Tuesday, November 14, 2006

Good Nursie! Here, Have A Biscuit

Good dog!"Who's a good nursie?" *pat pat*

Why should you read this post? Because all of us, at some point in our lives, will be looked after by a nurse. And it's important to understand that nurses are not a happy lot. In fact, some of them are pretty miserable. (And yes, if you're thinking that this whole this-post-applies-to-you-too intro is a desperate ploy to combat the dwindling comment count on my posts, you're right. So sue me. But first comment! --Editor)

I suspect that the reason nurses generally aren't very big on medical students is that as nurses, they take so much crap from doctors whom they can't fight much, so they might as well get us BEFORE we outrank them. This phenomenon isn't exactly restricted to the UK; nurses the world over pretty much have the same complaints. Only in the United States have I ever heard about nurse unions managing to make any real progress through strikes. (And if you guessed that my source of US healthcare news is the ever-reliable and extremely accurate Grey's Anatomy, then ding ding, you're right again! What are you, psychic?--Ed.)

Today, while I was mucking about with some poor guinea-pig's intestine trying to smooth-talk it into contracting for me, a friend of mine who is a graduate medical student started telling me about her clinical rotation at Addenbrooke's Hospital here in Cambridge. On her first day, upon walking into the wards:

Angry Overworked Nurse #1: Who're you?!

Medic: I'm...I'm supposed to start my clinical rota--

Angry Overworked Nurse #1: Where's your ID tag?!

Medic: Oh, uhm, it's in here...lemme fish it ou--

Angry Overworked Nurse #1: Why aren't you wearing it? You were TOLD to wear it at all times! Oi Angry Overworked Nurse #2, c'mere. Take this medic to Dr Snobbish Surgical Chief.

Angry Overworked Nurse #2: What? But--but she's a MEDIC. Why do I get her?

Medic: Um--

Angry Overworked Nurse #1: Because I said so! I've got lots of work here. I hate doctors anyway. Take her!

Angry Overworked Nurse #2: And you think I don't?! Right, you, follow me. And keep that bloody tag on!

Now I know that sounds like an exaggeration, but it's not that far off. My friend said that not only did the nurses hate her, they were also very open about WHY they hated her. They informed her in no uncertain terms about their disdain for doctors and openly bitched about them. Of course, my friend being the smart and sensitive person she is, recognised this bitterness for what it was, and eventually made friends with the nurses on her wards. But I was reminded of her when I came across this article in the Times, which got me chuckling.
King’s College hospital NHS Trust in London is offering nurses free cappuccinos and chocolate chip biscuits to encourage them to smile at patients. They introduced the reward scheme after surveys raised concerns that nurses were not being nice enough to the sick.
Any old idiot can see there's no shortage of material here to make fun of. In fact I'm quite sure several blogs have picked up on it and done exactly that (but no, I haven't found them yet, hence the absence of links --Ed).

But I'm not gonna do that today. That'd be a cheap shot. In fact, I rather agree with this method of reward. The article isn't pretentious about WHY the hospital has started doing this. It says quite plainly,
Trusts are introducing new initiatives to improve their “customer services” because, under government reforms, hospitals now need to compete for patients.
No beating around the bush there. Government numbnuts mess up the system enough to make hospitals compete for patients, but out of the whole hulking mess comes something that finally benefits the patient (that's you and me, folks. --Ed). According to the article,
Matrons at King’s College hospital hand special thank-you cards to nurses who are seen smiling at patients or relatives, chatting with patients, having a positive attitude or doing something to make someone’s day better. Selina Truman, head of nursing in general medicine at the trust, said “This scheme is very motivating because matrons and ward sisters praise the nurses directly. It has put patients back at the centre of our work.”
Believe it or not, folks, competition's actually made things better for the patients. Anyone who's ever been in a hospital will tell you that the attitude of the attending nurses makes a huge difference in the quality of your stay. And while offering nurses free coffee and biscuits may seem like a cheap way of getting them to clean up their act, it's actually workable. It's one of those 'little things that matter' that everyone seems to go on about (married people will understand. --Ed) and, as everyone knows (including the nurses themselves! --Ed) nurses really could use some coffee.

But what move like this could stand without naysayers? Lo, already they appear on the horizon:
However, an editorial in Nursing Times magazine said nurses did not need bribes to be helpful and pleasant to patients. It said: “Excessive workloads and paperwork prevent nurses from spending time with their patients and caring for them properly. This is a fundamental problem that can never be rectified with a hot drink and a biscuit, or other such imports from industry.”
That's true, Mr Anonymous-Editor-Hiding-Behind-Anonymity-To- Avoid-Being-Skewered-By-Fantastic-Wits-Like-Mine, but it's a step in the right direction. I'm assuming the editor of the Nursing Times has been a nurse him/herself at one point, and I challenge them to find a single nurse who WOULD mind a free coffee and biscuits in return for ignoring their insanely depressing workloads long enough to flash a smile and a kind word at a patient.

Still, though, all's not well that ends well in this light-hearted tale. The article gives a taste of a more serious issue brewing:

In recent years there have been growing concerns about nurses who are “too posh to wash” and prefer to spend their time on administrative and technical tasks rather than basic care.

Two years ago a resolution at the annual congress of the Royal College of Nursing proposed that nurses were now “too clever to care” and suggested that the compassionate part of their job should be delegated to healthcare assistants.
Nurses who think above their stations. *gasp* Can it be? Are nurses becoming too highly trained to perform basic nursing care? Is this phenomenon unique to first-world Britain, which is so saddled with political correctness and human rights that nurses are no longer fit to nurse? Is this a good thing, giving nurses rights and powers without having them undergo further education, or is it a recipe for disaster?

We may never know. Or we may find out someday. But when we do, I only pray that it isn't too late to salvage the National Health Service.


Mother Jones RN said...

There is an old saying that nurses eat their young, and unfortunately I have seen what you’ve described on many occasions. There is no excuse for rudeness. Personally, I’ve always taken students under my wing. You folks have enough to worry about without some stupid bitch coming down on you like a ton of bricks.

I like the picture with your post. Just last month our hospital administrator decided pass out cookies to the nurses to boost our morale. I told him I didn’t need a sugar high to feel better about myself.

HospitalPhoenix said...

Yeah I saw this article at the weekend too. I even wrote a similar blog post title to yours! Mine doesn't have a picture of a doggy though. So you win...

The Angry Medic said...

Mother Jones: Nothing else can properly capture what I feel towards you as simply as "thank you".

And I'm glad you're self-confident enough without the extra sugar pumping in your veins. I'd have pounced on em like a wet cat. Come to think of it, why don't they offer cookies to demoralised medics?

HospitalPhoenix: Awww, how self-effacing. Unfortunately a copy of Photoshop and some free time (which really should be spent working) does not a better blog post make :P your post was good and took a rather different tack, which I'll be commenting on soon. For now I must slink back to my essay and try to avoid being eaten by my supervisor in the morning :(

Spirit of 1976 said...

I've mentioned the whole nurse biscuit thing myself on my blog:


For the record, I think that the "too posh to wash"/"too clever to care" claim about nurses is a myth, brought about by rose-tinted "it was never like this in my day" reminiscing and a basic misunderstanding of what nurses do, and a failure to comprehend that it might involve things a bit more complicated than cleaning up piss.

It's true that RNs are spending less and less time at the bedside, but I would put this down to a combination of ever-increasing loads of paperwork and an equally ever-increasing list of things that have to be done by an RN and only an RN. It's certainly not because they're sitting at the nurses station thinking about how to write a witty deconstruction of Franz Kafka's 'The Trial.'

I know Dr Crippen has bought into the "too clever to care" mythos, but lately I've been increasingly noticing the list of errors he makes when talking about nurse education or the organisation of mental health services. (I'm not talking differences of opinion here. I'm referring to statements that are outright incorrect.)

For all that Dr Crippen complains about nurses not understanding medicine, I'm starting to take the view that he doesn't understand nursing.

Also, I'd like to assure you that I won't be accosting any med students on the ward. I'm nice to everybody, so long as I'm thrown enough nurse biscuits. :)

The Angry Medic said...

For the record, I think that the "too posh to wash"/"too clever to care" claim about nurses is a myth, brought about by rose-tinted "it was never like this in my day" reminiscing and a basic misunderstanding of what nurses do

as usual, Spirit ol pal, you hit the nail right on the head.

on behalf of all ward-rounding med students: thank you! I'll remember to stuff my lab coat pockets full of nurse biscuits :)

HospitalPhoenix said...

One of the main reasons I take great care to stay on the good side of my nurses is to ensure myself a reliable supply of posh chocolate biscuits.

I've even been known to wander into Sister's room and whinge that there are no nice biscuits on the ward, she has a stash of them given to the ward by grateful patients and she's always happy to oblige!

On the one occasion there were none, I was instructed to track some down, so I went to the hospital shop and bought loads of nice ones. The nurses liked that.

Anonymous said...

Healthcare assistants taking over roles of basic care from nurses is not unique to the UK (not Britain! Birtain's only part of the UK), it's the same in Australia, NZ, the states. Nurses are much more qualified than to do such basic things.
I really wish you'd research your topics properly, most of your posts have major major errors in them!

Spirit of 1976 said...

I think it's certainly true that there are advantages to delegating the basic care tasks to the HCAs (and to student nurses, incidentally, who do a surprising amount of the bedside care). However, I'm definitely of the view that if there's time to do so then RNs should muck in with the HCAs.

On the EMI ward where I went on placement last year, each morning everybody from the ward manager downwards spent 8am to 9am getting the patients up, washed and dressed. Personally, I admired the leadership of that ward manager for rolling up her sleeves with the RGNs and NAs.

Spirit of 1976 said...

Oops. The end of that sentence should read "with the RMNs and NAs", since it was a mental health ward.

HospitalPhoenix said...

The thing about blogging is that anyone can do it, and it's not proof-read before it's published. That's its beauty and also its downfall.

So (for example) Dr Crippen's views of nurses are based on his experience in primary care. Mine are based on working with nurses in a hospital specialty. Angry writes as a medical student.

None of us is a nurse expert. But that doesn't mean we're not allowed opinions and thoughts and feelings regarding nursing.

So... there.

Spirit of 1976 said...

So (for example) Dr Crippen's views of nurses are based on his experience in primary care. Mine are based on working with nurses in a hospital specialty. Angry writes as a medical student

...and I write as a final-year student nurse. ;)

But to be honest, roughly number#2346363422766 of the Things I Dislike About The NHS is the never ending capacity for nurses, doctors and other professsionals to sit around sniping at each other rather than coming up with constructive ways to help each other out.

Sure, nurses can bitch about arrogant doctors, and doctors can carp about clueless nurses but ultimately we're all there to help the patient. And if that can't unite us, then let's join together in common hatred of physiotherapists.

Bloody body-beautiful types, making us all look flabby and unfit with their square jaws, flat stomachs and buttcheeks like granite. I'd wipe them all out, except they all have such excellent physiques they could kill me with their bare hands.

The Angry Medic said...

Spirit: Personally, I admired the leadership of that ward manager for rolling up her sleeves with the RGNs and NAs.

Agreed. Now that I salute. Those sort of nurses should certainly be allowed, nay encouraged, to run hospitals.

And yes, whilst some may snipe against passing responsibility for washing to HCAs, I agree there can be some good arising. Though I also agree that some degree of care be left with nurses (and I know many nurses who'd second that).

HospitalPhoenix: None of us is a nurse expert. But that doesn't mean we're not allowed opinions and thoughts and feelings regarding nursing.

As usual, brilliantly put. So there indeed!

Kudos on the Crippen mention, btw. Your site stats should be climbing through the roof.

Anonymous: (not Britain! Birtain's only part of the UK)

I knew that!


I really wish you'd research your topics properly, most of your posts have major major errors in them!

Yes, well, I admit some of my posts may not exactly be up to scientific journal standard. I'm sorry, I'm ONLY a med student in one of the world's busiest universities, you know. (What am I saying? ALL med schools are busy, as are all med students.) I always do as much research as I can before I publish though.

And whilst HCAs taking over from nurses may be happening in other countries too, few of them have it to such an extent as the UK does. And this is what worries me. Whilst I have great respect for nurses and agree that they are qualified to do way more than just wipe arses and clean bedpans, it's when they start replacing doctors that my Spidey-sense starts tingling. Bad idea! Bad idea!

Anonymous said...

Ah.. bad nurses, annoying patients and stupid hospital protocol... the bane of my life and the misery of my existence. It's the end of another 80 hour week as a medical intern at a prominent Australian hospital.
Things that happen that shouldn't:
1. Nurses paging you and then walking away from the phone immediately
2. Nurses paging you with an extension number only even though there is a computer paging system which you can leave a message.
3. Family members expecting you to update them on the patient's progress every day - if we have 40 patients and spend 10 minutes talking to each patient's family, that equals 6.6 hours a day of essentially not doing things for the patients!
4. Family members who don't communicate with one another so you end up explaining what is happening every day to patient's son, niece, and aunt.
5. Nurses who page you at 2am in the morning asking you to put in a drip for IV fluids running at 24 hourly to start at 8am.
6. Patients who keep on 'accidentally' pulling out their IV cannulas. They're not old or confused, just fat or stupid.
7. Nurses who don't predict this happening and wrap the damn thing in 10 metres of bandaging.
8. The fact that I had to clip the toenails of 2 patients today to send off to the lab because the podiatrists wouldn't do it because the patient wasn't diabetic and nurses 'aren't allowed to' because they 'might injure the patient'.
9. The fact that there were no tools to cut nails on the ward so I had to quite dangerously use suture scissors.
10. The fact that I just asked the patients to cut their own damn nails and put them in the specimen jar anyway because there's much less risk of them hurting themselves that way.
11. The fact that one patient was too fat to cut her own toenails.
12. Nurses who ask you do sign requests for bloods, IV fluid orders etc for patients who aren't yours, but then refuse to have anything to do with any patients who aren't theirs.
13. Patients who automatically assume that female doctors are nurses.
14. Patients that won't hang up the phone when you get to them on ward round.
15. Patients that have to go to the toilet as soon as you have to put a drip in them.
16. Patients who say "You better get the drip in first go or you're in trouble" and mean it.
17. Nurses who page you and then when you get there they have to go for 'first teabreak' when you have not had lunch or dinner and have been working for 10 hours already.
18. Nurses who come up to you saying 'Mrs X won't take her medications. What do we do?"
19. Patients or patients families who are nurses or doctors.
20. Midwives who won't let medical students observe or perform deliveries.
21. Nurses who write in the notes "Paged Dr M with no response x3"
22. Patients who request referrals to see specialist units for problems for which they did not come to hospital.
23. Patients who say they can't go home on whatever day because 'my husband's working and can't pick me up'.
24. Nurses who force you to review the patient with dementia and classic sundowning because they are agitated but neglect to tell you about the quiet lady in the other room with a facial droop and weakness down one side of her body.
25. The son coming up to you the next day saying "I think my mother's had a stroke"
26. The 90 year old patients who refuse to be discharged to rehab or nursing homes, insist on going
home and then bounce back to your inpatient list 5 days later. And still insist they want to go home.
27. The fact that nurses have to do a course to be able to put drips in, but doctors just practice on themselves (and patients)
28. The fact that nurses can put in female catheters, but not male ones.
29. Nurses who page you about Mrs so and so, and when you get there find that they have not taken any obs for 6 hours.
30. Nurses who continue on gossiping about the latest hollywood gossip while you are standing there waiting to tell them to do some obs.
31. Patients that come in with pneumonia and say "you might as well do my hernia operation while I'm here"

Anonymous said...

Good nurses do exist. So do good patients.

1. The nurses that at least try to take blood from patients instead of saying "I'd rather you did it - she looks pretty hard".
2. The nurses that lay all the drug charts they want you to rewrite nicely on the workbench complete with blank new ones that already have patient stickers on the them.
3. The nurses that actually look up the last INR and write it down for you when you come to warfarin dose a patient.
4. The nurses with initiative to organise chest physio, social work, etc for their patients.
5. The nurses who tell patients families the general gist of what is going on rather than saying "I'll get the doctor to come and speak to you". Every. Day.
6. The nurses that do the IV cannulation course.
7. The nurses that help you by setting up the IV trolley or catheter trolley before you get to the patient.
8. The nurses who look at the metre long list of things you are supposed to do and rub off all the things that can wait until the morning.
9. The nurses that check their patients bloods for you.
10. The patients that realise that you don't have all day and come to outpatients wearing short sleeved shirts on purpose so that you can actually take their blood pressure easily.
11. The patients that actually try to help you, help them.

I can't think of anymore. Hmm.

beajerry said...

I am kind and smile to everyone, patients and medics alike. Does that mean I'll get Filet Mignon instead of a cookie?

Nathan said...

21. Nurses who write in the notes "Paged Dr M with no response x3

Ooooooo, I hate that.

Anonymous said...

Who says that giving nurses tasty snacks doesn't improve interactions? I find bringing cakes in on nights greatly reduces many of the nurse-related 31 instances, and is a pretty cheap investment.

Junior DocSpot said...

Just to let you know that the negativity that you receive as a Medical Student does improve when you qualify... a little.

I am going to (eventually!) do a post about how territorial they are when you start a new job... but I'm building up to it.

Otherwise, nice start to the blogging. You'll be famous in no timee ;)

The Angry Medic said...

anonymous: Good nurses do exist. So do good patients.

Agreed. They just like playing hide-and-seek. A LOT.

And thanks for those lists! I feel the urge to write another nurse post soon. I might use those. I'll be sure to credit them to 'anonymous' :)

Junior DocSpot: Aw shucks. It'll prolly be for Worst MedBlog Written or Saddest Life Ever.

But thanks for the assurance! You've made the light at the end of the tunnel so. much. brighter.

*bursts into tears of depression*

~mika~ said...

Your blog is so funny. My friends and I are stuck awake here in the ER. I personally hate what we American's call "Floor Nursing" which seems to be what you are refering to. When you rotate to the ER and ICU things will hopefully be better. Nurses who work in these enviornments have more education, clear critical thinking skills and a great sense of humor, like my friends and I. Or maybe it's just your country needs PRN Valim...better living through Chemistry I say.. Take Care

stewart bethell said...

dear Sir
i stumbled upon your blog by accident(no worry i'm not hurt) but i was in stiches reading about you life in nursing.

as a volunteer youth worker. i know where your coming from as there is nothing at the end of the tunnel for every good child you turn out there are 30 little B*&^%E£S out ther ruining someone life, and ending up in hospital where you will no doubt have to patch them up. and send them out into the front line of life again.

never fear.. i am organising a german beer night in ipswich,suffolk on the 20th ocvotber tickets are only £10. beer only £2.50 a pint winen and schnapps and live umpa music. Fancy dress i#optional

mail me for tickets

cheers unhappy youth worker, suporter for the young nurses! working hard to keep the NHS working.