Unsafe working conditions.

[Night Owl]

Hi all.

 

I didn't know if I should post this here or in the employment section but I think it's more appropriate here.

 

After 2 particularly bad night shifts I walked off duty and refused to come in for my last shift.

 

The reason? for over a year now I have made a stand for our ward being short staffed and that I felt that nursing care was compromised as well as patient safety. I wrote letters and incident reports through the right management channels and with 4 other members of nursing staff we went to see the Hospital Manager. (I am with a Union..........she was aware of the problems and was keen to give us all her support, but at the last minute did not come to the meeting. She has not made contact with me since).

The Manager left not long after.......not because of what we raised!)

Plans were drawn up to resolve these issues the best way the management could!!!!

 

We are now into the same situation and I refused to go into work because I was again concerned with the apauling staff shortages and compromised nursing care and patient safety. An incident report has been completed and parents have complained to PALS. I am now on annual leave for a week.

 

I feel that I am letting the team down for refusing to go into work but I hope I can change things by making a stand with all the supporting evidence.

 

I wrote another letter through the correct management channels and have spoken to them on the phone from home whilst on annual leave. They are going to make me make up my "missed" shift, they didn't know how to document it!! I am not sick.

 

They took my letter to the hospital managers meeting on Monday. I am awating feedback.

I am also waiting for a meeting with the managers to discuss these issues.

 

Lots of threads here are about other peoples concerns about hospital care and I just wanted you to all understand the problems we have in making a change to these issues.

 

I am doing this because I care for the patients I care for and the staff I work with and I will not make compromises that will endanger the care and safety of either.

 

The NHS is like a bucket with a hole in the bottom...........it doesn't matter how much money is thrown in it it will always be short. We are now having to make severe staff shortages.

 

I will be looking into the hospitals policy for whistle blowing when I go back to work or will get some one to e-mail it to me.

 

Please wish me luck because I am so angry that I find myself in this situation again.

 

Thank you for reading this.

 

Night Owl

[Night Owl]

Thank you both for your support. I really do appreciate it.

 

My collegues are behind me and the first time round we were all completing incident forms and speaking to management but when you find yourself in the same endless and hopeless situation people get disheartened and say, whats the point.

 

I have seen some very good nurses leave because the situation was so bad. I find that desperately sad and it doesn't seem to resolve anything.

 

If we don't make a stand then the issues go on, and I will not let that happen. I have been in this job for over 30 years and never, ever, have I refused to go to work. I was shaking and crying with rage as I left and was so angry that I was put in that position.

 

With parents backing us up, and we do encourage them to complain through PALS, we can back up the endless incident forms we complete for sub-optimal staffing or unsafe ward.

 

I will keep you updated if and when anything happens.

 

Thank you again for your support.

[Night Owl]

Hi Sali,

 

We have off duty records of staff for each 12 hour shift but due to staff changes and sickness our daily work book is more accurate. All the information is recorded on computer aswell.

 

Staff that are booked through bank or agency are booked through our bank office and their timesheets are signed and paid for by the wards they work on. This is all computerized documentation.

 

There is a ratio of trained to untrained staff per ward but this does not take into account increased patient dependency, this is when we will request extra staffing suitable for the need.

 

There is also a job freeze on at the moment so no new staff are being recruited. Before this as trained staff left the ratio changed and we were to accept higher untrained staff over trained staff.

 

I cannot be more specific of my area, but can only say that it is very specific in speciality and this staffing ratio is putting more stress on both trained and untrained staff to complete their working shift with no incidents occurring. Obviously there are shifts which work well and safe please don't let me paint a consistent bleak and hopeless picture.

 

Our problem at the moment is that our patient dependency is high but the extra staffing has been adhoc and then sometimes pulled for other areas due to the same staff shortages.

 

At present the managers, in there endless skill of management!, are looking at closing wards and moving staff like pins on a pin board without looking at the consequences they leave behind. If this happens they will be destroying well established teams and creating new ones that may well be out of their experience and knowledge base.

 

When the hospital is struggling to find beds for the patients being admitted 24/7 and a winter ahead of increased patients sickness (including Swine Flu) and inevitably staff sickness closing wards seems madness. They are not increasing the staff just squashing us into less wards.

 

Local families are then transfered out of the area to the next available bed, often miles away. This then hits the papers as families loose loved ones in the delay this causes for specalist treatment.

 

Sorry must stop waffling now.

[Night Owl]

I have just had a telephone call from the Matron of my ward. She is setting up a meeting on Tuesday 22nd December with the nursing Management so that I can discuss the issues I raised in my letter. There will be three of them and me!

 

I had the RCN rep. involved for support last year over similar issues but at the eleventh hour she didn't turn up at the meeting then! and has made no contact since. I am considering calling her again as this is a management meeting but then thinking what's the point!

 

I have contacted a more senior staff member for advice.

[Night Owl]

I have just completed this on my Union, The Royal College of Nursing, web site.

"Raising Concerns Raising Standards

 

This is an additional service to members who have concerns over clinical and staff safety in the workplace. It is important that nurses raise concerns directly with their employer. Registered nurses have a duty under the NMC to report concerns where patient care may be affected.

The Raising Concerns Raising Standards initiative is not an alternative to raising issues with your employer. However we are keen to hear of any issue that you think impinges on patient safety and the steps you have taken to get the matter resolved.

You can complete the form below and we will ensure that your concerns are made known to your RCN Country or regional office. Remember this is not a substitute for you reporting the issue to your employer or other relevant body."

[Night Owl]

Just had the RCN on the phone. They have arranged for someone from the RCN to phone on Monday 21st to go through everything..............how long have they got!

I have asked for their support at the meeting on Tues 22nd as it is with Management, they are going to let me know on Monday 21st.

The Regional Office is very interested too on what happens.

[Night Owl]

Thanks Feebee_71.

 

This is all over what I considered unsafe working conditions and putting my nursing registration at risk.

I refused to go in for a shift because I felt strongly that the ward was understaffed and we were not providing safe care. That is my right to voice my concerns and I have.

I am accountable for what I do and the care that I give.

I will keep this updated.

[Night Owl]

Night Owl,

 

As I head off for a night duty myself in a short time I know exactly where you are coming from and also feel at times that we are banging our heads against brick walls - especially when expected to keep HDU/ITU relevent cases on a general paeds ward because they 'aren't sick enough' to qualify for a specific retrieval service but we aren't trained sufficiently to use some of the equipment we are being made to use.

 

Fingers crossed for you and I will keep looking in on this thread.

 

Feebee_71

 

It sounds very familiar! Oh my god do you work in the same hospital as me?

Edited December 19, 2009 by Night Owl
Its a secret!

[Night Owl]

are they denying you a bed in HDU or ITU or just stating that your patients don't meet the criteria for retrieval ?

 

several of the paeds retrieval services only do level 3 but won't do certain kinds of the trauma as it is felt that level 2 patients not needing the scarce resource of the level 3 dedicated vehicle and team ( outside of the london and SE schemes most retrieval schemes work on one vehicle per centre or don't have a dedicated vehicle ) and certain kinds of trauma ( e.g. neuro) are actually better served by an 'ordinary' secondary transfer given the time lag that a retrieval creates due to activation and travel 'to' time ...

 

Sorry Zippy, you may have to read this from the start. Im a nurse in a very specific area having a "rough" time. Our patient dependency is high and we have lots of very sick patients. No HDU unit.

 

My nursing registration was put at risk and I refused to go onto shift!

I have never ever been put in that position before and it is very scary.

All the staff are behind me! and have been great with thier support for the meeting with management on Tues.

[Night Owl]

Hi Night Owl,

 

Sorry for delay in replying - was catching up on some sleep after work last night!!

 

I don't work down your way, my hospital is inside M25 domain!!!

 

I think many of us could relate to similar experiences at some time or another.

 

Feebee_71

 

Hi Feebee_71,

just got up! 2 more nights to go!

Since my refusal to go to work management have increased and are trying to protect us with extra staff which is making such a difference............but it took me being pushed to the edge professionally to make that change, they, again, didn't listen to us.

 

We have trialled high dependency tools but some of our all care patients don't trigger high dependency. We care for patients on CPAP, trachaes, (spent one shift intermittently bagging a patient on the ward with ITU Reg because there was ITU bed!) Oncology (I am a Chemo checker and giver) everything! multi-talented!!

 

Im trying to get across to management that we have high level of higher dependency patients and that is why are staffing needs increasing for their safety.

 

Now wheres my cup of tea gone..............another night shift looms!!

[Night Owl]

Thank you for your support and advice VikkiBP and NurseAnne.

 

I don't consider myself a "Militant Person", I just care about my job, the collegues I work with and the Patients we care for.

 

NurseAnn, do you complete incident forms for sub-optimal staffing?

Have any staff made an offical complaint to management? through the correct channels.

If you don't do this it's just venting your frustration and not getting anywhere. You are accountable for your care and if you can justify that this is not happening then management must be made aware.

 

They don't do anything I hear you say. You must go through the correct channels and if so bring in a nursing Union. It must be constructive comments and if you can come to the table with management with some ideas to resolve the situation.

 

Difficult I know.........I've been there exactly this time last year! But I consider that my letter I sent to management was justified. My Nursing Registration was put at risk and that is not acceptable.........by law I would loose my job if anything went seriously wrong.

 

If we accept poor staffing, struggle on, and not challenge management nothing changes for the better. Management have to take this seriously if you put in a contstructive incident form to prove sub-optimal staffing or unsafe practice.

 

I would urge nurses to bombard management with these sort of incident forms if you believe strongly in better care for your patients.

 

Sorry got to go..................another night looms.

[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!

[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.

[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.

[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.

[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.

[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

[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.

[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.

[Night Owl]

Thanks Boris. We have got heavy snow falling now! Just spoken to the ward manager and she will be in contact if she can get to work tomorrow.

[Night Owl]

Thanks NurseAnne. Meeting at 14.00hrs. Heavy snow overnight but O/H and daughters all moved their cars.......just!

[Night Owl]

Ok, was just about to update this when all I could hear was.......whats for tea?

 

Tea's in the oven!

 

Ok, update.

Meeting was held today between me, ward manager, Matron, Head of Nursing and RCN rep.

 

Firstly we discussed the issues around my letter and refusing to go to work as I believed that my nursing registration was being put at risk with sub-optimal staffing and being unable to maintain nursing standards, I believed that the ward was unsafe.

They all listened and agreed on what I was saying and made apoligetic noises.

 

We discussed staffing and the fact that it had been agreed for the shifts I was working, and the week up to them, that we were to have extra staff.........this happened but the staff members were taken away shortly after starting the shift. This was unaceptable and ultimately put us in a difficult situation where we struggled. Our concerns were not being heard.

 

We discussed the increased work load and increase dependency of the patient group we care for. In 2009 we had trialed a dependency tool designed by another hospital. It was huge and time consuming to complete for each patient for each shift. We hadn't had any feedback after the trial was completed........I asked. It was agreed that our dependency was considered high at the time of the trial........NO SH*T SHERLOCK...........thats what we were trying to highlight from the start.

 

The RCN rep told us about another dependency tool designed for the specific patient group I care for (sorry if this seems cloak and dager not identifiying more, but I can't).

The dependency tool was being trialled at another hospital before being available for our use. She said she would try and get me a copy.

 

We discussed if it was possible to do a brief dependency tool whilst we were going through this crisis until the other specific tool was available so that we could justify our increase in staffing demands. We all agreed that it would be good and will put something together over the weekend to show management and role out in use.

 

We also discussed previous actions identified by me in 2008 and brought to the managements table at that time. I stated that we are still fighting for staffing and having to justify our reasons..........nothing has changed in a year.

 

They looked at staff shifts and stated that if staff were struggling then we should impose shift time changes back to shorter shifts from 12 hour shifts making more days to work in a week.........not popular with alot of staff.

 

Sorry gotta get tea out back in a mo.

[Night Owl]

Thanks NurseAnne. Yep, sadly bad nursing ratios are here to stay and soon certain patients will be cared for by untrained staff doing task orientated care and the public will have to get used to that. Trained staff will "supervise" that care and carry out the extra care such as medication, dressings and extra care required.

 

I think that it's disgusting that we are travelling backwards in the nursing profession, or more like being bullied into it. I started my nursing career doing task orientated care , then in came holistic care for patients.

 

Strangely the public still see well staffed "Casualty and Holby City" TV programmes that show plenty of trained nurses caring for patients which is not realistic to whats happening in the NHS.

 

I can only fight to improve our current situation not the national problem.......that may take longer!!!!

 

By looking at staffing working hours there may be staff that will like the idea of changing their shift hours. Our whole time entitlement of staffing will be increased if we can get some staff to make the change to working earlys, lates and nights.

 

By devising a dependency tool, until we have the one being trialled by another hospital, we can prove our increased patient dependency and our requests for increased staffing to the management and beyond. Legally this will provide the backbone of what we are doing and management will have to accept the results and agree the changes.

 

The Head of Nursing was not in this current post when I made my last concerns heard in 2008. She was very interested to hear about it and the actions agreed and if the actions had been put into force. I took my file of paperwork with me!

I will be monitoring this on a regular basis and in a years time to see that improvements have been made. If not and the situation remains I will continue to bring this to the attention of the managers and the RCN.

 

After writting my initial letter at the start of all this I completed the "Raising Concerns, Raising Standards" form on the RCN website. I now know that the regional officer from the RCN has made an uninvited visit to the hospital and wants a full report from the RCN rep that came to the meeting and the Head of Nursing.

 

We will make a change to the care our patient group recieve and the staff caring for them...............we have to...........and there are plenty of nurses out there that must make a stand and complain officially and use the unions, and continue to make official complaints, constructive complaints backed up with incident forms and PALS complaints.