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 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 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.

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