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What happens if:

1. You're working in a foreign country
2. You don't speak the native language of that country
3. You're responsible for the welfare of children
4. There is only one native speaking psychiatrist you can refer kids to locally
5. You have serious concerns about the safety of a particular psychiatrist
6. You've notified your boss, management and CEO of your place of employment
7. No one has responded to your documented concern

What do you do?

I'm not going into any detail about what exactly I'm concerned about, but no one is bothering to listen. What can I do?

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Ruined

"Can you tell me what the email says?" I asked Matleena, the translator.

"Let's just forget about it" said Matleena, "It's over with now. It's not worth it". This was the second time she had refused and this of course only made me more curious. "Can you at least give me a rough idea?" I begged.

Matleena sighed and looked around to make sure no one could overhear. "Well, I've never, ever, read anything like it" she began. "It was utter, total filth, directed at you. It was poison".

This was a letter from an extremely wealthy Russian parent. Their daughter had complained that her medical treatment was inadequate. She claimed we had refused to let her see a doctor. She had a mild sore throat, no fever, no redness, no pus, and had only began during the night. When we had phoned the doctor he had said he couldn't see her until the next day.

I don't feel stupid calling the doctor for a problem such as this. The doctor and I have had many conversations lamenting the horrid, obnoxious behaviour of the kids we look after.

It only takes one email, or one phone conversation with a parent to understand where some of these kids get their problems from.

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I've changed

I haven't worked in a ward in years. These days it's the exciting stuff, you know, the emergency room or ski nurse or something else exciting that I do.

The other day I caught up with and old friend, from when I did work in a ward. I love the fact I don't have to wash patients anymore. And as a male nurse, I'm really relieved I don't have to wash female patients anymore.

As I get older I'm becoming old fashioned. I would just feel uncomfortable showering a female patient on my own these days.

I know what arguments you are going to say, and here's my reply.

1. I'm a professional and it's part of my job - Well, if I can't continue to help others and do good just because I'm not into showering little old ladies, well nursing isn't the caring profession I thought it was.

2. What if it's an emergency - Get real, "that patient needs a shower...stat".

3. It's not fair on your colleagues - You're probably right. But lets face it, men generally do accept being showered by a woman much easier than a woman being showered by a man. It's a fact.

4. If I want to keep my job, you have to do it - Fortunately I've moved away from the ward and will probably never come back, so it won't be an issue. If I was broke and needed a ward job, of course I would relent and shower as many women as would have me.

I'm sure there are plenty of nurses out there who will absolutely think I'm a bad nurse, maybe even a bad person. All I will say again to these people is "I thought nursing was a caring profession. Isn't the job stressful enough without turning on each other". We all have our likes and dislikes, and generally we all work through them, but surely there's some room for some give and take.

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Killing in the name of the Law

'An Air New Zealand flight attendant sacked after being dobbed in by police for drink-driving has lost her case in the employment court for compensation.'

The above insert was posted in the NZ newspapers. The women was on her way to work and had she not be pulled over, she would have turned up to work well over the zero tolerance alcohol policy. Fair enough.

Saturday night in the emergency room and a very drunk women managed to drive into the parking lot and stagger to the front desk. After abusing the staff she was eventually treated for a minor injury. We physically stopped her from driving, but she eventually got away and to her car.

We called the police to say a drunk patient was driving in her car.

After being arrested and charged with driving with excess alcohol, she laid a complaint against the hosipital for breaking confidentiality by phoning the police.

The complaint was upheld and the nurse who phoned the police ended up in court. After a couple of months of worry and stress, the nurse was able to work again. Thank goodness they didn't take her nursing license away.

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Too bad if you want sex

"Wow the nurse is here. I wonder what that means?" Greg said mischieviously as he walked into the classroom. "You're late Greg, hurry up and sit down, this lesson will be of particular importance to you" I gently chided. The rest of the class broke into laughter. Greg had a pretty new girlfriend and always made sure everyone else knew, both staff and students.

"Is this a sex talk sir?" piped up Jane from the back of the class. The rest of the class erupted."Sex talk" "Great, sex" "I know it all" "If you need some advice sir, don't be too shy to ask"

"Settle down kids, I've got some shiny new books for you to look at. Greg, come up here and help hand them out." The school had ordered one hundred books dedicated to teaching students about "Life Skills" and I had been asked to talk about sex, and contraception.

After brainstorming ways to be safe, we turned to our new books, the chapter titled "Sexual Health and Disease." The kids began to read. I quickly scanned the first page, not finding what I was expecting to see. I scanned the second and third page and I regretted not checking out the new books beforehand.

The kids began to laugh. The book did not mention 'Condoms' once. It didn't talk about any actual contraceptive devices. It talked about 'Healthy relationships, abstinence, and friends who don't put pressure on you'

It did talk about HIV, and told them to 'take up a hobby'

I'm requesting the school send the books back.
I've also heard a rumor that the USA has passed laws restricting what sex education books can say.
I want to know if this is true.
I will bring a book home from work and give you the name, authors and publisher.

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'BBC Article' new news but old news

Hospitals rapped for failing to give patients medicines
By Nick Triggle
Health reporter, BBC News

Elderly patient
The watchdog is writing to all the hospitals in England and Wales

Too many patients are not getting the medicines they need in hospital, a safety watchdog says.

The National Patient Safety Agency warned it was a problem in every hospital in England and Wales and is now writing to them urging action.

The watchdog said it had evidence of thousands of cases of patients getting their drugs late or not at all, including 27 resulting in deaths.

The government said patient safety was its top priority.

From September 2006 to June 2009, the NPSA received reports of 27 deaths, 68 cases of severe harm, including permanent disability, as well as another 21,000 less serious cases where drugs had not been given or had been given too late.

I'm surprised this has made the headlines as it's not bloody news. I remember those days in the surgical ward where I would regularly have 12-14 patients with a health care assistant. The assistant (depending on their experience) can take BP,Pulse etc, wash/shower patients and do the odd dressing.

I would give all the oral meds, give all the IV meds, get patients ready for theatre, be there for patients coming back from theatre, look after any infusions eg blood, change dressings, assist with daily hygiene needs, admitting and discharging patients and then looking after any patients not conforming and getting more ill instead of better.

I haven't included any of the less critical but also important things we do like: spend time with patients, exercising them, feeding them, showering them, educating them.

In fact I'm rather pissed off. This article is in the news now, when this was the situation twelve fucking years ago, and again six years ago when I was last working in Britain.

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Nursing Dectective

Hmmm, immaculate make-up, not good.
"You look well for someone who's been sick vomiting for four days" I said.
"I haven't eaten a thing for four days. I feel sick still now, but I'm trying to eat" said Sarah as she took a bite of her Snickers bar.
Hmmm, Snikcers bar, not good.
"Why didn't you call me then? I was on-call all weekend"
"I didn't want to bother you"
Hmmm, birthday party on saturday night, Sarah was checked out of dorm. Was seen at party. Not good.
"Your symptoms seem a bit odd Sarah. Vomiting for four days, no diarrhoea, mild stomach ache. I'm surprised you didn't go see a doctor then."
"Oh, I wasn't vomiting... Well, a little bit on friday night, then just some nausea."
Hmmm, story has changed. Not good.
Patient looks well, skin turgor good, lips not parched, immaculate make-up, smiling and energetic.
"You had a major assignment due this morning that you've missed."
"But I was sick. I still am stick, but getting better." It was the first time Sarah had raised her voice to me. "Are you calling me a liar?"
I raised one eyebrow "Are you?"
Sarah stormed out my office in tears.

Could I have handled it better? Maybe. Probably.
Every single day it's a battle of wits. This job isn't about medicine. It's about filtering the exaggerators, the liars and the truly sick. It's about looking at the whole picture, from school grades, school behaviour, discipline issues and absent parents.

I'm told not all school nursing jobs are like this. I'm also told that I should treat the patient, the symptoms, the signs of illness. I do this. But not all the times the symptoms add up.

But any nurse knows what someone looks like who's been vomiting for four days, oh, that's right, the story has changed, vomiting a little on friday and a little nausea for three more days.

I could be wrong.
But I'm not.
This time.

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The Dumping Ground

Maria, 14yrs old, caught stealing from another student, expelled from "World's Best Boarding School."

Maria, 14.5yrs old, found intoxicated, hospital called next of kin, no answer, so called me. Expelled from "World's Elite Boarding School."

Maria 15yrs old, found semi-conscious in nightclub, missing underwear, probably sex with stranger, expelled from "World's Top Notch Finishing School."

Maria 15.5yrs old, caught drinking, given warning, caught stealing, eventually expelled from "Boarding School for the Rich and Famous."

I was there on the last occasion. "You're the only people who've ever cared for me" Maria stammered, tears streaking down her face. My colleague, Jenny, was close to tears as well. "I'm sorry, it's not up to me" Jenny said, then gave Maria a hug.

Maria clung to Jenny as if clining to a life raft. She then gave me a hug as well. We helped load her bags into the car.

Jenny is one of many kids dumped into 'Elite' boarding schools around the world. I know there must be some truly quality boarding schools out there. But boarding schools are a business, and businesses are there to make money.

I blame the parents the most. They've got loads of money, but won't face up to the responsibility of raising their children. It's when children stray they need their parents the most. But I think Maria was an exception. I think her parents are assholes at best, but that's being kind. They're abusive assholes who need should be arrested.

But then there's the schools who know each child's background. They know they won't make a difference, but they'll take the money and accept the child. There are some good schools out there that are designed to take on troubled children, but many aren't.

If Maria had been allowed to stay, I think Jenny and I could have made a difference. But there's the other kids to think of and the school decided that Maria was too much of a risk. She could have cost them money.

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If I had the Power

If I was the head of the hospital, or even head of the nursing department.

1. Double nurses salaries straight away. By doing this we would save money. We would have no problem finding nurses to work as a fulltime employee, and we'd save millions each year in nurse agency fees.

2. Have doctors' about to do surgery personally sign the part of the body about to be operated on. As far as I'm aware, when the doctor who did the surgery signed the body part, they operated on the correct limb every time.

3. In general med/surg wards limit the number of nurse/patients to one RN per six patients.

4. Provide free meals to management, but they only get the same meals as the patients. I'm pretty sure this would improve some of the food I've seen in some places.

5. Support charge nurses when they make requests for extra staff.

6. Don't force in-house job positions to be advertised outside to the wider community when we already know who we want to employ and have quietly told the person they've got the job. This would save me and dozens of other nurses time and effort.

7. Use less out-sourcing, eg Cleaners and Kitchen services. In two hospitals where I was present when this happened, the quality of food and cleaning services dropped. This may not be accurate with other places, but it should be looked into.

8. Employ doctors who speak the local language. I've worked with so many doctors whose use of the English language was atrocious and dangerous.

These are just some of the things I'd do. I didn't actually have to think about this, it just came off the top of my head. Imagine what I could come up with if I ever did think about it a bit.

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Gynae nightmares

"Stop pissing around and start unloading the fucking breakfast trolley" bellowed Bettie. Bettie was my first charge nurse and I was just new graduate. "Is this normal?" I whispered to Shelly, my preceptor. Shelly's face wore a frown as she motioned for me to begin unloading the trolley. "They're not all like Bettie. She's a bad charge nurse. Don't trust her and cover your butt" explained Shelly.

I'd only been on the job one week and I hated my boss, hated all but a handful of the staff, and hated nursing. What the fuck was I, a male, doing in a gynaecology ward? I had the worst possible start to a nursing career that anyone could ask for. The patients regularly refused to have me as their nurse and the feeling was mutual.

What did management expect? I never had an interview, the hospital took the top dozen graduated from the nursing school and placed them in wards. It didn't help that my name had been mistaken for a women's name.

And now my preceptor was insisting I do everything a female nurse did. "I want you to catheterize Mrs Jones" said Shelly. I nearly walked out then and there.

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Another Drug Talk part I

"Sir, what's the most dangerous drug around?" asked Shane. The normally rowdy class was silent as twenty pairs of eyes locked onto mine.

As usual my presentation was last minute and unplanned. It may not have been the best way to presnt such an important subject but I preferred it that way. I just told stories of the things I'd seen and done during my years as a nurse. The stories of my two years spent working in a psychiatric ward were always very poignant when it came to talking about drugs.

"Well, I guess some are more dangerous" I began, but Shane interupted "Yeah, but which ones are more likely to harm us. Which ones are gonna kill us?" I paused briefly to consider the best way to answer. "They can all kill" I evetually said. "Some slowly and some quickly. There's no safe drug..." Shane interupted me again "Marijuana's safe" he called out.

It hit me like a bolt of lightning. It was time to tell them the story of Jamie's joint.

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help me understand

Miss Wright is a laywer, an American lawyer. She had a breast cancer scare a while back. Now no one will insure her.

Mr Obama wants everyone to have healthcare, not just the poor, but even a wealthy lawyer like Miss Wright.

Can someone explain why so many Americans are against public healthcare. There will still be the private option of 'elite' care that only money can buy, but what surprises me is that some people without insurance don't want public healthcare.

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Product of your nation

"Please sir, please excuse me" begged Monsab the Arab.
"But you look so healthy and well, I can't excuse you. I would be doing you an injustice if I did" I replied.
"But sir, I..." Monsab paused briefly to think of a symptom "I've got a sore stomach. I don't feel well at all" explained Monsab. But I wasn't feeling generous. I was feeling vindictive. Besides, it was a gorgrous day outside and Monsab could do with some fresh air. "No more begging Monsab. I won't excuse you. Now go." Monsab just stood there unmoving "But please sir, I'll pay you. How much do you want?" Monsab pulled out his wallet.

If only the kids put this much effort into something positive, they could make something out of their lives.

"I'll give you three seconds to go, then it's a Friday night restriction." Monsab left the clinic, but not before telling me I was cruel and uncaring.

Patient 2
"Please sir, please excuse me. Go on sir, give me a break, just this once" pleaded Naif the Arab. "But you're not sick. Being tired isn't an illness. Besides, the fresh air will do you good." It took five minutes to remove Naif from the clinic.

I saw twenty more Arabs that day. All begging, bribing, calling mums and dads, but I stayed firm. I was a bastard. I made them all go skiing.

That's a typical ski day in the health center. But I must be fair, the Arabs aren't the only ones I'm cruel to. I make everyone go skiing.

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mercenary nursing

I think I know why nurses never seem to do as well as the others. By 'others' I mean school teachers, firemen, and policemen.

Reason 1. It's a female dominated profession and women have traditionally been screwed over by men ever since time began. Even in today's modern western world, women genererally are paid less than men.

Reason 2. People who become nurses are generally very caring people. I've known quite a number of nurses who said they would never push for a pay rise because that would mean the hospital would go broke and the community would suffer if it was forced to close.

Simply put, nurses will never earn as much as their other public service coleagues.

So what am I going to do about it?

Well, I'm trying not work in a hospital. This is a shame as it's one of the most rewarding types of nursing, you know, directly helping those most in need. But other jobs outside the hospital, in the private sector, pay better. It's a shame, because working for the rich is really quite degrading at times. They don't ask, they demand. They don't say 'Thank-you' because they are paying you for a service and don't see why they should say Thank-you for something they've paid for.

I could say more, but I'm sounding too bitter. I do care, but maybe I care more for the poor and needy. Is that so wrong?

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The abuse continues

To the Health Center

'I am stunned at how negligent your medical care is. My son was seen three times and not once did you take him seriously'

The rest of the letter was just further complaining about how terrible we school nurses are, although one line did stand out:

'Am I to assume the reason you are a school nurse is because no genuine medical establishment would have you...'

I made a grab for the phone but my colleagues were too quick. 'No you don't, no rage writing' admonished Sheila 'You'll only make things worse.'

I didn't really see how things could be worse. None of my colleagues had at any stage seen the patient in question and the medical records backed us up. Either the child or the parent was blatantly lying. The most likely scenario is that the teenager had an accident while on holiday and they want the school's insurance to cover the costs.

"Fine. I won't call him. In fact I won't even bother with any kind of reply." Sheila was happy to write a reply. She's a natural diplomat. Her letter began with 'I'm sorry...' I left the room in disgust.

I'm not a politician and even if I were, sometimes some people need to be told the truth and told that their behavior is unacceptable.

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Desperation setting in.

Three years and thousands of hours later, and no one wants to publish my book.
The book consists of 300 hundred pages of hilarious, shocking, and sometimes disturbing content from my experiences working in different medical settings in three different countries.

I guess no-one is interested in this topic, although it's a shame because similar books that have been published in the past have all been best-sellers. I have considered the possibility that publishers just print the words 'best-seller' on all their books just to push up sales.

What's even more frustrating is that the last publisher to turn me down said my work was 'well written' and 'very entertaining'. His reason for turning it down was that the company had never published a book of this genre before and with the current economic climate they weren't willing to take a risk with a new author in an untested area.

I phoned him up to ask if what he wrote were true. 'I don't make claims I don't mean' were the publishers words. I was rather heartened by those words. He then went on to advise me to contact bigger publishers as he felt sure someone would take on my work.

Hasn't happened yet. Still trying, but getting desperate.

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