Out With The Old In With The New

It is past midnight and I can hear cheering.I walk up through the close and all my friends who said they would wait for me have gone. I knew they were drunk but not that drunk. I felt lonely and scared, I was all alone. I look up the hill to the big clock and see swarms of people all cheering, arms swaying in the air, staggering in drink induced happiness. I am not happy for I am alone. I walk up the hill towards
the big clock, cars drive by and their tyres are noisy on the cobbled roads and I am splashed as a car’s tyres trundle though a puddle. A man stands in a door way which has kilts in the window; he holds a cigarette and turns to me saying, ‘have you got a light miss?’ I reply by saying, ‘I am sorry but I do not smoke.’ ‘I see you are alone’ he says. I think for a minute and reply,‘no, my friends are up beside the clock.’ ‘You do not want to be alone tonight girl’, he states. I just ignore him and continue walking up the hill. I try to walk through the crowd as some of them try to shake my hand. A few of them jeer me, as I must look unhappy. ‘Cheer up hen, it’s no that bad,' one very straggly looking man states. I push my way through them all and walk down a banana shaped road with row upon row of shops. There are hardly any people in this street. I hear footsteps and look behind me. It is the man that asked me for a light. I am really frightened I just know he is following me.

Out of Breath


I walk faster and I hear his pace pick up too. If I run he will know that I am aware of him. I must run it is my only way to escape. I run down the hill towards a small roundabout and run across the road. I look around and see the man run too. I must find a taxi but there are few and they are all full up tonight. I am now running up a hill and my legs feel heavy. I look up and see a big monument which looks quite eerie and black. I keep on running and get to a big street with people swaying around, they all look drunk. Nobody takes any notice of me. I turn around and the man is gaining on me. My legs have become so heavy and I just can’t run anymore I cough and am out of breath. The man grabs my arm. ‘Where are you going miss?’ he asks. ‘Just let me go,’ I reply. He goes into his pocket and I see something shine in his hand. ‘If you want to be safe you need to come with me, make any noise and you will regret it’ I am so scared I try to shout, I see his face peering over mine in anger. I wake up and do not know where I am, it is very dark. I can’t see the usual streetlights. I lie still wondering where I am. If I am elsewhere I will soon know. I lift out my arm and reach over to find my phone. I grab it tightly as I know I am safe at home. I sigh with relief. I have had another bad dream. I lie back but wonder why there are no lights outside. I get up and turn on my light switch but it does not come on. I search for my torch which I keep on top of a cupboard for such emergencies. I switch on the torch and see the man who was chasing me in the light. I jump up out of bed, as I see the familiar street lights out my window.My nightmares are getting worse. I wander through to my kitchen, open the fridge door and take the milk out and pour it into a glass. I sit at my kitchen table and worry at how bad my nightmares have become. I wonder what they mean. I glance over at the clock, it is now 4am. I am too frightened to go back to sleep in case I get another bad dream. I switch on the radio and read my book while I sit on the couch; the cat sits on my lap. I suddenly wake up with the radio saying that it is 6am. Oh no, I will be late. I jump up and get ready.


Back Shift

I wander through the hospital and I bump into Elias the porter. I ask him where he has been. He says, ‘my back is injured with pushing the trolleys, I have been off sick.’ I feel sorry for him he always looks tired and unwell. Porters are on such poor pay and their work is so hard, they must walk miles every day. Their work is so undervalued. I tell him it is good to see him as we part company. I walk into a ward and I can smell pooh as soon as I enter. I hear a voice shout, ‘you are late, we start earlier in this ward.’ I say that nobody informed me but it falls on deaf ears as the nurse says go through into that room and listen to the taped handover.
I wander into a dusty old room and listen to a tape with many abbreviations and the nurse speaking could not talk any faster if she tried. I keep stopping the tape and rewinding it to try to get the information. I eventually give up. I wander through this very old looking ward. I am told I need to work with another nurse. I introduce myself and the nurse is pleasant back but is very flustered. I feel a bit lost as they are a bit through their morning already. I wander into a room to help a patient eat breakfast. The patient sighs at me as I do not feed her the way she likes to be fed. I quickly apologise and tell her that I am new. I take the patients plate out and place it on the trolley. The care assistant stands there and just stares at me but says nothing. I smile and say hello to her, she says hello back but with a very blank face. I hear that she has been there a long time. She clearly has no time for me and moans at me when I do not do as she instructs me. She said to me, ‘go and do this.’ As I always understood it I am not a care assistants’, assistant but I do not mind working as a team and I understand care assistants can be lovely people too. If she had asked me in a respectful manner I may have helped her out. I see her wander up to a nurse and I hear the nurse shout, ‘aye, is that right, we will see about that!’


Old Acquaintances

The nurse comes up to me and says, ‘Doreen wants your help, why did you refuse?' I feel awkward and do not want to rock the boat and say, ‘alright, I will help her.’ We get patients up and dressed, the care assistant orders me about and I feel very dumb. I feel my brain wanting to close off and I just want to go home. Everything I say is ignored by the care assistant. She wears brown epilates and is clearly very overweight. She orders me as though I am stupid. She rolls her eyes at me and is clearly aggressive. How did I get into this mess I think? Why exactly did I go to university to be ordered around by an overweight fascist with no education and her brown epilates are clearly quite appropriate. She sits at the nurses’ station and munches her way through a whole tin of Roses chocolates while talking about her son’s impending wedding to the other very interested nurses. One nurse is very young and looks at me now and again but tries very hard to be involved in the conversation in order to be accepted. The young nurse moans at me too as I try to find essential nursing resources in the cupboards. I am feeling more and more stupid. How soon they all forget they were once new here too. I am relived as I go for my breaks and I avoid the staff room as I am bored with hearing about Doreen’s son’s wedding. I wander into the canteen and see nurses from the old wards I escaped from. I feel awkward here too. I meet an old university colleague here but we just exchanged simple pleasantries as he seems immersed amongst his colleagues. The last time I saw him was just yesterday, he had moved wards because he hated it after all. I asked him if he was enjoying his new job but he said he hates that too and is looking for something else away from nursing. It reassures me I am not alone but confirms my theory that the current nursing culture is very bad indeed and is in need of an overhaul.


Beauty and the Beast

I watch the nurses as they show lack of care or respect for their patients or relatives let alone new colleagues like me. Nursing was never meant to be like this. Surely there is care and compassion and admittedly they are short staffed and overworked but in this ward at least and it may be true for others the aggressive care assistants are in charge.I, at least will remain true to who I am, remembering back to my dream many weeks ago with the elderly lady at the shore who told me to be myself. In my care at least I do all I can for patients and speak to them not like another patient but like a unique individual with a set of needs. I smile at my patients even although I feel bad in this environment. I make enemies because I am going against the tide of their normal culture and they hate me for it. Doreen does not get my respect or my interest in her son’s wedding. When I go home my mind is on what I could have done better to care for my patients. I listen to a lovely piano solo on my car stereo. In all things ugly there is always beauty. I take out my rubbish bins when I get home and relax reading my book.

Road To Nowhere

I got on to a big red double decker bus. I couldn’t find a seat and so I sat at the front upstairs. The bus took an unusual route and headed for the country. I turned around to see how many people were left on the bus. I was now alone. I couldn’t get off here because it was very far out of the city. I sat expecting the bus to change route but it didn’t. It turned and drove along the shore. I could see the sea but it wasn’t a calm day. The sea was throwing itself against the rocks turning white and frothy as it did so. The bus kept on going and the road became less than safe. It was narrow and we were driving along the edge, it felt like we could topple over into the sea. I felt frightened. Still the bus kept moving. It turned and creaked over the steep narrow roads. We were really high up over the sea, I kept looking out to see the journey ahead. The bus sped up and now we were going really fast. I saw a bigger bit road ahead and decided I would get off here. The driver looked angry at me as I left the bus. I was at the beach; it was now nice and sunny. To my left was the beach and to my right up the hill was a tennis court. The beach was full of people sunning themselves and children played in the sand. I looked up at the sky and it was changing from daylight to night time. The sun was blocked out by big black clouds. The sea was coming crashing in at a terribly fast rate. Everyone screamed as they tried to pick up their belongings before running away. The sea started to swell up onto the road where I was standing and I was up to my knees in it. I couldn’t move I was scared and even if I wanted to run there was nowhere to run all exists were blocked off. Why did I come this far, I thought?


I'm alright honest!

I jumped out of bed, looked at the clock and I had awoke ten minutes before my alarm. Driving on to work I couldn’t stop thinking about my dream. It was quite warm this morning and I looked up at the sky which still had some stars and was very clear. I wandered into the ward and before I could reach the room to get handover, the sister in charge said she wanted a word with me. She ushered me into a cold room with table and chairs. I sat down wondering what I had done. She had a mug of coffee in a cup with a cat on it. I looked at it as it was the only thing on the table to focus on. She began calmly by asking how I was getting on. I looked up in to her face, youth had deserted her a long time ago but she had a face that could be fixed up but anger had down turned her mouth and it had obviously set. She smelled of strong perfume and she had spilled something down her dark blue overall. Her eyes were a deep blue and she had died her hair a brown colour. Her face was darker than it should be with the tell tale signs of foundation lines around her chin. I said I was alright but then I went on to address some of the issue I had. I said I needed support in the ward to learn a new specialty not isolation. She went on to say that she was annoyed that I had contacted the union. She reminded me that she was my boss and if I have problems then I should address them to her. I said that while this may be true some of the staff is bullying me and I felt I could not speak to her. I said I can’t work in this environment. She got very angry with me and her top set of dentures slipped down as she shouted at me. ‘How dare you involve the union.’she said, ‘who do you, think you are?’ ‘What exactly is it you want’? She said. I told her calmly I just want to get on with my job and to be supported in that. She stood up and walked right over to my face, I could smell the coffee from her breath when she shouted ‘you are making me look like an idiot.’ I asked if that was all and could I go. I was quite scared but I dare not show her. ‘I want you to say everything here is alright, isn’t it?’ I replied, ‘er yes yes.’ I thought if I tell her what she wants to hear she will leave me alone. I reply, ‘well actually things were bad but now they are alright.’ She shouted at me, ‘GOOD!’ I put on a pretend smile and stood up. I walked down the ward feeling really scared. She had just bullied me and I needed to get out of here. In my break I phone the union and tell my steward what happened.

A date has been fixed for me to attend a meeting. I go into the meeting the next day feeling really anxious. I just want a peaceful life, going to work and then getting on with life but this has so far never happened. A woman from human resources and the directorate manager are there along with my steward. I am asked to discuss my issues with them. The directorate manager turned around and said that the sister said you are now alright now, is this true? I replied that I was not alright and I had to say this to get away from her as she was shouting at me. The meeting ends with me being allowed to work elsewhere. I am allowed to go home after the meeting. I am so happy to be away from this unit but through my experiences I do not know if things will be different anywhere else. Nursing has already got a set culture but surely there must be good places to work.


Enough To Raise Your Blood Pressure

I walk away with my back pack over my shoulder. I go into the staff canteen and see one of my old university mates. I ask how she is. She informs me that she is leaving nursing. I ask if she has contact with anyone else. She tells me that there are few of us left and that many have now gave up to do other work. I feel quite sad about it all, we all spent such a lot of time together and very few of us are happy. There must be a reason for this. Nursing is set in a busy environment were mistakes must not be made or we can be struck off. Paperwork is getting deeper and deeper. Our hours are long with very few breaks and we are always short staffed. This is a dangerous culture. It frightens me to think that any slip up could place me in front of the magistrate’s court. If you don’t document a patient’s condition, it didn’t happen; if you did it has to be precise. Omissions are just as bad as poorly written documentation. Damned if you do and damned if you don’t. Every piece of paper we sign our name too is a legal document. I like the way each ward has its own way of writing the notes and everyone blindly copies the same format for example, ‘patient had settled day, non-complaining, all care as planned’. One thing is, who on earth has a settled day in hospital? To write in the notes non-complaining, doesn’t say much about a patient at all. The best one is ‘all care as planned’. To write ‘all care as planned’ is obviously assuming the nurse has carried everything out that is to be carried out for the patient. However, if the nurse gets home and then realises she has forgotten to do something and the patient has an adverse reaction then the record of this has legally implicated her because she has stated that all care was given as planned. However, if the nurse writes nothing then the nurse could be deemed to not have carried out her duties.

There is no fool proof way of recording about patients but at best it pays to be honest. If the patient is complaining about pain, best write that the patient was complaining about pain and what you did as the nurse to alleviate it. As for observations, they are the most important key of how a patient is doing. If blood pressure is low or high and the patient looks well and is up and about, it pays to check back what their normal BP is because it may always be low or high and this could be their normal. New devices though are needed to cut out paperwork.
I walk out into the afternoon sun and go into my car which is boiling. I turn on my music and drive off with a sigh of relief over today. I just hope that my next ward is going to be alright.

Culture of Discontent

I lie reading a book on the Mayan and Aztec cultures. The culture is amazing but with some very grizzly ideas, but then it’s easy to cast judgment outside of a culture. Aztec law appeared barbaric and theft was dealt with by strangulation. Those found drunk would have their heads shaved on the first occasion and on the second they would have their house knocked down. The punishment on the third occasion rises sharply to death. I lay back thinking that I did not know anything about this culture until I read about it. The outsider of the nursing culture does not know what really goes on in nursing and I bet they would be just as horrified to read what goes on as I was to read about aspects of the Mayan culture.

I dream of what it must have felt like to climb the steps of the great Mayan pyramids knowing that death was to follow through ritual sacrifice. The dread from it all must have been so terrible that I could never imagine. All these people who died needlessly but then their leaders needed to look like they were in control and so their rituals appeared to have significant meaning to the people. Did their people never question why these people had to be put to death? It is so poignant that people accept their fate from what they are told by others and never ever question anything. This behaviour is nothing new as I lie thinking about my glossy filled book which still harboured a smell fresh from the bookshop, which incidentally also sells the most amazing coffee.

A Little Rash

I close my eyes and then the alarm goes off. I am feeling the dread of work and the only analogy I can think of at this time is walking up the steps of that big Mayan pyramid to be put to death. I think about phoning in with various excuses but don’t we all do that? ‘Hello, I’m sorry I can’t make it in today, yes, yes my cat choked on a chicken bone and well I need to take him to the vet.’ Or, ‘I was looking after a little old lady yesterday in the ward and she had a strange rash all over her face and now I have it.’ I doubt they would believe it. Oh well I must get up! I drive up towards the hospital and there are other nurses slowly wandering in. I can always tell the standard issue dark blue trousers with the white tunics hanging below the jacket. They wander in like zombies. They all look miserable and walk slowly from all different directions as though if they walk slow they will miss their shift altogether. As I wait at the lights I gaze across to a field and the dark lush green grass has a wet coating across it crystallised with dew, like a frosty icing on a cake. The trees look dark and eerie with a glimmer of sunrise in the background giving them a silhouette appearance. Green lights set my wheels moving and I turn off my music, my music is my only sanity in all of this, and a day spent without music is a sad day. I watch blue lights flash quickly past me and I see an ambulance bring another sick patient to be cared for. I wander to my ward and quickly get changed. I go to hear my handover and exchange very simple pleasantries but they are not reciprocated.

Maya Head

I try to write quickly but am unable to do so and miss lots of details out. I quickly ask if some details can be restated, I hear a sigh and I pretend I did not hear it. I am not familiar with this ward and many terms are abbreviated and I do not know what they all mean. I am told that I will be caring for beds 16-30 with another nurse and a care assistant. I quickly get started; the other nurse Brenda ignores me as I try to make conversation. I help the care assistant get the patients out of bed while the other nurse decides she is giving out the drugs. The care assistant has been here for many years and also ignores me. She sighs at me as I do things differently to her. I have my justifications and hers are just a way she has built up over many year. Why she does it, who knows, because she has always done it that’s all! She doesn’t ask questions she just does her job. She is an angry looking woman whose appearance has obviously withered in her anger with a face like the large carved head at the Maya city of Copan. She moans at me but I am too nice to speak back although I feel resentment. She never washes her hands and patients are moaned at too, so I am pleased I do not think it is not a personal vendetta against me.

The other nurse Brenda is clinically obese, an all too common sight these days and she wears the dress uniform. She likes to be in charge even although she is band five, the same as me and she has had no managerial skills to be in charge of me. I accept though that I am still unsure of this ward so do not care. She reminds me a patient is getting home for the day, she is having ongoing intravenous antibiotics but has now stopped them and she is due back later in the day to have more. She wanted it that way! As the patient leaves I throw out the intravenous line which is filled with some of the patient’s blood. As I close the lid on the bin Brenda shouts at me across the room filled with patients. She says that this intravenous line was good enough to use again when the patient came back in ten hours time. I think to myself and I examine my actions. I say ‘well it is in the bin now’. Afterwards I thought about this and just for one split moment I thought maybe she could be right and the ward is saving money. When I returned from the world of the insane I was glad I threw it out. How much money does the NHS actually save by reusing intravenous lines, attaching them back to the patient many hours later? What is the point in giving antibiotics for infections when they are pumping old blood but into the patient some ten hours later? Disgusting! If I was the patient I would refuse anyway. What sort of barbaric practice is this? Let’s go back to the old ways of giving the syringe a clean in between patients. What research was carried out to justify reusing these lines?

Mirror Mirror On The Wall Who is the Evilest of Them All?

I watch this nurse all day after this and examine her practice. She also never washes her hands and doesn’t even try to speak to the patients. If I was a patient and she came near me I would get out the bed and run as fast as my legs could carry me. She converses with the care assistant with the stone cold Mayan head but looks at me as though I where the mother of all evil. I check my appearance in the mirror as I go for my break to eat my cereal. I look at myself in the mirror feeling sorry for myself, beginning to wonder if I am emitting evil from somewhere unsuspecting. Perhaps I need to smile more I think, I try to smile in the mirror but just look stupid and just feel sad. It is hard spending each day at work without anyone to speak too. I don’t belong in nursing, I am not like them I think. Maybe they have something I do not. I comb my hair and walk towards the door when it is flung open. In walks a nurse that I saw from afar today in the other part of the ward. She looks up at me and says ‘I hate nursing, this is just my third month and I regret every bit of it’. ‘Maybe you will get used to it’, I say. She said that she was looking for another job already. She speaks to me about her experiences and bursts out crying. She is now getting counselling to cope with the bullies in her job until she can get another one. I understand what she is going through but I don’t want to tell her my experiences because I may make her feel worse. I go into the staff room to eat my cereal and I listen to a conversation about a poor young eighteen year old girl who has a severe illness and has no longer got the ability to do anything for herself. They discuss her very condescendingly because the patient was refusing to have anyone wipe her bottom after the toilet. How dare she be the spanner in the works of their cosy routine? One nurse pipes up, ‘she will just have to get used to it because that is her life from now on’ another nurse sarcastically laughs saying, ‘she says she will be going back to the gym, she is so out of touch with what is really going on.’ I felt so sorry for this young girl all her mobility cut off so young and I just couldn’t stand the way they were dissecting her life as though it were just another episode of Eastenders. What eighteen year old girl would gladly succumb to having all her dignity ripped away from her like that? Imagine having Mayan head lady come up to you saying, ‘I’ve come to wipe your butt’. Scary thought! The young girl may not be facing up to her realities yet because if she did then it would sink her as it would anyone. A big part of her life was going to the gym and why shouldn’t she dream of getting back there. Ripping away someone’s dreams is the cruellest thing any nurse could do! Hope is something that we all need! Nurses all need to be taught counselling skills.

Hope For Us All

I go back to the ward one patient is just thirty and she is so happy that she will be getting home at the end of the week. I didn’t get to know her but we had great conversations on everything and laughed together. Her face was very yellow and her eyes were sunken. She informed me she was getting married and she was so full of joy about it I could feel her happiness. She was diagnosed with cancer and was given three months to live. She shook me by the hand as she left the hospital at the end of the week and said you have been a great tonic. I looked into her sunken eyes as she left and I wanted to make her well but knew only a miracle would save her. It is hope that kept her going. The Mayan headed care assistant now thinks she is in charge and attempts to boss me around while the other nurse look smug. She informs me of so called ‘unit errors’, which are all trivial and are done by way of culture rather than any rationale. I ignore her and make some excuse for myself but then feel bad for not challenging her. She makes my life a misery. A little elderly man comes in and has traveled far, saying he is unsure of the visiting time. He asks if he can briefly see his wife as he has not come in before now. His wife is very unwell and the little man looks so upset. I open my mouth but before any sound comes out Mayan head lady shouts harshly, ‘you will need to wait until visiting time’. She expected the man to wait until mid afternoon. His car in the car park would be clocking up cash. I turn to the other nurse who agrees with the care assistant. So I am overruled. This upset me as I watched the little elderly man walk away slowly with his little brown leather holdall. I know we need to be strict but this is surely excessive. I accompanied his wife to have a procedure done and we came back for lunchtime. She started to deteriorate and became less responsive. Brenda checked the lady’s oxygen saturations and moaned that the equipment was faulty and just sighed and walked away. When she left the room I placed the oxygen probe on to the lady and noticed her oxygen levels were sitting at 82% and she was already on high flow oxygen. This was a bad sign. I immediately went to the doctor. The doctor said that the woman will not survive the next few hours. I went to the woman’s notes to find her next of kin contact, this was her husband. I tried to phone him but he had obviously been in. I contacted the patient’s daughter who came rushing in. The little elderly lady died and the daughter did not get the chance to say goodbye. Sadly, neither did the husband. I felt so cruel and heartless. Why did I not say something, I thought to myself?


We Are Just Obeying Orders!

I watched the elderly man hug his wife for the last time as I closed the curtains on them to be together. Mayan head lady said ‘well it’s not our fault we have rules to adhere too.’ This reminded me of an experiment carried out by Stanley Miligram whereby he showed that people adhere to authority figures. In this case an actor was receiving electric shocks for getting his answers wrong. In a social psychology article Stanley Milgram summarised his experiment in his 1974 article, "The Perils of Obedience" writing: I set up a simple experiment at Yale University to test how much pain an ordinary citizen would inflict on another person simply because he was ordered to by an experimental scientist (an authority figure). Ordinary people carrying out their jobs and without any particular hostility on their part can become agents in a terrible destructive process. Additionally, even when the destructive effects of their work become patently clear and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority. In this case the care assistant and the nurse had caused pain to adhere to orders. I myself had to go along with this because I did not have the authority to overrule the situation.


The Incredible Hulk


Later on I saw Brenda walking about in a plastic apron on top of her uniform. She had sweat running down her face. Mayan head lady asked her why she didn’t take her apron off. She turned around saying that she has burst the zip and doesn’t have another one to change into. Nobody in the ward was her size. She was to swelter under plastic for the rest of her shift. Plastic suited her because she was a plastic nurse with no feelings or care for others. She was the opposite of the plastic Barbie doll. Brenda the bull I thought. I discovered later that Mayan head lady was angry that I was filling the post her friend wanted. I being there ruined her cosy little set up. Oh dear, how sad, never mind. I open up my car and sit down reflecting on today. I do not know how long I will last in this ward but I have no choice right now. I felt like David Banner searching for a cure for the Incredible Hulk, the Incredible Hulk is the beast that is the culture of nursing. I drive home with wiper blades sweeping away the rain as it hits the car with great force. There is something peaceful about the rain and I do not play music as the rain plays its own song.

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.

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.

From The Heart

Inevitability

I am dreading going to work today. My boss may know I have said something now and I am worried she takes it out on me. I wander slowly into the ward looking down at the highly polished floor. A cheery smiling Polish cleaner all dressed in green smiles at me and says ‘cheer up miss, it surely is not that bad.’ I smile back knowing that this cleaner is always smiling. I wished I could be so happy in my work. I say hello to him and say that 'I am sure I will be alright.' I always speak to the cleaners, they provide a great service in the hospital and they often get such bad media attention for our hospitals being dirty. Their salary too is terrible. If your hospital is dirty don’t blame the cleaners they are an easy target, it is down to poor staffing and the nurses extended roles. We are supposed to clean up body fluids, mattresses, beds the lot. It is often difficult to clean everything when there is lack of staff. My priorities are the patients and you may argue that cleaning does affect patient health. It does, but if I have a dying patient while at the same time I need to clean a patient locker. My choice is always the patient. If we do not have enough staff then we must always prioritise. It annoys me that they say also that we never wash our hands. Of course we do and who the hell has time to record our frequency of hand washing with statistics, please get a life! Spend the money on getting us some staff please? Oh and one more thing while we are on this subject, I bet those that design hospitals never regularly burn their hands on the hot taps, most of the wards I am in do not have mixer taps and the water is too hot. Come on those doing the research, let me watch you put your hands under a scalding tap. If you do research you need to account for all your intervening variables like scalding hot taps. Oh, well, I have reached the report room and I walk in. I almost sit down when Sister Poppins walks through the door very harshly. She stares at me in a very frightening way. She does not speak, and just keeps staring at me. I feel on edge and so I just stand looking back like the rabbit staring at the headlights. I observe the red blotches around her nose, she must have been blowing it again she always does that. I also see the pink coloured lipstick that has missed her mouth and strayed into the creases up above her lips. Her hair looks neat today but her eyes are filled with rage. I could almost swear she has the rage virus out of the film 28 Weeks but she is doing her best to hide it. There is a whole lot of psychology going on between us. I feel like we are two angry cats sizing each other up. My anger is through being tortured. I feel hate towards her for what she is putting me through and I am filling up with emotion and I want to shout at her. I just want her to treat me like a normal human being. I would love to write here in words what went through my head but somehow this does not come easy and perhaps only those who have been bullied would understand that. We both gently backed away like two cats, not daring to show our backs.

Rebel with a Cause

She walked out the room. Everyone who was sitting down asked each other what that was about. I looked down at the grey carpet and shrugged my shoulders. I was not part of their team because I was ostracised anyway, she had made sure of that. I was always sent away. Today was no different; I walked away along the corridor to a ward I had not been in. I walk in and it is quiet. I am just in time to hear their report. So perfectly put, with good handover sheets and the nurses verbalising the patients’ conditions. I discuss with the nurse who I am working with, our plans for the general organisation of our shift. She comes over as being really nice. She tells me she is from Africa and she has a lovely manner with the patients. I can tell she really enjoys her job; she is a real nursing gem. We coordinate our work well. One thing, I do notice is that this ward shares facilities with the ward next door. A patient asks me for a drink of water and I go to the shared kitchen. I search everywhere for glasses and jugs. There are none other than a tray with many glasses and jugs on a trolley with a big white sheet of paper on top, with writing clearly marked in red pen, “Everything on this trolley is for the use of patients in ward 14 only” So, rather than annoy anyone, I went back to the other nurse and asked what we do for jugs and glasses. She said, that we just need to search around and that the staff on the other ward gets annoyed if we use their equipment. I search everywhere and I go to the main kitchen. All I see are tea cups. This is insane, I am searching everywhere for a container to get a glass of water and there is a trolley with jugs on it. Do we not share the same hospital? So, my patient should become dehydrated and do without water? Not on my duty they won’t. I go back to the kitchen and take a jug and glass from the trolley, feeling like a real rebel. Oh and if they complained when they counted their glasses and jugs I left them a little note to say, ‘I am sorry but I took the glass and jug because I thought we all work for the same NHS and patients come first.’ This insanity is rife in our hospitals. This equipment belongs to our ward and you can’t use it. Let us thrash this nonsense out, so we have a pot of money that goes to the NHS and it obviously gets shared out between services. So, wards have their own budgets and they want to keep what they have bought for their own patients. So, there is perhaps some logic in what they are trying to achieve but it has created room for nonsense and utter misery when trying to care for patients. How about we have a central store in a hospital and if we need equipment we go and get it, that’s more logical. Why are we short of anything in the first place? It’s crazy that we have nurses hoarding sheets, towels and other items to stop it being used by any other wards. Stop this insanity now!

What’s your Poison?

I spend the majority of my shift taking disorientated patients safely back to bed as they go for a wander. Many of them are at risk of falling and are so fragile that if they do fall they will break a bone. I give an elderly patient her medication, she is very confused. She asks me if I am a poisoning her. I smile and pat her gently on the shoulder and say ‘of course not but I am sure it will taste like poison.’ She looks up at my face which is very close to mine as I am leaning over smiling at her. She says, ‘I know you wouldn’t poison me dear, you have a very nice caring face.’ This fills me with warmth. I go through and speak to a male patient who has written some questions for me on a piece of paper. He asks why he is not a candidate for an operation as he has been told by consultants that he will not be fit enough for it. I look at his history and note he has a very bad heart condition. I say that I do not quite know the specifics of what the consultant said but my guess could be due to his heart problems. He informed me of languages he spoke and mentioned his big academic background. I looked at him and could see that he was now very frail. He seemed very proud of his academia. I showed an interest and asked about his languages. I got him to teach me some words and he smiled at his opportunity to use it. He told me I was a real tonic and that nobody in here speaks to him. Sometimes we can be so busy that we just deal with the physical ailments of a person that we ignore the whole person. The man smiled and I wished I could speak longer but had to deal with other patients. It was just nice to see him smile. Smiling is a good healer. It is a pity I could not do more for another patient. The lady was too ill to be resuscitated and would not make it if the doctors made any attempt. This side of nursing can be sad. We need to comfort these patients until their heartbeats are no more. This lady had terminal cancer and there was nothing more that could be done. The other nurse and I noticed how she was deteriorating. I quickly phoned her husband to say that his wife was very poorly and he must come quickly. While awaiting the husband, the patient slowly slipped away while we both held her frail soft hands. There is always an air of serenity and death always emits the same odour but it is not a foul odour, it is just death. We quickly tidied the patient up and changed her clothes to make her presentable. I brushed her hair and gently closed her wide open mouth. Music plays..."Thoughts Of A Dying Atheist, Muse"

Eerie whispers
trapped beneath my pillow
won't let me sleep
your memories

and I know you're in this room
I'm sure I heard you sigh
Floating in between
where our worlds collide

scares the hell out of me
and the end is all I can see
and it scares the hell out of me
and the end is all I can see

and I know the moment's near
and there's nothing you can do
look through a faithless eye
are you afraid to die?

it scares the hell out of me
and the end is all I can see
and it scares the hell out of me
and the end is all I can see

It scares the hell out of me
and the end is all I can see
and it scares the hell out of me
and the end is all I can see
Love Hurts

Birth and death bring opposite emotions but are both inevitable in life. We need to present death to the relatives with great care as it has lasting closure on an individual’s life. When the husband appeared I knew the patient was already dead and so I calmly asked him to come with me to the relatives’ room, knowing I had to tell him the bad news. It is always such a long walk. The silence to the relatives’ room is always so difficult. I imagined their long life together and how difficult it would be for this man left without his wife. I sat him down in the room and I sat close to him. He stared at me searching my face in desperation. I went through the sequence of events and told him with great care. I sat for a little while just listening to him talk while the news digested inside him unfolding like a flower in spring opening up for the first time. Tears rolled from his eyes and I knew my words came like boulders hitting him deep in the heart but I could not lessen them. I could feel my own emotion as usual and the knot in my stomach as I felt my own brown eyes glass over. I put my arm on his shoulder. I said that his wife is waiting on him if he would like to say goodbye. His family joined him as they came rushing up the corridor to hear the bad news. They all broke down in tears. I escorted them to the patient. I put down chairs for them and told them they can spend as long as they like. This was now their time, I patted the husband on the shoulder gently showing I care and left the room. I wanted to wrap my wings around them all and make their hurt go away but love hurts.

I pick up my rucksack and throw it over my shoulder. My shift is finished, my shift was difficult but I worked with a nice nurse. My meeting with my bosses and my union is next week. I wonder what to have for my tea, I have not eaten much today and my mouth is dehydrated as usual, we had no water dispenser let alone a cup to drink out today. I drive off, thinking of the relatives I left behind and how they will be left to cope. I turn on music by Incubus and the song is Love Hurts.

Tonight we drink to youth
And holding fast to truth
don't want to lose what I had as a boy
My heart still has a beat
But love is now a feat
(as common as a cold day in LA)

Sometimes when I'm alone I wonder
Is there a spell that I am under
Keeping me from seeing the real thing

Love hurts.....
But sometimes it's a good hurt
And it feels like I'm alive
Love sings
When it transcends the bad things
Have a heart and try me
'Cause without love I won't survive.

I'm fettered and abused
Stand naked and accused
Should I surface this one man submarine
I only want the truth
So tonight we drink to youth
I'll never lose what I had as a boy

Sometimes when I'm alone, I wonder
Is there a spell that I am under
Keeping me from seeing the real thing


Love hurts
But sometimes it's a good hurt
And it feels like I'm alive
Love sings
When it transcends the bad things
Have a heart and try me
'Cause without love I won't survive

Love hurts
But sometimes it's a good hurt
And it feels like I'm alive
Love sings
When it transcends the bad things
Have a heart and try me
'Cause without love I won't survive

Love hurts, oh
Love hurts
Without love I won't survive
Love hurts, oh
Love hurts
Without love I won't survive

A Price To Pay (part 11)

It’s time to get up. I hate getting up in the morning probably the same as everyone else who needs to get up for work. The difference is that I have twelve and a half hours ahead of me and I have a bad cold. My legs ache and I keep sneezing. I can’t stay off because Sister Poppins will moan because she expects the sick call the night before. I wished I could go out next week because all my friends are going to the theatre to see a great show and I will be working. I got my off duty just yesterday and as usual it is very late. I can never plan anything as a nurse. My mum and dad have still been trying to phone me and I am thinking that I had better call them or they may think something is wrong and phone the police. They are a bit like that, my mum and dad. My university mates have been in touch and it is great to hear from them. I met some nice people on my course but such a shame, such a change, they are all so different. I feel that they resemble battle wounded soldiers. They have seen so much in such a short time and I am no different but I am now seeing what is happening around me in the NHS! I know I was always destined to help people and that is why I am a nurse. The money has never motivated me but it would be nice to be able to live a reasonable life without debt and just get a little more for the job I do. Will that come to me, who knows? It is time for handover and I am sitting waiting. Everyone comes through to the office and I fix my squint badge with my name on it and I adjust my blond hair so that it is away from my face. I look up to see Sister Poppins and Mrs F Flat. I think I will be taught a bed bath today. Patients are obviously discussed during handover and I try to contribute but I am looked upon like I am the cleaner contributing to patient care. Sister Poppins ignores me. I do not respect her, I resent her and I do not like working here. I need to get out and go to employment where I feel welcome. Who wants a drop out nurse though? I think about possibilities but let’s face it I am stuck, I am in prison. What about my friends from university? The people I am in touch with are having a bad time and wished they had not done nursing. My friends are unable to buy a house and have a normal life; they can just share flats, great! I am told that I need to be a nurse today and not a care assistant. I get on with my job!

Coughs And Sneezes Spread Diseases

A patient is brought in from another ward and is placed in a side room. The relative is outside it speaking to Nurse Ratchet. Nurse Rathchet has a hand on her hip and still wears the nurses dress uniform. I wear a tunic and trousers. The trousers do not fit they are too baggy. I look at some paperwork on the desk and over hear them talking. Nurse Ratchet is not a caring person and the relative does not understand this infection and attempts to ask questions. Relatives and patients are outside our little medical knowledge ring. I think it is still important to realise that the public are far more informed than they used to be. The relative asks what infection her husband has and I hear the nurse avoiding the truth. I know that the infection is Clostridum difficile and the nurse is avoiding telling her. Maybe if nurses could be honest the situation would not be so out of hand. The public know when we are being secretive. It is obviously most annoying for anyone to have this condition but it is common and the only way to beat it is by being up front and honest. Let’s face it, the main cause is antibiotic usage and although people who are already very ill are often the most vulnerable it is antibiotics that are the cause. Why the secrecy? It can obviously spread around a ward fairly quick which is why patients get put into side rooms. Hygiene therefore, also becomes important. Hygiene is a big issue in hospitals especially with a high turnover of patients. In the area Jabba the hutt works, the old part of the hospital, hygiene is really bad. Sister Poppins runs a very tight ship and hygiene is very high on her list but sometimes to the detriment of the patients. The trouble is the design of many hospitals only supplies so many side rooms, so few patients can be isolated at a time. The trouble with poor hygiene too is that everyone uses equipment going from patient to patient. How many nurses go around taking blood pressures and do not bother to clean the cuffs and oxygen saturation probes in between patients? We can’t assume patients are clean. Patients quite regularly have a commode taken to their bedside but never have anything to wipe their hands. Doctors also walk about in their normal clothing going from bedside to bedside with their stethoscopes. I think they must hide somewhere to clean it because I have never seen anyone clean them. Why are doctors allowed to wear their normal clothes while we wear uniforms? Anyway, Nurse Ratchet’s tone goes up as she attempts to convince the relative that it is just a mild infection and it is very common. She avoids the name. It is a bit like the Scottish play that we dare not mention. It is like going back in time, don’t go out in the cold or you will catch a chill? Some nurses are just scared to say what the problem is. It reminds me of the patient that died and the nurse informs the relative, ‘I am sorry but she has gone.’ Before the nurse can explain the relative is shouting, ‘where has she gone how could you let her walk out?’ Nurses also ask patients ‘have you gone today?’ ‘Have you been?’ I remember the funniest I ever heard was with this male patient and the nurse is trying to ask tactfully about his bowels. The patient is not from this country so is confused by what she is saying. The nurse attempts many times with gestures and different ways of saying it. Finally, the patient catches on and with a smile and a glint in his eyes shouts. ‘Are you asking if I have crapped?’ The nurse’s face goes red and I need to leave the room because I am in fits of giggles. Nurse language is really awful and we should just say a thing how it is. Nurses learn to lie very quickly. When a nurse looks at the wound of a patient and there is this smell of rotten flesh with seepage and the patient asks the nurse how the wound looks the nurse screws up her face trying to avoid the smell while saying, ‘actually it is not that bad.’ We could not possibly say to the patient, ‘actually it smells absolutely awful and just looking at it makes me want to throw up.’ So lying to protect patients is common. But we do need to evaluate when lying is the right thing to do. MRSA is the other one that patients fear and so nurses avoid using the term. In this situation the relative raises her anxious voice and rather than reassure the relative, nurse Ratchet shouts back. Relatives are anxious and sometimes it is through this anxiousness that they become angry with nursing staff. So many attacks on nurses could be avoided from the start by the nurse showing patience and care. There are a percentage of patients and relatives though that will just have a tendency to lash out. People are unpredictable. Thankfully, I have never been hurt, so far. The relative gets angrier with nurse Ratchet and demands to see the doctor. Ratchet looks uncontrollably angry. The whole angry scene could have been avoided. Nurses often do not have people skills, sad, but true, there I said it. This same nurse Ratchet thinks I do not possess the skills to give a bed bath as she was discussing this with Mrs F Flat. The relative talks to the doctor stating that she plans to put forward a complaint.

Those That Can Do, Those That Can’t Teach.

I deal with all my patients, helping get them breakfast up, washed and dressed. The buzzers go all morning and I am fetching and carrying and juggling my work. There are many things I need to remember in my head all at once. I feel exhausted because I have the cold. I needed to organise my annual leave but I was scared to go near Sister to ask her anything in case she made trouble for me. She is not approachable at all. I spoke to one of the care assistants who reminded me that I have the right to my annual leave. I decided to write down my request of annual leave a few weeks ago in the manner she requested staff to do it. My request was left untouched while everyone else was getting theirs granted or nullified. At least they got theirs dealt with. I was getting tired and I had been working solidly for months without holidays. I asked for just three days off. Sister Poppins came over to me and very seriously said to me that she could only grant me an afternoon. Her eyes showed hatred towards me and I just could never understand why. I took the afternoon she gave me but was disappointed. There was no long lie in bed! I had looked in the annual leave book and noted that no other nurse was off and there was lots of staff on that day. I could not understand her, I knew she just did not like me and she wanted to make life hard. After all my running about I was called into the side room to watch a bed bath. My brain had trouble staying awake! She made such a meal of it. If I could spend this long over a bed bath none of the patients would be out of bed until afternoon. Nurse Ratchet spoke to me like I was a little naughty girl. I no longer felt like the little naughty girl. I felt like an adult who was being taught by someone who was attempting to keep me down by intimidation tactics. I did not let her bring me down or any of the other nurses and after many months of being treated less than human I was beginning to feel angry. Anger was welling up and it was not sudden, it was over a space of time. I would not show my anger, I kept it locked inside because it was not professional and if my anger gets the better of me then they have won. The trouble with anger is that it has to come out somewhere and just because I did not get angry back did not mean my anger did not come out. When I went home, my moods plummeted. I was not friendly and sociable anymore. My phone would ring and I would ignore it because I felt too unsociable to speak. My friends would still ask me out but I could never get out anyway. I was always given off duty for the weekend. I was cutting myself off from everybody. I was a loner, I really was in prison. From somewhere I gained this surge of energy to fight back and I continue to do so. I have not won yet but that means banning all bullying from work. In nursing there is a culture of nurses who think that being critical in a nasty way is helping develop the skills of the nurse. On the 17th October 2007 The Times Online had a story about the nurse of the year quitting her post as nurse “A “Nurse of the Year” is leaving her job because of the strain of working for the NHS in an atmosphere of “mistrust and fear”, in response to the article a nurse wrote in to state “They send the matrons down to put pressure on the staff which is causing more harm than good considering most of the matrons are in the job for the power trip.” The Sister’s are just as bad in many cases. On the 22nd of October there was an article titled ‘Pay a nurse peanuts and what do you get?’The discussion is about the columnist sitting vigil in ICU. From the outset ICU is so different from the wards and it is a very specialist type of nurse who is trained to work in ICU. It is also compulsory for a high nurse to patient ratio, which is also why funding ICU is so costly. ICU can never be compared to the wards. It is a little like comparing theatres to the wards as the skills needed can be so different. In both theatres and ICU much of the time patients are very heavily sedated so patients generally are not up and walking about. Theatre staff can be very good in anaesthetic rooms with very frightened patients going for operations. They are also very good in recovery. A lot of what happens in theatres is often hidden away and so poor theatre staff can be forgotten by patients. Still, in response to this article a nurse wrote, “I am tired of hearing about the poor under paid nurses, the angels. In many cases I have found nurses on general wards very uncaring and bad tempered. We are told they are too busy to help patients with their food and take them to the toilet.” In my response to this, if I was working night shift, I could share some thirty two patients with just one other nurse and a care assistant. I would love to ensure that all patients’ needs rightly are cared for but I have no control over staffing levels. If it is any consolation I think it is a disgrace that anyone is left in their own urine or pooh! It is true that many nurses are uncaring and it is a shame that the bad ones ruin it for all of us. If the owner of this comment had to run around all night for twelve and a half hours with just two half hour breaks, clearing up pooh, sick and all other bodily fluids with lack of staff I am sure she would also be bad tempered. Some nurses are lazy and some take their frustration out on the patients, these people are the rotten apples. I am physically and mentally exhausted after each shift. Why should NHS management sit on their big fat salaries with no real insight into what we put up with? When it all goes pear shaped, I know lets blame the nurses. Someone also wrote “Nursing leadership and example at ward level are absent with professional advice, correction and challenge, if it's ever given, regarded as 'bullying'. This could only come from a Sister. When the pressure mounts, the Sister is standing well behind the battle lines at her desk with her nice civilised day time hours, being allowed to go home at four in the afternoon. She can also choose when she goes on holiday. This comment is exactly the management style I mentioned earlier. It is outdated and in need of repair. I am glad she mentioned bullying because in other occupations it is clearly recognised as that. It is one thing giving correction and challenge but when I am doing my work, I do not want someone coming up to me while I am with my patients giving me random maths tests out the blue. I also do not want correction in front of patients which is utterly demoralising. I also do not want to be shown skills that I can clearly do. I do not only want spoken to too when I am deemed to have done something wrong. What is also wrong with praise when I am doing my job right? I never get that! In the older days nursing did not have the high level of academia that it does now. I have served my time at university which the Nursing and Midwifery Council are happy with and this proves I can carry out my job, while extra courses keep my skills up to date. There is nothing in any written documentation stating that I must constantly be given maths tests or be shown basic care over and over when I clearly have the skills. I am an adult not a child. I am the registered nurse who is accountable for my own practice. I need to know my limits and if I mess up it is me that loses my registration. If these Sisters or any other senior member of staff demonstrate the wrong way to do things and I follow this practice, if they are wrong, is it any defence in court to say I was just copying the Sisters practice. They would then ask, ‘if you saw someone jump from a bridge would you copy it?’ Would the Sister stand happily beside me supporting me all the way? I doubt it; I would be on my own, in a boat, without a paddle heading into the direction of Lonesville. I need to know my own limits and my nursing parameters. If I don’t know I will ask. In the older days of nursing, Sisters may have used this challenge approach to gauge what level nurses where at. Many of these outdated Sisters do not have academic qualifications themselves. I now challenge them to gain a degree qualification on a minimum nursing bursary. Let’s face it, how many times do Sisters make mistakes. I see them making mistakes all the time. Who corrects and challenges them at ward level? The point I am making is we are all human and humans by our very nature make mistakes. What we do not want is costly mistakes, which is why I never carry procedures that I am not trained to carry out. If I make a small mistake in the ward, I do not expect to get my head blown off for it and screamed at. What I would like is for someone to take me aside and say to me that I made a mistake and show me what I did wrong. I can take it, I am an adult and do not need shouted at in front of patients like the naughty child. It is all about the manner in which it is delivered. Better management skills are required please? Sisters need to go back to school!

McDonalds Has Come to Nursing

I watched this bed bath and learned nothing new. I would have been of far more use helping patients get to the toilet. Nurse Ratchet looked smug as she went over to speak to Sister Poppins while rubbing alcohol gel on her hands. She could not make it clearer she wants that vacancy. The interviews for the job are to be held in a few weeks. What more misery will she cause until she gets the job? I go to lunch to meet up with another friend who is leaving nursing. If the ‘Nurse of the Year’ leaves nursing and all my university friends are leaving there must be some size of a turnover in nursing. Maybe we have the same staff turnover as McDonalds. Scientific management views society as moving towards the fast food restaurant by efficiency, the optimal method for accomplishing a task. Calculability, objective should be quantifiable (i.e. sales) rather than subjective (i.e. taste), Predictability, standardized and uniform services, Control, standardized and uniform employees, replacement of human by non-human technologies. Nursing staff are easily replaceable, we are drones. Agenda for Change has devised the roles. The job description is standardized and the human qualities do not matter anymore. So, for example a nurse who comes along with years of experience who has gone through years of university needs to start alongside those other nurses who have the minimum qualifications. It is no longer about the individual qualities. Anyone with a brain who is treated like a drone from day one will not last long in nursing because it is the equivalent of sitting at the checkout at Tescos. So, what happens is they leave and gain employment in an area where their skills and qualifications are matched. Management does not care if we do not like the job or we fail at what we do because it is like pulling off another bin bag from the roll. We are easily replaceable. The sad side to this is that it is patients that pay the costs. How much does it cost to train each nursing student and then when the wards are left short staffed when the nurses can no longer cope, it takes time to get someone new in. New staff are not always efficient because they have not been given adequate support due to the bad training on placements in the hospitals but when they make a mistake it is their fault, they are blamed and they are struck off. How about doing something to keep existing staff? How about ensuring students are supported properly and not in the current bullying manner that goes on which teaches students that to ask questions is dumb.

The Spider Fights The NHS

After my evening break I sit down and fill out my notes while all the relatives ask me questions and the phone rings incessantly. Relatives who are used to being fobbed off come in with an attitude from the start. Many of them see I am not like some of these other nurses who are hostile and cold. I build a rapport with them; I get given lovely cards and get many a thank you when I try my best. I am open and honest with them all. I am there for the patients but I am a wave going in a slightly different direction from many others. I will fight for my patients but I also need to fight this horrible old nursing culture. I have two swords to cut through all of this but I am just one woman on the bottom rung of a two rung ladder. I am willing to fight, how many others will side with me? The NHS is worth fighting for and if all these good people leave we will be left with a poorer service than ever. When I look through the charts I notice that other nurses have forgotten to fill out certain parts. I do not blame them, I understand that patients must come first but try telling that to the Sister. It is nearly time for the end of my shift. I have spent a long day with my patients and I also think it is good courtesy just to say good night to them. They are not all the perfect patients and I am not the perfect nurse. I will never be Sister Poppins. I am me, I am human. On the way out I bump into relatives who want to chat and who want my knowledge of directions. I see relatives when I am out and about on my days off and they remember my name. I see a few care assistants I know as I leave. They are puffing away on cigarettes before they go in to do their night shift. We smile and wave at each other. I am now not far from my car. I am now feeling hungry and I take a tissue out my bag to wipe my nose. My cold still feels bad. I keep worrying that my mum and dad will wonder what is wrong with me. I take my mobile out my bag and dial their number, my mum answers and I say, ‘Hi mum it is me, I am alright, I am off in a couple of days and will come along to see you both.’ I wind down the window in the car to wipe away the rain from my mirror. I notice a spider making a web in the rain while being bombarded with water. It slips several times but does not give up. Is that what Robert the Bruce saw? If it was good enough for him, it is certainly good enough for me. ‘If at first you don’t succeed, try try and try again.’ Bullying is a fight we need to be in together. We all need to be in it to win it.

Education Is Not Just For Muppets (part 10)

As I walked past a porter in the hospital, he smiles and asks ‘well, were will you be based today?’ I tell him I am back to the old bit of the hospital again. ‘I do not think I have seen you in the same ward twice’ he laughs. ‘What are you today nurse or care assistant?’ ‘Actually, who knows,’ I say. ‘I am used all over and mostly as a care assistant,’ I moan. He laughs again and says, ‘I wonder when you will become a porter for the day.’ I have had my nurse training and now stagnation and degeneration. I heard a nurse say that if a ward is short of care assistants it is cheaper for them to use a band 5 nurse than to bring in an agency care assistant. I feel cheap! I have spoken to this porter a lot because I get all the accompanying the patients jobs to places such as the X-ray Department. The porter looks hard worked and tired but he always smiles. I have often moaned to him about Sister Poppins and he just laughs but he knows she has a reputation for being a tyrant. I feel sorry for the porters because they are on such poor pay for the jobs they do. They are always patient and they spend such a lot of their time walking at the beckoning call of everyone. The porter made me think of the character from the anti war film Platoon, Sergeant Elias, played by William Dafoe. He did his job and was a reasonable person. His quote from the film sums him up. “I love this place at night. The stars... there's no right or wrong in them. They're just there.” Elias the porter was just there too and always at the right time. I get to the old part of the hospital and feel the draught and watch the goose pimples appear on my arms. I look outside to see that it is raining again and I watch patients huddle in the doorway in their dressing gowns and slippers with a chimney of smoke going in all directions from their cigarettes. I go along the corridor and report to the nurses’ station. Jabba the Hutt catches the corner of my eye. She is sitting in the same place I saw her when I did my night shift with her. I wonder if she has moved at all since then. She is not eating biscuits but has a giant sized bag of tortilla chips. It is just after 8am and I ask what the plans are for me here today. She states that I am to help her today. I had a big sinking feeling, I felt like I was standing on a pile of mud and suddenly it turned to mush and I was being drowned in it. I am given many tasks all at once. I am as usual a care assistant cleaning, washing and toileting, the usual procedures. The only good bit about this is that I am being paid a nursing salary for a care assistant’s role. The downfall was though that I am actually a nurse and while carrying out any of these procedures even as a care assistant I am still liable as a nurse. I trained as a nurse and wasted many hours studying even being shown how to run a ward. The more I am used as a care assistant my skills will lessen as a nurse. As for job satisfaction there is none because I am task driven. Someone else is using their brain for me; I am a machine within a bigger machine. When I do get the chance to be with patients I do my best for them. I am not challenged I am bored! This is not what I trained for; I already had lots of experience as a care assistant.


University Challenge

Jabba does not smile, she moans at me to do her work while she sits there drinking coffee and eating crisps. I am now trying to make patients beds but there is no clean laundry. There are patients to go to theatre but there are no theatre gowns. Instead of making the beds with clean sheets we turn sheets around hiding food and blood stains and whatever else stains there are. I examined a couple of the mattresses and I was sickened to discover that they were dirty. These were beds awaiting patients. I also noticed the bed rails were disgustingly dirty. This whole ward was disgusting, it should be condemned. We are all taught very early on that we must use orange bags for clinical waste but there were no orange bags. I heard the ward was saving money. I watched as nurses and support workers tossed all sorts of disgusting waste into clear plastic bags instead of orange ones. Jabba kept dishing out the orders and I was her slave. Then out of the blue another nurse appeared she had been on some course and had come back into the ward. She looked at me, as I flicked through patients notes and said, ‘who are you?’ I informed her who I was and she abruptly told me that I should leave the nurses’ station because there was no room. She started asking me what I needed to know about the patients and then she told me about all her qualifications with a smug face. Talk about blowing your own trumpet. She then asked about my qualifications and before I even had the chance to answer she said, ‘yes you will know doubt just have a nursing qualification and no doubt be at the beginning.’ She had the manners of a pig. She looked like Miss Piggy too. In situations like this I never usually take up such a challenge because qualifications do not give someone better intelligence. On this occasion Miss Piggy needed brought back down to earth. I informed her of the qualifications I possessed and her face changed from one of smugness to one that looked like she had drank a full bottle of vinegar while sucking a lemon. I was a challenge because I had more qualifications than her. She started to ask me questions on nursing, just random questions. She was waiting on me tripping up but I didn’t. I had been through all this before with Nurse Ratchet and I decided to show her that I was actually more knowledgeable than she assumed. When she asked questions not only would I give the answer but I went on and on. She got annoyed with me and her Piggy face went from pink to red. She then told me to go and do something mundane and was on my case for the rest of the day. It was worth it though to bring her down a couple of pegs. I asked a care assistant if Jabba the Hutt got the vacancy she was after. The care assistant said she did not and that another nurse got it. There are nurses that are true gems out there as I stated previously and the nurse that got this job is a true gem, so I was pleased. It was lunch time and I helped to put out all the patients lunches. There was a patient there and she looked really dehydrated and I saw her jug of water had just been plonked down really far away from her, the water was warm. I would never drink it so I didn’t expect her too. She was not able to reach it and it would not have surprised me if she even knew it was there. I put down her lunch but she looked too weak to get her meal. I set her up so she could eat but she had very little ability, she was so frail. I started to help her eat and was told to stop by another nurse. ‘We do not have time to do that,’ she said. I asked if someone could take over and was told that everyone is busy. This annoys me, why bother having patients in hospital if they are unable to get a meal and lots to drink. It reminded me once when I was in A&E. I had not eaten or drank anything all day and got my first sip of water at 11pm. I was not on IV fluids either. I worked out that I had gone sixteen hours without water. I felt worse because I was dehydrated. It is basic common sense to supply fluids unless there is some reason not to. What is the point of pumping loads of drugs into patients if they also do not get basic nourishment? I was in this ward as a care assistant but I am a nurse. It is my duty of care to ensure patients are cared for, so I fed and watered this patient. The other nurse did not like it but why should the patient suffer. Oh dear I disobeyed orders again to care for a patient what punishment will I receive? I was sent off the ward to accompany patients to X-ray most of the day. I did not mind because I could have a laugh with Elias the porter and it was better than being shown how to do a bed bath all over again by Mrs F Flat.

Professionalise This!

I have come to the conclusion that nursing is not the profession that it promises to be. From around the middle of the nineteenth century the division of labour changed by establishing a grade of trained nurses. Trained nurses were placed between the doctors and the nurse domestics and they took on the work which had previously been carried out by apothecary surgeons. In 1916 the College of Nursing was formed. Although in contrast to doctors nursing achieved only small increases in autonomy and remuneration. Low pay is still the case today despite efforts to professionalise nursing with research and degrees. Nursing too is obviously made up of mostly women and nursing staff are the largest group employed within medical care making the likelihood of being given a salary anywhere near that of other medical professionals less than slim. Even in a previous study with nursing students they themselves divided nursing into ‘real nursing’ and ‘just basic nursing care.’ ‘Real nursing’ was viewed as that which used the knowledge of academia with which they were being trained for. ‘Just basic nursing’ was that which was done by auxiliaries and untrained staff. What appears to be happening is that the two types of nursing have become merged and hazy. Care assistants are being given more responsibilities while those that are educated to degree level are often being used as care assistants. The nurse is taught that she/he is accountable for all care and thus the job description of the nurse is actually very hazy. The nurse is expected to give all types of care which in theory sounds plausible but surely it is a waste of money training nurses to constantly be used as care assistants. A nurse can be used as a care assistant but a care assistant cannot be used as a nurse. Surely it is time to redefine the nurses’ job description. Student nurses do not go to study nursing degrees to become care assistants this is possibly why nurses leave the profession in their droves when they get the ‘just basic care’ parts all the time. They study to do the technical part of nursing.

Nursing Is Like Football, A Game Of Two Halves.

Now the other part which starts to emerge out of all this is that those with a degree can sometimes make those without them feel threatened. If a vacancy comes up, those with the qualifications are more likely to get it leaving those without, stuck in a job perhaps even burnt out. But because these older nurses have been there for so long they have perhaps came up through the ranks as an E grade, F Grade or even Sister. These people are in positions of power and rather than embrace and share knowledge with those that come in who are newer they are hanging on to their knowledge keeping it locked away. ‘It’s my football and you’re not playing’ syndrome. If we take away their knowledge which they have gained over the years what are they left with? So they retain their power by retaining their knowledge. Knowledge is power!Because they feel threatened they bully and use people like me as care assistants while they keep the knowledgeable ‘real nursing’ parts of the job for themselves. They are the ‘real nurses’ I am just a care assistant with a qualification in nursing.If the roles were clearly defined patients would be getting their basic care needs from care assistants including being fed if needed and encouraged to drink. Nurses could get on with what we are supposed to be doing. Demarcation of roles is required. I go back and forward to X-ray today and have lost count. Jabba the Hutt moaned at me but I guess she is sounding off because she did not get the job she went for. She did not get that job because someone came in with actual nursing qualifications coupled with experience and perhaps it shone through that she was a nursing gem. She will be Jabba’s boss; I can sleep well tonight knowing the patients are in safe hands. I throw my bag over my shoulder walking back along the corridor and past the dark doorway where patients are gathered smoking. I am beginning to see what is wrong with nursing but who will listen and pay attention? I go home to find a sealed brown envelope with my name on it. I tear it open to reveal a massive cheque. I had paid too much tax and Sister Poppins would not deal with it so I was on emergency tax for ages. I sat down thinking of all the nice things I could buy while the drudgery of today’s nursing gets pushed into a back drawer in my brains filing cabinet. Tomorrow is another day!