Saturday 12 September 2009

Uniforms Revisited

I am still really angry about this so here I go again.

I already blogged about this here.

We do not have much in the way of changing facilities for staff at my hospital. I do know of some hospitals that do provide changing facilities so that staff do not need to come to and from work in their work wear. I know of more hospitals THAT DO NOT HAVE THESE FACILITIES.

There were two wards at my hospital that had changing rooms for staff. Now that my ward has been redone we have one. We begged and begged and begged to get a changing room. If there hadn't been a major structural problem we never would have had our ward redone. The numerous other wards/units at this hospital do not have changing facilities.

Let me tell you what staff on my ward were doing before we were refurbished recently. I am telling you this because many many staff are still going through this.

We were getting accosted and verbally assaulted by matron types/senior office types and members of the general public for travelling to and from work in uniforms.

But they still would not provide changing facilities.

So we had the bright idea of changing in the staff toilet (very small decrepit room) at the beginning and the end of our shifts. We got away with this for awhile. Then we were caught by the housekeeper who had a fit over the fact that we were changing in there. Those who were caught changing in the toilets got in trouble and the rest of us were warned. What to do, what to do. We were still getting verbally assaulted and threatened if seen travelling to and from work in uniform by morons who thinks that this will spread MRSA around.

So we had another bright idea. There was a small supply cupboard just near the toilets. This room was about 7 by 10 foot. When we came to work we snuck in there to change out of our street clothes and into our uniforms (which we carried to work in a shopping bag). There was no place to store our street clothes, shoes, belongings so they were left on the floor in carrier bags or hung on a hook in this shitty supply cupboard. The domestic supervisor and housekeeper again caught us changing in there and went to the matron or chief nurse to complain. Busted again. Threatened again and told that we are NOT to change in supply cupboards and toilets. But we were still being verbally assaulted when seen on our way to work in uniform.

In the summer we were sweating buckets on the way to and from work because we tried to hide our uniforms under long winter coats. And we were still getting the "tsk tsk, look at those nurses coming to and from work in their uniforms" by silly old ladies mostly. These same silly people will also see a beauty therapist walking through town in her uniform and says "tsk tsk, look at that nurse wearing her uniform".

Sometimes a matron or an office type would stop us and say something about being in uniform on our way to work, even though we tried to make them aware of the lack of facilities. They threatened us for coming to and from work in our uniforms. They threatened us for changing in toilets and supply cupboards. And they continued to ignore requests for staff changing facilities. Most of the nursing staff at my hospital are still going through this. Some wards have found little cupboards and closets near their units to change in. And they haven't been caught yet. The rest are trying to hide their uniforms under long heavy coats as they travel to work.

The supply cupboard and the toilets were our only option. The only other option would be to change in the middle of the ward. Should we sneak into the patient bathrooms perhaps? Luckily Nurse Anne and crew are in a better place now. Wish I could say the same thing for everyone else.

The reason I am telling you about this is because every time there is a news story about nurses and or infection control in hospitals there is always some idiot bleating on about the fact that he has seen staff travelling to and from work in uniform.

Don't assume that we have changing facilities or our uniforms laundered. That is a very fucking stupid assumption to make. Uniforms are not the big problem with infection control anyway. And even so, we can get uniforms that are made out of anti-microbial stuff.

Instead of pissing and moaning about stupid crap and verbally abusing nurses on the way to work (or hairdressers in uniforms that you mistake for nurses because you are a fucktwit) here are some things you can do if you are concerned about hospital bugs:

1. Demand that the hospitals actually hire cleaners that clean and are there for more than a few hours a day.

2. Demand safe nurse patient ratios.

3. Demand better facilities. Beds that are all lined up withing inches of each other with all the patients sharing 3 commodes is a really really bad idea. here and here with a pic of a typical ward

4. Decent, functional handwashing facilities for the staff are a must. Ours fucking suck.

5. Stop transporters from dumping new patients into a bed that has only been vacated by a discharged patient moments ago. For fucks sake, allow us to clean the thing. If I am tied up with a sick patient I cannot leave him to clean the recently vacated bed. Hold your horses until I can do it or hire a cleaner to clean and prepare beds for the next patient. Fuck the targets.

6. Changing facilities for staff!! Proper laundering of our uniforms!! The hospital laundry will not touch our uniforms (if we send it through the hospital laundry it will be lost forever) and domestic household washing machines don't do the trick. But who cares. They need to be worrying about ratios, bed occupancy, and facilities before harping on about uniforms.

And yes, highly paid matrons really do hide behind trees to catch staff coming to and from work in uniforms. There are members of the public who think that they are doing some kind of good deed/community watch thing by looking for and targeting people on their way to work who appear to be in a nurse's uniform. Meanwhile no one, AND I MEAN NO ONE IN ANY KIND OF AUTHORITY POSITION is addressing the points I made above. Well, the RCN did for about 5 seconds a few years ago. The public doesn't address these issues either. I guess it's more fun to sit on your fat ass and say "these bloody slag nurses go on the bus in their uniforms and that is why we have MRSA". Idiots.

Wednesday 9 September 2009

Idiot Managers and Commodes.


We have a 20-30 bed ward. There is one toilet/showeroom. At any given time 99% of our patients are COMPLETELY UNABLE to walk there, even with assistance. Wheelchairs are often AWOL. Half the time we cannot even find one. We have 3 commodes for the whole ward.

The male patients are not a problem because they use bottles. The female patients are mostly large, unable to transfer out of bed onto a commode and require two staff to transfer them onto the commode. Either they have urinary frequency or dementia. Either way it won't be more than 5 minutes after they are assisted back to bed before they are again crying for the commode. They refuse bedpans. The damn things hurt, beleive me. With 3 commodes and 15 ladies crying for it all at once,all the time, you can see why we have problems. The dirty room is where the commodes are emptied and cleaned. This room is a long walk away from the patients.

So you are with the patient in bed 25. You have just assisted her back to bed. The lady in bed 24 sees you with the commode and demands it now. But in order to empty and clean it you need to walk all the way back to the dirty room. To get there you have to walk past at least 10 other people who shout for the commode as you walk by.

You clean the commode and head back to bed 24. On your way back the 10 people now inform you that they are pissing/shititng in their beds because you are not bringing that commode to them right now. 10 minutes later you finish assisting the lady in bed 24. She could not be left alone on the commode as she will almost certainly fall. Sometimes she does get left by the care assistants and nurses, because the others are screaming for the commode or you are in the middle of something that you cannot leave in order to do commode duty. For example, if you are caught leaving a deteriorating patient or being late with drugs because you were fucking about with commodes you could be looking at loss of registration and a lot more.

When you finish with the lady in bed 24 you need to push the commode full of piss and shit back down the looong hallway to the dirty room, past those initial 10 people who shouted for you to provide a commode over 10 minutes ago.

This is the setup. And of course it is the Nurse's fault when people are left in their own waste and commodes are not cleaned properly. Yeah right. What a fucking stupid ass set up this all is!!!! What a crock of fucking shit.

Remember that this goes on all day long. They will not allow us to have any more than 3 commodes. If we are lucky we have 3 or 4 or maybe 5 staff and most of them will be up in their eyeballs trying to keep people alive and painfree already.

We have 2 siderooms where MRSA and and CDIFF patients are isolated. Two of our commodes usually end up in there. One in each room. No, we cannot take them out and use them for a patient on the ward. 16 year old unthinking braindead agency untrained care assistants can't seem to grasp this by the way. You will not be able to clean the damn thing properly in the short amount of time you have. This means we are left with one other commode for the whole ward. It is a ward full of patients and visitors who wrongfully assume that if mum or gramps needs the toilet any member of staff walking by will immediately be able to provide one. They get angry when their unrealistic expectations are not met. Um. Ten people are in the que ahead of you dear, and some one is having a heart attack and the other 3 staff are tied up. What the fuck do you want me to do?

We are not allowed to have anymore commodes. They probably don't want to pay for it. If they did allow us to have more, there would be no room to store them anyway.

We have made management aware of what I have told you here. Their response has been silence. It's disturbing.

But what do we get to hear ten times a day from patients and visitors?

"You nurses are disgusting for making people wait for the toilet"

"You nurses are disgusting for only have 3 commodes and one toilet on this ward"

"You nurses are disgusting for the smell in this place" (the dirty room drain is often blocked)

"You nurses are disgusting for causing people to piss in the beds"

"You nurses are disgusting for not coming immediately with the commode"


"If mum or dad or auntie Gladys piss the bed IT IS ENTIRELY YOR FAULT YOU DISGUSTING NURSE"

Honestly, if I had a penny for everytime I heard one of these comments each shift I would be rich. These comments are what I listen to all day long. I listen to it as I am running between the dying and the suffering, when I am trying to talk to people who have just been told they have a death sentence and when I am running to people who are bleeding. I still have to listen to it when I leave those people to try and sort all of those who are desperate for a wee. I never hear "Thanks for leaving that dying patient to find me a commode". Instead I hear "What the hell took you so long to bring me that commode you fucking lazy bitch". Okay, since they probably don't know that I have other patients who are dying I guess I can let them off the hook for their shitty comments.

Everyone expects an immediate response from a nurse who is already in the middle of something that she cannot walk away from, even though there are ten other patients making the same demand, for the same piece of equipment all the time.

But of course the biggest problem is the filthy state of the commodes. The cleaners utterly refuse to touch the damn things. It is the job of the two nurses and two assistants for the entire ward to clean them. There is not enough time to clean them properly. They are in constant demand from impatient, needy people who need our help and their dignity maintained. There are not enough of us, there is a hell of a lot going on, and there are certainly not enough commodes and facilities.

One day we were left with two RN's and two untrained children to care for the whole ward. On that day a gaggle of overpaid worthless jobsworth infection control peeps showed up, and swabbed the commodes for germs. Now we are getting lectured about dirty commodes.

Why don't they staff the ward with nursing staff?

Why don't they staff it with cleaners who clean?

Why do nurses in these hospitals have so little in the way of domestic/housekeeping support?

Why do we have no say in any of this while having to always shoulder the blame, apologise, and listen to the verbal abuse.? Oh right. Management doesn't want to admit liability.

Why not deal with that? Why send overpaid worthless tits around with expensive swab kits to tell us what we all ready know?

So there you have it. Management cannot even fucking sort out the toileting facilities. They'll happily sit in their offices and let the frontline staff shoulder the blame however.

And what they hell can we do about these idiots who are running around with swab kits, who then lecture the hurried staff about "taking pride in their work".

Look, if any of you reading this are infection control or managers let me tell you something: Expecting nurses who are working with ratios that wouldn't even be legal in the shittiest part of Haiti to clean commodes properly is begging for failure. The idea of a nurse with 6 patients taking on cleaning duties is insane. IT WILL ALMOST CERTAINLY COMPROMISE PATIENT CARE. Nursing staff are so shafted these days that there is no way we can clean anything properly. We often have more than 12 patients per nurse here in the UK (a total abomination right on it's own). If you want to hit the nurses with these kinds of fucked up ratios, and then demand that they take on housekeeping duties as well you are a crazy fuck. You are smoking crack and even worse than that, you are not sharing it with the staff..

1.Increase the amount of cleaners/domestics on the ward.

2. Allow the cleaners to clean the commodes. Currently they are not supposed to.

3.Have domestics on the ward for more than 2 hours in the morning and 2 hours in the evening.

4.Allow us to have decent toileting facilities.

5.Have separate domestics for cleaning and food service. Duh.

Either do this exactly as I have directed here or shut the fuck up and go away for eternity. Those are your options. Make it so.

Rant over. The end.

Wednesday 2 September 2009

They want to cut clinical staff....still. Will they do it?

Here's an article that I found. It caused me to spit my coffee out all over my keyboard. But really I am not surprised.

NHS to Cut Staff.

Supposedly the health minister is publically denying that this is the way to go. God only knows what is being planned behind the scenes. I am not hopeful.

I really think we need to start helping the public to have a more realistic expectation of what kind of care can be given in hospitals. Let's see. We are 2 or 3 nurses to 30 patients now. I have always said that by the time I am old economic factors and changes in health care will have altered things so much that there will probably be one nurse covering 3 wards.

We'll see her maybe once a day for less than 2 minutes each if we are lucky - if all those patients of hers on all those wards are stable. If they are not stable, we will see her less. She'll fly past me while throwing super expensive medications that cure heart failure and diabetes at my 96 year old self. We'll know the nurse is on the ward when we hear the sonic boom, so fast will she be moving. We will barely have time to see her or catch our pills as she rushes past. Sound crazy? This is where we are heading. My angry patients say to me "well how would you like to wait hours for a commode". My official response is this: "when I am old, I will be waiting days for that kind of thing. Trust me"

Nurses are responsible for some pretty complex things now...even without taking on the role of Doctor. There is a large gray area that exists between diagnosing and treating a disease process and basic care. The docs have always done the diagnosing and treating part. The nurses do the basic care.

That gray area -for lack of a better term- includes things like implementing complex physicians orders, assessing and monitoring for changes in condition, and managing technology that keeps patients alive as well as coordinating lab results, medications, social problems, discharge planning etc. It's the nurse who gets nailed when this stuff gets screwed up. Indeed it is. And the nursing profession did not create this situation.

Medication administration is more complex now and it is the domain of the nurses. We are held liable for not catching doctors mistakes in prescribing. Seriously. That really pisses me off and is a whole 'nother blog post. If the freaks in charge want to hold nurses responsible for this shit then I can see why they are demanding that nurses all have degrees. I don't want a thick nurse coming near me or my ventilator , my IV drugs and lab results and I don't care how caring or warm hearted she is.....Being caring and warmhearted is necessary in a nurse but it won't stop her from getting somebody fucking killed.

Lab/diagnostic tests are more complex and getting more complex all the time. The doc may order the test but who is organising all the before and after care while coordinating all of the other things that needs to be taken into consideration for said test? The nurse. And it's a pain in the ass believe me. Doctors have no idea about what goes in to implementing their orders because they don't deal with that side of all exists in that gray area outside of diagnosing and prescribing and outside of basic nursing care.

This gray bubble that exists between diagnosing and treating illness (medicine) and providing basic care (nursing) will be a lot bigger when I am old. Much bigger than it is now. And the nurses are held responsible for the things that occur in this gray area. If this gray bubble was the size of a pinhead in 1970 it is the size of a football now. There will be less nurses, more patients, and a gigantic gray bubble the size of Jupitor in the future. The things that exist in that gray bubble cost money that no one has, and they will continue to cut clinical staff and other things that we take for granted to pay for it. Paying for a patient's basic medical and nursing care is expensive even now. It was not this expensive decades ago. Decades from now, the cost to provide what will then be considered the very basics i.e.tests and meds and technology will be so immense that we cannot fathom it. Say bye bye to having registered nurses around to hold hands and mop brows. Just get over it.

Anyway it seems that it is all going to go to hell in a handbasket a lot sooner than I thought it would. It's bad now, in a lot of places but not yet the disaster than I am predicting. I think we are on our merry fucking way thanks to the recession.

Here is the article with my comments in blue. I don't think I really need to say anything more.

NHS 'needs a 10% cut in staffing'

(UKPA) – 18 minutes ago
The NHS would need to slash its workforce by around 10% to help meet planned savings of £20 billion, it has been reported.

A study, commissioned from consultancy firm McKinsey and Company, said the workforce would need to be cut by 137,000 to meet efficiency savings by 2014.

It said clinical staff would have to go alongside administrators.

Christ we have no clinical staff as it is....I don't think that our RN to patient numbers wouldn't be legal in the shittiest parts of Mexico. Neither do the nurses have any kind of decent back up in the form of domestics, clerical.

The report, seen by the Health Service Journal (HSJ), recommends a range of possible actions such as a recruitment freeze starting in the next two years, a reduction in medical school places from October and an early retirement programme to encourage older GPs and community nurses to make way for "new blood/talent".

And we have no doctors doing ward work as it is...well there is one...for the whole FUCKING hospital outside of 9-5. Crap I can't even get a doctor to review a patient betwen 9-5 without jumping through flaming hoops. If I had a penny for every time one of these overwhelmed young doctors was flipping out and having a mental breakdown in my staff room I would be rich. Note to the junior docs...if you start crying your eyes and screaming "I cannot do this, I can't do this" while your pagers is going off 1000 times a minute The nurses will all be like awwww poor wee lad/lass and we'll make you tea and stuff.

"New blood and Talent". Hmm. That there is fuckwit talk for young, dumb, inexperienced and oblivious to what they do not know. New Nurses and Doctors need a hell of a lot of mentoring from the experienced. For years. Is this report really representative of the kind of shit that is being recommended to senior managers? Christ.

The report was presented to the Department of Health in March this year, the HSJ reported. It carries the department's logo and has been disseminated among senior NHS managers.
The study said £2.4 billion could be saved if hospitals with the lowest levels of staff productivity got up nearer the average.

Oh fuck. The small minded morons who happen to wield all the power have read the damn thing. These are the same bastards who want me to take responsibility for a lack of junior docs and the 16 year old untrained kid to take responsibility for nursing care.

And it said almost 40% of patients in a typical hospital do not need to be there at any one time.

True, many are not acutely ill but they cannot take care of themselves either, their families won't do it. Instead they want them waited on hand and foot by overwhelmed hospital staff who are up in their eyeballs dealing with acute patients. We do not have enough stepdown /sub acute /rehab facilities. There is your problem. If they build them, they will need to staff them.

The biggest causes are delays in patients receiving tests or therapies, and a lack of suitable care facilities in the patients' own home or community.
The report also said that if four million of the 29 million outpatient appointments each year could be cut this could save £600 million.

LOL. How about this- Instead of all these cuts we threaten them with having to pay for every funeral that they cause as a result of said cuts?

A further £700 million could be saved if procedures with limited clinical benefits - such as tonsillectomies, varicose vein removal and some hysterectomies - were no longer performed.
The analysis also suggests up to £8.3 billion of hospital estates could be "freed up".

I hope this is a joke. Take it for what you will.
I have been away so this post will have to do for this week's insane ramblings.