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".


uknurse said...

Dearie me, I really could have done with this leaflet on my last night shift......

Dino-nurse said...

Maybe you should forward a copy to the current Health Secretary :0)...I would certainly consider giving a copy to potential student nurses. we all feel your pain and I reckon that over the next few years things are only going to get worse :0(

Nurse Anne said...

Too harsh?

Anonymous said...

I think it is about time you retired - you can only deal with so much.....

Nurse Anne said...

Yeah yeah. Next post after the pamphlet one is going to be about compassion fatigue and why nice,caring, compassionate people turn into monsters-shells of former human beings after about a year of general medical ward nursing.

I have cut my hours right down and am doing something else now. But my one or two shifts a week keep me writing. So does watching the hair fall out of my full time and worn out colleagues

Anonymous said...

I'm about to apply to begin my training next September. Am I crazy?

Nurse Anne said...

Nursing is a wonderful job that I love when management fuck ups and the harshness of sickness and death do not overwhelm me.

Normally I would say do a year on general med or general surgery after you qualify to get good baseline experience before your specialise. That used to be good advice.

This has gone out the window. They will trap you there. And jobs are hard to come by whether you are a new grad, one year post graduation, or an RN of 30 years experience.

Work your socks off in school and go STRAIGHT to ITU, CCU, or another very controlled specialty. Stay away from the general wards.

Anonymous said...

i dissagree. patients get better and go home on general wards. icu is depressing and bitchy and unrealisitic. many patients dont make it and die long lingering deaths.
we all survived a year or two on the general wards. it was a right of passage and once you have done it.............well anything after is better. i personally dont like students comming straight into icu. it narrows their options.

on a another topic: relatives who phone the ward at 6am (just as i am drawing up the Cef and Met........) should be bloody shot. my best stratergy is give all patients their mobile phones and tell them to text their rellys regularly. I guess one of the best aspects of nursing is watching an old man: COPD, CCF, chronic renal failure, Ca, arthritis, skyping away to his wife who he has been married to for 65 years. I love to see how they adapt to technology and hardship and win through. I love their old brown suitcases, the brand new pyjamas (obviously nude in bed at home) the embarrasment about teeth, how they like to look in the comode after doing their business: just to see what they did, how they put up with dreadful tea and cold cornflakes for breakfast and finally get themselves into an old tweed suit and potter off home. they are SO brave some of them. I do like them, i really do

UCL Med Student said...

I find it so weird how doctors and nurses are like buses and trains completely having almost nothing to do with each other. All are helping people get into and out of the city centre, but with no real communication.

It's no way like TV where both doctors and patients know what's going on with everyone. :|

Dino-nurse said...

To the potential student nurse. I agree with Anne. ICU/HDU/CCU are the best places to work at the moment. Combined units have the happiest workers as just caring for ICU patients can be stressful. It would be better to get some general experience but you can do this during your training if you try to pick acute placements rather than community ones. If after 3 years you can stomach a general placement for a minimum of 6 months, try picking an elective surgical ward or a specialist respiratory medicine unit. Both are a good grounding for critical care. Alternatively working in recovery is also useful. Don't be put off as nursing is a wonderful career. Worst case scenario do as I did and use your qualification to travel.

Anonymous said...

"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"

Charming, absolutely charming.

Nurse Anne said...

Thanks anonymous. I often get told that I am charming. By patients especially.

You are right to imply that "circus animals" was a bad choice of words. Circus animals would probably be much easier to manage. A better description of these people would be "creature that came out of sigourney weaver's stomach in alien strung out on crystal meth".

I am not being mean. These are facts. This is how these people behave and it is how you and I will behave when our brains and bodies fail and we are walking a mile in their shoes.

My words do not imply that Nurses treat these people like circus animals or man eating aliens on drugs.

Patients may behave like that. But we manage the unmanageable the best way that we can. All the while remembering that they are human beings who were most likely kind, loving, intelligent people once upon a time.

Nurse Anne posts reality here and I will not sugar coat anything,hold back or lie in order to seem like the delusional public's unrealistic sweetheart ideal of a Nurse.

How the public can kick and abuse their Nurses over things they cannot control and then demean Nurses rather than getting a grip with the realities of life, sickness, and death like they do and expect compassion is beyond me.

Dino-nurse said...

Yup, unless you have cared for someone with end stage dementia or drug/alcohol withdrawal anonymous, you have no idea how they behave. I have seen a 6 stone woman throwing a fully grown man across the room when strung out on crack or PCP. I have also seen little old ladies manage to pistol whip nurses with a walking stick. Its not pretty. Unfortunately Hollywood would rather show people dying prettily in a flowery haze rather than the one on screen dies wetting/pooing themselves or choking on their own vomit/haematemesis. All patients who arrest on tv flatline and then come back to life with no ill effects other than a slight cough. The public at large have no idea about the reality of death and dying.

Nurse Anne said...

Had a detoxer run right over to a 90 year old woman patient in the bed across and spray hairspray right into her eyes whilst trying to gauge her eyes out.

I had to throw myself on this detoxer and try and use my weight to keep her on the floor. There were only two of us on duty for the whole ward. She tore a chunk of my hair out from my skull. As I was writhing in pain on the floor she grabbed a drip stand an launched it at another elderly patient. Then she peed in the middle of the hall. Tried to talk her down and she came at me with a fork. I am about 9 stone. She was a lot bigger and about 8 inches taller.

Normal day at work. It took two hours to get security up there and 3 hours to get a doc up there to prescribe something. Then he took off asap. I was left alone trying to keep this patient from attacking anyone else. They hadn't prescribed any chlordiazepoxide previously.

Did I get a lick of sympathy from the other patients who sat watching this spectacle? No. Even though I got the shit kicked out of me trying to protect them. I should have run for my life and let them deal with her.

They told me that I had better get her moved out of their ward or it would be my job. As if I could convince god to create a bed elsewhere that would accept her. And everyone knows that pyschiatry will not accept these patients because alcohol detox is not a mental illness.

Hospital management has told us to try and be more compassionate rather than dialing 999 on these patients. Fuck management. I called 999 6 times in one night shift because of this kind of thing.

The next day when I came to work this patient was still on the ward, still acting up. Turned out that her boyfriend had brought her some amphetimes when he visited. Management refused to pay for any extra staff or security.

This is not once in awhile stuff anonymous. I am on my way into work soon and am very likely to have to deal with this very thing once again.

Nurse Anne said...

Can you guys imagine what would happen if some pussy who works outside of acute health care had been subjected to an assualt like that at work whilst being responsible for people's lives?

They would have been of sick with stress for two weeks. Nurses are told to grow up,pull themselves together and get on with it.

Hell just the life and death responsibility without the assualt would probably have a secretary or a bank teller off for 6 months with stress and anxiety.

Nurses get told to suck it up.

Nurse Anne said...

I think Nurses should actually have proper counseling. If they did, there wouldn't be so much compassion fatigue (which leads to a lack of caring).

E said...

Damn, it's so good to be back and reading your posts Anne.

Anonymous said...

I was on night-duty with 3 staff-nurses, one only recent. One fat and sulky patient, wearing full make-up and varnished nails like talons, started going ape and shouting because "I don't want you to watch me take my medication". She was sharing a two-bedder with a little old lady who was having an op the next day but this selfish bully kept the light on all night because SHE wanted to read. The little old lady was too frightened to protest so she didn't get a wink of sleep. We had two emergencies that night and both patients could have died but even while I was rushing to get fluids and paging the doctor this horrible patient was still bitching. The stupid woman was too thick to understand that she wasn't the only patient who mattered on that ward and that there were other patients whose conditions were more serious than her own. The staff nurse offered to warn her to stop the verbal abuse but because she was nearly having a breakdown coping with the emergencies I couldn't ask her to do this as well. Some patients are just downright nasty.

Nurse Anne said...

I hear you anonymous. Some are nasty. Most are lovely but the nasty ones really screw things up for the lovely one. I have taken care of so many nice, sweet patients over the years who have had a hell of a time in hospital because of other patients who aren't so nice.

Mark p.s.2 said...

I do agree with your pamphlet.
It is a gift to be treated by hospital,nurse,doctor etc. not a right.
Though you and the medical professionals are confused as well.
The patient in the case of a mentally ill patient, can not leave the hospital, this makes the hospital room a jail from the patient perspective. They have lost their freedom. This is the likely cause of their anger, being forced to stay and obey medical orders.
If you have an "alert and oriented" sane patient who is abusive , they don't know they can leave?
Suggest they can leave if they are so upset/angered by the medical treatment.

Nurse Anne said...

People who are behaving like we are describing don't even know that they are in hospital or ill. They don't know who they are, where they are and they cannot comprehend what they are being told.

Mentally competent patients can self discharge. Some do most do not. But if they are unable to walk what will they do? If they self discharge against medical advice we are not allowed to arrange transport or anything. So unless they are well enough to walk out they are not going anywhere.

Nurse Anne said...
This comment has been removed by the author.
Anonymous said...

Mark p.s.2 wrote that "It is a gift to be treated by hospital, nurse, doctor etc. not a right."

I don't know where you're writing from Mark p.s.2, but in the UK health care is not a "gift", it is a public service paid for through the taxation system to which most of us contribute one way or another. Moreover NHS patients do have "rights" although clearly, as Anne's stories frequently show, many have no notion at all of the corresponding responsibilities.

Dino-nurse said...

NHS patients do have rights....
Yup, the right to demand methadone PRN (lol)...why would you self discharge to go back to your hovel when you can stay in an NHS bed with free food and drugs on demand? Does that sound too bitchy? There are times when I feel like a dealer. Poor old alcoholics- all they can get is chlordiazepoxide and multivits. Thats the real problem with medical wards- too many beds are occupied by detoxing patients (most unwilling to change so we just patch them up....again). ICU has the same problem- many of our patients are there either directly due to toxins or cigarettes, with the odd DKA thrown in to lighten the load. This country has always had a problem with drugs and alcohol yet we continue to make both readily available...its about time that booze and fags are taken out of the supermarket/corner shop and put back into specialist stores that sell nothing else and enforce an over 18 (or even over 21) policy. Personally I don't care how many small shop owners moan about this, if the culture changes then their lives will be easier. As for illegal toxins- how about a zero tolerence policing for a change? Oh but its only a spliff officer and it doesn't effect my driving...yeah right. Allow me to show you the latest hit-and-run victim in resus, moron. I would also string up (literally) all those who think the same about talking on their mobile whilst driving.

Mark p.s.2 said...

I had not read the comments here describing out of control patients.
If psychiatry won't take them (they are not mentally ill), logically it means the patient is a citizen being a criminal ( accused criminal until proven in court) if the patient goes beyond verbal abuse to physical attack.
I would put the out of control patients on a jail-hospital ward where security was quickly available if they acted up.
Charge them with a crime if they are not mentally ill.
But the prisons are full...?

Anonymous said...


I still think you are a little confused. Patients with infections often become extremely confused and disoriented. The confusion and bad behaviour stops when the infection is cured. That is why their delirium is considered part of a medical illness to be dealt with by medical doctors. What can a psychiatrist or jjail do for an infection?

UCL Med Student said...

Still waiting for part 2, Anne:D

Anonymous said...

Anne - where are you?!?

phatboy said...

Just a thought, but maybe you should direct all of that anger at the hospital management rather than your patients/clients/guests.

Nurse Anne said...

Well PhatBoy I don't think there is a thing in the world that management can do about people actually being delusional.

But maybe the public could direct their anger about their delusional ideas not being met at management instead of frontline staff? Just a thought.

Anonymous said...

Another memory which will never go away-As a junior nurse on a Central London Hospital ward.. A patient was being 'specialed' by a RMN on my open ward..???.
During the course of the shift as the patients aggressive mood escalated he got hold of and smashed a glass bottle(why was it there?) to threaten an nearby elderly patient with.
Everyone on this 'Nightingale ward' patients was exposed to this event and therby everyone was at risk. The targeted patient was terrified and so was I.My mask was well honed at this stage and I intervened .The male RMN did nothing and security were called. The male security staff eventually came up but did nothing but watch me continue to talk the patient down. In hindsight I was frightened and shocked but showing no emotion and not getting any proactivity from the senior (and only other) nurse to address the situation I abandoned the drug round I'd started an hour ago and instigated this patients immediate transfer of that ward. It did happen, dont know if it would now? No one asked me if I was ok, no-one.Just another one of hundreds of experiences we take home everyday.The complexity of the problems within the 'team' working and structure of the NHS are too overwhelming for me to think about at times and as has been said -is actually soul destroying. More recently what I experience more and more in central London ward working is the continuing lack of communication and blatant lack of willingness to work amongst some colleagues.. The NHS heirachy and silly attempts to break heirachy which makes it worse and allows abuse and bullying to flourish.The abuse of the word 'bullying' and 'discrimination' which allows extremely poor performance and to go unaddressed.etc etc etc Reading Nurse Anne is extremely empowering to us on the shop floor.Thank you for giving nurses a voice addressing some of the real issues faced by us everyday.
The scenario I described above is one of hundreds I have felt alone.Support wasn't forthcoming from mangers, colleagues, or the public etc That day I had to fight to protect that patient, other patients, myself, my colleages and the visiting public. I had never been trained to deal with that occurence, my collegue at the time basically tried to ignore it probaly through fear and I never received any post support at all.On reflection these events affected me mentally, spiritual , and physically and not much has changed. Nurses continue to be a conduit for abuse for all sections of the NHS society and its never discussed.That incident happened about 12 years ago. My burn out is coming on me again so to actually read and see the reality of what is going on in black and white print in Nurse Anne blogs (and what is discussed here is
just the tip of the iceberg) is a relief ! The identification I glean here is appreciated.Grateful thanks .Nurse Anne - To be admired.

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Anonymous said...

Thank you for your comments "Why aren't UK hospitals staffed by only qualified nurses"! What a nice, kind-hearted person you are! I work as a health care assistant in a large UK hospital and have been well-trained to do the duties that I do, thank you very much! So don't belittle me because I am not one of your precious "qualified nurses"! The only real training comes on the wards anyway, and not sitting in lectures meant for medical students that nurses do not have high enough IQs for! For that matter, why don't you take a few classes to improve your spelling - I have seen many incorrections. You are just a pathetic, little jumped-up bully, aren't you?

Anonymous said...

"The only real training comes on the wards anyway, and not sitting in lectures meant for medical students that nurses do not have high enough IQs for!" This petty comment clearly demonstrates how some healthcare assistants feel jealousy and resentment towards student nurses. The theory underpinning treatment is just as important as hands-on care. This is the problem, that healthcare assistants do not know exactly what students learn in University lectures nor do they understand how vital this knowledge is.

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