Thursday, 30 December 2010

Things I would love to say

Just once I would like to tell these patients and relatives how it is, without worrying about getting fired.

Why? You ask....

Because I get fed up with relatives who think that Nurses are in some kind of position to stop and chit chat.  The only people who have time for that are support workers and they can usually be found gossiping at the nurses station, wearing almost identical uniforms to Nurses. I am sick of the constant hammering we get from these people who don't seem to realise that we have a job to do or that there are people dying all around us.  We don't have time to explain things to them properly.  They don't have enough medical knowledge to understand what they are being told.  They stop every single random member of staff that they see (all of whom are going to view the patient's situation from a different angle-if they know the patient at all) and demand information. 

Then they accuse the Nursing staff of telling them "a different story".  It is a medical ward full of older patients.  These people are going to have one medical problem after another...sometimes the pneumonia is the biggest problem.  Sometimes renal failure is....Just because the patient was ?UTI on admission and we are now focused on her anemia does not mean that the staff is "lying" to you about "what is wrong".  She's a medical patient for Christ's sake.  They are never EVER simple, cut and dried. The diagnosis, prognosis, plan of treatment etc change faster than Tiger Wood's girlfriends. Most elderly people will be in their own waste, and in a real bad way of they are left unsupervised....leaving them to tend to other patients and duties is something every nurse has to do no matter how caring she happens to be.

For once I want to be direct and say exactly what I think in my sweetest little sarcastic baby doll voice. Or maybe just in a very matter of fact voice.

I take a big risk on the back of my patients by answering the phone at all.....many of my patients should not have been left for me to answer the phone.  I could get in big amounts of trouble if something happens to a patient and I don't catch it because I am answering relative enquiries.   Instead of being grateful to the Nurse for taking such a risk and leaving her patients to deal with stupid questions, all these relatives do is bitch about how long they waited to speak to someone.  Yes, there should be a member of staff who can update families without neglecting patients to do so....BUT THERE ISN'T.   And it isn't the fault of the Nursing profession.  We don't have any say in how to staff the ward.  No not even the sisters and the matrons get a say on that.

Thanks to hospital dramas the public has an unrealistic, ignorant and very unfair expectation of what they can expect in the hospital.  They don't understand what it means to share their doctor and nurse between multiple other patients.  They have no understanding of the true nature of prioritization. They don't understand why or how doctors and nurses prioritise as they do.  They refuse to acknowledge or accept that old age is a multi faceted  terminal illness that cannot be cured.  They refuse to accept that old age, sickness and death is crude, sad and ugly.  And they deal with it by lashing out at caregivers.

I had the most sympathy and empathy in the world when I started out. But the facts are this.  Even the most compassionate Nurses are having their caring natures sucked right out of them after more than a few months of Nursing.  I have seen some of the nicest people become Nurses.....only to become stone cold automatons after 6 months on the job.  It happens to most of them.   At times I have felt that I could walk past a bus full of children on fire and not bat an eyelash.  That is how bad burn out is.  When my grandmother died of the usual old age medical problems, in the usual old age medical way....I felt nothing Nothing.  I just shut down. And we were very close.  I think we survive working in health care by shutting off.

Sigh. Things I would love to say and get away with.  Management wouldn't back us up.  I have been told by managers "yes you are right and you did right but the relatives would never be capable of understanding this issue nor will we accept liability so we have to apologise and let you take the blame".

 I never would say these awful things because I constantly remind myself that patients and relatives DO NOT HAVE A CLUE and live in a fantasy world.  They mean well.  But their emotional state and ability to reason is usually not good. But at the end of a long day I cannot help thinking these things.

Here we go:

"I am so sorry you were on hold for 15 minutes when you phoned to call about your mother. This is an acute medical ward you see, there are sick people here. Actually, I was in your mother's room taking care of her when you called. She is having trouble breathing and we are trying to prevent her from getting re-intubated. I didn't think answering the phone was priority over that, but I know for next time that I should stop taking care of her, come to answer the phone and chit-chat with you for 15 minutes answering all the same questions I answered for your brother an hour ago  while she goes into respiratory failure and dies. I now know what is important here, thank you for reminding me. Oh and you called 15 min before and your were put on hold then as well.  Yes you are soooooo are right to imply that the patient I was taking care of at the time doesn't matter either.   My sincerest apologies. Next time I will know better.  Thank you for making me a better Nurse and showing me what is important."

I am sorry you do not like bariatric bed and feel the need to ring your call bell every 5 seconds to tell me this. I am sorry that you feel like your bariatric bed makes you stand out in the bay. Maybe you should have thought of this before you let yourself get to 30 stone thus requiring a bariatric bed.

You see honey, when you ask me for an blanket, water, whatever after I'm in the room, I am going to have to LEAVE the room to get the blanket, water, whatever. Trust me - I don't have one shoved down my cleavage just it case you want one. And management are not going to let us store them somewhere convenient or even allow us to have enough of those things for all the patients.  I am going to have to walk past 2 bays of people shouting for help just to get you more stuff.  If I stop to help them you will be waiting a long time. Yes, you miserable bitch, you are welcome.

Flashing your police badge at me will not make me let you up before visiting hours. Your wife is not dying, in severe pain, or a post op, she is sleeping.  Your constant demands and inane questions over and over again will seriously impair my ability to care for your wife and my 12 other patients. And from what I can tell she is probably happy to get away from you for a night seeing how rude, annoying, and belittling you are.

I'm sorry that sandwich the kitchen gave your husband expires today but I do have 7 other patients I want to at least eyeball to make sure they are alive and breathing before I hunt down some more food for him. No I'm not going to "just take a pudding" from the bereavement cart across the hall for you. Their family member is dying and you are absolutely ridiculous.

How could you not know that it is illegal, immoral and unethical for a health care professional to give you private information and test results about a patient over the phone?  Even if you are family, and the patient is out of it I can get fired for giving you private information.  Neither the hospitals, the doctors or the nurses make these rules.  We just have to follow them.  And my job isn't worth it.  What would posses anyone to call an ask the Nurses these things anyway?  Why would you do this rather than arranging a conference with the medical team?  You need a fucking psychiatric referral.  Unless you are brain dead you must know that we can lose our jobs for violating confidentiality.  Do you really think I am going to risk the loss of my job and home for you when you could get off of your fat ass and get the information you need just by contacting the medical team of doctors who will actually diagnose and treat you rather than harassing the Nurse and delaying the care given to other patients? I cannot read the doctors mind, or their handwriting.  And if I am at the nurses' station reading notes so that I can answer your queries I'll have like 50 dignity champions crawling up my ass accusing me of "ignoring patients and being too focused on paperwork".

To family members: Just because you call out and say, "Nan has to go RIGHT NOW," does not mean that I can come and help her to the bathroom RIGHT NOW. Believe it or not, I am not going to leave my new patient with chest pain, just because Nan needs to pee. If Nan were my only patient, I would be by her side helping her all day.  BUT SHE ISN'T MY ONLY PATIENT.   This doesn't mean that I don't care about your nan or do not like the idea of dealing with pee.  I do not know of a board of Nursing that exists in any country that wouldn't jump at the chance to strike off a nurse for leaving a chest pain patient to help another patient to the toilet.  They would fall all over themselves to strike off a Nurse who did that.  I am serious.  If Nurses don't prioritise people die.  Better to get in trouble for leaving someone in wee than to get done for manslaughter.  If you don't like this view, it may be time to consider hiring a one to one private duty nurse for your loved one.  And yes I am at the Nurse's filling in paperwork whilst your dad needs the loo!  You know why?  Because the patient in the next bed is bleeding to death.  The doctor has ordered a blood transfusion.  And the fucking path lab will not give me the blood unless they get their fucking paperwork.  I need to get it done and faxed before I take someone to the loo.  Otherwise I might find that my patient has bled to death because I delayed his paperwork and connsequently his blood transfusion by taking people to the toilet.  I don't want that on my shoulders. Yeah go ahead.  Jump up and down and scream because dad needs the toilet and his nurse is at the station faxing blood order forms.  Temper tantrums and nurse abuse are easier and more fun than thinking and understanding aren't they.

To the patient I discharged last week: Please don't call the ward to ask me for health advice. You are not under my care any more, and I am not allowed to give health advice over the phone FOR SAFETY REASONS.  Your notes were gone from this ward 10 minutes after you were out the door and I wasn't even on duty when you were here. Even if I know the answer to your question, the most I will say is "Go to your GP or to A&E," to cover myself. I'm sorry if that makes you angry....maybe you should have kept that follow up appointment with your doctor we made for you. 

To my angry patient: I'm truly sorry that you had to wait for two hours for pain medication last night. The Powers That Be at my hospital have decided that "no one will notice" if they cut staff at night. Sure you can complain about the nurse, but I know for a fact that she was doing the best she could. Maybe you should direct your complaints towards the management, instead of the nursing staff. Maybe if patients directed their anger towards management  in the first place our hospitals wouldn't be such a fucking mess and this kind of shit wouldn't keep happening. 

 STOP GETTING OUT OF BED. That annoying, high pitched loud beeping sound is going off because YOU'RE GETTING OUT OF BED.  If you fall I will have to do about 6 hours worth of paperwork, neurochecks, send you for a CT head etc.  That is going to really screw my other patients.  I wish I could be there to help you everytime you want to get out of bed. Unfortunately I am being forced to be responsible for 20 other patients that are too sick for a general ward all by myself.  No, the social workers, support workers, and phlebotomists cackling away at the Nurse's station are not "nurses who are ignoring you."  They are not nurses, and they aren't going to help you while I am tied up with the man across the hall who just pulled his dialysis tessio out and his bleeding profusely.

Stop bending your arm.  For the 500th time. That annoying high pitched beeping sound is going off because you are bending your arm causing your IV line to occlude.  No I cannot just "shut it off".  It is heparin for Christ's sake.  Do you want to die?  Just keep your arm straight.  That is all you have to do.  That is all you have to do.  If you keep bending that arm and then screaming at me because the IV pump alarm is beeping I am going to go into the treatment room and inject my veins with something that will kill me.  Then who are you going to bitch at?

 No, that person constantly with your roommate is not a private nurse the hospital is providing because we "like him better". It's security watching him at all times to make sure he doesn't try to kill himself or attack staff and other patients again.  He already gave a medical doctor a fractured skull when he was brought in for an overdose last night. And then he tried to jump on top of a patient and smother him in AAU. ( telling the patient this would violate the confidentiality of the combative patient, therefore I have to put up with the moaner complaining that he doesn't get a "private duty nurse" because " we don't like him").  The I have to put up with the family calling 10 times a day wanting to know why the other man in the bay gets a "private nurse" but not dad".

These are the drugs the doctor prescribed for you to make you better.  If I were really trying to poison you, you'd be dead already.

 If your pain is a 10/10 and you are asleep, or talking on the phone  complaining about the food. we need to clone your DNA for our race of superhumans we're working on down in the lab.

 Yes, it is your fault that your baby was born at 28 weeks. It had something to do with the crack you were smoking.

Yes, I did go to University to do this.  No that does not mean that I am "just like a wannabe doctor".  Degree nurses are prepared to work on the wards as a direct care Nurse.  They are not any closer to being a doctor than an old style training Nurse. A person needs to be pretty on the ball and knowledgeable to deliver the health care prescribed by doctors.  And that is what nurses do, we deliver health care. No, I do not think I should go back to school and become a doctor. Delivering health care is tough enough.  I have no interest in prescribing it.  If that makes a person stupid then so be it.

I will not get you another glass of water because you threw the last three cups I gave you at me.  Three strikes and you are out. You are not confused or suffering from dementia therefore you can't get away with it.  Yeah go ahead, call your daughter and tell her we are trying to kill you via dehydration. Remember when you pulled the central line out that we needed to infuse IV fluids into you?  Here is the phone.  You will look like a tit. She knows what you are like. And if you can go out to smoke every 10 minutes you can get your own water anyway.

If you are going to refuse to comply with any treatment recommendations given to you, you will keep getting sick, and I will continue having to deal with you. It's not a conspiracy against you, trust me, we're sick of you.

 You're crazy and so is your family. We can't wait for you to go home either. Unfortunately, the consultant decides that, not us.  And it is going to take him 8 hours to get here. Then it's going to take 4 hours for the junior doctor to prescribe your discharge meds.  Then it will take another 4 hours for pharmacy to actually dispense the meds.  And then I have to find time away from critically ill patients to go over your meds with you.  I cannot make this process go any faster.  Please stop bitching at me.  It makes me want to kill myself.  It is hard to have no control and yet have to listen to your constant whining for 12 hours.  So help me god, I'll hang myself in the treatment room if you don't shut the fuck up about how long it is taking for you to get discharged.

Get off your fucking mobile phone.  I have a grand 46 seconds with you to make sure that your blood glucose is stable and  get your prescribed drug regime that is due now into your system before I have to run back down the hall to make sure to implement the doctors' orders for that patient who is going downhill. I will be stuck at his bedside for hours once I get there and there is no one else to cover you or my 10 other patients from that point onwards .   Lets make sure that I use this 46 seconds to make sure that you and my other 10 patients are stable and alive because I won't get another chance to check on you.  And no I am not going to make you a cup of tea because that will take 30 seconds thus leaving only 16 seconds to eyeball and action my other patients before I head back down to the deteriorating one, who I never should have left in the first place.

If you're in here for "COPD exacerbation", getting regular ativan because you're "nervous" because you can't breathe, maybe you need to stop going outside to smoke a pack of cigs every day. I'll give you a nicotine patch, but I won't help you go kill yourself, so feel free to "report me to the doctor" for not taking you out to smoke at 3 in the morning -- and if you DO go out, I'm taking your  nicotine patch off, I don't want to have  you collapsed on the floor for no other reason than you wanted a buzz.

How can you be so nice when your family are so feral?  And my god, not only are they feral but they are stupid too.

This isn't a hotel and despite the uniforms we are not your maids/servants. We cannot wait on people and do our jobs at the same time.  And if I don't do my job people die. This is why I am NOT coming into your room every two minutes to change the TV channels. If I could do that for you I would.  But I can't.  If you think that this means I am mean and uncaring, you are a tit.  Anyway, if you can go outside to smoke every 6 minutes why do you need the nurse to change your TV channels? And no, I do not need a lecture about treating people like people and not numbers from someone who killed 3 people in two different accidents as a result of drunk driving.  If I can't get in here to change the channels for you then I can't get in here to change channels for you. Deal with it.  Maybe if you didn't watch so much damn TV you would not have such stupid ideas about what Nurses are here and able to do.

 Hell yes I took your father back to his room and shut the door in his face. I did, and I would do it again. He was looking in other pt's room's (females) while they were undressing.  He came in to a room to stare at a woman I was catheterizing.. He's alert and oriented, and able to walk and he knows how to use the call light, and he has no right to go into other pt's rooms and stare at them.

She accused me of making him feeling like a peeping tom..


But I didn't have the heart to tell her so.

Your complaints about 'the service' I am giving you aren't going to get you anywhere because I CAN'T HELP IT. There are 2 of us and 30 of you!  The goddman cadets sat at the station in their "just like a real nurse" uniforms aren't going to help! Here I am rushing around like crazy- you see me flying up and down the hall- and you, an alert, continent, and fairly able-bodied person, have the nerve to make whiny little passive-aggressive comments about how long you've been waiting for 'service'. All because you are jealous that the other man in your bay was getting constant attention!  He is a head injury requiring 15 minute neuro checks.  People like you are what is going to crash the NHS.  YOU. Not immigrants, single mothers and "overpaid" doctors.

To the adult son of the little old lady who just rolled onto the unit a little while ago....why no, there isn't a phone in this room, which I hadn't noticed because I've been too busy making sure your mother's pacemaker is capturing, that her incisions are WNL, that her observations are stable, that her pain is controlled, and that I can hear breath sounds on both sides. Sorry you were calling and calling and nobody was picking up...I guess I should get my priorities straight, huh?   I pity her for having you for a son.

I am a professional with a degree. Two of them, in fact. I am likely more educated than you and was also one of 70 accepted into a nursing school program with over 400 applicants.   I got you a blanket because you said you were cold and I had time to hunt one down.  I made some cups of tea for you guys because I lucked out this evening with all stable patients on very little drugs and drips. This does not mean that you should assume that I have nothing more than a high school education since I gave your good "service".  I actually am one of those degree nurses that you seem to detest. And I would love to tell you that. I would also like to tell you that you are a douchebag.

I am just the person who checks your blood sugar and administers your insulin according to the results. Why don't you get pissed off with yourself instead of me when I have to call the doctor about your blood sugar of 23 mmols.. I guess you think I have amnesia and don't remember that you already told me off earlier in the day when I tried to teach you that eating 10 burger king whoppers, with onion rings, while washing it all down with a liter of Coke might not be a good idea.  You also ignored me when I told you not to eat those donuts that your family brought in because it would raise your blood sugar.  And your family told me to fuck off when I reminded that that we were trying to keep your blood sugars under control.  And now that your blood sugar is so high that the meter cannot even give a reading you want to call me and your doctor "incompetents".  And still you are stuffing your face junk food.  And your doctor is now screaming at me because I had to call him about your high blood sugars and get orders  him from for insulin to treat you.  Thanks, asshole.

Is this some kind of a joke?  I actually think most of your family members possessions are gross and I have no interest in stealing any of their clothing or shoes. So please stop drilling me with questions regarding their missing underpants or socks that probably got carried away with the laundry. Trust me I don't want them!  And I am not leaving the post op bleeder in room 17 to hunt down your mother's nightdress. And 9 times out 10 the care assistants and I are moving way to fast to even consider worrying about a stray sock that may have been taken away with the bedding.  Your mother is in hospital....why they hell are you worrying about socks and nightdresses?  I will happily give you £40 out of my own pocket to replace them.  As long as you promise to fuck off and stop asking me stupid questions about lost items when I have blood to hang and doctors orders to catch up.  My purse is in the staff room, take it, use what you find in it to replace your mothers lost item and get the fuck out of my face.  Just get away from me.

Sir, let me tell you -- you are ONE nasty old man. Yes, we "forgot" your breakfast, and for that, I apologized up and down and sideways, even ran to the kitchen to personally see to it you got a lunch tray. And how did you reward me? You lit into me about every single injustice done to you at this hospital, including, :HORRORS: having to be "last in line" in the x-ray line because YOU had a sepsis infection.  Well you wouldn't want us to spread your infection to everyone else  via the xray machine would you?   I mean -- dude, you are getting out alive. Yes, little things were missed. There was probably a team of 100 or more taking care of you these last 3 weeks. Do you ever wonder that perhaps just everyday human error in a large organization COULD result in a few glitches in your care? Are YOU fricking perfect? You certainly expect everyone else to be.   I wish I could transport you back to the 19th century to receive their version of medical and nursing care.  They'll cut your throat and try to bleed you to cure you.  No costly xray machines, IV meds, or decent pain killers back then.  Have fun.

The truth is -- you were well taken care of in this hospital at a much higher cost than what you ever paid in. Most of the work that is done for you by the Nurses and Doctors goes unseen and happens out of your line of sight. People waited on you at your beck and call, every god damn 15 minutes. You have been nothing but nasty to everyone.  Well, I hope people like you get what you deserve - whatever that may be. You are nasty and rotten to the core. You see people in service to you and you simply choose to demean them. I hope where ever you're going, that it's not someplace good. You are evil to the core. You live a great country, get decent health care from a struggling and overburdened system free at the point of delivery, yet you continue to complain because the hospital doesn't revolve around you and your wants and needs. Ugh. You make me SICK.  Violently so.

To the relatives of patient in bed 60, I'm sorry but I cant give him back his call bell,dressing gown cord,belt or tie as he keeps trying to hang himself with them. No I also will not give him his shoes,book or flask back as he keeps throwing them at the nursing staff.  Don't fucking ask me again or accuse me of "taking his stuff" you are literally making me want to die.  

I'm sorry you got bumped for an emergent case, but the fact that you are not the emergency is a good thing to be grateful for, no?  I mean seriously...would you really want your hospital to refuse to give you a lifesaving operation right away when you have just been brought in from a car accident that ruptured your spleen because "the guy waiting for the hernia repair all day doesn't want to wait".  No you wouldn't.  So get a life. I just lost all respect for you.

I realise you don't want to care for your father because he's an incredible areshole. I don't blame you. However, I have a legal, ethical and moral duty  to take care of him, so stop with your guilt-driven inane complaints and requests, because unlike you, I have to actually make something happen for him and I can't go home and just blame everyone else when it gets too hard. Thanks.

Dude, honestly, do you really HAVE to drink over a GALLON of alcohol PER DAY? How do you do it? Do you also really have to smoke 2 packs a day on top of it? And, if you hate this place sooooooo much, and want to leave SOOOOO badly, why did you EVER present yourself to A&E in the first place??  Why do you keep doing this to yourself and then present yourself in A&E?  Why?  Why?  If the food is so bad and we are all stupid and worthless stop getting yourself admitted to hospital over and over and over again, sometimes 10 times in a month. We both know that there is nothing that the doctors can actually do for you and that you are only here for the free food, warm bed and morphine fix.

To my little old sweet lady in green bay you are SO sweet, SO well mannered. You were a joy today. And compared to the 3 rabble rousing drunks I had to deal with all day, you were like sugar and kittens. I thank you, and if the world had more like you, we'd all be so much better off.  I love you and I want to take you home with me.

I really don't care whether or not you take your damned pills. Do it or don't, but let's be quick about it because I have 8 more patients to see before I can pee.  No I can't leave pills here and walk away.  Sometimes I have too, but really leaving pills at the bedside is a very bad thing for me to do.

No, sir. I can completely understand why you don't want to do your treatments. Yes, sir. It does suck. Literally. And I'm tired of trying to talk you into doing it. After all, it's your health, not mine. I will try to talk you into it three times everytime I come around to you.  And after that I will document that you refused.  Then I am off the hook when you try to sue over your hospital acquired chest infection or some other complication. 

OK, sir. I absolutely understand that you don't want me bothering you overnight to cough and deep breath, use your incentive spirometer, check your glucose, put your oxygen back on or turn you on your other side. But if I went away and left you alone as you desire, you'd get pneumonia, be reintubated, become hypo (or hyperglycemic) and develop a bedsore.   Really, there is not need for calling me a bitch for disturbing you when I am just trying to prevent the above complications.  I hope your next nurse does get pissed off and ignore you and you get bedsores and pneumonia.  You will really be calling the Nurses some awful names then.  But she won't because we always try to do our jobs despite your nastiness. And I will continue to be in here over night to make sure you are okay even though you are a jerk.

No, I'm afraid I can't tell you anything more about Daddy's bowel movement that he had at 1 a.m. as I wasn't here and all that was documented by the night nurse was that he had one. I'm sorry I have no further information." Darling daughter went all the way up to the chief of nursing to complain about this. What I wanted to say was, "Are you SERIOUS?" Your father isn't having any GI problems and this has nothing to do with why he's here. I think you are one sick cookie to block my way in the hall and ask was it runny? How many cups was it? What color was it? Did he grunt when he had it? Get a life!! It's people like you that give the whole human race a bad name."

For God's sake, let your mother get some rest. The quality of the care I give will not be improved by you sitting there and GLARING at me all day. Yes, I do know what I'm doing. As a matter of fact, I KNOW HOW TO DO MY JOB BETTER THAN YOU KNOW HOW TO DO MY JOB. No, I'm not just going to let your mom die, unattended, without doing anything, because we are not of the same ethnicity. Let me do what I need to do for her, so that if I get tied up later at least I was able to see to her at some point in my shift.  If you can do better, take her home. Otherwise, get out of my way and stop asking the same stupid questions over and over again. And pass that on to your brothers and sisters while you're at it.

You have a pain rating of ten? Really? Wow, you must handle pain really well. The only time I had a pain of ten was during unmedicated childbirth, and during the height of that, there was no way I could have been talking on the phone, eating hamburgers or sleeping the way you are doing! Congratulations, you have a seriously high tolerance for pain!"

That's great that you'd like a diet black cherry vanilla coke with a little umbrella in it. I'd like a Martini after dealing with your fluid overload and high blood sugar that resulted from your non compliance with your doctors orders. . If wishes were horses, we'd all ride.

No, I don't know when the doctor is coming in. They don't answer to us. We are not in control of them. We do not have your consultant on GPS. Sorry that you only come in for ten minutes a day with Grandma Millie and want the physician here to answer your questions right away so you're not late for your nail appointment.  You are so right.  Nurses and Doctors should always drop what they are doing and come running so that you are not late for your nail appointment.  I am glad you brought this complaint to our attention.

I realize you are claiming that we never gave you your call bell, but the truth is that your call ball was lost in your abdominal skin folds. Yes, it might be time to think about weight reduction.

We always give your grandfather your call bell, and he always knocks it out of reach.  And there is no way it is physically possible for me to get around to him as soon as he knocks the bell onto the floor.

We did show your grandmother how to use the call bell but as her dementia causes her to forget everything within 5 fucking seconds SHE FORGETS. You know this. 

Hello, welcome to XYZ hospital: let's get three things straight off the bat: We don't control doctors, we don't control dietary, and we don't even know what is going to come through the door let alone what we will be doing 5 minutes from now.

Lets get realistic here. Supervisors and administration staff the place just well enough to keep people alive, that's it. Call bells are for "emergencies" and "immediate needs" only. Not for getting a tissue box moved to the other side of the table or having the temp. in the room changed.   Everyone loves the story "Little Boy who cried wolf" except when it applies to them. So many people abuse the bell so often for insignificant requests, when the request that actually justifies using the bell comes around they wonder why nurses aren't quick to respond.

For Christ's sake we still do not have fucking GPS tracking on the doctors. We didn't this morning, and we don't right now, and we never will.  They have scores of patients to see, all over the place and if we page them to ask when they are coming it will only slow them down.  If anyone asks me again when the doctor is coming I am going to kill myself by sticking my head into the macerator.

For Christ's sake the doctors have scores of patients on multiple wards with many different Nurses.  They do not have time to check in with is usually.  I can usually only find out their plans by abandoning the patients to bury my head in notes.  Then you will accuse me of abandoning patients to bury my head in "paperwork".

Lady, if you haven't noticed, hospitals are short staffed. I am ONE woman to at least 12 patients and NO help. You perhaps could have called in and reminded me -- that would have been courteous. But the immediate needs of survival, pain, meds, and immediate care of my other  patients trumps your husband's need to get a better pillow for now.  Why yes I AM on the computer while your husband is "waiting for his pillow".  How else do you think I am going to be able to order and obtain the life saving drugs for the patient who is going to die today without them?  I get one shot at ordering and obtaining this stuff for that patient and I am not going to blow it searching the ward for a pillow.  Sue me. 

I do not appreciate your glares and your short attitude with me. You should be grateful that your husband is receiving care at all in this hospital, that you have access to health care and that doctors are working SO hard to find out why he's having repetitive fevers. Your husband is wonderful and very appreciative -- you, however, are an ungrateful wretch of a woman who thinks the world must revolve around you. You and others like you are the reason for problems in health care, in my opinion. But go ahead and bitch.  I feel the days are numbered as to how long hospitals and this economy can support bending over backwards for folks like you. There's going to come a breaking point -- and mark my words, you will be on the wrong side of it.

No I cant get your dad home any quicker as we are waiting for transport to get back to us. There is 5 inches of snow on the roads and the county has a shortage of grit so I kind of doubt he will be coming home today. Ringing us every 5 minutes will not get him home any faster, if anything it slows things down as transport can't get through as you are on the blinking line!!!Trust us, we want him out of here as much as you do.   How the fuck could we possible know when the ambulance will get here when they don't have anyway of even knowing that themselves?  Why do you refuse to accept any kind of explanation? Get a life.

I have no idea where your doctor is at this moment, and No, I cannot "get him on the phone" for you to complain about your minor "back spasms" you all of a sudden decided you have in addition to the million pound workup you're getting to rule out your other issues. Your doc will round when all the other doctors round, and he will be in here eventually. One doctor does NOT report into each and every nurse who is taking care of his 80 patients -- he truly does not. He also does not sit around all day waiting for us to call him about your hangnail -- I mean -- it's about the WAIT. And don't worry, when the time comes, you WILL be routed OUT of this place, as soon as is humanly possible. So, why don't you just lay back, enjoy the free room, TV, food service and nurse, and just go with the flow. Honestly, I'd give ANYTHING to be able to lie there for 3 days and do absolutely nothing but watch TV, eat, and be waited on. Why can't you just enjoy that? I mean, dude, I'd give ANYTHING to be able to do that -- what is so wrong about it?

On treating patients like they are my own family members; I have already warned my family members that if they mistreat hospital staff, I will personally strangle them. When my aunt was in the hospital my dad interrupted her Nurse while she was doing drug calculations for another patient to ask a dumb question.  Nurse Anne ripped into her dad for that. 
So, if I were in a situation where I was taking care of a relative, I would hope I would not over prioritize their "personal" needs (TV turned off and on for them, two water pitchers kept full at all times, dialing the phone for them) over the "medical" needs of other patients my relative's Nurse was caring for.   

The doctor told me to get you walking.  I know that we need to get you walking.   We must get you walking.  So when I asked you to walk to the toilet 5 feet away I wasn't being mean and I do not need lectures on "what you deserve because you have friends on the board" and " lack of compassion in Nursing". If I fetch and deliver things for you rather than making you do it for yourself you will get a blood clot and die, or you will get pneumonia and die.   You won't get better if your don't grit your teeth and start trying to move around.  Yes, I know it isn't fun.  But you are not an elderly patient who really cannot do these things for herself. You are a 39 year old woman!!

I know your mother wants to go to bed. She already told me. There is no need to follow me down the hall. I am dealing with a man who just transferred himself to the toilet. That's why the alarm went off. I can't drop everything and leave him sitting here unattended just to put your mother to bed. He is confused, unsteady on his feet and he WILL fall... SHE understands that- why can't you? And don't you dare waddle down the nurses' station and start bugging them about it while they are in handover trying to ensure that all bases are covered with all the patients. The oncoming shift has ONE shot to get all the info they need to start their shift.  An omission thanks to interruptions could lead to a fatal error. GO HOME. Also, when i do put your mother to bed please don't stand there and watch me like a hawk. This room is small and every time I turn around you are standing directly in front of something I need. Again, GO HOOOOOOOOOME.

Are you really sure you want your 100 yr old grandma that you left in the nursing home for the last 20 years to be for full and active resuscitation? Even though she has a feeding tube,is getting dialysis everyday, has all four extremities contracted, a very large unstageable pressure ulcer on her bottom that requires a urostomy AND a colostomy, and hasn't been awake in 4 years?? So, You really want us to try and roll her to her back while her legs are curled up in the air and we can't pry her contracted arms away from her chest and then crack her ribs while we do CPR on her???  Okay then.  If my grandchildren do that to me rather than letting me go with dignity I will come back and haunt them to death.  I mean, my god........  What do your poor old grandmother ever do to you to you?  Why do you want to torture her with all this medical intervention?

Since you want us to call and ask permission for EVERY SINGLE thing that we do to your mom, I am just calling to ask you if we can put her on a bedpan now or would you like her to shit on herself in the bed? (this after daughter threw a fit when we took an emergency chest xray of her mom because she has pneumonia, copd, and chf and we didn't call her to ask permission) And YES you ARE allowed to come in every other day and throw a fit with the nurses and managers and DEMAND that the CEO come to the room RIGHT NOW to straighten out exactly WHYYYY your mom is getting omeprazole 40mg IV every morning. Please please talk to the managers and CEO right now actually. That way the managers and CEO will already know you are whacked out and crazy as a loon when you complain about me trying to reposition your mom every two hours.  There are patients and relatives making legit complaints and they don't get listened to because lunatics like yourself outnumber the people with genuine complaints 10 to 1.

If you can reach the call light that often, you can reach the

1. Kleenex

2. Water

3. Your magazine

4. Snacks

5. Blanket to pull up

6. Miscellaneous

since they are right next to the call light.

Seriously I have something like 8 minutes per patient per 12 hour shift.  And I need to cover about 1000 bases during those 8 minutes with you.Use your time wisely.

NO. This is actually YOUR job. There is nothing wrong with your hands. You are completely independent. The nurses help out people who can't do things for themselves. You can empty your own pouch. And when you leave here, who is going to do it for you at home? I understand you are frustrated but please don't blame it on me or the other nurses. It's an important part of your therapy that you be as independent as possible. I won't hesitate to help you but I won't do things for you that you perfectly capable of because it would only hurt you in the long run.

For relatives/visitors: we are not sitting here chatting, we are in handover. Would be nice if I could magically know all about my patients without it, but I can not. When you interrupt handover, it takes longer for me to get to your family member for their (non-urgent) request. When I tell you to go press the patient buzzer so the nurse looking after the patient can help you, the key phrase is nurse looking after the patient, who is not me - so don't come back in 5 minutes to give me an update.  If I am not assigned to a particular patient I cannot get involved for SAFETY reasons.  This isn't 1952.  I have enough liability and work on my shoulders just with my assigned patients. It has nothing to do with "not wanting to be bothered" you freak.

When I tell you that I can't make icepacks for you because we have an emergency with another patient, but you're welcome to make one up yourself:

1) don't tell me you don't know how - I worked it out and so can you; hint, they involve ice, a plastic bag and a pillowcase;

2) don't come wandering up to where all the drama is to have a look and get in the way - go back to your room;

3) don't buzz for me again 5 minutes later, I'm still trying to help this nearly dead girl by actioning her doctors orders.  Quickly.  At minimum it is going to be hours before I can get back to my other patients. This girl is ill. 
4) oh, she doesn't look that sick to you? I'll just tell the crash team that the patient in bed 24 thinks that the young girl with a blood sugar of  0.7mmol/L (27mg/dL) and a core temp of 31.4C (88.35F) is fine and they can leave.

All in a days work.  Sigh.

Thanks to for making this post possible.
Details have been changed to protect confidentiality.  You will not be able to identify anyone from these posts.  This post describes a days work, every freaking day.


The Dobbing Doctor said...

Bloody hell, I'm out of breath reading that because of the flashbacks.

That was the most vivid realistic account of what a medical ward is actually like that I have ever read.

I hope something gives and stuff gets sorted out.

murse said...

"If I was trying to poison you you'd be dead already"

Brilliant XD

Keep up the good fight

E said...

brilliant, loved each one and hated each one all once because the fact is everything you say has happened and is real. ugh.

another area of nursing to tick off my list once and for all when i graduate. medicine. check. avoided. never to be considered.

if only there was an area of nursing where you didn't have to deal with relatives at all. that would be 2/3rds of the problems with nursing in the NHS eradicated in one swift move. ill look into such areas. you should too, anne!

Anonymous said...

Everything you wrote was SO TRUE! As a medical SHO on ward cover (= out of hours being the one doctor covering 250 medical inpatients) it never ceased to amaze me how relatives would grab me as I was trying to deal with some peri-arrest patient and demand I discuss the ins and outs of their beloveds treatment. And then when I declined they would bitch bitterly to each other about how the other patient was being treated more favourably as I was even *calling* their relatives. Well yes, of course I was, because they needed to know the impending probable death of their relative, whereas your relative is 40, sitting there and talking to you...

Nurse Anne said...

What do they think is going to be resolved by explaining to them yet again that granny is being treated for a UTI? You tell them that one day and the next day they are at you wanting to know "what the plan is". And I want to say " WTF? What plan."

1. She is being treated for a UTI. That is what is causing her confusion

2. She is on abx for that.

3. She is 96 and from here on in it will be one fucking medical problem after another. Once we resolve the UTI something else will happen. At this age most people are at the beginning of the end, and it isn't fast.

4. Why yes she is malnourished...she has lost her swallow reflex (old age) she is so confused that she pulls out every line we put in (old age). And she looks like hell (old age).

Old is a long term terminal illness.

What is the plan you ask?

God is calling her home. The repeated hospital admissions is a sign that she is on her way. It isn't bad care. We are genetically predetermined to waste away and die when we get to a certain age. Every single one of us. Certain aspects of medical care can help, that is why we do it. But we aren't god.

All we can do is the best we can, but we aren't magicians.

We had a 105 year old come in after suffering a massive CVA. She is now paralyzed and bedbound. Her CVA was massive. Family is running up and down the ward screaming that the patient isn't eating or drinking or walking out of hospital because the medics and nurses are lazy.

At least doctors can get away from these relatives. They are there, in my face every minute of every shift. I cannot get through any kind of action without getting interrupted every two minutes because of them. If I am doing a job (like medicating a patient or putting in a cathetar etc) I am RUSHING RUSHING because I know that I am only 30 seconds away from the next interruption.

Nurse Anne said...
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Nurse Anne said...
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Nurse Anne said...
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Julie said...

OMG! I thought all of that had happened to you in one day!

We are trying to push the idea of a mimimum legal nurse staffing requirement up here. I think it'll take a while, but we're sowing the seeds. A lot's going to ride on who gets in in the Holyrood elections in May.

Anonymous said...

I am a lay person so can only empathise with the dreadful circumstances under which you are all expected to work. I have been a patient and have always been treated kindly, empathetically and professionally by nurses. It must be a calling of some sort because as far as I can make out all of you are underpaid, undervalued, overworked and the hours are definitely far too long.

I respect all that you say. Apart from a tiny thing - please a tiny request its the use of the word - retarded. I am so not hung up on political correctness not me. Its just that I guess if as we have a family member who is 'retarded', its use is deeply offensive. Even in jest.

I wish I could make things better for all nurses. Whenever I am in hospital which I am due to a rare genetic condition, I do try very hard not to whinge, complain, and all the rest you put so much better than I ever could above on the list of patient errors. Even if my family are worried I tell urge them to remember that it is no one's fault. Manners cost nothing afterall.

My guess is that despite all the dreadful conditions you work under sometimes the occassional please or thank you would make a bit of difference.

Frankly how you keep going back for more is beyond me. It can't possibly be because of the huge salaries, fantastic working conditions etc.

I just wish your blog was published daily in every single newspaper.

So from one very unimportant lay person I hear you. It makes me ashamed that in a supposedly civilised society you are expected to work in such dire conditions.

E said...

The issue (and it is a big one and has been covered in this blog several times but is worth repeating) is that relatives and patients have some idealistic image of nursing and hospital wards to be very modern, well-kept, and well-staffed.

TV's up and down the land churn out modern-NHS futuristic crap like Holby City where hospitals are run by doctors who sit in their offices or "locker rooms" all day planning the future of the hospital as if it is really their choice. The nurses are all well ahead of their work, supported and glamourous-looking, they are all in the doctors pockets and leave their shift on time and the only thing they worry about is their personal lives. The patients all look very comfortable and dying is very dignified and everything basically is hunky fucking dory.

Then people come across other media like the newspapers all saying that GP's and Hospital doctors are lazy. Nurses are paid too much, over-educated and they are all sadistic torturous demons from hell who don't have a patch on ole' Flo and have never done a good thing for a patient in the entire history of the NHS.

When regular joe public are exposed to both of these extremes it sinks in, then when dear old aunt betty has a massive CVA and they actually get exposed to the real truth. That maybe the NHS is a shit storm of bureaucracy, top-heavy with clueless managers and held together with a hope and a prayer by some of the best nurses and doctors in the world who have been worked into the ground.

This shocks joe public, but then again it would shock me if I didn't have a first clue about the NHS first-hand and thought it was a mix of Holby city and the Cincinnati Riots, as depicted on the BBC and in the Mail.

It's too far gone now too, if the media by some fat chance said tomorrow they were going to start showing the NHS or Nurses & Doctors in good light it would be too late. Not just because there's hardly any good light to show, due to the NHS being run into the ground by being stretched to the limit, but because the public have already watched and read what they wanna see and made their own judgements before they see it with their own eyes.

For once I would like to see a death rattle on TV, or an 80 year old patient with a UTI and because they're so confused, smearing their own shit up the walls & curtains, chasing a student nurse with their hands and arms covered in it.

I would love to read about how nursing ratios kill people, and how managers are the ones that should be held responsible for it.

Fat chance.

Nurse Anne said...

Hi Anonmymous,

You are right. I am going to delete that bad offensive word. It was in vogue in the place and time I was growing up and became habit.

I don't mind the patients complaining because they are sick, in pain, fed up etc.

I think the anger and frustration comes from the powerlessness that I feel to do something about it.

Dino-nurse said...

"This is the way the world ends, not with a bang but a whimper..."
I can remember the first time I watched a patient die. They had been dying slowly for weeks in a nursing home- not eating, slowly deteriorating...then they got a chest infection and ended up on a medical ward. It took a further week before they finally died...its not pretty and nothing could have stopped it. We are not designed to be immortal. Bodies wear out. This is what we all need to re-learn. Death at home used to be commonplace- long, lingering, smelly and messy.
As for joe public- I am at the stage now where I think...f**k it, bring on private healthcare as we've brought it on ourselves. Take responsibility for your weight/alcoholism/COPD/crap lifestyle choices....otherwise the NHS will not be there to pick you up for much longer....

Nurse Anne said...

Julie that kind of stuff usually does all happen every shift.Constantly.

Anonymous said...

Great post. I agree, amazing how families turn up en masse, before visiting hours then expect you to drop everything and talk to them, and answer irrelevant questions

Anonymous said...

"I'm sorry that your father has not been eating but what do you expect me to do when he doesnt eat? Pin him down, force his mouth open and force food down his throat? Is this how you manage at home? Should I be safeguarding him?"

Eliza said...

Wow, that was some rant! Oh but I'm with you, I'd so love to say what I think out loud, that would be so refreshing, but I'd get the sack, and I have a mortgage. I'll save it all up for the day I retire :-)

Anonymous said...

I think it`s about time you retired. You seem, and I say this with respect, burnt out.

Nurse Anne said...

Floor nurses get this bad after only a few months on the job. If everyone who felt this way retired there would be no one left.

Lil' ol me said...

Third year nursing student about to qualify, and I hear ya sister! I know that post is 99.9% of the wards in the UK, not just medical!

Witty reading, but sad that its all true and NHS staff have had to become 'numb' to deal with relatives and other daily crap.

Anonymous said...

i have just come back from visiting my (now dead) grandmother,i was amazed at how few staff there was around! ( ok it was a saturday night @2300hrs) but they let me in cos i had come 120mls to catch her before she went.
there wasn't even a security guard on the front desk,but you had to be buzzed into the ward.
they were polite and courteous even though it was the wrong time to visit,and i appreciated them letting me in.
i went back a few weeks later, with a box of chocolates just to show them i was grateful. otherwise they would never know that people ARE grateful for what they do for them ( and my nan would have done the same)
keep you chin up, we aren't all arseholes out here.

ps. all jobs have this element of just have to rise above it, and carry on.....THAT is what makes you an angel

pps if someone is being a p.i.t.a. tell them so ...and then do something nice for them, whilst really f**ks them up and you are queen/king of the moral high ground.

Anonymous said...

Love love love the posts, my comments are exactly the same as everyone else, it is a realistic picture of the NHS. I have left the NHS (at present)and work now in the cosmetic sector. I have got back my love of nursing, I am valued, encouraged regularly thanked by my managers. A temporary break has done me wonders and I am a better nurse and person for it. I wish you the best of luck and even if only a few relatives/patients read this it will help in the long run.

Anonymous said...

A close relative of mine had died. While I was still reeling with grief and heartbreak I had to give care to the most stupid and selfish female patient I had ever encountered. Every day she would glare daggers and be insulting and verbally aggressive to me. Talk about if looks could kill! The irony was that she had been diagnosed with the same life-threatening condition as my deceased relative so I had been motivated to do everything within my power to try to ensure that she, at least, would continue to live. Nurses are human too. They have their own experiences of tragedy but like Anne said, there is no crying in nursing. You can't sob on the patient's shoulder, you have to keep a stiff upper lip and get on with things. Nursing is truly a tough and thankless job.

Merik said...

So true..I used to be be a nurse in Acute Medical Admissions and later in Intensive care. The burn out you speak of is so real and so quick to set in.

We all become so jaded and it's mostly because of how we're treated by management rather than the patients.

Don't get me wrong, all the stuff you mentioned is annoying and shouldn't happen, but as much of it comes from ignorance as from idiocy or malice. Yet if management had your back, if they supported you or took any steps to defend your or even just helped you to care for your patients. . .then maybe it would be easier to weather.

Reading this post reminds me why I'm glad I don't work in the front line any more.

Anonymous said...

At the age of 94 my mother is having NHS treatment for skin cancer.
She has received the most up to date treatment available in this country and gets transport to the hospital and home again when she needs it.
In every respect, her care and treatment has been exemplary and I have only praise and admiration for all of the staff who have treated and looked after her. It's a pity not everyone has the same good experience.

We need more nurses, not fewer.

Anonymous said...

People used to respect nurses in the old days. Now nurses are treated like low lifes - people think it is just fine to abuse them and belittle them. But what would they do if there were no nurses - if we all said "bugger this I'm off to work in Tescos"? Would they appreciate us then?

And ... of course all the problems of the NHS is every nurses fault isnt it? Must be, we are the ones who take the abuse for it day in day out. I mean, we lie left right and centre as far as the patients and relatives are concerned, we have people stacked in corridors when there are hundreds of empty beds in the hospital ..... Yeah right!!!! As if!!! We should be allowed to speak out, fight back, tell people exactly how it is. We should throw the abuse right back at the people who give it to us.

We should be brave enough to back each other and all go out on strike in demand for better working conditions and the allowance to retaliate to the twats who abuse us!

If a school leaver told me they wanted to come into nursing I would probably persuade them not to bother, unless they don't mind feeling like tearing their hair out every shift!


Anonymous said...

I can't believe what I just read. I'm pretty close to being as angry as you. Everything you said was spot on. I'm sick and tired of being everything but a nurse. As far a manangement goes, they know we are overworked and have too many patients. Do they care NOOOOO. Quit a few months ago, I couldn't take the constant critizism of almost all of the nurses on my floor, while we are running our *** off. Thanks for the read, I loved it.

Anonymous said...

Cannot help wondering why some people wish to qualify as nurses when their personalities are so obviously at odds with the job. Is it for money, security, because they don't know what else to do, or is it simply the idea of parading about in uniform that appeals? For example those who are grim and hard-faced, never smile and totally lack communication skills or any sense of humour. Brash, insensitive types with foghorn voices who bellow orders down the ward (it is worrying if they don't have the intelligence to understand why people who are ill need peace and quiet.) Those who think sarcasm or humiliation are acceptable forms of communication and repeatedly make critical or negative comments about colleagues and patients alike,(whatever happened to being non-judgemental?) Are they so perfect that they never make even the smallest mistake themselves? Those who erroneously believe that their rank gives them the right to bully both the patients and those members of staff who are lower down the rungs of the career ladder. And last, but not least, those who feel that simply performing their alloted tasks in a robotic or mechanical way is all that is neessary and who lack the ability to empathise with patients.

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