Wednesday, 25 May 2011

New job new life!!

Nurse Anne is pretty happy right now.

My new hospital really seems to have the right idea!!

I now have 4-6 patients.  If any of them are acute then I get less. I have help.  Pharmacy bends over backwards to ensure that the Nurse on the floor has what she needs.  They know (and he said this) that patients suffer and wait too long for pain meds and other ordered drugs when pharmacy takes too long to verify orders.  In the UK the Nurse would be left on the floor with patients screaming in pain and screaming at the Nurse because they didn't get their drugs.  The reason their drugs weren't available wasn't because the doctor didn't prescribe it.  It wasn't because the Nurse was mean and lazy and didn't want to give the drug.  It was because the Nurse could not get her hands on the drugs until pharmacy did their thing.  And it would take hours and hours and hours to get pharmacy to comply.

 In the meantime the UK nurse deals with orders and care for her other patients-tasks that cannot be abandoned so she can sit with the man in pain.  The visitors and the patients stare at her and they say"that man is screaming over there, why is the nurse ignoring him and not helping him".  Well, she called the doctor 4 times over the last 5 hours to get an order for something to help the patient.  The doctor was finally able to come to the ward to prescribe something,  And now the Nurse is waiting on pharmacy. 9 hours total.  That is how long this process can take in the UK. 

Now, these things happen instantaneously for me.  If I have a patient that needs something I can get a doctor on the case and his order verified and dispensed by pharmacy almost instantly.  They work hard at this hospital so that the Nurse can have that. 

Food.  I am now in a place where kitchen sends up enough food to feed the patients.  No matter how ward staff in the UK filled out those menus, the bastards in kitchen never sent up enough.  And they only gave the Nurse a 15 minute window to get trays dished out and an entire ward fed.  In England, the ward staff had to run out with the trays, and put them near the patient.  They had to leave elderly patient's trays out of reach and continue on dishing out trays to the next patients.  Elderly patients trays were left out of reach to stop them from burning themselves on hot food or dumping bowls of soup over themselves.  The staff would run out with all the trays, hand them all out, deal with a 101 interruptions during this process and within 15 minute those goddamn fucking bastards from kitchen would be collecting those trays back in because "they had to take pots etc back down to kitchen and wash them because they wanted to get home on time". 

I actually asked kitchen staff in England if they knew that Nurses were getting blamed for starving patients.  I also asked them if they understand that we cannot help all those people and dish out food for an entire ward in 15 minutes.  They shrugged their shoulders and said yeah so what. 

And people blame Nurses starving patients?  WTF?  Nurses are the last people who have any kind of control over this process.  English nurses get smirked at and sneered at when they bring these issues up to managers.  And I am not talking about nursing managers.  I am talking about the non clinical managers who control everything,

In my current job I not only get enough food for my patients but the hospital understands that Nurses have sick patients with multiple orders and constant tasks that do not disappear at mealtime.  We get trained helpers from the diet department at mealtimes.  If I want an elderly patient to have a carer to stay with them at all times I simply have to ask.  Lets face reality.  Elderly patients need someone who can stay at their side all day in order to get hydrated, fed, and help with movement to prevent pressure sores.  If his Nurse has a full patient load and hundreds to drugs to give all day long she cannot do that for him.  Can we please face up to this fact rather than labelling Nurses as cruel witches who intentionally neglect people?

Now, when I am on days I always have multiple secretaries on the floor who answer the phone and protect the Nurses from unnecessary interruptions.  In the UK I did not have that.   We were told we had to answer the phone or else.  The phone rang constantly and a lot of time was taken away from the patients as a result.

I now have cleaners on the floor, lots of them!  And they are given time to clean rather than having to condense an entire day's worth of tasks into two hours because our managers don't want to pay for any more than two hours a day of cleaning,

No more having too leave the ward and run 3 floors down to restock the crash trolley after a crash.

I now work on a med-surg floor and it is still tough, this kind of nursing always is, but WHAT A DIFFERENCE IT MAKES WHEN THE WARDS ARE RESOURCED PROPERLY. And what a difference it makes when the people who run the hospitals understand that Nurses need to be with the patients, not doing every other profession's (social worker, pharmacy, lab. etc) job,

I have time with my patients now.  The amount of real time documenting we have to do (governement rules, yes government does regulate and accredidate US hospitals and fine them if the Nurses don't document the far end of a fart) is still immense and the penalty for failure to document is of course, termination.  But they are always looking for ways to make all this documentation as quick and as painless for the Nurse as possible without violating government policy.  Government policy in the UK dictates a lot of paperwork and data entry for ward based Nurses too (CQC and audits anyone?), but the system they use to do it is much more time consuming and the UK nurse has to do it all for 12+ patients rather than 4.  And she has less in the way of help. 

I have become 100% sure of something.

 Having well trained, skillful, kind, caring and hardworking nurses isn't enough.  It is only 50% of the equation.  If that is all you have, nursing care will -to put it bluntly- be shit.  Nurses need efficient work environments, manageable patient assignments, resources, and back up as well.  If you don't have both of these things in a hospital at the exact same time, nursing care will be shit. 

Tuesday, 10 May 2011

Regarding Unions:

This post is going to be about those fucked up, leftist, evil, worthless extortion machines unions.

I hate them.  In the late 19th and early 20th century they were necessary.  They brought into being good policies that are now enshrined in law.    Now they just exist to make themselves money and scoff at people who actually take on responsibility and work for a living.

I recently read a comment on this blog that concerned me.  I am afraid that the author of the comment saw the word "militant" in the title of this blog and mistook me for some pro union communist bitch. He didn't say that but that is what people think of Nurses isn' it.  So lets clear things up.  We may have to be hard bitches to stop people from getting hurt and dying in hospital but I think most nurses realise that unions are nothing but a really, really bad joke.

This is the quick, quick version of Nurse Anne's take on unions:

Please do not see the word militant in the title of this blog and think that we are pro-union.

Frontline clinical hospital nurses understand better than ANYONE that unions are worthless, evil extortion machines that care nothing for the people that they are supposed to represent.

Most Nurses are in the RCN for the liability insurance they provide. We need this to practice.

It would be very easy for any hospital nurse to get distracted by one of her 15 patients and their relatives long enough to make a fatal error. Long enough for this to happen is two minutes. That is the sole reason the RCN got my money.  If that happened to me they would help me with the legal stuff.  Supposedly.

Unions show no interest in and can do nothing about the short staffing, poor skill mix, shit working conditions, and unsafe patient care. They know they can't do a thing about it. They are only interested in making money for themselves. 

When I, at 26 weeks pregnant, was left as the only RN on a 21 bed ward for 14.5 hours unable to eat, drink, sit down or pee during all that time without risking a manslaughter charge the RCN did not want to hear about it.  The RCN rep told me that I should have "left the patients and gone for a lie down if it was so bad". Those were my days as an NHS Staff Nurse.

The other staff I had working with me that day were untrained care assistants and they could not help me with drugs, orders, assessments, monitoring and information management for all those patients. They were parked at the Nurse's station having a natter. You can see how it looks to the patients and visitors. On that day there were so many patients on IV drugs that it took me 50 minutes out of every hour to just mix and prepare, and administer the damn things.  That includes all the time I had to spend chasing pharmacy to get the fucking things. And on average I was getting them to the patients about 3 hours late.  That is because there were so many other things going on simultaneously to those drugs that on an RN could handle.  And I was the only RN.

The care assistants cannot help me with that, nor can they give information about the patient's care to relatives who were queing up at the nurse's station to get information------wondering why all the "nurses" were sat at the desk ignoring them whilst mum's IV meds were late.

Had the NHS hired all those new grad nurses that they trained; days like that never would have happened to me. I would have had other trained nurses working with me. You all bitch about new nurse training causing standards to slip.  Standards have actually slipped because trained nurses have been replaced on the wards with people who have never attended nursing school.  The one RN on duty gets overwhelmed and things get delayed.  Mistakes get made.  One hundred hardworking, good care assistants working with the RN cannot prevent that. That is why standards are slipping. 

What I am militant about on militant medical nurse is that fact that unions are bastard extortion machines that make it easy for management to starve the frontlines (especially nursing) of resources and funding.  Unions care about unions.  The end.

Please do not believe this bullshit that goes around about NHS nurses having an easy time of it compared to the private sector because they are unionsed public servants.

The RCN got my money every fucking month because I need liability insurance. I know that they won't do shit about working conditions and patient safety.

I am now abroad. My new hospital is non unionised.   The folks that run my new hospital have won awards for treating their nursing staff so well.  These people understand that when RN's have manageable patient loads, are well resourced, respected, and supported, our patients get better care.  It is cash well invested and makes the hospital money that gets put back into even better care for the patients.  We are non profit but not government. It is a good cycle.

All those expensive unions in the UK have never, ever made an attempt to get NHS managers and UK politicians to understand this.  Unions are just extortion machines that are interested in making money for themselves.  The doctors have the same problems with their union in the UK.  Even if these unions gave a shit, they would still be powerless to change anything at this point, unless they were completely restructured.  Maybe if NHS nurses had decent unions who were simply about protecting the worker things would be okay. But they are far from okay.

So I am non unionised now and can buy my own malpractice insurance. I am so happy these days I weep for joy. I now love my work. I am so happy to be back in the private sector that I cannot stop smiling.  Yes I am non unionsed, and if I make a mistake my new employer can fire me at will. So what?  If I fuck up that badly with only 4 patients,and much in the way of 24/7 back up and support  then I deserve to get the sack.   I don't always get a lunch break in a 12 hour shift.  But I get them a lot more now than I did when I was a unionised NHS whipping boy sacrificial lamb slave Nurse

Australia: One RN (an RN is a person who has attended Nursing school) to 4 patients on a general medical ward.  24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need. 

USA: One RN to 4-7 patients on a 30 bed general medical ward.  24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

Singapore: One RN to 4-7 patients on a 30 bed general medical ward.  24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.  This is what singamore nurses tell me anyway.  I've never been there.

England One RN to 12, 15 or 30 patients on a 30-ish bed medical ward.  She might have several untrained carers that assist with basic care only.  Pharmacy, clerks, and housekeeping are 9-5 and dump on the RN.  If the RN doesn't do their bidding, the patient doesn't get what he needs and the Nurse gets the blame.  The RCN is oblivious.

And I think the UK is more heavily unionised. What does that tell you?