nursing around

Huge News

2011-09-29T13:08:00.001+01:00

Have just signed a contract with Harper Collins.
They plan to have my manuscript ready for July/August 2012.
It's look at nursing from a male perspective.
7 years of work has gone into getting to this stage, so am very very excited.
Will let you know more soon.

Taking it easy at work, the best therapy.

2011-05-26T21:40:00.001+01:00

Nursing is fun, relaxing and peaceful. What a load of rubbish you must be saying, but it's true.

Let me explain:

Mr Davidson had been with us for ten days now and we'd gotten to know him pretty well. He was waiting for a bed. Not any old hospital bed, but a bed in the rehabilatation unit. Mr Davidson was recovering from a stroke.

The effects on his body were not unusual. If you leaned forward you could decipher his mumbling, he could walk with one nurse, but couldn't feed himself as his right hand lay at his side, his fingers curled like claws, and when he tried to use his left arm, well, it's pretty hard to cut your food with one arm.

"Evening Jack" I said as I walked in the room. He raised his head from his chest, and waved his good arm in my direction and mumbled a reply. "Back in a tick with your pills" I said, picking up his drug chart and heading back out the door.

By the time I got back his dinner had arrived and I began our routine.

1. Turn on the bedside radio to the 'Golden Oldies' station, just loud enough to provide a nice bit of background noise.

2. Sit back, put my feet up, open the dinner tray and commence cutting up the food and delivering it to his mouth.

3. Talk about sport, women, politics, or whatever seems to make Jack laugh.
(note to self, do not make him laugh while eating, may choke, swallowing is ok, but not great)

4. Enjoy time with patient.

5. Realize I've spent 15 minutes with patient and hastily leave room after making sure he's had something to drink and his call bell is within reach of his left hand.

Conclusion:
1. It doesn't take a RN to feed a patient, but I'm sick of seeing patients with food trays left out of reach, left to get cold or not used at all.

2. It's a nice part of the job and it's a chance to assess your patient eg Swallowing worse or better, movement of limbs, cognitive function etc.

3. These jobs should only be delegated to assistants if they are skilled. I don't like giving away these jobs, but realize sometimes I must.

4. I'm a pretty disorganized nurse at times as I always make time to spend with a patient, even if it's only an extra five minutes.

Why nurses don't complain

2011-03-18T13:30:00.000Z

I'm working an agency shift, first time in new ward, in a new hospital. The hospital is Swindon hospital, a hospital in England. It's brand new (well, it was at the time) and looks impressive, seems well staffed. I'm about to begin my first night shift.

Handover - The nurse who is to hand over me doesn't do this. She goes through a list of names saying - 'Joe bloggs is fine' and 'Mr Smith shows no change' and leaves. I know nothing about my patients.

I stop her from leaving the ward, asking about my handover, "Joe blogss in room 1 is unwell, we nursed him on the floor." She then exits the building.

I go to room 1 and find a man unconscious, naked, on the floor. Call the doctor to come and see him, but he's busy in the emergency room. I call the head nurse on duty for the shift. She's about ten years younger than me, and probably been out of college only one, maybe two years at most. She doesn't come to see my patient.

I go back to patient and eventually wake him with a very strong sternal rub. He's obviously a man off the street, the sores, the smell, the large doses of benzodiazepams prescribed in his chart give it away.

What about the other patients I know nothing about.

The first 6 bedded women's bay, I can see an infusion, oops, it's an insulin infustion. Patient won't wake up. Blood sugar reading says 'lo'. I turn off infusion and slowly open the dextrose saline while calling doctor again. Doctor still won't come, just gives me verbal orders to open up the dextrose a bit. I do an ECG, I do this for all unconsious patients, regardless of what we think may be the cause. Rapid AF. Check her notes, this is something new. Get on phone to doctor and yell at him. He comes to see the patient.

It's now one hour into my shift, haven't finished a round of my patients yet. Don't know what is wrong with anyone. Haven't started my evening drug rounds, let alone the IV meds.

Why didn't I walk out then? Why didn't I lay a complaint?

The answer is simple.

1. If I do walk out, I'm in big shit. How could I leave people in a life threatening situation. I should have walked out, but weighing up the pro's and cons is not simple.

2. If I complain, they will find lots of things I did wrong eg Meds not given, or given at the right time. IV fluids behind. Fluid balances not complete. There are so many things I just couldn't do because of the situation I was in, but if it comes to a court case, they will crucify me.

Conclusion

I may be taking a risk naming the hospital, but this story is only the beginning of a series of horrendous things I witnessed at this place. I want someone to take notice. Nothing will happen of course, but then that's the conclusion I've drawn. Nothing will change.

Random worries

2011-02-11T14:02:00.001Z

1. Try asking your doctor this, "If I were your son/daughter, would you still give me that course of antibiotics?" I bet the answer will be no. I've done it many times.

2. Why am I really at the doctor? What exactly are your expectations and are they realistic.

3. If I spend 4 hours or 24hrs in the waiting room at my local emergency department, can I handle the fact that I don't need any treatment. The doctor probably only gave you a bandage for your non swollen, non deformed, non bruised, sprained ankle that you can walk on fine, because he wanted to make you feel that something had been done.

4. Can I cope with the pain? A sprained ankle will hurt, especially the next day. I used to walk it off, I know this is the opposite of the correct treatment for a sprained ankle, but growing up this is what I thought you did. Guess what, it worked. I walked off the pain and was soon running around again.

5. Know what a bruise looks like. This may save you a trip to the doctor.

This may sound a bit harsh, but I've seen a patient who came to me because he wondered what the lumps were on his face. He had two pimples on his chin. I also had a patient who had a bruise to his thigh. He was fine, but said he'd never had a bruise before, he was 18yrs old.

I don't know what is happening to the world when people grow up without living, but it's pretty damn frightening.

Help

2010-12-27T12:55:00.000Z

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?

Ruined

2010-10-24T21:02:00.000+01:00

"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.

I've changed

2010-07-17T21:24:00.000+01:00

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.

Killing in the name of the Law

2010-05-09T08:08:00.000+01:00

'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 fuck they didn't take her nursing license away.

Too bad if you want sex

2010-04-14T18:41:00.002+01:00

"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.

'BBC Article' new news but old news

2010-03-16T07:13:00.000Z

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.

Nursing Dectective

2010-02-22T12:28:00.001Z

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.

The Dumping Ground

2010-02-10T15:11:00.003Z

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.

If I had the Power

2010-02-07T09:26:00.000Z

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.

Gynae nightmares

2010-02-06T20:29:00.000Z

"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.

Another Drug Talk part I

2010-02-03T16:57:00.000Z

"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.

help me understand

2010-02-02T08:34:00.000Z

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.

Product of your nation

2010-01-28T20:08:00.000Z

"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.

mercenary nursing

2010-01-24T12:17:00.002Z

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?

The abuse continues

2010-01-15T07:20:00.002Z

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.

Desperation setting in.

2010-01-14T10:56:00.002Z

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.

Why I want to give up nursing, Part III

2009-11-13T22:47:00.002Z

0600hrs - Wake up. Get to work 0645hrs. Fifteen minutes early. Hope to check some personal emails, get some fruit for breakfast.

0645hrs - First patient outside health center. Teenagers never get out of bed early. Must be quite sick. See student straight away. Delay breakfast.

0700hrs - First patient resting in bed. Two more students arrive. Again early. Look miserable.

1715 - Brief window to get breakfast. Spend five minutes in cafetaria. Wandering teaches waltz's by. Teacher complains that kids are waiting to be seen and I'm eating breakfast.

0720 - Ignore teacher. Am used to 5 minute breakfast and am seeing next wave of students.

0750 - First bell has gone. This is supposedly the signal to begin class, but instead 15-20 teenagers flood health center.

0900hrs - Finished with kids. Now have two denist appoinments and three doctor appointments. Colleague takes care of this while I rush to classroom upstairs where student has fainted.

1000hrs - Faint turns out to be vasovagal, nothing to worry about. Called to something more exciting. A chemical splash in students eye. Rush to go there, but no car available. The school has taken then second nurse car away. Has been ongoing problem since school expanded campus to include a building twenty minutes walk away up a mountain, but 3-5 minutes by car.

1020hrs - Finally get car and get to child. Taken to doctor. Fortunately student going to be ok.

1100hrs - Lunch clinic begins, colleague back in time to deal with this. Unfortunately ran out of beds in the health center at some stage and have ten kids scattered around campus in their own rooms. Next hour spent checking up on them.

1200hrs - Try to get lunch, but staff complaing that the health center at the new building is not staffed. Race to get there to see the critically ill students with their nasal congestion.

1330hrs - Finally finish clinic and join colleague at main campus to catch up/swat notes and find out what is going on.

1335hrs - Interupted by phone call. Abusive parents claiming we've neglected their child and left them suffering in their room deathly ill.

1340hrs - Track down deathly ill child. Is in bed with laptop, busy typing away. Claims to be sick, but I already know that a big assingment is due today. Student busy working on this. Student claims to be 'dizzy'. Sick of hearing this. Tell student that 'it's ok. I don't think you'll pass out lying down.'

1400hrs - Back in health center. Check emails. The abusive parent has sent an equally abusive email, even after I'd phoned them from students bedside to let them know their child is fine.

1530hrs - Supposed to finish work. But have four kids to take to doctor. Finish day at 1700hrs.

1700hrs - Home at last. Phone rings. Called to see sprainged ankle.

1730hrs - Phone rings again. Another angry parent.

1730 - 2000hrs - End up seeing multiple kids. Nothing urgent, but when I'm on scence, they make the most of it.

2010hrs - home at last.

0300hrs - Phone rings. Student, not sick, wrong number. Can't get back to sleep.

0600hrs - Get up for another day at work.

No one says please. No one says thank you. No one buys chocolates. Might go work in a hospital again.

Why I want to give up nursing, Part II

2009-11-13T22:19:00.003Z

"I'm not going anywhere near someone with swine flu" said a teacher at the back of the room.
"Me neither. I'm a teacher, not a nurse. That's your job" said another.

"Well, we're a boading school. If we get a lot of people with the flu, we're going to need help. Two nurses can't look after everyone."

"I never signed up for this" said the first voice. The voice belonged to Jason, one of the few 'old hands' at our school. "It's not in my contract" he added. The seventy odd teachers assembled there muttered their agreement.

"I'm not asking you all to do medical things. We need help getting them meals. Dropping off medicines. Helping arrange rooms to isolate new cases. We may ask you to check the odd temperature here or there, but we can't do it all."

"I'm not going anywhere near anyone" said Marie, the head of the english department. "Like Jason said, it's not in my contract. It's your job. I'm sorry, but that's the way it is." All heads were nodding in agreement.

'Well, it's not in my contract to look after staff' I felt like saying. 'I don't have to take you to appointments, or arrange appointments. I don't have to give you advice. I don't have to see your children. I don't have to tell you how to deal with that STD. I don't have to do any of the things I am happy to do whenever you come and see me.'

I didn't say this. I tried to be diplomatic. I failed.

In the corridor after the meeting.

"I'm not a nurse. They need to do their job."
"If they don't like it, change jobs."
"They never come and see the kids when we call them. What do they do all day?"

I wasn't supposed to hear this. But I did.

It's not the first time.

Why I want to give up nursing, Part I

2009-11-13T22:08:00.003Z

"I want my son to be tested for swine flu" said Mrs Smith.
"Ah, but your son hasn't been ill" I replied.
"He's had a cough, you saw him in the health center earlier in the week" countered Mrs Smith.
"I'm sorry, but he hasn't been back to see us. We did send all parents an email explaining the criteria for isolating students. We also explained we can only test according to government guidelines."
"I want my son tested. Then he can be treated sooner"
"I understand..."
"I don't care what you understand. You're not listening to me. I want my son tested"
"I'm sorry...."
"You're not sorry. You don't care. I'm a mother ten thousand miles away worried about her son."
"I understand...
"You don't understand. You're rude, obnoxious, uncaring..."

I turned the phone off.
I saw her son later that night. He seemed pretty well with his girl friend on one arm and a burning cigarette in the other.

That extra mile

2009-10-20T08:34:00.002+01:00

When do you want to go that extra mile for a patient? Or more accurately I should say 'why' do you go that extra mile?

It's not a big deal, in fact it can be quite small, but doing that bit extra can be as simple as forking out 50 cents for the old fella in room 1 who hasn't got money for his morning paper.

It may involve rounding up four nurses on a busy morning to help one patient to the shower who's been bed sponged for the last month.

It may be phoning up a patients neighbor to make sure their pets get fed.

The list of extra things we do is not always part of the job description, but we do them anyway. We do them because it is not just right, we do them because it feels right.

But there's one thing I've noticed about the people for whom I do the extra things.
They're not demanding. They're often old. They're really nice to the people looking after them. They appreciate what we do for them.

Their only fault is that they sometimes suffer in silence because they don't want to be a burden.

They're not rude, obnoxious, demanding, threatening or abusive.

It pays to be nice. And we appreciate your appreciation. You see, we like to go that extra mile.

keep your clothes on

2009-10-08T05:53:00.005+01:00

She was every man's worst nightmare, at least to work with. She was eighteen years old with wavy blonde hair, blue eyes, a perfect figure, but worst of all, she knew she was a knockout and knew how to use it.

I gotta say something, I can't keep looking at the ceiling. Hell, the low seating sure doesn't help. I'll have to say something. Not sure if it's appropriate, but it's making me uncomfortable.

"Chloe, this is getting ridiculous, please cover yourself" I demanded.

"Why sir? What on earth is wrong" Chloe flicked her hair and beamed a smile at me.

"It seems you've never learned to dress yourself properly. Your blouse is half undone, the top half that is, and everyone can see your chest" I explained.

Chloe made no effort to cover herself "It's awfully hot sir, just getting some fresh air" Chloe's smile was definitely looking predatory.

"Chloe, do I have to call your father and tell him you can't dress properly? I'm sure your assets work well with the rest of mankind, but in my health center you're going to dress properly." Chloe still didn't make an effort to do up her top.

It was time to cruel. Cruel to be kind that is. "And besides Chloe, as a nurse I've seen more breasts than you can imagine, and much more memorable ones."

Chloe quickly buttoned her top up.

Let's get constuctive, not destructive

2009-10-04T21:50:00.001+01:00

In New Zealand some Maori folks like to call the health system racist. They say their needs aren't being met.

Now let's just think about this a moment.

1. Some individual people may be racist, but how can you call a system racist when all it tries to do is help the sick.

2. No system is perfect, and people from all backgrounds probably feel at some stage or another that their local hospital doesn't quite meet their needs.

3. How is calling the system racist help anyone? Think about it a bit. Whether it's meant to or not, all talk like this is going to do is make a lot of good, caring, hard working nurses upset. Nurses take this personally, at least every single nurse I've worked with does.

4. Wouldn't it be more constructive to say "Hey, we've got a big problem with whatever..." be it with drinking, smoking, diet, access to health, heart disease etc. And then say "What can be done to solve these problems?"

The solution really is simple

2009-09-15T08:19:00.004+01:00

One hundred patients through our emergency room door was a very busy day for us. Hell, eighty through our doors was busy enough. I've since moved on from my busy, challenging, exciting little hospital, and I'm relieved I have.

I loved the emergency room. The staff, the challenges, the excitement. But now we easily see 150 plus 4-5 days a week. They've added a new nurse position to help with the extra work load.

It's six years since I last worked there, but I keep in regular contact with the few old friends I've still got there.

95% of the original, experienced staff I worked with have left. The new staff last about 2-3yrs on average.

Total burnout plus fear of screwing up due immense workload = Run for the hills.

The hospital has a budget it can't go over. The government has set aside 13 billion over x number of years for expected legal expenses due to litigation.

What if six billion of this was spent on adequate staffing. I'm pretty sure you'd save at least as much as you spent.

NZ's racist healthcare system

2009-08-02T10:15:00.002+01:00

The New Zealand health system isn't immune, and I bet the States isn't either, or the Australian. You see, we've all got something in common. We've either got an indigenous people, or at the very least a group of people who migrated to our respective countries before us white people did. This means you probably have a racist healthcare system. At least that's what the maori tribes in NZ are claiming. In fact some Maori elders claim there should be a separate health system because the current one is so racist.

Can someone please explain what a racist health system is?

I've looked after nearly every nationality in the world, and I treat people all the same, even the assholes and other less deserving (whether or not you think there are people less deserving is another argument we can save for another time.) I've treated white skinned people, brown, yellow, black and even a blue person once.

I've treated the very old to the newborn and everthing in between. I've looked after the foulest criminals to priests, monks, and judges. I give them all great care. But when the Maori tribes call the health system I work in racist, you're in effect calling me racist, and I'm a bit unhappy about this.

The NZ health service is free, meaning it's funded by the goverment and everyone has equal access. That sounds pretty fair to me.

Sometimes a Maori patient will get angry becuase we won't allow a dozen of more relativies in to visit, or we sometimes limit their visiting hours. In Maori culture family is an important part of healing, so when we ask all the relatives to leave, they say it's racist. I think it's racist, or at least very narrow minded for the Maori family to think that they are the only people who considers family an important part of healing.

I sometimes say it's not fair on the other three patients in the room who need to rest. The Maori family will say 'Give us a single room then'. In my hospital, single rooms are reserved for the seriously ill, and you should be thankful you're not in a single room. They then complain and call me racist. I say we have limited resources and we do the best we can. I try to be as tolerant as I can of your special needs, but the other patients have special needs as well, and sometiems these cannot be accomadated. A bit of tolerance goes a long way when your a patient or family member.

I don't want to generalise, and in fact most patients I care for, no matter what background, are very happy and grateful for the care they recieve. The problem seems to be with the upper hierachy, that is the tribal leaders. Of course it's the tribal leaders that are on television and the local news. I hope it's just these leaders getting worked up and not the general maori population.

Is American Healthcare better than mine?

2009-07-24T03:07:00.000+01:00

Again, I've been careless and raising my blood pressure by listening to Fox News. As the debate over government funded healthcare rages, fox news decided to support their ideas by saying the british health system is a disaster as well as the canadian public system. They may as well have attacked my new zealand system because we have a natinal health service.

Naturally they highlighted some individual disasters where people have suffered because of a public system, but it's easy to find examples to suit your argument, both for and against. Do you americans with good health insurance still have bad experiences? Of course you do.

Here in NZ everyone has free hospital healthcare, but if you can afford it you can pay for private healthcare. It seems to work. Whether I work in NZ, Britain, Australia, we all seem to deal with the same problems. We deal with the same people, the nice, the bad, the rich and the dirt poor. We deal with the same conditions, the strokes, the MI's, the trauma. From the american nurses I've worked and shared experiences with, it seems we all end up dealing with exactly the same stuff.

One thing which is interesting is that waiting times in British ER's are substantially less than that in most American systmes? Fox news didn't bother to mention that.

Anyway, I realise there is a lot more to and against this argument, but that damn Fox News is so bloody frustrating. I haven't actually heard any news from them, only one sided, uninformative and insulting comments to support their own agenda.

Tell me what it's like to nurse in America.

Politics, News and Nursing

2009-07-13T00:12:00.001+01:00

I'm a new zealander and I watched fox news for the first time. I was disgusted by how biased and uninformed their reporting was. Here's the scenario, it painted all nurses in a bad light.

14yr old girl rings up an abortion clinic and says she wants an abortion. She lets slip that her partner is 30yrs old. The girl says 'Will you tell my parents'. The nurse on the phone only has a few seconds to help this girl. She says 'no, we won't tell your parents if you don't want us to'. The 14yr old girl is then seen on fox news admitting it wasn't real and she happily joined in the news crew in bashing nurses who deal with sexual health.

It doesn't take a genuis to figure out public reaction. Shock, horror, outrage and disgust at this nurse and all abortion clinics.

Here's what really happens. I now work in a boarding school (male nurse) and deal with sexual health issues all the time.

A girl, (say 15yrs old) is worried she may be pregnant. The first thing she asks me is 'Will you tell my parents?' If I say I will tell her parents, she may not tell me what is wrong. In fact I've had one student who assumed we would tell her parents, and she climbed out of a forth floor window in the middle of the night and scaled down each floor using the balconies on each level. She was accompanied by three friends. If any of those friend had fallen, they would have been killed. They took themselves to a local hospital where it turns out she wasn't pregnant.

What's the point - People, students, kids, adults need to feel they have someone to turn to, someone safe, somewhere safe. They need to know that what they tell us is confidential. Your first concern is the immediate safety and health of the child.

What do I do when someone comes to me for help? I did have a patient who was 15yrs old and pregnant. I told her I wouldn't tell her parents. I did tell her I would talk to my colleagues and the school doctor.This encouraged her to tell me the whole story. After evaluating her situation, including family, boyfriend etc, and discussing with my even more experienced colleagues I encouraged her to tell her parents. She did this and the parents were so supportive. The girl was so relieved as well as surprised. Children are often surprised by how supportive parents can be when in true crisis. The parents came and dealt with the issue.

Back to Fox News Scenario - Fox news jumped on the anti-abortion band-wagon and highlighted how medical people keep parents ignorant.They inflamed the public. This issue isn't about abortion. This issue isn't about the parents (at first). It's about the immediate safety of the child. Hopefully family can and will become involved, although unfortunately not all kids have good parents they can turn to. And by providing a safe environment for the child she can be encouraged to deal with the fact her boyfriend is 30yrs old. Hopefully the guy can be thrown in jail for the rest of his natural life. (I'm a parent as well, I'm not a emotionally immune healtcare giver). Fox news didn't show what really goes on. They didn't show the thoughts behind the medical people dealing with these ethical issues.They showed a nurse in a bad light, trying to make a political point. We all know news is never unbiased.

Natural Selection

2009-07-08T11:11:00.002+01:00

A school night, midnight. Two boys, 16yrs old, in a super enhanced car. The car flew, it literally jumped over a 40cm conrete fence and smashed into the wall ten feet behind it. Booze and blood splattered all over the place.

Two boys dead and one in intensive care.

"Don't label our children as 'boy' racers" read the headlines in the local newspaper.

The survivor, the one in intensive care, told the nurses to 'fuck off' and the doctors to 'get fucked'. His attitude hasn't improved in the following days.

The nurses have begun to lose sympathy, although some never had much in the first place. Some are saying 'natural selection'. Some have become inured to the tragic condition that is part of being human. It happens.

It is horribly tragic.

I'm not evolved enough

2009-05-15T10:56:00.000+01:00

What was I thinking!!! What point is there getting my masters??? One class and I was ready to tell the tutor where to go.
"You haven't learned how to think critically" explained Mrs Crump. "Ah, I'm still not sure what you mean by thinking critically" I explained.

We were dealing with a scenario where I'd been working in an east London hospital on an Agency shift. I'd been left with eight acute patients, no handover, and a nurse assistant who called in sick. I was in the emergency room as well.

I'd complained but like the typical nurse I pulled through the shift for the sake of the patients. I know I didn't do as good a job as the patients deserved, but there was just too much to do.

"You didn't deal with the situation as you should have" explained Mrs Crump. "If you'd been thinking critically, and by that I mean taking control of your thinking and the situation, you would have made better decisions" said Mrs Crump.

I shook my head "So what was the right thing to do? Your explanation still hasn't helped me. I'm sorry, I just don't get it. I use common sense, and just try to do what is right. I did think of walking out but..."

I could have walked out, but as an Agency nurse filling in a random shift, I'd have been in dire straits. The agency nurse always gets the blame and never has any real support when the shit hits the fan.

Mrs Crump is the typical nursing tutor, idealistic but not practical. She's probably never done an Agency shift in a random hospital, they just didn't do it back in her day. I don't think she has thought 'critically'. It hasn't occurred to her that in some situations there is no right way, sometimes you just can't win no matter what you choose.

I didn't go to another masters class. I've been put off, or maybe it was the 4000 word essay that put me off. Oh well, never mind.

Opposites can't both be right

2009-05-08T12:40:00.002+01:00

"I would never operate on this" said Dr X in a firm voice. "Not only would it not be of any benefit, but there is a 30% chance you could permanently lose a quarter of your strength in that arm. Neither the patient or his family looked happy with this verdict.
"Well, ah, just send us the report and we'll speak to our own doctor back home" said the the patient. Home in this case being Germany.

The problem was that the specialist in Germany said that the specialist we went to was wrong and that the patient absolutely must have surgery. "I'd be crazy not to operate" were his words.

The patient is getting surgery soon.

I don't know who is right or wrong, but if the wrong person is right, the patient is going to suffer.

Nothing I can do about it either.

Common sense is just catching up with me

2009-04-17T06:00:00.002+01:00

Ideas I've had which no one thought anything of because when I mentioned them, I was and still am a nobody. It's just frustrating to see that they're being implemented now.

Idea number:

1. Hospitals employing own cleaning staff. Just read the BBC news and Scotland is employing over 600 new hospital employed cleaners, not contractors, to clean out their hospitals. I'm sick of cleaning equipment being locked away from me. I had a cleaner who said she doesn't clean up body fluids (vomit in this case) but wouldn't give me her mop or give me access to the locked cleaning cupboard. I wasn't trained enough.

2. Employing some male staff to work in the Psych ward every shift (I once worked in a place where often I was the only male on shift). I was called sexist. A year after I left they employed a couple of huge men to work as the muscle in the place. This only happened after a female member of staff was placed in a headlock and dragged down the corridor while none of the female staff, all of whom had been trained in restraint, could not stop him.

3. We always had difficulty finding out which patients could do what in the psych ward. ie which patients could leave the ward with supervision, which could not leave at all, and which patients were sectioned under the law. My suggestion was to have on the office whiteboard, next to each patients name, their legal status, their leave status, plus any special requirements if they can leave the ward. I was told this was not very confidential. One year after I left, this was in place and it made life much easier when trying to find out which, especially at short notice, who could leave the ward, especially for excursions for the patients.

I've had more great ideas, the above list is just off the top of my head. One big idea which I feel is critical to saving the NHS is this:

Making it a legal requirement to have at least one registered nurse per 6 patients, with the exception being night shift of course. I've regularly had up to twelve, sometimes 16 patients with a healthcare assistant, all in a busy surgical ward. Patients die because of this, it can't be helped.

What I'd really like to say

2009-04-16T12:52:00.003+01:00

As I opened the mornings emails a groan escaped my lips. There were three emails, two from Russia, one from the States. I knew none of them were going to be pleasant.

The first email - I am disgusted that the school would send my child to a place with third world conditions. My son will see a dermatologist urgently or there will be consequences.

The son happened to be on a school camping trip. He'd been bitten rather badly by either the mosquitoes or the sleeping bag he had used was full of bed bugs. The problem had resolved, the bites fading. Nothing a dermatologist could do.

The second email - I am writing to you because of the substandard care my daughter received. My daughter now needs surgery because you didn't bother to x-ray her. She has a fractured tail bone...

The daughter had self discharged from hospital, she said she wasn't in pain. And who the hell operates on a broken tail bone anyway?

The third email - I want to know how you can let children leave campus and get so drunk they end up in hospital...

The boy was celebrating his 18th birthday and his parents had given permission for him to leave campus and go to the city. They said he would be staying with his uncle. The hospital never called the uncle. They called me. I never saw the uncle because he never bloody existed.

What I wished I could say

The first email, the bedbugs - Dear Parents, do not threaten me or tell me what to do, ever. Your son got bitten by some bugs. This is what happens when you go camping. The bugs could have come from his sleeping bag, which you bought for him, or from some rather voracious mosquitoes. The bites have healed fine. A dermatologist would be of no benefit, other than to make you look desperate to blame someone for something that really is nobody's fault.

The second email - Dear Parents, Have you forgotten that it was your daughter that discharged herself from hospital because she was sick of waiting for an x-ray. Have you also forgotten that I recommended she stay, but she insisted she was fine and in no pain. I have never seen someone who actually has broken their tail bone be pain free and sitting fine in an upright position. I have also never seen someone have an operation for a broken tail bone, but this would not be the first time I've heard of absurd treatments from Russian doctors, although I am aware that with $20 US dollars you can get a doctor to write what you want from over there.

On another note, I hope the behavior witnessed by myself and the other nursing staff in the emergency room where your daughter was admitted was not typical. She was rude, abusive, obnoxious and generally appeared to be a spoilt, selfish, nasty little minx. I wonder where she gets this from

The third email - Dear parents, How can we expect to be held responsible when you say they are staying with relatives and take them away from campus. And since I haven't seen any sign of this uncle who was supposed to be looking after your son, and since it was I that got out of bed at 2 o'clock on sunday morning to drive two hours to the city to see your son, you should be on your knees thanking me. But you're probably feeling guilty for lying about this uncle, and I know you're lying because your son has admitted there never was an uncle. And now you're looking for someone to blame. Well take a look in the mirror.

Oh and this is not the first time your son has been in trouble for drinking, although it certainly is the worst. He says he's been drinking at home since the age of fourteen. I don't want to judge, but feel I must say that this is illegal.

I won't bother telling what I really wrote as that is too boring, too damn politically correct and cover your ass.

Missed Fractures

2009-04-10T09:33:00.003+01:00

"Don't you question the doctor?" asked Bryce. I took several slow breaths before replying as I was becoming more agitated with every word Bryce said. "No Bryce, we never advocate for the patients. We let the doctor do as he wants" I replied. "You what?" Bryce exclaimed. Caught off guard by my comment Bryce seemed to miss the sarcasm in my voice. Bryce is the head of the complaints department. I don't know how he got the position, especially as he is not a doctor or a nurse, although he did once work as an assistant in a lawyer's office.

"Bryce, we always advocate for our patients, but if the doctor says the x-ray is fine, then I tend to take his word for it. I'm not an x-ray specialist" I said.
"Well, the family are complaining because they say Miss Putin now needs surgery because the doctor missed the fracture on the x-ray. You were right there, you saw the x-ray" Bryce said.
"Are you saying it's my fault then? That I should have seen the fracture that even the most senior doctor on duty didn't pick up?" Bryce shook his head, "No, no, that's not what I mean" Bryce said almost apologetically.

"Bryce, why am I even here? This is between you and the doctor who saw the x-ray" I said. "But you were there, you saw everything. This was your patient" he said. "Well, if you want my opinion, well, here's how I see it. First, the patient apparently has a tiny break in the tail bone. She wasn't in that much pain. She wanted to go home. You don't do surgery for a broken tail bone. Oh, and this happened six months ago and we don't have the x-ray to confirm that there really is fracture that has been missed" I paused for breath. "When you put this whole thing together, this sounds like a load of shit."

I"m to dumb to understand that diagnosis

2009-04-08T06:10:00.003+01:00

"Fuck off" said Peter. I moved suddenly, catching Peter off guard. I grabbed the front of his shirt and slammed him against the wall. "Don't ever speak to me like that again Peter, or you'll be real sorry" I snarled. "You can't do that to me. I'm a patient. You're fucked" he managed to gasp. I replied by slamming his head against the wall, "Let's find out if you're right, eh."

The phone began ringing. I woke from my daydream. I reached over and answered the phone.

We do have a patient called Peter. The doctor thinks he has a Personality Disorder. I don't understand this diagnosis. To me he's the bastard who got caught drug dealing in the paediatric ward just after his wife had given birth. He's also the only patient who does tell me to "Fuck off" on a regular basis.

He's never been admitted to a psychiatric ward before, but after being caught by the Police he tried to kill himself. Ten paracetamol is not enough to kill, but his liver has got to be suffering. I'm sure he knew it wouldn't kill, but he probably didn't know he'd damage his liver.

Maybe I'm insensitive. Maybe unprofessional. But I'm allowed to dream.

Defibrillator Battles

2009-04-07T22:03:00.003+01:00

One heart attack down, another dozen to go I reckon.
Everyone smokes here, the maintainence guys are mostly over 50, or even 60 year old. They smoke about 30 cigarettes a day, and have a pretty decent amount of alcohol. Hell when I arrive at work in the morning to open the health center, the hall is full of the smell of cigarette smoke drifting up from the basement workshop.

The head of business has told me he's not keen on spending money on some defibrillators. "Well, there's legal issues involved" he said and "It's not just as simple as going out and buying a defibrillator." I shook my head at this "It is that simple. We buy it, then I show the staff how to use it. They're desgined so that even young children can use them. You switch it on and follow the instructions, which usually are "Push the button"

Anyway, to be thorough, I offered to have the school send me on a course to officially train others ie lay people like the teachers and maintainence guys, on how to work the damn thing.

Too much money apparently.

I wonder what happens when the next staff member drops dead. We had our first heart attack last week. Fortunately he survived, but no thanks to the health center.

You don't really want the truth!!!

2009-03-04T12:01:00.002Z

Is our curiosity insatiable? It would seem so. We relish the gory details. Whether on TV, in the newspaper, or in the bookstore, stories which tell the good, the bad and the ugly always sell... at least I thought so until now.

People love hearing the truth about what goes on in your average restaurant, the gross stories which show the horrible things which happen to your food. People love reading about the lies, cheating and debauchery of literally anything. But do people want to know what really goes on in your local hospital?

I think not. Again, the book I'm trying to get published, an honest look at nursing, told from a male perspective has been turned down. The publisher said it was written well, even said I had some writing talent, but they don't think books about hospitals and nurses will sell.

What makes it even harder is my book is not a cheap, nasty tell all book. It's an honest book which shows how amazing nurses are, what horrible conditions we sometimes work in, but also show some of the horror of what can happen. Why show the horror?

By showing the bad, we can see what happens when hospitals are chronically understaffed and managers cut staff. Maybe this way positive changes can happen.

By showing the bad we can see what it takes to be a great nurse or doctor, and show how easily it is to be a bad nurse or doctor.

The publisher enjoyed my work, but doesn't think the public want to know, as well as think the public can't handle it.

Religion vs Nursing

2009-02-23T21:25:00.002Z

A nurse in Britain was recently suspended for offering to pray with/for a patient. The patient said no. The nurse said 'Ok, no problem' and never offered again.

Has the world gone mad? Hell, nursing and caring for the sick has always been tied up with Christianity. There is no big deal about what this nurse did. She was professional.

If people find it offensive if being asked whether they would like to pray, then soceity is even more pathetic than i imagined.

Oh no, I got asked if wanted to pray, I need counselling. It's soooo offensive. Hell, I'll sue the insensitive religious buggers, that's what I'll do.

Simply put, we can't be too afraid to ask.

It doesn't matter what profession we are in. Everyone's so bloody worried about offending someone. Well, I'm offended that I can't ask. Hell, if the patient gets offended, too bad. Say 'Sorry, I won't ask again. I didn't mean to offend'.

Patients have rights as well. They have the right to appreciate what we do for them, and not take offense when none is intended.
Hell, any patient who decides to take offense is probably looking for an excuse to stir.

Patients need to show a little common sense and tolerance as well.
No one should ever be 'deeply offended' if asked in a non forceful or persisting, nagging way.

Get a grip you politico correcto's. A nurse should be able to offer if they feel it appopriate.

Sick of Management

2009-02-09T11:48:00.002Z

Aim of management - To get something for nothing

Aim of nursing staff - To give the best with nothing

From my first days as a new graduate nurse to many years later, all I've ever seen is senior management making life miserable for those that do the caring.

A classic example: Happened in my first ten months working. The ward was very short staffed and bed numbers increased from 25 to 30 beds. The charge nurse wanted to recruit this student nurse who had been working her electives there for the past four weeks. She was a great student who worked well and the staff liked. When the charge nurse wanted to employ her, the big bosses said no. The charge nurse (best I've ever worked under) quit as she was sick of not being able to do what was not just right, but safe, for the ward staffing level.

Within one month of her resigning, the student nurse (now a graduate nurse) was getting work on a 'on call' basis, all the time. This happened because the understaffed and overworked nurses in the ward kept calling in sick. The big management types realised that the extra workload with those five extra beds was too much for the already overworked nurses. They eventually employed the newly qualified nurse that the now resigned charge nurse wanted to.

Result - One great charge nurse lost. More anger/frustration at management.

A Thakless Job

2009-01-28T05:52:00.003Z

"Give me" said Darren, pointing at the medicine cabinet. I could hear Darren sniffling and blowing constantly into a tissue, but he wasn't going to get any sympathy from me. In fact very very of the teenagers in the health center waiting room would get sympathy for me.

"Ah Darren, what's your problem?" I asked, my voice deceptively calm. "I'm sick. Just give me some medicine" he said again, completely oblivious. "I know you're sick, but there's something wrong with your eyesight. Didn't you see the twenty other children in the waiting room who got here before you" I said as I placed my hand on his shoulder and gently turned him back towards the waiting room.

"But I'm sick. It will only take a minute. You can't do this. I'm sick" protested Darren. "I know, but you're not the only one here Darren. You're blocked nose is not an emergency. You'll have to wait just like the others" I explained. Darren's face went red, but not with embarrassment. "My parents pay your wages" he exploded as he pulled out his cell phone and hit the redial button. Thirty second later and he thrusts the phone to me "My parents want to speak to you." I shook my head and walked away. "You'll have to wait your turn just like everyone else. I'm not talking to them right now."

Sure enough I received a scathing email about how terrible the health staff are, how we don't care for the kids, how their child has been suffering terribly for the last month. It's normal. I expect it. It's a shame when you learn to expect this sort of behavior.

Oh, and if you're thinking I brought this on myself by not speaking to the parents, trust me, if I'd got on the phone things would only have been worse. It seems no matter how kind, how reassuring, how professional I am, phone calls usually go awry.

Oh well, maybe I'll get a job in anaesthetics.

Broken bones & Bullshit

2009-01-14T18:14:00.003Z

The kids at our school are privaleged to live in a ski resort, and even more privaleged to get two half days a school week to ski. It's just a shame so many break their bones. Two broken wrists on the first day. Both kids were jumping. I keep telling them to take it easy, but they never listen. Even so, I still feel some sympahty for these victims of their own over-confidence.

But there is a group I don't have sympathy for. In fact there's a group of students that make me want to bring back corporal punishment (caning).

Bang, bang, thump, thump, slam. I looked over at Stacey, my fellow nurse, "Ah, do you want to get that" I tentatively offered.

"You got to be bloody joking, you go out there" Stacey replied.

"I'll go out there then, but it won't be pretty" I offered.

The problem was that the health center was besieged by a horde of teenagers claiming they were either too ill or injured to ski.

One look outside at picture perfect day, the brilliant blue sky and glistening snow covered peaks made me angry enough to open the door.

"Why's the door locked? I'm sick. I can't go skiing"
"My knee's playing up, I can't go skiing"
"My mum said I'm too sick to ski, so I'm not going"

I motioned everyone to quienten down while blocking the door and physically restraining kids who tried to push past. "We're closed. You had your chance to come to clinic this morning at breakfast clinic. If you don't to your activity, you'll be marked as absent. Goodbye."

I began to close the door but someone's foot was in the way. I looked up at the owner of the foot. "Ah, olga, you need to move your foot, it might get hurt" I said, the soul of innocence.

"It's your job to help me. You're the nurse. My parents pay for you to help me, so do your job. I'll call my dad. You don't want me to call my dad." It was interesting to note the change in Olga's tone from just plain obnoxious to sinister. Olga's parents are Russian and as far as I can tell they've never earned an honest rouble in their life. Mafia, Russian Mafia, that about sums up Olga's family.

I took a moment to gather my thoughts. Should I make her cry. Should I tear her to pieces in front of her friends. Nah, she's not worth it. I know how to make her more angry.

I forced the door shut, completely ignoring Olga.

I am a caring nurse, but I don't care for bullshit.

Useless Parents.

2008-12-05T08:22:00.002Z

"Sir, sir, please help, it's urgent" begged Andy. The waiting room was full, but so far all I'd seen was kids with sniffly noses and scratchy throat. Andy seemed genuinely worried so I motioned for him to come to the front of the queue.

Andy strode into my office and stood hovering over me as I sat at my desk. "You can sit down Andy" I said. "I can't sir, I'm too worked up, I'm friggin scared sir." "It's ok Andy. Sit down and tell me what's wrong." Andy sat down and began to tell his story.

"It's my eyes sir, I keep seeing things" Andy explained. My ears perked up at this. This was a far cry from the usual complaints. "What exactly are you seeing? Describe as accurately as you can" I replied.

Andy's symptoms had began about a month ago. He started seeing jagged lines at the edge of his vision. At the start he only noticed the lines a couple of times a day, but now he was constantly seeing lines on the edge of his vision. There was no pain, and his vision was otherwise unimpaired. I asked the usual questions like: How often, How long, What makes it worse/better etc. But the biggest shock was still to come.

"Have you ever had problems with your eyes before? Problems of any kind?" asked. Andy seemed surprised by my question "Of course I have. I spent five days in an eye hospital in the states getting all sorts of things done. But you know this. Mum's told you before." It was my turn to be surprised "Ah, sorry Andy, but your mother has never said anything about this at all." I then produced his medical records to show him that his mother had never informed us of her son's medical history regarding the eyes.

Andy was taken to the local emergency eye hospital where he spent the next 16 hours getting every examination possible. The doctor eventually sent Andy and I home. He said there was no danger to Andy's vision, but he said he urgently wanted a copy of the records from when Andy had five days of testing at an American hospital.

"Hello, is the Andy's mum?" I asked. "Yes, how can I help" came the reply. "I'm calling about Andy, I'm the nurse who took him to the eye hospital. We urgently need his medical records, or reports, anything you have" I said. I then spent the next ten minutes explaining everything the eye doctor had told me. "All right, I'll see what I can do" said Andy's mum. The line went dead.

Two weeks later and nothing. No medical notes, no emails, no contact at all with Andy's parents. Andy was becoming angrier every day with his family. After receiving no reply to my emails I phoned Andy's mum for the tenth time and finally got through. "I've contacted the doctor and they'll fax the records through" explained Andy's mum after I'd politely berated her for doing nothing. "How long ago did you fax them" I asked. There was a pause, "Ah, an hour ago" again, another pause, "Ah, what's the fax number by the way." I hung up the phone.

Andy's mum was a liar and not dong a thing to help her son.

I eventually tracked down the records a got a copy sent from the American hospital and sent then to the eye hospital here in Europe. As soon as the doctor here got the report he requested to see Andy that same day.

Thankfully Andy's vision is going to be ok, although he will probably always see these lines.

No thanks have to go to Andy's mum.

What you don't know

2008-12-02T08:06:00.005Z

"He's such a quiet guy" were the words that people usually used to describe Pete. This was then followed by something like, "Yeah, he's a nice guy. Never bothers anyone." Even though I knew Pete on a 'friends of friends' kind of basis and knew his life style, even I never knew how sick he really was.

Pete got out of bed and wandered to the kitchen, lighting up a joint in the process. Smoking a joint wasn't anything special to Pete, at least in that it wasn't a special occasion. He never sat down with friends and smoked, there was no ceremony about it. Pete smoked marijuana as if he was smoking a regular cigarette.

Pete then went to work where he spent the day killing chickens. His day was broken down into morning tea break, where he smoked some pot, lunch break which meant more marijuana, then it was off home and dinner whereupon he smoked another joint. His evening was then spent in front of the television. He would then have one final toke then off to bed.

Whenever the boys' went out on the town Pete was always such help. "Who wants to be the sober driver tonight" someone would ask. No one would volunteer, then someone would say "Hey Pete, you haven't been drinking tonight. Will you drive for us?" In his typical monosyllabic way Pete always said "Yep"

In fact no matter what we did, where we went, or who we met, Pete was always there, somewhere. He rarely talked, was always helpful, and for someone who spent their life completely stoned to pieces, he seemed rather level headed. In fact we sometimes wondered if he had developed some natural resistance to the stuff as we never knew quite how he still managed to function.

I left that crowd, and I didn't see any of them for ten years. Then I bumped into Pete by accident.

The doorbell rang. "I'll get it" I offered and headed out to the security door. When I got to the door I stopped and stared in surprise at the person on the other side of the reinforced glass. Pete looked the same and behaved the same. He showed no surprise when I opened the door. "Gudday, it's been a while" was all Pete said. "Ah, Pete" I stammered, "It sure has...Ah, what can I do for you?" I asked. "I've come for my injection" he said. I was a bit slow catching on. "Ah injection for what?" I asked. In his usual calm, unhurried way, Pete said "My schizophrenia medication of course" Pete said with a knowing smile as he walked past me and down the corridor.

The rich kids health

2008-11-27T12:34:00.002Z

The rich kids behave differently from the poor kids. It was time to send them a message. All the kids got a message from their favorite, caring nurse:

"When you get sick, do you expect to be cured? How many of you think there's a medicine that will fix all your problems?
Unfortunately there's not a lot we can cure. We hope to find things to relieve the symptoms a little, but your body does all the work, it just takes a bit of time sometimes.

What's my point? A lot of you seem angry that you're not getting antibiotics from the health center. Guess what, antibiotics work for bacterial infections. 99% of you have viral infections, meaning antibiotics are useless.

There are certain things we look for to help us decide if an illness is bacterial or virus, we know what we're doing.

So, don't get angry, don't be obnoxious, and remember to say please and thank you.

If you're not happy about something, discuss it in a polite and calm way like a normal human being.

Some do's and don't when entering the health center

Don't say "I just need..." or "Give me some..." or "Only one minutes, that's all..."

Try "Can you please..." or "May I please have some..." or "What time suits you..."

Don't complain that we've made you wait till lunch clinic about your sore knee when it's been sore for the last week and you've not bothered to come to one single clinic in all that time.

Don't tell me that you mum said you need to rest, sleep, go on antibiotics or have surgery. Your mum isn't here, plus about one third of your parents never bothered to return your health information forms.

Don't put on make up. Confused. Well the last girl who came to see me with apparent horrendous diarrhoea and vomiting had immaculate make-up, lovely perfume, and smiled a bit too much. Real sick people don't do this.

Don't tell me you "Can't breathe" in long, rambling 20 word sentences.

Don't tell me you need to see a specialist doctor. You probably don't know what one is, and if you did want to see one, the waiting time is usually two weeks or more. Fortunately, due to the aide of our local doctor, we can usually get appointments much quicker.

If at any stage you think you can get better help, go ahead and do so. I'm sure there are plenty of over paid doctors in Geneva happy to take your parents money when any experienced general practitioner could have dealt with your problem.

Do tell us your health problem, especially your past history. I am shocked almost on a weekly basis when people complain to me that nothing is being done about their illness which they've had since birth, but never bothered to tell us about it in the first place.

Do use your common sense and be patient.

It is a fact that the poorer the patient, the poorer the family, the better manners they have, the more appreciative they are, and the better care they receive, and all because they not only know how to be nice, but they are nice. In fact the poorer people bring in the nicest chocolates, even though they can't afford it.

So, try being nice, try saying 'please' and 'thank-you' and you might find life in the health center a little easier.

Racist not, just Culturally aware

2008-11-26T08:01:00.004Z

"It's your job to tell the ones faking and the ones that are sick" moaned Marco, "So do your job" he added with a touch of venom. Poor Marco, he just doesn't know when to keep his trap shut. I was beginning to feel sympathetic towards him, but now he's turned me against him.

"Ah, Marco, when did I say you were faking your illness" I asked with forced politeness. "C'mon sir, you know I'm sick, just let me sleep. Don't send me back to class, please" he begged. Three years looking after teenagers and it still amazed me how the kids could be rude and obnoxious one moment and then pleading the next. But what amazed me more how they expected sympathy even after they insulted me. When I was their age I know I wasn't stupid enough to offend the person who I was hoping would help me.

There are two problems with Marco. The first is that he is Italian. I'm not being racist, just more culturally aware. All the Italian kids I look after insist on being sent to bed at the slightest sign of a sniffly nose or scratchy throat. They act like they are dying.

The second problem is that Marco is not used to being told what he can and can't do. All his parents have ever done is throw money at him, and sent him off to boarding school for someone else to raise.

"Marco, you're your own worst enemy, did you know that" I said. "What do you mean sir?" Marco replied sounding genuinely confused. "Well, you just don't know when to keep your mouth shut. I was going to let you have some time off school to rest, but now you've made me angry."

"I'm sorry sir, so sorry. You know me. I'm real sorry."

What to do. Well, I guess I'm just soft. I let the lad rest.

Compassionate Triage

2008-11-14T14:28:00.000Z

As Doctor Pru stood there reading the file her mouth turned down into a frown. "Who triaged this patient?" She called out across the room to anyone who would pay her attention. Everyone ignored her except me. I knew whose file she had and I knew she'd make a fuss, not because there was a problem, but because she loved to pick faults and seemed to relish making people squirm in front of her.

"A name would help Pru" I said, "Whose file you got there?"

Pru glanced at the file in her hand "Mrs Smith. Did you triage Mrs Smith?" She said accusingly. "Yeah, I did, what's the problem?" I asked.

"Could you tell me why she's in the triage 3 box. She's at most a four, or maybe even a five. For goodness sake why? why? why?"

"Well, she is 93yrs old Pru. She's from a resthome and it was a big deal getting here. They had to get an ambulance to get her here, then have to arrange one to take her back. She's got a carer sitting with her as well. I'd thought I'd sneak her in first. It just doesn't seem right to let a 93yr old lady wait for three or four hours" I explained.

Pru sighed and rolled her eyes, "We do not triage on age" she said as if this was the end of the argument and placed her file in the triage four box. "But Pru, it'll only take ten minutes to get her fixed. All we need is for you to take a look at her and I'll do the rest. C'mon Pru, I'm not going to leave a frail old lady sitting there for ages."

Pru grabbed Mrs Smith's file from the drawer. I felt hope. She then put it in the triage five box. She grabbed another triage three file and marched out to the room.

Saving the patient, and my Friends

2008-11-12T12:35:00.000Z

It began with a simple hello and went down hill from there.

“Ah. Hi,” I stammered, as my mind frantically went into overdrive trying to figure out where I’d seen this pretty blonde woman before. “Can I buy you a drink? It’s the least I can do,” she offered.

Something definitely was amiss because attractive young women didn’t generally offer to buy me drinks. I peered closer at her face. Recognition hit me like a sledge hammer. “Ah, I’m fine. I’m, ah, drinking water tonight--designated driver, you know? Thanks for the offer.”

She shrugged her shoulders. “Maybe another time,” she said, then turned to the barman. I made my escape.

“Hey, you gonna introduce us?”Jake said to me when I returned to our table. “Yeah, if you’re not interested, introduce her to me,” offered Simon. Both the boys had been behind me when Sophie (I’d remembered her name by now) had offered to buy me a drink.

“Ah, she’s not interested,” I said. The guys were angry. “What are you talking about? If you like her, that’s cool, but if not, don’t be selfish,” said Jake. “Yeah man, don’t be selfish,” echoed Simon.

What could I say? I couldn’t tell them who she was—that I had vivid memories of her foaming at the mouth and of her painting her room in feces. I couldn’t tell them that I’d looked after Sophie for two months in the psychiatric ward and that, even at her best, she would never be quite right.

So I suggested another bar, I bought a round of drinks, and Sophie was soon forgotten.

What do you think? Did I mistreat Sophie by not introducing my friends? Was I prejudiced? Well, probably, but for the right reasons. I was just using my common sense. I kept them safe, kept Sophie safe, and kept my mouth shut at the same time. We were all winners.

How hospitals kill (a brief summary)

2008-10-19T20:55:00.001+01:00

Am I stating the obvious?

I go to work, fourteen surgical patients. The nurse assistant called in sick and they couldn't find a replacement for the first four hours of my shift, and when they did, it was a first year student nurse.

I ask the cleaner to clean up some fresh vomit. "We don't clean up body fluids" was the reply. I tried to borrow her mop to clean it up myself. "You're not allowed to use my equipment, you're not trained. It's company rules" I then went to the cleaning cupboard to get some equipment, it was locked and the cleaner wouldn't open it for me. The equipment is owned by the company she works for. I ended up using a towel to clean the vomit up.

A patient slipped from his chair and I found him sitting on the floor, asleep. I tried to find a nurse to help me sit him up, but couldn't find one in the immediate area. I asked the cleaner to help me sit him up. "We're not trained to do that. It's against company policy." I became angry "I don't give a damn what your company policy is. Show some bloody compassion and get over here and help me." My appeal worked and we helped the patient up off the floor.

I walk into the emergency room and four nurses are permanent staff, while the other five are like me, agency plebs filling in. The thing is every night I work here the agency nurses outnumber the regular staff. I'm getting 30pound and hour while they're only getting ten. My agency gets another fifty pound an hour on top of my wages. Why don't they just double their own nurses wages, they'd be able to get more staff and still save money.

I watched Mr Smith die a little every day. His breakfast tray was always left out of reach. I'd come over from my side of the ward (I didn't have the time, but I did when I could) just to feed him. Every day he got weaker, more dehydrated. The infection spread throughout his lungs. He just stopped breathing one day. If he wasn't left in bed, or in a chair all the time. If there enough physical bodies to just get him going, I'm sure he would have made it.

Managers and government people are always trying to find ways to improve hospitals. They set goals, devise plans, install new systems, but they never work. We just need more bodies to do the basic work of a nurse, which is bloody well care.

Is anyone out there listening to what I say? I'm not the brightest or the most knowledgable, I just want a chance to be heard. I think I can make a difference.

Making a dreadful impression part II

2008-10-05T09:47:00.003+01:00

I'm now a school nurse, left the ER behind, the stress, the shiftwork, the adrenaline behind. I work in a very exclusive private boarding school in the european alps. The kids naturally don't know how lucky they are.

When Anna told me the other day she wants to be a nurse. I asked her why and she said she thought myself and the other nurses really nice people. It's very flattering, but should I tell her the truth?

Should I tell her about the long hours, the poor pay, the shift work, abusive patients, abusive family, abusive colleagues, understaffed and dangerous wards.

I could do this, but then there is something else I should do...

I should tell her what it's like to receive a box of chocolates from the poorest patient in the ward. I should tell her what it's like to see a patient make the transition from deathly ill to walking out the front door, and all because of you.

I should tell her about the adrenalin rush as the paramedics race in with a critical trauma and the feeling of awe and pride as we all worked as a team to perform a life saving miracle. I should tell her what it's like to give someone a heart stopping medicine to revert their heart back to a normal rhythm (you always cross your fingers that the heart restarts).

But most of all I should tell her that if you like helping others because it's part of who you are, if it makes you smile when you help someone else, then go ahead and be nurse. You'll enjoy your job and always be in demand.

Making a dreadful Impression part I

2008-09-26T12:51:00.005+01:00

"I'm going to be a nurse" a voice called out. I stopped and turned around, glancing at the sea of faces in the hallway. "Who wants to be a nurse?" I replied. "Me sir" said the voice again. It took me a moment to see wee Anna struggling amongst all the kids desperate to get to class on time. "I do sir. I want to be a nurse, I want to be like you." I was flattered, but I had better set Anna straight. "Come see me at lunch time if you're serious" I replied then continued on my way to the health center.

Teenagers are always saying silly things, for a laugh, for a reaction, or often beacuse they didn't think before they spoke. Anna was a top student, in more ways than one. Her grades were good, she was the best player in the volleyball team, and she was well liked. But what made Anna stand out was the energy, the enthusiasm she put into everthing she did. This energy had a ripple effect and made those around her. She was the most popular girl in school for all the right reasons.

Please don't become a nurse Anna.

What a horrible thing to say. I'm a nurse. I must be making a good impression if students want to be 'Just like me'. But she could be so much more. She already has so many other advantages compared to the other 99% of children around the rest of the world. Her family is wealthy, she's getting a top education, and she's a well balanced, popular teengager.

She will never get rich being a nurse. Her skills will be useless outside of a medical clinic. She will end up working long hours, irregular shiftwork including the dreaded nightshift. She'll be putting herself in a position to be shouted at, pushed around, punched by angry patients and relatives. She'll be putting herself in job that is becoming more and more litigious every single day. She'll be dealing with death, trauma, gore, seeing humanity at it's worst.

Why does she want to become a nurse? What should I tell her?

The Cost of Nursing

2008-08-08T21:01:00.005+01:00

I'm reasonably ok at Math, but I can't figure out why hospitals are always so broke. Let's take my last emergency room in London. Eight nurses on a shift. Four nurses working for the hospital at 12 pound an hour for the 11 hour night shift, and four nurses like myself, working for the agency at 30 pound an hour. I usually clocked 44-55hours a week.

Now, if you think this is costing the hospital a small fortune, the agency I work for takes another seventy pound an hour. So the hospital is paying 100 British pound an hour for an average of four nurses a night. Let's add it up, 11 hours at 30 GBP/hour is 330 pound per agency nurse per shift, multiply this by 4 and you get 1330 GBP for the night. For any American readers, that's 1660 dollars for the night.

The hospital keeps on saying it can't attract new nurses and that there is a terrible shortage of nurses. They don't have a choice but to pay agency rates. Hell, even the regular staff work the odd shift for the agency as their pitiful 12pound an hour is pretty pathetic.

Here's an idea. Why doesn't the hospital agree to pay their own nurses twenty pound an hour, plus sickness benefits, annual leave, plus pay for ongoing education. I think they would have no problem attracting permanent nursing staff and save a small fortune. I mean I've worked in London for four years and there's always been enough nurses around to fill in, even if we're from the agency. But I know myself and many of my colleagues would happily work for the hospital if they just paid a half decent wage.

But I'm not a manager and I'm certainly no math wizz, so can someone tell me why we don't give my idea a go.

We're all oppressors... at least I'm told so

2008-07-09T13:12:00.003+01:00

The Kamatua ground his thumb on the table, his eyes locked onto mine "See that thumb, that's you white people, and all Maori are under it" his voice quavered as he said this, seeming to struggle to contain his righteous anger. Somehow dinner had turned into a confrontation between the head of the local Maori tribe and myself.

How exactly did I end up in a confrontation with the head of the local Maori tribe? Well, as part of our nursing training the graduating class had to spend a night on the local Marae. The goal of the visit was to discuss ways in which we could help Maori people feel more comfortable in the white world of modern medicine. We were learning how to make Maori patients feel more comfortable in such an alien envirnoment, how to meet their cultural needs.

The confrontation began innocently enough. The kamatua decided to sit with me at dinner, and as happens with a group of people sharing a table, sharing good food, a conversation soon ensued. "This is a special place" he began, glancing round at his surroundings, his eyes lingering on some of the Maori carvings. I nodded my head. "It effects everyone, even Pakeha people like you" he said, obviously referring to being on the Marae. Pakeha is the Maori word for people of European, or white decent. "What do you mean, people like me?" I had to ask as his wording almost seemed to border on insulting. It seemed as if this was just what the Kamatua had been waiting for he answered without hesitation "The people in charge, our oppressors."

I sat there in silence, too shocked to be angry. I briefly wondered what this had to do with nursing. I wondered how this would make me a more caring nurse, but came up blank. I didn't need this confrontation, not now at the end of my three years of training. I didn't need to be labelled as a stirrer, a trouble maker, or even a racist. I tried to be diplomatic "Well, I'm just here to help people, that's what nurses do. I'm not into all this politics and stuff" I replied. My response seemd to anger him as his eyes narrowed, his face deepend into a frown "Fighting for our land, our culture isn't politics" he then ground his thumb on the table "See that thumb, that's you white people, and all Maori are under it."

So that's how I ended up here, on the receving end of a Maori leader. But I wasn't going to do down without a fight.

"To be honest, I really don't think this has anything to do with nursing. I don't need to be told how to care for Maori patients, least of all by such an unpleasant host as yourself." By this time we had attracted a small crowd of onlookers, amongst them two frowning nurse tutors. But I hadn't finished.

"As I see it, I'll treat anyone, from anywhere, on an individual basis. If I have a Russian, Korean or even a bloody Martian, I'll base my care on their individual needs." The Kamatua's face was filled with rage, but I wasn't worth further time. He rose from the table and walked away without another word.

It was an interesting experience spending the night on the Marae. This part has now been stopped as too many students were complaining that it had nothing to do with nursing, and I happen to agree. The biggest shock of all was what I can only describe as hate from my hosts.

Where's the racist?

2008-07-07T20:39:00.002+01:00

My eyes practically bulged out of my head as I read that last phrase again "...nursing staff, medical staff and environment systemically racist." The letter was signed by Marore family which I had come to know very well over the last two weeks. Helen Clarke leant forward in her chair, her arms resting on her desk "You were Mr Marore's primary nurse, so we're talking to you first. Nothing much specific has been said, and no names mentioned, but perhaps you could explain why the Marore family has sent this letter."

I sat there in silence, my mind a complete blank. I want to be honest, but I don't think it will work. The family wouldn't send a letter like this for no reason, but that's just the problem, I couldn't think of a reason. I couldn't think of a single reason why the Marore family found the care of their recently deceased father racist. "Sorry Helen, I don't have a clue. I acutally liked Mr Marore, hell, he even requested me to be his nurse every time I was on. Maybe it's just the family grieving, I mean they knew he was eventually going to die, but still, that doesn't make it a whole lot easier. Perhaps it's grief talking." The words seemed to slip out of my mouth on their own, and it took me a few moments to digest just what I had said. The more I thought about it the more my suggestion sounded plausable.

Helen nodded her head thoughtfully, "Perhaps you're right, but are you sure you can't think of anything specific, any reason why they would send a letter like this?" I took another look at the letter, "Well, it does say here that they feel the hospital policy of allowing only two visitors in at a time prevents them from healing in a traditional family way" I noted. "And was that enforced?" asked Helen. "C'mon Helen, you know it's never followed, as well as the visiting hours that are never followed. We always make exceptions. Hell, the minimum visitors that Mr Marore had were two. I swear we've had all his immediate family plus every cousin in there sometimes." Helen managed a brief smile before her face turned somber "But these are very serious allegations, it still has to be dealt with." I shrugged my shoulders "Sorry, can't help anymore."

I read through the complaint letter again, but it didn't help anymore. "Look Helen, the only specific thing they've complained about is the offical numbers of visitors allowed, the rest vague, it doesn't acutally complain about a specific person, just everyone. Perhaps you should request something specific from them, perhaps word it in such a way that you want their input so to make the system better."

Helen was in agreement and let me head back to work.

Over the next several weeks everyone in the department was questioned, and everyone came up blank. It caused a lot of stress and left a sour taste in everyone's mouth. Helen was no further ahead and did send a letter as I had suggested.

We'll hear the reply to that letter in a future blog.

An Unusual Argument/View on an old topic...

2008-07-02T21:31:00.007+01:00

Cough, splutter, cough, "I..... need some more..... oxygen" gasped Mr Jones. He couldn't have any more oxygen because too much of the stuff would kill him. He knew this, it had been explained many times before, but it didn't stop him desperately desiring enough oxygen to stop his breathlessness. Instead he had another nebuliser with room air pumping though the mask.

It was Mr Jones' third admission in five months, which was not bad for him. He had a run the previous winter when he had come in once a month for five months on end. It almost seemed that Mr Jones spent as much time in hospital as out. We knew him, he knew us, he knew the respiratory ward better than his own back yard (he no longer could walk in his own back yard as he got short of breath and had to go back on his oxygen after the exertion).

Ten minutes later the nebuliser was finsihed. "Could you... wheel me outside for a fag" his gasping wasn't quite so bad as he mananaged a sentence with only one pause for breath. I shook my head, "Ah, no Mr Jones, oxygen and a lit cigarette really don't go that well together" I replied. He managed a brief chuckle "Got away with it... all these years". I knew better than to argue, and he knew better than to try asking again.

Mr Jones was eventaully admitted to his second home, the respiratory ward. I went home, but stopped off at the local for a quick drink and catch up with a couple of friends, but didn't stay long as the smoke in the bar was so thick.

It may seem my point has been made, but I'm not done yet...

Over the next week the news was filled with those against and for banning smoking in all public places. Anong the various arguments against the ban was that they were being discriminated against, human rights etc.

Let's jump to Mrs Smith

Mrs Smith was sent to hospital because her family doctor was concerned about a lump in her arm. He was pretty sure it was just a lipoma. It was her first time ever in hospital as she is normally a healthy person who doesn't happen to smoke. The doctor there said it looked like a harmless lipoma as well, but she would need a biopsy, just to make sure. He also said it wasn't urgent.

What he didn't say to Mrs Smith but to myself (the attending nurse) was that if he had the time, or the hospital had the money, we'd get it done now, instead of letting her wait another month or more before she had the biopsy. She ended up going to her family doctor again who did the biopsy as it was quicker this way. (It was a harmless lipoma)

You know where I'm going with this yet?

Mr Jones the smoker is an extreme example of a smoker using up thousands upon thousands of pounds of health care over and over again, every time he is admitted to hospital. Most smoker's will at some stage cost the health service money because of their habit.

Mrs Jones has been admitted only once, and in need of a rather minor procedure, her visit a rather cheap visit compared to most, but she didn't get the ideal treatment because of cost.

So, for those diehard smokers who complain about their right to smoke, their right to sit and relax over a pint and light up at their local, especially on a rainy day, I have no sympathy, even if they have are old enough to have fought for their home and country.

Mrs Smith has a right to healthcare. She's not a regular, she doesn't get her money's worth out of the health service, but she does pay for the Mr Jones' of this world to get the best healtcare available to prolong his sufferring.

Don't get me wrong. I'm not heartless and going to deny the Mr Jones' the right to healthcare. I like people like Mr Jones, there's almost something comforting seeing the familiar face of Mr Jones as he's wheeled through the hospital doors. Then there's the banter back and forth over a very serious subject to look forward to. I want to help. All I'm doing is supporting the ban of smoking in public places.

PS As of July 2008, there are 250,000 fewer smokers in the UK since the ban started. In the long term, that's a huge amount of money saved, although it isn't seen in the short term.

Nurses... we're our own worst enemy

2008-06-24T13:33:00.003+01:00

"Hey doc, could you prescribe me some fluids please" I asked, the bag of intravenous fluids already in my hands. "What's up with this one?" asked Dr Munro. "Twenty year old male, intoxicated, conscious, obnoxious" I replied. Dr Munro began to write up a bag of IV fluids for my patient.

"What do you think you're doing?" protested Sue. Unfortunately I hadn't noticed her presence and she had taken another opportunity to go on the offensive. Sue was the nurse in charge of the 'Major' injury department of the emergency room. It didn't matter to her that I was in the 'Minor' injuries department. I thought that I wouldn't have to see her this shift, but she seemed to be stalking me. I shrugged my shoulders, "Just being organised" I replied calmly.

Dr Munro was startled as Sue grabbed the chart from under his nose. "The doctor hasn't even seen your patient yet, give him a chance to do some work. Your patient will have to wait to be seen" Sue said. "Ah, I realise Dr Munro is busy, that's why I'm making things a bit easier for him. It'll be at least another hour, probably two, until he sees my patient, and if I get him sobered up and cleaned up now, then he'll be ready to go home instead of having to wait another hour or two" I explained. I wasn't trying to justify my acitons to Sue, I was trying to make an effort to be polite. I might as well have held my tongue.

"That is not how we do things here" Sue began. I cut her off, "Well maybe you want to tell Dr Munro that, he was happy to do it. In fact this is the way we've been working all night. Perhaps you should ask him if I'm making his job harder" I glanced at Dr Munro who was trying to shrink into his seat. Sue's mouth opened, about to spout out another protest, but I cut her off again "Sue, you saw how busy we were at the start of the shift, no beds free and an overflowing waiting room, and Dr Munro and I have cleared the place out. Just what is your problem Sue?" I realised a little too late that my voice had risen by an octave or two. Sue's face turned red and she stormed out of my department back to her own.

I started the fluids on my patient and had him discharged in two hours. There was no 'Thank you" from Sue, but Dr Munro promised to buy me a round or two for saving his ass that night.

Going against the parents

2008-06-22T07:52:00.006+01:00

At six pm my cell phone rang. I put down my dinner plate and answered my cell phone. "Can you come quickly, he's breathing funny" said the woman on the other end of the phone. "Hello, who is this?" I asked. "Is this the nurse on call?" asked the stranger on the end of the line. "Yes. Now calm down" I spoke calmly in the hope of getting the women on the other end of the line to follow my example. "Now, who are you, and who is having breathing problmes, and where are you?" I asked.

The caller was Mrs Anderson, a teacher on duty in the junior boys' dorm. She was with a boy called Mohammed who was breathing rapidly. The boy had no history of asthma, no medical problems, and according to Mrs Anderson, no sign of any injury. I told her I'd be there in five minutes.

My diagnosis was instant, although I still gave him a full check up. Mohammed was sitting outside on the steps because he said the 'Air was more fresh.' He was breating at a rate of 40-45 breaths per minute. At 85 beats per minute his pulse was fine, and his blood pressure was a healthy 125/75. His hands were beginning to cramp, looking like a bird's claws.

I sat down next to Mohammed. I moved slowly and calmly, every movement, every phrase aimed at creating a calm environment, my body language trying to say 'Don't worry, you'll be ok.'

Mohammed was having what is known as a 'Panic Attack'. With end of year exams about to begin he'd been getting more and more worried the closer exams came. As far as 'Panic Attacks' go this was definitely a good exmple of how nasty they can be.

I spent the next hour talking to him, trying to get him to slow his breathing, trying to have him blow into a paper bag, but it was all to no avail. I called the emergency doctor but he was busy with an emergency and couldn't come to see Mohammed, but he gave permission for me to give Mohammed a medicine to calm him down.

The medicine worked wonders and withing twenty minutes of taking the small tablet he was fast asleep in bed.

"I want the doctor to see him now" insisted Mohammed's dad. I had to hold the phone away from my head as he was nearly shouting down the line. "I'm sorry, but the doctor can't see him, and besides, Mohammed is fine now, he's fast asleep" I said. I had spent the last twenty minutes explaining very simply what had happened, but it wasn't getting through. "You're just a nurse, I want a doctor to physically see him and assess him. Take him to hospital, call an ambulance. I don't care, but do your job. He's my son and you will do as I say."

Nurses are generally understanding people and put up with a lot of abuse, but not when it comes to compromising their patients. "I'm sorry sir, but that would be the worst thing to do to Mohammed right now. It's taken a lone time to calm him down, and finally he is asleep, his breathing is fine. It really would be wrong to wake him, especially to drag him out of bed and take an half hour drive down the mountain. It could trigger another panic attack." I was determined not to wake Mohammed up at this stage, it would be the wrong thing to do, and may even make him worse. I had to stick to what I knew was right, regardless of what the parent said.

"You're telling me what I can and cannot do with my own son. I want a doctor, no, a I want a specialist to see him tonight or you won't have a job by the time I'm finished with you" screamed Mohammed's father. "I'm sorry you feel that way, but I'm doing what I know is right for your son. You left him in our care, you trusted us to make the right decision. That's the issue sir, you're not here to assess your son. I am. If it makes you feel any better I'll be checking on him during the night and will take him to the doctor in the morning. I'll call you then. Goodbye" I turned off the phone.

Mohammed woke the next morning back to his normal self. He was at breakfast with his friends, laughing, running, doing all the things a healthy teenager should. I had made the right decision, alhtough I did wonder if it could have been handled better.

A Parent's right to know

2008-06-09T17:06:00.002+01:00

"Ah, I'm sorry Mr Smith, but I can't tell you" I said. There was a brief silence on the line, then it exploded in my ear. "Who the hell do you think you are? You're just a bloody nurse. I pay your bloody wages. Tell me what I want to know or you won't have a job by the time I'm finished with you." I held the phone away from my ear so the other nurses assembled in my office for this historic confrontation could hear.

Mr Smith was unhappy because his eighteen year old daughter, who was a student at our school, had needed some medical assistance, and he wanted all the details. He felt that because he paid for her to be here then that gave him free licence to look at all her health records.

"I'm her father and I demand to know what she was in the health center for" Mr Smith was beginning to sound like a broken record. "Perhaps you could speak to your daughter. But I can't divulge her health records to you. Even though she's at school, she's legally an adult now. Legally I can't give you her records" I explained. "So parents don't have any rights over their children? Is that what you're telling me?"

It wasn't about parents rights, but the right of the patient to recieve confidential care. Even though the patient is a student at a private boarding school. In fact, confidential care is even more important to a student living away from home, who often feels they have no one to turn to. Sometimes the health center is the only refuge some of these kids feel they have. If they think we are going to tell parents every thing the confide in us, it could in fact work against us, maybe even put students more at risk. I could tell there was no reasoning with Mr Smith, so stuck with the legal argument.

"Mr Smith, legally I can't tell you anything. I understand your worried, but I can say your daughter is fine" I said. "It's damn well not fine. It was a pregnancy test wasn't it, that's what she had" The guessing game had begun. It was time to end this conversation. "This conversation is over Mr Smith" I said. "Well, can you at least pass on a message from me?" he asked. That seemed reasonable enough and I agreed to do so. "Sure, go ahead" I replied. "You can tell her that if we find out it was a pregnancy test, she won't be getting a car for graduation, and she'll be paying her own way to university. Tell her she can give me the records herself, and if her record is clean, everything is ok."

"I'll be documenting this conversation Mr Smith. Goodbye." I hung up the phone, fuming with rage.

What is Euthanasia

2008-05-20T19:41:00.002+01:00

Mrs X has anywhere from hours, days, or even weeks to live. We all know she is going to die. She's on a continuous infusion of morphine, anti-emetics and anti-anxiety drugs, plus having intermittent boluses of morphine. Some nurses are very generous with their extra boluses of morphine, and others not so, although it always depends on how much pain she seems to be in.

Mrs X has a large tumour in her bowel. The surgeon had tried to cut it out, but upon opening her up had quickly closed her back up as there was nothing he could do. The wound had since broken down, parts of her bowel had fused together and she had bowel motion coming out of her abdomen.

At eighty six years old Mrs X was a strong woman, and had lingered in this state for 120 days. Anyone else would have died. She wanted to die, she asked us to end it. We nurses took turns looking after her as it was too much for one person to cope with.

Mrs X hasn't woken in the last 24hrs, although her eyes did briefly open once as she cried out in pain, but I don't think that really counts.

Nurse Y gave Mrs X the maximum allowed bolus of morphine, which didn't seem to help with her pain. She was still crying out as another spasm of pain twisted her body, as the air was forced through her vocal chords.

Thirty minutes later nurse Y gave another maximum bolus of morphine, within the allowed limit of course. Her pain did seem to settle.

Later that afternoon Mrs X died. It may have been hours, days, or even weeks earlier than she was due.

It was legal, specifically it was not defined as euthanasia as it was prescribed by a whole team of doctors. It was right.

In reality it was euthanasia.

Who's to Blame part II

2008-05-15T10:13:00.001+01:00

The silence didn't last long, it was broken with an almost incoherent Mr Wright exploding down the phone line "Who the hell do you think you are? You're just a bloody nurse. Don't tell me how to raise my kids. I've never been spoken to like that before." Even though I hadn't been exactly diplomatic in my dealing with Mr Wright I was still surprised by his outburst. I guess that's what happens when you have a guilty conscience.

I kept my mouth shut about this last thought. The line went dead. The damage was done. But I wasn't worried. The big lie which Mr Wright and Jeremy were part of was a common one. The parent lies to the school, often thinking their child is responsible enough to go to a big city in the center of Europe with their school friends. Next the child lies to their parents, because of course they don't drink, don't party, don't have sex and love visiting museums.

The only person Mr Wright should be disappointed at is himself, and he should not be angry at anyone, least of all his son who never sees his father. The son should be angry that even in hospital his dad can't take the time to see him. I should be angry at having to deal with a child whose father won't take any responsibility for his son. Sadly it looks like Mr Wright will never see this, because he's too busy trying to find someone to blame.

Who's to Blame part I

2008-05-12T10:32:00.003+01:00

"You'll be speaking to my lawyer" said Mr Wright. His voice was so loud I held the receiver away from my ear. "I'm only a nurse, I don't want to speak to a lawyer. I'm the person trying to help your son, Mr Wright." I struggled not to rush my words, struggled to stay calm. "My son could have died, and you let this happen, you know what these kids get up to, and don't do anything to prevent it. It's a disgrace, no, it's criminal."

At the age of fifteen, Jeremy was already a veteran of boarding schools. The last eight years of his life had been spent in a boarding school because his father was an oil man, and went wherever the huge multinational corporation sent him. He was a good kid, but he, along with his father, was guilty of the most common crime here at this school. It just wasn't quite time to tell him this yet.

I tried to change topic a little, move away from confrontation. "Perhaps you should come and see your son, he'll be in hospital a few days. It would help..." I never got to finish the sentence. "Help who? My son or you. I'm a busy man, I can't get away from work. Just do your job. I hold you personally responsible for making sure my son gets well." I found it strange the way he threatens me with lawyers, then expects me to patch up his sick son and holds me responsible. It was time to play hardball.

"Mr Wright, it would be easier if you were here because the Police will probably like to speak to you. To clear up some details." It wasn't exactly the truth, but it wasn't far off. Jeremy had taken ecstasy and been found unconscious outside a night club. He seemed to be making a full recovery, but it could very easily have turned out fatal. The police had actually been the first people to find Jeremy lying on the sidewalk.

"No, no, no, you'll have to take care of that. They don't need me there. Why do they want to speak to me?" I could sense the worry, the doubt. "I'm not sure, but Jeremy is only fifteen, not old enough to book a hotel on his own. You did tell the school that he was staying with an Uncle" I replied. The school only let students leave the campus overnight if they had parental permission that they would be staying with family.

"We are helping how we can, but he was your responsibility. I understand you are worried about your son, but we can't look after children when you don't tell us the whole story. There wasn't any uncle, there wasn't any adult supervision." There was silence on the other end of the line.

Parents to be...

2008-05-09T13:00:00.004+01:00

"Get me a fag woman" snarled Sam. Jenny shrank even lower in her chair, pressing her back hard against the frame, even as she began searching her bag desperately for a cigarette. Even lying on a bed in a hospital gown Sam managed to instill fear in his woman.

"Sam, you can't smoke in here" I explained as I began to change Sam's bag of intravenous fluids."Yeah, just wanna hold it, no harm in me holding it" Sam said. Jenny had given up trying to look for a cigarette and now sat with arms crossed, resting on her distended belly. She looked to be nearing the end of her third trimester, which may have explained why she was in bare feet, even though they didn't look particularly swollen.

"Woman, where's me fag?" Sam demanded. Jenny shrugged her shoulders "Don't have any" she replied. Sam's face turned to me, looking me in the eye "What're they good for eh? Nothing, can't even get her man a fag" Sam said to me as if confiding to a friend. "Well go and get me some" Sam paused while Jenny sat there unmoving, "Now." Jenny got up off her seat, and wandered out into the rain, barefoot, without a coat, and pregnant.

Twenty minutes later Jenny returned, soaking wet, shivering, and handed her husband a pack of cigarettes which he promptly opened and began to light up. I promptly made him put it out. With much cursing and threatening he responded by making Jenny carry his bag of IV fluids while he stood outside the main door puffing away.

Sam was discharged later that day, his wife in tow, barefoot, wet, pregnant, and carrying Sam's bags.

Never in Twenty Years

2008-05-06T17:51:00.002+01:00

Where should the line be drawn? It's only a rehabilitation hospital, not much more than a rest home really. They're not my thoughts, but from what I've seen and heard, that is the impression I get from the staff working there. It just goes to show how much the staff, the nurses that is, can make or break a place.

The hospital looks nice. It looks modern, both on the inside and out. It looks clean and looks well stocked with all the equipment needed to help patients recover from a multitude of ailments. It even passed my bathroom inspection. One of my most important criteria when it comes to judging a suitable ward environment is if they have a big, open, wheelchair accessable shower and toilet. You may think there are other more pressing priorities, but when you've got ten patients to wash before lunch, an easy access shower is a big deal.

The staff looked experienced. They all had grey hair and over a cup of coffee would relish any chance to relive nursing stories, especially horror stories, from days long past. They remembered the days when doctors' were gods, nurses servants, and patients did as they were told. Unfortunately they nearly killed a patient due to complete ignorance.

Mr Jones' chest pain began at 8pm, but he only told the nurses at midnight about his pain as it had suddenly become worse.

"We don't do that here" said Rose. I ignored her remark and placed the oxygen mask on Mr Jones' face. "You can only use the nasal cannula, were' not permitted to give any more oxygen than that. You need to take that mask off now." Rose was standing at the end of the bed, where she had stood for the last ten minutes, not helping me in the slighest.

I had given the patient his GTN (angina medicine) with no effect. His ECG (heart tracing) showed ST depression in all leads (sign of heart not getting enough oxygen) and had called the doctor who was coming in from home and was twenty minutes away. The doctor had given me specific insturciton on what to do, and I followed them exactly. It wasn't hard to do as I was doing what I had done thousands of times before in all my previous years in many different wards, and often in the emergency room.

I had the oxygen up high and asked Rose where the intravenous equipment was. "We don't do that here, this is a rehabiliation hospital" Rose repeated. I realised that I had to do this on my own. I used the IV equipment from the emergency resuscitation trolley and quickly inserted the tubing into a vein. I then drew up some morphine, Rose very reluctantly consenting to sign the stuff out of the locked cabinet with me because "We don't do that here" she said again.

The oxygen helped get the pain from the an 8/10 to a five and his ECG showed some improvement, but it wasn't quite right yet. I administered the first of the morphine, 2mg to start. Within five minutes the pain was down to a 1/10 and the ECG looked almost normal. By this time Dr Gates arrived.

Dr Gates was also a new doctor, only in his second week on the job, so he was caught off guard by Rose. "I'm not at all happy about this. I'm going to have to speak to the head of department. You can't do that here. I know you're the doctor, but we've never done this. It's a rehabilitation hospital."

By the time Dr Gates had extricated himself from Rose Mr Jones was pain free. He had a look at my collection of ECG's and congratulated me on a job well done. Rose was there, arms crossed, face red in fury as Dr Gates said this. "In twenty years we've never done this" was all she could say. Twenty years and you've never saved a life?

I guess after twenty years in one place, with

The Most Clever Gender

2008-04-30T16:32:00.002+01:00

It doesn't seem to happen to women so much. I would even go as far to say that it may be a male genetic trait. If you are between the ages of sixteen and twenty-five, male and in hospital on a friday or saturday night, then there is a good chance you are an idiot.

Young Shaun had been having a good night out, until someone decided to smash a bottle over his head while he was walking home. "That's gonna need stitches" I said as I pulled the flap of skin back into place. I was examining the laceration on the back of his head and guessed three, maybe four sutures should do the trick. "Oh fuck, can't you just patch it, put a bandage on it. I gotta get going, I gotta get to bed." I shook my head. "Well, get on with it then, let's get it over with." Again I shook my head.

It was a busy Friday night and Shaun's wound would have to wait. Instead of suturing him up I placed some gauze over the wound and wrapped his head in a bandage. "I have some other jobs to do first. Shouldn't be too long" I said "What's your hurry. "I gotta go, I have to catch the last night bus home, I ain't got no money left" Shaun pleaded. He looked ready to cry. "I'll be back as soon as I can, don't worry, we'll sort you out" I promised and left to see my other patients.

Over the next half an hour I was approached four times by an increasingly impatient Shaun, desperate to get home. As drunk eighteen year old's go, Shaun wasn't too bad. He didn't swear too much, wasn't threatening, did as he was told, and wasn't bothering the other staff or patients and so I took sympathy on him. "Tell you what Shaun, if you wait until I can sort you out, I'll arrange for the hospital to pay for a taxi to take you home. We don't normally do this, but I can arrange it." Shaun didn't say antything, no `Thank you´ no sign of gratitude. He just shrugged his shoulders.

Half an hour later I returned to find Shaun's bed empty. The receptionist remembered seeing him leave out the main door, intent on walking home. Shaun was no longer my problem.

Half an hour later Shaun was brought in by Ambulance. "What the hell happened?" I asked Shaun as the paramedic wheeled him past me. "Got beaten up again" he said. That much was obvious as he now had two black eyes, swollen cut lips, and the bandage around his head was gone and his laceration was seeping fresh blood from under the paremedic's dressing.

Shaun waitied to be seen and treated this time. In fact he stayed with us the rest of the night and took up the offer of a taxi at seven in the morning, just as my shift finished.

Nursing, what it's really like...

2008-04-17T18:11:00.003+01:00

"Do you mind having him again?" Tracy asked. It was morning handover and my last day of a six day stretch. I didn't know how to look after Mr Jones, in fact none of us seemed to be doing to well when it came to dealing with Mr Jones. I shrugged my shoulders "Fine, no problem" I replied.

By 0715hrs the night staff had handed over their patients and the day was about to begin even though I didn't feel ready to face it quite yet. But that's not an unusual sensation around this place, especially this last week since a staff member had called in sick every day this week and we could only get a replacement nurse for three of those days. Today was one of those days that we couldn't get a replacement.

At the entrance to Mr Jones' room the smell of rot struck, my steps faltered briefly, but I continued on. Mr Jones was lying across the bed, his head pressed against the safety rail, the blankets on the floor and the dressings on his legs tangled somewhere amongst the blankets, leaving his stumps exposed.

Several years ago and multiple surgeries ago the surgeons had begun operating on his lower legs, but they refused to heal. A lifetime of neglecting his diabetes and heavy alcohol meant that the circulation to his legs worsened with each passing year and the ulcers became worse, became blackened dead areas.

Without fail the surgeons kept on cutting back his legs, starting at the toes and working their way up, until now he was just a torso with thighs... thighs that wouldn't heal.

Dealing with Mr Jones was a team event, but I had six other patients so with a guilty conscience I tore myself away from Mr Jones to do a very quick lap of the ward to see if any of my other patients were in a worse state. This ended up taking twenty minutes as my three female patients all needed assistance to get on the commode to relieve their bladders. On my way back to Mr Jones I grabbed my colleague and friend, Sarah, to help out. I promised myself to give Mr Jones the best wash, do all his dressings first, and take the time to sit and feed him myself to make up for leaving him in such a state.

"Get out of it" bellowed Mr Jones when Sarah and I straightened him up in his bed, "Get ya hands off me" Mr Jones was lay helpless between us "I'll call the Police, that's what I'll do." As I looked down at Mr Jones feelings of pity, sadness, and revulsion all mingled within my body. The revulsion came from the trail of slime his stumps had left on the bed as we had lifted him up.

Sarah was busy trying to calm him down while I prepared for the wash. One linen basket, one infections waste basket, one bowl of warm soapy water, fresh linen and blankets, multiple wipes, half a dozen towels (I sometimes get told off for using too many towels), stump dressings plus several other smaller dressing for the small bed sores he has on his elbows and sacrum.

It took half an hour to fully get Mr Jones cleaned, his bed changed, his dressings cleaned and drained. It didn't help that half way through the wash Mr Jones decided to move his bowels (hadn't moved for the last two days) without warning.

Once the hygiene cares were taken care of his blood sugar was checked and breakfast started. Of course his blood sugars were high and he had his usual morning insulin. His protests had eventually died down, but I knew it wouldn't last long, just hopefully long enough for me to take care of my other six patients.

Over the next hour I managed to get my other patients fed, watered and their medications done. I went back to Mr Jones, not in the least surprised to find him lying across the bed, his stumps exposed, his hands picking at his stumps. I had tried everything to try to keep him from being able to take his dressing off, I had even tried the soft boxing gloves which the ward sometimes uses for cases like Mr Jones, but no one had been able to get him to keep his stump dressings in place.

The shift eventually came to an end and I headed home for my two days off before the next six days of grueling care. I mean that's what care is, being willing to do the grueling, sometimes gross work while understaffed, underpaid and misunderstood.

What's wrong with the NHS

2008-04-02T08:35:00.003+01:00

I sometimes wonder if I simplify things too much. When people complain about the care (or lack of care) they receive while in the care of the British health system, I come up with an easy solution. I compare the health system I trained and worked with in New Zealand, to the conditions I usually find myself part of in a typical British ward.

In NZ we have five patients, six at most, per Registered Nurse, whereas in a busy surgical ward in Britain I've have often 12, sometimes fifteen patients, with a student nurse, or nurse aide to help out.

Fortunately British nurses are superb task managers as they can give all the oral medications, then all the intravenous meds, replace IV fluids and maintain them safely. They can also monitor all urnine outputs, make sure no one is consitpated, wash everyone who can't do so for themselves, change the beds, dress wounds, admit any acute admissions, plan discharges, turn bed bound patients every half hour/hour, observe closely any post-op patients, all the while keeping an eye our for any patients not conforming and becoming more ill instead of better.

But I'm merely a simple nurse and my solution is to employ more nurses. But I'm not clever like management as they keep on finding ways to cut staff and keep them at a minimum to save money, to stay in budget.

With all the money they save they will have extra money to pay for all the Agency nurses working at double the money, plus the extra 300% which the Agecny itself earns.

They will have spare money to pay for the complications patients receive from substandard care. Then there are the law suits, the increased staff sick leave due to stress. More money to spend on infection control as it spirals out of contaol. More money to spend on patients who are spending longer in hospital. More money to spend training new staff as everyone with any experience and sense has left for greener pastures.

The list is endless, but I'm just an Agency nurse earning my 30 pound an hour for 11 hours paid work. Although maybe I should start my own agency as they Agency I work work takes another 60 pound on top of what they pay me. That's 1000 pound a day per employee. (I do work night shifts in the ER I should add)

The hospital I work at the most in London is run by fellow Kiwis and Austrailians, all working for the same Agency. We usually outnumber the regular hospital staff. That's 1000 pound a day per nurse, that's a lot of money to be paying out.

There must be more to this management business than meets the eye. I'm just not clever enough to be a manager.

To speak or not to speak

2008-03-18T07:53:00.001Z

It began with a simple "Hello" and went downhill from there. "Ah, hi" I stammered, as my mind frantically went into overdrive trying to figure out where I'd seen this pretty blonde woman before. "Can I buy you a drink? It's the least I can do" she offered. Something definitely was amiss because attractive young women didn't generally didn't offer to buy me drinks. I peered closer at her face. Recognition hit me like a sledge hammer. "Ah, I'm fine. I'm ah, drinking water tonight, designated driver, you know. Thanks for the offer." She shrugged her shoulders "Maybe another time then" she said, then turned to the barman. I made my escape.

"Hey, you gonna introduce us?"Jake said to me when I returned to our table. "Yeah, if you're not interested, introduce her to me" offered Simon. Both the boys had been behind me when Sophie (I'd remembered he name by now) had offered to buy me a drink. "Ah, she's not interested" I said, the guys gave me angry looks "What you talking about. If you like her, that's cool, but if not, don't be selfish" said Jake. "Yeah man, don't be selfish" echoed Simon.

What do I say? I couldn't tell them that I hadn't recognized her because I had vivid memories of her foaming at the mouth, or of her painting her room in faecs. I couldn't tell them that I'd looked after Sophie for two months in the psychiatric ward and that even at her best, she would never be quite right.

So I suggested another bar, I bought a round of drinks, and Sophie was soon forgotten.

What do you think? Did I treat Sophie wrong by not introducing my friends? Was I being Prejudiced? Well probably, but for the right reasons. I was just using my common sense. I kept them safe, kept Sophie safe, and kept my mouth shut at the same time. We were all winners.

Something's wrong, but is it you or me?

2008-03-11T17:25:00.004Z

There's something wrong. I'm not sure what, but it's getting worse.

Scene 1.
"I've got a sore throat" said Marcello. "How long has it been sore?" I asked. "Since last night" answered Marcello. "Well, I can get you some pain killers" I offered. "I don't want no damned pain killers, I want it fixed" the quiet calm of the school health centre was torn apart as Marcello jumped off the chair and began walking out the clinic. "That's all you do, give me pain killers. I want it fixed." I sat still, refusing to chase after Marcello, and refusing to explain to him again how illnesses and viruses work. He left the health center, late again for class.

Scene 2.
"I've got a sore knee" Murray had rolled up his trouser leg and I was examining a very normal, healthy, strong looking knee. "How long has it been sore" I asked. Murray took a moment to think things through "Well, maybe a year, on and off. If a do a lot of sport it hurts, but if I rest it I'm fine" he explained. "Is it sore right now, right this minute" I asked. "Well no" he confessed. "Well, what do you want me to do with it?" Murray's brow creased in thought, but he couldn't come up with an answer. "I don't know, just curious what's wrong with it."

Scene 3.
"I need some antibiotic cream, and a band aid" said Michelle. I looked hard at her forearm, trying to see where she had cut herself. "Oh, you'll need more than that, I think I'll have to take you to see the doctor" I said. "Really... Thank goodness I came to see you then" Michelle sounded almost happy. My attempt at sarcasm had gone way over her head. "No Michelle. I can't even see your cut. I can't see any blood. I can't see any bruise. I can't see a thing, and if there was something that needed a bandaid, I wouldn't go putting any cream on it." Michelle argued with me for several more minutes before she finally left the health center.

Scene 4.
"I want an x-ray" demanded James. At six foot three he was the tallest fifteen year old in the school and as I sat there staring up at the full height of him, I felt almost threatened. "But you don't need an x-ray" I replied. "My back is sore, it's been sore for three days. I need an x-ray." I motioned for James to sit down, sick of craning my neck. James had been weight training three days ago, and he had been doing some heavy bench presses when he had felt a twinge under his left shoulder blade. The pain wasn't bad. "Are you in pain now?" I asked. "No, but it's sore when I work out. Mum said I need an x-ray. I'm insured, and I have the right to an
x-ray." I'm sure he must be mimicking his mother's words.

I had already explained that he needed to give the weights a rest, but he wanted something that could make him get back training straight away. "An x-ray won't show anything, and it won't stop you from being sore when working out. You need to rest" James' scowl deepened, it was like talking to a brick wall. "You don't have the right to an x-ray either. Your mum doesn't tell me what to do, and I'm not going to expose you to unnessary radiation." James ended up storming out of my office, talking furiously into his cellphone. I subsequently ignored his mother's vicious email and hung up on her when she began yelling down the phone.

Conclusion
I swear I wasn't this like this when I was a teenager. I wasn't soft. When I sprained an ankle, I acutally believed you had to walk on it straight away until the pain went away. It worked. Maybe I'm getting old, maybe I'm getting tired of handing out needless bandaids. Maybe I need a change of scene, some genuine sick people to make me feel better. I wonder if this is what every generation feels. Is this what those of my parents generation felt, frustration at the spoilt, pampered generation that came after them?

Blame it on Mum

2008-03-06T08:17:00.004Z

One tequila, two tequila, three tequila floor. As I picked Steve up off the bathroom tiles I used some toilet paper to wipe the trail of vomit from his face. "Can you hear me?" I asked him. There was no reply. "Give me a hand" I called out. Two of Steve's friends came forward and helped me drag him out to the car. "What're you going to do sir?" asked Dan. Dan had been with Steve the whole night, helping celebrate Steve's fifteenth birthday. "Hospital" was all I replied. Dan wisely didn't say anything more, he knew he would be facing the wrath of the headmaster once Steve was taken care of.

The emergency room staff didn't have any luck trying to rouse Steve and the discussion turned to whether or not he needed to be intubated. By this time I began to use my nursing skills as an administrator of medicinal pain to try and wake Steve up.

By squashing fingernails, rubbing my knuckles across his chest and a bit of pressure applied to the inside of the eye socket, I managed to rouse Steve up. He woke with a start, and even though "What the fuck?" were the first comprehensible sounds he'd made since losing consciousness, it was good to know he could be woken and wouldn't need intubation. With the help of some intravenous fluids and a lot of poking and prodding, by the end of an hour Steve was sitting up in bed talking to us.

I eventually took Steve back to the dorm where he lives. I had the help of the headmaster as well as head of his dorm. As I tucked Steve into bed he whispered to me,"Why aren't they yelling at me?" referring of course to the headmaster and the dorm head. "There's plenty of time for that later. Let's just get you better" I replied."I don't wanna go home, they'll kick me out, won't they." I didn't give him an answer, "We'll talk about it in the morning, you just need to sleep" I said instead. "Mum doesn't care, I'll drink more at home" he said, "She lets me drink." I turned out the light and walked out the room, pondering Steve's words.

To cut a long story short, Steve was asked to leave the school. It was his third drinking offense in two months, although this was by far the worst. His mother came to collect him, and this is when things became worrying.

"Did you smell it?" asked Shelley "Or am I just imagining it?" I shook my head, "No, you're not imagining it, I smelt it as well. Spirits, I think, strong spirits" I replied. "And that was no German accent, she was slurring her words. She was drunk. She drove here as well."

We never heard from Steve again, although I think he made it home alive, at least there were no reports of serious road accidents in the newspapers. A child had been sent home with his mother who was at least mildly intoxicated. So what did we do about this.

We looked into the legal issues of working in a school in Europe, whose child is from another country. We could have called child protection services, but as this is considered a non-urgent case, it would takes weeks to get dealt with, and even an urgent case could take days. By this time the parent and child has left the country, flown back to Germany, USA, Turkey, Saudi Arabia. The country is always different, but the outcome the same because we have no power. We lost another child, in all the ways that a child can be lost.

The Drug Test

2008-02-29T08:56:00.004Z

"Why me?" exclaimed Mike. I shrugged my shoulders, "Just doing my job, nothing personal." Mike handed me the an empty jar "Well, I can't pee, sorry. I need some water" Mike grabbed a cup out of the cupboard and began to pour himself some water. "Sorry Mike, no water. Might dilute the sample too much." Mike slammed the cup on the bench, water spilling everywhere. "You think I'm guilty, don't ya. You're out to get me" Mike stormed out of the room and headed for the front door. "You can't leave Mike, you gotta stay until you pee. School rules" I said.

Just like last year when Mike was drug tested, it took four hours for Mike to pee. When he finished he handed me the bottle, "Satisfied" he said, sloshing the bottle as he handed it to me, spilling urine over the top and dribbling down the side. Even with my gloved hands I could tell that there was a problem "It's not warm. It's cold" I said. You need to do it again, and this time keep the bathroom door open." Mike took a step towards me, his mouth open, his eyes wide in disbelief. I took a step back. "You've got to be kidding. This is bullshit." I went ahead and tested his sample, which came back clear, but made him sit until he gave us another sample.

An hour later Mike gave me the next sample. "Feel the difference" I said as Mike was holding his sample. "What are you talking about?" protested Mike. I took the sample from his grasp, it's warm, I can practically see the steam rising off it. Mike flung his arms in the air "Whatever" he said, again storming out the room.

"Good news" I said to Mike, "It's clear." "I told you I was clean. You've got it in for me. I'll be telling my parents about this. This ain't over." I made sure it was over "Mike, you seem to be forgetting that you were caught asking another student for their ritalin. You made yourself target. That's why you were drug tested in the first place. Perhaps I should talk to your parents again about this." Mike shut up and got out.

I don't want anyone to be positive for drugs, but it's part of the job. It's nothing personal, but the only students to protest as loudly as Mike have always turned out positive for drugs. Mike is guilty, but he's been very lucky, that's all.

Psychotic Tales

2008-02-22T11:27:00.003Z

"Are you the devil?" asked Michelle, peering at me intently. I shook my head "No" I replied. "Are you sure?" she asked again, her voice sounding suspicious. "I'm sure" I replied calmly. Obviously satisfied with my answer, Michelle shrugged her shoulders and wandered off down the corridor towards her room. I headed for the treatment room to get Michelle's dinner time medications, nonplussed by Michelle's question.

None of us nurses are pertubed by Michelle's bizarre questions or behavior because this is just who Michelle is. She is thirty five and has spent half of her adult life in and out of Psychiatric institutions. She rarely has a lucid moment, instead she drifts from one delusion to the next, and when she does have a lucid moment, any truth is so tangled up in a web of mass confusion and delusion it's impossible to tell what is real and what is only real to her. But even more rarely Michelle would surprise us, even shock us, with a very sharp, bitter comment that would bring the reality of being a psychiatric patient home to us. Today was going to be one of those very rare days.

I read the drug chart carefully even though I knew Michelle's meds by heart. A touch of clonazepam to keep things calm, a big shot of chlorpramazine to slow her down, a couple of fluoxetine to cheer her up, and a decent whack of cogentin to counter the side effects of all the medication she takes. I also checked her log book, but she wasn't due her monthly injection of antipsychotic.

I caught up with Michelle in her room sitting on her bead staring at the floor. "I don't want those" she said as I offered her the pills. "Why not?" I asked. "I just don't want them" she insisted "They're bad for you" she added. I sat down on the bed beside her. She still hadn't looked up fromthe floor. "C'mon Michelle, you take them every other day, why not today?" I asked. Michelle kept her head down "I just don't alright. Just go away. Leave me alone. Stop harassing me" Michelle got up off the bed and stormed out.

Michelle was generally a bright, cheerful person, but she did have moments like these when for no obvious reason she became agitated, angry, and sometimes verbally abusive. At times like these it was even more important for Michelle to take her meds to help calm her down. I found her sitting alone in the lounge.

"What do you want now? You following me? I suppose you want me to have your baby" she said. "No Michelle, I just want you to have your medication, that's all. You know it will calm you down, relax you" I said. "Yeah, you just want me to have my rape medication, like everyone else" she said. Michelle grabbed the pottle of tablets from me and swallowed them. "Satisfied. See you round" she left me standing in the lounge, speechless, but horrified, because she was probably right.

Those times when Michelle is not in the ward, but in the community, any bastard could ply Michelle with a touch of alcohol, and with the meds she's already taking, she'd be anybody's. Hell, with the meds she's taking they wouldn't even need to use alcohol as the doses she's on are very strong.

I mentioned Michelle's comments to the other nurses. "She's probably right" was the general consensus.

Management vs Saving Lives

2008-02-13T07:51:00.004Z

The crew thought he was going to die, and they didn't know what to do. They were literally thousands of miles from home, a world away from their families. The closest city was a week away. The Russian vessel was fishing in some of the worlds most dangerous waters, within spitting distance of the Antartic ice shelf. The nearest help was me...well, not just me, but me and the emergency room crew whom I worked with, at the southernmost hospital in the world.

"Got it" I called out as I hurriedly grabbed the red phone. The red phone meant that a helicopter was on its way in. Several other nurses gathered around, their heads close to mine as they tried to overhear the call. "Emergency recieving over" I said into the handpiece. "We have a forty year old male with severe abdominal pain, localized to right iliac fossa. ETA twenty minutes." "Message recieved, out" I hung up the phone. I related the message to the others. "Is that all?" said Cherie in dissapointment. Cherie was an adrenalin junkie and if she wasn't jumping up and down on someone's chest or up to her elbows in blood and gore, then it didn't interest her. "That's a bit harsh" I replied, but I found myself speaking to her back as she headed back into the resusciation room.

Twenty minutes later the chopper landed and another three minutes after that our patient was wheeled into our department. Cherie was the first to greet the crew and led them over to my area, the moderate illness area."Suka,pizdec bolit,pomogi blyad" the patient yelled out to us as we transferred him from the trolley onto a bed. He was a giant of a man, a stereotypical iron pumping, Bolshevik, American eating giant. "What did he just say?" I asked. The two men in flight suits shrugged their shoulders "Not a clue" offered Mark, the head paramedic, "But he's in agony, that's for sure. It's his appendix, and it must be due to burst." By this time Jason, the ER doctor was at my side, listening to the handover from the paramedics.

"Kto nibud', nu sdelaite je shto nibud' ebannyi v rot" Yelled the Russian as Jason gently pushed on his abdomen. "I'll get the morphine" I offered, but Jason had other plans for me. "Someone else can do that, get me a translator, now. If we don't get one soon, I'm gonna have to take him to theater, and I don't want to do it without consent." I was hoping someone else would get that job as the bottom of New Zealand is not the easiest place to find a Russian translator.We did have a list of translators, three Japanese, two German, two French, one Romanian, two Polish, one Dutch... there were at least twenty nationalities covered, but no Russian. There was a Russian name there, but it had a line through it. I called hospital management to get them on the case.

"You have a Russian?" said Jenny. Jenny was the day duty supervisor for the whole hospital. She was in charge of both nursing and medical staff. "Yeah, helicoptered in twenty minutes ago. He's not well and we need a translator urgently" I said. "Does he have insurance?" Jenny asked. "Haven't got that far yet, busy trying to save his life." I replied. There was a brief silence on the phone, just long enough to make make me nervous. "You've got the list there in the ER office. There's a Russian on that" Jenny eventually said. "It's crossed out, and there's no other Russian speakers" I said. "Well there's nothing more I can do, you'll have to sort it out yourself for now Don't forget that man's insurance details. I'll come down there in a while to sort things out." The phone went dead.

I would much rather have been at the bedside as it was much easier than trying to find a translator. I asked every nurse in the department but they too couldn't help. I became creative. I called the Polish translator in the hope that they might speak Russian, after-all, they were once under the Russian thumb, but they were no help. The Romanian didn't speak Russian either and sounded almost offended at my ignorance. I called the police, and they said they would get back to me. They never did. My last call was to the High School. "Yeah, we have a Russian teacher, "Vlad Prudchenko" said the headmaster "I'll get him right away." Five minutes later a translator was on his way.

"Skolko stoit?" called out our Russian patient. I looked towards Vlad, the translator. "He want's to know how much." I looked at the doctor for guidance, but our Russian patient had more to say. "U menya est dengi i ya mogu zaplatit'" We all looked at Vlad "He says he has money, five hundred roubles" said Vlad. "Prosto pomogite mne" said the patient. "He's begging us to take away the pain" said Vlad. Jason had heard all he needed to "Tell him not to worry about the money. We'll fix him up and get him back on his ship. No one will come after him for the money." Vlad translated and I kept my mouth shut. The less people that heard this converstation, the less complicated things could get.

Our patient was operated on within the hour. The surgeon said his appendix was only moments from rupturing. We had saved his life. Two days later his ship sailed into harbour and he was there to greet his shipmates, and leave with them as well.

"What's the name of the shipping company?" asked a furious Jenny "We'll get them to pay the bill." I glanced at Jason sitting next to me in Jenny's office. "Sorry, I never got it. I work in the ER, so I didn't see the Russian after he had his surgery" I explained. "I specifically asked you to find out about his insurance, and you did nothing." Before I could answer Jason interupted. "He did ask about insurance, and the man said he could pay. The man's life was in danger and we took him at his word. We didn't have time to chase up the man's paperwork." Jenny alternated between glaring at Jason then me. I tried to shrink into my seat, relieved that Jason had spoken up. "If that's all you're going to say, then the matter is up to the board, and maybe the lawyers. You'll here from me soon. You can go" Jenny waved her hand for us to leave.

I got up, but Jason sat still."Ah Jenny, before you take things further, you might want to think about your actions that night" said Jason. The air could have been cut with a knife. I thumped back down in my chair. "You were called in to help a situation, but you didn't help. You said you would come to the department, and you never did. We are not management, we are the people saving people's lives. You left us to make a decision without support, and we did what we thought was right. I'm more than happy to speak to the board, anytime you want."

We never met with the board. We never recieved a reprimand, and we never heard about the matter again. The only time the matter came up was over a pint of ale that I had bought Jason. I pint he well deserved.

Breaking the C law,

2008-02-05T11:46:00.001Z

I broke the C law, not on purpose. Never mind, too bad, he'll get over it. And what is the C law?

"Dear Nurse, thank you for your email, but we feel our son needs to see a doctor as his cough sounds terrible. He complains of being constantly tired, unable to sleep, and states that you do not let him sleep in the health center. As his parents we expect this request to be followed through. We hope to be able to avoid taking this matter further."

"Dear parents,
We will be happy to arrange for your son to see the doctor. We can arrange it for either tuesday or wednesday no problem. I do feel that he is not looking after himself, in particular regards to his smoking, especially as he has asthma. It's a very worrying combination. He has also been away this weekend, and I know he was at a big party and he was found very inebriated. He really needs to rest."

Later that evening, in the corridor...

"Hey Dave" I called out. Dave was only ten or so feet in front of me, walking with a group of friends. He turned at my call. "How's the cough?" I asked. His face hardened, "Fine. Thanks for sticking your nose in my business sir. Thanks a lot" he said, his voice dripping with sarcasm, a hostile glint in his eye. I stopped in my tracks, caught off guard. Dave had never spoken that way before to me or to anyone that I knew. I motioned for Dave to come forward, "Come here, please" I asked quietly. Dave did as I instructed. "What are you talking about?" I asked. "Thanks for telling my parents that I smoke. It's none of your business." I took a moment to collect my thoughts.

"You've got a short memory Dave. After all we've done for you. And now you're angry because your parents know you smoke. Are you going to stop smoking now?" Dave stood at arms length from me, his arms crossed across his chest, his feet in a wide stance. He looked ready to attack. "Yeah. Don't have a choice, or my parents will withdraw me. Who the hell are you to stick you nose in my business?" he repeated. I had heard all I needed.

"You want me to feel bad because you're going to stop smoking?" my voice rose a couple of octaves. "Who looked after you when you broke your collar bone? Who looked after you when you smashed your face on that rock and needed surgery? Who visited you in hospital every day? Who brought your friends in to visit you because you were bored? Who stitched you up when you sliced open your arm? Who drove you from classroom to classroom in the snow when you sprained your ankle?" Dave stood there, his mouth hanging open. His friends had taken a step back, in shock at seeing me tear Dave to pieces. It was a side of me very few had seen.

"Well, I have my rights, Confidentiality and all and I pay your wages" stammered Dave. As stunned as Dave and his friends already were, they were still unprepared for my next onslaught.

"Your parents practically ordered me to take you to the doctor. Your parents are providing for your healthcare, and they need to know the facts. You say you want to...sorry, have to give up smoking now, and you want me to feel guilty about that? Well I'm sorry for caring. You think I'm doing this for the money? You don't pay us to care. Caring people is what we are. Next time you come here, we'll do it without the caring. You can't pay for that. You need to go away and think things through. Oh, and one last thing, don't ever speak to me like that again, or you'll see a side of me you won't like." With that I strode past him without a backward glance.

The next morning

"Dear Nurse,
Thank you for your reply. This is a rather unpleasant information for us; it is the first time we've heard about this; we appreciate your frankness. It is extremely worrying that he smokes with his asthma. He was in hospital several times when he was younger because of his asthma. We will be dealing with this matter immediately.
Again, thank you for your honesty"

Later in the morning

"I'm very sorry sir" said Dave. He was sitting in the chair opposite me. His girlfriend had convinced him to come and seek me out. "Do you mean it?" I asked. "Yes" he replied, "I just never thought things through. I'm an idiot." I nodded my head "Yes, you are an idiot, but we still like you." Dave burst out laughing. "You're the only person that makes me laugh when I'm sick" he said. "It's just part of the job, although it's a shame they don't pay me more for the humor" I added. Dave blushed, got up from his chair, shook my hand and left the room.

Fictional Scenario, Another Rich Parent

2008-01-28T12:16:00.001Z

NB: Fictionional event, but this made up scenario is not unusual from parents I deal with.

I sometimes catch myself sounding just like my father, berating the younger generation for their softness, while describing in vivid detail what life was like when I used to bike to school in freezing rain, or minus ten degree frosts. But the kids here don't believe me. They've had life too easy. It's made them weak, both physically and mentally. Or perhaps I'm just having a bad day, but it seems the rich are ruining their kids.

"What's wrong" I asked Sally as she came into my office. Sally slumped down into the chair, let out a huge sigh as if she had the world on her shoulders. She should never take up acting as she was far from convincing. Like all the other students before her, she had not bothered to be so sad and sick looking while sitting in the waiting room. Thirty seconds earlier she had been happily gossiping, joking and laughing, literally the life of the party. She was the epitome of health.

"I can't go to class today, I'm too sick" she claimed "It's my stomach ulcer. It's playing up." She was clutching the middle area of her abdomen, now rocking back and forth. I played along for a while. "Is it a stabbing pain?" I asked. She nodded her head. "Does it come and go?" Again she nodded her head. "Is it lower down, near your belly button?" She nodded her head. "What about food. Does food make it better or worse?" She was silent a moment, thinking of the best answer. "It doesn't make any difference" she finally said. "Then it doesn't sound like an ulcer. In fact it doesn't sound too serious at all" I said. She didn't seem relieved by my answer. "My Dad has one, and thinks I may have one. You can call him if you like." I declined the offer to talk to her father.

When working in a boarding school, there are a few extra questions that are worth asking, as it is always important to get the whole picture. "Do you have any tests in class right now?" I asked. "No, and my grades are good." I then checked her blood pressure, pulse, temperature which were perfect. I listened to her abdomen, gently palpated it, all seeming fine. I then offered her some medication to ease her pain, but she refused, saying she wanted some lemon tea. I got her some lemon tea and over the next hour the tea seemed to ease her pain and she happily marched off to her next class.

The next day, at the same time, she had the same symptoms. "Do you have a test in class today?" I asked. She shook her head. "Well, that's not what your teacher said. I had a phone call from your English teacher, and you've missed yesterday's test. Plus you also have a presentation due today." Sally seemed to forget her symptoms, the stomach clutching, the rocking back and forth. "Are you calling me a liar?" The venom in her voice caught me by surprise. "No, but your symptoms have a strange coinicidence of coinciding with your English class. I'm not saying you're lying about your illness, but you did lie about your tests." Sally got up from her chair "My father will have your job. No one calls me a liar" she stormed out of the office. He's more than welcome to my job.

The next day, I recieved a less than flattering email. It went like this:

To whom it may concern,

This Friday, my daughter had yet another stomach pain, apparently stronger than before. This is not the first time that this has happened as she has constantly been feeling sick during the semester. I believe she might have an ulcer, or even pancreatitis, but I haven't been able to check with a specialist so far due to work commitments.

During Sally's math class, she started to feel a powerful pain in her stomach, more powerful than before, thus she was sent to the health center.

Not only did she have to wait thirty minutes, but when someone finally bothered to see her, the nurse yelled at her to hurry up, was threatening and demeaning.

This nurse, and nothing more, has put my daughters health at risk, both physical and emotional. My daughter was so upset she had to leave and spent the rest of the day sufferring tremendously.

It is unacceptable that a high school, for which I pay top dollar, to have nurses call students liars as they are still just nurses.

I have spoken with my lawyers, and unless I have a full investigation of events, plus a complete assessment by a specialist, and an apology from the nurse involved, things will be taken much further.

I keep thinking of how my parents would react. They would find out the facts, they would begin with polite, but firm enquiries. They would be fair, they would want to know the whole story, from both sides. But my parents are normal, regular everyday people. They don't have the power and money that Sally's father has, but they damn well know how to avoid making a fool of themselves.

With the above scenario, which is common, management tell us to be diplomatic, to apologise for any misunderstanding. That we should listen, understand, and be professional. I don't like it when non-medical people tell me how to do my job.

I couldn't help myself, and told Sally's dad a thing or two.
See my next post.

My Drunken Ramblings

2008-01-19T19:57:00.003Z

The ride home on the tube is so long, especially after a busy shift in one of London’s busiest emergency rooms. To help pass the time I usually read whatever I can lay my hands on. This particular evening it was The Evening Standard. There was one article which caught my eye, then made me rather angry.

The further I read the more amazed I became at how utterly stupid politicians can be, but this really is no surprise. The article was about the drinking laws in Britain and the drinking habits of the average Brit. They wanted to relax the drinking laws, that is, allow pubs to stay open longer.

As if the bloody laws aren't relaxed enough already, whoever the idiot politicians are who thought this up must be have made these proposed changes under the influence of a stiff whiskey or two.

“Where do you live? What is your phone number?” I asked. Justin was only twelve years old and been found by the police lying in a pool of vomit in a park. I noted that he was well dressed in good quality, moderately expensive clothing so assumed he had a place to call home. Justin mumbled something unintelligible and I leaned closer to hear more clearly. “Justin, wake up, you need to tell us where you live.” We were pouring fluids into him through a vein to help rehydrate him. “Regges place” he mumbled. Regges place? “Who’s Regge Justin? Is he your dad?” “Regens Bark” he mumbled again. I finally understood what he meant, Regents Park. Right, we were making some progress.

“Hello, is this Mr Cornett?” I said. “Yes, how can I help?” he replied. “I’m a staff nurse at the hospital and work in the emergency room. I don’t won’t you to worry but we have your son, Justin, here with us……Yes, yes, he’s alright, he’s had a bit much to drink.” “WHAT…where did he get drink from? He doesn’t drink? Oh hell, is he ok?” I could hear a woman’s voice in the background. “What’s wrong? Is Justin ok?”

“Mr Cornett, your son is ok, but could you please come down and we will talk about it more here.” Before I hung up I could hear a woman sobbing in the background. I’ve made calls like this far too often.

When intoxicated, legless teenagers are becoming a more regular site in the emergency room; doesn't this suggest that drinking laws are relaxed enough? When intoxicated legless adults are regularly seen in emergency rooms all around Britain and New Zealand doesn't this suggest that drinking laws are too relaxed? When men, women, children and even the elderly are picked up out of the gutter in ever increasing numbers doesn't this suggest that drinking laws are relaxed enough? Exactly how relaxed does the government want its citizens to be? How relaxed is relaxed enough? Is there someone out there that has been missed, someone that has not been seen in their local emergency room already that I need to see next?

The next idea proposed by politicians was to train frontline nurses in how to help binge drinkers address their problems at an early stage, specifically in the emergency room. I pictured myself sitting down beside an intoxicated patient and discussing the finer points of being a binge drinker. They would either be asleep or telling me where to go. Is it not enough that we are already dealing with blood and gore, with violence and death, with overcrowding and chronic lack of staff? More work for fewer nurses is just what we need.

I don’t suppose many politicians have had to deal with a severely intoxicated person? Have they ever had to clean up after them while screaming at security to get them out of the department, let alone tried to alter their drinking habits. You would have more luck trying to convince someone high on cocaine that they should stop; at least they would be able to listen and respond. I suppose we could wait for them to sober up and then educate them, but then I don't want to keep a drunk in my department any longer than necessary.

During my last month working in a London emergency room I saw some prime examples of relaxed drinking like Mr Smith who had fracture his wrist and was complaining about the time waiting to be seen, he had got drunk and wrapped his fist around his wife's head. He's really a nice guy; he only hits his wife on Fridays' after coming home from the pub. Mr Smith waited a long time to be seen.

Mr Brown was unconscious; he had drunk himself into a stupor, apparently the noise from his crying baby had driven him to drink, he just needed some peace and quiet. The baby was dehydrated, cold and covered in muck. He's normally a good father, but he was having such a good time at the pub he forgot all about his child.

Mrs White had a broken nose; her husband thought it looked better on the other side of her head. I didn't know whether to feel sorry for her or not because she had got drunk at home then gone to the pub. She had tripped on some steps and now her twelve month old baby has a fractured femur.

But surely normal people wouldn't be like this? Surely normal people don't beat their wives and neglect their children?

We see more "normal" people in the emergency room with alcohol related problems than we do wife beaters or child neglecters. But it's the real bad ones that stick in your memory, plus they make for a telling story. But each weekend I see more and more "normal" people in hospital with alcohol related problems than I do the real bad ones. Something needs to be done, I just don't know what, but I do know that more relaxed or less relaxed drinking hours is certainly not the way to go. Relaxing the drinking laws may not, in the end, make any difference to the above mentioned people, but do we really want to take a chance? Can any good come of it?

Bought me a Doctor

2008-01-16T11:02:00.001Z

Marie rolled her trouser leg to her knee, "Can't you see it?" she asked, looking at me expectantly. I peered hard at ankle, but there was nothing to see. No bruising, no swelling. I gently touched her ankle, moving it up and down, then left and right. She didn't flinch. "I can't see anything, and it doesn't seem sore" Marie let out a small sigh of exasperation. "It doesn't really matter if you can't see it. My doctor back home said I have fluid on my ankle and I shouldn't go skiing. You can't make me ski. I have a doctor's note" Marie put her sock back on and rolled her trouser leg back down.

This was Marie's second and senior year at St Mary's exclusive boarding school and with her long blonde hair, blue eyes, innocent smile and billionaire father, Marie was used to getting her own way, even when her father was several thousand miles away in another country. "Would you stop talking rubbish. You and I both know there's nothing wrong with your ankle. Why don't you want to ski?" I demanded. Marie's face broke into that innocent smile "Why I don't know what you're talking about" she even had the gall to flutter her eyelashes at me. "Fine, I'll just have to clarify things with your dad" I said as I picked up the phone. Marie made a grab for the phone "You wouldn't dare. That's against confidentiality" I put the phone out of her reach and began to dial. "Ok, ok, you're right. There's nothing wrong with my ankle, just please don't call my dad. He'd be so disappointed to hear I'm not skiing" she begged. "Well then just be honest for once and tell me why you don't want to ski."

Marie's smile faded and her expression turned serious "I don't look good in ski clothes." I waved her out of the office, disgust evident on my face. "Let's see what your doctor has to say."

Three days later an email arrived stating that Marie had internal bruising to her ankle and was not to ski. It didn't say which ankle, and it didn't say what she could or couldn't do. I was no longer annoyed at Maria, after-all, she's being clever to get what she wants. I became angry at the doctor she had bought.

"Dear Dr, I'm a little concerned about Marie's ankle. You seem to indicate there is a problem, which Marie has admitted is not true, and is in fact fabricated. Could you please clarify this matter. It would be also useful if you could tell me which ankle is affected as you didn't mention this, plus Marie seems to have forgotten as well. Also, as Marie has had no previous restriction on activity, could you please explain in detail exactly what she can and cannot do. So far this year she has been hiking, biking, ice-skating and climbing among other things.
I look forward to your reply and trust you will set things straight.
Sincerely
The Health Center."

Cherie is off the hook. I've found a new target, the Doctor for sale.

Ashtmatics Anonymous, part II

2008-01-15T18:40:00.000Z

"Hold on a second, you come in here, two o'clock on a saturday morning, wheezing, coughing, smelling of booze, reeking of smoke and complaining that your asthma medicine doesn't work. And you say I'm judging you!" I only raised my voice a little. I could feel the adrenalin begin to surge in my veins, my haclkes beginning to rise, any thoughts of diplomacy evaporating. Darren began to protest, but I cut him off. "I then give you medicine, which you say doesn't work, and you say I've got an attitude." I turned my back on him, about to walk away.

"Hey, I'm sorry man" Darren called out. I turned around, looking at him expectantly. "I'm just so tired, sick of being sick" their was a note of desperation in his voiced. I softened my tone as I judged him ready to listen.

"How old are you?" I asked him. "Nineteen" he answered. "Do you live at home?" I asked. "Moved out six months ago. Living with some friends" he replied. "Were you always sick when you lived at home?" he shook his head. "How much and how long have you smoked?" I asked. He shrugged his shoulders, "Couple of years I guess, although only on weekends. That was when I was at home" he said. "And now?" I prompted. He shrugged his shoulders again, his body language trying to say, I don't care, but the incongruency between the visual and the spoken message was stark. "All the time, but it doesn' affect my asthma. The medicine just doesn't work anymore." I chose to avoid talking about the smoking for now.

"When did you last see your doctor. Maybe he could try you with some different medication?" I said. He looked at me in surprise "Two years, I think. What other medicine you talking about?" I went to the respiratory cupboard and took some of the various inhalers we had available and spread them out on the bed. "There's quite a few. Have you ever heard of a preventer?" He shook his head, "What exacatly do you mean by preventer?" I picked up the brown inhaler, "Just what it says, a medicine to help preventing you from having an asthma attack." He picked up the inhaler "It won't work on me. Nothing works" he moaned. It was time to get tough again.

"Darren, start acting like a bloody adult or move back home. Take some responsibility for yourself. Stop moaning and take some initiative. I'm not the person to tell you what you should do, and I'm not going to force you to see a doctor." Darren stared at me defiantly, "Fuck you. You can't speak to me like that?" I began to walk away again. "I just did. Get over it. Here comes the doc, don't be a stubborn idiot with him" I went over to the work bench and wrote down a number. "When you get out of here, this is the number for the asthma educator. It's up to you. Make the call. It may save your life. It's free as well" I handed him the slip of paper and left the room. I let the doctor know all that had happened.

Two weeks later, in a quiet moment in the emergency room, I made a quick phone call. "Who are you again?" Asked Sheila. "I'm calling from the emergency room. Just wondering if you've come across a guy called Darren Smith" I asked. "I'm not supposed to give out inforation" she said "Why do you want to know?" I briefly explained what had happened. "Yeah, I saw him, and I'll be seeing him again. He was a nice young man, he really seemed to appreciate all I did" there was a strange lilt in her voice, almost one of satisfaction, accomplishment, or maybe she even proud. "So you could do something for him?" I asked. "Of course. He was in a terrible way, but we've got him on the right track now." I thanked Sheila and hung up the phone.

Asthmatics Anonymous part I

2008-01-14T08:42:00.000Z

"It's always bad" Darren bent forward, hands braced on his knees, wheezed several breaths then continued, "The medicine never works." Not only was Darren's breathing wheezy and ragged, but
from the head down to his toes he looked unkempt, dirty, contagious even. His hair was greasy and uncombed, his face had at least a weeks growth. His clothes were covered with stains from at least several meals. Even his shoes had holes where his big toes were peering through.

"What medicine have you been taking?" I asked. He handed his ventolin (asthma) inhaler to me. "It's empty" he gasped "Ran out last week." I took a deep breath and sat down on his bed, a voice inside my head saying 'be patient, be patient' with the poor lad. "Ah, so your asthma has been bad for the last week?" I asked. He nodded his head. "And you haven't had any medicine in that time?" He nodded his head again. "Ah, can I ask why you didn't see someone sooner?" Darren kept his head bowed, unwilling to, or perhaps too exhausted to make eye contact "It's useless. Asthma medicine doesn't work for me." I placed a nebuliser mask over Darren's face, a mask containing the exact ingredients that he claimed didn't work.

Three nebulisers later and Darren's wheeze was much less audible and his breathing more relaxed. He was no longer sitting on the edge of the bed, hands on knees. He was able to sit back on the bed, although still in an upright position. A small victory, at least in the physical sense.

"I thought you said the medicine didn't work?" I kept my voice emotionless, as non-judgmental as possible. "The inhalers, they never work, I want what's in the nebuliser" he was able to look me when he spoke. "It's the same medicine" I replied "But you don't look like you've been looking after yourself. How much do you smoke a day?" His clothes reeked of smoke. "I didn't come here to be lectured. You don't know me, so don't judge me." Oh dear, to think I'm trying to be sympathetic, to think that this is his reaction to my nice side, how will he react when he sees my bad side?

The Conflict

2008-01-10T06:25:00.000Z

"Don't forget to note down any problems with the new health log" Cherie said enthusiastically "The computer guys want our input and are happy to make changes" Cherie waltzed out the room, her orders delivered. I turned back to the monitor, my brow creased in concentration. We had four hundred students at our boarding school and we still had three hundred and ninety still to put on the computer system.

The new computer record keeping system for the health center was good, but my fingers kept on tripping over the keyboard as I silently cursed the Americans. The problem was that when inputting patient entries for current events eg Simon has a headache, given paracetamol, the system accepted the regular system of date eg day, month, year. But when I went to put in the patients previous health information to update their overall health information eg vaccination records, it accepted the American date system ie month, day, then year.

I did as Cherie had instructed and noted the small fault with the system, feeling secure in the knowledge that my fumbling was serving a purpose, that is, to make the system better. Little did I know that a storm was brewing.

The next fault I spotted was when inputting the patients height and weight there was no place to put a date, an easy mistake to make and one easily rectified. I noted the glitch and got back to work.

"How's it going" without knocking Cherie barged into the room and stood over my shoulder, reading the information on my monitor. "Ah, fine Cherie" I stammered, "Taking a bit longer than I should, but slowly getting there" I swung round in my chair, coming face to breast with Cherie. A shudder passed through me and I looked up, our eyes making contact. "Why is it taking so long? I'm racing through them. Once you get going, it's quite easy" she sounded sympathetically disbelieving, but her eyes said 'You useless bastard'. "Well I have a couple of small things to improve upon" I suggested. "Oh, really, the system seems pretty fine to me. What's the matter?"

"Well, it's not really a big deal, but the system uses two different date systems. One part uses Amercian and the other uses the normal way" I then demonstrated on the computer exactly what I was talking about. "Oh, didn't notice that. Hasn't been a problem for me. Just be careful with the date and you'll be fine." The matter of the date was now dismissed.

"What's the other matter?" she asked. I turned back to the computer, "Oh, it's nothing" I said, don't worry about it" I said reluctantly. "No, I want to hear it, anything to make the job easier" Cherie's smile never faded, her false cheer more see through than ever. "Well, it would be good to have a date next to the height and weight" I tentatively suggested. "Oh, don't worry about that. We height and weight them on admission, so the date is the same for everyone" she said. "Ah, but the ones who have a completed physical, when we transfer that data into the computer, we need to put down what date the physical was done, it's sometimes months old." The smile faded at last "Yeah, but you can just write it at the top, where it says General Condition." "But everything else has a date, so why not this. I'm only trying to make our job easier" I said. "Don't interrupt me, I haven't finished speaking" Cherie brushed back her hair with a quick backhand movement then crossed her arms in a defensive posture. "There's no point. Just write it in the top. It's not that important" With that Cherie, my colleague, not my boss, left the room.

The fun and games had just begun.

The basics of nursing...again

2008-01-06T11:23:00.001Z

After four years temping in London, it's really hard to trust someone else to do a part of the care. This is mainly because of staff shortages and a corresponding lack of reliable aides to fill this shortage.

I've had aides that copied vital obs because they couldn't do a manual blood pressure. I've had aides who didn't know what was a good or bad blood pressure.

When working in london, with anywhere from 7-16 patients I have to rely on others to do the basics, but the fact is that the job is rarely done as good as I would like it. The result is that I'm not happy with the care patients are receiving, but I am helpless to do anything as the workload is too huge. I'm am not exaggerating when I say that in an afternoon shift I've been stuck with fourteen surgical patients, plus another that was admitted around dinner time. The Aide called in sick and the charge nurse got a second year student nurse to help me. Needless to say I soon left this job, in fact I walked out at around seven pm after an argument with the charge nurse.

Anyway, in my home hospital in New Zealand, we have maximum six patients per registered nurse. If you have a particularly heavy load, then you will have less. With this system you stay in touch with the absolute basics plus you have time to do the fancy stuff with all the new gadgets/technology etc. We have one nurse aide who circulates throughout the ward helping with bed making/washes etc.

On a more personal note, it is sad that we are too busy to do the simple jobs eg feeding patients. It is sometimes relaxing and therapeutic to sit with a patient, and spend some time talking, laughing, while performing a simple task. The more we move away from this contact, the more like a doctor we are becoming, eg assessing, diagnosing and treating. This is not what we are.

Doctoritis... I was once guilty

2008-01-05T10:36:00.000Z

Yes, once upon a time I suffered from Doctoritis, although at the time I was straight out of college, so I can blame it partly on my youth. But the rest of the blame lay with Dr Steele.

You see, I was an impressionable young man and Dr Steele had it all. He was a twenty nine, tall, handsome, worked out at the gym and had the muscles to prove it. He also had every women in the hospital in love with him. I pictured myself in his shoes. I thought that this is what being a doctor is like and that I wanted to be one. I was reluctant to tell strangers that I was a nurse, especially as a common assumption was that male nurses are usually gay. This is not the truth, although there are certainly a fair few represented.

Like all young nurses I was good at one thing, spending money on nights out on the town. Quite often Dr Steele would join us and it was always entertaining to watch Dr Steele in action. Out of the many nights that we spent on the town there was one moment which is still so vivid. It is so vivid because it when I first thought I had made a big mistake, I actually thought "Oh shit, I'm should have been a doctor, not a nurse."

That particular night a visiting women's netball team was visiting the city and we met up with them at the local pub. The bar was a U shaped bar and were on one end of the U and the visiting ladies were on the other end of the U. I watched as several attractive ladies kept glancing at Dr Steele, hoping to catch his eye. One of them succeeded and Dr Steele went into action.

He was drinking a cocktail and began stirring his drink with his straw. The woman whom he'd made contact with copied his motion and began stirring her drink with her straw. Dr Steele then gently began to poke his straw in and out of his drink, a motion which the woman copied. She then made her way over to us. After Dr Steele explained that he was a doctor, within minutes they had left the bar.

An hour later a grinning Dr Steele returned to the bar. The night was young and there was the rest of the netball team still to conquer.

I do not want to be a doctor and I am happy I am a nurse, but as I said, I was young and impressionable. I have been a nurse for thirteen years and you don't stay in this line of work that long if you're not in it for the right reason. And now, as an older nurse it is entertaining to watch the new, young, bright eyed students succumb to Doctoritis.

Dress Code

2008-01-03T20:01:00.000Z

So, the British Health Providers have been busy proving that they are a great big waste of space. They have printed out an 8,000 word publication telling staff how they should dress. Some of the recommendations included making sure staff had matching shoe laces as well as making sure that your hair is its natural colour. High heels should not be worn either. It then talks about safe clothing eg flat soled shoes, neckties and loose jewelery etc etc etc...

Anyone who has any experience dealing with patients, especially heavy patients requiring lifting, washing etc knows what is appropriate to wear and what is not. Considering that most nurses at some stage get sore backs no matter how careful they are, not once in thirteen years of nursing have I ever seen a nurse trying to lift, wash or transfer a patient while wearing high heels.

Thank goodness we have management that can take the time explain to us how to do our job, a job which many of them have never actually done. Obviously management have too much free time on their hands. They justify their actions by saying it will help reduce infection rates. I really don't see how matching shoelaces and hair colour affects this.

On a more personal note, I used to enjoy it when the nurses didn't wear a petticoat under their white uniform and they stood by the window with the morning sun shining through. I'm sure they did it on purpose.

I also love those who used to wear black or red sexy lingerie under their white dress. It really made it worth going to work.

On a more serious note, I think we look pretty good, and if someone was looking a bit scruffy, the charge nurse always sorted them out. No need for a 8000 word essay about it.

Back to Basics

2007-12-22T10:22:00.000Z

Some nurses recently said to me that nursing has changed so much and we do so much more, that we might as well be doctors. The two nurses who said this to me were both nurse anesthetists. They then went on to say that there a so many unskilled jobs that anyone could do, and that nurses should not have to do. In particular, they were referring to jobs such as showering/bed sponging, feeding, and dressing wounds. I found this rather sad. It seems that the fundamentals of nursing are being forgotten.

Confused? Well I'm referring to the days when RN's took care of the whole patient. Meeting hygiene needs, dressing wounds, and feeding patients eg stroke patients are not for the unskilled.

To me this feels wrong? It's these tasks which keep us in touch with the patient. For example, when we wash a patient we assess so much. When we log roll them onto their side we check their pressure areas, feel their skin under our hands: Are they hot, dry, cold and clammy. When we move them do they cough, does their chest rattle. When we feed a stroke victim we assess their ability to swallow. This is rather important as aspirating food into the lungs is never good. When we dress a wound, we observe each day its progress, it's shape, size, colour, odor, discharge. Is it pale red or angry red? There is so much that an experienced nurse automatically assesses when they look after the basic needs of a patient and it is not for the unskilled.

I realize that we do so much more, in some cases diagnose, treat/prescribe, or maybe we're nurse anaesthetists, but I feel that the absolute basics should always be a part of nursing. I am happy to delegate some basic jobs, but it should never be delegated because we feel it is a simple unskilled job for the unskilled health worker.

No Chance

2007-12-13T07:38:00.001Z

"I'm always scratching my head. Do you think it could be dandruff?" asked Louise. At twelve years old Louise was the youngest girl in the school. The high school sometimes took students a year early, they were called pre-nine's, referring of course to the ninth grade. Until I met Louise, I had never figured out why the high school sometimes took children one year earlier than normal.

"Well, I'd better have a closer look, it could be something else" I said as I put on some latex gloves. "Why are you putting gloves on? What could it be?" Louise asked nervously. "It's nothing to worry about, but you might have nits?" I explained. "Yuk, that's disgusting. That's so gross" Louise then pretended to vomit. I then began to search through her hair. I didn't have to search very hard as the nits were so big and there were so many, I could see them without having to sift through her hair.

"Yep, you've got nits" I said, "I'll get some treatment from the pharmacy today. Who's you're room mate? I'll have to get her checked as well" Louise again pretended to vomit, a big smile one her face the whole time. "How did I get them? Can I share them with my friends?" She really didn't seem too upset about the whole deal. She almost seemed to be enjoying the attention. "You could have caught them by direct contact from someone who already has them. You can even get them from using someone else's brush, or from their clothing" I explained "So it's really important I see you room mate." Louise went to her dorm and returned with her room mate, Nicole.

Nicole did have nits, although not as bad as Louise. Nicole acted the same as Louise, by expressing her disgust at having "creatures" in her hair, but she had a smile on her face and seeming to enjoy the attention. "Come back at lunch time and I'll have some medicine for you both. Oh, and I"ll call you parents, just so they know what's going on." Nicole nodded her head while Louise reacted differently. "They don't need to know" she said "Don't bother calling them" she said. "Why not? They need to know what's going on. It's part of my job" I explained. "There's no need, they won't care anyway. They'll say it was my fault" Louise pleaded. "Well, let's get the treatment started and we'll talk about this later" I suggested. As for the parents, I sent an email to both sets. Nicole's parents wrote back thanking the health center for helping their child, while I heard nothing from Louise's.

Nicole and Louise both received the treatment and after ten days were nit free, or in Nicole's words "creature free." Each day both girls came in laughing and joking about the "creatures" in their hair. They didn't need to come every day, but they enjoyed being in the health center. Between myself and the other two nurses who worked here, the girls probably received more positive attention than they were used to. At least in Louise's case, it was most likely the most positive attention she had received.

Over the next month Louise was involved in some rather serious incidents, all involving alcohol and boys. In fact she was even hospitalized because she had drunk so much and her 'friends' couldn't wake her. I had to pick her up from the hospital and had to call the mother. "She couldn't have drunk much, she's such a small thing. One tequila would be enough to make her very ill" said Louise's mum over the phone. "Well, she drunk enough to be unconscious. Her friends said she had a lot more than one shot of tequila" I said. "That can't be right. She's so small, she'd only need a few shots to be in such a state. Someone must have spiked her drunk. Can you do some blood test to check for that? I insist you do some blood tests."

During the drive back to the school campus I informed Louise that I had spoken to her parents. "She doesn't care. Mum's an alcoholic anyway. I'm just following in her footsteps." It's hard to know what to believe when kids talk about their parents, plus this wasn't the time to have a serious talk with her about her problems. I'd leave that up to the counselors. "What about your dad? He must be pretty upset" Louise kept silent.

Louise eventually left the school and was sent home. As I stated earlier, it was for an ongoing serious of problems. But I found out something so shocking that it made me worry just what sort of home she was returning to. It goes like this:

Two weeks before school was to begin for the school year, Louise's father had phoned the school and asked if he could drop his daughter off early, one whole week early. It was then explained to him that this was not possible as there were no staff at the school. The father then asked exactly what date school started, and he was told September twelve.

On the night of September 11th, at 2355hrs, Louise's father dropped his daughter off outside a dorm, unloaded her bags and drove off. No one knew she was here, she was left alone in a foreign speaking country, in the middle of the night.

By pure chance two staff members were walking home from a night out and found Louise and took care of her.

I got to say goodbye to Louise. "I don't want to go" she said to me. "I'm sorry, but it's not up to me. But you can't go on breaking the rules and doing so many dangerous things?" She nodded her head. "But you guys in the health center are the only people who've ever been nice to me, who've ever cared"

Five minutes later the driver arrived and took Louise to the airport.

I don't mean to sound cruel but...

2007-12-10T15:53:00.001Z

"What are you boys' doing?" I asked the boys' in front of me. "Ah, nothing" there was a pause as they thought of a suitable answer. They were standing in the dorm foyer dressed in ski jacket and pants. "Ah... just going for a hike. That's all." They must think I'm stupid. "Don't lie. If you lie to me, I'll just have to report this to the Dean." I was referring to Jim, the school Dean of discipline. "Well, we were just going up for a quick look. The snow looks so good. We were going to be back before lunch" said Justin.

Normally I encourage the kids to ski, but school exams began tomorrow (Sunday) and the headmaster specifically said no one can ski. He didn't want to risk anyone getting injured, in particular a broken bone, just before they were to start exams.

"Well, guys, I'm sorry but you know the rules" I tried to be sympathetic to their cause, but then I had a sudden thought. "Hey Justin, you're only a beginner skier. What the hell do you think you're doing going up? Do you want to break a bone?" Justin didn't even look guilty "I'm a natural athlete. I skied ten times last season. I am in the advanced ski lessons now." As a ski instructor of ten years, I knew that this was utter rubbish, but Justin probably genuinely believes he is good. "Well, whatever, but you can't go up today, the headmaster specifically said so. Is that clear?" Everyone nodded their head and headed back upstairs to their room to get changed out of their ski clothes.

As the nurse on call it was turning out to be a quiet Saturday morning and I was relieved that I had stopped a potential disaster from happening. Every weekend someone broke a bone. Ninety percent of the breaks were from kids going too fast and jumping. At this school any kid who could make it down a intermediate ski run thought they were good and could be found in the jump park. Some were even good at jumping, but rubbish at skiing. With the snow dumping down outside, I settled myself by the fire with a good book, expecting a quiet day.

At two o'clock the nurse mobile phone rang. "Hello, nurse on call" I answered. "It is doctor Munroe. We have one of your students here" he said. "Ah, you do?" I sounded surprised. Kids were supposed to call the nurse first, and then we took them to the doctor. Kids are not to go directly to a doctor. "We have a skier who has broken his collar bone. Can you come and pick him up?" said doctor Munroe. "Ah, the kids aren't supposed to be skiing doc, what's the kid's name?" "Justin. Do you know him?" said Dr Munroe. "I know him very well. I'll come and pick him up" I offered. "You don't need to worry, he just left in a taxi. It looks like he's trying to avoid someone" he said.

Justin isn't the first kid to try and hide an injury by sneaking to the doctor or even the hospital without contacting the school nurse. There was even one girl who, with two friends, sneaked out of the dorm at midnight and took a taxi to the hospital down in the valley. We never found out until the hospital sent us the bill. No matter how hard the kids try, we always catch them.

At two thirty I received a phone call from Justin. A very sombre Justin was asking for stronger pain relief. "Come to the health center and I'll see what I have for you" I instructed him. Ten minutes later we met in the health center. I couldn't help myself from saying "I told you so." Justin was still defiant "I'm a good skier, a natural athlete. I'm good at all sport" he said. It amazed me how Justin could still say this while his face was contorted with pain. Perhaps it's just as well he is in pain, maybe he'll learn a lesson. But that's just cruel of me...isn't it?

Choosing to be blind

2007-12-07T08:48:00.000Z

Before I begin, no names or places are real, but the situation is. It happened a couple of years ago, and the only reason it came to memory was that I have recently been giving some talks to the kids of drugs. I've also been recently dealing with some rather difficult parents. If the parent concerned in my next story did ever identify themselves, then it will be a mixed blessing. On one hand, the parent may be angry at me, but on the other hand it may just open their eyes, and by doing so, may just save a life.

"Do you think I should say something?" I asked the Sarah. Sarah was one of the other nurses whom I worked with. She had twenty years nursing experience behind her, twelve of those spent in boarding schools. "I don't see why not. It is a health issue. A very serious health issue. It would be wrong if we didn't say something" she said. "Yeah, but am I the right person to say something. The kid's already in trouble with Jim (dean of discipline) and he has already talked to the boy's parents. And you heard what Jim said, dad doesn't believe his kids would do such a thing."

Sarah was shaking her head in frustration, not at me, but at the father who wouldn't listen to what the school had to say. "Well maybe someone else needs to say something. Maybe he needs to hear it from someone else. We have to try." With that said I made the call to Mr Smith, father of Ian Smith.

"I've already talked about this with Jim, and the matter is settled. I don't appreciate you calling accusing my son of taking drugs" said Mr Smith. "I'm not calling to accuse anyone. I'm calling because I'm worried about Ian..." Mr Smith interrupted me before I could say anymore "Listen, I trust my kids. I know they wouldn't do anything. You cannot prove anything. They are good kids..." I decided it was my turn to interrupt him "I know they're good kids..." He interrupted me again. "Don't patronize me. You don't know my kids. I know they're good kids. Leave my kids alone or I'll sue you for harassment." I decided to give it one more try "Ok, but will you listen to me this once. If you don't agree with me, or want to speak to me after I've said my piece, then we'll leave it at that and the matter will be dealt with by Jim (Dean of discipline)." Mr Smith grudgingly agreed to listen.

I then explained the situation from our point of view, which was as follows:
Ian was found in his bathroom, with two other boys. They had a plastic bag filled with a dozen small, opened tins of varnish. A teacher walked in and found Ian sitting on the toilet, staring at the wall in a semi-conscious state. When spoken to he didn't respond. He was completely uncommunicative. The teacher hurried to get another teacher to come and help, and when he returned, Ian was still sitting there staring at the wall, looking pale, sickly, and still uncommunicative. The teacher's helped walk Ian to his bed where they lay him down and called the nurse. By the time the nurse got there (approx 15 minutes later) Ian was talking and almost back to normal.

"You've got no evidence. There were other children there. Ian was in the wrong place at the wrong time. This isn't the first time you've singled out Ian. You're out to get him. You have not right to accuse him of anything. Stay away or else."

I thought it best to end the conversation. Maybe with time he'll calm down and see reason. I wasn't accusing Ian, although I felt I had a justifiable right to. It's not politically correct or legally wise to go accusing, even when things are so damn obvious. I do wonder if anything I said would have made any difference. Jim, the dean of discipline didn't fare any better. It would be great if Mr Smith is right, but why can't Mr Smith at least accept that there is a remote chance he could be wrong. It's his son's life he is dealing with.

Parents, Priorities and Kids

2007-12-05T08:25:00.000Z

"I expect her to get better now" said the man on the end of the phone. I almost thought I could hear a hint of menace in his voice. The voice belonged Mr Smith, a naturally worried parent living thousands of miles away somewhere in South America. His daughter, Jennifer, was a student at the boarding school where I was working. "Well, we're doing the best we can. She's seen the doctor and is on her second course of antibiotics, so she should be fine" I replied, trying hard to keep my voice calm and neutral. "That's not good enough" he said "I want a real doctor. She needs a specialist. I want her to see a specialist today. Or do I have to come over there myself" when he said this, there was no doubt about the menacing tone in his voice.

I've heard it all before. Caring parents thousands of miles away accusing me of not taking care of their son/daughter. I've learned to have as little contact with parents as possible, as no matter what I do it will never be good enough, but sometimes I feel the urge to bite back.

"You're welcome to come over. I'm sure Jennifer will love it" I replied. "Shall I tell her that you're coming over then?" I added. "That won't...ah be necessary" my reply had caught Mr Smith off guard. Of course he wouldn't come over. He's just like many of the parents I deal with, too busy looking after their business instead of their children. "I'm sure you'll do what is needed." With that the phone went dead.

The problem was that one week ago Jennifer was diagnosed with a bad throat infection, commonly called Strep Throat. She had become sick one monday evening, about nine o'clock, whereupon I was called to see her. Her throat did look bad. It was an angry red and had a couple of small yellow spots. Her temperature was high and she looked dry. She was given the usual pain relievers, was given fluids and I instructed the dorm staff on how to care for her.

The following morning she was taken to the doctor where a Strep Throat test was performed, and following the positive result, she was commenced on the appropriate antibiotics.

After two days of antibiotics and analgesia, Jennifer felt much improved. So much improved that she wanted to go to class, which we allowed her to do. I did explain to her that even though she felt better, she still needed to take her antibiotics. It was a wednesday morning and everyone felt confident that Jennifer's illness would soon be cured.

Later that same day, around sixish, I caught up with Jennifer in her dorm because she hadn't come in to take her breakfast or lunchtime dose of antibiotics. "I feel so much better" she said when I asked her why she hadn't taken them. "Well, if you don't finish them you could get a lot worse. Do you understand?" She nodded her head. I then gave her a dinner time dose plus another to take around 10pm when she went to bed, that way she would only have missed one dose for the day. "Can I trust you to take them, or do I have to come and give them to you?" I asked. Jennifer promised to take the antibiotic. "You also need to rest this weekend. No going out. I want you resting in the dorm, staying warm, dry, no restaurants, no alcohol, and no partying." Jennifer again promised to do as asked.

I never saw Jennifer the next day (friday) or saturday. I saw her 6pm sunday evening after a phone call from the dorm staff which went like this: "She looks terrible. She's lying there not moving, please come quick." I made my way pretty quickly to the dorm.

As I walked into Jennifer's room I was almost knocked over by the smell of rot and bacteria. Jennifer was lying on her bed, staring at the ceiling, her lips parched, her breathing rapid and shallow and her bed soaked through with sweat.

It turns out that on Friday afternoon Jennifer's auntie had come and taken her away for the weekend. In that time, Jennifer said she had nothing to eat or drink because her throat was too painful, and she never took her antibiotics. On the sunday morning the auntie had taken her to hospital. She was discharged several hours later after being given a further course of antibiotics. The auntie never contacted any of us nursing staff or anyone else at the school. The auntie just dropped her off niece and left.

"Why was she so dehydrated? How could you let her get like that?" Mr Smith said accusingly. The phone conversation wasn't going well again. "Ah, Jennifer was under the care of her auntie. Jennifer never even told us she was going away. How can we look after someone when they are not here? Also, Jennifer insists she never had any food or fluids, and her friend who was with her confirms this. I don't want to blame anyone, but this is how she presented to us" As I said this I felt my ire rising. "You're calling my sister a liar?" Mr Smith fumed. "Ah, all I'm saying is she was away, when she was not supposed to be, and when she came back she was in this state. She came back at six pm, I was called at 1805hrs, and was with her by 1815hrs. We have done all we could for her, when she has been with us" I barely kept my voice calm. "Well your best is obviously not good enough" said Mr Smith. "Well, you did say you would come out here if you weren't happy with our care. Perhaps it would be best if you did, that way you can be assured your daughter is getting proper care." There was a brief pause on the line "Well, she's getting the care she needs now. So let's just leave it at that. I want a update every day on her progress. I want her to see the doctor every day and I want you to make sure she takes her antibiotics." I never got a chance to say goodbye as the phone went dead.

It is parents like Mr Smith that make me have as little contact with them as possible. Nothing we do is good enough. They rant and rave about specialists and threats of coming out here to deal with the matter personally, but generally they don't. Generally their board meeting is too important, or they send the family secretary out as they can't make some time for their own children.

Not all parents are like this, but many of these wealthy ones are. They have the money, the small or big fortune, but they don't have their priorities right. Their priorities are their business and making more money. It's a different sort of wealth from the one I'm used to.

I'm not perfect. I'm far too human.

2007-12-03T18:31:00.001Z

"I'm sorry" said the young man lying in front of me. "So you should be" I said and turned and walked away. The relatives of the man gave me hostile looks, but kept quiet. They may lay a complaint later, but I doubt it. Their son, brother, cousin, nephew, has caused enough grief already.

You're not going to like me for saying this. In fact it's the opposite of how nurses should be, but I can't be nice to that patient. I'm struggling to be civil, and for the most part, am managing it. How unprofessional of me, but he just killed his best friend. Fortunately the passengers of the car they crashed into survived.

He's not even a teenager anymore, so he can't use that as an excuse. He's twenty one and knows that drinking and driving kills. The guys weren't just a little drunk, they were roaringly drunk when they got into the car. His friend wasn't even wearing a seatbelt, but he, the driver, was. But it could just as easily have been the other way around, with the friend in the driver's seat and wearing the seatbelt.

My colleagues are treating him so gently, but I can't be gentle. My mum and dad were on the same stretch of road of the fatal crash only twenty minutes earlier. I keep thinking how easily it could have been them that they crashed into. The more I think the more angry it is making me, but I'll do my job, and give him the best medical care we can offer. Well, the best physical medical care, I'm not in the mood for the touchy feely stuff.

The Sex Talk

2007-12-03T07:22:00.001Z

"Hey, don't worry man. This is Switzerland" said Jason. I just hoped Jason was trying to be the 'Big man' in front of his friends and wasn't serious. I was having a discussion with a group of twelve 16-18yr old boys about sexually transmitted diseases. "What exactly do you mean by 'Hey, it's Switzerland?" I asked Jason. "You know, we're in the mountains man. It's not like a big city. No diseases here man." I stared hard at Jason for a moment. He sunk into his chair, a guilty smile on his face. "You really don't mean that do you?" I asked. "C'mon man, it's safe here. I'll be fine." I soon formed a plan on how to tackle this new found ignorance.

"Just for the record, this small village, used to be one of the biggest party places in Switzerland. It was also a hot-spot for intravenous drug users" I said. There was a chorus of protests at that statement. "You're bullshitting us. You're just trying to scare us...aren't you?" said Jason. I shrugged my shoulders, "Believe what you want. You seem to know this village better than me."

My plan wasn't to scare them, but to open their eyes, so I brought out my secret weapon. It was a chart that a teacher at another school had put together. This chart was a visual demonstration of all the students at a particular school of who had slept with whom. It linked all the people together ie If student A slept with student B, and student B had slept with student C, then in effect student A has slept with student C. The graph pretty quickly got way out of hand and in no time at all, every single sexually active kid was connected in some way to every other sexually active kid at the school.

The kids were horrified. If it wasn't such a serious subject, it would almost have been humorous to see the stunned expressions. I than made the matter even worse by suggesting that if student A visits another school for whatever reason, eg a sporting event, then student A is now connected with a whole new chart of every sexually active person from that other school. There were more gasps of horror. Even Jason was speechless.

Within one hour of that class, the health center was inundated with students requesting a STD check. It wasn't just from kids who had attended my little presentation. Word had spread throughout the school and everyone was worried. There was even a couple that were not sexually active, but just wanted a check, just to be sure. I did explain to this couple that they don't need to be tested, if they are not and never have been sexually active.

I never expected my talk to be so effective. Kids these days seem to think they know it all, but now I realize that I'm probably guilty of thinking they know it all. If I'm asked to have another talk with the kids, I suppose I could share with them some stories from my days working in a London walk in STD clinic. I can picture the kids faces now, and I can't help myself from smiling.

Judging Success

2007-11-28T20:05:00.000Z

I put a lot of effort into my work today. I did wonder if it was going to be worth it. By the end of the day I found that no only was it worth it, but that I want to do more.

I gave my first official drug education talk to the school kids. I have had 'unofficial' talks with the kids about drugs, but this was in front of a class of around 16 teenagers. I'm normally nervous when I talk to groups, but today was different. In fact today went real well. I didn't have a planned speech, just some keywords to trigger memories. Some of the memories that those keywords triggered were from my days dealing with teenagers in the psychiatric unit, some triggered memories of friends that have come undone by drugs, and some memories were from the good old emergency room.

I was asked to give a presentation by the social studies teacher, because the kids had just finished a week studying drugs. At the end of the week each kid had to give a presentation about a certain drug, eg Marijuana, Heroin, Cocaine etc. They had some great facts and figures, and the teacher thought that it would be a great way to finish this module with a drugs talk by the school nurse. The teacher said I had a whole free class to say anything I wanted. I decided to use my memories to give the kids a real life picture of what drugs can do.

The kids sat and listened attentively. No one fell asleep that class. No one made jokes. There was no chatter in the back of the classroom. I've never had a more attentive audience in my life. Time became meaningless as I delved into my memories about teenagers ruined by Marijuana. The kids were horrified to find out that Marijuana wasn't harmless after-all, especially to growing teenagers. They were even more shocked to find out that the person on the street selling cocaine is probably selling more battery acid than cocaine. They were disbelieving at first when I said you can't trust anyone, even your so called friends, because no one gives a shit when it comes to making a buck or getting fix.

I was a little surprised that the kids had no idea that heroin tends to stop people breathing. They didn't know what schizophrenia's was and they all cringed in their seats when I told them about a fourteen year old boy called Jake, who could see the spiders crawling on the floor, hear the rustle of their legs on the wooden floorboards, then feel the spiders as they crawled on his skin and then sank their fangs into him.

I wasn't there to scare the kids, although some probably were, but I talked about odds, or risk factors. Like a man asking his doctor what he can do to stop himself having a heart attack, I explained that everything in life comes down to increasing the risks or decreasing the risks. In the case of a heart attack, the risk factors are diet, exercise, weight, smoking. I explained that mental health is no different. It comes down to risk factors, several of which I discussed with the kids. You may be fine, and you may be ok, or perhaps your friends, but you increase your chances of things going wrong.

Never in my life have I talked for forty minutes so easily. I was incensed. I was a man on a mission. I ended up speaking to three classes that afternoon, three forty minutes sessions. And then I began to doubt. I'm not the expert. Maybe I've gone about this the wrong way. Who I am to educate about such things? I'm not qualified.

After the doubt came the belief that I had wasted my time, as well as the students time. No one really cared. They were quiet because my stories were entertaining, that was all. Then it happened.

I was back in my office when a 16yr old boy approached. "Excuse me Mr' asked the boy, "Do you have a minute?" he asked. I nodded my head, "Come in and grab a seat" I replied. The boy came in, shut the door behind him and grabbed a seat. "Can I ask you something?" he asked, "About your talk" he added. "Sure, ask anything you want" I replied.

I won't say anymore, as what the boy told me is of no importance to no one else but myself and the student. But what is important is that my talk made a difference, at least to one person. It was the best encouragement that I could ever have received. I realized then that even if I spoke to dozens of kids in a dozen different meetings, but I only made a difference in one life, then it is all worth it. Who knows, I may have even saved a life.

This should never happen to a man

2007-11-27T18:04:00.000Z

"Ah, I have a big bloody problem" said Mr Jones to nurse Brooke. Nurse Brooke was young, blonde, and just out of college. She had been accepted straight into the emergency room immediately post graduation. This was the hospital's new orientation policy and it was not too popular with some of the staff. The problem was that many nurses felt she should spend at least a year or two in the wards first. But Brooke's easy going personality and good looks, soon won over even the most hardened emergency room veteran. Especially the doctors.

"Well, that's what we're here for Mr Jones, fixing problems" Brooke explained. Mr Jones didn't look at all comfortable with Brooke. He wouldn't make eye contact and kept looking at the floor while grasping his privates. "I don't suppose there's any men around are there?" Mr Jones asked "I've got a problem down below, if you take my meaning, and it's fucking sore." Brooke felt the heat rise up her neck and turn her face bright red. "Ah, sure, I can get a male to have a look. But I really don't mind having a look. I'm a nurse, after-all." Mr Jones briefly made eye contact with Brooke "Trust me, it ain't pretty. But if you can help with the pain, go ahead." By now Brooke's cursiosity was well and truly aroused and she was almost eager to have a look 'down below.' "Well, ok then" Mr Jones began to unbutton his trousers.

I was seeing a patient in the bed next to Mr Jones and had heard everything. I was very curious myself as to what was going on 'down below' but kept out of the way as Brooke had everything under control.

"Oh my god" exclaimed Brooke. "Bloody hell. Be gentle woman" exclaimed Mr Jones. "I'm so sorry. Oh my god. What happened?" asked Brooke. "Don't touch a thing. Don't touch a bloody thing" said Mr Jones. "I'm sorry. I won't touch a thing. Here, let me just put a bit of gauze on it" offered Brooke. Brooke then emerged from behind the curtain and came over to me, her face pale in shock. "Ah, I think you'd better have a look" Brooke said. I wasted no time and went to look at Mr Jones' privates.

"How did you do that?" I asked Mr Jones. I was staring at a very bloody, mangled stump of penis. "Do you know what a Prince Albert is?" asked Mr Jones. I nodded my head, my face wincing in sypathy because I knew what he was going to say next. A Prince Albert is a chain that is threaded down the penis and is then pierced through the wall of the penis and the chain is then joined to form a loop. "Well, it fucking got caught didn't it. It damn near ripped the whole thing off" he said. It didn't really matter how he ripped it off, but I had to know "Ah, but how did you rip it off?" I asked. He lowered his voice so only I could hear "Ah, caught in some machinery, that's all." There was nothing more he would say and nothing more I could do, so went and got the doc.

Doctor Kassner was the senior doctor on duty that night and he was very talented with a needle and thread. Between Doctor Kassner, myself and nurse Brooke we spent the next hour suturing Mr Jones' penis back together. He was then admitted to the ward for overnight observation and sent home the next morning.

Two weeks later Brooke and I were working together again when Mr Jones came in to have his sutures removed. He certainly looked a lot livlier than his last visit although this was probably because his penis hadn't fallen off and he could pee normally. In fact he was in such good spirits that it was with tongue in cheek Brooke advised him that he should not get another Prince Albert. "You're bloody kidding right?" said Mr Jones.

Moral vs Professional Nursing

2007-11-22T17:35:00.000Z

Again, we have people complaining that if I can’t do something, a specific nursing task because of my beliefs, then don’t be a nurse. That sounds a little intolerant? The nurse who said this obviously hasn’t thought about all the good things that people can do, without going against their values/beliefs.

Nurses are supposed to be tolerant and caring, but so often we and intolerant to each other. Another important thing is compromise and working things out together. If you have a good team of nurses working together, then it is together that you can work with or around people’s weakness/strengths.

Why does everyone leap down my throat when I even mention about nurses not doing ’something’ I’m not talking about picking and choosing patients, I’m not talking about refusing vital care, I’m just getting people to think a bit about their own values and beliefs and how it blends in with their care, ie Does it affect you.

If you say it doesn’t then you either can’t see it, or you’re lying. It’s our beliefs/values that make us who and what we are, they influence us in every decision we make. Even if it means making the conscious decision to go against our beliefs/values to do what is needed for a patient. By making this decision, we are automatically incorporating our beliefs.

Everything is compromise. It would be nice if those people so willing to suggest I should end my nursing career, just because I dare mention that my own values/beliefs could influence my care, could be a little more caring towards another nurse as well as look at ways of compromising with their colleagues.

The question that needs to be asked is: “Where does professional responsibility end and Moral obligation begin?” For example, a doctor may believe in Euthanasia, while you don’t. The doctor asks you to administer a bolus of morphine. Or perhaps instead of administering morphine, they just withdraw care. What is your obligation? What helps you decide how to react and choose what to do?

What if you were working in a country as an aid worker and female circumcision is commonly practiced? What would you do? What if the patient is accepting of this, even wants this as in her culture this is expected? I’m pretty sure you would be in a moral and professional dilemma.

Overall I am disappointed at the reaction of my fellow nurses, to questions which are supposed to make you think.

An Unexpected Hurt

2007-11-21T21:08:00.001Z

I never thought I'd be a nurse. I had no great yearning to heal the sick and comfort the dying. I went into nursing because I thought "Why not?"

After twelve years I don't know what else I could be. I can't imagine not knowing what I do about looking after others. I've even forgotten what it must be like to not know about health and not have an understanding of illness.

What I have found is that I can deal with many sad and traumatic events, and even though it makes me unhappy, I often can keep myself separate from it. But there are times that really do get to me, and it's often the unexpected things. Let me explain...
I remember quite a number of years ago an elderly Scotsman called Mr Donaldson. All the time he was in hospital he never had a visitor. His wife had died several years earlier and his two children lived abroad. He hadn't seen a family member in three years. It wasn't that they weren't close, it was just that neither sons or father could afford to visit each other.
Mr Donaldson had a bowel resection and the formation of a colostomy. He went home two weeks after his surgery. When he went home he looked reasonably well, although understandably weary.

It was near christmas time, and in my part of the world Christmas means summer. This Christmas the whole town was on the street watching as the national pipe band competitions take place. For a whole two hours pipe band after pipe band filed by dressed in full Scottish regalia, kilt, dagger and all.

I was enjoying the parade, and then I saw Mr Donaldson, standing in a shadowed doorway at the back of the crowd. He looked even more pale than when he left. He looked even more thin and stooped. I was close enough to see what looked like moisture in his eyes. His eyes never left those of the pipers. He was wearing a kilt.

I found myself near tears. It felt like this parade was just for Mr Donaldson, as if it was some final farewell.

Another week later and Mr Donaldson was back in hospital. He was anemic, his colostomy wasn't working, and he was coughing up a lung. They took him to the operating room where he died.

2007-11-18T19:13:00.000Z

My Final Thoughts in regards to the male/female nursing issue. I've received a lot of grief from other nurses about genearlly not doing female catheterizaion.
I want to tell one more story, which I hope you read. It may really give you some food for thought.

As a student nurse, the school had problems finding a kindergarten placement for me. The kindergartens around the city didn't exactly have a problem with a male nurse, but the parents whose children went to the kindy did. When I finally found a placement, I was warned by the women who worked there that if certain parents come to see/collect their kids, that I should try not to be seen. Some of the parents only sent their children to that kindy because there were no male staff. What is my point?

The point is, we live in such a society where gender does matter. We live in a society where 99% of sexual assault victims are female. In an ideal world, a nurses gender shouldn't matter, but this is far from the case.

Now, when I began my first job, I received a letter in the mail saying I was accepted and was to spend 6months in ward 16. I had no interview, and I do wonder if the hospital management thought my name a female name. I was sent to the gynaecology ward. It was a job, I couldn't turn it down, plus after six months I would be transfered to another ward.

Now, every single patient in that ward was shocked when they realized they had a male nurse. Sometimes this was voiced to me, and other times the patient didn't say anything, but you could tell from their body language, the look in their eyes, their tone of voice, their general discomfort, that they didn't want a male nurse. Even when they said it was alright, most times they were still uncomfortable.

Now, as a new graduate with this extra hurdle, I had a problem. How did I get around this problem? I began by being far more sensitive to my patients privacy than the rest of the nurses in the ward. For example, when checking a surgical wound for a abdominal hysterectomy patient, I would put a towel over their genital area, and make sure I only saw the wound. When assessing PV bleeding, I had a brown paper bag at the bedside they could discreetly put the pads in and I could check them after. Of course I would ask them how much bleeding they had, but we all know how subjective this can be.

Patients did come to appreciate me and my efforts. I never once saw any of the other female nurses do the little extra things I did to make a patient comfortable. In fact, learning to do these things, was one of the best thing that came out of my time in the Gynae ward.

So, when nurses say we are nurses first, and men/women next, I find insensitive. I wonder if the nurses who say this have given thought to the way society is. I know as nurses we try to be above this, but it must be taken into consideration.

Now, as to my not catheterizing women. One nurse said "Why do you need a chaperone? Do you think you might do something bad?" The nurse who said this wasn't thinking about the world we live in. A chaperone is needed, even the male gynaecologists need one, at least in New Zealand.

This then brings up a practical issue. Why have two people to do a job that only one, needs to do. Why have a women standing watching me do a very invasive, intimate procedure on a woman, when I could be doing something useful to help her, while she does the catheterization.

Another scenario for those mothers out there with 16 year old daughters. In many countries 16 is the legal age of consent, and you are considered an adult. Imagine if your 16yr old daughter was approached by a male nurse. You, the mother is not there at the time. It is explained to her that she needs a catheter. She is nervous, but gives her consent. Is she nervous about the procedure, well probably, but I bet she's a damn sight more nervous about having a guy go down "there". She's probably so nervous that she doesn't realise she can say no, even if you say that you can get a female nurse. How would you, as the mother, feel about this?

Needless to say I would absolutely refuse to do this on a young, teenage girl, no matter what, even with a chaperone. It would not be right for the patient and it would not be right for me. I find it so strange to be called sexist because I care what my female patients think. I find it strange to be called sexist because I incorporate my values and beliefs in my care. Isn't that what makes us good nurses, using our values/beliefs to help provide great care.

For those who say that I shouldn't be a nurse because I "Don't do it all," I say to them, Is there anything you won't do because of your beliefs/values? And is all the good, the people that I have helped, the happiness and sadness that I have shared with patients in the last twelve years, is that now meaningless?

I'm sorry to hear that I shouldn't be a nurse because I don't "Do it all." I guess I'm just a failed nurse.

A caring nurse

A Lesson in Life

2007-11-16T22:02:00.000Z

"What are they doing here?" said Shannon, "They shouldn't be here. It's an emergency room for goodness sake" she added. I nodded my head in agreement, "Yeah, can't they see we're too busy" I added my two cents worth. At the time I had only been working in the emergency room for six months and I like all good junior staff, I was mimicking my seniors. You see, the problem was that we were ridiculously busy, with every bed full and the waiting time somewhere over four hours.

"I wish we could turn them away" Shannon said. Shannon was an incredibly skilled nurse. She had been working in the emergency room for over twelve years. Not only did staff turn to her when they needed help, but many junior, and not so junior doctors had even sought her advice. "Oh well, they'll just have to wait. Maybe they'll choose to go to their family doctor when I tell them that they will have to wait four hours" Shannon didn't sound hopeful.

What had Shannon so irked was that a mother had come in with her two children, aged four and six, both whom had diarrhoea, and both of whom could have been treated by their family doctor. There were always GP patients turning up to the emergency room and many, if not most of the nursing staff had at some stage vented their varying degrees of annoyance at this to one another. I genuinely felt this way myself at one time. But then that all changed.

A number of years ago one of my young nephews got sick with an ear infection. He ended up at the family doctor's clinic. One hundred dollars later he was sitting at home taking his antibiotics and analgesia. The doctor's fee was sixty five dollars, while the medicines took the other thirty five. My sister could afford it, but at the weekend he got worse and we had to see the emergency doctor. This time one hundred and fifty dollars was spent. Fortunately he got better. Unfortunately my other nephew developed an ear infection as well, and cost another one hundred dollars. We're not rich, we are just a normal family.

Now, when I see people in the emergency room who probably could have been dealt with by their own doctor, I am a different person. I'm a much more understanding person. It's not just about the money, it's about coming to the understanding that people often don't know where to turn to. They come to hospital for many reasons but they all have one thing in common. They are worried. For example: Why would you bring yourself to hospital in the middle of the night when all you have is diarrhoea. It's because you don't understand, maybe even you're scared. Sometimes people just need some simple reassurance and some education.

I do still look up to nurses like Shannon and I do still turn to my seniors for advice, but I no longer parrot their cries of despair at the inconsiderate GP patients. I haven't confronted them about their attitude, and it's too late now as I work elsewhere, but during my last several years in the emergency room I did my best to make those often less urgent patients feel at ease and feel important. I guess it's all about caring.

I'm a Sexless Professional

2007-11-13T18:18:00.000Z

I'm a professinal, at least that's what my colleagues say. But what does that exactly mean?
I recently had a discussion with some fellow nurses, all Amercican nurses, and told them that there are certain things that I am reluctant to do as a nurse. One of those things was the female catheterization.
"That's sexist" was one of the more polite remarks I recieved, while one of the more rational arguments was "We are professionals. As long as we behave in a professional way, then we should all have to do the same job." The group of women all agreed on this point. "So, does that mean we are nurses first, then man/woman second?" I recieved some confused looks, then eventually recieved a "Ah yes, well not exactly yes. No, ah Yes." I have asked this same question regarding catheterization of several male nuress, and they all agreed with the women.

Am I the only male who thinks that it is harder for a female patient as well as for a male nurse to do such an intimate procedure? Am I the only nurse who thinks that gender does matter? What harm does it cause if I choose not to do a procedure when there are capable people around who could do it just as well, plus make it easier for the patient.

And what does being a "Professional" mean? From what I'm hearing from others it sounds like I am a sexless machine capable of doing it all because that is what I am paid to do.

Instead I think of myself as a caring carer. I have my faults and biases. I make mistakes and I sometimes let my feelings help make my decisions. But I have a big heart and I do the job because I care first. I enjoy making people laugh when they're sick. I enjoy being able to make a difference in people's lives. I also do the job recognizing my faults, and if I ever think that my views/faults may jeopardize a patient, I know to get someone else to take over that patient's care.

I guess I'm not a very successful Sexless Professional. But I can live with being called sexist and unprofessional, just because I sometimes refuse to do female catheterization. I'm sure there's a lot worse things I could be.

I think I'm an Elitist

2007-11-10T21:03:00.000Z

Yeah, I'm quite comfortable saying that I tend to think less of people from wealthy backgrounds. It's this school that does it too me. More specifically, dealing with the parents of the kids whose health I'm trying to look after.

"I want a real doctor" a parent said to me today, "And then I'm going to sue the school." The woman was from Russia. She had begun the conversation by yelling and screaming, but after hanging up the phone on her several times she seemed to get the picture. "And why would you want to do that?" I asked innocently. It turns out that several Russian girls, along with forty other students, went on a school trip to France. The three Russian girls had shared a hotel room and it wasn't until the end of their three day stay that they noticed some itchy spots on random parts of their body. When they came back to school myself and the rest of the nursing staff concluded that they were bites, bed bug bites that is.

"How dare you send my daughter to a cheap hotel.." I interrupted her "Ah, I'm just the nurse, you need to talk to the headmaster" I explained. "Well, the medicine your school doctor prescribed didn't help at all. I want a real doctor. I'm going to take my daughter out of school to see a specialist." I can't imagine what good a specialist would do, except tell them to wash their clothes and bed linen, but I didn't argue. Wealthy parents, especially wealthy eastern European parents tend to like to throw their money around.

The above scenario is not unique. In fact many parents of the above mentioned ethnic group always begin a conversation by yelling, accusing and then threatening, although it does explain why the Russian Mafia do so well, if this is how the average Russian behaves.

But in reality these children and their parents aren't the average Russian. The average Russian/Eastern European I've met tends to be down to earth, honest and hard working, as well as rather poor. What I do know is that these wealthy parents made a lot of money very quickly over the last 10-20years. It's just a shame they've lost their values, although I suspect many of them had none to begin with. It's also a shame that money can't buy common class.

Trust no one, part 2

2007-11-08T11:29:00.000Z

I was woken early from my sleep by the phone. It was only nine o'clock and I had been asleep only a hour. "Were sorry to call, but it's urgent" said the woman on the line. It was Sheryl, one of the nurses from the agency. "What's wrong, what's happened?" I asked. I wasn't worried yet as I was couldn't think of anything that I had done wrong. "It's about last night. The hospital is furious" Sheryl said. "Can you give me some idea what it is all about?" I asked, still not too worried at this point. "You'd better come in, it'd be easier that way." It wasn't the answer I wanted. "Listen, give me some idea, or I'm not coming in. I should be asleep, and you want me to spend the next hour traveling to your office, worrying what on earth I have done." After several seconds of silence Sheryl spoke. "They said you prescribed and gave your own medicine, and the wrong dose as well." I felt my stomach lurch. "I'll be right there."
When I arrived at the office I was immediately taken to the manager, Miss Smith. She was very direct and didn't waste any time. "According to the charts you gave a patient voltaren 100mg. She was prescribed only 75mg twice daily. Plus you wrote on the chart that you gave 100mg. You're not supposed to write on the chart." I couldn't believe it. "I phoned the doctor, he prescribed it over the phone. I even phone the night nurse supervisor to make sure that it was ok to take a verbal order." Miss Smith nodded her head, "But what about the 100mg of voltaren? !00mg twice a day is too much." "But she missed out on her morning dose, and we had no 75mg suppositories, so we gave her the 100mg. The doctor did say it was ok." Miss Smith didn't look too happy at my words.
"And can you name this doctor involved, or the night supervisor?" asked Miss Smith. My mind was a blank. I'd had to phone three doctors as well as two night supervisors, none of whom would come to the ward. I shook my head. "Well then you're going to have to find out the doctors name. We've also contacted both night supervisors and both deny ever receiving your call and state that they do not allow verbal orders over the phone." I was struck speechless. My head was in a whirl. I felt that this wasn't really happening. Surely I would wake up in bed and find it was all a bad dream. "Well screw them, screw them all, this is bulshiit, utter lies" I was in a rage now. I have rarely felt so utterly full of wrath. For the first time since I had seen her, Miss Smith looked sympathetic. Perhaps she actually believed me. "Is this normal protocol? Am I supposed to carry out my own investigation? Am I supposed to ring around the hospital and interrogate the doctors and nurses. You've got to be kidding. It's my word against two senior nurses. I don't stand a chance. They are covering their own butt, that's what they are doing."
Miss Smith did believe me, and over the course of the next 24hrs the matter was dealt with. I was not to work in that ward again, or to be in charge again. I do find it ironic that I had never been asked to be in charge and was not only put in charge without my prior knowledge, but was left without another registered nurse to work with.
Eight years passed before I worked at that hospital again, this time in the emergency department, and guess what, they do take verbal orders, hospital policy does allow it. But I no longer take any verbal orders. I learned my lesson the hard way. When you're an agency nurse, you can't trust anyone, especially when the shiit hits the fan.

Trust no one, part 1

2007-11-07T20:48:00.001Z

Four years as an agency nurse in London means four years of trusting no one. My worst experience happened at one of London's most prestigious hospitals.
I turned up to work the night shift. The agency had said the hospital was desperate for another nurse. Not exactly encouraging words to hear, but I knew not to take offense. I took the job.
"Thank goodness you're here. It's very good of you to come at such short notice" said the nurse in charge of the afternoon shift. "Have you worked here before?" she asked. I shook my head. "Well I'll show you round then give you a handover." She then introduced me to Sheena and Irene, two nurse assistants that were on for the night with me. Sheena was from another ward and had only worked the occasional shift in the ward. She was only slightly familiar with the place, while Irene was an agency worker as well and had never even set foot in the hospital let alone the ward. "Ah, where's the other nurse?" I asked, naturally assuming that I had another registered nurse to work with. The charge nurse looked a little surprised, "Ah, didn't the agency tell you?" she said. I shook my head. "We couldn't get another nurse. You're our RN. You're inc charge tonight." I felt like I was in some kind of bad dream because this just couldn't be happening. I took the tour de farce with the charge nurse then began my shift.
Sister Grant in the side room was an seventy something nun in need of some pain medicine. According to her drug chart she had not been given her morning dose of voltaren. Voltaren is a analgesic similar to Ibuprofen. The drug was to administered as a suppository, or bullet up the backside. I was presented with several problems:
1. I was not going to near the private parts of a nun. She would be horrified.
2. She was prescribed 75mg of Voltaren twice daily. According to her chart she had missed the morning dose. The patient also said she had not had it.
3. We only had 100mg suppositories. I could give her the 100mg as she had missed her morning dose, but would need to get the prescription changed.

I tried to solve the problem by phoning a doctor. I called the medical doctor on duty that night to come and change the prescription. He said that I needed to call the surgical doctor as it was a surgical patient. I then called the surgical doctor who said it was a gynaecology patient. I called the gynae doctor who told me that because he was a private patient, originally under the care of a surgical consultant, I should call the surgical doctor. Needless to say I was rather confused.
After ten minutes I finally managed to get a doctor who agreed that she was his patient. He was the medical doctor. It turns out that Sister Grant began as a gynaecology patient, which unsurprisingly turned out to be a general surgical problem. The surgical problem was solved but she then developed a medical problem, and was then transferred to the medical team. The doctor then said that he couldn't come to the ward as he was too busy and offered to give me a verbal order to give the 100mg voltaren suppository. I said I'd call him back as I wasn't sure if I could take a verbal order.
I then tried to phone the night supervisor for some advice. I was put through to the first advisor, who advised me that she was responsible for the other side of the hospital and gave me another number to call. I finally got through to the correct nurse supervisor. I explained the situation with Sister Grant. "Can I take a verbal order?" I finally asked. "Yes" she said. I called back the medical doctor and said I would give the 100mg voltaren suppository.
I asked one of the assistants to give the suppository and the problem was solved. Or so I thought.
My real problems began the next day.