A Tale of Two Shifts

Don't worry.  I am not going to go all Dickens on you.  I am longwinded enough already.

Once upon a time in January 2010:

Monday Early Shift:

Two staff nurses (and 2 untrained agency carers with their fingers up their  noses) for 30 patients.  Nurses receive written warning from managers that we must attend ward rounds and drop what we are doing to attend them as soon as the consultant steps foot on the floor.  Staffing is not an excuse to miss them.  There are 8 different consultants.  Was on ward rounds from 8:30 until 11:30.  Didn't even get half of the 8 AM tablets started until half past 11.  That means that 4 hours into my shift I hadn't seen most of my patients at all.  The ones I did see only had me in the room long enough to throw their tablets at them. Then the next lot of consultants came at 12:15 and kept us until well after 2 o'clock.  They don't move very fast, these consultants.  I don't think anyone was fed.  Sometimes 3 of them will show up at the same time and all stand there talking at once demanding that the lone nurse follows them around.  We don't know when they are coming and can not plan for it.

I was supposed to finish work at 3 PM.  I left at 7 PM.  Unpaid for 4 hours.  I accomplished nothing in the 12 hours I was there and barely saw my patients. Patients deteriorated.  Tablets were rolling across the floor.  God knows who had what, or if they ate, drank, voided, were turned or if there were any new orders from the medics.

This is the norm these days.

This is the norm before people start calling in sick.

Thursday Early Shift:

A miracle happened  Thursday and I enjoyed it immensly because it may never happen again before I leave.

We had 4 experienced staff nurses and 2 experienced health care assistants to 28 patients.  Two of the four staff nurse (myself and Jane) had also been on Monday AM.  Our ward sister was also there on a management day and we actually had a ward clerk to answer the phone for part of the morning.

I had 7 patients to medicate for the 8 AM drug round, which I accomplished by 9 AM even
 though I took the time to assess them and help them with their breakfast.  There were no longer an IV's.  But no one was for discharge due to social cirmcumstances.   At 9:15 I was bedbathing and care planning. Only 3 consultants showed up for rounds.   Everything was done and ready to go.  The health care assistants finished off the bed bathing etc while I organised and implemented all the consultants new orders.  I got a lot of extra things done as well.  I took a 45 minute lunch break to make up for the 4 hours unpaid  and lack of a lunch break on Monday.  While I was eating my patients were cared for by another RN.

I feel very refreshed, like I just had a long vacation.

What were the patients' and the consultants view of all this?  "Oh you nurses are so much better than the ones who were here on Monday. Those lot either ran around frantic (Jane and I) or had their fingers up their noses (agency carers)"

Um, we are the same nurses who were here on Monday with a lot more in the way of help and resources!!

Now wonder management gets away with short staffing.

An article about the Kids from The Sunday Times.

This article is better than the usual rubbish that we get about nurses.  But the headline pisses me off;

Novices do Nurse's Job

They did hit on a lot of good points.  Then they fucked it all up by implying that nurses brought novices into the hospital to avoid hands on care.  Nurse have no control over hiring, firing, staffing matrixs, or skill mix of ward staff at any given time.

It is true that our hospitals hire people off the street and throw them onto a ward dressed in a nurse's uniform.  They are not even training them to be health care assistants  anymore.

These people are thrown right onto a ward instead of trained and experienced staff.  Absolutely.

The problem I have with the article is the headline really.

"Novices do Nurse's job"

Oh no they are not.  They are incapable of doing a nurse's job.  They are there on the ward.  They may wash patients and make beds if they feel like it.  But these things are a far cry from an accurate description of a real nurse's job.

If I am working on a ward as a nurse and the only other staff I have with me are two or three apprentices/care assistants then there is ONE nurse on duty.  This article makes out that it is the nurses who are wanting to dump all this work onto the novices and that really leaves a bitter taste in my mouth.  The lone nurse simply cannot attend to everything by herself.  She knows what needs to be done, she knows what the consequences are.   She starts out doing the things that only she can do (this is the stuff that makes a huge impact on patient survival) and she delegates the easy stuff to the novices. There is no other way to do things if you are the only nurse.

As the only nurse I am on my own with all the:

Medications  (40 minutes out of every hour of my time for much of the day)
Drips/calculations and monitoring
NG tubes,
Diagnostic tests organisation and preparation
admissions
discharges (complicated and time consuming)
communication with doctors, physios, pharmacy, path lab, specialists (they all go through the nurse rather than talk to eachother)
assessments to avoid "failure to rescue"
wound care
Peg feeds (I have never seen a care assistant change any kind of a drip bag)
suction/trach care
02 delivery and management
post procedure management and care
communication with family members (I cannot get 2 minutes straight free of this to see my patients)
specialing the critically ill patient but not leaving that bedside except to grab supplies and fast bleep the reg.
documenting every single thing that has been ordered for or is happening with every patient
managing and implementing blood transfusions
pressure area care

The novices don't even really know what any of that stuff is.  I singlehandedly have to stay on top of all that for 20 people whilst getting interrupted literally every two minutes.  When the heck can I do a bedbath?  I should be doing it for assessment reasons but something has got to give.

And in addition to all that I need to do basic care so I can see my patients general condition and bring any problems to the attention of the doctor.  But certain aspects of basic care are about the only things that novices can help me with.  I need to beg the novices to please clean and turn my patients when I am tied up with blood transfusions and doctors rounds.  I need to be apologetic towards them for not doing it myself.  Everyone just thinks that the nurse wants to dump the basics onto the kids rather than get her hands dirty. Nurses will sometimes abandon things that should not be abandoned in order to assist the apprentices with basic care, trying to prove that she is not "too posh to wash".  Then blood transfusion reactions do not get picked up quickly enough.

Recently I was 2 hours into my shift and still hadn't even seen most of my patients at all.  One of them took a turn for the worst and was dying before our eyes.  I was tied up with that, trying to ring his family to come in.  After that was over I made a series of attempts to check on my other patients.  Notice I said attempts.  Everytime I headed down the ward, phone calls came in and I had to backtrack to the phone. Their drips were empty, dressings were on the floor, cannulas were tissued, catheters were pulled out, people were in retention.  The apprentices were on the ward, but they don't get involved in that stuff.  They just come to tell me it needs to be done.

Finally after an hour of fighting, I got to the bedside of my first patient out of 20 who looked like she has been cooking a nice hospital acquired chest infection or had possibly aspirated.  She was laying flat and sounding pretty bad chest wise.  The apprentices would have bed bathed her and left her flat. God knows what they fed her but I doubt it was pureed enough. Her oxygen sats were low, 72% and her only past medical history is dementia.  I had just put the 02 on her face and sat her upright.  I needed to get some obs, could tell she was pyrexic.  She isn't on antibiotics as she originally was admitted for a collapse ? CVA.  She hasn't seen a doctor since 9AM Monday morning.  It is 4PM on Tuesday.  I think I need to get her seen. 

Smack in the middle of this two apprentices come into the room.  "Anna, there is a phone call at the station for you, it sounds urgent.  The ward clerk told us to come and get you".   Once we had a good but very part time ward clerk but she is away and has been replaced with shite.

I left my patient and walked all the way back to the nurse's station.  It was ambulance control.  They wanted the birthdate of a patient they had transferred out that morning.

Does anyone want to tell me why the ward clerk or the apprentices could not look through the discharge book or the notes and give the birthdate out to ambulance control?

This kind of shit happens every time I make an attempt to see a patient. All I am doing is backtracking to the phone, and praying that my patients are okay in the hands of the apprentices.

No.  The novices are not helping the nurses or doing a nurse's job.  We work for them I think.

A man who commented on The Times article wrote this:

As for the DofH quoting a rise in qualified nurses since 2007 of 8,563; it means nothing if they are passing their responsibilities to healthcare assistants. The increase in nurse numbers is just adding insult to injury.

Those DoH stats are a lie.  The few RN's on the ward are left with no choice but to delegate because the tasks that only they can do are overwhelming.  And it isn't the paperwork, unless you count the ten forms I have to fill in 20 times an hour to obtain life saving drugs ordered by a doctor.  The rest of the paperwork gets completely blown off to the point that we get in trouble over it.

When the apprentices and care assistants  are pissing and moaning and whining about being ordered to do bed baths on their own you have to remember this:  These kids have absolutely no idea about what the nurse has on her shoulders, nor do they understand how complex and time consuming it all is, nor do they understand the consequences of her not delegating tasks to the untrained staff.   It is the mere simple minds  who look at this situation and  say "the nurse doesn't want to get her hands dirty"

What is going on? What happened to respect?

No one has any respect for real nurses and junior doctors.

How I miss our experienced Health care assistants.  Now we get apprentices as they are called.  They are thrown onto the ward with no training and no experience in the place of experienced staff.

They wander around in nurse's uniforms and refuse to answer bells and help with turns.  They are unable to do observations.  "That is all the nurse's job" they say.  Well yes everything is actually the nurse's job, but I have a 150 drugs due in the next 45 minutes, the consultants are here to do their rounds, and family members are queing up to lay into me.  My blood transfusion is here and I need to do 10 things to get it started, and monitor the patient.

Consultants are constantly yelling at the nurses for observation charts not being done and intake and output charts not getting filled in.  They know damn well that it is physically impossible for the lone Nurse to attend to all of those things.  But they yell anyway.  I have no choice but to rely on the apprentices.  But I don't know how to get them to understand the importance of recording how much fluid a patient is drinking and how much they are voiding...without that information we could send someone into pulmonary oedema or miss pre-renal failure. Just keeping those charts accurate for all those people would be a full time job on it's own.  They just refuse to do it an I can't be there to do it for all those people.  The apprentices know that the consultants will lay into the nurses over it.  It's not the apprentices problem.  They do as they like. 

The domestics are leaving lists of jobs for the nurse to do so that the domestic can leave on time.  The nurse is already staying over 2 hours past the end of her shift just to accomplish the things that only and nurse can do, and that is before you take into account all the things she is having to pick up because the apprentices do nothing.

The clinical techs are bullying the doctors.  Clinical techs are people who are hired and trained to draw blood and insert cannulas.  They have no further education or registration.  You do not need any kind of schooling or anything to do this job.  The clinical techs often worked at tescos prior to being clinical techs. They just do venflons and bloods to take the load off the docs a bit.  Here is another group of people who have no real responsibility or consequences because they are not professionals, dumping on already overstretched professionals with no personal consequences to themselves. The problem is, they are sat in the cafe telling the doctors to do their own cannulas.  They tell the junior doctor who is running between multiple wards with all that life and death responsibility off for asking them to do a venflon. 

The clinical tech's favourite line is "Tell the doctor I am to busy, so he has to draw the labs himself". OMG you fucking slacker do you have any idea about what the doc has on his shoulders?  He has a list of jobs on mulitple wards.  IF he is telling you that he cannot take the time to draw blood, THEN HE REALLY CANNOT FUCKING TAKE THE TIME TO DRAW BLOOD.

The clinical techs are either answering pages to do venflons or they are kicking it in the cafe upstairs.  If they are asked to come and insert a cannula they want to know why the junior doc is being to "lazy" to do it himself.   Hey, if it doesn't get done it's the doctor's and nurse's ass isn't it?  The unregistered staff never has to suffer any consequences.  They don't.  They just keep on passing the buck which stops with the few of us who can be held accountable for our actions or omissions.

Recently I saw a clinical tech screaming at a junior doctor for paging her to draw some blood.  The clinical tech was annoyed because the doctor was already on the ward that required the blood draw.  She didn't see why the doc couldn't just do it herself.  The stupid little shit doesn't want to realise that the doctors have patients all over the fucking place and they they need to do what they can for the patients they are with, delegate anything that they can,  and then run off so that they can get to the next patients. 

The housekeeper takes 20 minutes worth of break time every  hour and follows the 2 nurses around reminding them to clean the toilets properly.  "Remember you have to fill in the cleaning forms, they are so important because management says they are".  Then she castigates the nurses as lazy.  Thick as pigshit she is.

If  a doctor points out that an alcohol handgel cannister is empty to the housekeeper, she turns around and points to the storage cupboard where the re-fills are kept.  Which means that it gets left empty because doctors are running their asses off trying to keep patients alive and really shouldn't be re-filling stock.

I had a domestic order me (when I was in the middle of a 2 hour late long and complicated drug round from hell) to empty the waste bins and collect in the dinner plates for her so she could leave on time.  I was already slated to be there 2 hours at least past the end of my shift just doing nursing stuff.  And that is before you take into account that my patients were sitting in pee soaked chairs for the last 8 hours because the apprentices, the only help I have, are refusing to lift the patients.  Out of everything that is going on, it is one of the only things the apprentices could do to help out. 

When we try and tell these people that the nurses and doctors are already overwhelmed and patient's are suffering we are told "Well, everyone is stressed".  Really.  And how the fuck are you people stressed when you are doing nothing and don't have any accountability to the law or a professional body?  Serioulsy.  If a care assistant or an apprentice causes harm to a patient the RN responsible for that patient takes the fall.  They are working on my license.

Pretty soon the domestics are going to be bleeping the doctors to empty the rubbish bins, so that the domestics can have their breaks.  Staff nurses rarely get breaks, and doctors never get them.  I am waiting for the apprentices to start asking the doctors to empty the catheters for them.  They are already refusing to assist the nurse's with anything.  "You are the nurse, do it yourself, don't dump your job on me, it's time for my tea break".  So the patient gets left sitting in pee for another hour until I can finish getting the guy with chest pain sorted out.
What happens when we try and knock these people into line?  They get all upset and cry that they are being bullied.  And management does not want the professionals pissing off the  easily controllable and cheap labour.  We are told that they are "stressed too" and that we should help them more.  Yeah it must be stressful spending the day on your mobile and going out for fag breaks.

What the fuck? 

Where is the respect and autonomy for professionals in this place?

It should go like this:

1. Doctors
2. RN's
.
.
.
.
.
.
The rest of you... Including management with a non clinical background.

That looks harsh doesn't it. I did not make that list because I am some snob who thinks I am better.  I may quite happily hand in my registration and proudly start working as an HCA or a tech again.  I made that list because if the shit hits the fan with patients, it is the doctors who have the most to lose.  The nurse comes in second with the most to lose.  That is why we delegate.  It isn't because we are lazy or snobby. Now show some fucking respect and give us a hand.

God I hate working weekends

I really fucking do.

I don't go out much so it's not like I mind actually having a job where I am required to work weekends.  I just hate working weekends in a place that completely falls apart because it's the mother fucking weekend.  The nurses and docs are there, running their asses off, the patients are there, getting completely pissed off but where is all the support staff?  At home, hungover.

No Pharmacy.

No housekeeping.

No supplies.

No clerical staff.

If there is anyone in path lab they are run off their feet to the point where they are invisible.


There is very little in the way of nurses and doctors but that is completely normal.

Sunday was not a good day.

 First of all we started the shift out of everything.  There was no linen to change the beds. Common drugs were missing.  We ran out of gloves and gowns and we had multiple people requiring either barrier nursing or reverse barrier nursing.  Spent the first two hours of my shift running around the hospital with a trolly trying to  nick stuff from other wards collect supplies whilst the day shift nurse stayed on to watch the patients.  There wasn't anything to steal.

We have 5 isolation rooms.  Three had c-diff. One has MRSA. The other room had a patient who was neutropenic.  These rooms are all in a row and the areas between these rooms were completely devoid of gloves, gowns, handwashing stations that actually had soap and anything else we actually required. 

We had one working dinamap.  One.  And one manual cuff for 30 people including the folks on isolation.  Does anyone see a problem here? 

The junior doctor was on her knees.  She was covering all the wards.  It took about 8 hours for her to get to my ward and see patients, attend to jobs.  I wasn't going to bother with the bleeping unless it was a pre-crash because that just slows the doc down anyway.  She new she had to come and I knew she would get there when she could.   IV fluid bags ran dry and stayed that way for about 10 hours until more were prescribed.  I grab a little tiny bag of saline and put it up at KVO just to keep the cannula's patent but really I shouldn't do that.

My other two staff members were young teenage girls first week on the job.  Not a clue.  Not a clue.

All three of them were off duty at 8.  I was there until  9:00 when nights started, alone.  I found patients who had been sat in their chair for 8 hours, pee all over the floor, tablets on the floor.  The fluid balance charts were empty.  One elderly lady had poured a cup of hot tea over her head.  


The state of my ward shocked me. 

And nights only had 2 staff.

The icing on the cake was when the site manager showed up and wanted me to thank him for giving me the two little girls and the bank nurse to help out.

Oh yeah thanks. I am going to put that on my incident form about all this and on my letter to the chief executive while I clearly explain that dumbing down and not paying enough staff to be around actually increases costs because of poor patient outcomes.

I see Creepy People.

Or crazy, stupid creepy people who watch to much TV perhaps.

People are generally ignorant about things in which they have no personal experience.

 Even the most open minded  person who is aware of his own limitations  will lay into medical and nursing staff  like a rabid dog. I put this down to fear,  the inability to deal with their mortality, their loved ones mortality, and the loss of control that all these things bring. Most people have no understanding about what a nurse is, or what she does, or what she has on her shoulders.  But that does not stop them from being a monday morning quarterback, ready to tear her to pieces.  The mental guidlines they use to measure their nurses (and doctors) by come from years of fictional and incorrect medical dramas that they have viewed on TV. 

On TV even the dying patient looks lovely and calm...because the nice nurses and doctors made her look that way. 
On TV nurses and doctors have lots of breaks to chat.   On TV a confused patient can be settled down with a kind word.  On TV the patient has his own crew of multiple nurses and doctors, around him at all times.   On TV the nurse will stop and attend to you as soon as you shout nurse because that is what she is there for, it's not like she'll have other patients sicker than you.  On TV the hospital provides that staff with enough linen to change the beds every day. 

On TV a trauma patient looks beautiful after falling out of a plane and survives horrific injuries because the doctors and nurses decide to make her look beautiful and make her survive.  On TV elderly people are never violent or aggressive. They never attack other patients or rip their tubes and lines out, as well as the tubes and lines out of other patients. If they do behave like that, the nurse (or the doctor) is shown sat at their bedside, holding their hands, because on TV doctors and nurses are not being rushed between multiple patients as if they are working on an assembly line.  On TV if a patient dies it is because the doctors and nurses are crap, incompetent or evil.

Now de- program yourself.

We deal with these kinds of attitudes on a day to day basis.  You wouldn't think that people are so stupid but they are indeed.  Everyone has stereotypes about lawyers, stock brokers, and McDonald's burger flippers.  But that is nothing compared to the bullshit they believe about medical care.


Last week I took over from another RN on the shift after hers.  On her day shift her youngish patient crashed and survived but she needed to one to one him for 6 hours until he went to another facility.  In real life these things occur all the time, and the nurse is not given another nurse to care for her other patients.  That means that they are without a nurse until the their nurse dumps her critical patient on someone else.  As she is walking back and forth to the medication room to get additional supplies for her patients she cannot, under any circumstances stop and get commodes or do a drug round or any such thing.  The healthcare assistants are around, trying to help out the best they can.  But they cannot do meds, or doctors orders, assessments, dressing changes, discharges etc.  This means that the other patients are without that stuff for as many hours as it takes for the nurse to lose her critical patient.  The nurse cannot control this in any way shape or form.

I took over from Rachel and my first job was to run to her other patients who hadn't actually seen a nurse all day.  The critical patient was now gone.   I caught up on the other patients care etc etc.  All I got from them was

"oh you are so nice compared to that horrible Rachel this morning, who ignored us completely" 

"Oh you are so nice, that Rachel hates old people"

 "That incompetent Rachel didn't bother to bring my tablets on time"

"That horrible nurse Rachel didn't change my dressings"

 "Thank god for nice nurses like you Anne, that horrible Rachel has no compassion"

"I am going to report that horrible Rachel, I shouted out for her to bring a commode and she ran right past me and told another girl to do it (Rachel was running for a bag of geloinfusion and the other girl was a health care assistant who could not help out with the critical patient).

It didn't matter how many times I explained that Rachel is actually an excellent nurse who was tied up with a critically ill patient that she could not allow to die.  It didn't matter how many times I explained that the reason I was able to care for them right now was because there was no longer a critically ill patient on the ward. It went right over their heads. 

Now I can certainly understand these patients being distressed by their lack of care.  I would be distressed as well, and angry.  But why would they assume that a nurse with multiple patients would be able to meet all of their needs instantaneously, at the drop of a hat?  What causes them to classify a nurse who doesn't do this as "lacking in compassion".  Even when they are told that their nurse has 15 other patients, that one of them is trying to die on her, and that management refuses to staff the ward with actual nurses as they did years ago even though the patients are sicker now............the average lay person still does not get it. 

This is why we lose nurses. 

The next day I was working with a lovely health care assistant.  She is 19 weeks pregnant and was scheduled to work an 8 hour shift.  We had no care assistant for the afternoon so she stayed on and in total did 14 hours.  Bless her heart. But even so we were struggling. The afternoon shift for 30 patients consisted of myself, another RN and this pregnant care assistant for 30 heavy and complicated patients. 

Their families don't want to be bothered pushing their service providers to hire nurses, they don't want to understand what intentional short staffing by management does, they don't want to be bothered backing the nurses up when they blow the whistle on short staffing  but boy oh boy do they love to lay in to the nurses for not providing one to one care. 

If you want someone to always stay with your mother while she is on the commode, or always have her pain medicine on time, or be there instantly when she needs the loo then what you want is indeed one to one care.  You don't want your mother's nurse to have any other patients.  The nurse has no right to control how many patients she has nor can she control what is going on with them.  She cannot even control how long she spends with them at a time, as all that depends on her other patients. To you, this seems to mean that the nurse "lacks in compassion".  I don't think it's the nurse who lacks in compassion, not by a long shot.  I think it is the public.  Mentally, they cannot deal with the reality of sickness, death and health care economics, so they lash out at the soft targets.  Nice.



Ellen, the lovely pregnant health care assistant went to hour 11 without a break of any kind or food and fluids. At hour 11 I told her to sit her ass down and have a break.  There were lots of things going on in the ward, we are always outnumbered by call bells and patients needing help.  But I didn't need a collapsed pregnant health care assistant on my hands as well.  The hospital will deduct 1.5 hours out of her pay for breaks whether or not she takes those breaks.  She was not going to take it.  I made her take one.  As I said before, I wasn't in the mood to deal with a collapsed and pregnant member of staff.  She finished what she was doing and went to the office with a mug of tap water and some dry crackers.  She didn't feel that there was anytime for her to disappear off the canteen.

Enter Simon.  He is the son of a frequent flyer patient of ours.  He likes to follow the staff around taking pictures on his phone.  If a patient is ringing a call bell he stands there with his watch and counts how long it takes for the bell to be answered, then he goes apeshit on the staff.. He doesn't bother to think about what the staff are actually right in the middle of at that moment.   He jots everything down in the notebook and shouts at the nurses.  To Simon, anyone in uniform is a  "nurse" and she is a nurse who doesn't want to take care of patients.  He tries to take pictures of patients so he can sent them to the papers and "shop us" for neglecting everyone.  If he sees a confused patient shouting out he demands that the staff "do something to stop her confusion and help the poor woman right now dammit".  Simon, there is absolutely nothing that a nurse can do to stop a patient from being demented and shouting out.  Nothing.  Nothing.  Nothing.  Nothing.  Even if I didn't have other patients who need things at this moment.   Simon is like our wards own little daily mail police officer.  We don't have security or anything, we can't kick him out, we just have to put up with it.


As soon as Simon saw Ellen head into the office with her crackers he was straight there, camera in her face, taking pictures of the "lazy nurse who is stuffing her gob whilst patients need help".  I had words with him, explained that Ellen was not a nurse, that she has put in a long day trying to help these patients and that she is expecting and needed to stop and eat.  He laughed at me and shook his head.

Simon is not just one guy, he is many.  We are getting more and more of this.  Simon himself is unemployed.  I doubt he ever went as long without food, working his tail off, as Ellen was doing.  Pregnant Ellen took a grand total of 10 minutes out of a 14 hour shift to stuff some crackers and tap water into her mouth.  And she was called lazy.  Only nurses and health care assistants could work a 14 hour day in horrendous conditions where they can barely function and still get called lazy by an unemployed 40 year old healthy (physically) male.   The other nurse and I skipped our breaks completely but even that did not get us off of Simon's hook, nor were we able to feed any patients or answer call bells quickly.

We are getting bombarded with Simon types and I don't really know what to do.  He wouldn't behave this way in a supermarket, or a bank.  If he did he would get kicked out.

What can we do about people such as Simon?

What can we say to people who think that there elderly mother was left on a commode  because the nurse is "cruel".

Why do they not think about what else might be going on?

It's fucking creepy if you ask me.

 I always find it very offensive that people will make these kinds of judgement calls about nurses without having any kind of idea what other things the nurse has on her shoulders at that moment in time.  We know that lay people have no idea of the function of a nurse.

What about people who shout out a nurse whilst she is in the middle of slowing bolusing an IV drug and demand that she stops what she is doing and bring granny a bedpan? 

Visitors do this and then run down to complaints whining about being ignored by the mean nurse who left crying granny without a bedpan. I know if I am bolusing a drug I will blank anyone speaking to me until I am done with what I am doing.  I made a mistake once because  relative rushed me.  They show no respect for the nurse, or the patient receiving the drug that will kill them if pushed in too quickly by a rushed nurse.  It is truly diabolical to start yelling nurse at anyone walking past in uniform and expect them to be able to stop what they are doing immediately and attend to you.  They are in no position whatsover to just drop the ball like that.

How can we make these people understand why these things happen?

Why do we get no back up from the Hospital chiefs?

Or the Media?

Or our Nurse leadership?

Or the Doctors?

They have all jumped on the "The nurse can do everything perfectly at all times for 30 patients all by herself and give them all one to to one care on another person's terms and timescales...and if she doesn't, she is "lacking in compassion" bandwagon. 

The terms and timescales of the patients, visitors, managers, doctors etc are a mute point anyway because they don't understand what else is going on in that ward.  No nurse on a large short staffed ward can take all the time with one patient that he needs, without bringing harm to another. 

I don't get it.  But I know it has a lot to do with people not being able to deal with the fear and loss of control that a hospitalisation brings.  I used to have sympathy.  Now I am sick and tired of being the kicking bag for their dysfunctional coping mechanisms and their inability to deal with the realities of sickness and death.

It's never pretty.  Sickness and death, old age, ischemic legs, loss of independence, infected wounds, sepsis, pulmonary oedema,  death etc etc is always UGLY and HARSH.  Even with the best staff on the case.  Two litttle 5 foot tall nurses are never going to be able to move a 15 stone combative patient gracefully.  We cannot stop people from falling.  We cannot force people to eat.

 It is never going to be pleasant or pretty.

So what can we do?

A Good One

Found this little anecdote on the net.  It was posted by a doctor.

A postoperative patient became angry during morning rounds.

 The doctor and the nurse had entered his room to review his progress.

The  very young  petite woman kept responding to the questions that the patient was directing at the big, tall,  muscular man in scrubs.

He wanted answers from the doctor dammit, not some “dumb slut nurse” as he phrased it.

The ITU Nurse–a former Big Ten offensive lineman  (American football player) politely introduced the patient to the little woman and informed angry patient that she was the  brilliant cardiothoracic surgeon who had saved his life the night before.

The cardiothoracic surgeon, in turn,  pointed to the big guy and introduced the patient to the “dumb nurse whose brains and education will be keeping you alive for the next 12 hours while I am away seeing my other patients.”

And check this out.  It's a video about the poster above.  The RCN should be doing this kind of stuff.

Crazy Dancing Arrhythmia Doctor: A Classic

Have you ever seen the crazy dancing arrhythmia doctor? This video is old!  I am sure that various medical students have had to sit through it in their lectures.  We had to watch it twice in nursing school.  Good times.  Take a peak and review your knowledge.  The best bit starts at 3 minutes and 30 seconds..The other best bit starts at 2 minutes 34 seconds.

http://www.youtube.com/watch?v=L-3ja1dIvPw&feature=related

Looks like there are others out there who remember crazy dancing arrhythmia doctor and they have put music to his moves!

http://www.youtube.com/watch?v=dEsemaDMkMQ&feature=fvw

I am telling you this should be required viewing in all medical and nursing schools. Who cares if it outdated. I'll never look at PVC's in the same way ever again.

Let's try and get Dr. Crippen to do a version and put it online.