Up To Your Neck In It.

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

Tasks are a Plenty

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

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

The End is Nigh

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

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

Chocolate Break

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

SHRITE Sister Your personality is Showing

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

The Beginning of the End.....

This is now 2008 and my story is just beginning.

Brainwashed

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

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

Oh, no

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

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

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

Night Shift

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

Sleeping Salvation

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

Breaks are For Resting!

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

Changes

Am I Dreaming?

I go to sleep feeling unwell. I am sore and my head hurts. I think about work, it is always on my mind, there is no escape. I am soon wandering through a forest in the dark. I hear noises and I think I am lost. I meet an owl, but no ordinary owl. He tells me that I am in control but I need to find my feet. He tells me I have powers that I am unaware off and so I am trying to find out what these are. I walk further and I feel scared. I run very fast, hearing footsteps behind me. I start to soar above the trees, I am in control, and I can fly. When I can’t control it I soar too high and I look down at the sheer drop below me. How am I doing this? I start to drop and I sink, my legs feel heavy and I try to run but I can’t anymore. It feels like I know longer know how to run. I look down at the grass and it is dying as I tread on it. The grass emits an odour, I feel sick. I need to eat but there is no food. I try to eat an apple but as soon as I take a bite I feel it sticking in my throat, I awake feeling ill. I am still sore and my throat hurts. I should have phoned in sick but I didn’t. I need to phone, I do not feel well. I phone in sick and I lie back down feeling the dread build up inside me, thinking about how much more trouble I have caused for myself. My crime was to become unwell I will soon suffer. Two more days go by and I still feel ill. I have developed a bad cold. I should not be absent, but if I go in to work, not only will I be giving my germs to patients but I could become a liability. I justify my reasons to myself at the same time knowing the NHS are not so understanding and they would sooner I came back ill to save costs. I have a meeting with my bosses about my work and my union steward will be there.

Margaret Thatcher , who is she?

I sit awaiting my verdict like a prisoner on trial while there is discussion about me. It is agreed that I will try out a new area. I am to leave Mary Poppins behind it feels so good. I am released from her grasp. It feels like I can breathe again as fingers one by one are peeled back from choking me. I could not have done it without my union. In this day and age people think unions are a thing of the past and that they all ran away from the iron fist of a certain previous Conservative leader called Margaret Thatcher; let me assure you that unions are a thing of now and of our future. If it were not for our unions, our working conditions would be equal to slavery. You would have no rights; it is the unions that have battled for your conditions and your pay. I urge you all to join. You out there who benefits from your colleagues subscriptions, it is time to join your union. It does not cost you much.I am not used to dealing with respiratory patients but I soon get to work learning all I can. The thought of collecting sputum has always turned my stomach, I guess even us nurses have our limits. I meet my new boss; she seems alright with me but she is not friendly. This is normal in terms of charge nurses, I have come to learn. I start to enjoy learning new skills and gradually settle in over a couple of weeks. Some of the nurses are nice but they still will not show me much. I try to learn from books and the internet. As nurses we are supposed to keep up to date anyway. I go into the staff room for my break one Tuesday night shift and get speaking to a really nice nurse who shares her experiences with me.
I ask her how I have not seen her before to which she says that she is a pool nurse. I never knew what the nurse pool was. She said that it was the same as me but she could work anywhere. She was a really experienced nurse and her skills are clearly remarkable. She said she only works nights because she has children and she had to leave her previous area because she could not get childcare for the long shifts. Nurse shifts are normally twelve and a half hours and usually start at 7.30 until 20.00. Then night shift starts at 1930 until 0800. We get an official one hour unpaid break, usually two half hours. I did not have children but planned to have them one day. I could not imagine how I would manage with childcare. This must be the most bizarre of employment that does not support women with children and yet the majority of nurses are women. Surely it is discrimination because as I think I understand it, there are no childcare facilities beyond 6pm and before 8am. Yet we have nurses with children expected to work these long hours. If this same scenario was applied to disabled people, that there is no disability rights beyond 6pm then they would rightfully be campaigning to change it. Why should women with children rights to employment in the NHS be lessened due to the expectations of long working hours? If I had children would I need to leave my job because I could not get childcare beyond 6pm? Why is it in the first place that women, with children are expected to work beyond the normal childcare facilities times? Surely those with children should be allowed to work during daytimes? Should there not be automatic rights to flexible working hours? Perhaps this would help retain more nursing staff. I wonder if there has ever been a survey done on the levels of nurses leaving due to childcare restrictions. Surely it would be cheaper in the long run to keep nurses that are trained. I know that there are some wards that are very flexible with working hours for those with children but largely it is still quite rigid. Off duty is done by those in charge and if you can’t do the hours allocated you could get a hard time. Could this also lead to bullying, I wonder? It’s alright for those in charge with their nice daytime hours but for the rest of us, we have these long hours that do not suit us all. It surely is time to take nursing into the contemporary era that we now live instead of constantly looking back. Sure we can learn from previous years but society has changed and it is always changing.

Matron Your Time is up.

Nurses no longer live in residence with the Matron deciding what time her staff can go to bed at night and if it is alright for her staff to get married. This authoritarian type of matron should be dead and buried along with the previous useless nurses hats that served no purpose other than get in the way. We are always told that in our modern age in the UK that we do not live in a totalitarian society. Why does this exist in nursing when politics have changed around it? Political leaders attempting to score more points talk about the past NHS as something good to go back too. The only good thing was that there were more beds for patients and patients were not thrown out of them before they were well enough to go home. Oh how good the old days were with no MRSA and other HAI’s! Let’s go back there for a little reflection. Even 50 years ago the average life span was a lot less. We still had Nightingale wards. Death rates from respiratory conditions were common as we had no vaccines to flu or pneumonia and it was common for women and children to die in childbirth. The sophisticated operating procedures that we now take for granted did not exist and during an operation instead of keyhole techniques there would have been massive incisions with greater blood loss. We would not have had the greatness of screening procedures that we take for granted in preventative medicine. So let us stop looking back to the good old days they are in the past. We have now advanced in medicine let us now advance in working practice. Bye bye Matron it’s time for retirement, we need to work as a team now, we do not need your authority or bullying tactics, our job is difficult enough. It is up to us all to manage to keep our hospitals clean not a Matron; if we do not know how to clean our hands then we should not be working there in the first place. So give us some credit that we know how to wash our hands and let you all be assured that we do wash our hands. We do not need some matriarchal figure watch us wash our hands. With the greatness of modern medicine more patients can be seen in a year.

However, the high turnover of patients in today’s era means that per year on average we are seeing an increase of patients using the same ward and the same beds. So potentially a ward could have different patients within hours. For example a patient admitted into a bed for a non emergency gall bladder removal could be replaced the next day with another patient. It is common now for this operation to be done as an inpatient day case as are many other procedures. If this operation was done on a daily basis on a five day working week, in that same bed in just one month there could have been 20 patients using it. That could potentially be 100 patients just in five months with all variances of additional diseases that the patients have. A four bedded area in a ward in just five months could have on average 400 patients sharing the bathroom facilities and then we wonder why there are HAI’s. The answer to HAI’s is complex but there should not be any patients sharing rooms. All single rooms with en suite facilities are the only way to go and if a patient can go home, home is the best place to be. I hear the horror of those reading this wondering about the cost of redesigning hospitals, better that than the cost of the NHS being sued for unnecessary deaths due to HAI’s. One death is one death too many. So, I finish my break and get back to work.

A Meer Trifle

When I get back on to the ward the crash team are all swarming over a patient. The patient is saved but will not last long and is taken to High Dependency. I look in on my patients and they are all asking what the commotion was. We are not allowed to discuss patients with other patients so it sometimes makes it difficult when other patients ask about each other. ‘It alright,’ I inform them, ‘a patient is just unwell’. There are some aspects of this job I still do not know about, so I ask a nurse who reminds me of a meerkat if I can try to apply humidified oxygen as I have not done that yet. I ask if she will show me but she looks at me as though I am someone to be despised, the mother or wife of a killer or worse a killer myself. What have I done to deserve this? I only asked! She turns around staring at me with utter contempt and says, ‘it’s alright I will do it’. Her neck is long and she is always looking around her. Her name coincidentally is katherine and everyone calls her Kat.

True enough, she has never spoken to me. She blanks me in the corridor and I always say hello. So, there is always one! Surely, things will get better. The Sister calls me in, and asks how I am getting on. I reply that I feel happy here and that I will soon settle in. She looks at me and does not smile. Her face takes on the resemblance of Hattie Jacques from the film Carry on Matron and she looks quite strict. ‘Well’, I think, ‘at least things will not be so bad because Mary Poppins would be worse.’ She shows me my record. ‘This record is not very good, you have a lot to learn’, she says. ‘I do not mind learning,’ I answer. ‘You need to go back to basics again,’ she says. ‘You are not a good nurse as I have heard a lot from your previous boss.’’ Well,’ she would say that because she bullied me,’ I say. She turns around with her face dark red and shouts, ‘how dare you speak to me about my colleague. ‘I do not want to hear any more about this.’ I go out the room in complete disbelief. This is not what I thought it would be like. I ask a nicer member of staff what this sister is like. 'She is a big bully,' I am told. ‘Stay away from her and you should be alright.’ I find out her history and it turns out she previously worked with Mary Poppins and they are best friends. I can hardly believe it, I took on another post to get away from her but it seems I am not so free. I feel the shackles go back around my throat. Battle axe Hattie is on to me and things may be worse. She stands watching me, I feel on edge as I try hard to fit in. I am bumped into and pushed aside by Kat and told to go and take observations on other patients after I shout for help as a patient collapses with a cardiac arrest. I did the right thing as we get the crash team in to help us. I guess I will always remain at the bottom and they will always ensure I stay that way. Kat goes in front of me to the changing room. She must only be in her early twenties. She checks her face and hair in the mirror; she likes to keep brushing her hair and always has loads of lipstick on. Her perfume is overpowering and it is difficult to breathe when she sprays it. She coughs really hard as it affects her too but as she coughs something falls out her mouth. Her teeth land on the carpeted floor. She sees that I notice them and she looks embarrassed. I smile inwardly but dare not let her see me. What goes around comes around I always say. I walk away but heavy hearted, this may not be what I thought. Is nursing for me? I sit down in my car and turn on the radio. I look out at the sky and see the moon shining bright with all the stars twinkling. I look down at my steering wheel and stare at my car logo in the centre. I imagine life before nursing. I feel flat.I listen to the music that beats out...
"Butterflies And Hurricanes, Muse"
change,
everything you are
and everything you were
your number has been called
fights, battles have begun
revenge will surely come
your hard times are ahead

best,
you've got to be the best
you've got to change the world
and you use this chance to be heard
your time is now

change,
everything you are
and everything you were
your number has been called
fights and battles have begun
revenge will surely come
your hard times are ahead

best,
you've got to be the best
you've got to change the world
and you use this chance to be heard
your time is now

don't,
let yourself down
don't let yourself go
your last chance has arrived

best,
you've got to be the best
you've got to change the world
and you use this chance to be heard
your time is now

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 Birds Perspective

Today, I have a meeting with my union steward. I have reached the pinnacle of what I can endure. I am up here on my own, looking down and seeing what goes on and like history that can’t be changed so too does my outlook. It is cold up here and I know no one cares so long as I fit in to the cogs of the big machine which operate in the wrong direction to that of the caring conscious. This act which I have learned so well, does not fit me like a glove, but is like the mask that was designed for another face and it keeps slipping down on me. This mask is the mask with the big black tear and black painted smile. I am sitting on a rock and I cannot fly away and so I wait until the time when I can come down from here. I sit and mull over my regret. I go along a section of corridor which has many different offices and a row of little shops as though I am in a shopping mall. The shops are in the wrong location, they have no place here. This hospital is all about making money from the sick, the company that owns the car park wants as much money as possible. It is all sewn up and it is endorsed with yellow double lines all around the outside of the hospital, just in case any of the bleating sheep stray from the flock and try to escape the payment. The sick and their families are herded in to make the payment to the company that sits on a wealth that is stolen on opportunistic illness and disease. Gaining profit from the sick could only be dreamed up and acted upon by people who have no conscious and it is the quintessence of all evil. I knock on the door of the Union office and am ushered in. I tell my steward everything but the words are hard to find and I feel it comes over, like gobbledygook. I am trying to say that I am being bullied but instead I pick out example after example. I feel confused and my emotions run high. I have not been eating properly and my sugar levels will be low. I see that the steward knows what I am saying and listens intently. My steward reminds me of a wise owl and has a wealth of information. I am in the situation whereby I must fight or flight. I feel I do not have the energy to fight and my body is warning me that I must run away. Still, I know in my head that I must fight back. I know my fight is against an army and not just one person. I talk until I can talk no more which is something quite unusual for me. Conversation is a commodity we all take for granted and we can iron out the most minuscule of detail with it.

Let The Battle Commence

I go back home and pour coffee into my cup and consider my fight. I do feel apprehensive like a soldier getting ready for battle. I need to meet my bosses and we need to talk this out. I evaluate what I need to say and it goes round and round in my head like a tornado about to hit a little village. Until then I need to stay calm, the calm before the storm.

Was That You Henry?

Be your shelf
It’s raining! The big wet drips hit the ocean like bombs. I stand at the shore looking out. Each drip has a sound of its own making the rain noisy but like a song. A man comes up to me and asks what I am doing. To be honest I do not know. I watch the sea swirl and the wind blows through my blond hair which is getting long now and blows across my face into my mouth. I look out and see someone on a boat, they are being thrown about and the sea is very stormy. An elderly lady comes up to me in a red waterproof anorak and asks me the time. I look for my watch but it is gone. ‘I do not know the time,’ I say. I look into her face and it is a patient that I cared for but she had died. I look into her eyes and they are big and blue. The lady looks very well. I ask her what happened to her. She says, ‘don’t worry dear, I am alright, you helped me come here and my family are with me but I am concerned about you.’ I said, ‘oh I am alright too.’ The lady said, it’s ok dear I know how it is don’t be scared, I am not one of them, you can be yourself, it’s so important to be yourself.’ I can’t be myself,’ I said, if I do I am doomed.’ The voice grew deeper saying, ‘be who you are.’ Me, how could I be me? I awoke and my mum was shouting at me. ‘Mum what are you doing?’ I shouted. ‘I stupidly stayed with you last night and your shelf has fallen down on your bed.’ My mum said. ‘You are lucky it did not land on your head.’ My shelf, myself, I think! I lie there for a few seconds thinking about my dream. I have books lying on top of me and one falls to the floor as I turn around. I hear my mum pottering about, what a bad idea having her over because my house will be rearranged again. ‘Forks on the left, knives to the right in the cutlery drawer.’ she always says. ‘You need to go in there and you need to tell these people what for.’ ‘Yeah, what does that mean exactly?’ I say, as I switch the television on. ‘Tell them that you are not taking the bullying anymore.’ Who exactly do I say this too?’ ‘Your boss, or her boss,’ she replied. She just does not understand, if only it was that easy. The fact is my boss is bullying me, how can I say? Bullying is normal in nursing. How wrong, how sad, that in a caring field it is normal to be bullied. My mum has ironed my uniform and it feels like cardboard as I get changed for my shift. My mind wanders back to my dream. I know I can’t be myself in nursing because they will bully me all the more. I need to appear like them. I wander through the corridors of the hospital and I bump into Elias the porter. He asks how I have been and I smile in my usual way. I tell him I am alright and he asks how Sister Poppins is treating me. He has a cunning smile as he asks about her, he says he has been in her ward a few times recently and she was moaning at him about taking so long. Elias never says a bad word about anyone; he wears typical porter clothes for the NHS, blue trousers and light blue top. He always looks tired. He shrugs his shoulders and says that he hopes I have a good day. We part in opposite directions. I make my way to the ward and as I walk in, there is the usual smell which is quite distinctive to my ward but there is also an overpowering smell of coffee. I go past the nurses’ station and Sister Poppins looks up at me, I still smile and feel stupid for doing so but let my smile fade away under a cloud. She does not say anything to me, nor does she smile back. She still stares at me as though she were about to tell me something bad but she doesn’t. She watches me walk past her. My gaze turns from her to the office door which I open with a heavy heart.
“Don’t be Horrid Henry.”
As I open the door, I see a familiar nurse auxiliary. I am so pleased to see a face I know, it can make my day better. He has a little mischievous grin and is often up to childish jokes but he is not nasty. He reminds me of the children’s cartoon character Horrid Henry. After handover he works with me with my patients. We get the patients up and make the patients beds. He talks incessantly joking the whole time. He is laughing saying that he needs to pull a prank on Sister Poppins. He laughs calling her scary Mary. He said the last time he was here she was shouting at him for leaving the toilet light on. She has signs on all the lights that they must be switched off. In fact she has signs everywhere, on cupboards and walls. One sign reads that tea and coffee is for patient use only, meaning staff need to take in their own. Another sign reads big lists of duties that staff must carry out on night duty which is stuck on every available wall. On the desk there is a sign that staff must not place any drinks there. We get on with our work and it is nice to have a laugh. The patients smile too, they really cheer up when there is someone who is very friendly. I hear this voice shouting, yoo hoo over here dear. I go over to a patient and she says, ‘I do not want to cause a fuss with my hotel bill but I think they have overcharged me.’ I smile and say do not worry your stay in hospital here is free.’ She says that I must take something and she will have her secretary write me up a cheque. Then she turns and asks what is on the hotel menu and will she need to dress for dinner. I look at her face and she has been eating chocolate after chocolate and it is all over her face. I ask if she would like a shower this morning. She keeps going on that the service in this hotel is wonderful. I just smile and know that she is confused but at least she is happy. She has various pictures beside her of her family. I look at the pictures and wonder how her life once was before she became ill.
More Water Please!
We organise many patients and the heat in the ward builds up. I am so dehydrated. I feel a little faint and stop what I am doing. Horrid Henry says he will get me a drink of water. He comes back a few minutes later saying that if I want water I will need to walk to the kitchen. Mary Poppins would not allow him to bring me some water. I go to the kitchen feeling light headed. I always wished we had a water dispenser on the ward; it’s such a basic need. I drink lots of water until I feel myself return to normal. I take my lip balm out my pocket and put it on. Because I have been so dehydrated and it is so hot I need to carry lip balm around to stop my mouth becoming dry. It is known as one of the basic essentials of nursing by many nurses. I go back to my patients but Sister Poppins stops me. She tells me that I should never walk away from my patients. I inform her that I was dehydrated and Horrid Henry tried to bring me some water. She said that there is no eating or drinking on duty in ward areas. She said that in future if I require a drink then I must ask permission to leave the ward. I know she is just picking on me and I look up at her and want to say something but know I can’t. I go back to my patients. Sister Poppins keeps coming through to check on me and keeps telling me off for little silly things. I really can’t take this ward anymore. Horrid Henry says, ‘don’t worry about her, I will get her back.’ ‘What do you have in mind?’ I say. He just laughs, he is an enigma. The day passes over with all patients doing well and a few will be going home in the morning, which is good. It’s always the nicer side of nursing.
Honest it wasn’t me.
Before my tea I need to go to an office to collect my pay slip, Horrid Henry is already on his break and another nurse will be covering for me. Sister Poppins has just left. I realise I am walking behind her in the corridor but she is still a little distance away. I then hear shouting, ‘Sister Scary Mary, Sister Scary Mary.’ It’s a non-descript voice and I look around but nobody is there. In fact, nobody is now in the corridor other than Sister Poppins and me. The voice gets bigger, ‘Sister Scary Mary!’ Sister Poppins turns around and sees me walking behind her. ‘Oh no’ I thought, she thinks that was me shouting. Sister Poppins stands for a second looking horribly at me and then walks away. This is not funny. I go back to the ward and Horrid Henry has finished early, so I don’t know if that was him shouting.
And they’re off
Sister has introduced taped handovers on the ward. They have become the new ‘in thing’. I really hate taping my voice and allowing others to hear it. Why tapes? Sister said that it is a breach of confidentiality having handover sheets. These are sheets of paper given to each nurse on duty prior to going on the ward to work. It informs the nurses about the patients and has basic information on it to ensure continuity of care. Handover sheets when done correctly fit nicely into the pocket and are a little bible to keep nurses right throughout the day; we can tick things off and add to them as the day goes on. The crazy thing is that everyone listens to a handover on a tape and takes notes, creating their own improvised handover sheet anyway. The situation is worse on tape and information can be lost. Nurses wanting to get home as quickly as possible speak as quickly as they can. It is like listening to commentary for a horse race as the nurse gets quicker and quicker. ‘And they are coming up to the finishing post and little Mrs Smith has developed a leg ulcer.’ It’s often hard to hear anything and taking down basic names and much information can be lost or misinterpreted. Nurses from other countries say that they hate the tapes because often English is not their first language and they are self conscious about their voice on tape and often they find it hard to understand the fast handover. I just want the handover sheets back with any updates vocalised personally to the nurses taking over. If it works don’t fix it, as they say. I go home into my car, its cold, its dark and I am exhausted. I hate my job. I need to look for something else. I think about what other opportunities I could have. I think about a nice little desk job or even just working in a shop. Anything has to be better than this. I start to think about the little elderly lady in my dream. She said that I need to be myself. I love caring for people but I just can’t do it because of the bullying. I need to hide the real me in my job. The real me is the caring person who is the real nurse. I am a nurse hiding behind the wall I have built to protect me. When the bullying can be stopped I will knock my wall down and the Angel of the NHS will be revealed.

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!