Which One is the Nurse? Does It Matter?

Yes it does actually.

Time to go off on a few tangents and let off steam. It's theraputic for me even if no one reads this longwinded crap.

Before I start I would like to deal with a misconception about highly educated nurses. People think that we think we are above bedpans and cleaning. This is just not true.

I have always said that the major problem with Nursing is this: People don't understand what a nurse is, what nurses do, how much they have to know, the amount of liability and accountability they take on, the amount of education they need to do their jobs, and the unbelievable amount of responsibility they have. They cannot differentiate between a Registered Nurse and a Nursery "nurse" and probably think they have the same level of education.

How do I know that the public is so freaking clueless? Because I read doctor blogs and then I hear people refer to their 17 year old niece who gets a job working in the hospital as an auxillary as "a junior nurse". Yeah. A Nurse. Yep. People think that employee who comes into their room to take a blood pressure is a nurse. Why did I work so hard to get the initials RN behind my name if people think that the trolley girl who serves tea is a nurse? Any female walking around the hospital in uniform is a "nurse". This is totally unnacceptable. If you analyze this further you can see some of the serious problems that can arise as a result of ignorance. Attitudes can Kill.

You think I am being petty? Walk into an airport and call an airline pilot "stewardess". Hell they all work in the same place so whatever right? Walk into a solicitors office and refer to the legal secretary as "solicitor"..why not they all work in the same place. Walk into a hospital and call the doctor "nurse". You all know not to do this yet you refer to an untrained but well meaning kid who simply makes beds and walks people to the toilet as "nurse" which is my legal title and I'm not supposed to get annoyed? If an HCA or an auxillary had to go through what I went through in nursing school they would probably flunk out. Yes I know I sound too much like Dr.Crippen when he is having one of his quacktitioner vs Doctor tantrums.

They (support staff) know that real nursing is a total bitch. Why do you think so many of them won't go off and become nurses even though their education would be free (in the UK) and they would make slightly more money? Why do all that work when one can have an easier (although backbreaking) job with no accountability and still get called "nurse". They are only on very slightly less than an actual nurse salary wise. The job is lightyears less demanding...even if they are breaking their backs doing all of the lifting, bathing, turning etc. I was an HCA once so I know the score. I used to think that HCA's did all the work and now I look back on that knowing what I know now and realise that I was just ignorant.

I worked my ass off through a rigorous 4 years at university where I was in lectures 8-12 hours a day and clinical placements on top of thaton the same damn day. I had to take university level chemistry, microbiology, anatomy and physiology 1 and 2, statistics, the pharmacology course from hell, and much more as well as nursing theory. The other students at this university could get shit grades barely above passing and still graduate but the nursing majors were kicked out if their final grade for any class went below an 80%. Two fuck-ups in clinical and you were gone and you didn't get your $40,000 a year tuition refunded. Okay I was on a full scholarship but I was still under an insane amount of pressure. While I was doing 8 hours of clinical a day on top of 8 hours of lectures in a single day the media studies majors were getting drunk and fucking around. Bastards make more money than me too.

We were going to be nurses and had to be better than the others. This is what we were told. Nurses have life and death responsibility and even small mistakes kill. Most other Uni grads won't have to deal with that or work in such a chaotic environment. They won't have to think as fast etc etc.

Nursing in the UK is no piece of cake either. There are two ways of becoming a registered nurse. One can either do a 3 year diploma AT UNIVERISTY, or a 3-4 year degree AT UNIVERSITY. Let me tell you something. The 3 year diploma is a lot tougher in many ways than your typical 4 year degree for non-healthcare staff at university. Any starting new grad RN walks into a job where he will have triple the responsibility and workload and accountability that a teacher, english major, or business major etc. will have. I have lost count of the number of people I know who have done nursing as a second degree and said it was shockingly harder than their first degree. They don't last long.

I have lost count of the people I know who have Bachelors degrees in other fields who have flunked out of diploma nursing. In places like the USA where an RN has a highter starting salary than most new grads we see engineers, teachers, accountants, computer majors and others going back to Nursing school because they want a higher paying job and they want to help people. In the UK we see people who go through some kind of mid-life and decide to switch careers into nursing because they feel that they have done nothing worthwhile with their other degree and they want a job that means something...they want to help people.

What do all of these people have in common? The vast majority feel that nursing school was the toughest thing they ever did yet it was cake compared to actually trying to function as a staff nurse on a general ward. I know 5 school teachers (2 with a masters degree who went back to nursing school. Three were located in the USA where nurses make more money and 2 were located in the UK where nurses make less money than a teacher. Only 2 of them actually made it through nursing school and none of them lasted more than a year as nurses. They were soon back to teaching and it wasn't because they have an aversion to shit and puke. They couldn't handle the information overload and the life and death responsibility, the nightmarish hours. The ones in the US took the pay cut and went back to teaching.

Sure nursing education is lacking in a lot of ways but it's a lot harder than you think believe me. Just because it isn't as hard and as long as medical school doesn't mean it is cake. Nurses need a good academic foundation as well as massive amounts of hands on training done IN THE RIGHT WAY. Years ago we had the latter and not the former. People died. Now we have the former but not the latter. People die. My belief is that nurses do need to have a 4 year degree as entry level BUT that doesn't mean shit without decent placements and mentoring and interships. You just can't have one without the other. You need both. But who wants to go to school that long to get paid less than a policeman?

In spite of these problems with nurse education, people who can legally call themselves nurses have worked hard to earn it. The 19 year old HCA who makes your bed has no idea what it takes to be a nurse. They have no accountability and don't have to make difficult decisions. They don't take responsibility for anything. They are working on my license. They do not understand all of the ins and outs of what I am doing and why. They hear in report that we have a patient with an HB that dropped fairly quickly who is still on 2 kinds of anti-coagulants for that clot and he now has maleena. He is in the bed next to the NBM guy who now has no IV access and a K+ of 1.9. I have to change some info here to comply with confidentiality but you get my drift. They hear these things but they don't know what that means or what's involved and they don't understand why I make a run for those guys as soon as I get out of report rather than "helping us" serve breakfast.

Even after completely 4 years of hell at Uni and graduating with a degree in Nursing I was STILL NOT LEGALLY ALLOWED TO CALL MY SELF A NURSE. I had to take a miserable hellish state board exam. I passed on the first go and then I was allowed to use the term nurse to describe myself without breaking the law for the first time. All this qualified me to apply for a job as a Junior D grade staff nurse in the UK. I paid my dues to the state board of nursing for my license and than the NMC. It costs money to maintain a license. Not an issue for support staff.

This unfuckingbelievable amount of ignorance regarding nurses, their legal responsibilities and their education leads to many things. Indirectly it leads to people suffering and getting shitty care.

First of all it's very easy for the powers that be to cull back the number of registered nurses and bring in untrained kids with nose rings, give them a uniform and teach them how to make a bed. The public doesn't really understand the difference between these employees and a "nurse". Their opinion of nursing as a profession goes out the bloody window. I have heard comments such as "an HCA does everything a nurse can do except give meds". You have got to be shitting me. I'll be writing about a day in the life of an RN in a later post and we'll discuss this.

This increase in non-professional staff and decrease in actual nurses is occuring at a time when patients are sicker and more complex due to advances in health care that SAVE THEIR LIVES, as well as increasing targets that cause us to have to run around like chickens with our heads cut off rather than focus on the task at hand. The liability and the litigation against nurses is increasing causing us to spend more time than anything covering our asses via documentation. If you didn't document it...than you DIDN'T DO IT. That is the rule and if you don't adhere to that you GET BUSTED.

Meanwhile the HCA's are spending most of the time doing patient care (i.e assistance with activities of daily living). I don't have a choice but to let that happen because I am so overwhelmed but it scares the living fuck out of me. If I bathed my own patients, fed them, and walked them to the loo I can do a hell of a good holistic nursing assesment during that time and decrease the risk of getting fucking slaughtered by the NMC. I will notice how you are breathing while bathing you. An HCA will not or may not connect any dots. I will notice if you are showing signs of internal bleeding, shock, neurological changes, drug reactions, dehydration, pneumonia, hypoxia, infection, etc etc etc ad nauseum. I will catch problems during this time and sort them. An HCA will bath you and go onto the next patient because she doesn't know any better. Does the term "Failure to rescue" sound familiar? Most HCA's are lovely and hardworking but they do not have a license or professional accountability. If they fuck up I am fully responsible. They can't connect the dots between your appearance on a good head to toe assesment and your meds, labs, etc.

Am I able to provide basic care and do a good nursing assesment of each of my patients during this basic daily activity? NO.

Am I forced to dump things like bed baths on the HCA's? Yes.

Does that mean that my patients problems are not getting noticed quick enough? Yes.

Are nurses happy about this? Hell No.

We are scared shitless. Doing simple bedbaths allows me to do a thorough assesment that can help a patient, catch trouble brewing and keep my cute little bottom out of trouble. We are not "too posh to wash". We are "pulled in too many directions at once to wash" and we hate this because we can't get a good handle on our patients general condition which leaves us open to litigation, as well as a lifetime of guilt. Plus you just look fucking stupid when you don't know that your patient has sore heals. a sacral sore and a cellulitic looking leg and you have been "caring" for him 2 shifts in a row.

In later posts I will talk about nursing assesments how much I learn about your general condition during a 2 minute chat and a bedbath, or a simple walk to the toilet. That assesment at the beginning of my shift can make or break you (and me). I believe that all care should be carried out by an RN with a small number of patients. I believe that I should have a smaller number of patients and do everything for them from hanging IV meds, assesments, care-planning, to wound care, and to cleaning their damn feet. Pedal pulses anyone? This is how I feel and yet I have no choice but to leave the bathing and the mobilizing and the talking to my patients to the HCA's. No choice whatsoever.


Where are the signs of horror regarding low patient ratios and a mass exodus of actual nurses from the bedside? Why doesn't the public care? Why aren't they worried and crying out regarding the dangers of short staffing? Because to them a nurse is simply the hospitals version of waitressing staff, and doctors (who are rarely ever on the wards) are somehow watching the nurses' every move and the patient's condition. Therefore nursing care is really no big deal.
This is what sets the stage for poor care in hospitals. Nurses are an easy target for managers, and we are one of the first things to get culled back when they need to balance the books. Until people realize just how important nursing care is and that we need lots of actual nurses around care will continue to deteriorate.

An Oldie but still a Goodie

Found this article during my web travels. Maybe my image for this post should have said "different day, different country, SAME OLD SHIT. This article is pretty old...2001 but it says a lot of things that are pertinent now. My belief is that things have really deteriorated since this article was written.

This piece is also American as is most of the other stuff I posted. It may be American but the stories that these nurses are telling could have come straight out of the mouths of British Nurses. I want to start seeing this stuff from British Journalists.

My lovely comments in bold.

Look, if you don't think that "medical economics" isn't completely fucking with the system here as much as it is in the USA than I am worried. Good care is no longer a priority. Making it appear that good care is the goal is the priority now. It doesn't matter if you are in an NHS hospital in Crapshire or BigBucks hospital in Bumblefuck,Wisconsin. It's all the same.

Same shit different country has always been my motto.


Prognosis poor in nursing shortage



Sunday, September 09, 2001

By Ford Turner
Of The Patriot-News

Nurse Kelli Diodato, less than two years out of Penn State University, worked at Harrisburg Hospital and had to care simultaneously for up to eight heart patients. People with "all kinds of IVs and chest tubes and lines in their arteries."

Diodato calls it "ridiculous." Four patients, she says, might have been an appropriate number.

Remember that advances in technology means that hospital patients are sicker, more complex and tougher to take care of than they were years ago.....Anne

One night last year, a supervisor insisted Diodato take responsibility for nine patients at one time. That night, she decided to get a new job.

She has since resigned. ***

Amy Baer quit a $24-an-hour nursing job at Harrisburg Hospital in March.

"I just wasn't able to give the care I wanted. ... I felt rushed and I didn't have time to do complete assessments the way I wanted to do them. I was overwhelmed," Baer says.

Baer recently started a new job as a $9.25-an-hour middle-school health aide. ***

Sally Long, a nurse at Harrisburg State Hospital, says she has watched mentally ill people go to other hospitals for medical problems, only to lie in the emergency room -- sometimes for days -- until the hospitals have staffed, non-emergency beds available.

"In the last few months I've seen it happen half a dozen times, and really one time is too many," she says. ***

Ask a hospital nurse, hear a disturbing story.

Piece the stories together, form a disturbing portrait.

Hospital nurses in central Pennsylvania are running themselves ragged in the face of a national nursing shortage.

Jesus are they talking about the UK?...Anne


They speak of stress, understaffing, and a widespread belief that the health care system puts money ahead of patient care. Veteran registered nurses -- the backbone of hospital nursing staffs -- are resigning in large numbers. Relatively few people are coming into the profession; hospital managers patch holes by hiring "temp" nurses and even by recruiting overseas.

Sound familiar? Would a UK hospital cull back staff to try and stay within budget? Would they pay out to bring in cheaper foreign nurses who aren't as likely to speak out when patient care is compromised? The correct answer is.... fuck yes........Anne

Of some three dozen midstate nurses interviewed by The Patriot-News, many say the shortage is compromising patient care, directly or indirectly.

They aren't alone.

Concern has grown nationwide over how patients are faring in the face of a shortage dramatized by some startling statistics:

Put a registered nurse in every one of the 106,537 seats at Penn State's Beaver Stadium, and cram about 20,000 more onto the football field -- that's how many nurses it would take to solve the nation's shortage.
The number of people passing the national registered-nurse exam dropped 23 percent in the past five years, from about 98,000 to about 75,000, according to the General Accounting Office.

Yet there are over 500,000 licensed Registered Nurses in the USA who refuse to work in healthcare. The UK is heaving with Registered Nurses who will not work in Nursing. They all say the same thing....Love Nursing/Hate the overwhelming work loads and sheer terror that the job entails (and don't even get me started who the unreasonable public who demands one on one care from a nurse they are sharing with 20 other sick patients...........Anne

Enrollments in Pennsylvania nursing schools -- those offering standard entry-level programs -- has dropped by more than 35 percent since 1995, from about 5,800 to 3,800, according to the American Association of Colleges of Nursing.
More than 40 percent of U.S. hospital nurses reported dissatisfaction with their jobs in a University of Pennsylvania study.

Two recently released studies -- one by Harvard and Vanderbilt universities, the other by the federal government -- concluded that care improves when more nurses are available. Although there have been nursing shortages in the past, this one is expected to last longer and hurt more. It is a numbers problem: The demand for nurses will surge as baby boomers reach their senior years. At the same time, the number of women between ages 25 and 54 -- the traditional core of the nurse work force -- is expected to remain unchanged.

But studies and statistics fail to convey the human side of nurses' everyday struggles.

Opportunities grow:


"Sometimes I come home and I cry," says one nurse who has worked at both Harrisburg and Holy Spirit hospitals. "People are really sick and they need good care." ***

"We feel kind of torn. We want to give the best care we can, and we do, but you fly around like a crazy person," says Christy Clippinger, a 36-year-old registered nurse who works in the operating room at Harrisburg Hospital.

***

Many things get blamed for the nursing shortage, including more opportunities for women outside of nursing, discontent among nurses, and staff cuts as managed care squeezes hospital finances.

With enrollment at U.S. nursing schools down from about 74,000 in 1995 to 58,000 last year, there are "fewer nurses in the educational pipeline," says a spokesman for the American Association of Colleges of Nursing.

The urgent question: Why?

"Girls aren't going into nursing anymore," says Lebanon resident Marie Garman, a licensed practical nurse for 35 years. "I don't know if they think it's demeaning or what, but it's not being pushed in high schools anymore, either."

Well I have banned my own daughter from a career in nursing. I wouldn't encourage anyone to enter the field. If you go to university and study anything else you will make more money, not have to know as much, not have to work as hard, work better hours and get more respect. It's a no brainer.......Anne

Meanwhile, non-nursing opportunities for women have exploded.

Leanne Clark, a 53-year-old nurse at Harrisburg Hospital, says that when she got out of high school "a woman either became a teacher, a secretary, a beautician or a nurse."

The wives of President Bush and Gov. Tom Ridge are librarians.

Today, women have opportunities in business, the military -- just about any field they choose.

Meanwhile, nurses' place in the health care system has changed dramatically.

Bill Cruice, director of the Pennsylvania Association of Staff Nurses and Allied Professionals in Conshohocken, says he believes the health care industry inflicted the shortage upon itself.

When managed care, in the mid-1990s, "decided that the health system would be driven by profit -- accountants and fancy consultants peddling their wares -- the entire atmosphere of what it meant to be a professional nurse on the front lines changed," he says. "Almost overnight it made being a nurse one of the most difficult jobs in the country."

Many hospitals cut 50 or more nursing positions as they sought to reduce costs in the late 1990s, says Jessie Rohner, executive administrator of the Pennsylvania State Nurses Association.

After that, he says, nurses felt no loyalty to their former employers. It became difficult to lure them back to the hospital.

Nurses also have seen job demands increase. Not just in patient care, but in scheduling.

Overtime -- described by some nurses as "mandatory," though most hospitals reject the term -- has become a drain on their lives. Some are told to work extra shifts every week. Others stay at work after their shift ends because they are a "DL," or designated late, nurse.

"When you work so many hours, you just aren't as good as you were at 7 a.m.," says a veteran nurse in the PinnacleHealth System.

Lydia Mogel, a nurse at Penn State Milton S. Hershey Medical Center, says her colleagues come to work sick "because if they call in sick, they get an 'occurrence' ... a written record that goes in your file."

Many nurses say the exodus from their profession is linked to a sea change in health care. Profits, they say, have become more important than patient care.

Profits/Targets/Budgets...whatever. Yes hospitals have to be fiscally responsible and not piss money away. But they have to make sure that they are putting the money into the right areas. Patient care would be a good start.......Anne

Their feelings are shared by Kerry M. Fagelman, a pediatric surgeon who practices at several midstate hospitals.

The shortage of nurses, he says, is compromising care in every hospital because the number of nurses available "has a direct impact on patient care and on patient mortality."

However, Fagelman -- who spent four years in medical school, eight years as a surgeon in training, and has had a surgical practice for 19 -- says the nursing shortage is one symptom of a much larger problem of "medical economics."

In short, he says, medicine has become a business in which health insurance companies and health care organizations suck away money that should go to providers such as nurses and doctors.

Sometimes they suck it away and put it towards stupid shit like more managers and paperwork as well as fucking stupid targets that merely give the appearance of better patient care. They resent having to provide nurses and doctors to care for patients let alone shuffle money their way in exchange for their hard work.....Anne

"It has come not to care, but to the dollar figure. How quickly can we get those patients in and out ... The care is not there that was there 10 years ago," says Cindy Fetchen, a 42-year-old registered nurse who works in operating rooms at Hershey Medical Center. ***

A 10-year veteran nurse at PinnacleHealth says: "It is more greed, toward money. It is a business. It is not geared toward the patient." She points to the recent shutdown of adult outpatient mental health services by PinnacleHealth as one example. ***

Another veteran PinnacleHealth nurse who requests anonymity says that, because of the nursing shortage, Harrisburg Hospital at times has had only nine of its 19 operating rooms functioning.

The crunch means patients sometimes are processed in a hurry.

The nurse says she saw surgeons ask for patients to be brought into surgery with prep work incomplete.

In April, the state fined PinnacleHealth for that very problem, along with an apparent breakdown in the procedure that surgeons use to verify the identity of some surgical patients. ***

While nurses are frustrated, they aren't complaining in a vacuum. Hospital officials acknowledge, and even echo, their complaints.

"Our job right now, as far as I am concerned, is to listen to them and understand what is going on in their work life, and try as much as we can to respond to it," says Roger Longenderfer, chief executive officer of PinnacleHealth. "We use a significant amount of agency nurses and temporary help -- that's a very short-term solution. We'd much rather have our own folks in place, but that does help fill the gaps to some degree."

A chief executive who gives a damn? Fuck. Where did they find him? I don't know which planet this bloke is from but it certainly isn't Earth. This statement makes it sounds like he gives a shit. Can't be. Either he is lying or he's not of this world. ....Anne

"What we want to pay special attention to is working to keep enough nurses on the front lines delivering direct care," says Darrell G. Kirch, president and chief executive of Hershey Medical Center.

You have got to be shitting me.....Anne

Julie Miksit, administrative director of nursing at Good Samaritan Hospital, says creative solutions have allowed the hospital to retain nurses and keep patient safety at a proper level. The hospital has not resorted to mandatory overtime and patient care is not being compromised, she says.

Still, nurses agree that, whether patient safety is affected or not, the shortage robs them of time to give hands-on, bedside assistance, or consoling, friendly conversation -- some of the things that drew them to nursing in the first place.


"My sister was diagnosed with breast cancer and died a year later. That strengthened my need to nurture. Sometimes I say, 'I'm going to leave nursing,' but then something happens to make me see the rewards," says Ivy Matthews, who works in the hospice unit of the VA Medical Center in Lebanon. ***

"I wanted to be a nurse since I was little. My brother was asthmatic since he was a baby. One day I stood on the porch while he turned blue, and I didn't know what to do. I wanted to be able to do something," says Lebanon VA nurse Penny Riehl. ***

Lawmakers have heard the hue and cry of nurses.

Still waiting for this to happen in the UK. I have watched what has happened in the USA over the last 10 years with nurses getting politically active. It hasn't been pretty. The health care lobby is pretty powerful. I have higher hopes for the UK really......Anne

A bill introduced in the state Legislature would limit services that may be performed by unlicensed hospital personnel. Another would protect whistleblowers who report problems at hospitals. A third would mandate the Pennsylvania Health Care Cost Containment Council to collect information on the quality of hospital care.

As far as I know this bill failed in Pennsylvania. The health care lobby is too powerful.......Anne

Rep. Pat Vance, R-Silver Spring Twp., a former nurse, said remedies for the shortage might include establishing a "career ladder" to give nurse's aides more opportunities to become nurses.

Is she on crack? Nurses aides and HCA's don't want to become nurses. They know the score. The fucking nurses want to be HCA's.......Anne

Meanwhile, hospitals are going to great lengths to recruit nurses.

Total fucking lie. I know this region and lived near there around the time this article was written. They made it appear that they were trying to recruit and retain. Kind of like what the NHS is doing now........Anne

Holy Spirit and other hospitals offer "signing bonuses." Lancashire Hall nursing and rehabilitation center in Manheim Twp. has recruited 18 nurses from the Philippines, and 155 other Filipino nurses could be working in area facilities within the next few months.

What about all of the experienced home grown nurses? Don't want to bring them back because they'll blow the whistle on your dangerous practices right fucko?want more pay for having more experience and responsibility. We can't have that now can we?....Anne

The real key, many agree, is to think ahead.

"Trying to market nursing as a good career is where we need to go to attract people to the field," says Good Samaritan's Miksit.

Yeah, Market it all you want. The job sucks. You are just training more nurses to burn them all out and turn them into ex-nurses after 2 years in the field......Anne

"You need to look at recruitment in high school and in junior high and have people with a positive attitude talking about it," agrees Lebanon nurse Marie Garman.

Guess that's me out then...as well as any other frontline nurse........Anne.

The health care system may first have to heal the day-to-day experience of those who should be their strongest recruiters: the men and women on nursing's front lines.

Care diminished:

"The treatments may be given. The bandages may be changed," says Colleen Swisher, who works in an intensive care unit at Holy Spirit. "But, when they are in pain, or they are anxious, or they are emotionally distraught ... if somebody can't be there, they aren't getting the care they deserve. And that happens all the time." ***

One 19-year veteran says she quit her full-time job at Harrisburg Hospital because, as a nurse, "What they are expecting of you is physically impossible to do safely."

That's about right......Anne

Her advice to the public: "Don't get sick. I'm serious." ***

I agree with that.........Anne

Staff writers Jeff McGaw, Monica Von Dobeneck, Marylouise Gingrich, and Erin Fitzgerald contributed to this report.

http://www.pennlive.com/news/patriot...8103194738.xml




Does anyone see any kind of pattern here?

I have to head out so I had to do this quickly. See ya Later....Anne

Why are so many nurses getting away from nursing?

Most journalists (especially the ones who write about hospitals) are morons. Occasionally Journalists do get stuff right. I have stumbled upon a couple of articles that demonstrate this rare phenomenon. Both of the articles I am posting here are American but the things they are talking about apply to UK nurses as well. I wish the British media would do this.

We have the same problems occurring on both sides of the pond in completely different health systems. I have worked in both the USA and the UK as an RN and I have always said that there are more similarities than differences...this is especially true when it comes to nursing. On both sides of the pond healthcare has been enslaved by the almighty dollar (or pound). The people running the hospitals do not see nurses as educated professionals who are crucial to patient safety. They see nurses as an expense that they want to do away with.

They will happily send a ward nurse an unstable patient who needs her constant presence at their bedside to survive the shift on top of 20 other patients who all need massive amounts of care. They will then refuse to send her another nurse or any kind of help citing money as the main problem. They know that people will assume that the shitty care those other 20 patients have received are a result of horrible lazy nurses. They won't have angry relatives screaming at them...the overwhelmed nurse will have that while she is busy trying to get blood hung on the guy with the GI bleed. If a patient was harmed in that situation do you know who the law would go after? The nurse. Fact.

Many good nurses have lost their registration due to situations like this one. The boards of nursing in the USA and the NMC here in the UK have taken an interesting stand on these situations. Their view is that a nurse is a professional and that if she agrees to take on a dangerous amount of acutely ill patients than she is liable. Completely. Their advice to us is that we need to get away from an employer who won't staff properly or we are liable and they will take our pin numbers so that we can never work in healthcare again. I have a written letter from them stating this. Their advice was to refuse a dangerous assignment as it is better to get fired and anger your manager rather than end up in court.

There are three problems with this stand by our nurse licensing organisations: first of all nurses have families and mortgages and financial commitments and can't just pack in their jobs. The second problem is that the UK has a complete recruitment freeze going on at the minute and there are NO JOBS. NONE. Most of our new grad nurses are unable to find employment. The third problem is that if you do take a stand and refuse to take on a dangerous assignment you will not only lose your job but get blacklisted and never get another. I have seen them give bad references and take disciplinary action against a nurse because they have refused to be the only nurse on a 30 bed ward. Two of these nurses are currently on the dole.

There is nothing forcing the managers to staff the wards safely. Nothing. This is why everyone is getting the hell away from the bedside. If you think they are getting out and going quaktitioner because they are too posh to clean up faeces and simply want to advance and get more pay you are mistaken. It's the impossible the workloads and the liability that are causing the nurses to flee. Nurses love nursing they just don't like abuse. More nurses are escaping the bedside completely by leaving healthcare all together. A very very small number are going into "advanced roles". If you go to feed that patient or clean up the other one who is lying in filth the time you spend away will kill one of your other patients. Patients weren't as unstable years ago. People like this died quickly and back then it was accepted.

I am hoping that British journalists will talk to nurses who are CURRENTLY working in our hospitals. I want to see them do research rather than the usual "nurses don't wash their hands and leave you in your own filth because they are mean" tabloid rubbish. I want our hospitals to improve. This is never going to happen until people in general realise that nurses are important and that we need lots of them. We already KNOW that having more nurses saves more money than it costs because of the reduction in expensive patient complications as well as inpatient stays. I am talking about Registered Nurses here...not the minimum wage paid housekeeper who was taught how to take a blood pressure and wears a uniform nearly identical to mine.

Nurses who have left nursing have said that it is going to take less patients and better working conditions to get them back into the profession. Having to clean up shit and puke are the least of our worries and the easiest part of the job really.

Our abhorrent salaries are the least of our worries.


Simply paying more money to nurses isn't going to fix anything.

In the USA an RN who has just qualified (including diploma and associate degrees) start at a salary of about $50,000-$55,000. In some places it is up to $60,000-$70,000. This is far higher than the salary that most university graduates obtain in the beginning. . Nurses earn more than policemen, social workers, and teachers. There is a lot of room to grow and it's fairly easy to bring in a 6 figure salary annually if you pick up lots of overtime. Nurses in the UK are banned from overtime right now and mandatory over time is completely unpaid. But even with a decent salary and wickedly awesome overtime pay USA hospitals cannot retain their nurses.

"In nursing, pay isn't the only issue. Difficult working conditions and understaffing also deter qualified people from pursuing the profession (see BusinessWeek.com, 8/21/07, "Labor Shortages: Myth and Reality"). But average annual wages for registered nurses (one of the most highly trained categories) is now just under $58,000 a year, compared with a $36,300 average for U.S. workers overall. And it's clear that qualified American nurses see that as not enough: There are 500,000 registered nurses who are not practicing their profession—fully one-fifth of the current RN workforce of 2.5 million and enough to fill current vacancies twice over."

"While nurses' advocates say better pay is critical, they also argue that working conditions must improve if the U.S. is to cultivate an enduring nursing workforce. Future projections of staffing troubles are ominous. The current 8.5% shortage is expected to surge to 29%—or more than 810,000 nurses—by 2020, according to the U.S. Health & Human Services Dept. "You will draw in some people with a good pay raise, but you won't necessarily get them to stay," says Cheryl Johnson, a registered nurse and president of the United Association of Nurses, the largest nurses' union in the U.S. "Almost every nurse will tell you that staffing is a critical problem. The workload is so great that there's not time to see how [patients are] breathing, give them water, or turn them to prevent bedsores. The guilt can be unbearable."

From: A Critical Shortage of Nurses http://www.businessweek.com/bwdaily/dnflash/content/aug2007/db20070828_104375_page_2.htm

You wouldn't even believe the figure of qualified British nurses who are living in Britain and refusing to work as nurses so I won't post it. The hospitals would refuse to hire them anyway. They want the registered nurses out.

Basically the Americans are paying their nurses more money and still nurses who love nursing don't want to do it. In the UK we are paying them absolute shit and yet nurses who love nursing don't want to do it. Check out some of the comments on that article. Could have been written by any nurse at my hospital.

Experienced well educated nurses who are dedicated to nursing are leaving the profession in droves and their managers are loving it. We train more nurses and they (well the ones who can find a job anyway) burn out quick. We burn them out faster than we can train them. What the fuck is going on? The bottom line is that healthcare revolves around money and nurses are seen as a cost. The powers that be don't even really know what a nurse does or what they are responsible for. They don't understand the outcomes that patients have when there are too few nurses. To these guys nurses are just a part of a budget that needs to be reduced. An inexperienced nurse is cheaper. A foreign nurse who can't speak english is cheaper and more likely to take abuse and accept dangerous workloads because he/she doesn't understand the law.

I have so many sick patients and I'm so scared that I am often throwing up before work due to nerves. I am not the only one at my hospital who feels this way. We have so many patients we can't even remember all of their names and medical problems. The whole shift becomes a rat race trying to run from one task to the next with constant interruptions. I can easily be halfway through 18 jobs at any given time. Then the consultant shows up to do rounds and wants information from me on people who I haven't even seen. Haven't even been able learn about them. Forget about being able to look in their notes or spend any time with them at any point during your 15 hour shift. We are not nursing we are putting out fires all day. Ninety-nine percent of us want to do real nursing. Most of us working today trained in the "the good old days".

Sometimes people stop breathing at mealtime. Sometime post-op patients come back to the ward at mealtime. Sometimes patients have a seizure at mealtime. Sometimes 8 people need pain killers at mealtime. Lots of times all this happens all at once at mealtime. There is no one to feed my other 12 patients who are unable to feed themselves. I am then accused of "letting people starve because I can't be bothered with real nursing care". Had I let any of that stuff go and fed my patients first I would be in court real fast. We rarely have doctors on the wards as they don't have ward based doctors at my hospital so it's not like they can do CPR while I feed everyone.

We ask management to please allow us to have help at mealtime. They have literally (oh yes) responded with "piss off". No they are not running around trying to get nurses in because they care about patient care. Quite the opposite in fact. These bastards don't even understand the link between staffing and patient care. I'm sure our chief executive doesn't understand the difference between a nurse and a porter. They want to save money.

So so afraid someone will die because I can't be 10 places at once and I will be charged with manslaughter. This is not an unreasonable fear but a very valid one. This was confirmed for me after I spoke to the NMC and an attorney who was once a nurse. The people who refuse to send any staff will have no comeback and that is the truth. It makes me so angry.

I thought this article illustrates the point I am trying to make about working conditions and why nurses are NOW seen as less caring than they used to be. A british A&E nurse could have written this. My Turn: If ER Nurses Crash, Will Patients Follow? - Newsweek My Turn - MSNBC.com
http://www.msnbc.msn.com/id/4051448/

The point this guy is making is this:

More patients+ more patients with increasingly complex problems+less nurses due to intentional short staffing = horrible care and nurses getting a bad reputation. They get verbally and physically abused. They become burned out. We are losing more bedside nurses to this than anything. Would an abused wife stay in a marriage where her husbands beats her if someone offers her more money?

What would happen of all the burned out nurses who left the beside decided to come back and work? Would that fix the problem? Nope. The hospitals wouldn't hire them. They don't want them. They don't want the new grads either. There are no jobs in the UK and they are getting harder to find in the USA. It's just one big roaring nightmare and I don't know how to make these people listen.

You need bigger balls than Rambo to handle nursing these days

Saw this recently and thought it was great.

Here is a description of the guys:

Sang Kim RN Cardiac Telemetry Nurse Snowboarder

Terry Misener RN, PhD Dean, School of Nursing Retired Lieutenant Colonel, U.S. Army

Yuri Chavez RN, CRNA Nurse Anesthetist 2:54 LA Marathon

Roland Jomerson RN Post Anesthesia Recovery Nurse Decorated Vietnam Combat Medic and Retired Major, U.S. Army

Don Mucciprosso RN Poison Specialist Nurse Harley Rider

Walter Moore, Jr. RN Intensive Care Unit Nurse U.S. Navy Seal Team One

Bill Maddalena SN Student Nurse 3rd Degree Black Belt Kenpo

L. Rey Ariola RN Cardiology Nurse Rugby Right Prop

Jason Scott Carrick SN Student Nurse Basketball Power Forward

Why am I so Angry?

I am angry because the nursing profession has been destroyed. Nurses are working harder than ever in a rapidly changing environment. Changes in medicine and the way health care is delivered has tripled the workload of hospital nurses. Nurses are caring as well as hard working and we DO CARE about our patients.

The problem is that even the most wonderful, professional, hardworking and caring nurses in the world are not able to cope with their workloads. On average a nurse spends less than 15 minutes with each patient during her 12-14 hour shift. Yet he/she is working so hard that they probably worked 14 hours without eating or even being able to pee. Not only is your nurse working 12-14 hours or more without being able to eat or pee but she is absolutely terrified. Nurse needs to be 10 places at once or someone will suffer or die and nurse gets into big trouble with the law. Patients and visitors want a one to one handmaiden with no concept of how many other patients a nurse has or what is going on with them. Nor do they understand the consequences of the nurse not prioritising correctly. Where are the managers in all this? They are intentionally short staffing the wards knowing full well that the public will take their anger out on the one nurse running her ass off between 30 patients.

Why is this happening? Hospital managers (whether you are in the USA or the UK) only care about money. They are INTENTIONALLY SHORT STAFFING THE WARDS. They are refusing the hire. They don't want to retain their nurses and love to see them burn out and quit. Good nurses are leaving the profession in droves because they are overwhelmed and frightened and cannot stand seeing their patients suffer. I am going to use this blog to focus on these issues. The managers need to be dealt with and the public needs a reality check and they also need to understand what is really going on.

I will start off with asking anyone who has bothered to read this far to look at this petition.

http://petitions.pm.gov.uk/nurseratios/

"A growing body of research evidence shows that increases in the number of patients cared for by each nurse leads to increases in hospital-acquired infections, pressure ulcers, malnutrition, dehydration and patient mortality. This also leads to increased levels of stress, demoralisation and "burn-out" among nurses. We therefore feel it is vital to tackle the understaffing of hospital wards. The government should set statutory minimum nurse: patient ratios, with penalties for NHS Trusts that fail to achieve these ratios."

Having set standards regarding staffing not only saves patients lives and reduces complications but it also saves money. Hospitals that have done this have seen their number of complaints plummet. Complaints are a huge expense for the NHS and all hospitals. Hospitals that have implemented this program have also seen their medication and other error rates dramatically decrease. They save more money by having more registered nurses on the wards. Study after study has shown that intentional short staffing by managers is not only dangerous but really very expensive. Registered nurses do make a difference. The managers want as few of them on the wards that they feel they can get away with in order to try and meet their budgets and save money. Having too few nurses around actually has the opposite effect.





Nurses and researchers have known for years that we are not short of qualified nurses...we are short of nurses who are willing to work in hospitals due to the insane and dangerous conditions. These conditions cause nurses to feel overwhelmed and leave. It destroys their health. We train more nurses but we cannot retain them at the bedside due to overwhelming, chaotic and dangerous working conditions. Set nurse patient ratios will allow hardworking nurses to do their jobs and keep nurses nursing. Employing more bedside registered nurses leads to a reduction in expensive patient complications as well as complaints and also saves big money. An astonishing number of qualified British nurses no where near retirement age leave the profession every year due to impossible workloads and increased liability.

If you need to know more and want to see stats and research done on this very subject look here and scroll down: http://www.nursingadvocacy.org/faq/short-staffed.html . If you don't look at this research you probably won't understand what the hell I am on about in this blog.


Nurse are not to posh to wash or too clever to care. We are overloaded and forced to make some really tough deciscions about which one of our multiple patients (who ALL need help now )gets care. Making the wrong decision lands your arse in court and kills someone. Meanwhile all of the "support staff" who have no liability hang around at the nurses station dressed in uniforms nearly identical to ours. That isn't to say that we don't have some excellent support staff that have a very difficult job. My big concern is that the patients/visitors don't know who is who. But that is a whole different topic.

The media and the politicians are abusing and devaluing both doctors and nurses. Yet the doctors are so close minded that they believe that they are the only ones who are the victims of this smear/spin campaign by the powers that be. Doctors jump on the "nurses leave people to lie in their on shit and starve because they don't care" bandwagon just as much as everyone else does. I can forgive the journalists/politicians/and joe public for not having a clue and being ignorant about what's going on with nursing care....but I can't find it in my heart to forgive the doctors. They should know better.

I am also a bit annoyed with former nurses who left the profession in 1982 and haven't been in a hospital since that time who are slagging off the younger nurses. They understand the situation like my hamster understands algebra. It's reality check time. Things are not always as they appear folks.

Off to work.

Nurse Anne.