Tuesday, 8 April 2008

Thats fighting talk girly!

Posted by Ain't No Angel
special mention to Dr Ellie

This post I'm going to discuss the discussion that has come up around my last post. In case some of you didn't know you can add comments after each and every post that the 2weeks team put up here on the interweb.
Following my lastest coffee/nicoteine fuelled rant, a disgruntled Doc has been furiously posting comments and generally venting her spleen on some of the topics I've been mentioning.
Now, this silly doc thinks I might be mad at her.........when in fact nothing could be further from the truth! In fact Ellie, your a kindred soul. I admired what you wrote, it took a bit of balls, (i'm working in urology so maybe I'll get that checked for you), and using some of what you wrote I'm going to add my bit in and maybe we'll come up with something resembling where I'd like nursing to be in a few years time.
Que copious quoting and plagiarism......

I'm an Irish doc who left due to the crap conditions and working hours in
Ireland. I'm currently working in New Zealand, which treats docs pretty well,
and our hours are extremely humane.

Btw, I certainly don't mean to direct this at you! You sound like a really nice
nurse, and the fact that you even KNOW about our working hours, let alone
care, says so much. Most nurses at home were not aware that we were forced
to be on for 36 hours straight and didn't believe us or care if we mentioned

As any regular reader will know I've mentioned this before, and it gets on my you know whats so much. NZ has a rough population of 4,264,871,very similar to Ireland, so we'll assume that it has a roughly equivalent tax take. Using this as a basis, then how come they can run their system without working their Dr's to death? Maybe, what we should do here is totally dismantle all the health service machinery and rebuild it in the image of NZ or another good example? Oh wait...........thats what the HSE idea was about.....whoops!

Nurses here, if a patient complains of chest pain, do an ECG, give GTN,
do a set of obs, and call you unless the patient is clearly crashing. If
they suspect a patient is in retention, they do a post mict bladder scan.
Many take bloods and site IVs, and only call you when they don't get them in. They take verbal orders for meds. They give first dose IVs-that's a BIG one that's always annoyed me intensely. In Ireland, many times nurses would go so far as to make us give the first dose of say, IV Augmentin, even if the patient had already had it on this admission, and we were just restarting him on it.

Thankfully giving first dose antibiotics has more or less gone in most hospitals, most of the time we happily give them with few problems. I'd really only start thinking about not giving something if I was really unfamiliar with it. Most times though, a quick call the the pharmacy dept is the best line, as to be fair, most Docs don't know much about the routes of all the mad scary type drugs anyways! I agree though, that first dose stuff was nonsense of the highest order in all but a very very few cases.

When I was a student, I worked in A&E on a placement for 6 weeks. Standard practice there for nurses to do ECG's, well in the dept I worked in. By the end of the 6 weeks, I was doing the things in my sleep. Now, as a fully qualified registered nurse....... I'm NOT ALLOWED do them..... for those not in the know, ECG's are pretty simple to carry out, in fact apart from Dr's the people who do them most as ECG Technicians, I'm not sure what qualifications they have, but I'd assume its not a PhD. Point is, its not that difficult.

Taking blood is another one. Nurses in general don't do this. There are exceptions alright, but for the main part they don't and aren't trained to do it. Even if I went on the course.......the hospitals won't let me do it, or put in a cannula. In fact, if I did do it, and it got out, I'd probably be disciplined. (BEHAVE!)

This all seems a bit silly doesn't it? But see it relates back to some of the things that I was saying before....

See, if i start taking bloods and putting in cannulas, then I'll end up doing them all, and I'll never get a Dr to do any of them. This takes time, so how am I going to get the time to fill in all the care plans, reports and ticky box bits and pieces of paper that I'm already snowed under with? I'll still have patient ringing the call bell when they need a hand in the toilet, I'll still have patients to help get washed in the morning, or to make sure that your granny eats her dinner. See where I'm going here?

There's no one really below the nurses that can take on the jobs so that we can take on a few of the extra Dr ones. Yep, there are the healthcare assistants being trained up as we speak, but until they actually create a proper job spec for these people, and sort out the area of delegation and the responsibility of the nurses for the HCA's practice, they are going to sit on the shelf and it'll all be another waste of time.

While I've no desire to become a "mini - doctor" I'd certainly feel that it'd make more sense to have nurses performing quite a few of the roles that the NCHD's are now doing. Unlike the private sector though, the public health system doesn't seem to much a fan of innovation, free thinking or change. Until, that realisation hits home, nothing will change, at least to a degree where things for patients and staff will get better.

Just a final point...........Ellie.......I always try to be nice to the Doc's. We are after all on the same side. Sure, I've let rip at a few of the pompous fools but I've made friends with plenty of your lot. The behaviour shown to you though as a female NCHD was a disgrace though, and on behalf of the muppet nurses that were like that......I'll apologise. It happens though, especially if your at least vaguely pretty, make an effort with your appearance or are a bit outgoing. Its jealousy i think, but who knows........just between you and me though, I'm always nicer to the girls than the lads........dammit.....Mrs Ain't No Angel is looking shhhhhhhhhhhhh don't tell her!


  1. Okay this post was fantastic, but first: "...every post that the 2weeks team put up here on the interweb".

    The interweb? You watched that Gordon Brown sketch on ITV's 'Headcases' didn't you? ;)

    Secondly, I'm glad the profession has a nurse like you. I've always been a bit on the side of the nurses myself too, they take a lot of crap from some doctors and not all of them are evil lazy incompetent doctor-bashers like some docs attest. I'm adding you folks to my blogroll! Hope you don't mind the heading I've given you :)

    Keep it up, I'll be back for more - and this time I'll make sure I'm not drinking anything when I read your Coke-spray-out-of-nose-inducing posts =)

  2. You're awesome, Ain't no Angel! You'll have to get rid of the "Ain't no" part though....

    I brought this up once on a different website and almost got death threats! although my nurse friends agreed with me! so thank you so much for seeing where I'm coming from and not getting pissed off!

    We totally should do the Thelma and Louise thing-with Rage against the Machine playing in the background! The HSE needs some serious shaking up. And you guys badly need some HCAs and aides etc, your nursing paperwork and notes etc is nothing short of ludicrous, you must write the equivalent of a novel every time you go to work! Interestingly-the nurses here have a great way of cutting down on their paperwork-they write in the medical notes where us and the physios etc write-and that way everyone sees everything that everyone else has written and we don't always need to hunt down a busy nurse and ask them how things are from their point of view, and they don't document a lot else apart from their entries in the notes. This frees up so much of their time to do other stuff. Also for feeding etc, they have assistants for all of that who document how much of what the patient ate and drank, and relay this info to the nurses who then work out fluid balance etc. There really are just plain more staff and more grades of staff here which helps tremendously.

    I completely agree with you about how Ireland and the HSE are wary of innovation and change. Here it's encouraged like nothing else. Actually there is an ex Irish nurse here who now has a managerial role in implementing new ways of improving the service to patients, and improving the working environment for nurses and doctors. I don't even know what his title is-there's just no equivalent of his post in the Emerald Isle! But he has implemented some great ideas, some that apply to us are centralising a team's patients on one ward, such a little thing, but makes such a difference to us AND the nurses as they aren't waiting all over the hospital for us to run from the other end and back.

    You actually made me feel so much better about the whole crappy thing-thank you! with more blogs like yours maybe word will eventually get out and improvements will happen! I might start one myself.....


  3. I just can't believe that nurses in Ireland aren't allowed to do ECGs...for goodness sake, it's something a trained monkey can perform. Stick the dots on, attach the conveniently colour-coded leads and press go. It's like people are deliberately holding people back for the sake of keeping things the way they were...

    Some Australian hospitals have a great service where a bunch of nurses run an IV service. I.e almost all cannulas that need siting are done by a team of nurses whose JOB is to do the hundreds that need doing each day. They are awesome at it because they get so much practice. This saves nursing staff time (they just ring the number and get the people up) and medical staff time during the days when they are run off their feet with everything..

    The Australian healthcare system has a lot of problems and flaws, but poor Ireland really seems to have some issues regarding progression and job roles etc. Hopefully someone with some power will come to their senses one day and start making some changes..

  4. Angry Medic....
    thank you for your kind words, and the link from your own blog to ours. Careful with the coke though, seen far too many patients with coke spray induced trauma!

    I've not really been a fan of the whole blog thing to be honest, but when asked to contribute to this one I've certainly seen the good in it.

    And you thought i might be mad...........

  5. Great stuff! A.N.Angel

    Keep up the debate. We need to hear more stuff from nurses (as well as Docs) on the front-line.

    Ellie - you should start a blog. I like a voice that is not afraid to stand up and be counted!

    We also need to start a campaign to send Harney out to NZ/Oz to see how it should/could be done.

    Things are definitely looking up around here.

    Yabba Dabba Do!

  6. Wow....I didn't realise how different hate health systems were....
    Everything you said sounded extremely reasonable.....why are they not doing it?