Friday, 13 March 2009

The Urology Ward vs The Medical Ward

Once upon a time I came to work on my medical ward to find that 3 staff nurses were scheduled to work the shift for 24 beds. Isn't that how every post on here begins?

That is a hell of a lot better than what we usually get. But it is still not safe especially when you look at research that shows what the numbers should be in order to protect the patients from harm.

We didn't rejoice because everytime we have more than 2 actual nurses at least one will get floated away to staff another ward.

Two minutes exactly prior to the start of the shift the phone rang. It was the supervisor. "You have 3 staff nurses, one of you must go downstairs to staff the urology unit because they only have one nurse and one hca on duty". As usual we made our case to him explaining why we cannot cope with only 2 nurses on our ward. As usual our cries fell on deaf ears. The fact was they only had one trained nurse and one assistant for 12 beds and you can never have only one trained. It was my turn to "float" so I went downstairs. I left my 24 full dependent and acutely ill patients with 2 nurses and 2 care assistants.

I arrived onto the urology ward and introduced myself to the only nurse. She explained that she would take the "heavier" 6 bed bay and I would take the lighter 6 bed bay. This was fine because I don't know much about urology.

It was so easy. I was responsible for 6 men. Nothing acute. They were mobile, and alert and orientated. They were self caring with their hygiene needs and wanted it that way. Not one of these chaps was over the age of 60. Not one of them had complex medical histories. Three of them were simple trials without catheters. 2 were going to theatre and sorting them out for that was a piece of cake. The procedures they were going for were simple. They were nice to me. They were polite. I had a basic nursing assessment done on all of them very quickly. I realised that my work was done here and the nurses back on my floor weren't even out of report yet. I walked around and around and asked these chaps if there was anything I could do for them. They smiled and told me to get myself a drink. I just couldn't believe it. At the end of the shift they complimented me and again thanked me for looking after them so well.

So I popped into the other nurse's bay and asked her if she needed anything. She had her 6 patients under control. She gave me some teaching about urology procedures and terms etc. She had some post ops and we assessed them together. It has been a long time since nursing school so I was glad to be updated a bit.

I had everything done on time. I had no problems getting patients to and from theatre because my other patients were fine, stable, and sensible. I didn't have to worry about anyone with dementia falling on the floor or throwing themselves onto the floor because I was tied up with someone else. I had no admissions. The discharge I did was a piece of cake since the patient had no social problems or care needs at home. I had a full 30 minute lunch break in an 8 hour shift. I left on time. I could not believe I got paid to have it so good. They even had a nice break room with a microwave and a fridge for staff.

Yes it can get really busy on that unit when they have more patients coming in for procedures than they have beds. Occasionally they get poorly patients.

But my god, did I have a fab shift that day. I told the nurse down there about what goes on upstairs and she said "yeah, that's why everyone needs to get the hell out of medical wards, I got out 5 years ago". She also told me that on days they have 3 nurses and a healthcare assistant for their 12 beds, and that the majority of their patients are younger and self caring. We are lucky if we get that for 24 patients upstairs. And my patients are medical trainwrecks. Sad but true.

Okay so I should escape but if everyone gets the hell out who is going to take care of acutely ill "oh my god they might fucking die if they if they don't get this intervention 5 minutes ago" patients as well as the chronic patients with complex needs, the elderly and the infirm, the social admissions etc.

Not all hospital units are created equal!!!!!

The general medical wards are under resourced, short staffed and treated like the ginger haired step children of the NHS.

Our most vulnerable patients suffer so much because of this. The medical nurses kill themselves on those wards day after day. The job we have on our ward is tough because we deal with so many different kinds of patients and they are so ill and dependent. Medical nurses are no less clever than other nurses but they are much more overwhelmed at times. I found units that are more homogenous in their patient populations to be so much easier. This isn't the first time I floated to another unit. I have perspective.

General medicine is nothing but a dumping ground. If a patient goes bad on this urology unit guess where they immediately get sent? They go upstairs to the medical ward.

If there are no beds at the psychiatric facility for the paranoid aggressive patient...they come to us. No beds in hospice and dying cancer patient needs pain control? Send her to the medical ward!

Admitted to a&e with a GI bleed? Send him to the medical ward!

100 year old patient found on the floor at home, cannot take care of herself and it is a 3 month wait for nursing home care? Send her to the medical ward. "The nursed down there are thick and do nothing but bedpans anyway".

Diabetic emergency requiring close monitering and sliding scale insulin drip? Go to general medicine.

Surgical ward patient overloaded with IV fluids now in heart failure? Send him straight to medical.

75 year old confused incontinant man whose family have abandoned him in A&E because he hits and wanders away and spreads faeces everywhere and falls? To the medical ward where 2 nurses are looking after 24+ similiar patients!!

Respiratory failure/pancreatitis/MI and no beds in the intensive and cardiac units: "Send them to the medical wards..... But we won't increase staffing levels just because there is a fucking ITU patient there who needs one to one" says the fucktwit managers.

Patient on a surgical ward cannot walk and needs the bedpan? "Send him to medicine, all the nurses do up there is bedpans anyway" says the surgical nurses. These surgical wards and homogenous units will also refuse to admit the kinds of patients I am describing above. They are also better staffed.

Dying cancer patient who is neutropenic? "Send her to medicine with the wandering, confused, MRSA patients and then sit back with a tub of popcorn and watch her daughter lay into the medical nurses and ask them if they "think it is funny" that her dying mum is having to be on a ward with "those types". Grab a beer and watch same daughter call the medical nurses every name in the book. Refuse the nurses request to move the lady a better unit or to give them more staff" says the managers with a grin.

I really want to fight for our medical patients but let me tell you: Job postings are few and far between at my trust anymore. But if they EVER advertise for a job on that urology unit I am going to make a play for it.

Disclaimer: I do know urology nurses who work on short staffed heavy units that also take vascular surgery, short stay surgery and the occasional medical patient. I know that they bust their asses. This post is not a dig at urology nurses in any way shape or form. I just wanted to spout off about my awesome shift.


vishnuprasath said...

The main advantage of urology is that it can be used for both diagnostic and therapeutic (treatment) purposes. Hence endoscopy has become a mandatory investigation in Gastroenterology.

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