If I had the Power

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

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

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

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

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

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

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

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

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

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

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Common sense is just catching up with me

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.

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What's wrong with the NHS

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.

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Management vs Saving Lives

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.

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Dress Code

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.

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How hospitals kill and get away with it, all the time

Infections, drug resistant bacteria, patients lying in their waste for hours on end. Medications given at the wrong time, not at all, or even the wrong drug. Why is this becoming more of a problem. The answer is simple, even though management can't seem to grasp the idea that having enough staff saves lives.

Sixteen surgical patients is more than enough work for two registered nurses, let alone one. I couldn't keep up with any of the things that needed doing, as there were patients fresh from the operating room, patients ready to go into the operating room, as well as all the intravenous fluids to give plus all the intravenous drugs and other oral medicines. I didn't have time to do any of the remotely humane things, like help feed patients who can't help themselves. The number of times I've seen untouched dinner trays sitting beside, but just out of reach of helpless patients is countless. Also countless is the number of times I've seen patients lying in bed all day, or sunken into their lazy boy chair, with their chin resting on their chest, and their wound dressing sitting on the floor, while the wound itself leaks a straw colored liquid tinged with red.

But sometimes I am given an assistant, usually a student nurse trying to make some extra money, or someone who decided to give up packing groceries at Sainsbury's and after a few months of training is supposed to be able to make my job bearable.

No nurse that I know likes seeing these things happen, we try our best with what we have, but it is so often survival nursing, and not the caring nursing which we really want to be. Management seem to forget that it's the caring side of nursing that saves lives and reduces complications. A perfect example of this is the stroke patient.

Mr Jones was 65yrs old and had a mild stroke affecting the left side of his body. By mild I mean he could still move his arm and leg, although the finer movement of his fingers was lost. With rehab, physiotherapy and good basic nursing skills he could come out of this with most his parts working.

0700hrs I begin a quick ward round to get my patients ready for breakfast. I have to be quick because I have patients who need to be ready for theater by 0715hrs. This is one reason I hate it when medical patients are mixed with surgical patients, everyone has a tight schedule to keep. I sit Mr Jones up in bed and place his bedside table in front of him, ready for when the breakfast trolley comes around.

0715hrs The theater porter moans at me because Mrs Smith isn't ready to go to theater. "She's in the toilet. You're welcome to tell her to hurry up" I tell him. He shuts up. I take Mrs Smith to theater five minutes behind schedule. The nurses in theater are a vicious lot and kept me waiting another ten minutes when I got there. I eventually return to the ward.

0735hrs Mr Jones has slipped down his bed and fallen asleep with his head on his chest. I grab an assistant and together we sit him up again. He grabs the cup of tea that has been placed on his table, but it's cold. I offer to get a new one.

0745hr I still haven't got Mr Jones his tea because I ended up answering two call bells and helped two people use the commode.

0810hrs Not sure where the time has gone, but I'm due to give my patients their intravenous antibiotics. I remember about Mr Jones and his cup of tea, but have to put it aside as I spend the next half an hour injection medicines into veins.

0850hrs I finally get a chance to check on Mr Jones. He's slumped in his bed again, his breakfast untouched and the cold cup of tea still sitting there. I look for an assistant to help me get him up, fed and watered. I make a promise to myself to make sure this gets done. I search for five minutes until I find someone available to help me.

0900 I am back at Mr Jones' bedside and have him sitting out on a chair. The movement has obviously stirred him up as he begins to cough, a moist, infectious sounding cough. I make a mental note to make sure to tell the doctor about this. The last thing he needs is pneumonia.

0903hrs One of my patient's bells is ringing. In fact it won't stop ringing. It's probably an elderly patient who has sat on their bell, but I have to go and investigate, it could be urgent.

0904hrs It's not urgent, it is only Mrs Bailey sitting on her bell. She apologizes profusely. I'm about to go back to Mr Jones when Mrs McDonald, the woman sharing the four bedder room with Mrs Bailey, says she urgently needs a commode.

0915hrs I'm back at Mr Jones' bedside. I've warmed up his toast in the microwave, and have a fresh cup of tea. I begin to help him eat when Sharon, the charge nurse comes into the room. "Have you done your medications yet?" she asked me. "No, I've been too busy" I reply. She frowns at my remark. "What are you doing with Mr Jones?" I thought it was obvious, "Feeding him" I replied. She seemed to disapprove of what I was doing. "Your assistant can do that. You have more important things to do." With that she ushered me out of the room and I began to do my medication round.

1030hr Medication rounds for sixteen patients take forever. It doesn't help that there are always medicines missing from the trolley and half my time is spent tracking them down. I finally checked on Mr Jones and he's fallen asleep in his chair, his chin on his chest. His breakfast trolley has been removed, but I know for sure that he has had nothing.

1045hrs I was supposed to have a morning tea break, but instead I spent it feeding and watering Mr Jones. It's the only attention he's received all morning.

That was a typical morning in a London med/surgical ward. Conditions are often worse. Over the course of two weeks Mr Jones developed a nasty pneumonia. His breathing became so labored and his lungs so shattered from infection that he eventually stopped breathing. The doctors and nurses made quite a heroic effort to save him, but to no avail.

Mr Jones could have been saved. All he needed was a bit of proper care.

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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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