Rambling on About Care in the Community and bed blocking.

Have you heard about the care in the community shit?

There are no beds in hospital. There is no staff in hospital. The Burger King down the road is staffed better than my ward and that is the truth. There are not enough places in the community and/or nursing homes to care for people. Meanwhile 80% of new nursing grads cannot find jobs and money is getting pissed away on luncheons so that the managers can have another meeting to plan another meeting and never take any action.

I work on a ward that is primarily medical and we take a lot of exacerbation COPD patients. Many of these patients are anxious and cannot deal with the fact that their nurse has other patients who may be sicker. I would feel the same way if I had copd and was struggling to breathe.

They are often on the call bell every 30 seconds for reassurance etc. Many of them are elderly and can barely manage to get out of bed onto the commode without help.


They want to "care" for these people in the community. They cannot even care for them in the hospital. They come in. They get ignored by overwhelmed nursing staff whose heart is the in the right place but cannot do their jobs. They deteriorate.

But home care is not the answer, because it will be managed badly like everything else and their is a higher chance of the ball getting dropped. The hospitals should hire some of the 80% of nursing graduates who cannot find jobs and care for these people in hospital. The matrons and the "specialist nurses" who spend their days drinking tea and coming up with retarded 20 page forms for the bedside nurses to fill in should get their asses to the wards and give a hand. I have a hard time referring to our so called leadership as "nurses". They don't deserve the title.


I don't see how any of our patients could manage at home for any length of time. Even when they are declared medically stable they are still dependent. They would all need one to one community nurses. Hospital care is bad and often leaves these people with more problems BUT this situation is fixable.


At the moment 80% of our patients are medically stable but unable to care for themselves at home. WE have a lot of elderly folks around here and no elderly beds and too few nursing homes. The hospital picks up the slack.

Many many many of my patients have been there for months and months. We have some who are waiting for beds in nursing homes, some who are waiting for care packages to be sorted for at home care, most who are unable to walk thanks to being left in a chair with no moblization because their nurse is so overwhelmed. They have family that won't or can't provide care and yet refuse help from social services. We have these people for months on end and there is no answer.

We have one patient who has been with us for 6 months. It was determined that she couldnt go home and needed nursing home care. She and her daughter picked out a nice one with help from social services. She had a bed at a nursing home near her daughter. She really wanted to go to that nursing home and sat in the hospital for 3 months waiting for a bed at this facility. I shit you not.

The day before she was to go there she told her daughter that she changed her mind and wanted to go to another nursing home. Daughter cancelled the nursing home bed and then came and told us (nursing staff)about an hour before she was to go. A surgical admit was slated to come into that bed in the afternoon. I shit you not.

It will be another 2 weeks before the new nursing home will come to assess her, and then we can find out if they will accept her. Then she will wait for a bed. Social services want the nurses to fill in another 20 page nursing assessment form again that is complete bollocks. No one will have time on any shift to do this. I am sure she will be with us another month AT LEAST. It may very well be a lot longer.

Then she gets angry when we have acutely ill patients and she gets less attention. The patient in the bed across from her arrested and whilst we were doing CPR she was overheard complaining that she has been at our hospital for months and never received that kind of attention. Makes me go grrrrr. This is not one unusual patient. This is 40-60% of our patients at any given time.

Some do get discharged home without adequate care in place because they want to create free beds. 72 hours later they are back in casualty with dehydration and a fractured neck of femur.

http://news.bbc.co.uk/1/hi/health/7075381.stm
Meanwhile I could get the accident and emergency staff brought up on harassment charges for ringing every 30 seconds making threats. I don't blame them really. It's their ass if their patients breech the 4 hour rule. And it is all completely out of their control.


So we are getting constant bullying harrassment phonecalls from accident and emergency and the bed manager ordering us to "get people the hell out" because patients are breaching the 4 hour waiting times in Accident and Emergency and there are no beds. There are so many more patients coming to the hospital than they can deal with. We have a side room where the roof is leaking and tiles are caving in due to flooding and I was ordered to put a patient in there.

I have recieved a phone call at 0200 that a bed has become free in an outlying hospital and to pick a patient and get them transferred out there NOW because we are breaching. Why are we nursing targets and not patients? Not one of my patients are going to be happy about woken up at 0200 and transferred god knows where. I was threatened and told that if I don't walk away from what I am doing (never mind the 50 year old patient who has just suddenly developed expressive dysphagia and numbness and weakness on one side and I am trying to get a doctor up and I am the only nurse) that I will be disciplined.

And their relatives are going to fly into a rage about grandpa being woken up at 0200and getting shipped out to god knows where. They will chew out the nurses that's for sure.

I focused on the poorly patient first rather than deal with the transfer. I'll get busted for that you know. I was the only nurse and I couldn't leave the unwell patient to sort a transfer (transport, informing relatives who will go ballistic etc etc etc).

It is the same damn problem in every post I make.

Handover Fun

One day I was the only registered nurse for 18 patients (worse than normal number of 15) for all of my shift from 0730 until 2130 hours. At 2100 my relief comes in. She has been off duty for a week and does not know the patients. She is a newish pool nurse. I need to give her a detailed report on each and every patient. She will be in charge of their care on night shift. Even if I only spend 2 minutes per patient during the report session, handover will still take 36 minutes. But two minutes per patient will not even scratch the surface in telling her everything she needs to know and handover to the day staff so they know. Three of the patients are acutely ill right now and have some really complex things going on. Most of them have relevant past medical histories that would take longer than 2 minutes to handover.

I had an admission at 2100 so I start handing over at 2115. The oncoming nurse cannot touch a patient until she gets report and knows about them. Doing that is begging for litigation. We really need to get started with this handover.

2115 hours
I start handing over at 2115, at 2116 a patient requests pain meds so I administer them, on the way back to handover a patient requests the commode so I help her with that. Phone call comes in from lab that new admit has an HB of 6. Eek. Call doctor. He orders a group and save...to have blood tonight etc etc. It will take a lot of time in itself between getting the blood from path lab, setting it up, moniter for transfusion reactions etc.

2130 hours
take patient off the commode and settle her into bed. She asks for a drink, my HCA's are tied up with a confused patient so I get this lady her drink. Can't handle complaints from patients saying that the nurse couldn't even be bothered to get someone a cuppa.

2135 hours
back to handover room. I was halfway through the first patient so I continue. I am in here and there is no RN to care for my patients whilst I am handing over.

2136 hours

phone rings. Angry relative wanting to know if the nurses "bothered" to change mum's nightgown today. He gets nasty. He obviously is in a bad mood and wants to kick out. Probably a regular reader of The Times who thinks there are lots of nurses up here eating the patients food and discussing politics since we are too academic now to wash and don't care about patients.

2138 hours
back to handover. we tick on nicely until...

2145 hours

I realise that patient who has an infusion of IV insulin is way over due to have her sugar checked. This is not something you can put off until later. It will need checking again in an hour. HCA's are still tied up so I do the BM. She asks for commode while I am there. I am useless at saying no.

2150 hours

back to handover.

2200 hours
I am just in the middle of telling on coming nurse what we need to do for a patient that has a drip with a med that she has never seen before....explain what we need to watch for, labs that are getting drawn in the night that she needs to stay on top of...

Visitor (who shouldn't be there at this time but has special permission) bursts into handover room. Demands that I get up off my ass and clean his mother up.

I am concerned with time at this point as it is way past the time that the night nurse should have started her assesments and drug rounds. Lateness could fuck things up royally for these 18 patients. 9PM meds have not been started yet. I see the HCA getting someone a pillow. I point her out to the visitor and say that I'm sorry cannot help you now...can you ask that young lady over there. He tells me that he didn't ask her because "that nurse looks busy meanwhile you nurses are sitting in here chatting" I resist the urge to punch his ignorant face.

2205 hours
It takes less time to sort out patient than to argue and explain to the visitor why I can't so I go to help her with assistance of oncoming nurse. It takes 5 minutes to clean her up and 20 minutes listening to the visitor and patient tell us what useless slags we are for not being at her bedside all the time, all shift. Arguing back is pointless.

2230
Back to handover. Ten call bells are ringing throughout the rest of handover. This is more than 2 HCA's can handle. If we go out there we will never get through this. Ever. Things are getting desperate now. I fly through the rest and say a silent prayer that I am not forgeting anything critical.

Phone call from patient's cousin who wants to know the ins and out of everything we are doing for his loved one. I have no choice but to be abrupt with him.

2250
I finish handover and realize that the hourly blood sugar check for the IV insulin patient is a little overdue as well as 100 other such things. I go to check it so night nurse can get started. Get stopped for 3 commodes on the way back to nurses station. The night nurse and HCA are tied up. One patient starts telling me off as she has been ringing for 15 minutes and asked why we couldn't be bothered to see to her.

Path lab has blood ready. That was fast.

2320

Head Home. I have been here since 0715 this morning and have been unpaid since 2130. I WILL be deducted on hours pay for lunch breaks I didn't have. Phone call comes in. I let night nurse get it. It is a relative screaming because their loved one was left to starve yesterday. Patient was NBM for an operation. Don't these people have anything better to do at this time of night other than stopping nurses from seeing their patients and interrupting them whenever they try to hand over critical info to the oncoming shift? WTF? During the day the phone never stops ringing due to this shit. At least there are less calls at this time.

I am going home. I am tired. Fuck the paperwork I haven't done. They can pull my registration for all I care at this point.

0400 hours

Wake up to see what why my baby is crying and it suddenly occurs to me that I forgot to tell oncoming nurse about a patient who should be NBM from midnight for a FBS test in the AM. Call work since she probably won't have time to look at the charts causing the patient to get breakfast. I am not the only nurse who calls in the middle of the night with this kind of stuff. There is way too much info to keep track up and no time to stop and review and take stock. At least this was relatively minor.

How different would things be if there was at least one other RN on duty with me to cover problems while I was handing over? You should see what it is like when we are one RN to 35. There was another RN on duty on the ward but she was even busier with her 18 patients. I don't know what time she got out. Her patients were on the other end and we didn't really see eachother.

A Journalist Gets It Right (and he's not from the UK)

He is an Editor turned Nurse turned Editor from the Wall Street Journal. This is a huge Newspaper in the US.

http://online.wsj.com/article_email/SB117738203850080018-lMyQjAxMDE3NzI3NTMyODUyWj.html

This is the kind of stuff we need to see from British Journalists. Here are some excerpts.

"In 2002, at age 40, I left my job as a page-one editor at The Wall Street Journal, my professional home of 15 years, to take a giant leap of faith -- in myself. Like a lot of people, I questioned my purpose after Sept. 11, 2001. Jolted from the complacency of a comfortable career, I became convinced that I could achieve selfish fulfillment through devotion to service -- to the individual, to the community, to the vulnerable.

I considered teaching. I considered law, medicine, pure science and research. But my thinking always returned to the nurses I had watched care for my mother a few years earlier, when she lay in an intensive-care unit in her final illness. I marveled at the way they melded an aloof, precise professionalism with a mysterious human (and humane) instinct. They seemed to operate in a purer space, beyond worldly distractions. I would be a nurse."

And



"My skills were those of any new nurse. With easily shattered confidence, I could start an IV, administer medications, bathe a bed-bound patient and change linens, change dressings, insert all sorts of catheters and tubes, read lab results and electrocardiograms. I knew to be vigilant against infection, pneumonia, pressure ulcers, medication errors and the many other lurking threats to hospital patients. On the burn unit, pain control loomed large. I also knew, as both executor of treatment plans and patient advocate, to keep a close eye on what doctors ordered. They make mistakes, too.

But in those first months, I felt stupid and slow, and thus dangerous. I hadn't yet mastered the ruthless efficiency of thought and motion that lent veteran nurses the appearance, at least, of enviable ease. Next to my crazed back-and-forthing, they floated around the unit, maintaining a cool composure no matter what crisis erupted.

The night began with the shift change, from 7:30 to 8. "The arrival of the replacement killers," as one nurse liked to put it. We straggled in, one by one, from the locker room to the nurses' station, crowding around the assignment sheet, groggy from unsatisfying daytime sleep.

Assignments were subject to wide variations. Typically, a critical but stable patient, often on mechanical ventilation, came with a second and even a third patient, in less serious condition, perhaps even a "walkie-talkie" -- alert, oriented and ambulatory, in clinical nurse-speak. If the rooms were spaced apart, I could look forward to spending 12 hours trotting like Edith Bunker back and forth across the unit, from patient room, to med room, to supply room, to another patient's room, to supply, back to the first patient's room, and on and on.

Already thin, I lost weight as a nurse.

Shift change was a noisy time, as day nurses, relieved to be relieved, gave "report" to the night nurses. I was anxious during report. For my patients' sake, I couldn't miss details -- "He may try to yank out his feeding tube," "You may need to bump up the sedation" -- but I was already parceling out the time. Second hands relentlessly swept the clocks mocking me from the walls.

Basic nursing duties were enough to keep me on my feet until dawn: initial head-to-toe physical assessments; hourly vital signs and other monitoring tasks; medications; bed baths and dressing changes; regular suctioning. First thing, I reviewed my patients' charts, checking for any outstanding physician orders that might devour precious minutes -- a blood draw for early lab work, perhaps, or an order to start tube feedings, or, as encountered one night, hourly enemas.

There could be no skimping, no coasting through a shift because of a headache or trouble at home. For 12 hours, I belonged to people whose survival was at stake. A sloppy physical assessment could later explode in disaster if a potential problem -- a bum IV, an incipient pressure ulcer, abnormal lung sounds -- went unnoticed. Rooms required meticulous inspection, too, to ensure that vital equipment was present and functioning: A missing bag mask -- attached to those blue vinyl footballs you see TV doctors and nurses rhythmically squeezing in emergencies -- could cause lethal delays.

Then came 9 o'clock medications -- for me in my early days, 9:15ish at best. Patients received as many as a dozen medications at once: injections, IV infusions and pills, either swallowed or crushed in mortar and pestle, dissolved in water and squirted down a feeding tube with liquid meds. Ointments applied, eye drops administered. For one patient, I could spend 30 minutes just gathering it all together and double-checking it for safety.

Burn care was a nightly abyss to be crossed with every patient. It was a big, messy, smelly job that demanded painstaking attention to detail. We usually helped each other or enlisted a patient-care technician -- the latter a negotiating tactic I began to cultivate after that night working alone without the lubricated mesh I needed. We had to work fast because burns impair the body's ability to regulate temperature; exposure can cause life-threatening hypothermia. And simply moving and turning a patient can cause blood pressure to soar or the heart to jump into a dangerous rhythm.

These were the basic functions, and on an uneventful night, I could just manage them -- the tasks themselves, and the documentation of them. If it isn't documented, the saying goes, it wasn't done.

I wanted to hover over my charges like a jealous hound, alert to the tiniest shifts in their biological function. I talked to my patients, to assess their mental status and their pain, to dispel their fears, to teach them about their conditions and treatments, and to learn details about their lives that might affect healing and recovery beyond the burn unit. But I felt hurried, with little time for the reassuring smile and comforting touch one sees on TV commercials that laud nursing as the caring profession.

Most nights, unexpected contingencies unwound the tight choreography of the shift, diagrammed in hourly increments in the sprawling spreadsheets of patients' charts. I lurched from one task to the next, fulfilling all requirements, but little more.

For a while, the electronic thermometers we used were in short supply, and the shift started with a mad dash to nab one. We made a joke of it, but behind the laughs, I heard the clock ticking. Infection control slows down all movement: Hands must be washed before and after every contact with a patient, and fresh gown and gloves donned every time one enters a patient room, to be discarded when exiting. A thermometer or any other piece of equipment moved from one room to another must be cleaned, too.

Often, it seemed, I came on shift to discover a clogged feeding tube. I had to pull the tube, insert a new one (in the nose, down the esophagus), and then wait for X-ray confirmation of correct placement in the patient's stomach before feeding could resume.

An order for bedside dialysis for a patient in acute kidney failure entailed mastering a contraption that looked like a prop from "Lost in Space" -- a big beige metal box on wheels, with knobby green and red lights flashing, rotors whirring, alarms buzzing. It came with printed instructions. Even so, obtaining the necessary solutions from pharmacy, priming the machine, attaching it to the patient and getting it running took a couple of hours, and then a lot of catching up.

A medication missing from the med room could prompt a trip down dark corridors to the pharmacy and back. Blood sent to the lab went bad before it could be tested, requiring a second draw. Dressing supplies ran out, calling for creative solutions. Patients being taken out of deep sedation yanked out their feeding tubes and IVs and fretted with their dressings. A fire in the city could yield new admissions, to be parceled out among us. And of course, infection or shock or some other problem could turn a stable patient into an emergency.

Regardless of the job at hand, my mind raced through the list of others awaiting my attention, convinced that my own feelings of being overwhelmed compromised my patients' well-being. Twelve hours weren't enough. I finished my shifts breathless, and delivered to the day nurses confused, fractured reports before hopping a train home in the morning rush hour.

So it went for the first six or seven months of my nursing career. The 12-hour frenzies, worry about my patients and paltry sleep bred chronic fatigue. I was often in a fog: At home, I spooned coffee into my cat's food bowl, and mistook toothpaste for shampoo. One afternoon, I leaped out of bed, showered, dressed and noticed only as I was heading out the door that it was 10:00 a.m. I had been asleep an hour, and didn't have to be at work for another nine. A deep ache gnawed at my lower back. My feet felt like ragged stumps. I fell asleep in chairs, on subway trains, in taxis, at movies, at supper tables."

If you click on the link there is even more good stuff. He talks about how having one patient who requires your constant presence at the bedside causes your other patients to suffer and be at risk and there is not a damn thing you can do about it.

This guy was on a burn unit with a small number of patients. I wonder how he would function in the NHS where the nurse to patient ratios cause the battle to be lost long before we come on duty.

Ladies and Gentlemen: We found a journalist who is not a learning disabled ,lying, incompetent pig. It is a special day.

Yet More Shit from the Times

Okay Nurses (and everyone else) this is a call to arms. This is war. I hope that everyone reading this sends The Times a letter. I have sent a few comments in. I hate liars. The Times is officially on my shit list now.

Here is another shining example of Journalism.

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article2708912.ece?Submitted=true


1. ITU nurses take better care of their patients than ward nurses because they are paid more and care more. WTF?

2. ITU nurses are so superior that they never have patients starving or lying in their own filth.

Not one statement is made of the fact that an ITU has one patient and mega back up and a ward nurse has anywhere from 10-35 patients with NO backup.

Not once is it mentioned that patients on the wards now would have been in ITU a few short years ago. Patients are more sick and more complicated today while staffing levels are falling dramatically.

This is like some kind of nightmare. We are never going to get our wards safely staffed if this is how people think.

The Times Dishes Up More Bullshit

http://www.timesonline.co.uk/tol/life_and_style/career_and_jobs/public_sector/article2662714.ece

Let's take this pile of shit apart piece by piece.

Nurses dish up nil by mouth

NOT ONLY are they too posh to wash, but today’s nurses are too posh for nosh. “I don’t do food,” says one nurse in Nursing Standard (Oct 10).


Even if this quote is true it is likely presented out of context. My years of experience tell me that this kind of attitude is no where near the majority. Most hospital nurses I work with would go medieval on a nurse that stated that she "let's patient starve". Is that even what she really said? Did she mean that she is responsible for the drug round at tea-time (as the only RN) and getting meds out late because she spent 4 hours feeding 20 people would land her a disciplinary? Or did she mean she intentionally lets people starve because she is crap? If that is the case and she is in the minority. I need to hunt up that edition of Nursing Standard and look at it in context. I don't do food either in my double shifts...as in I DON'T EAT.

Hospital caterers claim that there has been a shift in attitudes since nurse education moved into universities. Nurses now believe that serving meals and helping patients to eat is beneath them.

Oh Pray tell me what a hospital caterer knows about what is happening on our wards? I have never. ever. once.ever seen a caterer spend any amount of time on the wards. Never. What would they know about staffing levels, patient acuity, nurse accountability, the situation with the patients at mealtime? They know fuck all. I'd like to see them manage to give 20 IV meds due in the next 30 minutes (due or else there is hell to pay) and cater at the same time. What the hell kind of a source is a hospital caterer? Unless he sat in at handover and knows the score with patient acuity and staffing he is useless as a source. I love to feed people (it's a chance to sit down for the first time in so many long hours) but if someone is having chest pain I won't leave his nitro,obs,ecg transfer to CCU until 4 hours later when I am done feeding all those that need feeding. How would a caterer even begin to understand this?

“Florence Nightingale was happy to wash and feed patients and make them feel comfortable, but today’s nurses think that because they have a degree they do not have to do the basics,” says one manager in Dorset, who heard a senior nurse say: “I am paid too much to feed patients.”

In Florence's day there was no such thing as IV cardiac meds on titration, insulin drips, chest tubes, vents, cardiac arrests that were actually dealt with, bloods, critical lab results that must be reported, drug rounds, prep for theatre, extensive post op care, bladder irrigation, blood pressures to check regularly to deal with dangerous readings, ECG's to get when someone has an MI, equipment failures, IV pumps beeping that need trouble-shooting or else meds don't get infused, anaphylactic reactions to meds weren't deal with as they weren't understood so those folks just died, no blood transfusions with Frusemide to give whilst monitoring for heart failure etc. etc. etc.

People in her day died horrifically due to the lack of these things. Maybe we should return to that way of delivering care and I can happily and stress free spend my days bathing people. Sounds good to me. There is no love lost between me and florence. She hired convicts and prostitutes as nurses and they didn't want to be there. She had to be medieval to keep them there. This set the stage for people's attitudes towards nurses. Criminals who need to be kept in line.

Oh and you heard a senior nurse say what? What the hell kind of pre-school journalism is this? Someone heard someone say? A manager heard this? Probably the same kind of manager who kills people by short staffing wards and is looking to deflect the blame. What the hell kind of a source is "I Heard". I had a Medill graduate as a teacher of journalism in college and was the editor in chief of my college newspaper. "I heard" as a source would have landed us in hot water. I can see the veins popping out on Mr.Parrone's head as we speak. That was college journalism for christs sake. If she said that than she is a twit but certainly not a spokesperson for nurses.

“Nurses believe serving meals is not part of their job � it is beneath them,” adds a Berkshire-based caterer.

Bullshit. Another caterer who doesn't know shit jumps into the ring. Are these guys for real? I can say with all honesty that this is not the view of the majority of nurses. In would love to have protected meal times so I could feed my patients in peace. Nurses at my hospitals are fighting for protected mealtimes. I cannot stop docs from showing up to do ward rounds at mealtime. I cannot stop people from crashing at mealtime. I cannot stop phone calls from relatives at mealtime. I cannot stop call bells from ringing at mealtime. I can't make the important drugs that are due at mealtime go away. Even if I could, it would be nearly impossible to feed the sheer number of patients who need it, with only 3 of us. I can't make management give us more staff.

Public sector jobs
The attitudes were revealed in a survey carried about by the Hospital Caterers Association. Neil Watson-Jones, chair of the association, says: “I would like to see a return to basics. Care is about more than a clinical intervention. It is also about making the patient journey more comfortable.”

No shit Sherlock. We are very well aware of how the basics and comfort promotes healing. That's why we are fighting this fight Einstein. We want our patients to be comfortable and we want to provide basic care.

Peter Carter, the Royal College of Nursing general secretary, agrees that the switch from on-the-job training to classroom tuition may have gone too far.

“The lurch from the apprenticeship model to the academic model was far too great,” he says. “Nursing is the sort of occupation that primarily you have to learn in the work setting. There is no substitute for experiencing hands-on patient care.”

Oh dear me Peter. You have been missing in action as a bedside nurse for too many years. Research is showing that patients have a higher survival rate in hospitals that have a higher ratio of degree nurses. What everyone knows is that we need is a combination of academic theory and rigorous on the job experience. Student nurses will not survive unless we have both of these elements in nursing education. They need a gruelling mix of both to be top notch. But who wants to go through that just to get abuse? The vast majority of nurses nursing in hospital now are PRE PROJECT 2000.

There is also a concern that a softly-softly culture has developed in the NHS, putting staff before patients. Modern matrons who need to discipline nurses have to talk to them in a nice, soft voice, says Harriet Sergeant, a fellow of the Centre for Policy Studies, they can’t just bawl out sub-standard nurses.

Our matrons won't come anywhere near the liability minefield wards. They run from the ward nurses as they know they are letting us down. They know we are pissed off. One of them put her damn hand on my shoulder the other day and said "we all feel so bad for you guys as we know it is impossible down there" I gave her the look of death. Same matron came onto the ward to work once and left after 2 hours because it was "too much for her". I have seen them bawl people out, usually to save their own butts.

I'd like to see the Times actually interview bedside nurses. I am sure that they would interview over 50,000 of them until they found one stupid young pre-nursing student who says "I don't wanna wash". That is who they would quote whilst the quotes from the other 50,000 go to the shredder. They have to stick with their agenda you know. We can't have the truth get out can we? Too many powerful people would be in deep wouldn't they?

British Press: It's Nurse Bashing Month

Oh my god! The Times has sent my BS meter into the red!! Oh wait I'm not surprised.

If I don't vent out my true feelings on here and act all petulant my head will explode. So I decided to write this post out. The incident in Maidstone has unleashed a tirade of misinformed and unethical editorials in the papers. Ladies and Gentlemen it is Nurse Bashing month. I am starting to wonder if some of these so called journalists are paid to try and shift the blame away from the powers that be.

British Journalists seem to greatly enjoy writing abusive editorials regarding nurses without doing a lick of research first. The maidstone incident (which is only the tip of the iceberg in my opinion) seems to have kicked off Nurse Bashing Month in the British Papers. These journalists do not speak to nurses who are currently working at the bedside. If they talk to a nurse at all they will stick to speaking to nurses who retired 30 years ago and don't know what is currently going on. These journalists do not know what a nurse is, how much accountability and life and death responsibility nurses have or how overwhelmed they are with acutely ill patients.

They understand NOTHING about what is happening in our hospitals, and they can't be bothered to do any research and find out. I bet they don't even know how much liability nurses have and the consequences that exist for not prioritizing properly.

It's not like journalists have a job that involves massive amounts of chaos and responsibility and can empathise with us in any way. Let's throw a few nasty childish generalizations their way shall we?

As a matter of fact they probably don't speak to anyone or do any kind of research before they write these worst examples of journalism I ever saw editorials. At the very most their research probably consisted of talking to a friend of a friend who once saw an secretary gossiping at the nurses station with the occupational therapist and decided to run around saying that nurses spend their days sat at the nurses station. Remember that these people cannot tell who is a nurse and who isn't.

Things are so bad at the minute that if I took any kind of time out during my 8 or 12 or 15 hour shift to clean loos and wash windows my patients could be hurt so badly that I could be looking at the loss of my registration. It shouldn't be that way and did not used to be that way. It certainly wasn't like that for ward nurses of yesteryear. It is not that way everywhere yet but it is getting pretty damn close thanks to shithead managers, incompetent journalists and a misinformed public.

Yes the hospitals are filthy.

Mentally disabled journalists see this as "nurses don't feel like cleaning up and don't care about hygiene". Oh yes we fucking do. The ward is minging and it grosses me out to even work there. I would much rather spend the day cleaning, but someone else is going to have to take on responsibility and accountability for my patients first because otherwise I could end up hurting someone either by something simple like a missed med or something major like not noticing a change in condition. This is the position many of us are in every minute of our shifts.

Does it sound like I am exaggerating? Anyone reading this is welcome to spend a day shadowing a registered nurse on a short staffed acute medical surgical ward. Just say that you are thinking about nursing school and they'll let you follow a nurse for a day. Do it and make sure you follow him/her and learn as much as you can.

This is what I am upset about:

http://www.timesonline.co.uk/tol/comment/columnists/libby_purves/article2253546.ece

I agree with other nurses who have commented on this piece on allnurses that the author has obviously been out of the workplace for way too long and while she has a valid point re: the lack of cleanliness in UK hospitals, she is totally unaware of the pressures on the nurse working on the wards today. These twits have a lot of nerve writing about things they know nothing about. This one is from August.

And

http://www.timesonline.co.uk/tol/comment/columnists/minette_marrin/article2652761.ece
The Sunday Times. Their view of nurses:

1. We look like slags. You work for 12 hours nonstop and see how you look fucko.

2. We all earn over £30,000 a year. Um. Sure we do. If I got paid for all of the hours I work I might come close to that.

3. We don't actually do any nursing (especially cleaning), we just run around pretending to be junior doctors. I have enough life and death responsibility and problems without taking on theirs thank you very much.

4. We don't wash our hands. Yeah sure. Take me up on my offer to shadow a nurse for a day. Stick to her like glue and get into her shoes. See how impossible it becomes to wash your hands properly with all that is going on and the layout of the ward etc etc. We wash our hands as much as possible...which is not nearly enough and we couldn't do any better if you had a gun to our heads. Give me a smaller number of patients and a handwashing station nearby and you might see some results. I can't pee sometimes for 12 hours on some shifts.

5. We do not care what happens to our patients. We leave them to rot. Total fucking bullshit.

6. We don't care about cleanliness. Total fucking bullshit.

I had expected to read a well researched article. But as usual the fiction author who wrote it didn't bother to do any research at all. Do these assholes know that nulabour targets have led to managers freezing recruitment, that our nurse patient ratios on the wards are deadly, and that 80% of our new grad nurses cannot find jobs? Do they know that dead patients,infections, and bad outcomes increase for each additional patient a nurse has? Do.They.Shit.

This is completely unacceptable. These are just two examples of what I have seen too much of lately. These poorly written and researched articles misinform the public and shift the blame for what is happening onto the wrong people. This kind of journalism is what allows nhs managers and their henchmen to dangerously staff the wards and continue harming and killing patients with no comeback. I understand that most journalists probably have no understanding of responsibility or how to be truthful and do research.

They have no understanding of what it is like to have a job where you actually have to have knowledge and serious accountability. This lack of understanding is probably a requirement to do their jobs. They don't don't know what it is like to work in a chaotic environment being terrified that you'll make an error and kill someone. How could these underachieving fucktards write any kind of a decent factual article about nurses?

I am starting to think that they are all nothing but paid government shills, out to misrepresent nurses (doctors too) and shift the blame for all of the killing. That's right. I said killing. Maidstone is only the tip of the iceberg. Maybe I sound like a paranoid conspiracy theorist but my theory that they are all paid government shills makes more sense than the two editorials I posted.

Not all nurses are wonderful but the vast majority of bedside nurses are working hard and doing their best. If that wasn't the case this blog would be about how awful nurses are and how it affects patients rather than being centered around how short staffing kills people and affects the care nurses can provide.

I have seen a lot in my 12-13 years as a hospital nurse and have worked with many different nurses across the country, the world, and in all different kinds of specialties. I know what I am talking about. Remember this: Nurses today have twice the responsibility due to the momentous changes in health care that have occurred over the last 2 decades. Look at how the number of people on IV's has increased compared to the 1950's just as one tiny example. Nurses today choose to go into nursing despite the fact that they have other career choices. Nurses became nurses years ago because they had a choice between that and teaching. Many of them did NOT want to be nurses. See what I am getting at? The bottom line is that it doesn't matter how hardworking and caring a nurse is...if she has too many patients she is fucked and so are her patients.

Hygiene, nursing care, and patient safety have been destroyed by target and money obsessed managers who lack any kind of clinical knowledge. They are guilty of no less than murder. Journalists are their helpmates and accomplices by distorting information, misinforming the public and shifting the blame.

I want to see them all hang.

Fun on Night Shift.

Things I could do without on a Night Shift:

How about taking 20 phone calls from relatives at 0700 in the morning because they want to see what kind of night grandad had.

Do I sound like a total bitch?

This is at a time when there is no unit clerk on duty to answer the phone. The only phone this large ward has is pretty damn far from the bays where the patients are located. Great set- up huh?

It is only 30 minutes before I have to give report to the day staff and I have just had a cardiac arrest leading to a death 10 minutes ago (needed to inform the family and should lay him out, document and pack his belongings and clean the bed before day shift arrives).

Had an acute surgical admission arrive on the ward as the cardiac arrest was happening, a terrified LVF patient who is going bad and couldn't breathe and was in AF and needed multiple interventions and meds administered IV, a catheter for low output and fluid balance, and there is also all of the usual morning stuff do to like meds, multiple IV's due that need to be prepared and given etc etc. As usual this stuff is all happening simultaneously and I have to knock it all out in a ridiculously short amount of time and I am the only nurse. Oh. Shit.

There are 10 patients in wet beds and call bells ringing like mad at this time. Four of them were fall risks with dementia and were trying to climb over the side rails. There was only myself and a health care assistant for 20 patients. Couldn't get near the patients because of the phone calls. Trying to keep the LVF man from dying via lack of nursing intervention kept me at his bedside constantly. The doc can order the meds but if I don't give them at all and correctly and don't continually moniter the guy the shit will hit the fan. Should I leave him to deal with the wet beds and then go back to him? He might be dead by that time. I was worried about him, the acute surgical admit who was bleeding heavily and I can't see her from the LVF man's bed. I am worried about other 18 patients who all needed help, especially the 10 or 12 who are lying in their own filth. Others are ringing for pain meds. Leaving LVF man and bleeding out admission long enough to check out and draw up all those pain meds could be fatal. Shit. Shit. Shit.

So I blew off answering the phone and prioritized sorting the LVF guy, the acute surgical admission,and getting in touch with the dead man's family to tell them he was gone and remember to be gentle, calm, sympathetic and supportive even though I was nearly in tears myself. I hate making these phone calls. I would rather eat shit actually. This was an unexpected crash and death. Not pretty.

My HCA busted his ass trying to get to all the call bells, the wet beds, and finish morning observations on 20 people. He couldn't get around to them all himself. He spent most of his time keeping the fall risk dementia patients from landing on their heads. The patients were pissed off at him and complaining about how they were waiting so long and felt rushed when he finally got there. Then they didn't like the fact that he was a "male" "nurse" etc etc.

The phone was ringing non-stop and we blew it off. Felt bad because if my dad was in hospital I would be on the phone to his ward like a shot.

At 0730 I had to leave the floor to give report....rushed and incomplete. That is dangerous in itself. I ran through it quick as we really needed to get our asses back onto the floor pronto to the LVF man who was deteriorating. A bad report could lead to a chain of events that hurts a patient. None of this is good. The day nurses were sympathetic as we all have nights like this. I took over the night before from a nurse who had the evening shift from hell and many things were left undone. Everyone understands. We are a good team.

Can't wait to watch the complaints flood in from patients' relatives saying "I just rang to see how my loved one was and the evil nurses couldn't be bothered to answer the phone Friday morning....and granddad tells me he waited in a wet bed from 0630 until 0800!! Where is matron to whip these nurses into shape?" Um Er ...how about we ask where are the nurses? Oh that's right...they are looking for non-existent jobs.

What a lovely end to a 12 hour night shift. I was supposed to leave at 0800 and got out about 0930. No I won't get paid overtime. As a matter of fact I was off the clock and not getting paid from 0700 onwards as they deduct an hour for breaks we don't get. Getting out at 0930 was not bad considering. Sometimes night shifts are dead easy and sometimes they are like this. More of the latter I am afraid. 99% of them are more of the latter in this place.

I do love nursing but I could really do without all the simultaneous problems at the end of a long shift. That's just part of the job really but another five sets of hands would be nice.