To think NHS do gooders need to realise that the patient is not always right

[oggieogggie]

I've had a right few weeks of it. I'm an auxilliary nurse and my morning normally starts by taking breakfasts around the ward. Picture the scene if you will - a trolley full of cereal, bowls and milk and a pot of hot porridge.

I walk into room one = "would you like breakfast this morning?" patient (full mental capacity) says "well before all that I'd like you to fix my TV. I cant get the channel to turn over." I say "well I'll see to that after breakfast, would you like some cereal?" he says "not until my TV is fixed ... can't you just do it, it will only take a minute (so everyone else should wait until YOUR TV is functioning before they get their breakfast and you don't see that as selfish at all?) I don't say this - I remain professional.

Imagine a few more patients who decide that their TV/Slippers/Laptop chargers etc are more important and then the unfortunate patients who receive cold porridge as a result -

Next I take a tray of hot toast around = One patient demands "I want it buttering and cutting into thin strips." I explain that she will either have to press the buzzer for someone else to come and do it or wait until I have finished delivering toast before it gets cold. "But I want it NOW!" she demands. Ok, so it's fine that everyone else will receive cold toast? that's ok with you is it?

Imagine more of the same throughout the day

"I can't get my phone working!" = well I'm taking care of a rather ill patient at the moment, it will have to wait." "that's it!! I'm making a complaint!!"

"I want you to wash me." = "I will help you but you have to wash what you can yourself." = "why?? its what you get paid for!!!" no actually - I get paid to help people back to independence and to care for those who genuinely can't do it themselves ... " - "Ive had no sleep!! I want you to wash me! I can barely move I'm in so much pain!!" (well walking down the stairs for a fag 10 minutes ago must have been agony then eh?)

I'm sorry, but could it not be said that sometimes, just sometimes certain patients are not always right and that as staff members we should not live in fear of one of these people complaining that we're not jumping through hoops to keep them happy? And no I've never had a complaint against me - I do that nursey thing of taking the abuse and maintaining a smile. Just lately I can't quite shake the notion that the NHS (and Britain in general) is so bothered about political correctness and ultimate customer satisfaction that it's actually counter productive. Why are we all so polite??!

This is what Nursing has become -the assumption is that you are wrong ,neglectful, thick bitches

I don't think anybody here thinks that or has even hinted at it. However there are some nurses/HCPs that seem to have lost their sense of duty and care.

People just don't understand the workings of the NHS and when problems arise we are usually told it's because there isn't enough money - then you look around and see people appearing to have nothing to do it makes people wonder.

The thing about the pharmacy is absurd. There does seem to be a lot of buck-passing going on, 'pharmacy can't turn it round quicker' - well why not? If it's going to get people home quicker it darn well ought to be sorted out pronto. Not blaming nurses, or pharmacy, just management.

But I was there to watch the patient, my dd, and after the lack of care I had seen afforded another child (who, in fact, I looked after until her mother came - found out she could eat, could have water, and got her toast and a drink, and sat her next to my dd (her's was arm, so whe was mobile) and put on a video for them both and chatted to them. Not one person working on that ward put themselves out for her and she was all alone. I was frankly more than shocked.

If my dd's notes needed carrying then I could have carried them - I am after all entitled to make a freedom of information request to see anything held on those notes so I think that's a non issue.

Do you not think that if nurses seemed to care more, were more polite and respectful and made fewer mistakes, that they might not be regarded as wrong, neglectful and a little bit dim. I'm sorry but the comments that I still carry with me are the following: "ha, ha, if you're making this much fuss, God help you when labour really starts" the labour was back to back and the baby, due to a midwife's incompetence nearly died. And when I came back from an ERPC after a miscarriage at 12 weeks crying "oh did you want it (yes IT - not your baby) then?".

I'm really sorry but I'm really not very impressed and oh, yes, one more at my father's last appointment which was a check up really he didn't actually see a doctor. He had AML was out of remission and died two days later. He needed a £2.5k post mortem because the nurse didn't follow a protocol and ensure his notes were signed off by a doctor. The last thing my 70 year old father, after fighting for 12 months, would have wanted was that. Because a thicko (a nurse's words) of a nurse didn't get the notes signed due to an oversight. £2.5k of public money, a dead man split asunder in death. Lovely. As you were.

Yes but you're not allowed to expect a relative to do anything. What if halfway to x-ray you'd decided to go to the canteen or out for a cigarette? And left your dd alone with the porter?

I'm sure you wouldn't have done but some people might/do and the porter can't forbid you from leaving.

I do agree with you that nhs staff need to be polite and respectful to patients. People come to hospital when they're at their most vulnerable. They're often scared and in pain.

Even though at times I can be too busy to give the care I'd like to be able to I believe I'm always polite and kind. I explain stuff as best I can and apologise if people are waiting longer than they should have to for anything.

It costs nothing to be polite and kind to people, and to be honest it makes my job easier. If I have a good attitude then the people I'm caring for are likely to be in a better mood rather than pissed off and upset. Which benefits me as well as them!

I returned to work as a nurse after a long break and a lot has changed. Hospital stays are much shorter and the work feels more intense

During a shift, caring for elderly, Ill patients, we have constant buzzers to answer and I can never finish the work I'd like or need to do. The work is absolutely non stop and morale is very low as people are exhausted. Then they leave and so we are more short staffed. It's a vicious circle.

We have had complaints regarding care which makes me sad, but the truth is that I can't work any harder.
I'm already wondering how long I'll carry on.

I will tell you how the nhs works (sometimes).

Once open the times there was a nurse who worked in outpatients gynae clinic.

She had a patient who had a coil fitted, the patient wasn't very well afterwards.

The nurse gave the patient painkiller, tea, toast and love.

The patient had brought her other two children with her at her appointment. The nurse gave them squash, toast and care.

The patients husband worked away (armed forces), the nurses dh worked away (armed forces).

It was raining, very badly. The patient did not drive, she had to get w2 buses home. The nurse lived near to where the patient lived. The nurse drove the patient and her children home.

The patient was delighted with the care she received and wrote a thank you note.

The nurse received a disciplinary (the first she had ever received). Thank god I retire in 2.5 years.

Near Im sorry that your father died .

If a person isnt seen/examined by a doctor, who will then sign the death certificate, in the 14 days before they die then a PM is necessary.
Im not sure why this was a nurses fault ?

If a doctor did examine your father then they are wholly responsible for their documentation.

Blimey there are some horror stories from both sides. Whatever the cause of these problems it's not fair for the public to blame the staff or for staff to blame the public (where this thread started). If people spent as much time formally complaining to those in power as they do finding individuals to blame we might see some progress and less emotional damage done.

I stopped nursing 15 years ago when my children were small and decided I'd have a look at going back last year. Every one of my friends who work in the NHS told me it was a mistake (nurses, lecturers, HCAs, radiographers, drs...), that the NHS is not a good place to work anymore.
I thought I'd try it for myself though and had a couple of shifts as a HCA in our small, local hospital. It put me off forever.
I used to love my job, most of the time being able to give high quality care, talk to patients and really get to know them, but working those shifts in the local hospital made me realise how right my friends are.
There was one trained nurse on duty for 24 elderly, frail and often confused patients. Her main job was to do the consultant's ward round, hand out drugs, do the IVs, paperwork and spend hours on the phone trying to find residential care, nursing care or rehab beds for those patients no longer in need of medical treatment, but not able to return to their own home or previous placement.
There were two HCAs to support her and do the 'nursing'. There were confused patients trying to climb out of bed, climb into someone else's bed, wandering (wobbling) around the ward. There were patients who had had strokes who couldn't mobilise or feed themselves, they were incontinent and there simply wasn't time to give the care these people needed or deserved, even with me there as an extra pair of hands.
I asked the first gentleman I was asked to care for if he'd like a bath or a shower, but the HCA I was with told me there was no time for that, he could have sponge down. She was right, by the time lunch arrived we still hadn't finished washing and dressing everyone - we'd managed to make and change the beds, keep everyone from falling and any blood sugar checks had been done. With the best will in the world three people (or two, as was usual) can't give high quality care to that number of patients with complex needs.
The food for lunch had been brought in from an outside provider and I can't imagine there was much by way of nutrients in it. There is no kitchen in this new hospital.
Along with most people I know, I've always been proud to do my job to the very best of my ability and I really care that patients get the treatment I would want my family to receive, so I knew by the end of those two days that there was no way my conscience could let me go back onto the wards.

Too many of my friends who have been in the NHS for 25 - 30 years are looking to leave, or are on ADs in order to cope. We can't afford to lose those years of experience and expertise. We need properly staffed departments, with a good skill mix and staff who feel valued by management. Obviously there are HCPs who should choose a different career path, but I don't believe that's true for the majority.
We can't afford to keep training new staff only to lose them after a few short years because they've had enough.

girlstimesthree
How sad. But what you describe is exactly what I see too.
People are retiring or leaving in their droves because of pressure, stress and overwork.

Sad you're not coming back. But I don't blame you at all.

Its illegal to have one RN on duty - minimum of two as they have to check some drugs together .
That sounds awful and you are in a no win situation
Legal minimum ratios of RN to patients and criminalisation of institutional failures to provide this level of care are the way forward.
You wouldn't expect your cat or dog to lack standards of care would you let alone frail, vulnerable people

namechange. I know - the ward was split in half, so 24 patients in one half, 24 in the other and one RN on each side so drugs could be checked. They operated as separate wards though. Guess that's how they got around it?
hedghog I do feel sad about it - I love being a nurse. I hope things get better for you.

I often hear of only one qualified member of staff on a ward overnight. If controlled drugs need checking then they either call site sister or get a nurse to come from another ward which has two on.

I'm now working in mental health. There is only ever one qualified nurse on nights. This unit is part of a new build which is linked to 4 other similar wards. All of these wards are staffed with one qualified on a night shift.

The qualified nurses move between wards to check controlled drugs, often leaving the 2 HCA's (per ward) to look after the patients.

5 qualified nurses for 82 patients.
10 HCA's to help.

This is mental health services for older people. All have dementia.

Apparently, this is adequate staffing levels according to management.

The wards have only just recently been given an extra HCA per ward for the day shift.

6 staff per ward that is.

30 staff to wash, dress, feed, provide therapeutic care and assess 82 patients with dementia.

Sorry, typo there.

It 5 wards not 4.

Gah!

Not a typo after all

I need to go to bed...

A ratio of 1:3, isn't that manageable? Or is that also split over shifts so divided by 3?

I used to work on an 80 bed ward where there were meant to be 3 qualified staff and one HCA per night shift. It was common due to high sickness rates and not enough staff to cover shifts anyway to start the shift with 2 qualified. So 2 qualified and one HCA for 80 patients.

I did turn up for an early once to find there'd been one qualified staff and one HCA all night!

So the problems arise because of staff sickness and absence? Surely they can work out how to avoid this problem?

They can but they won't.

A ratio of 1:3 seems ok on paper, but when the qualified nurses are doing drug rounds, meetings, ward rounds, in the office typing up notes (all electronic on our ward, so they can't sit with patients while doing notes) making referrals etc, its even less.

These patients require two staff for personal care. They are confused and agitated, quite often physically aggressive. At times, you need 3 staff to do this.

Believe me, trying to provide the quality care they deserve is not easy. They are admitted for assessment, so the staff are supposed to provide a variety of activities to assess their behaviour so they can be discharged into the appropriate setting and on the right medications.

Most days they just about manage to keep them clean, fed and safe from harm.
Mental health services is supposed to be much more than that.

I've worked on medical care of the elderly. The patient to staff ratio is even worse.

HorseToWater - partly because of sickness. Also because they can't recruit enough staff so rely on people doing extra shifts. If people don't do extras they can't be forced to. They're struggling to recruit. Keep advertising and no one applies.

Morale gets lower, people go off sick, workload increases, morale gets lower, sickness increases.....

Paediatrics is slightly different in that we have more staff. But I still have friends who regularly look after 10 patients, I've had days where I've had 8 children to look after. I remember when I was a student looking after 7, that was normal.

There are guidelines on patient to staff ratios but that's exactly it, they're guidelines. Looking after 8 children having had surgery is bloody hard work. There are days where I've felt like I haven't even given basic care because I haven't had time. I have seen plenty of my colleagues in tears because they can't cope with the work load and management don't give a shit.

We need more staff, but it costs money so we don't get it. Instead we struggle and then get made to feel like we're shit at our jobs and don't care.

YANBU. There's a line in The Thick Of It where Peter Mannion says something controversial / un-PC. One of his flunkies says "You can't say that!" and he replies "Yes I can, I've met the public, they're fucking horrible." Obviously not all of them, some are lovely, but some of them are just greedy, selfish, entitled bastards.

Claraschu I'm a healthcare professional, I'm mostly very caring, but some people just take the piss. The ones that get me are the "Oi, I pay your wages, do X right now".