It?s easy, very very easy. (And now just realised long long this is so be warned!)
Let me explain, first of all pick a system that works and dismantle it slowly so that by the time its shit it?s too late.
Instead of having a ward housekeeper who see?s the cleanliness of her/his ward as a matter of pride and has a routine.And keeps the place so clean that you really could eat off the floor or the top of the waredrobe (Woe betide you if you left a dirty cup in a sink, or didn?t fetch her immediately if there was a spill!). Decide that if she can keep one ward this clean, she can do 2 and then 3, and then sack her because she physically can?t be in 3 places at once and replace her with a series of temp staff that have no interest or pride in their work.
Decide that the assistant housekeeper isn?t needed as every time you visit the ward she just bloody sitting down (next to a patient feeding them, a task that she has been trained to do or filling in a menu card or coaxing some water down a little old lady/man throat) I mean just sitting there, how dare s/he.
Or is chatting to the nurses (telling them that Mrs. X seems to be struggling with cutting her food, and Mr G ate all his breakfast and dinner with a little help for the 2nd day in a row, 
and why is she ordering a diabetic meal for Mrs W when she asks for 3 sugars in her tea/coffee
. Oh and by the way Mrs B is hiding her food in her bag, the bin, her neighbour?s bed etc)
So remove them from the wards and replace all of them with one person who flings menus at patients and returns 2 hours later and if they aren?t filled in makes it up.
Cut the ward clerk hours from 6 a day to 5 shared between 2 wards, so actually cuts the hours from 6 a day to 2.5.
Bring in protected meal times, which on paper means that there should be no visitors to the ward for that hour, that includes doctors, physio?s etc as well as family. And that patients shouldn?t be taken off the ward for xrays tests etc. Except that doctors are far far too important to be told what to do and when, so doctor?s rounds continue. And if Mrs B doesn?t have her Barium Swallow now we can?t tell why it hurts to swallow and this is the only spot free for the next week so it?s go now or wait in pain for a week. And Mrs W can?t eat till she?s had her blood taken. And that by preventing family from visiting means that Mrs A who is the only one who can convince her confused husband to eat can?t come and help.
And you know how nurses can be trusted with very very serious drugs and money and jewellery, that patients bring in, oh, and patients lives?? But don?t you DARE trust them with a box of cornflakes, some bread and butter and a few sandwiches, yogurts etc, that they could give to patients who are admitted after lunch/dinner/middle of night/ been starving all day waiting for a test/surgery that never happened.
God alone knows what they might do with them. As for milk or cups leave any of them in reach and before you know it there?ll either be wild parties or selling them on street corners.
And all that work that all the above people did, well the nurses can do it can?t they?
It?s not that they don?t want to do it in fact most of them would jump at the chance to spend time with a real actual patient, but they have to do things that only the qualified nurse can do like the drugs round, for example. And chase pharmacy for missing drugs, a job that the ward clerk used to do for you, and answer the phone in case it?s radiology saying they can fit Mr K in if he hasn?t eaten yet (ward clerk would have told housekeeper, patient and then you), or Mr F?s sisters husbands best friend milkman demanding that you tell them all about his treatment, that it?s fine he?s just the same as family really and threatening to sue you when you explain you can?t give out that info, (which again the ward clerk would have sorted, sometimes using the oh sorry I?m just the Ward Clerk and Nurse is busy can you call back in an hour?)
And the 6th call from Mrs H?s daughter asking how she slept, in the past the ward clerk would have just brought the phone to Mrs H.But because you have to answer the phone as 'Hello, Ward abc Nurse XYZ speaking' short of putting the phone down on them you're there till they run out of steam
And then sort out the IV drugs something that wasn?t that common on a general ward 20 years ago but is now routine. And 5 years ago you would gather up the charts go to the prep room, get out all the bits and draw them all up keeping all the empty bottles wrapper etc, then lock the door, and get your counterpart to come and check them and then you?d each take a tray you the drug for Patient 1 s/he the drugs for Patient 2, you?d check that you were each going to the correct patient and give the drug and so on till you?d finished.
Until someone decided that this could be a problem?
So from now on both of you needed to be there to draw up the drugs, and no you couldn?t both do it, one had to draw up the meds and the other stand and watch, watch all of it, you draw up the meds, walk with you to the patient, and watch you give the meds. Oh and to pay no attention to anyone else while watching your colleague. (So that any family visitors think that either 1 of you is not to be trusted or that you?re rude and lazy).
It wasn?t unusual on my last ward of 30 patients to have at least 17-20 of them on 4hourly IV anti-biotic. Several of them also on IV diuretics, a drug when been given by IV has to be given at no more that 1mg a minute, it was amazing how much info you could get from a patient in 4-6 minutes, discover that they weren?t drinking because it was making them pee all night and they were afraid that they might not make it to the loo in time because they?d forgotten their walking stick, or not eating because they hadn?t been 
in 3 days and no they hadn?t told anyone because well the doctors don?t need to know that do they, dear?
But when I left it had become policy that all IV diuretics were to be given by pump, and that will save so much time won?t it dear? Except you only have one working pump and it takes a good 10 minutes to set it up, and you need to clean it fully before it gets used on the next patient (quite rightly) and you can?t get another one because they now all stored centrally and that?s only open from 9-5 and it?s now 6:15 am and out of hours you have to contact the on call hospital manager who has the keys and then a qualified nurse has to meet him/her at the central store room and as it?s out of hours you?re only allowed take one pump even though you have 6 patients who need it.
Reduce the number of qualified Nurses on each shift employ more HCA?s, that is young kids who are called HCA?s but never trained properly (a properly trained good HCA is worth their weight in Gold) , are told they?ll get on the job training, that no one has time to do so either they learn nothing or they learn the how and not the why.
Dress everyone in virtually the same uniforms the difference been so slight that someone works there has to look twice, no hope for a short sighted ill patient or a visitor to the ward for the first time. So it looks as though there are loads of nurses but in reality there?s one qualified nurse, with usually sweet eager kids wandering around terrified to do anything because they haven?t been trained and can?t even clean up, wipe down surfaces etc because the private cleaning company the hospital brought in when all the old school ward housekeepers quit in disgust, lock the cleaning cupboard and confiscate the brush and pan you bought out of your own money claiming health and safety. .
And then when patients and relatives quite rightly complain that they or their family aren?t getting good care, smile, agree, nod and bring in hugely hugely expensive contractors to lecture nurses about dignity and care, but refuse to draft in any extra staff to cover the wards claiming lack of money, so that the staff have a choice of either attending and leaving the ward even more dangerous, or skipping it.
And then add yet another bit of frigging useless paperwork for the nurse to fill in.
When I first started working on a hospital ward as a auxiliary nurse there was 4-5 separate bits of paperwork to fill in to admit a patient, it was routine for you as the aux to fill it in, and for the qualified nurse to check them and do the ?important? bits aux nurse time 25 or so minutes (a good 10 minutes of that would be general chatting and getting a feeling for the patient, did they need more help than they were willing to admit etc) qualified nurse 10+ minutes depending on the patient.
By the time I left it took over an hour to fill in the admission paperwork, and that was just the paperwork that?s without even speaking to the patient and it all had to be done by the qualified nurse.
That?s in between the drugs round, the IV drugs, placing and setting up the NG feeds, ordering the controlled drugs, ordering the drugs so that the patients can go home, explaining that yes, the doctor did say you can go home today but unless one of your children can take you it takes 24 hours to get transport for you, and 48hr to set up the home help, or do your children not see that as their responsibility either? The doctors round, the social worker meeting, the wound dressings, liaising with the Macmillan nurse, the wound care nurse, the stroke nurse, the discharge co-ordinator etc. Explaining to the pharmacist that no I can?t read the doctors writing either and can he not call the doctor himself?
My personal issue was referrals once upon a time if you wanted to refer someone to the social worker, you were allowed to care for a patient and use your clinical judgment and knowledge of the patient to decide that this patient would need help when they went home, and would either call the SW office or if it was the day of the SW ward meeting bring up their name, same with physio/ OT / dietician etc all done.
Then they wanted a written referral, fair enough as a nurse it was drummed in to you that if it ain?t written down it didn?t happen. So it was a generic postcard sized thing on which you wrote the patients name, who they needed to see and a general reason why.
When I left the SW referral alone was over 4 pages long and could not be handed to them it had to be faxed to their office 2 floors down so that they could log it?s arrival which meant that you had to send it in office hours. Which once upon a time you asked the ward clerk to sort because the fax machine invariable stopped half way through, and you had to start again.
Oh and the physio one, that was a joy to all of us, physio is vitally important, but to refer patients you had to assess their ability to walk by getting them out of bed, but if you got them out of bed before they were assessed by a physio and they fell and hurt you or themselves you were personally liable. Oh the joy, the joy the physio and I had with that one; at one point our ward physio getting written up because she had seen a patient without having a referral done, even though I was sat at a desk trying to do it 
as I also was trying to do a SW referral, and talk to relatives on the phone, and arrange transport for a patient to a specialist unit.
And while you?re at it close the only facility that serves food out of ?office hours? i.e.: 9-5.
Because who really needs it, except the nurses, doctors, lab techs, porters, on call radiology, the few security staff who you haven?t sacked etc.
So you get to the end of the shift, 2 hour late, as at no point have you had time to do your patient paperwork (remember if it ain?t written down.. ) and you get home and undress in front of the washing machine cause there?s a strange stain on your uniform that you can?t remember how it happened. And cry in the shower and eat the most fatty fastest food you can find before falling in to bed and waking up with a yell at 3am when your subconscious finally caught up and reminded you that you moved Mrs I?s dinner out of her reach because she forgets that she cant use her right hand and always spills the tray over herself and it?s only luck that she hasn?t had a serious burn yet, and you fully intended to go back and feed her but then that patient fell and then it was visiting time and Mr C?s dressing was leaking, as was Mr K?s colostomy bag. And Mrs O daughter was kicking off because her Mum?s magazine was missing (you mean the one she puked on because you keep feeding her food that she can?t swallow. And we threw out?)
So you sneak out of bed not waking OH up, as he?s pissed off with you anyway because you were 2 hours late home, and sob down the phone to the night shift about how you?re the worst nurse in the world and you?re going to self report to the NMC.
Dear Lord this has been cathartic, I haven?t even mentioned the elderly consultant who saw any nurse under the age of 25 as his personal grope toy, the student nurse who physically assaulted me because I failed them on their placement because they refused to treat a HIV patient. The beautiful beautiful man I lusted after (in secret, I have some standards) until I met his wife, his ?commonlaw? wife, his girlfriend, 8 months gone, his boyfriend and caught him trying to slip his number in to the student nurses pocket. The other consultant who saw all nurses as her personal jack of all trades including once bringing her 9-10 month old daughter to work and dumping her on my lap while she did the ward round and bitching at me for (a) not keeping her quiet (b) not been able to write down her instructions one handed while LO yelled pulled my hair and generally tried to escape. I?m not normally a walk over but I was in total shock!! I kept looking for the camera, and what?s his name to jump out saying Ha Candid Camera, got you!! He didn?t.