The NHS is barely hanging by a thread: here’s why strike action needs to happen.

Hello all.

Although the general consensus on UK based subs appears to be that most support NHS strikes I have seen some pushback. People are concerned about the impact of elective surgeries being cancelled which could potentially causing more harm/deaths. I am basically writing putting this out into the world as my perspective as a nurse working in a surgical HDU (which mostly takes cardiac and vascular patients) at a London Centre for Excellence on why we need this short-term disruption to have any hope of making the system better in the long-term.

At the end of the day, the outcome of an elective surgery being cancelled due to strike action is no different from the surgery being cancelled and pushed back on the day of the operation because there are no beds or staff to adequately care for the patient. This is something that is already happening every single day. Now say you are an elective CABG patient and your surgery is scheduled on a strike day and it is cancelled ahead of time. This will be extremely frustrating of course, particularly if you booked the time off work already, but at least you have due warning so you didn’t waste your day packing/fasting/traveling to the hospital.

Now imagine that this doesn’t happen, and you come in first thing in the morning on the ward or the surgical admission lounge/unit, etc. You haven’t eaten since supper yesterday and you last had a drink of water at 06:00 as your pre-op booklet instructed you to. The nurse sees you and maybe takes some blood you’re your observations and gets you into a hospital gown. She doesn’t know what time you’ll be taken to the theatre exactly as this depends on the list/theatre coordinator/time the porters arrive etc. The surgeon and anaesthetist came to see you to take your consent for the operation. They tell you you’re currently second on the list so you should hopefully be heading down to theatres a bit after midday – I am now naming “you” in this scenario Patient B. Patient A is a simple case that will be ‘quickly’ done before you. You understand but the wait starts to make you increasingly anxious to get going and your hunger eventually starts giving way to nausea which makes you feel worse while you wait.

Eventually, it’s 14:00 and you’re absolutely starving. You find yourself getting into an argument with one of the nurses about what is taking so long because you were led to believe that you will be going down at 12:00 and you can’t be expected to carry on like this. The nurse tells you she’ll do her best to find out what is going on and then she flits off again. Maybe you follow her out to check that she’s doing what she says she will. You stand over her at the nurse’s station and don’t see her calling the surgical team, she is “just typing at the computer”. She tells you that she bleeped the team but is waiting for a callback, they’re busy in theatre and she doesn’t know what time they’ll be done with their current case.

Multiple other patients start confronting her about the wait time too. What could possibly be taking so long? Your appointment letter said to be here at 08:00 and that’s exactly what you did.

Suddenly it’s 17:30 and you hear that you might be cancelled as there’s “no bed” for you or there’s no staff to do the op or recover you or your surgeon has left the theatres. You’re furious because you’re parched and hangry and upset enough at being made to wait all day as it is. You’ve held up your end of the bargain and done everything right.? How could this happen? Well….

First of all, I don’t know why but the approximate time of “after midday” always seems to become an ironclad promise in the minds of any patient that that is when they are getting whatever said treatment. It is a guideline rather than a guarantee, please remember that.

Surgeons, their assistants, and scrub nurses are human too and might be taken ill throughout the course of the day, having come in when they really shouldn’t have in the first place. These healthcare professionals must often stand in one position whilst wearing very heavy and extensive PPE with 100% focus on a single series of tasks for hours at a time with no opportunity for breaks and drinks of water etc. They need to break for lunch and to use the toilets as much as any other person and often do not have the opportunity to do so without a significant personal toll. I would like all who are unconvinced by this to please watch a couple of minutes of the following (https://www.youtube.com/watch?v=raZnTDA30OQ&t=2424s) (I would also recommend the series in general if you have the time it’s eye-opening stufff) Now on a well-staffed day there are circulating members of staff around who can scrub in and relieve the original nurse/surgeon to allow them to take a comfort break but of course, this is not always possible, particularly in the winter due to sickness absence and the summer months due to annual leave.

None of the above even begins to account for any serious intraoperative complications that extend Patient As operating time. They can’t exactly ditch Patient A who is bleeding out to die just so that they can crack on with Patient Bs surgery. There is also no accounting for post-operative patients on the ward becoming very unwell and needing the surgeon’s attention and advice. Perhaps the surgeon had to leave theatres because there was a cardiac arrest on HDU and they had to go and do an emergency re-sternotomy on the patient in an attempt to resuscitate them.

Now the process of moving through the hospital according to levels of care during the elective cardiac surgery goes something like this (in my hospital at least) : Admission ward or unit to be prepped -> Down to theatres and into anaesthetic room -> the operating theatre -> theatres recovery -> either ICU or an overnight intensive recovery unit/post-anaesthetic recovery unit/whatever the hospital calls it -> HDU -> Ward. At every single step of the process a patient needs to be moved out of the bed you’re going to go into first.

Both Patient A and Patient B can be stuck on the admission unit at the start of the day before they even go down to surgery because there’s no beds in recovery and/or not enough nurses to open them all for patients. Eventually, THAT problem is rectified by the Site Nurse Practitioner sending nurses from ICU to go to work in recovery – this, of course, has the knock-on effect of making the remaining ICU nurses double up on Level 3 patients which is unsafe but hey the elective surgery didn’t get cancelled and THAT’S more important for the Trust metrics!

So there’s now a sufficiently qualified nurse manning that theatres recovery bed for Patient A so they can go ahead and have their surgery because there is somewhere to send them afterward. Patient B is therefore waiting for Patient A’s surgery to be complete and for them to have vacated the operating room (and for everything to be cleaned) before Patient B can go down and be anaesthetised. Now in an ideal world, we would wait for Patient A to have vacated the theatre’s recovery bed before we start surgery on Patient B, just in case Patient A has any complications. That would be the safe thing to do. Only bed pressures exist and they don’t want to cancel Patient B (or Patient C after them etc) so sometimes they just crack on anyway. This puts an unholy amount of pressure on the nurse in charge of recovery to get Patient A out of the recovery bed and send them up to Overnight Intensive Recovery/Post Anaesthesia Care Unit/ICU whichever they require. This involves a tonne of phone calls and pushing the nurse in charge of that unit, who in turn pushes the bedside nurse on that unit to hurry up and make themselves available for the new admission. This usually means discharging a patient from the OIR/PACU downstream to HDU so that Patient A can be moved into that empty bedspace. The problem is there’s no HDU bed available and the HDU nurses need to discharge the HDU patient to the ward and . . . there’s no ward bed, we been knew.

Now imagine anybody trying to get a coffee or lunch break amongst all this chaos and you can see why nurses are constantly getting UTIs and the Reg I linked to above got a kidney stone.

Meanwhile, Patient B is still sat on the admission unit waiting for his surgery and borderline harassing the poor nurse about what is taking so long. Now, this nurse either doesn’t know all the complexities that need to occur for the stars to align for Patient B to go down to theatres because they’re just not privy to all the bed management conversations going on, or they do know but literally do not have the capacity to explain all of this in a way to make the patient understand. I have apologised and tried to explain this type of thing until I am blue in the face but am then accused of “making excuses for our own incompetence” – I don’t bother any more and just tell them “sorry, no bed for you yet, trying our best”.

Now it is important to note that all of this is happening in a very highly regarded hospital that is a centre of excellence. Part of that “excellence” in my opinion relies on people like me and my colleagues being forced to give it their all every single day to facilitate all of these transfers which undoubtedly comes at the cost of safe care. My feet barely touch the ground for how many jobs I am doing and I am still falling short of being able to adhere to “best practice” guidelines. The whole system is. There is a PROFOUND nationwide capacity issue. This is happening in every single hospital up and down the country to varying degrees. This is what happens when you starve a healthcare system of its resources for 12 years.

I’m going to use the analogy of a factory assembly line for a minute. Imagine that half the staff on the assembly line are absent but the product they’re trying to assemble keeps coming in at the same rate as normal. The staff literally cannot keep up with the demand and half the products must be discarded at the end of the day because they are incomplete or not up to spec, this is through no fault of the staff that WERE present and just trying to do their jobs. Now imagine that the ‘absent staff’ in this situation is the lack of beds and the discarded products are the patients who get cancelled as a result of the lack of beds. (This can also be applied to GP appointments FYI)

Now imagine again that you are Patient B and the stars have aligned and you get the surgery after all. (Although you’re still pissed off you had to wait so long and you tell everybody who will listen about how bad your experience was and complain to PALS etc – tying up a poor ward manager/your consultant up in writing a response, wasting their time that could be spent with patients in the process) When you eventually come out of the surgery you go to theatres recovery because the bed is free. You feel like hell while a nurse dances about you taking your blood pressure and other observations every fifteen minutes for what feels like forever. They keep waking you up but the anaesthetic is in full effect and you just want to sleep for a month. You get irritated being woken up all the time and just want to move on already so you can get away from this annoying nurse. You eventually get transferred to OIR/PACU/ICU where you stay for the first day or two while you stabilise enough to step down to Level 2 care on HDU. You’re being woken up all night by various alarms going off, including your own, and are then woken up extremely early and are forced to sit out of bed before you feel ready. You have drains that are paining you but you’re still being asked to mobilise by the nursing staff. You don’t understand it and you just want to rest all the time to recover from your surgery. What you might not realise is how important it is to get out of bed to ensure that you don’t decondition post-surgery and to prevent things like constipation and pneumonia which can be complications of prolonged bedrest post-op and extend your recovery period, keeping you in hospital for longer.

You want your belongings that you brought in because you feel bored and understimulated and getting anxious about their whereabouts so you keep asking for somebody to get them but you’re told no because you’re in an intensive unit and there’s no space to put anything. You’re promised that you can get them “once you go to HDU”. Of course, the moment you get into HDU you then start pestering the HDU nurses to go get the bags because this is what you were promised, even though they have about a million and one jobs to do for you as their new admission as well as her other patient and so collecting belongings from off the ward isn’t something that she can even think about right now. You get irritated because they’re spending most of their time on the computer and don’t understand why she can’t just pop upstairs. You don’t realise the sheer volume of things she is legally required to document about her assessment of you and how time-consuming this is, even for experienced nurses. This has to be done as close as possible to the time of the assessment as possible to prevent legal trouble for the nurse. If she documents in retrospect she could be accused of falsification of records if something were to go wrong.

Whilst in HDU there are still a tonne of monitors alarming all the time and a constant flurry of activity. You’re starting to get overstimulated by the constant light and noise and the time that has elapsed since your surgery is growing and you are starting to wake up from your post-anaesthetic cloud. Pain might be kicking in and becoming more and more of a problem for you yet you are still pushed to mobilise when you just want to rest. After a day or two, you are told that you can step down to the ward today by the surgeon and you feel a surge of relief. Thank god! Now you can get out of this hellhole with all of the alarms and confused delirious patients shouting out at the nursing staff and actually get some sleep to recover. If you don’t make it to the ward that day after all you might get angry at the nursing staff for not facilitating the surgeon’s wishes and if you are nasty enough you might even berate them the entire fucking night and make them cry from how unpleasant you are when the only reason you didn’t go was that there were no ward beds for you to move to.

If there ARE ward beds available then the most manic process starts. As the surgeons come to see you at 09:15 the HDU nurse in charge is in a bed meeting and comes back to immediately start putting pressure on the HDU nurse to get you out before 11:00 for the new admission from OIR/PACU/ICU to come in to your bed. This is so that the patient that is currently in theatres recovery can be transferred into OIR/PACU/ICU and a patient waiting on the surgical admissions unit can now go down to theatres for their operation etc.

Problem is the HDU nurse now needs to not only complete some discharge paperwork that documents all of your invasive devices/lines etc but also the plan and her assessment of the following:

Your Airway – were you a difficult intubation during your surgery and what is your airway plan in the event of an emergency?

Breathing – breath sounds on auscultation, respiratory rate, oxygen saturations, whether your lungs are expanding equally, if your gas exchange on your last arterial blood gas was sufficient, if you have a cough with any sputum and if this was sent to the lab to target your antibiotic therapy

Circulation – your temperature, your heart rate and rhythm, blood pressure and whatever target your doctors may have for this, your capillary refill time, the temperature of your skin, whether you require any intravenous fluids, your last ECG and what it showed, your blood count results and clotting etc and any action that needs to be taken to correct these

Disability – your Glasgow coma scale, any confusion they have noted and what kind of funny things you may have said, any erratic behaviour, whether your pupils are equal and reactive, if you are able to move all of your limbs equally and with equal power, what your blood glucose is and any actions to correct all of the above,

Exposure- Pressure areas and skin condition, your mobility level and support required, how much you have eaten, drank, if you’ve taken a shit or had a piss and if you are continent/independent in doing this, what is the plan if you haven’t been able to poo yet? We also need to document any wounds that you may have. We are expected to document every scab, every mark, every mottling lest we are blamed for failing as a nurse and allowing skin damage to occur on our watch and causing patient harm. We are even expected to even document any individual bruises you may have, even if these are just from phlebotomy because if we don’t there could even be an accusation made about us – a friend of mine was accused of assault by a former patient (who had actually punched my friend) and had submitted photos of bruising on her arm to the police which were actually caused by a blood pressure cuff. These were used against my friends as evidence in a criminal investigation. Due to patient confidentiality, my friend COULD NOT ADEQUATELY DEFEND HERSELF FROM CRIMINAL CHARGES because she wasn’t allowed to tell the police that the patient had mental health problems that she hadn’t been declared to them. My friend was eventually cleared of the charges but now no longer works as a nurse due to her unmanageable anxiety surrounding the situation. Had my friend had the time and forethought to document “minor bruising noted to bicep from blood pressure cough” maybe it could have been avoided. As it was she didn’t have the time nor the presence of mind due to the stress of the job to document such minute details, she did moving forward though.

The HDU nurse also has to do all of the above on the computer before printing it but then ALSO has to start writing paper charts because the wards use not only a different (poor) computer system but also a mix of computerised and paper notes. They have to ensure that the doctors have prescribed certain things (like variable rate insulin infusions, for example) by hand and that she puts in the observations and actions that have been taken since midnight that day. They also need to do a paper fluid balance chart, again from midnight, and total intake and output from all sources and manually calculate your ‘net body balance’ from midnight. The nurse can’t use the total that was calculated by the electronic notes system because the electronic notes system does it from 06:00 to 06:00 so the balance would be ‘wrong’ for the ward nurses who do it from 00:00-00:00. To top all of this off they not only has to enter all of this onto any observation chart, but she also has to summarise it in long form in her notes. Because that is super efficient for already overburdened staff of course.

Meanwhile, they might well have to put a new peripheral cannula in place if you’re having your central line taken out (likely) which can take some time if you have difficult veins and also needs to do the usual 1-2 hourly observations of both yourself and her other patient at 10:00, including heart rate, blood pressure, respiratory rate, oxygen saturations, PCA obs, urine/drain output. They’re also still responsible for facilitating all the care and requests for her other patient even though they’re being told to prioritise the discharge.

Suddenly it’s somehow 10:30 and they still need to remove your catheter/central line/arterial line/temporary pacing wires/chest drains/whatever that were kept in until today to be reviewed. This is because the ward won’t accept patients with such devices due to nursing skill mix and inadequate supervision of such devices due to the higher patient ratio. Now, this removal process is often something that requires you to be still/lying flat for > 30 minutes so the nurse need to get you back to bed …… only you suddenly need to take a shit and won’t use the commode due to lack of dignity at the bedside. Because you still need to be on a cardiac monitor or supplementary oxygen the nurse can’t just walk you out to the bathroom and leave you! They have to walk you down there and hover outside the bathroom, not getting on with his/her documentation, so they can listen out for any alarm on your monitor indicating a low/high heart/respiratory rate/oxygen saturation that could indicate an emergency. Every nurse has a story about how they/someone they knew had a patient that arrested in the toilet. This happened to Heather at my old job and Anna at my new job.

Eventually, you get back to bed and your belongings/supplies are unceremoniously dumped on your bed around you and you are carted out. It’s a while until you see any members of staff on the ward and it’s a bit intimidating to go from having a nurse at your bedside almost all the time to having to use a call buzzer (which may not even work!) to get some attention. What you don’t see is that the nurse about to take over your care is still stuck doing the morning observation round or finishing off 08:00 meds because not all of them had been delivered by pharmacy on time and she had to chase them. She also has like 7 other patients, sometimes more, to divide her attention between. You also don’t see the stressed-as-shit HDU nurse pressuring the equally stressed-as-shit ward nurse into coming over to take handover because the HDU nurse is about to get a new admission from OIR/PACU etc and they need to rush back to clean the HDU bedspace or finish off the discharge paperwork that they hadn’t even had time to finish. They must also then spend forever trying to get it to print because we’re using fucking computers from the 90s which take an age to load and then randomly disconnect from the printer without reason (and then IT are usually patronising and unhelpful on the phone).

Meanwhile, there is one poor junior doctor who is getting paid absolute peanuts for their skills to cover the entire HDU. They have the consulant to call for advice and who does a quick round with them in the morning but they’re single handedly responsible for getting all the jobs done and everything is urgent. They have to write the medical discharge summary for you and the 7 other patients being discharged to the ward today and also re-prescribe all these medication regimes onto the different system that the ward uses, including any changes suggested by the surgeons from that very morning, before the transfer at 11:00 as well as doing all of the “doctor jobs” like referrals, imaging requests etc and just….you know… general medical reviews/putting hands on the patients for their assessments. Not only do they have to do all of the above but they also have to stop what they’re doing at any given moment and shift their focus to nurses, pharmacists etc who have come to ask them for some advice and to report any issues.

The same thing happens on wards too. People often take to social media to fume about having to “wait all day for a letter and a few tablets” because they just wanted to go home already. While I understand the frustration, what these people fail to understand is that when you have ONE doctor doing the work that could only be safely managed by FIVE doctors less urgent tasks like this get pushed down and down a never-ending jobs list. It might seem counterintuitive to have to wait so long for something small but they have to see the sick patients first and can’t even think about discharge letters and take away prescriptions until they’re sure the sick patient has an appropriate plan in place.

Let’s say we have one or two doctors to a 40 patient surgical ward. 30 of the patients are staying in the hospital for at least another day with jobs that need to be done that day to adjust their care or to help make a diagnosi to come up with a plan. Then you have ten patients that are well enough to be discharged home. The 10 patients simply are just going to have to wait while the one-two overloaded doctors attempt to finish all the jobs for the sicky patients first. If we were to put a sufficient level of staffing like 5 doctors to 40 patients then they suddenly go from 20-40 patients each to 8 patients each and are able to divide up the discharge summaries and take away medication prescriptions so that they are doing 2 each. Badda bing badda bom, medically fit patient gets discharged home quicker and we can use the bed for the delayed transfer patient in A+E. But we need more doctors and safer staffing levels to do that so it ain’t gonna happen.

You see the same thing in A+E complaints. “Waited seven hours for a five minute interaction with the doctor who sent me for an Xray, told me it wasn’t broken, got given paracetamol and a crutch and told to fuck off home” – it’s because that the five minute review was all you needed that you had to wait 7 hours!!

From a HDU nursing perspective, a lot of the transfer/discharge to the ward jobs are two man jobs. Unfortunately, because there are so many nurses are leaving critical care after covid there is very often a lot of novice nurses that are recruited to fill the gaps with barely any time invested in them to get them up to speed. I am currently working on a unit with 17 band 5 nurses. I have been here for 8 months and I am already the 5th most experienced band 5. Four relatively experienced band 5s have left in the time that I’ve been here and another one is working out his notice. This is how bad the skill mix can be sometimes. A lot of skills are unfortunately not taught to you as a student nurse and you need post-graduate training and competencies being signed off after x number of observed attempts in order to be allowed to do them at your workplace. This leads to situations where you could have say 6 nurses working on one shift but only 2 of the 6 are ‘competent’ in a necessary skill. Now sometimes nurse A needs help form nurse B to do a discharge dependent skill but nurse B is also the only “transfer trained” nurse working that shift (ie. she has passed another form of higher competency training and is able to escort unwell patients to other areas of the hospital where the other nurses are not yet able to do so) and has to go with an unstable patient to CT or MRI/interventional radiology department for a procedure/back to theatre for a revision of their surgery etc. That leaves nurse A up shits creek but with bed management still breathing down their neck because the patient needs to be transferred NOW. There is literally nothing that nurse A can do about the situation and yet s/he needs to be resilient and soak up all of the bad vibes and literally be blamed for something outside of their control because it disrupts patient flow.

That is all hospitals are about anymore. Patient flow. As many discharges from the ward as possible – even if the patient isn’t actually ready to go home yet – so that we can move patients down the stream and get as many patients out of A+E or admissions units as possible… yet somehow, despite all our efforts, it is still never enough.

Meanwhile, any relatives that come to the ward for visiting are getting increasingly anxious or aggravated that they have not been given a timely update. They start to to feel neglected and some take an oppositional/accusatory communication style with the nursing/medical staff. Staff are then forced to take a bunch of time they don’t have in order to reassure the relative/patient of any concerns that they may have and attempt to foster a better relationship.

Any abusive language or confrontational behaviour also needs to be documented by medics/nurses in detail and a time-consuming incident form should also be completed to have a contemporaneous note of the event and to make management aware of the incident. We have to do this so no inaccurate complaints can be made about us that can send us to the NMC for judgement.

Amongst all of this, nurses are constantly accused of not CARING anymore. Of being “too posh to wash” and lacking the basic skills requisite to call themselves a nurse. Many vilify nurses in opposition to the angel health care assistant who “does all the dirty work for the lazy nurses who are just on the computer the whole time”. I can literally count on one hand the number of shifts that I have managed in the last 8 years (5 as an RN and 3 as a student) to avoid wiping an arse or doing another ‘dirty job’ (unlike many of the HCAs I have worked with in that time who manage to hide themselves to avoid doing anything and choose which of the jobs I have attempted to delegate to them they will get on with). Junior band 5s usually do way more work than the HCAs because a lot of them abuse their inexperience. Of course, this is not universal, of course, there are some incredible HCAs out there, my colleague Linda is a superstar. I have just unfortunately seen this type of behavior way too often.

Sometimes I feel like if I hear about my patient’s wife who was a nurse back in the 60s when they ‘actually cared about their patients’ or ‘had proper standards’ or ‘did hospital corners’ one more time I might just fucking scream. As if the role hasn’t changed a thousand times over since then and that band 5 nurses in units like mine are expected to be able to titrate fucking inotropes independently while the wife he’s talking about was working at the equivalent of a fucking HCA back when the NHS was much more forgiving to nursing staff. As if I am capable of interpreting arterial blood gases and am going to go for my dialysis training soon but I can’t fucking fold a hospital sheet in a certain way. I always want to tell them I’m perfectly capable of doing hospital corners I just have a million other things more worthy to do in those two extra minutes it would take me. You can’t even do hospital corners on a pressure-relieving mattress they’re just too thick and the sheets aren’t big enough.

Back in the day his wife would be giving tablets, doing washes, and serving food to patients that could mobilise independently and that were about 20 years younger than the average hospital patient now. The doctors would manage all invasive devices and give all the IVs etc. A far cry from the expectations of your average nurse now. Most of our hospital patients now would have died back in the so-called golden age of nursing. The surgery or procedure of the patient saying all of this might not have even existed back then!

Unfortunately, nurses are fighting an uphill battle against the many developments in healthcare vs staffing capacity never increasing. There are now so many increasingly complex expectations placed on nursing staff but there has been absolutely no increase in staffing numbers to facilitate this. We are truly always being asked to do more with less and many live in fear of the impossible standards of the Nursing and Midwifery Council who strike nurses off for relatively minor indiscretions. We are held to a truly impossible standard with little consideration made by the NMC for the appalling working conditions we must endure, especially when compared to the General Medical Council. Doctors that make a mistake seem to be held to account of what their peers in that stage of their training would do, with consideration taken for things short staffing and other adverse events that had an impact on the individual’s decision making\*. The NMC is much more likely to ignore all of these factors and hold nurses to a neigh-unattainable standard of perfection. If you do not follow best practice guidelines to the fucking letter you can be dismissed. For example a pediatric nurse documenting a set of “15 minute observations” 17 minutes after the previous set on a poorly child, ignoring the fact that said nurse was likely doing other things like mixing/giving medications, applying oxygen and encouraging the distressed child to keep it on, generally reassuring the patient and parents etc.

\*Although they are clearly institutionally racist and come down much harder on BAME doctors than their white counterparts, but that is a conversation for another day.

To top it all off if we fuck up enough and make a grand enough mistake that contributes to a patient’s death, not only do we have to live with that guilt for the rest of our lives but we could also go to PRISON. The general public do not realise this. As a nurse, you can do everything within your ability in good faith and try your absolute hardest for your patients (and sacrifice your own health in the process for years or even decades) but mess up enough on one shift and you will be ruminating about it from behind bars. JUST GOING INTO WORK is taking this risk and said work pays a measly £27-32K (post 2022 pay rise salary for a band 5).

In general it’s pretty shit to be a nurse these days. We are shat on by the government, the media, our seniors, our regulating body and our patients. The breaks we miss are not paid. Nor are the hours we stay late. The latest that I have stayed after a day shift that started at 07:30 was until 23:45. I routinely stay half an hour after the end of my shift because I literally cannot complete my handover any quicker due to the complexity of information required. This time is never paid back in any way and I am seen as troublesome and demanding by my seniors for asking about it. The other day I did an extra shift on a ward because I needed the extra money. On this shift I felt so overwhelmed by trying to meet all of my patient’s needs that I dissolved into tears multiple times. I was so terrified of making a medication error. I didn’t have the chance to sit down to start writing my notes until the very end of the day. My shift ended at 20:00 and I went home at 21:30 AND I WAS THE FIRST NURSE FROM THE DAY SHIFT TO DO SO. God knows what time the other nurses went home. As stressful as everything I’ve described in this thread is I actually do enjoy this job more than any of the other five I’ve had since starting as a nurse THAT IS HOW BAD MOST PLACES ARE.

Now I appreciate that there are plenty of terribly nasty nurses our there who don’t appear to give a damn about their patients or doing their job well. I just complained about one and am routinely frustrated by then myself. I have been bullied to the point of suicidal ideation by one in the past. Having said this, I do implore that those of you who have read this far to try to exercise some empathy. The vast majority of these types of nurses came into the profession ready to do good and burned themselves out working in a broken system that never rewarded their hard work and actually punished them for things outside of their control. They have no more to give than the bare minimum. That is all they are capable of. I was so cripplingly depressed in the final days of my last job that by the end of the day it was taking me every ounce of energy had in me to just to hold my upper body up while I sat down writing my notes.

Please also bear in mind that the vast majority of nurses are still female and thus may be working an incredibly physically taxing job through horrendous period pain or while struggling with menopause. It is a quiet day for me if I only manage 12,000 steps (Most days in my current place are 15,000-20,000.) My personal record for one shift was 27,321 steps in a previous job) We may also be working without having eaten or drank in many hours and are just as parched and hangry as our fasting patients quite frankly but are expected to be emotional sponges and absorb all of their mean spirited behaviour. This does not entirely absolve people of personal responsibility for their behaviour, but it does make it more difficult to manage oneself when coupled with a million competing demands on our attention and a stressful environment.

I’m 29 now and my back hurts all the time. I have varicose veins. I have eye bags for days. I’m fat as shit and none of my clothes fit me because I don’t have the energy anymoreany more, something I once enjoyed, and live off processed shit. and my flat is a perpetual mess because I spend my days off watching Netflix in bed. I have lost touch with non-work friends. I never call my mum enough. I have missed the last four Christmases which really upsets her. I’m struggling to cut down on alcohol to a healthy level after developing the maladaptive coping mechanism of downing a bottle of wine after work to get to sleep. I’m pretty much a shell of the person I was once was and I think my story is pretty typical of other nurses that qualified around the same time as me.

It’s not all bad and I don’t always hate my job. Sometimes I’m moved to tears by the connection I have forged with a patient and the difference that I am able to make in some of the darkest moments of their life. I’m not always “saving lives”, I’m mostly just stopping people from getting sicker than they already are, but I have saved a couple along the way from being on the ball enough. I have also helped people die with dignity which I’m very proud of. I’ve done a lot to be proud of within the last five years and I’m grateful for the growth that I have experienced. I have acquired a lot of skills and knowledge along the way and my conscience mostly rests easy because I know I’m doing my best. I’m also grateful to have steady employment in times like these. It can just be so damn hard to remember all of this when 98% of any given day is unmanageable stress and about 2% is a rewarding moment of some kind.

I’m not sure why I wrote this all out. I suppose that I do find it cathartic just to put everything down like this even if nobody reads it….but I do want people to read this one. At least the top bit. I want people to try to get what we’re up against.

I want people to know that we are tired. We are at the absolute limit of our resilience. We have been for YEARS. I have been since before I even qualified. This should not be allowed to continue.

If you made it this far and are still unconvinced about strike action being necessary for the future of this country’s healthcare delivery, then I don’t even know what to tell you. The NHS has already collapsed. It collapsed years ago. Death figures won’t suddenly explode or whatever, but we will slowly sink into yet higher and higher preventable levels of morbidity and mortality while access to healthcare gets harder and harder. The few days of electives being cancelled will not kill more people than the system already has.

Thank you for reading, I really appreciate it.

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P.S. ALL OF THE ABOVE DOES NOT EVEN BEGIN TO COVER THE IMPACT THAT COVID HAS HAD ON OUR WORKFORCE. MY GOD. I don’t even have it in me to talk about how bad that was. I truly don’t. This post is literally about December 2022 only. Imagine all of the above times a hundred for a glimpse of the pressure that we were under during covid. Only instead of elective surgeries, it was covid admission followed by more covid admissions etc. The WORST. I had four patients die on one shift. I had to wash and wrap four patients in their shrouds and then clean the bedspace for the next admission. Absolutely brutal man.