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.

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.

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.

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?

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?

Ho, Ho, Ho, Part 2

Well despite my fears our department remained very quiet over the Christmas holidays. I don't think anyone died with us, we only had about half a dozen overdoses and most of the patients went home. Even better, the hospital had beds so no one waited too long. After my post of Christmas eve about having back pain and requiring a TENS machine I was a bit put out that the first 3 patients who attended on Christmas morning had back pain but had not bothered to take painkillers. We had loads of food, one girl made a superb home made soup and one of the doctors made a superb curry using his mum's recipe which was very tasty and there were chocolates and nibbles and cakes. I have not had a proper healthy meal for 2 days. But I managed to get away early on Christmas day.

Aren't Amazon wish lists a wonderful thing? This year I got loads of books and DVDs that I really wanted, brilliant (Note to family; sorry about the comments I made about you on 17th December). For some reason my wife has given me a guitar so I felt quite adolescent for a time as I used to play guitar when I was younger but this will keep me busy relearning how to play. Unfortunately I don't have the hair that I had when I first got a guitar (shoulder length) and I now have twice the stomach.

I hope you all had a peaceful and happy time, I hope that Santa was good to you and if I don't post before it, I hope you have a happy New Year and if you are working I hope it remains civilised.

Ho, Ho, Ho.

How did you spend Christmas Eve Grumpy?

Wired up to a TENS machine thank you. Over 25 years of humping patients about means my back is knackered and hurts on a fairly regular basis.

I have a load of presents sitting under my tree and as I will be working all day Christmas day I will open a few tonight. I will also open a few tins of cider and perhaps a bottle of wine.

I hope you all have a merry Christmas and if you are working I hope it is civilised for you - I will not use the Q word.

IT and Merry Chistmas

Hi everyone, sorry I have not posted recently but I have been having discussions with our IT department. I asked them about the hospital's policy on blogging and the answer was really what I expected, "Don't do it as you will breach patient confidentiality". Since this report about a doctor abusing the IT system came out there has been a bit of a crack down on IT stuff so I am keeping my head down. I have had a load of things to write about but unfortunately they are too easily recognisable to people. As there are only 5 million people in Scotland and only 5 large cities local stories tend to stick out and therefore identities become known. Once some time has passed and people have forgotten and I can figure out a way to tell the stories without identifying anyone I will write them.

It's almost Christmas - Ho! F'n Ho! - I am of the persuasion that Ebeneezer Scrooge was a badly misunderstood man, I am definitely a Christmas? Bah Humbug! person. This year I am working so I will have to put up with jollity from my colleagues and the result of what happens when people are being happy from my patients. I'm quite sure there will be broken bones, RTA's punch ups and the odd heart attack to keep us busy.
Bit of nostalgia now, in Scotland Christmas was never a holiday. Our holiday was New Year. I remember getting up on Christmas morning going out on the bike I received from Santa and delivering papers, Christmas was a working day in Scotland and it wasn't until the 70's and 80's that it changed. I enjoyed Christmas when my children were young it's just as I've gotten older I can't be bothered with all the nonsense that goes with it - pushing through crowded shops, people laying in enough food to last through a biblical famine - honest the shops will only be closed for 2 days at most and I always seem to get silly presents from my family, I sometimes wonder if they have actually met me. I have been told that what I really need are grandchildren and then my attitude will change. Ah well, I hope YOU all have a good Christmas and Happy New Year.

Complaints

I have received many complaints over the years from patients and relatives. Some have been justified and are usually caused by bad communications. Most however are a waste of time and are usually caused by us (the hospital) not doing what the patients wants when they want it. These complaints are usually about the wait to be seen but two complaints recently have just topped them all.
The first was from a couple of young guys - early twenties - who when I asked when the patient had hurt themselves the friend said "Well it will be about three hours ago now the time we have waited here." This time I thought hang on, I know we are busy but our waiting time is not that long so I checked their arrival time. From the time of arriving in the department to being seen by me was 40 minutes, on our busiest day of the week with a full waiting room. They were complaining about waiting 40 minutes. I was less than diplomatic and asked if they had noticed the number of people surrounding them in the waiting room? No, they just felt that having to wait under an hour was still too long.
The other complaint was definitely the weirdest one I have dealt with. I was giving a patient a meal - that he had ordered from a menu - and he complained that the food was too white. What? The food was too white. White cod, with white potatoes and white cauliflower all on a white plate. How do you answer that one? Turns out he was a lecturer in catering and felt that a bit more thought should have gone into presentation, despite the fact that he had ordered it. He also mentioned (complained?) that the green salad had some red tomato in it. Still don't know if he was winding me up or serious.

Thank you.

I would like to thank the people who have commented on my posts, I do not always get to answer them due to work commitments. When I do get a chance to answer the comments it seems to me that the moment has passed. But please keep commenting, good and bad - especially good. Every one of them is appreciated.