Letter from Nurse in Distress

I recently opened my email to find this letter from a nurse from the United Kingdom.  She asked for my help. I replied that I wished I could wave a magic wand but that the best I could do  — at least at the moment  — was post her letter and subsequent ones on my website.  So here is her first letter.  As well as the second giving me permission to print her letters.  Please respond if you have had similar experiences, if you can think of something for her today.

Dear Ms. Gordon:

I have just today finished reading your book entitled “Nursing against the Odds”.  I wanted to congratulate you on writing such an outstanding book.

I have recommended it to almost everyone I know. It was so well written I am in awe.  It has really helped me to articulate my feelings about nursing.

I am an RN who is currently working on a large general medical ward in the NHS.  I spent over 20 years in North America and completed my nurse education at a respected school of nursing in the States before coming back to the UK.

For two years I have been blogging about my experiences as a bedside nurse and have been fighting an ongoing battle here.  I believe that the situation

with nursing in the UK  has deteriorated significantly since you wrote “Nursing against the Odds”.  It’s still very good on some wards but the staffing continues to be criminal on too many wards. This situation is not being addressed because stereotypes about nursing are getting in the way.

Burned out from caring for anywhere from 12-30 acute and dependent medical patients as the only RN and despairing at the fact that the NHS

was denying jobs to new graduate RN’s while hiring 16 year old cadets with absolutely no training to place in nurse’s uniforms and staff  the wards I

took some time off of research attitudes towards nursing and vent my frustration via blogging.

I just never could understand how the public could be silent and watch their

highly skilled ward nurses get replaced with untrained kids, and than complain that the few nurses who are left “are too posh to wash patients” and “to clever to care” as a result of nurse education moving into the universities.  Many of these ward RN’s are the sole RN for anywhere from 10,20, even 35+

patients on acute care wards with no back up, no staffing by acuity and no support from their managers.  Some of our new grad degree nurses cannot even

find employment on the wards. Most of our current bedside nurses (from my viewpoint) did train back in the “good old days” and they are also on their knees and unable to cope. The government is mandating insane targets for the hospitals to achieve while cutting them off from funding.  But they always seem to hire more and more highly paid management consultants.

We certainly do not have dietary staff to pass trays or assist with meals. On my ward we don’t even have a ward clerk to answer the phone much of the time.  Beds are filled the minute they become empty.  We take critically ill patients as well as frail,dependent, and elderly patients with dementia.

How could we possibly attend to basic care or feed 20 elderly and confused patients singlehandedly whilst monitoring and implementing life saving care for critically ill patients?

The major media outlets are running story after story about “Fallen Angels who starve patients” and “Callous nurses who do not clean up soiled patients immediately” but they never seem to write about the appalling nurse patient ratios or ward conditions.

They seem to be completely unaware of the fact that patients are sicker, more complex and the number of trained nurses at the bedside are being slashed.  On my ward which is about 25 beds on a good day we will have 2 RN’s and 2 young untrained cadets who cannot even take a set of vital signs.  On some occasions it is better but often it is worse.

What I am finding is that these kinds of numbers are becoming the norm up and down the country on general medical wards.  My hospital sometimes leaves one RN to 35 med/surg patients on the floor below mine.  They do this And then they get great joy over accusing RN’s of not wanting to bedbath patients and dumping all basic care onto care assistants/cadets out of “laziness”.  Even our medium sized ED department was left with only one RN and one care assistant for the entire department on some shifts.

The media is going crazy with stories about poor nursing care in our hospitals.  Many stories seem to focus on the fact that around 1990 this country started educating nurses in university.

This is supposedly the entire reason that nursing care is so terrible now.

Apparently people seem to think that educated nurses have no “compassion” and see patient care beneath them. While this may be true for a rare individual I firmly believe that the real problems are staffing,lack of respect for bedside nurses and ward conditions.

Even now, two years into blogging and months after I wrote a piece for the Guardian about staffing I am still getting hit with comments about how “nurse education” is to blame for poor nursing care.

And the worst thing about it is that many of these public statements, stories, and comments are coming from retired nurses who haven’t been anywhere near a patient since the 1970’s.  They claim that newer nurses are not given enough clinical placements and are not taught to care.

Based on what I am seeing from my students and new graduate colleagues I think that these accusations are for the most part groundless.

I believe that university education is vital for RN’s.  Our university students must take nearly 3000 hours of clinical time to graduate.  However the quality of their time on the wards is poor even if the quantity is good.

They are only mentored on the wards by a harried nurse with 11+ patients. This hurts new nurses but it does not excuse the poor staffing and abusive working conditions.  It would not be any better if their training was vocational only.  The ward conditions just do not allow the student to have a good learning experience.

Hopefully another major newspaper will be doing an article about nurse staffing on our general wards this weekend (so they said when they contacted me).  I am bedside nurse but not a journalist, writer, or PR specialist by any means. My blog is more emotive than anything, used as a stress reliever for me. I never really expected that many people to read it. I feel a bit over my head here and was hoping I could get some advice or tips from you?

Here are examples of the only kinds of story we are seeing in the media here about nurses:

http://www.dailymail.co.uk/health/article-1027549/Nurses-rated-kindness-patients.html

How are we supposed to demonstrate compassion and NOT delegate to healthcare assistants when we are one nurse to 12+ med/surg patients?

http://www.dailymail.co.uk/health/article-561164/Why-gossiping-nurses-symptom-NHS-crisis.html

http://www.telegraph.co.uk/comment/personal-view/6111056/Nurses-need-to-clean-up-their-act.html

http://www.timesonline.co.uk/tol/news/uk/health/article844443.ece

This lady is always in the newspapers here and deams herself a spokesperson for nurses.  She worked as a nurse for a few years in the 60’s and 70’s.

http://www.timesonline.co.uk/tol/news/uk/health/article844443.ece

http://www.dailymail.co.uk/health/article-1091005/LORRAINE-MORGAN-Uncaring-Slovenly-Some-nurses-disgrace—I-say-Im-nurse-myself.html

No mention of the fact that that large wards are being staffed with 2 nurses who are on their knees merely with the medications and 3 care assistants who have had no training.  No mention of the fact that they have cut domestics and are expecting the nurses to clean.  Or that nurses are working 12+ hours without a break in an abusive environment.  No mention of the fact that we are forced by the hospital to wear falling apart, torn, and stained hospital provided uniforms only.  They have cut down on allowing the nurses to request replacement uniforms and we are forbidden to purchase our own. No wonder we look awful.  It’s just sad about the cleaning.  We have 4 commodes to be shared by all the patients on the ward and the hospital is demanding that the nurse spends a full 11 minutes between each patient use cleaning the commode.  My ward is full of immobile elderly patients who are all crying for the commode at once!

I have personally seen plenty of visitors call the nurse lazy when she doesn’t respond immediately to a callbell.  Never mind the fact that at that very moment in time  her other patient is about to die and she is trying to get an airway in or she is administering long overdue pain medicine to another patient who is in agony. It takes a long time to handover all pertinent info for 25 patients to the oncoming shift. Then throughout the shift we are constantly bombarded with phone calls (only phone is at the station) and handovers on incoming patients (also via phone). The hospital demands that all staff coming on duty listen to handover for all patients on the ward. This often leads to accusations of staff “gossiping” around the nurses station by visitors and patients.

I know that not all nurses are perfect and blameless but from my vantage point all I am seeing is excellent hardworking nurses set up to fail day after day.  Repeated communication with our unions and professional bodies have failed. Completing incident forms and taking our cases to our hospital chiefs have failed.  I am not sure where to go from here.  I have this blog that was started to vent some negative energy (it’s ahem, less than professional at times) but even though there has been some bad language etc I have always promoted excellent bedside nursing care and maintained confidentiality.

I recently wrote a piece for the comment section of the guardian about nurse staffing numbers but I don’t think I really made my point.  It had to be kept short and I had about 5 minutes to write it.   Most newspapers only seem to speak to older retired nurses who talk about how wonderfully they washed the floors.   I am trying to get them to see the light a bit.

I hate to bombard you with all this but have you any advice?

Best Wishes,
Anna

When I wrote to Anna, she sent the following, which arrived this morning.

Dear Mrs. Gordon,

Thank you for replying.  I recently came off of a shift where there were only two staff  for 20+ patients.  We had no ward clerk.  No housekeeping.  Nothing.  We got slammed for not answering the phone right away in order to receive report on 2 new admissions.  Our ED units are fined for not getting patients moved on in less than 4 hours in a government intiative to reduce hospital waiting times. There is one working ward phone and it is located quite far away from the patients.  The two of us could not answer the phone because we discovered one of our patients about to crash and we were swinging into action.  Ten other patients were crying for help and were being ignored during this situation.  We were told that if those new patients breached the ED waiting times as a result of us not answering the phone to take report and get them onto the ward we would be held accountable.   The problem here is the general attitude towards nurses.
I don’t know what else to do but keep shouting out about it.  Nurses up and down the country are telling me that they are experiencing the same things.  If you want to put my letters on your site that’s fine with me.
Best Wishes,
Anna
Militantmedicalnurse.