An intelligent comment from Daily Mail reader

I read this comment.  Then I collapsed.  And when I came around I thought I would post it to my blog.

Alan from York I don't know who you are but I love you!!

Maybe if nurses were allowed to nurse, not spend most of their shifts being clerks, recptionists,social workers, cleaners,junior doctors and being at the beck and call of every other profession who walks onto a ward things might improve. This is before they spend hours trying to answer the numerours calls from various family mambers about how their relative is. Spent a week in an NHS hospital watching one of the most put upon professions working themselves into the floor to meet the competing demands and expectations of patients, management and doctors and being constantly criticisied and blamed for everything thatr happens. A week in a hospital near the nurses station is most informative and some professions need to change their attitude towards the nursing staff. The most work shy group the ones who are ment to take blood but spend more time thinking of reasons not to was enlightening to overhear their conversations.

http://www.dailymail.co.uk/health/article-1366832/One-NHS-workers-NOT-recommend-hospital-treatment.html#ixzz1GsSmZqkj

Dr. Rant is back Ya all!

I am their number one fangirl.   I want the t- shirt, the autograph, everything.

http://www.drrant.net/

More job cuts

Mental Nurse beat me to it but here you go:

http://www.guardian.co.uk/society/2011/feb/17/nhs-hospitals-axeing-frontline-staff

and remember........

http://www.guardian.co.uk/society/2010/jul/07/nhs-jobs-cuts-coalition

Notice the line about the Royal College of Nursing "confirming" that nearly 10,000 posts (qualified Nurses) have been cut due to vacancy freezes.

Nurse Anne told you so.

And I have an inkling that their number is only the tip of the iceberg.  My trust alone has got rid of nearly 60 District Nursing posts.  Our hospital is appalling for not replacing Nurses. 

As they say over at Mental Nurse: And so it begins......

You think the care in the hospital is shit now?  Just wait.

Epic Win...Kind of....

Somebody posted a link to my blog and it actually made it into the comments section of the Daily Mail.

Not that their readers will give a crap or ever understand the situation.  But you know, it is something worth celebrating anyway I think.

Stopping in to say Hi.

Hello everyone!

I just thought I would put in a quick update in order to let you know I am still alive.  I have been flying in and out of the country sorting out all kinds of things.

I have indeed seen the recent reports into the poor care of elderly patients.  I have also seen Dr. Grumble's post on starving patients. Yawn.

Dr. Grumble's post reminds me of an old old story that I once heard whilst on holiday in the United States.  We were driving through Kentucky and met some interesting people.  Here's the story:

Once upon a time an old farmer with a young son and a teenage daughter was at work in his fields.  His little boy came running towards him.  "Papa Papa!  Sissy and your hired man are in the barn.  They climbed up into the hay loft and took their clothes off !  Dang it Papa they are going to pee on the hay!".   "Son" says the old farmer "It would appear that you have your facts right and your conclusions wrong."

And it is just so with Nursing care in this country.  The media and the public are getting some facts right i.e. malnourishment and elderly patients not getting the care that they want.  But their conclusions as to why these things are happening (blaming nurses and nurse education) are way off base.

In the meantime I just want to make a few things clear.

The vast majority of staff on your average NHS ward are not Nurses.  The are carers.  They have never attended any kind of Nursing school either hospital based or university based.  On your average shift 3 out of 5 staff are non nurses.  My 6 chair hair salon has more than 5 staff on duty at any given time.  My 35 bed ward?  Never more than 5.

There are no ward jobs for real Nurses.  New nurses are signing on or leaving the country.  You really don't have any degree Nurses working on the wards or in NHS management.  They are rare birds in the UK.

The vast majority of Nurses in the NHS both in high level management positions (chief nurse, matrons, nurse specialists) ARE INDEED OLDER NURSES WHO TRAINED UNDER THE OLD SYSTEM. 

Of the few Nurses on the wards, the VAST MAJORITY are older nurses who trained under the old system.  My ward has no degree nurses unless you count me (and I had old fashioned hospital training as well as the degree I did abroad).  The ward upstairs?  No degree nurses.  The ward downstairs?  No degree nurses.   The matrons?  Nurses who trained in the 70's who got degrees later.  The Sisters?  Ancient hospital trained certificate nurses, older than Methulusah.  And so on and so forth.

Where people are getting the idea that there are all these degree nurses running around NHS hospitals from I have no idea.  Our newer Nurses are mostly in Australia doing direct patient care with a 4 to 1 ratio.  What is left in the NHS? Ancient nurses who trained decades ago and are too old to immigrate.  But of course an NHS ward only has two of them a shift (sometimes one for an entire ward). The rest of the staff is comprised of untrained uneducated unlicensed carers.  The few new nurses we have taken on are absolutely disgusted.  They hate being the only qualified on shift and being so snowed with drugs, orders, etc that they have to leave patient contact to carers who cannot connect the dots between general condition and plan of care. They are quitting.

Even if a new Nurse qualifies with a degree  and gets a job she cannot just go straight into management or clipboarding.  She has to get years of experience as a bedside arse wiping drug giving sheet changing  Nurse before she can even think about moving on.  And as there is no promotion or jobs she isn't going to be moving on into anything.   She sure has hell cannot even look at specialist nursing until she has years and years of old fashioned nursing experience under her belt.

Tick boxes?  Well yes we have been told we have to do that.  But there is no time during the shift to do it so we stay over unpaid to do it and avoid discipline.  Why do we have to do it?  Is it because some fancy degree nurse says we should?  NO.  Our senior nurses are not that dumb.  It is because the DoH/ CQC will fine the fucking shit out of the hospitals if we don't.  And my hospital has no money anyway.  They cannot get fined.    When the CQC came in I was happy.  I thought someone was finally doing something. All they were concerned about was whether the box ticking was done.  And if it wasn't done they wanted BLOOD.  These people are AUDITORS AND BUREAUCRATS  not nurses/doctors/ or god forbid educated Nurses.  I expressed my shock over their attitude to my ward sister.  "Why do they only care about forms?" says I.  "They are not clinical.  They are business people" says she.  I thought they were going to sort the place out.  But they just want the damn audits and tickboxing.

If you see a Nurse filling in forms at mealtime it is because she just got orders for a blood transfusion for a patient who is bleeding to death and haematology wants the Nurse to fill in 100 forms to actually get the blood.  If she feeds the patients and then fills in the forms to get the blood her patient will be dead.  And so is she.  Pharmacy, path lab, equipment library and social services are the true cause of lots of form filing.  The hoops that they make us jump through to get what we need and avoid a medical crisis are insane.

Matrons, chief nurses and Sisters are figure heads with no authority.  Never forget that.  They have no say in staffing or how many Nurses they are allowed to hire.  They have no say in whether or not we get carers rather than Nurses.  They have no say about cleaners or how many hours they can work.  They have no say about whether or not we can have a ward clerk, or if broken equipment on the ward can be replaced or fixed.   Everything is controlled by the folks who hold the purse strings. The ones who really try to push the issue are out of a job.  The rest just ask for things and get told No.

What is happening at my trust recently?

We certainly don't have enough cleaners.  And they have a very short amount of time to do their jobs.  It isn't enough for a 35 bed ward.  The powers that be are reducing them further.  Now we will have one cleaner for 3 hours a day to do about a 100 jobs.  Everything will be half assed and you know what?  She can't help it.  IF you think you could keep a ward clean in that time frame on your own you are crazy.  If you think that a lone qualified Nurse with acutely ill patients and over 1500 drugs to give 3 times a shift can clean you are also crazy. If you think a strict Sister or Matron who "runs a tight ship" is going to fix this you can go fuck yourself.  Sisters and Matrons and Nurses have NO SAY IN THIS.  

Kitchen never sends up enough food at mealtime so even if we did have time to get meals out and feed people we would run out pretty quick. 

No equipment.  Can't find anything in an emergency. No one to do stock. 

Shall I go on?  I was going to and then I decided to stop myself.  I am not out of the woods yet.

Anyway I hope to go into some of this stuff in more detail later.  Some of it is kind of delicate and I don't want to be in the country anymore when I let loose.

Chow!

What it is like.

Back to the Medical Ward. Yay.


NOT.

My 13 hour night shift was due to end  at 0700; at which time I have to be ready to give report to the oncoming Nurse.

Starting  at 5AM I had to:

Start a magnesium infusion, give calcium gluconate and  start an IVI with K then an addiphos infusion and take off a whole load of other doctors orders for a patient with deranged U+E's.  The addiphos probably won't go up till day shift. He could have crashed at any moment with a K that low and I didn't want to leave him.  He had bloods done over night and the results came back at 04:30. The doc wrote the new orders just afterward.  I had to run around like a nut just to find some magnesium to start and of course document every aspect of all of this.  All had to go through a central line.  As you know this is time consuming. 

I needed to get vital signs and obs on all 19 of  my patients by 7 AM.  If you wake the patients up before 6 to start getting all their obs they get angry.  If I didn't start before 6 they would never got done and we would potentially miss the signs of a deteriorating patient.

I had to IV fluids on someone with renal failure.  I had noticed his rubbish output at midnight but it took until 04:30 to get the doctor as he was the only doc on for multiple wards.  Bloods hadn't been done for days on this patient and I needed to draw them.

I was also trying  to keep the 02 on another patient, a confused patient who was desaturating without it and kept taking it off his face.  He has disorientation secondary to sepsis so he could not understand me when I asked him to keep it on.  He needed a mask rather than a nasal cannula.

At this time I also had to obtain,, mix, and administer 15 (yes fifteen) IV antibiotics for 8 patients that were prescribed them.  This has to be done by 0800.  Day shift starts at 0700 but doesn't even get out of handover until nearly 0800 so they can't do it. I had to do them and finish them by 07:30 AM.

I had 5 patients ask for controlled analgesia during this two hour window.  This again is very time consuming.  The system for obtaining and administering controlled drugs is a joke.

During this window I also had to be up to date on the current status of all my 19 patients. For example any little thing that changed with them on my shift I need to be onto right away.  Examples of this include changes in observations, neuro observations. fluid balance, blood sugars etc.  I had 5 diabetics.  I need to act on every little thing and document it and it all needs to be done right now.
I had to act on the fact that I just noticed that my patient who is being treated for a UTI is completely unresponsive with a low BP.  Had to call the doctor and wait for him to get around to calling me back.  Fast IV fluids ordered as well as a million other things that needed to be done ASAP.
Two patients who needed IV antibiotics woke up and pulled their IV cannulas out.  Two others pulled out their urinary catheters.  It was like a blood bath for all 4. 

I needed to monitor the patient on the IV insulin infusion closely.  His blood glucose still isn't right.  Something is wrong about this.  Her consultant wanted her to stay on this infusion over the weekend.  All night long I had told the house officer that the insulin infusion and the iv fluids that get hung with them were running out and that he needed to prescribe more so that I could hang more on the patient.  The only time the doctor came was at 4:30 in the morning.  I handed him the chart but he put it down and "forgot" to prescribe it before he got bleeped away somewhere else.  Called him again and he said that he couldn't "come back to your ward" for awhile.

I had to deal with the fact that a patient woke up in agony with a blocked catheter.  It needs irrigating.  It was draining a few hours ago.

Remember all this is what got thrown my way between 5 AM and 7 AM. I was the only RN for double digit patients.

There were two lots of IV frusemide to give. 80mg. They need to be set through a pump.  Got to watch those BPs because even though they are borderline (and I wouldn't give it if they were a smidge lower) these two chaps really need it.

I didn't want to leave the side of any one of these patients.  But my god.  Just standing in the treatment room mixing and preparing all these IV drugs is extremely time consuming.

I had to leave a few of the antibiotics for day shift.  Day shift was so busy that they didn't give the 8AM meds that I didn't give until nearly noon.

I got a phone call at 0600 to take a direct admission from A+E as there are no beds anywhere else.  The A&E nurse gave me report on my new patient. He is a drunk and combative alcohol patient who fell and hit his head. They  want neuro obs every 15 minutes.  He is sleepy but when he wakes up he knocks stuff over and hits. I didn't want to take this patient because the only empty bed I have is in a bay with 5 nice but frail confused elderly men.  He will need a lot of admission stuff doing as soon as he gets to the ward i.e. paperwork to get his admission orders sorted..  The rest of the admission paperwork and all other legally required documentation I will knock out after my shift ends by staying over unpaid.

And that is just some of it.  If I went into all the knowledge I have to have to manage those things we would be here all day.   If I fucked any of that up just this much I could be held responsible for someone's death.   Nurses are legally responsible for delivering the orders given by a doctor and monitoring patients.  And my list reflects my doing just that.

That was my lot to carry and carry alone.  I was the only qualified Nurse for those 19 20 patients There is no way that I can articulate on this blog how long it takes to prepare and mix and infuse and flush etc etc all those IV meds that were prescribed and due.  It takes a lot of time away from the patients.  Real hospitals have 24 hour pharmacies that make it their job to stay on top of new orders and mix and prepare and get to the Nurse these IV meds when they are do to be given.  My NHS hospital DOES NOT have this.  Even during the 9-5 hours that they are open they do not do that.  They just develop more paperwork for the Nurses to fill in so that we can actually get the drugs and not get fired for a med error by omission (not giving a prescribed drug to a patient on time).

The only help I had was a teenage cadet called Beth.  There was nothing in the above list that she could help me with.  Nothing. She cannot even do observations/vital signs or check blood sugars.  She is not a Health care assistant or a Nurse. I wish I had that lovely HCA from the surgical ward with me.  He was mint. Beth  refused to empty the catheters so that we could monitor an accurate fluid balance  because "that's gross".


Between 5AM and 7AM this is what Beth had to do:

Change a few beds
Help people to the toilet.
Answer call lights and tell patients that the Nurse will be there as soon as possible.  This confuses them since they think that she is a Nurse.  She is wearing the same uniform as me after all.
Serve hot drinks at 7AM (she puts a trolley together and just blows past anyone who appears to be asleep rather than waking them up and encouraging fluids). 

I would rather just do the drinks myself but....you have seen my list of jobs happening at this time.
If anyone pees or drinks she needs to measure it and write the value on the fluid balance chart.  She didn't bother because she doesn't understand the point. As a matter of fact I asked her to do just that whilst my arms were loaded with IV meds, vital signs equipment, and new admission orders.   She just rolled her eyes at me and said she was "too busy" because she was "serving drinks".Doctors and Nurses could kill a patient if they don't have an accurate fluid balance.  Serving drinks took her all of 5 minutes since she ran past any patient who was sleeping or quiet.  Then she sat at the station on her mobile.


Beth cannot help me with anything on my list as she is not a Nurse.  But I must help her change those beds on top of everything else otherwise we get the cries of "those damn new fangled to posh to wash RN's leave all the real work to the care assistants".  And I just don't want to fucking hear it.

And at 07:30 she will be out the door on her way home regardless of what is going on in that ward.   She is not a Nurse, she is not licensed.  What does she care?  I will still be giving report.  Giving report on 20 patients takes a long time.  Who is looking out for my patients while I am handing over?  Beth will be on the Bus.  She doesn't understand what I have on my shoulders with those patients...she doesn't even understand what addiphos, deranged U+Es, hypoglycemia and sliding scale insulin means.  She has no idea what a Nurse does she just sees me flying in and out of rooms.   She tells the patients that she is a "real nurse" and a "nice nurse" because she is the one who serves them tea.  And they suck it up.  Most of what I am doing for them goes unseen by them.

Cadet Beth is real pissed off because she had to do the bed changes on her own mostly.  She will piss and moan to anyone she who will listen about how she was left to do all the real work (8 out of 14 bed changes; I managed to assist with 6 of them) because the Nurse "wouldn't help her".  The patients will tell her that she is the "nice nurse" who was kind enough to provide them with a drink and say "some others cannot be bothered with that because they think they are so high and mighty".  And the patients will say this too Beth whilst looking daggers at me.  They have absolutely no fucking clue what needs to be done to keep them alive and who is doing it.;  They get that the doctors are the brains who prescribe treatment.  And they get that nice nurses  staff like Beth "care" enough to give them a drink.  But they totally miss the knowledge bus on everything that is smack in between of that.  The bus took off and the patients are still at the station.


Beth was on her way home at 07:30.  I was still there on the ward tying up legally required loose ends at 9:30.  They stopped paying me at 07:30.  I think that without the new admission I may have made it out of there by 8:30 but nevermind.  My daughter was late for school.  Again.

Fuck this shit.  I want a clipboard job.  And when I leave I will be replaced with another cadet. And when that happens there will be one RN to 40 beds rather than one RN to  20 beds.

I love bedside Nursing but this is just too damn much.  It isn't Nursing that is the problems it is the working conditions.  The day shift nurse will be in for it.  When the consultants come in and see that the fluid balance charts are blank from the night shift (thanks Beth, you worthless slut) they will smackdown on the Nurse who happens to be standing the closest to them.

Imagine how different things would have been if this was the scenario:  Instead of just Beth and I for those 20 patients IMAGINE IF we had the recommended ratio of one nurse to 4 patients.  Imagine if each of those 4 patients were sharing one Nurse rather than all 20 sharing one Nurse and one cadet?  Imagine if each Nurse was able to do total care for her 4 patients......everything from dealing with IV infusions to changing their beds and encouraging a drink of tea.

I would stay in the job if that was the case.  But it will never be the case here.  NHS hospitals do not want to hire qualified Nurses to work at the bedside.  They do not want to pay for that.

When I finally left the ward at 09:30 I was near tears.  I was so rushed during those hours I was terrified that I made  a mistake and killed somebody.  I was afraid that maybe I hung the wrong meds on the wrong patients. I was afraid I missed somethingm like a low BP or a patient who had stopped fucking breathing.  OMG I hope that patient finally kept his 02 mask on.   I was afraid that one of the patients would go down to PALS and tell them about how I was the mean nurse who ran past them as they were shouting for help (I had to).  Oh but that Beth, she was lovely and made us tea....

Had a Blast on the Surgical Ward. part 2

I just remembered one of the best things I experienced during my little shift on the short stay surgical ward.

His name was Sam.

No no no stop thinking like that.  Nurse Anne is a happily married woman.

Sam is an utterly fabulous health care assistant.  By the end of the day I called him Saint Sam.  Nurse Anne is a bit rusty with Surgical Nursing but I couldn't have failed with Sam on my team.

He was good with the patients.  He could do observations, blood sugars and he cared enough to let me know of any problems he felt were arising with a patient.  He even brought people back from theatre.

A good HCA is worth their weight in gold.  They may not be able to help with drugs and all that kind of stuff.  If I am the only Nurse on a medical ward for the shift I may have over 80 IV drugs to give.  That takes hours.  And Nurse's make drug errors and cannot get to their patients when they have that many IV's to do.  So even if I had a hundred Sam's working with me in a situation like that I would still be struggling and short staffed.

But if I  knew that Sam was keeping a careful, knowledgeable and watchful eye on my patients whilst I was tied up with Nursing stuff it would make me feel a whole lot better.  I wish we had people like Sam on our medical wards.  It would be a real help to know at least there was someone reliable to look at my patients whilst I was preparing over 80 IV meds and getting dragged on doctor's rounds and to the phone.  But we do not get Sam types on the medical wards.  We used to have Sam type HCA's but as they quit and retired they were not replaced.  And we got the kids instead. Sucks.  We have a couple excellent HCA's left in medicine but the rest of the care assistants are all kids/cadets/apprentices/auxillaries with serious knowledge and common sense deficits and a whole lot of attitude.

I asked Sam why he doesn't do his Nurse training.  He gave me a wry smile and laughed out loud.  " I am happy as I am.  From  my vantage point Nursing looks like a nightmare.   I used to work on a medical ward as an HCA and I know how the qualified nurses suffer.  As an HCA I don't have to fuck about with drugs, assessments, orders, doctors or take any responsibility.  And on the surgical wards things run more smoothly than on a medical ward. I just enjoy interacting with the patients and helping them out.  And it is great.  Why would I want to give up a job I love ?"

Our medical wards need to have good RN's and health care assistants.  I think the ideal ratio is 80% RN's to 20% health care assistants in the composition of ward staff.

But the current ratios we are working with are something like 30% of staff are RN's and 70% are cadets/kids/apprentices/axilliaries.  

The hospital lies and tells people that on any given shift their medical wards are staffed with 65% Nurses and 35% care assistants.  This is a lie. 

Anyway I tried to get Sam to beg for a transfer to my ward and he nearly fainted because he laughed so hard.

Forest Gump GPs and hospital Consultants all across the land are telling anyone who will listen that the problem is "degree nurses who don't want to work on the wards".  Bullshit.  Managers are turning away both older trained and newly qualified Nurses when they apply for jobs as bedside Nurses on the wards.  They would rather hire kids.  Cheapo cheapo productions.