I have a question for you, a bit of an ethical dilemma. I patient came in the other day with a fairly nasty limb injury. Nothing unusual in that you think, but he was dressed in work overalls and was dirty from working. OK, that is what you would expect, but when he was asked what his occupation was he stated he was unemployed. Now, my question is this, can I report him? I really want to, he is sponging off the state and getting money for working and it pisses me off that I am paying taxes which will get even larger to subsidise this thief. And he is a thief because he is stealing from you and me and every other taxpayer. However, according to the rules I have to treat him the same as everyone else, not judge him and certainly not report him.
I was watching the programme "The Hospital" the other night and it was about obesity and the treatment of obesity. It showed a couple who were to put it politely, huge. She was on the list for a gastric band and her partner who was even larger, was not. What got to me was that both of them were on Disability Living Allowance as they were too fat to work. Now this couple were able to walk the streets and go to McDonald's and even have a sex life as they had a child. So how are they disabled? Yet again I am being forced to pay for people who don't contribute and expect everything handed to them.
Saturday, 25 April 2009
Monday, 20 April 2009
Whistleblowing
I have been missing for a while as I have had no internet access - my computer broke and I had to get a new one and then I struggled to set up my internet.
Margaret Haywood is a nurse who did undercover filming for television and has now been struck off by the NMC for breaching patient confidentiality. This means that all health care professionals are at risk of being struck off if they tell the public what is happening - management really don't want you to know how bad your local hospital is. This includes bloggers, so I have been unable to write much recently as (apart from no internet) I have been unable to find things which were anonymous enough to not be recognisable.
The RCN is fighting for her and there is an online petition to help her available here http://www.gopetition.com/online/27030.html please sign it, every little helps.
Unfortunately Margaret was always going to be struck off, this is not new and I have blogged before about how shabbily Graham Pink was treated 20 years ago and nothing has changed.
Margaret Haywood is a nurse who did undercover filming for television and has now been struck off by the NMC for breaching patient confidentiality. This means that all health care professionals are at risk of being struck off if they tell the public what is happening - management really don't want you to know how bad your local hospital is. This includes bloggers, so I have been unable to write much recently as (apart from no internet) I have been unable to find things which were anonymous enough to not be recognisable.
The RCN is fighting for her and there is an online petition to help her available here http://www.gopetition.com/online/27030.html please sign it, every little helps.
Unfortunately Margaret was always going to be struck off, this is not new and I have blogged before about how shabbily Graham Pink was treated 20 years ago and nothing has changed.
Tuesday, 17 March 2009
Staffordshire
The news from Stafford about their failings in emergency care makes horrific reading, the story for those who have not heard can be found here. Central government has as usual taken no responsibility and are blaming the people on site, despite the fact that the hospital appears to have been trying to carry out government policy by saving over £10,000,000 to achieve foundation status. What is the first thing that goes when hospitals are saving money? Staff, and who are the biggest staff group (apart from admin staff who never get paid off)? Nurses. Research has shown that if you have more trained nurses per patients then patients do well, but the corollary of this is that if you have less nurses patients die. Want to know what happens on a ward when you have low staffing levels? Read this, almost anything Anne writes will give you a good idea of how poor staffing affects patients and staff. The blogosphere seems to be united in noting that this is not something that has just happened and should, and in some cases was, foreseen - read Dr. Crippen, read The Jobbing Doctor follow some of the links and read about Dr. Rita Pal. Why were staff not complaining? What was happening to the complaints letters that must have been getting sent? In my hospital people complain that we have the wrong brand of cola in the vending machines, never mind that their relatives are lying in urine and faeces. So were the relatives getting fobbed off with excuses? And who was getting blamed? Actually, I know the answer to this one; every complaint would have been acknowledged and an apology given, the complainer would have been reassured that 'something will be done', this will never happen again, lessons have been learned and staff will be retrained.
My expertise is Accident & Emergency, I happen to think that the 4 hour target for emergency care is a good thing, but it must have a system in place that allows patients to move on to wards, not being moved into unobserved rooms. The 4 hour target is a hospital and community problem, not just an A&E problem. Why should a patient with a sprained ankle wait 6 hours to be seen because other patients keep getting prioritised ahead of them? I read American blogs where they write of patient being in the ER for 9+ hours without being seen, and I remember patients waiting for hours in our own waiting room. At a certain point you are just punishing people for not having a serious enough illness. Targets are good but they must be used as guidance, there has to be room to manoeuvre and there has to be a system to say this patient does not come under the 4 hour target because.........
Why did they only have one A&E consultant? An adequate number of consultants is vital for the good running of a modern department. 25 years ago 1 consultant, who was an orthopaedic surgeon would be in charge of A&E on a part time basis. This was proven to be dangerous, this why there is now a proper A&E training for doctors and A&E is now seen as a specialty in it's own right. The same goes for nursing staff, A&E cannot run without experienced nurses and an adequate number. Being 17 nurses short in A&E is to mind negligent and will cause deaths. It takes about a year to turn an experienced nurse into an A&E nurse, again, we are a specialty in our own right.
My sympathies are with the relatives of all those who have died or who have gone through a horrendous experience in this hospital when they are at their most vulnerable. My sympathies are also with the (front line) staff who have had to work through this and may get some of the blame when it is obvious that staffing levels were decided by accountants and executives.
What happens now? There may well be a public enquiry, there will be pious exclamations to 'never let this happen again' but, it will. Until we can have adequate staffing on the wards, staff are valued and they have proper training for the job they are being asked to do patients will continue to be let down and neglected.
My expertise is Accident & Emergency, I happen to think that the 4 hour target for emergency care is a good thing, but it must have a system in place that allows patients to move on to wards, not being moved into unobserved rooms. The 4 hour target is a hospital and community problem, not just an A&E problem. Why should a patient with a sprained ankle wait 6 hours to be seen because other patients keep getting prioritised ahead of them? I read American blogs where they write of patient being in the ER for 9+ hours without being seen, and I remember patients waiting for hours in our own waiting room. At a certain point you are just punishing people for not having a serious enough illness. Targets are good but they must be used as guidance, there has to be room to manoeuvre and there has to be a system to say this patient does not come under the 4 hour target because.........
Why did they only have one A&E consultant? An adequate number of consultants is vital for the good running of a modern department. 25 years ago 1 consultant, who was an orthopaedic surgeon would be in charge of A&E on a part time basis. This was proven to be dangerous, this why there is now a proper A&E training for doctors and A&E is now seen as a specialty in it's own right. The same goes for nursing staff, A&E cannot run without experienced nurses and an adequate number. Being 17 nurses short in A&E is to mind negligent and will cause deaths. It takes about a year to turn an experienced nurse into an A&E nurse, again, we are a specialty in our own right.
My sympathies are with the relatives of all those who have died or who have gone through a horrendous experience in this hospital when they are at their most vulnerable. My sympathies are also with the (front line) staff who have had to work through this and may get some of the blame when it is obvious that staffing levels were decided by accountants and executives.
What happens now? There may well be a public enquiry, there will be pious exclamations to 'never let this happen again' but, it will. Until we can have adequate staffing on the wards, staff are valued and they have proper training for the job they are being asked to do patients will continue to be let down and neglected.
Saturday, 7 March 2009
It's Grumpy Time
Had a really grumpy week so far, out with my wife in a bar and was standing waiting to be served while the barman was busy, in walked another customer and was immediately served. Ranted and raved a bit then walked out and went to another bar which was in fact a better bar. A few days later had a few drinks with colleagues from work and standing at the bar again waiting to be served (different bar) and the barmaid was serving some young guys - no problem I don't mind waiting my turn. An older guy came up to the bar and stood just up from me and was served by a barman. This time I lost the plot as I could not walk out as everyone else was eating, so had a good old moan and received an apology from both the barman and the other customer - sometimes it is good to moan.
Also been grumpy at work, but this time I felt it was justified. What is it with some parents? If you tell me that you can't wash your 2 year old's face because "He wont let me" or your 3 year old does not like taking medicine so he will not take it I will not be the slightest bit impressed with you or your parenting skills or indeed your skills as a functioning adult. 2 and 3 year old's do NOT get an opinion, what they want does not enter in to any discussion I have with you. Don't get me wrong, I am quite happy to cajole a toddler and I am actually quite good with kids (honest) but I just wonder sometimes who the parent is and what is going to happen in few years time when these precious little darlings become teenagers and adults.
By the way Mr Racist b*st**d, if you are going to use racist terms at home remember that your kids will hear and copy you. When a child is playing in our Wendy house and tells another child "You can't come in as you are a N***etc." then we know where it has come from. If I had heard it I would have done something, I at least would have challenged you about it but unfortunately it was heard by a student who didn't tell anyone until you were gone.
Also been grumpy at work, but this time I felt it was justified. What is it with some parents? If you tell me that you can't wash your 2 year old's face because "He wont let me" or your 3 year old does not like taking medicine so he will not take it I will not be the slightest bit impressed with you or your parenting skills or indeed your skills as a functioning adult. 2 and 3 year old's do NOT get an opinion, what they want does not enter in to any discussion I have with you. Don't get me wrong, I am quite happy to cajole a toddler and I am actually quite good with kids (honest) but I just wonder sometimes who the parent is and what is going to happen in few years time when these precious little darlings become teenagers and adults.
By the way Mr Racist b*st**d, if you are going to use racist terms at home remember that your kids will hear and copy you. When a child is playing in our Wendy house and tells another child "You can't come in as you are a N***etc." then we know where it has come from. If I had heard it I would have done something, I at least would have challenged you about it but unfortunately it was heard by a student who didn't tell anyone until you were gone.
Saturday, 14 February 2009
IT (again)
Do IT people live in a different world to the rest of us?
I ask this because my and a lot of other people's e-mail has been down recently, we are completely locked out of the system. What is IT's response? They send an e-mail out asking people not to call them if they have a problem with their e-mail. What??? The only reason I found out about this is that someone whose e-mail was working showed it to me.
Why is it that after every upgrade to our IT system of whatever kind the system then goes down? Surely by now they should have computers which work.
I ask this because my and a lot of other people's e-mail has been down recently, we are completely locked out of the system. What is IT's response? They send an e-mail out asking people not to call them if they have a problem with their e-mail. What??? The only reason I found out about this is that someone whose e-mail was working showed it to me.
Why is it that after every upgrade to our IT system of whatever kind the system then goes down? Surely by now they should have computers which work.
Teamwork
My dictionary defines team as "in common action" and teamwork as "combined effort, cooperation". Yesterday I had a fine example of this although I did have to force it from those involved. I took a patient up to a ward and as usual the staff were all very busy and there was no one to help me move the patient on to a bed. I looked in the area used a small staff room and there were 4 or 5 doctors sitting there just chatting, some with their feet up and obviously not busy. Now in fairness this is not that common an occurrence as doctors are busy people too but I thought, "I have to get back to my department, there is no nurses available but I just need some people to help me move the patient". So I asked the doctors to help - I received a blank look bordering on ignoring me but I am made of sterner stuff so I again asked for help but this time I did not give them a choice I pointed out that they were not doing anything, I needed help and the patient needed help so come on guys bums off seats and get over here. I think they were more surprised that someone expected them to 'handle' a patient than any thing else but they gave me the help I needed. I thanked them very nicely and pointed out that if they come to work in A&E they will be expected to help and sometimes be a bit more hands on than they are used to.
A fine example of teamwork in action.
Sometimes I feel that I write too much about conflict in ward areas, but in the department I work there is a good working atmosphere between the nursing and medical staff that has been forged through long experience with each other and a willingness to respect each others professionalism. I am well aware that I cannot do my job without the willingness of the senior doctors to support me. When attending interviews, a favourite question is how would you ensure teamwork? I think it is sometimes worth remembering that the team is not just nursing staff but everyone in the department.
A fine example of teamwork in action.
Sometimes I feel that I write too much about conflict in ward areas, but in the department I work there is a good working atmosphere between the nursing and medical staff that has been forged through long experience with each other and a willingness to respect each others professionalism. I am well aware that I cannot do my job without the willingness of the senior doctors to support me. When attending interviews, a favourite question is how would you ensure teamwork? I think it is sometimes worth remembering that the team is not just nursing staff but everyone in the department.
Sunday, 8 February 2009
The NHS
One of my favourite bloggers has made a reappearance after being missing for some time and she has come out fighting.
Militant Medical Nurse is a staff nurse who works on a medical ward and she must have been reading some of the bad press nurses are getting recently as she has put in her experience of meal times on the ward here. Go read it, it is a long post but it is exactly as I remember it from my time on the wards and is one of the reasons I don't do wards now, soul destroying is the word that springs to my mind, especially when she follows it up with this. Now, I don't know if Dr. Crippen at NHS Blogdoc reads this or not (don't really care) but it would be nice to know that instead of carping on about nurses he would actually do something. Instead of saying that nurses are not allowed a career path and promotion to practitioner we should all stay on the wards and wash bums and clean floors and toilets and bedpans he tried to complain to the people who matter in hospitals - the managers. For some reason he assumes that nurses are able to control how many nurses are on a ward, this is decided by manpower planning and/or human resources. If I as a nurse practitioner was forced to move back onto a ward as a staff nurse then someone would need to be paid off to make way for me to keep staffing at the levels they are funded. I will ask a question, when GP's and Consultants were given their brand spanking new contracts did any of them say "wait a minute, what about more nursing staff on the wards?" No? I thought not. What you do get is,...... Well read the last few paragraphs about ward rounds and mealtimes in Militant Medical Nurse's post.
A while ago I wrote a post about a parent who attended our department and was upset about my questioning her behaviour in not giving her child the MMR vaccine. It was such an angry post that I deleted it very soon after writing it. It now appears that perhaps I should have left it in place as the anti-vaccine lobby has recently had a boost from a broadcaster on LBC radio. When the broadcaster was taken to task by the excellent Ben Goldacre at Bad Science her lawyers immediately attacked him threatening him with legal writs. The full story can be found here and a follow up can be found here.
I would recommend Dr. Crippen's take on this at NHS Blogdoc as he has put the whole story much better than I can. It is only when Dr. C starts going on about nurses and nursing that I think he is an uninformed moron, on most things I tend to agree with him.
Militant Medical Nurse is a staff nurse who works on a medical ward and she must have been reading some of the bad press nurses are getting recently as she has put in her experience of meal times on the ward here. Go read it, it is a long post but it is exactly as I remember it from my time on the wards and is one of the reasons I don't do wards now, soul destroying is the word that springs to my mind, especially when she follows it up with this. Now, I don't know if Dr. Crippen at NHS Blogdoc reads this or not (don't really care) but it would be nice to know that instead of carping on about nurses he would actually do something. Instead of saying that nurses are not allowed a career path and promotion to practitioner we should all stay on the wards and wash bums and clean floors and toilets and bedpans he tried to complain to the people who matter in hospitals - the managers. For some reason he assumes that nurses are able to control how many nurses are on a ward, this is decided by manpower planning and/or human resources. If I as a nurse practitioner was forced to move back onto a ward as a staff nurse then someone would need to be paid off to make way for me to keep staffing at the levels they are funded. I will ask a question, when GP's and Consultants were given their brand spanking new contracts did any of them say "wait a minute, what about more nursing staff on the wards?" No? I thought not. What you do get is,...... Well read the last few paragraphs about ward rounds and mealtimes in Militant Medical Nurse's post.
A while ago I wrote a post about a parent who attended our department and was upset about my questioning her behaviour in not giving her child the MMR vaccine. It was such an angry post that I deleted it very soon after writing it. It now appears that perhaps I should have left it in place as the anti-vaccine lobby has recently had a boost from a broadcaster on LBC radio. When the broadcaster was taken to task by the excellent Ben Goldacre at Bad Science her lawyers immediately attacked him threatening him with legal writs. The full story can be found here and a follow up can be found here.
I would recommend Dr. Crippen's take on this at NHS Blogdoc as he has put the whole story much better than I can. It is only when Dr. C starts going on about nurses and nursing that I think he is an uninformed moron, on most things I tend to agree with him.
Monday, 19 January 2009
Backs
I have written before about having a painful back after 25+ years of humping patients about. Nowadays I follow a no-lift policy which will hopefully limit any damage done. But yesterday I had to deal with a large man who was lying on the trolley making no effort to sit himself up. His relatives came to me and asked if I could lift him up the bed, bearing in mind this man was bigger than I am and weighed more than me I refused and said that I don't lift patients. Before I could get a chance to say that I would get some help and some lifting aids they were asking if one of the girls (female nurses) could lift him? I'm afraid I exploded a bit and asked through very gritted teeth that if I as a 13 stone 5' 9" male had refused to lift, what made them think that a 9 stone 5' 2" female was going to do it? Apparently female nurses have superhuman strength and can lift several times their own body weight. No wonder the biggest complaint from nurses is "my back is hurting today" and back pain is one of the main reasons for staff having to leave nursing early.
Tuesday, 13 January 2009
Parenting
I know that all the youngsters have mobile phones and can't seem to do anything without it being glued to their ear, I even have a phone. But I have discovered a couple of bad points about them. First off we now have a generation of children who cannot problem solve, for example if I missed my last bus home when I was a teenager it was up to me to get myself home, I had to think about it and solve the problem. Now all a child has to do is call home and mummy or daddy will come rushing out to pick them up - can't have little Johnny/Janie walking the streets with all those muggers and rapists. This is wrong because there are no more muggers and rapists and child molesters out there then there ever was, this is not new it is just reported more and gives children and parents a false sense of insecurity and does not foster independence in children.
Mobile phones are noisy and other peoples conversations tend to be boring and inconsequential - my conversations on the other hand are witty, intelligent and insightful.
Mobile phones can take your attention from what you are supposed to be doing. Young lady presented with child who was patient. Child playing happily in our play area, mum playing happily with her mobile phone - texting or playing games but engrossed in what she was doing. Child shouts out "Mummy I need the toilet" loudly and several times. I was aware of this but was busy and did not pay a whole lot of attention. Mum paid no attention to this at all and continued what she was doing. Little one had no choice but to do toilet in our play area despite toilet being about 20 feet away and clearly marked 'Children's Toilet'. When this was pointed out to mum what was her reaction?............ Nothing, did not bother her at all. Even when we challenged her behaviour we were met with a shrug of the shoulders. And who do you think cleaned up the mess?............. Yes the staff. So, how much chance do you think that this little one has for the future when her mother can't even take care of her toileting needs ahead of the mum's need to text?
Mobile phones are noisy and other peoples conversations tend to be boring and inconsequential - my conversations on the other hand are witty, intelligent and insightful.
Mobile phones can take your attention from what you are supposed to be doing. Young lady presented with child who was patient. Child playing happily in our play area, mum playing happily with her mobile phone - texting or playing games but engrossed in what she was doing. Child shouts out "Mummy I need the toilet" loudly and several times. I was aware of this but was busy and did not pay a whole lot of attention. Mum paid no attention to this at all and continued what she was doing. Little one had no choice but to do toilet in our play area despite toilet being about 20 feet away and clearly marked 'Children's Toilet'. When this was pointed out to mum what was her reaction?............ Nothing, did not bother her at all. Even when we challenged her behaviour we were met with a shrug of the shoulders. And who do you think cleaned up the mess?............. Yes the staff. So, how much chance do you think that this little one has for the future when her mother can't even take care of her toileting needs ahead of the mum's need to text?
Sunday, 4 January 2009
Dogs and Doctor Who
A rant today and not hospital or NHS related.
I took my dog out this morning, nothing unusual there but while we were out we met other people with their dogs. Now, my dog is a very timid thing and runs away at the sight of bigger dogs - she is also a bully and intimidates smaller dogs - and to make matters worse she is in season at present. These people were allowing their dogs to run around in a pack with no control at all with the result that I had to curtail her walk a bit and go in a different direction to what I wanted, I have met these people before, they think it is all right for their dogs to chase other dogs, "They're only playing" is the cry. Sorry, but they are not, they are pack animals and they will attack single dogs. I once had a large dog steal my dog's ball, it's owner then spent about 10 minutes chasing it around the park shouting "Good boy, come here now" but not actually doing anything. Eventually I lost the plot and shouted at her that "he is not a good boy and all you are doing is reinforcing his behaviour! Control him NOW!" As you can imagine this did not go down well and I was the bad one as he was only young - but he was off the lead. If you can't control your dog don't take them off their leads!
I grew up with Doctor Who, my doctor was William Hartnell, and I remember watching the first episode in 1963. I watched them all every week but as I grew older and during Jon Pertwees' time I lost interest completely and would only watch intermittently. I liked the new series with Christopher Eccleston and David Tennant because of some very good stories and good acting. But, I wonder if the new Doctor, Matt Smith will be able to cut the mustard? He looks far too young to have the gravitas of someone 900 years old but time will tell. A comment I have read here from BBC insider Pickwick asks if there is a love interest will we be having Hollyoaks in space?
I took my dog out this morning, nothing unusual there but while we were out we met other people with their dogs. Now, my dog is a very timid thing and runs away at the sight of bigger dogs - she is also a bully and intimidates smaller dogs - and to make matters worse she is in season at present. These people were allowing their dogs to run around in a pack with no control at all with the result that I had to curtail her walk a bit and go in a different direction to what I wanted, I have met these people before, they think it is all right for their dogs to chase other dogs, "They're only playing" is the cry. Sorry, but they are not, they are pack animals and they will attack single dogs. I once had a large dog steal my dog's ball, it's owner then spent about 10 minutes chasing it around the park shouting "Good boy, come here now" but not actually doing anything. Eventually I lost the plot and shouted at her that "he is not a good boy and all you are doing is reinforcing his behaviour! Control him NOW!" As you can imagine this did not go down well and I was the bad one as he was only young - but he was off the lead. If you can't control your dog don't take them off their leads!
I grew up with Doctor Who, my doctor was William Hartnell, and I remember watching the first episode in 1963. I watched them all every week but as I grew older and during Jon Pertwees' time I lost interest completely and would only watch intermittently. I liked the new series with Christopher Eccleston and David Tennant because of some very good stories and good acting. But, I wonder if the new Doctor, Matt Smith will be able to cut the mustard? He looks far too young to have the gravitas of someone 900 years old but time will tell. A comment I have read here from BBC insider Pickwick asks if there is a love interest will we be having Hollyoaks in space?
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