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Night Owl

Unsafe working conditions.

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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


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Night Owl,

I am appalled that you find yourself in such a situation. After Margaret Haywood's treatment by the NMC, it's a wonder that any nurse raises her head above the parapet.

This must be a tough one for you. I admire you for making a stand but you must be torn between doing what is right and compromising patient care further. I'm not criticising you for this; you seem to have tried endlessly to highlight and deal with the issues. Part of me wonders why your colleagues are not standing with you in solidarity. It would certainly focus management attention and make the public (rightly so) aware of the issue.

It will be interesting to see what the whistle-blowing policy is post-Margaret Hawyood.

Me. Well, it's easy for me to say, but I would think about how I would feel if it was my loved one in the bed. After following the official line, I would resort to sub-version if necessary, alerting MP/press. The public would applaud you for it. However, you risk your career.

Please let us know how things progress. I wish you well. It's probably of little consolation, but I'm on your side.

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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.


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I have a question. Is there an accurate record kept of who is on duty for each shift, including a breakdown of personnel - viz. trained nurses, bank nurses, HCAs etc? How long is this information kept and is it available via Freedom of Information?

 

Do hospitals have policies which state the preferred ratio of trained nurses to patients on particular wards? I'm assuming there is no legal obligation to ensure that a minimum number of trained nurses need to be present on a shift?

 

Many thanks.

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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.


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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.


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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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."


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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Good luck at your meeting on Tuesday. I would say you need to have some support, so yes, contact your Union Rep. Make sure you get a properly recorded copy of the meeting as well.

 

I have a midwife friend (ex midwife now) who after 32 years decided she would take early retirement because of the conditions they were forced to work under. :(

 

Very sad situation as it isnt cheap to train a nurse.

 

BTW, meant to say, if you are happy with your thread here, then fine. If you want it moving, then just hit the red and white triangle which is

 

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Yes, good luck Night Owl. I am not in your field but whatever job I did, if I was left with nobody to accompany me as my witness and for support, I would cancel the meeting and no amount of sweet talk would change my mind.

 

Let us know how things go.

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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.


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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Night Owl,

 

Glad to hear you have had contact from RCN and I hope they are able to support you at this meeting next week. When I had an issue that went to disciplinary stages I was represented by my union rep and he was able to get all allegations dropped due to the inconsistency of the person bringing the disciplinary in regards to what constituted intermittent absence as opposed to sick leave.

 

I would certainly use the union if I had to face such a matter again and wish you all the best for next week,

 

Feebee_71

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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.


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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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

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That is good news the RCN are going to give you some support. Lets hope they can provide someone to go with you on Tuesday.

 

Keep us updated please. :)


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Read Here

4: Staying Calm About Debt

Read Here

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Please Read

 

 

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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 by Night Owl
Its a secret!

Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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Night Owl,

 

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

 

 

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 ...

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

 

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

Edited by maroondevo52
Removed secret word

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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 ...

 

Hi Zippygbr,

 

The patients are too unwell to stay on our unit - we aren't an HDU or ITU unit and only have minimal training for CPAP when used on Bronch's or septic babies with respiratory distress and associated acidosis - but are not sick enough to be retrieved by CATS (London & SE area scheme) whose criteria seems to be intubated & ventilated only. Secondary to that they are also deemed to be too sick to stay with us and can't be transferred by us as too sick but still not sick enough for retrieval.

 

On one occasion we had an HDU bed at a central London hospital for a baby but no way of transferring them to the bed as too sick for nurse/doctor transfer but not sick enough for CATS transfer.

 

Feebee_71

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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.


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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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!!


Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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Hi Zippygbr,

 

The patients are too unwell to stay on our unit - we aren't an HDU or ITU unit and only have minimal training for CPAP when used on Bronch's or septic babies with respiratory distress and associated acidosis - but are not sick enough to be retrieved by CATS (London & SE area scheme) whose criteria seems to be intubated & ventilated only. Secondary to that they are also deemed to be too sick to stay with us and can't be transferred by us as too sick but still not sick enough for retrieval.

 

On one occasion we had an HDU bed at a central London hospital for a baby but no way of transferring them to the bed as too sick for nurse/doctor transfer but not sick enough for CATS transfer.

 

Feebee_71

 

CATS is a level 3 service

 

i don't see how a patient can be 'too sick' to be transferred by a middle grade or senior doctor and an experienced nurse - becasue after all this is what a retrieval scheme uses

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Oh dear what a predicament. I admire your stance and willingness to stand up for what you believe in! I am not a nurse, but do work in the NHS and know what it's like to try and do your job with one arm tied behind your back. The only thing I can advise you of is this -

''They are going to make me make up my "missed" shift, they didn't know how to document it!! I am not sick. ''

This can be recorded on ESR (Electronic Staff Record) as unauthorised leave either paid or unpaid, therefore you won't have to make up the missed shift. I'll read your post with interest and good luck.

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Night Owl,

 

I completely sympathise. You did the right thing.

 

I have been blogging on a site called Militant Medical Nurse about these same issues. I work on a 25 bed medical unit that takes everything from care of the elderly, acute medicine, ortho, surgical, psychiatric, and HDU when no beds are available. We are lucky if we have 2 RN's per shift. The minimum safe levels of patients to RN is 1:6, and that is only if acuity is low and the RN has good back up.

 

There is no excuse for this. Management could have these wards staffed if they wanted to. They don't want to and they know and laugh over the fact that the public gets it's jollies over slamming "cruel nurses". In 13 years of nursing I have yet to meet a cruel nurse or a nurse that is too posh to wash.

 

It is cost effective to have more RN's on duty because of the decrease in sentinal events that occur with safe RN ratios. But the public just blames the nurses so management gets away with intentional short staffing. Not too long ago I had 3 patients who were pre arrest and a few more critical ones. I was the only RN on duty. I was at the desk trying to get a doc and infusion pumps ordered so I could implement orders for these patients and I was bombarded with visitors laying into me because I wouldn't drop what I was doing and bring someone a pillow. Sometimes I think visitors who behave like this want us to kill critical patients or something. A couple of patients nearly died because I couldn't get past visitors screaming about patients not getting helped with their meals. Did they not think that I would have helped those patients if I didn't have other critical ones? Do they really think that one RN can feed 12 people by herself in 20 minutes? They are all nuts. Not one of them ever complains to management about the nurse patient ratios. When the nurses complain, we get ignored. When a patient gets harmed the nurse gets the blame which includes striking off the register and possible criminal charges. Management walks free and just rants on about teaching the nurses about dignity to improve things. What a joke.

 

Hospital administration is like the general public. They don't know what a nurse is....and they don't want to pay any to be around. They think that a 17 year old who gets a job in the hospital caring for patients is a "nurse". It's sick.

 

Anyway I would love for you to do a guest post on my blog. It is all anonymous of course. The NMC just shoots the messengers.

Edited by NurseAnne
add some words

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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.

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Keep up the fight against Bank Charges.

 

 

Got Debt problems?

Don't panic, put the kettle on and read this

 

:-) Everything I write comes from my heart and head! The large filling cabinet that is my knowledge of life, however warped that may be!! :-)

 

<<< Please tickle my star!! if I have managed to help you or just made you chuckle!

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