Policy! Policy! Policy!
To whoever that came up with these "laws", policies and rules, I only have ONE word to describe him/her - DENSE!
Few more weeks to the end of working in the UK, and I cannot express how f*cking PLEEEEAAASSSSEEEEDDDD I am. I will miss some nurses and my fellow doctor colleagues, but I will definitely not miss the crap in the hospital here. I had enough of their insane laws and policies, of which makes absolutely NO sense, and I know I must rant umpteen times abt these in the blog before.
1. Venflons
Please DO NOT go around telling people that u're a nurse if u can't even do a venflon. Honestly, I wouldn't even dare tell anyone I'm a nurse to save myself embarassment if someone asks me if I can site a venflon. And these nurses are telling me that it's illegal in the UK for them to do it without a certificate (note: u NEED a CERTIFICATE to site a venflon) and they need to go for a day course to be trained. A DAY, mind u. Imagine spending 9am-5pm learning how to site a venflon and take blood. 8 hours to be taught how to do it....gosh..this course is either OVER INTENSIVE (I'm being sarcastic here), or the students are completely thick. In medical school, I spent 2 hours learning how to site venflons, take blood, put catheters, suturing, etc etc. And I had was someone showing me ONCE only.
Got bleeped non stop during my on call to do venflons when my priority is to clerk patients. And these nurses love bleeping at 5.05pm to get me to do them. Clearly, the venflon wouldn't have gone off exactly at 5pm sharp, and it was obvious that it was dragged till past 5 for whatever reason. Had enough of this crap, and pardon me, I did became rather attitude today after tolerating such rubbish for months, telling them straight off that I am busy, and it's too bad that I'm not available to do it NOW on the spot.
Patients won't die without one dose of antibiotics, and they will not die without having fluids into the body for a while. If these nurses cannot wait, then sorry, they can do it themselves.
Shall not blame nurses totally regarding this. Have to admit that some docs in the hospital are freaking lazy, and if they know the patient is difficult to cannulate, they just pretend to drag it and shoo off the minute the clock ticks 5pm.
2. Phlebotomy
If an entire ward is being "closed" to visitors because of too many infections in that particular ward, the phlebotomists are not allowed to bleed patients there. Hence, the doctor of that ward will have to bleed all the patients himself/herself. Reason given is that it's hospital policy because phlebotomists go around the hospital bleeding patients, and this can cause cross infection. This policy pissed me off terribly a few times, and I got so fed up, I went to tell the "policy department" that maybe they should bar me from going to other wards too since I'm seeing patients in this ward, bleeding them, and I'm also liable to spread it to other people in the hospital since I'm also going to other wards to see patients. And the typical answer u get frm these angmos: "HOSPITAL POLICY".
3. Vital Observations (e.g. Blood pressure, pulse, temperature etc)
Doctors do their ward rounds at 9am and in this hospital, and it's at this time, u'll see nurses giving patients a wash. And observations are supposed to be done only at 10am. So everytime I'm in the wards doing my ward round at 9am, I'll have patients missing frm the bed (cos they're in the toilet bathing) or my patients will be busy being washed at the bedside by nurses. And for those present, I can't even assess how stable they are without any of those observations being done.
Makes me wonder if there's any sense in having me in the ward at 9am. I might as well sleep for 2 more hours, and then start work at 11am when all my patients have been washed, and obs have been done.
Wonder who started this policy now.
4. Nurses taking referrals for hospital admission
May I ask, how much medical education does a nurse (even senior) compared to a Registrar (2nd to a Consultant)? And it's these nurses who are admitting patients from GPs who ring up and asking for patients to be admitted. These nurses are not trained to dig further into histories and assess if these patients are highly in need of an admission. All the GPs have to do is tell them a brief story (bet u the nurses won't even know if the story makes sense and have no clue what is wrong) and if a bed is available, the patient is sent in for us doctors to see. This becomes a nightmare for us docs because many of these patients who end up coming in, makes the hospital a hotel, and aren't prepared to go home anymore. And they end up lodging for months, bringing in all the photo frames from their house and making friends with the entire ward.
Where does this insane rule of nurses accepting referrals come from? Obvious isn't it?
5. Reviewing patients
I cannot tell u how many times I've been bleeped to go to wards to see patients who are so claimed by nurses that they are really not well, in pain, in this, in that. Go on and let your imaginations run wild.
Then off I rush to the wards, believing their story, only to find the patient comfortably sitting up, talking with his fellow room mates, and happily enjoying their food.
Hmmm....VERY UNWELL indeed.
Believe me, 50% of this "patient is in pain" calls I get are lies, because when I see the patient, he/she will tell me that there was no pain at all.
Once bitten, twice shy. And I've seriously allowed myself to be bitten uncountable times. But I've learnt the trick now. I tend to ask the nurses numerous questions, and if I think the observations are stable, I will take my own sweet time if I'm busy. If it's desperately urgent, they will bleep me very very soon. But if the ward only starts bleeping me again like after 2 hours, clearly, it's not urgent like they so claimed.
Tell me, nurses are the ones whom doctors should trust in assessing these basic things. But with them lying, please don't blame docs for being nasty, and u resulting in the "all docs are bastards" syndrome. Blame your wonderful nursing colleagues instead.
Today, I got bleeped every 1.5 hours to review a patient in a ward with some other stupid jobs. URGENT they said. And since I was extremely busy, told them there's no guarantee that I'll be able to get there in the next hour. Obviously, those nurses weren't satisfied with my answer, told me to hold on while they liaise together to make it sound more drama. Ended up using 5 mins arguing with them. And my Registrar, who got so irritated with them when I told him what happened, went up to that ward to ask them what the problem is all about. Guess what? When they saw the Registrar appearing in the ward, they went "It's ok..it's not urgent...". And they think the Registrar will nicely let them off by saying nothing. Good thing he went "So if it's not urgent, why did u people keep bleeping my house officer?!"
He went to review that patient nonetheless, and true enough, this patient had NO PAIN at all. Urgent...MY FOOT! I knew it was gonna be one of those stupid tricks of theirs since the bleep didn't go off every 15 mins.
6. MEWS
This is a scoring system for the observations, and if the score goes above a certain number, it means the patient needs medical attention. I shall not totally throw the MEWS out of the window and say it's completely crap, because if the score is high, clearly there is something wrong. It only gives medical professionals an idea of how well/unwell a person is, but not the full picture. But because it's THE POLICY that if the MEWS go above a certain score, then doctors have to be bleeped. Fair enough, but it does piss ur ass off when u rush down to the ward to find that this patient is comfortably sitting ard (walking even!), talking and eating, and realising that the same score has been there for like a week. I appreciate the fact if I get bleeped regarding high scores, and be told by the nurse (my ward sister does this..and I love her to bits) that the patient is very stable, has been high on the scores for days, and she'll bleep me again if there's any major changes.
7. Massive attack
Whenever u step into a ward during on call because u're bleeped to do ONE job, u will never find one job waiting for u like u thought. And sometimes, it makes me wonder if there's a collaboration between the nurses in the ward, because when one nurse knows u're there, ALL the nurses will know. They will then make sure u do all their jobs before they'll let u off the ward. Imagine that happening in every ward.
Few more weeks to the end of working in the UK, and I cannot express how f*cking PLEEEEAAASSSSEEEEDDDD I am. I will miss some nurses and my fellow doctor colleagues, but I will definitely not miss the crap in the hospital here. I had enough of their insane laws and policies, of which makes absolutely NO sense, and I know I must rant umpteen times abt these in the blog before.
1. Venflons
Please DO NOT go around telling people that u're a nurse if u can't even do a venflon. Honestly, I wouldn't even dare tell anyone I'm a nurse to save myself embarassment if someone asks me if I can site a venflon. And these nurses are telling me that it's illegal in the UK for them to do it without a certificate (note: u NEED a CERTIFICATE to site a venflon) and they need to go for a day course to be trained. A DAY, mind u. Imagine spending 9am-5pm learning how to site a venflon and take blood. 8 hours to be taught how to do it....gosh..this course is either OVER INTENSIVE (I'm being sarcastic here), or the students are completely thick. In medical school, I spent 2 hours learning how to site venflons, take blood, put catheters, suturing, etc etc. And I had was someone showing me ONCE only.
Got bleeped non stop during my on call to do venflons when my priority is to clerk patients. And these nurses love bleeping at 5.05pm to get me to do them. Clearly, the venflon wouldn't have gone off exactly at 5pm sharp, and it was obvious that it was dragged till past 5 for whatever reason. Had enough of this crap, and pardon me, I did became rather attitude today after tolerating such rubbish for months, telling them straight off that I am busy, and it's too bad that I'm not available to do it NOW on the spot.
Patients won't die without one dose of antibiotics, and they will not die without having fluids into the body for a while. If these nurses cannot wait, then sorry, they can do it themselves.
Shall not blame nurses totally regarding this. Have to admit that some docs in the hospital are freaking lazy, and if they know the patient is difficult to cannulate, they just pretend to drag it and shoo off the minute the clock ticks 5pm.
2. Phlebotomy
If an entire ward is being "closed" to visitors because of too many infections in that particular ward, the phlebotomists are not allowed to bleed patients there. Hence, the doctor of that ward will have to bleed all the patients himself/herself. Reason given is that it's hospital policy because phlebotomists go around the hospital bleeding patients, and this can cause cross infection. This policy pissed me off terribly a few times, and I got so fed up, I went to tell the "policy department" that maybe they should bar me from going to other wards too since I'm seeing patients in this ward, bleeding them, and I'm also liable to spread it to other people in the hospital since I'm also going to other wards to see patients. And the typical answer u get frm these angmos: "HOSPITAL POLICY".
3. Vital Observations (e.g. Blood pressure, pulse, temperature etc)
Doctors do their ward rounds at 9am and in this hospital, and it's at this time, u'll see nurses giving patients a wash. And observations are supposed to be done only at 10am. So everytime I'm in the wards doing my ward round at 9am, I'll have patients missing frm the bed (cos they're in the toilet bathing) or my patients will be busy being washed at the bedside by nurses. And for those present, I can't even assess how stable they are without any of those observations being done.
Makes me wonder if there's any sense in having me in the ward at 9am. I might as well sleep for 2 more hours, and then start work at 11am when all my patients have been washed, and obs have been done.
Wonder who started this policy now.
4. Nurses taking referrals for hospital admission
May I ask, how much medical education does a nurse (even senior) compared to a Registrar (2nd to a Consultant)? And it's these nurses who are admitting patients from GPs who ring up and asking for patients to be admitted. These nurses are not trained to dig further into histories and assess if these patients are highly in need of an admission. All the GPs have to do is tell them a brief story (bet u the nurses won't even know if the story makes sense and have no clue what is wrong) and if a bed is available, the patient is sent in for us doctors to see. This becomes a nightmare for us docs because many of these patients who end up coming in, makes the hospital a hotel, and aren't prepared to go home anymore. And they end up lodging for months, bringing in all the photo frames from their house and making friends with the entire ward.
Where does this insane rule of nurses accepting referrals come from? Obvious isn't it?
5. Reviewing patients
I cannot tell u how many times I've been bleeped to go to wards to see patients who are so claimed by nurses that they are really not well, in pain, in this, in that. Go on and let your imaginations run wild.
Then off I rush to the wards, believing their story, only to find the patient comfortably sitting up, talking with his fellow room mates, and happily enjoying their food.
Hmmm....VERY UNWELL indeed.
Believe me, 50% of this "patient is in pain" calls I get are lies, because when I see the patient, he/she will tell me that there was no pain at all.
Once bitten, twice shy. And I've seriously allowed myself to be bitten uncountable times. But I've learnt the trick now. I tend to ask the nurses numerous questions, and if I think the observations are stable, I will take my own sweet time if I'm busy. If it's desperately urgent, they will bleep me very very soon. But if the ward only starts bleeping me again like after 2 hours, clearly, it's not urgent like they so claimed.
Tell me, nurses are the ones whom doctors should trust in assessing these basic things. But with them lying, please don't blame docs for being nasty, and u resulting in the "all docs are bastards" syndrome. Blame your wonderful nursing colleagues instead.
Today, I got bleeped every 1.5 hours to review a patient in a ward with some other stupid jobs. URGENT they said. And since I was extremely busy, told them there's no guarantee that I'll be able to get there in the next hour. Obviously, those nurses weren't satisfied with my answer, told me to hold on while they liaise together to make it sound more drama. Ended up using 5 mins arguing with them. And my Registrar, who got so irritated with them when I told him what happened, went up to that ward to ask them what the problem is all about. Guess what? When they saw the Registrar appearing in the ward, they went "It's ok..it's not urgent...". And they think the Registrar will nicely let them off by saying nothing. Good thing he went "So if it's not urgent, why did u people keep bleeping my house officer?!"
He went to review that patient nonetheless, and true enough, this patient had NO PAIN at all. Urgent...MY FOOT! I knew it was gonna be one of those stupid tricks of theirs since the bleep didn't go off every 15 mins.
6. MEWS
This is a scoring system for the observations, and if the score goes above a certain number, it means the patient needs medical attention. I shall not totally throw the MEWS out of the window and say it's completely crap, because if the score is high, clearly there is something wrong. It only gives medical professionals an idea of how well/unwell a person is, but not the full picture. But because it's THE POLICY that if the MEWS go above a certain score, then doctors have to be bleeped. Fair enough, but it does piss ur ass off when u rush down to the ward to find that this patient is comfortably sitting ard (walking even!), talking and eating, and realising that the same score has been there for like a week. I appreciate the fact if I get bleeped regarding high scores, and be told by the nurse (my ward sister does this..and I love her to bits) that the patient is very stable, has been high on the scores for days, and she'll bleep me again if there's any major changes.
7. Massive attack
Whenever u step into a ward during on call because u're bleeped to do ONE job, u will never find one job waiting for u like u thought. And sometimes, it makes me wonder if there's a collaboration between the nurses in the ward, because when one nurse knows u're there, ALL the nurses will know. They will then make sure u do all their jobs before they'll let u off the ward. Imagine that happening in every ward.
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