I wasted my F'ing time!!!

That's what I was told the other day, this poor patient had come all the way to hospital at his own expense and we did nothing for him. Never mind that I gave him a complete examination of his injury, sent him for an X-Ray which probably cost between £100-£200, gave him my opinion on his X-Ray and diagnosed his problem and then to finish it all I treated him and gave him advice for after care and told him it would take 2-4 weeks to heal completely. Because I did not 'fix' his injury so that he was pain free NOW he wasted his time coming here and walked out telling all and sundry that we are useless and don't do anything for people. Ah well, such is life in any ED in the world.


I was at the gym again today, and thought one of the people was having a fit. I was all ready to rush over in full life saving mode when I realised that what I thought was a seizure was this idiot practicing a karate move and had accidently hit the wall and bounced off. Why he was doing karate moves in the actual gym and not upstairs in the studio I'll never understand, but it is better than TV.

Silly Boy

Junior doctor thought that the nursing staff were being annoying because we kept calling him to get a patients pain controlled. Eventually he thought of a plan; he would get the nursing staff to carry out 15 minute neuro obs as the patient had a headache. We tried to get him to change this, arguing it was not in the patients best interest as he would not get any sleep and he was not ill enough for this level of observation. we even pointed out that if the patient really needed 15 minute obs they should be transferred to a neuro ward or at least be CT scanned. No, the bold boy was going to get the nurses running around because we had annoyed him. Being the experienced nurse I am I took him aside and spoke to him male to male and told him that if he insisted on this then we would do it and then we would page him and tell him the results. Every time we took a set of recordings he would be told. OK he said, go ahead, I will just turn off my pager. Then I dropped the bombshell onto his little power play. If you do not answer your page when we call we will keep paging you until you do answer. If after 15 minutes you have not answered we will then phone the registrar on call (his senior) and tell him the results and ask him what he wants done, and we will do this no matter what the time is. 2 minutes later, order cancelled and a junior doctor suddenly aware that a) he is at the bottom of the pile and b) nurses have ways of getting our own back and making uppity doctors behave.

Later on he turned out to be an OK guy, he was just having a bad day and had tried to take it out on us and we let him know we would not put up with it - everybody happy.

Nursing

I came across this post by a midwife today which has me worried, is this normal? Does this really go on in our hospitals? I have been a patient a few times recently and I have had on the whole a good experience. I realise that as soon as nurses in wards find out that I am a Charge Nurse, my wife is a Staff Nurse and my mother is a retired Sister I am going to get good care as at the very least they do not want us carrying tales around the hospital about 'that awful ward' and in all fairness, I think my hospital is pretty good anyway. But it started me thinking, is there a lack of knowledge in today's nurses about basic things? I have a degree in Nursing, my colleagues all have degrees in Nursing and I must assume that most of the nurses in the hospital have a degree in Nursing. So, does this make us better nurses than those nurses who have retired or are my age and heading rapidly towards retirement? In other words, am I a better nurse for having a degree than I was before I got it? The answer in my case is that it has really made no difference, but mainly because I got my degree fairly recently and managed fine for years without it. Having all nurses with degrees should make us a better profession but it does not make us better nurses. What does make a difference is training and having a pride in what you do. When I started training I worked with an old fashioned ward sister, everybody was afraid of her but her patients loved her. Why? Because she knew every patient on her ward, she knew what was wrong with them, she knew what drugs they were on, she knew their families and she knew what was going to happen to them. She ran her ward with a rod of iron, it was her way and her way only, the nursing process, team nursing and patient allocation were only words to her. If any nurse on her ward had dared to say to a relative "he's not my patient I'll find his nurse" she would have shouted and screamed at the offender so much that they would never, ever say that again (every patient was yours). I had worked in construction and in factories and she terrified me. So if she was such a tyrant why do I think very fondly of her? Why does everyone I speak to who remembers her speak fondly of her? Because she taught us our jobs, no excuses were tolerated, if a patient was sick that was our priority. Now we have recording sheets with colour coded areas which give 'scores', the higher the score, the sicker you are, she would have thrown them out - she knew when a patient was sick.
So what was the difference between then and now? Firstly, the college of nursing taught us what we needed to know, we learned about diseases and the disease process and how to nurse someone with those diseases, you learned hands on nursing on the wards. Secondly, student nurses were not 'supernumerary' they were there to do a days work and to learn while doing (we were paid a wage for this, not a bursary). Thirdly, there was less paperwork to complete and there was not the same pressure to document every little thing (OK I appreciate that this was perhaps wrong and documentation is important but paperwork is very time consuming). Lastly, there were more staff on the wards, even if those staff were students they had a lot more responsibility then, often caring for up to 6 patients with an auxiliary nurse (Health Care Assistant). So can we move back to those days? Probably not, but we can at least try to make our nurses proud to do the job, take pride in having done the best for everyone in our care, but can we please get the tools to do the job we are trained to do. A few more staff on the wards would go a long way, government actually giving a c**p about the NHS and can we please get rid of some of the managers. I read in a blog somewhere this comment - "If half the managers in the NHS did not turn up for work tomorrow, would we notice"? Now substitute managers for any other job title and ask the question.

Credit Crunch? What Credit Crunch?

Just a quick post today, they tell me there is a credit crunch going on. US is bailing out the banks to $700BN and the UK is giving banks £50BN, nationalising banks and telling us all that we are going to have to tighten our belts and that mortgages are going to be impossible to get, blah blah, wrack and ruin, blah blah, doom and gloom etc. So can someone please tell me why my bank has written to me INCREASING the credit limit on my card because I have been a good boy. I did not ask for this, I do not need this and I don't particularly want it but I've got it.
No wonder people spend too much and land in trouble.

Love

Isn't it nice when people fall in love? You hope that they will be happy and that it will last and they can go onwards into the future together as a couple. The reality in A&E is somewhat different. Young couple brought in from the street by ambulance, both absolutely out of it with alcohol. Both 20 so should know a bit better. She had wet herself and had vomited so her face and hair was covered in puke - lovely! He was only drunk. We put them in separate cubicles on trolleys but next thing he was in her room talking to her and holding her hand, fair enough, it will keep them both quiet for a bit. Next thing we hear is him climbing on the trolley to lie beside her and we can see this on the security cameras, so someone went to stop this. By the time they got there they were really trying to 'get it on' in a very confined space and although love will find a way, it won't in our department, in public and on camera. So we separated them and put him back in his cubicle by which time he was covered in her puke. They left 2 minutes later hand in hand and she was giving us abuse for being perverts(?). Ah well, I'm sure the long walk home would cool their ardour as no taxi would take them the state they were in.

Thank you

Wow, I have 6 followers, thank you every one of you and thank you to every one who spends some time of their day reading the "stuff what I wrote" I really appreciate it. If I do not put you down for following it is not personal it is just that I don't have the computer skills to add you. I read a lot of blogs on Google reader as it saves having to look at every blog and I only see the ones that are updated. So thank you again.

Fred died today.

Fred died today, not a problem, he was old and had been ill for a while and it was just his time. Why am I telling you this? Trauma Queen has a post here which reminded me of a couple of sets of parents. the first was a mum who worked in the hospital, her son had 'gone off the rails' when he was 12. The usual, he was being bullied so started missing school then he joined in with a few others and began shoplifting then more serious thefts and assaults until he was spending most of his life in jail. I first met him after he had been assaulted, fairly serious but the police still came and arrested him on discharge. Mother was absolutely distraught but was completely aware of what her son was doing but as she said "He's my child and always will be." I still see his name in the local paper being involved in theft and assault and his mother still cares about him.
The other set of parents had 5 sons, they grew up in the same area that I did so I was aware of them but never knew them. Throughout the 70's, 80's, and 90's the parents, and us in A&E, watched these young men become more and more dependent on drugs. They would sometimes get clean and settle down. Could not get jobs but at least were going straight. Then one by one they would slip back into drug use. This became their lives, cycles of drugs, prison then release and a methadone programme. Eventually, one by one they all died from HIV related illnesses. Their parents, Fred and Joan, both very nice people could not understand how their family turned out the way they did. What did they do that caused all of their sons to become dug addicts? This thought has haunted their lives and yet throughout it all they remained supportive and loving. I once watched Joan take one of her sons shoes home when he was in hospital to keep him in - her words were "If he has no shoes I know he will be here where he is safe", did not work. He discharged himself against medical advice with a chest drain in (we took it out before letting him go) and he walked out in his socks. He had managed to stay with us for 2 days but the call of the drugs,and his equally addicted friend, were too strong. Strangely, every time I met the sons they were never violent or aggressive, they had been well brought up and never gave us any trouble. They were just drug addicts.
So, rest in peace Fred, I have often admired you and your wife that you never gave up on your kids and hope that if I was in your place I would be as tolerant.

I'm back,

I've been on holiday, had a great time but start back to work next week. Ah well, it's like I've never been away.
Had an experience which made me think while I was away. I was taking a picture of a pretty village in England and happened to get a couple of kids (about 7 years old) in shot, thought nothing of it until my wife pointed out that it could look very suspicious a fat, bald, middle-aged man taking photos of children but I should be OK as she was with me!! This got me thinking that perhaps in this day and climate of child protection that she was right so I deleted the picture (the joys of digital cameras) and took another picture which had no children in it. But afterwards reflecting on it (see I did learn something at university - how to reflect) I thought back to my student days when I had to work on the paediatric wards. No police checks in those days, I was assumed to be safe with children as I was a nurse.
I recall one instance where I was allocated 3 children to look after in the morning, nothing unusual, happened every day. This day I decided to shower 2 of the kids and wash the other, have no idea of diagnosis and illnesses after all these years but the children were all independently mobile and were looking forward to a shower. My own kids at that time were about 10 and 12 so I was used to dealing with children. Anyway, one of the kids, a little girl of about 8 disappeared and I could not find her, she could not get out of the ward as the handle was too high for her so I was not too worried, but she was holding me up. Found the poor girl in the shower trying desperately to turn it on and shower herself for me, obviously in floods of tears and cold and naked. What did I do, the only thing I could do, I found a big warm towel and wrapped her up in it and gave her a big cuddle, I then washed her under the shower and we carried on with our day. No harm, everybody happy and I did not even think to put the incident in her notes. Would I do the same thing today? Not a chance, I have not changed (apart from getting older) but the world has changed. I could not put myself into a position where I would be alone with an 8 year old girl in a shower. To my mind the way it seems to work is that this would just be an informal way to resign my job. It is not just males, one of my colleagues used to do voluntary work with cubs and beavers but found that what they sometimes needed was a quick cuddle then on they go - she was not allowed to do that.
Nowadays I have an Enhanced Disclosure (Scotland) number and we have had people who came to us for jobs having to be unemployed for a couple of weeks as they had resigned from their last job and their disclosure form was not through.
One of the games I played with my own children and some of the patients at the time was to put your noses together and then you have to try to bite the other persons nose while all the time still touching noses, if the noses came apart you had to stop. Children of a certain age love it because it is totally stupid and impossible to actually bite anyone. But there is no way I could do something like this now.

Pee

Those of us who work in health related fields particularly nurses ambulance people and doctors have a rather strange bodily function which we all seem to develop. This is the ever expanding bladder. In my case I go to the toilet at 7:00pm and suddenly realise that the last time I was at the toilet was 6:30 am that morning. I really, really need to drink more water.

On a related subject, young guy came in to us complaining of passing blood, no pain but urine was red. OK asked the usual questions, being doing anything different, strenuous or kinky but no, nothing unusual. Checked vitals and put him in a cubicle. Got a specimen of urine and tested it - no blood, not even microscopic amounts. Asked again anything out of the ordinary? Oh yes, I was eating a load of beetroot yesterday.

My cold is better, and my wife still has not got it, but strangely enough all her workmates are starting to phone in sick with colds. I told you, 'Typhoid Mary'.

Baby Docs

Well we're into September now and the new doctors have been here a month and are settling in a bit. Because of the new training for doctors it is strange having a mixture of people who are very experienced and some who are inexperienced. Because all the doctors are new, we don't know who is who and can have an occasional mix up. One doctor was sitting in the department the first week not doing anything so one of the nurses gave him a patients card and pointed him in the direction of the patient. Rabbits and headlights immediately sprang to mind, with a whimper of fear he was out of his seat and in a quavering voice stammered that he was just the junior doctor and with that he ran off up the corridor. Poor guy was just qualified and had never seen a patient before as a doctor, we brought him back and reassured him and he seems to have settled in to the department and is doing jobs more in keeping with his experience. One thing that I have noticed with this bunch, and keeping the grumpy bit of my name going, is if I tell a doctor not to do something because it is not departmental procedure or protocol or because the consultants won't like it, why do they argue with me? Also some are self assured, some are a bit diffident and others are way overconfident and need very careful watching. I'm sure this is the same all over when new doctors start and as we get to know each other everything will settle down and we will work as a team again.