15 March 2008


I have just found out that Potentilla has died. It's not a surprise. It's not a shock. The first thing that I ever learnt about her was that she was dying. She knew. The world knew.

The first time I ever saw the name Potentilla was when out of the blue a comment was made on my blog. Although the blog has now largely been taken down and searching the comments electronically is not possible, I do remember her first comment. In due course I will find it but for now my memory must suffice. As best I can remember she said simply that she had been lurking for a while and had decided to make a comment. I think she also said something complimentary about the blog. I instantly thought that there was something a bit special about Potentilla. I can't now quite remember why but it was plain from her very first comment that she was not shooting from the hip and that her comments were likely to be very considered and well-informed. I turned out to be right. I must also admit that I was a bit worried to find myself entering some sort of relationship with somebody who was a patient and was dying. What if she started asking me about what sort of treatment to undergo next? That would be awkward. But Potentilla was far more sensible than that.

My blog developed over time. It was much stronger when I took it down than when I started it. Perhaps to some extent this would have happened anyway but, possibly unknown to her, Potentilla played an important part in melding and shaping my blog. Many of my posts were written hurriedly. Often I took only the time it takes to type out the letters. Good writing needs more than that. And checking facts takes time I do not always have. As a result there would be weak arguments or factual errors. When there were, Potentilla would pounce. I never, of course, met her but there seemed to be a formidable element to her. I often would worry that Potentilla might tear a post to shreds. If she did her criticism always had a sound basis. I do recall that she once savaged a post that I created in only a few moments. None of the work was my own. I had cut and pasted from dnuk. I had thought the points made were good ones. But Potentilla did not. She was, of course, right. She was so fired up that she had failed to notice that I was posting the views of somebody else. She did spot this eventually and then paid me a compliment by suggesting that she thought I must have gone doolally until she realised that I was just cutting and pasting. I knew then that with Potentilla out there I needed to be sure of my ground before hitting the publish button. I missed her when she did not comment on something I thought she would be interested in. I knew that it was because she was unwell. Then quite suddenly, to my relief, she would reappear and without asking I would know that she was feeling better. And now Potentilla is no longer out there. But she is still having an influence. If I ever start blogging again (this post is a one off) I will not hit the send button until I have carefully considered what Potentilla's response might have been.

Potentilla's real name was Christian Jago. She knew my real name. I didn't tell her. She found out by piecing together information in the blog. I knew my secret was safe with her. I had no doubt about that. She did not hide her own identity. I knew her real name from the start. But for me she will always be Potentilla.

If there are still any readers of this blog (I don't check to see any more) they may notice that I am now writing in the first person. Dr Grumble wrote in the third person. Potentilla objected to that too. But only once. The third person was a way of distancing me from Dr Grumble. But for this post, my small tribute to Potentilla, I don't want to distance myself.

If you have not already done so you can read Dr Crippen's tribute here.

02 March 2008

Nobody wants to wipe bottoms

So says Alex Thomas, a medical student. Dr Grumble agrees. He has said as much himself. As Alex says, there is not much point in getting nurses to wash their hands if they will not deal with patients lying in their own excrement. Senior nurses of 20 years ago warned Dr Grumble of the the consequences of moving nursing away from basic nursing care and towards the technical. We didn't dream then it might move further towards the diagnostic - that would have been unthinkable. But very quickly the unthinkable has happened. The nurses of old were right and Dr Grumble was very wrong. If the government wants nurses to become doctors, then train them to be doctors. And then the logical thing would be to train the healthcare assistants to become good old-fashioned nurses. But this won't happen because this would cost too much. So let's have the nurses doing nursing. And let's reward them for doing the really difficult tough nursing. Why do you have to sit in an office to get paid well as a nurse? Or do the doctors job? It's much more difficult to run a busy ward well. And this job used to command respect. It really did.

This post was first published on 3rd December 2006. Dr Grumble has republished it now because the public is now becoming aware of how recent government policies have damaged the nursing profession. The govermnent failed to recognise the value of proper nursing. Partly as a consequence, the distinction between medicine and nursing has been eroded. Roles and responsibilities need clear definition. Tooke has recognised this. Without this you get chaos. Caring for the acutely ill is a bit like fighting a war; proper command and control at ward level are essential. But command and control on the wards is a thing of the past.

Some people seem doubtful as to the veracity of Lord Mancroft's allegations. Dr Grumble can tell you that, in response to questionnaires, reports of nurses talking over patients are commonplace. The managers react by sending out a round robin telling people to behave. But what you really need is proper nursing by proper nurses.

Dr Grumble was so wrong

Many years ago senior nurses told Dr Grumble that nurses should never be taken away from the hands-on provision of basic nursing care. Dr Grumble thought they were crackers. They told Dr Grumble that it would be the beginning of the end of nursing. Dr Grumble took the view that as nursing was becoming more technical and there was a need for nurses to take on technical tasks usually done by doctors, it would be better to get others to do the chores like washing bottoms. How wrong he was. Basic nursing care is important. Nurses, very senior nurses, used to tell that to Dr Grumble. They were right. And basic nursing is, yes, nursing. It is not anything else. It should be done by a nurse and a senior nurse should ensure that it is done properly.

Nursing as it used to be. Note the staff patient ratio.

Now nurses are trained away from the wards. Some are too clever to care, others too posh to wash. See what the lovely Amy Wilkins, a student nurse, has to say on this. Her more senior colleagues agree with her. But for how long?

Dr Grumble was so very wrong.

This post was first published on 6th May 2006. It has been republished because at last the public is becoming aware about the fall in the quality of ward-based nursing. Unfortunately there is no focus any more on nursing standards - traditional nursing standards - because everybody is distracted by a government hell bent on moving nurses to call centres or turning them into quasi doctors. We need people in charge on the wards. They should be senior nurses. They should be responsible for the behaviour of their nurses and the cleanliness of the ward. They should be held responsible if anything goes wrong. Is there any point in throwing in that all this no blame culture thing has gone too far?

It's a shame nobody listens to Dr Grumble.

01 March 2008

Dr Grumble's second post ever

Dr Grumble is a hospital doctor. One Saturday recently he did a ward round and lost his temper. He lost his temper because no nurse was prepared to join him on his round. He checked with the junior doctors who told him that this was now the norm. There was now never a nurse on the post-take ward rounds, the rounds that deal with all the acute medical admissions. Dr Grumble is not so young. He is old enough to remember that in the past there used to be a nurse on every consultant ward round. Losing ones temper can be advantageous. He did get a nurse to join the round but she joined it with such bad grace that he felt her presence was wasted.

What has gone wrong with our health service? All this talk of teamworking but nurses do not seem to be prepared to liaise with the doctors any more. There was a time when the ward sister was valued, revered even. But now all nurses want to do is leave the wards and work for NHS Direct - or become a specialist nurse or a nurse consultant. The ward sister is no longer valued. It's doubtful if the title even exists any more. Life on the wards for a nurse is now so grim they can't be blamed. But it is sad, very sad.

The Sunday ward round was no better. Worse really. But there was no time to try and manage the nurses. Patients had to be looked after whether or not the nurses were prepared to help. Dr Grumble did his best.

On Monday he took things further and then was sorry for how he had behaved. Nurse staffing levels were down by one third and had been so for some weeks. The nurses were struggling. No wonder they resented joining the round. It was all they could do to meet the basic nursing needs of their patients.

As a penance Dr Grumble decided to start this blog. A blog to vent his wrath and tell the people of the UK how bad things have become in the health service they still cherish.

Nobody in the hospital where Dr Grumble works will know of his blog. He is not going to tell them. If you tell things as they are you must maintain your anonymity. The events will not identify him because this sort of thing is happening in NHS hospitals throughout the country - every day.

This post was first published on 3rd April 2006 when it was entitled Now not so happy. It has been republished now because nursing standards are in the spotlight following Lord Mancroft's recent comments. Actually things can change for the better. The nursing standards in Dr Grumble's hospital have improved. And Dr Grumble is not saying this just because he has now been identified. Sadly, Lord Mancroft's comments have the ring of truth about them. But were the staff he was referring to really nurses? You see a lot of people who may look like nurses (apart from their dirty finger nails) are not actually nurses at all. And where are all the nurses? Perhaps you need to ask the Witch Doctor and her Black Cat. Or look here.