Hospital shambles

I spent about 6 hours yesterday sitting in A&E of the Royal Infirmary with my dad from 6am to 12noon.

Not once did anyone use the antibacterial handwash in his bay. Not once. But then it was empty so they wouldn’t have had much joy anyway. I did ask a few folk if they’d give me a new one but no joy.

Dad was hooked up to 15 minute blood pressure which was taken automatically, along with his oxygen level and resps. From time to time a nurse had to come in and write these figures down. Most of the time they didn’t say a word to my Dad. No “How are you?” No “I’m just taking a note of this for your file.” No “Everything is looking fine, don’t worry.” No “Can you get you anything?” No nursing. Just note-taking.

At around 8am Dad decided it was breakfast time.  I asked a nurse if it was okay to get him a coffee from the machine in the waiting room. “No,” she replied, “we’ll get it. Just give me a minute.”  An hour later I asked the same nurse if he could get a drink as he suffers from dehydration occasionally and is diabetic.  “Here’s a cup of water.”  At 10am I asked a nurse who had come to write things down again if they ever got breakfast in this place.  (For I’m pretty sure all the nurses did.) “Only if they are well enough to eat and drink,” was the reply.  “Well, he is,” I said. “<Sigh> Alright, I’ll get someone to get it for him. Toast ok? Coffee?”  A young smiley nurse brought it to us 10 minutes later. I didn’t see anyone else being offered anything and not all of them were on death’s door. Far from it, as far as I could see. No wonder they are ill.

The doctor was called away 3 times in the course of speaking to us. I have no complaint about that. There were other sick people. He always came back, sometimes after an hour, and apologised. (Dad thought he was too young to be a consultant!)

Dad was to be kept in for observation for it may have been a heart attack but there were no beds.  We were told we’d just have to wait.  But then someone came in who was quite poorly so dad was put out of his cubicle and parked beside the nurses bay in the corridor.  He was meant to be on oxygen but the nurse who was going to get some portable oxygen never returned.

In the course of our time there I watched nurses deal with a drug overdose patient hand-cuffed to 2 policemen. They wore gloves while dealing with her but then would come out and answer the phone while wearing the gloves. What about the next person who picks up with phone without gloves?

I saw lots of things. What I didn’t see was nursing. What I didn’t see was caring.

Is that too harsh?  Were they busy? Yes, I’d say they were kept pretty busy.  But how much longer would it have taken to talk while doing the blood-taking, or the ECG, or pillow plumping – oh sorry, I forgot, there were no pillows. A shortage.  I didn’t see hand-holding, reassuring arms round shoulders, listening. Too busy to listen perhaps? A listening shortage.  I saw nurses deal with a patient and go back to the computer screens and stand and click the mouse until the next task. Filling in on-line forms? Possibly. But most of the time they didn’t type anything, just stood and swirled the mouse around while looking about – but never catching a relative’s eye.

I realise that emergency medicine is different from ward nursing. But I don’t accept that they are too busy to talk and reassure. And I don’t accept that a system can’t be put in place that someone makes breakfast for those in the emergency ward. For they were not all emergencies, as far as I could see.

Bring back Matron. Not to swish around checking the nurses are all working. No, a Matron who walks round the beds asking the patients if everything is okay.

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28 thoughts on “Hospital shambles

  1. Why, in this day & age, would a nurse have to *write down* a blood-pressure reading, anyway?

    …and if they were properly automated, who would bemoan the lack of “personal touch”?

  2. Would it be terribly old fashioned to think “It wouldn’t be like that in my day”?

    I must be getting old, because the quality of nursing IS deteriorating since I was in clinical practice. It is all about degrees and not about people. It is all a job and less about a vocation. I used to be proud to be a n RGN, and now I am relieved that I am no longer registered.

    I used to write passionately about the difference that nursing made, and now… all I see are hard-nosed people unprepared to enter into that relationship which gives “moderated love” as a colleague described it. My clinical speciality was ITU/CCU: people at their most ill and most vulnerable; relatives at their most bereft. It is better that I wear a cassock onto the wards these days, as I wouldn’t belong in theatre greens any more. I still care. I’m still enough of a manager to feel that it isn’t good enough.

    Prayers for you and your dad, Ruth

  3. Tim, I wondered about that myself as clearly all of Dad’s obs were being transmitted to the computer on the nurses’ station. I think it is so the doctors can enter the cubicle and pick up a file on the way which has everything written down on it for them. A bit old fashioned, I grant you.

  4. Fr S, you are right of course. it was different long ago. Why? Because it is now a degree course? Because of cutbacks and finance and staff shortages? I don’t know. But I can’t accept that common sense tells you to talk to someone who is ill. It is just plain rude not to. ‘Moderated love’ is a good way of describing it.

    And then there are more cutbacks so less chaplains too. None of whom wear collars, let alone cassocks! More’s the pity.

  5. I feel embarrassed to be an employee of NHS Lothian. It shouldn’t be like that and I know someone in authority who would be very interested to hear your comments. Let me know if you’re happy for me to speak to her – or I can let you know who to contact.

  6. Once in Glasgow, I spent an afternoon trying to get someone to clean the blood of the reception desk at ER. Afterwards (when nothing had happened by the time I left) I called the NHS to say ‘I’m not here to shout and complain, but you need to know that they are not keeping people safe’. A senior member of staff was on the phone in minutes, was very attentive, and kept sending me updates on how they were dealing with it.

    So, I was left with mixed feelings: a lot of good people who are really trying to make things better, and a lot of others who truly aren’t.

  7. I can not help thinking that there are too many managers devising KPI to show how well they are doing. Recently political pronouncements “announce” more staff here or a new facility there.

    Is it that we need more nursing who consider nursing as a vocation rather than a job and have patient contact rather than meeting “Management Targets”.

    Maybe we should bring back Matron – who is a senior nurse – not a “Manager”.

  8. I agree. In a hierarchical system standards have to be set from the top down. Leadership. I wonder when anyone last asked how the nurses were doing or made them a cup of tea?

  9. Oh it gets better too. First he maybe had a heart attack, then he definitely did, then didn’t, and now it is a partial collapsed lung. But he is now in the cardiac ward so needs to go back to Combined Assessment but they have no beds. The doctor from CA was meant to go up and assess him yesterday morning and still hadn’t last night.

    But must report that nurses on that ward are lovely and do talk to patients. And handwash is used too.

  10. Another embarrassed NHS Lothian employee here. I’m so sorry that your Dad and you had such a dreadful time. Do do do complain – I know you shouldn’t have to, but you must.
    I wonder whether the nurses in A&E forget that they are actually nurses; you know, the sort that nurse people and don’t just treat patients? Perhaps the NHS should have an annual ‘remember your vocation’ day – a bit like Easter for healthcare workers!

  11. as a chaplain of an Emerg. dept what you have said is I am sad to say so typical of what folk experince. part of the problem is that nurses at times would rather act as ‘would be doctors’ all technology and writing scripts rather than the old fashined nursing duties. if you get yourself in this position again…

    i. ask for the hospital page holder, they are the duty manager like in a shop out of hours and they will deal with problems then and there.

    ii.let the staff see that you are keeping notes / journal and writing down names and times, that always gets around the team that someone may have evidence to complain.

    iii. make a written complaint as thats when things change. if you see a lack of hand washing and use of gel authorities should know..

  12. What exactly was your role in all of this? It sounds like you were a dispassionate bystander making notes for a newspaper?
    Surely your role was to provide support for your father? It’s a shame you did not feel up to this task.
    The nurses are usually grateful when a relative accompanies their loved one to hospital so they can provide support and allow the nurses to get on with other tasks. It’s humbling what horrors busy A&E nurses have to face day in day and day out, dealing with drug addicts, teenage drunks, suicide attempts, mutilated bodies from road accidents and sudden death. Not mention the risk of physical assault and abuse from the public. Most people could not tolerate this. You are not to know what the nurses have witnessed prior to coming to attend to your father. The fact is you don’t know a great deal.
    Nursing has changed greatly over the last 20 years. If your father collapses who do you want a nurse to mop his brow or one who has the skills and training to provide immediate lifesaving treatment? I guess you would rather have someone to stand by the bed and offer platitudes.
    You seem to take great delight in rubber necking on everyone else’s business in A&E, and making misguided and erroneous assumptions. I guess this is why you couldn’t get off your chair to go and get your father a drink in case you missed some juicy incident write in your note book.
    Medicine is not an exact science like mathematics where 2+2=4, it more of an art, based on science, where investigations and disease history are used to make a diagnosis. This diagnosis changes and is modified over time as more information comes to light. You seem to think you live in an ideal world where everything is perfect, where the doctor snaps his fingers and arrives at the correct diagnosis every time and where child abuse and paedophilia in church run care homes never existed. Your one of these people who think that whenever a person becomes ill or even worse dies there must be someone to blame and it must be the fault of the medical staff.
    Anyone can sit in chair and make a critique of another person’s work. We put our money in the church collection plate in the hope the money will be used wisely for Gods work but we don’t really know if we are getting good value from our clergy. What do our clergy get up to when there not watching day time TV? Are they working hard for their stipend and free houses? Or are they like MPs fiddling the expenses to get more out of the parishioners?
    Instead of criticising the nurses it would be far more useful to offer words of support for a profession so often unfairly maligned. At the end of the day it is often a thankless task, working long hard hours doing what they can to help ungrateful people with little monetary reward. Unfortunately it’s attitudes like yours that cause so many nurses to leave the profession and take up other jobs which are less satisfying but ultimately better paid and where they can be treated with respect.
    Nathan

    • Bravo, Nathan. Finally someone who is happy to step off the bandwagon and express a different opinion. It seems that everywhere you look these days, the TV, newspapers and now it seems, a ‘christian’ Reverend are slating nurses and blaming them for all the failings of the NHS. We will be held responsible for the war in Iraq next. After all, we are responsible for MRSA aren’t we? Surely it must be true, it’s been on the television for years now!
      If people spend less time absorbing sound bites from cheap media sources and actually find out facts for themselves before making judgements, they may realise that it is possible to have an informed (and dare I say it- individual) opinion.
      There is no doubt that the Ranting Reverend picked up on some important issues that should be brought to the attention of the department in question. However, what is disappointing is that the Reverend chose this particular media to air her criticisms. If she were genuinely interested in improving patient care – rather than note-taking and blog-writing- perhaps she should have spoken to a senior member of staff at the time.
      I do know from experience that nurses in this environment work under incredible stress. Not only the obvious demands of sick patients and emergency situations, but budget cuts and government targets to name but a couple.
      Developments in our technological age affect everyone in almost every walk of life and the NHS is no different.
      The government’s 4 hour wait target puts immense pressure on staff- and yes, everything is recorded on computers now. Blood test requests and results, Xray requests and results, Ct scans- this culture dictates that increasingly nurses (and doctors) are seen to congregate around computer screens because this is the best place to pass on and share information efficiently.
      I notice that although the consultant seemed equally pressed for time, he did not come in for any criticism, nor did any of the doctors. One does wonder whether your expectations of the nursing role are a little out-dated. Of course, I do not condone a nurse who does not even speak to a patient in such circumstances, but we are under a lot more pressure to perform a variety of different duties than the nurses in the days of Florence. Unfairly attacking nurses for these developments are unhelpful and frankly, un-christian.
      One A+E department in my area had a ‘housekeeper’. This wonderful lady spent eight hours every day devoted to ensuring everyone (patients NOT nurses) was comfortable and well fed. She had no medical qualifications and performed no nursing care. She took a tea trolley around the waiting room, brought blankets (not pillows- that is a long story, but you won’t find many A+E departments that can keep hold of their pillows), magazines, was generally devoted to ensuring everyone’s comfort- you get the picture. I have not been aware of many departments who have a housekeeper and budget cuts made short work this one too.
      So who gets the drinks now? Lets give that job to the nurses as well. External contractor for domestic services won’t pay to innoculate their staff against Hepatits B? Lets get the nurses to empty the bins and clean up blood spills too.
      Do you see where I’m going with this REV RUTH??
      Nurses who leave are not replaced because the money has been used elsewhere. The nurses you observed during your trip to A+E have no control over these decisions, but they are the frontline staff that are doing their best to get the job done. And I’m willing to bet they did not get the breakfast that you seem to begrudge them so much.

  13. Ruth, I have read all the comments with interest. I was a patient myself a couple of years ago, and I was horrified by some of the things I saw, mostly by nurses, but also some doctors. I would take issue with one of the things you wrote, nursing degrees started in the UK in 1956, I trained that way in the 1970s, and I do not think it has anything to do with the lack of proper care we see so often today. I’m not sure what the answer is, certainly better leadership…

  14. So, Nathan, where do you get off being wrong *and* offensive?

    Your statement
    Surely your role was to provide support for your father? It’s a shame you did not feel up to this task.
    is an unfounded evil assumption and your comment gets worse from there.

    There is something about the phrase “moderated love” which sums-up this thread; it is a desired state both from the patients’ perspective (to feel cared for, the lack of which is what Rev Ruth expresses here) and from the nurses’ (because we do actually know they have rights, stresses & strains of their own as well).

    Further, your statement:
    Medicine is not an exact science like mathematics where 2+2=4, it more of an art, based on science, where investigations and disease history are used to make a diagnosis. This diagnosis changes and is modified over time as more information comes to light.
    is gibberish. Medicine is a science; there are vital roles played by evidence and statistics feedback loops. That the understanding of a phenomenon changes over time is a mark of a science evolving better theories.

    Anyone can sit in chair and make a critique of another person’s work.

    Yes, and there’s not much wrong with that, in proportion to the amount the person knows, has an open mind, is non-opinionated about it, correctly identifies (in)justice, etc. Just because you dislike that something is said does not mean what’s said is automatically wrong.

    If your father collapses who do you want a nurse to mop his brow or one who has the skills and training to provide immediate lifesaving treatment?

    Actually, if *my* father were to collapse, I’d expect a paramedic to come along and do the essential paramedic bits, and the nurses to be present in hospital to do the nursing bits (which includes them being done in a caring fashion) when he gets there.
    So, you present a straw-man fallacy as well.

    What do our clergy get up to when there[sic] not watching day time TV? Are they working hard for their stipend and free houses? Or are they like MPs fiddling the expenses to get more out of the parishioners?

    I think you’ll find clergy are also practitioners of “moderated love”, a care for the community on pastoral grounds, that involves quite a lot of time spent visiting their needy, as well as providing guiding wisdom for society through the media of local community and church committees, sermons and more; without this social care, how many more people do you think would wind up in the hands of the health service?

    Instead of criticising the nurses it would be far more useful to offer words of support for a profession so often unfairly maligned. At the end of the day it is often a thankless task, working long hard hours doing what they can to help ungrateful people with little monetary reward.

    You’re talking about nurses here? Not clergy? Just checking…

    • Tim, yes you are right. My comments regarding Ranting Ruth caring for her father were wrong, I am sorry about this and apologise to Ruth for being so harsh.
      However, it is frustrating that many people are so narrow minded and have such a blinkered view of the health service. ‘Moderated love’ is great, but as you said this must apply equally to patients and relatives as well as the medical staff. There is not much ‘moderated love’ seen in A&E when a fight breaks out in the waiting room on a Saturday night. Your lovely-dovey touchy-feely stuff is not much use then! The nurses and their colleagues have to step in and sort things out, while the hospital mangers, clergy, MSPs etc are tucked up in bed.
      You misunderstand scientific principles applied to medical practice. Having been involved in clinical practice for over 25 years I think I have some knowledge of this. Medicine is not an exact science, even when precise measuring tools are used. As an example, I had my eyes tested last year. As part of an experiment I went to 5 different optometrists. 4 out of 5 gave me a different prescription. This is a speciality which uses various measurement tools to arrive at a diagnosis which can actually be measured numerically! The reason for these discrepancies are that human beings are involved which always introduces variables. These results were repeated nationally and reported in the journals.
      What precise, exact, clear-cut, accurate scientific measuring tool is used in the differential diagnosis of mental illness? There is none. Most provisional diagnosis are made during the interaction between the doctor/nurse and the patent during a consultation. What the patient says about their symptoms and how this is interpreted is a skill. The art is in sifting through this information to decipher what is important and relevant. This is not like physics, maths or engineering where there is always a precise answer. People are different and disease displays its self differently in different people. Ranting Ruth, like every relative, wants instant answers, but does not understand the process by which medical diagnosis are arrived at and how things change over time. So no real evidence of ‘moderated love’.
      What is surprising about reading the comments is how out-dated people’s views are of medicine and nursing. Some want to hark back to the old days where nurses are perceived to be more caring and attentive. Conveniently forgetting that in the good old days patients could be hanging around for 7 or 8 hours in A&E waiting for a doctor to come down from the ward. Now many patients can be treated by experienced nurses, discharged or referred on for more specialist treatment more quickly and efficiently. And no Tim, paramedics don’t work in hospitals. If someone collapses in hospital it is invariably the nurse who is the first responder. Some in this blog would prefer them to offer reassuring words, but most I think would prefer a professional with skills and experience to initiate the appropriate lifesaving measures.

  15. Yes, well said Tim. My sister, a senior sister on ITU, is very critical of a lot of modern nursing and says that it is very much the role of outsiders to criticise, as to do so from the inside is to invite discipliary action.

  16. Sounds a bummer to me, Ruth. Trouble is, in my experience, making a fuss at the time leaves you with the fear that one’s aged relly will suffer when you’ve gone – and that’s not getting at anyone; it’s merely human nature. The vulnerable remain vulnerable – and that’s why what you say is important.

  17. I really take exception to that comment, goforchris. (And there are so many misguided comments here)
    I accept that Rev Ruth observed at least two examples of bad practice (poor hand hygiene and poor communication) during her father’s hospital admission. However, to malign the whole nursing profession is unfair and to suggest that complaining about it may result in..what exactly? Harm to your relative? Really?!! I’m so shocked and disappointed that people could think that about nurses. The profession has certainly moved on a lot, but it is still a caring profession and one that no-one chooses to follow for monetary reward. Nurses must move with the times or get another job, but they shouldn’t be criticised because their role has changed. They can’t help that. There are far less junior doctors around nowadays and so nurses do take on a lot of duties formerly undertaken by them. Nurses did not implement these changes and it is unfair to criticise them for it.
    Please, a little common sense here. Remember there are many, many excellent examples of caring nurses – it’s just that people seem far more ready to be judgemental and complain (just checking this blog, it seems everything from plumbers to overcooked scones come in for criticism) instead of recognising that good things happen too.
    I see however, that you have plumbed a rich vein of nurse-hating supporters here Ruth, so I think I will step out of this one-sided pointless discussion now.

  18. revruth, I came here via MP’s place and I just wanted to drop a note of support to you. Although I am an American I had a very similar experience in October of this year. The patient was me. I also may have had a heart attack (the doctor spend all of 3 minutes with me during my 24-hour stay and never said, one way or the other) and I was extremely saddened by my whole hospital care experience.

    After lying in an uncomfortable bed for many, many hours and having no feedback whatsoever I got a bit irritable when a nurse came to take my vital signs literally minutes after an aide had just done the exact same things. I asked if they actually communicated with each other and received a sharp rebuke. I was whisked into a semi-private room, hooked up to a monitor and oxygen, and then left to fend for myself for the next 24 hours of observation.

    I have no relatives and so was alone. It was a frightening, expensive experience. I have not followed up with any doctors or further tests yet because I can’t afford to do so.

    As you know, I’m sure, we have no NHS in America, unfortunately and the cost of my little hospital stay was far beyond what I can afford, even with my “good” insurance. I am now, essentially bankrupt.

    The other reason I haven’t gone for follow-up and further testing is that I don’t relish being treated as something other than human. I don’t like being poked and prodded without any kind of communication to me about why it is being done or what the result is. I don’t like being left alone for several hours with nothing to eat or drink, no updates, no recognition that my own time is worth something when the doctor is extremely late in coming to discharge me. I don’t like being ignored or patronized when I ask questions about my body and my prognosis/diagnosis. It was horrible.

    My tests were all essentially normal so I am gambling on good luck at this point but I have little other choice — I can’t seek further treatment until I pay the bills from the last hospital stay.

    I appreciate what was done to help me stay alive (and I will pay dearly for it for a long, long time) but I am dismayed at how far removed actual care and dignity seem to be in modern medicine since we have made all these miraculous advances in lifesaving.

    Prayers and peace to you and yours.

  19. SallyC – the name of the blog is Rantings.

    Priscilla, I am so sorry to hear about your experience. I can’t imagine what it must be like to have to ‘pay dearly’ for health care. And somehow you imagine if you are paying for it, then it should be of a really high standard. I am sorry for you that it doesn’t. Please accept my prayers for better health and financial stability.

  20. Frances, I was only questioning whether it was to do with degrees. It was a comment that I’ve heard over and over from other people since this happened. I happen to know a young woman who struggled with essays but was a great ‘nurse’ – she kept failing the written work but the feedback from ward placements was that she was a wonderfully caring nurse. I was just wondering about nursing becoming so much about technical work (machines, computers etc) and less about arms round shoulders.

  21. Nathan, thank you for commenting again in response to Tim. I think you have misunderstood several of my comments. Let me just clear some of them up…

    There were no fights breaking out, no sirens, no big emergencies on the morning in question. If there were I would have understood a rushed nurse with no time to speak. As it was, it was a fairly quiet morning and the nurses had plenty time to stand and chat about last night and TV and normal conversation. I didn’t expect ‘lovey dovey’ behaviour at all – just a reassuring word to a bewildered old man with dementia.

    And where did I say that I wanted an instant diagnosis? Of course I didn’t. I’m not an idiot.

    You say that in the good old days people hung around for 7-8 hours in A&E. Dad managed 8 hours so have things really improved as you say?

    And for you to say that people commenting on this blog would prefer kind words in an emergency to action is just idiotic. Nobody said that and you are just being provocative to suggest otherwise.

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