"Productive Ward" - more codswallop from the nursing hierarchy
I was flabbergasted to find that yesterday the Royal College of Nursing was complaining that:
An increase in paperwork is preventing nurses from spending enough time caring for patients, nurse leaders claim. The Royal College of Nursing has called for extra investment to help nurses cope with non-essential paperwork, such as filing, photocopying and orders. A poll of 1,752 nurses found that a fifth of the time of a standard nurse is spent doing non-essential paperwork. BBCI suppose it is good to welcome the hierarchy of the RCN on one of their rare visits to the Planet Earth. Better late than never to notice that the nursing profession is bogged down in paperwork. Speak to any doctor in the UK and he or she will tell you that it is becoming impossible to find a nurse who will do hands on nursing. Most of the ambitious nurses have been “promoted” to senior posts from which they churn out reams of meaningless protocols. The few remaining “hands on” nurses dare not lift a finger without first checking a protocol and ticking a box. And we are not talking here about protocols for complex medical procedures such as lumbar puctures. We are talking simple things like handing out lunches or feeding patients.
Age Concern has reported
What on earth is the Productive Ward Programme? You have never heard of it. So Dr Crippen is going to take you through it so that you can begin to understand why the few remaining “hands on” nurses are in despair; why 25% of nursing students drop out of nursing before qualification; and most of all why doctors are sick and tired of nurse-specialists and nurse-consultants. Remember that things like Flabby-Jowls' “Productive Ward Programme are introduced (sorry, “rolled out”) by nurse-consultants and people of their ilk.
There are two more videos to watch. Episode 1 “The Journey Begins…” and Episode 2, “The Realities of Implementation” both of which may be found at the NHS Institute for Innovation and Improvement.
The Productive Ward module structure is described in full on line here. I will quote but one short paragraph chosen for its priceless first sentence.
Hi Nicky. How has Productive Ward helped you?”
Nine out of ten nurses do not always have time to help patients who need assistance with eating, despite shocking levels of malnutrition in older patients. Six out of ten older patients are at risk of becoming malnourished or their situation getting worse while in hospital. Age ConcernWhy has this happened? Nurses are chronically understaffed of course. Let us not forget that. But also they are pressurised by their masters to fill in forms. If the form is not filled in, they get into trouble. If the patient is not filled with food, well, no one notices apart from the patient, and no one has the time to listen to him. Then we have an intervention from the Chief Nursing Officer, Christine “Flabby-Jowls” Beasley who says:
We are all with you there, Flabby-Jowls. But then she goes on to say:
"Nurses should spend their time caring for patients, not having to carry out unnecessary administrative tasks."
"However, some paperwork is necessary for good patient care. It is important that we look at the way wards are run to help increase time spent with patients. For example the Productive Ward programme, produced by the NHS Institute, helps nurses and other front-line staff find ways to release time to care."Even the starting premise is wrong. Flabby-Jowls say “find ways to release time to care”. A characteristic bit of nurse-speak. She does not think before she opens her mouth. Should nurses not be caring all the time?
What on earth is the Productive Ward Programme? You have never heard of it. So Dr Crippen is going to take you through it so that you can begin to understand why the few remaining “hands on” nurses are in despair; why 25% of nursing students drop out of nursing before qualification; and most of all why doctors are sick and tired of nurse-specialists and nurse-consultants. Remember that things like Flabby-Jowls' “Productive Ward Programme are introduced (sorry, “rolled out”) by nurse-consultants and people of their ilk.
The NHS Institute has found that ward nurses in acute settings spend an average of just 40% of their time on direct patient care. Recent research by Nursing Times also shows that nearly three in four ward nurses say that is not enough and 90% of those polled say that patient care suffers as a result. The Productive Ward is an innovative and practical programme of work which aims to help turn around this situation by releasing time to care. More than that it's a systematic and inclusive approach to improving the reliability, safety and efficiency of the care that you deliver. By creating a really strong focus on the processes of care within your ward setting the Productive Ward will significantly increase the proportion of time you spend providing direct care to patients, improve the experience of both staff and patients and organise your ward so that space works for you rather than against you – saving you time, effort and money.Did you really read through all that? Well done. Now you get to see a video of “Productive Ward”. Watch it. It is almost unbearable but please persevere. It introduces you to “Productive Ward” at its best.
There are two more videos to watch. Episode 1 “The Journey Begins…” and Episode 2, “The Realities of Implementation” both of which may be found at the NHS Institute for Innovation and Improvement.
The Productive Ward module structure is described in full on line here. I will quote but one short paragraph chosen for its priceless first sentence.
A ward leader implementing the Productive Ward will start with the Ward Leader's Guide. Then, with the ward team, they will first work through the foundation modules (Knowing How we are Doing, Well Organised Ward and Patient Status at a Glance). These provide both a solid foundation for the more challenging 'process' modules (more details below) and a grounding in basic improvement principles.Can you imaging working for people who produce psychobable and videos like this? Working for An “Assistant Service Improvement Facilitator” like Kirsty Bray? And has Productive Ward really delivered? Let’s talk with Nicky Proctor, Staff Nurse in Plymouth.
Hi Nicky. How has Productive Ward helped you?”
"I’ve been particularly involved in sorting the new Feeding and Airways cupboard; previously, the contents were in three places and you had to go to all three to get what you needed; now there’s just the one location and it has been a real positive, definitely saving time." Nicky ProctorWell done, Nicky. You have tidied up a cupboard.
You think I am making this up, don’t you? Sadly not. It is for real. Nickly exists and can be found here.
By this stage you must be beginning to understand why doctors’ hearts sink when a nurse-consultant approaches. How can this rubbish be foisted on the once proud nursing profession? The answer is simple, and takes us back to Flabby-Jowls herself.
By this stage you must be beginning to understand why doctors’ hearts sink when a nurse-consultant approaches. How can this rubbish be foisted on the once proud nursing profession? The answer is simple, and takes us back to Flabby-Jowls herself.
Don't mention Hattie Jacques to the new chief nursing officer. After only two weeks in her new post, Christine Beasley has already had her fill of references to the "oooh, matron" character embodied by the Carry On star. By Beasley's own admission, it is now two decades since she went near a bedpan. The GuardianThat’s right. She has not had any practical nursing experience for years. Years and years. Look at her c.v.
Career 1962: began training at Royal London hospital and worked as a staff nurse before taking 10 years off to have a family; 1984: assistant director of nursing, Ealing health authority (HA); 1986: assistant general manager, community services, Ealing HA; 1987: director of community nursing, Riverside HA, London; 1991-92: acting chief exec, Riverside HA; 1994: acting regional nurse director, North Thames regional HA; 1995: regional nurse director, North Thames; 1998: regional director of nursing and operational development, NHS London; 2002: head of development and nursing, Directorate of Health and Social Care; 2003: partnership development director, NHS modernisation agency.Nursing, real nursing, has no chance of surviving whilst ridiculous women (and men) like this are running the profession. Flabby-Jowls has no “hands on” nursing experience. The same applies to most of the upper echelons of the profession. And does she think she is a good role model for nurses and patients?
Obesity is a huge concern for the nation, and a cursory glance at a typical nursing or midwifery conference reveals that a signif icant proportion of this stressed workforce are failing to follow the healthy eating agenda, hampered by the often dismal offerings of hospital canteens and the curse of disrupted eating patterns on shift work. Beasley's response is surprisingly at odds with the idea of the "role model" aspiration the government has for smoking. She says: "Sometimes it is very useful to share the same problems with patients, because you recognise it is difficult." A case of a mixed message, to nurses and the public alike. (The Guardian)
Christine Beasley's eating habits are a matter for her. But, one wonders, if she were not sitting at a desk producing protocols all day but instead rolled up sleeves, went down to the ward and learnt how to do some basic nursing we would not all be better served? It is not going to happen.
For the time being, doctors are (with difficulty) surviving in this environment, for even the lowliest houseman is better trained and more knowledgeable than the nurse-consultant and can take a step back and laugh. The junior nurses cannot. If they do not follow every diktat of preposterous people like Christine Beasley, they will be out of a job.
Labels: Chief Nursing Officer, Christine Beasley, Productive Ward, psychobabel
72 Comments:
I don't see anything intrinsically wrong in anything which the staff at ground level have done to implement this scheme. BUT, is it not all common sense stuff which the ward managers should be seeing to anyway?
What on earth this has to do with Chris Beasley's weight, I've no idea.
It's to do with consistency of message, and leading by example:
Obesity is a huge concern for the nation, and a cursory glance at a typical nursing or midwifery conference reveals that a signif icant proportion of this stressed workforce are failing to follow the healthy eating agenda, hampered by the often dismal offerings of hospital canteens and the curse of disrupted eating patterns on shift work. Beasley's response is surprisingly at odds with the idea of the "role model" aspiration the government has for smoking. She says: "Sometimes it is very useful to share the same problems with patients, because you recognise it is difficult." A case of a mixed message, to nurses and the public alike.
+++++
Truly a mixed message.
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I don't see anything intrinsically wrong in anything which the staff at ground level have done to implement this scheme. BUT, is it not all common sense stuff which the ward managers should be seeing to anyway?
that is really worrying, and is the whole point. The reason the nursing profession is going down the tubes is that people do not understand that nurses need to get on with some work, rather than writing silly protocols about how to wipe bottoms.
John
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great piece,
the problem has been created by nurses themselves, the psychobabbling management climbing fatties who quit ward nursing when their stomachs outgrew the quality street supplies,
mind you, medicine is going the same way as trainee doctors are now forced to fill in ridiculous amounts of useless paperwork
Well that's us nurses summed up pretty neatly.
Lions led by flabby donkeys.
Roll on September when I enrol in plumber's college.
"that is really worrying, and is the whole point. The reason the nursing profession is going down the tubes is that people do not understand that nurses need to get on with some work, rather than writing silly protocols about how to wipe bottoms."
Okay, tell me what is wrong with ward staff realising that at mealtimes:
1) It's taking a long time to get the meals served
2) Because of this, some patients are getting cold food
3) Whilst all this is going on, the staff are too busy doing other things that patients who need help to eat are not getting that help
... and then trying to address the problem by liasing with the catering department regarding the storage/serving of food, and introducing protected mealtimes so that staff have time to feed patients?
These are all sensible ideas, and are infact indicative of excellent nursing care. What is sad is that this is not going on all the time anyway, and these hospitals apparently require a "problem solving for dummies" 'toolkit' to be foisted on them by the DoH.
As for obesity - I'm sure we could find a few obese senior doctors too, y'know...
A few years ago I was a newly admitted patient on ward that got an outbreak of D&V. Looking throigh my records there is form filled in my nursey.
"How should this patient be protected from this outbreak?"
Patient should be moved to a nursed in side ward. Box ticked.
BUT I WAS NOT MOVED -and a poorly elderly woman mistook my bed for the toilet.....lovely!
However -the paper work gave me good virtual nursing care - -a shame I wasn't a virtual patient.
And you would have thought that the job description of an assistant sevice improvement facilitator might include improving the service patients receive. Not so. Improving the service in this sense merely means allowing the trust to hit (or seem to hit) government targets. If you ask them to facilitate an actual improvement in the service you can forget it: They are too busy trying to identify "high impact changes".
Many of the ideas these programs come up with are sensible. The trouble is they are just what any well led ward or institution would be doing anyway, and the paperwork and committee hours spent on this and other initiatives are draining the NHS to dryness.
But they are keeping people in government jobs which is after all the only object of the exercise
We have a number of Modern matrons. (Two I think but I have never counted), No idea what any of them do all day, at least I didn’t until I found some minutes from a meeting they were in about implementing “Essence of care” bench marks. Funny that the monumental importance of “Essence of care” must have passed me by, can’t think why.
In defence of hospital canteens the one at my hospital produces very good food considering their budget.
Weight is an issue that came up a lot when i starting clinical medicine.
In a couple of hundred medical students we only had a couple of higher BMI people. In the hospital it was comented on by many that the large majority of the nurses were overweight.
I always wondered why until i did attachments and saw that the juniors never got a protected meal break (and for the first time in my life i didn't eat for a day) whereas the nurses had biscuits and sweets galore in the "tea room".
If you want good working relationships give the juniros a sweetie. We will get bigger and happeir and the nurses will maybe loose a little wieght and good feelings will abound.
My god i need typing lessons.
Sorry about the poor quality of the above posting.
I have been nurturing a little theory that I would like to share, and one I believe Dr Crippen has advocated before, but for politicians.
It is simply this - leave the design of services to those who actually provide and use them, if we need a bit of outside help we will ask for it.
If policy makers (in either medicine or nursing) are divorced from the consequences of their decisions then they can get up to all sorts of shenanigans.
To use an old cliche "don't ask for something you are not willing to do yourself".
If a nurse or medical policy maker (or senior manager, of course) thinks a 30-bedded ward can be run by a couple of knackered RGNs + HCA, then this policy, with the name of the person responsible for approving it, should be the first bit of information supplied each time a complaint arises (such as 90 deaths due to inadequate infection control measures).
If Christine Beasley & Co think they can do any better, then put on the uniform and lets see them get on with some real work.
Maybe it's just that the nurses are healthy and the medical students are sick http://www.theage.com.au/articles/2008/03/24/1206207070339.html
i absolutely agree with you DR C...i work on a foundation liver ITU and i hate the waste of resources...come visit us on a wednesday morning and you'll find no less than 5 G grades...2-3 doing admin time or "floating" the charge nurse AND a manager...visit on a sturday night shift??? if you're lucky just one G, one F and the rest band 5&6 and overwhelmingly foreign nurses!!!
everytime i make a suggestion about clinical skills/practice that would benefit the patient...i'm told this is the NHS, we don't have funds for that!!
the amount of paperwork in the form of audits, lists and reminders which they childishly post in the toilet is truly amazing!!!
the latest is the staff refrigerator policy...it starts out with..
no carrier bags, please use the clear plastic bags provided...
i am not joking here.
"And we are not talking here about protocols for complex medical procedures such as lumbar puctures. We are talking simple things like handing out lunches or feeding patients."
You got it. At my trust we now have a "Peripheral Venous Cannula Care plan". This runs to four sides of A4 (admittedly the last 2 are for repeat signatures). This needs to be completed every time a cannula is inserted.
The form states that: "Only staff who are competent and have evidence of competency in cannulation may insert the peripheral venous cannula. PVC insertion must be performed in accordance with CP 01 ’Protocol for the performance of peripheral venous cannulation’ following the guidelines as detailed in the Royal Marsden Manual (Chapter 14)"
Okaay. So as an anaesthetist of 7 years experience I now can't insert a cannula because I don't have evidence of competency in doing so. Can someone please tell that to every specialty houseman who phones me at night to put a cannula in when they have failed?
This document was put together to try and prevent cannula associated infections (laudable enough).
Hmmm. Which group of doctors puts in the most cannulas (or is it cannulae - sufficiently modern doctor not to have studied the classical languages)? Anaesthetists.
How long do most perioperative cannulas stay in for? Less than a few hours post op.
So we now have a form designed by nurses with no input from the group of doctors who are going to have to fill it in the most. A form that is going to add a couple of minutes per case on my list (OK if I only have an all day case, 20 mins if I have 10 cases) which then may cause a list to overrun and a patient to be cancelled (such is the militancy of theatre staff)all to prevent a problem that won't happen because the cannula won't be in long enough to cause an infection.
Inspired!
An irriated gasman
'Hands on Nurses' seem to be a dying breed. What is worse though, is that nurse 'managers' (term used VERY loosely) are culling them.
Apparently, in the world of nursing having your own office makes you judge, jury and executioner. My Mother someone who spent more time on the ward she worked on than in our home, was an extremely 'Hands on nurse'.
Unfortunately, ward politics and back-stabbing from the top means she is now suspended. For what? Not saying please or thank you?! I kid you not. Suspended for a year, not told why, frog marched off the premises, told not to contact any of her colleges.
Nursing has been my Mothers life since she was 17 (she is over 50 now) she has very few friends that are not nurses. Did anyone care that she had a complete nervous break down.... only our GP and the long suffering family.
Not however, the hospital she dedicated many years of service to. No not one bit, no apology a kangaroo court full of personal attacks she couldn't answer, and a years probation. For.... not saying please or thank you when in a highly stressed situation.
I worked as a health care assistant for 3 years while waiting to be seconded for nurse training (which thankfully I NEVER did). If I reported every time a nurse, patient, doctor was rude to me there wouldn't be much of a profession left.
Worse, only five years ago while working at the same hospital that has disciplined my Mother. The then nurse 'manager' told me it was a 'big girls world' and I had to 'deal with it' when a patient trapped me in his room and groped me.
As far as I can see, nurses make bad managers because the people in those jobs. Seem in my opinion to be the ones that didn't want to be 'hands on' in the first place. Worse I'd say struggled with putting the patient first to begin with.
Nurse 'managers' seem to be the type of person on the ward always found time for their break, even using the guise of paperwork. Went home on time, and complained to anyone that would listen when they had to be there for 2 minutes after their allotted time.
However, then again I might of just met bad senior nurses, and if so I'm sorry my views are warped or caused offense.
Well now I have a "claim to fame" here as I have been nursed by the one who tided a cupboard! As a post op patient I was in agony and did she care.........well go on you don't need 3 guesses ! So long as the cupboard was tidy after all Dr!
Actually, I am not sure that all the irksome protocols can be blamed on nurses. I think it is down to Trust Policies on Health and Safety/Risk Assessment /Clinical Governance. All staff are reduced to the lowest common denominator to mitigate risk - including gasmen.
Christine Beasley - not quite sure how relevant her weight is, and I fear that weight fascism is rife in the NHS as in the rest of western society. Weight is also ,as you Docs should know, related to social hierarchy.
I think one of the most regrettable changes in nursing was introduction of the Nursing Process during the 1970s - all this endless pointless analysis of the role began at that point.
Like many senior nurses I fled from hospital because it was worse than a dogs life.
PS We had a consultant cardiologist speaker at our primary care education session earlier this evening- he enthused about how 'his' nurse quacktitioners had dramatically improved patient outcome and access to expedient clinical treatment. Put that in your pipe and smoke it Dr Crippen.
And what might have been a good post is ruined by childish references to Christine Beasley's weight.
Of course, all those fat, drunk, fag-smoking doctors I've met in my career must be a figment of my imagination.
But that's just tit for tat, so let's get to the meat of the post. In a former life as a practice development nurse, these kinds of initiatives landed with a heart-sinking thud on my desk on a regular basis. The dullards in the CNOs department and other higher echelon nursing posts have to justify their existence by producing this kind of tripe every now and then. Essence of Care, for instance. Did the audit. Did it make a blind bit of difference? Did it fuck, but at least the box got ticked and the DH were off our backs until their next momentary enthusiasm came along.
It's all best ignored, consigned to the circular filing cabinet, whatever.
The problem is not that nurses want to become managers, it's that only the crap seems to float to the top. Be a lickspittle, forelock-tugging, protocol-loving robot and you'll clamber up the ladder. Actually think for yourself, and you can find yourself very isolated.
Nowadays, I teach mental health nursing. The CNO has had her sticky fingers all over our curriculum. She's never taught in her life, she's not an educationalist, she's never been a mental health nurse but she's banged out thousands of words about what we should be doing. And we all have to do it or else.
I'm getting out of the whole nursing arena as soon as I can. It's terminally fucked, and people like Beasley are responsible for that.
"even the lowliest houseman is better trained and more knowledgeable than the nurse-consultant"
Fucking bollocks. Back that assertion up, please. You completely undermine an otherwise extremely well observed and written blog.
Idiot. Arrogant idiot.
If we don't do direct patient care, we get bollocked or criticised, if we don't do the paperwork or follow the protocols we get bollocked or disciplined. And people wonder why so many of us have lost the ability to care!
We're a fucked up profession (debate the appropriateness of the term 'profession') in a fucked up NHS in fucked up country run by self serving dictators. Probably a few politicians as well though they don't seem to have a lot of effect.
Am I a pissed off nurse (30 years experience)?
Do bears shit in the woods?
It is an interesting thing that in the TV soaps featuring nurses, they are all nice and slim _ and you can see the patient (star I guess). However the shows that are filmed in real Emergency Departments (I guess the producers want to show the excitement) the patient is so very often obscured by a "Curtain of Nurses". Certainly the nurses you see at conventions and in the nursing journals (always holding a glass) demonstrate that the gaining of status appears to be ugleogenic.
Perhaps the preception of the nursing profession portrayed in the TV world is even more distorted than we think.
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I thought your comments were very insightful - cough ! especially the comments about nurse x's jowls... [ this is me being sarcastic btw ]
But although I did laugh I admit !
I berated myself afterwards, you were blatantly rude and a touch hurtful, dont you think ?
I am a nurse and I should have been a bit enraged at your
' rant '
However, you should give nurses a bit of a break, they are pawns in a game, played by politicians, managers etc.
You are a dr you know that ?
MOST nurses work very hard and are very well intentioned, so try to be a bit nice to them .. please
Who made you in the nurse police ?
But I agree [ bar the rude comments ] with your general sentiments .. just dont bully nurses, they are a SOFT target ...
why do you hate them so much anyway !
I'm confused (easy, I know).
The title of this article is '"Productive Ward" - more codswallop from the nursing hierarchy', but the Productive Ward material is produced by the NHS Institute for Innovation and Improvement. One of their board members was a nurse (Professor Tony Butterworth CBE) but the other 14 weren't as far as I can see. Were nurses somehow responsible for setting up this department? Is it nurses that buy the training material from the Institute? Why are nurses at fault in this example?
Nice post Dr C. Excellent use of italics and block quoting. Videos laid out in good order and not so many typos.
I think it would have benefitted from some use of Monty Python and perhaps a touch of some completely obscure random link page to a Delia Smith cooking recipe.
Anonymous: Mon 8:04 - Fuck off and get your own sweets.
Protocols are bloody useful. Someone should write a protocol on constructing protocols tho.
The irriated gasman above has a point about being consulted. Nurses cannot write protocols for other professions to follow - those who perform them should write their own.
Protocols stop medics and nurses from cutting corners and doing silly little things like amputating the wrong leg.
They also reflect clinical governance and ascribe accountability.
Personally, I'd be happy to bodge on with the job as sometimes there are many ways to skin a patient and the risks are negligible (eg PVC). However, until such time as I see a medic stand up and defend a nurse who gets berated or suspended from duties for 'not following protocols' or for using initiative to save the team time and then seeing the rest of team disappear into the shadows while they are left out to dry - I will protocol til my arse is sore.
Who can I rely on more to support me in my hour of 'oops I fucked up' - a formally constructed protocol - or a junior houseman or even senior consultant who might put up their hand and say "yeah well it was a mistake and that happens so lay off the nurse - we're a team here"?
Man alive, reading this really brings home how much good ACC does for docs and nurses alike here in NZ. For people who haven't heard of it before it stands for Accident Compensation Corporation, and it covers ALL medical and nursing mishaps so 1) doctors and nurses cannot be sued no matter what happens and 2)if a mishap has truly occurred, the patient always gets compensation
This has a huge knock on effect, particularly where defensive medicine and excessive documentation is concerned. Neither docs or nurses spend all day writing down every last little thing and what they did and what so and so said and thought and blah blah blah. The nurses nurse, and do a great job, and the docs do their job, and it works really really well. If something happens, the attitude is "Why did this happen? what can we do to prevent it in future?" as opposed to "Who did this? How can we punish them for their misdeeds?" which is a stupid fucking attitude in any organisation that needs good staff and good organisation. I noticed this straight away when I came out here from Ireland, where litigation is probably higher than the USA, and nurses do almost nothing but paperwork and forms anymore, covering their asses, and we in turn, scribble notes and refer and unnecessarily scan etc etc, trying to cover ours.
"Weight is also ,as you Docs should know, related to social hierarchy. "
No, except for those rare examples where it is caused by a genetic fault, it's 'related' to being too greedy and too lazy...
Social hierarchy has sod-all to do with it, as you might have realised if you took your nose out of your A level sociology textbook long enough to note the plethora (that means 'an excessive amount' by the way...) of fatties in the dole queues.
spot on AE CN
mens sana has hit the nail on the head, really.
Some policies (not cupboard cleaning, alas, alack) are quite sensible and dare I say useful, in theory. However, the way they're put together (and more importantly, the time they take to put together and 'roll out') are prohibitive. Couple this with the pressure nurses are put under to complete the protocols (that's a posh way of saying 'tick the boxes') and you have a rather silly situation.
Someone has already commented that these policies are only things that good nurses should be doing anyway. Like the 'Nursing Process' and the rest of that style of thing. The lack of good nurses makes this, inevitably, impossible.
As a student of this fair profession, I've come to accept that being a good nurse in the 21st century involves looking after patients whilst navigating hoops and dips thrown at you by various bodies and groups. I can live with it. Until I get another experience to go and do my job in another country, at least.
Good post, except the video froze my pc (my Bullshitwall works again).
Surely it's not just nurses or not just the NHS, it is the never ending ascendancy of managerialism and, worse, managerial consultism.
Ask a teacher, a police man, a civil servant and it's the same.
I sit on a local commissionning group and we had to spend a morning learning about "World Class Commissionning" ie, common sense with a shitload of jargon, diagrams and paperwork.
I know a guy who has just started working as a Management Consultant for Lord Darzi (he is avoiding me at the minute for some reason) and there are three different lots of Consultants advising the Darzi team so they have just got a fourth to advise and "coordinate" the other three.
Didn't Douglas Adams lump them with hairdressers and telephone sanitizers in Hitchiker's Guide to the Galaxy? Ah well, their day will pass and there will rejoicing throughout the land.
Ahh yes, the 'B Ark' ridding golgafrinchim of an entire useless third of their population, whilst inadvertently populating earth with a group of people who couldn't make fire but knew how to run a formal meeting by the agenda - and who said satire was dead.
Dr C's comments about Ms Beasly's weight are a little cruel, but accurate - and sadly there is a high level of obesity amongst nurses and care assistants. There are fat doctors (I'm one) but many fewer than there are fat nurses - certainly not having rigidly proctected meal times helps keep juniors weight down! However there are more alcoholic/addict doctors than nurses as a proportion, but then more nurses are murderers as a proportion (Shipman distorts the 'numbers killed' but is the only doctor convicted of Murder in the UK for many, many years). None of this is relevant to the debate about protocols, and B***s**** emanating from the NHS.
Someone above said 'protocols are important' - well to an extent it helps if people are aware of good practice and that we try to be consistent. However rigid protocols are seldom appropriate for patient care - as patients are individuals who need individualised care and treatment. That we need a protocol to say that patients should be fed warm food, on time and assisted when required just shows a low point care has sunken too on the wards of this nation. That someone thinks that sorting out the cupboards so that the 'airway stuff' goes in the 'airway section' and the 'nutrition stuff' goes in the 'nutrition section' is worthy of a proud report simply beggar's belief - I'm proud to announce that we've centralised all our nappy changing gear in one easy to find drawer under the changing table -FFS!
Dr Cs comments on Ms Beasly's CV are spot on - and sadly the same can be said of our much-unloved Chief Medical Officer, again irrelevantly a Jowly B****d.
Protocols may not be written by nurses, although many are, but they are written by trust management teams who are heavily influenced by 'nurses' in the mold of Ms Beasly (sadly she did not break it!)- those who feel that obsessively 'documenting' everything means that good care is being given, those who believe that writing down step by step guides mean that good care is being given. And then they move into trying to tell doctors what to do - in one place I worked a 'practice development nurse' lectured all the new start Junior house officers on how to put in a venflon - 'think pink' was her phrase, and 'always use the Anti-cubital fossa (inside of elbow)'. And why did she spout such nonsense? Because those where the only venflons she could get in and she was never there at 3am when Mrs No Veins on intravenous medication venflon gave up becuase the elbow had been flexed one to many times, and never had to try and resuscitate someone using one of her inappropriately sized venflons. It took me and my colleagues months to undo the damange, and yet this B***dy woman was allowed to continue preaching this rubbish and has no doubt now written some BS protocol for everyone to follow.
Protocols can lead to hidebond care - I recently spent 2 hours sorting out putting a patient onto a pain relieving medication by a slightly unusual route because that was what was best for him - 5 minutes to discuss and agree the plan with the patient, 30 sec to write the prescription and then 1 hour 54 mins and 30 seconds getting the nurses to do something that was 'not protocol' - not becuase they could think of a single reason why my plan was not reasonable but simply because the 'protocol' (written by other nurses needless to say) didn't include this route of drug administration. 2 hours of my time is not that precious to me, but it was two hours that I could've spent seeing other patients who were post-operative, pre-operative or otherwise in need of an anaesthetic review. "Productive ward" my arse!
Mr Ian,
Go on give me a sweetie :)
You have oh so many and we have none!
I do actually bring in extras for the ward (Tesco finest fresh cookies go down a treat) however there is never any left when i come back :(
Signed,
A poor hungry junior with a sweet tooth.
Dear all, sadly this post sums up Britain. A nation obsessed with pompous language and ineffectual action.
I could not listen to the all of the video. What complete and utter tripe. I pray to God I never get ill.
Dr Jane Doe: I agree - Human Error approach is far more sensible to dealing with errors. But it needs managers to implement it and management managers to accept it as, dare I say it; protocol.
Picking up another point; Anon 8:04 - again:
"In a couple of hundred medical students we only had a couple of higher BMI people. In the hospital it was comented on by many that the large majority of the nurses were overweight."
Why do medics have a 'higher BMI' and nurses are 'overweight'?
And if that's the same Anon 11:37 just above "I do actually bring in extras for the ward (Tesco finest fresh cookies go down a treat) however there is never any left when i come back" - I think I found out who's making them overwieght.
Stop putting cookies in the nurses hand you frkn eejit.
No wonder you're hungry and poor - how the fook you managed to survive medical school....
And finally.... to the Gas Man (who I like but....)
"However there are more alcoholic/addict doctors than nurses as a proportion, but then more nurses are murderers as a proportion"
When a nurse kills a patient thru negligence - it is pressed as a murder charge.
When a doctor kills a patient thru negligence - it is hushed over and watered down and filed in a dark cupboard.
Just another example of how the medical profession supports its members better than nurses.
If nurses had the same support as medics then who knows.. Beverly Allit could have been the next flabby jowelled Chief Nursing Officer.
Mr Ian - there is a difference between MURDER and negligence. Are you telling me (baring in mind I am a grantham born guy who actually knew some of the victims as he grew up) that Beverly Allit didn't murder but instead was 'negligent' and needed 'the same support as medics'.
That is plain obtuse.
Gasman - you are mistaken if you think that the cannula forms are designed to PREVENT infections. They are designed to BLAME infections on someone. I myself recently got dragged into an office by a jumped up infection control nurse monster and the microbiologist to examine 'what went wrong' with a patient I 'gave MRSA to'. Why me? because their cannula site which i put in (on admission) got infected (48hours later).
James
Mr ian,
The students and juniors can wear clothes that make it hard to say they are "overweight" the uniforms that the nurses wear let you know they are.
I can't stop bringing in the cookies as that makes them happy and me not get grief.
I don't think 10 cookies a week between the nurses and HCA's is doing the damage :)
I survived medical school a adelicate balance of wit and charm...it's all used up now so all i have left is a bag of cookies and puppy dog eyes.
Mr Ian on the murder thing, the cases i can think of recently have all been nurses deliberatley "topping" the patients.
Apart from shipman i can't thin kof any recently where a Dr did it on purpose.
Jane_T
I'm confused (easy, I know).
The title of this article is '"Productive Ward" - more codswallop from the nursing hierarchy', but the Productive Ward material is produced by the NHS Institute for Innovation and Improvement. One of their board members was a nurse (Professor Tony Butterworth CBE) but the other 14 weren't as far as I can see. Were nurses somehow responsible for setting up this department? Is it nurses that buy the training material from the Institute? Why are nurses at fault in this example?
Agreed, its not the nurses faults that they have been handed down this crap from on high.
Fact is the whole productive ward thing is effective. Its a smashing idea. Its a smashing idea based solely on common sense and not requiring a full elcture series and coloured crazy diagrams.
In the time it took some muppet to come up with the module names they could have looked ona ward, realised the crash trolley is always in the way of moving beds in and out, that having a stock of Inco pads and vomit trays in each bay would be really handy, that for surgical aptients having their full set of notes in the trolley is not needed, and instead a ring binder with their recent admission ntoes is far better and easier. [still trying to get my wards to do the latter! trying and failing]
mr ian - if nurses don't get the same support as doctors, it really is largely our own fault. As a profession, we are divided, lackadaisical in support of our colleagues and suffering from a chronic case of tall poppy syndrome.
To those moaning about protocols, consider them another product of the compo culture. Go off protocol, and there's the fear that someone, sometime might sue you.
If any of the women who were ward sisters when I were a lad had been on the reiceiving end of this patronising, dumbed down, protocol led bollocks, they would have stuffed it up the arse of the nearest 'nurse manager' lit the end and retired to a safe distance before the inevitable explosion of all the gas and wind contained in these people.
But then, these sisters were REAL nurses.
There are 6 jobs up for grabs, be quick, the gravy train is leaving the station soon.
How's about this for £50k to £62k:
'We are looking to fill a role in our Building Leadership Capacity team. The team exists to guarantee that the NHS has a constant stream of high potential future leaders in the pipeline.'
Or this for £42k to £52k:
'We are looking for an Associate to join the Learning Team to promote the NHS Institute’s products, concepts and models of innovation and improvement to the wider national HR, OD and workforce community. You will be responsible for specific projects and programmes which support the work of the NHS Institute and its priorities. You will also play a key role in scoping and making proposals for activities which will influence, inspire and motivate the HR, OD and Workforce community to incorporate improvement models and concepts at a local level.'
http://www.institute.nhs.uk/option,com_jobline/Itemid,554.html
ok I concede death by negligence is manslaughter, not murder. But the principle of professional support was my point.
In answering the nurses killing patients - I could debate the morphine scripts in palliative care... but hey.. I agree with euthanasia.
Anon cookie supplier: 10 cookies a week. Tight arse. (yes I am arguing both sides.. it's fun)
Nurse Lecturer: Agreed. Nurses let nurses down. I'm not about to blame medics for our own failings - but some help would ...well, help.
And finally; Crippo -
Those REAL nurses still exist but are very quickly stamped on for being anti-establishment and non-concordant with the organisational 'protocols'. I like to think that's why I can't get promoted anymore.
Ah Mr Ian i promise if i get an ST post it will go up to at leat 15 a week!
If not then i will be one of the HCA's grubbing around for a free cookie ;)
The sad thing is that i am actually wondering what job i could do if i don't get a training post...never thought it would be at the forefront of my mind 5 years ago.
Of course junior doctors are more knowledgeable & trained than nurse practitioners! What training have NPs had? A nursing diploma, plus "courses" full of psychobabble, plus a Masters in gobbledegook from Shitsville ex-poly from the arse end of rubbishtown.
Doesn’t a lot of the problem come down to pay? The only way for an experienced nurse to make proper money is to move into management so they do that even if it isn’t where their strengths or interest really lie.
My wife is a physio (and a very good one if patient satisfaction is the primary criterion), but despite being a true believer in the NHS she has found that the only way to earn a decent wage is to work in BUPA hospitals or for herself.
If she’d stayed in the NHS she would have had to move into a supervisory role to earn the same money, and she didn’t want to do that because it’s treating patients that really interests her.
If this is an issue for nurses too – and I’d like to know whether they think it is – the answer is to pay good hands-on nurses more.
Anon 3:17
Fuck off you're a twat
Anon with cookies: if you want a job in psych it's at least a packet a day.
Anon 3:17 - I agree with Anon 4:17
(are you related as you both have the same surname "17"?)
Rob: As a shop floor nurse I make more than my manager (and their manager) due to shift loadings and overtime opportunties etc. To be a higher paid hands on nurse I would be happy to advance as a clinical practitioner (or lecturer) but there are few opportunities - which is another reason I welcome NPs.
Dr Crippen: Do you bring your practice nurse cookies?
Mr Ian,
Thanks, I’m genuinely interested to know whether pay is an issue or not. So you can advance up the pay scales without moving into management?
Would that still be possible if you wanted a maternity break or to work part-time, say?
Snoresville rules again. Same old rant, same old same old.
How in heavens name do people take the offensive material you write seriously?
Goodbye.
Mr Ian, I know. It's a crying shame. Whenver I meet a good, caring, praactical nurse who enjoys working on a ward and actually looking after people, they are in the process of being smashed to pieces by the kind of person attracted by dr snuggles' adverts.
Being (I think) of roughly the same vintage as my near namesake Crippen, I understand why he goes off on these rants. It's desperation. You have to have worked in the NHS for as long as I have to expereince the dunmbing down that has gone on over the last 30 years, and the advance of the mediocrity that has taken place.
I repeat; some NPs are excellent. Many nurses are superb. Many doctors likewise. But they won't be around for ever if the likes of 'jowly' have their way.
I notice the fat, ugly nurse you highlight in your picture has a CBE. Do you?
So nursey isn't by the beside holding hands and wiping arses...tut tut. Btw an old (45 plus) man's arse is so much harder to wipe clean of shit than a woman's. It gets into all the creases (and there are many) that are known commonly as BOLLOCKS.
Mr Ian, as a medic I have defended nurses who didn't follow the protocol, but I was told off by managment. It was not my business. In the Netherlands we alos have protocols but we are better in bending the rules and in making exeptions when common sense requires this. Fear is ruling the NHS, and nurse-managers.
I think one of the most regrettable changes in nursing was introduction of the Nursing Process during the 1970s - all this endless pointless analysis of the role began at that point.
here here
Dr C .. you are spot on.. nurse ratchet and co are wizards in reinventing the obvious and GET RID of them.
They are idiots.
Hospitals should be run by drs and Nurses
not blathering idiots like the aforementioned person.
Mr Ian:-
"ok I concede death by negligence is manslaughter, not murder. But the principle of professional support was my point.
In answering the nurses killing patients - I could debate the morphine scripts in palliative care... but hey.. I agree with euthanasia."
Much cleverer people than yourself have debated the principles of pain relief shortening life span from moral and legal standpoints.
As it stands there are few that disagree that if a person is in pain and you give them an acceptable dose of morhpine and it shortens their life span then it is neither manslaughter nor negligence nor euthenasia.
Just the other day I effectively 'topped' an old lady. leaking 10cm AAA in 90+yr old, the poor lady was for TLC and in pain. I hooked her up with a diamorphine syringe driver and within 4 hours she was dead. Would she have lived longer without it? undoubtably. Her obs were relatively ok, she probably would have gone on for another day or two.
You are arguing I effectively euthanised/murdered her. I would say that the far far more unacceptable answer would be to leave her in pain.
But once again it brings us around tou YOUR original inference. Allit was not trying to treat pain. Nor was Shipman, nor were those two most recently convicted nurse. They were trying to kill for varying reasons from attention seeking to money seeking to some misplaced social crusade.
I reiterate to compare those people with everyday staff and everyday actions is offensive.
Goodness me, you post something here go away and do something useful, comeback and blow me if the debate has not deteriorated into 'F**k off you T**t'.
It is a shame that the two commonest ways for nurses to be paid more is a)to become a manager or b)to become a pseudo-doctor. Simply being a damn good nurse no longer seems to be worthy of reward - despite the fact that one of the few good bits of 'nursing research' about shows that ward nurse:patient ratios have an impact on mortality. Yes, that's right - people who are not closely looked after by proper, trained nurses DIE more often than those who are. And thats not nurses sitting in offices, or nurses playing at being the houseman during H@N, thats good old fashioned ward nurses who care for their patients. As someone who works in ITU, I have no doubt that the biggest single factor which improves outcomes is the 1:1 nursing - these nurses are generally extremely experienced and are confident nursing very sick patients, but they don't try and be doctors and I don't try and be them.
And yes, I believe there have been many more prosecutions for manslaughter by gross negligence of doctors than of nurses - murder is very different. I agree that the regulatory authorities in nursing are frequently harsher than medical ones, although the GMC seems intent on closing this gap, but this is not the same as criminal prosecution.
Anon 11:57
"Just the other day I effectively 'topped' an old lady."
And a noble thing you probably did. Unfortunately, and in your opinion, I am not one of the 'much cleverer' ones who is able to reason that death is not the worst thing in the world.
As for offending you - thios is Crippen's site - if you don't like to be offended by others opinions go to disneychannel.com
Anon 7:36 -
"I have defended nurses who didn't follow the protocol, but I was told off by managment."
Sorry for your loss.
If you are friends with an orthopod perhaps he can arrange for a new backbone?
Rob: Advancing up the ay scale is very difficult if you want to stay in hands on care - NPs offer an opportunity to do just that and I believe there are those nurses who provide excellence of care that deserve to be paid more and take more responsibility. I would agree there is much debate about the extent to which NPs should take responsibility and on a clinical basis alone I prefer the status quo - nurses actually remaining as independent care deliverers and team players - not independent diagnosticians. However, the NP drive is govt fiscal policy and stands to save substantial coffers.
Angry gasman: thanks for the support
Anon 10:42 -
"Hospitals should be run by drs and Nurses"
They tried this. The govt made Trusts who were individually accountable for managing their service. The Trust made a heap of nurses and doctors into managers who dealt with the issues that were presented to them. They failed to deal with the issues that weren't presented to them or the issues that lived within the issues. So the govt said - "Look - this is what you need to be sorting out" and they called them "Targets". Trust management then went "Ok let's go for targets" and forgot about the other issues until more targets were developed.
Trusts are shit at seeing the bigger picture and planning for the next 5 years because they are staffed by clinicians who are only good at healing people; not developing a 5 - 10 plan. Plus they are isolated to their own geographical area and are selfish to their own needs.
Managers are nothing more than puppets now and the chasm between govt and managers is so big that they have no idea what the govt really wants unless it is pointed out in a nice document with idiot proof bullet points called targets. Hence Crippen's post on "Productive Wards" - I mean - wow - we're supposed to be productive?
Targets are measured by outcomes. Desireable outcomes are determined as moving from position A to position B.
The moving is done by clinical & administrative staff and the NHS puts out a whole training package about how to efficiently 'move'.
I much preferred it when we just did the illusion of moving.
I much preferred it when we just did the illusion of moving
What makes you think we aren't still doing the illusion of moving? Targets are just a new part of the illusion. Yes, people aren't languishing on trolleys in A&E any more because they're languishing in 'beds' in a bit of A&E that's been curtained off and called a 'ward'. Or they're going on a little ride round in an ambulance, waiting to take its place in the queue.
The one thing that DOES seem to be moving inexorably upwards is the rate of HAIs, despite all the deep cleans and infection control targets and quangos and commissions set up to provide 'quality care'. My mother died of one, in a so-called 'centre of excellence'.
This govt shoves marzipan on a dog turd and expects nobody to notice the smell.
Sigh. I am old enough to remember when the nursing cardex was the only documentation that was needed (as well as the obs charts, drug charts etc) and careplans were written by HAND for things like dressings to ulcers or a task that was very specific for a particular patient- sensible documentation that allowed you to make sure that wounds were being treated appropriately. It was taken as read that if you were looking after a patient then they would be washed, fed, toileted etc etc as this was basic nursing care. Now the paperwork is the "cover your butt" kind. If its not documented, it wasn't done...I place the blame for this squarely in the lap of the US. The last 20 years we have continued to suck up every bit of litigious crap that has come over the pond. As for the productive ward.....hmmm. Whilst I agree that sometimes it does help to have an outside eye to spot ways that things can be improved, this is another load of crap. Why do the nurses on my unit spend 20% of their day filing, sorting out admin problems, dealing with the kitchens, plumbers, hospital hierachy? Well thats because we have no ward clerk. She was laid off as the 18 hours a week on a Band 2 salary was obvioulsy breaking the bank. How many IR1s have I filled in this week alone because staffing levels on MAU were dangerous? Our monthly sisters meetings should be discussing these sort of issues- this month we are meeting with matron to defend ( yes, thats the exact terminology used on the memo) our infection rates. Now we all know that not enough staff=corner cutting so as far as I am concerned the fact that infection rates are higher on MAU than on HDU is directly linked to workload and staffing numbers....both wards run at maximum bed occupancy at all times but the turnover on MAU is far higher. HDU nurses normally have to care for a maximum of 2 very sick patients. MAU nurses will often be caring for 14 (many of whom are as sick as the HDU patients, they just haven't got a bed there yet).
‘Trusts are shit at seeing the bigger picture and planning for the next 5 years because they are staffed by clinicians who are only good at healing people; not developing a 5 - 10 plan.’
Interesting. Two great friends of mine (children’s godfathers) are hospital consultants in different parts of the country and different specialisms.
Both have said on more than one occasion that they are very happy for managers to take over the non-clinical work and leave them to concentrate on what they do best.
The problem is that a) they need better managers (ie ones that understood and were sympathetic to the needs of the medical staff) and b) those managers then need to be set free of spurious centralised government targets.
''Drs should be run by drs and nurses ''anon 1042 [ me ]
Angry gasman said :
''They tried this. The govt made Trusts who were individually accountable for managing their service. The Trust made a heap of nurses and doctors into managers who dealt with the issues that were presented to them. They failed to deal with the issues that weren't presented to them or the issues that lived within the issues.''
Oh !! well whats to be done then ?
However,I do think politicians need to separate their hot air [ any thing they say ] and their reelection agendas from the current issues in health care.
If managers become mini target police - that is not good...doing the work of the politicians.
Maybe the NHS needs to look at the way it commissions services ?
It is not exactly an innovative organisation, rule bound and finds it difficult to move quickly and adapt to changing conditions.
Anyway, there is a solution to all this and I believe it lies in mamaging health in a practical clinical manner.
Maybe the NHS is just a big slug - it is slow and gigantic .. I also think the NHS does support lethargy and a lack of accountability in many of the work force.. and I am not talking about the clinical staff ..
anyway Dr C's article aptly highlights this problem ... someone wants a promotion [ usually a manager ] they instigate a solution maybe via various committees, they impose it rigorously .. but really its not a solution but firefighting a bandaid ..
anyway I hae noticed that many [ not drs or some nurses ] but many in the NHS approach their work in a very robotic fashion, they are so hide bound by rules.. and there seems to be a general malaise effecting the organisation in my humble opinion
sorry I misquoted angry gas man - it was mr ian .. apologies .. :)
Well done Dr C, you've achieved the considerable feat of getting me really rather cross.... You've again demonstrated your unerring ability to go off half-cocked about something that you clearly have a less than complete understanding of. Oh, and had a go at the nurses. Again.
The 'Productive Ward' programme is not about drawing up endless protocols, it's about freeing up time to care because YES, that's what nurses should be doing.
They should not be wasting time walking from one end of the ward to the other because two bits of related kit are stored miles away from each other. They should not be wasting time looking for items that are put back in the wrong place. They should not be wasting time running down to stores because the ward supply of sutures has run out. They should not be wasting time getting quotes for equipment, chasing MEMS over a safety/maintenance issue or designing posters for a new initiative. THIS is the type of thing that a decent Productive Ward programme addresses.
Yes, a lot of it is basic common sense. However, nursing staff often don't get around to addressing these things because they spend their time doing their damndest to take care of the patients instead. What the Productive ward programme does is invest some proper time in looking at making the processes more efficient and removing waste, investing time so that time is ultimately better used.
This isn't some new-fangled management gobbledegook programme that The Institute have just dreamt up. it's the same, proven techniques that have been used in private sector industries and services for decades.
What's more, the productive ward schemes that have been implemented have generally been a resounding success. Clinicians find their jobs less frustrating, as their environment is now geared towards the carrying out of their roles. Their time is utilised more effectively, and so they can accomplish more in fewer hours. Ultimately, patient outcomes are improved. All of this is proven, evidence based fact. The 2 productive ward programmes launched at this Trust have ben universally popular and supported, by NS, Docs/Consultants, management and support staff alike.
The programme's direction is led by clinical staff, and facilitated by management and non-clinical support. You know why the latter are involved? Because Doctors and Nurses do not, in fact, know EVERYTHING. All your wonderful medical training does not make you, for example, an effective system analyst. That's why us awful non-clinical NHS staff exist - because the clinicians should be using THEIR training, and allow US to use OURS. Some of us even have qualifications you know! Proper ones, from proper Universities! Hard to believe I know.
Mutual respect between clinical and non-clinical staff is found throughout our Trust. Perhaps you might consider the concept yourself.
Hi NHS PEN PUSHER
I look forward to your comments, but on this one we will have to agree to differ. Frankly, I am surprised about your lack of insight. Of course the Mission Statement is about freeing time. What you don't understand is that this is an anal, over-analytic, load of codswallop the reductio ad absurdum of improving working practices. It is complete crap.
John
NHS pen pusher is probably aka c. beasley :)
A measured response to my borderline tirade Dr C ;)
It all derives from this:
http://en.wikipedia.org/wiki/Toyota_Production_System
and is, to my mind, a very logical and reasonable concept. Lean thinking has been applied successfully in many areas of my Trust. For example, Radiography DNAs have been cut drastically by applying the same 'Lean' service improvement ideas. I'm sure the benefits of cutting a swathe through the numbers of DNAs doesn't require any elaboration. Surely results like that prove its worth?
Dear pp -
the problem on the ward is very simple to address - you do not need advice from models used by toyota production systems.
The problem is ... shock horror...
theer are not enough trained nurses .. and by trained nurses I mean RGN's on the ward...
Now if this proble was addressed appropriately eg by employing adequate trained nurses ..
1] the pts would have good care
2] there would be time to tidy cupboards and maximise work place efficiency
3] managers would be left twiddling their thumbs contemplating their defunct and ridiculous management models..
Anyway, its not rocket science...
In a former life as a practice development nurse, these kinds of initiatives landed with a heart-sinking thud on my desk on a regular basis.
flashlights rc helicopter video games
The reason the productive ward actually manages to save time and improve quality- against measurable outcomes, is that it is an idiots guide to common sense and much needed as most nurses are intrinsically very dim, unable to take responsibility for their own decisions or even make them without feeling the need to cover their arses by writing ' doctor informed'everywhere. This is the reason why Nurses like myself left-to maintain our sanity. I do however take exception to the profession being belittled by Doctors- who never condem each other -eveing when they are very selfish, rude offhand and driven by money.
As a nurse with 19 years of bedside experience, I feel I am probably qualified to add my comments to this discussion. The Productive Ward initiative sounds a lot like the "Transforming Care at the Bedside" initiative in the US. And yes, it is also grounded in the Toyota organisation's management model.
Too bad I'm trying to care for patients and not churning out cars.
I left the UK for Canada 15 years ago. I have often wondered about the outcome of the 'Time and Motion' studies we were subjected to. Has it really taken 15 years to figure out that nurses at the bedside providing care equates to better outcomes?
Unless doctors and nurses in some way unite to fight bureacracy interfering in the provision of patient care, the industrialisation of health care will continue.
@NHSPenPusher - Oh finally I SEE...*slaps forehead*...It's "Lean" for wards!!! 'Lean' (similar to 'efficiency' in Olde Englishe) is a actually great concept that is currently very popular in hospital chemistry labs. When you're swamped by 2000+ samples a day (this is a typical figure), getting a 'lean' expert to come and tidy the place up, move all the equipment into more sensible places and generally streamline your processes by even a fraction can make a huge difference. In theory it's common sense, but sometimes you can't see the wood for the trees and you need the help of an outsider who does nothing else but look for inefficiencies all day.
So...we went 'lean' in our lab by going to a couple of informal talks and bringing in two outside experts for a few days. FFS it does NOT include 'investing' hours of your time in dull videos, huge documents in management speak, rainbow-coloured house-shaped diagrams and glowing testemonials from people with silly job titles.
I heard of "Productive Ward" a while ago and somehow I knew it would turn out to be something like this - a very simple concept, wrapped up in jargon.
As somebody that is experiencing the Productive process I couldn't be more happier. It's given us on the "Shop Floor" a voice!! All those little things that get in our way of actually caring for people are being looked at. It has given us the opportunity to make our ward near enough what we want it to be. Ok I agree it's all been packaged like something out of the Early Learning Centre but it's worked. Even the cynical of dinasours have come around to the idea and realised some aspects of our job have to change. PW is the perfect vehicle to achieve this.
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