Buy the time I reach hour 10 without anything to eat my human side takes over and I can no longer smile. I am always so scared that I will hurt or kill someone because I cannot be ten places at once. Would I simply lose my job and my registration? Or would it go to a criminal court as well? There is no back up and no support. The relatives troop in ready to have a go at me for anything they can find wrong. Grandpa hasn't been shaved, grandma doesn't have her slippers. And I can't even get past them to get to my septic patient with her IV antibiotics, and IV fluids. Her BP is bottoming out and she is becoming vacant and unresponsive. As I try to get past them they imply that I am being rude to them.
After that I need to get back to check on the previously hypoglycemic patient who seemed better last time I checked him. How long ago was that? He has been having these hypo episodes, not due to the usual cause and no one knows what is going on with him yet. After I clear that I can get to the controlled drugs for the cancer patient. IF I get all that accomplished then I can get to all the drugs that were due over an hour ago, and if I can get through that then I can try and conquer some basic care. It has been like this all day with no let up. Never has there been more than 90 seconds where I could carry on uninterrupted. Never. Never. Everything I have to do has to be accomplished in 90 second blocks of time in between interruptions, sometimes less. I've just had 10 hours of that.
I lose the ability to smile at this point. I just want all my patients to be safe. I am so scared that tiredness and hunger are going to cause me to lose my concentration and I am going to fuck something up. Focus focus focus. Push yourself and keep going. Now someone needs a heparin drip immediately. Septic patient first. Can I organise Mr. Smith's heparin drip and all the ins and out of that at the same time that I make up the syringe driver for Mrs. Jane? Can I do both those things while I turn Mrs. Peel? She has grade 3 pressure sores and hasn't been turned in hours.
Damn. I have to prioritise the heparin infusion first. Got to get the right heparin, syringes, tubing and pump, set it up, cannulate the patient which on it's own takes forever, organise blood draws etc. If I keep getting interrupted through that, the patient waits longer and longer to have his infusion.
Then I have to fight my way through hordes of visitors and call bells to get to Mrs. Jane's syringe driver for pain control She has already been waiting for hours. Then after I clear that I can turn Mrs. Peel. By the time I finish sorting out the heparin infusion and get to Mrs. Jane she will have been waiting in pain way too long. Mrs. Peel's pressure sores and the fact that she has been on her back for hours and hours is also weighing on my mind. If I run past the call bells and people shouting for help I can get to the hep infusion up and running, 30 minutes later get to the syringe driver and 20 minutes after that get to Mrs Peel. I usually have 15 patients. So multiply this scenario by 5 all day long. Then factor in the fact that the nurse never goes more than 90 seconds without an interruption, and someone who doesn't understand the situation trying to steer her into another direction.
OMG the hypoglycemia patient!!!! Oh fuck!!!!
Drop the heparin infusion and leg it back down the ward past the call bells, the crying, the begging for help. The hypo patient is again very hypo, pale, sweaty and vacant but I can get sugar gel into his mouth safely,still will need an IV. I need more supplies. Back down the ward I leg it still past all the crying and begging patients and hordes of visitors waiting to pounce. Up and down the ward 3 times, past all these really pissed off people to get every supply I need. The ward lay out is terrible.
I start to think about what would have happened if I had stopped to answer the myriad of requests for the commode and pain killers that were communicated to me in between drawing up that heparin infusion and realising that it had been to long since I checked back on the hypo man. I may have found a body in that bed. And then I would have had to call his family. My blood runs cold, my stomach goes into knots and I feel a bit sick myself.
The septic patient hasn't gone anywhere and I haven't been back to him since I hung those antibiotics and IV fluids. Let's hope he didn't have any kind of allergic reaction. Let's hope he is still alive. He never should have been left in the first place. Still there was the heparin infusion, the pain meds for Mrs Jane. The hypo patient. Back down the wards, past the bays of really pissed off patients ringing their call bells, shouting for help and hordes of visitors ready to pounce.
I don't think that there are a lot of people who can smile and look happy in this scenario. Why are nurses expected to?
Are we supposed to be superhuman? They don't even pay us for all the hours we work for christ's sake.
Just look at some of those comments!
And yes. Academic degree educated nurses are taught about basic care. Very much so. My first semester of nursing school was anatomy and physiology , nutrition, and pharmacology lectures in the morning and 5 hour lectures of NURSING 101: BASIC FUCKING CARE in the afternoon. Bed making. Bed bathing. Hygiene. Skin care. Pressure area care, etc ,etc, etc,etc,etc,etc,etc. The next day was a 10 hour placement on a ward. Fuck up a bed bath or on bedpan duty and Mrs. Lewis, the nursing 101 instructor would have you for her lunch, in front of everyone. And the next day was lectures again. The day after that was wards again and so on and so forth.
We did this for months. That was first semester only. 10 hour days, baby. It got harder later on. Especially when they threw chemistry and microbiology on top of advanced medical surgical nursing lectures and constant ward placements in second semester. The microbiology, anatomy and physiology and chemistry etc were taken with other university students who also needed to take those courses, not just other nursing students.
We were taught nursing on our nursing courses. Not medicine. Not how to pretend to be a doctors. It was nursing that we were taught. God forbid if we tried to put a medical diagnosis on our care plans and schematics rather than a nursing diagnosis. Our nursing professors would have had their rulers up our backsides, flinging us out of school. This was 1994. All right all right I didn't train in this part of the world but still.
The new graduated nurses that I am working with now here in the UK have a very good handle on basic care. The kids and the carers do silly things sometimes. But the newly qualified nurses that we have had are pretty damn good. The vast majority of new nurses and nursing students were Health Care Assistants for years (decades even) prior to attending nursing school. How could they not know how to bath a patient or make a bed?*Patient names in this post were invented by me and are not based on real people.