Tuesday, 16 June 2009

Good God, we had a nice week.

A couple of really good things happened this week. First of all I have earned a hell of a lot of comp time for working unpaid hours over the end of my shift. The hospital cannot pay overtime and has demanded that we take the time back. I did a couple of 8 hour shifts. It's not like being at work at all. I loved the 8 hour shifts. I was able to come home and still have part of my day.

I cannot go into to much detail on here but between restructuring at the hospital etc we not only ended up with a few closed beds but extra staff from another unit. Usually we get their patients but not their nurses. It's really true, sometimes managers do not fuck up and the gods of nursing shine down on us. I am sure that the closed beds etc wrecked havoc in the rest of the hospital but on my ward, things were smooth.

Not only did I only do an 8 hour day but I had only 5 patients. Only 2 of them were acutely ill. That's right. A non nursing colleague of mine came onto our ward, looked at the numbers and said "Whew, Annie is going to put her feet up today". No chance my friend. I wanted to see if I could still nurse patients properly when I have a controllable work load and time on my side.

I immediately set out doing everything as it was meant to be done, my patients got a thorough nursing assessment and I caught onto a lot of stuff that was a bit worrying. It scared me to think about how much we miss on our usual rush days. When the consultants came for their rounds I was ready with any info they needed about the patients. I knew those patients inside and out. I knew every drug they were on, everything that happened since admission, every test result, what their normal level of orientation and mobility was like, social circumstances etc. I had a chance to read all their notes. It doesn't take a lot of doing to read up on a handful of people.

Usually the medics can barely find one of us to do the ward round and if they do, we are barely able to answer a simple question about the patient "John Smith? Oh. Is he my patient? Let me look through my handover sheet. You ask if he has passed urine yet......Um I don't even know what he looks like". It's no wonder that they think the nurses are all retarded.

The rounds went well. My patients were happy. I felt like they were getting the safest care I can provide. The drug rounds took 15 minutes rather than the usual 2 hours. Less patients means less people phoning and less time running to the phone.

Not only did we have a 1 to 5 ratio but we had an extra nurse to coordinate. She wasn't from our unit and there wasn't much happening so she busied herself with the important jobs that never get done basically.

I had one extremely sick woman who needed many interventions. The family made a point of thanking me for taking such good care of her, and they told me that knowing that she is getting good nursing care makes their sad situation bearable. They said that they thought that I had worked really hard and that they appreciated it, especially considering the horror stories that they heard about the place.

Of my 5 patients only one needed to be fed and the HCA and I fought over who was going to do it.

5 patients isn't always going to be easy. Had they been critically ill I would have been run off my feet. It's not always the number of patients you have but the acuity as well. I was lucky in the fact that I had a smaller than normal number of patients who were not very acute. Woo hoo.

And that's it. Soon the new units/beds etc open, all the beds will fill at lightening speed and the nurses we have will all be spread out even more thin than we are now. I got a letter from management addressing my concerns about the usual state of the staffing ( I last wrote to them months ago). He was pleased to inform me that we are getting 0.5 of a cadet. Uh uh.


Happy1 said...

Hello Anne, welcome back.

Our A&E dept has just opened a 5 bedded Observation Unit, for fairly well A&E patients, who do not not need to be admitted into hospital, but need a period of observation before going home.

(4hr targets mean they can't stay in A&E anymore - so lots of money has been spent on extending the department, creating a mini obs ward, extra equipment and staffing etc etc - and this had occured all over the country, in most A&E depts, in order to meet the government target. Probably cost the NHS zillions of pounds...what a ridiculous waste of money).

Anyway....I had the pleasure of spending my shift looking after 5 fairly well patients ...and ...oh..my...god.

What an absolute dream. Every patient had every need met, as you describe in your post. The nursing care that I was able to provide was the nursing care that I would love to provide every day. It is the kind of care that nurse education teaches about, that the public rightly expects, that the patient deserves.

But at a ratio of 1 nurse to 5 patients, it is a one-off special situation, and will not occur under any other circumstance.

I very much enjoyed my shift, and shall be looking forward to rotating into the observation unit again. Its ward work as it should be.

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