Friday 29 October 2010

Dense Doctors

That title may sound a bit harsh.  I know that our doctors are very intelligent when it comes to medicine.

But apart from that they seem to know sweet fuck all.

This is especially true when it comes to what is going on in the wards.  It is true in regards to Nursing.  If  Nursing care goes bad  medical orders do not get carried out  and patients do not get monitored.  In short the doctor's whole plan of care goes out the fucking window. 

You would think that they would be a little more......well.....interested.

But no.  They are delusional.

This is what I have learned about doctors in over a decade of Nursing.

1.  They think all nurses are the same person or clones of the same person with a hive mind.

For example, if the Nurse on the shift before you missed something, it's your ass if you are the one on duty when doc graces your ward with his presence.  If you are forced to float to a specialty you never worked or trained in before the doctors expect you to telepathically mind link with absent Nurses who have experience that area the minute you arrive on the ward  They will not bother to write their orders or give you a heads up about things you need to know and wouldn't know unless you have experience there.  They won't bother with any of that yet they'll go apeshit later when you forgot to remind them to prescribe something. Remember that they think Nurses are all the same drone with a hive mind who know each Doctors' individual ways.
2.  They have no idea how to implement their own orders, or how time consuming and complex it is to implement their own orders.
  Don't even get me started on the bullshit with the IV meds....both getting a hold of them and actually preparing them.  Or fighting with pharmacy, equipment library and path lab.  No Doctor they do not just keep everything on the ward for us.  No they do not keep chest tube kits in a place where we can get them etc etc etc.

3.  They have no idea how to work the system as a result of the Nurses doing it for them.

 They don't understand why things don't happen instantly.  For example, all RN's know it takes 6 weeks to get a patient into a Nursing home and that nothing can be done to speed this process up.    Yet day after day the medical consultant walks in the very afternoon after he wrote that 90 year old Mabel can be discharged that morning and wants to know why she is still on the ward.  Then he goes on a rant about how the Nurses can't be arsed to discharge patients.  I could go on and on about this one, there are thousands of examples.

4.  The saddest thing I learned about doctors and the crux of this post is that doctors are not able to distinguish between Nurses and ward assistants.

There are many times I am running my ass off trying to give a 150 IV meds all due now whilst the HCA's/cadets/auxiliaries are hanging out at the Nurse's station.  The few jobs they can do are complete. They cannot help with the large proportion of the workload that only an RN can handle.  Many doctors will walk onto a ward, take a look at the assistants hanging out at the station and exclaim "The Nurses don't seem to busy today".   Dickhead. I am the only Nurse, and I am on my knees completely overwhelmed.  What the assistants are doing (or not doing) is in no way indicative of how busy the Nurses are!  Assistants are not Nurses. 
Sometimes I will be 3 hours behind getting much needed drugs into patients and managing other patient problems and some young doctor will stroll onto the ward and ask me to hold an arm for him so that he can draw some ABGs.  For god's sake, grab one of the assistants hanging around the Nurse's station for that.  That is something they can actually do.  Don't delay Mrs. Smith's pain relief any longer by causing me to stop and hold an arm!!   It's not like the care assistants can give the meds and handle the Nurse stuff while I am tied up holding an arm for you!

A doctor walked onto my ward and wrote some orders for IV fluids and IV antibiotics for a patient with Pneumonia.  As the only Nurse for all of those patients I was tied up and didn't see him arrive or know he wrote any orders.  He handed the chart with his orders to a care assistant and left the ward.  The care assistant has no idea about orders etc.  She put the chart down on the station where it got immediately buried.  And she said nothing to me.  I had 25 patients that day (a staffing ratio no Nurse can function well with)  and it was taking a hell of a lot of time to see everyone and process their orders.  It was 3 hours before (by luck) I found the chart and the orders.  Patient was in septic shock by that point.  Doctors, you need to tell the actual Nurse about these things, not some underpaid teenage assistant that you have confused with Nursing staff.

Then there was the doctor who started yelling at me for having 4 bays full of patients rather than one!!  "That is too many patients! You should have one bay per Registered Nurse".  Yes Sherlock, no shit.   I appreciate the fact that you have actually noticed that the RN ratios on NHS wards are horrible and dangerous and that this has a dire effect on patient care. But what the hell would possess you to think that they Nurses on the ground have any say in how we are staffed or how many patients we have?  Even the ward Sisters are not allowed to have a say in how their wards are staffed.  Duh.

I could go on and on.  These doctors are clueless about what is going on with Nursing care and RN staffing on the wards.  And frankly, I am getting sick of it.

My cousin in law is a doctor in the USA.  He is not as dense as his colleagues here.  If he finds out that his patients' RN's are being forced to take on more than 4-6 patients at a time he gets on the phone to MANAGEMENT and starts screaming. He tells management that he will have his patients pulled out of there by the end of the day and admitted somewhere else if they do not staff the facility properly.

 He doesn't care how compassionate or knowledgeable or wonderful the Nurses are in that place.  He knows that with poor staffing ratios that they cannot function even if they are wonderful.   The facility would lose a ton of money if he pulled his patients out of there so they wouldn't dare short staff the place.  They did it once, never again.  Managers of hospitals all over the world think that intentional RN short staffing is the way to save cash.   

He is a good doctor, and understands that without decent Nursing care delivered by RN's the patients are screwed.  He understands that there will be nothing in the way of decent Nursing care in a place where Nurses are denied resources and safe staffing ratios.  And he acts on it. 

But it seems it is too much to ask for UK doctors to even understand what a Nurse is, let alone stand up for them.  They haven't even grasped the notion that these Nurses are taking on too many patients to be able to care for anyone properly, and that they are being forced into a position where they cannot spend two minutes demonstrating compassion without risking a disciplinary for not filling in paperwork.  Too bad.

Friday 8 October 2010

Holy Shit

Not content with forcing RNs to take on more patients than they can handle, recruitment freezes, pay freezes,  and hellish working conditions that would cause most people to collapse from sheer fucking exhaustion the powers that be have come up with a new plan.

Already the working conditions are so chaotic that it is usually impossible for the RN's on my type of ward to take breaks.  We stay over late at the end of a 12 hour shift unpaid and still cannot manage to keep up with paperwork. We do the jobs of pharmacy, portering, social services etc and are held accountable for their faults.

But I guess that is just not enough.  I will post the entire article here.

Nurses told to work for free to save their jobs

By Ryan Crighton and Catriona Webster
Published: 06/10/2010

Nurses are being asked to work extra shifts for free to save their jobs – as health boards across Scotland spend up to £30million hiring agency staff. Almost 4,000 NHS jobs, including more than 1,500 nursing and midwifery posts, will be axed this year due to cutbacks, according to Health Secretary Nicola Sturgeon.
But last night it emerged that the country’s 14 health boards have set aside a combined £30million for temporary nurses and theatre staff over the next four years.
NHS Grampian hopes to save £385,000 by asking staff at Aberdeen Royal Infirmary’s surgical unit to take on one more shift each month – for no extra money.

The agency staff contract, which has just been awarded, will see nine firms provide workers to fill staffing gaps as health boards – including NHS Tayside and NHS Highland – deal with the spending crisis in the public sector.

The contract will last for two years, with the option of extending it for two more.

Last night the Royal College of Nursing (RCN) Scotland raised fears that the deal could reverse efforts to cut reliance on agency workers.

RCN associate director Norman Provan said: “Nursing teams have led the way in recent years by changing the way in which their work is managed so that reliance on costly agency staff has been reduced. As health boards cut costs by not replacing staff when they leave, we will be monitoring them to ensure they do not reverse the trend of recent years and begin relying too heavily on agency nursing to fill the gaps.

“If health boards do realise that they need to fill the gaps created by their unsustainable cost-cutting tactics, they must recruit additional permanent staff in the best interests of patient care.”

Labour shadow cabinet member Richard Baker added: “It looks like different parts of the NHS are not talking to each other. When NHS Scotland is spending £30million on a contract to provide agency nurses it seems ridic-ulous that NHS Grampian is asking their nurses to work an extra shift for nothing.”

An Aberdeen company is one of the nine firms which will share the contract. H1 Healthcare Solutions – which trades as PCSG Healthcare – said it could take on up to 250 health workers during the duration of the deal.

An NHS Scotland spokes-man said the contract replaced an agreement which was about to expire. He said the number of agency nurses being used was falling, and that trend would continue.

He added: “Whilst agencies will always have a role in providing supplementary staff, this only supplements internal efforts to meet the staffing requirements.”

The RCN has also voiced concerns about NHS Grampian’s plans to share an extra 188 12-hour shifts between its nurses. It is understood that nurses in the surgical unit at ARI would receive an extra 15 minutes unpaid break per day to compensate for the extra shift.

One angry ARI nurse, who did not want to be named, said: “Everyone is unhappy about these changes. We’ve been asked to meetings but the feeling is: if we contest it, they won’t care. We’ve been given 90 days to comply.

“They are trying to save money but the added pressure is all on the nurses, it’s coming out of our pockets. We are being asked to work for nothing.”

Another said: “The thing the nurses are worried about is patient care. We already have skeleton staffs because of the recruitment freeze, so we don’t get our breaks.”

Colin Poolman, the RCN’s local officer for Grampian, said members were furious about the plans. “This change in working arrangements is clearly to the detriment of our hard-working and over-stretched members who are bearing the brunt of the cuts being made by NHS Grampian,” he said.

Tory health spokeswoman and Highland MSP Mary Scanlon said the plans were the first time she had ever heard of a public body asking staff to work for free.

A spokesman for NHS Grampian said the measures will help secure jobs.

He said: “The proposal is to move from 13 to 14 shifts in a month in the surgical one division of ARI. It will potentially save £385,000 which is very important in the current financial climate. The alternative would be to employ fewer staff.”

The fuckers can have my job.  Fuck them.  I'd also like to point out something.  When we do get agency Nurses in from the outside it is a disaster.  A Nurse simply cannot handle taking on a massive patient load on an acute ward unless she is there all the time.  It is like running.  If you stop training for that marathon, you just won't be able to keep up.  We have had a few disasters lately at my trust because of agency Nurses getting thrown in as the only qualified.

Meanwhile back in my neck of the woods the matrons are threatening ward staff nurses with sacking if we  don't get our fingers out and make sure that the insane amounts of ridiculous paperwork is completed.  According to them, any bad care that occurs is a result of Nurses not doing paperwork. 

I recently had a patient fall out of bed.  I wasn't  watching him at the time because I had two other bays of patients and a side room.  I was also running around the hospital looking for the "bed rail assessment" paperwork forms to fill in for him so that I don't get sacked.  You would think that if they want us to fill in these forms like they are holy then they would provide each ward with enough of the actual forms.

When one of my colleagues didn't complete her paperwork because there was none on the ward she was told that she should have left her patients and searched the other wards in the hospital.  Not something that one can do if she is the only RN for 15 patients.

What are we?  Fucking Slaves?  The government is cutting pay, cutting jobs, and cutting benefits for people from whom they take the pay and jobs.  I suppose soon they will be counting us as 3/5 of a human being and loaning us Nurses out to work for other trusts  for a fee.  And they will line their pockets with that fee.

Oh Massa Oh Massa...please don't send me down da river to work  staff'dshire. Please Massa, I dun bin a good Nursie, don't send me down da river. Don't separate me from my man and my little chilluns Massa.  Oh Lord Jesus Massa hasn't I dun bin a good Nursie yes I has Massa. Oh jesus oh jesus

Seriously guys if they get away with this shit things are going to SNOWBALL. It seems like we won't be eating if we don't put up with slave like conditions, and having recently worked a 14 hour shift without being able to take a break I am really feeling a bit like I am not considered fully human.  Maybe just 3/5 of one.
Thanks to grumpyRN for alerting me to this story anyway.

Thursday 7 October 2010


Hi Everyone,

I know I haven't been blogging much and I apologise for that.  I have been really busy lately.  I may just take this blog off the net for a few more weeks.   I am not being "got at" or anything.  I am just being careful.  You can always email me at