The patients and visitors think that anyone walking around the ward in uniform is a "nurse". How wrong they are.
A nurse in the UK trains for about 3-4 years at uni. I think I doctor is 5-6 years initially. Untrained cadets and carers have zero years of training. Some have NVQ's. I did 4 years at university and then took a licensing exam to qualify as a nurse. I was taught about how to nurse a patient with diseases and treatment plans diagnosed and ordered by doctors. I took microbiology, anatomy and physiology etc to help me understand what I need to know. I have a professional registration and accountability.
First of all, the cadets are not allowed to do the majority of things that need to be done during the course of a shift. They do not have a professional license and cannot be held responsible for any errors. Everything they do is on the registration of the RN that they are working with that day.
They do not have knowledge behind patient conditions, treatments, drugs, doctors orders etc. On my general ward, and many general medical wards throughout the country (hell the world even), the majority of staff on duty are indeed kid types rather than actual nurses. The actual nurses cannot even remember the names of all their patients because they are so overloaded. This is not an NHS only phenomenon.
The kids can do a few things. They can bedbath a patient. They do this as quick as they can. The do not notice changes in condition or plan nursing care around the patients needs.
"Ah", says Nurse Anne as she is bathing a patient "His mobility is impaired, his skin integrity is at risk he needs to be repositioned frequently. His sacrum is breaking down already. He needs an airmattress. Oh look, His left side is showing a dense weakness and there was no weakness yesterday, no history if a stroke. The doctors have been treating him something else entirely.
The doctors might want to know about this now instead of 2 days from now when they do rounds. Can he swallow without choking? I need to make sure he eats safe foods and that he can swallow safely first! He doesn't need aspiration pneumonia on top of everything. He is due to have medications this morning and damn is he tachycardic. O2 sats and temperature are fine. Hmm. He just failed the safe swallow test I gave him using a teaspoon of water. Really fucking failed it, but he is alert. Left side of his face is droopy. He is hypertensive and tachy and cannot swallow his little digoxin pill, or any other meds. He might need a cannula to have his meds/fluids IV since he cannot swallow so I will get that sorted as I call the medic etc etc etc". Shit, I better put a Nil by Mouth sign above his bed so that the tea lady doesn't give him any. He'll fucking inhale that stuff right into his lungs. I could go on for 3 pages about that guy alone. There are many nursing care tangents that I could branch out onto about this fictional patient of mine. It's not my job to diagnose what has happened to this guy, even though it is pretty obvious. I am here to notice changes in condition, make medics aware of changes in condition, and plan nursing care around all that.
But when kids bath all the patients they just do it quickly and run to the next patient. They don't pick up on this stuff. They would bathe a patient as I described above and then throw sandwiches that are hard to chew and swallow at him for lunch and run to the next patient. I am so tied up with all the constant bullshit that I have no choice but to delegate basic care to kids. It fucking sucks. It is like working blind when I don't provide basic care to my own patients. I cannot relay to you here how scary this is for me.
I spend the whole morning with drugs and ward rounds, and phone calls from relatives and at about 12:30 a medic comes across one of my patients with a one sided weakness, facial droop, no history of stroke and a plate of hard sandwiches and half drunk cuppa on the table at the far side of the bed. He sounds chesty too. "When did he get like this?" says the medic. Damned if I know says Anne. I had so many meds to give this morning (took 2 hours), so many rounds (1 hour), discharges (very complicated, angry screaming daughter who wanted her dad out now so the whole thing took forever), constant phone calls from relatives, social workers etc etc (every 10 minutes for 4 hours) and one emergency over the last 4 hours that the kids bathed the patient. The cadets and I walked onto the ward at 0800 into all this plus 15 patients who needed full assistance with morning hygiene and each one takes 10-25 minutes each to do the bare minimum. The morning hygiene and 10 bed baths were the only thing the kids could help me with. Now Anne looks like a tit.
The kids can fill in intake and output charts. If someone has a cup of tea then you record the amount on the intake section. If they pee, you record the amount on the output section. It ain't rocket science and it sounds lame but it is extremely important. People are on fluid restrictions because their NA level is fucked. They may be in heart failure. They may be going into pre renal failure due to dehydration. I need to know their Intake and output and more importantly, the doctors need to know.
But try getting a kid to remember to fill in these charts after they have handed out drinks or taken a bedpan away. It's like pulling fucking teeth.They are in such a rush to get onto the next patient (and avoid complaints from prima donnas who take it as a personal insult when they are made to wait) that they do not document the one thing that they are allowed to document. I want to do it all myself. I do not have eyes on the back of my head. If I did all the care myself I would know if someone has passed urine etc. But I cannot be there every time someone needs to pass urine. It's physically impossible. The kids can be there, it is one of the only things they are allowed to do. But they don't really understand why we are measuring and recording, so it's not all that important in their minds.
I am tied up with too many IV drugs that need to be mixed and given, 3 angry relatives on the phone, a new admission who says she cannot breathe and a patient discharge as well. The kids cannot help me with any of that. But the weights need to be done now. That is something that they can do. They can weigh a patient and write down the number. I have asked them to do it. It's important. They are not going to do it. They don't seem to understand why weighing patients is important. Heart failure patients are weighed. It is always the last thing on the cadet's short list of jobs. Granted that the kids have many call bells ringing all the time, the nurse is tied up with bullshit and the cadets don't want to get bitchslapped by patients who think that they are being made to wait on purpose.
Here comes a consultant showing up on the ward round, seeing the incomplete charts and asking the registered nurse if she is to stupid to fill in a fluid balance chart or a weight chart. "Are these nurses to retarded to document whether or not someone has a wee" he whispers to his junior medic in a gentle yet astonished tone with a posh accent. We heard him. LOL.
Some kids can take blood pressure, heart rates and temperature (obs). They have been asked by me to check obs on all 15 of my patients please. They did 8 of them only. I didn't find out that they only took obs on 8 patients until hours later. They didn't tell me about the pyrexia in bed 31.
"Why did you not take obs on all the patients" says Nurse Anne. "Well the other patients were already done on the last obs round 4 hours ago so we skipped them". Nurse Anne slams her head into a wall. The obs are done every 4 hours to look for changes in condition!!!!
Why didn't I do my obs myself? I wanted too. Again, it is a chance at assessment missed and I feel blind. If I stop at the end of a bed to look at the obs chart all the other patients in the bay start shouting "nuuurse". I need to rely on shitty obs being flagged up for me sometimes. I don't have a fucking choice. At the time that this set of observations were due I was knee deep in bringing a rare surgical patient back from theatre (rare because we don't get a lot of surgical patients), arranging pain meds for a dying cancer patient, taking an admission, and was outnumbered by angry relatives wanting to speak to a nurse. The surgical patient was so hypotensive that I cannot believe they let him out of recovery.... and this is with IVF running fast, and that was taking my time and causing the hospice patient to wait and wait and wait for her next prn dose of pain killers. The kids couldn't help me with anything that was happening during that moment in time....except for that set of observations, bedpans and intake and output charts.
Enter Tara. She's the new kid in town and she is about 17. She is my latest ward kid and she really really doesn't want to be here. Most of the kids work hard and try hard even if they fuck up occasionally. Tara refuses to do things because "it is too disgusting". Tara has no interest in going to nursing school. Maybe she did when she first started, but once she got on the ward and reality set in she changed her mind. But she won't quit. She stands in the middle of the ward and refuses to do anything. We had to get management to get rid and get rid they did (they do come through for us sometimes). But there were a few weeks when things were rough. I was on shift with Tara many times with a full on load of 10-15 patients and only little Tara and maybe another cadet or HCA to help. .
I need to go now. I'll put part one in the title and finish the story about Tara later. I don't know how these get so long.
http://militantmedicalnurse.blogspot.com/2009/04/more-fun-with-kids-part-2.html
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