Thursday, 12 March 2009

Feedback? Oh Please.

A friend of mine recently left nursing after 25 years in the profession. One day she came to work on an evening shift on a busy surgical ward.

She was to be on her own with 14 patients, half of whom were major post ops who arrived back on the ward as she was in handover. MAJOR POST OP PATIENTS MUST HAVE CONSTANT MONITERING OR THEY COULD EASILY DIE.

As soon as she escaped from handover she knew she needed to get to those post op patients who hadn't been assessed properly upon return from theatre. She already knew of two who were going severely down hill. Others could have been bleeding to death. Others were crying for pain meds, as you would do if you just had your uterus removed and no one put you on a pca. Administering and preparing this type of analgesia is very time consuming.

For the first 45 minutes of her shift she was constantly obstructed by relatives who were stalking her for information. They were relatives of stable patients who were waiting for discharge. I think there were 5 people waiting for discharge. All of their families descended upon this nurse as soon as she was out of handover. She wasn't even going to think of starting the time consuming discharge paperwork until her post ops were sorted.

First she was nice to them. She explained that she could only give them a few minutes of her time due to ill patients. They wanted more. They demanded that she answer 100's questions right then and there and immediatedly arrange the discharge orders, paperwork etc. The relatives didn't give a flying fuck about those other patients. At minimum it would have taken the nurse hours and hours to sort them out, and even then she would not be able to leave them and spend hours on discharge bullshit. This is why a&e can never get people into beds.

She started to panic because she wasn't able to get past the relatives to get to her nurseless post op patients. Finally (after about 3 minutes of this shit...too long for a deteriorating post op patient) she got very firm told these dangerous assholes that she had other priorities and explained that she needed to get to her patients and she pushed past them. They spent the next 40 minutes or so her so stalking her around the ward. She carried on with what she needed to do.

She wanted to say: Stable patients will never be a priority in this situation. Deal with that. During a situation like this we don't care if your parking meter expired an hour ago and you want your wife discharged so you can go. We just want to avoid needless deaths and suffering. Deal with it and shut the hell up.

But she didn't say that at all, she is too professional. She just kept going while explaining that she was very busy.

She took damn good care of those post op patients and got two bleeders back to theatre. But this incident lead to an official complaint about her being a "sour faced bitch" who was "very unhelpful". She's left nursing as a result of this incident. I think she did the right thing. She was an excellent, hardworking and caring nurse and it is a massive loss to that ward.

Why didn't she have other nurses working with her looking after those 14 patients? Management decision.

No one is going to explain these situations to patients yet they are going to have them grade us and provide feedback. Great.

nurses to be rated for being nice

They are pulling the same shit with doctors.

feedback for GP's

I once had a patient with a blood sugar of 26mmols (high sugar reading in british measurements) officially complain about me for not going downstairs and getting her a dairy milk chocolate bar.

Simultaneously with this her family was putting in an official complaint about the nurses and doctors not controlling her blood sugar. Family was also bringing her mcdonald's milkshakes in daily and refusing to comply with the fluid restriction that she was on. They were smuggling in bottles of lucazade. They go smart and started hiding the bottles under the bed. This was after they were given educational sessions by the diabetes specialists and tons of literature. They also gave us hell because her chronic leg ulcers were not healing. Well fuck me, I wonder why?

These people are going to be rating me on how well I do my job?


Lucien said...

As a doctor, I've had one official complaint about me. I was covering the acute medical wards and the outliers, as well as the post-take ward round and all the jobs from that, on Easter Monday, i.e. the fourth day of a four-day weekend. I thought it was going to be a living hell. However, it seems all the patients who were going to go off over the weekend had done so the day before. I started work at 8:30am, and had amazingly no poorlies to go and review immediately, so joined the PTWR. The post-take went on until about 12pm, and I finished the jobs from that at about 1pm.

When I'm on ward cover, I triage the bleeps I get. There are three levels: either the patient needs to be seen immediately (periarrest, acute asthma, prolonged seizure, frank haematemesis), the patient needs to be seen urgently (chest pain, septic etc) or the patient has something non-urgent and joins the queue (cannulas, catheters, falls, relatives wanting to speak to a doctor who knows nothing of their relative and is busy trying to keep half the hospital alive). To my astonishment, every bleep I received all day was category 3. It was the most oppressively dull shift of my life. I waded through the rubbish until 4:30pm, when I handed what I hadn't done over to another house officer.

I concentrated on the acute wards at first, then the wards with most jobs. One chap was stuck on one of the orthopaedic wards, for his sins. He was waiting for gent levels. I checked his U&Es when I got the bleep, which were fine, so he joined the queue. I got the bleep for this at about 10am, got another bleep at 12:30pm, and didn't make it to him. A beleaguered doctor finally arrived at about 10pm, which meant the chap couldn't go home until the morning. He subsequently complained about being made to wait all day.

In fairness, he was right, but there was nothing I could do about it; again, in fairness, the complaints dept were really understanding about it, and just said 'yeah, fair enough, that makes sense' and sent me on my merry way...

Still, no matter how shoddy our staffing levels, we usually cope. We'll get the jobs done eventually. The ever-rising tide of bullshit you guys have to face at completely unsafe staffing levels continues to astonish me, and the thought of one of my loved ones ending up in hospital is bloody worrying...

FatGirl said...

"I once had a patient with a blood sugar of 26mmols (high sugar reading in british measurements) officially complain about me for not going downstairs and getting her a dairy milk chocolate bar."

This reminds me of when I was a student on a medical ward and one of our patients ate her way into DKA courtesy of the leauge of friends.

juli said...

All sounds depressingly familiar - I'm waiting for the day a patient (or relative) makes a complaint about me. I've had a couple of half-hearted complaints to the nursing sisters on the wards I look after, generally along the lines of ''that OT who's responsible for me/my dad/my mum/my brother's wife's sister's auntie's goldfish not being able to be discharged today because they can't get the supposedly essential equipment to us until tomorrow.'' Never mind the fact that they live in an area where our equipment service only delivers to once a week so rather than keep the patient in hospital waiting I'm going above and beyond my duty by collecting the equipment from stores myself and delvering and fitting it myself, but can't do it today because I have to attend the very important case conference that it's taken me more than a week to organise and is essential for another patient's discharge plans.

I can sort of understand some of the complaints of relatives and patients - to them that particular patient is the most important person on that ward, and it's not their fault we're all desperately understaffed, but you can't excuse the idiots who just don't relaise that we're doing what we're doing because it's in thier/their relative's best interests.

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