Saturday, 21 February 2009
Report/Too many patients/overwhelmed: Part 3
What to do?
If both of us (the only 2 RN's for a large ward) try and take handover on all the patients we are fucked. The sheer volume of information and the insane amount of time it takes to get through handover together with constant constant interruptions is a nightmare. It takes hours. Then it takes time away from the patients if we are constantly trying to meet up and hand over any changes/updates to each other. We try and we fight to pull it off but it just doesn't happen. We can't even wade through the top priority doctors' orders that will kill a patient if it doesn't get sorted immediately without fighting interruptions.
We do both feel responsible to every single patient on our large ward.
We have learned from repeated bad experiences that it just doesn't work for us both to keep constant track of all the patients. Accept it or fuck off.
So we each take a "side". I take team A which is beds 1-18. Carly takes beds 19-35. No it is not because we are thick, or lazy, or don't give a damn. We are working with what we are allowed to have, not what we want to have. We are coping the best that we can in a situation we have no control over.
Even though I only have a side I am still overwhelmed. Violently so. It becomes insanely impossible to nip over to the other side in a safe manner. It is impossible to keep track of my own side and get them everything they need even if I completely ignore Carly's patients.
Of course I won't ignore her patients if they need help and I am the only one around. But I won't lay a hand on them either without checking with Carly. Too many gods damn bad mistakes have happened because a nurse who wasn't up to date with another's patient answered a call light and patient request. They get real upset when I tell them I am not their nurse but that I will get her to deal with their request. Nine times out of 10 someone wants food when they are nil by mouth or a med that they are not allowed to have. It's not something I can sort out for them without throwing my own patients out the fucking window. Five minutes down can do that. Yeah. Really. It could take me a long time to chase Carly down, and in the meantime my own patients are falling out of bed and wondering where I am with that pain med.
So what do we get for trying to do our best in a difficult situation? Shit and constant abuse basically. That about sums it up.
Visitors and doctors especially are the worst. The walk onto the ward, grab the first person they see in a uniform and want immediate answers as to what is happening with their relative/patient. They take no notice of the information board that tells them who is who on shift and who is responsible for who. They take no notice of how few staff are actually there. They take no notice of the fact that I am running down the ward with an airway. They want what they want and they want it now. They don't seem to get that they really hurt patients by behaving like this.
They blow right past the info board and want to be babysat for the duration of their visit to the ward by the first person in uniform that they come across.
They don't give a flying fuck about what she is smack in the middle of either.
Not even a pleasant "are you the nurse looking after Mrs. Smith, and if not could you please point me into the direction of the nurse who does know her?". Oh fuck no. We cannot talk to nurses like they are human beings can we.
It's more like "Hey you! You are in a nurses uniform, stop what you are doing immediately and answer my questions, follow me around like a lapdog for as long as I want and no I am not concerned about the fact that you are in the middle of sorting out someone with a k+ of 6.7 with calcium gluconate and a little IV dextrose/insulin. I will not look for notes myself, or wait for the nurse who knows my loved to be able to safely leave her patients and speak to me. I want what I want and I want it now and damn the consequences to your other patients".
That's what we get about 6 + times an hour every hour. If you think that is an exaggeration than I invite you to shadow me at work for a shift and see just how damaging these visitors/doctors etc can be. The logical thing to do is help them quickly if they are inquiring about my patient or point them in the direction of Carly if they are asking about one of her patients. If I say that I cannot leave what I am doing to help them, they need to respect me as a professional and understand that I really cannot leave my patients to babysit doctors and visitors right this minute.
Tell visitors and doctors this and they throw temper tantrums. They insinuate that nurses "don't care", "can't be bothered" and all the usual shit. Fuck you. If I am saying "That isn't my patient" do not assume that I do not care about him, or that I don't want to be bothered. Never assume. It makes you out to be a twat.
Maybe I have been trying to hang blood on my GI bleed for an hour whilst fighting constant interruptions. I know that the blood takes absolute priority but I am still battling and upsetting people in order to actually hang it. GET. OUT. OF. MY. WAY.
Maybe I am already 20 minutes late checking that blood sugar on my patient with the insulin drip who isn't looking so good. I am 20 minutes late with it because a relative stopped to ask me a question, a patient then asked for a commode and I was too much of a pussy to say no to her and risk her anger by making her wait. And now you are in my face, and the woman with the insulin drip is going hypo and looks a gray colour!! There comes a time when the nurse has to draw a line and say NO. I need to prioritize and do what I need to do, YOU get off YOUR ass and go and find that patient's nurse to answer your questions and leave me alone !!!
Maybe I don't know the patient enough to answer your questions intelligently and I am so overwhelmed that I cannot hunt down his nurse or his notes to find out. I still haven't checked that blood sugar and the lady with the insulin drip isn't looking so good, nor have I hung that blood. Standing in front of me and refusing to let me pass until I answer all of your questions and hand you notes that you could easily find yoruself will not change this situation in the least. I will just push you out of my way.
Maybe I was finally on my way to get some pain meds for my cancer patient or investigate the guy who hasn't passed urine in 12 hours. Do not hold me up from that in order to make your life easier!!!! How very dare you, you fucktard!! If stop now to fuck around with visitor/doctor requests there is no one to take over my job. No one. Get it asshole? This is why nothing gets done around here.
These interruptions for my own patients and patients that I do not know cause it to be an uphill battle just to get someone a pain pill.
Maybe I am remembering that time I did answer a request from a patient I didn't know only to find out that I should have never touched him without knowing every bit of info about him. Bad outcome. Real bad. That situation happens a lot because we do want to help.
We don't want to say "It's not my side, I don't know about him" because we don't want to appear stupid and lazy and uncaring. WE also don't want to spend 20 minutes chasing down the other nurse when my own patient is going hypo, another is bleeding out both ends and the man with the potassium of 6.7 has probably arrested because I haven't got the stat meds his doctor ordered up yet etc. I usually have all this going on at once for the duration of my shift.
For the sake of safety and efficiency sometimes we have to say "I cannot" or "that's not my patient". It's not meant to be indifferent. Quite the opposite actually.
I have a license and a hell of a lot of accountability. If I say I cannot walk away from what I am doing right now then I fucking mean that I cannot allow myself to be interrupted right now without hurting patients. I am not ignoring you and I do understand that your needs are important.
Deal with it and shut the fuck up. I did not create this situation but I am trying to ensure that the patients on the ward survive it.