Nurses at the frontlines

I just need to get that out there-Let’s be clear—-NURSES not doctors, resp techs, lab techs and least of all administrative staff are facing the highest risk of Ebola in this country.

In West Africa it may be a little more equal although I read Docs are on strike there but here as in most western healthcare systems the nurses are taking care of these patients. Gloved hands on skin, close proximity care.

Yesterday we had a 2 hour meeting about what staff should be wearing and today another 3 hours including a presentation directly from some of the docs in Nebraska and Atlanta (Emory) but not Texas. I want to point out that those are two vastly different scenarios.

Nebraska and Emory have special biological units where they have special teams that have been practicing for the past ten years, they had a few days notice before the arrival of their Ebola patients.

Texas, in their defense, is a run of the mill community hospital. Their Ebola patient arrived unannounced. I would stress that this is a huge difference which is reflected in the outcomes.

As this evolves and I think it will get worse before it gets better. Lots of people salute and praise serviceman, firemen and policemen but hey-you-nurse1

I just want to express my support and loyalty to my colleagues. I will be there guiding nurses in taking off their personal protective gear.

Stay Calm

I am a Nurse and for the past 3-4 years I’ve specialized in Infection Prevention. Unless you are living under a rock you may have noticed what I have been hearing for the last 3 months- that the Ebola epidemic in West Africa is not slowing down.

I was getting annoyed at all the meetings we were having to discuss the status of the epidemic and our plans in case a patient wanders in to the ED but this week when a patient was identified and confirmed in Texas everything got a bit more serious.

I’m not one to panic but I can say that hospitals large and small are being advised by the CDC to have a protocol in place and this week revised some of their recommendations. READ HERE For instance, before ED staff were told to ask patients about recent travel if they presented with a temp greater than 101.5, now they have added in “or a subjective fever” meaning the patient may not have a fever at that moment but they felt feverish the night before. Obviously at this point travel history his VERY important but as there are no direct flights from West Africa to the US, all people from West Africa are arriving indirectly through various gateway cities in Europe which makes determining travel history a little tricky. And let’s face it African geography is not exactly a mandatory subject- as I was called by a nurse because a patient was from Gabon but when I told her that isn’t one of the source countries she said-well, how should I know….

I read this article with interest because it talks about how US Nurses say the are unprepared for Ebola patients. I think this is somewhat true and I think that nurses will have the greatest exposure risk but I also feel like nurses need to be open to hearing the facts about how the virus is transmitted (not airborne, by contact with body fluids-think HIV). Next week we will ramp up educating staff about how to don/doff their Personal Protective Equipment (PPE-gowns, gloves, masks, etc) removal being the key! Maybe that will help reassure them, at least the nurses at my hospital.

My own very humble opinion is that if the patient in Texas dies and/or any of his contacts becomes symptomatic the whole world will go bat shit crazy!!! The perception will be that if they can’t handle this in the US we are all doomed (and secretly thinking they could have done better). More likely the patient will survive and the world will finally dump a boatload of money and resources in West Africa and get this under control…

Healthcare 1.0

Strolling through Twitter today after seeing stuff like this_74314465_tim18Blc9ZFgCIAEahhB

I invariably run across the equivalent of saying “you’re fat”~ to paraphrase the usual rhetoric

~healthcare in the USA is more expensive, with shittier outcomes than every other country on the planet and millions of Americans go bankrupt without insurance~

What’s the point?? Every healthcare system is close to the breaking point, held together by the dedication of its staff.

Here’s my 6 ideas for supporting healthcare in any country!

  1. Support fundraising events at your local hospital. Call and see what’s going on. At my hospital we have supported charity events like St Baldrick’s, but we also have volleyball  & baseball games between departments to raise money
  2. Organize, join, participate in and support healthy habits- a 5k run, smoking cessation, a walking club
  3. Take your business (doctor’s appointments) to your local hospital instead of to the fancy, shmancy hospital across town. Sure, be vigilant, ask questions but if you have insurance they will be glad you are there.
  4. Find out what their infection rates are. In the US, that would be on Hospital Compare. Be educated about current best practice-visit the CDC website for lots of healthcare resources.
  5. Support Nurses!!! Say please and thank you, ask questions and listen to what they tell youalways-thank-your-nurse
  6. Stop complaining about your wait, the waiting room chairs, the foreign staff~unless you are seeing a witch doctordownload (1)

Let’s stop pointing healthcare fingers-images (4)

who’s best, cheapest, slowest…take responsibility for your health and respect those that dedicate their lives to helping you stay healthy.




7 years and 183 days

that’s how long i’ve worked for the NHS. i haven’t counted the days….it was printed on my pension statement. not bad for someone who only came for a year.

i wanted to see how national health, socialzed medicine worked. i have seen it up close and personal-the good, the bad and the ugly. i’ll have to wait and see what i find back in chicago at a public hospital before i give my critique.

one sign of things to come is that i went in to my unit (tricked by my boss) and saw a sign for a meeting for band 6 nurses (me). it mentioned a skill mix review….i texted my other band 6 friends and asked if they are being demoted.

they seem to think that is what they will be told. of course it won’t be tomorrow or without some (polite) foot stomping and there will be pay protection for a year or three but…i believe it will happen.

and why? why would a hospital drop some of its most experienced, hardest working nurses down a pay scale???? because it needs to save £22 million and because there are no other jobs out there…

i really feel bad, i wish i could take them with me!!!

new years eve ICU style

on thursday i got a haircut, pretty short but more significantly it is almost totally au naturale-meaning very light brown and grey. doesn’t bother me in the least…because i don’t have to look at it!

the conversation with the hair washing girl centered around the holidays-being that it was between christmas and new years. did i have a nice christmas? i worked…any palns for new years? i’m working….mmm, in order to keep the conversation going i did point out the perks of working on the holidays. usually extra pay, extra breaks, lots of snack food and just a generally more pleasant atmosphere than any other time…oh yeah and the patients…a certain sense of purpose either because they are very, very sick or a desire to include them in the festivities if they are awake.

last night i had two patients, each with potentially life threatening illness but currently in that critical post op period- that rosy time when i can say with confidence that everything went well and appears to have solved their very big problem but knowing also that things can go terribly wrong tomorrow or next week or next month…

my patients, two men-one my age and one slightly older were awake and awaiting the arrival of the new year. one had a very quiet, hoarse voice due to a previous surgery and one i found out had a very deep, resonant voice. at midnight he said “happy new year” but not getting any response he got slightly louder and booming saying – here’s to 2011! happy 2011…(no repsonse)…i’m looking forward to the  new year…(a whispered response)…this is going to be a good year…this the year i get my health back… is anybody awake?  this did slowly get some response from staff…wishes for a happy 2011 and some big laughs…

new years or not nurses on the night shift are programmed to whisper and shhush after 10pm…

i don’t think he realized that in fact only he and my other vocally challenged patient were awake and he was doing his best…the others were all sedated.

both my patients, in the absence of wives, family and friends shook hands and pulled me closer for a hug and gave me a peck on the cheek-imagine a kiss from two men at midnight!!

so to my new BF’s – sid and peter-wishing you a smooth recovery!

welcome back

tracya-research nurse, is turning back into tracya-critical care nurse. officially 31st of march but i will be working lots of shifts in the hospital between now and then. there are a few reasons for that:

  1. money, moola, big bucks, dosh
  2. they are d.e.s.p.e.r.a.t.e for nurses
  3. it’s winter, cold, dark and there’s nothing better to do….

i worked my first regular shift in the new hospital yesterday-i am still shell shocked. i called last week to confirm which shift i was on and i asked the charge nurse-“how’s it going, over there?” she said-“you’ll find out when you get here…” not exactly a glowing report…

when i got there i had to trek from one end to the other through more doors, having to swipe through most of them, than i care to remember the place is huge!! luckily i found a familiar face who was coming in for the same shift as me…i asked her “so, how’s it going. over here?”…as we walked back to the unit (through 5 or 6 doors) she told be it was horrible and gave several examples of things that had happened….and as if on cure as we approached the door of our unit the porters were wheeling out a dead body…

we went to the coffee room and my old friend was having something to eat-he let me know that at 12pm he was only just having his morning break…another bad sign…

i asked the charge nurse if i could have a handover (on all the patients) because i hadn’t worked for so long and she said sure, but could i just go give a hand in bed 21 while she tried to get a bed for another patient….never got handover and never left bed 21…

the very short story is that it was chaos…okay so i was new and didn’t know where anything was but nobody else knew either!! my patient had to be intubated (put on the ventilator) but was unstable for the next three hours and had very low oxygen levels- i was comfortable with that part and really felt good as all my old skills came back but when i said to someone where is the bronchoscope?…i just got blank looks…ummm, it might be over there…it might be next to the crash trolley….where’s the crash trolley?…it’s around the corner just past the cupboard between the seminar room and bed 14….i didn’t have a clue and the whole unit is a maze-it seems like you could just go around in circles all day…

and of course it’s been divided up into the inside and the outside—kind of like the number 11-outer circle bus

except there was no map and the inside has no sunlight…there’s going to be a lot of despressed, stressed nurses in birmingham~~did i mention that we expanded from 14-15 beds to 20 beds and that we are using loads of outside agency nurses?

it’s weird to go from my cushy research job, preaching patient safety to the real patient world equivalent of walking over burning coals. at the end of the shift i saw the nurse that i walked in with-she asked me if she was wrong…i told her that her comments did not even come close to describe the horrors of the situation. i have a feeling the blog is going to become a lot more interesting over the next few months…..

what is your nurse worth?

it’s been ages since i complained about how nurses are treated like “angels of mercy” rather than professionals, with degrees, specialized experience and high levels of responsibilities, that we are.

this story has been all over the news for the past 24 hours…

Top managers in England’s NHS trusts received average pay rises of nearly 7% in 2008-09, compared with less than 3% granted to nurses, a report says.

An Incomes Data Services report into boardroom pay at more than 380 trusts found chief executives earned seven times more than the average nurse.

Senior managers in NHS trusts typically earned £147,500, the report said.

The NHS Confederation said trusts needed top managers to help them through financial challenges.

can anyone tell me why a chief executive deserves a 7% increase when nurses got less than 3%????

this really put me over the edge~~~

The highest-paid chief executive was at Guy’s and St Thomas’ NHS Foundation Trust in London, with £270,000, the report said.

A spokesman for Guy’s and St Thomas’ said: “The pay of our chief executive, Ron Kerr, reflects the experience, expertise and responsibility that the role demands, and we are delighted to have a chief executive of his calibre to lead the organisation.

“Guy’s and St Thomas’ is one of the largest, most complex and successful NHS Foundation Trusts in the country.”

£270,000 per year??? that’s around $400,000….

my random hypoxic ( low oxygen from hyperventilating) thoughts about that are~~

  • does this person really expect the rest of the employees at this hospital to think that if he only got 3% like them that he would’ve walked??
  • does this person actually say to their spouse “this measly salary of £270k just is not enough to make ends meet…i need to look for a new job!” ?
  • does this person ever stop and think about the “little people” the ones who actually do the work that makes him look good?

let’s play a substitution game with the next statment that attepmts to justify this outrageous salary

“The pay of our chief executive, Ron Kerr, reflects the experience, expertise and responsibility that the role demands, and we are delighted to have a chief executive of his calibre to lead the organisation.

insert tracy a. critical care nurse….or any one of the thousands of nurses, who by the way have a starting salary in the NHS of £20,000/year

the pay of our nurse, tracy a, reflects the experience, expertise and responsibility that the role demands, and we are delighted to have a nurse of her calibre to take care of really sick patients.

why doesn’t anyone ever say that? well, actually they do say that every once in a while….usually in conjunction with telling me that i am only getting a 3% pay raise….or that i will have more work to do, with less staff on crappier shifts….

isn’t that a mixed message?? this chap can have his ridiculously high salary justified but the rest of us are only there because  ~~we have hearts of gold? we want to save the world one patient at a time? we idolize florence nightengale?

we shouldn’t have aspirations for a bigger house, a new car, a few sunny holidays to wash away the images of working in critical care…

did i mention this is a public sector job? the NHS is a government employer? there is a recession on last i heard….and an election…