Surrounded by Idiots: The Complaints Manager.

Received a phone call from a colleague fairly recently. I am going to document what she said on this blog.

She also works on the same ward that I am/did.

Not too long ago she was one of two RN's for the whole ward. She was the RN for one side and sister was the RN for the other side.

They were running their assess off, constantly interrupted and overwhelmed and by 11 AM everything was fucked up. Half the meds weren't given, gent levels etc weren't done, discharges weren't going anywhere because the nurses couldn't sort them out, patients were filthy, and no call lights were being answered. Their were 2 care assistants who were trying to bed bath everyone, and answer bells. Nightmare.

So around 11:30 AM this moron from the complaints department struts onto the ward and proceeds to glare at the nurses with complete contempt. She tells them that a another complaint came in about nurses not feeding patients.

This is a regular occurance:
http://militantmedicalnurse.blogspot.com/2008/03/protected-meal-times-what-fucking-joke.html

Moron collars the sister, and pulls her into the office and demands that she sits there for 2 hours answering questions about the day the complaint when in, what staff members were on, do they not understand that nutrition is vital etc etc. She made sister formulate a response right there and then. Kept her in that office well past dinner time. Moron also had the nerve to roll her eyes at Sister when Sister declared that she needed to get back onto the ward ASAP. I don't even understand why moron bothered, her official response to the complaints will only be lies.

That left one RN and 2 care assistants to cope with all the patients, alone. We really, really needed Sister back on the ward. When she came out of the office, moron collared her again, insinuating that sister wasn't interested in the complaint or the situation.

The dinner trolley appeared at noon and the three staff were trying to feed 10 plus people themselves whilst managing care for the other 19. Moron would not get off Sister's back. People were not getting fed.

The staff nurse was in a blind panic because so many orders from docs that needed to get done stat were not getting done. She told me that she really thought someone was going to die. Listen people you can have the most brilliant doctor in the world but if you don't have a nurse that is able to implement and coordinate all these orders you are fucked.

Some visitors were on the ward at this time. We are not strict about visiting times when people are extremely ill and family cannot get there during the set hours. The lay out of the wards is such that they can see everything, even sister in the office engaged in discussion with moron.

While sister was being held in the office, and the 3 staff that were left on the ward were struggling to cope, two of the visitors walked downstairs to the patient complaint services office to complain about "oblivious" nurses not feeding patients. Never mind the guy with the pre-renal failure who hadn't even had any fluids started yet and that the staff nurse was trying to stop him from pulling his cannula out.

So at least 2 more complaints came in on that very day at that very lunchtime. If the people who were complaining or perhaps the managers were not completely fucking retarded maybe we would have been given more nurses instead.


If I hadn't witnessed these kinds of experiences myself all the time I would never believe it.

EDIT: I understand that the term retarded as used in context here is very offensive, crude and not at all politically correct. I apologise for that. I am even offending myself right now.

I am sitting here wondering if there is a better term to use to describe the behaviour of these people. There is not. They just have low IQ's. They retard the nurses efforts to care for the patients.

Productive Wards and Releasing Time to Care

Dr. Crippen (and many other bloggers) has written about this already. If you need details regarding what "Productive Wards" is then google it.

So when this bullshit came to my hospital they decided to make all the ward sisters attend a series of lectures about it.

A ward sister is an RN obviously and they will not pay more than 2 RN's to be on our large ward at any time. If we have 3, one gets sent away to staff a more "important" unit.

Ward sister was ordered to leave the ward to attend these lectures on "Releasing Time to Care" for the duration of her shift.

This left one junior RN in charge of the whole ward with 2-4 care assistants. The shift was 0700 to 1500 hours and the lecture thing that sister had to attend was pretty much the whole shift.

This is a 25 (sometimes 35 if the fuckers open the other wing even though they cannot staff it) bed acute medical ward where every patient needs constant support and just finding prescribed meds and/or setting them up to infuse for that many people can take 50 minutes out of every hour.

The hospital refused to pay for any nurses to cover the ward while the ward sister was at the lectures.

This meant that a junior RN was not only in charge of her 15 patients but sister's 15 patients as well plus charge nurse for the ward. Alone. The morning drug round alone takes 3 hours for that amount of people and that's if she doesn't stop everytime a patient shouts out for help or begs for a commode.

Even if she carries on without allowing herself to be interrupted, the patients will not get the drugs they need on time or anywhere near on time. It is just too much. Blood work gets fucked up as a result of these drug errors, people get hurt, people suffer etc. Time is extremely important with drugs. She will also get constantly interrupted by phone calls and doctors during this time, and they will not give a damn about the patients that they are not responosible for...

A consultant will show up (not at a set time but at a time it suits him, usually during our drug round) to see a patient in bed B.

The nurse will be getting pain meds out for bed A when doc decides to grace us with his presence. You would not believe how much of a long, time consuming process getting morphine up and out, ready to deliver is...

Doc will expect the nurse to drop what she is doing to shadow him on his visit to bed B. Immediately.

He does not care about the Nurse's patient in bed A because bed A is not his patient. Only bed B is his patient. He doesn't give a shit about the fact that the nurse would have to leave bed A in pain to attend his round. He doesn't give a fuck about the fact that there are no other nurses on the ward to help bed A. He probably doesn't know and he doesn't care either. He has other problems and the nurse's problems are the nurse's problems.

Either we end up with a screaming, tantruming consultant whinging about his precious time or a patient left to wait for pain medication. There is no other Nurse because she is at the "releasing time to care" lectures and management won't replace her on the ward. And yes she has to attend the lectures or management will fuck her up. There are only care assistants and they cannot attend rounds or infuse pain meds. The care assistants are struggling at this point just to get everyone fed, washed and answer bells without making them wait for hours, suffering in agony.

But no. Management will not get another nurse in to cover absences due to the productive ward lectures. The nurse not on the lecture that day will be left alone to be abused.

...by the way if Nurse Anne was in that situation she would just tell the consultant to fuck off because someone she is responsible for is screaming in pain.

And yes, I do understand that ward rounds are extremely important and so is the consultant's time. I would still tell him to fuck off. Unless of course I had another nurse. Then one of us could get the pain meds and the other could be dutiful and attend rounds.

Too bad management doesn't think that way.

Sick sick bastards all of them.

For the Docs (especially the junior docs: we like them better)

Just a few quick thoughts.

This blog was started so I could blow off steam. It is entirely nurse-centric. Nursing is all I really know.

I am always complaining about how tough nursing is right now. It's because I want things to get better. This does not mean that I do not understand how bad things are for other health care professionals. I am talking about the doctors mainly. Junior doctors especially. Consultants are just a mystery. I just try and avoid consultants 100%.

From what I can see it looks as if junior doctors are actually going through living hell. We do feel bad for them. We feel bad when we can't help them out. We feel bad when we have to keep bleeping them for stupid shit. But yeah, we have too. We feel bad when we find out something about a patient that needs a doctor review 8 hours into my shift rather than 2 hours ago when the doctor was actually on the ward. Now he/she has to come back here AGAIN when many other wards are trying to get him/her to see their patients. We haven't bleeped you 3 times an hour to be a bitch or make things harder for you. We are just constantly missing things because we have no time to read notes and assess people properly. It's bad. Honestly, we don't want to fuck up your orders or land you or ourselves in hot water.

We know that you had to be highly intelligent just to get into med school and that you have an extremely high IQ. We know this even if you just asked a silly question. We know that your hours are shit compared to ours. We know that you have more patients and are constantly dealing with acute stuff.

We actually worry about the junior docs...and take cash bets on which ones are going to keel over and die from stress before age 35. We get pissed off when we see consultants talking down to their juniors and yelling at them in front of everyone.

We think that it is a damn shame that you can't get anything done without that bleep going off. I would have thrown the fucking thing out the window. Obviously we respect the job you do. Even so, I am still going to run in the other direction and not make eye contact when you walk onto the ward. That's probably because I haven't yet been able to implement those orders you gave me over an hour ago. Yeah oops.


There is always going to be some nurses that hate doctors and give them a hard time. My experience is that the majority of us are not like this. The majority of us do not want to do your job either. No thanks. I really wanted to be a nurse, despite all the shit (literally and otherwise). I like the idea of nursing people, NOT spending my days diagnosing and prescribing. That doesn't sound like any fun to me. But that is just me. More power to those of you who choose to go down that road.


But the whole point of this blog is to explain things from the nurse's point of view, that's all.

OMG THEY TOOK OUR STAFF AWAY

You can thank the managers for this crap, the matrons for being indifferent, and the nurses for stupidly behaving like martyrs to try and keep the patients safe.

A bit of background. My trust got rid of float pool and bank nurses. The nurses who worked pool or bank were used to cover sick leave, maternity leave, short staffed wards etc.

Management fucking got rid of them over the last few years.

When a ward is short staffed they pull nurses from another ward.

What wards do they always pull staff away from? MEDICAL. GERIATRIC.

If anyone has read my blog you know that normal numbers on my ward. Sometimes we are 35 beds with 2 nurses and 2 healthcare assistants. When the ortho ward is short staffed, or a surgical ward is short staffed they will take our staff away to cover. When we are short we are told "sorry there is no help available". Can't expect those sick bastards to spend money and resources on medical patients can we.

Came into work one day last spring already stressed because I knew that there were only 3 RN's and 2 HCA's for the entire ward. This is better than usual but still shit. 5 minutes into the shift I got a call from the dreaded site manager.

"You need to send one RN to the surgical ward and one care assistant to the gynae ward".



Nurse Anne: "WTF that only leaves us with 2 nurses and 1 care assistant for 35 beds. We have elderly patients who need total care but also acutely ill patients"

Site Manager: "Tough it out. Prioritize. Do nothing but deal with emergencies and meds."

Nurse Anne: "No. I can prioritize but I also want to see my patients safe, clean, and pain free as well as fed".

Site Manager: "You have a house keeper. Put her to work as a nurse for today."

Nurse Anne: "Ummm she doesn't know how to be a nurse and who will clean and make food?"

Site Manager: "Not my problem. If your RN and HCA are not onto the surgical and gynae wards in the next 5 minutes you can consider yourself on final warning. Goodbye."


Nurse Anne: "Fuck you".

Okay I didn't say fuck you but I didn't send the staff either. He came down to the ward himself and collared them. I am not a good enough nurse to handle so many patients with so little. I don't know anyone who is that good.

So I decided to be real nosey and called the wards that I was ordered to float my staff to for the duration of the shift. The gynae ward (relatively well patients) had 3 nurses and 2 HCA's for 20 self caring young female patients ALREADY. But they didn't feel that they could manage on that so they asked for more.

The surgical ward was 30 beds and had 3RN's and 3 HCA's already. They also felt that this wasn't enough and they were probably correct but they should not have had my staff. I do understand that surgical patients require massively frequent monitoring.

I was left with 35 acute medical and geriatric patients with 2 nurses and one health care assistant.

So What happens when we call for help?


"Sorry no staff available to help you"

"Tough"

"just prioritize" (that means ignore the patients and do paperwork to cover your ass)

"Not my problem"

"Can't afford Agency".

"Deal with it".

They are damn focused on putting a show on for the younger patients in surgical/gynae/ short stay wards. But our patients are mostly confused and dying so fuck them say the managers. The nurses that are down there on medical and elderly wards busting their asses will take the blame right?

I had a chat with Matron about this situation. She shrugged her shoulders and looked at me in a very patronizing way and said "there is nothing I can do, you will just have to cope".


Almost every day that I went to work we ended up with less staff than my charge nurse had scheduled because they got floated elsewhere.


I don't know what I was expecting from her or any of those matrons really. She was the same twunt who left me as the only RN for 35 beds once. I was 25 weeks pregnant and when I got into hour 10 without being able to take a meal break safely I asked her for help. Not even a full break, just 5 minutes to get a drink. She literally turned her back on me without saying a word and went home for the day. That is an honest to god true story. That was the worst shift I had ever. Ever.

I may have been extremely short on nurses that day but the safety of patients required me to be able to do the job of 5+ people. I will never ever martyr myself like that again. And they say that if only the nurses took a little pride in their work things would be better. I got nothing out of that shift but a whole lot of patients that were really angry with me because they had to wait so long for things. They got terrible care that day even though I had pushed myself so hard.

And the modern matrons are supposed be teaching us about caring...

You can see why they will not bring back the old style matrons and sisters. The old style nursing superheroes would put an immediate stop to this bullshit. The modern managers , nursing leaders, and modern matrons would have to hire bodyguards and then go and crawl under a fucking rock. The old style nursing sisters and matrons would fuck. them. up.

Report/Too many patients/overwhelmed: Part 3

What to do?

If both of us (the only 2 RN's for a large ward) try and take handover on all the patients we are fucked. The sheer volume of information and the insane amount of time it takes to get through handover together with constant constant interruptions is a nightmare. It takes hours. Then it takes time away from the patients if we are constantly trying to meet up and hand over any changes/updates to each other. We try and we fight to pull it off but it just doesn't happen. We can't even wade through the top priority doctors' orders that will kill a patient if it doesn't get sorted immediately without fighting interruptions.

We do both feel responsible to every single patient on our large ward.

We have learned from repeated bad experiences that it just doesn't work for us both to keep constant track of all the patients. Accept it or fuck off.

So we each take a "side". I take team A which is beds 1-18. Carly takes beds 19-35. No it is not because we are thick, or lazy, or don't give a damn. We are working with what we are allowed to have, not what we want to have. We are coping the best that we can in a situation we have no control over.

Even though I only have a side I am still overwhelmed. Violently so. It becomes insanely impossible to nip over to the other side in a safe manner. It is impossible to keep track of my own side and get them everything they need even if I completely ignore Carly's patients.

Of course I won't ignore her patients if they need help and I am the only one around. But I won't lay a hand on them either without checking with Carly. Too many gods damn bad mistakes have happened because a nurse who wasn't up to date with another's patient answered a call light and patient request. They get real upset when I tell them I am not their nurse but that I will get her to deal with their request. Nine times out of 10 someone wants food when they are nil by mouth or a med that they are not allowed to have. It's not something I can sort out for them without throwing my own patients out the fucking window. Five minutes down can do that. Yeah. Really. It could take me a long time to chase Carly down, and in the meantime my own patients are falling out of bed and wondering where I am with that pain med.

So what do we get for trying to do our best in a difficult situation? Shit and constant abuse basically. That about sums it up.

Visitors and doctors especially are the worst. The walk onto the ward, grab the first person they see in a uniform and want immediate answers as to what is happening with their relative/patient. They take no notice of the information board that tells them who is who on shift and who is responsible for who. They take no notice of how few staff are actually there. They take no notice of the fact that I am running down the ward with an airway. They want what they want and they want it now. They don't seem to get that they really hurt patients by behaving like this.

They blow right past the info board and want to be babysat for the duration of their visit to the ward by the first person in uniform that they come across.

They don't give a flying fuck about what she is smack in the middle of either.

Not even a pleasant "are you the nurse looking after Mrs. Smith, and if not could you please point me into the direction of the nurse who does know her?". Oh fuck no. We cannot talk to nurses like they are human beings can we.

It's more like "Hey you! You are in a nurses uniform, stop what you are doing immediately and answer my questions, follow me around like a lapdog for as long as I want and no I am not concerned about the fact that you are in the middle of sorting out someone with a k+ of 6.7 with calcium gluconate and a little IV dextrose/insulin. I will not look for notes myself, or wait for the nurse who knows my loved to be able to safely leave her patients and speak to me. I want what I want and I want it now and damn the consequences to your other patients".

That's what we get about 6 + times an hour every hour. If you think that is an exaggeration than I invite you to shadow me at work for a shift and see just how damaging these visitors/doctors etc can be. The logical thing to do is help them quickly if they are inquiring about my patient or point them in the direction of Carly if they are asking about one of her patients. If I say that I cannot leave what I am doing to help them, they need to respect me as a professional and understand that I really cannot leave my patients to babysit doctors and visitors right this minute.

Tell visitors and doctors this and they throw temper tantrums. They insinuate that nurses "don't care", "can't be bothered" and all the usual shit. Fuck you. If I am saying "That isn't my patient" do not assume that I do not care about him, or that I don't want to be bothered. Never assume. It makes you out to be a twat.

Maybe I have been trying to hang blood on my GI bleed for an hour whilst fighting constant interruptions. I know that the blood takes absolute priority but I am still battling and upsetting people in order to actually hang it. GET. OUT. OF. MY. WAY.

Maybe I am already 20 minutes late checking that blood sugar on my patient with the insulin drip who isn't looking so good. I am 20 minutes late with it because a relative stopped to ask me a question, a patient then asked for a commode and I was too much of a pussy to say no to her and risk her anger by making her wait. And now you are in my face, and the woman with the insulin drip is going hypo and looks a gray colour!! There comes a time when the nurse has to draw a line and say NO. I need to prioritize and do what I need to do, YOU get off YOUR ass and go and find that patient's nurse to answer your questions and leave me alone !!!


Maybe I don't know the patient enough to answer your questions intelligently and I am so overwhelmed that I cannot hunt down his nurse or his notes to find out. I still haven't checked that blood sugar and the lady with the insulin drip isn't looking so good, nor have I hung that blood. Standing in front of me and refusing to let me pass until I answer all of your questions and hand you notes that you could easily find yoruself will not change this situation in the least. I will just push you out of my way.

Maybe I was finally on my way to get some pain meds for my cancer patient or investigate the guy who hasn't passed urine in 12 hours. Do not hold me up from that in order to make your life easier!!!! How very dare you, you fucktard!! If stop now to fuck around with visitor/doctor requests there is no one to take over my job. No one. Get it asshole? This is why nothing gets done around here.

These interruptions for my own patients and patients that I do not know cause it to be an uphill battle just to get someone a pain pill.

Maybe I am remembering that time I did answer a request from a patient I didn't know only to find out that I should have never touched him without knowing every bit of info about him. Bad outcome. Real bad. That situation happens a lot because we do want to help.

We don't want to say "It's not my side, I don't know about him" because we don't want to appear stupid and lazy and uncaring. WE also don't want to spend 20 minutes chasing down the other nurse when my own patient is going hypo, another is bleeding out both ends and the man with the potassium of 6.7 has probably arrested because I haven't got the stat meds his doctor ordered up yet etc. I usually have all this going on at once for the duration of my shift.

For the sake of safety and efficiency sometimes we have to say "I cannot" or "that's not my patient". It's not meant to be indifferent. Quite the opposite actually.

I have a license and a hell of a lot of accountability. If I say I cannot walk away from what I am doing right now then I fucking mean that I cannot allow myself to be interrupted right now without hurting patients. I am not ignoring you and I do understand that your needs are important.

Deal with it and shut the fuck up. I did not create this situation but I am trying to ensure that the patients on the ward survive it.

Taking report on too many patients PART 2

I am having a really tough time articulating this for people who are not nurses. I will try anyway because it is so important. If have ever wandered onto a ward expecting the first person you see in uniform to have the information you want, and then threw a tantrum about the "stupid nurses" you should read this. If you have ever become upset because a nurse responded with "that's not my patient" you should read this. You need a reality check.

I have had a few emails off of nurses about report and handovers. The American nurses are telling me that they arrive to work and take report on 4-12 patients on their 30 bed acute wards. That report alone takes 45 minutes due to the sheer volume of information one needs to know to be a primary nurse for those patients. Then there are the constant interruptions throughout handover. The idea of taking report on the whole ward and staying on top of everything for all of those people is generally understood (by those of us who do this everyday) to be "ludicrous". First of all it would take hours. You cannot be away from those patients for hours receiving handover.

However, the idea of getting involved with the patients that you haven't had handover on is understood to be dangerous. It is impossible to keep up with your own assignment let alone get involved with the other one. What if my patient gets labs drawn late, IV med late, or I miss a change in condition because I went to research a patient on my colleagues assignment so that I could answer a relative's question? I have harmed my patient if I do that. I want to help the family but it may take ages to hunt down that patients nurse and it will take ages to make my way to the notes and research and investigate the answers to their questions. it's doubtful that anyone has had the time to document everything anyway. I am constantly interrupted during the day, constantly with these queries.

It is a nice idea to think that all nurses on the ward during a shift have up to date knowledge about all the patients. But in practice it doesn't work at all. Yet having report only on one side of patients and not being aware of the situation with the other nurses patients is also a massive problem. This is what I am trying to reconcile.

If nurses decide to constantly try and update eachother about their patients so that everyone knows what is happening we end up with nothing but big fuck ups. First of all, any time spent away from patients trying to handover is dangerous. Who the heck is doing the work and watching the patient with a trained eye if we are constantly updating eachother? The teenage cadets? You would not believe the sheer volumes of information we are trying to keep track of and you would not believe how quickly things change and how unorganised it all is these days in acute care. You also wouldn't believe how easily a patient could be killed either because the nurses are constantly trying to handover to eachother, or because they weren't.

Nurses are of course encouraged to help out their colleagues and their colleagues patients when the need arises. But taking something on with a patient outside of your assignment when you do not have up to date info on them is a minefield. If another nurse's patients asks for something so simple like a glass of water or a pain med and you supply it without being updated you could seriously harm someone. It's more complex than this, but I am trying to keep it simple for the sake of clarity.

Our acute medical wards started moving from 4 nurses to 2. This what at a time when the patients were becoming more complicated, the work loads were tripling, and everything just started moving faster. Things will continue in this upwards spiral due to modern changes in healthcare.

We realised at this point that 2 nurses taking handover at the beginning of their shift on 35 patients was taking too long. We started work at 7:30 AM. The night nurse comes off the ward at 7:30 AM and starts giving us report on each patient: Name age, doctor, diagnosis, history, tests, assesments, treatments, social , physio, meds, problems, old issues, new issues etc etc. It was 9:00 before report ended and we hadn't even set eyes on the patient yet. You need a heads up on so much information your brain hurts when it is all over and you can barely process what you heard. It's likely that I haven't met any of these patients before.

Not only that but the care assistants would constantly be in and out during handover to tell us that someone had fallen, someone couldn't breathe, this patient needed morphine, another has just vomited a litre of blood. You can't leave that until the end of report. You also cannot touch a patient until you have had report. The phone rings constantly during report. No ward clerk present thanks to cutbacks.

The first thing all the relatives do when they wake up in the morning is ring to ward to find out what kind of night mother had and ask what time the docs are coming. Be damned if we nurses know when the consultants are going to grace us with their presence. If the night nurse is on the phone constantly answering questions we are not getting handover. We are sat there getting pissed off because we haven't started our shift yet. We (the day nurses) can't head out onto the ward and start anything if we don't actually know anything about the patients.

We do not learn what we need to know about them by osmosis or psychic ability. We are not there everyday and when you come back in after a day off everything has changed. We need time to learn about the patients' issues. That's why we have handover. This is not an issue in nursing homes and subacute units. They have the same patients there day after day and only need a quick handover to update.

I have often come in after 3 days off to find that I am the primary nurse for 15 + patients I have never laid eyes on before. And we can't even get through report or have a quick look at the notes before we start our shifts due to constant interruptions primarily in the form of phone calls from relatives. Jesus try keeping all the names straight in that situation let alone everything else. Just try it or shut the fuck up.

We know that you can't have the day nurses sat in a room for 2 hours at the beginning of their shift trying to get handover. The night nurses stopped being paid from 0800 onwards so they were there unpaid until 0900 or even 1000 trying to give us report. What is the solution to this? We no longer have a charge nurse/sister/matron there 5 days a week who knows the patients like the back of her hand. If we do have sister on duty, she is there instead of a staff nurse. That means she has to be a primary nurse doing care and cannot fart about with the doctors all day staying updated on patients. We tried taping report. That failed due to constant interruptions.

So our solution was this: There are 2 nurses for a 35 bed ward. Instead of both of us trying to listen to report on all those patients we will EACH TAKE A SIDE. Night Nurse Kate can handover patients in bed 1-18 to me. Night Nurse Beth can take the other day nurse aside and handover beds 19-35 to her. Then we are usually out of handover at 8:15. Then I can go and actually set eyes on my patients a lot earlier and get started. All 35 of them are due meds that have to be given on time before 0900. Otherwise they are written up as errors. We need to get started.

This is why nurses each have a "side" rather than updated info on all patients.

Are you guys following me so far? I hope so. This is really important even if you are bored.

I'm not done with this subject yet. The ranting and swearing is going to come in part 3.

Nurses should not take report on all patients on the ward...PART ONE

I got a massive shock to the system when I stupidly returned to the UK following my training and working for a short time in the USA.

Over there I was working on a 36 bed general medical surgical unit. It was considered violently unsafe for a nurse to take any more than 6 patients...12 in an absolute staffing emergency. You could increase the ratios at night due to less interruptions.

We had "pods". Each 6 bed pod had its own nursing station, it's own phone and it's own nurse, it's own supply cupboard and it's own hand washing station. This staff nurse only had handover on those 6 patients. All the info she needed for those 6 patients was right there, not mixed up with the other 30 patients. The idea was that it is extremely dangerous to have handover and irresponsibility for more than your pod on busy day shifts. on nights there was one nurse to 12 so she had 2 pods.

Every single day we had a charge nurse (sister) who was in charge of the whole ward. She was there 5 days a week and knew about all 36 patients on the ward. That was good. She was our leader. It is stupid to expect a staff nurse to come in after days off and take report on 36 patients anyway. It takes forever to get handover on that many patients and it is way too much information to keep track of for any amount of time.

Things change so violently and quickly during the day that if you were trying to care for a group of patients and keep track of all the issues for the whole ward you would fail. This was understood by our managers and anyone else with a fucking braincell. That is why each staff nurse stayed in her own pod, only had handover on those patients. The charge nurse was the only one who had report on all 36 patients from the night charge nurse. She did not have a specific patient assignment. She went from pod to pod checking that the nurse and the patients there were doing okay.

Picture the shock to the system I had when I came to the UK to find that on a 35 bed ward there were only 2 staff nurses, no charge nurse and that we were supposed to listen to report on 35 patients we never saw before. How fucking stupid. On a 35 bed ward there would be 2 or 4 nurses listening to report on all the patients. Report at the beginning of the shift took hours. Now we don't even have four nurses, just two. All the notes for all 35 people are jumbled together at the nurses station and there is only one nurses station and one phone. It's fucktarded.

Let's back up a minute. Decades ago an NHS hospital ward had 35 beds and it worked out that you always had one nurse on duty to know about all of the patients. Matron or charge nurse was there every day without a specific patient assignment. First of all, the patients were no where near as complex as they are today on a general ward. General wards today are full of chronic people with complex problems who would not have lived very long back then.

Decades ago patients stayed in the hospital for a lot longer allowing the staff to get to know them. Things didn't move as fast or happen as fast. There were not as many targets, paperwork and changes throughout the day as there are now. I may do 11discharges in one day now. Things were at a slower pace back then. There were more nurses and everyday there was a charge nurse/sister/matron on the ward in charge. She was there every day and knew that ward like the back of her hand. She had staff nurses to care for the patients while she supervised and kept up with the information.

We don't have any of this going for us now. And it's not our fault.

They certainly won't pay for a charge nurse to be there everyday on top of two staff nurses. Most you get now is a charge nurse and a staff nurse or two staff nurses. Each will take a side of patients. If the charge nurse is the primary nurse for her 12-14 people than it becomes impossible for her to follow what is going on at the other side. We did try and have both nurses listen to both sides and get handover for the whole ward. We failed miserably. There was so much information to know for all those people that report was taking nearly 2 hours. There were so many changes during the day that we couldn't find time to catch each other up. Every time we tried we failed due to interruptions.

The other problem we have is this: Nurses are often working 14 hour shifts 3 days a week rather than being there 5 days a week. Saves the hospital some cash. To come in after 2 or 3 days off and listen to handover on 25 or 35 patients you don't know and then try and keep track of all the information is crazy. It's like begging for errors and mistakes. As a matter of fact we know for a fact that it will cause vital info to get missed out lead to mistakes. American nurses would be shocked at the idea of having all ward nurses know about all the patients on a 25-35+ bed ward. Actually anyone with a fucking brain would be shocked that people think that this could work nowadays.

I need to go now and will finish part 2 of this later.

Then I will have a holy motherfucking shit fit angry rant at the people who deem the ward nurses thick and lazy for not having up to date info on all the patients on their ward at all times.

If there are any nurses (especially outside of Britain) who are reading this I would like to know how many patients you get report on at the beginning of a shift. What would you think of sitting and listening to handover on 35 patients at the beginning of a day shift in acute med-surg? Maybe you'll decide for the only 2 staff nurses on duty to listen to report for both sides and work together. Do you think it would work? If you split it and each took 17 or 18 patients each how would you keep track of your 18 patients and your colleagues 17 patients as well? How can you keep track of all the minute details of 36 people with rapidly changing conditions and orders?

Please answer if you have time. British blog land is full of doctors and members of the public having a shit fit and calling the ward nurses stupid and lazy for not having up to date info or assessments of all 35 patients on a ward at all times.