It's true. We look like slobs.
First problem is the uniforms. Right now I have only one that fits. I am not allowed to have anymore from the trust due to financial cutbacks. I am not allowed to buy my own uniforms outside of the trust. I sometimes leave work at 10PM at night and have to be back at 7AM the next day. I am a clean freak so that means that everytime I come home from work I wash the uniform and put it in the drier before I go to bed. I do this even if I left at 10PM and have to be back at 7AM the next day.
I get up at 5AM to get ready for my early shift and take the uniform out of the drier and iron it. Then it goes in a carrier bag and sits by the door while I get dressed. The uniform has been worn and washed so many times it looks like hell no matter what I do. If you get caught traveling to and from work in your uniform you are instantly dismissed. They have already made a few examples.
We are told that we need to change at work or else but there are no changing facilities. I think the other section of the hospital has them but we were not allowed to use them. There are portacabins outside (a 20 minute walk away)full of mice and we were told to use those but no one has given us a code to get into them.
Staff on my ward have to change in the domestics cupboard just outside the doors to the ward. It is very small and usually there are 2 of us in there getting changed. When someone else comes in and opens the door....anyone in the foyer can see us. This especially sucks during the 1PM start when countless visitors are standing around in that foyer.
Some of us started sneaking to the toilets to change but they were caught and told that this is unacceptable and to use the supply cupboard or the mice-a-cabin as I call it. The trust will NOT launder or store our uniforms, or give out new ones at this point. Other trusts do it, and they provide decent facilities for their staff as well.
So my worn out uniform has been carried to work in a sainsbury's bag and I have changed into while trying not to fall into an old cleaning bucket. My normal clothes get stored in the sainsbury's bag on the floor of the cleaning cupboard. There are 5 tiny lockers for everyone.
I am still meticulous about my appearance otherwise. I plait my long hair and wind it up in a coil for work. I pin every stray piece in place. I always shower before and after every shift. My nails are short and they get scrubbed and clipped again before work. I wear minimal natural make up so I don't scare the patients. I wear expensive shoes to work. They are very smart and comfortable. I'm a vain little shit.
10 hours into my shift without any sort of break the other day I caught a glimpse of myself in a mirror and nearly choked. Strands of hair all over the place, dry chapped peeling lips, bags under my eyes, stains on my face from crying after a death and a uniform that looks like it has seen heavy duty daily use since 1950.
This is actually very demoralizing because I am usually a snob about appearance and like to look good. I stay healthy and fit and take care of myself. I like expensive make up and beauty products and never wear the same outfit twice. I always take loads of time before work to try and look reasonable even if it means getting up at 5AM.
But that brief glimpse in the mirror showed me that during a long shift I look like the slovenly pig nurse that the public always complaints about.
If I could get a break during a shift I would redo my hair, apply some powder and lipgloss and clean my self up. Care assistants, secretaries, domestics and everyone else get time during the day to do this. I cannot even go pee without getting behind and making my patients angrier. Those of you who can take time during the work day for a makeup and hair check make me sick.
When I worked overseas the nurses bought their own uniforms from nursing stores. I never wore the same outfit to work twice. Like I said I am vain and can spend some serious money on clothes. I looked so much better. The uniforms I chose for myself were nicer with good labels and they were better quality and more professional than the shit the NHS gives us. I even bought uniforms made from bacterial resistant fabrics.
Older nurses that haven't worked in awhile may find this shocking as they were always supplied with fresh smart and clean uniforms every shift. They are also the ones who bitch the most about the appearance of todays nurses.
Tuesday, 10 February 2009
The Complaints Procedure in a Nutshell
I wanted to add this to my post about protected meal times but it just got to long. At university my english professors used to get on my back about rambling and run on sentences and you can see why!!!
Those of you have been reading my blog know that staff at my hospital have been complaining and pushing management to hire more nurses for years. Instead they have turned away scores of newly qualified nurses and told them that there are no jobs. Occasionally they hire a 17 year old care assistant on less than minimum wage and expect us to be very grateful for that. Teenagers that age with no experience cannot seem to grasp that if we say that a patient has swallowing problems and needs pureed diet you don't fucking give them sandwiches and biscuits. They leave pnuemonia patients lying flat and pyrexic patients (temp of 39.5) covered with 200 blankets because they are "shivering". I am rambling again.
I have written about feeding patients and how the nurses have pushed and pushed and sent numerous complaints into management about the clusterfuck that is meal time. The vast majority of these letters of complaint from staff came from my ward. We have the monopoly on patients that cannot feed themselves and we are also the most short staffed.
Between July and January we sent many letters. We begged. We pleaded. Management refused to speak to us and the matrons stated that they couldn't do a thing about it all. But we have our letters dated, copied and on file. All of them.
In March or thereabouts the complaints department received a complaint from the daughter of a patient from our ward. This woman was horrified about how much weight her loved lost while an inpatient on my ward. She was understandably angry about finding cold food left in front of her relative, out of reach. So she did the right thing and complained. She mistakenly believed that management doesn't realise what is going on. She wanted them to know so that the problems could be fixed so no one else suffers.
We saw the letter of complaint even though we never should have. Militant Medical Nurse has spies everywhere you know. We also saw the response from management which I have paraphrased here:
Dear Mrs. Jane Doe,
We are so sorry to hear about your relative's ordeal. We will deal with the nursing staff and make sure that they understand that it is their job to feed patients. They will have a ward meeting about this issue.
Okay, the last two sentences are pretty much word for word.
This letter went out from the same managers that had received the complaints from the nursing staff demanding protected meal times. They knew what the situation was.
Management and the good folks at the complaints department were questioned by a colleague of mine about this letter. They were asked why they just dumped this whole thing back on the nursing staff. Their response was "well sorry but we cannot admit liability on the part of management".
Oh the shame. Now this woman basically thinks that we are too stupid and lazy to help vulnerable people at mealtime. It finally dawned on me that our hardwork trying to cope at mealtimes and letters of complaint were meaningless. It's mortifying.
Sunday, 8 February 2009
Medical and Geriatric Wards PLEASE READ
I thought I would put this here so anyone who might read this can understand where I work and where I am coming from. I am going to try and keep this as simple as possible.
This blog is a portrayal of working on a 25 bed medical ward in the NHS. Medical wards take people with GI bleeds, Heart problems, Renal problems, Pneumonia, Lung disease, cancer, asthma, sepsis, general deterioration etc etc etc. This means that we are a mainly a geriatric ward. Most people who need to be hospitalized with these problems are elderly. The majority of my patients are completely unable to care for themselves due to extreme illness or dementia. Usually both together. The majority are confused. A severe medical illness will do that to you even if you were totally with it last week.
The opposite of this ward is a general surgical ward. These wards usually have younger patients who have a problem that needs sorting and that is the end of it. Think of the 26 year old male with a hernia. He goes in and has his hernia done. He has no other problems and is self caring. He goes home the same day. Sometimes surgical wards get really sick patients with severe problems but because the nurse's other patients are mainly self caring she can focus on the ill patient without leaving her other patients sat in shit for 4 hours.
The surgical ward is always better staffed than the medical wards. Always. Our hospital has a short stay surgical unit. They take easy cases. Young men like the one I described above are the norm down there. They will never take elderly medical patients as they are usually not suitable for an operation i.e. they'll probably die on the table. They have 15 self caring young patients who have no major medical problems. They get 3 nurses and 1 health care assistant for those 15 patients.
Cardiac wards are staffed in a similiar fashion but are also a lot busier. Even so, a nurse on a cardiac ward will often not have more than 5 patients some of whom are self caring and orientated. Compare this to a medical/elderly ward where the nurse has 15 patients and not one of them can feed themselves. Medical nurse will also have acutely unwell patients who could die if she leaves them long enough to help her more medically stable patients who are incontinant and struggling with basic hygeine.
Orthopedics is usually staffed well compared to medical/elderly and if one of their patients starts going down hill they are immediately sent to a medical ward where the nurse is caught between 20 elderly patients who need to be fed anc cleaned and the patient who came from the ortho ward who is now dying of heart failure because they overloaded him with IV fluids.
This blog is about working on a medical/elderly ward. It is an accurate represention of that without breaching confidentiality.
It is not an accurate representation of your nan's orthopedic ward where she had her hip done, or the surgical ward where you had your tonsils out, nor is it any kind of portrayal of cardiac wards. It is a whole different world from ITU and CCU where the nurse has 1 or 2 patients and massive back up.
My ward is a medical ward. This is the one your grandfather will go to after CCU stabilizes him, or maybe he isn't stable at all when he comes to me and I have to prioritize his care above hygeine care for other patients in order to ensure his survival. My ward is the one where nursing home patients go to when the nursing homes and their families cannot cope and there is no other place for them to go. They are medically stable when they come to me but are confused, malnourished, immobile, aggressive and incontinant and demand one to one care and so do their relatives. The relatives do not give a shit if I have a 30 year old mum down the bottom of the ward who can't breathe and needs a neb and a zillion other interventions to get even remotely comfortable. They don't care that I have a 63 year old who is raising her grandchildren and is now bleeding out due to a GI bleed and needs blood. They will tear me apart for leaving their elderly relative long enough to stablize the others. But the lawyers would tear me apart if I dared to leave an unstable medical patient to take another patient to the toilet. The nurses on my ward are in this position every minute of every shift they work. They are constantly caught between doing basic care for the elderly without harming someone is acutely medically ill. I cannot speak for nurses on surgical, ortho, cardiac, and intensive care wards.
I like caring for elderly people as challenging as it is. I see an old woman and I know that once she was someone's beautiful baby, someone's child who made mummy and daddy so proud. She was a gorgoeus, intelligent and vibrant young woman with plans for her life. She was someone's sweetheart and bride.
My elderly patient with dementia was someone's wife and the glowing mum to a new baby once. She was a shoulder to cry on for her older children and she probably busted her ass to care for her own aging parents as well as her own family. I know that if my own babies live a long time they are sure to end up like the old woman I see in front of me and I hope someone cares for them in their old age.
I know this and my colleagues know this. All of us.
So why does the public think that we hate old people? We don't hate old people. But society and our bosses certainly do.
Read the blog to see what shifts are like for nurses on these wards.
This blog is a portrayal of working on a 25 bed medical ward in the NHS. Medical wards take people with GI bleeds, Heart problems, Renal problems, Pneumonia, Lung disease, cancer, asthma, sepsis, general deterioration etc etc etc. This means that we are a mainly a geriatric ward. Most people who need to be hospitalized with these problems are elderly. The majority of my patients are completely unable to care for themselves due to extreme illness or dementia. Usually both together. The majority are confused. A severe medical illness will do that to you even if you were totally with it last week.
The opposite of this ward is a general surgical ward. These wards usually have younger patients who have a problem that needs sorting and that is the end of it. Think of the 26 year old male with a hernia. He goes in and has his hernia done. He has no other problems and is self caring. He goes home the same day. Sometimes surgical wards get really sick patients with severe problems but because the nurse's other patients are mainly self caring she can focus on the ill patient without leaving her other patients sat in shit for 4 hours.
The surgical ward is always better staffed than the medical wards. Always. Our hospital has a short stay surgical unit. They take easy cases. Young men like the one I described above are the norm down there. They will never take elderly medical patients as they are usually not suitable for an operation i.e. they'll probably die on the table. They have 15 self caring young patients who have no major medical problems. They get 3 nurses and 1 health care assistant for those 15 patients.
Cardiac wards are staffed in a similiar fashion but are also a lot busier. Even so, a nurse on a cardiac ward will often not have more than 5 patients some of whom are self caring and orientated. Compare this to a medical/elderly ward where the nurse has 15 patients and not one of them can feed themselves. Medical nurse will also have acutely unwell patients who could die if she leaves them long enough to help her more medically stable patients who are incontinant and struggling with basic hygeine.
Orthopedics is usually staffed well compared to medical/elderly and if one of their patients starts going down hill they are immediately sent to a medical ward where the nurse is caught between 20 elderly patients who need to be fed anc cleaned and the patient who came from the ortho ward who is now dying of heart failure because they overloaded him with IV fluids.
This blog is about working on a medical/elderly ward. It is an accurate represention of that without breaching confidentiality.
It is not an accurate representation of your nan's orthopedic ward where she had her hip done, or the surgical ward where you had your tonsils out, nor is it any kind of portrayal of cardiac wards. It is a whole different world from ITU and CCU where the nurse has 1 or 2 patients and massive back up.
My ward is a medical ward. This is the one your grandfather will go to after CCU stabilizes him, or maybe he isn't stable at all when he comes to me and I have to prioritize his care above hygeine care for other patients in order to ensure his survival. My ward is the one where nursing home patients go to when the nursing homes and their families cannot cope and there is no other place for them to go. They are medically stable when they come to me but are confused, malnourished, immobile, aggressive and incontinant and demand one to one care and so do their relatives. The relatives do not give a shit if I have a 30 year old mum down the bottom of the ward who can't breathe and needs a neb and a zillion other interventions to get even remotely comfortable. They don't care that I have a 63 year old who is raising her grandchildren and is now bleeding out due to a GI bleed and needs blood. They will tear me apart for leaving their elderly relative long enough to stablize the others. But the lawyers would tear me apart if I dared to leave an unstable medical patient to take another patient to the toilet. The nurses on my ward are in this position every minute of every shift they work. They are constantly caught between doing basic care for the elderly without harming someone is acutely medically ill. I cannot speak for nurses on surgical, ortho, cardiac, and intensive care wards.
I like caring for elderly people as challenging as it is. I see an old woman and I know that once she was someone's beautiful baby, someone's child who made mummy and daddy so proud. She was a gorgoeus, intelligent and vibrant young woman with plans for her life. She was someone's sweetheart and bride.
My elderly patient with dementia was someone's wife and the glowing mum to a new baby once. She was a shoulder to cry on for her older children and she probably busted her ass to care for her own aging parents as well as her own family. I know that if my own babies live a long time they are sure to end up like the old woman I see in front of me and I hope someone cares for them in their old age.
I know this and my colleagues know this. All of us.
So why does the public think that we hate old people? We don't hate old people. But society and our bosses certainly do.
Read the blog to see what shifts are like for nurses on these wards.
Protected meal times
Please check out my protected meal times blog below. The date on it says March. That might be when I started it but today I finished it.
Wednesday, 12 March 2008
Protected Meal Times: What a Fucking Joke
We all know that frail elderly patients are becoming increasingly malnourished in hospital. We all know that their trays get left out of reach, that no one comes to assist them with their meals. We all understand that it is the JOB of the registered nurses to ensure that nutrional needs of patients are met. The registered nurses understand this better than everyone. We even understand it better than those of you who accuse the nurses of not wanting to be "bothered" feeding patients. Fucking simpletons.
Good nutrition is vital. People who have inadequate intake of diet and fluid do not get better. They deteriorate. They are at risk of impaired skin integrity. Wounds do not not heal as well when one is malnourished. I have seen renal failure, electrolyte imbalances, dry cracked painful lips, mouths and tongues on elderly people who are not given drinks. They are so confused that they often pull out their IV cannulas making hydration via IV fluids impossible. I have seen frail
elderly people get even skinnier in hospital to the point that they appear to be skin and bones. Pressure sores form. You can see muscles and bone as the sore is so deep. The become more disorientated. Renal failure courtesy of dehydration. They suffer. It sucks. It should never happen yet it frequently does.
We are constantly interrupted every thirty seconds during mealtimes. Everyone from relatives to pharmacy to doctors to physio does this. The registered nurses at my facility all got together and got on management's case. We pushed for protected meal times. We fought hard. Let's take the evening meal for example: At 6PM the domestics bring the food trolley out and it is the job of the nurses along with the help of the care assistants to get dinner served to every single patient. There are 25 patients and because we are a medical ward that has a high number of elderly patients most of our people are either too sick to feed themselves or too confused to just too old. Usually we have anywhere between 8 and 20 people who are identified as feeds. Each patient takes about 20 minutes to feed. Some are faster and some are slower but we will work with the average. Many have no appetite.
If I take 2 patients that is 40 minutes down. The other nurse takes 2 patients and that is 40 minutes down. The first HCA takes 2 patients and that is 40 minutes down. The other HCA tries to feed 2 but also tries and manage all the people asking for the toilet, ringing the bell during this time. There are 2 Registered nurses and 2 care assistants for 25 patients IF WE ARE LUCKY.
That means that the best case scenario is that 40 minutes after the trays have been dropped onto the bedside table only 6 people have been fed and the rest have had trays sat in front of them going cold for 40 minutes while they stared at it. And remember that the phone is ringing off the hook at this time and we have no ward clerk. Remember that pharmacy is showing up with controlled drugs and demanding that a Nurse instantly stop what she is doing to check those narcotics in....god forbid if the precious pharmacist gets delayed or GASP has to do it herself.
The example I wrote above is best case scenario. It really is. But the reality is this: People will become extremely unwell around mealtime unexpectedly causing me to have to haul some serious ass and stay focused on them in order to carry out the doctors orders and not harm them. If that situation occurs the doctor is going to have a shit fit if I leave him and his patient to run off and feed people. That leaves 2-3 to try and cope with all the feeds, and everything else.
The phone rings non stop during mealtimes. Non-fucking stop. We can thank the relatives for that as they get 5 people to ring for the same patient every hour. If you ask them to get one person to ring once day in order to minimize the nurses having to spend all shift running to the phone every 2 minutes they become nasty, abusive and most of all paranoid....accusing us of not wanting to share information. They also like to spend ages giving their dysfunctional family history i.e. "5 different people have to ring because so and so doesn't speak to so and so".
Ringing a ward during mealtimes when your loved one is stable and you have already rung 5 times during the day is very disruptive. The phone is a hell of a long walk away from the patients and the food trolley. I no sooner put the phone down and start the trek back up to my patient before the damn thing rings again. You have no idea how many problems we have with this. No goddamn wonder they have trays out of reach and food gets cold. If the patient is frail and confused we may leave the tray out of reach whilst hoping to get back and feed him in good time. Leave the tray where he can get it and he will choke himself and throw it onto the floor. We have to hand all the trays out before we can go back and feed. Have to. Without interruptions this takes 25 minutes. With all the usual interruptions it takes longer.
I can ignore the phone and try to carry on but the last time I did that management got a complaint from a relative about us not answering the phone for an hour and we got a disciplinary. No they won't fucking pay for a ward clark to be sat there on an evening answering the phone.
The other day the daughter of one of the 30 patients rang and demanded to speak to the Nurse immediately. I was trying to feed 3 patients at the time as well as monitor a patient with a head injury. She demanded that I come to the phone even though the HCA told her it was mealtime. She scared the HCA. I came to the phone. The woman wanted to me to answer 101 stupid questions and tried to keep me on the phone. I told her that I was trying to take care of patients and that it was mealtime it would be best if she rang back later. "How dare you, I have an appointment later and it would be very inconvienant for me to ring later" she said. I often tell my friends and family that you are in more danger from you Nurse's other patients' relatives than you are from a bad nurse or doctor. I managed to get off the phone with this bitch and when I got back down the ward my head injury patient was on the floor again.
One of the ways I try and sort this is I really start moving my ass at 4PM...or as soon as I finish sorting out all the things that should have been done during the day. If I have been lucky I have sorted out all the day shift problems by that time. It is a losing battle but I try.
I try and knock out every med /IV and otherwise that is due between 4:30 PM and 6:30 PM. There are tons of them each with a problem. Half the time the stuff isn't there and I have to leave my patients to leg it to pharmacy.
I also spend that hour and the half giving pain meds to anyway known to have pain. I ask everyone if they need anything. We try and get everyone toileted. We try to turn and reposition and clean everyone who needs it. I try to do a quick assessment of all my patients (usually about 14)to head off any problems that may rear it's ugly head at meal time. I try to ignore all the interruptions in order to do this and I pray that I will be able to focus on meals when that trolley shows up at 6PM. But relatives and non ward staff piss and moan when they walk onto a ward and interrupt a Nurse and she doesn't drop what she is doing immediately to service their non essential problem. What I am trying to accomplish is impossible but it doesn't stop us from trying. I just want to be able to focus on feeding patients. We all do.
So 6 PM rolls around, the domestic arrives with the food trolley and I don my lovely pinny and start getting trays out. Never mind that I have critically ill patients who need their meds. I did them an hour ago but they want more. We identify the patients who need help with coloured trays, but we already know anyway. I keep an eye on the health care assistants to ensure that they are bringing pureed diets to people with swallowing problems so that they don't choke to death etc etc. I make sure that the diabetics get a diabetic meal. I try to feed people. We run down to the kitchen getting stuff that patients want that are not on the food trolley.
Now despite that fact that we busted ass from 4PM to 6PM trying to sort everyone out, that wall now is lit up with call lights ringing. Absolutely lit up. We can keep trying to feed or we can answer the bells. I will try and send one care assistant off to get all of the bells while the 3 of us try and feed. Most people are ringing for things like an extra pillow or a blanket. Things they didn't think of before. Many of them are elderly and confused and to be honest they just forgot that someone already walked them to the toilet 20 minutes ago, or they need to go again because the good old bladder just ain't what she used to be. But man will they hit the ceiling and complain if they wait awhile for the nurse to come. Family members who rang at 4:30 ring back again to answer the same dumb questions. For the love of god we have no idea when the doctor is coming, when discharge will happen, when pharmacy will bring those meds or when the ambulance will come. FOR THE LOVE OF CHRIST THERE IS NO WAY FOR THE NURSES TO KNOW THESE THINGS.
The phone is ringing non fucking stop. I am ignoring it even if it means trouble later. I am determined to feed these people.
Five minutes after the domestic brought the trolley out the lady in bed 3 has had a bowel motion in bed and due to her dementia has spread it everywhere. This is a 4 time a day event with this poor lady. She is bedbound and weighs about 19 stone. Would you like the 4 of us (and it will take all 4) to take 20 minutes/probably more to clean her up and then go back to feeding? Or would you like me to leave her like that until I finish feeding the others? Who is feeding the patients whilst the 4 of us are trying to maintain the dignity of the lady who has had the accident? No one. The trays are going cold and the domestic will collect them back in. The bitch.
Oh oh. I do need to answer the phone at 6:10 because the sound of the ring tells me it is an internal call. It is pathology lab. The lady in bed 10 came in this afternoon and had blood taken. She looks like hell. But there is no obvious sign of bleeding. I haven't wanted to leave her side. She has an HB of 5 they say. Look it up. She'll die if I do not get a doc down now to assess her and probably order some blood. She needs obs doing, and tests etc. Then I have to go through a long and complex and time consuming process to get the blood and get it hung. If that was your mum would you want me waiting on that for another hour plus or so while I attempt to feed? Tell me what you think. She needs to be escorted off the ward for a test by a member of the ward staff. The endoscopy department does not care that this leaves 2 or 3 of us to do all these feeds. if we don't send an escort, they won't do the life saving diagnostic test. Now there are 2- 3 of us.
At 6:15 my cancer patient who is dying rings to say that the pain meds she has had isn't helping and you can tell by looking at her that the poor women is in excrutiating pain. It is safe for her to have some oramorph now. I will get it for her simultaneously with sorting the blood for the other woman. But what about the trays going cold?
The oramorph is a controlled drug. Two nurses have to go through a long and time consuming process in order to be able to access that medicine and give it to her. I will not make her wait. Fuck you for asking me too. I had to pull the other RN away from feeding a patient in order to access the oramorph (morphine). There is no way to access it without 2 registered nurses. Now one care assistant is trying to do all the feeds, the food is going cold and the domestic collects them back in.
But what is the most fucked up part about mealtime? Is it the fact that the domestics are on a tight time scale and will run down the ward collecting all the meals back at 6:30 whether they have been eaten or not? Is it the fact that the relatives will show up at 6:30 with venom shooting out of every pore of their being screaming at me wanting to know why grandpa has a cold, untouched tray in front of him?
No the most fucked up thing at meal time is the goddamn doctors. I look after 14 patients with 8 different doctors and they LOVE to show up at mealtime to do a ward round and demand that the nurse drop what she is doing and follow them around for a half an hour. The bastards do it every fucking mealtime. I hate them. When the nurses asked for protected meal times we begged the docs to try and do their rounds outside of mealtime. The response was that their ward round will get done when it is convienant for them, not the nurses. They also laughed right out loud at us for asking. And you can bet your ass that on every single mealtime we are sure to have 2 or 3 consultant doctors show up to do rounds. Remember that best case scenario I wrote about above? The one where we can at least get 6 people fed in 40 minutes if all hands are on deck. You can fucking forget it thanks to the docs. I can refuse to attend their ward round and keep on feeding. But it means getting screamed at in front of all the patients and a complaint about me going into management.
Whether we have 6 people who need to be fed or 16, the number of staff DOES NOT alter. We get 2 nurses and 2 healthcare assistants no matter what. If I get a contracter into my house to do some work, and it looks like the job is bigger than he anticipated he gets more staff. If a nursery takes more children than the normal numbers on any given day they get more staff. A hair salon has more staff in on their busiest days. This does not happen in nursing.
So I open the newspaper and I see comments galore accusing the nurses of not caring about feeding patients. They suggest coloured trays to identify vulnerable patients....as if we are too stupid to know. They all look the other way when the hospitals get rid of nurses and refuse to hire nurses. The coloured trays don't do shit. They don't help at all. You can take your coloured trays and shove them you your asses. Please help us instead of making things worse.
So we begged management for protected mealtimes. We begged them to help us tell the public not to ring at this time. We begged the docs to not do ward rounds at this time if they can help it. We asked a higher power to not allow anyone to crash or become extremely unwell, especially during meal times. We begged management to allow us to increase our numbers. We begged the domestics to not collect the damn meals in so quickly when we haven't had a chance to feed.
Their collective response has all pretty much been : Fuck you Nurse. Fuck you.
Thanks a lot for your fucking support.
The nurses will keep on trucking but if they only bit of help we get is a goddamn coloured tray...then I just don't see things improving.
Good nutrition is vital. People who have inadequate intake of diet and fluid do not get better. They deteriorate. They are at risk of impaired skin integrity. Wounds do not not heal as well when one is malnourished. I have seen renal failure, electrolyte imbalances, dry cracked painful lips, mouths and tongues on elderly people who are not given drinks. They are so confused that they often pull out their IV cannulas making hydration via IV fluids impossible. I have seen frail
elderly people get even skinnier in hospital to the point that they appear to be skin and bones. Pressure sores form. You can see muscles and bone as the sore is so deep. The become more disorientated. Renal failure courtesy of dehydration. They suffer. It sucks. It should never happen yet it frequently does.
We are constantly interrupted every thirty seconds during mealtimes. Everyone from relatives to pharmacy to doctors to physio does this. The registered nurses at my facility all got together and got on management's case. We pushed for protected meal times. We fought hard. Let's take the evening meal for example: At 6PM the domestics bring the food trolley out and it is the job of the nurses along with the help of the care assistants to get dinner served to every single patient. There are 25 patients and because we are a medical ward that has a high number of elderly patients most of our people are either too sick to feed themselves or too confused to just too old. Usually we have anywhere between 8 and 20 people who are identified as feeds. Each patient takes about 20 minutes to feed. Some are faster and some are slower but we will work with the average. Many have no appetite.
If I take 2 patients that is 40 minutes down. The other nurse takes 2 patients and that is 40 minutes down. The first HCA takes 2 patients and that is 40 minutes down. The other HCA tries to feed 2 but also tries and manage all the people asking for the toilet, ringing the bell during this time. There are 2 Registered nurses and 2 care assistants for 25 patients IF WE ARE LUCKY.
That means that the best case scenario is that 40 minutes after the trays have been dropped onto the bedside table only 6 people have been fed and the rest have had trays sat in front of them going cold for 40 minutes while they stared at it. And remember that the phone is ringing off the hook at this time and we have no ward clerk. Remember that pharmacy is showing up with controlled drugs and demanding that a Nurse instantly stop what she is doing to check those narcotics in....god forbid if the precious pharmacist gets delayed or GASP has to do it herself.
The example I wrote above is best case scenario. It really is. But the reality is this: People will become extremely unwell around mealtime unexpectedly causing me to have to haul some serious ass and stay focused on them in order to carry out the doctors orders and not harm them. If that situation occurs the doctor is going to have a shit fit if I leave him and his patient to run off and feed people. That leaves 2-3 to try and cope with all the feeds, and everything else.
The phone rings non stop during mealtimes. Non-fucking stop. We can thank the relatives for that as they get 5 people to ring for the same patient every hour. If you ask them to get one person to ring once day in order to minimize the nurses having to spend all shift running to the phone every 2 minutes they become nasty, abusive and most of all paranoid....accusing us of not wanting to share information. They also like to spend ages giving their dysfunctional family history i.e. "5 different people have to ring because so and so doesn't speak to so and so".
Ringing a ward during mealtimes when your loved one is stable and you have already rung 5 times during the day is very disruptive. The phone is a hell of a long walk away from the patients and the food trolley. I no sooner put the phone down and start the trek back up to my patient before the damn thing rings again. You have no idea how many problems we have with this. No goddamn wonder they have trays out of reach and food gets cold. If the patient is frail and confused we may leave the tray out of reach whilst hoping to get back and feed him in good time. Leave the tray where he can get it and he will choke himself and throw it onto the floor. We have to hand all the trays out before we can go back and feed. Have to. Without interruptions this takes 25 minutes. With all the usual interruptions it takes longer.
I can ignore the phone and try to carry on but the last time I did that management got a complaint from a relative about us not answering the phone for an hour and we got a disciplinary. No they won't fucking pay for a ward clark to be sat there on an evening answering the phone.
The other day the daughter of one of the 30 patients rang and demanded to speak to the Nurse immediately. I was trying to feed 3 patients at the time as well as monitor a patient with a head injury. She demanded that I come to the phone even though the HCA told her it was mealtime. She scared the HCA. I came to the phone. The woman wanted to me to answer 101 stupid questions and tried to keep me on the phone. I told her that I was trying to take care of patients and that it was mealtime it would be best if she rang back later. "How dare you, I have an appointment later and it would be very inconvienant for me to ring later" she said. I often tell my friends and family that you are in more danger from you Nurse's other patients' relatives than you are from a bad nurse or doctor. I managed to get off the phone with this bitch and when I got back down the ward my head injury patient was on the floor again.
One of the ways I try and sort this is I really start moving my ass at 4PM...or as soon as I finish sorting out all the things that should have been done during the day. If I have been lucky I have sorted out all the day shift problems by that time. It is a losing battle but I try.
I try and knock out every med /IV and otherwise that is due between 4:30 PM and 6:30 PM. There are tons of them each with a problem. Half the time the stuff isn't there and I have to leave my patients to leg it to pharmacy.
I also spend that hour and the half giving pain meds to anyway known to have pain. I ask everyone if they need anything. We try and get everyone toileted. We try to turn and reposition and clean everyone who needs it. I try to do a quick assessment of all my patients (usually about 14)to head off any problems that may rear it's ugly head at meal time. I try to ignore all the interruptions in order to do this and I pray that I will be able to focus on meals when that trolley shows up at 6PM. But relatives and non ward staff piss and moan when they walk onto a ward and interrupt a Nurse and she doesn't drop what she is doing immediately to service their non essential problem. What I am trying to accomplish is impossible but it doesn't stop us from trying. I just want to be able to focus on feeding patients. We all do.
So 6 PM rolls around, the domestic arrives with the food trolley and I don my lovely pinny and start getting trays out. Never mind that I have critically ill patients who need their meds. I did them an hour ago but they want more. We identify the patients who need help with coloured trays, but we already know anyway. I keep an eye on the health care assistants to ensure that they are bringing pureed diets to people with swallowing problems so that they don't choke to death etc etc. I make sure that the diabetics get a diabetic meal. I try to feed people. We run down to the kitchen getting stuff that patients want that are not on the food trolley.
Now despite that fact that we busted ass from 4PM to 6PM trying to sort everyone out, that wall now is lit up with call lights ringing. Absolutely lit up. We can keep trying to feed or we can answer the bells. I will try and send one care assistant off to get all of the bells while the 3 of us try and feed. Most people are ringing for things like an extra pillow or a blanket. Things they didn't think of before. Many of them are elderly and confused and to be honest they just forgot that someone already walked them to the toilet 20 minutes ago, or they need to go again because the good old bladder just ain't what she used to be. But man will they hit the ceiling and complain if they wait awhile for the nurse to come. Family members who rang at 4:30 ring back again to answer the same dumb questions. For the love of god we have no idea when the doctor is coming, when discharge will happen, when pharmacy will bring those meds or when the ambulance will come. FOR THE LOVE OF CHRIST THERE IS NO WAY FOR THE NURSES TO KNOW THESE THINGS.
The phone is ringing non fucking stop. I am ignoring it even if it means trouble later. I am determined to feed these people.
Five minutes after the domestic brought the trolley out the lady in bed 3 has had a bowel motion in bed and due to her dementia has spread it everywhere. This is a 4 time a day event with this poor lady. She is bedbound and weighs about 19 stone. Would you like the 4 of us (and it will take all 4) to take 20 minutes/probably more to clean her up and then go back to feeding? Or would you like me to leave her like that until I finish feeding the others? Who is feeding the patients whilst the 4 of us are trying to maintain the dignity of the lady who has had the accident? No one. The trays are going cold and the domestic will collect them back in. The bitch.
Oh oh. I do need to answer the phone at 6:10 because the sound of the ring tells me it is an internal call. It is pathology lab. The lady in bed 10 came in this afternoon and had blood taken. She looks like hell. But there is no obvious sign of bleeding. I haven't wanted to leave her side. She has an HB of 5 they say. Look it up. She'll die if I do not get a doc down now to assess her and probably order some blood. She needs obs doing, and tests etc. Then I have to go through a long and complex and time consuming process to get the blood and get it hung. If that was your mum would you want me waiting on that for another hour plus or so while I attempt to feed? Tell me what you think. She needs to be escorted off the ward for a test by a member of the ward staff. The endoscopy department does not care that this leaves 2 or 3 of us to do all these feeds. if we don't send an escort, they won't do the life saving diagnostic test. Now there are 2- 3 of us.
At 6:15 my cancer patient who is dying rings to say that the pain meds she has had isn't helping and you can tell by looking at her that the poor women is in excrutiating pain. It is safe for her to have some oramorph now. I will get it for her simultaneously with sorting the blood for the other woman. But what about the trays going cold?
The oramorph is a controlled drug. Two nurses have to go through a long and time consuming process in order to be able to access that medicine and give it to her. I will not make her wait. Fuck you for asking me too. I had to pull the other RN away from feeding a patient in order to access the oramorph (morphine). There is no way to access it without 2 registered nurses. Now one care assistant is trying to do all the feeds, the food is going cold and the domestic collects them back in.
But what is the most fucked up part about mealtime? Is it the fact that the domestics are on a tight time scale and will run down the ward collecting all the meals back at 6:30 whether they have been eaten or not? Is it the fact that the relatives will show up at 6:30 with venom shooting out of every pore of their being screaming at me wanting to know why grandpa has a cold, untouched tray in front of him?
No the most fucked up thing at meal time is the goddamn doctors. I look after 14 patients with 8 different doctors and they LOVE to show up at mealtime to do a ward round and demand that the nurse drop what she is doing and follow them around for a half an hour. The bastards do it every fucking mealtime. I hate them. When the nurses asked for protected meal times we begged the docs to try and do their rounds outside of mealtime. The response was that their ward round will get done when it is convienant for them, not the nurses. They also laughed right out loud at us for asking. And you can bet your ass that on every single mealtime we are sure to have 2 or 3 consultant doctors show up to do rounds. Remember that best case scenario I wrote about above? The one where we can at least get 6 people fed in 40 minutes if all hands are on deck. You can fucking forget it thanks to the docs. I can refuse to attend their ward round and keep on feeding. But it means getting screamed at in front of all the patients and a complaint about me going into management.
Whether we have 6 people who need to be fed or 16, the number of staff DOES NOT alter. We get 2 nurses and 2 healthcare assistants no matter what. If I get a contracter into my house to do some work, and it looks like the job is bigger than he anticipated he gets more staff. If a nursery takes more children than the normal numbers on any given day they get more staff. A hair salon has more staff in on their busiest days. This does not happen in nursing.
So I open the newspaper and I see comments galore accusing the nurses of not caring about feeding patients. They suggest coloured trays to identify vulnerable patients....as if we are too stupid to know. They all look the other way when the hospitals get rid of nurses and refuse to hire nurses. The coloured trays don't do shit. They don't help at all. You can take your coloured trays and shove them you your asses. Please help us instead of making things worse.
So we begged management for protected mealtimes. We begged them to help us tell the public not to ring at this time. We begged the docs to not do ward rounds at this time if they can help it. We asked a higher power to not allow anyone to crash or become extremely unwell, especially during meal times. We begged management to allow us to increase our numbers. We begged the domestics to not collect the damn meals in so quickly when we haven't had a chance to feed.
Their collective response has all pretty much been : Fuck you Nurse. Fuck you.
Thanks a lot for your fucking support.
The nurses will keep on trucking but if they only bit of help we get is a goddamn coloured tray...then I just don't see things improving.
Monday, 4 February 2008
Stupid Bitch Matrons
Bring Back Matron you say? Oh they are back all right.
At my hospital we always had a saying..."Matrons are like ghosts...we know they exist but we never see them."
Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.
Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of "Nurse" onto one of these people*.
I have posted the stats regarding Nurse patient ratios. I have posted research into medical errors. I have posted about some of the insane practices that were happening on my ward and continue to occur almost daily. It doesn't take a rocket scientist to figure out that people do and can get hurt. At the very least is the little 90 year old man sat staring at a tray off food he cannot feed to himself..whilst his nurse is busy elsewhere. If anything makes me feel like going postal, it is that scenario. Staff nurses are not perfect and they do make mistakes, but many of the mistakes that happen are down to system errors that could have been prevented.
My ward was opened to another specialty and now takes 3 or 4 different specialties. We are the (now 40 bed) dumping ground for EVERYTHING. This was the result of a management decision that was not thought through. As usual we are left worse off than we were prior to said management decision. None of the RN's were cross trained and fuck up after fuck up occurs daily. The nurses are stuck with too many patients, no back up, no support in a specialty in which they have little or no experience.
The Matrons know the situation. There are many many highly paid matrons at my hospital. One for each specialty. Did any of them come to the ward to provide guidance and leadership or help out during the restructuring? HELL NO. They basically disappeared into thin air. Totally fucking AWOL.
Did they put on a pinny and come and help out on the ward? HELL NO.
Did any of them come anywhere near the ward or a patient? HELL NO.
Did they return our phone calls? Rarely.
Have we ever seen them act like a nurse? HELL NO.
Would any of them be able to name a patient on our ward? Nope.
Once, two years ago, a Matron did come to the ward to help us put because we were so short. This is the only time we recollect that this has happened. I was overwhelmed with really sick patients. Matron informs me that A. She does not remember how to do a drug round and will not do it. B. She is not comfortable with IV meds and will not help with that. C. She volunteered herself to answer the phone and call lights. So I got left with all the hard stuff, and supersuck (who makes double my salary) did fuck all.
That was the last time we saw a Matron (or a Nursing Leader) on the ward in a clinical capacity. They stay far far away and leave the staff nurses to suffer alone. We have written letter after letter about the conditions on these general wards and they are ignored, or Matron shrugs her shoulders and says "we feel so bad for you".
What.The.Fuck?
Don't feel bad for us...you are a highly paid nurse...get your arse to the floor and help us...be a goddamn nurse...provide some goddamn leadership by example. Come up with a plan for cross training the staff. Back us up when we are getting threatened by the chief nurse for complaining when we are one nurse to 24 patients. At the very least come and help us feed patients when YOU KNOW that we are 2 nurses to 15 feeds and everything else that is happening simultaneously. I have worked with bedside nurses who have masters degrees and chose to work at the bedside. The situation is so bad, it should be all hands on deck. Fuck whatever it is that you do all day. I have yet to see anything that you "do" benefit a patient.
I don't know what they do in that office all day. I don't know why they hate their nurses. I don't know why whatever the fuck they are up to in that office is so much more important than the patients and the staff.
I do know that despite the fact that they know how short we are working, they love to re-arrange our paperwork and make it more complex. Certain forms have gone from 5 pages to 20. I know that they are trying to redesign our care plans because the current ones are never filled in properly. I informed the Matron that it doesn't matter what structure our paper work takes...it is going to be FUCKED because of time constraints and overwhelming nurse patient ratios. I must not have got through.
When do we see Matrons? When there is an inevitable cock up. Then they are down to the ward like flies to a horses ass to ensure that all blame is directed onto the staff nurse and the hospital does not appear negligant or liable. Then the same error happens again with a different nurse because these are SYSTEM errors not NURSE errors. Once again Matron comes down hard on the individual member of staff without troubleshooting the problem. Fucking worthless whores. I saw it happen to too many of my colleagues and I got the hell out before the day came when it was my turn.
As far as I am concerned, most of our so called nursing leadership are traitors to nurses and patients alike. Don't even get me started on the NMC, the RCN or any of the other worthless pieces of crap who refuse to address the real issues. I'd like to see them all lined up and shot*.
*if there are any Matrons out there reading this that care about patients and support their nurses than I apologise to you personally. The rest of you are overpaid stupid worthless bitches.
*Nurse Anne is a non-violent pacifist and she does not believe in shooting our so called nurse leadership for their crimes. She just fantasizes about it.
Saturday, 2 February 2008
Nurse/ Patient Ratios: The Facts
http://query.nytimes.com/gst/fullpage.html?res=9405E6DD1530F93AA25752C1A9649C8B63
In the journal article, University of Pennsylvania researchers analyze why nursing care means more to hospitalized patients than pillow plumping and good cheer.
They culled data from more than 200,000 patients and 10,000 nurses to calculate that for every additional patient a nurse is assigned to care for, the odds of a patient's dying within a month of hospital admission rises 7 percent. In other words, when your nurse cares for seven other patients on a shift, your chances of dying from whatever ails you are about 30 percent higher than it would have been if your nurse had only three others.
Nurses in the UK average about anywhere from 1-10 to 1-20. It can be anything the managers want it to be and believe me, they want to divert as much money away from decent staffing as they can. When patients complain about waiting for a call bell to be answered, the managers forbid the nurses from talking about and explaining staffing levels because they "will not admit liability". They lay the blame with the nurses and nurses get a bad reputation. This is a fact.
http://www.nursingadvocacy.org/news/2002may30_nejm.html
May 30, 2002 -- In today's issue of the New England Journal of Medicine (NEJM), researchers Jack Needleman of the Harvard School of Public Health in Boston and Peter Buerhaus of Vanderbilt University’s School of Nursing in Nashville, Tennessee found that nurse short-staffing leads to deadly consequences for patients.
The study analyzed discharge data from 6 million patients and financial data and staffing surveys from 800 hospitals in 11 US states. When nurses were short-staffed, patients suffered up to 25% more life-threatening complications including infections, bleeding, pneumonia, shock, cardiac arrest, and "failure to rescue," all of which contributed to an increased length of hospital stay
http://www.massnurses.org/safe_care/Safe_Staffing/news/2005/PhysSurv.htm
78% of MDs believe RN staffing levels are too low, 82% believe quality is suffering, an alarming 1-in-5 doctors report patient deaths due to nurses caring for too many patients
(this article comes from the USA, where general ward nurses have 1-8 as opposed to the 1-10,20 etc that we have in the UK.)
http://www.crnbc.ca/downloads/402.pdf
AS RN to patient ratios decrease from 1:4 to 1:10, the number of post op surgical patient deaths climbs dramatically. (aiken, Clarke, Sloan,Solkalski and Silber 2002).
UK nurses average anywhere from 1:10 to 1:20 on general medical and surgical wards.
http://allnurses.com/forums/f300/don-t-blame-nurse-fix-system-266262.html
The Allnurses.com discussion forum cites numerous first-hand stories of how nurses have blamed themselves, or have been blamed by hospital administrators, for dangerous and sometimes fatal medical errors. In most cases, these incidents reflect far more on deficiencies in the systems in which nurses must work.
At least four out of five medical errors are probably due not to negligence or carelessness, but to deficiencies in the system in which doctors and nurses must work. The ISO 9001:2000 standard and its health care specific modification, IWA‑1, recognize that people work in a system, and that a deficient system cannot deliver good quality no matter how skilled or careful the workers might be.
It is a general rule in industry that only 15 to 20 percent of trouble comes from negligence, carelessness, and incompetence. The rest is due to deficient organizational systems that make trouble almost unavoidable. W. Edwards Deming's 85/15 rule says that 85 percent of all defects and errors are the fault of the system in which people must work, while 15 percent results from carelessness and negligence. Frank Gryna cites an 80:20 ratio, with 80 percent of errors and mistakes being "management-controllable" and only 20 being "worker-controllable." [1]
(i.e.organizational problems such as a NHS managers who have no clinical experience, a bad attitudes towards nurses and ignorance regarding nurse patient ratios. Total hospital wide system failures that cause the nurse to have to spend time away from patients i.e. chasing pharmacy up to do their jobs)
http://www.hbs.edu/research/facpubs/workingpapers/papers2/0203/03-059.pdf
Recently conducted large scale research found that:
In a given unit the optimal workload for a nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission. A workload of 8 patients versus 4 was associated with a 31% increase in mortality. Higher nurse staffing levels resulted in reduced numbers of urinary tract infections, pneumonia, upper gastrointestinal bleeding and shock in medical patients and lower rates of "failure to rescue" and urinary track infections in major surgery patients
(What have I said regarding the ratios we are working with at my hospital? According to this research even 1:8 is bad on a general ward...let alone the 1:20 that happens on mine).
This paper from Harvard is an excellent explanation as to why working conditions and piss poor management causes nursing care to be so bad.
http://www.hbs.edu/research/facpubs/workingpapers/papers2/0203/03-059.pdf
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