A Tale of Two Books

Nurse Anne always has her head buried in a book, but I tend to avoid fiction like the plague and it's rare anymore that I touch anything that isn't completely history or science focused.  If you want to check out a couple of books to read in the New Year have a look at these links. 

The first one is "Nursing Against the Odds"  by Suzanne Gordon.  Loved it for the most part. If there is anything that I learned from this book it is this:  The NHS, the media, the NMC, the public, and our chief nurses are doing everything WRONG when it comes to retaining nurses at the bedside and maintaining/improving the quality of patient care by nurses. Oh wait, I pretty much already knew that.  We are set up to fail from the get go.  This is true  no matter how caring and serious about quality nursing care we are or how many unpaid hours we work extra after 12 hour shifts with no break.  Patient care still sucks.

In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, we have a major shortage of nurses. Why are so many RNs dropping out of health care's largest profession? How will the lack of skilled, experienced caregivers affect patients? These are some of the questions addressed by Suzanne Gordon's definitive account of the world's nursing crisis. In Nursing against the Odds, one of North America's leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis. Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals. In Gordon's view, the public image of nurses continues to suffer from negative media stereotyping in medical shows on television and from shoddy press coverage of the important role RNs play in the delivery of health care.

Gordon also identifies the class and status divisions within the profession that hinder a much-needed defense of bedside nursing. She explains why some policy panaceas - hiring more temporary workers, importing RNs from less-developed countries - fail to address the forces that drive nurses out of their workplaces. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctors and nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care.

"The journalist Suzanne Gordon provides a powerful depiction of nurses' struggles to keep patients alive in an unsafe health care system. Read this book to see why national health care quality goals will not be achieved until nurses' work environments are fundamentally transformed."--Linda H. Aiken, University of Pennsylvania

And then there is the book I just finished titled "Mao's Last Dancer".  I have absolutely no interest in Chinese culture or Ballet yet I couldn't put this one down.  The real story in this is one of human interest.  Li Cunxion narrorates  a fascinating glimpse into the history of Chinese-U.S. relations and the dissolution of the Communist ideal in his life.  I knew Mao was one bad guy but never really understood what went on in China during the great leap forward as well as I should have.   The portrait of life under Mao as painted by the author, is so vivid that I nearly wept. Unrelated but I hope that humanity's natural tendency to whine and want everything taken care of for them by big brother never sends us back down the road to communism. Yeah, bring on the shitty comments about my  ignorance.  Yawn.

Raised in a desperately poor village during the height of China’s Cultural Revolution, Li Cunxin’s childhood revolved around the commune, his family and Chairman Mao’s Little Red Book. Until, that is, Madame Mao’s cultural delegates came in search of young peasants to study ballet at the academy in Beijing and he was thrust into a completely unfamiliar world. When a trip to Texas as part of a rare cultural exchange opened his eyes to life and love beyond China’s borders, he defected to the United States in an extraordinary and dramatic tale of Cold War intrigue. Told in his own distinctive voice, this is Li’s inspirational story of how he came to be Mao’s last dancer, and one of the world’s greatest ballet dancers.

So that's a boring blog post for you all.  Have a good one.

Slapheads: RGN version

I am a big fan of Mental Nurse and wanted to copy their slaphead series. They've done RMN,s, HCA's, Patients, etc in their slaphead posts. Here I go with an RGN's version, the militant medical nurse way. If you think I am a shameful copy cat just let me know in the comments section.

Of course none of the following applies to myself or my current colleagues. We are super nurses and should have a cape to go along with our superpowers.  I have run into some real freaks over at HCR Manorcare in my years and years of nursing. 

Indeed I have, in my time, run into all of the following charactors listed below. Repeatedly. Maybe you have as well.

Coasting till Retirement Colleen- Colleen did her training long before I was born.  She used to be a fantastic nurse but years of abuse from patients, relatives, colleagues, and management whilst doing an impossible job has destroyed Colleen's spirit.  She is a shell of a human being with it's life force sucked out.  She arrives to work.  and then bursts into tears and does the bear minimum that she can get away with just to get the hell out of there.  She snaps at people, locks herself in the treatment room, and looks at students as if they are crazy. Her colleagues have to pick up her slack. She has calenders all over the place, counting down the next year or so until she retires.  She have has pen marks on her arm, counting down each minute until the end of her shift.  Every painful second gets Colleen closer to retirement. Amen.



Nerdie Nellie---- Nerdy Nellie is going to drive yours truly into alcholism and I don't even drink.  Nellie is usually a twentysomething new nurse who takes her job so seriously we have nicknamed her psycho.  She comes into work two hours early, unpaid, and leaves two hours late, unpaid and goes over everything with a fine tooth comb repeatedly.  If anything goes wrong on the ward, even if it has nothing to do with her she starts weeping and throwing herself on the floor screaming "I'm sorry, I am such a crap nurse, it is a privilidge to be here and I don't deserve it because I am awful".  She does observations about twenty times more than necessary.  She gets a thousand things done in the time it takes the rest of us to get 10 things done. She never takes a break even if we are not busy because she does not feel that she is deserving.  Nellie will work 15 hours straight through on a non busy day, and then apologise to the patients for not being good enough.  She spends all of her time outside of work reading nursing journals.   If another nurse makes and omission or mistake Nellie goes mad.  After she finally does leave work, she calls the ward 10 or 20 times to make sure that all the patients are okay and that she didn't forget anything.  All night long. Forgetting is easily done when you have total chaos and too many patients.  It upsets all of us but Nellie actually needs medication and a CPN.

 Nerdy Nellie and Coasting it Coleen must never be put on duty together or on the same day because sparks fly.  A nightmare from hell is Nellie coming on duty and taking over from Coleen.  HOLY. SHIT.  Meow.  But out of all of them , Nellie's  are  clinically excellent and what I want for my nurse if I am unwell.  That is what stops me from strangling her to death.   I did ask her once if she ever stopped blaming herself and took a good hard look at patient ratios and multifaceted systems errors.  Her eyes glazed over and she stares off into space.  It gave her something to think about.  Nursing education tells nurses that everything is their fault, even the doc's errors and management incompetence.  The universities are churning out  Nellie's at an alarming rate.  Time to buy stock in pharmacutecal companies that make anti-anxiety meds and anti-depressants.

Lazy Len.... Typical lazy male staff nurse (ooohhh I am going to get some shitty comments for saying that).  Len does nothing on the rare occasions that he shows up for work.  Nothing.  I don't know how the hell these Len's get away with it.  He is a master at passing the buck.  A master.  None of his patients seem to have any pressure ulcer documentation.  The reality is that Len just never bothered to look at their skin etc etc etc etc.  He hangs around with Pervy Peter and management Molly.

Management Molly... Molly qualifed in the 70's and hasn't been on a ward since.  She love magnets, paperwork, targets, and describing the  nurses who actually have the balls to show up on the wards as "lacking in compassion".   She is clueless.  She has no idea what is going on.  Once in a blue moon she will do a quick ward walk through on a day where two RN's are struggling to make order out of chaos and care for an appalling high number patients with no staff and resources.  She will interrupt them to say "well you don't look very busy, here is a 40 page catheter audit to fill in on every patient with a catheter. "  She likes to refer to patients as customers and clients and talk about their journey's through healthcare. But she will not go anywhere near one.  I don't know what she does all day but entire forests are dying and she drinks more tea than exists in all of China.  When you try and explain to her the actual situation on the wards her eyes glaze over.  She has no idea what you are talking about and thinks that you are really nothing but complaining rif raf, complaining for the sake of it.


Crazy Connie....I have run into a few of these and they make me shiver with terror.  Luckily the ones I knew were fired. Crazy Connies crush up paracetamol tablets, mix them with tap water, and inject their brew into IV bags.  They sport a massive behive and love to wear an old fashioned nurse's cap, white dress, and white stockings.  She talks to her dead dog all night long. Out loud. She never bothers with drug charts, if a patient is asking for pain medication she just hands them whatever it is she is carrying around  in her handbag.  She walks up and down the ward talking to herself, while blaming herself for her boyfriends death in a car accident because "another dude liked me and put a voodoo curse on Rocky to get him out of the way". I do hope that all Connie's get the help that they need and stay the hell away from nursing.  The truly scary thing is that I have run into more than one of these types.

Pervie Peter.....typical perverted male staff nurse (am I being offensive?  Good.  Now let's continue). Todd from Scrubs has got nothing on Staff Nurse Peter..  He lears at you with a sickening grin. Constantly.  He constantly tries to look down your tunic top, admits it, and laughs about it.  And when you go into the office to do some charting he follows you in and sits way too close.  They will not give this guy a nursing student to mentor under any circumstances.  He rates the quality of the hospital staff by cup size and their "hotness".  He speculates about what kind of knickers the female docs wear.  He finds out where you live.  And one night when you are on the sofa with your husband watching a movie you look at your window to see Peter with his face pressed up against the glass staring at you.  And this is how he interacts with us older middle aged look like hell females.  You should see what he puts the younger members of staff through.  Hospital management does nothing about Peter types who harass his coworkers.  Until he starts on the young female relative of a patient.  Then all hell breaks lose and we never see Peter again. 

Old Fashioned Alice. ....  Alice trained when Christ was a babe in arms and she let's everyone know it when she gives her reasons for refusing to retire. She was brought up on the moors of yorkshire and has an accent to go with it.  Her jowels are the size of a small country and she is either huge or extremely tiny.  She is so old that agency HCA's didn't realise that she was a nurse and told her to "get back to the bed and ring the bell for help".   

Here are some classic Alice-isms: "In our'n day we didn't use gloves, we had shit all over our hands and went from one patient to another and I see no reason to change"  In our'n day we smoked at the nurses station, it gave the place an air of sophistication".  "In our'n day we didn't have any of this fancy shmancy life saving stuff and it was better and so are coal fires". "What is the point of infection control and IV antibiotics, we didn't ave none of th'at nonsense in our'n day".  "I'm making a cuppa for the relatives, and then I'll deal with the bleeder, that's how it was done in our'n day". Coming on duty after Alice's shift blows chunks because you have half of her workload that she ignored to pick up as well as your own.  No meds have been given, notes are being burned to heat the fire that Alice thinks we need for heating the ward and patients are deteriorating before your very eyes.  But their beds have perfect hospital corners and they have all had a cuppa and a fag. Even the ones on 02 have a fag.  Alice doesn't believe that 02 is flammable because "we didn't worry about that shit in our'n day".  Oh, and she thinks that modern nurse training is pants and tells mentally ill patients to "BEHAVE".

Should have stayed an HCA Shirley........Shirley had been an HCA from her late 20's until her mid forties.  She thought she knew more than the nurses.  She thought she ran the ward.  She loved to crack jokes at the nurses expense:  "Nurses don't change lightbulbs silly, they just document that they did".  She repeatedly slagged off the nurses for not doing all the basic care.  She didn't do it either, of course.  When one nurse had 5 critical patients during a drug round for 30 of them, Shirley would tell the patients "I am the one who does all the real work around here because I am an old fashioned 'nurse'".  Then Shirley would go out for a 2 hour fag break and leave the Nurse with 5 critical patients to answer all the call bells alone for 30 people .  Then one day Shirley decided to go to nursing school.  Despite loads of reservations from her mentors she somehow passed.  She nearly didn't and it took her 4 years to do so.  She graduates and gets a job on her old ward. 

But she cannot handle the nurse workload and makes more drug errors in one day than I have seen in  a lifetime.  She is in tears from the stress.  She just avoids the really sick patients because she is so lost with it all, and goes about still working as an HCA, ignoring critical problems while her colleague does her job for her.  She is great at bed bathing  and gossiping but has no executive function whatsoever. Constant constant communication errors and fuck ups. Then she goes off sick with stress, resigns (or got sacked), and now works at Primark.  Sweet fucking come uppance. I love it.

Happy New Year Everyone!  Be a better nurse than the ones on this post!

Who wants nurses away from bedside care?

Anytime there is a piece about nursing or care in our hospitals on the net there is always some shmuck posting his thoughts about what the problem is.

"Nurses don't want to work at the bedside" 

"Nurses want assistants to do all the real work"

"Nurses want degrees so they can be paid more and not get their hands dirty" 

People who say these things are Shmucks.

I even had one jerk telling me that the nurses themselves were behind the hospitals drive to hire care assistants instead of nurses because "nurses don't want to get their hands dirty".   Ha ha ha.  As if nurses could dictate to the hospital who they hire.

Nurses were forced away from the bedside.  They did not leave the bedside because they hate patient care.
I wrote another letter to a manager.  I tried to explain that we have more patients than we can handle etc etc etc.  That more care assistants than nurses  on the team means death and is not at all cost effective.

I actually got a response.  But all it does is show that he doesn't have a clue. Nor did he really read my letter.

"Nurses can either take a three year diploma or a four year degree course although there are moves to make all nurses take a degree, and I imagine part of the push behind that is to increase the starting salary. It will also probably mean more assistants on the ward, as the move to make nursing into a more clinical role will mean that the more hands on tasks will devolve to HCAs. This is a shift that has been happening for many years (alongside moving tasks from doctors to nurses) as it reduces costs at the same time as encouraging specialisation."

Fuckhead thinks that "dumbing down" reduces costs!  It doesn't. He wants me to "specialise" and play doctor while the HCA's screw up my patients' nursing care.  As a matter of fact I am sick and tired of having to play doctor and order diagnostic tests etc because it is taking us 10 hours to get a doctor to see our patients in hospital because there are so few doctors.  Example: If the nurses do not order the INR tests for warfarin control then they won't get done for a week. 

I have never seen anyone miss a point so massively.

It was NOT the nurses who did this people.  It's not about the nurses  "not wanting to get their hands dirty".

Edit 28/12.
Clueless management types have destroyed the level of care in our hospitals and driven nurses away.  I agree with the commentator who said that nurses need to be indpendent contractors...was it Suzanne Gordon who first said this?.  Nurses should be independent contractors and move away from this government run crap. It's worse than corporate run crap really.  Let's not be their scapegoats any longer. Let's no longer allow ourselves to be put in situations where we cannot do our jobs.

Nice resource about RN staffing ratios

Remember two things:

1.  NHS nurses on general wards have anywhere from 10-30 patients.

2.  A health care assistant is not a nurse.  Whenever we are using the term nurse on this blog or in research like the following we/they are referring to RN's.  If you are not licensed to practice you are not a nurse, even if you are wonderful caring person who works in the hospital providing patient care.  You are not a nurse unless you are licensed.  And you are not licensed if you did not go to university.  Unless, of course, you are older than Methuselah .  But if you qualified as a nurse without university you are probably long dead or at the very least retired.

Nice one. And the conditions over here are triple brutal.

Hope everyone had  a nice Christmas.  I'm a bit busy but will be back to blogging and answering emails soon.

Unsafe Staffing: Time to Jump Ship.

I have a meeting with our chief nurse next week.  Again.  Let's hope he shows up this time.  I am going to ensure that my words ruin his christmas.

I am sick of nurse leadership.  They don't have a clue.  They don't know what to do.

I'd like to organise something like this for as long as I stay here.

Recently worked a 12 hour shift.  There were two staff for over 20 beds.  That was it.  Twenty heavy medical patients that mostly required two to transfer, multiple IV's, patients with dementia constantly falling out of bed, 10 or 12 of them crying and screaming for a nurse all at once all shift.  WE couldn't even physically get to any of them 90% of the shift.The shift after us had one nurse.

Our sister ward had one member of staff.-an RN and that was it.  A 35 bed surgical-ortho ward had 1 nurse and 1 care assistant.  Express medical admissions had 2 people staffing it for 12 hours.  So basically I had it good.  My patients are a lot more stable and there were 2 RN's.  Horrendous but better than other wards.  I have never had so much back pain in my life.  I am in agony and can barely sit still while I type this.  Merry fucking Christmas.  Decent hospital management is supposed to invest in frontline staff and regular staff pools as well as on call staff.  They cannot invest enough in this kind of thing and it would save them money in the long run.  But instead they let everyone go, and try to band aid everything with agency care assistants (NOT NURSES).  Then they refuse to allow us to call agency anyway.

A couple of Patients were on the phone (mobiles) to their families about the lack of care.... who then got all upset and tried to ring the ward and speak to the "nurses" to find out what was going on.  The constant ringing phone just took us away from those patients even more.  They complained about us if we didn't answer the phone, but when we did leave the area where we could see the patients to answer the phone our patients got hurt.  Not one of those family members rang management to complain about staffing levels.  They just laid into the nurse who was trying to get away from the phone and get back to the patient area.

The site manager (nurse supervisor on duty) did what he could.  There was no staff anywhere in the hospital to pull from.  He tried to come to each ward for some minutes and take over to give each staff member a quick break. He did this all night.  No stopping for him.  Twelve hours is a long time to go without food and water and constant cognitive overload.

A teacher, office worker, etc would have lost their rag after 10 minutes. Imagine a teacher's reaction to having to work 12-14 hours non stop in an area of education that they were not used to teaching.  Then give them 30 kids they never met before. Then set it up in such a way that they are having to leave their classroom every 2 minutes to answer the phone and speak to families members of their pupils.  When I call my kids' school I leave a message for the teacher and she rings me back in the next day or two.  And it's not like she has life and death situations to walk away from in order to answer the phone!  Imagine if a classroom teacher had to run to the office and answer the phone every two minutes and imagine if this action could get one of her pupils killed.  Then imagine that her headteacher was threatening her with disciplinary action every time the phone didn't get answered while refusing to hire admin staff. Teachers would run a mile in this situation.  Run a mile.

My patient had a reaction to a drug.  Scared me enough to really make me tremble and get nauseous.  The drug I needed to stop the reaction was not on the ward.  Pharmacy was closed.  I had to leave him and my other patients and ring around until I found a ward that had the drug.  The only other member of staff had a bleeder and we were dealing with that as well.  Could not leave the ward. My patient was not crashing out but very unwell.  Believe me when I say we could not leave that ward. Add a dozen 90 year old patients to the mix screaming for their mamas over and over again and you can get a feel for the situation.

But then I had to ring around and find a ward that had the drug and enough staff on duty for one to leave and bring it to us.  Couldn't leave my ward with only one person.  God knows what the porter was doing.  He said he couldn't get the drug and bring it. I asked him what he was possibly doing that was more important!  They are fucking porters for christ sake not professionals with accountability.  Rather than waste time arguing I went back to ringing wards and found one with 3 people on duty and my drug.  They legged it up to me.  It took me way too much time on the phone to obtain this drug in an emergency situation. 

When the ringing relatives managed to get their call answered they pissed and moaned about the line being busy for so long, the phone not being answered right away....keeping me away from the patients even longer to give me an over the phone bollocking.  These people must have some level of mental retardation.  Morons probably think I was on the phone chatting to one of my boyfriends.  Remember that everything these idiots ever learned about Nursing comes from the Daily Fail and No Angels.

We are getting no help from the NMC, the unions etc.  

Make no mistake about it, nurses and senior nurses have been reporting these issues and believe me the NMC will to go after frontline staff.  If the NMC, the RCN, and Unison say that we haven't been whistleblowing  then they have confused me completely. Those in a position of power will not even acknowledge the staffing issues and the antiquated system/layouts/and ward set up nor will they acknowledge other management failures.  Our incident and grievance forms are probably being used to light some administrators oven.  Too many NHS nurses cannot function at all in their working conditions, not even the good ones.

They are only focused on going after individual nurses.And like the public they are blind to the real issues.  They just don't want to face it.  It's more fun to go after the frontline nurses who are trapped in a situation where they cannot function.

It's time to jump ship.  I have said this for a long time but have not been pro-active about it.  But the housing market is improving.  Had a long talk with the other half recently. He hasn't got a transfer back overseas yet that we have been waiting for.  We are not waiting any longer.  I hate to mess up his career in this economy but he is packing it in and we are getting out. It's a big thing to ask.  But he understands and is supportive.  At least someone (who is not a nurse) is understanding and supportive.  I am sure that somewhere in the NHS there are wards functioning well...but they probably won't be for long and I am not going to risk it.

The Slovenian model of care

Wake up and smell the coffee with Ronald Reagan circa 1981.




Correct me if I am wrong here  (really I mean that) but isn't this model of care pretty much everywhere except western Europe.

Currently, the residential homes in the UK are  little victorian townhouses with lots of steps. The staff is comprised of care assistants.  Once those patients deteriorate and age enough to the point that they are confused and /or cannot mobilise they get sent into hospital and wait 8 weeks for a bed in a nursing home.  The minute a patient becomes confused suddenly or mobility deteriorates they are sent into hospital. 

The nursing homes here are wee little old victorian townhouses with lots of steps.  They have RN's on duty 24/7 as well as care assistants.  But, they do not take patients on IV fluids of any kind, they cannot give IV antibiotics and if a patient needs a chest xray they get sent into hospital. Many of them will not cannot take peg feeds etc. 


Is it really any goddamn wonder why are acute medical hospital floors in the NHS are 75% nursing home patients who are very demanding but not acutely ill?  Their relatives expect them to be cleaned and fed and entertained constantly.  They don't seem to realise that the hospital is only staffed with just enough nurses to barely keep on top of all the IV meds for the 25% acutely ill.  The hospital is the worst place for any medically stable but dependent elderly person to be. Duh.

Are they really just figuring out now that this set up is bad and that they need to "modernise"?

They should have figured it out in '81.  No excuses.  The NHS should have planned for his and implemented something before Reagan was shot and anyone ever even heard of Madonna.  Here we are in 2009 and suddenly they wake up?  Fucktards.  And nurses are taking the heat for the elderly getting poor care? Christ.

I worked in a "long term care" facility- in lets say- Maryland many many (more than 10) years ago.  It was set up very similiar to what is described in this article.

Ground floor was physio, OT, patient entertainment, restaurant etc.

Floor One: residential care with 60 beds.

Floor Two: EMI with  60 beds

Floor Three: nursing home with 60 beds

Floor Four. 30 beds. Skilled nursing unit for patients needing IV antibiotics, blood, IV fluids, Peg feeds, complex pressure ulcer management etc.  This was to keep extreme geriatric patients out of the hospital unless absolutely necessary.  Hospitals are the worst place for medically stable but extremely geriatric dependent patients.  The hospital staff cannot cope with acute patients and nursing home patients at the same time.  They are not staffed too cope.

Floor four had another 30 beds.  This was ultra skilled nursing care: long term patients on ventilators etc.

The local area was full of such homes.  They were known as nursing homes.

Sometimes patients needed to get sent to hospital.  But 24 hours a day we had a respiratory therapist on staff at the facility.  The GP's and specialist doctor surgeries  who were responsible for the patients did daily rounds and always had one on phone duty to give the nurses any orders required  We had a guy with a mobile x-ray machine and we could get one done 24 hours a day.  We had a phlebotomist who came in to get the bloods that needed to be taken every morning.  We had our own pharmacy.

If a patient became confused we checked their temperature and dipped their urine...maybe got the doc to order a chest x-ray from our in house chest x- ray guy.  When elderly people become confused it is sometimes due to an infection.  We could start IV antibiotics and fluids right then and there if that is what the doctor wanted. Other problems like extreme bradycardia and ecg changes would warrant a call to 911 and transfer to the local hospital a&e.   It was the doctors decision. But we even treated DVT's at the facility. he gave IV heparin infusions.  The skilled unit also functioned as a stepdown, rehab area for hospitals to discharge elderly patients too.   If they couldn't care for themselves at home once they recovered they stayed with us and moved downstairs. We took patients who paid privately and medicare, medicaid patients as well as insurance patients.

When a residential home patient became unwell but did not require hospitalization they were moved to the skilled nursing floor.  If their cognitive or mobility issues continued to deteriorate, which is what happens to most elderly people whether or not the decline is accelerated by a disease process, then they moved onto the nursing home floor at this same facility.

The NHS may be looking at this model of care but I doubt they will want to fund it and staff it properly.

At work in the NHS we get many many phone calls from angry family members of our patients.  "The residential home won't take 99 year old granny back because she can't walk now AND IT IS ALL YOUR FAULT BECAUSE YOU LET HER LAY IN BED."  Umm. Granny had a massive stroke.  Anyway Granny will wait 6-8 weeks for a nursing home and develop a pressure ulcer and hospital acquired chest infection.  Much of the time we are not staffed in away that allows us to bathe and feed granny at any point without killing KILLING our acute patients. Sorry.  We (frontline staff) did not create this situation nor can we control it. We aren't the ones who want it to be this way.  We want a controllable workload so we can do basic care for our dependent patients as well as deal with all the other things getting thrown our way.

We get patients from residential homes who are sent in due to confusion, diagnosed with a urine infection, given oral trimethoprim and stay in the hospital for 6 weeks because the residential home "cannot cope".  Yeah it does take this long to sort out another place for them to go on discharge.

Elderly people will deteriorate cognitively and physically. A disease process that you or I would get over quickly will accelerate this decline in elderly patients and most of the time they will not get their former level of function back.  The nurses did not do this to your gran. 

The current system in place for dealing with our elderly patients is a total fail and it cannot function in the 21st century as the geriatric population explodes dramatically.  We may be keeping people alive more now but not always at a level where they can function independently. Don't blame the hospitals and for god's sake please don't blame that lone RN running between 15 acutely ill patients and trying to care for  multiple elderly and dependent patients between giving IV drugs etc.

The system is not set up in a way that they can manage the rapidly growing aging population. 

Look at the system.

Is it any wonder why our elderly community is suffering?  Who still believes that their suffering and lack of care is down to uncaring nurses who require dignity lectures? Some people just need to be slapped and then thrown off a fucking cliff you know.   If only these older out of touch nurses would focus on the real problems rather than indulging in the nursing profession's greatest pastime-eating their young. If only....
Personally, I would love to turf the acute patients and drug users out of my face and sit with and nurse sweet granny all day.  But you would never know it when I am at work and running past these poor elderly patients at 10 miles an hour, ignoring their cries because my pregnant heroin user just shot up in the day room and collapsed on the floor at the same time that some one else has started with a lethal GI bleed.

Am I wrong?  Am I way off base about nursing and residential homes in England? Am I wrong about the ones overseas?  Let me know.  One can still be provincial even if  she has lived all over the world. Seriously.

Owned Part two

Read part 1 first.

So I arrive onto the clusterfuck "surgery suite" at 0800. There was a list on a table of patients due to arrive. Two were already there pissed off that there was not a member of staff there to greet them. The list had 11 people's names on it along with the names of each of their consultants.  Names I didn't recognize.  What the list did tell me was the general order that they would be going to theatre in and what they were having done.   There were 3 charts on the desk.  That means 8 charts are missing.  The charts provide me with names, dates of birth, hospital identity numbers, past medical history, whether they had pre op assessments etc etc.  These are all things that I need to get pre op bloods and all the paperwork done etc.  I was guessing about the pre-op bloods.  The two patients now there did not know if they had any done. Great.  Each patient all need 5 forms filling in for admissions, tpr forms, operation checklists, consent forms, care plans, make identity wrist bands out for each one etc etc.  All patients were told to come in by 9 AM.  The last person on the list was scheduled to go to theatre at 3 PM.

The list tells me that the first person on the list is the first person I need to get ready.  But you have to move fast because theatres change the order on the list without communicating that to the ward staff.   They might just show up at 9 AM to take the patient that is last on the list, and he better be ready.  So it is a situation where you move as fast as you can to get everyone in gowns, the admission and pre op paperwork which must be sorted before they can go the theatre, bloods for group and save etc.  Make sure that they are consented, venflon are in and any pre op medications are ordered and available to give.  Once the doctor has prescribed them you have to harass and chase pharmacy for the drugs.

But without charts it was impossilble.  The first thing I did was tell the patients to change into theatre gowns and sit down while I went to the phone and rang around to look for the notes.  No one had a clue so I had to leave the surgical suite and hunt them down from the wards that they were supposed to go to.  The "never worked in a hospital before" care assistant was useless.  She was offering patients cups of tea!!  They are all nil by mouth for their operations for christ sake!!  She couldn't even do pre op blood pressures.  The patients thought she was a "nurse" and of course laughed  at a typically stupid nurse who didn't know that they weren't allowed to eat.

By 09:30 they were all there and I had all 11 notes.  I was running my tits off trying to get everyone ready along with bloods paperwork and other problems that need sorting before theatre because any one of them could get called to go 1st thing. I started with the people who were scheduled to go first on the list and went from there.  Many of them hadn't been to pre assessment and hadn't been consented which means I had to figure out which docs to page, what there page numbers were and tell them that patients were not consented.  At our hospital they must be consented before theatre, and a senior doc has to do it.

By 10:00 I was getting there.  I had established a good rapport with the patients and my 1st one had got to theatre, everything done for his operation. Yay me.  I hadn't forgot as much as I thought about surgical.  I was having to move quickly though.

At about 10:15 a timid looking young woman walked into the surgical suite.  I asked her name.  She told me it was Miss Doe.  Her name was not on the list.  She was just an extra 12th patient that they sent to me with no warning.  She handed me a letter from the hospital that told her to arrive at 9 AM for her termination of pregnancy that was scheduled for today.  She apologised for being over an hour late. Poor thing.  No wonder she looked horrible.  I felt so bad for her. I had no notes for her.  And I had to spend 10 minutes finding them.

And as I explained in part one I have no idea at all about abortions or gynae...do they do it by giving them a pill to induce miscarriage?  Do they operate?    Do they do it by sticking a coat hanger up their vagina?  Damned if I know.  I have not a clue.

If I had some warning the night before that I was going to be looking after gynae patients I would have been on google looking stuff up until 2 AM.  But there was no warning.  At 10:15  Miss Doe showed up, she was an hour late, I had no notes or drug chart for her and I know nothing about gynae.  Site manager confirmed that she was indeed going to be my patient and so were a few other gynae patients as the gynae ward was full.

Her notes had just arrived on the ward.  No pre-assessment.  No consent. No nothing and a blank drug chart to boot.  Shit.  I had just stepped over to the nurses station to ring the gynae ward and ask what I am supposed to do with this girl.  First I was going to ring the gynae team and see if they had any orders.   I got through to the gynae team secretary as the docs were not answering their bleeps.  The only thing she could tell me was that the gynae consultant knew this girl was coming to the makeshift surgery suite and was on her way down.

No shit, I couldn't believe my luck.  Having the gynae doc here so quick would give me the guidance I needed.  At 10:25 the gynae consultant walked onto my surgical suite.  The patient had been there 10 minutes.  The consultant immediately picked up the patients notes, glanced at the drug chart and threw it into a wall.  We had the following exchange in front of all the patients, including Miss Doe.  Consultant gynaecologist is in caps. because she was screaming like a banshee.

"WHY HASN'T SHE HAD HER PRE- OP PESSARY"

"Um. Her what?"  "She has only been here a few minutes and I don't have her...."

"STOP WITH THE EXCUSES.  WHY HASN'T THIS WOMEN HAD HER PESSARY.  YOU SHOULD HAVE CALLED US TO COME AND PRESCRIBE IT RIGHT AWAY. 

NOW YOU WON'T GET THE PESSARY FROM PHARMACY AND THAWED OUT IN TIME FOR HER OPERATION.  HOW DARE YOU.  HOW DARE YOU NOT GET THIS SORTED WHEN YOU KNOW HOW PAINFUL HER T.O.P. WILL BE WITHOUT A PESSARY TO SOFTEN HER CERVIX.  WHY WOULD YOU DO THIS TO A PATIENT.

"YOU NURSES DO NOT KNOW HOW TO PRIORITISE.  YOU DON'T CARE IF PATIENTS ARE IN PAIN BECAUSE OF SOMETHING YOU DIDN'T DO.

I couldn't really get a word in edge wise. She went on and on with the above type of stuff for about 10 minutes. I honestly do not know where all of that poison directed at me came from.

  But it did dawn on me that they must give termination of pregnancy patients some kind of vaginal pessary to make things easier.  It sounded like the things come frozen and need to thaw first.  It sounded like it needs to go in a few hours before the procedure to maximize the effect.   Doctors don't always remember to prescribe thing (happens with a lot of things) and depend on experienced nurses to know it needs to be prescribed.  They expect the nurse to know and call them and tell them that the patient is here and hasn't been ordered her whatsitcalled yet.  And we cannot obtain anything important like that without a prescription from the doctor written on the drug chart.

Now I didn't know anything about a pessary until the gynae consultant from hell started shooting her mouth off.   But had I had just a few more minutes with the patient I would have been able to get one prescribed by a doc and obtained from pharmacy.  The gynae ward nurses would have given me a heads up.  If only I had ever got a chance to phone them in the 10 minutes I was aware of Miss Doe's existance....well the 3 minutes out of 10 where I wasn't chasing after her notes as well as sorting my 11 other patients out.  We nurses help eachother out a lot via phone when one is floated to an unfamiliar area.  I had a gynae nurse on the phone to me once as her ward was taking medical patients and she didn't have a clue.  I clued her into many things that the doctors will not write or communicate with you but expect you to do.

The gynae consultant from hell had her gynae junior doctor with her.  Throughout the consultants tirade the junior doctor folded her arms across her chest and glared down at me, and every few seconds she added her two pence worth whilst nodding her head.  "yes what you have done is very bad, very bad indeed, very cruel towards the patient, very cruel indeed".  All within earshot of the patients of course.

Now I am perfectly capable of standing up for myself but really I couldn't get a word in edgewise AT ALL and I was not going to stoop to her level.  I had never seen, heard of, or worked with this doctor before.

We had 12 pairs of eyes, merely a few feet away focused on us. Those eyes belonged to my 11 patients and the 12th patient, Miss Doe who was listening intently.  Had they not been there I would have called that consultant a stupid bitch to her face, kicked her in the cunt and walked away.  But they were there.  I got the prescription, I got the pessary, I thawed it out and it was in the patient plenty of time before she went to theatre.  She was fine.  I managed to pull everyting together for everyone else as well.

But the rapport I had worked hard to establish with those patients that morning was ruined.  For the rest of the day they looked at me as if I was some incompetent bitch who wouldn't get them what they needed. 

Wow gynae doc, what a way to make sure that the blame for any fuck ups caused by the unorganised chaos in this hospital will not be attributed to you.  Kudos and applause, even if you are a total bitch.

When I blog on here I often changed details.  No details were changed here .    This happened just as I wrote it, it happened to me, it happens a lot to registered nurses and it is definitely militant medical nurse raw.

But at least it wasn't a fuck up in some area that was really critical and acute, as happens to many floating nurses when doctors don't bother to write out orders or strike out prescribed drugs that shouldn't be given .............drugs that are still prescribed on the drug chart to be given.  The nurses actually do get the heat for that you know.

This stuff happens all the time, and it is the reason registered nurses throw such temper tantrums when they are asked to float.