Unsafe working conditions.

[Night Owl]

Ok, I'm at work and there is a note in the work book from the Matron saying can she re-arrange the meeting!

I'm miffed that it was written in the work book and she felt she couldn't write a note to me and put it in an envelope.

 

That means nothing will happen till the new year now.

 

Oh well, RCN are phoning tomorrow, I will discuss it with them.

 

Back to work then.......

[Night Owl]

It can't get any worse!

 

I have had one and a half hours sleep after a 12 hr night shift and have been waiting for the 12.30hr call from the RCN. It's now 14.00hrs and no call no Email NOTHING AT ALL!!!!!

 

I am sooooooooo hacked off now!

[borisbeaver]

One thing to mention. You should be protected from any "persecution" under the whistleblowing legislation.

[Night Owl]

Thanks Boris.

 

Yep I have the hospital whistleblowing policy and the NMC paper, "Whistleblowing or escalating concerns?" just in case.

 

I did speak to a reporter after the Tonight Programme called "How safe is your Hospital?" in April 2009.

 

I have contacted the RCN and they say to contact them again when I have another meeting arranged.

[Sali]

There will be many non-nurses following this post with interest and fully supporting the actions of Night Owl.

 

NurseAnne is wrong. The public are not fools. Lots of us who see our relatives suffer and die at the hands of the NHS do not blame the nursing staff directly and we do complain to management and see it as their responsibility to ensure that staffing levels are sufficient. The management's response seems always to be that they have 'changed procedures' or some such nonsense....and then the same failures recur, because ultimately the root causes (understaffing being one) are not addressed.

 

I have read parts of the blog and I found it quite offensive; slamming the Daily Mail, (believe me it is not the only newspaper reporting negatively on the NHS), bitching about 'over concerned' visitors and whinging about the pay of other professionals. Do you really expect family to stand by and say nothing when they can see their loved ones in pain? I hope you are never on the other side of the fence. In a service industry, it will be always those in the front-line that come under attack. This is not exclusive to the NHS.

 

Night Owl has encouraged visitors where appropriate to complain to PALS. The current complaints system favours management cover-up and evasion. It is not in the management's interests (personally) to expose the truth. Look how many months Mid-Staff and Essex were a problem before becoming public. The CEO of Staffs walked away with six months pay I understand. Believe me, many of us are wondering why he was not prosecuted.

 

I completely understand the frustration that Night Owl must feel and what a tough decision she has made in taking this stand. It is not only the nurses who feel that they are banging their heads against a brick wall trying to change things for the better - the 'concerned' public feel this too. Perhaps, together, we will succeed.

[MsWeatherwax]

NurseAnne and Night Owl, I applaud you both. I'm NOT a nurse, but I do work in the NHS and I do know where *both* of you are coming from. Good luck Night Owl, I'll keep checking in to see how it's going.

 

Sali, I know what you're saying but I have seen me begging people to make a proper complaint in the past. I understand that when things go wrong it's frustrating, but screaming abuse at someone, or threatening them, then never taking it further doesn't change a thing.

 

We all know that the first point of contact in a situation is likely to cop the initial anger - most of us don't take it personally, and we've been trained to deal with it even though it's not very nice. However, you'd be amazed how many people don't ever complain properly. All you can do then, as staff, is record the incident appropriately, but if it was backed-up by a complaint from the patient or relative involved it would be so much more effective.

 

There's a really odd culture in this country sometimes - it's OK to go berserk on a ward on the spur of the moment when things go wrong but complaining officially when you've calmed down, and are able to put your point across, is somehow too much fuss to make.

 

It's really hard - I know in problem areas there are people who would like to do just what Night Owl is doing, but if we all did it the service would collapse and people would die. That's why it's so important to support people like NOwl, who to my mind are very brave individuals - it's much harder to go out on a limb yourself than with full strike action.

 

I doubt there will ever be a perfect answer, though.

[Sali]

I have never been abusive to any member of the medical profession whilst visiting my relatives, although I have been shouted at by a nurse when I asked for a bedpan for a relative. I have also never witnessed, in over two years of daily visits, seen any other relative shouting abuse or going beserk. I'm sure it happens, but I wonder how long the fuse has been burning.

 

People generally do not formally complain because they feel they or their relative may suffer as a result (and it can), they don't want to make a fuss or they simply do not think that it will make the slightest bit of difference. It is a sorry state of affairs.

[Night Owl]

Sali and MsWeatherwax.........you made me cry!

 

Thank you so much for your kind words.

I love my job. I should do I have been doing it for a long time. I also care about my job and those I care for, thats why I will fight for good standards of nursing care. I also care for those I work for and always manage to give some sort of help and support to those that are struggling.

 

We have correct chanels for complaints to be effective and management to take notice but these must be constructive and not simply venting frustration.

 

We are always so careful in maintaining patient confidentiality and whilst visitors may vent their anger on us as front line staff we are not always able to stop what we are doing at the drop of a hat to listen.

 

It is the most stressful situation to be in when a loved one is ill in hospital and will make a normally independent person feel very vulnerable and frightened.

 

I will try and get back to visitors and listen to them before advising them on the best cause of action. Again this is not always possible.

 

We are being expected to work at breakneck speed to achieve tasks in the working shift. Accidents happen. I will not stand by and watch them happen when they can be avoided simply with more staff.

[zippygbr]

There will be many non-nurses following this post with interest and fully supporting the actions of Night Owl.

 

NurseAnne is wrong. The public are not fools. Lots of us who see our relatives suffer and die at the hands of the NHS do not blame the nursing staff directly

 

so the 10 + years of direct , personalised , abuse and agressive behaviour i have witnessed or experienced was all fantasy?

 

the public do blame Nursing Staff - FACT!

 

 

 

I have read parts of the blog and I found it quite offensive; slamming the Daily Mail, (believe me it is not the only newspaper reporting negatively on the NHS),

 

the Heily Heil, however is universally negative and provides no balance in it;s Health reporting and contiinues to wheel out irrelevant personalities who may have trained as nurses 40 or 50 years ago but have no recent clinical practice at all to wax lyrical on what is wrong with 'modern degree nurses who are too posh to wash ' forgetting of course the huge changes in hospital clinical practice in the intervening years ,

 

bitching about 'over concerned' visitors

 

 

it does not need a nurse to refill a water jug when the jug is there and there is a clearly signed chilled water fountain and clearly marked ' this tap is drinking water' above the cold tap on many of the sinks ... an empty jug at the beginning of afternoon visiting is a good sign ! - it shows that he patient has drunk at least a litre so far today ...

 

is it beyond the abilities of a mere mortal to spread out a blanket which is folded at the foot of the bed ?

 

and whinging about the pay of other professionals. Do you really expect family to stand by and say nothing when they can see their loved ones in pain? I hope you are never on the other side of the fence. In a service industry, it will be always those in the front-line that come under attack. This is not exclusive to the NHS.

 

the difference is that t other professionals are not expected by the public and the press to stand there and be a punchbag

[Night Owl]

Being on the frontline, as nurses working on wards in hospitals, we do get angry, frustrated patients and visitors that will vent their anger. Sometimes this is uncalled for and petty but sometimes it is justified. They need to be showed the right way to vent this frustration. This confrontation is unpleasant and upsetting.

 

We all want the best for our loved ones in hospital and research never seems to move fast enough. Then there is postcode lottery for medication.

 

The NHS is like a bucket with a hole in the bottom. Doesn't matter how much money you throw in there will never be enough to go round. The public from birth to death will need the NHS at some point in their lives and the standard of care they receive deserves to be consistant throughout any speciality. It's not at present.

 

Nursing Staff have a duty of care to report drops in standards, the more that do the bigger the eventual change may be. Nurses are accounable for the standard of care they give and must not accept poor standards of care. Nurses must bombard management with constructive incident forms and where possible constructive complaints from patients and their carers so that changes can be made. Inform Unions for advice and support.

 

I would challenge any other profession to work a 12hr shift with little time to go to the toilet yet alone have a drink or a break. We are dammed if we are good and we are dammed if we are bad by the public and the press. The truth is quietly swept under the carpet. It must stop. We are doing the best we can with the resorces we have been given.

[citizenB]

Sadly, as there is any walk of life, good and bad. The bad will get the press and the good will take the flak.

 

Very rarely do you see a full page spread in the newspaper that praises the caring work done by most nursing staff.

 

It isnt right and it isnt fair on those within the NHS who still view their calling as a vocation.

[MsWeatherwax]

Sadly, as there is any walk of life, good and bad. The bad will get the press and the good will take the flak.

 

Very rarely do you see a full page spread in the newspaper that praises the caring work done by most nursing staff.

 

It isnt right and it isnt fair on those within the NHS who still view their calling as a vocation.

 

Couldn't have put it better.

 

I work with a smashing team, and pretty much every day there's people who stay behind so we can slot in "urgents", or make sure patients are returned safely. I'm not even going to say we don't get a lot of thanks, because we've had some lovely cards from people who've been through - it honestly makes your day to know that someone has noticed that you've tried your best for them. We don't get tons of them, but it does happen, and we get so much flak it's nice to know we're appreciated.

 

Sali, I'm sorry - I didn't mean to insinuate that you had been abusive! Honestly, when you work in a hospital day in, day out, you'd be shocked at the way some people treat the staff. I've personally seen 2 violent attacks on nurses this year alone, not to mention the umpteen racist incidents. It's a very emotionally charged atmosphere a lot of the time, and sometimes people don't react how you expect them to, or even how THEY would expect to. As CitizenB says, there's good and bad on both sides. I honestly don't know how you find the balance in such a big organisation, but I wish I had a magic wand sometimes.

 

NightOwl - you're as soft as I am then? Really, good luck - please keep us up-to-date and let us know if we can help. I really appreciate what you're doing.

[Sali]

I reply to Zippygbr's comments from the 22 December.

 

so the 10 + years of direct , personalised , abuse and agressive behaviour i have witnessed or experienced was all fantasy?

 

the public do blame Nursing Staff - FACT!

I don't think you could have read my comment fully. I said I had never witnessed abuse or attacks on my two years of visiting. I didn't say it did not happen. I have a close relative who is a nurse, who has worked on various wards in various parts of the country, and she has never been attacked or abused. I'm sure A&E on a Friday and Saturday night can be hell.

 

it does not need a nurse to refill a water jug when the jug is there and there is a clearly signed chilled water fountain and clearly marked ' this tap is drinking water' above the cold tap on many of the sinks ... an empty jug at the beginning of afternoon visiting is a good sign ! - it shows that he patient has drunk at least a litre so far today ...

is it beyond the abilities of a mere mortal to spread out a blanket which is folded at the foot of the bed ?

Yes, it does if the person laying in the bed is not able to assist themselves. An empty jug is not a sign that a patient has drunk a litre! There were many occasions when I visited and there was either no jug or no glass...and the fluid chart was blank too. I became so fearful and anxious about the neglect of my relative that for two weeks I sat for six hour stints without moving from the bedside. Not one time outside of meal times (and even then it was not consistent) did any member of staff assist any patient (in need of help) with fluids.

One time I arrived to find my relative shaking with cold beside an open window . I often fetched extra blankets when I saw my relative was cold because there were too few nursing staff to notice individual's needs.

 

the difference is that t other professionals are not expected by the public and the press to stand there and be a punchbag

How self-obsessed are you? How about fireman, ambulance crew, police, teachers?

Feeling so embittered must surely have an impact on your patients.

Night Owl is trying to take positive action to change things for the better. I don't think Nurse Anne's blog will have the same effect?

Edited January 4, 2010 by Sali

[NurseAnne]

Sali,

 

Nightowl's methods have been tried by thousands of nurses up and down the country for years. THey have all failed and things are getting worse. I hope she succeeds and hope that she lets us know.

 

Since 1990 hospital managers in the globally have dealt with spiralling costs, sicker patients requiring more complex care by slashing the numbers of Registered Nurses on the wards and replacing them with untrained assistants.

 

This is why nursing care is so bad. The nurses are overwhelmed. You are sharing your nurse with so many other people that she cannot even keep them straight and dealing with the top priority stuff is like being on a hamster wheel. Just getting life saving meds and equipment that are prescribed out of the blue takes lots of form filling and hoop jumping.

 

The situation now, is a heck of a lot worse than it was in say 1995. Nurses never received the abuse etc that they receive now. It is horrific. Take it from someone who is currently working in a high level short staffed acute area of a struggling trust.

 

I understand your comments about the water jugs and the blankets but I think you miss the point. Unless you know exactly what is happening with your nurse's other patients at that moment in time, unless you understand the hoops she has to jump through to sort it all out, unless you understand the consequences of her making the wrong decision about where to be and when then you do not understand why she hasn't brought that water jug or blanket.

 

I am devoted to basic care and comforts for my patients but during the course of a 14 hour shift I find it impossible, impossible to even get a minute uninterrupted to check on the basics. It is hellish and I am not kidding. It was not this bad even 5 years ago.

 

I take offense at the implication that Nurses do not understand what it is like to be on the otherside. I elderly parents that are in and out of hospitals, days without their leg ulcer dressings being changed. I have a husband with a chronic illness that causes him to be in and out of hospital. I have a son with special needs. I have been a hospital patient on wards similiar to my own. We do get the other side. We get both sides. You do not.

 

I understand that if my nurse has another patient that is critical than she cannot even leave him for two seconds to fetch a water jug. I understand that she is forced to take more of these patients than she can handle due to intentional understaffing by hospital chiefs. I get that if she makes the wrong decision about where to be and when then she could end up before a judge very easily. In the states I saw a nurse jailed for missing some critical lab values getting phoned in, resulting in a death. The reason she missed them was because she was playing handmaiden servant to the relatives of another patient who thought that she should be there at all times, the minute their dad rang his bell for a blanket etc. This is true. This happens.

 

You have to be willing to understand that on a general ward your nurse has more patients than she can handle or get to in a shift, that she is constantly interrupted to a point that she cannot even give a drink without getting interrupted between pouring the water into the glass and getting that glass to the patient's lips. It is this bad in many places.

 

IF this is how it is, and hospital chiefs are hellbent on not staffing and running the wards properly then you need to get used to the idea that you cannot expect your nurse to appear immediately and work on your schedule. I am sick of the public expecting one to one care and then refusing to acknowledge the situation the wards. This is a terrible state of affairs. If I am ever sick again I want my nurse there immediately. Under the current conditions on the wards she will not be there for hours even for something simple like helping me with a snack. This is why I blog about it and people are indeed listening.

 

The situation was similiar in the US for years and nothing changed until the nurses really stepped things up and became militant and outspoken.

[NurseAnne]

Since 1990 there has been something like a 110% increase in patient acuity (that means they are sicker and more complex) and a 30% reduction (intentional by management) of registered nurses at the bedside. And it gets worse every year. So I really have no patience from the input of nurses who worked years ago and left the wards pre-1990's.

 

If you don't understand that registered nurse is not always going to be able to fill a jug or fetch a blanket (something we are not happy about, we want to do these things)then you don't really even have a fundamental understanding of what a registered nurse is or what they have on their shoulders.

 

In 1996 I worked on a lovely short stay surgical where I never had more than 6 patients and I always had a charge nurse to back me up in a critical situation. I was able to do everything for my patients and we never had any complaints or abuse.

 

In general medicine the wards are not set up that well, as a matter of fact their nurses are set up to fail. These are the wards where our elderly patients (my mum and dad) get admitted when their heart failure kicks off, or they are septic or have pneumonia. Their nurse doesn't stand a chance and neither do they. These wards and the staffing matrixes have to be restructured.

[NurseAnne]

"How self-obsessed are you? How about fireman, ambulance crew, police, teachers?"

 

In the US registered nurses have higher salaries than all of the above listed by you. I lived there for years. I have known many fireman, teachers, cops, and ambulance crew who have gone into nursing and every single one will tell you that hospital nursing is 10x harder, with higher levels of responsibility and critical thinking skills needed. Every one of them.

 

The UK has almost no chance of hanging onto any of her nurses. In parts of the US and Canada now, they have strictly legislated RN to patient ratios. This means that no RN can take more than 5 patients at a time, and if one of her patients becomes so critically ill that she cannot leave his bedside she gets another RN to care for her other 4 patients. UK nurses do not have any of this. If one of her nurses goes downhill, there is no one to care for her other 12 or 15. This is law over there and in Oz and it is being implemented and it is more cost effective to hire RN's than it is to cause patient deaths and complications from lack of RN's.

 

They will be poaching all your nurses. And ff you are going to lay into a nurse caring for 20 acutely ill patients for not filling in water jugs you pretty much deserve to lose them all.

 

Another piece of advice-never assume that all the staff you see hanging about the nurses station are nurses. And never assume that they are personel that can assist your or know about your loved ones condition. They probably are not and the real nurse who is responsible will be up to her eyeballs and trying to avoid any interruptions just to up her chances of getting critical drugs out on time and critical assessments made.

[Night Owl]

Thanks for your input NurseAnne.

I agree with a lot of what you say.

 

Nurses are being put under ever increasing pressure to complete their shift with no serious incidents and the ratio of trained and untrained staff is seriously shifting. Job roles should be clearly defined but we relying on untrained to do far more for rubbish rewards in pay. Some are brilliant and go on to do their nurse training because of the encouragement and new skills, but some will let you know what they can and can't do and stick to it.

 

I can't be more specific about my area because of other threads I have on CAG but suffice to say that until something changes the NHS will always struggle with staffing.

 

It is so difficult to maintain patient confidentiality when a patient or visitor is shouting about something they are worried about when the nurse is dealing with something far more important at that time.

 

The public are getting more blame orientated in everything but going about the wrong way to make significant changes. We encourage patients and visitors the correct way and by getting them to support the underlying cause of alot of their concerns are from serious understaffing and not just moan about trivial problems which will have very little effect.

 

If we can get the public and nurses to complain about specific concerns on mass change has to happen but everyones sits back and lets someone else do the stammping. We need help to make changes happen.

 

The General Election will again see broken promises for a better NHS and more funding. They will fight for votes by using the NHS football to kick around and make themselves look good.

[NurseAnne]

Night Owl,

 

The NHS is currently using world war two era models of staffing and they are doing in with lower proportions of qualified staff on the wards than you had in previous decades. When you take into account that patients are becoming sicker, more complicated, the elderly population is exploding and that we are now expected to do more with less in order to cut costs it is no wonder that standards of care are declining.

 

The hospitals are also full of patients who would be better suited for a nursing home but there are not enough care homes to care for them all. They languish in hospital instead. But the ward they are on is only staffed with enough RN's to stay on top of things like crisis management and IV drugs. The set up does not allow us to actually "care for" medically stable elderly patients who merely need help with activities of daily living. There are no elderly wards at my hospital. Elderly patients with dementia who need one to one care in order to avoid falls and accidents are being placed on wards where their nurse already is up to her eyeballs with multiple acutely ill patients.

 

Of course it is not bad everywhere yet. The general medical wards seem to be the ginger haired step children of the NHS. Some of our surgical and ortho wards are functioning okay.

 

I am really getting sick of all of the "fallen angels" and "too posh to wash" rubbish.

 

It's as if people think that if only the nurse was a little more compassionate or a little less educated that she would suddenly have the ability to answer 10 call bells, feed 25 people, manage critically ill and deteriorating patients as well as answer a non stop ringing phone all at once whilst holding hands and being patient and sympathetic. It's a joke.

 

Of course media stereotypes and journalists in general don't help things. The picture they portray of nursing is so way off the mark it is scary. The public's view of nursing and what nurses should be doing comes from the subconscious images that they developed after years of watching Casualty, ER, and House.

 

I actually had one person ask me why we were so stressed with life and death responsibility. She thought that we have ward doctors around to manage all aspects of care and that the nurse merely assists him. This is how people think.

 

There is one good journo. Her name is Suzanne Gordon and she wrote a book about nursing called Nursing Against the Odds. Her basic idea is that media stereotypes cause the public to have messed up and dysfunctional views of nurses and that is why they become abusive towards nurses. They have unrealistic expectations that don't get met and then they get angry. That hospital cost cutting, poor working environments and changes in health care dynamics are leading us to a nurse-less society. She has concluded that the reason things have become so bad and unrealistic for nurses is because of that whole angel image. All these things cause registered nurses to flee the bedside which is what cost cutting hospitals want.

 

It is a book I highly recommend for anyone who wants to know why nursing care in hospital is so bad.

Edited January 5, 2010 by NurseAnne

[Night Owl]

Suzanne Gordans "Nursing Against the Odds" is a very interesting read, thanks for that NurseAnne.

 

Link (not sure if allowed)

Nursing Against the Odds review

[NurseAnne]

A lot of good reviews here. Amazon.com: Nursing Against The Odds: How Health Care Cost Cutting, Media Stereotypes, And Medical Hubris Undermine Nurses And Patient Care (The Culture and Politics of Health Care Work) (9780801439766): Suzanne Gordon: Books

 

The centre of nursing advocacy can have a one track mind with their reviews. They rub me the wrong way at times.

 

I worked in the US for awhile and the UK for a long time as well. The similiaries are striking. The hospitals have behaved in the exact same manner. But the conditions here in the UK are triple brutal for nurses. The public here has a much more backward, ignorant view of nurses and what a nurse is and that is probably why. The same management consultants who destroyed care on hospital wards USA were hired by the NHS I think. This is kicked off early to mid 1990-ish and is reaching a head now.

Edited January 6, 2010 by NurseAnne

[Sali]

NurseAnne

 

I have consistently commented in my posts that I recognise understaffing to be a major, (but not the only cause), of declining standards of care in our NHS and I rest the blame on this stupid Government and those that manage our hospitals.

 

I'm sorry to hear that your husband has a chronic illness and that your son has special needs. I'm sure you have enormous empathy with your patients. I'm not questioning how tough your job is or how hard you work.

 

I am intrigued to know how you think your blog will help? As a member of the public I found it alienated me from the nurses' plight.

 

I desperately want things to change for you and the patients - one of which I may be one day.

 

I note you mention that in the States there is a legal requirement for a trained nurse to patient ratio. This is something I previously considered when my relatives were in hospital. It would be a way of making the management accountable.

 

Perhaps the NHS should be dismantled? It was a great idea of Mr Bevan's, but the world has changed. The NHS seems to be so heavily abused and no organisation that the government has a finger in seems to be well-run.

[Night Owl]

Ok, update today.

 

Phone call from Ward manager this morning. She is re-orginising our meeting that was cancelled. We have re-scheduled for next week, 13/01/10 at 2pm. Present at the meeting will be Ward Manager, Matron and she has contacted the RCN rep to attend.

 

What has happened since I wrote the letter and made a stand?

Well, we are getting more staff that are not being poached for other areas.

Plans are grumbling for re-organisation of some of the wards to improve on patient care and staffing...........this will divide alot of well established ward teams, and have a big effect on staff moral, but until it is set in stone at least something is being discussed.

 

Will update this soon.

[Maggie_moo]

I have to say I've been following this with a great deal of interest, it's been fascinating. I hope your meeting goes well Night Owl

[Night Owl]

Thanks Maggie. It's interesting to have input from both sides.

[Night Owl]

Weather forcast for tomorrow is heavy snow...........looking bad for my meeting tomorrow at 14.00hrs. I will be in contact with my ward manager tomorrow morning for an update on whats happening.

 

I feel like I'm slowly being swept under the carpet!

 

I won't let it happen because things on the ward are going from bad to worse now with doctors now completing incident forms.