Up To Your Neck In It.

Driving on to work I watch the sun come up, it looks brilliant orangey red. It shines off the wet road. There are many stars still twinkling, I still feel cold although I have my heater on in my car. I am tired and I dream about ways of moving out of nursing. I long to work normal hours instead of twelve and a half hour shifts on rotas which means I can never plan anything anymore. My working life is going nowhere and I went to university to become everybody’s skivvy. I was never prepared for this job. I was taught very little at university. So much for training being fifty per cent practice and fifty per cent theory, that is a laugh. I was struggling to get the opportunity to practice as a student nurse and now I am just expected to get on with it. So much for being able to use research based practice. If I try anything different I need to challenge the routine drones who shout, ‘we do it this way here’, but they never question why. How dare I challenge the nurses? Anyway, what nurse has time to look up the internet to check on practice? How many times I have been told off for sitting down at the computer checking up the correct nursing procedures? Did you know it is a sin for a nurse to sit down on a ward? Even the heavily pregnant ones who are due sit down breaks are made to feel bad for sitting down. Universities are so out of touch with the realities of nursing. So for instance if I need to find something out about practice I need to go home and look it up, if I remember after a twelve and a half hour shift. The question is how many nurses actually use the computer at work to educate themselves? Anyway, why are we doing twelve and a half hour shifts if it doesn’t suit us or fit in with family life? Just how safe is this anyway? Would you seriously want a nurse to give you your insulin in the morning after twelve hours of work, if she didn’t sleep much? In all honesty, I wouldn’t as it is dangerous. Let’s face it, we are human and need rest. Some time ago when nurses gave out drugs on a drug round this was all they did; they did not need to answer phones and buzzers at the same time, distracting them from the job in hand. In all honesty wards are unsafe, too many patients with many needs, too few nurses, too much paperwork and tasks to do all at the same time. Distractions are plenty. Let us look at the role of the nurse? What is her/his role?

Tasks are a Plenty

The nurse comes on shift listens to the handover of the patient; this is her bible on the patient for the day with requests and expectations. If you miss something at this stage, you could miss something vital. You need to be alert and listening. When you get on to the ward you will already have some idea of what to expect for the day. The day starts with the drug round if on a safe ward. If not, the night staff would have given out the drugs. Oh dear, how many errors? Anyway, after this or during this the breakfasts arrive. Patient buzzers go at the same time to get help to the toilet. IV fluids come to an end and the pumps beep to remind you. The phones start ringing from relatives asking the nurses how the patients are. Physiotherapists arrive on the ward and have specific demands. Occupational health workers also come in asking specifics about the patients. Meanwhile, after breakfast it is time to get patients up and dressed to sit all day beside the bed. Nurses go into the poorly designed showers to get feet and clothing wet to carry out their duty of cleaning the patients for the many patients that are too ill or physically challenged to manage on their own. Doctors come around and the nurse needs to tag along to hear the progress and share information.

After this, it is time for the measly half hour break to eat something. Sitting with soaking feet and dishevelled hair with a bowl of cereal before combating the next bit. Some patients can go home and this is often a good time depending on the pharmacy order which is often awaited depending on if the nurse gets it in on time. Again the drugs for the patient to go home with are dependent on the nurse. Lunches arrive and the patients also need their drugs. Lunches and drugs are given with little time to ensure patients actually eat. Food charts and fluid balance charts are guessed on and filled in as haphazardly as always. What about wee Jessie in the corner did she eat her lunch before it was whipped away? Nobody knows! She may be starving but can’t communicate. The nurses had been too busy to notice if wee Jessie ate. It is now time for wound redressing if they were not managed this morning. The phones go constantly as relatives, doctors, OT’s, community nurses and blood results phone in. The bleeping of IV fluids goes as a constant reminder to change the bag. Patients who are too ill and are in bed need constant turns to stop bed sores. Patient buzzers go all day to ask for help to the toilet. New patients come in; paperwork needs done for all patients. Don’t forget constant observations, blood pressures, oxygen saturations and temperatures. For those that have slipped downhill the docs need to be made aware. Patients vomit and need injections to stop it. Relatives come in to visit and the whole ward is swarmed in visitors at the same time. They ask all sorts of questions and sometimes get angry because they can’t understand why we are not standing over their mother or father the whole time. The demands are always raised during visiting times. We get another half hour break. After break it is tea time and the patients get the usual routine as lunchtime and breakfast time. Patients often soil themselves, they can’t often help it and it is normal for us to need to clean it up. Sheets, clothing and bedding get covered in it. We always hide this part of nursing but why it is human nature? Someone needs to clean it and both nurses and care assistants deal with it. It is not a nice task but it is the reality of nursing. Can you imagine then the wards that have diarrhoea and vomiting outbreaks? We change bed after bed and the whole ward smells. We go home smelling of pooh with our disgusting uniforms which slip neatly into our washing machines at home, then they wonder about why we end up ill and pass it on to our families. We do not want to take out uniforms home. Scrubs for all laundered in the hospital and kept in the hospital is the answer. We get another half hour and that is if lucky. We are only entitled to one hour unpaid break.

The End is Nigh

Anyway, it is time for patients who are not in bed to go to bed and prepare to give the nursing handover to the night staff. It is always a worry that enough information is handed over. Oh and do not forget to hand over the drug keys from the uniform pocket this may mean a drive back to the ward.

Above is the broken down version of the nurse’s role, there are many more little jobs, like fetching and carrying and accompanying patients places. When the patient becomes really ill then we also need to deal with this. Can you imagine this for thirty patients with two or three nurses and a care assistant? Remember we always run short when nurses go on break? If three members of staff get one and a half hours each for break that is four and a half hours we run short of staff. Do any of us really have time to train students?

Chocolate Break

I have worked hard today in this rotten ward with no support or friendliness from any of my colleagues. I am isolated. This ward is full of cliques and I am situated in the old part of the hospital. Jabba the Hutt the obese nurse works here and she loves to eat chocolate Hob Nobs while I run about doing her work. I worry about the state of her health and fear she will have a cardiac arrest as she sweats profusely with the thought of work. It is hardly surprising she has no energy and she is not promoting good health to the patients. We live in a society that has to be politically correct and we are no longer able to manage our overweight issues which affect health. It is not being un-politically correct to state that on a regular basis we as nurses hurt our backs attempting to slide obese patients up the bed. Because we are understaffed we do not have the manpower and it is common for two small female nurses to pull a heavy obese patient up the bed. Slide sheet or not, it is hard work. I recognise obesity is a problem in this day and age and even recognise that it is difficult to keep the weight off but we could at least manage the work load if we had more nurses on the ward. Nurses who are overweight in the NHS should be given priority to a free gym pass. In fact, give us all one and build a gym in the hospitals for us. We are on the front line of promoting health and we should be good specimens within sensible reason and how dare any nurse who is grossly overweight from overeating with no exercise tell a patient who is overweight how to lose weight. Those in glass houses and all that! There is always the exception and that is those that have medical conditions which cause a weight increase. Those of you that fit this category can relax; I am not including you in this. There is another way to look at this, working twelve and a half hour shifts promotes poor health in an unhealthy environment. Can we really be promoting good health working like this? Who are we kidding?

SHRITE Sister Your personality is Showing

I am under the rule of a new sister blue office troll. I can only call her Sister Elizabeth and she is on HRT. HRT stands for Hellish Righteous Toad. Sister Hellish Righteous Toad Elizabeth is her name. Abbreviated is SHRTE. Sounds like...... anyway, she is no nice woman and watches me carefully. She knows I have gone to my union and she wants to dispell any rumours about her ward. She speaks to me as though I have slid off her shoe when nobody noticed. I am not favoured by her at all. She wants to speak to me but not today. I am to see her tomorrow. I go home looking at the setting sun and listening to the radio which informs me ‘Scottish NHS bullying running at 50%
5 November 2001: a confidential survey by Grampian University Hospitals Trust reported in The Scotsman reveals that nearly 50% of staff working for a leading hospitals trust have been bullied at work. "Undue pressure to produce work" was the largest single cause of bullying. This figure of 1 in 2 echoes Charlotte Rayner's seminal survey from Staffordshire University Business School in June 1994.’

The Beginning of the End.....

This is now 2008 and my story is just beginning.

Brainwashed

My mum is so old fashioned with views that could sink a battle ship. I go to visit her on my day off but I have more battles with her. She kept telling me that I need to settle down and have a husband look after me. She said I should not be working at all. She was blaming me for being outspoken. ‘Women should know when to keep their mouths closed’, she would say. I could feel the annoyance as I sat staring at her perfect little world obscured by society’s realities. Oh, to pull off her rose tinted glasses and put ‘my world’ specs on to her glazed over eyes. I told her that she should be proud of me, for here I am independent and with a view of my own. I pitied her, for I know she was a mere servant to my father and times did not allow her to live. They did what they were told by society and society was telling her how to keep her daughter in line. Socialisation breeds herds of sheep and my own parents trotted along with flock. My mother told me that if I had not been outspoken my first relationship would not have broke down. It was my fault because I must have said too much back and I am not content to be the housewife. I am outspoken, that is me. Thank you mother, you taught me not to be like you. However, I am not yet outspoken enough to deal with the bullies in nursing, I would go to work and do what I was told, like a good little girl. Just because I did not speak out openly did not stop my brain from speaking out. Alarms bells rang in every ward about how wrong the culture of nursing is, except for the few exceptional nurses of course.
I would lie awake every night wondering what I could do to make things right. This night was no exception and I lay in bed dreaming. The big black crow appeared again as it so often did, looking down waiting to swoop. The crow was about justice for all the wrong doings. At first I was looking up but then I became the crow looking down. I am eyes and ears and I see and hear everything but how do I tell everyone what goes on? I have no voice. I watch the breakfasts dished up to the patients, who is ensuring those who are weakest are fed? Heavy duty painkillers and antibiotics, dehydration with little food is enough to floor the strongest let alone the weakest. ‘Come on Mrs Brown you need to eat and I have no time to stand here and feed you because after lunch I need to hand out your tablets, there is only one of me to fifteen patients right now, how do I manage this workload?’ The nurse looked stressed and worn and was doing her best but her best was not good enough, she was understaffed. She would give out the drugs but was so distracted by the millions of jobs in between she would forget to sign for drugs and leave drugs lying around. She heard a moan from the corner of the ward and realised that the patient had soiled herself again. She looked at the distressed patient and it was up the patient’s back. Nobody was around to help her clean the patient up and she was in the middle of the drug round. What could she do, the patient is too heavy to lift alone? Relatives walk in and find their mother covered in faeces. Sister comes out her office to discover the angry relatives. Instead of being understanding Sister blames the nurse. Finally after months of this, the nurse snaps and gets angry, patients and colleagues suffer, so long as the jobs are done, who cares about being nice, being nice has no place in nursing. As for smiling, that is well wiped off the nurse’s face. Who is this nurse? The nurse is the seventy per cent of nurses. To get the job done they learn to bully because they do not want Sister breathing down their neck. Sister is the evil dark blue Troll who lives in the office and only comes out to belittle the nurses. They feed the culture of bullying. They are at the top of the bullying hierarchy. I fear becoming one of that seventy per cent that it haunts me in my sleep. I wake up from the alarm on my phone. I go through my usual routine to get to work. I work beside an angry elderly nurse who bosses me around. Patients get a bed bath at 5am in this ward. I stare up at the cracks in all the paintwork and the tiles in the ceiling are loose. The sinks have seen better days and it is impossible to get near them due to the patients beds. Many nurses in this ward ignore washing their hands just because it is part of the culture. This ward is an exception; it is not like other wards. It is the quintessence of evil wards. I would like this ward condemned along with the heartless mean staff that run it. Run in and save all the patients then cover it up for all eternity in dirt. It holds up to its well known reputation. Nobody wants to work here and there are always vacancies. Everyone knows about their bullying. What does HR do about it? They do nothing, for they know what goes on here but choose to ignore it. One nurse after another leaves and some odd nurses stay to join the ranks of the bullies. The bullies have become one big gigantic ego driven organism feeding off any new staff coming in. Dr Who writers could never dream up such a disgusting nausea filled monster. HR does not have the guts to fight that type of monster and so it eternally lurks in the old part of the hospital waiting to pounce on new recruits. Join nursing if you dare for you may be sent here. I never knew that women could be so hostile and so brash with patients. If I disobey them, I will suffer. How do I escape this ward? I consider giving up nursing for good and quickly go home after work to apply for jobs. Supermarkets are beginning to have some appeal to work in. How did nursing get so bad? Working in Sister Poppins ward was heaven compared to here. How do I get out? I sit in my car staring out at the setting sun which I missed again today, wondering, how people have become such sheep and how they say nothing but follow everyone else. I am no follower but I am alone. I have a long hard road ahead of me and I can see nothing new on the horizon.
"Every Day Is Exactly The Same"

I believe I can see the future
Cause I repeat the same routine
I think I used to have a purpose
But then again
That might have been a dream
I think I used to have a voice
Now I never make a sound
I just do what I've been told
I really don't want them to come around

Oh, no

Every day is exactly the same
Every day is exactly the same
There is no love here and there is no pain
Every day is exactly the same

I can feel their eyes are watching
In case I lose myself again
Sometimes I think I'm happy here
Sometimes, yet I still pretend
I can't remember how this got started
But I can tell you exactly how it will end

I'm writing on a little piece of paper
I'm hoping someday you might find
Well I'll hide it behind something
They won't look behind
I'm still inside here
A little bit comes bleeding through
I wish this could have been any other way
But I just don't know, I don't know what else I can do
Written by NIN

Night Shift

It is 15.30 and I need to get up for my night shift. I stare over at the flashing red lights on my alarm clock wishing I could lie here just extra few hours more. I haven’t slept well, I was on day shift just a day ago and my body clock has not adjusted at all. I will need to try to have something to eat before work and I find it hard to eat through the night. It seems so abnormal. I eat some pasta and throw some fruit into my bag. I drive through the dark city as it all winds down for another night. It is cold and I turn up the heating in my car. I have my music to wake me up but I am tired and wonder how I will get through tonight. I stare up at a shining star that looks so lonely I also feel quite alone here but I know deep inside I am gaining strength to fight on. I get to the car park entrance and notice that spaces are few. I wander up the stairs feeling the dread build up with each step. I go into the ward but it is quiet and the smell of finished cooked food hits my nostrils. I see relatives sitting around beds like they were sitting around a camp fire gaining warmth, realising how precious these people in beds really are. A relative looks up at me and smiles saying goodbye to me as he walks gingerly out the door. I do not know this man but I am a nurse and my duty is to be happy and polite even though sometimes I feel miserable. I say goodbye to this relative I may not know him but I do not know his pain either and for that reason I have to be polite.
I sit in handover listening to this god awful tape with blurry sounds and no way of understanding spellings and pronunciations. I hope nobody sees my handover sheet. I beg anyone to listen to a tape of anyone speaking and try to copy down what is being said. Let’s face it, we are a multi-cultural society and I do not know spellings of names from many other cultures by someone attempting to pronounce it on a blurry tape. Print outs are better and accurate. I go out on to the ward; I need to look after eighteen patients with another nurse and a care assistant which seems not too bad. One patient is quite ill though and may not get through the night and another patient has just been diagnosed with cancer. I get the patients settled for the night and the male patient who was diagnosed with cancer sits staring blankly into the air. My instinct wants to walk away from him because it means confronting the situation and I know that his situation will hurt me inside too because I guess I am very empathic. My nature however, tells me it is my duty to speak to him and spend time with him. You know when someone gets a diagnosis like this it is always the small little things that make life for the patients hard. I list many support groups but I sit on the chair by the bed understanding the patient and what he is going through. He does not have children but always wanted them and so many things in his life are left unfulfilled. I can’t make everything right but I can be there and that’s all that matters. I know I have other patients to attend but I need to give this patient my attention too. He does not look ill but inside his head is swirling like a tornado and I need to put some calm in there to be able to help him think rationally. We are nurses, taught to care for the physical ailments of pain but of the psychological pain many nurses do not know how, but it is our duty to be there.
The patient breaks down in tears and I wish I could wave a wand and make it all better but I can’t and so I am filled with his pain in this same room. I am sharing his pain, it rips me apart. I give so much more of me than what I get in my pay. I should cut off from the hurt of people’s pain but I am definitely human and I have a duty. I sigh with a heavy heart as I walk slowly out his room; he is only thirty years old, and why is life so cruel?

Sleeping Salvation

All the patients are asleep now or at least I think so. I wander back and forward in the night looking at the patients. It is time for my hour break at 3.00am and I go to the staff room. I set my alarm on my phone and sit on the chair and accidentally nod off. Abruptly, a big nurse walks in shouting that there is to be no sleeping in the staff room. I awake suddenly, to see an overweight nurse shouting at me about sleeping. Hang on I think, this is my hour, I am not being paid for it and I am not on duty. I ask her what I have done wrong. She said that if I was needed in a hurry I would not be fit. I said that I am not being paid and did not need to go back to work until the end of my break. I said that if this was day shift I could be in the staff canteen for an hour and no-one could get me there. I also said that I did not sleep well in the day time which is quite common for those on night shift. The nurse mumbled something back at me but to be honest I did not care.

Breaks are For Resting!

Night shifts are strange because nobody admits to needing a sleep but everyone is tired and nobody admits to sleeping on their breaks in case they get into trouble but many nurses do it. Oh dear, I have given away a little secret. It is obviously more productive to have nurses that power nap on their break because they will be more refreshed. It has been scientifically proven that power naps work and are more productive. I mean, many nurses still need to give out drugs in the early morning after a twelve and a half hour shift. I know if I was to get drugs from a nurse who had been awake all night I would rather it was from the one that had the power nap.
I go back to the ward feeling better for my nap and see that there is a patient who is not too well. The other nurse was not aware. I tell her that the patient looks ill and I check observations. Observations say it all; the patient is not to be resuscitated as he would not make it anyway. I hold his hand and stroke his forehead as he passes away very peacefully. The relatives are on their way already. We deal with the patient in the usual manner and get him ready for visitors. Other patients sleep through the night oblivious to the events. The other nurse yawns as she shoves in crisps to her mouth like a steam train needing coal for fuel. As for me, I have slept and am wide awake and have made do with fruit all night. We dish out drugs in the morning and check patient observations. We ensure that our fluid balance charts are done and that patients are comfortable. After handover, I walk along the ward and each patient thanks me for my care. The patient with cancer speaks to me and shows hurt in his face. He taps me on my arm awkwardly saying thanks for my kindness. He has tears in his eyes and I know I must go. I wander down the stairs and pick up a newspaper as I leave. It is cold outside but it is sunny again and it hurts my eyes but it feels good.