Wednesday, 1 April 2009

Here Come the Kids: Part 2

Make no mistake about it. SOME trusts are using kids in place of trained, experienced staff. And our numbers are still bad. Most of our kids are youngsters. To me, a 17 year old is a child. Some kids are older and want to go into nursing someday but do not have the entry requirements for nursing school. This program would be a good one if it was managed properly. But once the kids are on the wards, the site managers (who are struggling to staff the hospital and have no choice) start floating staff away.

Went to work one day and there were 2 staff nurses, 2 HCA's and 3 kids on my 25+ bed medical ward. That is not enough anyway. Look at nurse patient ratio research. There should be no more than 1 nurse to 6 even with 100 untrained staff on. It is a fact. Even one to 6 would be a struggle. If I had only 4 that is 15 minutes per hour per patient. That is not enough time to do anything.

The site manager arrived on the ward at the beginning of the shift.

"Oh lookie lookie here, You have 3 kids on this shift" One nurse and one HCA are going to ward B upstairs"

Me: "WTF! That leaves us with one nurse, one HCA and 3 inexperienced kids who are not allowed to do anything!"

Site manager: "You have 3 extra sets of hands in the form of kids. Ward B has only one trained and once HCA on today." "I am so so sorry"

The Site manager actually looked sad. I don't think she had a choice. I backed down.

Ward B has 35 beds and their patients are much more acute than ours. I have worked on ward B and I was hurting for the nurse up there that day when I heard of her situation. She needed the other RN more than I did. I sent my staff over to her. The manager would have dragged them there herself if she had to anyway.

But this left 1 RN, 1 HCA, and 3 kids on my ward. Trained staff should never be outnumbered by untrained. Doing the AM drug round for 25 people would have taken until lunchtime (and it did).

The following stories did not all occur on the same shift.

Kid horror stories (Many details have been changed to protect confidentiality. There are medical patients up and down the UK in every single medical ward who fit these descriptions to a T. The patient conditions that I am describing could be the case for literally thousands of people all over the place. If you think you recognise a person or a situation you are dead wrong.)

And not all wards are this badly staffed. Some are well staffed with crap and some are short staffed with great nurses. Others are everywhere in between.

Horror story 1
Had a patient on nebulizers, not to have his inhalers as it was the same drug. Wife didn't understand this and didn't ask me. She brought in his inhalers thinking we were neglecting to medicate him and left them on his table. As a kid walked by the patient and wife asked for help with inhalers. Kid wanted to help out and started giving the bloke two puffs on his inhalers every hour. Patient assumed that since he was poorly he should have inhaler more and grabbed a kid (thinking she was a nurse) No one came to me (THE NURSE) and asked. The kid should have known better. She may not have known that inhalers should not be given every hour or on top of what he was already having. She should have known that they are not to touch any kind of medication. Can we say tachycardia etc?

Horror story 2
Kids are changing a patient's gown. They cannot get the IV line out of the gown in order to get a new one on. They are not allowed to disconnect it and don't know how anyway. Patient has history of CCF and his getting an infusion of saline with K+ because his frusemide dropped his K+. Kid has the bright idea to take the tubing out of the machine and wire the bag and line through the patients sleeve. Great idea except she forgot to close the clamp on the tubing. The whole bag started to infuse at way to fast a rate. Basically it bolused. The machine and the tubing we use in the machine should prevent this from occurring. They often fail. Patient is lucky to be alive. You do know what happens when you bolus a lot of fluid quickly into someone with ccf right? You also know what happens with a potassium(K) bolus right?

Horror story 3
Patient collapses and is admitted to hospital. Bradycardia is noted. Her digoxin levels were extremely high. She had been recently put on 250mcg. Digoxin was actually stopped on admission by the docs. Family and patient thinks that we are neglecting her by not giving her daily digoxin but just bitches about it instead of asking someone. It had been explained but sometimes it doesn't sink in. They are so busy being paranoid and focused on thinking that the nurses are neglecting them intentionally that they just do not take things in. Of course the real problem is that no one ever explains anything to them properly. That is the major factor.

They bring in her digoxin in from home. They leave the box of this drug on her table. Patient asks passing kid if kid will help her with her tablet as "My GP 2 years ago told me that I has to take my digoxawhatsits every single day and not one of these bloody hospital nurses have bothered even once in all the time I have been here".

Kid remembers that she is not allowed to dispense meds and is smart enough to refuse but leaves the tablets where the patient can get them and "forgets" to tell nurse. Kid doesn't even tell the patient that she is not a nurse and leaves the patient to think that she has been blown off once again. Patient was about to help herself to her "missed" doses on top of today's "missed" dose of 250mcg of digoxin whilst she still had a pulse of 45. By the grace of god I was walking by and saw her trying to get tablets of the box. By the grace of god. I think we all have guardian angels sometimes. I know I do.

Horror story 4 (more of a PIA than horror)
One patient was extremely extremely difficult even for the best doctors to cannulate. But she needed constant IV infusions of a medication. She didn't want a central line unless no one at all could get a peripheral line in. She was advised to have the central line but she was stubborn. But it was okay as long as we had a good peripheral line in. One doc got a really really good peripheral line in and we just needed it to last for 2 days at this point. We flushed it regularly. We bandaged it and we check it often because sometimes the dressings go funny or they get knocked.

But early in the evening I went to this patient to commence another infusion and investigate why the pump had not been beeping and the line wouldn't flush. The old bag was was hanging there but capped off and not attached to the patient? The pump was switched off WTF? How long has that been like that?

About 2 hours prior the transporters had shown up to take this patient for an xray. Only a kid was around. They cannot take a patient on a drip downstairs without a staff member escorting and staying down there until test is done and escort patient back to the ward. Kid had 3 people on commodes and couldn't go. She didn't know where I was (bandaging a leg in a side room) and she couldn't see anyone else. Kid and transporter have the bright idea to cap off the infusion so he can take the patient without an escort. No one fucking tells me. The transporter and the kid were both in a hurry. The drip should never have been stopped and the cannula needed flushing if the drip was stopped/capped off otherwise you lose the cannula and it becomes non functioning. Of course it wasn't flushed. I didn't even know the damn thing was taken off. So the cannula clotted off. That is why I could not flush it. Oh shit.

Number 5
Patient's daughter phones the ward and a kid answers. "My dad is going home today" (they always think this is the case even when it isn't). "When will he be ready".

"Oh he should be ready later, around lunchtime" says the kid. The kid assumed that the relative knew what she was talking about and kid also knew that we usually pull all the discharges together around lunchtime. No one mentions a thing to me. The patient was still on IV antibiotics and not even close to discharge. The consultant wasn't even due to see him until tomorrow and in the meantime we were continuing current treatment. So the daughter takes time off of work to come in a collect him at lunchtime only to be told that no one has mentioned a word about discharge. "But the nurse I spoke to this morning on the phone TOLD me blah blah blah." she screamed at me in a rage. I was in the middle of a drug round at this time and had to walk away from it and ignore the patients to search the doctors notes (couldn't find them and had to search forever) to see if maybe doc had come to see patient, changed IV's to orals, and discharged the guy without giving me a heads up. Of course he hadn't. Daughter was in a rage. At me of course.

Number 6
As usual I was running my tits off. I had a drug round do for 15 patients. I had blood to hang. I had someone in pain who needed a syringe driver (takes forever to set up in ward terms), I had another patient with a temp of 39 and no urine output. All at once. All of it needed sorting now or it is errors and write ups. And god knows what was going on with my other patients. Their fucking urine output could have stopped hours ago, their catheters could be disconnected and on the floor, they could be in distress or dead. Damned if I know. I can't even wade through the poorly patients and the interrupting visitors long enough to get down there. The other nurse was bringing a patient back from theatre and I was alone on the ward with 2 kids throughout this.

The kids were outnumbered by people crying for the commode. Kid Jane had just transferred Maude onto the commode. Maude is confused and old and she falls a lot. She is unable to walk unaided but forgets this. Sometimes we have to leave patients on the commode and move on because they asked for one at a time when we cannot stay there with them. But not Maude. Maude is a huge fall risk even in bed with both side rails up. If the kids had paid attention in handover they would know this.

Kid Jane just got Maude onto the commode when Kid Jennie shouted for help. She had tried singlehandedly to get Martha onto a commode. But Martha is obese and immobile and was too heavy so Jennie shouted for the only other help available. That was Kid Jane. But Maude wasn't done weeing. Jane left Maude on the commode and went to help Jennie and Martha. Maude ended up on the floor. Jane should have stayed with Maude and made Martha and Kid Jennie wait even though Martha was screaming at Kid Jennie and saying "If I wet myself it is all your fault, you little fucking cunt." Fat immobile Old ladies can use the anglo saxon let me tell you. Then tend to get like this anytime they do not get immediate one to one care. Kid Jane should have made Kid Jenny and Martha wait until Maude was finished.

An hour later the same thing happened again. The exact same thing. Maude ended up on the floor again. I got to explain to Maude's raging screaming son how his mother managed to end up on the floor twice in 1.5 hours. And while I was dealing with him who was sorting the deteriorating patients that I mentioned at the beginning of this, or getting to the others that no one had seen? Nobody. And in 1.5 hours I hadn't gone very far with sorting any of it out either. And Maude's son was like a bulldog who wouldn't let go. "I'll never forget that it was YOU who just couldn't be bothered with an old woman like mum and let her fall. I'll get you for this!" The next day Martha's family were screaming at the nurses because Martha told them that we were always making her wait for the commode. Like we have a choice. You've got to love these fucking people. I would have told them that lack of staffing, inexperienced kids, and Martha's demanding nature caused another patient to end up on the floor in a pile of piss.

I should add that Martha and Maude's beds were nearby and if one asked for the commode so did the other about 10 seconds later. As Martha needs 2 people and Maude needs one to transfer her to the commode and stay, and we only have 4 staff on the ward in total for 25 similiar patients, you can see why it's a problem. It's probably every 30 minutes or so that they want the commode. This is down to old age, weak bladders, and forgetfullness.

I could go on for pages. I am not even close to done. I'll try to fit it all into the next blog post if you want. These things are not once in awhile isolated incidents. The kids are all on my license as they are supposed to be (supervised) and I do not have eyes on the back of my head or xray vision or the ability to clone myself and be 10 places at once.


Nurse Ratchet said...

Jeez Anne. Not everywhere is as bloody awful as this. FFS leave and get yourself a job somewhere where you can keep your sanity. I worked somewhere like that once and it took my best friend to shake me and tell me to get out before I went mad, for me to do it.If staffing is that crap, and they won't use agency, get out get out get out, before you end up leaving nursing for good because it's broken your spirit.
Lord, makes my day look rosy !

Nurse Anne said...

There are no other options for the nurses who work at this hospital. Trust me. The enxt nearest hospital is even worse. They could go and work at KFC or Burger King but it would be a hell of a paycut and they would not be able to pay their mortgage. Some people have done that and are now renting.

Happy1 said...

Well I can relate to it...thats why I left the wards to work in A&E. Its 'slightly' better.

Anonymous said...

I was a very capable and confident person before I commenced nursing but I left at the very end of my training because the culture of the NHS was destroying my self-esteem. Throughout my previous career I was treated with dignity, courtesy and respect. The NHS was a real eye-opener in that there were frequent attempts at bullying and I was spoken to with such rudeness that I only managed to keep my temper with superhuman effort, with hindsight how I wish I had told some people a few home truths. Ironic really when the NHS bangs on and on about dignity and respect! Significantly, I seldom had negative experiences with the most hard working staff nurses - they were just too damn busy keeping their noses to the grindstone to fanny around playing mind games. Nurse Anne, Nurse Ratchet et al I salute you - I honestly do not know how you do it day after day after day. Never mind angels, I think you are saintly!

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