I think this post describes a violation of natural justice, committed by the DoH and the self-serving managers who bow and scrape to obey their nonsense decisions.
Nurses (and others) choose to train and work this job to help people get better. Especially patients who want to get better, who co-operate, who make an effort. But for most of our working day, we can’t.
Some examples of how patients co-operate in getting and staying well.
Taking their tablets and depots, taking responsibility for collecting them, renewing the prescription, turning up on time etc.
Engage in, sometimes becoming equal partners in a therapeutic relationships with their psychiatrists, named nurses (on the wards), CPNs and CCO, psychologists and so on.
Patients who tell their CPN or GP or Mum when they think their symptoms are coming back, knowing it may, at worst, mean an increase in meds or a spell in hospital.
BPDs who genuinely participate in their Stabilisation, Mentalisation or DBT treatment. Who fall off and get back on again, who keep trying though it is way harder than you and I could ever imagine.
Obviously we (*) have to accept that nurses can’t only cherry pick those brilliant patients and never work with the more difficult and complex kinds. Some NHS roles can do that, psychotherapists, sex offender therapists, in fact most professionals who have to assess for patients most likely to engage and can’t waste time on – er, timewasters. We don’t get that. We have to admit and nurse whoever comes through the doors. And heaps of those are timewasters, fools and criminals.
*) I know, I know. I’m speaking for myself, but I’m honestly representing heaps of others I know/have known.
Who are the more difficult and complex kinds? A handful of examples.
1. Treatment resistant/refractory schizophrenics who are never, ever going to recover. These patients have a chronic, deteriorating illness (like Crohn’s, diabetes, auto-immune disorders) which needs years of care, support and treatment to delay and slow the pace of decline.
2. Genuinely disorganised, chaotic and forgetful patients who try to remember appointments but cannot manage it. They require more work from us, but they deserve it.
Procedures and boneheaded management diktats make it harder e.g. when managers try and make all community patients come in to collect their meds. It’s to cut down the number of home visits to drop tablets off. Patients who quickly decompensate and deteriorate when off their meds can become –
– so anxious they daren’t get on a bus to the pharmacy.
– so depressed they cannot get out of bed to answer the door, never mind leave the flat.
– so disorganised they can’t remember what tablets they’re on, where they last put them, what time it is, when did I last eat something?
– so paranoid they don’t let us in when we call, don’t answer the phone, disengage altogether.
I’ve seen all these in real life.
Better to spend a small amount of staff time delivering their meds than the gallons we’ll have to spend stabilising them after they relapse. Re-titrating medication doses. Crisis visits. Medical appointments, distressed parents, maybe even admissions to hospital.
3. Brain damaged patients. (Acquired Brain Injury is the current term, to separate them from LD patients who were born with one) These don’t get better either. Anoxia from a failed suicide attempt and Korsakoff’s from a lifetime of drinking are common causes.
4. Perpetually dysthymic people for whom anti-depressants don’t work (because they don’t have depression per se). These patients are frequent flyers, often via Crisis or Psych Emergency (whatever the local variant’s name is). They have never been happy, don’t know what it feels like and most days they weigh up whether it’s worth trying life just one more day vs ending it all.
Continued in ‘It’s a crap job now 4’ Pt 2
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