Tuesday 4 December 2007

Rambling on About Care in the Community and bed blocking.

Have you heard about the care in the community shit?

There are no beds in hospital. There is no staff in hospital. The Burger King down the road is staffed better than my ward and that is the truth. There are not enough places in the community and/or nursing homes to care for people. Meanwhile 80% of new nursing grads cannot find jobs and money is getting pissed away on luncheons so that the managers can have another meeting to plan another meeting and never take any action.

I work on a ward that is primarily medical and we take a lot of exacerbation COPD patients. Many of these patients are anxious and cannot deal with the fact that their nurse has other patients who may be sicker. I would feel the same way if I had copd and was struggling to breathe.

They are often on the call bell every 30 seconds for reassurance etc. Many of them are elderly and can barely manage to get out of bed onto the commode without help.

They want to "care" for these people in the community. They cannot even care for them in the hospital. They come in. They get ignored by overwhelmed nursing staff whose heart is the in the right place but cannot do their jobs. They deteriorate.

But home care is not the answer, because it will be managed badly like everything else and their is a higher chance of the ball getting dropped. The hospitals should hire some of the 80% of nursing graduates who cannot find jobs and care for these people in hospital. The matrons and the "specialist nurses" who spend their days drinking tea and coming up with retarded 20 page forms for the bedside nurses to fill in should get their asses to the wards and give a hand. I have a hard time referring to our so called leadership as "nurses". They don't deserve the title.

I don't see how any of our patients could manage at home for any length of time. Even when they are declared medically stable they are still dependent. They would all need one to one community nurses. Hospital care is bad and often leaves these people with more problems BUT this situation is fixable.

At the moment 80% of our patients are medically stable but unable to care for themselves at home. WE have a lot of elderly folks around here and no elderly beds and too few nursing homes. The hospital picks up the slack.

Many many many of my patients have been there for months and months. We have some who are waiting for beds in nursing homes, some who are waiting for care packages to be sorted for at home care, most who are unable to walk thanks to being left in a chair with no moblization because their nurse is so overwhelmed. They have family that won't or can't provide care and yet refuse help from social services. We have these people for months on end and there is no answer.

We have one patient who has been with us for 6 months. It was determined that she couldnt go home and needed nursing home care. She and her daughter picked out a nice one with help from social services. She had a bed at a nursing home near her daughter. She really wanted to go to that nursing home and sat in the hospital for 3 months waiting for a bed at this facility. I shit you not.

The day before she was to go there she told her daughter that she changed her mind and wanted to go to another nursing home. Daughter cancelled the nursing home bed and then came and told us (nursing staff)about an hour before she was to go. A surgical admit was slated to come into that bed in the afternoon. I shit you not.

It will be another 2 weeks before the new nursing home will come to assess her, and then we can find out if they will accept her. Then she will wait for a bed. Social services want the nurses to fill in another 20 page nursing assessment form again that is complete bollocks. No one will have time on any shift to do this. I am sure she will be with us another month AT LEAST. It may very well be a lot longer.

Then she gets angry when we have acutely ill patients and she gets less attention. The patient in the bed across from her arrested and whilst we were doing CPR she was overheard complaining that she has been at our hospital for months and never received that kind of attention. Makes me go grrrrr. This is not one unusual patient. This is 40-60% of our patients at any given time.

Some do get discharged home without adequate care in place because they want to create free beds. 72 hours later they are back in casualty with dehydration and a fractured neck of femur.

Meanwhile I could get the accident and emergency staff brought up on harassment charges for ringing every 30 seconds making threats. I don't blame them really. It's their ass if their patients breech the 4 hour rule. And it is all completely out of their control.

So we are getting constant bullying harrassment phonecalls from accident and emergency and the bed manager ordering us to "get people the hell out" because patients are breaching the 4 hour waiting times in Accident and Emergency and there are no beds. There are so many more patients coming to the hospital than they can deal with. We have a side room where the roof is leaking and tiles are caving in due to flooding and I was ordered to put a patient in there.

I have recieved a phone call at 0200 that a bed has become free in an outlying hospital and to pick a patient and get them transferred out there NOW because we are breaching. Why are we nursing targets and not patients? Not one of my patients are going to be happy about woken up at 0200 and transferred god knows where. I was threatened and told that if I don't walk away from what I am doing (never mind the 50 year old patient who has just suddenly developed expressive dysphagia and numbness and weakness on one side and I am trying to get a doctor up and I am the only nurse) that I will be disciplined.

And their relatives are going to fly into a rage about grandpa being woken up at 0200and getting shipped out to god knows where. They will chew out the nurses that's for sure.

I focused on the poorly patient first rather than deal with the transfer. I'll get busted for that you know. I was the only nurse and I couldn't leave the unwell patient to sort a transfer (transport, informing relatives who will go ballistic etc etc etc).

It is the same damn problem in every post I make.

Sunday 18 November 2007

Handover Fun

One day I was the only registered nurse for 18 patients (worse than normal number of 15) for all of my shift from 0730 until 2130 hours. At 2100 my relief comes in. She has been off duty for a week and does not know the patients. She is a newish pool nurse. I need to give her a detailed report on each and every patient. She will be in charge of their care on night shift. Even if I only spend 2 minutes per patient during the report session, handover will still take 36 minutes. But two minutes per patient will not even scratch the surface in telling her everything she needs to know and handover to the day staff so they know. Three of the patients are acutely ill right now and have some really complex things going on. Most of them have relevant past medical histories that would take longer than 2 minutes to handover.

I had an admission at 2100 so I start handing over at 2115. The oncoming nurse cannot touch a patient until she gets report and knows about them. Doing that is begging for litigation. We really need to get started with this handover.

2115 hours
I start handing over at 2115, at 2116 a patient requests pain meds so I administer them, on the way back to handover a patient requests the commode so I help her with that. Phone call comes in from lab that new admit has an HB of 6. Eek. Call doctor. He orders a group and save...to have blood tonight etc etc. It will take a lot of time in itself between getting the blood from path lab, setting it up, moniter for transfusion reactions etc.

2130 hours
take patient off the commode and settle her into bed. She asks for a drink, my HCA's are tied up with a confused patient so I get this lady her drink. Can't handle complaints from patients saying that the nurse couldn't even be bothered to get someone a cuppa.

2135 hours
back to handover room. I was halfway through the first patient so I continue. I am in here and there is no RN to care for my patients whilst I am handing over.

2136 hours

phone rings. Angry relative wanting to know if the nurses "bothered" to change mum's nightgown today. He gets nasty. He obviously is in a bad mood and wants to kick out. Probably a regular reader of The Times who thinks there are lots of nurses up here eating the patients food and discussing politics since we are too academic now to wash and don't care about patients.

2138 hours
back to handover. we tick on nicely until...

2145 hours

I realise that patient who has an infusion of IV insulin is way over due to have her sugar checked. This is not something you can put off until later. It will need checking again in an hour. HCA's are still tied up so I do the BM. She asks for commode while I am there. I am useless at saying no.

2150 hours

back to handover.

2200 hours
I am just in the middle of telling on coming nurse what we need to do for a patient that has a drip with a med that she has never seen before....explain what we need to watch for, labs that are getting drawn in the night that she needs to stay on top of...

Visitor (who shouldn't be there at this time but has special permission) bursts into handover room. Demands that I get up off my ass and clean his mother up.

I am concerned with time at this point as it is way past the time that the night nurse should have started her assesments and drug rounds. Lateness could fuck things up royally for these 18 patients. 9PM meds have not been started yet. I see the HCA getting someone a pillow. I point her out to the visitor and say that I'm sorry cannot help you now...can you ask that young lady over there. He tells me that he didn't ask her because "that nurse looks busy meanwhile you nurses are sitting in here chatting" I resist the urge to punch his ignorant face.

2205 hours
It takes less time to sort out patient than to argue and explain to the visitor why I can't so I go to help her with assistance of oncoming nurse. It takes 5 minutes to clean her up and 20 minutes listening to the visitor and patient tell us what useless slags we are for not being at her bedside all the time, all shift. Arguing back is pointless.

Back to handover. Ten call bells are ringing throughout the rest of handover. This is more than 2 HCA's can handle. If we go out there we will never get through this. Ever. Things are getting desperate now. I fly through the rest and say a silent prayer that I am not forgeting anything critical.

Phone call from patient's cousin who wants to know the ins and out of everything we are doing for his loved one. I have no choice but to be abrupt with him.

I finish handover and realize that the hourly blood sugar check for the IV insulin patient is a little overdue as well as 100 other such things. I go to check it so night nurse can get started. Get stopped for 3 commodes on the way back to nurses station. The night nurse and HCA are tied up. One patient starts telling me off as she has been ringing for 15 minutes and asked why we couldn't be bothered to see to her.

Path lab has blood ready. That was fast.


Head Home. I have been here since 0715 this morning and have been unpaid since 2130. I WILL be deducted on hours pay for lunch breaks I didn't have. Phone call comes in. I let night nurse get it. It is a relative screaming because their loved one was left to starve yesterday. Patient was NBM for an operation. Don't these people have anything better to do at this time of night other than stopping nurses from seeing their patients and interrupting them whenever they try to hand over critical info to the oncoming shift? WTF? During the day the phone never stops ringing due to this shit. At least there are less calls at this time.

I am going home. I am tired. Fuck the paperwork I haven't done. They can pull my registration for all I care at this point.

0400 hours

Wake up to see what why my baby is crying and it suddenly occurs to me that I forgot to tell oncoming nurse about a patient who should be NBM from midnight for a FBS test in the AM. Call work since she probably won't have time to look at the charts causing the patient to get breakfast. I am not the only nurse who calls in the middle of the night with this kind of stuff. There is way too much info to keep track up and no time to stop and review and take stock. At least this was relatively minor.

How different would things be if there was at least one other RN on duty with me to cover problems while I was handing over? You should see what it is like when we are one RN to 35. There was another RN on duty on the ward but she was even busier with her 18 patients. I don't know what time she got out. Her patients were on the other end and we didn't really see eachother.

Saturday 27 October 2007

A Journalist Gets It Right (and he's not from the UK)

He is an Editor turned Nurse turned Editor from the Wall Street Journal. This is a huge Newspaper in the US.


This is the kind of stuff we need to see from British Journalists. Here are some excerpts.

"In 2002, at age 40, I left my job as a page-one editor at The Wall Street Journal, my professional home of 15 years, to take a giant leap of faith -- in myself. Like a lot of people, I questioned my purpose after Sept. 11, 2001. Jolted from the complacency of a comfortable career, I became convinced that I could achieve selfish fulfillment through devotion to service -- to the individual, to the community, to the vulnerable.

I considered teaching. I considered law, medicine, pure science and research. But my thinking always returned to the nurses I had watched care for my mother a few years earlier, when she lay in an intensive-care unit in her final illness. I marveled at the way they melded an aloof, precise professionalism with a mysterious human (and humane) instinct. They seemed to operate in a purer space, beyond worldly distractions. I would be a nurse."


"My skills were those of any new nurse. With easily shattered confidence, I could start an IV, administer medications, bathe a bed-bound patient and change linens, change dressings, insert all sorts of catheters and tubes, read lab results and electrocardiograms. I knew to be vigilant against infection, pneumonia, pressure ulcers, medication errors and the many other lurking threats to hospital patients. On the burn unit, pain control loomed large. I also knew, as both executor of treatment plans and patient advocate, to keep a close eye on what doctors ordered. They make mistakes, too.

But in those first months, I felt stupid and slow, and thus dangerous. I hadn't yet mastered the ruthless efficiency of thought and motion that lent veteran nurses the appearance, at least, of enviable ease. Next to my crazed back-and-forthing, they floated around the unit, maintaining a cool composure no matter what crisis erupted.

The night began with the shift change, from 7:30 to 8. "The arrival of the replacement killers," as one nurse liked to put it. We straggled in, one by one, from the locker room to the nurses' station, crowding around the assignment sheet, groggy from unsatisfying daytime sleep.

Assignments were subject to wide variations. Typically, a critical but stable patient, often on mechanical ventilation, came with a second and even a third patient, in less serious condition, perhaps even a "walkie-talkie" -- alert, oriented and ambulatory, in clinical nurse-speak. If the rooms were spaced apart, I could look forward to spending 12 hours trotting like Edith Bunker back and forth across the unit, from patient room, to med room, to supply room, to another patient's room, to supply, back to the first patient's room, and on and on.

Already thin, I lost weight as a nurse.

Shift change was a noisy time, as day nurses, relieved to be relieved, gave "report" to the night nurses. I was anxious during report. For my patients' sake, I couldn't miss details -- "He may try to yank out his feeding tube," "You may need to bump up the sedation" -- but I was already parceling out the time. Second hands relentlessly swept the clocks mocking me from the walls.

Basic nursing duties were enough to keep me on my feet until dawn: initial head-to-toe physical assessments; hourly vital signs and other monitoring tasks; medications; bed baths and dressing changes; regular suctioning. First thing, I reviewed my patients' charts, checking for any outstanding physician orders that might devour precious minutes -- a blood draw for early lab work, perhaps, or an order to start tube feedings, or, as encountered one night, hourly enemas.

There could be no skimping, no coasting through a shift because of a headache or trouble at home. For 12 hours, I belonged to people whose survival was at stake. A sloppy physical assessment could later explode in disaster if a potential problem -- a bum IV, an incipient pressure ulcer, abnormal lung sounds -- went unnoticed. Rooms required meticulous inspection, too, to ensure that vital equipment was present and functioning: A missing bag mask -- attached to those blue vinyl footballs you see TV doctors and nurses rhythmically squeezing in emergencies -- could cause lethal delays.

Then came 9 o'clock medications -- for me in my early days, 9:15ish at best. Patients received as many as a dozen medications at once: injections, IV infusions and pills, either swallowed or crushed in mortar and pestle, dissolved in water and squirted down a feeding tube with liquid meds. Ointments applied, eye drops administered. For one patient, I could spend 30 minutes just gathering it all together and double-checking it for safety.

Burn care was a nightly abyss to be crossed with every patient. It was a big, messy, smelly job that demanded painstaking attention to detail. We usually helped each other or enlisted a patient-care technician -- the latter a negotiating tactic I began to cultivate after that night working alone without the lubricated mesh I needed. We had to work fast because burns impair the body's ability to regulate temperature; exposure can cause life-threatening hypothermia. And simply moving and turning a patient can cause blood pressure to soar or the heart to jump into a dangerous rhythm.

These were the basic functions, and on an uneventful night, I could just manage them -- the tasks themselves, and the documentation of them. If it isn't documented, the saying goes, it wasn't done.

I wanted to hover over my charges like a jealous hound, alert to the tiniest shifts in their biological function. I talked to my patients, to assess their mental status and their pain, to dispel their fears, to teach them about their conditions and treatments, and to learn details about their lives that might affect healing and recovery beyond the burn unit. But I felt hurried, with little time for the reassuring smile and comforting touch one sees on TV commercials that laud nursing as the caring profession.

Most nights, unexpected contingencies unwound the tight choreography of the shift, diagrammed in hourly increments in the sprawling spreadsheets of patients' charts. I lurched from one task to the next, fulfilling all requirements, but little more.

For a while, the electronic thermometers we used were in short supply, and the shift started with a mad dash to nab one. We made a joke of it, but behind the laughs, I heard the clock ticking. Infection control slows down all movement: Hands must be washed before and after every contact with a patient, and fresh gown and gloves donned every time one enters a patient room, to be discarded when exiting. A thermometer or any other piece of equipment moved from one room to another must be cleaned, too.

Often, it seemed, I came on shift to discover a clogged feeding tube. I had to pull the tube, insert a new one (in the nose, down the esophagus), and then wait for X-ray confirmation of correct placement in the patient's stomach before feeding could resume.

An order for bedside dialysis for a patient in acute kidney failure entailed mastering a contraption that looked like a prop from "Lost in Space" -- a big beige metal box on wheels, with knobby green and red lights flashing, rotors whirring, alarms buzzing. It came with printed instructions. Even so, obtaining the necessary solutions from pharmacy, priming the machine, attaching it to the patient and getting it running took a couple of hours, and then a lot of catching up.

A medication missing from the med room could prompt a trip down dark corridors to the pharmacy and back. Blood sent to the lab went bad before it could be tested, requiring a second draw. Dressing supplies ran out, calling for creative solutions. Patients being taken out of deep sedation yanked out their feeding tubes and IVs and fretted with their dressings. A fire in the city could yield new admissions, to be parceled out among us. And of course, infection or shock or some other problem could turn a stable patient into an emergency.

Regardless of the job at hand, my mind raced through the list of others awaiting my attention, convinced that my own feelings of being overwhelmed compromised my patients' well-being. Twelve hours weren't enough. I finished my shifts breathless, and delivered to the day nurses confused, fractured reports before hopping a train home in the morning rush hour.

So it went for the first six or seven months of my nursing career. The 12-hour frenzies, worry about my patients and paltry sleep bred chronic fatigue. I was often in a fog: At home, I spooned coffee into my cat's food bowl, and mistook toothpaste for shampoo. One afternoon, I leaped out of bed, showered, dressed and noticed only as I was heading out the door that it was 10:00 a.m. I had been asleep an hour, and didn't have to be at work for another nine. A deep ache gnawed at my lower back. My feet felt like ragged stumps. I fell asleep in chairs, on subway trains, in taxis, at movies, at supper tables."

If you click on the link there is even more good stuff. He talks about how having one patient who requires your constant presence at the bedside causes your other patients to suffer and be at risk and there is not a damn thing you can do about it.

This guy was on a burn unit with a small number of patients. I wonder how he would function in the NHS where the nurse to patient ratios cause the battle to be lost long before we come on duty.

Ladies and Gentlemen: We found a journalist who is not a learning disabled ,lying, incompetent pig. It is a special day.

Friday 26 October 2007

Yet More Shit from the Times

Okay Nurses (and everyone else) this is a call to arms. This is war. I hope that everyone reading this sends The Times a letter. I have sent a few comments in. I hate liars. The Times is officially on my shit list now.

Here is another shining example of Journalism.


1. ITU nurses take better care of their patients than ward nurses because they are paid more and care more. WTF?

2. ITU nurses are so superior that they never have patients starving or lying in their own filth.

Not one statement is made of the fact that an ITU has one patient and mega back up and a ward nurse has anywhere from 10-35 patients with NO backup.

Not once is it mentioned that patients on the wards now would have been in ITU a few short years ago. Patients are more sick and more complicated today while staffing levels are falling dramatically.

This is like some kind of nightmare. We are never going to get our wards safely staffed if this is how people think.

The Times Dishes Up More Bullshit


Let's take this pile of shit apart piece by piece.

Nurses dish up nil by mouth

NOT ONLY are they too posh to wash, but today’s nurses are too posh for nosh. “I don’t do food,” says one nurse in Nursing Standard (Oct 10).

Even if this quote is true it is likely presented out of context. My years of experience tell me that this kind of attitude is no where near the majority. Most hospital nurses I work with would go medieval on a nurse that stated that she "let's patient starve". Is that even what she really said? Did she mean that she is responsible for the drug round at tea-time (as the only RN) and getting meds out late because she spent 4 hours feeding 20 people would land her a disciplinary? Or did she mean she intentionally lets people starve because she is crap? If that is the case and she is in the minority. I need to hunt up that edition of Nursing Standard and look at it in context. I don't do food either in my double shifts...as in I DON'T EAT.

Hospital caterers claim that there has been a shift in attitudes since nurse education moved into universities. Nurses now believe that serving meals and helping patients to eat is beneath them.

Oh Pray tell me what a hospital caterer knows about what is happening on our wards? I have never. ever. once.ever seen a caterer spend any amount of time on the wards. Never. What would they know about staffing levels, patient acuity, nurse accountability, the situation with the patients at mealtime? They know fuck all. I'd like to see them manage to give 20 IV meds due in the next 30 minutes (due or else there is hell to pay) and cater at the same time. What the hell kind of a source is a hospital caterer? Unless he sat in at handover and knows the score with patient acuity and staffing he is useless as a source. I love to feed people (it's a chance to sit down for the first time in so many long hours) but if someone is having chest pain I won't leave his nitro,obs,ecg transfer to CCU until 4 hours later when I am done feeding all those that need feeding. How would a caterer even begin to understand this?

“Florence Nightingale was happy to wash and feed patients and make them feel comfortable, but today’s nurses think that because they have a degree they do not have to do the basics,” says one manager in Dorset, who heard a senior nurse say: “I am paid too much to feed patients.”

In Florence's day there was no such thing as IV cardiac meds on titration, insulin drips, chest tubes, vents, cardiac arrests that were actually dealt with, bloods, critical lab results that must be reported, drug rounds, prep for theatre, extensive post op care, bladder irrigation, blood pressures to check regularly to deal with dangerous readings, ECG's to get when someone has an MI, equipment failures, IV pumps beeping that need trouble-shooting or else meds don't get infused, anaphylactic reactions to meds weren't deal with as they weren't understood so those folks just died, no blood transfusions with Frusemide to give whilst monitoring for heart failure etc. etc. etc.

People in her day died horrifically due to the lack of these things. Maybe we should return to that way of delivering care and I can happily and stress free spend my days bathing people. Sounds good to me. There is no love lost between me and florence. She hired convicts and prostitutes as nurses and they didn't want to be there. She had to be medieval to keep them there. This set the stage for people's attitudes towards nurses. Criminals who need to be kept in line.

Oh and you heard a senior nurse say what? What the hell kind of pre-school journalism is this? Someone heard someone say? A manager heard this? Probably the same kind of manager who kills people by short staffing wards and is looking to deflect the blame. What the hell kind of a source is "I Heard". I had a Medill graduate as a teacher of journalism in college and was the editor in chief of my college newspaper. "I heard" as a source would have landed us in hot water. I can see the veins popping out on Mr.Parrone's head as we speak. That was college journalism for christs sake. If she said that than she is a twit but certainly not a spokesperson for nurses.

“Nurses believe serving meals is not part of their job � it is beneath them,” adds a Berkshire-based caterer.

Bullshit. Another caterer who doesn't know shit jumps into the ring. Are these guys for real? I can say with all honesty that this is not the view of the majority of nurses. In would love to have protected meal times so I could feed my patients in peace. Nurses at my hospitals are fighting for protected mealtimes. I cannot stop docs from showing up to do ward rounds at mealtime. I cannot stop people from crashing at mealtime. I cannot stop phone calls from relatives at mealtime. I cannot stop call bells from ringing at mealtime. I can't make the important drugs that are due at mealtime go away. Even if I could, it would be nearly impossible to feed the sheer number of patients who need it, with only 3 of us. I can't make management give us more staff.

Public sector jobs
The attitudes were revealed in a survey carried about by the Hospital Caterers Association. Neil Watson-Jones, chair of the association, says: “I would like to see a return to basics. Care is about more than a clinical intervention. It is also about making the patient journey more comfortable.”

No shit Sherlock. We are very well aware of how the basics and comfort promotes healing. That's why we are fighting this fight Einstein. We want our patients to be comfortable and we want to provide basic care.

Peter Carter, the Royal College of Nursing general secretary, agrees that the switch from on-the-job training to classroom tuition may have gone too far.

“The lurch from the apprenticeship model to the academic model was far too great,” he says. “Nursing is the sort of occupation that primarily you have to learn in the work setting. There is no substitute for experiencing hands-on patient care.”

Oh dear me Peter. You have been missing in action as a bedside nurse for too many years. Research is showing that patients have a higher survival rate in hospitals that have a higher ratio of degree nurses. What everyone knows is that we need is a combination of academic theory and rigorous on the job experience. Student nurses will not survive unless we have both of these elements in nursing education. They need a gruelling mix of both to be top notch. But who wants to go through that just to get abuse? The vast majority of nurses nursing in hospital now are PRE PROJECT 2000.

There is also a concern that a softly-softly culture has developed in the NHS, putting staff before patients. Modern matrons who need to discipline nurses have to talk to them in a nice, soft voice, says Harriet Sergeant, a fellow of the Centre for Policy Studies, they can’t just bawl out sub-standard nurses.

Our matrons won't come anywhere near the liability minefield wards. They run from the ward nurses as they know they are letting us down. They know we are pissed off. One of them put her damn hand on my shoulder the other day and said "we all feel so bad for you guys as we know it is impossible down there" I gave her the look of death. Same matron came onto the ward to work once and left after 2 hours because it was "too much for her". I have seen them bawl people out, usually to save their own butts.

I'd like to see the Times actually interview bedside nurses. I am sure that they would interview over 50,000 of them until they found one stupid young pre-nursing student who says "I don't wanna wash". That is who they would quote whilst the quotes from the other 50,000 go to the shredder. They have to stick with their agenda you know. We can't have the truth get out can we? Too many powerful people would be in deep wouldn't they?

Thursday 25 October 2007

British Press: It's Nurse Bashing Month

Oh my god! The Times has sent my BS meter into the red!! Oh wait I'm not surprised.

If I don't vent out my true feelings on here and act all petulant my head will explode. So I decided to write this post out. The incident in Maidstone has unleashed a tirade of misinformed and unethical editorials in the papers. Ladies and Gentlemen it is Nurse Bashing month. I am starting to wonder if some of these so called journalists are paid to try and shift the blame away from the powers that be.

British Journalists seem to greatly enjoy writing abusive editorials regarding nurses without doing a lick of research first. The maidstone incident (which is only the tip of the iceberg in my opinion) seems to have kicked off Nurse Bashing Month in the British Papers. These journalists do not speak to nurses who are currently working at the bedside. If they talk to a nurse at all they will stick to speaking to nurses who retired 30 years ago and don't know what is currently going on. These journalists do not know what a nurse is, how much accountability and life and death responsibility nurses have or how overwhelmed they are with acutely ill patients.

They understand NOTHING about what is happening in our hospitals, and they can't be bothered to do any research and find out. I bet they don't even know how much liability nurses have and the consequences that exist for not prioritizing properly.

It's not like journalists have a job that involves massive amounts of chaos and responsibility and can empathise with us in any way. Let's throw a few nasty childish generalizations their way shall we?

As a matter of fact they probably don't speak to anyone or do any kind of research before they write these worst examples of journalism I ever saw editorials. At the very most their research probably consisted of talking to a friend of a friend who once saw an secretary gossiping at the nurses station with the occupational therapist and decided to run around saying that nurses spend their days sat at the nurses station. Remember that these people cannot tell who is a nurse and who isn't.

Things are so bad at the minute that if I took any kind of time out during my 8 or 12 or 15 hour shift to clean loos and wash windows my patients could be hurt so badly that I could be looking at the loss of my registration. It shouldn't be that way and did not used to be that way. It certainly wasn't like that for ward nurses of yesteryear. It is not that way everywhere yet but it is getting pretty damn close thanks to shithead managers, incompetent journalists and a misinformed public.

Yes the hospitals are filthy.

Mentally disabled journalists see this as "nurses don't feel like cleaning up and don't care about hygiene". Oh yes we fucking do. The ward is minging and it grosses me out to even work there. I would much rather spend the day cleaning, but someone else is going to have to take on responsibility and accountability for my patients first because otherwise I could end up hurting someone either by something simple like a missed med or something major like not noticing a change in condition. This is the position many of us are in every minute of our shifts.

Does it sound like I am exaggerating? Anyone reading this is welcome to spend a day shadowing a registered nurse on a short staffed acute medical surgical ward. Just say that you are thinking about nursing school and they'll let you follow a nurse for a day. Do it and make sure you follow him/her and learn as much as you can.

This is what I am upset about:


I agree with other nurses who have commented on this piece on allnurses that the author has obviously been out of the workplace for way too long and while she has a valid point re: the lack of cleanliness in UK hospitals, she is totally unaware of the pressures on the nurse working on the wards today. These twits have a lot of nerve writing about things they know nothing about. This one is from August.


The Sunday Times. Their view of nurses:

1. We look like slags. You work for 12 hours nonstop and see how you look fucko.

2. We all earn over £30,000 a year. Um. Sure we do. If I got paid for all of the hours I work I might come close to that.

3. We don't actually do any nursing (especially cleaning), we just run around pretending to be junior doctors. I have enough life and death responsibility and problems without taking on theirs thank you very much.

4. We don't wash our hands. Yeah sure. Take me up on my offer to shadow a nurse for a day. Stick to her like glue and get into her shoes. See how impossible it becomes to wash your hands properly with all that is going on and the layout of the ward etc etc. We wash our hands as much as possible...which is not nearly enough and we couldn't do any better if you had a gun to our heads. Give me a smaller number of patients and a handwashing station nearby and you might see some results. I can't pee sometimes for 12 hours on some shifts.

5. We do not care what happens to our patients. We leave them to rot. Total fucking bullshit.

6. We don't care about cleanliness. Total fucking bullshit.

I had expected to read a well researched article. But as usual the fiction author who wrote it didn't bother to do any research at all. Do these assholes know that nulabour targets have led to managers freezing recruitment, that our nurse patient ratios on the wards are deadly, and that 80% of our new grad nurses cannot find jobs? Do they know that dead patients,infections, and bad outcomes increase for each additional patient a nurse has? Do.They.Shit.

This is completely unacceptable. These are just two examples of what I have seen too much of lately. These poorly written and researched articles misinform the public and shift the blame for what is happening onto the wrong people. This kind of journalism is what allows nhs managers and their henchmen to dangerously staff the wards and continue harming and killing patients with no comeback. I understand that most journalists probably have no understanding of responsibility or how to be truthful and do research.

They have no understanding of what it is like to have a job where you actually have to have knowledge and serious accountability. This lack of understanding is probably a requirement to do their jobs. They don't don't know what it is like to work in a chaotic environment being terrified that you'll make an error and kill someone. How could these underachieving fucktards write any kind of a decent factual article about nurses?

I am starting to think that they are all nothing but paid government shills, out to misrepresent nurses (doctors too) and shift the blame for all of the killing. That's right. I said killing. Maidstone is only the tip of the iceberg. Maybe I sound like a paranoid conspiracy theorist but my theory that they are all paid government shills makes more sense than the two editorials I posted.

Not all nurses are wonderful but the vast majority of bedside nurses are working hard and doing their best. If that wasn't the case this blog would be about how awful nurses are and how it affects patients rather than being centered around how short staffing kills people and affects the care nurses can provide.

I have seen a lot in my 12-13 years as a hospital nurse and have worked with many different nurses across the country, the world, and in all different kinds of specialties. I know what I am talking about. Remember this: Nurses today have twice the responsibility due to the momentous changes in health care that have occurred over the last 2 decades. Look at how the number of people on IV's has increased compared to the 1950's just as one tiny example. Nurses today choose to go into nursing despite the fact that they have other career choices. Nurses became nurses years ago because they had a choice between that and teaching. Many of them did NOT want to be nurses. See what I am getting at? The bottom line is that it doesn't matter how hardworking and caring a nurse is...if she has too many patients she is fucked and so are her patients.

Hygiene, nursing care, and patient safety have been destroyed by target and money obsessed managers who lack any kind of clinical knowledge. They are guilty of no less than murder. Journalists are their helpmates and accomplices by distorting information, misinforming the public and shifting the blame.

I want to see them all hang.

Sunday 21 October 2007

Fun on Night Shift.

Things I could do without on a Night Shift:

How about taking 20 phone calls from relatives at 0700 in the morning because they want to see what kind of night grandad had.

Do I sound like a total bitch?

This is at a time when there is no unit clerk on duty to answer the phone. The only phone this large ward has is pretty damn far from the bays where the patients are located. Great set- up huh?

It is only 30 minutes before I have to give report to the day staff and I have just had a cardiac arrest leading to a death 10 minutes ago (needed to inform the family and should lay him out, document and pack his belongings and clean the bed before day shift arrives).

Had an acute surgical admission arrive on the ward as the cardiac arrest was happening, a terrified LVF patient who is going bad and couldn't breathe and was in AF and needed multiple interventions and meds administered IV, a catheter for low output and fluid balance, and there is also all of the usual morning stuff do to like meds, multiple IV's due that need to be prepared and given etc etc. As usual this stuff is all happening simultaneously and I have to knock it all out in a ridiculously short amount of time and I am the only nurse. Oh. Shit.

There are 10 patients in wet beds and call bells ringing like mad at this time. Four of them were fall risks with dementia and were trying to climb over the side rails. There was only myself and a health care assistant for 20 patients. Couldn't get near the patients because of the phone calls. Trying to keep the LVF man from dying via lack of nursing intervention kept me at his bedside constantly. The doc can order the meds but if I don't give them at all and correctly and don't continually moniter the guy the shit will hit the fan. Should I leave him to deal with the wet beds and then go back to him? He might be dead by that time. I was worried about him, the acute surgical admit who was bleeding heavily and I can't see her from the LVF man's bed. I am worried about other 18 patients who all needed help, especially the 10 or 12 who are lying in their own filth. Others are ringing for pain meds. Leaving LVF man and bleeding out admission long enough to check out and draw up all those pain meds could be fatal. Shit. Shit. Shit.

So I blew off answering the phone and prioritized sorting the LVF guy, the acute surgical admission,and getting in touch with the dead man's family to tell them he was gone and remember to be gentle, calm, sympathetic and supportive even though I was nearly in tears myself. I hate making these phone calls. I would rather eat shit actually. This was an unexpected crash and death. Not pretty.

My HCA busted his ass trying to get to all the call bells, the wet beds, and finish morning observations on 20 people. He couldn't get around to them all himself. He spent most of his time keeping the fall risk dementia patients from landing on their heads. The patients were pissed off at him and complaining about how they were waiting so long and felt rushed when he finally got there. Then they didn't like the fact that he was a "male" "nurse" etc etc.

The phone was ringing non-stop and we blew it off. Felt bad because if my dad was in hospital I would be on the phone to his ward like a shot.

At 0730 I had to leave the floor to give report....rushed and incomplete. That is dangerous in itself. I ran through it quick as we really needed to get our asses back onto the floor pronto to the LVF man who was deteriorating. A bad report could lead to a chain of events that hurts a patient. None of this is good. The day nurses were sympathetic as we all have nights like this. I took over the night before from a nurse who had the evening shift from hell and many things were left undone. Everyone understands. We are a good team.

Can't wait to watch the complaints flood in from patients' relatives saying "I just rang to see how my loved one was and the evil nurses couldn't be bothered to answer the phone Friday morning....and granddad tells me he waited in a wet bed from 0630 until 0800!! Where is matron to whip these nurses into shape?" Um Er ...how about we ask where are the nurses? Oh that's right...they are looking for non-existent jobs.

What a lovely end to a 12 hour night shift. I was supposed to leave at 0800 and got out about 0930. No I won't get paid overtime. As a matter of fact I was off the clock and not getting paid from 0700 onwards as they deduct an hour for breaks we don't get. Getting out at 0930 was not bad considering. Sometimes night shifts are dead easy and sometimes they are like this. More of the latter I am afraid. 99% of them are more of the latter in this place.

I do love nursing but I could really do without all the simultaneous problems at the end of a long shift. That's just part of the job really but another five sets of hands would be nice.

Friday 19 October 2007

Fighting Back and Losing: But NOT GIVING UP

1. Staff nurses at my hospital are so distraught over the poor ratios, the rotten nursing care, and the burn out of staff that they are staying over at the end of their shifts unpaid to fill incident reports re: near misses and errors. They mention the poor staffing levels and their direct effect on patient in most of these reports. They have been doing this for years but it has accelerated in the last several months.

Response from Management: Completely ignored.

2. Staff Nurses have requested meetings with the powers that be to talk to them and explain what is going on and how dangerous it all is to the patients and nurses themselves. Have requested that some of these guys spend a shift shadowing a nurse to get a feel for how crazy it all is down there on the floors. Have requested that they look into research regarding Nurse patient ratios and how shitty ratios run hospitals into the ground and really fucks patients and their nurses up.

Response from Management: Completely Ignored.

3. Nurse Managers throughout the hospital get together and send a letter to the powers that be trying to reason with them and explain what is happening to nurses and patients as a result of their refusal to hire and staff the wards. These are the nurse managers who help out on the floor.

Response from Management: Completely Ignored.

4. Apparently Consultants have come together (ages ago) and written to the bosses because the staffing on the wards is even scaring the shit out of them.

Response from managers: Nothing.

Goodness me even a "we understand your position and are trying to think of ways to improve the situation" would be greatly appreciated. Throw us a bone for christs sake.

5. Five Staff nurses (3 on my ward) have left to take lower paid jobs outside of health care. This has been over the last few months alone. I have lost count of the ones before that. Three have obtained teaching assistant jobs. Two have headed for the supermarkets. These nurses hold degrees in nursing and invested a lot of time an energy into their education and their work. They say they'll come back when things improve. I would do the same thing. I would happily take a pay cut to get out but I will be applying for a nursing job in another country in the next year or two and want recent experience on my CV. I may get out anyway to protect my nursing license if things don't improve.

Response from Management: Nothing.

But they are talking about compulsory redundancies which will cause them to get grief from unions so they are more than happy to see registered nurses quit. It's more of a "don't let the door hit your arse on the way out mentality" and "thanks for making our job that much easier by leaving voluntarily".


Have written to the press, asking them to look into what is going on with the recruitment freeze, the appalling ratios, and the effect this has on nursing care. Have been ignored so far. It is more fun to write pieces that describe nurses as uncaring if she can't feed 20 people at the same time by herself while managing acutely ill patients by herself. Oh yeah give me 2 HCA's so they can each feed ten patients by themselves while answering call bells that are constantly ringing. Problem solved. Not. What we need is cloning technology or a course in how to astroproject.

Any suggestions about how to fight back? Have already been down the NMC and Union route many times.

Edited to Add: Just found this article about some American Nurses who have been fired for whistleblowing about unsafe ratios. They are fighting back and trying to get the message out. Maybe we should go door to door.


Tuesday 16 October 2007

It Just Gets Worse

Eight years ago when I started working at my current hospital I was hired to work on a general medical/care of the elderly ward that had 35 beds. Sister was there five days a week and a day shift (0730-1530) would have had 4 staff nurses and 4 HCA's on a good day. This meant that the 35 patients were divided up into 2 teams. On each team there was 2 staff nurses and 2 HCA's. We worked hard and we managed. The patients were cared for very well. Call bells were answered. The drug round/orders/ward round/discharges and admissions was done by one nurse on the team whilst the other nurse and the 2 HCA's helped patients, gave them breakfast and did bed baths as well as answering call lights. The two teams helped each other if one was struggling.

On many of our shifts the med nurse was able to lend a hand to the other nurse and HCA's. This is especially true if there was very little in the way of admissions/discharges/acute patients and short ward rounds on a particular day. We had bad days and we had short staffed days. But it wasn't the norm. We had a full time ward clerk who was excellent.

That ward was suddenly shut for refurbishing 6 years ago and opened again as a smaller specialty ward. Two months ago it was shut again and another specialty is planning on getting it but for now it is empty.

When it shut staff was dispersed. I went to a 15 bed short stay surgical ward. Lap chole patients/hernias/ENT etc etc. We also had a day surgery suite. It was brilliant. Very fast moving because of all of the patients coming in and out but excellent. I now had younger patients who were not chronically ill. They got better and went home. This 15 bed ward had one charge nurse in charge of the whole area. One staff nurse for bay one and 2 siderooms and 1 nurse for bay two and one sideroom. We had 1 or 2 HCA's and lots of students. Our patients raved about how excellent that place was. I loved it there and could have stayed. We always had excellent nurse patient ratios and zero complaints. We had lunch breaks because there was someone to cover our patients. We had 2 part time ward clerks.

More restructuring. That ward was taken over by another specialty and all of the staff were sent elsewhere to make way for their staff. Moved again. Lots of people were being moved to medical and they didn't know or want to work in medicine so they left as there were other jobs back then. They were not replaced. I went back to medicine.

Myself and the staff from my original ward were reunited on an older ward that was worse than the original ward. Once again we were doing medical and care of the elderly. This ward had a couple less beds and way way way less staff. Now we had 2 staff nurses and 2
HCA's for only 4 less beds than we had on our first ward. Most of us were the same nurses on the original ward yet care deteriorated. We had crap shift after crap shift. People left and were not replaced. Our manager is not allowed to hire. Our ward clerk became ill and retired. She was not replaced. The layout of the ward meant that the only phone was a long way away from the patients. Constant running back and forth. If I was doing a drug round and the phone started ringing I would run down to get it but by the time I got there the caller would have given up. I once again made my way down the ward and halfway down it would start again so I ran back up. Did this between 5 and 10 times an hour.

A year or two later this ward was shut along with some others. It was old and falling to bits. There is no money to refurbish. We were having bed crisis after bed crisis even before these wards were shut. Staff re-deployed again. People have quit. I am now on a bigger ward with more beds. This ward is medical/surgical/care of the elderly and a speciality that I know fuck all about. These patients should not be mixed together. It is becoming more and more medical day after day and goodness knows were the specialty and surgical patients are going. The specialty nurses this ward had are distraught. The staffing is so much worse than what we have ever had. It has been getting progressively worse for the last 6 months.

The nurses have reported what has been going on and taken action but it is falling on deaf ears. My heartbreaks when I see how our elderly patients are neglected and suffering. It is appalling. I can't even describe what I am seeing. It is hard when you are working your ass off because you give a damn, and so are your colleagues and yet the patients are basically getting left to rot. Important things are getting missed. Med errors are happening. People aren't getting fed. On that ward we may have 2 people who need to be fed or we may have 20 or anything in between. Staffing levels are not adjusted for this. We used to leave on time but now even if you are determined too you will have to go over your shift by one or two hours unpaid.

Nurses have legal obligations that we have to meet and "being short staffed" doesn't get us off the hook. Poor documentation is the number one thing that causes nurses to lose their registration. I have seen people die because something simple wasn't handed over or written down and it got missed. Some of that paperwork bullshit needs to get done. We often refuse to do the non-essential paperwork. Our manager has no say in anything that is going on. As a matter of fact our nurse managers often get themselves in serious hot water for speaking up.

I stopped into work on Sunday to check the off duty and they only had 4 members of staff on for the whole large ward. There was a 4th HCA who was doing a one to one with a elderly lady with dementia who was trying to pull our her central line and falling constantly. The third HCA was doing a one to one with another elderly Alzheimer's patient who was attacking other patients. She had thrown a water pitcher at one and wasn't going to be coaxed into stopping. The nurse and the other HCA were trying to hold down the fort alone. Luckily it was a Sunday. They had more patients than usual because storage cupboards and the day room have both had beds put in to accommodate patients.

People who want overtime are refused as it won't be paid. If you do work over you are unpaid but can take time back on another day. This is rarely possible because the ward is so short. Our uniforms are falling to bits and cannot be replaced due to budget cuts. We bring them to work in a bag and change in to them in a supply cupboard that doesn't lock and opens into a hallway were people are waiting. Our uniforms are in such a state that we are buying trousers on the high street and wearing those under our tunics.

With every week that goes by I start hoping that things will get better and improve but I am losing hope fast.

Targets have run these facilities into the ground. I hope that something changes soon. Can't take much more of this.

I went through a very competitive program and a top university to become a nurse. It was a lot tougher than your average bachelors degree. A growing body of research has shown that the more education a bedside nurse has the higher the survival rate is for his/her patients. Research is continuing to show that if nurse patient ratios are poor people suffer and die. As health care continues to become more complex and change dramatically the education level required of registered nurses will continue to rise. Not only do nurses of the 21st need to be better educated but we need a lot more of them.

This does not mean that nurses who are well educated think they are above cleaning up patients. Far from it. See my "which one is the nurse" post to see why well educated nurses should be doing basic care. The vast majority of us realise this already.

A high school drop out who works down the road at the Burger King has better working conditions than I do. Nursing care is vital. How are we going to get more recruits in if they require more and more education yet the pay and the conditions are deteriorating? Most of our new grad nurses cannot find jobs anyway. I don't see how things can continue to circle the drain like this.

Friday 12 October 2007

Jokes Jokes and more Jokes.

Some of these are funny. I decided that I am carrying way too much negative energy around and need to lighten up a bit.

Top ten reasons to become a nurse:

Pays better then fast food, though the hours aren't as good.
Fashionable shoes and sexy white uniforms.
Needles: "Tis better to give then receive"
Reassure your patients that all bleeding stops...eventually.
Expose yourself to rare, exciting and new diseases.
Interesting aromas.
Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
Do enough charting to navigate around the world.
Celebrate all the holidays with your friends- at work.
Take comfort that most of your patients survive no matter what you do to them.

You know you're a nurse if...

You believe every patient needs TLC: Thorazine, Lorazepam and Compazine.
You would like to meet the inventor of the call light in a dark alley one night.
You believe not all patients are annoying ... some are unconscious.
Your sense of humor seems to get more "warped" each year.
You know the phone numbers of every late night food delivery place in town by heart.
You can only tell time with a 24 hour clock.
Almost everything can seem humorous ... eventually.
When asked, "What color is the patient's diarrhea?", you show them your shoes.
Every time you walk, you make a rattling noise because of all the scissors and clamps in your pockets.
You can tell the pharmacist more about the medicines he is dispensing than he can.
You carry "spare" meds in your pocket rather than wait for pharmacy to deliver.
You refuse to watch ER because it's too much like the real thing and triggers "flash backs."
You check the caller ID when the phone rings on your day off to see if someone from the hospital is trying to call to ask you to work.
You've been telling stories in a restaurant and had someone at another table throw up.
You notice that you use more four letter words now than before you became a nurse.
Every time someone asks you for a pen, you can find at least three of them on you.
You can intubate your friends at parties.
You don't get excited about blood loss ... unless it's your own.
You live by the motto, "To be right is only half the battle, to convince the physician is more difficult."
You've basted your Thanksgiving turkey with a Toomey syringe.
You've told a confused patient your name was that of your coworker and to HOLLER if they need help.
Eating microwave popcorn out a clean bedpan is perfectly natural.
Your bladder can expand to the same size as a Winnebago's water tank.
When checking the level of orientation of a patient, you aren't sure of the answer.
You find yourself checking out other customer's arm veins in grocery waiting lines.
You can sleep soundly at the hospital cafeteria table during dinner break, sitting up and not be embarrassed when you wake up.
You avoid unhealthy looking shoppers in the mall for fear that they'll drop near you and you'll have to do CPR on your day off.
You've sworn you're going to have "NO CODE" tattooed on your chest.

3 Nurses and a Wish

A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarfs and wearing large polished stoned jewlery.

"I am 'Gina the Great'," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses could think otherwise.

The nurses quickly aurgued among themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first. "I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone.
The floor nurse went next."I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me coccoa and doughnuts." With a puff of smoke, she too was gone.

"Now, what is the last wish?" asked the lady.

The charge nurse said," I want those two back on the floor at the end of the lunch break."

Two doctors were in a hospital hallway one day complaining about Nurse Nancy.
" She's incredibly mixed up," said one doctor. "She does everything absolutely backwards.
Just last week, I told her to give a patient 2 milligrams of morphine every 10 hours.
She gave him 10 milligrams every 2 hours. He damn near died on us!"
The second doctor said, "That's nothing.
Earlier this week, I told her to give a patient an enema every 24 hours.
She tries to give him 24 enemas in one hour! The guy damn near exploded!"
Suddenly, they hear this blood-curdling scream from down the hall.
" Oh my God!" said the first doctor, "I just realized I told Nurse Nancy to prick Mr. Smith's boil!"

Murphy's Law for Nurses:

You can please some of the patients all of the time, and all of the patients some of the time, but you just can’t please the family.

Management truly believes you are overpaid. But would never work for what they pay you.

People farthest from your work area are the least needy - and least afraid of pushing the nurse call. Invariably.

The more minor the injury, the more angry that person is for having to wait. While the little old guy with crushing chest pain says, "Oh, it's ok, I've waited this long already..."

Your patient is finally absorbing their NG feed after days of aspirating - but they pull the tube out just before the consultant does his ward round.

The number of staff to be found on the ward is inversely proportional to the scale of the emergency.

You've just given a patient a meal - pie, roast potatoes and a sponge pudding with custard - when the consultant says they're ready for the operation.

A very healthy patient, when admitted to a very small room, will require a vent, a cooling blanket, hemofilter, six pumps and a digital television before the end of your shift, requiring you to climb over the bed to get out of the room.

The hospital always sends admissions to your nursing home at change of shift on your weekend on - the physician's weekend off.

The lift always breaks down when the 400 pound patient needs to be transferred from one bed to another.

You tell your patient, "If you need anything at all, just push the button and I'll be there". She smiles and says she's "Fine, thank you nurse."
The next morning she complains to the physician, "No one came near me all night and I couldn't sleep, because I was in agony."

In a life threatening emergency, the speed of the doctor's response is inversely proportional to the speed of the patient's decline.

More Here:

Saturday 29 September 2007

One For the Emergency Nurses

This is a fantastic article. Well written and funny too. I have never done A&E myself but I have a few friends and relatives that do. It sounds pretty hellish even on a good day.


I've ceased with the pre-shift ritual of meditating in my parked truck along with a soothing piece of music. No more prayers to God en route to work asking for more patience, more humanity, more understanding. I have accepted the fact that it will be no different than any other night in the Emergency Department, no matter if I blare Yanni's rancid piano etudes or make a promise to God to pass out my own body parts to the discharged patients as they leave. Nothing will change. I use to look forward to making a difference in someone’s life, helping a poor soul whose body has given out. Those moments are few and far between now. Instead, I resign myself to the fact that the next 12 hours will be spent pasting a fake smile on a tired body, going through the motions of caring, repeating ready-made lines of false concern and giving out medical advice that fall on deaf ears. I use to feel important in my role as Charge Nurse at a major ER of an inner-city charity hospital. Now, as I sit in my truck at 6:45 in the evening, gangster rap blaring, I send out a quick impromptu message to God..... "Please God, allow me the opportunity to be gainfully employed 12 hours from now."

7:02 PM-

I receive a quick report of the clingons and leftovers who haven't made it out of the department by change of shift and to no surprise to myself and the night crew, a few names are all too familiar and the reports of their latest "illness" easily recitable from memory. The usual apologies from the day crew for not getting them out before we arrived go unnoticed. A shrill screech from one of the psych beds startles no one. We all just look up from within the "safe" confines of the nursing station, confirm that our overweight security force is camped out beside the room, shake our heads briefly and go on about our business. We go through the ritual of taking our own baseline vital signs, popping a few Xanax and removing sharp objects from our pockets. Patient safety is important and we wouldn't want to accidentally stab one of them repeatedly in the chest.

7:17 PM-

My primary job aside from direct patient care is triage. Initial interview, vital signs, brief medical history, current medical problem, current medications, height, weight etc etc. My first of 35 or so fits the typical profile of this or any other ER in the country. 40 year old, female, morbidly obese, diabetic, hypertensive, multiple psych meds, very little English, less common sense, no means to pay. She complains of the usual nausea, vomiting, diarrhea and generalized abdominal pain. She's already spent thousands of dollars of other people’s money last week for the same complaint. She didn't fill her scripts, didn't follow up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to alter her diet one iota in order to prevent another attack of diverticulitis. Her idea of a "Clear Liquid Diet" was a bucket of chicken and bowl of menudo an hour prior to her arrival. So here she is, totally oblivious as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, follow up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was able to tolerate semi-solid/or solid food.

She bitches profusely when she is not brought straight back and put into a bed, instead she is sent back out to the waiting area for a lengthy wait. We are full and busy with the truly "emergent" patients but she can't seem to fathom this. She barrels through the exit door, into the waiting area calling me every name in the book (in Spanish) and swearing to never come back again. "PENDEJO!", she mutters. Oh, she'll be back.


7:31 PM-

My 3rd patient is a 23-year-old mother of 3, the oldest being 10. She has somehow mistaken our "EMERGENCY DEPARTMENT" for a pediatric clinic and wants her brood "checked out" because they feel "hot." No temperature ever taken at home, no Tylenol or Motrin given before the decision was made to spend $1500.00 of other people's money and to waste our time babysitting 3 snot-nosed, unkempt ankle-biters who are no more sicker than the man in the moon. I usher them one at a time onto a scale for weights and am not surprised that each is twice the size they should be at their particular ages. One, I have to pry finger foods and a "Big Gulp" from their obstinate little mitts prior to the weight so as not to inadvertently add 5 lbs to his already triple digit reading. The electronic scale beeps incessantly and reads, "ONE AT A TIME, PLEASE."(Ok, not really) With all their vitals being normal they are ushered out into the waiting area where they eagerly pounce on the furniture and run around like the defensive line for the Attention Deficits.

I am verbally attacked by my obese belly pain lady, who has "been waiting for hours" (uh, how about 20 minutes). I instantly notice the "positive Cheetos sign" on her fingers and around her lips and remind her that the sickest are seen first and to have a seat. She tosses me a "Pincha Pendejo" and rumbles back to her seat. I sneak in a quick call to God asking that he makes sure she looks before she plops back down in her chair(s). I can hear the intercom announcer now, "CODE BLUE TRAUMA, ER WAITING ROOM." I mentally picture the scenario of the code team spending the next hour removing baby Julio from the rectum of a 300-lb verbally abusive Hispanic woman. "NEXT"!!

9:21 PM-

I've survived the dinner crowd with my job intact and make my way back to the treatment area to assist the rest of my team in the treatment of the patients who were lucky enough to make it back ahead of the non-emergent riff-raff. I make my way to the EMS radio station when I hear....."Unit 842 code 2 patient report"....we have a 102 year old nursing home patient,....found unresponsive on the floor....no IV....she's now awake, combative, confused, covered in stool, incontinent of urine, blah, blah, blah..." The report from the nursing home prior to her EMS transport reveals that this patient had a tendency to "dig out stool from her rectum when constipated." "Oh, that's just friggin lovely"

9:25 PM-

The waiting room intercom a buzz......"I beeen waiting for 10 hours, you pendejo...you piece of...." Click!

9:33 PM

Our lovely elderly finger painter arrives, covered in poop from head to toe. EMS personnel smirk as they wheel her by, updating us as to any changes en route. Nope, no changes, except that now she's given up the fight and is again unresponsive and her breathing more shallow. In an instant her breathing stops and is immediately rushed to trauma 1 where CPR is initiated. "CODE BLUE ER-1, CODE BLUE ER-1."

9:57 PM-

"Time of death, 9:55" is belted out by the code team leader. "She never stood a chance." "It was her time." "She had a long and good life." Blah Blah Blah Blah. She had a horrendous death. Born covered in amniotic fluid, but certainly a proud moment for her parents one can be sure. She died, however, covered in shit, piss and bedsores. The nursing home where she spent her remaining days in agony and perpetual loneliness should be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to waste while the understaffed workers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged through her personal belongings. A courtesy call to the nursing home is placed telling them that Mrs. Mullins will not be coming back and has been transferred to the ECU (Eternal Care Unit). I hear, "Whew, thank God.....CLICK."

10:22 PM-

Our usually bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and varied complaints of, migraine headaches, chronic back pain, stress, anxiety, fibromyalgia, blah, blah, blah....! They are easy to spot, almost always familiar, with the same ole' story. Most we know on a first name basis. They are all, coincidentally, allergic to the same medications; Tylenol, Motrin, Vistaril, Toradol, Aspirin or any other non narcotic or harmless placebo we've attempted to quell their "pain" with in the past. The only thing that works is "Demerol" and they must have a large supply of Vicodin in the form of a prescription when they leave. (Vicodin has Tylenol in it but apparently doesn't cause a severe allergic reaction when mixed with euphoria,....go figure!)

Security is usually called, for to tell them "no drugs tonight" is just asking for a fight. $1000.00 later of other peoples money and they usually leave with their buzz on and their script for Vicodin. But usually not before asking for a "shot for the road" or additional scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often the number of pills given, depending on the frequency of the prescribed dose. This usually last a few days for the typical drug seeker and then they'll usually return with more "pain" and a hungry monkey.

In the age when Doctors are sued for both under treating pain OR for prescribing too many narcotics and "getting them addicted", we medical personal are caught up in the proverbial "catch 22". More often than not I have been written up and on several occasions was at a point where my job was in jeopardy because I challenged their pathetic lies whenever these low-life drug addicts invaded our ER's. Now I just shut up, shake my head and pray for an overdose.

11:12 PM

Waiting Room intercom is ringing off the wall. "...how long will I.......can you tell me where I am on the list......Donde esta su Doctor.......I can't find my child........the dingo ate my baby.....PINCHE PEDEJO, I BEEN HEER FER TWO DAYS AND MY ASS FEELS LIKE SOMEONE POURED SALSA RIGHT UP MY..........click.

Midnight in the garden of good (for nothings) and the evil (doers)-

After a flurry of non emergent triages, (sore toe, "the shakes", anal abscess, foreign bodies in the nose, ears and stomach of a 2 year old, blah blah, blah) I call in an astute, well dressed, middle aged white male, who is walking quite gingerly and refusing to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess,. or perhaps....no!....NO!......NOOOOOOOOOOO!


The story goes (and it is a common one) that he and the Mrs. were "experimenting" in bed (against his wishes, no doubt) when a vibrator was jammed in his keester and is now painfully out of reach. Given the nature of the "injury" he is whisked back to a private room, placed on his side, lubed up like a 57 Chevy, and a valiant effort is made to retrieve the 12 inch "perpetrator with ribs" from his large bowel. All to no avail. At one point we had a hold of the foreign body (actually, it was made in the US) but the colon wouldn't let go of it's new found cylindrical friend. We tugged, twisted, yanked, pulled, all efforts proving futile. Finally the physician stopped, exhausted from the tug-o-war match, with the forceps, commonly used to removed big headed babies, protruding from the prominent lawyers butt, he made the decision to call in the surgical team. All efforts to remain professional, however, fell by the wayside when, during a moment of silence, a low buzz was detected in the room. Had the blood pressure cuff inflated? Were the incandescent lights buzzing? Was the TV on?

No, no and no. We looked at the forceps and noticed they were vibrating uncontrollably, instantly realizing at that point that this thing was STILL ON. A mad rush by the scant crew to the exit door of the private room was attempted as to not embarrass this local professional with our boisterous laughter. No dice.

We will all eventually be written up and apologies made for our "unprofessionalism and disregard for the patient’s privacy and mental well being". That's ok. We needed that to preserve our own mental well being. Still proving that laughter is still the best medicine.

1:02 AM

Ten triages later and its dinner time for this mentally worn crew. We retrieve our food, locate it to the middle of the nursing station and we eat. Not all at once, mind you but usually a bite at a time. Eat a French fry, go wipe an ass in ER-1, a bite of a Big Mac, go clean up cherry cool-aid flavored vomit in ER-4, a sip of Dr Pepper, then physically restrain a combative Scitzo-effective patient. By 2:15 we have polished off the last bite of a hardened burger, ate our last stale French fry and sucked down the last gulp of our watered-down soda. A soda that is now as warm as fresh urine and food that is as cold as Mrs. Mullins in ER13.

2:30 AM-

Ahhh, my favorite time during the entire shift is upon us. The "Last Call at the local bar crowd" (LCLBC) start to pour in to the front entrance, while EMS brings the ones who got the shit kicked out of them through the back ambulance entrance. "Santa Rosa, this is unit 842....we are coming code 2 trauma with a 19 year old male.....closed head injury....intoxicated...combative....soiled....bloody.....no insurance.....blah, blah,blah.

The same ole song and dance spews from this patients bloodied spout as he is wheeled into Trauma-2......"I was just minding my own business"......"I only had two beers"....."I don't do drugs"..... "Can I get something to eat?" "RAALLLLLLPHHH!" "Housekeeping to ER Trauma-2, Housekeeping...."

2:31 AM-

"Dear Lord, If ANYONE can make time travel possible, it's you, God." "Pleeeese, send me forward to 7 AM.

3:03 AM-

Patient waiting room intercom is screaming..........."CLICK"......."BANG, BANG, BANG".

3:15 AM-

I am ushered into the staff break room for a "time out" and reminded by the night supervisor that the cost of the intercom will be deducted from my paycheck.

4:18 AM-

Our portly female beast of a woman is finally ushered back to a room but not before mumbling under her breath as she brushes past me, "Pendejo"! A major "abdominal work-up" is ordered. 40 lab tests, urine tests, stool cultures, abdominal x-rays, Cat Scans, blah, blah, blah......She's placed in a gown that looks like curtains stolen from the Grand Ole Opry, and given the reminder "Opening to the back, please," tossed in for good measure. ("Lord, give me the strength to...........Oh forget it, never mind")

She's given a URINE cup as she bounces her way to the bathroom. She fills it with STOOL. "Housekeeping to ER, STAT."

Can't find a blood pressure cuff large enough so we must take a chance at an erroneous reading by placing it around her calf or forearm. The hydraulic bed grunts and groans with ever twitch and shift from this woman of substances. She continues to bitch and moan and will eventually file a complaint with (in) human resources, I am sure. Multiple attempts at IV access finally yields a vein that hasn't been choked off by the mass of arm fat and IV fluids are initiated. After a quick assessment by the ER physician she is off to radiology, with a little 120 lb tech pushing 600 lbs of patient and bed up to the 3rd floor for a series of $3000.00 radiologic exams. X-rays that were done just last week and that she has no intention or means to pay for. It would have been easier (and cheaper) had she driven to Sea World instead. Certainly more accommodating for a woman of her stature.

5:57 AM-

Multiple early morning stragglers are triaged and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. "One Hour Left", I thought. We get all the results of the voluptuous Ms. Hinojosa's tests back and surprise, surprise...."Diverticulitis." Perhaps this time she will be compliant with her meds, compliant with her diet, compliant with her follow up, compliant with life. "Fat chance,"I thought. (Pun intended).

Her IV is removed and a half gallon of fat globules ooze from the harpoon hole. She is hoisted off the bed with the help of several departments within the hospital; half of who will call in sick tomorrow with severe back spasms. The battered stretcher which now resembles a low-rider after a major accident is towed to the back for repair. Ms Hinojosa is discharged but not before requesting a breakfast tray. Request denied.

Off she goes to the local "Taco Cabana" for a flurry of assorted breakfast tacos and a bowl of menudo. "She you in a few days, Ms Hinojosa."

"Pinche Pendejo!"

6:47 AM-

The dismal faces of the morning crew are evident as they reluctantly make there way in, some still in mid-prayer, the newer nurses with walkman's on, listening to ocean waves or cricket noises saturated with Muzac. A quick report is given to the mentally exhausted night crew and apologies made for the missing bed in ER 3 and the dead body in ER-12.

7:07 AM-

Each member of the night crew, each with a phone in hand, are awaiting the instant the clock strikes 7:08 where, with lightning speed, a flurry of buttons will be punched to clock out, ending another horrendous but typical night in the ER.

7:47 AM-

I pull up to my apartment and sit quietly in my truck. I recall the night’s events and wonder if I had made any critical errors in care or judgment. I mentally prepare for the answers to the complaints made the night before by this unique ER culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society.

I say a prayer for Mrs. Mullins and her family and curse all those who've abused the system in the last 12 hours, spending thousands upon thousands of dollars of other people’s money but contributing nothing to society what-so-ever. Once I deem that I will have a job come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, meander up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am able to fall asleep. I don't. I am woken by a dream whereby the ER staff are all patients in the waiting room on a busy night. I am called into the back where a 500-lb female nurse is ripping my clothes off with one hand and swinging a 6 foot rectal scope in the other like a pair of numchucks in a Bruce Lee movie. The alarm clock sounds and I immediately spring up and grab my ass, praying that a 6-foot proctoscope isn't dangling precariously from it. It's not. I breathe a sigh of relief and make my way to the shower and into another fateful night of chaos and mayhem.

6:43 PM-

I pull up to the ER, park my truck and sit. I clip on my name badge, giggle as I read our "Mission statement" tattooed on the back. "To extend the healing ministry of Christ," it reads, and I take a minute to ponder that statement. I smile, acknowledge it's powerful and profound meaning and bow my head to pray. "Lord, today, give me your divine power to accept my responsibilities within this ministry. I pray that..."

Just then a beat up delta 88 rolls by on two wheels, with a definite lean to one side. I watch as they take up two parking spaces in the "staff" lot and out pops Ms Hinojosa. I cringe. She leaves a trail of urped-up fajita and menudo through the patient parking lot, into the physicians parking area, towards the ER entrance. Anger churns inside me and I hang my head, looking down at my badge and the mission statement on the back. I try desperately to find the peace and pride I felt just 2 minutes earlier and I resume my prayer......"Lord,....I just.......If you could only find it in your heart to............OH FORGET IT!!!!!....... NEVER MIND."

Michael Brown is a Registered ER Nurse from Texas. He is currently taking no medications at this time.

Article Source: http://EzineArticles.com/?expert=Michael_Wayne_Brown

Wednesday 26 September 2007

Oh Crap.

If my managers ran air traffic control.

Even the angry militant types get a bit nervous from time time.

I'm freaking out a bit here about what the next few days at work are going to be like. You can bet your ass that I am going to spend Friday getting screamed at by consultant surgeons and their registrar and SHO henchmen. Yep that's right...surgeons. But isn't Anne a medical ward nurse you ask?

Let me give you some background. Two weeks or so ago my acute medical mixed ward was shut down with no warning. Literally came into work and the doors were locked.

This was done because of financial problems but we were told that they were going to clean the bays. They moved half of the staff including me onto a new ward in a totally different specialty and the other half god knows where. Our new ward continues to be half their original speciality and some overflow medical as there are massive problems in A&E getting beds for medical patients. WE didn't have enough beds before my ward was shut. It's always been a huge problem. It has been chaos since the minute is shut and now.

The nurses on our new ward are a bit upset to put it mildly about taking our patients and our staff. The staff from my old ward (myself included) have no experience in this new specialty at all. I didn't even do any kind of training in this area in nursing school. The medical patients should not be near any of their patients for many reasons. But we have no choice to have them altogether as they are so short of beds we just put them where we can.

We have not been given nor will we be given any kind of orientation or training in our new area. The day after our ward closed and we were put onto the new one our staff and the staff on the new ward were left to it. So we divided the ward into medical patients and nurses and new specialty nurses and their patients and acted like 2 teams. We thought that this would be the best way to go. We had no guidance from the powers that be. We just decided to let the medical nurses and medical patients make one team and the speciality patients and their nurses make another team, and we tried to keep them physically separate.

The powers that be came down and said oh no you guys must integrate none of this separation shit and then they abandoned us to our fate. They were really very nasty actually. You would think that the matron for the new specialty (and our old one) would have been around to guide us or something. None one has been around providing any leadership really. Just band 5 staff trying to do their best. Matrons are like ghosts. We all know they exist but have never seen one.

The staffing has been horrendous. Only my hospital could combine 2 wards and have worse ratios with less beds. How the fuck does that happen. We have actually been working with worse numbers than what we usually have. The first week down there was nuts because we couldn't actually find anything. No one showed us around. For the most part we are getting along with the staff down there and are trying to stick together but we are all so overwhelmed. No one has any time to teach the other about their speciality. Mistakes are happening and the complaints are flooding in.

It is working out that a lot of the medical nurses are having to take bays of patients that are mostly from the new specialty with no one to help. It is working out that there are many shifts when nurses from the original specialty on this ward are not there at all so the medical nurses are fumbling along trying to figure it all out as they go. This is happening a lot and I have no idea why.

I am on the next 2 late shifts. It will be just myself and a newish grad who doesn't speak much english from my old medical ward as well as an HCA from my old ward. There won't be any matrons from this speciality around. Nurse manager is off. 20 of the 30 beds are the speciality patients rather than medical patients. I am bricking it. I have no experience in this area and it looks like I am in charge. I hope someone high up gets a clue before tomorrow and does something. People who have tried to make a case for why this is bad bad bad have been labeled complainers and trouble makers.

So I will be possibly in charge of an area I am not familiar with. Same thing happened to one of my medical colleagues last week. All hell broke loose because the ward was totally staffed by medical nurses who didn't have any training or experience in the new speciality. Chaos ensued when patients were coming back from theatre with epidurals etc. Where is the leadership? They promise to send more help and it never happens. Last week I was on a dayshift with all medical nurses and I asked for help....and guess who they sent me....a medical nurse from another ward! What the fuck? She refused to do it and pissed off back to her ward...no relevant experience.

Later on the sent me an RN from another ward similiar to this specialty and he saved our asses. I have to say that I love that nurse. However he swore that he would never come back to this chaos and disorganised mess. Not only are most of the nurses unfamiliar with this specialty but they are so short staffed that they can barely catch their breath. The ward is too short for anyone to go off for any kind of training. No one who values their pin number wants to step foot in this place. Remember my earlier posts? If anything happens it will be the nurse that gets busted rather than the management. That is how the law regarding this stuff works.

How does this shit happen? Where are the highly paid matrons? Why aren't we allowed to have any staff? Why did the managers think that this little stunt would work? What are these people smoking and can I have some please?

First of all the powers that be are like everyone else. They think that nursing is a simple little job where one makes beds and hands out pills. If one can do that on a medical ward they can do that on another specialty ward right? WRONG. This is what I was getting at in my "which one is the nurse and does it matter" post. Stupid ignorant ass fucktarded attitudes and ancient nurse stereotypes cause mega problems that affect patients very badly.

I am freaking out big time. Someone say something positive to make me feel better please. Maybe I'm just a total wuss but I am truly upset about this. There is lots of stuff I can't go into detail about. If I am a sissy we all are because my colleagues aren't in a very good place emotionally either right now.

This bullshit is happening all over this country and it is going to get worse. Lots of wards/beds are being closed and staff shuffled about. I have friends in other trusts who have told me similiar stories that would scare the shit out of you but they have asked me not to write about them.

I live about 2 minutes from an airport. Who thinks I should just grab the next flight out of the country? I may actually look into the airline stewardess thing after all. I bet they would like to have an RN on board right? I wouldn't have to commute as far to work. I'll go away and have a think.

Sunday 23 September 2007

Now for Something Positive and some Random Whinging too!

I have been busting my arse trying to get this baby signed and I am happy to see that there are now well over 200 signatures!!!


I hope that when the "appropriate Government Department" sees this petition that they don't immediately dismiss it as costing "too much money". Everyone except for stupid fuck politicians knows that more nurses per patient means that we have LESS EXPENSIVE COMPLICATIONS, DEATHS, COMPLAINTS, ETC ETC. The money saved far outweighs the cost of employing more staff. Well, that is the conclusion of everyone who has ever seriously studied and researched this issue. More research in the UK is needed but someone in this country is going to have to give a damn first.

Meanwhile Gordon Brown is going to piss money away trying to make the hospitals cleaner because that is supposed to eradicate MRSA and C-diff. Jesus Christ pass me the fucking Vodka. It's now official: Journalists and Politicians have never taken a basic microbiology course. Yes clean hospitals are important. Yes, hand washing is important. Yes MRSA definitely sucks ass.

You won't see the end of hospital acquired infections no matter what you do. You can reduce the number and good hygiene is always important for too many reasons to list here.

American hospitals are all private with 24 hour housekeeping/cleaners and mostly private rooms that are en-suite and they have a huge MRSA problem. Most people are colonized with MRSA but if you are healthy you don't know it. When you become elderly, frail, immunocompromised and have a nice open wound you might develop a problem. It's proven that most people are actually coming into hospital with mrsa on their person already.

Staph aureous has always lived on humans and caused problems in the weak and frail and sick since before jesus was born. Now this very same bacteria is antibiotic resistant as a result of overuse of antibiotics. Staph Aureous (SA) is now methicillan resistant (MR) so we now have MRSA. They are estimating that up to 70% of the population is carrying MRSA on their person. An infection control doc I once worked with in the States says that it is much higher than that number. Swab the locker room and equipment of the nice little gym you pay to work out in and you will find MRSA galore.


I have said this over and over again. And don't even get me started on the c-diff and antibiotics.

Hospitals in the Netherlands contained their problems with MRSA by screening everyone prior to letting them walk in through the goddamn hospital doors.

MRSA is a killer but by far not the only one. We are probably losing more people as a result of "failure to rescue" because their nurse has too many other patients.

We have worse things to worry about than MRSA. But Gordon Brown wants to play politics so there it is folks. Spin Spin and more Spin.

Gordon Brown wants to close down wards for a week at a time for cleaning.


In the News of the World, he vowed that over the next 12 months all hospitals would be restored to a pristine state of cleanliness to rid them of infections such as MRSA and Clostridium difficile.

Turnover of beds

He said: "A ward at a time, walls, ceilings, fittings and ventilation shafts will be disinfected and scrubbed clean."

There are many hospitals in England that are closing down wards and are heaving with patients that they cannot find beds for. The beds they have are filled with elderly patients who stay in hospitals for months and months because there are not enough long term care facilities.

Now Gordon is going to close down wards for cleaning for a week at a time! Fantastic! What a terrific idea! Too bad no one at the hospitals ever thought of that before! Oh wait. Actually they did think of it BUT THERE IS NO PLACE TO PUT THE FUCKING PATIENTS. They are overwhelmed already. They can't meet their A&E targets because there are no beds. We can't discharge most of our elderly medical patients because even though they are medically fit and do not need to be in hospital...there is no one to care for them. These people aren't safe to be left alone for 2 minutes in a padded locked room. Family members refuse to agree to nursing home care, are unable to look after the patient themselves..etc...etc. Takes months for social services to get their finger out. We have people for 4-6 months. Oh yeah and then there is the fact that you can deep clean the wards as much as you want..the patients will all be crammed into another place constantly coming in and going out....everything rush rush rush. I think Gordon smokes crack I really do.

You can bet your ass that Gordon is going to force the hospitals to close down wards for cleaning without providing the hospital with any kind of assistance (financial or anything) to deal with the crisis that is going to ensue from lack of beds etc. We recently lost a 35 bed ward and chaos has been ensuing ever since. Total fucking chaos from the minute it was closed and until right now. It's a mess. They couldn't afford to keep it open, they couldn't afford to lose the beds. Most of the hospitals in this country can't handle a loss of beds for any short period of time. How is he going to pull this off?

I do, however, like the idea of going to work and scrubbing and cleaning the ward for a few shifts. Sounds like a vacation day.