Two cases, one I, sadly, have come to expect, the other was a bit more surprising.
In the first we find ourselves going to an elderly man who has fallen out of bed, normally a nice simple job that doesn't require much from us apart from a quick dusting off, a check to make sure that they aren't hurt and to make sure that this simple 'mechanical' fall isn't the start of something more serious.
Being the eagle-eyed medical professionals that we are, we notice that our patient has a lot of sores on his body – so we ask him about them.
He's been getting them for a while and the district nurses have been out to dress the sores on his legs for a few weeks now. The sores have since spread to his arms, but the nurses won't dress them as it's not in their care plan. He has been trying to dress them himself – with little success.
Once upon a time I did a nursing placement with a district nurse service, one of the things that you get very good at very quickly is the ability to dress leg wounds. You see so many ulcerated legs you start thinking that everyone over the age of sixty must have them.
You learn how to dress these wounds so that the dressing stays on, so that it is clean, and you make sure you use the best dressing for that particular type of wound.
I look at the dressings on the man's legs. These dressings are awful. They are secured (and I use that word loosely), not with medical tape, but with Sellotape. The bandages are the wrong sort of bandages so they are just falling off his legs. I wasn't too impressed with the underlying dressing either, the layer that is supposed to promote the healing of these sores.
I could maybe understand the dressings not being of high quality if the patient were the type to undo his dressings but he isn't. Couple this with the open sores on his arms that hadn't been dressed at all and I could only really say that this was a very poor example of nursing care.
So I did the only thing that I could, I took him to hospital so that his wounds could be treated properly, and then I filled in one of our 'vulnerable adult' forms, hopefully someone higher up the food chain will take notice of my concerns and do something about the terrible treatment of this patient.
I'm used to poor care in the community, I expect better in hospitals.
We were called to transfer a patient with many broken bones from a ward in one hospital to another hospital, a fairly simple job although the journey would take over an hour. Little did I know we'd take about the same amount of time picking the patient up from the origin ward.
We arrived on the ward and found that our patient was quite a chirpy fellow, he was covered in plaster casts and had an external fixator through his pelvis. No problem, this wouldn't be a tricky transfer.
I asked the handover nurse what sort of pelvic fracture he had, while it's been some time since I studied orthopaedic treatment (in a non-emergency setting), I suspected that due to the presence of the fixator it would be a an 'open book' fracture.
The nurse told me that she didn't know, and handed the notes at me.
Non-plussed at this lack of knowledge about the patient that she was looking after I asked what else he'd broken.
“Dunno”, I was told by the nurse.
I gritted my teeth.
There was a strange contraption attached to the patient's leg – to be honest I wasn't sure what it was, so I asked the nurse.
I wasn't altogether surprised when she told me that she had no idea what the device was for.
It was about then I started to see red – as a nurse you need to know about your patients, you should definitely know what the various bits of equipment hanging off the patient are for and how to look after them. Imagine if this bit of kit needed to be removed once an hour – without knowing this you could put the patient at risk of serious harm.
If you get a patient arrive in your ward with something unusual you find out what it is and how to look after it, to do otherwise is, in my eyes, a basic failure of nursing ability.
The nurse noticed I was getting annoyed at her lack of knowledge and at her apparent apathy towards the care of her patient.
“It's not like I've lied to you”, she said referring to the machinery, “I could have said I knew what it was for”.
“That's not the point”, I replied, “the patient came down from ITU with it attached to them, you should have asked how to look after it when it was handed over to you – or you could have rung up ITU at any point during the day and asked them over the phone. It's hardly rocket science”.
She stomped off in a strop. I don't think that she understood the point I was trying to make.
I checked the notes that we'd been given – there wasn't a CD of the patent's x-rays in there.
“The orthopaedic nurse will have it”, I was told by another nurse, “she'll have gone home by now”.
“Can you not get another copy”, I asked.
“I don't know how”.
“Tell you what”, I offered, “bleep the Ortho SHO and get them to burn you a new copy, because otherwise the receiving hospital will think you are all idiots here”.
“Oh – that's a good idea”, she agreed.
So finally – after an hour at the hospital we were ready to move the patient onto our trolley. I looked at the patient's drug chart.
“He last had his painkillers seven hours ago”, I told the nurse.
“Yes?”, she said, “he's not in pain”.
“Ah, but just think”, I explained, “we are going to drag him from his bed across to our trolley, then wheel it through the hospital and into the back of an ambulance. We are then going to drive that ambulance over the horribly bumpy streets of London for an hour. Might he not benefit from a bit of pain relief before we head off?”
After an injection of what I wold consider a homeopathic dose of analgesia I then had to browbeat some of the nurses to help us move this immobile man across onto our trolley. I also had to teach them how to safely move someone who has half a tonne of metal holding them together .
So… I know that this isn't a specific orthopaedic ward – but all I was looking for was a bit of common sense, even for someone to realise that their current knowledge isn't good enough for this patient and ask for help. But, sadly, there wasn't any of that self-awareness that I'd hope to see in a sentient life-form, let alone a professional.
I don't know – sometimes I feel like returning to nursing so I can stalk the wards with my 'Big Stick o' Learning' gently tapping people on the head until they realise that NHS shouldn't be a watchword for slapdash care.
Or is it just me, is this acceptable care these days? Should I stop being so harsh on other people, expecting them to do at least as well as I would think I could do? Am I just judging these others as being incompetent while blind to my own inadequacies? Would I really prefer a return to 'old fashioned' matrons who would tear you off a strip in public, thus humiliating you and making the lesson stick in your head – or are the 'modern matron' with their clipboard and 'softly, softly' approach in fear of 'stressing out' an employee the way forward?
I dunno – I just drive a van.
The Peter Principle is the principle that “In a Hierarchy Every Employee Tends to Rise to His Level of Incompetence.”, something that seems particularly apt in the NHS. However, I sense that this works in all forms of life and work. Consider this my Monday Question – What is the worst sort of incompetence you have come across lately.
Commentors who just post 'The Government' will be mocked for their stating of the obvious and their lack of imagination.
Go on, have a moan…