Sunday, 13 December 2009

Owned Part two


Read part 1 first.

So I arrive onto the clusterfuck "surgery suite" at 0800. There was a list on a table of patients due to arrive. Two were already there pissed off that there was not a member of staff there to greet them. The list had 11 people's names on it along with the names of each of their consultants.  Names I didn't recognize.  What the list did tell me was the general order that they would be going to theatre in and what they were having done.   There were 3 charts on the desk.  That means 8 charts are missing.  The charts provide me with names, dates of birth, hospital identity numbers, past medical history, whether they had pre op assessments etc etc.  These are all things that I need to get pre op bloods and all the paperwork done etc.  I was guessing about the pre-op bloods.  The two patients now there did not know if they had any done. Great.  Each patient all need 5 forms filling in for admissions, tpr forms, operation checklists, consent forms, care plans, make identity wrist bands out for each one etc etc.  All patients were told to come in by 9 AM.  The last person on the list was scheduled to go to theatre at 3 PM.

The list tells me that the first person on the list is the first person I need to get ready.  But you have to move fast because theatres change the order on the list without communicating that to the ward staff.   They might just show up at 9 AM to take the patient that is last on the list, and he better be ready.  So it is a situation where you move as fast as you can to get everyone in gowns, the admission and pre op paperwork which must be sorted before they can go the theatre, bloods for group and save etc.  Make sure that they are consented, venflon are in and any pre op medications are ordered and available to give.  Once the doctor has prescribed them you have to harass and chase pharmacy for the drugs.

But without charts it was impossilble.  The first thing I did was tell the patients to change into theatre gowns and sit down while I went to the phone and rang around to look for the notes.  No one had a clue so I had to leave the surgical suite and hunt them down from the wards that they were supposed to go to.  The "never worked in a hospital before" care assistant was useless.  She was offering patients cups of tea!!  They are all nil by mouth for their operations for christ sake!!  She couldn't even do pre op blood pressures.  The patients thought she was a "nurse" and of course laughed  at a typically stupid nurse who didn't know that they weren't allowed to eat.

By 09:30 they were all there and I had all 11 notes.  I was running my tits off trying to get everyone ready along with bloods paperwork and other problems that need sorting before theatre because any one of them could get called to go 1st thing. I started with the people who were scheduled to go first on the list and went from there.  Many of them hadn't been to pre assessment and hadn't been consented which means I had to figure out which docs to page, what there page numbers were and tell them that patients were not consented.  At our hospital they must be consented before theatre, and a senior doc has to do it.

By 10:00 I was getting there.  I had established a good rapport with the patients and my 1st one had got to theatre, everything done for his operation. Yay me.  I hadn't forgot as much as I thought about surgical.  I was having to move quickly though.

At about 10:15 a timid looking young woman walked into the surgical suite.  I asked her name.  She told me it was Miss Doe.  Her name was not on the list.  She was just an extra 12th patient that they sent to me with no warning.  She handed me a letter from the hospital that told her to arrive at 9 AM for her termination of pregnancy that was scheduled for today.  She apologised for being over an hour late. Poor thing.  No wonder she looked horrible.  I felt so bad for her. I had no notes for her.  And I had to spend 10 minutes finding them.

And as I explained in part one I have no idea at all about abortions or gynae...do they do it by giving them a pill to induce miscarriage?  Do they operate?    Do they do it by sticking a coat hanger up their vagina?  Damned if I know.  I have not a clue.

If I had some warning the night before that I was going to be looking after gynae patients I would have been on google looking stuff up until 2 AM.  But there was no warning.  At 10:15  Miss Doe showed up, she was an hour late, I had no notes or drug chart for her and I know nothing about gynae.  Site manager confirmed that she was indeed going to be my patient and so were a few other gynae patients as the gynae ward was full.

Her notes had just arrived on the ward.  No pre-assessment.  No consent. No nothing and a blank drug chart to boot.  Shit.  I had just stepped over to the nurses station to ring the gynae ward and ask what I am supposed to do with this girl.  First I was going to ring the gynae team and see if they had any orders.   I got through to the gynae team secretary as the docs were not answering their bleeps.  The only thing she could tell me was that the gynae consultant knew this girl was coming to the makeshift surgery suite and was on her way down.

No shit, I couldn't believe my luck.  Having the gynae doc here so quick would give me the guidance I needed.  At 10:25 the gynae consultant walked onto my surgical suite.  The patient had been there 10 minutes.  The consultant immediately picked up the patients notes, glanced at the drug chart and threw it into a wall.  We had the following exchange in front of all the patients, including Miss Doe.  Consultant gynaecologist is in caps. because she was screaming like a banshee.

"WHY HASN'T SHE HAD HER PRE- OP PESSARY"

"Um. Her what?"  "She has only been here a few minutes and I don't have her...."

"STOP WITH THE EXCUSES.  WHY HASN'T THIS WOMEN HAD HER PESSARY.  YOU SHOULD HAVE CALLED US TO COME AND PRESCRIBE IT RIGHT AWAY. 

NOW YOU WON'T GET THE PESSARY FROM PHARMACY AND THAWED OUT IN TIME FOR HER OPERATION.  HOW DARE YOU.  HOW DARE YOU NOT GET THIS SORTED WHEN YOU KNOW HOW PAINFUL HER T.O.P. WILL BE WITHOUT A PESSARY TO SOFTEN HER CERVIX.  WHY WOULD YOU DO THIS TO A PATIENT.

"YOU NURSES DO NOT KNOW HOW TO PRIORITISE.  YOU DON'T CARE IF PATIENTS ARE IN PAIN BECAUSE OF SOMETHING YOU DIDN'T DO.

I couldn't really get a word in edge wise. She went on and on with the above type of stuff for about 10 minutes. I honestly do not know where all of that poison directed at me came from.

  But it did dawn on me that they must give termination of pregnancy patients some kind of vaginal pessary to make things easier.  It sounded like the things come frozen and need to thaw first.  It sounded like it needs to go in a few hours before the procedure to maximize the effect.   Doctors don't always remember to prescribe thing (happens with a lot of things) and depend on experienced nurses to know it needs to be prescribed.  They expect the nurse to know and call them and tell them that the patient is here and hasn't been ordered her whatsitcalled yet.  And we cannot obtain anything important like that without a prescription from the doctor written on the drug chart.

Now I didn't know anything about a pessary until the gynae consultant from hell started shooting her mouth off.   But had I had just a few more minutes with the patient I would have been able to get one prescribed by a doc and obtained from pharmacy.  The gynae ward nurses would have given me a heads up.  If only I had ever got a chance to phone them in the 10 minutes I was aware of Miss Doe's existance....well the 3 minutes out of 10 where I wasn't chasing after her notes as well as sorting my 11 other patients out.  We nurses help eachother out a lot via phone when one is floated to an unfamiliar area.  I had a gynae nurse on the phone to me once as her ward was taking medical patients and she didn't have a clue.  I clued her into many things that the doctors will not write or communicate with you but expect you to do.

The gynae consultant from hell had her gynae junior doctor with her.  Throughout the consultants tirade the junior doctor folded her arms across her chest and glared down at me, and every few seconds she added her two pence worth whilst nodding her head.  "yes what you have done is very bad, very bad indeed, very cruel towards the patient, very cruel indeed".  All within earshot of the patients of course.

Now I am perfectly capable of standing up for myself but really I couldn't get a word in edgewise AT ALL and I was not going to stoop to her level.  I had never seen, heard of, or worked with this doctor before.

We had 12 pairs of eyes, merely a few feet away focused on us. Those eyes belonged to my 11 patients and the 12th patient, Miss Doe who was listening intently.  Had they not been there I would have called that consultant a stupid bitch to her face, kicked her in the cunt and walked away.  But they were there.  I got the prescription, I got the pessary, I thawed it out and it was in the patient plenty of time before she went to theatre.  She was fine.  I managed to pull everyting together for everyone else as well.

But the rapport I had worked hard to establish with those patients that morning was ruined.  For the rest of the day they looked at me as if I was some incompetent bitch who wouldn't get them what they needed. 

Wow gynae doc, what a way to make sure that the blame for any fuck ups caused by the unorganised chaos in this hospital will not be attributed to you.  Kudos and applause, even if you are a total bitch.

When I blog on here I often changed details.  No details were changed here .    This happened just as I wrote it, it happened to me, it happens a lot to registered nurses and it is definitely militant medical nurse raw.

But at least it wasn't a fuck up in some area that was really critical and acute, as happens to many floating nurses when doctors don't bother to write out orders or strike out prescribed drugs that shouldn't be given .............drugs that are still prescribed on the drug chart to be given.  The nurses actually do get the heat for that you know.

This stuff happens all the time, and it is the reason registered nurses throw such temper tantrums when they are asked to float.

65 comments:

GrumpyRN said...

Sorry Anne, for once I am going to moan about you.

If you are going to allow anyone, FY1, FY2, Registrar, Consultant, Nurse Manager or Chief Executive of the trust to scream and shout at you whether in front of people or not you are always going to be on a hiding to nothing. You have to stand your ground and scream back even if it is only to tell them to shut the f**k up and give their arse a chance and to take some responsibilty for their own patients. You are a professional and you have to demand that you be treated as such. In any other industry it is bullying. What can they do to you? Sack you? This is what industrial tribunals are for.
If people have a genuine complaint then great, let them make it politely and sensibly, otherwise walk away.

Nurse Anne said...

Oh don't worry Grumpy, it was dealt with and I did let them have it when I got away from the patients. Then I put in official grievances about it.

It was dealt with.

Nurse Anne said...

But that isn't going to stop it from happening again unfortunately.

Nurse Anne said...

I got a written apology from the junior but not yet from the consultant.

Nurse Anne said...

Next nurse that floats somewere unfamiliar will get the same kind of treatment from the docs. If she yells back in front of patients then she will be made to look like the slaggy nurse trying to shift blame to the godlike can do no wrong doctor boss.

You have to be a bit more passive aggressive. That's how you really bust them. Maybe it's different for you grumpy, as you are a male.

Matt said...

I hope you mentioned about the massive breach of confidentiality that this so called professional did in such a spectacular manner.

Nurse Anne said...

It was unbelievable Matt. Obviously something else was bothering her and she just blew her top. It's been a long time since I got pimped like that. If it happens, it happens when one works in areas that they are unfamiliar with. But to answer your question: yes.

GrumpyRN said...

Came back on to add that I realise you had been dumped into an impossible situation and it didn't matter what happened you were going to get slagged and slated but you were too quick for me.

I agree it does make a difference being male but only when shouting down male docs. I remember years ago being told to go and argue with one consultant because I would not burst into tears with frustration - no, I am likely to punch him out of frustration (getting far too old for that nonsense) although in all honesty it was never a problem. I find that putting in official grievences against consultants is a waste of time as nothing will ever come of it - they work with different rules to the rest of us.

Anonymous said...

Report her to the Medical Registry for unprofessional conduct and breach of confidentiality. But by now, you should know how I feel about your health system. It sucks. You're all going to have to take steps to take it back before it gets worse. All those patients should have been pre-admitted and blood work drawn at least 24 hours prior to their procedure. That would have eliminated confusion and streamlined the process for you and them. The pessary should have been ordered the day before to be given on the morning of surgery. So many things could have been done to make your day easier. And it just speaks volumes about how incompetent your NHS leadership is, that they would create such a horrible situation for the nurse and patients. What a horrible, outdated system! I feel so sorry for all of you to have to work under such third world conditions and under such grossly incompetent management!

Prisoner of Hope said...

You describe a system failure caused by short term crisis decisions that are not properly thought through. Even though you initiated grievences about the specific incident this might only give the individuals concerned a chance to pause for thought next time the system breaks down again. It is unlikely to address the underlying causes of the problem.

20 years ago I was told by an eminent clinician (who recognised the need for responsible stewardship of publicly funded services) that all clinicians "want to the best for the individual patient in front of them at the time , irrespective of cost, and irrespective of how that might affect their ability to the best for other patients waiting to see them". (Prof Cyril Chantler in discussion)

This is what patients and their families expect, want to hear and believe. It is the basis of a personal high quality service.

However the rampant political managerialism of todays NHS with local storm trooper managers slavishly obeying orders damages that motivation. These failed local leaders are often ignorant of the effect of their decisions over staffing levels and mismanagement of variations in resource levels.

I know what I am about to propose is impractical but what I would like to see instead of isolated reporting of personal grievances is a system that asked each health professional after each clinic, ward duty, theatre session etc to be able to log on (anonymously) and state what, if anything, stopped them doing the best for their patients during that clinic, ward duty, theatre session etc. ( not individual patient mishaps but the more generalised faults that if corrected could benefit many more patients in the future)

These system shortcomings could then be collated by an independent body and analysed. Monthly - or even weekly- reports should then be produced at national, city/town and hospital and ward levels.

These aggregated reports should then be reported to whatever public body is responsible. They should be expected to identify the corrective action required and this should be minuted and monitored.

After each such public meeting a press release should be produced with a summary of the top issues and specific corrective actions identified.

Perhaps if such a system was introduced you would not need the outlet of this blog and patients and their families might be better able to understand not only why things breakdown but what will be done to avoid repetition in the future.

I think such a process should be enshrined into a proper constitution for the NHS. This would replace the public relations exercise that is currently wasting much public money which could otherwise be better spent staffing patient care at adequate levels.

Anonymous said...

basically you killed that womans baby by inserting that pessary. didnt you? how do you think the other 11 patietns felt? knowing you were a murderer? why didnt you just get busy nursing your other patients and disapear for coffee when the consultants turned up? why did you even bother to find notes. if this stupid woman got herself pregnant, i am sure she can find the money to go to a private clinic to terminate. why should the medical wards take such a patient? why should nurses have to be involved in this guarstly infantcide? maybe having no pessary would make it more uncomfortable for the patient and she will pay more attention to contraception in the future. I really like what you are saying nurse anne, about poor staffing, but when it comes to using up your whole morning on this farce i realise that you are competelely insane. why would a mother of young children be working in acute medical wards anyhow? surely you must be too tired to have sex with your own husband or do the housework or help your kids with their homework and friends. you are SUCH a marter!!!!!!!!!!!!!!

Nurse Anne said...

Jesus Christ.

1. I refused to give her the pessary because I never gave one before. The gynae nurses usually give them to soften the cervix not induce abortion. I asked the junior gynae doc give the pessary if he wanted it given. I have no experience with those things.

2. Bringing my personal views into work would get me fired. I do have personal views and they led me to an area of nursing that is not gynae. I do work in medicine. On this day I was floated somewhere else.

3. This was not a medical ward. It was a surgical suite that was opened for the day and I was sent to staff it alone not having any idea that I would be taking gynae patients. I did clearly explain this in the post. You obviously have comprehension problems.

The rest of your rant is even too ridiculous to answer.

Nurse Anne said...

It all happened on a 9 bed day surgery suite dear. That was explained. Had I had medical patients to look after, the gynae patient would have been low on the priority list.

Anonymous said...

glad you did not insert the pessary. (i also would not have a clue how to do it), good stuff now i can continue to enjoy reading your blogs without worrying about your ethics ect.
thankyou.

Nurse Anne said...

The thing is this: if you are a nurse you do not take your views on abortion into work. You have to remain professional with every patient regardless of your opinions.

I hate abortion. That is why I avoid gynae like the the plague.

But if I do end up having to take care of a TOP patient then I bury my opinions effective immediately and treat her with the same level of TLC, respect and consideration that I show everyone else. I treat every patient the way I would want my mother treated-regardless of whether or not I agree with their lifestyle. Their lifestyle and choices are none of my business.

And I stay away from "clinics" and gynae.

GrumpyRN said...

"basically you killed that womans baby by inserting that pessary. didnt you? how do you think the other 11 patietns felt? knowing you were a murderer? why didnt you just get busy nursing your other patients and disapear for coffee when the consultants turned up? why did you even bother to find notes. if this stupid woman got herself pregnant, i am sure she can find the money to go to a private clinic to terminate. why should the medical wards take such a patient? why should nurses have to be involved in this guarstly infantcide? maybe having no pessary would make it more uncomfortable for the patient and she will pay more attention to contraception in the future. I really like what you are saying nurse anne, about poor staffing, but when it comes to using up your whole morning on this farce i realise that you are competelely insane. why would a mother of young children be working in acute medical wards anyhow? surely you must be too tired to have sex with your own husband or do the housework or help your kids with their homework and friends. you are SUCH a marter!!!!!!!!!!!!!! "

Anne, how dare you have children and work as a nurse! You should remember what happened years ago in the good old days when matron was about - you would have given up work as soon as you got married and become a kept woman. Then you would have had time for sex and housework and homework and such. You see, you all think old grumpy doesn't care but he does, we need to keep women barefoot and pregnant, chained to the kitchen sink waiting on us hand and foot and make sure my tea is on the table when I get home. That way all the ills of the world will be sorted, and us men can get back to being your lords and masters. Sorry, I can't keep this up, trying to find any more stereotypes is too tiring.

Anonymous - I feel privileged, I really do! Never have I seen such an ill informed rant. The grammar and spelling are atrocious, you do not seem to possess a Caps shift on your key board to capitilise the start of a new sentence and you lack the most basic understanding of what a pessary is and what it does.

Anonymous said...

Wow! Anonymous, you must be a troll! You do not know the circumstances behind the TOP; so how can you even be sure that this was an elective procedure and not a medically necessary TOP? I don't know the circumstances either, and know squat about gynae. That said, calling Anne a murderer is out of line, even if you apologized. This is not a forum for abortion rants. Also, alluding to Anne's sex life is inappropriate as well. You should be ashamed of yourself. By the way, you misspelled martyr. The rest of your grossly inarticulate rambling is too silly to even bother with. Good on you, Anne, for deigning to even answer. You're a better woman than I am!
Casey in the USA

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You Divide everyone at the party into two groups,
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(Thank you rounds are always welcome, of course.
I believe my exact words were "I don't want to be your dirty little secret. The decline of the East side blues scene was disheartening, but, it also gave rise to the need for a fresh start, which came in the form of the next blues-only venue, Antone's, founded by the late Clifford Antone, during the summer of 1975.

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At the end of each round read out the cumulative
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