Wednesday 12 March 2008

Protected Meal Times: What a Fucking Joke

We all know that frail elderly patients are becoming increasingly malnourished in hospital. We all know that their trays get left out of reach, that no one comes to assist them with their meals. We all understand that it is the JOB of the registered nurses to ensure that nutrional needs of patients are met. The registered nurses understand this better than everyone. We even understand it better than those of you who accuse the nurses of not wanting to be "bothered" feeding patients. Fucking simpletons.

Good nutrition is vital. People who have inadequate intake of diet and fluid do not get better. They deteriorate. They are at risk of impaired skin integrity. Wounds do not not heal as well when one is malnourished. I have seen renal failure, electrolyte imbalances, dry cracked painful lips, mouths and tongues on elderly people who are not given drinks. They are so confused that they often pull out their IV cannulas making hydration via IV fluids impossible. I have seen frail
elderly people get even skinnier in hospital to the point that they appear to be skin and bones. Pressure sores form. You can see muscles and bone as the sore is so deep. The become more disorientated. Renal failure courtesy of dehydration. They suffer. It sucks. It should never happen yet it frequently does.

We are constantly interrupted every thirty seconds during mealtimes.  Everyone from relatives to pharmacy to doctors to physio does this. The registered nurses at my facility all got together and got on management's case. We pushed for protected meal times. We fought hard. Let's take the evening meal for example: At 6PM the domestics bring the food trolley out and it is the job of the nurses along with the help of the care assistants to get dinner served to every single patient. There are 25 patients and because we are a medical ward that has a high number of elderly patients most of our people are either too sick to feed themselves or too confused to just too old. Usually we have anywhere between 8 and 20 people who are identified as feeds. Each patient takes about 20 minutes to feed. Some are faster and some are slower but we will work with the average. Many have no appetite.

If I take 2 patients that is 40 minutes down. The other nurse takes 2 patients and that is 40 minutes down. The first HCA takes 2 patients and that is 40 minutes down. The other HCA tries to feed 2 but also tries and manage all the people asking for the toilet, ringing the bell during this time. There are 2 Registered nurses and 2 care assistants for 25 patients IF WE ARE LUCKY.

That means that the best case scenario is that 40 minutes after the trays have been dropped onto the bedside table only 6 people have been fed and the rest have had trays sat in front of them going cold for 40 minutes while they stared at it.  And remember that the phone is ringing off the hook at this time and we have no ward clerk.  Remember that pharmacy is showing up with controlled drugs and demanding that a Nurse instantly stop what she is doing to check those narcotics in....god forbid if the precious pharmacist gets delayed or GASP has to do it herself.

The example I wrote above is best case scenario. It really is. But the reality is this: People will become extremely unwell around mealtime unexpectedly causing me to have to haul some serious ass and stay focused on them in order to carry out the doctors orders and not harm them. If that situation occurs the doctor is going to have a shit fit if I leave him and his patient to run off and feed people. That leaves 2-3 to try and cope with all the feeds, and everything else.

The phone rings non stop during mealtimes. Non-fucking stop. We can thank the relatives for that as they get 5 people to ring for the same patient every hour. If you ask them to get one person to ring once day in order to minimize the nurses having to spend all shift running to the phone every 2 minutes they become nasty, abusive and most of all paranoid....accusing us of not wanting to share information. They also like to spend ages giving their dysfunctional family history i.e. "5 different people have to ring because so and so doesn't speak to so and so".

Ringing a ward during mealtimes when your loved one is stable and you have already rung 5 times during the day is very disruptive. The phone is a hell of a long walk away from the patients and the food trolley. I no sooner put the phone down and start the trek back up to my patient before the damn thing rings again. You have no idea how many problems we have with this.  No goddamn wonder they have trays out of reach and food gets cold.  If the patient is frail and confused we may leave the tray out of reach whilst hoping to get back and feed him in good time.  Leave the tray where he can get it and he will choke himself and throw it onto the floor.  We have to hand all the trays out before we can go back and feed.  Have to. Without interruptions this takes 25 minutes.  With all the usual interruptions it takes longer.

I can ignore the phone and try to carry on but the last time I did that management got a complaint from a relative about us not answering the phone for an hour and we got a disciplinary. No they won't fucking pay for a ward clark to be sat there on an evening answering the phone.

The other day the daughter of one of the 30 patients rang and demanded to speak to the Nurse immediately.  I was trying to feed 3 patients at the time as well as monitor a patient with a head injury.  She demanded that I come to the phone even though the HCA told her it was mealtime.  She scared the HCA.  I came to the phone.  The woman wanted to me to answer 101 stupid questions and tried to keep me on the phone.  I told her that I was trying to take care of patients and that it was mealtime it would be best if she rang back later.  "How dare you, I have an appointment later and it would be very inconvienant for me to ring later" she said.  I often tell my friends and family that you are in more danger from you Nurse's other patients' relatives than you are from a bad nurse or doctor.  I managed to get off the phone with this bitch and when I got back down the ward my head injury patient was on the floor again.

One of the ways I try and sort this is I really start moving my ass at 4PM...or as soon as I finish sorting out all the things that should have been done during the day. If I have been lucky I have sorted out all the day shift problems by that time. It is a losing battle but I try.

I try and knock out every med /IV and otherwise that is due between 4:30 PM and 6:30 PM. There are tons of them each with a problem. Half the time the stuff isn't there and I have to leave my patients to leg it to pharmacy.

I also spend that hour and the half giving pain meds to anyway known to have pain. I ask everyone if they need anything. We try and get everyone toileted. We try to turn and reposition and clean everyone who needs it. I try to do a quick assessment of all my patients (usually about 14)to head off any problems that may rear it's ugly head at meal time. I try to ignore all the interruptions in order to do this and I pray that I will be able to focus on meals when that trolley shows up at 6PM. But relatives and non ward staff piss and moan when they walk onto a ward and interrupt a Nurse and she doesn't drop what she is doing immediately to service their non essential problem. What I am trying to accomplish is impossible but it doesn't stop us from trying. I just want to be able to focus on feeding patients. We all do.

So 6 PM rolls around, the domestic arrives with the food trolley and I don my lovely pinny and start getting trays out. Never mind that I have critically ill patients who need their meds. I did them an hour ago but they want more.  We identify the patients who need help with coloured trays, but we already know anyway. I keep an eye on the health care assistants to ensure that they are bringing pureed diets to people with swallowing problems so that they don't choke to death etc etc. I make sure that the diabetics get a diabetic meal. I try to feed people. We run down to the kitchen getting stuff that patients want that are not on the food trolley. 

Now despite that fact that we busted ass from 4PM to 6PM trying to sort everyone out, that wall now is lit up with call lights ringing. Absolutely lit up. We can keep trying to feed or we can answer the bells. I will try and send one care assistant off to get all of the bells while the 3 of us try and feed. Most people are ringing for things like an extra pillow or a blanket. Things they didn't think of before. Many of them are elderly and confused and to be honest they just forgot that someone already walked them to the toilet 20 minutes ago, or they need to go again because the good old bladder just ain't what she used to be. But man will they hit the ceiling and complain if they wait awhile for the nurse to come.  Family members who rang at 4:30 ring back again to answer the same dumb questions.  For the love of god we have no idea when the doctor is coming, when discharge will happen, when pharmacy will bring those meds or when the ambulance will come.  FOR THE LOVE OF CHRIST THERE IS NO WAY FOR THE NURSES TO KNOW THESE THINGS.

The phone is ringing non fucking stop. I am ignoring it even if it means trouble later. I am determined to feed these people.
Five minutes after the domestic brought the trolley out the lady in bed 3 has had a bowel motion in bed and due to her dementia has spread it everywhere. This is a 4 time a day event with this poor lady. She is bedbound and weighs about 19 stone. Would you like the 4 of us (and it will take all 4) to take 20 minutes/probably more to clean her up and then go back to feeding? Or would you like me to leave her like that until I finish feeding the others? Who is feeding the patients whilst the 4 of us are trying to maintain the dignity of the lady who has had the accident? No one. The trays are going cold and the domestic will collect them back in. The bitch.

Oh oh. I do need to answer the phone at 6:10 because the sound of the ring tells me it is an internal call. It is pathology lab. The lady in bed 10 came in this afternoon and had blood taken. She looks like hell. But there is no obvious sign of bleeding. I haven't wanted to leave her side. She has an HB of 5 they say. Look it up. She'll die if I do not get a doc down now to assess her and probably order some blood. She needs obs doing, and tests etc. Then I have to go through a long and complex and time consuming process to get the blood and get it hung. If that was your mum would you want me waiting on that for another hour plus or so while I attempt to feed? Tell me what you think. She needs to be escorted off the ward for a test by a member of the ward staff. The endoscopy department does not care that this leaves 2 or 3 of us to do all these feeds. if we don't send an escort, they won't do the life saving diagnostic test. Now there are 2- 3 of us.

At 6:15 my cancer patient who is dying rings to say that the pain meds she has had isn't helping and you can tell by looking at her that the poor women is in excrutiating pain. It is safe for her to have some oramorph now. I will get it for her simultaneously with sorting the blood for the other woman.  But what about the trays going cold?

The oramorph is a controlled drug. Two nurses have to go through a long and time consuming process in order to be able to access that medicine and give it to her. I will not make her wait. Fuck you for asking me too. I had to pull the other RN away from feeding a patient in order to access the oramorph (morphine). There is no way to access it without 2 registered nurses. Now one care assistant is trying to do all the feeds, the food is going cold and the domestic collects them back in.

But what is the most fucked up part about mealtime? Is it the fact that the domestics are on a tight time scale and will run down the ward collecting all the meals back at 6:30 whether they have been eaten or not? Is it the fact that the relatives will show up at 6:30 with venom shooting out of every pore of their being screaming at me wanting to know why grandpa has a cold, untouched tray in front of him?

No the most fucked up thing at meal time is the goddamn doctors. I look after 14 patients with 8 different doctors and they LOVE to show up at mealtime to do a ward round and demand that the nurse drop what she is doing and follow them around for a half an hour. The bastards do it every fucking mealtime. I hate them. When the nurses asked for protected meal times we begged the docs to try and do their rounds outside of mealtime. The response was that their ward round will get done when it is convienant for them, not the nurses. They also laughed right out loud at us for asking. And you can bet your ass that on every single mealtime we are sure to have 2 or 3 consultant doctors show up to do rounds. Remember that best case scenario I wrote about above? The one where we can at least get 6 people fed in 40 minutes if all hands are on deck. You can fucking forget it thanks to the docs. I can refuse to attend their ward round and keep on feeding. But it means getting screamed at in front of all the patients and a complaint about me going into management.

Whether we have 6 people who need to be fed or 16, the number of staff DOES NOT alter. We get 2 nurses and 2 healthcare assistants no matter what. If I get a contracter into my house to do some work, and it looks like the job is bigger than he anticipated he gets more staff. If a nursery takes more children than the normal numbers on any given day they get more staff. A hair salon has more staff in on their busiest days. This does not happen in nursing.

So I open the newspaper and I see comments galore accusing the nurses of not caring about feeding patients. They suggest coloured trays to identify vulnerable if we are too stupid to know. They all look the other way when the hospitals get rid of nurses and refuse to hire nurses. The coloured trays don't do shit. They don't help at all. You can take your coloured trays and shove them you your asses. Please help us instead of making things worse.

So we begged management for protected mealtimes. We begged them to help us tell the public not to ring at this time. We begged the docs to not do ward rounds at this time if they can help it. We asked a higher power to not allow anyone to crash or become extremely unwell, especially during meal times. We begged management to allow us to increase our numbers. We begged the domestics to not collect the damn meals in so quickly when we haven't had a chance to feed.

Their collective response has all pretty much been : Fuck you Nurse. Fuck you.

Thanks a lot for your fucking support.

The nurses will keep on trucking but if they only bit of help we get is a goddamn coloured tray...then I just don't see things improving.

Monday 4 February 2008

Stupid Bitch Matrons

Bring Back Matron you say? Oh they are back all right.

At my hospital we always had a saying..."Matrons are like ghosts...we know they exist but we never see them."

Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.

Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of "Nurse" onto one of these people*.

I have posted the stats regarding Nurse patient ratios. I have posted research into medical errors. I have posted about some of the insane practices that were happening on my ward and continue to occur almost daily. It doesn't take a rocket scientist to figure out that people do and can get hurt. At the very least is the little 90 year old man sat staring at a tray off food he cannot feed to himself..whilst his nurse is busy elsewhere. If anything makes me feel like going postal, it is that scenario. Staff nurses are not perfect and they do make mistakes, but many of the mistakes that happen are down to system errors that could have been prevented.

My ward was opened to another specialty and now takes 3 or 4 different specialties. We are the (now 40 bed) dumping ground for EVERYTHING. This was the result of a management decision that was not thought through. As usual we are left worse off than we were prior to said management decision. None of the RN's were cross trained and fuck up after fuck up occurs daily. The nurses are stuck with too many patients, no back up, no support in a specialty in which they have little or no experience.

The Matrons know the situation. There are many many highly paid matrons at my hospital. One for each specialty. Did any of them come to the ward to provide guidance and leadership or help out during the restructuring? HELL NO. They basically disappeared into thin air. Totally fucking AWOL.

Did they put on a pinny and come and help out on the ward? HELL NO.

Did any of them come anywhere near the ward or a patient? HELL NO.

Did they return our phone calls? Rarely.

Have we ever seen them act like a nurse? HELL NO.

Would any of them be able to name a patient on our ward? Nope.

Once, two years ago, a Matron did come to the ward to help us put because we were so short. This is the only time we recollect that this has happened. I was overwhelmed with really sick patients. Matron informs me that A. She does not remember how to do a drug round and will not do it. B. She is not comfortable with IV meds and will not help with that. C. She volunteered herself to answer the phone and call lights. So I got left with all the hard stuff, and supersuck (who makes double my salary) did fuck all.

That was the last time we saw a Matron (or a Nursing Leader) on the ward in a clinical capacity. They stay far far away and leave the staff nurses to suffer alone. We have written letter after letter about the conditions on these general wards and they are ignored, or Matron shrugs her shoulders and says "we feel so bad for you".


Don't feel bad for are a highly paid nurse...get your arse to the floor and help a goddamn nurse...provide some goddamn leadership by example. Come up with a plan for cross training the staff. Back us up when we are getting threatened by the chief nurse for complaining when we are one nurse to 24 patients. At the very least come and help us feed patients when YOU KNOW that we are 2 nurses to 15 feeds and everything else that is happening simultaneously. I have worked with bedside nurses who have masters degrees and chose to work at the bedside. The situation is so bad, it should be all hands on deck. Fuck whatever it is that you do all day. I have yet to see anything that you "do" benefit a patient.

I don't know what they do in that office all day. I don't know why they hate their nurses. I don't know why whatever the fuck they are up to in that office is so much more important than the patients and the staff.

I do know that despite the fact that they know how short we are working, they love to re-arrange our paperwork and make it more complex. Certain forms have gone from 5 pages to 20. I know that they are trying to redesign our care plans because the current ones are never filled in properly. I informed the Matron that it doesn't matter what structure our paper work is going to be FUCKED because of time constraints and overwhelming nurse patient ratios. I must not have got through.

When do we see Matrons? When there is an inevitable cock up. Then they are down to the ward like flies to a horses ass to ensure that all blame is directed onto the staff nurse and the hospital does not appear negligant or liable. Then the same error happens again with a different nurse because these are SYSTEM errors not NURSE errors. Once again Matron comes down hard on the individual member of staff without troubleshooting the problem. Fucking worthless whores. I saw it happen to too many of my colleagues and I got the hell out before the day came when it was my turn.

As far as I am concerned, most of our so called nursing leadership are traitors to nurses and patients alike. Don't even get me started on the NMC, the RCN or any of the other worthless pieces of crap who refuse to address the real issues. I'd like to see them all lined up and shot*.

*if there are any Matrons out there reading this that care about patients and support their nurses than I apologise to you personally. The rest of you are overpaid stupid worthless bitches.

*Nurse Anne is a non-violent pacifist and she does not believe in shooting our so called nurse leadership for their crimes. She just fantasizes about it.

Saturday 2 February 2008

Nurse/ Patient Ratios: The Facts

In the journal article, University of Pennsylvania researchers analyze why nursing care means more to hospitalized patients than pillow plumping and good cheer.

They culled data from more than 200,000 patients and 10,000 nurses to calculate that for every additional patient a nurse is assigned to care for, the odds of a patient's dying within a month of hospital admission rises 7 percent. In other words, when your nurse cares for seven other patients on a shift, your chances of dying from whatever ails you are about 30 percent higher than it would have been if your nurse had only three others.

Nurses in the UK average about anywhere from 1-10 to 1-20. It can be anything the managers want it to be and believe me, they want to divert as much money away from decent staffing as they can. When patients complain about waiting for a call bell to be answered, the managers forbid the nurses from talking about and explaining staffing levels because they "will not admit liability". They lay the blame with the nurses and nurses get a bad reputation. This is a fact.

May 30, 2002 -- In today's issue of the New England Journal of Medicine (NEJM), researchers Jack Needleman of the Harvard School of Public Health in Boston and Peter Buerhaus of Vanderbilt University’s School of Nursing in Nashville, Tennessee found that nurse short-staffing leads to deadly consequences for patients.

The study analyzed discharge data from 6 million patients and financial data and staffing surveys from 800 hospitals in 11 US states. When nurses were short-staffed, patients suffered up to 25% more life-threatening complications including infections, bleeding, pneumonia, shock, cardiac arrest, and "failure to rescue," all of which contributed to an increased length of hospital stay

78% of MDs believe RN staffing levels are too low, 82% believe quality is suffering, an alarming 1-in-5 doctors report patient deaths due to nurses caring for too many patients

(this article comes from the USA, where general ward nurses have 1-8 as opposed to the 1-10,20 etc that we have in the UK.)

AS RN to patient ratios decrease from 1:4 to 1:10, the number of post op surgical patient deaths climbs dramatically. (aiken, Clarke, Sloan,Solkalski and Silber 2002).

UK nurses average anywhere from 1:10 to 1:20 on general medical and surgical wards.

The discussion forum cites numerous first-hand stories of how nurses have blamed themselves, or have been blamed by hospital administrators, for dangerous and sometimes fatal medical errors. In most cases, these incidents reflect far more on deficiencies in the systems in which nurses must work.

At least four out of five medical errors are probably due not to negligence or carelessness, but to deficiencies in the system in which doctors and nurses must work. The ISO 9001:2000 standard and its health care specific modification, IWA‑1, recognize that people work in a system, and that a deficient system cannot deliver good quality no matter how skilled or careful the workers might be.

It is a general rule in industry that only 15 to 20 percent of trouble comes from negligence, carelessness, and incompetence. The rest is due to deficient organizational systems that make trouble almost unavoidable. W. Edwards Deming's 85/15 rule says that 85 percent of all defects and errors are the fault of the system in which people must work, while 15 percent results from carelessness and negligence. Frank Gryna cites an 80:20 ratio, with 80 percent of errors and mistakes being "management-controllable" and only 20 being "worker-controllable." [1]

(i.e.organizational problems such as a NHS managers who have no clinical experience, a bad attitudes towards nurses and ignorance regarding nurse patient ratios. Total hospital wide system failures that cause the nurse to have to spend time away from patients i.e. chasing pharmacy up to do their jobs)

Recently conducted large scale research found that:

In a given unit the optimal workload for a nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission. A workload of 8 patients versus 4 was associated with a 31% increase in mortality. Higher nurse staffing levels resulted in reduced numbers of urinary tract infections, pneumonia, upper gastrointestinal bleeding and shock in medical patients and lower rates of "failure to rescue" and urinary track infections in major surgery patients

(What have I said regarding the ratios we are working with at my hospital? According to this research even 1:8 is bad on a general ward...let alone the 1:20 that happens on mine).

This paper from Harvard is an excellent explanation as to why working conditions and piss poor management causes nursing care to be so bad.

Sunday 20 January 2008

Connecting Some Dots

Staffing issues/Bed Occupancy/ Fucktwit politicans/ Superbugs


INCONSISTENCY and mismanagement threaten a critical shortage of GPs and nurses, warn two Fylde coast MPs.
Ben Wallace, MP for Lancaster and Wyre, and Michael Jack, MP for Fylde, said a leaked document on cuts to the NHS wage bill showed bad personnel management.
The document, part of the draft version of the NHS pay and workforce strategy for 2008 to 2011 in England, predicted that within four years the NHS will have a shortage of 1,200 GPs, 14,000 nurses and 1,100 doctors.
It also revealed an extra 3,200 consultants the NHS cannot afford to pay and an excess of 1,600 allied professionals, health scientists and technicians.
The Government has announced that more than 900 NHS staff are to be made redundant across the country as part of hospitals reorganisation.
Mr Wallace said: "The whole thing shows the Government's incompetency when it comes to workforce planning.
"It has encouraged people to join the NHS but now is laying people off and, in my own constituency, I hear of health professionals, for example, midwives, who cannot find a job.


From a recently qualified Graduate Nurse

Well, a few day's on the ward and I have neglected to really mention much of what I have been doing. There is still no job, though there have thankfully been a handful more job's posted on the NHS jobs site for my hospital. It would seem that the reason I was not shortlisted for the job on the ward was that there were 47 other student nurses who applied for the post. Yes, 47 students without jobs. I am not making this up, as I saw the pile of application forms. There were over 100 applications made when you add in the registered Nurse's that applied for the post. Good news is that they are going to keep my application if anything else turns up.


St├ęphane Hugonnet and colleagues from the University of Geneva Hospitals, Switzerland, investigated the number of patients admitted to the ICU who developed ventilator-associated pneumonia (VAP), over a four-year period. They then compared this to the number of nurses on duty for each patient in the preceding days. VAP affected over a fifth of the 936 patients who received mechanical ventilation during the study.

The team found that when there were lower numbers of nurses, patients were more likely to catch pneumonia six days or more after being placed on a ventilator. This suggests that bacteria are transferred between patients, or from one site to another in the same patient. This could be due to short-staffed nurses having less time to follow hand hygiene recommendations and proper isolation procedures or being unable to provide adequate care to the ventilated patient. The nurses' training level had no effect on infection rates.

Plus This:

ScienceDaily (Jan. 16, 2007) — Hospital death rates can be reduced by employing more Registered Nurses and the routine use of care maps or protocols, according to a study in the latest UK-based Journal of Advanced Nursing.

A ten per cent increase in the proportion of Registered Nurses employed was associated with six fewer deaths per 1000 discharged patients.
The death rate also went down by nine per 1000 discharged patients when the number of Baccalaureate-prepared (university graduate rather than diploma qualified) nurses went up by ten per cent.
A ten per cent increase in adequate staffing and resources (as reported by nurses) was associated with 17 fewer deaths per 1,000 discharged patients.


Hospital acquired infections such as MRSA and C.Diff. are on the rise. There is much evidence to suggest this is mostly down to two main factors, poor hygiene standards and bed occupancy.

Bed occupancy rates within Lincolnshire are high, very high. 99.2% !!! (Apr 05-Apr 06) The govt. target is 85%.

Several times a year the whole United Lincolnshire Hospitals Trust is on red alert. This refers to the trust having no available beds whatsoever. On 25th November 2006 Lincoln hospital had to close wards as 10 patients had the c.diff bug. One patient died.

Before any more beds and services are cut at our hospital we should ask the Trust board how they can justify further cuts to bed numbers at a time when we have already had one major outbreak at Lincoln and the bed occupancy numbers are massively over government requirements of 85% occupancy.

Quotes from around the press :

"People with MRSA should be treated in isolation, but that does not happen because bed occupancy is running at almost 100 per cent. We have heard of hospitals pulling the curtains around a bed and pinning a note on it to say "isolation".
Katharine Murphy, of the Patients' Association

"Good infection control is being thwarted by high bed occupancy levels, a lack of isolation facilities and too many patients with different conditions being placed together in wards."
Edward Leigh. Public Account Committee,,1260861,00.html

And This:

Staffing patterns and nurses' working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals' ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed.

A recent evidence-based practice report sponsored by the Agency for Healthcare Quality and Research concluded that a relationship exists between lower levels of nurse staffing and higher incidence of adverse patient outcomes (14). Nurses' working conditions have been associated with medication errors and falls, increased deaths, and spread of infection (15–30) (Table). RN staffing levels have been associated with the spread of disease during outbreaks (17,22,23,25,28). However, increasing nurse-to-patient ratios alone is not adequate; more complex staffing issues appear to be at work. Many studies have found that the times of higher ratios of "pool staff" (i.e., nursing staff who were members of the hospital pool service or agency nurses) to "regular staff" (i.e., nurses permanently assigned to the unit) were independently associated with healthcare-associated infections (16,17,21,27). The skill mix of the staff, that is, the ratio of RNs to total nursing personnel (RNs plus nurses' aides), is also related to healthcare-associated infections; increased RN skill mix decreases the incidence of healthcare-associated infections (20,29,30). In a recent comprehensive review of the literature, the authors concluded that evidence of the relationship between nurses' working environment and patient safety outcomes, including healthcare-associated infections is growing. They also concluded that stability, skill mix, and experience of the nurse workforce in specific settings are emerging as important factors in that relationship (31).

Anyone see where I am going with this?

And Gordon Brown is going to spend millions on supposed "deep cleaning" instead of creating jobs for front line staff, and redesigning hospitals and creating beds.

I do not need to create a link to my posts about the staffing at my trust or managements attitude towards this problem. Randomly select any of my previous posts and read about it. We do not have enough beds to cope. New nurses cannot find employment anywhere. WE have 3 closed wards at our hospital. They are nightingale wards so cannot be used (as per government orders) but there is no money to refurbish (as per government penny pinching). I know of trusts that have the lowest staff to patient ratios in the country. They have superbug problems. They want rid of hundreds of frontline staff but they advertising for new management consultants.

Gordon, you ignorant slut.

Our domestics are only working 4 hour days and in that time they must serve breakfast and dinner. They are only hiring part timers as domestics. There are 2 domestics to do this in 4 hours and clean the ward as well in that time. The ward is at 100% bed occupancy and is totally overcrowded. They could not clean it properly if you had a gun to their heads.

Everyone understands this and has already connected the dots...everyone except the fucktwits in charge....

Thursday 10 January 2008

Temper Tantrums

I think I am really losing it as a Nurse. I am still very compassionate but a hardened shell made of diamond has formed around every compassionate and empathetic bone in my body. I want to stand in the middle of my ward and shriek, scream at the top of my lungs: THIS IS REALITY. IT SUCKS BUT THIS IS HOW IT IS AND I CANNOT CHANGE IT. THIS IS NOT HOW THINGS ARE SUPPOSED TO BE AND I CANNOT CHANGE IT. NOW PUT ON YOUR BIG GIRL PANTIES, AND DEAL WITH IT LIKE A FUCKING GROWN UP.

The things some of these people bitch about...Their unrealistic expectations for one to one care....The belief that you are going to get one to one care in hospital.....the belief that the nurse you are sharing 35 patients with can revolve the world around you and your families schedule without fucking killing someone.......

I'm just a nurse who wants to do my job well and take care of my patients.

My assignment of patients wasn't so bad, that turned out to be a blessing later. My colleagues day sucked. It was her and myself for 28 patients. My 14 were in good shape. They were mostly walking wounded. One poorly patient went to ITU. No upcoming discharges. I was able to get in and do a good assessment on everyone at the beginning of my shift and get a good handle on everything. I was able to do this because I went into work early. Only 2 of them were on IV meds. No confused wanderers that day. It was good. I enjoy days like this because they are so rare. I recently got a couple of beautiful thank you notes from patients. The cards were waiting for me when I went into work. I feel bad because I know the care could be so much better.

My colleague had the other 14 patients who were tougher. She ended up with a death, 3 critically ill patients and 4 palliative care patients whose families were angry and inconsolable. I was able to spend most of my shift helping her out since my assignment was so good.

We have no free beds on the ward but are slated to get an admission at 3PM for minor surgery the next morning. The admission comes in and we sit her in lounge. She appears to be a very well lady. She is raging because there is not a bed yet. I told her it is okay as long as she is here and we can sort out her stuff and prepare her for theatre la de da. Called the bed manager and said please find this lady a bed.

Well a bed did become free around half past 3. We knew it would really. A patient in the side room died. The family was there. They were hysterical.

A relative of the dead patient was so distressed we nearly sent her to A&E..She was a young adult and when told that her dad died she lost control of her bladder. The rest of the family was no better. More family came in to say goodbye. We couldn't lay out the body and get it moved to the morgue because the family was laying on top of the corpse and couldn't bear to leave him. This went on for hours and hours. I was so heartbroken for them. It's not cool to say "look we have a new admit that needs this room, please leave". We gently tried to tell them that they could see him in the chapel of rest and encouraged them to get a cuppa while we sorted out dad and prepared him to leave the ward. They were having none of it. They would not budge. They would not converse with us. I don't think their English skills were great. This was the only bed we were going to have. There were no other beds free, or that could be made free.

Bed manager was aware of the situation there were no beds anywhere else. That's what she said anyway but she is also a well known liar.

Meanwhile the new admission in the lounge was getting increasingly PISSED OFF. WE were not going to tell her that there was a body in her upcoming bed
that we couldn't move. I could tell that she was the kind of person who would completely flip out about that.

By 5PM she was in the lounge crying because she was told to come into hospital for her op and expected to come into a bed and see her doctor straight away. She was to have a hernia repair the next day. I left 28 patients to hook her up with magazines, food, a TV some blankets to get comfortable and apologized profusely regarding the bed situation. I told her she wouldn't see her doc until tomorrow morning anyway even if she was in a bed. It did no good. Every 5 minutes she came out of the room to berate us, call us useless for not getting her bed ready. Then she called her husband and he came in ranting and swearing. Then she called her sons and they rang the ward every 5 minutes ranting swearing and threatening us. So did her sister. I guess they thought that this would get her in a bed faster.

This went on until 9PM. She had to go into the bed where the body was, there was nothing else we could do. We couldn't throw the recently bereaved family out. There was 7 of them and 2 of us. Site manager was aware and said his hands were tied. Thanks for the help you fucker. It was 9PM when we finally were able to lay the body out, get him transported to the morgue and clean the room for the new admit.

If you want to know why your nurse isn't answering your call bell, spending time with you etc is because they are messing around with this stuff.

This woman was crying and cursing saying that having to wait for a bed like this was the worst thing that ever happened to her in her life. I had to try so hard not to laugh at her. I brought her a dinner tray in the lounge and she threw it on the floor. I am sorry. The lounge she was in was nicer than the room itself. She had comfortable chairs etc. She wasn't ill. She had food, water, TV and a phone. She was coming in and out to smoke.

My colleague suggested that we should give her full responsibility of 3 bays by herself, then she could have something to really whine about.

By 8PM I came so close to grabbing her by the hair, digging my nails into the back of her head and dragging her to the room with the corpse in it so that I could point to it and the grieving relatives and say "NOW THAT IS A REAL FUCKING PROBLEM". "NOW THAT WOULD BE SOMETHING TO GET UPSET ABOUT".

I came damn close. Maybe it's time for sick leave.

Thank god my 14 patients were all right. They saw me for about 2 seconds each. If one of them had deteriorated, it would have been missed. If any of them peed the bed they sat in it for the duration of my shift.

Edited to Add: I just made a few phone calls and have an appointment with my GP tomorrow. I am now off sick. I hate complaining to my GP, since she probably has too deal with 100x more bullshit at work. I hate feeling this way.

I have had close relatives die horribly. I have had medical problems myself and as stressful as that was I feel ten times worse and more anxious about going into work. I can't handle the abuse and getting sworn at all the time. I don't get to throw tantrums and cry when I am feeling like that. I'll get complained about if I so much as forget to smile. Maybe if they just offer me a chocolate cookie that will make it all better and force me to smile.,,2087-2450166,00.html

I am not going to follow my own advice and put on my big girl panties and suck it up anymore. I am still job hunting so maybe something will turn up. I will even go and work at Asda if they are hiring. If the house sells first we are out of here.

Monday 7 January 2008

Beauty Salon VS. General Medical/Surgical Ward

Okay guys check this out.

I was talking to my little sister yesterday. She is a hairdresser in the States. She works from 0900 to 1500 daily and makes WAY more money than I do because of the tips she gets. We had a conversation the other day.

Nurse Anne: So how many chairs do you have at your hair salon?

Little Sister: uuuuum like 10 chairs.

Anne: How many staff do you have on a normal day?

Little Sister: Um... like.... never any less than 4 or 5. Um like we take one hour lunches. And if customers don't like waiting it's tough titties. Um like and oh yeah we sit in the back and like smoke and shit and make them wait longer if they complain.

They can leave if they don't like it like okay? Yesterday Kiki and Emilio did my hair and my nails because it was like a totally slow day. We closed down the shop for an hour or 5 and had a little party. Like I think I am going blonde at work tomorrow. Emilio will fix it for me.

Jesus Christ where is their manager and/or owner?

But I digress...

Okay so let's go back and analyze this. They have 10 chairs. The maximum number of people being seen to at once is 10. They may also have customers waiting in the lounge. No harm comes to them as a result of waiting for awhile. They have 10 chairs and 4 to 5 staff.

My 35 bed (now 39 beds because the treatment rooms and day rooms are now patient rooms) ward considers itself lucky if we have 4 staff. We get on our knees thanking Jesus if at least 2 of those staff members are actual nurses. Our patients are acute, highly dependent,and many have dementia. They can die or have extremely bad complications because of one little fuck up or missed bit of information. I had 10 of them who needed to go off the ward for essential diagnostic tests the other day. At the same time. Why does god hate me?

All of them needed escorts because they were either on 02, they had dementia and would wander, fall and get lost if left alone in x-ray, or they were on drips that could not come down. All that stuff requires an escort from the ward staff to go with the Porter and stay with the patient.

We had 3 staff on duty. 10 patients needed to be off the ward with an escort (Nurse or HCA). No escort means no test basically. Radiology has a shit fit if they are asked to come to the ward to do a chest x-ray on someone who is too poorly to go down there and there are no escorts. The other departments constantly have shit fits because they want the nurses to revolve everything around their particular diagnositc department. Endoscopy is the worst for this by the way. Fuckers. Just kidding. ;)

Does anyone else think that any of this is completely sick?

We have been harassing the managers and matrons for months trying to get them to meet with us. The only response we have got from the powers that be recently went something like this "You are well staffed as far as we are concerned. Deal with it and cope".

Wednesday 2 January 2008


Between a destroyed computer and a sick kid I haven't been able to get on and post for awhile and for that I apologise!! I hope you all (if anyone still comes over here) had a Merry Christmas!!