AIBU to think that Cameron is telling nurses to do things that they already do?

[MyNameIsNotNurse]

Or aim to do given the oppertunity.
Link

David Cameron's 'ideas'
Hourly checks on patients to make sure they have had enought to eat/drink and are comefortable.
Isn't this just basic care?
Also to have members of the public doing spot checks on their local hospitals, isn't this just going a bit too far?

I would really like him to do a 12 hour shift on a busy ward, with sick people needing more than just the hourly walk around to make sure that things are ok.
What about the patients who are in need of 15 minute observations. Patients with poor mobility who take more than 30 seconds to get to the toilet and needs assistance every step of the way. What about the drug rounds? Then multiply that by 30 pateints for 2 staff nurses (some with little experiance) If 1 patient is really ill thats 1 nurse down so 30 patients beeing looked after by 1 nurse, and maybe 1 or 2 HCA.

Why does he not discuss the staffing issues, which most wards have the mountains of paper work which each and every nurse has to get through every shift which takes away from the care of patients.
Most nurses I know stay behind to finish paperwork, turn into work when they or their family is not well, go without breaks, work 12hours a shift, do extra shifts and Given up our measily 3% payrise over 3 years.

He's just making a lot of noise saying we should do things we already do in order that the public think we're not doing them and we lose support?

I know some RNs at my NHS trust approached management because they had an interest in working in maternity. They were told that RNs are not employed in either labour and delivery or post natal wards. There were told to either become a midwife or let their RN registration lapse and work as a health care assistant for less money if they wanted to go to work in the mother/baby wards.

Is it different at other trusts in England? Are their trusts in England that employ RNs on maternity wards?

In America our maternity floors are staffed with RNs. Labour and delivery is one RN to 2 patients and post natal is one RN to 3 patients. And if the shit hits the fan, the nurse gets help.

there not their I meant.

Mrs H, I still don't get why you are blaming general nurses for not giving you care when maternity wards do not employ general nurses?

There were no nurses there to care for you, only overstretched midwives.

I am telling you what is wrong with Nursing...short staffing. You simply do not grasp the situation. If your maternity ward was staffed with Nurses you would have received care. Like I said before, I nearly bled to death on an NHS maternity ward. The midwife wasn't able to check on me because one of the newborns coded (code blue, cardiac arrest) or something and she had several post ops. Lucky I got out of there alive. No one could have done any better in her shoes though. I couldn't have and neither could you.

and you don't seem to grasp the notion that if a midwive has 25 other patients that she physically cannot be there to help you and your babies. It doesn't mean that she didn't want to help you, or understand that you need help.

If a c/s patient passing heavy clots having just given birth to twins isn't high on the priority list I'm not sure who is to be frank.There was plenty of staff,we saw them. They had other staff too in different uniforms.I didn't want a midwife specifically,anybody would have done.

Quite clearly my needs were of no consequence and I would have been just regarded as a whiner going by your posts.It was the fact that nobody was sent in my direction,the attitude,the tutting,the rudeness,the no thought for my dignity in a top teaching hospital that along with my other experiences leads me to think a big shake up in nursing attitude is needed and DC's new initiatives are spot on.

For those of you who have had an awful time, there is no doubt about it.
The things you are talking about are basic and undoubtably important aspects of nursing care. Including the listening and talking to patients with empathy and compassion.
However, let me give you a typical scenario.

I am on a ward with 32 patients. I am allocated 16 of those. I have a band 2 HCA to help me. I am also in charge of the ward today and am carrying the surgical nurse bleep. There are 4 of us in total on duty as someone phoned in sick at 7am. There is a freeze on agency nurse bookings and there is no bank staff available at short notice.

8 of my patients are Post op patients, 4 are on hourly observations including hourly urine measurements, 2 are on 2 hourly observations and hourly urine measurements. 10 are on 4 hourly observations. 10 are on 6 hourly iv antibiotics. 4 are on 4 hourly IV fluid regieme. 1 is on hourly blood sugar measurements and insulin sliding scale infusion. All have 6 hourly meds due. 3 are on NG feeding which has recemtly been started, so aspiration is due 4 hourly. 10 of the patients need full assistance with hygiene needs. 2 need some assistance. 4 can shower independently.
2 have large abdominal wound dressings that are currently being done daily. Both will take at least 45 minutes to do.
One has not peed for 6 hours post surgery, I have to catherise her.
2 patients have to be discharged, and there is another patient coming from A/E via surgery.
One of the post op patients is bleeding and needs to go back to theatre.
One patient has to go to CT scan, and needs a nurse escort.
Because I am carrying the surgical bleep, I am taking calls about staff sickness on the surgical wards, and have to deal with bank to try and replace them for the night shift.
One family is waiting to speak to me about post discharge care for an elderly parent and a referral to hospice.
Another patient has just had diarrhoea, and the 2 health care assistants are busy cleaning her and changing her bed.
The phone has not stopped ringing. The ward Clerk only works til 2pm, so we have to do the phones.
I have not had lunch. I have not been to the toilet. But that doesn't matter too much because I have not had time to have a drink since breakfast.
Luckily, most of my patients are nil by mouth so I don't need to feed them or ensure that all get a meal, but I do need to do mouth care. My HCA will assist the patients that need meals, once she is finished with the diarrhoea patient.
3 patients are requesting to get back into bed, as they are uncomfortable, but I cannot do it on my own. 2 are requesting pain medication, and I need to the other RN as it is a controlled drug which legally has to be checked by 2 nurses, but shes gone to CT scan with the other patient. I bleep the site manager who can come in about 10 minutes, meanwhile the patient has to wait.
One of the registrars wants me to do a ward round. As the nurse in charge I have to go with him otherwise I will have no clue of the management plans for those patients, and I doubt I will get a chance to read the medical notes until after my shift.
I've just found out we have run out of sheets and towels.

I have worked many many shifts like this as have many other nurses. There is a reason I left ward nursing to go to ICU. Its still busy, the patients are critically ill, its still crazy and I miss breaks and don't get to go to the toilet, but I do all my running around in 2 bed spaces max instead of 16 to 20.

Do you see how things go wrong, do you see how things get missed? There is only so much that can be done while the staffing numbers and the skill mixes are so poor? Really I can only go so fast. Then I fall down.
I would love to be able to do everything that needs to be done. But physically we are limited by the amount of staff we have.

Mrs. H, airway and cardiac issues take priority over bleeding. Nurses use something called the "ABC"s to determine who they see first. Airway, breathing ,circulation.

There simply was no one there to care for you, and as midwives and nurses get no say in this I fail to see how you can blame them. We all think that patients in your situation should have a nurse with you and assessing you and helping you and monitoring you when you are bleeding out etc etc. Management will not finance it. End of. And it's a shame because that level of care could prevent a lot of expensive complications.

I'm a nurse and have been following this thread, trying to work out a middle ground. The answer in the NHS is to have more registered nurses working and to have a way of the general public identifying who is a registered nurse and who is not. Nurses and midwives take a lot of abuse about how they don't provide care, yet patients and relatives can't identify who those people are - everyone on a ward wearing a uniform is identifief as a 'nurse' whether they hold that registration or not.

I find it very interesting that those who complain about 'nurses' haven't responded to some of the scenarios posted by other nurses on this thread, seemingly tarring all nurses with the same 'uncaring' brush rather than identifying how 1 nurse can provide appropriate nursing assesment and care for 30 patients while doing all the other stuff ward nurses are expected to do.

I've worked with people who are lazy, but have found them to be in the minority - most nurses are just trying to do the best they can with the very limited resources.

MrsH and Newjob, you are really arguing the same point.

MrsH, you did not have the care that you have a right to expect. That is clear. But I can guarantee that there was not enough staff on duty because there never is on the post natal ward. It's appalling. It's absolutely not right.
The reason your care was so bad is likely because management will not approve any more staff on that shift.
I hope you complained, in writing.
Not that that will change things after the fact. You should not have been left with newborn twins that you couldn't lift when you had just had major abdominal surgery. And someone should have investigated your passing clots in case you were heading for a PPH.

There should have been more staff. More midwives, more HCAs.
Its what we are all complaining about.

As I've said before often a shortage of staff wasn't the problem,there were plenty milling around.I couldn't give a stuff who does basic care but the fact is if you are responsible for patients you get somebody to deal with basic care,non nursing staff-anybody.

Quite clearly there is a problem as judging by this thread some nurses think any patients not in cardiac arrest are just whining time wasters who think they are in as hotel and just need to get on with it. For this very reason they don't delegate or organise themselves or their wards in order for patients to have the basic care they need.

Surely it's not that difficult to organise non nursing staff to check water,bedding,food,the need to talk on a regular basis-oh I guess it is if you just think they're whining time wasters.If you were lacking in the empathy stakes you wouldn't bother would you which is clearly what is happening.

So getting back to the op it isn't happening and DC,s new initiatives are much needed.

I have been an RN for 22 years. When I first started as a qualified nurse I would usually have a maximum of 6 patients to care for and of these several would be ambulatory and able to feed and wash themselves and require dressings and drugs etc from me. 8-12 patients is now the norm on the wards.

The patients on the whole were weller than people are now. For example a gall bladder removal used to stay in at least 7 days, these are now done as day cases, so we simply never get these lighter patients.
Surgeons 20 years ago did not do huge complex abdominal and head and neck surgeries on 85 year olds, they were generally told sorry you have inoperable cancer and sent off to the oncologists who, unlike todays oncologists, who give "just one more cycle of chemo" to a patient on their last legs, used to give them a morphine infusion and call in the family. Now they get a huge operation, a stay in ICU, a long stay on the ward then care of the elderly until a nursing home can be found because sadly a partially sighted, osteoporotic person with a touch of dementia (worsened by the illness)often finds coping with an ileostomy or a tracheostomy pretty hard.

Pretty much all inpatients now are much more dependent than they were when I was starting out, the list of tasks that a nurse is reponsible for has grown and grown. Ward nurses now do a lot of the tasks that were done by junior doctors in addition to the nursing tasks and a whole raft of paperwork that simply didnt exist. I am insulated from the worst of this by working in ICU where we have fought for and maintained good staffing levels although this is seriously under threat at the moment.

Nurse education is failing to deliver RN's with the skills needed to cope with todays patient population and we as a profession are failing to address issues of poor performance both within the student body and the qualified (the NHS makes it bloody difficult to get rid of anyone and the hoops you have to jump through make even the most dedicated manager want to cry)

I love my job and I am good at it, and I despair of us all being tarred with the same brush. I know there are some crap nurses out there, just like there are crap teachers and crap lawyers and crap parents.
I have seen some bloody good nurses gradually broken down by the relentless pressure of short staffing and unreasonable demands. Sadly they are lost to the profession, the crap ones seem unbreakable.

MrsH, did you complain. Properly I mean. Because if there was adequate staff and you were ignored, there really is no excuse.
No one would deny that.

There are shit nurses and shit midwives, (the NMC strikes people off every month) but please remember, there are an awful lot of good ones too.

Tbh you do sound like a whiner who thinks they are top priority Mrs H- just because you saw plenty of staff does not mean they were even registered midwives/hca's etc- and its very impressive how you know the staff to patient ratio just like that.

Actually, I dont think MrsH sounds like a whiner. She sounds like someone who had a very rough post op/ post delivery time.
I think she was asking for anyone to take notice that she was not coping, unable to move properly,lift her babies, and frightened that something would go wrong.

It does happen you know. Doesn't mean its right though.
And yes, she had the right to expect good care from the NHS.
Its a shame that she didnt get it.

No I didn't I was a 1st time twin mum away from family/home,surviving those early months pretty much took all my head space.

Also I presumed that was just the norm,it was a teaching hospital so you presume they know their stuff.I was on the gyne ward a year before and it wasn't much better.

Also they saved my life that year before,rushed in with OHSS seriously ill.I had top treatment -until I went on the ward.I also had top treatment in the run up to the twins birth,fab consultant,tip top care,really well looked after as a day case by the consultant and her team,fab birth too.Kind of felt some loyalty to the hospital as a whole.

It was just the nursing care that let the hospital down.

Sadly my experience hasn't been that much different in different hospitals since.

Melty you're right I just wanted anybody,have no idea what all the different coloured uniforms are for and don't care. Anybody would have done,even untrained staff such as a cleaner or a porter.

Eau when my dp visited(wasn't allowed to stay the night) he walked past groups of staff sitting chatting round the station and came in to find chaos/upset by my bed.

Every time he went hunting he found staff doing nothing,not busy.Staffing levels were not a problem.

Trouble is MrsH, cleaners or Porters wont go near bodily fluids. Not in the job description you see.
And sadly, postnatal wards are never staffed as well as the labour ward areas. Most Labour wards are oversubscribed, too many labouring mums, and short of midwives as it is. If someone goes off sick, they will pull someone off post natal.
No nurses in our post natal wards, and there really should be, as they have a lot of surgical patients. We have nurses on the HDU part of post natal, but they don't get moved, as the HDU area is always full.
You would have had a couple of midwives and a couple of Midwife Support workers. Thats it.
And its not enough.
And managers put the housekeeping staff, support workers, neonatal hearing screeners all in similar uniforms to the midwives. The cynic in me thinks it is to bluff patients into thinking there are a lot of staff. Just no way of knowing what sort of staff....
Our CE has recently instigated a rule that everyone wears a huge name badge the size of a dinnerplate. it says Name, and Job. So at least there will be less confusion as to who is who.
Shame they wouldn't actually spend more money on staff though.

Mrs H if those members of staff at the nurses station were not nurses and midwives then they cannot help you.

Unskilled workers are not allowed to go outside of their scope of practice. In other words, they are no allowed to do nurse things. A health care assistant is not allowed to assess you and implement actions or contact a doctor when you are passing clots, a cleaner and a secretary really are not allowed near your babies to help you out with that. They could get sacked for going out of their scope of practice and playing nurse. This is why I think that all the staff on the wards should actually be qualified.

There were plenty of times when I was at work and I was the only nurse for 34 patients. I had 11 of them waiting for pain meds, families with questions, acutely ill patients getting transferred off the floor to critical care, admissions, IV infusions that needed monitoring. And this was all at once.

All I had to help me were 4 health care assistants and they are NOT allowed to go near or assist with any of those tasks. So they were hanging out at the station, maybe catching up on menus or other things that they are allowed to do. Visitors would see them sat down and go nuts because their family members were waiting for pain meds. But there was nothing that the care assistants can do about that. The visitors were assuming that the staff that they saw at the nurse's station were people that could help.

How different that shift would have been if we had 5 nurses instead of 1 nurse and 4 health care assistants!

Ust a quick question to Mrs H and sorry I don't want you to feel got it you are just the most voiciferous person on the other side of the fence. Did you buzz and ask for assistance with getting your babies out the cot? Did you buzz and ask for assistance putting them back in? Did you buzz and ask for assistance going to the toilet? If not how do yo expect the staff to know about it? I f you did are you saying they refused?

Mrs H - they probably didn't give you a pack of sanitary towels as they probably didn't have a whole pack. Where I work you wouldn't have got a single one as we don't provide them. We don't have any on the ward.

I've often had to direct a partner to the 24 hour Tesco down the road to go and get some more.

I understand that qualified nurses have a lot of work to do with lots of patients. But what about all the other staff on the ward who are actually the ones employed to do what used to be called "nursing"?

You are told to bring adequate supplies of ST's in. It's a reasonable assumption that a patient or their relatives would bring them. In my experience patients do not like hospital issue ST's-they are like cheap lumpy camping mattresses-and so bring their own.

if a patient is 'caught short' or low in funds, of course they are supplied but hospital shops sell them and relatives have a responsibility to bring stuff like that in post natally.

Lesley-

not sure what you mean-

I understand that qualified nurses have a lot of work to do with lots of patients. But what about all the other staff on the ward who are actually the ones employed to do what used to be called "nursing"?

If they are not nurses, they do not nurse. Quite simple. I for one, do not want the ward hostess or cleaner or an OT or physio or theatre tech or social worker or radiographer or dietician or speech therapist or porter or cook to nurse me. Al these staff will be seen around a nursing station at some point. Many in clinical uniforms.