Productive ward. Again. Kill me please.

Productive ward: releasing time to care is back in full swing on my unit.

Apparently the ward would run as smooth as silk if only nurses understood how to tidy cupboards and work more efficiently.


The physical ward layout (appalling), the chaos, the constant interruptions and the massive lack of qualified staff make the idea of working efficiently a joke. The closest we can come to being efficient is taking dangerous short cuts just to ensure that we can actually assess everyone and get all the drugs out and administered without a fatality. All registered nurses are forced to do this on a daily basis because of the working conditions that they cannot control. Anyone who says that this isn't true is a liar.


Even if we could tidy and reorganise the cupboards we would still be up and down that ward constantly, wasting precious minutes. The thing needs to be redesigned and rebuilt to be truly workable. Half our supplies are always missing and require the ward staff to abandon patient care to obtain things constantly throughout the shift. Productive ward isn't going to fix this mess, it just puts more culpability onto the nurses. Pharmacy, and equipment /central supply are 9-5 Monday to Friday. And even during 9-5 they are fucking useless. They cause is more work than any patient ever did. Their worldview is that the lone RN on a ward with 20 something patients is there to make their job easier. God how I hate them.


Let me give you an example of something that happens about 100 times during an 8 hour shift. The lab calls me at 4PM and tells me that my patient's most recent blood results are barely compatible with life. My job is to inform the doctor who is covering. He orders a medicine. Of course pharmacy won't allow us to keep it in stock. To get the medicine I have to ring pharmacy, leave a message, wait for them to call back and then argue with them for about 15 minutes. They are pissy because they are supposed to finish work for the day at 5PM. They stomp their feet and say that they will not bring said drug to the ward. I have to walk the written doctor's order for the drug to pharmacy.


I get there and they ignore me for another 15 minutes while I bang on the glass. I. am. Serious.


They say that they will ring me as soon as the drug is ready. I reiterate the fact that I need this drug NOW. I cannot sit there however. I have many other things going on with my other patients that are almost as high a priority.. 30 minutes sat in pharmacy could seriously harm my patients who are now nurseless. Pharmacy promises me that they will bring the drug to me asap. If I send a care assistant rather than go down there myself it is bound to get all fucked up. 99% of the time we cannot get through to them via phone as they have it permanently on voicemail.


Back to the ward now. I need a special pump to deliver this med that we also are not allowed to keep on the ward as per central supply's dumbassness. I call central supply. A grumpy man who is obviously eating something chewy answers the phone. I tell him what I need. Very slowly he responds with "Well you will just have to come down here and get it".


But I cannot. I am hoping to get this drug administered ASAP as soon as that slut from pharmacy gets her ass here (and she had better hurry I swear to god).


I tell Dick from Central Supply that I am in no position to leave the ward (yet again) and my care assistant is trying to stop my alcohol detoxer from attacking the other patients (so am I while I am on the phone).


He chews whatever the fuck he is eating and slowly responds with "sigh sigh siiiigghhh. I will bring it up if I must. You had better go around your ward and find every piece of equipment that belongs to central supply. Clean it and label it before I get there and put it on a trolley so I can bring it back with me. I don't wanna make two trips. I'll be there in 15 minutes so have it ready for then."


Yeah right Dick. I am chasing pharmacy right now. There is now only myself and a care assistant on the ward. The other RN is now in recovery picking up her post op patient and the other care assistant had to escort a dementia patient to the CT scanner because the staff down there don't want to deal with it. I have a patient who has blood results that show that she needs this drug infusing via this particular pump NOW. I have an alcohol detoxer who is beating the care assistant, trying to beat other patients and myself and we cannot get her doctor to come up here and prescribe sedation. I have 20 other patients as well. I had over 15 IV antibiotics due in the last hour that I haven't even begun to mix. I have a que of angry relatives that want to know exactly what it is we are doing for their loved one. I will certainly be ignoring Dick from Central Supply's request.


And pharmacy still is not here. I ring them. I get voicemail. I can't go down there and neither can my care assistant.
You leave one person on the ward and a crash occurs you are fired.

Now the doctor who prescribed the drug for the patient with scary blood results is on the ward. He looks at his patient. His face turns the colour of a tomato. He glares at me. "Why the hell hasn't the drug I ordered been started yet? What the hell are you doing? Do you not understand that it is priority?" he screams.


Yes I do doc. But I cannot give what I don't have or pull syringe pumps out of my ass. I have already been ignoring many sick people over the last hour trying to pull this together. By the way...do you see that patient over there beating the healthcare assistant? See the scratches on my arm? Her doctor is tied up somewhere...will you prescribe her some sedation? Benzos not appropriate I know...how about haldol...anything?


"No. Not my patient. Get the anti -scary- blood- results- drug up now and call security for your combative patient."


The he left. We did call security actually. Those are the porters. They informed us that they are too busy.


OMG where the fuck is that slut from pharmacy. Their phone is still engaged. I cannot leave the ward. Dick from central supply showed up with the pump, took one look at the alcohol detoxer who was licking the floor and trying to hit anyone who came near and left quickly.


Now I have my pump. But where oh were is that slut from pharmacy.


I run to the end of the ward and peer down the hallway. There is the slut from pharmacy. She is holding what looks like the box containing the drug I need. She is stood talking with her friend from medical records that she has obviously run into on her way here. I walk over to her. I grab the box out of her hands. "Is this for ward R" I say. "Yes" she says whilst looking shocked that I just grabbed something out of her hands roughly. And off I go back to my ward whilst shouting "I needed this an hour ago".

"Those nurses really have an attitude don't they" she says to her friend.

Now I move at the speed o0f light getting the drug out mixed, ,measured, drawn up and doing my maths calculations. My other RN is back from theatre and quickly she checks my arithmetic. I get the drug up and grab a set of obs on my patient. Finally after over an hour of bullshit she is getting the treatment that the doctor ordered. What if I had dropped the ball on this an hour ago? What if I hadn't notified her doctor of her blood results or stayed on pharmacy's ass, multitasked, moved quickly and ignored my other patients calls for help to get this patient her treatment? The brilliant doctor and his brilliant treatment orders go nowhere if they are not implemented. And implementation of treatments is totally the domain of the registered nurses. It takes knowledge and you have to fight! Diagnosing and prescribing (the doctors domain) is only the first step of a very complex process of caring for hospital patients.


Now I brace myself to settle down this detoxer (she has already taken a chunk out of my upper arm) so we can get back to caring for all the patients...but in 10 minutes it will all start again and we will be looking for things.

This is how bad things are during 9-5 hours. You should see what it is like trying to get what you need out of hours.

But they want us to understand that if we tidy cupboards on the ward all will be well. Productive ward will not in any way shape or form deal with the bullshit from central supply and pharmacy. It will not address the fact that we are running these wards with so little staff that we can barely address 1% of what we should be doing. But this is their "solution" to problems that they do not understand.

Now that productive ward is back in full swing our ward sister has been forced to put a cork board up at the nurse's station. On it she has been forced to put little motivational messages. We are supposed to add to these messages by writing our feelings onto the board. The messages say things like:

Releasing time to care: I will understand that I am here for the patients

Working more efficiently so every shift will be a joy!.

Helping the ward to be more organised so that we can spend time with the patients.

Every single member of ward staff is supposed to grab a colourful marker, some nice paper and add their happy visions about the productive ward to this board. I haven't added mine yet. Do you guys have any suggestions for me?

I was thinking about stealing this from mental nurse and posting it on the happy happy joy joy board.

Coming back to the bedside: Nurse Amnesia

I really like Nurse Ratchet and her most recent blog post really struck a chord with me.

http://nurseratchet666.blogspot.com/

Ok, so I've had a wake up call. Last night I worked on the "Assessment/admissions/somewhere you go so you don't break the 4 hour target" ward. It's the first time in years that I haven't done my overtime either in A&E or my own team. And strangely enough I really enjoyed it - and realised how far removed I've become from real life. Jeez - it took me 'till 0300 hrs to catch up - they'd had such a busy day that pretty much every one of my patients (and I only had 5) had fluids running behind, IV AB's not given,hourly urines not done - not to mention the very demanding patient who was in tears as her fan had broken.

I have to say that I neglected her, and her "lesser" needs to sort out the chap with neutropaenic sepsis, and the woman I had going to Theatre for a laparotomy, and the ALD with the pump that kept turning off, meaning her drug regime was about 6 hours behind. Bloody hell it's hard. I left the demanding patient for an unacceptable amount of time while I dealt with my poorly patients, but managed to catch up, as I said, by the morning.It's really really hard to work in these places, not helped, I am sure, by my lot telling you that you have to churn the patients out, and get them in. I saw some really good examples of good nursing last night, my hat is firmly off.I am eternally glad that I have done my time in these places, and that I actually don't need to spend every day going home handing over everything I haven't done anymore, because there hasn't been time.It's a scary old place, and it's only September.


Nurse Ratchet had 5 patients.

I am glad that Nurse Rachet enjoyed her shift and I am glad that she go her "wake up call". I think that many other senior decision makers in the NHS need to get a similiar wake up call.

It is damn hard to work on the frontlines. People do forget just how bad it is on the wards. It's similar to the kind of amnesia you get post childbirth. While you are in the throes of a 40 hour labour with a breech baby and no anaesthetist to do an epidural or c section ...well it is so bad that you want to die. You lose your mind from the pain and wonder just who the hell is doing all that screaming.

But a few months after the delivery you are telling your pregnant friends that "it's not that bad". And you cannot remember what it felt like. Your husband remembers and practically needs therapy and a shrink after watching you go through that, but you cannot remember much at all. Then when baby number two comes along and those intense contractions begin again you finally remember how bad it is and wonder what the hell made you do this again. "Oh shit here we go, what the fuck was I thinking? How could I forget this pain".

People who haven't been on the wards in awhile not only have nursing amnesia but they don't realise all the changes in healthcare delivery and pace that have taken place. Our site/bed /nurse managers have long forgotton just how hard it all is, and unlike Nurse Rachet, they will not be returning for a shift to find out. Site managers and bed managers are trying to work with what they have as far as staffing goes. It's the folks above them that are making all the bad decisions, and many of them are former nurses. They are all suffering from nurse amnesia. They are incapable of making intelligent staffing decisions. Their minds are on budgets.

I remember my last maternity leave. I stopped into work with my beautiful new baby to show him off while I collected my post. I looked around the ward and thought things like "this doesn't look to bad" "They don't look crazy busy " and "Why the hell was I so stressed when I did this".

I came back from maternity leave ready to go, ready to be supernurse and really believing that the little voice in my head who told me to brace myself was my mind playing tricks on me......nah...it won't be that bad!!! My first day back after 6 months was as the sole RN for 24 medical beds. And it got steadily worse from there. It wasn't until I came back that I actually remembered just how bad it truly is on a short staffed ward.

But we do not allow the bedside nurses (including sisters) to have any kind of say in how the wards are staffed and run even though they are the only ones who could do so intelligently. The only "nurses" who get to have a say are the ones who left bedside care years and years ago and whose main priority is making friends with the business managers.

Why?

Another Safe Staffing Video

I wish I would have posted this below with the other testimony videos.

The man in this video has been a bedside nurse for 6 months. Now he is getting the hell out. Listen to him speak about what happens when you have 6 patients and one goes bad. Now remember that we have 10-15 patients per registered nurse in the UK and rarely a floating a charge nurse. On my ward we never have a floating charge nurse.

http://www.youtube.com/watch?v=kVpJ-icOk1I&feature=related

Take in what these people of saying and spread the word. I am so sick and tired of assholes who think nurses are leaving the bedside because they think they are "above" shit and piss. Shit and piss are probably the best and easiest part of the job when you are a hospital nurse. Those are not the reasons we leave.

BY THE WAY: If any of my dear readers are retired from the bedside nurses who cannot seem to get why today's nurses are freaking out over taking more than 6 patients please look at the testimony in my post below from nurses who trained when you did and are still at the bedside. If you are one of these people who think that the crux of the problem is that today's nurse training is "crap" you especially need to click on this link and get yourself an education.

I'll show you where the caring is when I pull my shoe out of your backside.

Have a great day ya all.

The Daily Mail is so Fucked up.

This article is a few months old. I guess I am really slow. Definitely not as slow as the person who wrote the article below however.

http://www.dailymail.co.uk/debate/article-1209573/The-harsh-truth-We-nurses-just-forgotten-care.html?ITO=1490

I can't even begin to comment on this. It is so full of inaccuracies. Makes me weep when I realise that people actually believe this shit. No mention of the fact that the NHS runs acute 30 bed ward with 2 RNs who are scared shitless that someone will die because they couldn't be ten places at once. Their only help AT ALL is a couple of untrained kids who have no idea what is going on and wander around aimlessly wearing nurses' uniforms. A nurse in that position cannot be caring or focus on basic care without getting someone fucking killed get it? No mention of the fact that these are the wards where are elderly patients are sent. Sometimes I just find it all too painful to comment on in an articulate manner. No shit the patients think we are cruel can't be bothered, we are running past them faster than the speed of light.

And no Rona, we are not running around trying to play doctor and diagnose patients. We are not obsessed with the medical model of care...far from it kiddo.

Christ.

Visitors from Hell

I found this on the net and thought it was funny.

Top Ten Visitors from Hades:

10. The man who snuck in three cats to visit his asthmatic mother.

9. The visitor who ate all his father's food, then rang the nurse to say that the patient was still hungry and needed another tray.

8. The wife who asked you to take her stroked-out husband to the bathroom whenever SHE really was the one who had to go.

7. The son who emptied his mother's colostomy bag into the wastebasket.

6. The husband who fell asleep in the patient's bed while his wife was in the bathroom.

5. The wife who discontinued her husband's central line herself, because “John likes to sleep on his right side.”

4. The 80 year-old daughter of the 98 year old man, who kept turning off her father's continuous gastric feeding because, "He never eats this much a home."

3. The children of one patient who insisted upon using their mother's portable IPPB machine as a scooter in the hallway.

2. The husband who kept sneaking in chocolates for his newly diagnosed diabetic wife.

1. The man who never actually visited his mother, but called twelve times every shift to criticize the nurses, the doctors, the food, and anything else that came to mind.

Here are some of my own additions to the above list: (details changed as confidentiality will not be breached in any way shape or form on this blog. Hospital patients and visitors up and down the country pull these stunts all the time every day. You do not recognise anyone here)

The man who thought that the only reason the nurses put a catheter into his wife was because they are "lazy" so he pulled it out with the balloon inflated and didn't tell anyone. Not only was there trauma but she went into severe retention.

The woman who brought litres of pop into her partner who was in severe CCF and on a fluid restriction. After we explained why this is a bad idea she continued to do it and they just hid the bottles.


The husband who shoved food into his wife's trach because he felt that we were starving her to death.

The daughter who messed with the pump and ran her fathers IV fluids in super fast because she thought that we were dehydrating him to death. The fluids that were hanging had potassium.

The man who punched his demented mother and called her a stupid bitch because she did not recognise him and peed on the floor. Prior to this he had accused the staff of being abusive towards her because the tea trolley girl gave his mum tea with sweetener rather than sugar. She was diabetic.

Anyone who doesn't understand that people with end state dementia do not want to eat and will not eat no matter how hard you try and accuses a nurse who is running between 15 of these patients as well as doing a 100 other things whilst being constantly interrupted of "starving gran to death".

The family who feeds their stroked out gran with no swallow reflex despite the staff telling them that this is dangerous. Then they want to sue the hospital when gran dies of aspiration pneumonia. She got pneumonia from the nurses starving her don't you know. Yep. It doesn't matter how many times you try and explain it, they just don't get it. It's actually very sad.

The visitor who takes the patient with fibrosis in the next bed off of her 0xygen and then places it on his gran who is being treated for a Urinary infection instead because "why should the lady in the next bed get something that my gran doesn't". Never mind that gran has o2 sats of 100% on air anyway and the lady in the next bed is now cyanotic. Our beds are very close together.

The visitors who call the asthmatic patient in the bed next to their auntie "a fucking noisy bitch" because she needed to be nebulised at night. Of course the poor asthmatic patient overheard them complain and was in tears apologising because of her breathing treatments being so noisy. The poor thing. I gave those visitors hell.


Management won't do anything about any of this and if we say anything to patients and visitors we just get flipped off. Hospital chiefs want to promote the customer is always right image, much to the detriment of the nurse's sanity and patient care.

That's all for now.

US nurses fight ....and they already had better ratios than we do!

American nurses have been speaking out about the dangerous conditions in which they are working. Do you know what really struck me when I was watching the following videos? The staffing conditions in the UK are much worse. Exponentially worse. All the horrors that these nurses describe are extant here. We need to get a movement going and we need to get people to listen.

The nurses in the USA have a little more going for them when speaking out however. They have many more job opportunities than UK nurses. If a UK nurse pisses off the NHS she is done. There are private hospitals here etc but they are not as numerous as they could be and neither are the jobs. The region I used to live in across the pond had 7 different hospitals owned by 7 different companies all within a 40 minute drive from my home. In addition to that there were 75 plus facilities that where hiring all within an hours drive. These places were owned by 10 or so different companies who were all in competition with each other. In addition to that I could have looked at working in a doctors office, a school, one of the many home health care companies or for an insurance company. The jobs were plentiful. If I had publicly shopped the hospital I worked in for unsafe staffing, I still could have possibly had another job somewhere else. My new employer might have been hesitant to hire a whistle blower, or they may have loved the fact that I made their competitor look like shit.

Not here. Not here. UK nurses are gagged if they want to survive financially. You mess with the Goliath NHS and you are pretty much done. Margaret Haywood, the nurse who helped to film patient neglect and expose it on panorama has recently be reinstated. Who thinks she will actually get hired on a general ward at an NHS hospital? I don't think they'll touch her with a ten foot pole but for her sake (and the patients) I hope that they will hire her.

The nurses of California fought hard and publicly for the safety of patients. Nurse patient ratio legislation was written and passed. Soon other states followed suit after their governments listened to the testimony of brave front line nurses.

I don't care if you are in a socialist hellhole like the UK or a capitalist pig stye like the USA. The fact is that in both places the people who run hospitals and health care facilities are crooked bastards who resent having to put money into front line services. They intentionally short staff their facilities and then whine (fake whining as they don't really give a shit) about the "nursing shortage". They kill patients. They claim that they are staffing their facilities very well whilst having no understanding whatsoever as to how to staff a unit. They give each nurse so many patients and so little in the way of support and resources that working 12 hours straight without a meal will barely keep your patients alive let alone allow you to "care". Nurses are professionals with a license. If something out of my control happens because I am running in too many directions at once I have to take the blame. The managers who play with people's lives walk free. That's always how it has been. People will always blame the stupid, uncaring, mean, incompetent nurse while missing the big picture. This is why the situation has deteriorated so badly.

Take a look at the vids below. I want you to keep in mind one thing throughout: the situation is worse in the UK. If the nurses testifying in this video are describing just how people die when one RN is running between 8 patients keep in mind that an RN in England will be running between 16 patients on a similar ward.

1. http://www.youtube.com/watch?v=q18ttHO4Uyc We don't use restraints in the UK. But we have more patients. We just have a lot more of total falls out of bad rather than half falls out of bed.

2. http://www.youtube.com/watch?v=OIkwHcuA0F0
I like this woman. She has been a bedside nurse for over 30 years and is shocked about the deterioration in care. She knows the score and you won't hear her twittering on about "uncaring over educated nurses". The unholy trinity of nursing i.e. Lorraine Morgan, Claire Raynor, and Monica Dennis.... all left bedside nursing around the time that the nurse in this video started apparently. The three of them think that nurses invented nursing assistants to get out of doing nursing care. They don't have a fucking clue. Also listen to what the woman in this video says about the numbers of patient one RN should have. Nurses on surgical wards in the UK are taking on a hell of a lot more than 8 patients. Do the math for what their mortality rates are why don't you? Let me tell you, the idea of giving an RN a large number of patients (more than 6) and then throwing a few care assistants in that the nurse should oversee is a total fucking FAIL.

3. http://www.youtube.com/watch?v=bIHrFg33d34

Well said babe. This woman is another one who has been nursing since around the time the unholy trinity left nursing. I blogged earlier about how those that run hospitals have manufactured the nursing shortage to save a few quid. It's true. States like California that have enacted nurse patient ratio legistlation have had NO trouble recruiting enough nurses, and preliminary research has shown that their staff sickness rates have decreased, and they have saved money despite the fact that they have a lot more RN's to pay. The reduction in patient complications and complaints has saved so much money that it has offset of the cost of all those RN's. Their nurses are well educated, provide total care and no one is complaining about not being bathed or fed.

4.http://www.youtube.com/watch?v=JkhZ9dCZIp8&feature=related

More from Oregon. I like the guy at the end of this video. I like what he says I mean.

So you think that these videos are American and have no bearing here? Bullshit. The hospitals here are also "balancing their budgets" on the backs of the nurses. The situation here in England is much worse than what is being described in these videos. Much worse. And the nurses here do not have the back up of the politicians or the public, thanks again to the likes of the Claire Raynor and Lorraine Morgan perpetuating the historical hangover image of nursing...you know...nurses are uneducated slags who should be able to care for 100 patients for 16 hours without a break and sweep the floor with a smile and look beautiful and fresh as a daisy at the same time. If they won't do this they need sustained beatings whilst we ignore the crooks who run these hospitals. Ladies and Gents the statement in italics is basically the essence of what the government, mainstream media, hospital chiefs and dinosaur nurses are saying.

And then we wonder why the nursing care in our hospitals continues to deteriorate.

Glad I stayed on my ward. The other ones are worse.

Yes. Really. I sure as hell wouldn't want to work on any other ward in this hell hole.

Let me tell you why. The ward below us has 30 medical beds. But we still never have enough medical beds at this hospital.

Management will often take 8 beds from the day unit next to this large medical ward and admit medical patients. That gives the ward below mine 38 medical patients rather than 30.

They are staffing this large medical ward with one Registered Nurse and a few kids on fucking day shifts. They are slamming that ward with admissions even when there is only one RN down there. Holy. Shit.

Any more than 4 patients to one RN is officially dangerous and sets even the best nurse up to fail.

The patients see the kids running around and think that there are " several nurses".

"Why isn't anything getting done when there are 4 bloody nurses on duty?" they say.

There are not 4 fucking nurses on duty. There is one nurse and 3 kids. The 3 kids cannot do shit. That is why you are waiting for hours for pain medicine and that is why no one has the time to speak to your relative about your care. The kids cannot help the nurse with any of that. The lone nurse cannot leave the drugs, the medically unstable and the dying to answer questions for relatives. Not without harming someone anyway.

Our letters to management about the lack of actual nurses have finally been answered. "You will be getting 3 new kids who have no experience and are barely literate that will start at the end of the month".

Oh great. As if that is going to help. Management can dress these people in nurses' uniforms (even though they are nothing like a nurse) and pay them less then minimum wage if they are 16. This is the only reason they are getting hired. These managers should be set on fire I swear to god.

My ward has 20 something beds and we are getting 2 RN's most days. It is hell on earth and the relatives get more ridiculous with their expectations with each passing day. The patients are getting sicker and mistakes are happening and we are no where near having a safe ratio. But my god; At least I am not downstairs.