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The truth about short staffing and an open apology that your call bells been ringing for 10 minutes


So, I know you hear a lot about the NHS, about nurses tirelessly campaigning for safer staffing levels, about the whole system being underfunded.  And we’re all inundated with politicians using it as their bait in upcoming elections.  One sides telling you they’ll invest x amount, another that they’ll recruit z amount more.  Both blaming each other for the chaos that’s the current climate.  And in between all this, the power of social media means we’re flooded with stories of the queues outside emergency departments, about patients left needing the toilet and delays in getting treatment. And only if you look more closely, do you see the positive stories shining through like the first shaft of sunlight after a storm.

But I’m sure you’ve had your own experience? There’s not one of us who hasn’t at some point either visited a family member or been the receiver of hospital care. 

I’m a nurse, but I have a family, and I’m not immune to illness, disease and tragedy, I understand, and I’m in this job precisely because I care.  About you.  About your family and loved ones, and about your home situation.  But I also see it from this side.  The misunderstood job role, and how it must seem to you.  So this is hopefully going someway to explain. 

In each day, I may have 9 people to whom I have a duty of care.  9 people who are acutely unwell and who’s current condition, medical background, mobility, skin condition, treatment plan, social situation and prognosis it is my job to not only know but consume.  When I’m not talking because I have a meds trolley in front of me, and I ask if you could either wait 10 minutes or ring your bell if its urgent – I’m not being ignorant.  I’m not simply reading a chart the drs have written and dishing out a pot of pills.  I don’t need a degree for that.  I’m looking through at your last blood pressure and heart rate and cross checking the corresponding medication for any contraindications.  I might be questioning the dose in order no harm comes to you.  I’m talking to you, yes to introduce myself and make sure you know who I am and that I’m looking after you today, but as you’re answering me, I can see how you’re breathing, I can see if you look or feel unwell.  Are you working harder to breathe? Are you talking in full sentences? Is your breathing equal?

 Behind every single question and action that you’re subject to – what our entire job is based around – is evidence based practice.  You’re being asked if you’re pressure areas can be checked regularly, because the evidence tells us illness, infection, poor nutrition and decreased mobility for any reason are contributory factors of developing pressure ulcers.  Which, evidence tells us are almost entirely preventable.  We want to get you up and moving after surgery because evidence tells us this leads to the most positive outcomes.  We’re not winging it, we’re not making it up, its all been studied and its all to improve patient outcomes.

The very nature of the NHS, and why its so wonderful is that its there for everyone.  No matter your background, financial situation, previous experiences, age or gender – if you’re ill – it’s there.  All this means there might be 9 completely different reasons for being in hospital.  And we’re trying our best to reach the best outcome.

But to do this effectively, we need more staff.  Believe me, we’re just as frustrated as you.  We have to prioritise the sickest people.  And I understand how frustrating this must be for you, you haven’t seen me for an hour.  But I’m working with a team - cannulating a patient and getting fluids and antibiotics for them, putting up an urgent blood transfusion for them, taking bloods to diagnose the problem. 

Or I may be in a side room, holding the hand of a man with no family, who’s taking his last breaths in this world, making sure he’s as comfortable as possible, and reassuring him that he’s not alone.  I’m here.  And taking a few minutes after the last breath has left his body, to close his eyes, to tell him I hope he’s at peace, and tell him that he’s still not alone.  Its not a policy but a personal belief that – we don’t come into this world alone and wherever I can possibly help it – no one should die alone.

And then I come out of that room and I see you’re call bell ringing.  “I’m sorry you’ve been waiting, I understand you’re frustrated.  I’m here now, lets get you sorted”.  I would never tell you what’s happened before I got to you, or why I’m late.  I know that’s not part of your journey.  As I talk to you, I’m remembering my handover.  Why you’re in, that you’ve been short of breath and can’t walk far without stopping, that you’re anxious about being in hospital, and I apologise again for leaving you waiting.  Then I’m gone again.  But this time, I’ve gone to make up IV medication for another patient, to order meds for another, to pass on my concerns about another to the drs; to check the blood sugar levels of 3 others, and if needed, give treatment on these results; to change a wound dressing on another patient; to re-check the blood pressure of another; to ask the family member of another patient how they’re coping at home, and if they feel they need more support. 

And in between all this, I hear you “I’m sorry to bother you” (NB: you are NEVER bothering me, I need you to talk to me – tell me whats wrong, tell me you’re worried, tell me your dad isn’t normally confused like this, tell me you didn’t understand what the drs said, tell me you can’t cope at home- all of it- I want to know.  It’s why I’m in this job – I want to help.  I’m not ignoring you when I’m writing, but unfortunately – for every procedure, every conversation, for everything you see me do – there’s a pathway, there’s a policy and there’s paperwork attached to it.  What maybe doesn’t get advertised is that in our world  - if it’s not written down – it didn’t happen.  And we’re reminded constantly “just doing it won’t stand up in a court of law”.  I am caring for you, but in order to consistently provide the best evidence based care for not only you but future generations, this involves accurately following guidelines and documenting that I have done so.  But, I don’t mind working through breaks, and staying late after my shift to catch up on this, if you need me now.  And I’m there, to help you get back on your feet; to hold your hand when you’re scared; to put cream on your legs, to help you to the toilet, to answer questions about your medication, to explain why we’ve changed your treatment, to explain why we need another blood test  - any of it.  All of it.

But the sad fact is, however you dress it up with politics – there isn’t enough of us.  The very evidence our job is based around tells us we need more staff for this to be safe.  Safe for you and safe for us. 

The NHS is full of the most wonderful people, working together as an amazing team under incredible pressure.  Honestly, every day I meet the most devoted and committed people dedicated to helping others.

Long after you’ve left hospital and you’re name has left my memory, I remember you.  How much more I wanted to be present by your side, how I wish I’d been able to answer that call bell quicker, how I hope you’re safe and doing well at home – that you’re coping.  How I hope you knew how much I cared. I know this is quite possibly the worst time of your life and I’m here to help.  I’m busy and we’re short staffed but we’re only stressed because we want you to receive the best care. 


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