Friday, 1 May 2009

Nellie's Shift

Nellie volunteered herself to do an extra shift on her day off.

There was only one nurse for the ward that day and that is dire. Beth was to be that nurse and she was freaking out about it. Nellie said that she would come in and work the day shift.

It was chaos. Thank god Nellie came in. A childminder may be able to set a limit on the number of people she looks after but a nurse cannot. A childminder cannot have additional children dumped on her with no warning, on top of her other charges. But we do this to nurses and expect them to function every day. Otherwise, they would have to close much needed beds.

Nellie and Beth had a crap day. Half the patients were acute medicals with massive amounts of stuff going on. The workload was unreal. The other half of the patients were 100% dependent elderly patients.

I would feel safer leaving my 9 year old unattended on a ward than my 98 year old grandmother. My 9 year old can follow directions, ensure his own safe environment to a point, ask questions, communicate, remember instructions etc. He will not throw himself on the floor, or try and eat his own faeces. He will not forget that he has a broken leg and try and walk to the toilet. I am not being disrespectful to people with dementia. I am explaining to you the facts of their condition and why they need so much care, rather than an overwhelmed nurse who cannot be there.

Your average person will go on and on about how they cannot help grandma in hospital. But if it was his or her 9 year old child, their arse would be parked on that ward 24/7. Visiting hours. On my ward we will let you stay as long as you behave. But no one wants to stay with grandma. They don't have the time. If it was their 9 year old child hospitalised they would find the time and not leave his side. Yes but it is the nurses who do not care. Right.

Nellie and Beth had a patient go into cardiac arrest mid morning before they even finished the 0800 tablets. It was a bad one. I am so glad I wasn't there. I would have freaked the fuck out. Cardiac arrests are the norm on medical wards. But when it catches you unexpected its like someone sticking their fist into your stomach and pulling all over your guts out and stamping on them. I cannot describe how I feel in those situations any better than that.

At 11:00 hours Beth needed to go in and talk with the now dead patient's family. This left Nellie on the ward. Alone. By 11:30 she had got through 5 of the 13 patients that still needed their 0800 meds. She was focused. She was rushing and nearly made a massive medication error but luckily she re-checked and she caught it. She became even more focused. Medication errors kill thousands of people in hospitals every year. Many (some say most) of these errors are caused due to the nurse being interrupted and or overloaded. It's a big problem.

There are mountains and mountains of individual drug charts each with many different medications prescribed on them and every single thing on those charts needs intense scrutiny. It took her until after lunch but she sorted the mess out. And it was a big mess. There was a lot of other things going on as well that only a nurse could deal with. She could hear the weeping and wailing from the family room, and knew that Beth wasn't having a good morning either. Only 3 HCA's were trying to hold down the fort basic care wise. They managed to bedbath and wash every patient who needed it. There were 15 patients such as this who need at least 15-20 minutes each if you are going to do a half ass job. Before they moved onto their next patient the previous ones were crying out again. That it. Two nurses (one with a grieving family) and 3 care assistants with a whole entire ward of patients who are more dangerous on their own than a young child.

A few weeks later our manager received a complaint to respond to. The reason for the complaint occurred on the day and the time of Nellie's extra shift. It went like this.

"I visited your ward on such and such a date around 11:30. I was appalled to see the condition of the patients. Call lights were not being answered. There was a lady who did not have any shoes on and she was sitting out in her chair. Her bed was unmade. Nursing care has really gone downhill. The nurse was in the middle of the ward staring at a trolley, oblivious as to what was going on and did not appear to care anyway. Her name was Nellie Doe. I looked at her name tag. I believe that if matrons came back to hospitals nurses like this would be dealt with."

True story. It's really not funny. This is getting beyond a fucking joke.

Thanks for coming in on your day off and working your tits off Nellie. I doubt you'll be suckered into it ever again.

Fact is, this is the kind of bullshit that the complaints department has to wade through on a daily basis.

I have a friend who works on a medical telemetry floor. The nurse's station is in the middle of the ward and their are monitors all over this station, displaying patient cardiac rhythms. That is telemetry. The patient wears a device that sends a reading to these monitors at the nurse's station. These monitors need constant monitoring. Sometimes you have a few patients to on telemetry and a staff member to just sit and watch the monitors. Some times most patients are on telemetry and you have no one to watch the monitors. Leads need to be printed etc. A missed assessment will kill on there.

My friend who works in telemetry reported that they are always getting complaints from visitors about "the nurse's sitting at the station watching TV's. Why do the nurses need those TV's? Why can't they look after the patients instead?"

Documentation and Computerised charting is essential, ESSENTIAL to patient safety whether we like it or not and there is a hell of a lot if it that needs to be dealt with for all your patients, during the course of the shift.

"Why are all the nurses playing on the computer rather than looking after the patients".

Yes, this is the kind of bullshit that the complaints department has to deal with. No wonder the real complaints don't get deal with properly.

So who thinks we will talk Nellie into taking on another extra shift?


SSS said...

Can I ask you a really silly question, Anne? Where is your ward manager during the day shift? Can she not help with the drug round?

Anonymous said...

I really can't make any of this out. Week after week you describe hideous, unresolved chaos. SSS's question above isn't at all silly, I'll put it another way: who's in charge?

Nurse Anne said...

When the person in charge is on duty (the ward manager) he is the primary nurse for 12+ patients as well, completely overwhelmed on his own drug round etc. Management stuff gets done as in his own time unpaid as much as possible. He does double shifts all the time to avoid staff nurses having to work as the only staff nurse. He's killing himself.

He is fighting for more staff, resources, and equipment. All the time. And he shopped the place to the unions etc.

The powers that be are supposedly hiring and putting this plan into action and that plan into action. They keep promising it will get better and the unions back off. In some ways it is better, and in some ways it gets worse.

I think things are looking up after staffordshire blew up. Suddenly there were jobs advertised for actual real live Nurses. I am hearing similiar things from other hospitals in the area so..............

Nurse Anne said...

But if the shit hits, they will blame my saint of a ward manager. And he is a saint.

Happy1 said...

The reason the public make these mis-informed complaints is due to the media slating nurses constantly.

The conditions Anne describes are not unusual - it goes on in my hospital too.

The ward manager is not 'extra' to the nurse numbers on shift, the manager works as a nurse.

Unlike our bloody Matrons.

Nurse Anne said...

Happy is right.

My medical ward is by far not the worst one.

We don't have as many beds as the others and sometimes are patients are no where near as acute.

We love our ward manager, and we always work our arses off because we want to do our best for him. He goes way above and beyond the call of duty. Some of the ward managers on other wards do not inspire their staff in this way. We feel the same way about our assistant ward nurse manager person.

If the shit hits they will scapegoat them.

What I am describing on this blog is bad but believe me, it gets worse in other wards/hospitals.

Methuselah said...

You blog makes me sweat every time I read it: you capture the stress of such all too well. God knows how you cope with it all day after day.

WRT the "TV watching", if I may make an asinine suggestion, perhaps mounting a laminated sign reading "Cardiac Monitoring Screen Area" or similar above the screens could shut up the complainants?

SSS said...

You're kidding. He takes 12 patients???? How the fuck is he supposed to do his job?????

Oh fuck me, that's worse than I could have possibly imagined. You make the late 80s sound like the good old days. I hope they recruit as soon as possible.

Hang in there, Anne.

Nurse Anne said...

I hope so too SSS. All the nurses on these wards are on their knees.

The relatives come in and look at us like we are dirt that they have just scraped off their shoes.

Medical Aesthetics Position said...

Not only do I agree with most of the comments left before me, but I also feel greatly attentive to what everyone here is expressing in their comments. Some of you I can say that I truly am able to relate to you, and some just make me wonder if I can ever relate to the way lots of you feel! In some ways it could be happy but if the feeling isn't really in the happiness stage of things then all I can say is I hope the becoming aware part of things does eventually work out for all of us in the end of things.. But alongside this topic, I love it! And it really is great to see a lot of us participating and really putting effort into collaborating one of the best blogs we've yet come to see!

UCL Med Student said...

This sounds awful. I hit the wards next year, and if this is what I see I still think I'm going to be shocked...

Nurse Anne said...

Just wait, UCL, until you hit the medical gero wards. Surgery is supposed to be much better. Our critical care units are spot on. What I am hearing from friends who are nursing on general surgery wards is not good.

Nurse Anne said...

I should have added however.

Surgery is supposed to be good but lately I am hearing stories that shock me.

UCL Med Student said...

Well I start that in August - so I'll let you know what I see!

Anonymous said...

That was a fascinating read. A whole 15-20 minutes to bedbath a patient eh? Such luxury. On my ward I was told bluntly I must work faster because it should take me no longer than 10-15 minutes to bath or shower each of my patients including time taken collecting toiletries and clothes and escorting them to the bathroom and back!!! Perhaps we should use rollerblades to get us around the ward quicker. Perhaps we could strap the patients to giant skateboards to make it even faster! Now there's a thought.

PS Hope I never have to have surgery after watching a staff nurse larking about play-fighting rolling on the floor in her uniform and then going to tend a patient just back from an operation. This only happened the once so far as I know but it should not have happened at all.