The Mental Consultant

No he was not a psychiatric consultant. The man is just crazy.

He showed up when I was in the middle of ten other things and demanding that I attend his ward round one morning.

He had 8 patients on my ward and when we got to patient number 3 I heard the strangest clicking sound coming from across the ward. I looked over to see where the sound was coming from.

I saw a 30 something known epileptic patient having a massive seizure. If you have never seen something like this it is indeed scary. I have seen many and still find it tough. It has been awhile and I felt very scared and less than confident.

The clanking sound I heard was his teeth hitting the siderail as he was seizing. He also looked a bit blue.

His RN was all the way down the other end of the ward on the phone with abusive demanding relatives. There were 2 of us for 28 patients that day. I knew all about my 14 and the other RN had his 14 that I barely knew. I dropped the ward round consultant like a hot potato and ran over to the seizing patient. I was yelling for the HCA to grab this patients nurse as I needed 02 and some diazepam.

It was a long and violent seizure and he looked cyanosed. As I was trying to get him into a decent recovery position and get 02 set up the ward consultant comes running over throwing notes across the room and screams at me:

"How very dare you walk away from my ward round!!"

The patient was still seizing at this point. But it wasn't this particular consultants patient so I don't think he cared.

I just carried on with what I was doing. The consultant walked off in a rage. There was a little 96 year old lady who was walking by with a zimmer frame on her way to the toilet. She witnessed the whole thing and she is as sharp as a knife. As the consultant walked away she looked at him in disgust and said "what a twat, the god damned bastard".

Maybe you had to be there but her comment had me in stitches for the rest of the day. I am still laughing because she was so cute. I love old people.

Listen Up Lunatics: Well educated nurses care the most about basic nursing and hygiene needs!

And we are the best at delivering it. So there.

It is the old fashioned trained bunch that are running around with the protocal checklists. The degree educated nurses are younger and still finding their feet on the wards.

Let's look at my day between 8AM and 2PM.

When I come to work on a morning I will have anything from 12 to 20 patients as the only RN. A degree educated RN. The only help I have is the health care assistant (HCA).

I have 2 drug rounds to do. One before 0900 and one before 1300. The first one takes about 2 hours if I am not interrupted by the phone. We have no ward clerk most days. The reality is that I am interrupted on an average of every 2 minutes and 30 seconds. I actually timed it. I start at 0800 after a 30 minute handover. I eye up the sickest patients first and then I start the first drug round.

The second drug round at 1300 only takes about 30 minutes if I am not interrupted. But constantly interrupted I am.

I will average about 9 or 10 patients on IV antibiotics/meds. Sometimes none. Sometimes all of them are on IV meds. Staffing is not adjusted. Only one nurse if you have 3 patients on IV meds and only one nurse if all 20 are on IV meds.

These IV antibiotics are due every 4-6 hours. Or 2, 3 or 4 times a day. They take about 15-20 +minutes EACH to set up, check, mix, and administer to the patient. Again, I am constantly interrupted. So imagine that I have 10 of them to give and it takes a conservative estimate of 10 minutes each to set up and delivery every 4-6 hours. The realise that I am not getting more than 3 minutes without an interruption.

Are you doing the maths so far?

If it is a weekday I will spend about 2 hours or so on the morning doing doctors rounds when he decides to show up and demands that I stop what I am doing right now and attend the round. My group of patients have 6 different consultants. There are many of them showing up and demanding that I stop what I am doing and listen in on their ward round all morning.

Phone calls from families and social workers etc takes 20 minutes out of every hour. This is an all day thing.

Then there is always the critical patient thrown in there for good measure who requires 101 interventions ordered by the doctor and required now. I may have one doctor throwing stat orders at me for this patient simultaneously while 2 others are standing there demanding that I drop what I am doing and go on their ward rounds for the other patients.

I get admissions and must do complex discharges during this time frame. The discharges are extremely time consuming.

There are dressings to do, lab tests to look up, and deteriorating patients. If I do not catch onto the deteriorating patient quickly I am in deep deep trouble. If I mess up or miss any of these jobs I am talking about there will be hell to pay. Hell to pay. it's not like years ago when you just got a bollocking from the sister and the harmed patient got swept under the carpet. Now it is bollocking, loss of registration and possible criminal negligance charges.

This is what goes on between 8 AM and 2PM.

I carry this all alone and it is hell. It is all encompassing and overwhelming.

The only help I have through all this is an HCA and the only thing she can do is bedbath and toilet and the majority of the morning she is off the ward escorting patients for tests because the departments don't want to have to deal with the patients.

It takes about 5 hours non stop to see that all morning hygiene needs for this group of patients as they are so dependent. That means it takes her 5 hours to get to the last patient. The HCA tackles this alone between escorts and answering the constantly ringing call bells.

I need to be helping the HCA with all the hygiene needs and basic care but who can help me with the overwhelming numbers of medications due, phone calls, nursing interventions, and doctors rounds? Who is going to give the stat IV amiodarone to the guy with the pulse of 190 while I am helping the HCA bedbath? No one. Because there isn't anyone else. The patient gets worse and maybe dies because he didn't get his amiodarone and I go to coventry.

Does anyone want to tell me how I could possibly attend to basic care on a morning like this?

If I cannot wash my patient myself I am missing out on assessing them properly and let me tell you: It is like working blind. So much gets missed. The HCA is in a hurry too and she washes them as if they were on an assembly line. She doesn't really take note of changes in condition nor does she know what to look for. Things get missed. Patients have better outcomes when they are recieving total care by a well educated ward nurse with less than 4-6 patients. It is not debatable. These staffing numbers in the UK are a sick fucking joke and are the one and only reason behind poor care on the wards. I have absolutely no choice but to delegate all the basic care to the HCA. No choice. I hate it. It is the only side of things she can help me with on this all encompassing workload from hell.

Sometimes one of my old fashioned trained colleagues is on duty instead of me as the only RN. She is still a ward nurse and not graduated to freak with a protocal level. It's not like they will ever pay both of us to be there at the same time caring for the same group of patients. She carries this same patient load all alone with only an HCA to help. She cannot get anyone washed or attend to hygeine needs any more than I can. I have barely scratched the surface of describing all the things that the RN has to carry alone ALONE ALONE FUCKING ALONE during that time frame. And they say that I am being lazy for not helping the HCA with the basic care. Who the fuck is going to help me with all the doctor rounds, IV's, phone calls etc?

Any suggestions about how I could do the basic care myself in a situation like this? I would like to hear from all the nutjobs and psychopaths who say that degree nurses do not care about basic nursing care first. Dignity revolution, I am talking to you.

And no, they are not going to give us more staff. And yes the IV's etc are the nurses legal responsibilty. I cannot just ditch them because I don't want to do them. The doctors will never again do them.

The patients of degree educated nurses are proven to have lower mortality rates. I believe that if we went back to old fashioned training for nurses that the ward staffing numbers would get much worse. It would give the managers a massive excuse to not staff the wards with qualified staff. As a matter of fact I know they would think like this. I'll explain in the next blog post. Been up all night.

Hell must have frozen over. They sent me a staff nurse!

But it was only for one shift.

I was the only trained for 25 medical patients and couldn't do it alone. She was from SCBU. SCBU is the special care baby unit or neonatal intensive care to our American friends. It was the only place the site manager could pull a staff nurse from. I had more than a few patients on controlled drugs and these drugs cannot be accessed without a second staff nurse. I needed an RN.

The woman hadn't done adult ward nursing since she trained in the Crimea.

So I gave her the three freaking out Alcohol detoxers, the violent mental health patient arguing with the bed (still waiting and waiting for days to see the mental health people, dumped in medicine meantime), the pancreatitis who couldn't get a bed in ITU, the COPDer who was going down the tubes and the wanderer with dementia*. Hey that's only a small group of patients! I took the other 18.

I'm just kidding. I took them all and put her to work with the 2 HCA's. At least she was there to do the controlled drugs with me. Nice woman anyway. There were 2 staff nurses and 2 HCA's with the addition of the nice SCBU nurse.

They got me all excited thinking that I was going to get a second staff nurse to take the other team of patients. Then I find out she was from SCBU. It felt like getting coal in my stocking on Christmas morning.

I guess this was preferable to me getting sent to SCBU. I'd run away from there screaming.

I got through the shift with my sense of humour intact. Lucky me it was only an 8 hour shift and I got out of there 10 hours after I started. The next day I took my kids to McDonalds for a very once in awhile treat. They think it is a treat, I think it's just gross.

It wasn't even McD's busiest time of the day and they had 9 freaking staff. Let me rephrase that: McD's had 9 fucking staff on. All at once. That is something that you will never ever see on a 25 bed medical ward, or even the 35 bed one. I nearly threw my diet coke across the room. I bet they don't leave new starters alone to run the place either.

Just needed to whine a bit. I have to hold it all in and smile pretty at work.

* patient details changed. Confidentiality has not been breeched.

Here Come the Kids: Part 2

Make no mistake about it. SOME trusts are using kids in place of trained, experienced staff. And our numbers are still bad. Most of our kids are youngsters. To me, a 17 year old is a child. Some kids are older and want to go into nursing someday but do not have the entry requirements for nursing school. This program would be a good one if it was managed properly. But once the kids are on the wards, the site managers (who are struggling to staff the hospital and have no choice) start floating staff away.

Went to work one day and there were 2 staff nurses, 2 HCA's and 3 kids on my 25+ bed medical ward. That is not enough anyway. Look at nurse patient ratio research. There should be no more than 1 nurse to 6 even with 100 untrained staff on. It is a fact. Even one to 6 would be a struggle. If I had only 4 that is 15 minutes per hour per patient. That is not enough time to do anything.

The site manager arrived on the ward at the beginning of the shift.

"Oh lookie lookie here, You have 3 kids on this shift" One nurse and one HCA are going to ward B upstairs"

Me: "WTF! That leaves us with one nurse, one HCA and 3 inexperienced kids who are not allowed to do anything!"

Site manager: "You have 3 extra sets of hands in the form of kids. Ward B has only one trained and once HCA on today." "I am so so sorry"

The Site manager actually looked sad. I don't think she had a choice. I backed down.

Ward B has 35 beds and their patients are much more acute than ours. I have worked on ward B and I was hurting for the nurse up there that day when I heard of her situation. She needed the other RN more than I did. I sent my staff over to her. The manager would have dragged them there herself if she had to anyway.

But this left 1 RN, 1 HCA, and 3 kids on my ward. Trained staff should never be outnumbered by untrained. Doing the AM drug round for 25 people would have taken until lunchtime (and it did).

The following stories did not all occur on the same shift.

Kid horror stories (Many details have been changed to protect confidentiality. There are medical patients up and down the UK in every single medical ward who fit these descriptions to a T. The patient conditions that I am describing could be the case for literally thousands of people all over the place. If you think you recognise a person or a situation you are dead wrong.)

And not all wards are this badly staffed. Some are well staffed with crap and some are short staffed with great nurses. Others are everywhere in between.

Horror story 1
Had a patient on nebulizers, not to have his inhalers as it was the same drug. Wife didn't understand this and didn't ask me. She brought in his inhalers thinking we were neglecting to medicate him and left them on his table. As a kid walked by the patient and wife asked for help with inhalers. Kid wanted to help out and started giving the bloke two puffs on his inhalers every hour. Patient assumed that since he was poorly he should have inhaler more and grabbed a kid (thinking she was a nurse) No one came to me (THE NURSE) and asked. The kid should have known better. She may not have known that inhalers should not be given every hour or on top of what he was already having. She should have known that they are not to touch any kind of medication. Can we say tachycardia etc?

Horror story 2
Kids are changing a patient's gown. They cannot get the IV line out of the gown in order to get a new one on. They are not allowed to disconnect it and don't know how anyway. Patient has history of CCF and his getting an infusion of saline with K+ because his frusemide dropped his K+. Kid has the bright idea to take the tubing out of the machine and wire the bag and line through the patients sleeve. Great idea except she forgot to close the clamp on the tubing. The whole bag started to infuse at way to fast a rate. Basically it bolused. The machine and the tubing we use in the machine should prevent this from occurring. They often fail. Patient is lucky to be alive. You do know what happens when you bolus a lot of fluid quickly into someone with ccf right? You also know what happens with a potassium(K) bolus right?

Horror story 3
Patient collapses and is admitted to hospital. Bradycardia is noted. Her digoxin levels were extremely high. She had been recently put on 250mcg. Digoxin was actually stopped on admission by the docs. Family and patient thinks that we are neglecting her by not giving her daily digoxin but just bitches about it instead of asking someone. It had been explained but sometimes it doesn't sink in. They are so busy being paranoid and focused on thinking that the nurses are neglecting them intentionally that they just do not take things in. Of course the real problem is that no one ever explains anything to them properly. That is the major factor.

They bring in her digoxin in from home. They leave the box of this drug on her table. Patient asks passing kid if kid will help her with her tablet as "My GP 2 years ago told me that I has to take my digoxawhatsits every single day and not one of these bloody hospital nurses have bothered even once in all the time I have been here".

Kid remembers that she is not allowed to dispense meds and is smart enough to refuse but leaves the tablets where the patient can get them and "forgets" to tell nurse. Kid doesn't even tell the patient that she is not a nurse and leaves the patient to think that she has been blown off once again. Patient was about to help herself to her "missed" doses on top of today's "missed" dose of 250mcg of digoxin whilst she still had a pulse of 45. By the grace of god I was walking by and saw her trying to get tablets of the box. By the grace of god. I think we all have guardian angels sometimes. I know I do.

Horror story 4 (more of a PIA than horror)
One patient was extremely extremely difficult even for the best doctors to cannulate. But she needed constant IV infusions of a medication. She didn't want a central line unless no one at all could get a peripheral line in. She was advised to have the central line but she was stubborn. But it was okay as long as we had a good peripheral line in. One doc got a really really good peripheral line in and we just needed it to last for 2 days at this point. We flushed it regularly. We bandaged it and we check it often because sometimes the dressings go funny or they get knocked.

But early in the evening I went to this patient to commence another infusion and investigate why the pump had not been beeping and the line wouldn't flush. The old bag was was hanging there but capped off and not attached to the patient? The pump was switched off WTF? How long has that been like that?

About 2 hours prior the transporters had shown up to take this patient for an xray. Only a kid was around. They cannot take a patient on a drip downstairs without a staff member escorting and staying down there until test is done and escort patient back to the ward. Kid had 3 people on commodes and couldn't go. She didn't know where I was (bandaging a leg in a side room) and she couldn't see anyone else. Kid and transporter have the bright idea to cap off the infusion so he can take the patient without an escort. No one fucking tells me. The transporter and the kid were both in a hurry. The drip should never have been stopped and the cannula needed flushing if the drip was stopped/capped off otherwise you lose the cannula and it becomes non functioning. Of course it wasn't flushed. I didn't even know the damn thing was taken off. So the cannula clotted off. That is why I could not flush it. Oh shit.

Number 5
Patient's daughter phones the ward and a kid answers. "My dad is going home today" (they always think this is the case even when it isn't). "When will he be ready".

"Oh he should be ready later, around lunchtime" says the kid. The kid assumed that the relative knew what she was talking about and kid also knew that we usually pull all the discharges together around lunchtime. No one mentions a thing to me. The patient was still on IV antibiotics and not even close to discharge. The consultant wasn't even due to see him until tomorrow and in the meantime we were continuing current treatment. So the daughter takes time off of work to come in a collect him at lunchtime only to be told that no one has mentioned a word about discharge. "But the nurse I spoke to this morning on the phone TOLD me blah blah blah." she screamed at me in a rage. I was in the middle of a drug round at this time and had to walk away from it and ignore the patients to search the doctors notes (couldn't find them and had to search forever) to see if maybe doc had come to see patient, changed IV's to orals, and discharged the guy without giving me a heads up. Of course he hadn't. Daughter was in a rage. At me of course.

Number 6
As usual I was running my tits off. I had a drug round do for 15 patients. I had blood to hang. I had someone in pain who needed a syringe driver (takes forever to set up in ward terms), I had another patient with a temp of 39 and no urine output. All at once. All of it needed sorting now or it is errors and write ups. And god knows what was going on with my other patients. Their fucking urine output could have stopped hours ago, their catheters could be disconnected and on the floor, they could be in distress or dead. Damned if I know. I can't even wade through the poorly patients and the interrupting visitors long enough to get down there. The other nurse was bringing a patient back from theatre and I was alone on the ward with 2 kids throughout this.

The kids were outnumbered by people crying for the commode. Kid Jane had just transferred Maude onto the commode. Maude is confused and old and she falls a lot. She is unable to walk unaided but forgets this. Sometimes we have to leave patients on the commode and move on because they asked for one at a time when we cannot stay there with them. But not Maude. Maude is a huge fall risk even in bed with both side rails up. If the kids had paid attention in handover they would know this.

Kid Jane just got Maude onto the commode when Kid Jennie shouted for help. She had tried singlehandedly to get Martha onto a commode. But Martha is obese and immobile and was too heavy so Jennie shouted for the only other help available. That was Kid Jane. But Maude wasn't done weeing. Jane left Maude on the commode and went to help Jennie and Martha. Maude ended up on the floor. Jane should have stayed with Maude and made Martha and Kid Jennie wait even though Martha was screaming at Kid Jennie and saying "If I wet myself it is all your fault, you little fucking cunt." Fat immobile Old ladies can use the anglo saxon let me tell you. Then tend to get like this anytime they do not get immediate one to one care. Kid Jane should have made Kid Jenny and Martha wait until Maude was finished.

An hour later the same thing happened again. The exact same thing. Maude ended up on the floor again. I got to explain to Maude's raging screaming son how his mother managed to end up on the floor twice in 1.5 hours. And while I was dealing with him who was sorting the deteriorating patients that I mentioned at the beginning of this, or getting to the others that no one had seen? Nobody. And in 1.5 hours I hadn't gone very far with sorting any of it out either. And Maude's son was like a bulldog who wouldn't let go. "I'll never forget that it was YOU who just couldn't be bothered with an old woman like mum and let her fall. I'll get you for this!" The next day Martha's family were screaming at the nurses because Martha told them that we were always making her wait for the commode. Like we have a choice. You've got to love these fucking people. I would have told them that lack of staffing, inexperienced kids, and Martha's demanding nature caused another patient to end up on the floor in a pile of piss.

I should add that Martha and Maude's beds were nearby and if one asked for the commode so did the other about 10 seconds later. As Martha needs 2 people and Maude needs one to transfer her to the commode and stay, and we only have 4 staff on the ward in total for 25 similiar patients, you can see why it's a problem. It's probably every 30 minutes or so that they want the commode. This is down to old age, weak bladders, and forgetfullness.

I could go on for pages. I am not even close to done. I'll try to fit it all into the next blog post if you want. These things are not once in awhile isolated incidents. The kids are all on my license as they are supposed to be (supervised) and I do not have eyes on the back of my head or xray vision or the ability to clone myself and be 10 places at once.

Here come the kids. God help us.

Yeah it just gets worse and worse and worse. The photo above pretty much depicts the only new staff members we have had over the last few years.

Once a upon a time there was some dickhead worthless manager with a large salary and too much time on his hands He had a determination to justify his existence and job title. So he came up with a plan to staff the wards in a cost effective way.

It is anything but cost effective. Costly and begging for a million pound lawsuit is a better way to describe this crap.

They actually started hiring ward staff at one point before now. But these people were not nurses or health care assistants (who at least have of a bit of a clue). What we got was something called cadets and trainees. Once upon a time I was bitching about health care assistants. Now I want my experienced health care assistants back.

On paper it looks good. Replace all the leaving HCA's and nurses with cadets and trainees. In some places they are called apprentices. They are on minimum wage and do not get shift differentials to work unsocial hours. The 16 year old kids are on less than minimum wage. They will be an extra set of hands on the wards. They will learn about nursing. The trust can get away with paying them less for a myriad of reasons. They are on less than a healthcare assistant. But it is an extra set of hands on the ward in a nurse's uniform. Hopefully someday they will want to go to nursing school.

The idea is supposed to be that (in the beginning of their career as nhs employees) these kids work along side knowledgeable staff and learn and help out. I am just going to refer to these people (apprentices, cadets, juniors, trainees) as kids since most of them are barely out of high school. They are completely untrained and have no prior experience in healthcare.

Occasionally we get a good one. You know what I mean. The ones who are aiming for medical school and nursing school and want to learn all they can are great. But even so they are still dangerous. This is not their fault. I'll explain why in a minute.

Others have no interest in nursing and just want a paycheck. Macdonalds would be much easier love. Some figure this out after about 2 weeks and leave.

Others cannot even spell their names, have no chance of getting into nursing school BUT think that they are already nurses simply because they have a job on the ward caring for patients.

Their confusion is understandable. First of all, their uniform is identical to a nurse's uniform except for one tiny little detail. They have a dark green stripe on the sleeve. Nurses have a light green stripe. The patients and relatives think that every woman in uniform on a ward caring for patients is a nurse and addresses all of them this way. God, does that piss me off. "Nurse" is my hard earned title. Most staff on the ward are nothing like a nurse and this includes healthcare assistants. Sob. I miss the healthcare assistants. I just want someone who knows what they are doing around. Now I have "kids" instead.

And not one of these "kids" has any idea of just what they are walking into. Not one. This job is a little different than selling ice cream cones like they did last summer.

The first few weeks that these untrained kids with no nursing knowledge and no understanding of consequences came onto the ward they were not supposed to be counted in with the staffing numbers. Instead they were supposed to shadow the existing staff and learn how to do the few things that they are actually allowed to do. They cannot even take observations or do blood sugars at this point. They certainly cannot fill in a fluid balance chart. If they know how to do it they certainly hide it well because they never fucking do it. Ever.

What happened on the very first day we had "the kids" starting on our ward (the very beginning of their orientation period)? That shift we had 2 nurses and 3 health care assistants. When the site manager saw that we had 2 new cadets on for that shift in addition to the 5 of us they immediately floated our 3 health care assistants somewhere else. That left only 2 registered nurses and two purple haired, tattooed brand new cadets.

They do this every fucking time we have someone new start. From the first day on the job when new staff are supposed to be on orientation and supernumerary the staff that is supposed to be training them is floated off the ward to cover extreme short staffing on another ward. They do this to new graduate nurses their first week on the job. They do this when we have student nurses on the wards. They float away some of the regular staff to cover dangerously short other wards because we have an extra set of hands in the form of nursing students. The nursing students spend all day running after call bells and never fucking learn anything.

When yours truly started as a brand new nhs staff nurse, having never worked in an NHS hospital before because I lived with my dad for awhile and trained abroad; I had 2 days being supernumerary and then on the 3rd day I was left in charge of the ward whilst my mentor was sent to cover sickness on the ward downstairs. New nurses should be on a 6 month preceptorship as new nurses. And please, none of this BS about how this is due to academic nurse training not preparing people. That has nothing to do with this.

The university trained nurses are getting plenty of time on the wards as student nurses. PLENTY. It is the quality of that time that is the problem. THE FUCKING QUALITY.

Almost immediately after the kids started we were finding that the experienced staff were outnumbered by the kids on most shifts. But they are still being paid as "apprentices". They were never trained properly to do the few things that they are allowed to do because they were never there in addition to a well staffed ward. If we had 2 staff nurses and 3 kids we were grateful. A fucking supercuts salon has more goddamn trained staff than that. And they only have to deal with one person at a time.

I said earlier that it was the idea that these kids would gain vocational experience and go on to nursing school later. Ha ha ha ha. They see the nurses getting screamed at, blamed for everything, working like dogs 14 hour shifts with no breaks while the kids themselves have multiple tea breaks and hide in the toilets on their mobiles. If I say anything to them management will get real upset with me for upsetting the cheap labour.

None of them want to be nurses anymore. If anything they have been talked out of it. Right now they get to prance around in nurse's uniforms, get addressed as "nurse" by the patients and visitors, all the while taking lots of breaks and not being accountable for any of their actions. They don't have a registration. Everything they do is on my registration. They are happy right where they are.

Our HCA's are becoming a thing of the past. The ones that are leaving are not being replaced by anything except kids. I feel like I am spending 99% of my time babysitting these new dangerous brats. At least the HCA's were goddamn trained to do their goddamn jobs.

That's cruel of me. There are a few of them who work hard and at one time wanted to continue into nursing. Many of them are doing way better than I would have done thrown into a ward like this at age 16.

But it is still a really fucked up situation. And all this time qualified nurses with years of experience who moved into the area are getting told "sorry, no jobs". That hopefully will change now that the Staffordshire story broke. We are holding our breath, desperate for a miracle and some trained staff.

I need to run now but I will do a blog post all about cadet horror stories and explain just how much this situation screws with patient care.

Ensuring that we have Compassionate nurses.

We need compassion in nursing. We need our patients to receive wonderful and dignified treatment.

But forcing ward nurses to take a ridiculously high number of patients, working 8-14 hours without a break in addition to massive amounts of unpaid time in a vain attempt to avoid being struck off hardens people. They become numb. Some nurses are just crap. Most are working themselves into an early grave trying to do their job well. The bad ones and the good ones are both working in insane conditions. Let's improve the conditions and weed out the crap.

This country is collectively mentally ill. We give nurses outrageous numbers of patients and expect one to one care. If she can't do it we call her lazy and uncaring. Sick sick sick.

If you want the nurse to be there every single time your loved one is wet, in pain, or needing his medications then you want one to one care. You don't want your nurse to have any other patients. This is not something he/she can control. Yet you say nothing when the wards are intentionally short staffed. You bitch about sloppy nursing care but want the nurse to take on insane numbers of patients in order to save you some money. You don't care if she works a 14 hour day with nothing to eat and that only allows for the bare minimum to get done. You complain about her and close your eyes to the situation.

If my grandma goes into hospital and I find out that her nurse has more than 4 other patients the shit hits the fan. I will tear into the boss. I want my grandma cared for. Stopping her nurse from seeing her other patients by complaining and harassing and stalking her over something she cannot control only makes things worse for all of them, including my grandma. If grandma's nurse has a bleeder in the next bay then no she can't take my grandma to the toilet right now, or for a long time. I can abuse this nurse to death but it won't change the situation. If I bully the nurse into putting my grandma's toileting needs first then the bleeder dies because he didn't get what the doctor ordered.

Daily mail readers and Dr. Crippen think that the overwrought nurses will be so much nicer if society ensures that they are poorly educated and chased around by an old fashioned matron carrying a stick to beat them with when they crash and burn. Uh yeah, problem solved.

Read this article. This is how you begin to get good, compassionate nurses who respect dignity.

You should treat them with dignity and you should not abuse them day after day.

You should admit that their job is tougher than most others rather than subscribing to old fashioned and incorrect views of nursing that lead you to believe that a moron with a good heart would make a wonderful nurse. Have you any idea of just how much an RN needs to know to be a safe nurse?

You should respect them and help them to cope. I don't think for a minute that listening to soothing music and doing push ups is going to improve things all that much. The point here is that someone is actually recognising that poor conditions for nurses means poor conditions for patients and they are trying to do something about it.

Would you beat a dog every day and then leave them alone with a child? No? But you want to treat nurses like shit, working in overwhelming 3rd world conditions where they have to go 8 or 12 hours without eating, work unpaid hours to boot and then you expect them to be compassionate and stay at the bedside?

Anyway I'll quote some of the article here. Edit :no I won't now because blockquotes are evil. Just click on the links.

http://www.nursinglink.com/news/articles/5731-hospitals-creating-programs-for-nurses-to-combat-compassion-fatigue

http://allnurses.com/nursing-news/hospitals-creating-programs-338202.html

Why Are the Nurses Always Hanging around the Nurse's Station, the computer etc.

"Why are they always hanging around the computers and the nurses station"?

"Why are are they always filling in forms?"

"Does this mean that they don't want to nurse patients?"

Well, if you are even asking these questions, you are probably totally fucking ignorant. They ARE nursing patients by doing these things you moron. They are also trying to avoid harming patients, getting struck off by the nursing and fucktwittery council and ending up in a courtroom.

I'll get back to the CCU part 3 thing later.

Just look at these bizarre quotes from over at Dr. Crippen:

"I shall probably be shot for saying this, but the common factor in
very many of the horror stories seems to be nurses. Endless excuses are made -
not enough staff, too busy, not enough training etc etc. But I have personally
seen many instances where there is a clutch of nurses round the computers, but
none in the ward. Nurses all seem to want to be doctors, or at least look like
and be treated as doctors, and few of them want to nurse. Hence Nurse
Practitioners. Since the start of the ridiculous Project 2000 this has
escalated. (ducks down below the parapet)"

Yes you had better duck below the parapet you ignorant fucking shit. First off all, project 2000 died pretty soon after it was born. Most nurses working in the NHS right now did the traditional training. Lastly, just look over at America. Their nurses are highly educated at universities and you won't hear of patients over there starving to death. They also have much less ancillary staff on the wards than we do. Yet the patients get better care. They get basic care. Think about why this is the case. I will give you a hint. A 24 bed medical ward in the USA will have 7 trained nurses and 2 care assistants. In the UK the same ward would have 2 trained nurses and 3 care assistants. The nurses over there are highly educated, they graduated from highly competitive expensive schools, they get kicked out of school if they do not get top grades in their university science courses and the have a smaller number of patients. They can do the care and complete the other aspects of their work.

"A few years ago my wife was in two different hospitals in fairly quick
succession. In both I saw nurses routinely clustered around a computer screen,
chatting. In one, when I walked over with a question I found that they were
talking shop. So I walked over several times in the next few days; it was
shop-talk every time. In the other I had twice visited the nurses' cabal. Each
time the talk was mere gossip. Naturally, it was the gossipmongers' hospital
that was highly rated, internationally famous and so on."

First of all let me say this: I do not believe for a minute that either of the authors of these quotes are able to distinguish between a nurse and a cleaner, tech, auxiliary nurse, OT, dietitians, administrative staff, etc. I don't believe that they understand why nurses need to spend time on computers and form filing. I cannot believe that anyone would think that a nurse is trying to act like a doctor and avoid patients by hanging around on the computer or filling in a form. It is mindblowing that anyone in the 21st century could think like this.

Secondly I am suspicious of anyone who uses the terms "nurses" and "sisters". Many (not all) of these general wards will not pay nurses and sisters to all be on duty at the same time. Two "nurses" tops. If sister is on shift than it is "sister" and "nurse" and they are each the primary RN for a large number of patients. The rest of the staff kicking about are not nurses, or anything like a nurse. If you are going to use the term "nurse" you had better be damn sure that you know what you are talking about. People who use the term "nurses" plural whilst referring to general medical wards are probably talking shit.

Why do comments like those above piss me off?

1. Nurses stations are gathering places for all sorts of staff, all day long. These people may be in uniform but they greatly outnumber nursing staff. My ward is in a very central location. People love to use OUR fucking nurse's station as their own personal break room, meeting area etc. They tie up our phones, our computers etc. They are not nursing staff nor are they employees of my ward so it's not like they are going to answer a call bell or see a patient. The clinical techs are the worst. They work all over the hospital and they travel in groups. They are NOT ward based. When they are not busy you can bet your arse that they are feet up at MY nurse's station. If you look at the station at any random moment you will see occupational therapy, clinical techs, physios, dietitian, social workers, clinical techs sat on their arses, nurses from other wards who have stopped down to borrow something but are not allowed to touch a patient on my ward, clinical techs, clinical techs sat on their arses, pharmacy techs and more clinical techs. I have to fight my way through this crowd of people to get my work done at the station.

I know for a fact that relatives and visitors generally refer to this eclectic group as "nurses ignoring patients". We hear you say it, and we laugh at your fucking stupidity. This occurs on a daily basis and it gives me some much needed comic relief during a long and break less 12 hour shift. Thanks for that.

I had a little fun with this situation one day. There were 2 nurses and we were hours behind, patients were waiting and suffering. I could see visitors glaring at the nurse's station, giving each other knowing glances. I have been around long enough to know what they were thinking. So I acted like a bitch.

In a very loud assertive voice I shouted " Listen up, I want all non nursing staff who are hanging about the nurses station to stop using our ward as a break area. The patients and visitors think that you are actually nurses that you are ignoring patients. Can you not hang out in the cafe upstairs please?" All five techs who were having their break at the station got up and walked out, leaving the station empty of human beings. The visitors etc looked surprised. I know I sounded like a jerk but it was worth it. Nurses should do this kind of thing more often. I've done it more than once in order to make a point. It works and I haven't got told off for doing it yet.

I don't often get meal breaks and I don't want to see others get them if I can't. That was the other reason I threw them off my station.

2. Computer work and paperwork is nursing too and is absolutely essential to patient care. We violently hate this but it is a fact of life that we cannot control. They will string me up from great heights and deny my patients essential treatment if I fuck this up. If I was responsible for a small group of patients I could get through this stuff very quickly. But I am responsible for a large number of patients (12+) and the amount of computer and paperwork I HAVE to complete becomes extremely time consuming. Even if you ditch all the crap that is not essential and just focus on the absolute high priority stuff it is still very time consuming if you have a large number of patients. This is true if I have once care assistant or nursing student helping me out or 20 of them. This crap still has to be done only by the registered nurse. I'd rather be at the bedside.

The pharmacy won't give me the meds I need without filling in forms and placing orders on the computer. I had a patient who was about to arrest because he had a K+ of 7. I notified the doc of the blood results and he ordered the necessary intravenous meds. I had to jump through a million computer hoops to get the pump to deliver the meds. I had to had to jump through a million paper work hoops to obtain the drugs that needed to be given. I had to fight with equipment department and pharmacy. It took an hour to get the damn stuff and I ignored my other patients whilst I was trying to pull this together. I would have been responsible if he had died because I did not get the ordered treatment initiated.

Pharmacy will no longer stock us with half the stuff we need. Forms forms forms and arguing to get those ordered pain meds that your mother needs right now is the norm. Forms and fighting with pharmacy to get stat life saving medication is a regular occurrence. Obtaining routine medication is an even greater nightmare. I have to leave the patients and spend too much time on the phone, the computer etc arguing with these people just to do my job. They will not bring things to the ward so I have to leave my patients or send an HCA. We always have a large number of staff OFF the wards running after equipment and pharmacy.

If the paperwork isn't right the scan people and the blood people will not perform your test. Your skin may be a mess and what you need is an air mattress. It is like pulling teeth to get one. Back on the computer and the phone I go to obtain one.

Lab test results. For whatever reason our lab is not always phoning in critical blood results. This means that if I don't break away and run to the computer to check bloods something may get missed. I have found HB of 5 that they never called in. I have found screwed up electrolytes that they never phoned in. If I don't know about them how can I inform the doc? How can the patient get treated? How do I know if I can continue on with that K replacement or not? I frequently have to break away from the ward throughout my shift to run off and look this shit up.

Updating patient information for the next shit: This is crucial to patient safety but never gets done properly. I have seen incredibly bad patient outcomes occur as a result of this getting screwed up. It is extremely time consuming for the number of patients that I have. But every time I try and get near that computer visitors are on me like flies to shit, accusing me of ignoring the patients.

There is never going to be a time of day when I don't need to be at the computer or filling in forms to get my patients the things they need. This is constant throughout the shift. There is also never a time of day when I don't have 10 people that need basic nursing intervention immediately. Even if I saw to them previously they will need help all over again less than 15 minutes later.

Once I was on the computer trying to get something and a relative grabbed me to get her mum a pillow. She walked past 3 hca's who were making beds and came to me while I was trying to order a much needed item. She thought that the HCA's were busy and that I was doing nothing because I was on the computer. So she came to me. I went and did it myself rather than incur her disdain by making her wait or asking an HCA. On the way back to the computer a patient asked me for a commode. I got it right then and there and went back to the computer. Then I found out that I had missed the boat on obtaining what I needed for my patient by 5 minutes and now must wait until Monday morning to get it. Wards may be 24 hours but pharmacy, equipment, and path lab are NOT.

If I spent all day at the computer and pouring over paperwork I would not scratch the surface of getting all of it done. If I spent the whole day doing commodes I still would not get to all those patients in time. It is chaos and we are only able to do a little bit of each. Did I tell you that my childminder is charging me £1 a minute for each minute that I am out of work late and she has my child? I do push a lot of the computer work towards the end of my shift and complete it during unpaid hours to avoid ignoring the patients all shift. My childminder is making good money as a result of me getting out of work late and staying on unpaid. I have to pay her for time I did not get paid for. Nice huh. Next time I am going to get it all done while I am on duty and get the hell out of there as soon as my relief comes. If the patients and the visitors don't like me sitting at the computer all damn shift documenting and get things that they need then they can pay my childminder and I will stay over and do it at the end of my shift.

The amount of money I have spent on childcare for hours that I did not myself get paid for would buy me two new cars.

Look at this quote by Florence Nightengale:


"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

She is 100% right. The more we sacrifice, the more they want and the more they complain.

To hell with all this. I am just going to sit back and watch this ignorant country run every last nurse out of here with their impossible and ridiculous expectations and generalisations. America and Australia will be more than happy to have British nurses to help maintain their strict nurse patient ratios. They know that British nurses are damn good at their jobs and they are anxious to poach them.

Rant over. Back to the CCU part 3 now.