A Nurse with Sense and thoughts on Relatives.

Every once in awhile I see a comment out there in blog land that really hits the nail on the head.  I found this comment over at jobbing doctor.  It was written by Dinonurse who should really have a blog!  I was trying to explain that there needs to be controls over the numbers of relatives ringing the wards.  That maybe we should enforce the one relative rings about the patient and speaks to the other family member rule.  It is the job of the nurse to communicate with family and try and keep the next of kin updated.  But one nurse to 22 patients? Imagine what happens when each of those patients has 10 relatives each ringing throughout the day and demanding a chunk of the nurse's time?  No nurse will be effective if she is on the phone with relatives 40 minutes out of every hour, repeating herself.

Rrecently I was delayed for 10 minutes getting to Mrs. Smith with her blood because Mr. Tate's relatives grabbed me in the treatment room to ask questions.  I wanted to help them but had to get away as fast as I could as blood bags cannot be left sitting around or they go bad and hurt the patient when they are infused.  After talking to Mr. Tate's relatives I went back for Mrs. Smith's blood.  Then the phone rant.  It was another one of Mr. Tate's relatives.  Got off the phone with him and went back for the blood.  The phone rang again.  It was Mr. Tate's neighbour wanting all the same information.  Got rid of him.  Went back for the blood.  Then Mr. Tate's relatives grabbed me again in the treatment room to explain the same thing to another relative who had just arrived. I had to throw a very expensive bag of blood away, order another unit and Mrs. Smith's treatment was delayed.  None of Mr. Tate's relatives felt that I spent enough time with them even though I put another patient's health on the line to give them the time that I did.  When they were nicely asked to try and communicate the information to eachother they responded with a "no, it's not convientant for me to do that".

Now imagine that each nurse has this going on with the relatives of up to 22 people all day long.  The nurse is the only one who can answer phone enquiries, give drugs and treatments, and catch onto changes in condition that require a medical review.  The rest of the staff on the ward are care assistants and cannot get involved with any of this.  Love the care assistants but they don't magically turn into nurses who can carry on with the drugs just because I got tied up with families.

Even the nicest nurses in the world are cursing the relatives under their breath when not one of the IV drugs that were due between 6pm and 9pm have been given because not only are visiting hours occuring around that time frame, but phone calls are still coming in.  You might have to repeat the same chunks of information to 5 members of the same family in 20 minutes. 

One relative (must be the named relative on the admission form) rings or questions the nurses.  And it is his job to let the other relatives know what is going on.  If you are visiting and have a concern to raise with the nurses by all means do it.  But beyond that it gets dangerous.  Relatives are important.  Patient care is more important.  The very last thing that a lone RN on a large ward can do is pull away from patient care to deal with your dysfunctional family dynamics.  Talk to eachother.  You can also make an appointment with the medical team to get a very detailed explanation of your loved one's situation.  I cannot believe that you want me to pull away and abandon my patients yet again today because you, your seven siblings and mum's partner do not want to speak to eachother and each want to call the ward separately.  It is bullshit and I am calling you out on it.   If you mum was my only patient I would happily give you all the time in the world and go through the notes with you.  If I had other nurses to continue with the workload I would leave them to it, make you a drink, and explain the treatment plan to you.  But I don't.

Back to Dino's comment.

Want to know why nursing care is deteriorating?

Want to know why the mean nurses "cannot be bothered" to speak to the relatives?

Want to know why "nurses" today seem so unprofessional and unaware?

Check this out:

A bit late into the fray...heres my tuppence worth (for what its worth). The NHS is in its death throws and nobody is brave enough to tackle the root problems...no one could have envisaged just how far medicine would have advanced in the last 60 years. The original thinking was that everyone would work for a living and pay NI and rarely end up in hospital having to take back some of the money. Nowadays many acute wards are filled with patients who have never really paid any NI (and please, I am not "having a go" just stating a fact) or if they have, a stint on the ICU will quickly cancel out all that they have paid in.


Long ago, staff nurses on acute wards were expected to look after 4-6 patients. They had ENs and auxillaries and students to help them. They had senior nurses and sisters who were clinically active (not stuck in an office) and each "firm" of doctors had their own ward (hence you also had the HO and SHO around on your ward most of the time.) Jump forward 30 or so years and now the acute wards are filled with patients who would have been on an HDU or even an ICU in the 70s. The patients are often older, have more complicated medical histories, people generally are living longer but are not actually that healthy.
 
Add to that that the culture in the UK has always involved drinking and smoking heavily not to mention the ever present problems with crack and other IV drugs. Medical treatments have moved on quickly. Take an MI patient for example...in the 70s if you had a "community arrest" -hell, if you arrested in hospital you had little chance of surviving...now you get thrombolysed and PCI'd and stented and statins etc etc. GI bleeds get scoped and stabilised and ICU admissions if needed, ICU patients get horrifically expensive drugs (APC anyone?). The cost per patient has drastically increased BEFORE you factor in the cost for nursing/medical care. There lies part of the problem...more acutely ill patients with expensive therapies...the NHS managers know that in order to pay for the meds and the rehab etc they have to save money and the easiest way is to replace nurses with HCAs.
 
Afterall they can do most of the "nursey" stuff right? Wrong, they can do very little of the stuff that an RN has been trained to do...jump forward another 20 years and you wll not find a qualified nurse outside of the ICU. Many of the acute wards where I am are already full of APs and HCAs...these are not nurses. The one poor staff nurse that is on for the shift has TOTAL responsibility for the lives of 28 patients.
 
Now I understand that this has been said before but really think about this. Imagine that you are responsible for 28 people. One of them suddenly deteriorates and requires your input...what happens to the other 27? Next time you visit a relative on an acute ward, count the number of RNs and then compare the number of HCAs. Count the number of patients with IV infusions and then work out in your head if it takes 20 minutes to sort out an IV infusion just how much time is left for EVERYTHING ELSE? Nurses do not run for their own health so if you see one running past you, they are heading for the crash trolley or a bag of noradrenaline not tea and biscuits! Sorry if this sounds unfeeling but at the end of the day, nurses are supposed to be there for the patients...if your relative was having a heart attack and the patient in the bed next to them was having an acute asthma attack ( both potetially fatal) would you be happy if the RN was stuck on the phone?