Kellett’s Laws Of Nursing

When I worked in the Urgent Care Centre I would often have student nurses spending their shift with me. Unfortunately for them I have many views and no shortage of desire to share these views with anyone within earshot. I’d also try to fit in some teaching if there was the time.

Over *mumble* years of nursing and ambulance work I formulated a few basics laws of nursing that I would inflict on as many students as I could catch. I never did get around to writing them down. Until now. 

Kellett’s Laws Of Nursing

1) Do Not Bullshit

If someone asks you to do something to a patient and you either do not understand or do not know how to do it then tell the person asking you. Do not under any circumstances ‘have a go’ and hope that it works out for the best. This is how you kill patients. For example if I send you to do an ECG (heart tracing) and you do it wrong I could end up sending them home without knowing that they are having a heart attack. I know it’s embarrassing to tell someone you don’t know how to do something – but it’s a damn sight more embarrassing to have to explain yourself to the coroner and the family of the patient you just killed. If you don’t know how to do something – don’t do it. Your biggest pressure is admitting a hole in your knowledge – and this ties in with my Fourth Law. This is how medical students were once trained – and look at how many people they kill.

2) It Hurts Them, Not You

Few people like to inflict pain on other people, but sometimes it has to be done. If I am sticking a needle in someone, it isn’t in the patient’s best interests for me to do this slowly and cautiously because I’m worried about hurting them because it will only hurt them more. What I often see is student nurses wincing before sticking a needle in someone as if they were about to inject themselves. Sometimes you just have to pull out that toenail despite the patient’s pain. (And yes, you can numb the toe – but that involves two injections into the base of the toe – and that really does hurt). What often doesn’t help the patient is if you are pulling faces, looking worried and being overly apologetic. Remember, it’s not going to hurt you – just do what needs to be done quickly and professionally and then get on to the next thing. Like wiping a bum, giving a suppository or examining someone’s genitals – it’s worse for them than it is for you.

3) Cynicism Kills Patients

I warn my students that they will either kill, or come close to killing, their first patient around two years after they have qualified. When they first qualify they are scared of doing the wrong thing, they will believe everything a patient says and will be exceptionally careful practitioners. Then their more qualified colleagues will start to corrupt them with their cynicism – ‘Oh he’s not in that much pain’, ‘She’s drug seeking’, ‘That’s not a heart attack, that’s attention seeking’. As we all like to fit into the social groups we find ourselves in, the new nurse will start emulating the more experienced nurse, specifically their cynicism. Unfortunately the new nurse does not have the experience of their colleagues* and so will dismiss a chest pain as ‘attention seeking’ and a patient will die. I like to err on the side of caution – if someone comes to me complaining of loads of pain and then skips out of the department after I’ve given them the good painkillers, then the only pain to me is my ego. Speaking of ego…

4) Leave Your Ego At The Door

Do you know what most complaints are to the NHS? ‘Attitude’. I’ve seen way to many staff get into an argument with a patient or relative because their ego will not let them back down. You do not need to ‘win’ your fights in order to do the right thing. For example – I have seen hundreds of patients who come to me in order to get antibiotics for viral illnesses. This is not only pointless but also downright dangerous. But most of them still leave the room smiling and happy despite my refusal to give them the antibiotics. I explain and if they argue I calmly explain again. I do not feel that I have to ‘win’, or prove that I am ‘smarter’ than them. The biggest obstacle in the way of calmly addressing a patient’s concerns is the nurse’s ego. My advice – the only way to win a primate hierarchy arguing game is simply not to play in the first place. I’ve been guilty of breaking this rule myself and it never ends well.

5) Anything You Do, Don’t Do, Or Do Badly, Can Kill Your Patient

It’s a summation of the above laws really but it does what it says on the tin. If you do something you might kill your patient. If you do something wrong you can kill a patient. If you do something badly… yep, you can kill your patient. So how do you stop from killing your patient? Simple – you pay attention, you do the best that you can for them, if you don’t know something then ask, if you are out of your depth then get help, and you keep learning and improving your knowledge. Treat each patient as if they were a beloved family member, or simply treat them how you would like to be treated. And if that doesn’t work then just imagine the Coroner or Judge staring at you over their glasses and asking your quite pointedly why you thought doing that was a good idea.

These may be a little tongue in cheek, and no doubt someone else has describe these elsewhere – but I think that you can avoid a lot of trouble if you just follow these laws.

Maybe I should expand these laws into a book ‘So, You Don’t Want To Kill Your Patient?’

*And age does not mean experience, as an ambulance driver will say you can have twenty years of experience, or you might have one year of experience repeated twenty times.

Who I Am, What I Do

My name is Brian Kellett and I used to write a blog under the name Tom Reynolds. The old blog went down when the company hosting it stopped running their blogging platform. I moved my old blog ‘Random acts of Reality’ to here. All of it is here but at some point I lost the commentors names. Sorry about that.

I used to work on the ambulances, then I worked as a nurse practitioner in an urgent care centre. Now I’m a community nurse, looking after adults.

This means things like giving eye-drops and insulin, dressing leg ulcers, and doing supportive visits for people with chronic health problems. It gets a bit more complicated on occasion but that is it in a nutshell. I do not give people baths or feed them as that is the role of social services and home carers.

Since changing my job, I plan on writing a lot more. This is because I’m working eight hour shifts rather than twelve hour ones.

I wrote two books – Blood, sweat and tea, More blood, Sweat and Tea and these were collected into one volume – Sirens. These books were the basis of the TV series ‘Sirens‘. It got cancelled after one series – sorry.

I have back problems, bowel problems and depression, along with other pains and failures. This makes life sometimes annoying by which I cope by being angry at things.

I’m in the process of working on a new book and on a secret project codenamed ‘Truth Bastards’ that may or may not see the light of day.

I spend too much time gaming and can often be found on Steam as bkellett. I am also spending a large amount of time playing Guild Wars 2 on the Piken Square server – mostly as Tom Weylan.

I tweet a lot as @Reynolds and I don’t use Facebook if I can help it.  I am too old to use Tumblr.

The best way to reach me is through email, or via twitter.

Paperless Fail

I have a slight problem in the way in which I conduct my life and the way in which it impacts my job.

For the past year I have been trying to go as paperless as possible, that means things like having utility and bank statements sent via email. For those businesses that don’t do email statements I scan them into my computer, file them away, back them up and shred the originals. If you want to see last January’s gas bill I can pull it up on my phone and show you. Likewise if you want to see a pile of shredded paper I can show you that.

The problem is that I have a new job (Something I’ll be writing about once my feet are under the table a bit more), and with a new job comes things like brand new ID cards, smart-cards, parking permits – that sort of administrative faff that is apparently essential but, for those of us not used to office work, rather annoying.

But why am I having problems? Well along with this faff comes the instructions on many of these forms that I need to provide ‘Two utility statements, a rent statement and a bank statement’, presumably to make sure that I am who I say I am and that I’m not trying to sneak away with a parking permit I shouldn’t have.

(As an aside – Newham’s business parking permit needs such specific forms of ID I’m surprised that they don’t also ask for security clearance from MI5).

All of which puts me in a bit of a bind because I don’t have any paper statements – I can show you my forms over the internet, on my phone or print them out for you – but if a bit of paper comes from my printer rather than the ones the energy companies use… well tough luck and try again.

This means that for part of today I have been emailing banks and utility companies asking them to send me a paper statement…

Paperless working – it only works as long as you don’t have to fill in any forms.

Our New War

The secretary of defence, Phillip Hammond, has stated that he will resist any further cuts to the armed forces. He said that the government’s priority was that they should be ‘defending the country and maintaining law and order’. He has said that the welfare should be cut by 0.5% in order to keep the armed forces at their current level.

The problem that I have with these statements is that ‘defence’ no longer means what it meant in the past. If you want to protect the people of Britain from death and injury then invasion from foreign powers comes pretty low down on the list of things we need to worry about.

Let’s take a look at the number of people who have died from ‘War’ in 2011 − 14 people.

The number of people who have died from infectious diseases is – 484,367 people.

By some coincidence the number of people who have also died from heart disease is – 484,367 people.

How about people who have died from just ischaemic heart disease? – 64, 435 people

How about the common type of age-related diabetes? – 1889 people.

Malnutrition killed 65 people in 2011.

Over four and a half times more people died of malnutrition than died in war. In a developed country.

(All numbers from the ONS – a fascinating read, although perhaps not recommended for hypochondriacs).

It is well known that poverty massively increases your chances of developing heart disease. Looking at a few studies, poverty pretty much doubles your chances of developing heart disease.

Poverty is one of the biggest influences on poor health, if you are a poor child then your risks of becoming chronically ill and dying young are greatly magnified.

Don’t take my word for it – google ‘poverty health outcomes uk’.

Our new war, from what we need more defence against, is disease. 

While I’m not going to argue that we disband the armed forces, our current threats are more terrorist than state-led. I doubt that the countries of the world are sitting around thinking ‘If only Britain didn’t have an army, we could roll in and conquer them completely’.  I’d suggest that if you look at the reasons given for the most recent UK terrorist attacks – it’s because we have soldiers in Afghanistan ‘protecting British interests’ by shooting at brown people that we have idiots blowing themselves up on public transport.

No, our biggest threat to life in the UK is disease the risk of which is increased by poverty. Poverty can be countered by welfare, which Mr. Hammond would like to see cut, and by the NHS, which is having it’s budget slashed while large parts of it are being sold off to private companies who want to make a profit from your sickness.

We need our ‘army’ to fight against what kills more people – disease, and by extension, poverty. At the moment the ‘slack’ in the system of dealing with disease is pretty much non-existent. Look at when one kebab shop was delivered contaminated meat – Seventy people became ill and made the local hospital declare an internal major incident. I know – I was there.

Now imagine what it will be like when the last antibiotics stop working, or when an influenza epidemic hits. We need to be investing now in order to save lives.

So instead of welfare and the NHS budget being cut so that soldiers can continue to war on the other side of the world, we need more effort to remove poverty from Britain and we need an NHS that will be able to cope with the incoming health crises that are likely  to be just around the corner.

iTunes Playlists

The new release of iTunes has had me thinking about playlists. I’m largely bored by playlists, I’m sure that we all have them – playlists called ‘At the Gym’, or ‘Walking to work’, maybe ‘In the bath’, or even just ‘Happy’, ‘Sad’, or ‘Romantic’.

I have playlists organised by decade, ’80’s’, 90’s and so on.

I think that we need a new way to think about playlists, one that will spark imagination rather than to just be a way of organising our tracks.

What sort of music would you put in the playlist ‘My Nemesis is Dead at My Feet’?, how about ‘Songs to play at my funeral’, or even better ‘Songs to *never* be played at my funeral’. What about playlists like ‘Drinking champagne on the top of a tower block while pissing over the edge’? ‘Being chased by remnant KGB assassins’? ‘Songs that I sing aloud to when I’m drunk and alone’? Or even ‘On discovering that I’m not actually human’?

How about ‘Songs to commit serial murder by’, or the more prosaic ‘Soundtrack for my favourite book’?

What would be in your ’24 hours until the planet explodes’ playlist, or the much happier ‘A meteorite wipes out the houses of parliament while every damn MP is in the building’?

What would be your playlist for ‘Finally Achieve Godhead’?

Come on folks, let’s be a bit more creative than ‘Relaxing Toonz’.


I’m working on something at the moment, let’s codename it ‘TRUTH BASTARDS’, (the idea was suggested to me by the rather excellent David Wynne).

It’s a near future thing set in the world of citizen journalism – the key thing is that it is set in a ‘post-Leveson’ world.

I’ll admit to making some guesses about what Leveson’s report might have said and the fallout from the same. After all I started working on this some months ago when Leveson report was taking evidence. I thought that after Leveson the public would trust the media less and would turn towards the citizen journalists that are on the whole rather more successful at self-regulation.

Turns out that this is unlikely to be the case and that the ‘post-Leveson’ world is pretty much the same as the ‘pre-Leveson’ world.

What this means is a bit of a rewrite, one in which the otherwise very ethical citizen journalists will, instead of agonising over using some somewhat morally grey methods, will actually revel in the horrible things that they do in order to get to ‘the truth’. Their justification is that at least they are going after the villains, rather than the parents of murdered teenagers or just making crap up in order to please the politicians.

This may, of course, change if some sort of cross-party group actually does something about press standards – but as I understand it ‘cross-party’ is parliamentary code for ‘do bugger all’.

Conspiracy Theory

The government closes the wards at a hospital and reduces funding so that the A&E four hour wait target is failed. The government then calls it a ‘failing hospital’ and sells it off to a private company. The government then gives the private company plenty of taxpayer’s money so that it can re-open the wards, reduce the waiting time and become a ‘succeeding hospital’.

The now succeeding hospital now turns a profit which goes into the pockets of the private comapany’s shareholders – who just happen to be members of the current government.

After all if it’s good enough for Gove to do to schools, it’s good enough for Hunt and Lansley to do to hospitals.

It’s Not Rocket Science

It is really quite simple – there aren’t enough ambulances to meet demand, why there aren’t takes a little more thought (but not much).

Take for example this story about a cyclist waiting two hours to go to hospital, and then needing a helicopter to pick them up.

A cyclist who broke his hip in an accident was forced to spend two hours lying on the roadside before being transported in the back of a furniture van flagged down by police because there were no ambulances available.

“I was there for a long time – two hours – and in a lot of pain because I have a low resting heartbeat which means I couldn’t be given morphine. It was raining and I was getting really cold and shivery.

“Eventually more paramedics arrived with blankets but I was still lying on the roadside and I was told I wasn’t even on the waiting list for an ambulance because there was a shortage.

“The paramedics were really kind and professional and caring but they were all saying this was ludicrous and down to budget cuts.”

In despair, the paramedics called for an air ambulance but were told the nearest one, in Essex, couldn’t take off because of high winds. A second helicopter from Norfolk was scrambled but couldn’t land in the road because of safety problems so had to touch down a mile away from Mr Knight.

“A policeman flagged down a passing furniture van driver and asked him to take me,” said Mr Knight.

Now add in the recent report showing that there just aren’t enough beds in hospital, and if there are enough beds then patients coming into the emergency department can’t be sent to the wards. This means the the emergency department gets full and they haven’t the room to take a patient off of an ambulance stretcher. This means the ambulance spends longer waiting and can’t turnaround for another call.

The number of people left waiting in ambulances outside accident and emergency (A&E) departments for more than half an hour has risen by over 100,000 in just two years, raising fears over the NHS’s ability to safely achieve the government’s aim of £20bn in efficiency savings.

Realise that ‘efficiency savings’ in real english is ‘cuts‘.

So, not enough beds means that ambulances have to wait longer to get clear of hospitals which results in increased waiting times for ambulances.The solution to this problem is apparently to close some emergency departments so that waiting times will get longer.

The results of a public consultation on the closure of four hospital accident and emergency units in north-west London have been released. The findings show support for ending services at Charing Cross, Central Middlesex, Hammersmith and Ealing.

I despair, I honestly do.

Story Idea

Thrown up here for very little reason.


150 years after the last great war, a war in which nuclear, biological and technological weaponry razed the planet, the remnants of civilisation are held together by the wandering Asclepius Order – young doctors following the handed down traditions of healing.


The world is a dangerous place, bandits carve out kingdoms, paranoia is a way of life and the are still live weapons of nearly unimaginable power left in the dark places.


The Asclepius Order is part scientist, part scholar and part healer, they wander the wastelands trying to keep enough people alive in order to maintain a good ‘breeding pool’ of humans. Every life lost, be that devil or saint, endangers the mission of a restored earth.

What Random Acts of Reality turned into