The BBC came out with this little article recently.
"Colour-coded nurses' uniforms to help patients in Wales recognise who is in charge on hospital wards are being unveiled.
The assembly government said the new unisex scrubs would clear up confusion about who does what.
Ward sisters will wear navy blue, clinical specialist nurses royal blue, staff nurses sky blue and healthcare support workers will wear green."
It's a waste of time. Patients and visitors think that anyone walking around the ward in uniform is some kind of nurse. The fact is that the nurse is massively outnumbered by untrained staff and those who are at a level above staff nurse do not come near the wards. Our uniforms are currently colour coded with a different coloured stripe designating our rank so to speak. I do believe that we need better uniforms and laundry facilities and changing rooms. But I do not have any confidence in the fact that the public understands what a nurse is or understands the difference between a nurse and a care assistant.
When patients need a bedpan or a drink they think the ask for the "Nurse". I would like to be doing those things for people, as I know that they appreciate it and are grateful for any help. But the fact is that if I am in the middle of the drug round, ward rounds, emergencies and I am the only nurse with a few care assistants then I HAVE to delegate these things to the care assistants.
The 3 hour drug round to get everyone their 8 AM medications will turn into a 6 hour drug round if I do not delegate all the simultaneous requests for the commode that I get while focusing on the drugs etc to the care assistants. It's not like the care assistants can carry on with my work while I stop to help with toileting. The vast majority of errors etc that I have seen during the course of my career occurred because of nurses being interrupted for these kinds of things. I am already going to be getting interrupted constantly for things like phone calls, visitors, doctors orders, admissions etc anyway. The care assistants cannot help me with that either.
This leads to patients saying things like "That nurse (the care assistant) was kind enough to stop and help me wash my back but that mean nurse (the lone RN doing the drug round for 15 people while managing someone who needs constant monitoring) couldn't be bothered.
Even if the patients can differentiate between a nurse and the care assistants they are still going to ask for the "nurse" when they want something relatively minor. The nurse is usually up to her eyeballs with constant problems and cannot always get that commode. Nurses have to make quick decisions as to where they can go and when.
Janelle was a colleague of mine who got written up over something like this. She was a lone nurse for the ward with only care assistants to help. It was 7PM and she was still doing the drugs that should have been out at 5PM. She was running between a GI bleed and a COPD (infected excab) patient who was really kicking off as well, very short of breath and looking septic too. She had visitors of other patients up her backside wanting immediate answers. Sitting down with them and giving them those answers would have taken her away from the GI bleed and the COPD patient for too long. She was the nurse and had to deal with it all alone. The care assistants cannot help with things like this.
At one point she was drawing up some antibiotics and getting IV fluids reading for the COPD patient when the care assistant burst into the treatment room. "The woman in bed 3 says she must have a nurse right away. I told her that I am a care assistant and I can help but she says she wanted a nurse straight away". The patient in question often gets chest pain and Janelle thought that this must be why she wanted a nurse. So she legged it to bed 3. "I want a commode, that is why I demanded a nurse" says the woman in bed 3. "I am going to let Lena the care assistant to help with you with that right now because I have a situation with another patient who needs some medications" says Janelle. Cue the patient getting pissed off and complaining as a result of not understanding the situation. Cue Janelle being stupid and getting her a commode to appease her. Cue the medic showing up and pitching a fit because the IV antibiotics and IV fluids were not yet started on the copd patient and Janelle, the only RN, was handing out a commode while the care assistants twiddled their thumbs.. Janelle was complained about by both the patient asking for the commode and the medic of the poorly patient.
Nurses do not mind giving out commodes, cups of tea etc. But we are rarely in the position to do so. We did not create this situation, it is out of our hands. There is a lot of work that can only be done by a nurse and we are severely outnumbered by untrained staff who can really only help with basic care.
Colour coded uniforms are not going to change much. Nurses who are trying to concentrate and focus and get from one sick patient to another with drugs and treatments are still going to get interrupted constantly and asked to deal with things that the care assistants could handle. And we will continue to have mistakes and omissions as a result. I have seen severe mistakes occur because of it.
We are taught to prioritize but we have all walked away from things that we should NEVER have walked away from in order to prove that we are not "to posh to wash". And problems have occurred. I have seen patients harmed because their nurse was off helping other patients to get commodes. They are sensitive to the fact that people are accussing them of being "to clever to care" and then they do something stupid. I have seen more patients hurt by this rather than harmed by uncaring nurses.
Please realise that the nurses are professionals who are overwhelmed with their workload and understand that horrendous consequences can occur if they are not allow to focus and delegate. Please realise this rather than accusing them of being shirkers who are trying to get out of getting their hands dirty.
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