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??!

Latara

COPD is the worst to witness isn't it and no matter what you do - fans set to blow softly by their face, sitting forward on pillows, sedatives- it is all so inadequate...

Do you have somebody you can confide in or a peer supervisor for times like this- does your charge nurse encourage you to ventilate after a hard shift?

I think windymill is pointing out that it seems to be a waste of resources to have two staff escorting patients, it does seem absurd that if someone vomited post op in a hospital that there would be nobody else around to help. She made a fair assumption, she can only go by what she has observed. No need to get defensive. People do support nurses, they don't know how the system works that's all. At the moment it isn't working but staff seem prepared to get annoyed with patients when they point it out. Trust has broken down yet it is an essential part of the relationship. The moment you stop treating patients as individuals, it is time to reconsider your career.

Kudzugirl no, we don't really have anyone to talk to, we're too busy. But it is upsetting when you get to know your patients and seeing them so distressed is horrible because you feel so powerless to help whatever you do at the end doesn't really help.

It has stopped working because priorities have changed...managers only want to save money, people have to work harder within the same number of hours. Unrealistic expectations and complaints for no reason do go on, fuelled by the Daily Mail anti NHS frenzy.

I am not defensive. Upthread I have been absolutely upfront about what I see as poor care and have been pretty damning about some nursing that I have experienced both as a patient and as a nurse myself.

Often what seems to be a vast waste of resources is a policy resulting from an unfortunate event (s) or a patient complaints. I don't agree that an assumption about every single nurse based upon the care spell she experienced via a relative is a fair assumption either.

Staff don't get annoyed with people pointing out poor care. What annoys them is lazy assumptions, insults about the nurses who do care and total disregard of the posters who have taken time and trouble to explain things to her. Expecting to be treated as individuals goes both ways and every hospital has a staff charter making it clear what they expect from the users of their services too. Don't moan about being lumped together as patients when you then do the same to the staff.

Many of us have assisted their patients/clients to make complaints and have themselves suffered the career consequences of blowing the whistle.

Latara

Have a chat with your colleagues about setting up some form of peer supervision off ward. I know the working week is long but even half an hour per fortnight or even month of structured peer supervision can help strengthen your defences. You do need a safe space to talk about things like this.

There has been nobody on this thread who has been rude or dismissive of the work that nurses do. People see the problems and think it can be done better. There is definitely something wrong if one poster has a 30:1 ratio and another has a 3:1 and says that's stretched. It seems a bit hit and miss from the outside looking in.

There has been a poster who has been rude and dismissive about nurses.

The best thing today were the 3 elderly men in the bay who had ''I just called to say I love you'' played on Hospital Radio especially for the nurses.. and sang along to us while we were caring for the man with COPD (who enjoyed it as well). Bless them. (Even though I had to break up a fight between 2 of them earlier in the shift!). Work is difficult but really worth it most of the time.

Poor OP - As a doctor I completely understand where you are coming from. There are many really dedicated, talented and compassionate nurses and HCAs but they are being stretched incredibly thin.
There is a NATIONAL NURSING SHORTAGE - people are leaving the profession in droves .

Unfortunately there is a mismatch between what the NHS can afford and the care that patients want or need. As someone said the priority needs to be that every patient is safe, clean and given the right medication and monitoring and this is sad as we healthcare professionals want to be available to deliver more personal care and service. So many patients are demanding and rude to nurses it is unbelievable and people seem unable to comprehend that nurses have to balance the needs of ALL the patients and families that they are looking after.

Last week at midnight I offered a young woman (who had been assessed and was well enough to go home) tea and biscuits before she set off. Her boyfriend decided to help himself to the patient food too. He then complained that he did not want biscuits and why couldn't I (or someone else) order him some sandwiches and crisps. He gave me a mouthful when I directed him to vending machines. He could not understand that my time should be spent assessing patients, and that the nurses were looking after a very sick patient or that the porter was needed to take patients to Xray or even that he was just not entitled to a freeby.

Having said that I was really upset after my EMCS that I received so little help, was not brought enough food or allowed to clean my face or teeth before bed. These are important, having a TV fixed during breakfast is not.

The bottom line is that the NHS needs more money if we want quality healthcare but we need to stop beating up nurses and HCAs and treat them properly if we want people to do the job which is bloody difficult.

Yes it is nothing but not varied. Like the time my pregnant colleague was kicked to the floor by a visitor because she was in the middle of a drugs round and couldn't show him where the ice machine was personally.

Oh and another friend who had scalding tea thrown in her face ( the patients tea) when she told a visitor that the ward didn't give tea and a meal to all its visitors. Told him politely too. No edge, no arsiness. Yes I witnessed it.

Kudzu she didn't make any assumptions about every single nurse, just complained about the ones she thought weren't helping that child. There are a lot of generalisations abput the public though, that they are complaining for no reason. Why would they bother to do that, most people don't have the time or the energy. In a healthy organization a complaint is seen as an opportunity to improve things. It should be factored in as part of its duties. People complain because things are so bad. And it does add to the workload, of course it does. It's up to management to think it through.

Reading this I think I've been lucky with the patients and visitors I've encountered in my career!

I've encountered plenty dementia / acutely confused patients who've kicked off - but their violence and bad behaviour is a lot easier to cope with than deliberate rudeness and violence from patients / visitors with full mental capacity.

Olympic for every aggressive and arrogant patient how many polite ones are there? People are all different - do you think it's getting worse?

She did -go back and read her posts.

I have never assumed or stated that all the public complain for no reason. Sometimes sometimes some patients don't understand what the role of each employee of the organisation is and that is partly down to a lack of clarity from the org. But people do have the responsibility of educating themselves too. Obviously not if you are rushed in as an emergency or lack agency but when I use any service I make a point of educating myself about what I might see and expect and who to expect it from. And some of the complaints on here have been from posters who lack understanding about what they have experienced. Some complaints (only a few) come from completely unreasonable demands too. It is NOT your nurses job to mend your TV. They can report it or show you how to call patient line but it is not their responsibility nor should it be.

Many Paed wards have policies where parents are encouraged to get involved with their children's care. Not because the staff cannot be arsed but because kids do better when it is Mum or Dad carrying out personal care, giving some meds etc. My own daughter has had serious surgical intervention requiring a year and a half of limited activity including three months of bed rest. We were encouraged to carry out a lot of her care according to how comfortable she was with it. This included administering medication.

I cannot explain why a child should remain unobserved for what appears to be 12 hours or more. I have never come across this in nearly thirty years of health care experience. However if a child is stable and has a parent sleeoing next to them and is asleep themselves, a nurse will know that this is actually the best medicine. A stable child can have obs charted before retiring for the night and upon wakng in the morning. That is perfectly acceptable as long as a rationale is given - an explicit rationale- for such a nursing decision and it is documented on the nursing and medical records.

Yes I could not have a problem with a patient with Dementia. The biggest complainers about the behaviour of patients with Dementia come from other patients around them. Compassion is in short supply when it comes to the disturbance they can cause.

It's not that the organisation can't improve, sometimes it's as the OP says, that some patients or more likely their relatives, have become very rude and overly demanding . For example, during visiting time, while on my way to see a sick patient, I have been asked more than once, if I can "fetch a chair " as there are not enough at the bedside for extra visitors. I have been asked to speak to relatives on a daily basis for no particular reason... That can't work because we are attending sick patients in other areas of the hospital and haven't got enough time unless there is a clinical deterioration etc. Because we are visible, and available, it is assumed we have time for all of these things but they are not the most important thing that hour we have to do, because if we stopped and chatted and didn't do our other work, no one else would and those patients may well become more unwell or die.
If you were in a solicitors office, would you knock on his door while he was on the phone to a client and get him to fetch you a chair or run through your local boundary issues and then get arsey when he said he was busy ? No. It's not that the NHS can't take complaints on board, but there is a lot of interference and rudeness from visitors and relatives these days which isn't based on a real problem. It's just being demanding because they feel they can be, and as OP says, no one ever really answers them back , because we always have to be polite and take it on the chin.

But it is going to be harder to recover when dementia patients are causing stress and worry, it's a false economy to put them in together.

And fixing the telly could have taken 10 seconds. Giving it a go wouldn't have ruined everyone's morning.

Brakeover you can't expect members of the public to understand your workload. Your managers should be helping you if you are overstretched, complain about them, not the person who asked you to fetch a chair.

It isn't just fixing the telly once though is it? It is over and over again. Add up all that time. Then deal with the c/o of 'where are my meds?', 'where is my breakfast?', 'I have been waiting for my shower/dressing change/depo injection/ECT/discharge/ Section 117 leave papers to be done etc tec. Do you think mending a TV is more important? Because we cannot do it all plus the jobs that are NOT ours to do.

It costs a lot of money to train and maintain HCP training. We are NOT TV engineers.

It's NHS s fault for lapsing on boundaries and rules and trying to be too available.
We needtoput some public information notices up about what is and isn't available and who everybody is etc.

No, you don't understand... We are doctors we look after sick patients . We are not over stretched clinically we can do our work, although it is very busy, what I am saying is, visitors and relatives have vastly unrealistic expectations in general and this thread sums it up by saying... Fix the tv why not it won't take long! No,that's not the point, it's not our job, you may as well get someone in off the street to fix it or become Hospital Volunteers and change the channels etc yourselves .... Have you considered that?

HORSE TO WATER - yes for every rude patient or relative there are many more polite reasonable and kind people.
But I don't remember encountering this kind of entitled behaviour this much in the past.

Not everyone with COPD has ever smoked.

horse In the main, the managers don't give a monkeys how stretched the staff are. They care about their budgets which are being ever more squeezed. It doesn't matter how much you complain, it just slides off them. Many will just say what we've seen said on this thread - if you don't like it, you can go. So those that can do and those who can't become increasingly disillusioned and frustrated that they can't do their jobs properly.
My oh is a senior consultant and he's on the verge of handing in his notice because more changes are coming in which will mean he'll no longer be able to provide a safe level of service and he's not prepared to have his professional reputation put at risk. He's in a position professionally which should mean he has some say in staffing levels, however, all his concerns and those of his colleagues have been brushed aside because there's an algorithm which says they should be able to do the job with x number of staff. You just know that when care falls below par it'll be the front line staff who get the blame again despite them being the ones fighting to keep services going.