Tuesday, 4 December 2007

Rambling on About Care in the Community and bed blocking.

Have you heard about the care in the community shit?

There are no beds in hospital. There is no staff in hospital. The Burger King down the road is staffed better than my ward and that is the truth. There are not enough places in the community and/or nursing homes to care for people. Meanwhile 80% of new nursing grads cannot find jobs and money is getting pissed away on luncheons so that the managers can have another meeting to plan another meeting and never take any action.

I work on a ward that is primarily medical and we take a lot of exacerbation COPD patients. Many of these patients are anxious and cannot deal with the fact that their nurse has other patients who may be sicker. I would feel the same way if I had copd and was struggling to breathe.

They are often on the call bell every 30 seconds for reassurance etc. Many of them are elderly and can barely manage to get out of bed onto the commode without help.

They want to "care" for these people in the community. They cannot even care for them in the hospital. They come in. They get ignored by overwhelmed nursing staff whose heart is the in the right place but cannot do their jobs. They deteriorate.

But home care is not the answer, because it will be managed badly like everything else and their is a higher chance of the ball getting dropped. The hospitals should hire some of the 80% of nursing graduates who cannot find jobs and care for these people in hospital. The matrons and the "specialist nurses" who spend their days drinking tea and coming up with retarded 20 page forms for the bedside nurses to fill in should get their asses to the wards and give a hand. I have a hard time referring to our so called leadership as "nurses". They don't deserve the title.

I don't see how any of our patients could manage at home for any length of time. Even when they are declared medically stable they are still dependent. They would all need one to one community nurses. Hospital care is bad and often leaves these people with more problems BUT this situation is fixable.

At the moment 80% of our patients are medically stable but unable to care for themselves at home. WE have a lot of elderly folks around here and no elderly beds and too few nursing homes. The hospital picks up the slack.

Many many many of my patients have been there for months and months. We have some who are waiting for beds in nursing homes, some who are waiting for care packages to be sorted for at home care, most who are unable to walk thanks to being left in a chair with no moblization because their nurse is so overwhelmed. They have family that won't or can't provide care and yet refuse help from social services. We have these people for months on end and there is no answer.

We have one patient who has been with us for 6 months. It was determined that she couldnt go home and needed nursing home care. She and her daughter picked out a nice one with help from social services. She had a bed at a nursing home near her daughter. She really wanted to go to that nursing home and sat in the hospital for 3 months waiting for a bed at this facility. I shit you not.

The day before she was to go there she told her daughter that she changed her mind and wanted to go to another nursing home. Daughter cancelled the nursing home bed and then came and told us (nursing staff)about an hour before she was to go. A surgical admit was slated to come into that bed in the afternoon. I shit you not.

It will be another 2 weeks before the new nursing home will come to assess her, and then we can find out if they will accept her. Then she will wait for a bed. Social services want the nurses to fill in another 20 page nursing assessment form again that is complete bollocks. No one will have time on any shift to do this. I am sure she will be with us another month AT LEAST. It may very well be a lot longer.

Then she gets angry when we have acutely ill patients and she gets less attention. The patient in the bed across from her arrested and whilst we were doing CPR she was overheard complaining that she has been at our hospital for months and never received that kind of attention. Makes me go grrrrr. This is not one unusual patient. This is 40-60% of our patients at any given time.

Some do get discharged home without adequate care in place because they want to create free beds. 72 hours later they are back in casualty with dehydration and a fractured neck of femur.

Meanwhile I could get the accident and emergency staff brought up on harassment charges for ringing every 30 seconds making threats. I don't blame them really. It's their ass if their patients breech the 4 hour rule. And it is all completely out of their control.

So we are getting constant bullying harrassment phonecalls from accident and emergency and the bed manager ordering us to "get people the hell out" because patients are breaching the 4 hour waiting times in Accident and Emergency and there are no beds. There are so many more patients coming to the hospital than they can deal with. We have a side room where the roof is leaking and tiles are caving in due to flooding and I was ordered to put a patient in there.

I have recieved a phone call at 0200 that a bed has become free in an outlying hospital and to pick a patient and get them transferred out there NOW because we are breaching. Why are we nursing targets and not patients? Not one of my patients are going to be happy about woken up at 0200 and transferred god knows where. I was threatened and told that if I don't walk away from what I am doing (never mind the 50 year old patient who has just suddenly developed expressive dysphagia and numbness and weakness on one side and I am trying to get a doctor up and I am the only nurse) that I will be disciplined.

And their relatives are going to fly into a rage about grandpa being woken up at 0200and getting shipped out to god knows where. They will chew out the nurses that's for sure.

I focused on the poorly patient first rather than deal with the transfer. I'll get busted for that you know. I was the only nurse and I couldn't leave the unwell patient to sort a transfer (transport, informing relatives who will go ballistic etc etc etc).

It is the same damn problem in every post I make.


the a&e charge nurse said...

Hi Anne - good to hear from you again.

As you know, it certainly won't get any easier for the COPDs as winter bites.

The infrastructure to support such patients [in the community] simply doesn't exist in the majority of cases.

So, when they break down they first come to us, and then at 3hrs 59mins we send them to you - apart from the really lucky ones who are sent home with ABx and pred, once they've had a blast of oxygen and a few nebs, of course.

Anyway, I hope you had a peaceful Xmas and may I wish you all the best for the New Year.

By the way, the rumours about me and Dr Crippen are simply not true, honest ;o)

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