In the immediate aftermath of the release of the Francis Report into events at Mid Staffordshire NHS Foundation Trust, I identified that David Cameron's crocodile-tears and apparent humility were just a feint that would quickly turn into an attack on the NHS nationally (yet another front in their all-out war on it), using Mid Staffs as a template for attacking other hospitals - and Labour.
Nurses in Britain will probably have at least some peripheral awareness that national negotiations are currently in progress to determine our Agenda for Change terms and conditions (i.e. what we get paid).
What a lot will not be aware of, however, is that our colleagues working for 19 NHS trusts in the South West of England are facing real terms cuts to their pay and conditions, thanks to the South West Pay Cartel – Basically, 19 trusts in the South West have banded together in an attempt to adopt a regional pay structure. This despite the Health Minister telling the Cartel that regional pay is a terrible idea, and they have no legal right to leave the Agenda for Change T&Cs.
Well, this is depressing.
I think I need to address the people who live in the South West of England at this point. It’s an older population than most parts of England, because many people retire there, and the economy is not vibrant, so many young people leave to work elsewhere. In other words, it is disproportionately dependant on the NHS, because older people = more use of healthcare.
So to the people of the South West: Let me tell you what is going to happen where you live, if regional pay is adopted there, and pay is cut as a result (it will be, that’s been the transparent goal of the Cartel from day one).
Medical schools, nursing schools and schools for allied practitioners such as physiotherapists, occupational therapists, radiologists, turn out a class of fresh, eager new professionals every year. And those professionals look for jobs. Do they look for work in a part of the country they know to be more expensive than average in terms of living cost, and where they know they’ll get paid less? No. They do not.
Existing healthcare professionals in the South West will suddenly be faced with a choice: Stay and get paid less, or go and get paid more. What happens? Those who can move away, move away. It’s not hard to get a job as a qualified healthcare professional. Really. I get sounded out or asked to apply for one at least once a month. We can work anywhere; our qualifications are universal, and our professional registrations are good enough for the whole world.
So at this point, no newly qualified professionals will be moving to the South West, and a lot will have left, leaving hospitals desperately short-staffed. What do they do? The only thing they can do; they’re legally obliged to maintain safe staffing levels, so they get agency staff at an average cost of £146 per hour to cover the shortfall.
So what do you, the patient, get? You get inconsistent care, where you rarely see the same nurse twice during your hospital stay. You get a lack of continuity because the nurses looking after you are not a part of the team, and they have no real incentive to make sure your needs and requirements are handed over to the next nurse on shift.
What do the trusts get? Well, let’s just look at nursing a minute, because that’s what I know: A newly qualified nurse on Agenda for Change terms costs employers around £11 per hour in all. That’s about £125 for a twelve hour shift (note: That’s not what the nurse takes home, that’s what they cost the employer including pay). An agency nurse, on the other hand, costs £146 per hour (the best paying agency offers a flat rate of £32 per hour, the rest goes to them), or around £1750 for a twelve hour shift.
In other words, by cutting pay for nurses the South West Pay Cartel will ensure that everybody, including themselves, loses out financially. The only people who win will be nursing agencies and their very well paid employees.
And let’s not forget the bigger picture: We need newly qualified staff, who’ve been trained in the newest and best ways of doing things, to come and tell us when we’re doing something in an old-fashioned way. Medicine should be evidence based, and evidence improves and changes. We don’t all have the benefit of being able to sit down and plough through the journals every day to stay up to date, so those new staff are a crucial part of keeping our practice up-to-date.
I think what scares me the most is how very obvious this all is. Executives at those trusts are in dire need of opening their eyes, taking off their financial blinkers, use whatever metaphor you like. They’re going to bankrupt their trusts, and they’re going to do real harm to patients in the process.
I guess I can’t really blog about nursing and not mention the Stafford Hospital report. For anybody who’s been living under a rock, the tl;dr version is: Care was not good enough at the Stafford Hospital, and unnecessary deaths resulted.
Ouch. I can only imagine how nurses at that hospital feel right now. Frightened. Embarrassed. Defensive. Angry. Probably a cocktail of all those and more. But that report has been pored over and analysed and quote-mined to death; the only thing that I want to say about it directly is: The report’s author has already admitted that he was wrong to name the whole hospital as the problem, when in point of fact the issue was isolated to two wards – And he even narrowed it down to specific staff on those two wards.
And yet, on the basis of this report, nursing in Britain is going through what feels like a witch hunt. This isn’t a nice time to be living through, speaking as a nurse. The media cannot wait for us to screw up and sell more papers for them, and the government are eager to push any agenda which makes the NHS as-is look inferior, because they’re ploughing ahead with privatisation by stealth (if you doubt that, read the full text of the Health and Social Care Act, then come back to me) and want to minimise resistance from the general public.
What’s worse is, nursing can’t get a mention on social media without a barrage of comments from uninvolved lay-persons who think they know how to fix all of nursing’s woes. From dead reckoning, at least ninety percent of the people making such comments can be summed up as “Bring back Matron!”, even though Matron never actually went away in the first place. Personally I think that there is a small but very vocal minority of sexually deviant people who fantasise nightly about Hattie Jakes in a white tabard and starched cardboard hat, and who want to populate our hospitals with her.
My point here is this: Nursing is a profession that people have so little respect for (until they actually see us in action) that they feel perfectly comfortable with telling us how to do our work, in spite of their own absolute ignorance. Dunning-Kruger effect – They’re too stupid to know that they’re stupid.
Of course, in amongst the Hattie Jakes fans, there are always one or two comments along the lines of “my mum laid in her own faeces for hours!”. Actually, that’s a really good example to use because it’s so common and yet usually such obvious tosh. How would you know that your mother had been laying in faeces for hours unless you were actually there to see it? And if you were there to see it, why didn’t you nag somebody until they came and cleaned your mother up? Now, I’m not saying that anybody visiting a hospitalised relative should ever be in a position to have to provide care, but honestly? If I was visiting my elderly grandmother in hospital and nobody had cleaned her up after a few minutes and repeated requests? I would just do it myself. And I know that’s not really a fair generalisation, because I am a nurse, and cleaning poo from elderly people is very much in my job description, but I think the point remains valid.
People in general don’t seem to provide care for elderly relatives as much as they used to. There is a very sad tendency to expect the NHS and/or Social Services to do everything. And that really isn’t the point of socialised health and social care.
I have encountered my share of families who pick up on every single detail of their relative’s care, and get angry and upset and claim that it isn’t good enough even when it’s absolute gold standard. They’ve all had one common feature: Guilt. In general, it’s often the family of an end-stage terminal patient who’s been an inpatient for weeks or months, but whose family have never been to visit until the day they’re phoned and told that their relative is fading fast and now would be a good time to come and say goodbye. That’s the point when you know as a nurse that you’re in for a challenge, because the family are justifiably upset that their relative is dying, and they’re feeling guilty about not visiting while he/she was still actually conscious and able to interact with them. They lash out at staff, and it’s our job to take it and to never, ever judge them. We don’t know why they never visited, and it’s not our business.
It’s also our job to deal with patients who are confused and/or demented. I personally know four or five nurses and auxiliaries in the last year alone, who have been assaulted severely enough by dementia patients, to have needed time off work to recover. This is something that is poorly understood: If a person has dementia so advanced that they form no new memories and have few or no original memories, then as far as that person is concerned, they are always in a strange place, surrounded by strange people. A lot of they time they won’t even know who they are, let alone the people in blue who want to come and give them a wash. Fear and anger are natural responses to that, so sometimes as nurses we get physically assaulted. I’ll leave aside the issue of people who assault us because they’re just plain horrible people, because that is rare outside of the ED.
Now, I don’t want to play the martyr here. Honestly, I don’t; I think that’s a terrible and manipulative thing to do. Everybody who ever trained as a nurse knew very well that they were getting into a hard, physical job which comes with a lot of responsibility and very little financial reward. We all knew from the outset that we’d be working twelve hours without a break, often followed by four hours of unpaid overtime. We all knew that our home life would suffer for our choice of profession. We knew that we were going to get insulted, spat at, berated and punched.
We knew all of that. But we never agreed to be whipping boys and girls for every politician and bored journalist in Britain. And that, sadly, is what we are becoming.
If I get any message across in this post, I hope it’s this: On the basis of a report about specifically identified staff on two wards in one hospital, the government and media now seem to be on a mission to destroy the working reputations of more than a million clinical staff working across almost four hundred NHS trusts. They’ve totally ignored patient’s opinions (the last CQC survey showed that 91% of patients who responded rated the care that they received as excellent, very good or good), and they’re completely blanking the vast majority of clinical staff, particularly nurses, who deliver that excellent care against stacked odds.
So if you’re a nurse or an HCA or an NA or an AP or even (whisper it) a doctor, then hold your head up. The vast majority of your patients think that the vast majority of you are brilliant. And really, do any of us care what anybody else thinks?
For my first proper post, I thought I’d talk about a placement I had as a student, at a large Emergency Department (ED) and some of the experiences I had there. Then I thought about it some more and realised that the vast majority of them were probably not fit for public consumption (for example, the man with a broken-off neon light-bulb tube in his rectum, always a good one for Foreign Object Top-Trumps) and that I should be a little bit careful about what I talked about. So I decided I’d talk about TV crews.
TV crews are maladjusted.
I’ll let that sink in.
Good. Now I’m going to justify it.
I had the terrible misfortune to spend a couple of months working in an ED at the same time that a well-known TV company were there filming for a fly-on-the-wall documentary program about
amusingly lodged foreign objects the sterling work of the heroic medical professionals who staff these bastions of all that is good about humanity.
Some of what the TV crews did caused me to have… Let’s call them “ethical doubts” about their presence.
Case 1: Morbidly Obese Man in Cardiac Arrest.
Most EDs have a Resuscitation Room (“Resus” for short) right next to the ambulance entrance. It’s where you’re taken if you’re:
a) Already dead and we want to try to bring you back, or;
b) Looking like you’re about to die and we want to try to stop you.
Think of a big, brightly lit room full of excitingly medical looking kit (a surprising amount of which is used for putting various tubes in various orifices) and wired-looking people in scrubs. Now add a slightly nervous looking yet ruggedly handsome student nurse to the picture and you’ll have it about right.
On the day in question, an ambulance came in under blues and twos (blue flashing lights and two-tone siren) with a very obese man on board in cardiac arrest (his heart had stopped). The paramedic was pumping on his chest as the doors opened, and we got him out and on the table in double-quick time. Pretty quickly he had various tubes inserted in various orifices, various needles inserted in various vessels, various sticky things stuck on various exposed flesh, and the tightly controlled chaos of a crash unfolded.
Folks, this bit is going to shock you: “ER” is full of crap. Most crash calls are not successful. Even the few that are successful are very rarely followed by successful rehabilitation and discharge of the patient. If you have a cardiac arrest, it is extremely likely that you will die.
So our very obese man passed away in a frenzy of activity.
Do you remember the picture you formed earlier of Resus? Kit, tubes, caffeine-addicts, student nurse? Add three more people to the scene.
A camera man.
A sound man.
Now imagine the events of the day again, but this time imagine the TV crew filming the whole thing, from the back of the ambulance and through Resus.
Imagine, if you will, your ruggedly handsome student nurse threatening to turn the boom mic into just another Amusing Foreign Object, sans lubrication, if the sound man doesn’t get it out of the damned way of the damned lights. Imagine the crash team, already under immense pressure to get every single decision right because every single one of them might dictate whether their patient lives or dies, and now imagine how much more pressure is on them because it’s being filmed for national TV. Imagine how the patient would have felt – stripped to his underwear, bowels and bladder voided on the table, wobbly bits wobbling. Imagine a nurse doing chest compressions and having to pump hard enough to break the patient’s sternum just to get his chest moving – Crack! “That’s great TV!”, says the producer.
Afterwards, I asked the producer to explain the ethics of their presence to me.
“Well,” he said “If the patient lives, we ask permission to film afterwards. You know, retrospectively. If they die, we ask their family.”
I think I must have looked puzzled at this point, because he went on to say a lot more, using much longer words like “demographics” and “public right to know”. It didn’t really add content to the opening reply, though.
Case 2: Dying Lady who Didn’t Know She Was Dying
Later the same day, we had a patient brought in by her family following a collapse and loss of consciousness at home. Much testing and scanning revealed that she was in the extremely advanced stages of cancer and had collapsed due to metastases in her spine and brain. Oncology gave her a few days to live, and were frankly baffled that she’d still been upright and able to mask the symptoms from her family for so long. The job of breaking the news to the family fell to a young, newly qualified doctor, who was accompanied by a nurse (nurses are generally better communicators than doctors) and a student nurse (who needed to learn how these things are done).
Unknown to us at the time, there was also a TV camera poking through a gap in the curtain, filming the exchange.
News was broken. Weeping ensued from family, comfort was given as far as possible by medical persons present, grief counsellor was recommended via information leaflet.
And then: Curtain is drawn back, smiling TV producer with clip-board in hand turns to family and says:
“I wonder if I might talk to you about consenting for us to show that discussion you just had on TV. You want to be on TV, right?”
The TV crew were forcibly ejected by nursing staff at that point.
I’ll end this post, which is already longer than I planned, by telling you that I refused to sign a consent for the TV company to show any footage of me – so they couldn’t use any of the film they shot that day, because I was in almost all of it.
Hello, good [insert time of day here], and welcome! I am Custador, AKA The Angry Nurse, and this is my new blog. I’ve blogged on many topics unrelated to being a nurse, over a period of several years, as well as moderating blogs for other people for a long time. But I thought that what the internet really needs is: More graphic stories about bodily fluids, from a trained professional body fluid handler. The internet is short of those, right? In all seriousness, I hope that this blog will cover a plethora of subjects, from professional and ethical issues, to sharing experiences, to gross-out tales about the incredible size of some of the turds nurses see (I’m not even kidding, some of them have been gigantic).
And that’s that. Now I’d better start writing something with some actual content to it. Stomach content, maybe. Hmmmm…