Can't get enough of those basics

I think I'm quite lucky because I learned some very useful lessons withing my first year of training that have stayed with me. Unfortunately in most places I have worked since I left my home hospital, it seems that many people never learned the lessons I did. Confused? Well here's what I mean.

As a male I tend to be a touch on the messy and disorganized side. When I first started work my patients rooms were clean but not so tidy, with books/magazines left sitting on the cabinet or patients table. If a visitor had left a chair in the room, I would leave it there, thinking that they will use it tomorrow. Sometimes I would leave food/drinks on the bedside cabinet/table. Other times I would let the room become crowded with gifts that relatives had left behind, things like flowers, chocolates, wine etc. Then one day that all changed.

"You really need to keep things tidy" Jan explained to me one evening before I was due to go home. It had been a busy afternoon and I had done all the real big, important jobs, like take care of the blood transfusion, kept a close watch on my big post op patient, and felt quite confident that I was doing a good job. I was a touch offended by Jan's comment. "What's wrong?" I said a little too defensively. A comment like this from Jan, a nurse with nearly forty years experience hurt. "You can't leave the rooms cluttered at the end of a shift, especially the end of the afternoon shift" she began to explain, but I interrupted her "'I've been so busy, besides, it's only going to get untidy tomorrow. I've looked after my patients well." Jan made me sit down and told me an important lesson.

"It's not fair on the night staff, or the patient" she said. "It's a nightmare for the evening staff to have to wade through the room worrying about tripping over things and knocking things over" She had a point. I had not given any thought to the night staff. "And there is the safety issue as well" she explained "Imagine if something happens in the night and they have to rush in, with an arrest trolley and all. It makes it real difficult." It was a simple explanation and I promised to make an effort.

That night I had my rooms spotless. All chairs were removed. All food/drink put away, along with books/magazines. Extra things like vases of flowers etc were either placed in a safe part of the room, or removed for the night. The room looked spotless. I just wish I could make more effort on my own room.

It was as fate was watching me that night. When I turned up to work in the morning I found out that Mrs Jackson had suddenly and unexpectedly passed away. She had been one of my patients whose room I had made spotless. Jan was there with me as I heard the news. "Did they have any trouble getting in the room" I asked my charge nurse. "No problem at all" the charge nurse said, "The night girls even mentioned that your rooms were particularly spotless." Jan gave me a sly smile.

That lesson has stayed with me ever since.

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Nurses should never rise above it all

More and more, nurses are doing things that traditionally were the role of doctors. From taking blood, setting bones, prescribing medication, the list is endless. Our role has changed, but not always for the better.

In British hospitals I've often found nurses either too busy to do the basics, such as washing a patient, turning patients in bed, toileting, or even doing patient dressings. Often I found a nurse assistant doing a wound dressing and I wouldn't even get to see how the wound was progressing. Often these assistants are only doing as they have been instructed, which is understandable as six months ago many of these helpers were working in the supermarket.

Nursing means taking care of a whole patient. It's not taking blood, giving antibiotics, changing infusions, prescribing medication. All of these jobs are a part of what we do now, but they are useless if the basics are not performed properly. It's no good giving a patient the latest antibiotic if he hasn't been turned for two hours and his pressure sore has broken down and become infected.

In the very act of performing a bedsponge, you automatically do an assessment of a patient. You look at the heels, elbows, buttocks and other pressure points. You feel the skin under your hands, is it soft, brittle, dry, hardened. You talk to the patient, are they confused? You see how well they move as you roll them around the bed. You listen to their breathing, are they coughing when you turn them. Do they feel warm? Does he or she open their eyes?

Some nurses don't have time to do this, while many other nurses think they are above these jobs. More than one charge nurse, or even just a senior nurse, has refused to help me lift a patient up the bed, even though they were they only staff around at the time. "I'm too busy" or "Find an assistant" are the usual responses.

We can't afford to be too high and mighty to do the grunt work. It's an integral part of the job. I guess I'm just a modern old fashioned nurse, and always will be.

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Dirty old place called Hospital

MRSA. That stands for drug resistant bacteria, the type that keeps on killing people again and again in our hospitals. Governments in all the industrialised world are spending countless millions trying to combat this problem, but are not having much success. Why are they having no luck? Let me tell you the story of ward thirteen, the 35 bed surgical ward I've spent the last few weeks in.

There's vomit on the floor. It's not unusual, it does happen. I'm used to cleaning up the occasional bit of vomit, but the cleaner is here with me. She just happened to be in the room when I noticed it. "Can you please clean it up?" I asked the woman. She shook her head "It's against the rules" she answered.

It seems rather strange to me, a cleaner with a mop, not cleaning up the vomit on the floor. I asked the silly question of "Why not?" "It's a body product, and we aren't allowed to touch that. We don't have the training." I don't actually have any training either, I must have missed the lesson in nursing school about how to clean up vomit, but I have to do something.

I asked her to give me her mop. "It's against the rules" she replied again, to which I asked again, "Why?" "You're not trained to use my equipment. If you injure yourself or anyone else I could lose my job." As yet I've never managed to harm anyone with a mop, although I was beginning to have some serious thoughts of how it could actually be done.

Next step is to go to the cleaning cupboard and get a mop and soap-like stuff. I should have guessed, the cupboard is locked. "You can't go in there" I was beginning to think the cleaning lady was stalking me. As it turns out the ward doesn't own any cleaning equipment. The equipment belongs to the cleaning company that is hired to clean our hospital. The cleaning company is terrified of being sued, so strictly enforces rules about body products and use of it's tools.

The result is that I clean up shit and all sorts of stuff with a towel which is pushed around by the sole of my shoe. Sometimes I put on gloves and get down on my hands and knees to clean crap up. It's impossible to keep my uniform clean, so I take it home and try to get it cleaned and dried for the next day as my other uniform is still in the washing machine, soaking wet. I never like taking my uniform home as I'm not really keen on spreading hospital germs to my wife and children, but hospitals no longer do staff laundry as it saves them quite a bit of money. In fact it's another outside agency that now does the laundry, so I guess they really need to save some money somehow. It would be so much easier if things were done the old way, with the hospital taking care of its own business, taking pride in doing a job properly, because none of the outside service people that I've seen seem to give a damn.

I wonder what new plans the government will come up with to combat hospital infection???

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The Brits don't wash

Everyone makes fun of the French, especially the Parisians, about their lack of bodily hygiene, but the British are pretty bad as well.

The ward has two bathrooms for 35 patients. The toilets are too small to manovour in a chair on wheels, have no handrails, and it's a bloody circus act trying to help any of the elderly patients a little less nimble. The damn showers are a nightmare as well, with a big step at the entrance which makes it impossible to wheel the chair in.

It's probably just as well as there is no room to move in there even if I did manage to get patient and chair in. Poor Mrs Knight, she hasn't had a shower in the three weeks she's been here. She keeps on washing herself with a facecloth at the bedside every morning. I don't have the heart to tell her she needs a better wash, so instead I said I would take her to the shower.

The pressure is now on. Mrs Knight has just half her foot amputated. The surgeons just cut it off, no stitching together, and every time I look at the foot, it's just a big gaping wound. Can't see it healing, but the doc's obviously know more than me. We made it to the shower, it was a tight squeeze, and even though she nearly tripped over the damn step at the entrance to the shower, she's very happy to be clean at last.

As I couldn't fit a seat in the cubicle, she spent the duration of the shower leaning on me while standing up, holding her foot off the ground. She wasn't even embarrassed to have a male standing there holding her up as she washed herself because she was so grateful to be clean at last. Back at the bedside she kept on thanking me over and over for taking the time to help her.

I didn't actually have the time to spare, it is a busy surgical ward after all, and I have 10 other patients to look after. They're all overdue for thier morning meds. Oh well, I may be late, but I did the right thing. I did the small things that show patients that I care.

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