New job new life!!

Nurse Anne is pretty happy right now.

My new hospital really seems to have the right idea!!

I now have 4-6 patients.  If any of them are acute then I get less. I have help.  Pharmacy bends over backwards to ensure that the Nurse on the floor has what she needs.  They know (and he said this) that patients suffer and wait too long for pain meds and other ordered drugs when pharmacy takes too long to verify orders.  In the UK the Nurse would be left on the floor with patients screaming in pain and screaming at the Nurse because they didn't get their drugs.  The reason their drugs weren't available wasn't because the doctor didn't prescribe it.  It wasn't because the Nurse was mean and lazy and didn't want to give the drug.  It was because the Nurse could not get her hands on the drugs until pharmacy did their thing.  And it would take hours and hours and hours to get pharmacy to comply.

 In the meantime the UK nurse deals with orders and care for her other patients-tasks that cannot be abandoned so she can sit with the man in pain.  The visitors and the patients stare at her and they say"that man is screaming over there, why is the nurse ignoring him and not helping him".  Well, she called the doctor 4 times over the last 5 hours to get an order for something to help the patient.  The doctor was finally able to come to the ward to prescribe something,  And now the Nurse is waiting on pharmacy. 9 hours total.  That is how long this process can take in the UK. 

Now, these things happen instantaneously for me.  If I have a patient that needs something I can get a doctor on the case and his order verified and dispensed by pharmacy almost instantly.  They work hard at this hospital so that the Nurse can have that. 

Food.  I am now in a place where kitchen sends up enough food to feed the patients.  No matter how ward staff in the UK filled out those menus, the bastards in kitchen never sent up enough.  And they only gave the Nurse a 15 minute window to get trays dished out and an entire ward fed.  In England, the ward staff had to run out with the trays, and put them near the patient.  They had to leave elderly patient's trays out of reach and continue on dishing out trays to the next patients.  Elderly patients trays were left out of reach to stop them from burning themselves on hot food or dumping bowls of soup over themselves.  The staff would run out with all the trays, hand them all out, deal with a 101 interruptions during this process and within 15 minute those goddamn fucking bastards from kitchen would be collecting those trays back in because "they had to take pots etc back down to kitchen and wash them because they wanted to get home on time". 

I actually asked kitchen staff in England if they knew that Nurses were getting blamed for starving patients.  I also asked them if they understand that we cannot help all those people and dish out food for an entire ward in 15 minutes.  They shrugged their shoulders and said yeah so what. 

And people blame Nurses starving patients?  WTF?  Nurses are the last people who have any kind of control over this process.  English nurses get smirked at and sneered at when they bring these issues up to managers.  And I am not talking about nursing managers.  I am talking about the non clinical managers who control everything,

In my current job I not only get enough food for my patients but the hospital understands that Nurses have sick patients with multiple orders and constant tasks that do not disappear at mealtime.  We get trained helpers from the diet department at mealtimes.  If I want an elderly patient to have a carer to stay with them at all times I simply have to ask.  Lets face reality.  Elderly patients need someone who can stay at their side all day in order to get hydrated, fed, and help with movement to prevent pressure sores.  If his Nurse has a full patient load and hundreds to drugs to give all day long she cannot do that for him.  Can we please face up to this fact rather than labelling Nurses as cruel witches who intentionally neglect people?

Now, when I am on days I always have multiple secretaries on the floor who answer the phone and protect the Nurses from unnecessary interruptions.  In the UK I did not have that.   We were told we had to answer the phone or else.  The phone rang constantly and a lot of time was taken away from the patients as a result.

I now have cleaners on the floor, lots of them!  And they are given time to clean rather than having to condense an entire day's worth of tasks into two hours because our managers don't want to pay for any more than two hours a day of cleaning,

No more having too leave the ward and run 3 floors down to restock the crash trolley after a crash.

I now work on a med-surg floor and it is still tough, this kind of nursing always is, but WHAT A DIFFERENCE IT MAKES WHEN THE WARDS ARE RESOURCED PROPERLY. And what a difference it makes when the people who run the hospitals understand that Nurses need to be with the patients, not doing every other profession's (social worker, pharmacy, lab. etc) job,

I have time with my patients now.  The amount of real time documenting we have to do (governement rules, yes government does regulate and accredidate US hospitals and fine them if the Nurses don't document the far end of a fart) is still immense and the penalty for failure to document is of course, termination.  But they are always looking for ways to make all this documentation as quick and as painless for the Nurse as possible without violating government policy.  Government policy in the UK dictates a lot of paperwork and data entry for ward based Nurses too (CQC and audits anyone?), but the system they use to do it is much more time consuming and the UK nurse has to do it all for 12+ patients rather than 4.  And she has less in the way of help. 

I have become 100% sure of something.

 Having well trained, skillful, kind, caring and hardworking nurses isn't enough.  It is only 50% of the equation.  If that is all you have, nursing care will -to put it bluntly- be shit.  Nurses need efficient work environments, manageable patient assignments, resources, and back up as well.  If you don't have both of these things in a hospital at the exact same time, nursing care will be shit.