Um. What does this tell you?

http://www.nursingtimes.net/whats-new-in-nursing/news-topics/health-workforce/dramatic-decline-in-nursing-posts-fuels-job-fears/5018755.article

The number of nursing vacancies has fallen by nearly 40 per cent in the last year, according to data gathered by Nursing Times.

The figures, together with new data from the NHS Information Centre, have fuelled fears that NHS trusts are freezing vacancies, are not replacing nurses and are converting posts to lower grades in order to tighten budgets.

Shock horror. Yawn.
and

http://www.nursingtimes.net/whats-new-in-nursing/news-topics/health-workforce/nurses-and-healthcare-assistants-forced-to-retire/5018724.article

Eleven nurses and 21 healthcare assistants have been forced to retire by an East Midlands primary care trust despite the government’s plans to scrap the default age for retirement from October next year.

and
 
http://www.nursingtimes.net/whats-new-in-nursing/students/new-nurses-struggling-to-find-jobs/5018525.article
 

RCN Scotland has said policies such as freezing posts and not replacing people who leave mean newly qualified nurses and midwives are struggling to find jobs in the NHS. The union has warned “unsustainable tactics” are being used by health chiefs struggling to cut costs, and called for more to be done to protect frontline services. It added the decisions could have “devastating consequences” for patient care in the future.

Remember this my dear reader: This has gone nationwide.  And it has been going on for a hell of a long time.My trust still hasn't hired any nurses.  But they have been advertising for management posts with stupid names and "champions" on salaries around £130,000 a year.

Dame Christine Beasley

So who thinks that she would grant this site an exclusive interview?

Anyone?  You can place your bets in the comments section.

I am going to try both Chrissy and Peter Carter.

I have some nice questions in mind.  Add your questions below.

:)

Charlotte Gets Yelled at For Feeding a Patient.

Charlotte is a colleague of mine who is excellent at her job.  She completed her training at University about 6 years ago. She is a wonderful bedside registered nurse.  She really stays on top of things and will work a 14 hour day without a break to do her best to ensure that the patients all receive their treatments and orders.

Like the rest of the RN's on the duty roster Charlotte often finds herself as the lone RN for 19 patients when she is on shift.  She may have one or two apprentices to help.

Just mixing preparing and administering all of the drugs due at 8AM takes until way past lunch time when you are the lone Nurse for 19 patients.

 Not only is medication administration complicated and time consuming but the lone RN will be constantly interrupted by doctors, relatives, patients, pharmacy, social services, path lab etc etc during her attempts to get her patients their first lot of drugs for the day along with a basic nursing assessment.   There is no break, no let up from these interruptions.

 The apprentices can neither continue with the drugs or deal with the interruptions.  Many medics will show up during this time and demand that the Nurse abandon her patients to follow them around on a doctors round for an hour.  The doctors don't care if patients don't get their ordered treatments or get cared for by an RN.  They just like to monopolise the Nurse's time for the sheer fun of it.  It takes until lunchtime for Charlotte to see each patient once and administer the drugs due at 8AM.  And that is if you keep it to two minutes with each patient and then run off.

On Tuesday morning Charlotte was receiving handover from the Night Nurse.  11 out of 19 of Charlotte's patient's that day were going to be unable to feed themselves.  Charlotte hauled ass that morning.  She took short cuts with the drugs and ignored the phone calls from families.  This was the only way she would get to a point where she could obtain the ability to feed all of her patients at lunchtime. 

Noon rolls around.  Both apprentices are off the ward escorting patients to diagnostic tests leaving Charlotte trying to feed 11 people by herself simultanously while handling everything else that is going on for those 19 people.  She was grateful that no one was really poorly at that time and that the high priority things (blood transfusions, life saving drips that need to be put together and administered) were under control by noon. 

She happily commenced a serious and whole hearted attempt to feed her 11 patients.  She started with the first two patients who were next to eachother and tried to feed them at the same time while telling the patient across the bay that she would be there to help as soon as she could.

Enter Doctor Hellboy.  He has been told repeatedly not to show up at lunch time to do his rounds so that the Nurses can feed the patients.  When a doctor arrives to do rounds he pulls the Nurse away from whatever she is doing for a good hour and a half. But Doctor Penisbreath has a lot of patients to see and not a lot of time and it is very convienant for him to show up for rounds at lunch.

But he shows up at lunchtime anyway.  He doesn't care if patients get malnourished as long as they are not his patients.  He walked up to Charlotte as she was feeding her first two patients, snapped his fingers at her and announced " I am here for my rounds, come on now" and he walked away expecting Charlotte to follow him.   She did not.  She continued feeding her patients.  He went nuts on her. Absolutely nuts.

"How dare you refuse my ward round blah blah blah how can you know what the plan is with the patients if you don't attend the ward round blah blah blah".

Charlotte held her ground and was able to get most of her patients fed.

The funny thing about this particular consultant is that he has been overheard telling the complaining family of a malnourished patient "These Nurses today cannot be bothered feeding patients, they went to university you know".

What a cock eh?

Same guy declined to give his support to our ward sister when she made a case for getting extra RN's employed so we had enough to feed the patients and attend ward rounds.  Therefore we could know the "plan" with the patients and get them fed as well.  My ward sister was not only shot down on that request but the medical manager, chief nurse etc laughed in her face and told her she was "exagerrating the ward conditions".  None of these people have been on a ward in over 20 years.

I wouldn't bother posting this if it was a one off but the consultants are pretty much on my shit list this week for these same kinds of things.  And the next few posts will reflect that.

They have sunk even lower.

Can't believe I am having to tell you guys this.

We are losing our cadets/apprentices whom we have been trying to get up to speed for the last year or so.  Most of them are still crap as they have not had nurse training and don't understand the patients.  But if the trust refuses to staff the wards with real Nurses then the best we can do is try and help these kids succeed.

The apprentices have been doing NVQ things since they started in order to get them qualified as a Health Care Assistant.

All of them but one have passed their competencies and can now be health care assistants.  As they are turning 18, they will also be paid more than £3.00 an hour.

The trust has told them that they have to re-interview for HCA jobs now that they are no longer apprentices or whatnot.  Their contract as cadets is up.  Only one out of the seven is getting employed on the ward.  The rest are getting told where the door is.  Lots of tears.  A few of these kids were showing promise and were thinking of Nursing school someday.

And we are getting a new batch of 16 year old untrained inexperienced kids on £3 an hour to "bring up our staffing numbers".

The people who are the most pissed off at this situation are the two excellent experienced Health Care Assistants we have left on the duty roster.  Both of these women have been health care assistants for 15+years. They have been through hell in back trying to show these little snots the ropes. They have been through hell and back trying to carry all of the basic care while the lone Nurse was tied up with rounds, drugs, emergencies, and the cadets were chilling at the nurse's station.  It is easier for a proper health care assistant to get a job somewhere else than it is for an RN.  So these two are talking of leaving.

Man oh man we are so fucked.  No change there then.

The wards are going to be staffed with one or two RN's and 2 or 3 apprentices who don't listen no matter how many times you tell them that if a patient only has 50mls of urine in their catheter over the last 12 hours YOU NEED TO TELL SOMEONE.  The RN's have way too many patients and interruptions. It is physically impossible for the RNs to keep an eye on these things themselves.  Regulating the real health care assistants won't do squat for us as we don't actually have any health care assistants.

If you want to read more about the untrained assistants who are replacing Nurses on the wards as a result of management directives look at these links:

http://militantmedicalnurse.blogspot.com/2009/03/here-come-kids-god-help-us.html

http://militantmedicalnurse.blogspot.com/2009/04/more-fun-with-kids-part-1.html
http://militantmedicalnurse.blogspot.com/2009/04/more-fun-with-kids-part-2.html
http://militantmedicalnurse.blogspot.com/2009/12/feeling-sorry-for-kids.html

Dear Mental Nurses, Doctors...anyone really

What the fuck is going on?  I need you to shed some light on something for me.

Why are GP's sending self harmers and anorexics who steadfastly refuse ALL TREATMENT as direct admissions onto medical wards?

These people have no medical issues. This is happening a lot lately.  I can understand an overdose needing IV parvolex but when they are purely mental health issues we cannot manage them.   We don't know what to do with them.  Psychiatry is refusing to take them over until we "force feed" these patients.  This is something medical doctors and nurses ARE NOT ALLOWED TO DO UNDER ANY CIRCUMSTANCES IN A DISTRICT GENERAL HOSPITAL AND WE DON'T MAKE THE LAWS.  We can't section them apparantly as they need to go to their previous psyche facilities for that.  News to me. We have resorted to begging these patients to eat, on our hands and knees.  This includes the chief exec visiting these patients and doing some begging.  The psyches won't take these patients over but will be taking the hospital to court if we don't "make" these people eat, stop threatening suicide etc etc etc.

Why the hell are the medical consultants getting this dumped on them?

The GP's are even sending people to AAU with "anxiety" and no other problems at all.  Even if we can get the psyches into see them (mission impossible on a good day), it could take over a week.  And medical patients die due to lack of beds, and getting discharged to early to free up more beds.

We have no RMN's on staff so basically we are up shit's creek.  The local psychiatric hospitals won't "get involved".

What am I missing here.  These patients definitely do NOT have medical issues.  No electrolyte imbalances yet.....or confusion related to infection.  Nothing like that. 

What is going on?

Will probably have to delete this.

This Makes Me Sick

Today I learned that my ward is gaining more beds.  We will be taking more acute patients and having higher throughput.  After a letter writing campaign initiated by myself, the ward sister and another senior staff nurse a letter was received by management.  "We are sorry to hear of your staffing issues.  You will be getting extra staff in the form of .5 of an auxillary. By our calculations this will bring you to a full complement of staff". 

What. The. Fuck.

We are losing two HCA's.  This leaves us with two HCA's in total on the duty roster.  The other care assistants are all inexperienced apprentices and auxillaries.   I know of 4 HCA's who want jobs on my ward.  They have been turned away.

Management has taken the only room on the ward that we have for lunch breaks and handover and are turning it into a patient sideroom.  This leaves us cramped into a very small space for handover. 

The day staff had to sit on the floor while the night nurse who had been on duty for over 14 hours had to sit precariously on a wobbly ledge thing for the change of shift handover.  It takes a half an hour at least to handover.  Talk about uncomfortable. If we handover at the nurse's station patients will overhear us and report us for "breaching their privacy".

Breaks are impossible.  The staff nurse really isn't in a position to leave the ward for a 15 minute walk to the canteen due to short staffing.  She won't have another nurse to watch her patients. She will not be able to eat in the cramped handover room from hell unless she sits on the floor and wants to get interrupted every 2 seconds.  That means the staff nurse's only option is to eat at the nurse's station thus inviting a whole bunch of smart ass comments from visitors and doctors who do not realise that she is only taking 10 minutes to eat in a 12 hour shift.  Nor do they realise that she has no where to go to eat.

Then I come home from work and see this shit.

What the hell is going on?

Nurse Anne's Information Pamphlet for Patients and Relatives: PART 1

I would like to print out a little pamphlet called "let go of your delusions" and hand it to every alert and oriented patient who arrives on my floor.  And all relatives.  This does not, of course, apply to confused patients, demented little old ladies or drug addicts going through acute withdrawal. I expect those patients to act like circus animals. However, if you are an adult who has voluntarily sought help for a medical problem, and are now lucky enough to even be in a hospital bed, there are some things you should know.  Thanks to the posters at allnurses from whom I stole  borrowed this idea. Writer's block is a bitch.


#1. YOU WILL NOT SLEEP. This may sound cruel, I mean, how can you get better if you don’t sleep? However, if you come to a hospital expecting a nice, quiet spa environment with cute nurses fluffing your pillows before you drift away into a healthful sleep, you are delusional. Time is short – the government and managers want as many people in and out of your hospital bed in as short a time as possible.. You will be woken up throughout the night to have blood drawn, blood pressure taken, IV meds administered, quick neuro assessments to ensure that your brain is not oozing blood. You will also likely hear people screaming and crying, cursing and laughing all night long. If you are lucky, it is not your own confused roommate who is constantly climbing out of bed only to set off his bed alarm.  We cannot cure dementia or give them a magic pill.  They may very well walk into your room and shit in the corner.  They may try and get into bed with you.  They will scream out for "billy" or "help" or another dead loved one all night long no matter what we say or do for them.  They will not remember or retain anything we tell them.  This is dementia. These kinds of patients are increasing tenfold.  Unless you are in maternity or paedatric wards we cannot shelter you from this.  It's not only dementia.  Patients with severe medical illness, and other conditions will become confused, disorientated and unmanageable, even without the dementia factor.  This is also increasing ten fold as more people survive severe illnesses. The hospitals are busting at the seams with these people.  I even heard of a demented wandering elderly patient getting put on a maternity ward as there was no other place for her.  We are lacking beds.  No we cannot "send them somehwere else" or just "give them something".  Wish I could.  If you think you may need something to help YOU sleep, 3:00 AM is NOT the time to ask your nurse for temazepam. Ask ahead of time when your registered nurse can call the doctor for an order. Which brings me to my next topic. . .



#2. YOUR NURSE DOES NOT HAVE ACCESS TO ANY DRUG THAT MEETS YOUR FANCY. If you suddenly feel pain or your left knee itches, your nurse cannot reach into her magic scrubs pockets and procure any drug you like.  Nor can she just get and give anything your normally have at home as prescribed by your GP.   In hospital Doctors are the one who must order any and all medications, EVEN IF IT’S “just my usual piriton". Do not get mad at the mean nurse who won’t bring you extra morphine because your back hurts. That mean nurse must put out a call to a doctor, has wait for him/her to call back, pray that he/she is in a good mood and will give you the requested drug, write an order in the chart, scan that order to the pharmacy, wait a zillion years for the pharmacist to profile the medication, wait another zillion years for the pharmacy tech to bring the medication, then the nurse can bring you your drug. This can take a while. There is absolutely no way around this, even if you have a gun to my head. Do not think the nurse is secretly hiding your medication and enjoying your  discomfort. Which leads nicely into my next heading. . .



#3. THE NURSE IS NOT YOUR ENEMY. Yes, the nurse must do things that sometimes causes discomfort – we must start IV lines, insert catheters, change dressings on painful wounds, give you shots – but we do these things to help you get better. We take no joy in them. You know that doctor that just left your room? The one to whom you were very nice and polite? The one to whom you listened quietly, asked no questions, and didn’t bother to tell that you are bleeding profusely out of your rectum or experiencing chest pains? Yeah, well HE is the one who orders these tests and blood draws and procedures. Speaking of that. . .



#4. TELL YOUR DOCTOR ABOUT YOUR SYMPTOMS. I cannot believe how many patients lie there quietly, smiling away when the doctor is in the room asking how they are feeling. “Oh, fine, Dr. Bighead! I feel great!” then. . .5 minutes later when the doctor has left the floor, this same patient is suddenly in excruciating pain, has numbness in her right foot and blurry vision. When asked why the HELL they didn’t tell the doctor who just left, they shrug “oh, I don’t know. . .I didn’t want to bother him. . .he is so busy.” Then the nurse must call the doctor and tell him that the nice, smiling patient they just saw is now a quivering mass of pain and can’t feel her own face. This leads doctors to think that nurses are nutcases. And it leads them to scream at us for paging them 5 minutes after they walked off the ward on their way to see their other patients, a job that takes them all day even if they rush and take short cuts. But mostly they just think that the Nurses are exaggerating or crazy. Which takes me to my next point. . .

#5. DO NOT TAKE YOUR ANGER, FRUSTRATION, ANNOYANCE OR SCHIZOPHRENIC HALLUCINATIONS OUT ON YOUR NURSE. In general, doctors are treated like gods and nurses are treated like shit. Plain and simple. We as nurses try to proclaim that we are professionals and that we make a difference – in actuality we are treated very poorly by most people in the health care world. We are in the very difficult position of being the “coordinator of care” for patients, yet we lack any power to actually make decisions. We have all the responsibility but none of the power. I spend so much of my day making phone calls, trying to make things happen. Trying to get test results, find out what is going on, talk to the doctor, get medications ordered, figure out why the patient has not yet had that MRI of the brain or echocardiogram. Nurses are viewed as nagging wives. . .and tend to be treated as such. But no one else in the hospital is going to take responsibility for getting this stuff done for you. Doctors, in general, do not talk to nurses, they do not tell us what is going on with patients nor do they tell us the future plan of care. For me to figure out what is going on, I often have to try to read the doctor’s handwritten progress notes, which is pretty much like trying to decipher ancient Egyptian hieroglyphics on a pyramid wall.  I cannot sit at the nurses station for as long as it takes to read their notes. There is very little direct communication between doctors and nurses. If you want to know if you have cancer, for the love of god, ASK YOUR DOCTOR.


#6. YOUR NURSE HAS 10-20 OTHER PATIENTS, SOME OF WHOM ARE A HELL OF A LOT SICKER THAN YOU EVEN IF YOU ARE PRETTY DAMN SICK.   Nurse has no control over how many patients she has but she maybe looking at a manslaughter charge if she goes to clean the incontinant lady before she gets to the diabetic with the hypostop. If you ask your nurse for some coffee and a newspaper, and she tells you that it will be a few minutes, do not get huffy and demand to see her nursing supervisor. For all you know, that nurse has a patient in the next room who is not breathing or is in desperate need of some pain medication. As nurses, we must prioritize, and yes, my “least sick” patient will get less of my time. This is not to say you are not important and I am ignoring you, but no, I don’t have time to listen to you whine about your chronic neck pain when I have another patient who is having a seizure or gasping for air as he drowns in his own secretions. I get no help with this.  I just have to prioritize all the time.



#7. “H” DOES NOT STAND FOR “HILTON. Don’t complain to me about the food, the lack of TV channels, the view from your window, the “smell” of the hospital, of not being able to take a shower or go downstairs for a cigarette. You are in the hospital. Get that through your head. It is NOT like being at home or on vacation. We now call “patients” our “clients” or worst yet, “guests.” Our administrators are much more concerned about if our patients are happy than if they are getting better. My boss is always telling me how much my patients “like me” but I never hear anything about my actual care. It would be better for the hospital’s rating if I let that overweight diabetic eat her ice cream and get really ill rather than tell her NO – at least she would be “happy.”  You know all those high taxes you pay?  They don't even cover the cost of your diagnostic tests and drugs.  You will not get the "penthouse suite" to recover from your CABG. And the hospital will most certainly not fork out the cash for you to have your own private duty nurse who can always be there for you.  You Nurse most likely cannot be in your room for more than 2 minutes at a time without risking lives.  If she doesn't limit herself to a few minutes max with each of her patients at a time she will miss the boat on something big.  And in her line of work it's life and death. 


#8. SOMETIMES IT IS GOING TO HURT. Yes, getting out of bed and walking after abdominal surgery hurts. Pancreatitis? Oh yeah, you are going to hurt and you are not going to be eating anything for days.  You won't be allowed too.  #18 IV in the AC? Yup – it is going to hurt and likely be uncomfortable as hell for as long as you have it. DEAL WITH IT. You are in the hospital. Yes, it sucks and No, I don’t expect you to be happy about it, but don’t constantly whine and complain and demand that I “do something about it.” You are not going to be magically cured just because you are in the hospital, and sometimes there is pain that even high levels of narcotics does not completely eliminate. Walking the day after surgery hurts, but it is the only way to heal, avoid pneumonia, and get out of the hospital.  And if we overdo it with the painkillers you won't move, you won't get out of bed.  Then you will get pneumonia and possibly a fatal blood clot.  No I cannot alter reality. 

So that is part one.  I will be continuing this in part two with "the nurses and doctors did not give your gran dementia, lung cancer and heart failure" and " we have no way in hell of knowing when you are going to be admitted, transferred, discharged or when the hell the doctor or transport vehicle is coming.  Please stop asking.  The amount of time spent away from dying patients to answer your stupid fucking questions that require a crystal ball is a crime against humanity" and also "there are a million and one PERFECTLY good reasons that you or your loved one cannot have food or fluids.  We are not starving or dehydrating  you/her/him to death, the illness is".