More fun during "protected mealtimes"

By 2PM I had discharged 3 of my patients and transferred two others to rehab and long term care facilities.

I had 5 empty beds! I made sure that the bed manager knew this. Our patients are always breaching the targets in a&e due to lack of beds. If she knows I have beds then she can get patients out of express admissions unit/medical holding and send them to me. Then she can get patients out of a&e and into medical holding.

I was left with a mere 10 patients (25 beds on ward total, and one other nurse). The healthcare assistant and I ran around making sure the beds were cleaned. I had to walk away from some important time sensitive things to help her do the beds quickly. Usually the discharged patients are not even out the door before the transporters are dumping another into that bed. What if the staff hasn't had time to clean the bed because the new patient is coming before the old one is out the door? Well then the porter will just dump the new patient into a dirty bed and go off on his merry way. He has other places he needs to be and it isn't his problem if the nurse gets an admission with no notice. It isn't his problem if she cannot sort the discharged patient's bed out right away because Gladys in the next bay collapsed onto the floor with a massive GI bleed. The buck always stops at the nurse and the numerous support staff goes on their merry fucking way and do as they please.

If the new patient complains about getting dumped into a dirty bed or gets ill as a result the ward nurses have to take all the blame. The porter can do as he pleases. Even if the patient has been on the ward less than 10 seconds anything that happens to that patient during that 10 second period is the responsibility of the RN. And they often send up admissions that I am not expecting and dump them and walk off while I am in another patient's room and don't see.

Sometime after I declare our number of planned discharges/empty beds to the bed manager the nurse from the "sending ward" calls me on the phone and tells me about the patient they are sending to me. This is called handover. After that happens the patient may arrive on the ward 3 minutes or 5 hours later or anywhere in between. They get sent to me at the convienance of the sending nurse's unit. I have no idea when they will show up on the ward. What I do know is that they like to send them all at once either at change of shift or mealtime. I don't know why it is that way. Either they are being twats or the situation on their unit is such that they have no choice.

Sometimes there is so much going on with the patients I already have that there is no fucking way I can nip down to see the new admission as soon as I want to and need to. I do not get given an exact time as to when they are coming so I cannot plan for it really.

I want to and very much need to go and see my new admission and give him a once over and a kind word of welcome as soon as he comes onto the ward. As a matter of fact I really fucking NEED to see him. But it isn't always going to happen right away. The ward receives admissions when it is convenient for those who are sending the admissions. That means admissions are arriving when I am up to my eyeballs in other things.

No thought whatsoever is given to what is happening on the receiving ward. That means that I am often getting new patients when it is unsafe. It means that I cannot always get to them straight away. Wanting to get to them straightaway and understanding that it is crucial for me to get them straight away is not enough to make it happen. This is the case even though I am an extremely hard worker and easily able to multitask.

If I had 5p for everytime a walking wounded transfer said "well I have been here 20 minutes and not one of the staff has seen to me yet" I would be rich. How I would love to say "well they sent your ass up here when I was smack in the middle of inserting an NG tube into someone with an obstruction.

As a matter of fact it is a crime for me to leave that very unwell patient at anytime for any reason EVER especially to be down here apologising and kissing your medically stable ass. But I took a risk to come down here because I care about your welfare too. Believe me, I took a massive risk when I left him and came to you. It's because I don't trust the ward who sent you or the transporters who dumped you here not to leave you in a bad way. Once upon a time the ward who sent you handed over that they were sending me a stable patient and when the man got here he was dying. It may have taken me 20 minutes to get here. But I got here as soon as I could. I did it in the only 30 second period I had to check on you and make sure that you are actually stable as they said you were. Your welfare is important to me, even if you are a complete twat. A word of thanks rather than a stupid smart ass comment about how long you had to wait would be more appreciated. Not one thing about this situation is created by the nurses. Nor can they control one bit of it.

Back to the point of this post. I had 5 empty beds at 2 PM and the bed manager knew this at 2:05 PM. She knew that those beds were coming up and already had transfers slated to come to us.

We got the beds ready right away because we know what happens. 3PM rolled around and I had not received a phonecall from a medical holding unit nurse to give me handover on a patient that she would be sending. By 4 PM I had received a call from the holding unit nurse. She handed over two patients. I told her to send them now, before mealtime.

By 5Pm nothing. At 5:50 they called and handedover 3 more patients. At 5:55 they sent all 5 of them up together. The porter left them in the middle of the ward and walked away. I found them all when I came out from a bay where I was pulling a central line.

3 of them were confused. None had wrist bands on to ID them. The one who was supposed to be treated for dehydration with an IVI and a had low potassium according to today's blood report had NO IV. No venflon. Nothing. Nothing prescribed for his K+ of 2.2. First priority above all else right there. Had to get a venflon and get something prescribed. He wasn't taking oral anything. The last note from a doc who saw him prior to his arrival on my ward said to hang IV N. Saline with 40 mmols of K+ and monitor fluid balance closely. Well duh. But he never prescribed it onto the medication chart. In the UK nurses are not allowed to transcribe orders from the doc's notes to the drug chart. The doc has to write it on the drug chart. Yeah. And for those of you who don't know, if your potassium is that low your heart will stop.

The one that had urinary retention (according to handover) and had not passed urine in 11 hours (bladder scan that was done in medical holding showed 800mls in bladder). The sending nurse handover to me that she was going to cath the patient. This was a few hours ago. He was supposed to have a catheter inserted. There wasn't one.

So all this was happening at the same time and there were 2 nurses and 2 HCA's. It was 5:55 PM. The supper trolley comes now, and we have 20 minutes to get all the food out and served and fed to all 25 patients (and 10 feeds). I also have an hours worth of a drug round due now and people need their pain killers. I can't even get to the new patients new and read up on them to see if there have been any changes since they were handed over. This is because the notes are on the desk and that is where the visitors are queing.

I go for the notes to read up on my patients and make sure there aren't any other life threatening "surprises" left over from the sending unit and the visitors of the other patients go for my jugular." Patients are crying for nurse and suffering and there is that nurse with her face in the notes" "Don't you know that grandma cannot feed herself cannot reach her drink? Don't you horrible people care?" It's not like I can through all the notes in a few seconds. Getting all the information that I need to takes time and concentration. But the families go nuts when they see me open a chart....then mistakes happen because the nurse does not have all the info she needs to be able to function.

The domestic was stood with the supper trolley hands folded staring at me menacingly while I was getting the venflon into the low K+ guy. The other nurse did the catheter. One HCA sorted the ID and wristband situation and tried to get the new people settled into their beds. They new admits got really pissy when she moved at the speed of light and wouldn't stay or organise their belongings in the cupboard. The reason she was moving so fast is because one HCA was now trying to serve and feed all the patients on the ward by herself. Impossible for speedy gonzalez let alone 50 year old Linda. We all needed to pitch in and help. Even with all 4 of us on deck it was never going to happen, let's be honest. It was 20 past 6 before I sorted out the man with the low potassium and by that point the fucking domestic was trying to collect all the dishes in so that she could get home on time.

Now it is 20 past 6. I was trying to keep an eye on my unstable patients, figure out who actually ate and who didn't...everyone was simultaneously shouting "nurse nurse nuuuuuursssse" as I walked by and the visitors who just arrived were queing up at the nurses station to bitch at me and tell me things I already know. My drug round still wasn't started. At this point I would be lucky if I finished it by 7:30 PM. That means it is going to be another hour before I get around to everyone in pain with their medicine. IF I stop at any point to talk to visitors or answer the cries of "nurse nurse nuuursssssse" it's going to take a lot longer.

FUCK. FUCK. FUCK.

Later on we again had two empty beds by 7PM. I told them so no later than 7:05PM. They handed over patients at half past 7 and then sent them both up together at 9PM. I am off duty at 9PM but the night nurse was going to struggle handling two new admits, her initial drug round, and all the problems that were happening. Really no choice but to stay late and unpaid and sort the new admissions. You would think that transfers from medical holding would be easy to deal with because the staff in medical holding due the initial admission and paperwork and "supposedly" get treatment started. When they are coming to us, they are merely transfers not proper admissions. Therefore it should be easy and straightforward. But it is not straightforward as that and I'll explain why later.

In the meantime if there are any medical express/holding/admissions nurses and bed managers around can fucking you tell me why the hell you send them up in clumps at mealtime and change of shift?

To be continued.