Monday, 26 July 2010

This Makes Me Sick

Today I learned that my ward is gaining more beds.  We will be taking more acute patients and having higher throughput.  After a letter writing campaign initiated by myself, the ward sister and another senior staff nurse a letter was received by management.  "We are sorry to hear of your staffing issues.  You will be getting extra staff in the form of .5 of an auxillary. By our calculations this will bring you to a full complement of staff". 

What. The. Fuck.

We are losing two HCA's.  This leaves us with two HCA's in total on the duty roster.  The other care assistants are all inexperienced apprentices and auxillaries.   I know of 4 HCA's who want jobs on my ward.  They have been turned away.

Management has taken the only room on the ward that we have for lunch breaks and handover and are turning it into a patient sideroom.  This leaves us cramped into a very small space for handover. 

The day staff had to sit on the floor while the night nurse who had been on duty for over 14 hours had to sit precariously on a wobbly ledge thing for the change of shift handover.  It takes a half an hour at least to handover.  Talk about uncomfortable. If we handover at the nurse's station patients will overhear us and report us for "breaching their privacy".

Breaks are impossible.  The staff nurse really isn't in a position to leave the ward for a 15 minute walk to the canteen due to short staffing.  She won't have another nurse to watch her patients. She will not be able to eat in the cramped handover room from hell unless she sits on the floor and wants to get interrupted every 2 seconds.  That means the staff nurse's only option is to eat at the nurse's station thus inviting a whole bunch of smart ass comments from visitors and doctors who do not realise that she is only taking 10 minutes to eat in a 12 hour shift.  Nor do they realise that she has no where to go to eat.

Then I come home from work and see this shit.

What the hell is going on?


Anonymous said...

I think you ought to start leaking to the press anonymously. Get a journalist from the local paper to start asking management questions. You might see improvements fast.

Nurse Anne said...

Oh it's been tried. Two retired Nurse's from my area went on a major news network about it all. As soon as they retired they when public and tried to shop the place.

No one cares.

Anonymous said...

Typical Daily Fail.

Ill-educated idiots or "I nursed in the 1980's" people out of touch with the cold hard reality.

WAKE UP CALL it is different now. Patients are higher acuity. Nurses are fewer.

Patient dropping their BP tachycardic RN on versus feeding.....erm....

Matt said...

Found this on a blog the other day:

"The Daily Mail, a simmering cesspit where sympathy and civility go to die"

Sums up the newspaper really.

Anonymous said...

Get the f*** out of there! You couldn't pay me enough to work under the conditions your describe. The top-heavy management has already proven that they do not respect you and are completely out of touch with reality. It will only continue to get worse.

Nurse Anne said...

The only way to work for another trust is to sell out and move. That is something we are working on.

Frustrated Fairy said...

I'm due to start my nursing training in September and I really am wondering if I'm doing the right thing already :S You all really need to take a stand, breaks are not optional, it surely can't go on, management need to take responsibility.

Dino-nurse said...

The only way things will change is if nurses get together, stop whinging and be proactive. We need a union that will stand with us, not against us. We need to follow the examples of the US and Oz and take industrial action. Prior to this we need to get a petition going that asks for a review of SAFE staffing levels. Its all very well saying that we need to be cost effective-however safe staffing levels would mean no pressure sores, falls, malnourished patients etc etc...problem is NO ONE WANTS TO PAY as its only old, vulnerable patients. We forget that we will all be old at some point. If I was admitted to ED or an admissions unit I would be terrified. Less staff on the wards means that more acutely ill patients deteriorate and end up on the ICU. Just today our CCOT staff (nurses and docs) have wanted to admit 4 patients from the hospital and we currently have- you guessed it- NO BEDS.

Nurse Anne said...

We did the petition thing.

Had thousands of signatures from across the UK.
Whitehall responded with some bullshit like "staffing levels are best managed at local trusts".

I am in favour of a walk out. So are my colleagues. I say this knowing it may kill a lot of people. It's not just the stuff I am whinging about on here. It is everything.

Last week when I came on duty the lone RN for 19 patients told me her patient died because he needed one to one monitoring. She had two such patients and had to choose which one to stay with pretty much sealing the death warrant for the other guy. Shje called for more staff and they sent her a 17 year old untrained auxillary who was sat on the nurse's station on her mobile. Not that a teenager would have been of any use anyway.

This has got to stop.

Strike strike strike. Walk out time.

Nurse Anne said...

Oh it's already started. There were 2 RN's both working this AM. No chance to leave the ward for a quick bite to eat so the one RN took a few bites out of a sandwich while she was looking up some bloods at the Nurse's Station. She was on a 14 hour shift and all she did was grab a few bites of a sandwich while she was working rather than endanger the patients by leaving the ward to take a proper break.

"You are very unprofessional to sit there eating....go to your break room!!!" booms a consultant as he walks by.

And the trust will still deduct her for 2 half an hour meal breaks that she will not take.

You couldn't make it up..

Can't wait to see how we get dicked by the GP's when they get to decide how much we are paid.

Imagine all the GP's out there that belive that have patients crying in their office about poor care....and who believe the "too posh to wash, to clever to care" bullshit.

They aren't all like Jobbing Doctor...

Dino-nurse said...

I foresee many RNs leaving the UK unless things drastically improve. Now that all our newly qualifieds will have degrees, they will be on level pegging with the US and the rest of the world. This is what makes me laugh...joe public thinks that all the little filipino nurses are here because they want to work in the, they are here because they want to work in the US and we are a good stepping stone whilst waiting for their work visas. Plus they are almost all degree-educated, so strike two. I stand by my predictions that given another decade of this, the only place you will find hands-on RNs will be ED and critical care. This will allow trusts to save a packet by having untrained staff on acute wards with minimal supervision...woe betide any RN who takes a sisters post on these wards as they will be hung out to dry.

Anonymous said...

Ridiculous bullshit and Im tired of hearing that these people dont get fed 'cos nurses are lazy - trained nurses are v. rarely lazy people I find ....and nurses are all too willing to get their work done and provide excellent care - but its a simple matter of math - fewer nurses + high # of high acuity patients = lower standard of care - also I read they are going to be closing nursing homes - so those patients will be ending up onn acute wards. Brilliant...

Nurse Anne said...

Our ward sister is on her knees. They are asked to do the impossible. She puts in a 30 hour workweek at home on top of a 40 hour week working shifts as the lone RN with nothing but auxillaries to help.

Dino you are also right about the Philipino nurses.

They are all educated to the US degree-BSN standard. In comparing notes with a philipino colleague I learned that we even used the same textbooks at school. You know I did my training in the US.

And they are only here to improve their English to get to the United States.

Anonymous they are always on us about delayed discharges but there is not place to send these people to and you are right they are going to close nursing homes.

The public depicts the nurses as lazy when they don't get what they want. They want me to come right now to get their mother a commode...but I have to finish what I am doing on the computer---Mr. Jones is about to crash and I am ordering the drugs that the Registrar has just ordered for him. If I get the commode and then go back to the computer Mr. Jones is dead.

The public sees this as "lazy Nurse sat on facebook while granny was suffering"

As if we can even access facebook from the trust computers.

Nurse Anne said...

Goddamn daily mail has my IP address banned or something. Can anyone post there? I know it is a waste of time and energy trying to wake up all those stupid people who think that Nurses brought in the auxilliaries because they are "too posh to wash".

And the ones who think that University training pulled student nurses off the wards are even more stupid.

But it might be worth a try to post a link to this blog there or say-google militant medical nurse.

uknurse said...

I must NOT ALLOW myself to read any more of those stupid head will EXPLODE!

Who are these bloody idiots?!?

Nurse Anne said...

The fifty plus crew along with a smattering of self centred shallow babyboomers.

Ohhh I am going to get slammed for saying that.

uknurse said...

Anne i've tried leaving your blog details on the Daily Fail site soooo many times...and they won't allow it. Why would they? The truth contradicts their sensationalist bullshit. It awful, I cannot believe that they spew this evil.

uknurse said...

I've left the MMN link again. Watch that won't be published :(

Anonymous said...

the year is 2110 and capgrass`s great great grandchildren are off to london on the methane gas train to visit the Nurse Anne`s museaum which is housed next to a great london hospital. (which has now been turned into an aquarium as hospitals dont exist anymore as they became too expensive...........its all done on line now.
they watch the realisitic wax-works and listen to the smells and sounds of a 2010 ward and then they move on to see a model of Dino nurse and this ancient looking antique called a Servo-i. and they refuse to enter the really scary section called "the long term wean" but they did agree to experience the feeling of being buried alive by paperwork. Afterwards their Father took them to a cafe to cheer them up and they all enjoyed a plate of chips.

Dino-nurse said...

Tee Hee. Lets hope they also included the x-rated room where you could enjoy the experience of being shafted by the government. Have just come back from a scary meeting where they are considering opening "weaning" beds on one of our acute medical wards. They want ICU to staff it initially...on a voluntary basis (bribed by a Band 6 supplement) and to train the permanent staff. The physios have already voiced their concerns...increased call-outs for them out-of-hours as the ward staff will not cope. I have added my concerns about the risks to patients and the increased load on ICU (we will not get additional staff during the start-up phase). Managers poo poo-ed this as they think it will save money by freeing up ICU beds. I have tried to point out that long term wean patients are often the trickiest and the ones that even with 1-to-1 nursing by expreienced nurses can still deteriorate rapidly. Our chief consultant left after half an hour saying it will be over his dead body. It will certainly be over someones dead body if it goes ahead. ICU has the luxury of experience plus gasmen on 24/7. Medical units will normally have an F1 or F2. I can hardly wait for the first panicked call as someone has plugged off. Cue me running along a corridor dragging hi-flow/CPAP/BiPAP/Drager (none of which will be available outside the ICU) whilst trying to fast bleep an ICU SpR to meet me.

Uni Lecturer said...

Oh Dear Me Anne!

You do have this 'thing' about 50+ nurses, don't you? How about roping in some thirty and forty year olds too? Very few are degree educated!

I would ask you to consider who lectured these bright new degree educated nurses? Us thick oldies!

C'mon gal! we all need to work together now! Stop this devisive action! Are you working for whatever government is in power? It appears to me that you are!

Lets all work to rule! Get off your high horse gal! Unite! Don't divide!

Nurse Anne said...

You have misunderstood what I am saying completely Uni Lecturer.

I hope you really aren't a uni lecturer because you don't sound that bright.

The fact is that Nurse's today (whether they are uni educated, old school, or whatever) are being attacked by former Nurse's who haven't stepped foot in a ward in over 25 years.

These retirees do no understand the current conditions that nurse's are working in and they are attacking us for things we cannot control.

And that is what I am talking about.

uknurse said...

I physically cannot read any more of those stupid comments on the Daily Mail link you have done!! Its is making me feel sick with rage - these idiots are so brainwashed and one track minded for nurse-bashing!

If there is one thing in this life that the Daily Mail has taught me it's -DO NOT BELIEVE ALL YOU READ IN THE PAPER!

People read this SHIT and believe it! Its disgusting! I have sent your website link twice Anne, along with a link to reputable evidence into WHY nursing care suffers - ie : Nurse Patient ratio's, burnout, underfunding etc etc. It balances the story excellently - in a manner these idiots need to learn.

Did they publish it??

Did they fuck. I am raging.

Uni Lecturer said...

I give up Anne!

You atack all who want to help! You have your own agenda... and I really don't know what it is!

Do you?

capgrass said...

dear Uni lecturer
please dont give up and leave the site. Wisdom and wit is EVERYTHING and i am looking forward to your posts.
love from Capgrass.

capgrass said...

So the management won and capgrass was sent to do an agency shift (£32 per hour on a sunday) on a medical ward: she was allocated 4 tracheotomy "weaning patients" and a 5th patient "self caring" who wanted to go home but needed Capgrass to organise TTOs, dressing, teach how to inject fragmin, OPA, Transport, and fill in menu for lunch. Ah ha thought shall i cope? Well i know! i`ll cut corners! its the only way! of course i`ll check my suction is working ect but I am not going to hoist anyone out of bed. Forget the bristol stool chart; in fact I have put it in the box of chocolate 5th patient has given me. My F1 thinks it is a chocolate selection display. Forget my saving lives; if there is an I.v. cannula............good: so what if it is 10 days old. drugs? well i really havent got the time so i`ll just sign for them anyway but not give them. anyhow at least i have done all the obs! now: time to do an ABG.......great! the patients have arterial lines, not transduced but SO WHAT! so off Capgrass trots to ICU with a blood gas. meanwhile the trachy patient in bed 2 on Cpap becomes discontected. No one notices (its a whisper flow: no alarm system0 and Capgrass is busy ringing the door bell for ICU................. anyhow Dino isnt around cos she is visiting the donut of death (CT scanner) with an ICU patient. thus the disconection goes on and on and on, and meanwhile Capgrass has decided to go to the new Costa coffee house to get a latte as this shift looks likes its going to be Dino wants to bring the CT patient to the medical ward to as her manager thinks it will save moneeeeeee

Dino-nurse said...

Oh how we laughed. Just as an aside, Uni lecturer- what are staffing levels like in your neck of the woods? Do RNs on acute wards have more than 6 patients each? More than 10? If its closer to the later, do you think that this is a safe environment for your students to be learning in? I have alot of involvement with our school of nursing and am always trying to get them to give me a straight answer on this one. Many of the students we see on the ICU tell stories of being on duty on general wards (medical and surgical) with 2 RNs and maybe 1 HCA for 28 elderly, acutely ill patients. As for the admissions units- it would terrify me to have responsibility for a student as well as all those patients. This is often where fairly junior students are dumped. The school can only threaten to remove the students but then, uh oh, where else to put them? So they do nothing. Student numbers have almost doubled in 6 years- bums on seats=cash. Having worked as a lecturer myself ( science not nursing) I know how difficult it is to teach labs with over 100 students crammed into space designed for 50. Difference being I was not sending these students out into an unsafe workplace as part of their "education". You seem to be missing the point somewhat- we are not "having a go" at non-degree educated nurses. I trained in the late 70s myself so do not have a nursing degree. Instead when I left nursing in the 90s I did a science degree (whilst bringing up my kids) and then went back to nursing after finding that I missed it and lecturing was not for me. The "nurses" that I have no respect for are the ones who are now senior managers but have NEVER set foot on a ward since the 90s. There are many of them. I wish that the NMC would rule that to keep your PIN you need to do some ward-based nursing every year. When I worked in the US many of the nursing managers HAD to keep their skills up as when the nurses worked to rule, they were the ones who had to come onto the floor and work. Medics have to stay clinically active so I think we should have to as well. Any thoughts?

Nurse Anne said...

What would I do without you Dino!!

Bodrules said...

All the blogs I read about endemic failures within UK industy or the Public Sector, all have one common theme - fcuking useless mangement, and the further up you go, the more uselss the b'stards get.

I look forward 9sarcasm btw) to the cuts, as we know what will happen - umpteen layers of shiny arse management will be left alone, ditto the legions of support staff that the uselss box tickers seem to be able to get (no matter how tight the budget), whislt the coal face staff get the boot - all so the iron rice bowls of the bureaucracy are saved.

Ironically, they'l lthe nuse the declining performance to adgitate for higher budgets, whcih wil inevitably be spent predominantly on expanding their empires.

pj said...

Shit, your staffing levels are appalling - even in our shit hole of a hospital they're better than that - and that's still not enough.

"There have been complaints for years about nurses not bothering to help frail and elderly people eat their meals, often placing food out of their reach and throwing it away uneaten."

This sums it all up really - nursing staff are progressively being replaced by HCAs and yet the government and public fail to recognise the difference between trained nurses and teenagers fresh of the street.

To me HCAs are almost invisible because, except for a few notable exceptions, they can't be trusted (and are unwilling anyway) to take responsibility for anything so I can't even pass on messages to them or ask them questions about my patients, and they can't actually do anything on the ward that I might want done. Which means I'm constantly harrassing the nurses for stuff (even drugs I could give myself but I'm not allowed because I don't have a key to the drug cupboard).

Nurse Anne said...



Quote of the month. When it gets to the point that there are no Nurses at all on the wards and patients are dying because they are not getting drugs, getting overloaded with IVI's etc etc the public will still be saying that "the whole problem was when they put nurse training into higher education"

That's how dumb they are.

Dino-nurse said...

Anyone remember Labour coming into power along with the "THINGS WILL ONLY GET BETTER" anthem? Well, it didn't. Now the tories will complete thatchers legacy and privatise whats left. Its started already...we have a shiny new body scanner parked outside ED thats leased from a US company. Staffing levels are down (as always) but ICU used to be seen as an area that should be staffed longer the case. Yesterday we had 14 proper ICU patients (most ventilated and several on renal replacement and cardiac catheters) and 10 staff plus already not an ICU. Still had to send 2 staff to the surgical unit as otherwise they would have to cancel ELECTIVE surgeries. Never mind that we will now be blamed for 2 breaches in ED as I refused to ship 2 patients out to our new halfway house (mixed experiemental "monitored" ward which means that all patients have monitors attached but staffing is still one nurse to 8 patients)the reason? They were long term trache weans and as I have said until I am blue in the face , these are the most dangerous group to skimp on. No doubt I will be held to account next week :0(

Nurse Anne said...

It's sick isn't it.

Anonymous said...

PJ - you have hit the nail on the head as far as my trust goes.

As a newly qualified itching to start work as a staff nurse there are no band 5 jobs at my trust, so I am working bank as a HCA in the mean time to keep my foot in the door.

Assistant Practitioners (APs) are very much in vogue at my hospital. After all, they can do EVERYTHING a nurse does except administer medication. I have yet to fathom what they actually do that is beyond the remit of a HCA.

Don't get me wrong, some of the experienced HCAs are fantastic, but others are terrible.

And why can they never complete fluid charts? The poor RN subsequently gets bollocked by the medical team on the ward round because they have no information regarding patient's hydration. Crazy!

Nurse Anne said...

Well of the docs keep up their bollocking and screaming they will soon find the wards staffed with only auxillaries and the doctors will have to take off their own orders, give their own drugs, organise their patients on discharges, and monitor their own patients. Wait until they see how complicated all that is and how long it takes.

If the hospitals don't want RN's and the doctors just want to bollock us for stuff we cannot control why don't we just walk out and leave the auxilliaries and the juniors doctors to get on with it?

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