Monday 26 July 2010

This Makes Me Sick

Today I learned that my ward is gaining more beds.  We will be taking more acute patients and having higher throughput.  After a letter writing campaign initiated by myself, the ward sister and another senior staff nurse a letter was received by management.  "We are sorry to hear of your staffing issues.  You will be getting extra staff in the form of .5 of an auxillary. By our calculations this will bring you to a full complement of staff". 

What. The. Fuck.

We are losing two HCA's.  This leaves us with two HCA's in total on the duty roster.  The other care assistants are all inexperienced apprentices and auxillaries.   I know of 4 HCA's who want jobs on my ward.  They have been turned away.

Management has taken the only room on the ward that we have for lunch breaks and handover and are turning it into a patient sideroom.  This leaves us cramped into a very small space for handover. 

The day staff had to sit on the floor while the night nurse who had been on duty for over 14 hours had to sit precariously on a wobbly ledge thing for the change of shift handover.  It takes a half an hour at least to handover.  Talk about uncomfortable. If we handover at the nurse's station patients will overhear us and report us for "breaching their privacy".

Breaks are impossible.  The staff nurse really isn't in a position to leave the ward for a 15 minute walk to the canteen due to short staffing.  She won't have another nurse to watch her patients. She will not be able to eat in the cramped handover room from hell unless she sits on the floor and wants to get interrupted every 2 seconds.  That means the staff nurse's only option is to eat at the nurse's station thus inviting a whole bunch of smart ass comments from visitors and doctors who do not realise that she is only taking 10 minutes to eat in a 12 hour shift.  Nor do they realise that she has no where to go to eat.

Then I come home from work and see this shit.

What the hell is going on?

Wednesday 14 July 2010

Nurse Anne's Information Pamphlet for Patients and Relatives: PART 1

I would like to print out a little pamphlet called "let go of your delusions" and hand it to every alert and oriented patient who arrives on my floor.  And all relatives.  This does not, of course, apply to confused patients, demented little old ladies or drug addicts going through acute withdrawal. I expect those patients to act like circus animals. However, if you are an adult who has voluntarily sought help for a medical problem, and are now lucky enough to even be in a hospital bed, there are some things you should know.  Thanks to the posters at allnurses from whom I stole  borrowed this idea. Writer's block is a bitch.

#1. YOU WILL NOT SLEEP. This may sound cruel, I mean, how can you get better if you don’t sleep? However, if you come to a hospital expecting a nice, quiet spa environment with cute nurses fluffing your pillows before you drift away into a healthful sleep, you are delusional. Time is short – the government and managers want as many people in and out of your hospital bed in as short a time as possible.. You will be woken up throughout the night to have blood drawn, blood pressure taken, IV meds administered, quick neuro assessments to ensure that your brain is not oozing blood. You will also likely hear people screaming and crying, cursing and laughing all night long. If you are lucky, it is not your own confused roommate who is constantly climbing out of bed only to set off his bed alarm.  We cannot cure dementia or give them a magic pill.  They may very well walk into your room and shit in the corner.  They may try and get into bed with you.  They will scream out for "billy" or "help" or another dead loved one all night long no matter what we say or do for them.  They will not remember or retain anything we tell them.  This is dementia. These kinds of patients are increasing tenfold.  Unless you are in maternity or paedatric wards we cannot shelter you from this.  It's not only dementia.  Patients with severe medical illness, and other conditions will become confused, disorientated and unmanageable, even without the dementia factor.  This is also increasing ten fold as more people survive severe illnesses. The hospitals are busting at the seams with these people.  I even heard of a demented wandering elderly patient getting put on a maternity ward as there was no other place for her.  We are lacking beds.  No we cannot "send them somehwere else" or just "give them something".  Wish I could.  If you think you may need something to help YOU sleep, 3:00 AM is NOT the time to ask your nurse for temazepam. Ask ahead of time when your registered nurse can call the doctor for an order. Which brings me to my next topic. . .

#2. YOUR NURSE DOES NOT HAVE ACCESS TO ANY DRUG THAT MEETS YOUR FANCY. If you suddenly feel pain or your left knee itches, your nurse cannot reach into her magic scrubs pockets and procure any drug you like.  Nor can she just get and give anything your normally have at home as prescribed by your GP.   In hospital Doctors are the one who must order any and all medications, EVEN IF IT’S “just my usual piriton". Do not get mad at the mean nurse who won’t bring you extra morphine because your back hurts. That mean nurse must put out a call to a doctor, has wait for him/her to call back, pray that he/she is in a good mood and will give you the requested drug, write an order in the chart, scan that order to the pharmacy, wait a zillion years for the pharmacist to profile the medication, wait another zillion years for the pharmacy tech to bring the medication, then the nurse can bring you your drug. This can take a while. There is absolutely no way around this, even if you have a gun to my head. Do not think the nurse is secretly hiding your medication and enjoying your  discomfort. Which leads nicely into my next heading. . .

#3. THE NURSE IS NOT YOUR ENEMY. Yes, the nurse must do things that sometimes causes discomfort – we must start IV lines, insert catheters, change dressings on painful wounds, give you shots – but we do these things to help you get better. We take no joy in them. You know that doctor that just left your room? The one to whom you were very nice and polite? The one to whom you listened quietly, asked no questions, and didn’t bother to tell that you are bleeding profusely out of your rectum or experiencing chest pains? Yeah, well HE is the one who orders these tests and blood draws and procedures. Speaking of that. . .

#4. TELL YOUR DOCTOR ABOUT YOUR SYMPTOMS. I cannot believe how many patients lie there quietly, smiling away when the doctor is in the room asking how they are feeling. “Oh, fine, Dr. Bighead! I feel great!” then. . .5 minutes later when the doctor has left the floor, this same patient is suddenly in excruciating pain, has numbness in her right foot and blurry vision. When asked why the HELL they didn’t tell the doctor who just left, they shrug “oh, I don’t know. . .I didn’t want to bother him. . .he is so busy.” Then the nurse must call the doctor and tell him that the nice, smiling patient they just saw is now a quivering mass of pain and can’t feel her own face. This leads doctors to think that nurses are nutcases. And it leads them to scream at us for paging them 5 minutes after they walked off the ward on their way to see their other patients, a job that takes them all day even if they rush and take short cuts. But mostly they just think that the Nurses are exaggerating or crazy. Which takes me to my next point. . .

#5. DO NOT TAKE YOUR ANGER, FRUSTRATION, ANNOYANCE OR SCHIZOPHRENIC HALLUCINATIONS OUT ON YOUR NURSE. In general, doctors are treated like gods and nurses are treated like shit. Plain and simple. We as nurses try to proclaim that we are professionals and that we make a difference – in actuality we are treated very poorly by most people in the health care world. We are in the very difficult position of being the “coordinator of care” for patients, yet we lack any power to actually make decisions. We have all the responsibility but none of the power. I spend so much of my day making phone calls, trying to make things happen. Trying to get test results, find out what is going on, talk to the doctor, get medications ordered, figure out why the patient has not yet had that MRI of the brain or echocardiogram. Nurses are viewed as nagging wives. . .and tend to be treated as such. But no one else in the hospital is going to take responsibility for getting this stuff done for you. Doctors, in general, do not talk to nurses, they do not tell us what is going on with patients nor do they tell us the future plan of care. For me to figure out what is going on, I often have to try to read the doctor’s handwritten progress notes, which is pretty much like trying to decipher ancient Egyptian hieroglyphics on a pyramid wall.  I cannot sit at the nurses station for as long as it takes to read their notes. There is very little direct communication between doctors and nurses. If you want to know if you have cancer, for the love of god, ASK YOUR DOCTOR.

#6. YOUR NURSE HAS 10-20 OTHER PATIENTS, SOME OF WHOM ARE A HELL OF A LOT SICKER THAN YOU EVEN IF YOU ARE PRETTY DAMN SICK.   Nurse has no control over how many patients she has but she maybe looking at a manslaughter charge if she goes to clean the incontinant lady before she gets to the diabetic with the hypostop. If you ask your nurse for some coffee and a newspaper, and she tells you that it will be a few minutes, do not get huffy and demand to see her nursing supervisor. For all you know, that nurse has a patient in the next room who is not breathing or is in desperate need of some pain medication. As nurses, we must prioritize, and yes, my “least sick” patient will get less of my time. This is not to say you are not important and I am ignoring you, but no, I don’t have time to listen to you whine about your chronic neck pain when I have another patient who is having a seizure or gasping for air as he drowns in his own secretions. I get no help with this.  I just have to prioritize all the time.

#7. “H” DOES NOT STAND FOR “HILTON. Don’t complain to me about the food, the lack of TV channels, the view from your window, the “smell” of the hospital, of not being able to take a shower or go downstairs for a cigarette. You are in the hospital. Get that through your head. It is NOT like being at home or on vacation. We now call “patients” our “clients” or worst yet, “guests.” Our administrators are much more concerned about if our patients are happy than if they are getting better. My boss is always telling me how much my patients “like me” but I never hear anything about my actual care. It would be better for the hospital’s rating if I let that overweight diabetic eat her ice cream and get really ill rather than tell her NO – at least she would be “happy.”  You know all those high taxes you pay?  They don't even cover the cost of your diagnostic tests and drugs.  You will not get the "penthouse suite" to recover from your CABG. And the hospital will most certainly not fork out the cash for you to have your own private duty nurse who can always be there for you.  You Nurse most likely cannot be in your room for more than 2 minutes at a time without risking lives.  If she doesn't limit herself to a few minutes max with each of her patients at a time she will miss the boat on something big.  And in her line of work it's life and death. 

#8. SOMETIMES IT IS GOING TO HURT. Yes, getting out of bed and walking after abdominal surgery hurts. Pancreatitis? Oh yeah, you are going to hurt and you are not going to be eating anything for days.  You won't be allowed too.  #18 IV in the AC? Yup – it is going to hurt and likely be uncomfortable as hell for as long as you have it. DEAL WITH IT. You are in the hospital. Yes, it sucks and No, I don’t expect you to be happy about it, but don’t constantly whine and complain and demand that I “do something about it.” You are not going to be magically cured just because you are in the hospital, and sometimes there is pain that even high levels of narcotics does not completely eliminate. Walking the day after surgery hurts, but it is the only way to heal, avoid pneumonia, and get out of the hospital.  And if we overdo it with the painkillers you won't move, you won't get out of bed.  Then you will get pneumonia and possibly a fatal blood clot.  No I cannot alter reality. 

So that is part one.  I will be continuing this in part two with "the nurses and doctors did not give your gran dementia, lung cancer and heart failure" and " we have no way in hell of knowing when you are going to be admitted, transferred, discharged or when the hell the doctor or transport vehicle is coming.  Please stop asking.  The amount of time spent away from dying patients to answer your stupid fucking questions that require a crystal ball is a crime against humanity" and also "there are a million and one PERFECTLY good reasons that you or your loved one cannot have food or fluids.  We are not starving or dehydrating  you/her/him to death, the illness is".

Sunday 11 July 2010

RN safe staffing (1 RN to 4 patients) saves money and lives; Untrained staff instead costs money and lives

Safe Staffing

As you read this please keep in mind that here in the UK there are no legal nurse staffing requirements and we are often one RN to 10-35+ patients in hospital. This is getting worse year after year.  Patients are getting older, sicker and much more complicated whist wards are replacing nurses with untrained staff.  MANY MANY TRUSTS HAVE BEEN SLASHING THE NUMBER OF REGISTERED NURSES AT THE BEDSIDE FOR YEARS EITHER REPLACING THEM WHEN UNTRAINED KIDS OR NOT AT ALL. PATIENTS ARE SICKER.  THERE ARE LESS REGISTERED NURSES.  I DON'T CARE WHAT THE GOVERNMENT'S OFFICIAL STATS SAY.  THEY LIE.

Nursing ratios save money and lives

By Suzanne Gordon

July 9, 2008

BEFORE ITS legislative session ends in July, the Massachusetts Senate has an opportunity to protect hospital patients as well as the nurses who care for them by approving the Patient Safety Act that was passed overwhelmingly in the House a month ago.

The ratios bill would require that the Massachusetts Department of Public Health implement enforceable limits on the number of patients a registered nurse can be assigned, thus providing patient protection in all acute care hospitals. As the Senate debates this measure, it should consider the positive effects that legally mandated nurse-patient ratios have had where they've already been enacted - in California and Australia.

In California, since 2005, no nurse on medical surgical floors can be assigned more than five patients at a time. On equivalent units in Victoria - the second largest state in Australia - the minimum required staffing for every 20 patients is five RNs, backed up by a "charge nurse" who has no patient load of her own and is thus free to assist other RNs.

In both California and Victoria, ratios were originally introduced because excessive RN workloads were putting both nurses and patients in jeopardy, while adding to overall healthcare costs. More than 60 studies have documented that hospital understaffing results in more patient deaths, plus more preventable complications like pneumonia, urinary tract and catheter infections, and medication errors. A study done in 2005 by Michael B. Rothberg in the journal Medical Care put a price tag on these problems, concluding that a nurse who had time to prevent a case of pneumonia "saved $22,390 to $28,505, or $4,225 to $5,279 per additional hospital day." When nurses prevent an adverse drug event, they save the patient from an "added 2.2 hospital days at a cost of $3,344." On the other hand, if understaffing leads to complications after surgery, the resulting patient stay can be 8.1 days longer than normal, adding nearly $11,000 to the total expense.

Unmanageable workloads have also created an exodus of nurses into other fields or nonpatient-care jobs. According to a study by L.J. Hayes that appeared in the Journal of International Nursing Studies, hospital nurse turnover in 2006 - outside of California - ranged from 15 to 36 percent per year.

A study by economist Joanne Spetz, just published in the nursing journal Politics, Policy, & Nursing Practice, finds that ratios in California have increased RN job satisfaction and reduced turnover. According to Spetz, nurses are happier at work because they now get to spend more time at the bedside - particularly on patient education - which has a positive impact on nurse turnover and thus on the quality of care.

Researchers at the University of Pennsylvania have compared nurses in California with those in Pennsylvania and New Jersey - states without minimum staffing requirements. California RNs reported greater job satisfaction, leading to less burnout.

Ratio foes claim that ratios will cripple hospital functioning and force ERs to shutter their doors, because not enough RNs are available to meet the new requirements.

The hospital industry in California cited similar dire consequences in its bid to thwart full implementation of ratio legislation. In 2005, however, the state supreme court found no evidence that any hospital or ER there had closed due to new staffing mandates as opposed to the usual reasons for a shutdown (poor management, precarious finances, and consolidation of several nearby facilities).

Easing the nursing workload gives RNs who have dropped out of the active nursing workforce an incentive to return and encourages those already employed to stay. In Victoria, the government lured more than 7,000 inactive nurses back into the workforce. In California, nurses in hospitals that have fully complied with the new standards say ratios have had the same effect and many of those who reported they wanted to leave the profession say they will now stay.

Further legislative inaction on the issue of safe staffing in Massachusetts will only prolong an unacceptable status quo that drives nurses out of their profession, leaving too many hospital patients under-protected. If we want there to be enough nurses to care for the waves of baby boomers who will soon fill our hospitals, the time to act is now.

Suzanne Gordon is co-author of "Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care."

If you need anything else to shove up your hospital chiefs ass print the following  links out.  I doubt the fuckers will read any of it because they don't care about patients or saving money. But it's worth a try.  You could always roll the articles up and use them to slap them!  There is a reason I am getting super militant about all this at the moment.  The only new staff we are getting are 16 year old "apprentices" because the hospital can get away with paying them £2.00 an hour.  They are terrible.  This will kill so many people and cost so much money as well. But the trust thinks it needs to save money on "staffing costs" so they replace real nurses with teenagers who cannot do even 1/10 of the job.   The regulation of HCA's won't help us because we have only 2 or 3 HCA's left.  Then we have a few staff nurses, and the rest of the staff is comprised of non nurse non hca apprentices.  Help help help.


Saturday 10 July 2010

Memo from Management to all Hospital Staff.

This was originally done by an American Nurse.  I sexed it up a bit to make it a bit more British.  Had to leave in the bit about the guns however.

As many of you may know, NHS District General Hospital is experiencing layoffs and financial problems. We can't possibly be expected to stop hiring managers and paying them huge bonuses.  And cutting trained nursing staff , doctors and other frontline clinicians to the very bone isn't making us enough money.  All Staff that haven't been made reduntant and dicked out of redundancy pay please read the following memo: 

To: All Hospital Staff

From: Management

Subject: Cost-Cutting Measures

Effective August 5, this hospital will no longer provide security. Each consultant will be issued a .38 caliber revolver and 12 rounds of ammunition. An additional 12 rounds will be stored in Theatre . In addition to routine medical duties, consultants will rotate through the car park and entrances. In light of the similarity of monitoring equipment, the ICU will now take over surveillance duties.

Housekeeping and physiotherapy are being combined. Mops will be issued to those patients who are ambulatory, thus providing range-of-motion exercises as well as a clean environment. Families and ambulatory patients may also sign up to clean the rooms of non-ambulatory patients for special discounts on their parking fees.

Ward clerks and secretaries will be  assuming groundskeeping duties. If they cannot be reached at his/her office, it is suggested that you walk outside and listen for the sound of a lawn mower, weed whacker, or hedge clipper.

Due to cutbacks in phlebotomy and laboratory staff, a policy has been developed that blood tests be performed only on patients who are currently bleeding.

The Radiology staff is being reduced and physicians are informed that they may order no more than 2 X-rays per patient stay. This is due to the turnaround time required by Boot's photo lab.

In addition to the overall recycling program, a bin for the collection of unused fruit and bread will be provided on each floor. Families, patients, and the few remaining employees are encouraged to contribute discarded food products. The resulting moldy compost will be utilized by the pharmacy for the production of antibiotics. Additionally, maggot infestation of the compost will be encouraged in an attempt to develop alternative approaches to wound care that don't involve time-consuming dressing changes that require RN's..

All staff will be issued with the uniforms of a Registered Nurse to ensure that each ward/department appears to have at least one RN on duty.  The general public will always assume that any member of staff caring for patients is a Nurse.  We will continue to capitalise on their stupidity.

Family members will be encouraged to scream and yell at harried frontline staff and pull them away from trying to keep patients alive rather than talk to someone who actually has the power to elicit change. 

This will save money in the complaints department and prevent expensive delayed discharges and bed blockers.  PALS is being combined with catering and they will be too busy making sandwiches to listen to complaints. 

We will continue to enocurage the public to directly sue doctors and nurses rather than go after managers who put professional clinicians in situations where they cannot function.

The dieticans will now combine with morgue staff.  By the time the lone hospital dietican makes his way to malnourished patients who cannot take regular food and require supplements, the patients will be dead.

All visitors and patients will be issued with at least 2 copies of the Daily Mail each day.  This is to ensure that they continue to accuse overburdened overworked and underpaid frontline doctors and nurses of being "overpaid, lazy, and uncaring" rather than blaming managment for lapses in care.  We have lifestyles to maintain.

Pharmacy will open for one hour on a Wednesday morning rather than just regular M-F office hours.  And they will still expect the Doctors and Nurses to abandon patients in order to bend over backwards for them because pharmacy staff is so "busy".

IV tubing lines are now good for 600 hours.  If you change the line before this you will be sacked for not being cost conscious.  If your patient gets septicemia as a result of bacteria breeding like Brangelina on said IV tubing you will be sacked.  You will then be replaced with a Patient journey flow discharge liason champion coordinator.  We have mistresses that require jobs with six figure annual incomes you know.

Any questions please contact someone else.

The Management.

Wednesday 7 July 2010

Job Losses

Thousands of NHS jobs are being cut despite Government promises to protect frontline services, a union has warned. The Royal College of Nursing (RCN) is aware of almost 10,000 posts that have been lost through recruitment freezes, redundancies and people not replaced when they retire, or which face cuts in the future. This is double the figure reported two months ago, although the RCN has now gathered details from more trusts......

I am willing to bet that most of these "job losses" come from qualified nurses at the bedside, providing direct patient care.  I know this is the case in my neck of the woods.  The trust hires untrained kids who have no intention of becoming Nurses to replace the real Nurses that flee.  The kids cannot do the job, and the qualified nurses left are covering too many patients.  The trust covers their asses by saying "oh yes we have hired more nurses".  They have not hired more nurses, they have hired kids and auxilliaries.

A trusted source tells me that a trust near mine has shed over 70 district nurse posts over the last few years.  This trust covers a pretty large area.  They lose them through retirement and "natural wastage" and don't replace them.  Registered Nurses are an older workforce and most of them are closer the retirement age than not. Newly qualified and job hunting older RN's are having great difficulty finding jobs at the bedside.

And so it goes.

Tuesday 6 July 2010

No opt-out: nurses told of 'moral duty' to save money/Christine Beasley: Bitch

Once again our esteemed chief nursing officer Christine Beasley is being a stupid government shill bitch.  I am really getting sick and tired of all the bullshit that comes out of the mouth of that fat cow.

I really don't see how we could possibly save the NHS any more money.  These fuckers are ruining professional nursing in this country by harping on about this crap rather than confronting the real problems. Patients often live or die by nursing care (who is actually going to give you the treatment your doctor ordered and monitor you for deterioration, chase your diangositic tests, fight with the doctor to get your pain killers etc etc).

Read the article. But more importantly read all the comments afterward.  My colleagues have said it all.

No opt-out: nurses told of 'moral duty' to save money News Nursing Times

Christine you are a shill and a traitor.  Find another way to save cash.

Patient Faking Seizure in ER

I am getting addicted to watching these. I am going to make one for NHS medical wards.

Sunday 4 July 2010

Dear Media (newspapers, TV, and movies):

Found this little gem on the web and thought it worth posting here.  Make no mistake about it; the media portrayal of nurses is killing people. 

A Letter to Hollywood:
Nurses Are Not Handmaidens
Laura A. Stokowski, RN, MS Posted: 03/12/2010

Dear Hollywood,

We, the nurses of the world, have something to say to you. Nurses are not what you think. Nurses are independent, highly educated, and skilled healthcare experts who save lives every single day. We work hard and are dedicated to making differences in people's lives. And we are really sick of going home after a 12-hour shift, turning on the television, and seeing ourselves depicted as brainless bimbos. This has been going on far too long, and it has to stop.

The Clown Took a Job as a Nurse

I remember a time when I was in nursing school, watching TV with my roommate, Liz. A skit came on, in which a famous comedienne of the day was dressed up like a clown. For some reason the clown had to leave the circus. "So," said the narrator, "the clown took a job as a nurse." We laughed at the absurdity of this, but I never forgot it.

We were in the middle of a demanding 4-year nursing program, and the suggestion that anyone, even a clown, could be a nurse, just like that, was wounding. I think it was then that I began to take notice of how Hollywood represents nurses. The answer is...badly. But it isn't just disrespect that comes through in Hollywood portrayals -- it's contempt, and it's not at all subtle. You scorn us in the way you pigeonhole nurses on the small screen -- it seems that we're either half-wits, nymphomaniacs, or latter-day Nurse Ratcheds. Obviously, you have no concept of nurses as autonomous, knowledgeable professionals.

We work alongside physicians, but we are their colleagues, not their subordinates. Yet in every hospital drama, physician characters are ordering nurses around, treating them like uneducated servants, or performing nursing care themselves and getting the credit for it, while the nurse characters just fade from view. I can almost hear your reaction to my complaints. There, there, dear, don't take it personally, it's harmless, it's funny. Is it, really? Will it still be harmless or funny one day in the future when you are in the hospital and you press your nurse-call button and no one responds? Or it is answered -- eventually -- by a minimally trained hospital "technician"? The nursing shortage will have reduced our ranks considerably, and driven many of us into early retirement.

It doesn't help the situation when schoolchildren and teens already discount the notion of becoming nurses because of the way nurses are portrayed on Grey's Anatomy. Becoming a nurse, they believe, is a waste of their talents.[1] Maybe You're Misinformed I'm going to give those in Hollywood the benefit of the doubt, and assume that they just have the wrong impression of nurses, and have no idea what nurses really do. But for the non-nurse readers, we'll pretend that you are in the hospital, and you've just had emergency heart surgery.

Who do you suppose will be at your side, watching your blood pressure, making sure you don't go into shock?

Who will be alert for the slightest hint of life-threatening hemorrhage?

Who will respond in mere seconds if your heart begins to beat irregularly?

Who will make sure that your chest tube doesn't get blocked and cause you to go into cardiac arrest?

Who will keep the circulation moving in your lower legs so you a clot doesn't develop and you don't die from a pulmonary embolism?

Who will be constantly watching to make sure that you don't stop breathing, that you are getting enough oxygen, that postoperative pneumonia is not developing?

Who will relieve your pain before you even have to ask?

Who will explain everything that is happening to you and teach you how to take care of yourself after you go home?

I'll give you a hint -- it's not your physician. It is your nurses. They will see you safely through one of the most dangerous times of your life, doing all these things and more. And just so we're clear, I'll tell you what your nurses won't be doing. They won't be clustered around the nurses' station as though at a cocktail party, flirting with physicians. They won't be in the broom closet or the stairwell or behind the patient's curtain giving sexual favors. They won't be trailing after the physician as he marches down the hall, in case he needs a cup of coffee or someone to dump on.

Nor will they be in the receptionist's chair, moaning about not being able to get into medical school. If these scenes sound a little familiar -- I'm not surprised. This is how nurses are regularly portrayed on television dramas. No Angels of Mercy, Please Hollywood, we're not asking you to glorify nurses. Don't turn us into heroes or martyrs. We just want to be accorded the respect, the esteem that our education, status, and profession warrant. We want our dignity back. We don't want the entire world to think of us as sleazy, dim-witted underlings. We want to erase the image of the "naughty nurse" -- this is your bizarre fantasy, not ours. We want young, impressionable children to view nursing as a viable, respected, and even admired profession, one they would be proud to call their own. But most of all, we want our patients to trust us and value our knowledge, so that when we teach them how to become healthier people and live longer, healthier lives, they will listen. This, our most treasured ability -- the core of nursing -- is what you threaten with your cheap attempts to increase ratings by ridiculing the nursing profession.

So my question to you is, is it worth it? Is the money you make from entertaining viewers with mentally unbalanced, sexually promiscuous, or idiotically subservient nurse characters worth influencing potentially hundreds of thousands of young men and women to shun a career in nursing? Will you feel content, even proud, the next time you encounter a nurse, in the thought that you regularly chip away at her self-respect and her ability to be effective in her job? Or will you infuse some realism into your tired stereotypes? You can start by discarding the following myths -- their demise is long overdue.

Myths About Nurses Perpetuated by Hollywood and Other Uninformed Media

1. Physicians are nurses' superiors in the hospital hierarchy- nurses "work for" physicians. Not true. Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians.

2. Nursing doesn't require much education. Nursing education is highly specialized, intense, and rigorous, because nursing itself is a profession grounded in science. Many people, if they believe nurses go to college at all, think that most nurses attend a brief 1- or 2-year program. In fact, 58% of nurses presently have a bachelor's degree or higher, a number that is growing every year. The "2year" nursing program doesn't really exist - the associate's degree in nursing requires prerequisites even before entering the nursing program, making it essentially a 3-year program. And in many areas, new graduate nurses undergo extended fellowships in the clinical setting that greatly increase their education and skill in nursing as they enter the profession.

 3. Nurses mainly "fetch things" for physicians. Nursing is a practice that is unique and distinct from medicine. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.[2] Nursing's focus, and what sets it apart from medicine, is the whole person, not just the specific, presenting health problem, and nursing encompasses both actual and potential health problems. Nursing's scope of practice has been shown in numerous studies to save lives and improve health outcomes.

4. Nurses are those who aren't smart enough to get into medical school.
This might be the most irritating myth of all. It presupposes that nursing is just a tiny subset of medicine, a fallback for people who can't quite make it up the ladder. However, nursing is a different profession, not the same profession watered or dumbed down.

Read more here:

And check this out if you can:  How the media portrayal of Nurses is killing thousands of people every year.  Not only is the public' s view of nursing completely warped, but the managers who run our hospitals are under the influence of these media stereotypes also.   This is why we don't ahve enough real nurses to care for the patient's on our wards.  And this is why the few real nurse's we have are forced to do everyone's elses job as a money saving exercise by the powers that be.


Thursday 1 July 2010

Out of the mouths of babes

I feel really bad for the decent cadets and health care assistants for writing this.  But the fact it is that many of them are not so good and should not be employed instead of Nurses.  They fact is that they will continue to be employed instead of Nurses.  Neither job seeking RN's who trained in the 70's nor new graduate RN's can find jobs on the wards. 

Here is the latest one from  the ward next to mine:

Patient became unwell in the night with..... let's say sepsis, very weak and has gone from able to attend to her own hygiene needs to being totally helpless.  This has happened very quickly.

Enter the auxillary, who has sat with the Nurse and "listened" to handover and all the information on these patients at the beginning of the shift. She  goes into the room.  I put the word "listened" in quotes because many auxilliaries, cadets and the like sleep through handover.  They just just get on with baths and forget everything else.

"You could wipe your bum yesterday, why not today?" says the auxillary to the patient.

I cannot convey how nasty and condescending she sounded when she said it.  A blog just cannot convey that.

The Nurse didn't know that this happened.  She was up to her eyeballs in drugs, orders, doctors rounds, discharges, emergencies, and admissions for her 15 patients while the auxilliaries were doing all the basic care unsupervised.  This is why we want RN staffing ratios to improve.  RN's all know that RN's must be involved with basic care.  This is true whether the RN trained in the 1970's under the hospital programs or in the 1990's under the hospita/university training programs.  It is the managers that do not understand this.

She found out when the patient's daughter came at her screaming and wanting to know how any "Nurse" could be so stupid and rude to her mother.  The Nurse gently explained that the auxillary "is not a nurse and doesn't have the knowledge but that is no excuse for what she said".    We have to say this to relatives a hundred times a day.

To appease the patient and her daughter the patient was transferred to my ward.  This is how I know about it.  I grabbed the non nurses (the only people I was working with that day, no other qualifieds) and I made them listen to me as I explained the patient's condition.

But the non nurses who come on duty tomorrow will again have a mini sleep during handover and the same thing may happen again.

Does anyone think it is funny that all these complaints about nurses being "rude"seems to coincide with the hospitals replacing real nurses with untrained people?