Monday, 23 February 2009

Productive Wards and Releasing Time to Care

Dr. Crippen (and many other bloggers) has written about this already. If you need details regarding what "Productive Wards" is then google it.

So when this bullshit came to my hospital they decided to make all the ward sisters attend a series of lectures about it.

A ward sister is an RN obviously and they will not pay more than 2 RN's to be on our large ward at any time. If we have 3, one gets sent away to staff a more "important" unit.

Ward sister was ordered to leave the ward to attend these lectures on "Releasing Time to Care" for the duration of her shift.

This left one junior RN in charge of the whole ward with 2-4 care assistants. The shift was 0700 to 1500 hours and the lecture thing that sister had to attend was pretty much the whole shift.

This is a 25 (sometimes 35 if the fuckers open the other wing even though they cannot staff it) bed acute medical ward where every patient needs constant support and just finding prescribed meds and/or setting them up to infuse for that many people can take 50 minutes out of every hour.

The hospital refused to pay for any nurses to cover the ward while the ward sister was at the lectures.

This meant that a junior RN was not only in charge of her 15 patients but sister's 15 patients as well plus charge nurse for the ward. Alone. The morning drug round alone takes 3 hours for that amount of people and that's if she doesn't stop everytime a patient shouts out for help or begs for a commode.

Even if she carries on without allowing herself to be interrupted, the patients will not get the drugs they need on time or anywhere near on time. It is just too much. Blood work gets fucked up as a result of these drug errors, people get hurt, people suffer etc. Time is extremely important with drugs. She will also get constantly interrupted by phone calls and doctors during this time, and they will not give a damn about the patients that they are not responosible for...

A consultant will show up (not at a set time but at a time it suits him, usually during our drug round) to see a patient in bed B.

The nurse will be getting pain meds out for bed A when doc decides to grace us with his presence. You would not believe how much of a long, time consuming process getting morphine up and out, ready to deliver is...

Doc will expect the nurse to drop what she is doing to shadow him on his visit to bed B. Immediately.

He does not care about the Nurse's patient in bed A because bed A is not his patient. Only bed B is his patient. He doesn't give a shit about the fact that the nurse would have to leave bed A in pain to attend his round. He doesn't give a fuck about the fact that there are no other nurses on the ward to help bed A. He probably doesn't know and he doesn't care either. He has other problems and the nurse's problems are the nurse's problems.

Either we end up with a screaming, tantruming consultant whinging about his precious time or a patient left to wait for pain medication. There is no other Nurse because she is at the "releasing time to care" lectures and management won't replace her on the ward. And yes she has to attend the lectures or management will fuck her up. There are only care assistants and they cannot attend rounds or infuse pain meds. The care assistants are struggling at this point just to get everyone fed, washed and answer bells without making them wait for hours, suffering in agony.

But no. Management will not get another nurse in to cover absences due to the productive ward lectures. The nurse not on the lecture that day will be left alone to be abused. the way if Nurse Anne was in that situation she would just tell the consultant to fuck off because someone she is responsible for is screaming in pain.

And yes, I do understand that ward rounds are extremely important and so is the consultant's time. I would still tell him to fuck off. Unless of course I had another nurse. Then one of us could get the pain meds and the other could be dutiful and attend rounds.

Too bad management doesn't think that way.

Sick sick bastards all of them.


SSS said...

I had a 'lively discussion' with a consultant some years ago on my old ward when he insisted that I accompanied him on all his rounds even when I was busy. Apparently it was my job as sister to follow his entourage round the whole ward and stand there even though I was never invited to participate. I tell a lie, I got to push the notes trolley back to the middle of the ward at the end of the round so it wasn't all bad. Needless to say he was informed that I had neither the time nor the inclination to push a notes trolley round his patients and that he would get a nurse if a)there was one free and b) if he was going to have the decency to encourage some nurse participation. It went down like a lead balloon but I got my way.

I pissed myself when I read the thing on Crippens blog about the nurse who was able to organise the cupboard. Just incredible. There's no way I could work in the UK again. No way. I read your blog and I want to weep. You're amazing.

Nurse Anne said...

They haven't yet had the bright idea of having the docs flagging orders and having a unit clerk take them off and putting them into the system for the nurses. On the rare occasion we get ward clerks they aren't very useful anyway.

They (consultants)want us on the round to follow with the trolley so we know the plan with the patients. But the only RN for a large number of patients cannot spend hours between 0800 and noon following the docs around.

viagra online said...

You're right, and I've been reading the details in different blogs, and I think the hospitals are doing a excellent work on it. We need more time to understand this new politic.

nlee said...

I really sympathize with you and it scares the hell out of me that this is what Barack Obama is trying to bring to the US. The patient/nurse staffing ratio in the US right now is 5 patients to 1 RN. Nurses have time to really care for patients... you should come and work in the US.

Saad Amir said...

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