snoopy29

dear other nurse it has come to my attention that all is not well in the world of nursing. alkthough many of us enjoy the actual hands on care we provide we are beset with frustrations and things that make our role so much harder. it is increasingly clear to me that the problem lies with ..... the other nurse ..... to whom i offer the following advice.......... the nurses on the opposite shift - now i am sure that you are a really nice bunch but it is only fair to point out that the work on my shift is much harder/complex/more demanding (delete as you feel appropriate) than mine. i know that you have times when the work is done and you sit magazines in hand and i would be grateful if you would consider filling those quiet times with things that would make my life easier like re-stocking/ completing care plans or beginning the work that usually falls to my shift. the nurses on the other wards or areas - i work in an acute area and no-one else experiences the stresses and pressures in the way that emergency department nurses do. as the more specialist nurse i feel it only fair to point out that i could of course do you role in my sleep and as such feel able to comment and critique what you do. the newly graduated nurses - now i accept that everyone has to start somewhere but the need you have to be more thorough and check everything you do holds the team back. in the time it takes you to assess a patient an experienced nurse could have seen twice as many patients. your endless questions and requests of how to do things take us away from our own patients and constantly slows us up. if you could just learn and gain experience wothout bothering us that would be great the old school nurses - now we fully understand that in order to switch on and operate your new mobile phone you had to enlist the help of your teenage children but in the workplace this level of technophobia is simply not tolerated and quite frankly you need to get with the programme - we don't have the time or the resources to show you how to work all the new technical equipment and your fear/unfamiliarity of all things to do with a computer needs addressing by you - if you cannot keep up then its about time you got out. the nurses in management - now again we understand that someone has fullfill the management roles but there you sit in your ivory towers in relatively highly paid posts out of touch with the reality of hands on nursing. it's not real nursing that you do is it???? but hold on a minute what is that heading my way - its a thunderbolt of recognition that at some time during my nursing career i have been that other nurse - how can that be i ask myself because that means that the problem in that case must lie with not with them but with me??? so what do i see when i am in the shoes of myself as ....... the other nurse........ the nurse on the opposite shift ...... yes we have a different set of demands but they are no less than that of the opposite shift. admittedly we have times that may be quieter but we often work with less staff and have responsibility for many subtle roles like checks and stocking which unless you are doing them yourself can go unnoticed. nightime changes patients they can become disorientated or frightened and can need a totally different level of care - how many times have we all heard "you would not believe the sort of night we had with ........" and yet as soon as dawn breaks peace and serenity reigns. the nurses in the other wards/ areas ...... having worked in many different areas one thing i have learnt is that there is no one area where the "best" nurses work and no one area where the work is harder/ more specialised / better than anywhere else. there are good and not so good nurses in every area of nursing and each area of work presents its own demands and challenges. each and every one of us (within the limits of availability of work) works in the area of our choice and if we are looking at other areas thinking they have it so much easier/ less demanding than us then we always have the option to switch. once a week i bank in a ward area and know that i will work flat out for the entire shift within a group of incredibly knowledgable skilled nurses. the newly qualified nurse .... yes as a new nurse i was slow and did endlessly check but the flip side was i was incredibly keen, eager to learn and came with a whole range of bang up to date theories and practice. i was willing and in fact welcomed the opportunity to do any part of nursing and rewarded any investment by soaking up knowledge like a sponge and working as hard as i possibly could to establish myself as a nurse. i had not devloped some of the bad habits i got into over time and was not in anyway jaded by time or cynicism. the old school nurse ...... ok, ok i admit the mobile phone technophobe is me and any new technology takes me longer than most to master however please be patient with my technical slowness because i also carry many many years hands on nursing experience. there is very little that i have not directly experienced and even less that will faze me and i am more than willing to share this experience and help the next generation learn the skills imparted to me. i do have to be stopped when i wander off on a trip down memory lane but within that journey i have taken so much that is as relevant today as when i started nursing. the nurses in management ....... what gets lost in our moans at the management nurses is that without them we would not be able to do our ands on nursing jobs. in truth we need the structure and protection of policies and procedures to protect us. my time is management roles showed what a thankless (and on occasions lonely) task they could be caught between the demands placed by non-clinical executives balanced between the expectations of the working nurses. it is not a role i would ever want to repeat and am truly grateful for the nurses able, and willing to fullfill it. i think dear other nurse what i am coming to recognise is that to each and everyone else we are "the other nurse". in this day and age of increasing pressures and responsibilities it is so easy to point the finger of blame and judge each other but the truth is none of us can really pass judgement until we have walked in the other nurses shoes. my reflection came after a very busy night shift - i was utterly frustrated with nurses in other areas/ roles/shifts but didn't stop to see it from their perspective. i gave myself a huge mental shake and reminded myself that ultimately we are a team with a common aim to provide the best possible patient care we can,and if we could very simply work together with a littlerespect for each other the nursing world would be a much nicer place to be. before i get utterly flamed i guess i need to point out that this post has been written very tongue in cheek but my message is relatively serious - if i and every other nurse stopped looking externally for the problem and pointing the finger of blame and instead looked at ourselves then wouldn't nursing life be a far more tolerant and gentle place to be????? i am so proud to be a nurse but on occasions the way nurses treat and percieve other nurses utterly disappoints me ....... just my thoughts.... yours, with respect,

It can be a tricky one because I usually find that the patients most vocal about "our duty" to get them home safely and their "right" to have an ambulance back are often those that clinically have the least need. We have a small budget for hospital funded taxis. I advocate long and hard to have this resource for elderly or chronically unwell patients or simply those patients that find themselves in an emergency department in the early hours of the morning with genuinely no way of getting home. With the rest I happily offer them the use of the phone to arrange a lift or say I am more than willing to speak with the local taxi firm and arrange for them to go home via a cash point. Failing this I say I have no objection to them waiting in the waiting room or lastly I offer to send them home in a hospital taxi on the basis that they will be billed at a later date. In my experience any one of the above tends to work. In truth, although we could argue long and hard about personal responsibility I don't want a scantily clad young patient walking home along dangerous roads in the middle of the night and will do whatever I reasonably can to get them home safely.

"rechecks the temp with a second thermometer and documents findings. Obtains blood cultures while at the same time siting an IV access device, in anticipation of receiving orders for IV fluids and anti-pyretics. Explains to the patients the need to also obtain sputum, stool, and urine specimens. Considers isolating the patients if symptoms justify this. Contacts the doctor to inform and also request prescriptions. Commences a fluid balance chart, and documents all actions." Right I know I should probably leave well alone but feel the need to add my two pennorth. Skylark i'm old school but unlike you're anticipated response if my pt spiked a temp, in addition to re-checking the temp, I would do a full set of obs, prescribe the anti-pyretic myself, site two cannula's if obs indicated sepsis whilst taking blood for a baseline set, venous gas, and lactate, set up a request for chest xray, whip off a quick ECG and ask a Doc to review. Simple standard stuff. I understand and sympathise with your comments on the failings in UK nurse training but feel your generalisations undermine the points you are making. My personal views are that the first year post-qualifying is the time that UK nurses learn most and feel that my role as a mentor is to fill the many gaps that new nurses have. I am proud to be a UK nurse.

Wow - I have just come across this post and read a number of the comments with disbelief and a fair degree of outrage. If there was not so much tragedy and loss surrounding these events I would find the image of the machine gun toting British bobby randomly shooting innocent members of the public laughable. Thankyou Skylark for eloquently portraying the facts. I have been deeply saddened by the senseless criminal acts perpetrated and am very clear that this is not a protest by the opressed but people choosing to behave in a way that is unacceptable and this would be the case wherever it happened in the world. This post began with an international message of support for UK nurses affected by the rioting. I am grateful for that thought. My support and concern extends to...... My paramedic colleagues who faced stone throwing and petrol bombing and yet time and time again went in, without judgement, to treat those injured. The hard working people that have had their business and livelihoods destroyed and are now faced with re-building. The familes and friends of those who have lost loved ones. I have been left humbled by the compassion and dignity they have shown. I will never forget the father of the young asian men killed protecting their community asking for peace and an end to the violence. Many months will be spent analysing and unpicking the politics, origin and right or wrongness of the events hoepfully to ensure that they never recur but what matters right now is the human cost and that is where my energies and thought are focussed

I will be completely honest with you ..... I am in my 40's, very fit and healthy and yet I know there is no way I can continue to work in an acute area for much longer. The work is physically incrediblydemanding - at the end of a long day my back aches and my feet are like water melons! - I wear a pedometer and usually clock up 14 miles on an average shift. I am lucky in that I have the luxury of choice because I have years of experience under my belt and know that when I am ready to leave acute care then I have realistic softer options open to me. If being a nurse is your dream then follow that but have a very clear idea about where you want that to be, what realistically you can sustain and what are your chances of obtaining that and those answers should form the basis of your decisions. good luck with whatever choices you make

In your opinion this nurse is both negligent in her care and directly abusive to patients. You have documented your concerns and reported them. The truth is that that should now be the end of your involvement. Your focus needs to return to your role and your patients care. Clearly if you see anything else then you document and report. We have systems in place to ensure that concerns are investigated and acted on and you only have your part of the picture. Its up to the managers to look at the whole story and you need to place a degree of trust in that. There is a very real danger that professional concerns can turn into a personal vendetta - be very cautious. I hate it when nurses misuse the control they have and there is never any excuse for cruelty or poor care but I would very gently remind you that your responsibility is to report, continue to protect your patients but not to act as judge and jury.

I believe that mental capacity is all important here. If a patient that lashes out is assessed as lacking mental capacity through for example alzheimers or head injury then the care facility has a duty of care to the patient, other patients and staff to have a robust care plan that gives guidance on how their behaviour can be safely managed. If a patient has capacity and chooses to hit you then this is assault and a criminal matter. I would simply ask my managers which model your patient fitted into - if they then don't act you have evidence that they are failing to protect.

I read your post and think there are a lot of positives..... I always say to newly qualified nurses to expect to feel as though you know absolutely nothing for the first year - the second year post qualifying is even more scarey because you fully understand just how much you don't know!! The mistakes you are making are simply part of the learning process and what you need is a bit of gentle guidance and support - that's it simple really. It sounds like there are some hidden agendas here and you need to have a careful objective look at what is best for you. Nursing is scarey enough without having to constantly feel like you have to watch your back - That grinds you down and however good a nurse is leaves you questioning your worth. Now is not the time to make big decisions. You just need to keep yourself and your registration safe. Document document document and if at any point you struggle make your managers aware this has two benefits first you can hand on heart say you realised your limitations and safely sought help and secondly in there somewhere will be a manager that understands the pressures you are under and will work with you rather than against to support you. good luck

well i have waited many years to see my ideal job advertised and as it has yet to happen though i would write my own advert........ wanted: a keen committed nurse to join our supportive team in a well run, well equipped and adequately funded unit. the team is made up of a wide range of nurses and is supportive in nature. the ethos of the ward is entirely patient focussed and delivering the best possible care drives what we do experience - not necessary. we accept and understand that there may be some fantastic candidates out there who more than make up what they lack in experience in enthusiasm, potential and the desire to learn. we can train anybody what we can't do is add on those qualities to someone's experience however extensive. support - the unit encourages a hands on approach from the most junior to senior nurse and we hope that much of your learning will come through direct example however you will also be allocated an intelligent dynamic preceptor that no only values teaching and empowering but measures their success on how their preceptees do. training - we have a robust training schedule that means that all staff are given the necessary training both internally and externally in order to fullfill their role effectively. the policy contains a clause ensuring that training is allocated on a fair basis as opposed to on a who is flavour of the month one! sickness - we prefer to employ nurses rather than robots and realise that nursing can be physically and emotionally exhausting so undertsand completely that at times you made go off sick. when this happens we will give you the full support of the occupational health department - not to bully you into coming back far to quickly but in order to ensure that you have whatever is necessary to facilitate your recovery. family friendly policy - not only do we have one but we believe in it. we value our nurses that have children and realise that if we change their shift with twenty minutes notice we are likely to leave them without childcare and the inconvenience of a harrassed nurse with various children in tow. off duty - we have a special electronic system for allocating off duty so that it is done fairly and cannot be influenced by who is best friends with the off duty co-ordinator! it sounds a very loud alarm if a nurse ends up doing all the weekends or public holidays or any other assortment of undesirable shifts - and immediately gives you an extra day off. parking - not only does the unit have adequate parking it is well lit and within a reasonable walking distance of the unit. equipment - the unit is well stocked with equipment that has not only been purchased with direction from the nurses but is also maintained so you will not waste endless time trying to find not only the right equipment to do the job but one that is also fully functional!! promotion - is a real possibility and is based on your experience, values and skills as a nurse and never in order to move someone less deserving upwards and therefore more removed from patient care. overtime - is available if you would like it but is never mandated. in addition you work the hours you are paid to work, when your shift finishes you will be expected to go home safe in the knowledge that the new shift are on and sufficiently well staffed to take over any care. targets - our management body have decided that figure led targets only have limited use and we are measured primarily on patient satisfaction. demand is expected to be quite high for this once in a lifetime post so early application is advised!!! :)

Just a different perspective...... If I have a newly qualified nurse and an experienced one making the same minor mistake I will tend to (gently!) correct the new nurse. My reason is that the habits, good, bad or indifferent that we form in those early days stay with us throughout our nursing career and those early days are the time to get it right. Its never about point scoring or exerting power its about using the absolutely golden opportunity that having a new, keen and eager to learn nurse presents. Some of the things that I give guidance on must appear really, really petty - for example if a new nurse is not following the uniform code to the absolute I will get them to correct it. I personally believe that in order to be seen and respected as the professionals we are we need to look the part. With more experienced nurses I let it go because I believe they have had their guidance and if they choose to not present themselves professionally then that is their choice - and what naturally follows is the consequences are also theirs. Just my thoughts.

I see and triage on average about 100 patients per shift and have probably five minutes to take an initial history and do enough to ensure that all immediate clinical needs are met - analgesia, xray, bloods etc. I believe that I need to make my patient feel sufficiently at ease that I can quickly and easily take a history and allay any fears they have. How I do that depends on the patient - a child I will make laugh, an elderly patient I will go in to the waiting room to collect. Communicating with patients so that you ensure they understand you and just as importantly you understand them is something you learn over time and there is no one stock answer that fits all. Like a number of other posts I don't bond with my patients - Its true that some patients touch your heart for whatever reason you will never ever forget them but for the most part I see, assess and treat with a smile and compassion and then move on and that is why I am still nursing 26years later.

Dear New Nurse Well you and I have just had a very difficult meeting haven't we? Over the years I have seen so many newly qualified nurses join our ranks - the shy, the quiet, the studious and ones like you - the confident. With care, teaching and nurturing many of these nurses have gone on to be great nurses but equally many have fallen by the wayside or become tired or burnt out. I believe the patterns that we form when we start nursing can continue throughout our career whether they are good, bad or indiffererent and that is why I feel so passionately from day one it is important to get it right. The meeting was difficult because you believed that you are doing a fantastic job and the failings if any are down to your colleagues and not you and I gently had to tell you otherwise...... You have so much potential - you are bright and quick and confident but there is still so much to learn. That is not a failing on your part in any way - I honestly believe that nurse training gives us the theory and a chance at testing the water but its only when qualified that the true learning begins. Enjoy the luxury of having the protection of time to learn and instead of seeing this as holding you back see it for the opportunity it is. Having seen many nurses like you this is what I suggest..... Learn to value all your patients - don't be known as a " first at a trauma last as a bedpan" nurse!!. I know that you like the exciting high profile patients but in truth we see far less of them than the everyday patients. They may just be "another abdo pain" but they are frightened in pain and deserve the best possible care we can give them. Learn the value and personal reward of doing the best you can for them without feeling the need to rush through their care in case you miss something "more exciting". The traumas still come and if you are a good solid nurse then you will be better placed to work with these traumas. The elderly are our bread and butter - pretty much whichever field of nursing you go in you will care for a high number of elderly patients. I see how it frustrates you that they are slow and need extra care but I would implore you to see the bigger picture. These patients come with a lifetime of history and experience -see the whole picture and treat them with the respect they deserve and remember one day we will all be elderly and wanting our nurse to be gentle, patient and respectful. Never ever cut corners - how good we are as a nurse is not measured on how quick we are. We can all wizz in and assess a patient in 5 minutes flat but that begs the question of are we giving our patient the best possible care we can? Learn to be thorough - ultimately if things are missed that will come back to you. Boring though it is documentation keeps us and our patients safe - treat it as your friend. Drug errors occur when complacency sets in and procedures aren't followed - to keep myself in check each shift I remind myself how I would feel if one of my patients got the wrong meds and trust me its a powerful motivator to do everything possible to get it right! Learn to value and respect your colleagues. Trust me along your nursing journey you will meet every variety. I know that currently you have little time for the nurses you perceive as not as dynamic as you but the truth is that these nurses are the backbone of nursing care. Remember that nursing assistants are there to assist - and not do all your manual work. My rule is that I will never expect a nurse of nursing assistant to do anything I am not prepared to do myself !!!- in the time that it takes me to ask someone to get a bedpan usually I could have done it myself and beneffited from seeing the patient, checking pressure areas etc. If you think these tasks are beneath you then maybe, just maybe direct nursing is not for you. The respect for your colleagues extends to other areas - if you turn up late then they have to stay late - don't expect them not to be sizably fed up if this happens and you breeze in without an apology. Yes it might just be 5 minutes but it is 5 minutes of their time and your time is actually no more precious than theirs!!! Believe me when I tell you that one day the penny will drop and you will see with utter clarity not how much you know but how little you know and trust me that day is very very scarey!! You are so confident at the moment and I have heard you say when other nurses have tried to guide you "I already know that". It is not about other nurses scoring points it is about them developing what you know and making it into something solid and meaningful. The reason that I told you all the above was not to be mean or nasty and trust me I get absolutely no pleasure in upsetting you but firstly I have a duty to ensure our patients get the best possible care and secondly I believe that you have the potential to be a really great nurse but you honestly stand at a cross roads and of you carry down the other road you will become an arrogant, careless and cold. I know which nurse I would rather work with and more imprtantly which nurse I would want looking after me. Good luck new nurse and prove to me that you truly have the potential that I see.

The post is entitled "is nursing care a thing of the past?" and quite simply my answer would have to be no. I have been nursing for over 25 years and although much has changed, generally nurses do what they do because they care and want to make a difference. Sadly there are always going to be examples of appalling care but on the whole most nurses I know would be suitably horrified by the tale above and their practice consistently reflects that they want the best possible care for their patients. Yes training methods have changed but I believe that nurses worldwide aim to give their patients the best possible care they can. Just my thoughts.

Interesting thread and very thought provoking. My intellect tells me it makes not a bit of difference to my patient what they are wearing but my emotion wants this last opportunity to make them comfortable. In particular, and admittedly I am sure it is far more about my needs, if I am looking after a baby that has died I carry them down to the morgue carefully and warmly dressed. It would haunt me to do otherwise.

In answer to the original question many years ago when I started nursing I was so terrified of caring for the dying and dead that I almost gave up nursing. My terror stemmed from a friends "well-meaning!" mother who was also a nurse sharing all sorts of stories that I now know where not true about all the things that dead patients where supposed to do! I would come on shift and if there was a dying patient I would physically shake. I was really scared but could not put into words why. After another death and knowing I would need to lay the patient out I hid in the linen cupboard. I was found bya wise old nurse. First she told me that what Iwas feeling was enitrely normal and second and most importantly that she would try to turn things around and teach me how to value this part of nursing. Despite her shift having finished she came with me and did all the post mortem care. She chatted away to the patient telling them how much more comfortable she was going to make them. I found myself forgetting they were dead and just seeing them still as my patient. Every time I looked at my patients face I froze and my wise old nurse told me simply to stop looking and get caring. Afterwards she took me for a coffee and told me that she felt as a nurse she was in a supreme position of trust in that she would be one of the last people that could make sure that the patient had the best possible care and was treated with dignity. She said to always remember they were a patient first, dead body second! Now things didn't change for me overnight but with her patience they did change. These days care of the dying is an area I feel passionate about and rather than holding any fear I believe it is one of the most important roles I fill as a nurse. Its funny but having been scared means that I have some insight when family members are frightened and hope I afford them the same patience and understanding given to me. My advice is to find a nurse like mine! Don't give up - the fact that you care and that it matters makes you a better nurse.

WOW I don't know whether to shake my head in absolute awe or be terrified for the patient last to be seen at the end of one of those mammoth shifts! I love the international perspective on nursing - apart from the humanitatian side I would never have considered the nursing impact of the natural disasters before reading some of these responses. In the UK if more than three inches of snow is forecast it has hospital managers in melt down.

Just out of curiosity I wonder who across the world officially works the longest long day. Rules are travelling time plus working hours...... My regular hours are 07.00 till 19.30 which is a reasonable 12.5 hours plus an hours travelling so 13.5. My bank ward works 07.00 till 21.00hrs a much more feet wearing, back breaking 14 hours plus an hours travelling so 15 in total. but my day is a walk in the park compared to a colleague who also works the 07.00 till 21.00hrs but with 2 hours travelling per day, which by my sums makes his day 16 hours. Fine for a one off but two in a row makes my eyes water. I am sure there are nurses out there working longer so over to you................

When I add up all the pro's and cons of the nursing world the pro's always outstrip the cons for me but I thought I would share some of my loves and hates of the jobs in the hope that people will add theirs. I love just being a nurse and after 25 years nursing still get a sense of pride when someone asks me what I do and I answer "I am a nurse". To this day when I put my uniform on I feel a deep sense of pride and believe that what we as nurses do is unique. I love being able to make a difference - knowing what to do when someone critically ill comes through the door. All that training and experience means that when someone is frightened, sick and in need of care, reassurance and fast effective treatment then we know exactly what to do. I sometimes look at the sea of frightened faces that surrounds you in an emergency situation and know that we as nurses make a difference. I love being the person that reassures, comforts and takes care of the patient. I love it when a very simple act like giving an elderly patient a drink or a blanket results in them holding my hand and thanking me. For me nothing in the world beats that feeling of knowing that the patient felt safer or more comfortable. I love that there is so much diversity in our profession and so much opportunity to find a niche. The nursing world needs so many different types and personalities to fill the variety or roles that there really is a place for everyone. I love knowing that what we do and just as importantly how we do it can markedly impact on a patients experience. I love mentoring and training student and newly qualified nurses and seeing them grow and rise up the ranks. I take a huge amount of pride in their accomplishments and love it when they outrank me! BUT....... I hate that on so many levels what we do is not valued. In comparison to other emergency services our pay is low and currently once again our pensions are under threat. One of my closest friends is a police officer and in addition to pay they receive a number of job benefits like free travel and subsidised housing - Im not saying they shouldnt have them but some equality would be nice. I hate that because we are a caring profession our patient loyalty is misused. How many times have we stayed late knowing it is unsafe to leave. Many colleagues routinely add an extra hour to their shifts because they don't feel they can safely leave until the work is done. I hate that there are never enough resources and much of my shift is spent searching for working basic equipment like a thermometer and yet there seems to be money available to buy super specialised equipment that collects dust on a shelf. I hate that for a caring profession we don't seem to care about each other. I hear nurses being grilled when they have had to phone in sick and a sense of loyalty results in nurses pushing themselves to come back when not fully recovered as we are all too aware of the consequences of leaving the shift short. I have seen so many good, capable nurses physically or emotionally burned out by the profession and wonder when we will learn that you can only work nurses so hard for so long before something gives. I hate impossible targets set by people that have no real idea about the true working of a nursing environment. I hate that on occasions these targets seem more important than the people that really matter our patients. I hate that there are never enough beds and there is a constant pressure to get patients fixed quickly and back home freeing up a bed. I hate it when patients become a percentage target rather than individuals. I am sure I have many many more but these are a few of my love and hates for starters. For me there is no greater profession than nursing and no better reward than seeing a sick patient get well but its fair to say our profession is not without its challenges. I would love to hear other peoples...................

Don't get me wrong I have my fair share of days when I am thoroughly disillusioned and fed up with being a nurse but I do think what we do as nurses, wherever in the world we are doing it, is both incredible and unique and sometimes it is easy to lose sight of that. What got me thinking was my shift today. Pretty much a normal day in the ED until we got a call through pre-alerting us to a major trauma. We where told to expect a number of casualties from a factory fire and the paramedic kept repeating "this is bad, really bad". I won't go into details about what followed but anyone who has worked with severely burnt patients will have a pretty good idea of what we encountered. The nurses on duty, even those not directly involved in the patients direct care where all massively affected by what they saw, smelt and had to deal with and yet all I saw was utter professionalism and compassion. Not a single nurse involved left before they had done everything they could for their patient - many working hours after the end of shift. I know that after they left they will all be hugging thier love ones a little bit closer tonight and that very few if any of them will sleep tonight. Despite the magnitude of what they faced every nurse involved did what they are trained to do, quickly, gently and efficiently. Its not just about the clinical care. I saw fear, terror and pain on patients faces and whilst chaos ensued it was the nurses talking to them telling them everything was going to be just fine. It was the nurses that the patients kept looking to for reassurance. Day after day nurses everywhere deal with people that are in pain or frightened. What we do and how we do it makes such a difference and is seen as just part of our job. We hold hands with the dying and try to make sense of chaos with distressed, confused and bewildered relatives. Today I saw nurses struggling with their own emotions but still managing to bring comfort to families. It takes a special person to be able to do that. When I started nursing, nurses where held in the highest of regard and sadly that is not the case today. I am not saying that all nurses are angels or anything even close to that but I do think that every day we do things that other people could not even begin to understand. Yes we moan and complain and sometimes think about switching to something less physical, emotional and demanding but underneath that I hope that every nurse out there knows what an incredible job they are doing. I stared my nurse training almost 25 years ago to the day and remember then feeling desperately proud to be working towards being a nurse. Today reminded me that nurses are right to feel proud.

A few months ago I decided that in order to pay my son's way through university I would need to do some extra hours. I thought through the options and decided that it would be good for me to do the hours out of my usual area of work and to add interest to do them in a different hospital. I duly applied for the nurse bank in the hospital I trained in and after the usual checks got cleared to work. In my day to day post I am a senior nurse and seen as experienced In my bank role I would be back to wearing a newly qualified uniform. Now don't think this is about ideas of my own grandeur as I am always first in line to get a bedpan and there is no job I am not prepared to do. Some months in I have to say I cannot believe how badly bank nurses are preceived and treated by permanent staff. Let me fill you in on the rules...... 1) Forget you have a name - now I have no problem in other nurses calling my nurse the bank nurse or similiar but clicking your fingers at me whilst hollering "oi thingy" is not going to make me feel valued and just for the record I can ignore "oi thingy" for a very long time. 2) Grow a camel's hump - I have lost count of the number of shifts when I have looked around and realised that I am the only qualified nurse on the ward only to find the permanent staff happily sat in the tea room. Now I don't begrudge anyone a break but please can you tell the bank nurse and secondly remember that occasionally just occasionally she might welcome a break too. 3) Develop psychic powers - I have been to countless wards where they have gone "have your handover and off you go". Luckily I know the hospital and wards well but a quick here is the emergency trolley and fire exits would not go amiss. When I have asked for a quick ward tour I have been tutted at! As ever god bless the health care assistants as they are the ones that respond to my" can anyone tell me where" pleas!! 4) Develop a thick, in fact rhinocerous type skin - the expectation appears to be that if you are banking its because you are a pretty useless nurse and cannot get a job anywhere else!!!!. On handing over nurses will say things like "oh you didn't do that dressing did you - it's very complex" in a tone of voice that clearly indicates it must be way beyond my capabilities and I must surely have messed it up!!! Heaven forbid you show any initiative - I moved a patients room around, he had been in hospital months and the new arrangment meant he could see out of the window which he appreciated. The nurse I handed over to sighed heavily and remarked that it would take her ages to unarrange as they always had there rooms the other way around!!!!! 5) Lose the need to be valued - on so many occasions I have finished a shift, said I was going and left without anyone even raising there head. I work as hard as I can, stay until the work is done and don't mind if I get given the heaviest, most dependent, confused and aggressive patients but a "thanks for your help" would go a very very long way. So my plea is that nurses value nurses. I know there are good, bad and indifferent bank nurses but to be fair there are good bad and indifferent permanent nurses. In my position I get to go back to my permanent job and every so often one of my old senior colleagues will happen across me and ask what on earth I am doing - this is usually followed by the nurses that have ignored me, given me all the worst jobs, or clicked there fingers at me tentatively asking how their manager knows me and I have to admit to a tiny sense of satisfaction when I explain!! The exception to the above are the health care assistants who wherever I work seem to go out of their way to help and assist. I truly take my hat off to all bank or floating nurses and have learnt many a hard lesson over the past few months.

The call bell divas that push all my buttons are the ones that have got fed up waiting for their call bell to be answered after all of 12 seconds so decide to pull the emergency bell. It doesn't seem to faze them that firstly a very loud bell sounds or secondly the room is filled with every doctor or nurse in the department!! I quite like it when we have doctor changeover and have the ultra keen newbies responding as I can think of no greater detterent that having a naso-pharyngeal tube inserted by a new doctor desperately trying to assist as they have been taught that that bell tends to indicate some poor patient is in dire straights :-)

When will I know that I have crossed that fine line and become burnt out as opposed to tired, experienced and realistically cynical? How do nurses know when it is time to go??? Taking hand over today I realised I could not raise an ounce of enthusiasm to deal with the group of patients sat in minors. The chronic back pain who had not taken any analgesia, the very intoxicated guy who refused to vomit on a bowl preferring the floor, the alledged self poisoning who,s bloods came back clear but kept "trying" to hang herself but only when someone was looking and the angry patient who deliberately kept targetting his verbal rage at the youngest smallest nurse and I thought I don't know that I can do this today. I don't know that I can stay calm and non-judgemental when all I really wanted to do is say "your all a waste of space, please go home then we can deal with someone who is really sick". How unfair - they were all patients in my care and deserved more than that. I worry about the physical toll this job takes. Thirteen hours, in charge, and on the go is physically exhausting. At night my feet and back ache so much I could cry. I have been on every manual handling course known to nursekind but when a patient needs resuscitating or is about to launch themselves off the trolley that all goes out of the window. Some days I will be lucky to get a drink (yes, I do belong to a Union!) and the expectation is that you work late and get called in on your days off at short notice as unsurprisingly our sickness rates are through the roof. I wonder sometimes if I will hit retirement age and have a body that is quite simply too knackered to be of any use. I worry about the emotional cost of this job. Every day we see and hear things that break a little piece of your heart. We deal with desperate grieving relatives, terrified patients facing death and see things that most people can only imagine. We listen to the tales of tragedy that force someone to try to take their own life and on a daily basis support when someone is told there life will be ending shortly. We deal with death, dying and loss every single working day. We look after elderly relatives that have lost there life partners of 60 plus years and parents who's children have died before them. I wonder how much capacity any one nurse has for seeing, hearing and dealing with these things. I know that these days if I get a cardiac arrest in I will deal with it professionally and to the best of my abilities but within an hour the truth is unless the circumstances are exceptional I will have pretty much forgotten about it. I wonder sometimes if we get given a set quota of compassion, kindness and empathy and once that has gone then thats it - no popping down to the emotion shops for a quick top up. I sometimes come home from work and feel emotionally it has sucked me dry and there is nothing left for my family and friends. They could have a limb hanging off and I am sure my response would be "have you taken any analgesia - no - well in that case don't come crying to me, and make sure you don't get blood on the carpet on your way out!!" How long is it acceptable for my family to stand second in the queue. I know that I am tired. Tired of unrealistic targets set by people that wouldn't know a bedpan if it bashed them on the nose. I am tired of working in a blame led culture where management are quick to point the finger but slow to lift a hand. Tired of never having enough - enough time, nurses, resouces, beds - in fact the only thing I ever have too much of is patients!!! But as soon as I think of moving on or up the following stops me....... The patients - the desperately sick ones who you clinically turn around, the frightened one that you make feel safer, the older ones who still believe that nurses are angels and are grateful for every little thing you do, the children that are scared or in pain that you make laugh just by being daft. If I am being honest some of my patients drive me to distraction but ultimately they are the reward of the job. My team - I l love being able to share my experience with new or junior members of staff. One of the big rewards is seeing someone newly qualified go from being terrified and utterly inexperienced to confident and capable. Quite a few nurses that I have mentored have gone on to far outstrip me in the career stakes and I take delight in knowing that I precepted all my direct managers! So how will I know?????? I love being a nurse and am so proud of what I do but at times I question "at what cost". I know that I don't want to be a grouchy burnt out nurse that sees the patients as an inconvenience rather than the reason we do what we do. I see some nurses so emotionally burnt out that the only delight they seem to get is in making their junior nurses and students lives an absolute misey and don't ever want to be that nurse. For me being a nurse has always been an absolute gift but I think maybe the time will come fairly soon when I need to be part traded for a newer, fitter, more modern model......

:) I know I probably should not have found this as funny as I did and fully expect the flames to follow but I am still quietly chuckling to myself....... I was in one of the nurse practitioners rooms when a well to do gentleman came in for assessment and treatment. I had noticed him before on one of his many trips to the nurses station demanding an update as to when exactly he would be seen treated and "out of this hole". He gave a brief history of an untreated bite, saying he had not done anything about it before because his time was precious and he could not afford to spend time messing about with doctors and nurses. His limb was hugely swollen. The nurse practitioner tried to take a full history and establish allergies etc but this patient was having none of that. He told her in no uncertain terms that he needed it sorting immediately and it had to be 100% better by the morning when he was due to fly out of the country on business. Finally admitting defeat the nurse practitioner got up and started rummaging in the cupboard, with me thinking what on earth is she goijng to give him that will work that quick . She put her head out and completely deadpan said "Sorry, no can do, seems there is no chance of getting it better by tomorrow, i've checked and I'm all out of Fairy Dust, its usually right here next to flucloxacillin but seems like I have used mine up on patients before you that also needed miracles performing!!!!" Cannot help but think how much easier life would be if we each came equipped with a little bottle of fairy dust :)

Fractured zygoma - don't know what hurt most my cheek or dented pride for not ducking in time!! Will go to my grave saying he got a lucky shot. I pressed charges, the court felt that because he was heavily intoxicated he could not be held fully accountable for his actions so he received a nominal fine. Not police bashing but on the same day a police officer was in court having been assaulted in the line of duty and his perpetrator received a two year custodial sentence!! Still can't figure that one out.

Even the most seasoned ED nurse still gets upset when it is a paed. Contrary to popular rumour we do not have our emotions and tear ducts removed on induction! There is a support network to deal with children but it is important to remember we are touched as professionals, the parents are touched as humans and the people who love that child most in the world. If we are so outwardly upset we cannot function we cannot help the family and part of what we do for the child is to help the parent. In the cases where the parent has also caused the injury then our mantra is that they are still the parent and our job is to treat the child. The judicial system will hold any abuser accountable and pass judgement, so that is not down to us. An ED is not the place for judgements whatever they are about. good luck with your journey