Uniforms Revisited

I am still really angry about this so here I go again.

I already blogged about this here.

We do not have much in the way of changing facilities for staff at my hospital. I do know of some hospitals that do provide changing facilities so that staff do not need to come to and from work in their work wear. I know of more hospitals THAT DO NOT HAVE THESE FACILITIES.

There were two wards at my hospital that had changing rooms for staff. Now that my ward has been redone we have one. We begged and begged and begged to get a changing room. If there hadn't been a major structural problem we never would have had our ward redone. The numerous other wards/units at this hospital do not have changing facilities.

Let me tell you what staff on my ward were doing before we were refurbished recently. I am telling you this because many many staff are still going through this.

We were getting accosted and verbally assaulted by matron types/senior office types and members of the general public for travelling to and from work in uniforms.

But they still would not provide changing facilities.

So we had the bright idea of changing in the staff toilet (very small decrepit room) at the beginning and the end of our shifts. We got away with this for awhile. Then we were caught by the housekeeper who had a fit over the fact that we were changing in there. Those who were caught changing in the toilets got in trouble and the rest of us were warned. What to do, what to do. We were still getting verbally assaulted and threatened if seen travelling to and from work in uniform by morons who thinks that this will spread MRSA around.

So we had another bright idea. There was a small supply cupboard just near the toilets. This room was about 7 by 10 foot. When we came to work we snuck in there to change out of our street clothes and into our uniforms (which we carried to work in a shopping bag). There was no place to store our street clothes, shoes, belongings so they were left on the floor in carrier bags or hung on a hook in this shitty supply cupboard. The domestic supervisor and housekeeper again caught us changing in there and went to the matron or chief nurse to complain. Busted again. Threatened again and told that we are NOT to change in supply cupboards and toilets. But we were still being verbally assaulted when seen on our way to work in uniform.

In the summer we were sweating buckets on the way to and from work because we tried to hide our uniforms under long winter coats. And we were still getting the "tsk tsk, look at those nurses coming to and from work in their uniforms" by silly old ladies mostly. These same silly people will also see a beauty therapist walking through town in her uniform and says "tsk tsk, look at that nurse wearing her uniform".

Sometimes a matron or an office type would stop us and say something about being in uniform on our way to work, even though we tried to make them aware of the lack of facilities. They threatened us for coming to and from work in our uniforms. They threatened us for changing in toilets and supply cupboards. And they continued to ignore requests for staff changing facilities. Most of the nursing staff at my hospital are still going through this. Some wards have found little cupboards and closets near their units to change in. And they haven't been caught yet. The rest are trying to hide their uniforms under long heavy coats as they travel to work.

The supply cupboard and the toilets were our only option. The only other option would be to change in the middle of the ward. Should we sneak into the patient bathrooms perhaps? Luckily Nurse Anne and crew are in a better place now. Wish I could say the same thing for everyone else.

The reason I am telling you about this is because every time there is a news story about nurses and or infection control in hospitals there is always some idiot bleating on about the fact that he has seen staff travelling to and from work in uniform.

Don't assume that we have changing facilities or our uniforms laundered. That is a very fucking stupid assumption to make. Uniforms are not the big problem with infection control anyway. And even so, we can get uniforms that are made out of anti-microbial stuff.

Instead of pissing and moaning about stupid crap and verbally abusing nurses on the way to work (or hairdressers in uniforms that you mistake for nurses because you are a fucktwit) here are some things you can do if you are concerned about hospital bugs:

1. Demand that the hospitals actually hire cleaners that clean and are there for more than a few hours a day.

2. Demand safe nurse patient ratios. http://www.medicalnewstoday.com/articles/156173.php

3. Demand better facilities. Beds that are all lined up withing inches of each other with all the patients sharing 3 commodes is a really really bad idea. here and here with a pic of a typical ward

4. Decent, functional handwashing facilities for the staff are a must. Ours fucking suck.

5. Stop transporters from dumping new patients into a bed that has only been vacated by a discharged patient moments ago. For fucks sake, allow us to clean the thing. If I am tied up with a sick patient I cannot leave him to clean the recently vacated bed. Hold your horses until I can do it or hire a cleaner to clean and prepare beds for the next patient. Fuck the targets.

6. Changing facilities for staff!! Proper laundering of our uniforms!! The hospital laundry will not touch our uniforms (if we send it through the hospital laundry it will be lost forever) and domestic household washing machines don't do the trick. But who cares. They need to be worrying about ratios, bed occupancy, and facilities before harping on about uniforms.

And yes, highly paid matrons really do hide behind trees to catch staff coming to and from work in uniforms. There are members of the public who think that they are doing some kind of good deed/community watch thing by looking for and targeting people on their way to work who appear to be in a nurse's uniform. Meanwhile no one, AND I MEAN NO ONE IN ANY KIND OF AUTHORITY POSITION is addressing the points I made above. Well, the RCN did for about 5 seconds a few years ago. The public doesn't address these issues either. I guess it's more fun to sit on your fat ass and say "these bloody slag nurses go on the bus in their uniforms and that is why we have MRSA". Idiots.

Idiot Managers and Commodes.

Christ.

We have a 20-30 bed ward. There is one toilet/showeroom. At any given time 99% of our patients are COMPLETELY UNABLE to walk there, even with assistance. Wheelchairs are often AWOL. Half the time we cannot even find one. We have 3 commodes for the whole ward.

The male patients are not a problem because they use bottles. The female patients are mostly large, unable to transfer out of bed onto a commode and require two staff to transfer them onto the commode. Either they have urinary frequency or dementia. Either way it won't be more than 5 minutes after they are assisted back to bed before they are again crying for the commode. They refuse bedpans. The damn things hurt, beleive me. With 3 commodes and 15 ladies crying for it all at once,all the time, you can see why we have problems. The dirty room is where the commodes are emptied and cleaned. This room is a long walk away from the patients.

So you are with the patient in bed 25. You have just assisted her back to bed. The lady in bed 24 sees you with the commode and demands it now. But in order to empty and clean it you need to walk all the way back to the dirty room. To get there you have to walk past at least 10 other people who shout for the commode as you walk by.

You clean the commode and head back to bed 24. On your way back the 10 people now inform you that they are pissing/shititng in their beds because you are not bringing that commode to them right now. 10 minutes later you finish assisting the lady in bed 24. She could not be left alone on the commode as she will almost certainly fall. Sometimes she does get left by the care assistants and nurses, because the others are screaming for the commode or you are in the middle of something that you cannot leave in order to do commode duty. For example, if you are caught leaving a deteriorating patient or being late with drugs because you were fucking about with commodes you could be looking at loss of registration and a lot more.

When you finish with the lady in bed 24 you need to push the commode full of piss and shit back down the looong hallway to the dirty room, past those initial 10 people who shouted for you to provide a commode over 10 minutes ago.

This is the setup. And of course it is the Nurse's fault when people are left in their own waste and commodes are not cleaned properly. Yeah right. What a fucking stupid ass set up this all is!!!! What a crock of fucking shit.

Remember that this goes on all day long. They will not allow us to have any more than 3 commodes. If we are lucky we have 3 or 4 or maybe 5 staff and most of them will be up in their eyeballs trying to keep people alive and painfree already.

We have 2 siderooms where MRSA and and CDIFF patients are isolated. Two of our commodes usually end up in there. One in each room. No, we cannot take them out and use them for a patient on the ward. 16 year old unthinking braindead agency untrained care assistants can't seem to grasp this by the way. You will not be able to clean the damn thing properly in the short amount of time you have. This means we are left with one other commode for the whole ward. It is a ward full of patients and visitors who wrongfully assume that if mum or gramps needs the toilet any member of staff walking by will immediately be able to provide one. They get angry when their unrealistic expectations are not met. Um. Ten people are in the que ahead of you dear, and some one is having a heart attack and the other 3 staff are tied up. What the fuck do you want me to do?

We are not allowed to have anymore commodes. They probably don't want to pay for it. If they did allow us to have more, there would be no room to store them anyway.

We have made management aware of what I have told you here. Their response has been silence. It's disturbing.

But what do we get to hear ten times a day from patients and visitors?

"You nurses are disgusting for making people wait for the toilet"

"You nurses are disgusting for only have 3 commodes and one toilet on this ward"

"You nurses are disgusting for the smell in this place" (the dirty room drain is often blocked)

"You nurses are disgusting for causing people to piss in the beds"

"You nurses are disgusting for not coming immediately with the commode"

"If I piss or shit the bed IT IS ENTIRELY YOUR FAULT YOU DISGUSTING NURSE"

"If mum or dad or auntie Gladys piss the bed IT IS ENTIRELY YOR FAULT YOU DISGUSTING NURSE"

Honestly, if I had a penny for everytime I heard one of these comments each shift I would be rich. These comments are what I listen to all day long. I listen to it as I am running between the dying and the suffering, when I am trying to talk to people who have just been told they have a death sentence and when I am running to people who are bleeding. I still have to listen to it when I leave those people to try and sort all of those who are desperate for a wee. I never hear "Thanks for leaving that dying patient to find me a commode". Instead I hear "What the hell took you so long to bring me that commode you fucking lazy bitch". Okay, since they probably don't know that I have other patients who are dying I guess I can let them off the hook for their shitty comments.

Everyone expects an immediate response from a nurse who is already in the middle of something that she cannot walk away from, even though there are ten other patients making the same demand, for the same piece of equipment all the time.

But of course the biggest problem is the filthy state of the commodes. The cleaners utterly refuse to touch the damn things. It is the job of the two nurses and two assistants for the entire ward to clean them. There is not enough time to clean them properly. They are in constant demand from impatient, needy people who need our help and their dignity maintained. There are not enough of us, there is a hell of a lot going on, and there are certainly not enough commodes and facilities.

One day we were left with two RN's and two untrained children to care for the whole ward. On that day a gaggle of overpaid worthless jobsworth infection control peeps showed up, and swabbed the commodes for germs. Now we are getting lectured about dirty commodes.

Why don't they staff the ward with nursing staff?

Why don't they staff it with cleaners who clean?

Why do nurses in these hospitals have so little in the way of domestic/housekeeping support?

Why do we have no say in any of this while having to always shoulder the blame, apologise, and listen to the verbal abuse.? Oh right. Management doesn't want to admit liability.

Why not deal with that? Why send overpaid worthless tits around with expensive swab kits to tell us what we all ready know?

So there you have it. Management cannot even fucking sort out the toileting facilities. They'll happily sit in their offices and let the frontline staff shoulder the blame however.

And what they hell can we do about these idiots who are running around with swab kits, who then lecture the hurried staff about "taking pride in their work".

Look, if any of you reading this are infection control or managers let me tell you something: Expecting nurses who are working with ratios that wouldn't even be legal in the shittiest part of Haiti to clean commodes properly is begging for failure. The idea of a nurse with 6 patients taking on cleaning duties is insane. IT WILL ALMOST CERTAINLY COMPROMISE PATIENT CARE. Nursing staff are so shafted these days that there is no way we can clean anything properly. We often have more than 12 patients per nurse here in the UK (a total abomination right on it's own). If you want to hit the nurses with these kinds of fucked up ratios, and then demand that they take on housekeeping duties as well you are a crazy fuck. You are smoking crack and even worse than that, you are not sharing it with the staff..

1.Increase the amount of cleaners/domestics on the ward.

2. Allow the cleaners to clean the commodes. Currently they are not supposed to.

3.Have domestics on the ward for more than 2 hours in the morning and 2 hours in the evening.

4.Allow us to have decent toileting facilities.

5.Have separate domestics for cleaning and food service. Duh.

Either do this exactly as I have directed here or shut the fuck up and go away for eternity. Those are your options. Make it so.

Rant over. The end.

They want to cut clinical staff....still. Will they do it?

Here's an article that I found. It caused me to spit my coffee out all over my keyboard. But really I am not surprised.

NHS to Cut Staff.

Supposedly the health minister is publically denying that this is the way to go. God only knows what is being planned behind the scenes. I am not hopeful.

I really think we need to start helping the public to have a more realistic expectation of what kind of care can be given in hospitals. Let's see. We are 2 or 3 nurses to 30 patients now. I have always said that by the time I am old economic factors and changes in health care will have altered things so much that there will probably be one nurse covering 3 wards.

We'll see her maybe once a day for less than 2 minutes each if we are lucky - if all those patients of hers on all those wards are stable. If they are not stable, we will see her less. She'll fly past me while throwing super expensive medications that cure heart failure and diabetes at my 96 year old self. We'll know the nurse is on the ward when we hear the sonic boom, so fast will she be moving. We will barely have time to see her or catch our pills as she rushes past. Sound crazy? This is where we are heading. My angry patients say to me "well how would you like to wait hours for a commode". My official response is this: "when I am old, I will be waiting days for that kind of thing. Trust me"

Nurses are responsible for some pretty complex things now...even without taking on the role of Doctor. There is a large gray area that exists between diagnosing and treating a disease process and basic care. The docs have always done the diagnosing and treating part. The nurses do the basic care.

That gray area -for lack of a better term- includes things like implementing complex physicians orders, assessing and monitoring for changes in condition, and managing technology that keeps patients alive as well as coordinating lab results, medications, social problems, discharge planning etc. It's the nurse who gets nailed when this stuff gets screwed up. Indeed it is. And the nursing profession did not create this situation.

Medication administration is more complex now and it is the domain of the nurses. We are held liable for not catching doctors mistakes in prescribing. Seriously. That really pisses me off and is a whole 'nother blog post. If the freaks in charge want to hold nurses responsible for this shit then I can see why they are demanding that nurses all have degrees. I don't want a thick nurse coming near me or my ventilator , my IV drugs and lab results and I don't care how caring or warm hearted she is.....Being caring and warmhearted is necessary in a nurse but it won't stop her from getting somebody fucking killed.

Lab/diagnostic tests are more complex and getting more complex all the time. The doc may order the test but who is organising all the before and after care while coordinating all of the other things that needs to be taken into consideration for said test? The nurse. And it's a pain in the ass believe me. Doctors have no idea about what goes in to implementing their orders because they don't deal with that side of things.....it all exists in that gray area outside of diagnosing and prescribing and outside of basic nursing care.

This gray bubble that exists between diagnosing and treating illness (medicine) and providing basic care (nursing) will be a lot bigger when I am old. Much bigger than it is now. And the nurses are held responsible for the things that occur in this gray area. If this gray bubble was the size of a pinhead in 1970 it is the size of a football now. There will be less nurses, more patients, and a gigantic gray bubble the size of Jupitor in the future. The things that exist in that gray bubble cost money that no one has, and they will continue to cut clinical staff and other things that we take for granted to pay for it. Paying for a patient's basic medical and nursing care is expensive even now. It was not this expensive decades ago. Decades from now, the cost to provide what will then be considered the very basics i.e.tests and meds and technology will be so immense that we cannot fathom it. Say bye bye to having registered nurses around to hold hands and mop brows. Just get over it.

Anyway it seems that it is all going to go to hell in a handbasket a lot sooner than I thought it would. It's bad now, in a lot of places but not yet the disaster than I am predicting. I think we are on our merry fucking way thanks to the recession.

Here is the article with my comments in blue. I don't think I really need to say anything more.

NHS 'needs a 10% cut in staffing'

(UKPA) – 18 minutes ago
The NHS would need to slash its workforce by around 10% to help meet planned savings of £20 billion, it has been reported.


A study, commissioned from consultancy firm McKinsey and Company, said the workforce would need to be cut by 137,000 to meet efficiency savings by 2014.


It said clinical staff would have to go alongside administrators.

Christ we have no clinical staff as it is....I don't think that our RN to patient numbers wouldn't be legal in the shittiest parts of Mexico. Neither do the nurses have any kind of decent back up in the form of domestics, clerical.

The report, seen by the Health Service Journal (HSJ), recommends a range of possible actions such as a recruitment freeze starting in the next two years, a reduction in medical school places from October and an early retirement programme to encourage older GPs and community nurses to make way for "new blood/talent".

And we have no doctors doing ward work as it is...well there is one...for the whole FUCKING hospital outside of 9-5. Crap I can't even get a doctor to review a patient betwen 9-5 without jumping through flaming hoops. If I had a penny for every time one of these overwhelmed young doctors was flipping out and having a mental breakdown in my staff room I would be rich. Note to the junior docs...if you start crying your eyes and screaming "I cannot do this, I can't do this" while your pagers is going off 1000 times a minute The nurses will all be like awwww poor wee lad/lass and we'll make you tea and stuff.

"New blood and Talent". Hmm. That there is fuckwit talk for young, dumb, inexperienced and oblivious to what they do not know. New Nurses and Doctors need a hell of a lot of mentoring from the experienced. For years. Is this report really representative of the kind of shit that is being recommended to senior managers? Christ.


The report was presented to the Department of Health in March this year, the HSJ reported. It carries the department's logo and has been disseminated among senior NHS managers.
The study said £2.4 billion could be saved if hospitals with the lowest levels of staff productivity got up nearer the average.

Oh fuck. The small minded morons who happen to wield all the power have read the damn thing. These are the same bastards who want me to take responsibility for a lack of junior docs and the 16 year old untrained kid to take responsibility for nursing care.

And it said almost 40% of patients in a typical hospital do not need to be there at any one time.

True, many are not acutely ill but they cannot take care of themselves either, their families won't do it. Instead they want them waited on hand and foot by overwhelmed hospital staff who are up in their eyeballs dealing with acute patients. We do not have enough stepdown /sub acute /rehab facilities. There is your problem. If they build them, they will need to staff them.

The biggest causes are delays in patients receiving tests or therapies, and a lack of suitable care facilities in the patients' own home or community.
The report also said that if four million of the 29 million outpatient appointments each year could be cut this could save £600 million.

LOL. How about this- Instead of all these cuts we threaten them with having to pay for every funeral that they cause as a result of said cuts?

A further £700 million could be saved if procedures with limited clinical benefits - such as tonsillectomies, varicose vein removal and some hysterectomies - were no longer performed.
The analysis also suggests up to £8.3 billion of hospital estates could be "freed up".

I hope this is a joke. Take it for what you will.
I have been away so this post will have to do for this week's insane ramblings.

Shutting down for awhile

Hello,

I'm going to have to shut this down for awhile. Things are deteriorating very quickly at work and I need to continue to pursue other methods of dealing with it.

I'll hide the blog for awhile until things chill out.

Annie

The Retired Nurse

I love this one.

Once upon a time I got an admission. This lady was technically elderly but was very youthful in looks and manner and as sharp as a knife. She is a nurse and worked on my ward about twenty something years ago as a staff nurse. I think she retired in the 80's. I think she was pretty old then.

"Over there in that side ward we had the cardiac arrest from Hades" "You see that closet over there, they used to have 2 patients in there and once we got stuck behind equipment".

This woman was great. We didn't want her to leave the place. She kept us laughing with her stories about things that happened years ago.

She seemed very concerned about Nurse Anne and her colleagues...

"Why are you not taking meal breaks, they used to prepare meals for the staff"

"Why do they not launder your uniforms or provide changing areas?"

"Where's the staff?"

"Why do they let the visitors interrupt and harass you so? Matron would have dragged them out of here by their shirt collars"

"Who is in charge? You cannot be the only nurse for that many patients and be 'in charge'!"

I couldn't answer her questions. Did they really provide all those things for nurses years ago?

One day she leaned in close to me. "There are 5 of you on duty right now. How many of you are nurses"

Hmm. I decided right then and there to be brutally honest with her. She isn't stupid. I wasn't in the mood to hold back. She was on her way home that afternoon anyway. And I trusted her.

"Two of us are actually nurses. I have been qualified for over a decade but am still technically a junior staff nurse because they won't promote and because of agenda for change re banded me downwards despite a pristine nursing record. I am the most senior nurse on duty so that makes me charge nurse as well as primary nurse for 12+ patients without the pay and official title. Susan is the only other nurse. She has been qualified for 6 months. She is the primary nurse for the other 12 patients. The other two members of staff are health care assistants. The third member of staff is a "kid" with even less training than the care assistants receive." That is all of us, for the whole ward, for 12 hours+.

My Nurse-patient took off her glasses and looked at the ground, rubbing her eyes. "They really are bastards you know. In the mid eighties, they started with this 'health care assistant idea'. We were very against it you know. Patients need trained, qualified staff. We were against all this, but they reassured us that the health care assistants would be used in addition to qualified nurses not instead of qualified nurses."

I would have liked to tell her that we are lucky if we get an experienced health care assistant these days. We are down 5 members of staff in total and if we are LUCKY we get 2 junior staff registered nurses and 2 or 3 untrained 16 year old "kids" for an entire shift. That is if we are lucky. These kids don't seem to hear call bells, nor can they feed patients without the patient aspirating, they don't seem to notice nil by mouth signs, nor do they understand about not sharing commodes between the MRSA patient and the surgical patient. They cannot seem to understand about intake and output charts. They leave side rails down. The next day they are sent to work on a different ward. And I will get a couple more who don't know their way around mine. The medics want the staff nurses to also function as a charge nurse/sister and have us at their beck and call following them on ward rounds for hours. This basically leaves the patients with nothing, NOTHING as far as nursing input.

We cannot watch these kids. They need babysitting and we can barely get the drugs out let alone watch Brittany and Brandon and stop them from fucking up. Tell them off and get stern and they call mummy and cry. It is dangerous. We need direct RN to patient ratios in line with the RCN recommendations that are dependent on adjusted for patient acuity. We need this right now.

The retired Nurse assure me that we were doing well considering what we were up against and said "God bless. I don't know how you do it. Thank you so much".

I hope she continues to recover and would like to see her kick Claire " I haven't nursed since Nixon went to China but I am convinced I have a clue" Raynor's behind. Ms. Raynor doesn't really understand what is happening on these wards. She thinks that an RN can go to work and spend all shift focused on basic care without killing someone and getting hung drawn and quartered. It ain't the nurses who made things this way darling. It's not the nurses who wanted this. They have this level of responsibility without being pretend doctors. It's not the nurses who decided that nursing needs to be a well educated profession. So who/what is the culprit? He goes by a few names: progress in medical care, increased knowledge, changes in health care delivery and economics.

Admissions and Transfers: NIGHTMARE

I wrote some bits and pieces about what happens when we get an admission and transfer in and old post.

Let me expand on that even more.


We are taking admissions and transfers when we already have way more patients than we can possibly get around too.


They are arriving on my ward when it is convenient for the sending ward to send them. I get a "ball park figure" for when my new patient(s) may arrive. He may come in 5 minutes or 5 hours. That is all I know. I don't know when they are coming. Therefore I cannot organise my time around my other patients to accommodate the new ones.

But that is a mute point. I cannot organise anything. I am trying to accomplish anything I can in the 30-90 second periods of time I have between interruptions. The entire shift is like this. We may be working our assess off, but we are only ever ever hitting on the very top priority things. We are getting the tip of the iceberg chipped away but nothing else.

The patients have this idea that if the nurse is not at their bedside as and when they want her, that she is not caring for them. They have no idea how much goes on behind the scenes, or behind the nurses station really, to keep their ass safe and alive throughout the duration of my shift.


Admissions are sent unexpectedly at mealtimes, during handover, change of shift, when my MI patient has another heart attack stopping me from getting to the cancer patient with the pain medication she has been crying for during the last hour. Unless you are retarded you will understand that the heart attack patient is first priority in this scenario with 02, ecg's, stat orders and organisation for possible transfer to the coronary care unit etc.


If I skim the surface with heart attack man and do the bare minimum to keep him (and my nursing registration) safe from harm then I can get to the cancer patient needing pain killers in 45 minutes. That is 45 minutes if I ignore the other patients crying out for me. IF I don't ignore them, it will be hours before I get to the cancer patient with her pain killers. Setting up her narcotics, checking them for safety and administering them between all the other interruptions takes another 15 minutes.


Where am I now? Oh yes, the admission. And the other patients crying for help and everything else. I go to the admission, walking past multiple voices begging me for help with everything from getting a drink to getting a commode . My new admission and his daughter look at me sharply. "We have been on this ward for nearly an hour and YOU have not bothered to come and check on my father". The other patients are still crying and I really need to check back on my cancer patient to make sure that she is tolerating the narcotics okay and still breathing. They may not be infusing properly because of a kink in the line and she may weep in agony until I get back to her. They might infuse to fast or be too much and she might die. And I will be blamed. Your grandma and ten other people's lovely grandma's are sat weeping in their own urine right now. Right. Back to my admission and his pissed off daughter.


The admission itself is a lot of work and that right there is the crux of this blog post. When these patients come to us they are a fucking mess secondary to a lovely stay on what I term "the sending ward". These wards are called acute medical admission units, short stay medical units, medical admission units, medical assessment units. It is all the same thing really. From here on in I will refer to these places as sending unit hell, or SUH.

They come to us filthy. They come to us in pain with no prescribed pain medication. They send them up with insulin infusing IV. It was ordered to stop 10 hours ago, 10 hours before they were sent to the ward. But it is still infusing without any dextrose etc. The patient has a BM of 1.5. They come up dehydrated with orders for IV fluids prescribed hours ago, yet not started. No venflon is in place. Half the paper work is missing. Trying to figure out what is going on with these people is a mission in itself which can take a lot of time. When these people come, and they come with no warning, I need to leave my other patients and do a bit of assessing and research. Otherwise all hell breaks loose. Most of them are elderly people, who need someone there at all times to ensure that they are clean, hydrated and that their dignity is maintained. If I spend any more than 30 seconds at a time with any one person then all hell will really break loose and I just won't get to see some people.

Sometimes SUH will handover that the patient had bloods done. They were not done. Or that sando k was started yesterday for a low potassium. It was never ordered or given. Last bloods were 36 hours ago and the potassium was 2.1. If I don't contact the medics and let them know that this stuff is going on then they cannot sort it out and treat the patient. It is the nurses legal responsibility to field this crap. SUH tell us that the patient is for an urgent OGD, and that the test was ordered. It was never ordered. Now I have to chase up a doctor to order this test. The patient has been sitting and waiting for this test, and has been starved. The test department doesn't even know he exists. The medic is overwhelmed and cannot get to the ward to order this test for awhile. But the patient again has a dropping HB. Not good. Lots of phone calls and paperwork to sort this nightmare out. And you can bet your ass that it is indeed my problem, with my ass on the line.

They send patients up with the wrong notes, without wristbands, and dump them in the middle of the ward. They send them up as they are taking their last breaths. They have sent septic patients with a low white cell count secondary to chemo without warning, and the porters have dumped him in a dirty bed that has only recently been vacated and not yet cleaned. They did this while I was down the hall in another patients room hanging blood. It was 10 minutes before I saw. I just had to hang that overdue blood then the hca was going to finish ups and our first mission after that was to clean that room. But they couldn't hold off for 10 minutes. They dumped him. Its not like we have any kind of domestic support.

They send them up with dressings and ulcers but no documentation as to how long they have been present and when the dressings were last changed. It is very doubtful that I will have the dressings I need in stock and pharmacy is closed. If this is a Friday it will be Monday before I get those dressings. They send them up without telling us that they are diabetic, or that they are allergic to wheat.

Why does this happen? The nurses in SUH don't have an easy time of it, by any means.. First of all, they have A&E on the phone every 5 seconds demanding that they move people out NOW. Secondly, there are twits with clipboards and magnets constantly up there ass screaming about targets and getting patients moved NOW. With all that going on, it is very doubtful that they ever see their patients for very long and get to sort things out before transfer to the wards. Targets Targets Targets.

They send up confused and wandering fall risk patients without warning, when I and the other staff are already outnumbered by confused, wandering fall risk patients who need one to one supervision. This is often happening while I am trying to help your gran with her tablets, which will then end up on the floor as I go running to hear what that "thump" was. It is the sound of a body hitting the floor. Third time this shift, same person, and a big fat piece of paperwork for me. Those have to be filled in whenever someone falls. No, I do not leave them unsupervised because I want them to fall. You are crazy for even suggesting that.

Then send up violent alcohol detox patients, before I even get the the falling and sick ones. The families come onto the wards with the new admissions and demand to speak to the receiving nurse the second the patient arrives onto the ward. But I am in the middle of a 100 things and people are dying and they are falling and they are shouting out. The family member makes a snotty comment about how "that nurse cannot be bothered speaking to us because gran is old, and they don't care about old people".

The powers that be tell the ward nurses to stop complaining about the screwed up transfers that we are getting. "They have done all the admissions work in SUH, you only need to settle the patients onto the ward".

Um Right.

More fun during "protected mealtimes"

By 2PM I had discharged 3 of my patients and transferred two others to rehab and long term care facilities.

I had 5 empty beds! I made sure that the bed manager knew this. Our patients are always breaching the targets in a&e due to lack of beds. If she knows I have beds then she can get patients out of express admissions unit/medical holding and send them to me. Then she can get patients out of a&e and into medical holding.

I was left with a mere 10 patients (25 beds on ward total, and one other nurse). The healthcare assistant and I ran around making sure the beds were cleaned. I had to walk away from some important time sensitive things to help her do the beds quickly. Usually the discharged patients are not even out the door before the transporters are dumping another into that bed. What if the staff hasn't had time to clean the bed because the new patient is coming before the old one is out the door? Well then the porter will just dump the new patient into a dirty bed and go off on his merry way. He has other places he needs to be and it isn't his problem if the nurse gets an admission with no notice. It isn't his problem if she cannot sort the discharged patient's bed out right away because Gladys in the next bay collapsed onto the floor with a massive GI bleed. The buck always stops at the nurse and the numerous support staff goes on their merry fucking way and do as they please.

If the new patient complains about getting dumped into a dirty bed or gets ill as a result the ward nurses have to take all the blame. The porter can do as he pleases. Even if the patient has been on the ward less than 10 seconds anything that happens to that patient during that 10 second period is the responsibility of the RN. And they often send up admissions that I am not expecting and dump them and walk off while I am in another patient's room and don't see.

Sometime after I declare our number of planned discharges/empty beds to the bed manager the nurse from the "sending ward" calls me on the phone and tells me about the patient they are sending to me. This is called handover. After that happens the patient may arrive on the ward 3 minutes or 5 hours later or anywhere in between. They get sent to me at the convienance of the sending nurse's unit. I have no idea when they will show up on the ward. What I do know is that they like to send them all at once either at change of shift or mealtime. I don't know why it is that way. Either they are being twats or the situation on their unit is such that they have no choice.

Sometimes there is so much going on with the patients I already have that there is no fucking way I can nip down to see the new admission as soon as I want to and need to. I do not get given an exact time as to when they are coming so I cannot plan for it really.

I want to and very much need to go and see my new admission and give him a once over and a kind word of welcome as soon as he comes onto the ward. As a matter of fact I really fucking NEED to see him. But it isn't always going to happen right away. The ward receives admissions when it is convenient for those who are sending the admissions. That means admissions are arriving when I am up to my eyeballs in other things.

No thought whatsoever is given to what is happening on the receiving ward. That means that I am often getting new patients when it is unsafe. It means that I cannot always get to them straight away. Wanting to get to them straightaway and understanding that it is crucial for me to get them straight away is not enough to make it happen. This is the case even though I am an extremely hard worker and easily able to multitask.

If I had 5p for everytime a walking wounded transfer said "well I have been here 20 minutes and not one of the staff has seen to me yet" I would be rich. How I would love to say "well they sent your ass up here when I was smack in the middle of inserting an NG tube into someone with an obstruction.

As a matter of fact it is a crime for me to leave that very unwell patient at anytime for any reason EVER especially to be down here apologising and kissing your medically stable ass. But I took a risk to come down here because I care about your welfare too. Believe me, I took a massive risk when I left him and came to you. It's because I don't trust the ward who sent you or the transporters who dumped you here not to leave you in a bad way. Once upon a time the ward who sent you handed over that they were sending me a stable patient and when the man got here he was dying. It may have taken me 20 minutes to get here. But I got here as soon as I could. I did it in the only 30 second period I had to check on you and make sure that you are actually stable as they said you were. Your welfare is important to me, even if you are a complete twat. A word of thanks rather than a stupid smart ass comment about how long you had to wait would be more appreciated. Not one thing about this situation is created by the nurses. Nor can they control one bit of it.

Back to the point of this post. I had 5 empty beds at 2 PM and the bed manager knew this at 2:05 PM. She knew that those beds were coming up and already had transfers slated to come to us.

We got the beds ready right away because we know what happens. 3PM rolled around and I had not received a phonecall from a medical holding unit nurse to give me handover on a patient that she would be sending. By 4 PM I had received a call from the holding unit nurse. She handed over two patients. I told her to send them now, before mealtime.

By 5Pm nothing. At 5:50 they called and handedover 3 more patients. At 5:55 they sent all 5 of them up together. The porter left them in the middle of the ward and walked away. I found them all when I came out from a bay where I was pulling a central line.

3 of them were confused. None had wrist bands on to ID them. The one who was supposed to be treated for dehydration with an IVI and a had low potassium according to today's blood report had NO IV. No venflon. Nothing. Nothing prescribed for his K+ of 2.2. First priority above all else right there. Had to get a venflon and get something prescribed. He wasn't taking oral anything. The last note from a doc who saw him prior to his arrival on my ward said to hang IV N. Saline with 40 mmols of K+ and monitor fluid balance closely. Well duh. But he never prescribed it onto the medication chart. In the UK nurses are not allowed to transcribe orders from the doc's notes to the drug chart. The doc has to write it on the drug chart. Yeah. And for those of you who don't know, if your potassium is that low your heart will stop.

The one that had urinary retention (according to handover) and had not passed urine in 11 hours (bladder scan that was done in medical holding showed 800mls in bladder). The sending nurse handover to me that she was going to cath the patient. This was a few hours ago. He was supposed to have a catheter inserted. There wasn't one.

So all this was happening at the same time and there were 2 nurses and 2 HCA's. It was 5:55 PM. The supper trolley comes now, and we have 20 minutes to get all the food out and served and fed to all 25 patients (and 10 feeds). I also have an hours worth of a drug round due now and people need their pain killers. I can't even get to the new patients new and read up on them to see if there have been any changes since they were handed over. This is because the notes are on the desk and that is where the visitors are queing.

I go for the notes to read up on my patients and make sure there aren't any other life threatening "surprises" left over from the sending unit and the visitors of the other patients go for my jugular." Patients are crying for nurse and suffering and there is that nurse with her face in the notes" "Don't you know that grandma cannot feed herself cannot reach her drink? Don't you horrible people care?" It's not like I can through all the notes in a few seconds. Getting all the information that I need to takes time and concentration. But the families go nuts when they see me open a chart....then mistakes happen because the nurse does not have all the info she needs to be able to function.

The domestic was stood with the supper trolley hands folded staring at me menacingly while I was getting the venflon into the low K+ guy. The other nurse did the catheter. One HCA sorted the ID and wristband situation and tried to get the new people settled into their beds. They new admits got really pissy when she moved at the speed of light and wouldn't stay or organise their belongings in the cupboard. The reason she was moving so fast is because one HCA was now trying to serve and feed all the patients on the ward by herself. Impossible for speedy gonzalez let alone 50 year old Linda. We all needed to pitch in and help. Even with all 4 of us on deck it was never going to happen, let's be honest. It was 20 past 6 before I sorted out the man with the low potassium and by that point the fucking domestic was trying to collect all the dishes in so that she could get home on time.

Now it is 20 past 6. I was trying to keep an eye on my unstable patients, figure out who actually ate and who didn't...everyone was simultaneously shouting "nurse nurse nuuuuuursssse" as I walked by and the visitors who just arrived were queing up at the nurses station to bitch at me and tell me things I already know. My drug round still wasn't started. At this point I would be lucky if I finished it by 7:30 PM. That means it is going to be another hour before I get around to everyone in pain with their medicine. IF I stop at any point to talk to visitors or answer the cries of "nurse nurse nuuursssssse" it's going to take a lot longer.

FUCK. FUCK. FUCK.

Later on we again had two empty beds by 7PM. I told them so no later than 7:05PM. They handed over patients at half past 7 and then sent them both up together at 9PM. I am off duty at 9PM but the night nurse was going to struggle handling two new admits, her initial drug round, and all the problems that were happening. Really no choice but to stay late and unpaid and sort the new admissions. You would think that transfers from medical holding would be easy to deal with because the staff in medical holding due the initial admission and paperwork and "supposedly" get treatment started. When they are coming to us, they are merely transfers not proper admissions. Therefore it should be easy and straightforward. But it is not straightforward as that and I'll explain why later.

In the meantime if there are any medical express/holding/admissions nurses and bed managers around can fucking you tell me why the hell you send them up in clumps at mealtime and change of shift?

To be continued.