Thursday, 14 January 2010

Hell In Staffordshire Revisited. They are indeed blaming nurses for management failures.

I really didn't want to have to do another blog linking  a Nursing Times article yet again.  In my opinion they are lying shills who do not know how to find decent sources to quote in their articles. But I cannot help myself.  You have to keep in mind that the woman quoted in this article (Julie Hendry) will not have any experience taking on 15 medical patients on a large ward as the only RN these days.  This is a situation that would suck the caring and the empathy out of Mother Theresa.   If she did understand it, she is solely working under the direction of the management twatterati. So basically, she doesn't have a clue or she is hiding it. She is scapegoating nurses just as her management overlords have instructed her to do.

 It's no big secret that nurses are acquiring much in the way of trauma and psychological damage as a result of the ward conditions, and their inability to care for their patients as a result of lack of trained staff and managements refusal to address safe trained nurse to patient ratios.  Ratio stats.

We know that the problems in Staffordshire with nursing care were down to trained nurse to patient ratios that wouldn't be legal in a third world country.  I recently did a shift with only 2 of us for the whole ward.  Management did not care about the staffing levels.  One of my biggest nightmares is seeing patients developing pre renal failure etc as a result of dehydration.  I am commited to seeing that patients are hydrated properly.  But I didn't have a chance.  There was not one second during that shift where I was able to assist someone with a drink.  Not at all.  And it was all down to factors that were out of my control.

If you have not yet heard about Staffordshire look here. And here.

Here is a story from the BBC.

My take on it here.

Here is a comment from Nurse who actually worked there. She commented on my blog.

Anonymous said...

Nurses with 'tude?
I started to develop a bad 'tude at Shitford General. This was a mad busy surgical ward, horribly understaffed and with some very acutely ill patients.
Because of the pressure in ITU we were taking HDU patients all the time. These patients were not really stable enough to be nursed on a surgical ward having had major ops like gastrectomy and oesphegectomy.
These patients needed at least half-hourly monitoring. Some had trachys. All had multiple drains, feeding tubes, catheters, stomas and multiple IVI's and IVABx. You might have two of these HDU patients to your twelve-bedded bay.
In your bay you might also have recovering colosomy, appendectomy, amputation patients with the usual complement of diabetics and complicated medical problems.
I got an attitude all right. One day a patient newly back from theatre after having extensive bowel surgery developed obvious cardiac signs (low BP, tachycardia) and was going down the tubes fast. I bleeped the team and we swung into action.
In the midst of the emergency another patient stuck his head round the curtains and demanded I do his toe dressing RIGHT NOW. The Registrar yelled at him to get out.
We saved the post-op patient. He went to CCU and all was well. I left that shift four hours late then had two days off.
On my return the ward sister pulled me up for not doing the toe dressing, the patient had complained and had said I had a "bad attitude"
Fuck him and the selfish horse he rode in on.

Well said. HDU and ITU patients are critically ill.  If a nurse is responsible for these kinds of patients she cannot see her other patients.  At all.  Full stop. So why was shitford hospital forcing their individual nurses to take these kinds of patients on top of 10 other patients, shift after shift, and day after day? Unless you are one of these clueless visitors to the hospital or a member of the media you, of course, understand that if you have a critically ill patient for 12 hours THEN YOU CANNOT SEE ANY OF YOUR OTHER PATIENTS FOR 12 HOURS. And here in the NHS you DO NOT get another nurse to help you care for those other 10  patients.  You will have to go to the  nurse's station to check orders, order equipment and get/give information about your critically ill patient.  It's probably a good idea to ignore anything else but what you are doing for that critically ill patient whilst you are at the station.  You do not want to get delayed getting back to him because you were talking to a relative of another, stable patient.  The relatives of your other patients will, of course, accuse you of ignoring their loved ones to hide at the station.  They don't understand anything.

Who wouldn't have a bad attitude when you are up to your eyeballs in life and death stuff, afraid that people you are responsible for are going to die because you can't give them the time.  You are dehydrated yourself and 9 hours without a meal.  Your sickest patient just got worse and you have seconds to implement the actions that you need to ensure his survival.  And just at that moment in time someone gets in your face and demands that you stop what you are doing to change a toe dressing.  There is not a human being alive who would not explode in that instant.  Nurses handle it better than others could, and they bite their tongues more often than not. 

You're welcome.

Edited to add:  Don't forget to add your comments over at the nursing times as well.


the a&e charge nurse said...

A new management stooge is brought in after the shocking events at Stafford, so what is the first thing she does? - starts crying (ahhh).

Ms Hendry then switches to cliche autopilot, claiming:
“It’s about putting the right people in as ward leaders. If you’ve got highly visible nurse leadership at ward level – your ward sisters and matrons are on the physically wards not in meetings, being reactive, answering complaints.

So the 'visible' Matron's will abandon their meetings to show their faces on the ward for 5 minutes - sounds great, doesn't it?

the a&e charge nurse said...

By the way - here's the official Stafford report.

Guess what the investigators found?
*poor nurse/patient ratios.
*few post-reg educational opportunities.
*non-nurses performing clinical roles (triage, etc)
*bullying/intimidating management culture.

Umm, I'm sure I've heard all this before?
Pity Ms Hendry's predecessor could not see what was at the end of her nose

Nurse Anne said...

When she says that she "replaced a lot of senior nurses" my first thought was "yeah, she got rid of anybody who mentioned criminal third world staffing levels."

Brian said...

Nurse Anne, if you read the full report, you'll find the nursing care at Mid Staffs is rightly criticized. However, it is clear to anyone who chooses to read the report objectively (which seems to exclude most journalists), that the source of the problems was a whole range of management failures. The sort of things that you write about in this blog. That being the case, I hope the interim director of nursing is investing as much emotional energy in reforming the Trust management as she is in choking over her videos.

Nurse Anne said...

Glam. I have said 1000 times over that the nursing care was horrendous. When nurses are short staffed they have to ignore call bells, leave people in their own waste, they are unable to attend to basic care, they have to peel the hand of a dying woman who wants them to stay in the room to help her pass because of what is happening with another patient.

All these things happen as a result of shortstaffing not mean nurses. So yes, the nursing care would have been horrendous.

the a&e charge nurse said...

"I hope the interim director of nursing is investing as much emotional energy in reforming the Trust management".

If Anne's blog tells us anything, it's that managers either do not understand, or more depressingly, do understand but prefer to overlook those factors which would improve standards of nursing care.

To be fair to the managers they are hamstrung by endless, centrally imposed targets.

Take the A&E target (98% of patients seen and sorted in <4hrs) - remember this standard is NOT negotiable.

Wanless tells us that more than 19 million patients (and rising) attend A&E every year - this means 18,620,000 irrespective of their individual need, or complexity (children, psychiatric patients, life threatening trauma, etc) MUST be seen and sorted in an artificially compressed time frame.

Now anybody who has worked in A&E for more than 5 minutes will tell you that this level of productivity is simply impossible 24/7 - 365 days of the year.
There is not an A&E in the NHS that is not cheating in some way so as to make it APPEAR that the target is being hit.

Needless to say ward staff become hacked off when they are forced to accept patients with less and less having been done for them because A&E staff have diverted their attention to the next 3 or 4 ambulance crews waiting to hand over a fresh batch of patients.

The integrity of nursing staff has been ground down and compromised by this situation - so what can the likes of Ms Hendry say to the board when there is simply no room for manouvre?

I have heard some A&E's agonise over how long incoming patients should be kept waiting, while staff hurriedly try to package a patient that is creeping up to a 4 hour wait.
After a while these pressures start to get to you and I have no confidence that the sort of 'supa-nurses' envisaged by Ms Hendry will alter this fundamental landscape.

To my mind these sorts of dilemmas encapsulate many other conflicts that play out across the NHS, both in hospital and in the community - surely if a quick fix was possible, somebody would have thought of it by now.

My guess is that the current economic climate will makes things worse rather than better - we will just have to keep tuning into Anne to see her experiences match my prediction?

the a&e charge nurse said...

"we will just have to keep tuning into Anne to see her experiences match my prediction?"

Oops, should say, we will just have to keep tuning into Anne to see IF her experiences match my prediction?

Anonymous said...

A&E Charge Nurse, what you say is so true. I've worked in A&E for a couple of years, and i am so demoralised with it all. I am sick of working to meet targets, instead of working to provide patient care. The priority of the day is to get patients out, from the minute they arrive. Never mind the fact that they need care and treatment. I am sick of taking poorly patients to the ward with their treatment half started/finished. I am sick of having my workload directed by the clock instead of patients needs. I am sick of putting pressure on my nursing colleagues on the wards. But I don't know what else to do, only have to read this blog to realise that the pressures on the wards are even worse. I only ever wanted to care for people. But the NHS won't let me :(

the a&e charge nurse said...

Indeed, anonymous - even desk bound commentators, like RCN secretary Peter Carter, recognise the negative effect on patient due to the rigidity of a 98% target.

Here are the findings from the (fairly) recent RCN survey;

capgrass said...

its like A/E has turned into a glorified traige station. When i used to work in A/E in london........regular tramps used to come in and when we were quiet we used to give them a bath and de-louse them. UGH the socks i used to pull off......once a large bit of dead diabetic foot came off as well. patients used to spend the night on trolleys........which was most uncomfortable for them and the kitchen used to send up sandwiches but never enough. There used to be some lovely smell..............i particullarly liked Kaolin poltice smell and also Friars Balsum. as Surgical spirit. The ECG machine was a night mare: all these little red rubber suction balls that kept popping off. Also we used to squeeze loads of sodium Bicarbonate into people during cardiac arrests. Overdoses used to have their stomachs "pumped" i remember lots of long bits of tubing and a sort of funnel thing. it was quite a deterrant for those people who keep comming back! After a busy night shift, we used to go out to a posh hotel for a fatboy breakfast. It was good. the IRA bombing was at its height and it was stressful.

the a&e charge nurse said...

Oh, we still get our regular 'gentleman of the road', Capgrass, although stomach wash outs are virtually a thing of the past I'm glad to say.

I understand reception staff at Stafford provided a sort of triage (rather like the system in the 80's) which consisted of comments like;
"oi nurse, this one is still bleeding", or;
"why is that old man clutching his chest and turning a funny colour, nursey".

North of the river breakfast was sometimes held at Smithfield meat market (after the last night).
I stopped going after experiencing near hallucinations following a rather heavy session, what a lightweight, eh?

Brian said...

A/E Charge Nurse: Thank you for your comment. I was trying to be ironic, or possibly sarcastic. In any case, the last sentence of my previous comment was not intended to understood exactly as written.

And Nurse Anne... er... yes... did I disagree with you?

Brian said...

Capgrass wrote: "Overdoses used to have their stomachs "pumped" i remember lots of long bits of tubing and a sort of funnel thing. it was quite a deterrant for those people who keep comming back!"

Yes, I remember them too. And let's not forget that the actual stomach tubes came in a range of sizes so that the really undeserving overdoses could be made to suffer properly. But Capgrass, do you have evidence that being cruel to people who OD discourages them from having another go? If not then we must conclude that some nurses, at least, are capable of sadistic behaviour towards their patients. Which means that when nursing care is poor all possible reasons for it should be investigated including deliberate cruelty.

capgrass said...

mea culpa glamorgist: I agree that quote "those who have the potential to do the most good are also capable of the most harm". I also agree that i have NO evidence to say that stomach pumping was a deterent. Once I washed someone out and he returned 4 hours later having done the VERY SAME THING and every time we "pumped him" he thanked us profussely. he was a simple mild soul........but obviously distressed by the voices in his head. Mea Culpa........i am glad we dont do that nasty treatment no more. Although sometimes i hate to think of all those dangerous pills lying in the stomach and wish we could just get them out rather than just processing the paperwork, waiting for a porter.......wasting time handing over to the CAU nurse and wondering how many hours the patient will wait till she has time to get some more parvolax from pharmacy, find the i.v. guidelines book, and start the bloody treatment!!!!

mcmillan nurse said...

Dr crippen is nurse bashing again............see his lots comment on comments section. He accuses some idiot of being a nurse. Please Rise to our defence a/E charge and grumpy and anne

Surgical Instruments said...

It is very useful information. I like it very much. It will be help a huge number of people, who have the interest in this field. Keeps it up great work!!!!!.

Dr Da Vinci said...

Macmillan nurse. Dr Crippen, Dr Grumble, Nurse Ann and A+E charge nurse are all essentially saying the same thing.

All our resources are being dedicated to flying in hot shot management consultants who encourage excessive amounts of bureaucracy instead of investing in front line services.

Dr Crippen is not nurse bashing, Nurse Annn is not doctor bashing.

People like you create these tensions.

Doctors and nurses need to stick together and stick it to the managers, the lives of our patients depend on it!

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