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??!

Have you ever wondered why there is no management presence on the wards when there is a problem .. From fire alam to no beds to lost teeth to datix incident to assault issue to police issue to angry rellies issue to leaking roof issue
Why is that ?

It's my responsibility to order all the ward stock.

The approval list (management) is ridiculous.

Trying to get the basic order approved takes a day or two as it has to go through 3 senior nurses before it gets to procurement.

Try ordering essential stock items just before the end of the financial year.

I had my order of medical sharps bins refused last week.

Where are we supposed to put used needles or iv meds?

Honest this is true . One year we were told that our dept hadnt used all its budget so we must order anything we want before April or lose it
Not hey lets pass it on to next year .

If we didnt then the next years budget would be lowered . So all year you scrimp on dressings and equipment . This is part of the rot that comes from management who have no idea at all .

Oh yes the pre april spend spend spend.

A lot of businesses do this, you'd think the NHS though would be ran correctly so it didn't happen. Instead of scrimping all year and then buying shit loads of things we don't need just before April.

They do have the nurses over a barrel. There is no way they can document all the stuff they legally need to document. It is physically impossible.

Whistleblow officially and they will scrutinize your documentation and everything else. Try to stay on top of the documentation and you get relatives bitching because you are doing paperwork rather than waiting on them. And management isn't going to back you up on that and stand up for you.....even though they will shitcan you and throw you under of the bus if everything is not documented as it happens three times.

I'd seriously rather die horribly under a train very slowly and painfully whilst eating shit and getting raped by a horse rather than work as an NHS staff nurse on a medical ward ever again. You couldn't pay me enough to deal with them again.

10 years in the NHS and I never laid eyes on our managers that control staffing, beds, budgets, refuse to pay for security etc. Several times we demanded a meeting with the chief executive. He refused. So did the next one.

Yes managers are awol. They are awol whether a druggie is beating a nurse who has been left alone on a ward with him and 30 other patients. They are awol when a family is seriously flipping out and threatening to kill the staff. They are awol when people die horribly. They are awol when the nurses demand their presence. They fucking suck. Go into a well run restaurant and the manager is on the floor with his staff and he can do their jobs. The NHS is run by people with a background in finance and they are not interested in what nurses and doctors do and they sure as hell are not going to go near a ward. Ever.

I agree with so much that has been written by the nurses here.

I could give plenty of examples of the unreasonable behaviour of patients and their families.

All I will say is that any talk of "lessons learned" after Mid Staffs is meaningless waffle unless the govt is willing to set minimum staff ratios. You could be the nicest nurse, in the best equipped hospital, but if there is not enough staff, then there is no point. If you are short staffed, you cannot care properly, or safely, it burns you out and you leave.

Care has changed, what nurses have to do has changed. Not because we have "ideas above our station", but because instead of having patients who just need some o2, I.V fluids and tlc, they now need umpteen complicated infusions, have complex observations that need to be completed and are much sicker then patients were in the past. Oh, and are now accompanied by families who think you are there to serve them in the manner of a silver service waitress.

We have it the other way round, but not spend spend spend throughout the year.

We are only allowed to order the minimum throughout the year, then Feb - April, barely anything at all.

The ward sister has no say anymore. No decision making is at ward level.

Putting a bank shift out has to be approved by senior management, the same with ordering stock.
Quite often bank shifts are refused to cut the staffing budget, so the are willingly leaving the ward short.

These managers have never stepped foot on the ward, but when something goes wrong I.e a patient dies, its the nurse and the ward sister who end up in the coroners court.

I hate that management include students in the staff numbers.

Horse

You told us to buy things from our own pockets.

We all read that correctly.

You can't argue with stupid, guys.

For those still in doubt google Militant Medical Nurse. Every word she says is true.

Nursing has changed.

Put a legal ratio of qualified staff to patients of 1-5 on medical/surgical wards and the care will improve dramatically. If Australia and California can do it, why can't we?

Of course taxes will go up but that's the consequence.

Pobble

One of the things I blew the whistle on was the counting in the numbers of supernumerary student nurses. It was done surreptitiously leaving us with not enough staff to do 1-1 specialing and stints in the Low Stimulus environment.

Student RMNs are not allowed (in that trust) to special clients or be in the LSE alone. When you roster in a student nurse that means the shift is one (or two) down on the numbers for these tasks. Staff end up having to do endless 1-1's which is tiring because it requires acute concentration and risk management. You need to bring your A game.

It also means that if a high risk client kicks off, you may not have enough staff to manage the situation (inc C&R). If you don't have enough trained staff to manage violence what happens to the other clients put at risk?

I was bullied, hounded and harassed because I blew the whistle ending up having to move trusts to get away from it.

So people bleating at nurses telling us we 'need to do something' and not 'tolerate it' - well they can just piss off. I'd like to see how many times they've risked killing their entire career and life's work because of a principle. Most of them are too damn lazy to even vote.

One of the recommendations from the Francis report was staff ratios. The government chose to ignore it. Instead they come out with hourly rounding. A nurse is supposed to visit each patient hourly and ask them do they need anything. Cup of tea? Pillows etc. Then tick sheets to prove they have done so. This just shows how clueless this government are. They dont understand nursing role at all. They see us as customer service representatives. Smiling sweetly, getting tea and plumping pillows
15 patients means 3 mins per patient each hour. When would we get time to give drugs, assist with washing, feeding, care plans, escorting for procedures, dressings, toiletting, dealing with pharmacy, social issues. Enquiries deteriorating patients. Discharges and admissions which generate a ton of paperwork etc etc etc

The idea that patients/clients can be tick boxed . They can be okay one minute and in desperate need the next. Need, not want. Again the training teaches you how to differentiate.

My role is to be with clients- presencing. So much of what we do is intanglible and is pretty imperceptible to the untrained eye. A good psych nurse can be like a tuning fork- measuring, gauging and ultimately influencing the pitch of a unit or clients environs. That cannot be tickboxed!

Wasn't staffing levels the main issue in the Francis Report? Yet the media and govt translate that into poor nursing care and a lack of compassion because that suits their agenda so much better.
I feel so much for those of you who are still stuck there. Never in a million years... And I'd never suggest any kind of public service to my kids which is so sad.

Yes staffing was one of the main issues. Staff at the hospital had tried desperately to get management to listen. Literally hundres of incident forms were generated by nursing staff regarding unsafe staffing levels. Pretty much glossed over by the media. Unfortunately when a hospital runs like this the good nurses leave or burnout. What you have left are stressed disinterested and burnt out staff with very little compassion left

Over 500 incident forms generated by nursing staff regarding unsafe unsafe staffing. Near miss and actual clinical incidents ' disappeared '.
Very convenient for managers trying to deflect blame

We generate an incident form for every unsuitably staffed shift. We also report it to the site manager as per NMC regulations that every nurse is bounded by.

Yeah it does so much good.

Here's an example of a shit patient.

I'm rushing down the corridor, blatently BUSY, gloves on, bedpan in hand, patient wailing that "it's coming out, it's all over the floor!!!" as I pass I shout to the cleaner "major floor incident in room 4!!" she starts getting her stuff ready - suddenly I'm stopped by a 45 year old woman stood mid coridor in a dressing gown and slippers, mug in hand asking "do us a coffee love?"

errr hows about fuck off, love?

So a toxic combo of: understaffing, growing number of patients with dementia (often with other complex health problems) and people who think a hospital is a hotel.

And rudeness and violence (both physical and verbal) and you have it expat..

That, too. Lack of security staffing.

I'm actually agog about people demanding coffees and side rooms.

Luckily I'm quite looking forward to my shift today. We'll have a good team on who I enjoy working with. The patient - staff ratio should be ok. That's how it should be all the time.

The patients who were there on Sunday should still all be there and are all nice despite having multiple problems such as dementia etc and their relatives are ok too.

I'm feeling more positive today (hopefully won't come back on thread tonight wailing ''I've had a terrible shift...'' etc).

The big problem on many wards is the lack of a 'Ward Hostess' to serve breakfasts, lunches and suppers, do the tea round, collect the dishes and wash the cutlery, wrap up the cutlery for the meals, order the meals (individually for each patient) etc etc - all takes up valuable nursing time.