lunch tray. And how did you reward me? You lit into me about every single injustice done to you at this hospital, including, :HORRORS: having to be "last in line" in the x-ray line because YOU had a sepsis infection. Well you wouldn't want us to spread your infection to everyone else via the xray machine would you? I mean -- dude, you are getting out alive. Yes, little things were missed. There was probably a team of 100 or more taking care of you these last 3 weeks. Do you ever wonder that perhaps just everyday human error in a large organization COULD result in a few glitches in your care? Are YOU fricking perfect? You certainly expect everyone else to be.   I wish I could transport you back to the 19th century to receive their version of medical and nursing care. They'll cut your throat and try to bleed you to cure you. No costly xray machines, IV meds, or decent pain killers back then. Have fun.

The truth is -- you were well taken care of in this hospital at a much higher cost than what you ever paid in. Most of the work that is done for you by the Nurses and Doctors goes unseen and happens out of your line of sight. People waited on you at your beck and call, every god damn 15 minutes. You have been nothing but nasty to everyone. Well, I hope people like you get what you deserve - whatever that may be. You are nasty and rotten to the core. You see people in service to you and you simply choose to demean them. I hope where ever you're going, that it's not someplace good. You are evil to the core. You live a great country, get decent health care from a struggling and overburdened system free at the point of delivery, yet you continue to complain because the hospital doesn't revolve around you and your wants and needs. Ugh. You make me SICK. Violently so.

To the relatives of patient in bed 60, I'm sorry but I cant give him back his call bell,dressing gown cord,belt or tie as he keeps trying to hang himself with them. No I also will not give him his shoes,book or flask back as he keeps throwing them at the nursing staff. Don't fucking ask me again or accuse me of "taking his stuff" you are literally making me want to die.

I'm sorry you got bumped for an emergent case, but the fact that you are not the emergency is a good thing to be grateful for, no? I mean seriously...would you really want your hospital to refuse to give you a lifesaving operation right away when you have just been brought in from a car accident that ruptured your spleen because "the guy waiting for the hernia repair all day doesn't want to wait". No you wouldn't. So get a life. I just lost all respect for you.

I realise you don't want to care for your father because he's an incredible areshole. I don't blame you. However, I have a legal, ethical and moral duty to take care of him, so stop with your guilt-driven inane complaints and requests, because unlike you, I have to actually make something happen for him and I can't go home and just blame everyone else when it gets too hard. Thanks.

Dude, honestly, do you really HAVE to drink over a GALLON of alcohol PER DAY? How do you do it? Do you also really have to smoke 2 packs a day on top of it? And, if you hate this place sooooooo much, and want to leave SOOOOO badly, why did you EVER present yourself to A&E in the first place?? Why do you keep doing this to yourself and then present yourself in A&E? Why? Why? If the food is so bad and we are all stupid and worthless stop getting yourself admitted to hospital over and over and over again, sometimes 10 times in a month. We both know that there is nothing that the doctors can actually do for you and that you are only here for the free food, warm bed and morphine fix.

To my little old sweet lady in green bay you are SO sweet, SO well mannered. You were a joy today. And compared to the 3 rabble rousing drunks I had to deal with all day, you were like sugar and kittens. I thank you, and if the world had more like you, we'd all be so much better off. I love you and I want to take you home with me.

I really don't care whether or not you take your damned pills. Do it or don't, but let's be quick about it because I have 8 more patients to see before I can pee. No I can't leave pills here and walk away. Sometimes I have too, but really leaving pills at the bedside is a very bad thing for me to do.

No, sir. I can completely understand why you don't want to do your treatments. Yes, sir. It does suck. Literally. And I'm tired of trying to talk you into doing it. After all, it's your health, not mine. I will try to talk you into it three times everytime I come around to you. And after that I will document that you refused. Then I am off the hook when you try to sue over your hospital acquired chest infection or some other complication.

OK, sir. I absolutely understand that you don't want me bothering you overnight to cough and deep breath, use your incentive spirometer, check your glucose, put your oxygen back on or turn you on your other side. But if I went away and left you alone as you desire, you'd get pneumonia, be reintubated, become hypo (or hyperglycemic) and develop a bedsore.   Really, there is not need for calling me a bitch for disturbing you when I am just trying to prevent the above complications. I hope your next nurse does get pissed off and ignore you and you get bedsores and pneumonia. You will really be calling the Nurses some awful names then. But she won't because we always try to do our jobs despite your nastiness. And I will continue to be in here over night to make sure you are okay even though you are a jerk.

No, I'm afraid I can't tell you anything more about Daddy's bowel movement that he had at 1 a.m. as I wasn't here and all that was documented by the night nurse was that he had one. I'm sorry I have no further information." Darling daughter went all the way up to the chief of nursing to complain about this. What I wanted to say was, "Are you SERIOUS?" Your father isn't having any GI problems and this has nothing to do with why he's here. I think you are one sick cookie to block my way in the hall and ask was it runny? How many cups was it? What color was it? Did he grunt when he had it? Get a life!! It's people like you that give the whole human race a bad name."

For God's sake, let your mother get some rest. The quality of the care I give will not be improved by you sitting there and GLARING at me all day. Yes, I do know what I'm doing. As a matter of fact, I KNOW HOW TO DO MY JOB BETTER THAN YOU KNOW HOW TO DO MY JOB. No, I'm not just going to let your mom die, unattended, without doing anything, because we are not of the same ethnicity. Let me do what I need to do for her, so that if I get tied up later at least I was able to see to her at some point in my shift. If you can do better, take her home. Otherwise, get out of my way and stop asking the same stupid questions over and over again. And pass that on to your brothers and sisters while you're at it.

You have a pain rating of ten? Really? Wow, you must handle pain really well. The only time I had a pain of ten was during unmedicated childbirth, and during the height of that, there was no way I could have been talking on the phone, eating hamburgers or sleeping the way you are doing! Congratulations, you have a seriously high tolerance for pain!"

That's great that you'd like a diet black cherry vanilla coke with a little umbrella in it. I'd like a Martini after dealing with your fluid overload and high blood sugar that resulted from your non compliance with your doctors orders. . If wishes were horses, we'd all ride.

No, I don't know when the doctor is coming in. They don't answer to us. We are not in control of them. We do not have your consultant on GPS. Sorry that you only come in for ten minutes a day with Grandma Millie and want the physician here to answer your questions right away so you're not late for your nail appointment. You are so right. Nurses and Doctors should always drop what they are doing and come running so that you are not late for your nail appointment. I am glad you brought this complaint to our attention.

I realize you are claiming that we never gave you your call bell, but the truth is that your call ball was lost in your abdominal skin folds. Yes, it might be time to think about weight reduction.

We always give your grandfather your call bell, and he always knocks it out of reach. And there is no way it is physically possible for me to get around to him as soon as he knocks the bell onto the floor.

We did show your grandmother how to use the call bell but as her dementia causes her to forget everything within 5 fucking seconds SHE FORGETS. You know this.

Hello, welcome to XYZ hospital: let's get three things straight off the bat: We don't control doctors, we don't control dietary, and we don't even know what is going to come through the door let alone what we will be doing 5 minutes from now.

Lets get realistic here. Supervisors and administration staff the place just well enough to keep people alive, that's it. Call bells are for "emergencies" and "immediate needs" only. Not for getting a tissue box moved to the other side of the table or having the temp. in the room changed.   Everyone loves the story "Little Boy who cried wolf" except when it applies to them. So many people abuse the bell so often for insignificant requests, when the request that actually justifies using the bell comes around they wonder why nurses aren't quick to respond.

For Christ's sake we still do not have fucking GPS tracking on the doctors. We didn't this morning, and we don't right now, and we never will. They have scores of patients to see, all over the place and if we page them to ask when they are coming it will only slow them down. If anyone asks me again when the doctor is coming I am going to kill myself by sticking my head into the macerator.

For Christ's sake the doctors have scores of patients on multiple wards with many different Nurses. They do not have time to check in with is usually. I can usually only find out their plans by abandoning the patients to bury my head in notes. Then you will accuse me of abandoning patients to bury my head in "paperwork".

Lady, if you haven't noticed, hospitals are short staffed. I am ONE woman to at least 12 patients and NO help. You perhaps could have called in and reminded me -- that would have been courteous. But the immediate needs of survival, pain, meds, and immediate care of my other patients trumps your husband's need to get a better pillow for now. Why yes I AM on the computer while your husband is "waiting for his pillow". How else do you think I am going to be able to order and obtain the life saving drugs for the patient who is going to die today without them? I get one shot at ordering and obtaining this stuff for that patient and I am not going to blow it searching the ward for a pillow. Sue me.

I do not appreciate your glares and your short attitude with me. You should be grateful that your husband is receiving care at all in this hospital, that you have access to health care and that doctors are working SO hard to find out why he's having repetitive fevers. Your husband is wonderful and very appreciative -- you, however, are an ungrateful wretch of a woman who thinks the world must revolve around you. You and others like you are the reason for problems in health care, in my opinion. But go ahead and bitch. I feel the days are numbered as to how long hospitals and this economy can support bending over backwards for folks like you. There's going to come a breaking point -- and mark my words, you will be on the wrong side of it.

No I cant get your dad home any quicker as we are waiting for transport to get back to us. There is 5 inches of snow on the roads and the county has a shortage of grit so I kind of doubt he will be coming home today. Ringing us every 5 minutes will not get him home any faster, if anything it slows things down as transport can't get through as you are on the blinking line!!!Trust us, we want him out of here as much as you do.   How the fuck could we possible know when the ambulance will get here when they don't have anyway of even knowing that themselves? Why do you refuse to accept any kind of explanation? Get a life.

I have no idea where your doctor is at this moment, and No, I cannot "get him on the phone" for you to complain about your minor "back spasms" you all of a sudden decided you have in addition to the million pound workup you're getting to rule out your other issues. Your doc will round when all the other doctors round, and he will be in here eventually. One doctor does NOT report into each and every nurse who is taking care of his 80 patients -- he truly does not. He also does not sit around all day waiting for us to call him about your hangnail -- I mean -- it's about the WAIT. And don't worry, when the time comes, you WILL be routed OUT of this place, as soon as is humanly possible. So, why don't you just lay back, enjoy the free room, TV, food service and nurse, and just go with the flow. Honestly, I'd give ANYTHING to be able to lie there for 3 days and do absolutely nothing but watch TV, eat, and be waited on. Why can't you just enjoy that? I mean, dude, I'd give ANYTHING to be able to do that -- what is so wrong about it?

On treating patients like they are my own family members; I have already warned my family members that if they mistreat hospital staff, I will personally strangle them. When my aunt was in the hospital my dad interrupted her Nurse while she was doing drug calculations for another patient to ask a dumb question. Nurse Anne ripped into her dad for that.
So, if I were in a situation where I was taking care of a relative, I would hope I would not over prioritize their "personal" needs (TV turned off and on for them, two water pitchers kept full at all times, dialing the phone for them) over the "medical" needs of other patients my relative's Nurse was caring for.

The doctor told me to get you walking. I know that we need to get you walking.   We must get you walking.  So when I asked you to walk to the toilet 5 feet away I wasn't being mean and I do not need lectures on "what you deserve because you have friends on the board" and " lack of compassion in Nursing". If I fetch and deliver things for you rather than making you do it for yourself you will get a blood clot and die, or you will get pneumonia and die.   You won't get better if your don't grit your teeth and start trying to move around. Yes, I know it isn't fun. But you are not an elderly patient who really cannot do these things for herself. You are a 39 year old woman!!

I know your mother wants to go to bed. She already told me. There is no need to follow me down the hall. I am dealing with a man who just transferred himself to the toilet. That's why the alarm went off. I can't drop everything and leave him sitting here unattended just to put your mother to bed. He is confused, unsteady on his feet and he WILL fall... SHE understands that- why can't you? And don't you dare waddle down the nurses' station and start bugging them about it while they are in handover trying to ensure that all bases are covered with all the patients. The oncoming shift has ONE shot to get all the info they need to start their shift. An omission thanks to interruptions could lead to a fatal error. GO HOME. Also, when i do put your mother to bed please don't stand there and watch me like a hawk. This room is small and every time I turn around you are standing directly in front of something I need. Again, GO HOOOOOOOOOME.

Are you really sure you want your 100 yr old grandma that you left in the nursing home for the last 20 years to be for full and active resuscitation? Even though she has a feeding tube,is getting dialysis everyday, has all four extremities contracted, a very large unstageable pressure ulcer on her bottom that requires a urostomy AND a colostomy, and hasn't been awake in 4 years?? So, You really want us to try and roll her to her back while her legs are curled up in the air and we can't pry her contracted arms away from her chest and then crack her ribs while we do CPR on her??? Okay then. If my grandchildren do that to me rather than letting me go with dignity I will come back and haunt them to death. I mean, my god........ What do your poor old grandmother ever do to you to you? Why do you want to torture her with all this medical intervention?

Since you want us to call and ask permission for EVERY SINGLE thing that we do to your mom, I am just calling to ask you if we can put her on a bedpan now or would you like her to shit on herself in the bed? (this after daughter threw a fit when we took an emergency chest xray of her mom because she has pneumonia, copd, and chf and we didn't call her to ask permission) And YES you ARE allowed to come in every other day and throw a fit with the nurses and managers and DEMAND that the CEO come to the room RIGHT NOW to straighten out exactly WHYYYY your mom is getting omeprazole 40mg IV every morning. Please please talk to the managers and CEO right now actually. That way the managers and CEO will already know you are whacked out and crazy as a loon when you complain about me trying to reposition your mom every two hours. There are patients and relatives making legit complaints and they don't get listened to because lunatics like yourself outnumber the people with genuine complaints 10 to 1.

If you can reach the call light that often, you can reach the

1. Kleenex

2. Water

3. Your magazine

4. Snacks

5. Blanket to pull up

6. Miscellaneous

since they are right next to the call light.

Seriously I have something like 8 minutes per patient per 12 hour shift. And I need to cover about 1000 bases during those 8 minutes with you.Use your time wisely.

NO. This is actually YOUR job. There is nothing wrong with your hands. You are completely independent. The nurses help out people who can't do things for themselves. You can empty your own pouch. And when you leave here, who is going to do it for you at home? I understand you are frustrated but please don't blame it on me or the other nurses. It's an important part of your therapy that you be as independent as possible. I won't hesitate to help you but I won't do things for you that you perfectly capable of because it would only hurt you in the long run.

For relatives/visitors: we are not sitting here chatting, we are in handover. Would be nice if I could magically know all about my patients without it, but I can not. When you interrupt handover, it takes longer for me to get to your family member for their (non-urgent) request. When I tell you to go press the patient buzzer so the nurse looking after the patient can help you, the key phrase is nurse looking after the patient, who is not me - so don't come back in 5 minutes to give me an update. If I am not assigned to a particular patient I cannot get involved for SAFETY reasons. This isn't 1952. I have enough liability and work on my shoulders just with my assigned patients. It has nothing to do with "not wanting to be bothered" you freak.

When I tell you that I can't make icepacks for you because we have an emergency with another patient, but you're welcome to make one up yourself:

1) don't tell me you don't know how - I worked it out and so can you; hint, they involve ice, a plastic bag and a pillowcase;

2) don't come wandering up to where all the drama is to have a look and get in the way - go back to your room;

3) don't buzz for me again 5 minutes later, I'm still trying to help this nearly dead girl by actioning her doctors orders. Quickly. At minimum it is going to be hours before I can get back to my other patients. This girl is ill.
4) oh, she doesn't look that sick to you? I'll just tell the crash team that the patient in bed 24 thinks that the young girl with a blood sugar of 0.7mmol/L (27mg/dL) and a core temp of 31.4C (88.35F) is fine and they can leave.

All in a days work. Sigh.

Thanks to allnurses.com for making this post possible.
Details have been changed to protect confidentiality. You will not be able to identify anyone from these posts. This post describes a days work, every freaking day.

A Letter from the RCN

2010-12-17T13:37:00.000-08:00

From Peter Carter:

"Last week we wrote to you with news of an important proposal from the NHS in England.

Despite already imposing a two year pay freeze, the NHS in England has now told the RCN and other NHS trade unions that there isn't sufficient money to pay increments for any NHS staff for up to two years. In exchange for a total increment freeze, the NHS are offering a guarantee of no compulsory redundancies for some staff.

Yesterday, RCN Council held a meeting to discuss the proposal. This email is to tell you about that discussion and to set out the next steps.

RCN Council examined the proposal in great detail. We need to be clear that Council will not accept or reject the proposal until you and every other RCN member has had the opportunity to share your views. However, Council wanted me to share with you their initial thoughts.

Council were unanimous in their opinion that the proposal does not offer any kind of guarantee for nursing staff and that, if implemented, it could signal the end of national terms and conditions through Agenda for Change which the RCN fought so hard for.

Although the proposal sets out a guarantee of no compulsory redundancies for those on bands 1-6, this will only apply in trusts that decide to opt-in and will involve local discussions and agreement.

RCN Council also believe that, in reality, the vast majority of nurses are not facing this threat. Instead, the real danger to patients and services comes from the tens of thousands of posts which are set to be cut through recruitment freezes and deleting vacant posts.

To give up any prospect of career progression in exchange for a measure that does not guarantee staffing levels, not to mention job security for all nursing staff, will understandably anger many of you. We also know that an increment freeze will have a real financial impact at a time when VAT is set to rise, the cost of living is going up and pension contributions are increasing.

So what happens next?

Council have asked me to start the process of discussing the proposals with our sister unions in the NHS. We also need more information from the NHS in several key areas:

What is the funding gap that decision makers are trying to bridge?

What other savings are planned, and how will they be achieved?

If NHS staff are expected to accept yet another restriction on their pay, what else is being done to save money?

How many jobs are at risk, and how many would be avoided through the guarantee?

How can Foundation Trusts, who have autonomy over their own pay agreements, guarantee no compulsory redundancies?

The guarantee only extends to staff between bands 1-6, what about the thousands at bands 7-9?

Let me be clear. Asking for this information does not mean that we are 'negotiating' on the proposal at this stage. It simply means that we need to have all the information in order to share it with you, our members, so you can have all the facts before you tell us your views. I wish to assure you that, ultimately, it will be you, our members, who accept or reject this offer.

We are your union, your voice for nursing and we will act in your best interests and those of your patients.

Over the next few weeks we will be sharing news with you about our consultation process, in the meantime, please do carry on telling us your views through your branches and boards, your Council members, through the Frontline First website, via the the RCN's Facebook page or by emailing us at frontlinefirst@rcn.org.uk.

Thank you to all those who have shared your thoughts already. We wish to assure you that we are listening to each and every comment.

Yours sincerely,

Dr Peter Carter

Chief Executive & General Secretary

P.S. You can find out more about the terms of these proposals by watching this video: http://frontlinefirst.rcn.org.uk/pay-proposal"

No.

2010-12-13T13:24:00.000-08:00

Get a load of this.

Health campaigners have responded angrily to a suggestion from an NHS boss that staff could “donate” a portion of their annual leave as part of an effort to save £30m. In a staff bulletin, Epsom and St Helier Trust chief executive Samantha Jones said that employees could play an important role in helping to save the money in the current financial year.

She wrote: “A number of you have said that you would be willing to sacrifice some of your annual leave allowance and come to work instead.“It might seem obvious, but each and every single day off in the organisation costs the Trust money. This is particularly true if a member of bank or agency staff has to be hired to cover for your post.

“I fully support this idea, and in fact I have decided to work on one of my annual leave days. If everybody agreed to work just one annual leave day, it would make a significant contribution in helping to achieve our goal.” Ms Jones explained that in many NHS trusts, staff were agreeing to reduce their contracted hours between now and the end of the financial year, in return for an appropriate reduction in pay

Militant medical nurse says no. The last shift I worked was 12 hours long. They deducted an hours worth of pay for a break that I could not take without risking patient safety. Then I had to stay over another 2 hours unpaid to complete all the paperwork. It's a legality. But if I tried to do it during my shifts patients and visitors would accuse me of neglecting patients. So I waited until I handed over to the night nurse and then I completed it.

Nurse's already work a lot of unpaid hours. Even when we stay over late unpaid we still cannot accomplish everything. On most days I hand over a list of patient needs that I never got to sort out to the next Nurse. Chances are that she won't be able to do any better. Same with the next shift. And before you know it a patient waits three days before that sore they asked someone to look at is actually seen.

Last weekend I was asked to work an 8 hour shift because they only had one RN on the ward. I felt bad for her. I felt bad for the patients. So I went in. It ended up being 10 hours with no break. And I WILL NOT be getting paid for any of that. I am supposed to take the time back as "time owing". This is something I will not be able to do because the ward is short staffed and busy. I will never get paid for those hours or get them back. My childminder is getting paid for watching the kids for me during those hours!

Never again will I pull an extra shift.

No they are not getting anymore out of me. They need to find other ways of saving money.

I like this suggestion from one of the commentators on the article:

If I was paid a decent wage for the work I do and was paid overtime for all the time I stay late then I might agree that it was a possibility. However I am not, so ask the CEO or your countless operations managers or a modern matron or 2 or 3 if they can help you out

Abso-fucking-lutely.

Nursing in the NHS: A Comparison

2010-12-10T06:52:00.000-08:00

Having worked both abroad and in the NHS I noticed a few things.     Man oh man have I noticed a few things.

Nurses in British hospitals do not have the support or resources to do their jobs. No amount of caring, compassion and old fashioned training can fix that. The are constantly put upon by pharmacy, porters, secretaries, housekeeping and supply departments in order to make the working lives of those people easier. I spent 3 hours out of my shift yesterday running around the hospital in a frantic search for the drugs my patients were prescribed. This left my patients nurse-less and un monitored.. It can take up to 8 hours to find and obtain common drugs that Boots could dispense in 5 minutes.

I want to go back in time...back to my old job in a setting that seems futuristic compared to the setting I am working in now. I decided to ask Doc Brown and Marty Mcfly for some help with this.  They will loan me the DeLorean or Darth Vader from the planet Vulcan melts their brains. Their choice.
In 1995 I was working in as a qualified Nurse in another country. I worked on a 28 bed ward. There were 8 RNs on duty for a shift. One of those RN's was in charge. One RN floated between teams and covered lunch breaks. We had 3 ward clerks from 7AM to 3 PM and two ward clerks from 3PM to 11PM. This was essential to keep notes and information organised and deal with all the phone calls and enquiries. If my patients' doctors ordered some IV antibiotics I wrote the order  on the drug chart or entered it into the computer. The ward clerk then faxed it to pharmacy. If she didn't do that immediately she was in trouble. Hundreds of orders like this are flying at qualified Nurses every hour and we need support to stay on top of it. Otherwise patient care gets completely neglected.

Pharmacy had a duty to get that drug to me when it was due, prepped and ready to go. If it was a STAT med, they had 5 minutes to get it to me or they were disciplined. Pharmacy was open 24 hours and they assigned a pharmacy tech to each ward. It was THEIR JOB to ensure that the Nurse had the drugs she needed at her disposal and ready to go as soon as they were due. There was an individual medication drawer for each patient and when you opened it you would find what you needed for the upcoming drug round as well as prescribed as needed medications for that patient. If you didn't find it and had to go and chase around looking for stuff, you wrote up pharmacy for a disciplinary. Pharmacy had faxes of all the patients drug charts. Every time that drug chart was updated with a new order the ward clerk faxed it to them immediately. Or else.

Each Nurse and support worker in that place carried a hospital mobile phone clipped to her pocket. I could stay with a patient whilst calling a doctor. I could stay with a patient whilst calling another Nurse for assistance. If a family member, pathology lab or a doctor called for me the ward clerk would transfer the call to my phone. That way I didn't have to leave what I was doing to answer a call. In the NHS I have to abandon the patient and walk past a score of them crying for help just to get to the ward phone. Then I have to stand there and que for the phone. Then I bleep the doctor. Then I have to stand there looking like an idle simpleton and wait for him to call back. Then I can walk back past scores of people crying for help and go back to what I was doing. If stop to help the people shouting for it, I may not get back to the man on the sliding scale fast enough to stop him from developing hypoglycemia and going into a coma.

We had hospital social workers to organise discharges and care. We had security.

These people were very well aware not to interrupt the Nurses unless it was an emergency. Most of the time they complied. In the NHS these people do not have a clue. If a social worker, a phlebotomist, or a porter etc interrupted Nurse during her drug round to ask a stupid question (i.e are you the Nurse looking after Mr Jones) they would have been disciplined. If they want that question answered they could look at the big board that had the room assignments, the patients name and the name of the Nurse written next to it, or they could ask a ward clerk or a tech. In the NHS people constantly walk onto the ward, right past the board that shows what Nurse is assigned to who and asks if I am looking after so and so. I get interrupted on average every 2.5 minutes with this shit all day long in the NHS. There is no respect for the Nurses here, they are not left alone to do their jobs even for a minute. The supporting departments in NHS hospitals think that the ward Nurses work for them.

I shit you not. In the NHS these people walk up to a staff Nurse whilst she is with a patient, concentrating on drug calculations, medicating a dying patient and holding the hand of a distraught relative......to give her "instructions" about what THEY need to make THEIR job easier. Porters do it. Pharmacy does it. Kitchen does it. House keeping does it. Our pharmacists started screaming at one of my colleagues the other day. He came onto the ward with some CD's (a miracle in itself, usually we have to fetch them). The only Nurse there was unable to stop what she was doing and check those meds in because she was with a patient so he had to wait 5 minutes. He went apeshit and tore her apart. While she was still with the patient. Our domestics go mad if the night nurses haven't started the domestics AM duties for them. On nights there is only three enough and I am NOT going to release the HCA,myself or the other Nurse from patient care to collect and wash cups and jugs.   Nursing management knows about this, and they seem more keen to side with the domestic managers.

Great scott!

In my 28 bed ward overseas in 1995 we had 24/7 housekeeping. If a patient got discharged I called the maid on her phone and she readied the room for the next patient. If I left a patient with a GI bleed to clean a room myself I would get struck off for sure. Oh sorry I let your dad bleed to death because we were getting a new patient and I needed to clean the room in order to prove that I am not above such work, Yeah right. That would go over real well. There is never a time in a Nurse's day when she isn't caring for someone that sick. The maids made sure that the Nurses were not dealing with that stuff in order to ensure that patient care was not compromised. The housekeepers here will walk up to a Nurse whilst she is in the middle of clearing someone's airway and tell her that a room needs to be cleaned.

Only next of kin is legally allowed to get info about the patient in both North America and the UK. Any relative who rang that hospital had to give the next of kin password to the switchboard operator before they were put through to the ward. This helped the Nurse to avoid getting into a long winded conversation with someone who isn't allowed to have information. Patient care comes first before relatives. A legit caller could also be put through to the charge Nurse for information while I continued on with my job. The switchboard operators here do not even attempt to protect the Nurses from unnecessary interruptions. They just put the drunk and belligerant caller through.

In the NHS there is no charge Nurse free of a patient assignment who can talk to these people. All day long I have multiple neighbours, friends and extended relatives calling constantly demanding test results etc. When the Nurse is running to the phone every 2 minutes, it leads to a whole lot of patient neglect. Management should be protecting Nurses from unnecessary interruptions.

1995. Since then patients are even more ill, more complicated and there is increased throughput. And in the NHS we are working with a lot less than we had when I worked in North America in 1995.

Let's talk more about working in the NHS in 2010. It sure is a step backward from 1995 in North America.

Here in the backwards future In the NHS we are often 30 beds with 2 Nurses and three care assistants. That is all. No charge nurse. One of the staff nurses who is the most experienced has to take charge even though she is the sole nurse for a team of patients. Fail. It cannot be done. Every time she gets stopped to answer relatives' questions and answer their phone calls her patients go without a Nurse and are neglected.

We get a ward clerk for 0900 until 2:30 from Monday until Thursday and that is all.

The ward clerk can't even handle all the numerous calls coming in for all those patients. If we have 5 relatives calling multiple times for 30 patients all day long it gets to be too much. We cannot even get a free phone line out to call a doctor in an emergency.

So she gets stressed and goes for a coffee break and the Nurse has to cover the phone whilst doing her job Nursing patients. The NHS ward clerk will ask the Nurses who are 3 hours behind on their drug rounds to file paperwork for her as one ward clerk for 30 beds is too much. It is too much. But I am in no position to help her. She also spends half her day looking for notes because doctors do not even have the decency to put notes back where they found them. This causes things to get lost. She cries a lot and disappears off the ward. Sometimes she is covering two wards.

If a family member phones the ward clerk walks over to me whilst I am in the middle of inserting a catheter and trying to maintain a sterile field and tells me that Mr. Smith's daughter is on the phone. Then the ward clerk walks away.

This leaves Mr. Smith's daughter on hold until I can get to the phone, really pissing her off. Or I can just stop what I am doing in the middle of a procedure to answer the phone. 9/10 it is an enquiry that the ward clerk could have answered if she would have bothered to ask what the caller wanted. These kinds of interruptions are constant for the Nurse in the NHS. With less staff and poor management and almost zero modern gadgets to help us out with today's increasingly ill patients we are fucked the minute we walked onto the ward.

We have two phones on the 30 bed NHS ward here in 2010. They are at the Nurse's station. There is no such thing as hospital mobile phones or pagers for the Nursing staff. It is a long walk past lots of needy patients to get to the phone. I have to stop what I am doing and answer a whole lot of phone enquiries whilst trying to Nurse my patients. I have to stop what I am doing and abandon patients to make calls to doctors or to fight with pharmacy and supplies to get what I need.

I have to leave the patients and go looking around for another member of staff if I need assistance. It was faster and more efficient to be able to ring the Nurse on the other end of the ward directly. A phone call from the little phone clipped to my pocket direct to the little phone clipped on her pocket. But not in the NHS. I have to hunt her down. Then I get delayed as patients shout for help as I walk past. Or I can ignore them, hunt down a colleague for assistance, ignore them again as we head back to the patient I just left etc. Call bells are worthless as no one has time to answer them. I spend so much time walking to and fro looking for staff and stuff, and then getting shouted down for help by patients as I am walking past, that I never can get on with anything. Patients and relatives stop you as you are walking past, show no regard or consideration about what you might be in the middle of for another patient and expect you to attend to them immediately. It isn't fair on the other patients or the Nurse.

Holy Shit Doc. This is heavy. This sounds worse than 1955. Who in their right minds would expect Nurses to be able to be there for patients and not make mistakes in these conditions.

NHS Pharmacy. The bastards. They are open 9-5 Monday through Friday. But they stop taking requests at 4:30 PM. It isn't until after 4PM that the junior medics get released from their rounds to prescribe stuff, review stuff, and write discharge drug orders. If I can get them to write stuff up in time I have to take the drug chart with me, leave my patients and leg it to pharmacy. If it is 4:31 pharmacy tells me too bad, that they will not fill the order. Then I have to search the hospital to get what I need. But I won't be doing that unless it is an emergency because I probably cannot leave my patients to go on a drug search yet again

Pharmacy also closes for an hour between 12-1PM. That means if I need a STAT med at that time I am stuffed unless I abandon my patients during lunchtime to go on a search throughout the hospital.

NHS pharmacy does not stock us up properly. Basic common medical drugs that a BOOTS could dispense in 30 seconds are AWOL on my ward. Each of my 15 patients are each on 10 drugs each due at 8AM and four other times throughout the day. Of these ten drugs for each patient: three of them will usually be in the drug cart or the patients locker. 3 of them will be completely AWOL and I will have to order them from pharmacy and the rest might be obtainable if I leave the ward to go on a drug hunt.

I can usually figure out what I need by 10 AM and I order them at that time. I do not get the drug chart back or the drugs until about 5PM when pharmacy goes home and cannot answer any questions. Right before they go they send out the packets to each ward with all the stuff we ordered. They do not dispense anything ordered that day until after 4:30 unless you walk down there constantly and beg. They barely answer their phone either. The other 4 drugs I will usually be able to locate if I ring other wards and walk down there to get them. This is very time consuming and an 8AM drug round that should take an hour takes about 4 hours. Pharmacy in the NHS DOES NOT prepare IV drugs for the Nurses. Nurses here have to dilute the powdered med and prepare the infusions. This is very time consuming. I may have 9 patients prescribed to have IV BenPen 2.4 grams 4 times a day. That means that at 8 AM,12 noon, 6 PM, and 10 PM I have to spend well over an hour diluting,mixing, and preparing each one for infusion. In decent hospitals pharmacy does this for the Nurses and sends up the bag ready to hang.

The constant interruptions from patients asking where their drugs are and relatives phoning slow me down even more. If I stop to help those shouting for help it slows me down even more than that. And still there will be ordered drugs not given despite doing my best. In order to even order the need drugs, pharmacy has paperwork for the Nurse to fill in. Then we have to run said paperwork down to pharmacy ourselves. For each and every drug. If pharmacy even thinks that the drug may be someone on your ward or on another ward in the hospital then refuse to supply it. And send a nasty message suggesting 6 or 7 places where you should look or it. Sorry but I am too busy getting screamed at by patient's relatives over late drugs and other things I cannot control.

Great Scott Marty. England's hospital pharmacies of the future fucking suck. Are you sure this is 2010 and not 1910?

NHS Hospital Pharmacy's favourite lines are "It is the Nurses job" and "We are going home at 5 and it is 4:31 so we will not help you" and "Did you search other wards for it first before you bothered us".

Woe to the patient who is waiting for their discharge drugs. Woe.

The doctor will tell them that they can go home during his round at 9AM. He will be unable to come back to the ward until about 4PM and then he has to write and prescribe all those discharge drugs, as long as he doesn't have really sick patients elsewhere who need to see him again. No way he has time to do it during the day while on rounds. And in the preceding days writing discharge orders just isn't priority. Then we have to beg pharmacy to accept the orders that late in the day. Then they fuck it up but by the time we realise they are closed and have gone home.

NHS housekeeping. We have two domestics from 7-2. Then one from 5-8. No 24 hour domestics here. in the NHS we just have part time domestics who think that the Nurses work for them. They don't give a rats ass of the Nurse gets struck off for neglecting her own duties.

If a patient gets discharged the bed is now free. AAU is chomping at the bit to get one of their patients into my bed. Domestics will not sort the room. I have to stop my endless search for drugs and do it, or pull the care assistants away from trying to do basic care to do it. This has to be done right away or we get held accountable for any breaches in A&E. The domestics are too busy trying to clean the floors and toilets and serving tea. They will often interrupt the Nurses in the middle of emergencies to ask for help collecting in cups and jugs for washing. They will walk past a care assistant on commode duty to tell a Nurse that someone needs the toilet. While the Nurse is in the middle of calculating a drip. Great now my concentration is gone and I need to start over. And the patient's treatment is delayed. We have a 15 minute window to feed 30 patients or we inconvenience the domestics. They just go and collect the plates in whether or not we have been able to get the patients fed. We have resorted to begging them not to do this but if they delay the collecting of the dinner plates back in then they are slowed down with their work. I don't think that they have any concept of the difference between HCAs and Nurses.

The NHS Equipment library expects the Nurse to clean and tag any equipment we have used before we send it back to them. The Nurses haven't been doing this properly because we have so many patients that need help, so many things to do and we are so behind....and scared for our registration and our patients lives. If I haven't seen crying incontinent patients for 7 hours because I am hunting for medications and trying to keep the acutely ill alive I am sure as hell not going to fuck around cleaning and tagging equipment. So it wasn't getting done properly or at all.

Equipment library made us a nice little poster showing step by step (at least 10 steps in all) how to clean and package an air mattress for them etc. They hung this little poster on our ward wall. They also made us a nice little instruction booklet regarding how to label and tag said equipment. *Every line has to be filled in for the equipment library, and this is the responsibility of the ward staff.*booklet. I can't speak for every hospital in North America. But I do know that the support staff in mine would have never dreamed of asking the Nurse to disregard patient care to do their job for them.

That equipment still isn't getting cleaned, tagged and packed up properly or at all. So equipment library made us another nice poster with pictures so that we can understand how to clean and tag their equipment properly. One of their staff even modeled for it and they showed her doing each of the 20 things that needs to be done to clean and repack and tag and air mattress. I hope someday that fucking bitch dies because her Nurse is elsewhere packaging up an air mattress nice and neat.

Fucking drug carts and keys in the NHS. In 1995 in North America I had a drawer in a pyxis device for each patient. My hospital was one of the first to trial this kind of device. This drawer had every possible drug I could need for this patient as ordered by the doctor. I was able to access and unlock the drawer by keying in my personal identification number.

Don't even get me started on kitchen staff, IT, social services or bed managers in the NHS. Just don't.

Nursing is tough enough without having to search for drugs, staff, answer the phone and package equipment for staff who do nothing but work 9-5 Monday through Friday and take lunch breaks every day. Lazy bastards.

If I have 10 patients that means I get 6 minutes with each patient every hour. Now take into account the answering of the constant stream of phone calls, the drug hunts, the relatives etc. The one patient going poorly who needs 40 minutes out of every hour.......

Anyway it seems that Doc Brown has the DeLorean up and running! And if that doesn't work I will just keep on trying to get abroad.

Pyxis drug machines,24 hour pharmacy and housekeeping, multiple ward clerks, ward staff mobile phones, supportive support staff.....hell yes when this baby hits 88 miles per hour Nurse Anne is going to see some serious shit.

Post from a disillusioned Nurse

2010-12-09T01:32:00.000-08:00

I found this on allnurses and can understand everything this poor girl is saying. It is all true. Families and Patients behave this way because of their social conditioning about Nurses and because of unrealistic views they have as a result of media portrayals of Nurses, Doctors, and Hospitals. A hundred years ago sick and dying patients were cared for at home. Families understood first hand what illness and death actually look like. The sick and the terminal wasted away,developed sores and became delirious at home with their family members watching and doing everything possible. No Nurses or Doctors were around to blame it all on.

I recently read an account of the death of Willie Lincoln, a 12 year old boy in 1862. His father was the president of the United States. Willie contracted Typhoid fever and screamed in agony as his bowel perfed. This sickness and suffering went on for months. He was treated at home, in his parents bed. He wasted away to nothing and lost his mind through delirium. His family had front row seats to the reality of sickness and death. They had no Nurse around to blame it on. If they had a Nurse I doubt they would have started screaming at her because pharmacy delivered medication late or because the x ray department couldn't fit Willie in for an xray that day. They would have been grateful that those things existed. I doubt they would have accused her of Starving their son when he got past the point of being able to eat and digest food, a usual part of terminal illness. I think they would have been intelligent enough to realise that Nurses have no control over those things.

People today have a very sanitised view of it all thanks to TV. Therefore they cannot handle the realities of sickness and death. The reality is that terminal sickness and death looks like hell, even with the best of modern medicine. When they are confronted with this reality they go absolutely apeshit on the very people killing themselves to try and help. So very sad. They are going to embitter every Nurse we ever train and run them the hell away from the bedside. The following was written by a Nurse who has been in the profession for 5 years.

When I was in nursing school, I was so excited to get finished and get a job. I thought I would enjoy doing nursing tasks all day...meds, IVs, injections, dressing changes, catheters, assessments. I was so proud to tell people I was becoming a nurse. My job would be exciting all day long. I would be working hard and helping people. I would get respect...

But 5 years later, ha! What a joke! Don't get me wrong. I am grateful to have a job in this bad economy, but nursing sure turned out to be a disappointment. I never thought that I would be worked to death the way nurses are. I never thought I would be talked to like a dog the way I am by patients, their families, people from other departments, and some doctors. I never thought bosses would be so quick to stab you in the back and try to get you in trouble. I thought I would be a valued employee and appreciated for what I did because I am a nurse who truly has a heart, cares about my patients, likes to get along well with others, and work as a team.

Instead, as a nurse you are treated like a peon. You have a team of 15 patients and are running like a mad woman to take care of all of them properly while your manager sits on her butt looking for any one tiny thing you might miss (while not offering to lift a finger to help you). Families sit in the room watching you like a hawk assuming you are going to hurt their family member..... Griping because you have to turn people with skin issues or check for incontinence. Griping because you have to change an IV. The other day I had a family member sitting there watching me like a hawk as I had to change the patient's IV site. Mind you the patient was an obese lady with huge arms and had had to have deep lines in the past due to difficult access. She said to me very rudely, "You get ONE stick, then somebody else is gonna do it." Then proceeded to stand and watch me with her arms folded across her chest. Excuse me, since when does the family dictate my job? That really burnt me up. Fortunately I got her IV on the first stick, but I have to take crap like that from people or I would probably be written up by my manager. I never thought nursing would be like this. When I visited people in the hospital before I was a nurse I had respect for the medical staff and would never dream of talking to them the way I am talked to.

You are blamed for everything. Doctor comes in late today? Nurse is yelled at about it by family. Doctor changes a medicine and doesn't tell the family about it or the Nurse? Nurse is grilled about it. Lab wakes patient early for blood draw? Nurse is yelled at about it. Doc orders stat MRI at 5 pm on a Friday? Nurse is yelled at about it by Radiology. Assistant doesn't check patient for incontinence while nurse is trying to medicate a critically patient in the other room? Nurse is yelled at about it by family. Medicine is late from pharmacy? Nurse is yelled at about it. Dietary doesn't send up a food tray for a patient or send up what the patient ordered then refuses to communicate with the Nurse? Nurse is yelled at about it by patient and family. Family members interrupt you while you are trying to calculate a cardiac drips that the doctor ordered to stop your heart patient from dying to ask where mum's nightdress went. Then they throw a tantrum because your won't stop what you are doing to look for it. What the hell makes these people think that a Nurse with multiple patients can provide them with service? Are they all mad? We can do nothing right. It has really been disheartening. We go into nursing to help people and instead are treated like crap. I can honestly say that nursing is the job I have felt I have been the least respected in of all the jobs I have ever had. It has just been very disappointing. I WANT to like nursing because I spent all of this time getting trained and getting licensed but wow.

Minnesota Nurses tell it like it is

2010-12-08T05:02:00.000-08:00

Please understand that this is very relavent to what is going on the UK. We may have national hospitals but we also have hospital chiefs earning 6 figure salaries whilst freezing vacancies for qualified nurses, denying wards the resources needed to function etc. The public doesn't want to hear about this. The only seem to want to walk onto a ward where one Nurse is caring for double digit numbers of patients and abuse her and accuse her of "lacking compassion". When she is calling a doctor or handing over critical information to other staff she is accused of "gossiping at the nurse's station". When she is looking in notes to try and find out what the hell is going on with her 15 patients she is accused of "ignoring patients in order to play with paperwork". When she has a crash during mealtime she is accused of "letting patients starve". And when pharmacy shuts up shop and leaves the wards without medication that they need the Nurse is accused of "not bothering to give dad his tablets". What the hell is wrong with you fucking people? You want to leave your loved one on large wards where 5 staff are covering over 30 patients and you want instant responses to call bells and one to one care? Fuck you.

It has got to stop. If you don't want to support safe staffing legislation then fine. But don't you dare abuse a Nurse because your family member waited hours for help. It is out of the Nurses' hands now and in yours.

Here is another excellent video...testimony from the President of Minnesota's nursing association. Everything she says is relevant to UK nursing.

This one below is just sad.

Save the nurses!

2010-12-08T04:47:00.000-08:00

Why oh why is the RCN not doing stuff like this?

I love Australian Nurses

2010-12-08T04:41:00.000-08:00

One2Four - The way to safe patient care

2010-12-08T04:39:00.000-08:00

UK Nurses are one to 10 on a good day, 18 on a normal day and 35 on many days.

Need your Help: Daily Mail

2010-12-07T04:18:00.000-08:00

They are really outdoing themselves this time.

I can't post on their site but if any of you can go here and post some comments I would be greatly obliged. If it isn't too late that is. This post has been delayed as I have been trying to research some stats.

Most of the comments are just funny. Many of them are from embittered older nurses who don't have a clue about what is going on these days. As a matter of fact, most of them still seem to think that project 2000 is still in existence. It hasn't been used to train nurses in about 15 years.

The Nurses who did train under project 2000 are less than a fraction of a percent of the workforce.

Nurses tend to be older. The vast majority of Nurses working in the NHS RIGHT THIS MINUTE trained under the old system.

Latest quotes I am getting are saying that less than 3% of Nurses in the NHS right NOW did NOT train under the old system. That means that 97% of them did train under the old system. But lets be conservative. Let's say only 70 percent of current Nurses trained under the old system. That still means that currently only 30% of our Nurses trained under the new system. But I am still researching this so do not quote this as gospel. It doesn't matter anyway, as the vast majority of staff on the wards are not nurses and didn't train under any kind of system.

So what is the deal with blaming poor standards of basic care educated nurses who critically think? Nurses like that are a rarity in the NHS. They are so rare, in fact, and so outnumbered by old fashioned trained Nurses that they cannot be the ones to blame for the current situation. I don't blame the old fashioned Nurses either. The vast majority of my RN colleagues are old fashioned trained. They have been doing their jobs for decades, stayed current with their knowledge and know their stuff.

If the Daily Mail and the public really cared about in hospital care they would:
A. Promote safe RN to patient ratios
B. push hospitals to invest money in the front lines of care
C. Invest in 24 hour in hospital services.

The problem is the way that these wards are run and the lack of support for Nurses. I will do some comparisons of my time working as a Nurse in North America and as an NHS Nurse in order to demonstrate what I mean. Next post.

Nurses we are not hiring

2010-12-06T04:53:00.000-08:00

I am hearing disturbing things from new nurses who are looking for bedside nursing positions. I am also hearing bad things from older, hospital trained nurses who are looking to get back into the workforce and or job hunting due to relocations etc.

They cannot find jobs. This is the situation in the UK and also in the USA.

Hospitals will tell you that there is a nursing shortage. There is, of course, no shortage of Nurses. Hospitals simply do no want to hire all the Nurses that are needed to care for the critically ill and complicated patients that are on the wards these days, End of.

I found this video that was created by a new graduate Nurse. The best part is when the hospital manager tells the Nurse that since there are no jobs at the hospital he should go into long term care (nursing homes) whilst describing the conditions in those hellholes perfectly.

Check it out if you want.

Shock Horror: Patient at Staffordshire Left without 0xygen

2010-11-23T05:03:00.000-08:00

http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11814091

These headlines do not surprise me at ALL.

Let me tell you a little story.

On my 34 bed medical ward many of the patient beds do not have oxygen ports at their beds or nearby. Our trust can spend millions on management consultants. pointless IT schemes, and PR. But they cannot seem to get oxygen ports in at every bed. This is strange. Every other patient getting admitted to a medical ward seems to have respiratory problems, a history of lung problems or medical problems that may cause the patient to require 02 at some point.

A few months ago I had a patient go into respiratory failure all of the sudden. This was at 4:30 in the morning. There was one 02 port in her bay, 3 beds away. It was being used by a patient with severe pneumonia. I had to locate a bed space with 02 and locate it quickly.

Every bed space that had 02 nearby had a patient using it. I found one in the bay on the other side of the ward. Bed 2 in that bay had an 02 port. The patient in that bed was a COPDer and he wasn't using is 02 for over two days. He was the healthiest guy on the ward. I had to wake him up. I had to tell him we needed to move him to get another patient on his oxygen. Lucky for me he was nice about it. I don't know how I would have felt being woken up at 4 in the morning for someone to move me and use 02 that I might need at some point. The patients next to him at 02 at their beds and could not be moved. The distribution of 02 ports are uneven.

So we moved him into the hallway on his bed. Then we moved the crashing patient in respiratory failure into that bed space by moving her on her bed. We got her into the space with 02 and hooked her up. Then we moved the the stable man into the space without 02.

You are all welcome to be Monday morning quarterbacks here but the facts are this: We had seconds to find a solution. And this was the only one. We have learned the hard way that begging the porters to get up off their assess and bring a portable o2 cylinder to the wards takes too much time. And we have learned that using the o2 on the crash trolley is not a good solution either. Murphy's law will ensue, and another patient will crash if the crash trolley is in use.

The only thing management cared about the next day was the fact that there was a female patient in a male bay. The government doesn't want mixing of the sexes. They weren't concerned about the lack of 02 ports, space etc that necessitated the move.

The medical admissions unit is under a lot of pressure to get their patients onto the wards very quickly. They have A&E on the phone screaming "we are breaching we are breaching, we need to send you admissions, for the love of god get your goddamn patients to the wards and make us some beds".

Yes, medical admissions must get their patients shipped up to the medical wards very quickly. They know that not all beds on the wards will have 02. They know that the ward Nurse will not accept a patient that requires 02 if she doesn't have a bed to put him in.

But they need the ward nurse to accept the patient so that A&E doesn't get fined for missing targets.

So what do they do? They do not tell the ward nurse that the patient they are sending up is on 02. They just send the patient up via the porter. The porter doesn't know or doesn't care. He just brings the patient to the ward and dumps them there. Half the time they cannot even be bothered to let the Nurse know that her new patient has arrived. When the Nurse finds out that the patient needs 02 she has to scramble around trying to move beds etc in order to get the patient some 02. She has to re-allocate beds. Change all details on the computer, change paperwork around etc etc. All these things must be sorted even if you simply swap bed 4 with bed 2. And it has to be done immediately.

Just another example of what gets dumped onto a ward Nurse who is solely responsible for 19 patients. It usually happens straight in the middle of meal time. Or right in the middle of her drug round when she is trying to stay with and help confused patients with their medication.

Meanwhile in another bay an old woman's 02 tubing has disconnected and her distraught relative is waiting for what seems like an eternity for the Nurse to come along and sort it out.

Dense Doctors

2010-10-29T06:04:00.000-07:00

That title may sound a bit harsh. I know that our doctors are very intelligent when it comes to medicine.

But apart from that they seem to know sweet fuck all.

This is especially true when it comes to what is going on in the wards. It is true in regards to Nursing. If Nursing care goes bad  medical orders do not get carried out and patients do not get monitored. In short the doctor's whole plan of care goes out the fucking window.

You would think that they would be a little more......well.....interested.

But no. They are delusional.

This is what I have learned about doctors in over a decade of Nursing.

1. They think all nurses are the same person or clones of the same person with a hive mind.

For example, if the Nurse on the shift before you missed something, it's your ass if you are the one on duty when doc graces your ward with his presence. If you are forced to float to a specialty you never worked or trained in before the doctors expect you to telepathically mind link with absent Nurses who have experience that area the minute you arrive on the ward They will not bother to write their orders or give you a heads up about things you need to know and wouldn't know unless you have experience there. They won't bother with any of that yet they'll go apeshit later when you forgot to remind them to prescribe something. Remember that they think Nurses are all the same drone with a hive mind who know each Doctors' individual ways.
2. They have no idea how to implement their own orders, or how time consuming and complex it is to implement their own orders.
Don't even get me started on the bullshit with the IV meds....both getting a hold of them and actually preparing them. Or fighting with pharmacy, equipment library and path lab. No Doctor they do not just keep everything on the ward for us. No they do not keep chest tube kits in a place where we can get them etc etc etc.

3. They have no idea how to work the system as a result of the Nurses doing it for them.

They don't understand why things don't happen instantly. For example, all RN's know it takes 6 weeks to get a patient into a Nursing home and that nothing can be done to speed this process up.    Yet day after day the medical consultant walks in the very afternoon after he wrote that 90 year old Mabel can be discharged that morning and wants to know why she is still on the ward. Then he goes on a rant about how the Nurses can't be arsed to discharge patients. I could go on and on about this one, there are thousands of examples.

4. The saddest thing I learned about doctors and the crux of this post is that doctors are not able to distinguish between Nurses and ward assistants.

There are many times I am running my ass off trying to give a 150 IV meds all due now whilst the HCA's/cadets/auxiliaries are hanging out at the Nurse's station. The few jobs they can do are complete. They cannot help with the large proportion of the workload that only an RN can handle. Many doctors will walk onto a ward, take a look at the assistants hanging out at the station and exclaim "The Nurses don't seem to busy today".   Dickhead. I am the only Nurse, and I am on my knees completely overwhelmed. What the assistants are doing (or not doing) is in no way indicative of how busy the Nurses are! Assistants are not Nurses.
Sometimes I will be 3 hours behind getting much needed drugs into patients and managing other patient problems and some young doctor will stroll onto the ward and ask me to hold an arm for him so that he can draw some ABGs. For god's sake, grab one of the assistants hanging around the Nurse's station for that. That is something they can actually do. Don't delay Mrs. Smith's pain relief any longer by causing me to stop and hold an arm!!   It's not like the care assistants can give the meds and handle the Nurse stuff while I am tied up holding an arm for you!

A doctor walked onto my ward and wrote some orders for IV fluids and IV antibiotics for a patient with Pneumonia. As the only Nurse for all of those patients I was tied up and didn't see him arrive or know he wrote any orders. He handed the chart with his orders to a care assistant and left the ward. The care assistant has no idea about orders etc. She put the chart down on the station where it got immediately buried. And she said nothing to me. I had 25 patients that day (a staffing ratio no Nurse can function well with) and it was taking a hell of a lot of time to see everyone and process their orders. It was 3 hours before (by luck) I found the chart and the orders. Patient was in septic shock by that point. Doctors, you need to tell the actual Nurse about these things, not some underpaid teenage assistant that you have confused with Nursing staff.

Then there was the doctor who started yelling at me for having 4 bays full of patients rather than one!! "That is too many patients! You should have one bay per Registered Nurse". Yes Sherlock, no shit.   I appreciate the fact that you have actually noticed that the RN ratios on NHS wards are horrible and dangerous and that this has a dire effect on patient care. But what the hell would possess you to think that they Nurses on the ground have any say in how we are staffed or how many patients we have? Even the ward Sisters are not allowed to have a say in how their wards are staffed. Duh.

I could go on and on. These doctors are clueless about what is going on with Nursing care and RN staffing on the wards. And frankly, I am getting sick of it.

My cousin in law is a doctor in the USA. He is not as dense as his colleagues here. If he finds out that his patients' RN's are being forced to take on more than 4-6 patients at a time he gets on the phone to MANAGEMENT and starts screaming. He tells management that he will have his patients pulled out of there by the end of the day and admitted somewhere else if they do not staff the facility properly.

He doesn't care how compassionate or knowledgeable or wonderful the Nurses are in that place. He knows that with poor staffing ratios that they cannot function even if they are wonderful.   The facility would lose a ton of money if he pulled his patients out of there so they wouldn't dare short staff the place.  They did it once, never again. Managers of hospitals all over the world think that intentional RN short staffing is the way to save cash.

He is a good doctor, and understands that without decent Nursing care delivered by RN's the patients are screwed. He understands that there will be nothing in the way of decent Nursing care in a place where Nurses are denied resources and safe staffing ratios. And he acts on it.

But it seems it is too much to ask for UK doctors to even understand what a Nurse is, let alone stand up for them. They haven't even grasped the notion that these Nurses are taking on too many patients to be able to care for anyone properly, and that they are being forced into a position where they cannot spend two minutes demonstrating compassion without risking a disciplinary for not filling in paperwork. Too bad.

Holy Shit

2010-10-08T10:29:00.000-07:00

Not content with forcing RNs to take on more patients than they can handle, recruitment freezes, pay freezes, and hellish working conditions that would cause most people to collapse from sheer fucking exhaustion the powers that be have come up with a new plan.

Already the working conditions are so chaotic that it is usually impossible for the RN's on my type of ward to take breaks. We stay over late at the end of a 12 hour shift unpaid and still cannot manage to keep up with paperwork. We do the jobs of pharmacy, portering, social services etc and are held accountable for their faults.

But I guess that is just not enough. I will post the entire article here.

Nurses told to work for free to save their jobs

By Ryan Crighton and Catriona Webster
Published: 06/10/2010

Nurses are being asked to work extra shifts for free to save their jobs – as health boards across Scotland spend up to £30million hiring agency staff. Almost 4,000 NHS jobs, including more than 1,500 nursing and midwifery posts, will be axed this year due to cutbacks, according to Health Secretary Nicola Sturgeon.
But last night it emerged that the country’s 14 health boards have set aside a combined £30million for temporary nurses and theatre staff over the next four years.

NHS Grampian hopes to save £385,000 by asking staff at Aberdeen Royal Infirmary’s surgical unit to take on one more shift each month – for no extra money.

The agency staff contract, which has just been awarded, will see nine firms provide workers to fill staffing gaps as health boards – including NHS Tayside and NHS Highland – deal with the spending crisis in the public sector.

The contract will last for two years, with the option of extending it for two more.

Last night the Royal College of Nursing (RCN) Scotland raised fears that the deal could reverse efforts to cut reliance on agency workers.

RCN associate director Norman Provan said: “Nursing teams have led the way in recent years by changing the way in which their work is managed so that reliance on costly agency staff has been reduced. As health boards cut costs by not replacing staff when they leave, we will be monitoring them to ensure they do not reverse the trend of recent years and begin relying too heavily on agency nursing to fill the gaps.

“If health boards do realise that they need to fill the gaps created by their unsustainable cost-cutting tactics, they must recruit additional permanent staff in the best interests of patient care.”

Labour shadow cabinet member Richard Baker added: “It looks like different parts of the NHS are not talking to each other. When NHS Scotland is spending £30million on a contract to provide agency nurses it seems ridic-ulous that NHS Grampian is asking their nurses to work an extra shift for nothing.”

An Aberdeen company is one of the nine firms which will share the contract. H1 Healthcare Solutions – which trades as PCSG Healthcare – said it could take on up to 250 health workers during the duration of the deal.

An NHS Scotland spokes-man said the contract replaced an agreement which was about to expire. He said the number of agency nurses being used was falling, and that trend would continue.

He added: “Whilst agencies will always have a role in providing supplementary staff, this only supplements internal efforts to meet the staffing requirements.”

The RCN has also voiced concerns about NHS Grampian’s plans to share an extra 188 12-hour shifts between its nurses. It is understood that nurses in the surgical unit at ARI would receive an extra 15 minutes unpaid break per day to compensate for the extra shift.

One angry ARI nurse, who did not want to be named, said: “Everyone is unhappy about these changes. We’ve been asked to meetings but the feeling is: if we contest it, they won’t care. We’ve been given 90 days to comply.

“They are trying to save money but the added pressure is all on the nurses, it’s coming out of our pockets. We are being asked to work for nothing.”

Another said: “The thing the nurses are worried about is patient care. We already have skeleton staffs because of the recruitment freeze, so we don’t get our breaks.”

Colin Poolman, the RCN’s local officer for Grampian, said members were furious about the plans. “This change in working arrangements is clearly to the detriment of our hard-working and over-stretched members who are bearing the brunt of the cuts being made by NHS Grampian,” he said.

Tory health spokeswoman and Highland MSP Mary Scanlon said the plans were the first time she had ever heard of a public body asking staff to work for free.

A spokesman for NHS Grampian said the measures will help secure jobs.

He said: “The proposal is to move from 13 to 14 shifts in a month in the surgical one division of ARI. It will potentially save £385,000 which is very important in the current financial climate. The alternative would be to employ fewer staff.”

The fuckers can have my job. Fuck them. I'd also like to point out something. When we do get agency Nurses in from the outside it is a disaster. A Nurse simply cannot handle taking on a massive patient load on an acute ward unless she is there all the time. It is like running. If you stop training for that marathon, you just won't be able to keep up. We have had a few disasters lately at my trust because of agency Nurses getting thrown in as the only qualified.

Meanwhile back in my neck of the woods the matrons are threatening ward staff nurses with sacking if we don't get our fingers out and make sure that the insane amounts of ridiculous paperwork is completed. According to them, any bad care that occurs is a result of Nurses not doing paperwork.

I recently had a patient fall out of bed. I wasn't watching him at the time because I had two other bays of patients and a side room. I was also running around the hospital looking for the "bed rail assessment" paperwork forms to fill in for him so that I don't get sacked. You would think that if they want us to fill in these forms like they are holy then they would provide each ward with enough of the actual forms.

When one of my colleagues didn't complete her paperwork because there was none on the ward she was told that she should have left her patients and searched the other wards in the hospital. Not something that one can do if she is the only RN for 15 patients.
Bastards.

What are we? Fucking Slaves? The government is cutting pay, cutting jobs, and cutting benefits for people from whom they take the pay and jobs. I suppose soon they will be counting us as 3/5 of a human being and loaning us Nurses out to work for other trusts for a fee. And they will line their pockets with that fee.

Oh Massa Oh Massa...please don't send me down da river to work staff'dshire. Please Massa, I dun bin a good Nursie, don't send me down da river. Don't separate me from my man and my little chilluns Massa. Oh Lord Jesus Massa hasn't I dun bin a good Nursie yes I has Massa. Oh jesus oh jesus

Seriously guys if they get away with this shit things are going to SNOWBALL. It seems like we won't be eating if we don't put up with slave like conditions, and having recently worked a 14 hour shift without being able to take a break I am really feeling a bit like I am not considered fully human. Maybe just 3/5 of one.
Thanks to grumpyRN for alerting me to this story anyway.

Break

2010-10-07T10:07:00.000-07:00

Hi Everyone,

I know I haven't been blogging much and I apologise for that. I have been really busy lately. I may just take this blog off the net for a few more weeks. I am not being "got at" or anything. I am just being careful. You can always email me at Militantmedicalnurse@gmail.com.

Love,
Anne

Quote from a Newly Qualified Nurse

2010-09-30T00:11:00.000-07:00

Found this quote on the Nursing article linked on the post below.

I am a newly qualified nurse working as an auxiliary on the bank when I am lucky enough to get shifts, there has been so much red tape to stop newly qualified nurses from getting a job in the NHS. It is very disheartening to go through all the studying and work to have nothing in the end. I am now looking to go in a new career direction as I need paid employment and that is not something I can find as a nurse sadly. When will they realise they need frontline staff and this is not something they can cut?

I keep hearing this over and over again from new Nurses. Over and over again.

How can people blame university (new) training for Nurses for the hellish conditions on the wards when our new RNs cannot even find jobs? The vast majority of Registered Nurses practicing in the NHS trained under the old system and they are on their knees due to the lack of RNs. We need RNs and we need new blood to replace an aging workforce. What we don't need are more untrained unskilled minimum wage earning ward assistants. But that seems to be all that we are getting.

Pay Freeze or Job Loss?

2010-09-27T23:25:00.000-07:00

Reason number 386 that we are all trying to get out of the UK. The pay. Registered Nurses (Not care assistants) already work a large number of unpaid hours. Our pay does not increase as our workload triples or becomes more complex during the course of a shift. We do not get paid for overtime much of the time. We are on less than RN's in other first world countries. Child tax credits are gone, child care costs are sky rocketing. Taxes and cost of living are high.

I have often hesitated to conplain about pay on this blog. The problems I describe go way beyond "RN's are not paid enough".

But have a look at this:

And look at this quote from the same article:

“If we have a demoralised workforce, performance will suffer, quality will suffer, so it’s up to nurse leadership to make sure that doesn’t happen"

Nurse leadership? Nurse Leadership? Oh shit. What are they going to do? They are too busy blowing the chief executives, looking down on floor Nurses (who are much more knowledgeable by then way) and trying to be corporate suits. We aren't going to get sweet fuck all from those age 55+ sluts.

Footloose: Nursing School Style

2010-09-24T09:57:00.000-07:00

From the Louise Herrington School of Nursing at Baylor University.
For a Baptist school with a strict academic admissions criteria which is really very competitive; their students are pretty funny.

My students are told to make me a video like this or fail the placement. ;)

Another Classic Quote from High Level Nurse

2010-09-24T09:03:00.000-07:00

We already had a previous comments post. This new comment wins hands down.

I cannot tell you if the person who said the following is a Matron, a Clinical Lead, a Nurse Specialist, a non ward based Nurse manager etc etc. But she is one of the above.

Like most of the silly commentators mentioned in my previous post she is an older nurse, trained under the old system; she hasn't worked on a ward since 1982 and she HATES Nurses who choose to stay at the front lines providing direct patient care. She sees them as "Nurse Failures". Thank god that us University educated Nurses don't think like that. We are going to be on the wards providing direct patient care until we retire anyway. It is where you start out when you graduate Nursing school and these days it is where you stay as there is NO PROMOTION and recruitment freezes.

She has given the frontline staff nurses even more scores to do. Not content with having them down twice a week she now wants us to do them on all 35 patients every day (irregardless of risk factors) and document the results in 4 different places. Each sheet of paper of course requires the nurse to write the patients name, date of birth, 9000 digit long NHS number on both front and back. There is the waterlow score for pressure areas, the nutrition score, the fall risk score. Blah blah blah. If a patient deteriorates and moves from a low waterlow score to a high one then obviously there is higher risk of pressure area damage and certain actions we will then need to implement. As if we wouldn't realise without the score....eye roll.

We told Nurse Ancient that this amount of writing is ridiculous, physically impossible etc etc. She called on us to ask why her scores were not being done.

When we told her we had too many patients, too many things going on at once and that doing this insane amount of redundant paperwork was impossible and pointless she called us "whingers". And then she said:

"You don't really have to score them every day if you are busy.....just copy down what the last person wrote or make it up...guesstimate....just make DAMN SURE THAT THE DOCUMENTATION IS COMPLETED".

Um. Well what is the point then? If I am going to write all these names, patient info, scores and numbers on 4 different worksheets back and front for 35 people I need to know that it is actually going to benefit the patients.

Still not going to do it. She can bite us. They just had 5 RN's quit simultaneously off the 40 bed even more short staffed hellhole ward below mine. Let's see if we all get sacked for refusing.

Our younger RNs are scared of the Queen Bee "Nurse" quoted on this post. There they are running around, trying to get all this stupid paperwork done so that they are seen as "good nurses" by their "superiors".

Militant Medical Nurse knows that being a good nurse is inversely proportional to being a good employee. Fuck the non essential paperwork, I have patients to nurse. I am trying to teach this notion to the youngsters. Safe patient care first: fucktwittery last...Of course if the hospital gets sued and the paperwork is not 100% complete (including scores) a barrister will use that to nail the trust (and clinicians responsible for patient) to a wall.

will continue

Sadness

2010-09-22T01:47:00.000-07:00

It's been an emotionally draining week.

I have had many many lovely, kind, interesting and funny patients on my assignment recently. These people are a joy to look after.

And it's amazing to me that they can be so sweet and lovely when they are so sick. I would be a miserable bitch and then some.

Many of them are way too young to be getting these shit diagnosis and prognosis. They are young with young children. It is unbearable. We are talking 30s, 40s and 50s.

I didn't want to be there when the consultant told Mr. and Mrs. Doe that John has cancer everywhere. The look of agony and fear on their faces is keeping me awake at night.

Another young patient who likes to prank the Nurses (in a nice way) and has me laughing so hard that I cry is also very very sick. He suddenly deteriorated on a recent shift of mine. I was shaking in my boots, thought we were going to lose him then and there. Thank god my other patients were okay and I was able to stay with him at all times. The team really pulled together well. The junior doctor was brilliant and so was her senior. The xray folks and ITU nurse were on the scene right away and very competent. The ICU ward that I rushed this patient to was fabulous. I was proud to work in that place after seeing how well the team functioned. I am surprised that ITU accepted him but they did.

I think they saved his life that night even if it only extends his life for a few more days. But facts are facts and the truth is that this person will not be with is much longer no matter what we do. He didn't want me to call his partner in because "she'll worry too much and the little ones are in bed and can't be left alone". He said he will see her during visiting. I am afraid that he won't be there for the next visiting hours. But I couldn't tell him that. It isn't my place. He wouldn't let me call his partner. He was adamant. The medical team were on their way in to speak to him at that point and were going to be very very direct and they are going to speak to the partner. I think he knows the score anyway but is in denial.

Instead of being pleased at myself and the team for a job well done I feel like crap with a knot in my stomach.

The icing on the cake was my dying elderly patient. This patient has sprightly elderly parents. The parents had asked that we ring anytime so that they could be with their 70 year old child when he dies. One morning it became very obvious that this was going to be it and I phone them to come in straight away. The patient died before the family made it back to the hospital. The arrived on the ward and I didn't want them to go into the side room and find the corpse so I asked them to come with me into the family room first. When I asked them into the family room they pretty much realised that he had gone and started grabbing onto each other.. When I sat them down and told them that he had indeed passed and that I was so very sorry the mother started screaming and tearing her hair out. I don't care how old you are or how old your child is......losing your baby is the worst thing in the world.

Later on we received lovely letter from this family thanking us for our kindness and for caring for this patient so well. Still feel like complete shit.

* details have been changed to maintain confidentiality.

The Stupid Things They Say

2010-09-10T13:32:00.000-07:00

Here are some authentic quotes from hospital managers and chiefs, family members, doctors etc etc for your entertainment:

1. "Why do you need any more than 2 qualified Nurses on a 35 bedded ward? Two Nurses and two untrained ward assistants should be plenty".......said by my Chief Nurse who hasn't worked on a ward since John Lennon walked the earth. Is this what she is telling management? The cow.

2. "I don't want to hear any more whinging from you Nurses about protected mealtimes. If you get interrupted by doctors during that 15 minute window that you get to feed patients then stop feeding the patients. If I were a patient I would rather the Nurse attend ward rounds with the doctor and get me discharged rather than hand out meals"..............................Another Nurse leader from my hospital who is older than the hills and last did ward nursing in the 80's. She seems to miss the point that it is wrong to starve one dependent person in order to get healthy patients' discharge paper work in order. And they say that younger Nurses are the problem.

3. "Audits are basic nursing care in my book. Deal with it"........said by a medical manager when he was told by ward sisters that their are not enough Nurses to care for patients basic needs on general wards....................... let alone fill in time consuming audits for him. Hell, we can't even keep these people alive in the time we have when we ignore the form filing.

4. "Why do you need a second Nurse for your 30 bedded ward when I have already sent you two untrained 16 year old ward assistants who have never been to nursing school to help staff your ward for the shift?  Deal with it and cope.  AND we are sending you 6 admissions and don't give me that shit about not being able to handle the patients you all ready have"..............................................Bed Manager.

5."If the phone is ringing and you are busy don't answer it" ........said by a high level and as old as Moses Clinical Nurse Manager when she was told that we need a ward clerk because a Nurse cannot take time to answer the phone every 30 seconds. This is especially true when we are the only qualified nurse on duty and trying to stay on top of doctors orders and keep patients alive. Sounded sensible until:

6. " And if I hear one more complaint for a relative who phones up here to enquire about their family member because the Nurses aren't answering the phone right away there will be a disciplinary"........said by same manager on another occasion when we told her that the only RN on duty cannot spend 55 minutes out of every hour answering the phone without harming patients. Then it gets worse.

7.. "The idea of a 30 bed ward needing a ward clerk to answer the phone for the Nurse is ridiculous. The Nurses can do that. We are not paying for a ward clerk" ...said by same manager after a patient nearly died of a major error because a Nurse was on duty alone and trying to answer a phone that never stopped ringing rather than concentrating on her job. We (with the support of a medical consultant) were begging for a ward clerk. Again.

*update, they gave us two part time clerks dressed in scrubs who sit in front of the nurse's station painting their nails and telling dirty stories. They only work 4 hours a day. Part timers from the job centre. They don't answer the phone either.
8. "I don't know anything about a staffing problem with Nurses. "............said by our Chief executive publicly one year and 147 short staffing incident forms after I started this blog and 1 day after the press picked up on what is going on here. It was a few months after the recruitment freeze on Nurses and the hiring drive for untrained ward assistants on minimum wage instead.

9. " Untrained Care assistants are Nurses too and as long as they are there you are not short staffed"............said by Chief Nurse (ancient trained) after I complained about being the only trained nurse for 20 patients with no one to help but a 17 year old ~~child~~ ward assistant who has never even thought about attending nursing school or any kind of training. That shift was so bad. Half of those patients didn't have life saving orders given by doctors implemented that shift because I was overwhelmed. And I ran my ass off for 12 hours non stop. Not one cup of tea, not one pee break. Got screamed at by consultants for stuff not being done too. Thanks for your support and understanding, asshole.

10. "The Nurses aren't taking care of my gran" and "The Nurses don't bother to answer the phone"....said by an ~~idiot~~ relative who likes to call the ward 5 times an hour and get her entire sibling set to do the same. All 9 of them.  I can either take your idiotic phone calls all the time OR I can see to the patients. Doing both is physically impossible.

11. "Nurse I need you to stay with me uninterrupted for 10 minutes while I do this procedure. NOW."....said a by a registrar to me, after he showed up on the ward without warning to do a procedure. This was his greeting. The procedure was routine and non urgent.

12"And just how the fuck do you want me to do that? I am the only Nurse for 19 patients, 10 of them have family members up my ass and hostile over stupid shit. My patient in 4 has blood shooting out of his mouth and rectum and no IV access, two of my dementia patients are on the floor and one is spreading shit up the wall causing other patients to scream, the detoxer is trying to beat the care assistant with a drip stand, the phone is ringing off the hook. I have people on 4 hourly IV antibiotics that have been missing doses all day, I have patients who are on IV fluids whose bags have been dry for hours with urinary outputs dropping off and AAU are sending me three admissions. Oh and there are 3 other doctors here wanting the same thing from me for their patients. Fuck off out of my way NOW...............said by me to the Registrar in number 10 as I pushed past him and ran to the bleeder. That was my greeting.

13. We are the real nurses here because we do bed baths.....said by a ward assistant. The fuck you are.   I have been running my ass off for hours managing hundreds of meds, drips, problems, etc etc while you did a few bedbaths between playing on your mobile and having fag breaks. Since you are not a nurse you cannot help me with the 6 IV meds due in the next 15 minutes, the phone calls, the orders, the treatments, the assessments, the admits and discharges etc. Seriously. Just bite me.

14. "Tough shit, I only care about my father, your problems are your problems you slag".............said by a visitor after I told her that I could not come right now and fix her dad's blanket because I have a critically ill patient going south with a page and a half of doctor's orders that are complicated and needed to be implemented immediately as in 5 minutes ago. She had grabbed my arm to ask me to fix her dad's blanket while I was running to the treatment room to get 02 masks and IV fluids.

15. "The treatment of my mother in this place is appalling. You Nurses are pigs"...............................said by another happy visitor after I told her 24 stone mother that I could not lift her on my own and that I could not get her chocolate from the shop when she has a BM of 22 after insulin and is waiting to see if her legs need chopping off as a result of non compliance with her diabetes care.

16. "My taxes pay your wages"..............and what do my taxes pay for...the fucking boogeyman? To be honest I don't think your taxes pay for shit. That is why I am working so many unpaid hours and being forced to take on more patients than I can handle while being denied resources. It is why my workload triples just as I am getting a payfreeze. We all pay taxes, you are not special. That is why I won't kill one patient to come and deal with your dad's non urgent need right now. Hell, even if your taxes did cover the cost of this shit (and they don't sunshine), I still wouldn't kill one person in order to deal with another's non urgent need.   You see love, missing a doctors order for a fast IV bolus of fluids because I am fluffing daddy's pillow could get a crashing patient killed and me in a whole lot of legal trouble.   You need to sit down and try to behave like a grownup.

Um. What does this tell you?

2010-08-31T06:38:00.000-07:00

http://www.nursingtimes.net/whats-new-in-nursing/news-topics/health-workforce/dramatic-decline-in-nursing-posts-fuels-job-fears/5018755.article

The number of nursing vacancies has fallen by nearly 40 per cent in the last year, according to data gathered by Nursing Times.

The figures, together with new data from the NHS Information Centre, have fuelled fears that NHS trusts are freezing vacancies, are not replacing nurses and are converting posts to lower grades in order to tighten budgets.

Shock horror. Yawn.
and

http://www.nursingtimes.net/whats-new-in-nursing/news-topics/health-workforce/nurses-and-healthcare-assistants-forced-to-retire/5018724.article

Eleven nurses and 21 healthcare assistants have been forced to retire by an East Midlands primary care trust despite the government’s plans to scrap the default age for retirement from October next year.

and

http://www.nursingtimes.net/whats-new-in-nursing/students/new-nurses-struggling-to-find-jobs/5018525.article

RCN Scotland has said policies such as freezing posts and not replacing people who leave mean newly qualified nurses and midwives are struggling to find jobs in the NHS. The union has warned “unsustainable tactics” are being used by health chiefs struggling to cut costs, and called for more to be done to protect frontline services. It added the decisions could have “devastating consequences” for patient care in the future.

Remember this my dear reader: This has gone nationwide. And it has been going on for a hell of a long time.My trust still hasn't hired any nurses. But they have been advertising for management posts with stupid names and "champions" on salaries around £130,000 a year.

Dame Christine Beasley

2010-08-04T11:09:00.000-07:00

So who thinks that she would grant this site an exclusive interview?

Anyone? You can place your bets in the comments section.

I am going to try both Chrissy and Peter Carter.

I have some nice questions in mind. Add your questions below.

:)

Charlotte Gets Yelled at For Feeding a Patient.

2010-08-03T02:35:00.000-07:00

Charlotte is a colleague of mine who is excellent at her job. She completed her training at University about 6 years ago. She is a wonderful bedside registered nurse.  She really stays on top of things and will work a 14 hour day without a break to do her best to ensure that the patients all receive their treatments and orders.

Like the rest of the RN's on the duty roster Charlotte often finds herself as the lone RN for 19 patients when she is on shift. She may have one or two apprentices to help.

Just mixing preparing and administering all of the drugs due at 8AM takes until way past lunch time when you are the lone Nurse for 19 patients.

Not only is medication administration complicated and time consuming but the lone RN will be constantly interrupted by doctors, relatives, patients, pharmacy, social services, path lab etc etc during her attempts to get her patients their first lot of drugs for the day along with a basic nursing assessment.   There is no break, no let up from these interruptions.

The apprentices can neither continue with the drugs or deal with the interruptions. Many medics will show up during this time and demand that the Nurse abandon her patients to follow them around on a doctors round for an hour. The doctors don't care if patients don't get their ordered treatments or get cared for by an RN. They just like to monopolise the Nurse's time for the sheer fun of it. It takes until lunchtime for Charlotte to see each patient once and administer the drugs due at 8AM. And that is if you keep it to two minutes with each patient and then run off.

On Tuesday morning Charlotte was receiving handover from the Night Nurse. 11 out of 19 of Charlotte's patient's that day were going to be unable to feed themselves. Charlotte hauled ass that morning. She took short cuts with the drugs and ignored the phone calls from families. This was the only way she would get to a point where she could obtain the ability to feed all of her patients at lunchtime.

Noon rolls around. Both apprentices are off the ward escorting patients to diagnostic tests leaving Charlotte trying to feed 11 people by herself simultanously while handling everything else that is going on for those 19 people. She was grateful that no one was really poorly at that time and that the high priority things (blood transfusions, life saving drips that need to be put together and administered) were under control by noon.

She happily commenced a serious and whole hearted attempt to feed her 11 patients. She started with the first two patients who were next to eachother and tried to feed them at the same time while telling the patient across the bay that she would be there to help as soon as she could.

Enter Doctor Hellboy. He has been told repeatedly not to show up at lunch time to do his rounds so that the Nurses can feed the patients. When a doctor arrives to do rounds he pulls the Nurse away from whatever she is doing for a good hour and a half. But Doctor Penisbreath has a lot of patients to see and not a lot of time and it is very convienant for him to show up for rounds at lunch.

But he shows up at lunchtime anyway. He doesn't care if patients get malnourished as long as they are not his patients. He walked up to Charlotte as she was feeding her first two patients, snapped his fingers at her and announced " I am here for my rounds, come on now" and he walked away expecting Charlotte to follow him.   She did not. She continued feeding her patients. He went nuts on her. Absolutely nuts.

"How dare you refuse my ward round blah blah blah how can you know what the plan is with the patients if you don't attend the ward round blah blah blah".

Charlotte held her ground and was able to get most of her patients fed.

The funny thing about this particular consultant is that he has been overheard telling the complaining family of a malnourished patient "These Nurses today cannot be bothered feeding patients, they went to university you know".

What a cock eh?

Same guy declined to give his support to our ward sister when she made a case for getting extra RN's employed so we had enough to feed the patients and attend ward rounds. Therefore we could know the "plan" with the patients and get them fed as well. My ward sister was not only shot down on that request but the medical manager, chief nurse etc laughed in her face and told her she was "exagerrating the ward conditions". None of these people have been on a ward in over 20 years.

I wouldn't bother posting this if it was a one off but the consultants are pretty much on my shit list this week for these same kinds of things. And the next few posts will reflect that.

They have sunk even lower.

2010-08-02T07:51:00.000-07:00

Can't believe I am having to tell you guys this.

We are losing our cadets/apprentices whom we have been trying to get up to speed for the last year or so. Most of them are still crap as they have not had nurse training and don't understand the patients. But if the trust refuses to staff the wards with real Nurses then the best we can do is try and help these kids succeed.

The apprentices have been doing NVQ things since they started in order to get them qualified as a Health Care Assistant.

All of them but one have passed their competencies and can now be health care assistants. As they are turning 18, they will also be paid more than £3.00 an hour.

The trust has told them that they have to re-interview for HCA jobs now that they are no longer apprentices or whatnot. Their contract as cadets is up. Only one out of the seven is getting employed on the ward. The rest are getting told where the door is. Lots of tears. A few of these kids were showing promise and were thinking of Nursing school someday.

And we are getting a new batch of 16 year old untrained inexperienced kids on £3 an hour to "bring up our staffing numbers".

The people who are the most pissed off at this situation are the two excellent experienced Health Care Assistants we have left on the duty roster. Both of these women have been health care assistants for 15+years. They have been through hell in back trying to show these little snots the ropes. They have been through hell and back trying to carry all of the basic care while the lone Nurse was tied up with rounds, drugs, emergencies, and the cadets were chilling at the nurse's station. It is easier for a proper health care assistant to get a job somewhere else than it is for an RN. So these two are talking of leaving.

Man oh man we are so fucked. No change there then.

The wards are going to be staffed with one or two RN's and 2 or 3 apprentices who don't listen no matter how many times you tell them that if a patient only has 50mls of urine in their catheter over the last 12 hours YOU NEED TO TELL SOMEONE. The RN's have way too many patients and interruptions. It is physically impossible for the RNs to keep an eye on these things themselves. Regulating the real health care assistants won't do squat for us as we don't actually have any health care assistants.

If you want to read more about the untrained assistants who are replacing Nurses on the wards as a result of management directives look at these links:

http://militantmedicalnurse.blogspot.com/2009/03/here-come-kids-god-help-us.html

http://militantmedicalnurse.blogspot.com/2009/04/more-fun-with-kids-part-1.html
http://militantmedicalnurse.blogspot.com/2009/04/more-fun-with-kids-part-2.html
http://militantmedicalnurse.blogspot.com/2009/12/feeling-sorry-for-kids.html

Dear Mental Nurses, Doctors...anyone really

2010-08-01T04:28:00.000-07:00

What the fuck is going on? I need you to shed some light on something for me.

Why are GP's sending self harmers and anorexics who steadfastly refuse ALL TREATMENT as direct admissions onto medical wards?

These people have no medical issues. This is happening a lot lately. I can understand an overdose needing IV parvolex but when they are purely mental health issues we cannot manage them. We don't know what to do with them. Psychiatry is refusing to take them over until we "force feed" these patients. This is something medical doctors and nurses ARE NOT ALLOWED TO DO UNDER ANY CIRCUMSTANCES IN A DISTRICT GENERAL HOSPITAL AND WE DON'T MAKE THE LAWS. We can't section them apparantly as they need to go to their previous psyche facilities for that. News to me. We have resorted to begging these patients to eat, on our hands and knees. This includes the chief exec visiting these patients and doing some begging. The psyches won't take these patients over but will be taking the hospital to court if we don't "make" these people eat, stop threatening suicide etc etc etc.

Why the hell are the medical consultants getting this dumped on them?

The GP's are even sending people to AAU with "anxiety" and no other problems at all. Even if we can get the psyches into see them (mission impossible on a good day), it could take over a week. And medical patients die due to lack of beds, and getting discharged to early to free up more beds.

We have no RMN's on staff so basically we are up shit's creek. The local psychiatric hospitals won't "get involved".

What am I missing here. These patients definitely do NOT have medical issues. No electrolyte imbalances yet.....or confusion related to infection. Nothing like that.

What is going on?

Will probably have to delete this.

This Makes Me Sick

2010-07-26T11:20:00.000-07:00

Today I learned that my ward is gaining more beds. We will be taking more acute patients and having higher throughput. After a letter writing campaign initiated by myself, the ward sister and another senior staff nurse a letter was received by management. "We are sorry to hear of your staffing issues. You will be getting extra staff in the form of .5 of an auxillary. By our calculations this will bring you to a full complement of staff".

What. The. Fuck.

We are losing two HCA's. This leaves us with two HCA's in total on the duty roster. The other care assistants are all inexperienced apprentices and auxillaries. I know of 4 HCA's who want jobs on my ward. They have been turned away.

Management has taken the only room on the ward that we have for lunch breaks and handover and are turning it into a patient sideroom. This leaves us cramped into a very small space for handover.

The day staff had to sit on the floor while the night nurse who had been on duty for over 14 hours had to sit precariously on a wobbly ledge thing for the change of shift handover. It takes a half an hour at least to handover. Talk about uncomfortable. If we handover at the nurse's station patients will overhear us and report us for "breaching their privacy".

Breaks are impossible. The staff nurse really isn't in a position to leave the ward for a 15 minute walk to the canteen due to short staffing. She won't have another nurse to watch her patients. She will not be able to eat in the cramped handover room from hell unless she sits on the floor and wants to get interrupted every 2 seconds. That means the staff nurse's only option is to eat at the nurse's station thus inviting a whole bunch of smart ass comments from visitors and doctors who do not realise that she is only taking 10 minutes to eat in a 12 hour shift. Nor do they realise that she has no where to go to eat.

Then I come home from work and see this shit.

What the hell is going on?

Nurse Anne's Information Pamphlet for Patients and Relatives: PART 1

2010-07-14T01:41:00.000-07:00

I would like to print out a little pamphlet called "let go of your delusions" and hand it to every alert and oriented patient who arrives on my floor. And all relatives. This does not, of course, apply to confused patients, demented little old ladies or drug addicts going through acute withdrawal. I expect those patients to act like circus animals. However, if you are an adult who has voluntarily sought help for a medical problem, and are now lucky enough to even be in a hospital bed, there are some things you should know. Thanks to the posters at allnurses from whom I ~~stole~~ borrowed this idea. Writer's block is a bitch.

#1. YOU WILL NOT SLEEP. This may sound cruel, I mean, how can you get better if you don’t sleep? However, if you come to a hospital expecting a nice, quiet spa environment with cute nurses fluffing your pillows before you drift away into a healthful sleep, you are delusional. Time is short – the government and managers want as many people in and out of your hospital bed in as short a time as possible.. You will be woken up throughout the night to have blood drawn, blood pressure taken, IV meds administered, quick neuro assessments to ensure that your brain is not oozing blood. You will also likely hear people screaming and crying, cursing and laughing all night long. If you are lucky, it is not your own confused roommate who is constantly climbing out of bed only to set off his bed alarm. We cannot cure dementia or give them a magic pill. They may very well walk into your room and shit in the corner. They may try and get into bed with you. They will scream out for "billy" or "help" or another dead loved one all night long no matter what we say or do for them. They will not remember or retain anything we tell them. This is dementia. These kinds of patients are increasing tenfold. Unless you are in maternity or paedatric wards we cannot shelter you from this. It's not only dementia. Patients with severe medical illness, and other conditions will become confused, disorientated and unmanageable, even without the dementia factor. This is also increasing ten fold as more people survive severe illnesses. The hospitals are busting at the seams with these people. I even heard of a demented wandering elderly patient getting put on a maternity ward as there was no other place for her. We are lacking beds. No we cannot "send them somehwere else" or just "give them something". Wish I could. If you think you may need something to help YOU sleep, 3:00 AM is NOT the time to ask your nurse for temazepam. Ask ahead of time when your registered nurse can call the doctor for an order. Which brings me to my next topic. . .

#2. YOUR NURSE DOES NOT HAVE ACCESS TO ANY DRUG THAT MEETS YOUR FANCY. If you suddenly feel pain or your left knee itches, your nurse cannot reach into her magic scrubs pockets and procure any drug you like. Nor can she just get and give anything your normally have at home as prescribed by your GP. In hospital Doctors are the one who must order any and all medications, EVEN IF IT’S “just my usual piriton". Do not get mad at the mean nurse who won’t bring you extra morphine because your back hurts. That mean nurse must put out a call to a doctor, has wait for him/her to call back, pray that he/she is in a good mood and will give you the requested drug, write an order in the chart, scan that order to the pharmacy, wait a zillion years for the pharmacist to profile the medication, wait another zillion years for the pharmacy tech to bring the medication, then the nurse can bring you your drug. This can take a while. There is absolutely no way around this, even if you have a gun to my head. Do not think the nurse is secretly hiding your medication and enjoying your discomfort. Which leads nicely into my next heading. . .

#3. THE NURSE IS NOT YOUR ENEMY. Yes, the nurse must do things that sometimes causes discomfort – we must start IV lines, insert catheters, change dressings on painful wounds, give you shots – but we do these things to help you get better. We take no joy in them. You know that doctor that just left your room? The one to whom you were very nice and polite? The one to whom you listened quietly, asked no questions, and didn’t bother to tell that you are bleeding profusely out of your rectum or experiencing chest pains? Yeah, well HE is the one who orders these tests and blood draws and procedures. Speaking of that. . .

#4. TELL YOUR DOCTOR ABOUT YOUR SYMPTOMS. I cannot believe how many patients lie there quietly, smiling away when the doctor is in the room asking how they are feeling. “Oh, fine, Dr. Bighead! I feel great!” then. . .5 minutes later when the doctor has left the floor, this same patient is suddenly in excruciating pain, has numbness in her right foot and blurry vision. When asked why the HELL they didn’t tell the doctor who just left, they shrug “oh, I don’t know. . .I didn’t want to bother him. . .he is so busy.” Then the nurse must call the doctor and tell him that the nice, smiling patient they just saw is now a quivering mass of pain and can’t feel her own face. This leads doctors to think that nurses are nutcases. And it leads them to scream at us for paging them 5 minutes after they walked off the ward on their way to see their other patients, a job that takes them all day even if they rush and take short cuts. But mostly they just think that the Nurses are exaggerating or crazy. Which takes me to my next point. . .

#5. DO NOT TAKE YOUR ANGER, FRUSTRATION, ANNOYANCE OR SCHIZOPHRENIC HALLUCINATIONS OUT ON YOUR NURSE. In general, doctors are treated like gods and nurses are treated like shit. Plain and simple. We as nurses try to proclaim that we are professionals and that we make a difference – in actuality we are treated very poorly by most people in the health care world. We are in the very difficult position of being the “coordinator of care” for patients, yet we lack any power to actually make decisions. We have all the responsibility but none of the power. I spend so much of my day making phone calls, trying to make things happen. Trying to get test results, find out what is going on, talk to the doctor, get medications ordered, figure out why the patient has not yet had that MRI of the brain or echocardiogram. Nurses are viewed as nagging wives. . .and tend to be treated as such. But no one else in the hospital is going to take responsibility for getting this stuff done for you. Doctors, in general, do not talk to nurses, they do not tell us what is going on with patients nor do they tell us the future plan of care. For me to figure out what is going on, I often have to try to read the doctor’s handwritten progress notes, which is pretty much like trying to decipher ancient Egyptian hieroglyphics on a pyramid wall. I cannot sit at the nurses station for as long as it takes to read their notes. There is very little direct communication between doctors and nurses. If you want to know if you have cancer, for the love of god, ASK YOUR DOCTOR.

#6. YOUR NURSE HAS 10-20 OTHER PATIENTS, SOME OF WHOM ARE A HELL OF A LOT SICKER THAN YOU EVEN IF YOU ARE PRETTY DAMN SICK. Nurse has no control over how many patients she has but she maybe looking at a manslaughter charge if she goes to clean the incontinant lady before she gets to the diabetic with the hypostop. If you ask your nurse for some coffee and a newspaper, and she tells you that it will be a few minutes, do not get huffy and demand to see her nursing supervisor. For all you know, that nurse has a patient in the next room who is not breathing or is in desperate need of some pain medication. As nurses, we must prioritize, and yes, my “least sick” patient will get less of my time. This is not to say you are not important and I am ignoring you, but no, I don’t have time to listen to you whine about your chronic neck pain when I have another patient who is having a seizure or gasping for air as he drowns in his own secretions. I get no help with this. I just have to prioritize all the time.

#7. “H” DOES NOT STAND FOR “HILTON. Don’t complain to me about the food, the lack of TV channels, the view from your window, the “smell” of the hospital, of not being able to take a shower or go downstairs for a cigarette. You are in the hospital. Get that through your head. It is NOT like being at home or on vacation. We now call “patients” our “clients” or worst yet, “guests.” Our administrators are much more concerned about if our patients are happy than if they are getting better. My boss is always telling me how much my patients “like me” but I never hear anything about my actual care. It would be better for the hospital’s rating if I let that overweight diabetic eat her ice cream and get really ill rather than tell her NO – at least she would be “happy.” You know all those high taxes you pay? They don't even cover the cost of your diagnostic tests and drugs. You will not get the "penthouse suite" to recover from your CABG. And the hospital will most certainly not fork out the cash for you to have your own private duty nurse who can always be there for you. You Nurse most likely cannot be in your room for more than 2 minutes at a time without risking lives. If she doesn't limit herself to a few minutes max with each of her patients at a time she will miss the boat on something big. And in her line of work it's life and death.

#8. SOMETIMES IT IS GOING TO HURT. Yes, getting out of bed and walking after abdominal surgery hurts. Pancreatitis? Oh yeah, you are going to hurt and you are not going to be eating anything for days. You won't be allowed too. #18 IV in the AC? Yup – it is going to hurt and likely be uncomfortable as hell for as long as you have it. DEAL WITH IT. You are in the hospital. Yes, it sucks and No, I don’t expect you to be happy about it, but don’t constantly whine and complain and demand that I “do something about it.” You are not going to be magically cured just because you are in the hospital, and sometimes there is pain that even high levels of narcotics does not completely eliminate. Walking the day after surgery hurts, but it is the only way to heal, avoid pneumonia, and get out of the hospital. And if we overdo it with the painkillers you won't move, you won't get out of bed. Then you will get pneumonia and possibly a fatal blood clot. No I cannot alter reality.

So that is part one. I will be continuing this in part two with "the nurses and doctors did not give your gran dementia, lung cancer and heart failure" and " we have no way in hell of knowing when you are going to be admitted, transferred, discharged or when the hell the doctor or transport vehicle is coming. Please stop asking. The amount of time spent away from dying patients to answer your stupid fucking questions that require a crystal ball is a crime against humanity" and also "there are a million and one PERFECTLY good reasons that you or your loved one cannot have food or fluids. We are not starving or dehydrating you/her/him to death, the illness is".

RN safe staffing (1 RN to 4 patients) saves money and lives; Untrained staff instead costs money and lives

2010-07-11T01:19:00.000-07:00

Safe Staffing

As you read this please keep in mind that here in the UK there are no legal nurse staffing requirements and we are often one RN to 10-35+ patients in hospital. This is getting worse year after year. Patients are getting older, sicker and much more complicated whist wards are replacing nurses with untrained staff. MANY MANY TRUSTS HAVE BEEN SLASHING THE NUMBER OF REGISTERED NURSES AT THE BEDSIDE FOR YEARS EITHER REPLACING THEM WHEN UNTRAINED KIDS OR NOT AT ALL. PATIENTS ARE SICKER. THERE ARE LESS REGISTERED NURSES. I DON'T CARE WHAT THE GOVERNMENT'S OFFICIAL STATS SAY. THEY LIE.

Nursing ratios save money and lives

By Suzanne Gordon

July 9, 2008

BEFORE ITS legislative session ends in July, the Massachusetts Senate has an opportunity to protect hospital patients as well as the nurses who care for them by approving the Patient Safety Act that was passed overwhelmingly in the House a month ago.

The ratios bill would require that the Massachusetts Department of Public Health implement enforceable limits on the number of patients a registered nurse can be assigned, thus providing patient protection in all acute care hospitals. As the Senate debates this measure, it should consider the positive effects that legally mandated nurse-patient ratios have had where they've already been enacted - in California and Australia.

In California, since 2005, no nurse on medical surgical floors can be assigned more than five patients at a time. On equivalent units in Victoria - the second largest state in Australia - the minimum required staffing for every 20 patients is five RNs, backed up by a "charge nurse" who has no patient load of her own and is thus free to assist other RNs.

In both California and Victoria, ratios were originally introduced because excessive RN workloads were putting both nurses and patients in jeopardy, while adding to overall healthcare costs. More than 60 studies have documented that hospital understaffing results in more patient deaths, plus more preventable complications like pneumonia, urinary tract and catheter infections, and medication errors. A study done in 2005 by Michael B. Rothberg in the journal Medical Care put a price tag on these problems, concluding that a nurse who had time to prevent a case of pneumonia "saved $22,390 to $28,505, or $4,225 to $5,279 per additional hospital day." When nurses prevent an adverse drug event, they save the patient from an "added 2.2 hospital days at a cost of $3,344." On the other hand, if understaffing leads to complications after surgery, the resulting patient stay can be 8.1 days longer than normal, adding nearly $11,000 to the total expense.

Unmanageable workloads have also created an exodus of nurses into other fields or nonpatient-care jobs. According to a study by L.J. Hayes that appeared in the Journal of International Nursing Studies, hospital nurse turnover in 2006 - outside of California - ranged from 15 to 36 percent per year.

A study by economist Joanne Spetz, just published in the nursing journal Politics, Policy, & Nursing Practice, finds that ratios in California have increased RN job satisfaction and reduced turnover. According to Spetz, nurses are happier at work because they now get to spend more time at the bedside - particularly on patient education - which has a positive impact on nurse turnover and thus on the quality of care.

Researchers at the University of Pennsylvania have compared nurses in California with those in Pennsylvania and New Jersey - states without minimum staffing requirements. California RNs reported greater job satisfaction, leading to less burnout.

Ratio foes claim that ratios will cripple hospital functioning and force ERs to shutter their doors, because not enough RNs are available to meet the new requirements.

The hospital industry in California cited similar dire consequences in its bid to thwart full implementation of ratio legislation. In 2005, however, the state supreme court found no evidence that any hospital or ER there had closed due to new staffing mandates as opposed to the usual reasons for a shutdown (poor management, precarious finances, and consolidation of several nearby facilities).

Easing the nursing workload gives RNs who have dropped out of the active nursing workforce an incentive to return and encourages those already employed to stay. In Victoria, the government lured more than 7,000 inactive nurses back into the workforce. In California, nurses in hospitals that have fully complied with the new standards say ratios have had the same effect and many of those who reported they wanted to leave the profession say they will now stay.

Further legislative inaction on the issue of safe staffing in Massachusetts will only prolong an unacceptable status quo that drives nurses out of their profession, leaving too many hospital patients under-protected. If we want there to be enough nurses to care for the waves of baby boomers who will soon fill our hospitals, the time to act is now.

Suzanne Gordon is co-author of "Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care."
http://www.massnurses.org/legislation-and-politics/safe-staffing/p/openItem/1009

If you need anything else to shove up your hospital chiefs ass print the following links out. I doubt the fuckers will read any of it because they don't care about patients or saving money. But it's worth a try. You could always roll the articles up and use them to slap them! There is a reason I am getting super militant about all this at the moment. The only new staff we are getting are 16 year old "apprentices" because the hospital can get away with paying them £2.00 an hour. They are terrible. This will kill so many people and cost so much money as well. But the trust thinks it needs to save money on "staffing costs" so they replace real nurses with teenagers who cannot do even 1/10 of the job. The regulation of HCA's won't help us because we have only 2 or 3 HCA's left. Then we have a few staff nurses, and the rest of the staff is comprised of non nurse non hca apprentices. Help help help.

http://susanrosenthal.com/general/rn-to-rn-a-conversation-of-global-concern

http://www.massnurses.org/legislation-and-politics/safe-staffing/scientific-research

http://www.ahrq.gov/research/nursestaffing/nursestaff.htm

http://www.healthwatchttp://www.patientsafetyasap.org/pdf/ratios_patient_safety.pdf

husa.org/downloads/MASS_Nurses_Association-Why_the_Staffing_Ratio_Law_is_Needed.pdf

http://nurseactioncenter.org/campaign/Staffing_Ratios/explanation

http://www.nursezone.com/Nursing-News-Events/more-news/Study-Finds-Lower-Nurse-to-Patient-Ratios-Save-Lives-Help-Nurses_33960.aspx

http://mnablog.com/2010/05/17/mnas-proposed-safe-staffing-ratios-would-save-twin-cities-hospitals-money/

http://www.nursingadvocacy.org/news/2006/jan/21_abc.html

http://www.nursingadvocacy.org/faq/staffing_research/rothberg_2005.pdf

Memo from Management to all Hospital Staff.

2010-07-10T08:56:00.000-07:00

This was originally done by an American Nurse. I sexed it up a bit to make it a bit more British. Had to leave in the bit about the guns however.

As many of you may know, NHS District General Hospital is experiencing layoffs and financial problems. We can't possibly be expected to stop hiring managers and paying them huge bonuses. And cutting trained nursing staff , doctors and other frontline clinicians to the very bone isn't making us enough money. All Staff that haven't been made reduntant and dicked out of redundancy pay please read the following memo:

To: All Hospital Staff

From: Management

Subject: Cost-Cutting Measures

Effective August 5, this hospital will no longer provide security. Each consultant will be issued a .38 caliber revolver and 12 rounds of ammunition. An additional 12 rounds will be stored in Theatre . In addition to routine medical duties, consultants will rotate through the car park and entrances. In light of the similarity of monitoring equipment, the ICU will now take over surveillance duties.

Housekeeping and physiotherapy are being combined. Mops will be issued to those patients who are ambulatory, thus providing range-of-motion exercises as well as a clean environment. Families and ambulatory patients may also sign up to clean the rooms of non-ambulatory patients for special discounts on their parking fees.

Ward clerks and secretaries will be assuming groundskeeping duties. If they cannot be reached at his/her office, it is suggested that you walk outside and listen for the sound of a lawn mower, weed whacker, or hedge clipper.

Due to cutbacks in phlebotomy and laboratory staff, a policy has been developed that blood tests be performed only on patients who are currently bleeding.

The Radiology staff is being reduced and physicians are informed that they may order no more than 2 X-rays per patient stay. This is due to the turnaround time required by Boot's photo lab.

In addition to the overall recycling program, a bin for the collection of unused fruit and bread will be provided on each floor. Families, patients, and the few remaining employees are encouraged to contribute discarded food products. The resulting moldy compost will be utilized by the pharmacy for the production of antibiotics. Additionally, maggot infestation of the compost will be encouraged in an attempt to develop alternative approaches to wound care that don't involve time-consuming dressing changes that require RN's..

All staff will be issued with the uniforms of a Registered Nurse to ensure that each ward/department appears to have at least one RN on duty. The general public will always assume that any member of staff caring for patients is a Nurse. We will continue to capitalise on their stupidity.

Family members will be encouraged to scream and yell at harried frontline staff and pull them away from trying to keep patients alive rather than talk to someone who actually has the power to elicit change.

This will save money in the complaints department and prevent expensive delayed discharges and bed blockers. PALS is being combined with catering and they will be too busy making sandwiches to listen to complaints.

We will continue to enocurage the public to directly sue doctors and nurses rather than go after managers who put professional clinicians in situations where they cannot function.

The dieticans will now combine with morgue staff. By the time the lone hospital dietican makes his way to malnourished patients who cannot take regular food and require supplements, the patients will be dead.

All visitors and patients will be issued with at least 2 copies of the Daily Mail each day. This is to ensure that they continue to accuse overburdened overworked and underpaid frontline doctors and nurses of being "overpaid, lazy, and uncaring" rather than blaming managment for lapses in care. We have lifestyles to maintain.

Pharmacy will open for one hour on a Wednesday morning rather than just regular M-F office hours. And they will still expect the Doctors and Nurses to abandon patients in order to bend over backwards for them because pharmacy staff is so "busy".

IV tubing lines are now good for 600 hours. If you change the line before this you will be sacked for not being cost conscious. If your patient gets septicemia as a result of bacteria breeding like Brangelina on said IV tubing you will be sacked. You will then be replaced with a Patient journey flow discharge liason champion coordinator. We have mistresses that require jobs with six figure annual incomes you know.

Any questions please contact someone else.

The Management.

Job Losses

2010-07-07T02:59:00.000-07:00

http://news.aol.co.uk/nhs-face-job-cuts-despite-promise/article/20100706214049114132510

Thousands of NHS jobs are being cut despite Government promises to protect frontline services, a union has warned. The Royal College of Nursing (RCN) is aware of almost 10,000 posts that have been lost through recruitment freezes, redundancies and people not replaced when they retire, or which face cuts in the future. This is double the figure reported two months ago, although the RCN has now gathered details from more trusts......

I am willing to bet that most of these "job losses" come from qualified nurses at the bedside, providing direct patient care. I know this is the case in my neck of the woods. The trust hires untrained kids who have no intention of becoming Nurses to replace the real Nurses that flee. The kids cannot do the job, and the qualified nurses left are covering too many patients. The trust covers their asses by saying "oh yes we have hired more nurses". They have not hired more nurses, they have hired kids and auxilliaries.

A trusted source tells me that a trust near mine has shed over 70 district nurse posts over the last few years. This trust covers a pretty large area. They lose them through retirement and "natural wastage" and don't replace them. Registered Nurses are an older workforce and most of them are closer the retirement age than not. Newly qualified and job hunting older RN's are having great difficulty finding jobs at the bedside.

And so it goes.

No opt-out: nurses told of 'moral duty' to save money/Christine Beasley: Bitch

2010-07-06T22:32:00.000-07:00

Once again our ~~esteemed~~ chief nursing officer Christine Beasley is being a stupid government shill bitch. I am really getting sick and tired of all the bullshit that comes out of the mouth of that fat cow.

I really don't see how we could possibly save the NHS any more money. These fuckers are ruining professional nursing in this country by harping on about this crap rather than confronting the real problems. Patients often live or die by nursing care (who is actually going to give you the treatment your doctor ordered and monitor you for deterioration, chase your diangositic tests, fight with the doctor to get your pain killers etc etc).

Read the article. But more importantly read all the comments afterward. My colleagues have said it all.

No opt-out: nurses told of 'moral duty' to save money News Nursing Times

Christine you are a shill and a traitor. Find another way to save cash.

Patient Faking Seizure in ER

2010-07-06T10:55:00.000-07:00

I am getting addicted to watching these. I am going to make one for NHS medical wards.

Dear Media (newspapers, TV, and movies):

2010-07-04T01:49:00.000-07:00

Found this little gem on the web and thought it worth posting here. Make no mistake about it; the media portrayal of nurses is killing people.

A Letter to Hollywood:
Nurses Are Not Handmaidens
Laura A. Stokowski, RN, MS Posted: 03/12/2010

Dear Hollywood,

We, the nurses of the world, have something to say to you. Nurses are not what you think. Nurses are independent, highly educated, and skilled healthcare experts who save lives every single day. We work hard and are dedicated to making differences in people's lives. And we are really sick of going home after a 12-hour shift, turning on the television, and seeing ourselves depicted as brainless bimbos. This has been going on far too long, and it has to stop.

The Clown Took a Job as a Nurse

I remember a time when I was in nursing school, watching TV with my roommate, Liz. A skit came on, in which a famous comedienne of the day was dressed up like a clown. For some reason the clown had to leave the circus. "So," said the narrator, "the clown took a job as a nurse." We laughed at the absurdity of this, but I never forgot it.

We were in the middle of a demanding 4-year nursing program, and the suggestion that anyone, even a clown, could be a nurse, just like that, was wounding. I think it was then that I began to take notice of how Hollywood represents nurses. The answer is...badly. But it isn't just disrespect that comes through in Hollywood portrayals -- it's contempt, and it's not at all subtle. You scorn us in the way you pigeonhole nurses on the small screen -- it seems that we're either half-wits, nymphomaniacs, or latter-day Nurse Ratcheds. Obviously, you have no concept of nurses as autonomous, knowledgeable professionals.

We work alongside physicians, but we are their colleagues, not their subordinates. Yet in every hospital drama, physician characters are ordering nurses around, treating them like uneducated servants, or performing nursing care themselves and getting the credit for it, while the nurse characters just fade from view. I can almost hear your reaction to my complaints. There, there, dear, don't take it personally, it's harmless, it's funny. Is it, really? Will it still be harmless or funny one day in the future when you are in the hospital and you press your nurse-call button and no one responds? Or it is answered -- eventually -- by a minimally trained hospital "technician"? The nursing shortage will have reduced our ranks considerably, and driven many of us into early retirement.

It doesn't help the situation when schoolchildren and teens already discount the notion of becoming nurses because of the way nurses are portrayed on Grey's Anatomy. Becoming a nurse, they believe, is a waste of their talents.[1] Maybe You're Misinformed I'm going to give those in Hollywood the benefit of the doubt, and assume that they just have the wrong impression of nurses, and have no idea what nurses really do. But for the non-nurse readers, we'll pretend that you are in the hospital, and you've just had emergency heart surgery.

Who do you suppose will be at your side, watching your blood pressure, making sure you don't go into shock?

Who will be alert for the slightest hint of life-threatening hemorrhage?

Who will respond in mere seconds if your heart begins to beat irregularly?

Who will make sure that your chest tube doesn't get blocked and cause you to go into cardiac arrest?

Who will keep the circulation moving in your lower legs so you a clot doesn't develop and you don't die from a pulmonary embolism?

Who will be constantly watching to make sure that you don't stop breathing, that you are getting enough oxygen, that postoperative pneumonia is not developing?

Who will relieve your pain before you even have to ask?

Who will explain everything that is happening to you and teach you how to take care of yourself after you go home?

I'll give you a hint -- it's not your physician. It is your nurses. They will see you safely through one of the most dangerous times of your life, doing all these things and more. And just so we're clear, I'll tell you what your nurses won't be doing. They won't be clustered around the nurses' station as though at a cocktail party, flirting with physicians. They won't be in the broom closet or the stairwell or behind the patient's curtain giving sexual favors. They won't be trailing after the physician as he marches down the hall, in case he needs a cup of coffee or someone to dump on.

Nor will they be in the receptionist's chair, moaning about not being able to get into medical school. If these scenes sound a little familiar -- I'm not surprised. This is how nurses are regularly portrayed on television dramas. No Angels of Mercy, Please Hollywood, we're not asking you to glorify nurses. Don't turn us into heroes or martyrs. We just want to be accorded the respect, the esteem that our education, status, and profession warrant. We want our dignity back. We don't want the entire world to think of us as sleazy, dim-witted underlings. We want to erase the image of the "naughty nurse" -- this is your bizarre fantasy, not ours. We want young, impressionable children to view nursing as a viable, respected, and even admired profession, one they would be proud to call their own. But most of all, we want our patients to trust us and value our knowledge, so that when we teach them how to become healthier people and live longer, healthier lives, they will listen. This, our most treasured ability -- the core of nursing -- is what you threaten with your cheap attempts to increase ratings by ridiculing the nursing profession.

So my question to you is, is it worth it? Is the money you make from entertaining viewers with mentally unbalanced, sexually promiscuous, or idiotically subservient nurse characters worth influencing potentially hundreds of thousands of young men and women to shun a career in nursing? Will you feel content, even proud, the next time you encounter a nurse, in the thought that you regularly chip away at her self-respect and her ability to be effective in her job? Or will you infuse some realism into your tired stereotypes? You can start by discarding the following myths -- their demise is long overdue.

Myths About Nurses Perpetuated by Hollywood and Other Uninformed Media

1. Physicians are nurses' superiors in the hospital hierarchy- nurses "work for" physicians. Not true. Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians.

2. Nursing doesn't require much education. Nursing education is highly specialized, intense, and rigorous, because nursing itself is a profession grounded in science. Many people, if they believe nurses go to college at all, think that most nurses attend a brief 1- or 2-year program. In fact, 58% of nurses presently have a bachelor's degree or higher, a number that is growing every year. The "2year" nursing program doesn't really exist - the associate's degree in nursing requires prerequisites even before entering the nursing program, making it essentially a 3-year program. And in many areas, new graduate nurses undergo extended fellowships in the clinical setting that greatly increase their education and skill in nursing as they enter the profession.

3. Nurses mainly "fetch things" for physicians. Nursing is a practice that is unique and distinct from medicine. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.[2] Nursing's focus, and what sets it apart from medicine, is the whole person, not just the specific, presenting health problem, and nursing encompasses both actual and potential health problems. Nursing's scope of practice has been shown in numerous studies to save lives and improve health outcomes.

4. Nurses are those who aren't smart enough to get into medical school.
This might be the most irritating myth of all. It presupposes that nursing is just a tiny subset of medicine, a fallback for people who can't quite make it up the ladder. However, nursing is a different profession, not the same profession watered or dumbed down.

Read more here: http://www.tcorn.org/stokowski.pdf

And check this out if you can: How the media portrayal of Nurses is killing thousands of people every year. Not only is the public' s view of nursing completely warped, but the managers who run our hospitals are under the influence of these media stereotypes also. This is why we don't ahve enough real nurses to care for the patient's on our wards. And this is why the few real nurse's we have are forced to do everyone's elses job as a money saving exercise by the powers that be.

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Hospital Staff Nurse Interviews Hospital Administrator

2010-07-02T11:08:00.000-07:00

Out of the mouths of babes

2010-07-01T07:29:00.000-07:00

I feel really bad for the decent cadets and health care assistants for writing this. But the fact it is that many of them are not so good and should not be employed instead of Nurses. They fact is that they will continue to be employed instead of Nurses. Neither job seeking RN's who trained in the 70's nor new graduate RN's can find jobs on the wards.

Here is the latest one from the ward next to mine:

Patient became unwell in the night with..... let's say sepsis, very weak and has gone from able to attend to her own hygiene needs to being totally helpless. This has happened very quickly.

Enter the auxillary, who has sat with the Nurse and "listened" to handover and all the information on these patients at the beginning of the shift. She goes into the room. I put the word "listened" in quotes because many auxilliaries, cadets and the like sleep through handover. They just just get on with baths and forget everything else.

"You could wipe your bum yesterday, why not today?" says the auxillary to the patient.

I cannot convey how nasty and condescending she sounded when she said it. A blog just cannot convey that.

The Nurse didn't know that this happened. She was up to her eyeballs in drugs, orders, doctors rounds, discharges, emergencies, and admissions for her 15 patients while the auxilliaries were doing all the basic care unsupervised. This is why we want RN staffing ratios to improve. RN's all know that RN's must be involved with basic care. This is true whether the RN trained in the 1970's under the hospital programs or in the 1990's under the hospita/university training programs. It is the managers that do not understand this.

She found out when the patient's daughter came at her screaming and wanting to know how any "Nurse" could be so stupid and rude to her mother. The Nurse gently explained that the auxillary "is not a nurse and doesn't have the knowledge but that is no excuse for what she said". We have to say this to relatives a hundred times a day.

To appease the patient and her daughter the patient was transferred to my ward. This is how I know about it. I grabbed the non nurses (the only people I was working with that day, no other qualifieds) and I made them listen to me as I explained the patient's condition.

But the non nurses who come on duty tomorrow will again have a mini sleep during handover and the same thing may happen again.

Does anyone think it is funny that all these complaints about nurses being "rude"seems to coincide with the hospitals replacing real nurses with untrained people?