Tag Archives: Health

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.

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.