Thursday, 14 May 2009

The Surgeon Who Screamed At Me.

Once I was working on a medical ward that started taking surgical patients when the surgical ward was closed for refurbishment. When we were first told about this we celebrated.

We assumed that the nurses from the closed surgical ward would come to us along with their patients. They were short staffed on their 20 bed ward and we were short staffed on our 25 bed ward. Their ward was closing. We assumed we would get them as well as their patients.

Wrong wrong wrong.

Management sent most of them to staff other parts of the hospital.

One morning I came into work and was handed 5 care of elderly demented patients. They were climbing all over the side rails, falling out of bed and spreading porridge in their hair as well as eating their own faeces. Constantly. Old age and dementia will come to many of us. Looking after a patient such as this is tougher than managing a group of hyperactive toddlers. One patient with dementia was having a blood transfusion and she bit through the tubing and was spraying the walls with it. In addition to that I had 5 medical patients including an alcohol detoxer who was licking the floors and very disoriented. You cannot control and or rationalise with people like this. Not at all. They need someone there at all times or all hell breaks loose.

I also had 5 surgical patients. 3 of the surgical patients were given the go ahead to be discharged at 11AM. Discharges are often multi faceted and time consuming. The patients who are being discharged think that they are the most important people in the world and don't seem to get that the nurse is running between and managing dying patients while she is also organising their free discharge drugs to take home, follow up appointments and discharge letters etc.

The two other surgical patients were for theatre in the afternoon and somehow I managed to get them ready for it, spending about 10 seconds with each one and barking orders about gowns. I wanted to be a good nurse for them but I had to move fast.. Just doing that little bit and taking the time to rush through the discharges caused my elderly patients to be on the floor 3 more times. Those discharges were done in a half ass manner as I was rushing, but it was still enough to cause neglect to my elderly patients. The site manager was up my ass because they had more patients than beds as usual and demanded that I needed to sort the discharges. I know I know, the site managers are getting shat on from a great height. I did ask her for help but she said that there was no one to send.

Before the 3 discharges were out the door the 3 new surgical cases for the afternoon were on the ward. The beds needed to be cleaned and the new surg patients needed to be admitted (time consuming) and prepared for theater (time consuming). They also had a million questions (time consuming). My 5 acute medicals and my 5 elderly dementia patients were still there, doing the same things that they were doing this morning. That won't ever change. The alcohol detoxer was still licking the floor, refusing meds and throwing things at other patients. You cannot sedate people like this. You will hurt them more. Haloperidol is a joke and benzodiazapines are out of the question for this patient.

I do not have the right to get an additional nurse to help me while I am in the middle of this kind of situation. I do not have that right. But the hospital management has every right to dump more patients on me in this kind of situation. I did not create this situation. But I am responsible for any problems and bad outcomes.

Jesus christ it has been a long time since I looked after surgical patients? Am I doing everything right? I never worked with their surgeon before and do not know his ways. All doctors have different ways that they like things done but they won't communicate this. The nurses who work with them regularly just know.

I couldn't focus on the discharges very well because I also had someone with pancreatitis who was going downhill. I did get "forced" to get the discharges done and that is when my pancreatitis patient really went south. The pancreatitis person was critically ill. There was only one other nurse on the ward with me that day. She ditched her patient to give me a hand. It took two of us to monitor and implement orders for this man, that is how bad it was. We couldn't leave his bedside. The three care assistants we had carried on with bathing and toileting. They cannot admit patients, help with discharges or deal with the acutely ill in any way. They were going to make my surgical beds up , get the new patients in them and gown them and get basic observations but the elderly patients were constantly falling. Constantly. The phone was constantly ringing.

At this point the new admit surgical patients were filtering in and the beds were not cleaned. It was only 5 minutes since the discharged patients left. I'll be damned if I am going to leave a dying patient to clean a bed and kiss arse and admit a minor hernia patient for the PM theatre list. "Welcome to Nut ward, You are my only patient and I am here to gently guide you through the journey of having your minor hernia repaired and answer all your questions and bring you tea. Can I shove my nose a little further up your ass please?" Yeah right. I am surprised that management hasn't scripted that one yet.

At this very moment the surgical doctor came onto the ward. He saw that his new admission patients for the afternoon lost were not yet in beds, admitted, or ready for theatre.

So he tries to pull me away from the pancreatitis guy (the patient of another doctor) to scream and scream and scream at in the face, eyes bulging, on his tippy toes...


This is in front of the patients. 3 of them are already pissed off because they have taken time off of work and shown up onto the ward for a long awaited operation and the beds are not ready for them. The first one is first on the afternoon list and he isn't even in a bed or admitted or anything. The afternoon list starts in 20 minutes. There is not yet a bed in ITU for my critically ill patient. What about my other acute medical patients? What about my elderly patients who haven't been given a drink all day? The blood transfusion had yet to be restarted on the woman who bit right threw her first unit of blood. When was that? Over 4 hours ago? HB of 6 by the way. Oh Shit. Getting more blood and restarting that transfusion could have easily taken me away from the others for a long time. Very long time. And she will bite through the next transfusion as well because she has dementia and I will be back with the pancreatitis patient, or the other medical patients, or the surgical patients, rather than in her room.

It is not an exaggeration . It is a normal day.

Where are all these managers and highly paid matrons? Just like ghosts. We know they are there, we just don't see them.

Where are all these supposed "new nurses"? The government is telling people that there are more than ever now.

Why was I put into this position as a former e grade now band fucking 5 medical ward staff nurse?

What kind of a stupid fucktard thinks that a nurse should walk away from critically ill patients, acute patients, and at risk elderly patients to discharge and admit stable minor short stay surgical patients?

How does a fucktard such as this actually get into medical school?

Why didn't management let us have the surgical nurses if we were getting their patients? We would have had to additional RN's on the ward that day.

Why are they so against staffing these wards?

Who was in charge of the ward that day? Me. The only other RN that day has less seniority but we both had heavy and large patient assignments. I had to take the official role as charge even though I was a very overwhelmed primary nurse to a group of patients.

When is this going to end?

It did have a good ending. Kind of. At least we were entertained. I blanked the surgeon. He went even more apeshit at me. This caused the medic of the pancreatitis patient to go apeshit at the surgeon. We damn near almost had a doc fist fight. Those are the best. You have got to get your kicks somehow.


The Shrink said...

"This caused the medic of the pancreatitis patient to go apeshit at the surgeon. "

I like your thinking, girl :-)
Support from medical colleagues has to be the only way out of shoddy staffing levels you've no influence over, and resulting abuse that's wrong brought to your door.

One of the perks of being a Consultant who's also part of the management structure is that as a Director you get to direct. I've been on a ward and required of a manager that they leave the unit since they were politely and quietly but psychopathically laying into a really good ward nurse who was busy nursing (in a less frantic ward than your corner, but acutely confused, wandering, aggressive patients none the less). Explaining that she was compromising patient care and I therefore required she left the unit, but I'd meet with her at the next governance group meeting to hear her views.

She left the ward. Result! Better, when she was carping on about the "issues" at the monthly governance meeting, it was clear to everyone she had petty, irrelevant nonsense and looked an eejit on trying to force this as "mandatory" on ward areas.

Really, truthfully, the only reason I take time out to do management nonsense on top of my already too busy week is for this sort of thing. It means that most of the time I can stop managers inflicting nonsense on us. And in rare moments, they listen to clinicians' words, and we get things our way. But, mostly, it's just so I've a voice with managers to say no, behave, let's not do that.

Surely your senior medical colleagues can help stop arsy surgeons or managers from bringing needless pain to your door?

Nurse Anne said...

Yeah, they stick up for us sometimes.

I filled in about 10 incident forms and did at least 2 letters of complaint (one about the surgeon) just for that shift alone.

Never heard a word back.

Happy1 said...

This surgeons aggressive confrontation could have been put to so much use if he had directed it more appropriately. He would have been better to head off going to Management or the Director of Nursing.

He obviously had concerns for the well-being of (some but clearly not all) patients. What did he think you were up to...playing cards in the office watching TV?

The lack of intelligence / decency / common sense / team spirit (ie - we're all in this shit together..) is astounding.

It does make you wander how one so blind can reach such a level of seniority.

Anonymous said...

A young (2nd year)trainee-medic screamed abuse at me (humiliating me in front of listening patients)because she hadn't bothered to find out - (perhaps too busy talking about her favourite subject i.e. herself) - that my then role as a third-year student was to manage the care of groups of patients (a quarter of the ward in my case) delegate tasks and supervise staff. In fact students begin managing patients from about the middle of their second year. An emergency had arisen with one of my own patient group, (yes, I had warned her first thing that morning that the patient's condition had deteriorated) but she took the HCA I was supervising to assist her and bawled at me to "carry on dishing out food to the patients"!!! I had worked on the same ward with her for three months but she didn't have a clue what my role was! Some of these kids are unbelievable, they are so self-obsessed and blinkered. Put them a white coat and their arrogance knows no bounds!

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