Thursday, 7 January 2010

Calling all general ward NHS RGN's: Some questions.

Not to leave out all the CCU,ITU, and A&E nurses but your units are a completely different structure.

I am hoping to hear from RGN's who work in (or recently worked in) general surgery, general medicine, geriatrics, --any large ward really.

I have learned a lot from my own blog via comments/emails etc.  I have learned that things on my ward are much easier and better than some other wards.  I have learned that we are a hell of a lot worse off than some others.  In short there are wards functioning well in the NHS and others that are hell on earth.  I am in the middle-purgatory perhaps.

I will start this.  Please continue in the Comments Section on this Post.  I hope I get some replies!  This is totally anonymous, I have no idea how to find out where or who you are.

1.Qualification: RGN

2.Ward: Acute Medicine/general Medicine/Geriatrics/Surgery

3.Beds: 18-30 depending on if they open our second hallway in a bed emergency or if they give it to surgery.

4.Real Nurse staffing per shift: sometimes one RN, sometimes 4 Rn's. We might get lucky and have 4 nurses to 18 patients show up one day but one will usually get taken away to staff another unit.  I have seen 1 RN to 30 in my time.  2 nurses  to 18-30 patients is the most common number.  Not good considering 1-6 is safe only for non confused non acute patients.  My patients are acute and confused.  Mostly confused.

5.How many HCA's do you have per shift including cadets? Is your ratio of untrained to trained staff  increasing? We have either 1,2,3,or 4 HCA's per shift.  One will get sent away if we have 3 or 4. And as with nurse staffing, these numbers have no bearing on patient acuity.  We can have 30 beds,with really sick dependent patients with 2 nurses and 1 HCA or we can have 18 stable geriatric patients  with 3 nurses and 3 HCA's.

6.Does your ward staff by acuity?  Do you get another trained nurse to care for your other patients if one of your patients becomes critically ill and needs to be specialed?  If you have sicker patients on the ward than usual do you get another RN? Or more HCA's?  If you move from 2 patients who need to be fed to 18 patients that need to be fed does your staffing adjust for this? 
Not on  my ward. Not by a long shot.

7.Do you ever get sent to staff areas that you are completely unfamiliar with and get expected to take over as the primary nurse for a group of patients? Yes

8.Does your hospital have a good, solid plan to cover sickness ,staff absence, increased acuity or dependency without pulling from one ward to another or using agency? No. Mine only gives us untrained carers from agencies, not nurses.  To cover RN sickness they pull staff and leave one ward short to cover another short ward.

9.Have you ever in your career worked an 8 to 12 hour shift without a break due to  chaotic, unpredictable, dangerous ward conditions? Are your patients in danger in any way when you do take a meal break? Yes. I recently ditched 12 hour shifts because I am getting to old for this shit. When I do take a meal break it leaves like 2 or 3 staff on the wards, not all nurses.

10.Do you have a senior charge nurse (without her own patient assignment) on every shift to coordinate and back you up.  No.  But research shows that I should.  I used to have a senior charge nurse without her own assignment coordinating and supporting the staff nurses about 5 years ago.  Makes a huge difference.

11. Do you ever see your Matron or get guidance and support from him/her? No Mine does not approach the wards.

12. Are you pressured into leaving very ill patients to push multiple discharges or take admissions (which are time consuming and complicated).  Does this happen during meal time? Drug rounds?  Yes. Yes Yes.

13. Are you given any kind of block of uninterrupted time to see your patients and care plan for them?  No. Not at any point in an 8 or 12 hour shift.

14.  Have you ever seen a patient suffer a complication (dehydration,pressure sores) or failure to rescue because you or a colleague could not get to him fast enough? Yep.

15.  When you fill in incident forms about short staffing is anything done? Not really.  They might band aid for awhile or send a letter saying how they are hiring another 18 year old with no experience.

16. Are you able to mentor nursing students,new staff, untrained carers with no experience properly on your ward? No. Hell no. And I am very dedicated to doing just that.

17. Does the physical design of your ward work against you and cause inefficiency?  Mine does, it is ancient.  But other wards at my very hospital have a good design. It makes a huge difference.

If anyone can take the time to give me honest answers here I will really appreciate it.  If your ward is great, let me know and if not let me know.

21 comments:

Nurse Anne said...

1.Qualification: RGN

2.Ward: Acute Medicine/general Medicine/Geriatrics/Surgery

3.Beds: 18-30 depending on if they open our second hallway in a bed emergency or if they give it to surgery.

4.Real Nurse staffing per shift: sometimes one RN, sometimes 4 Rn's. We might get lucky and have 4 nurses to 18 patients show up one day but one will usually get taken away to staff another unit. I have seen 1 RN to 30 in my time. 2 nurses to 18-30 patients is the most common number. Not good considering 1-6 is safe only for non confused non acute patients. My patients are acute and confused. Mostly confused.

5.How many HCA's do you have per shift including cadets? Is your ratio of untrained to trained staff increasing? We have either 1,2,3,or 4 HCA's per shift. One will get sent away if we have 3 or 4. And as with nurse staffing, these numbers have no bearing on patient acuity. We can have 30 beds,with really sick dependent patients with 2 nurses and 1 HCA or we can have 18 stable geriatric patients with 3 nurses and 3 HCA's.

6.Does your ward staff by acuity? Do you get another trained nurse to care for your other patients if one of your patients becomes critically ill and needs to be specialed? If you have sicker patients on the ward than usual do you get another RN? Or more HCA's? If you move from 2 patients who need to be fed to 18 patients that need to be fed does your staffing adjust for this?
Not on my ward. Not by a long shot.

7.Do you ever get sent to staff areas that you are completely unfamiliar with and get expected to take over as the primary nurse for a group of patients? Yes

8.Does your hospital have a good, solid plan to cover sickness ,staff absence, increased acuity or dependency without pulling from one ward to another or using agency? No. Mine only gives us untrained carers from agencies, not nurses. To cover RN sickness they pull staff and leave one ward short to cover another short ward.

9.Have you ever in your career worked an 8 to 12 hour shift without a break due to chaotic, unpredictable, dangerous ward conditions? Are your patients in danger in any way when you do take a meal break? Yes. I recently ditched 12 hour shifts because I am getting to old for this shit. When I do take a meal break it leaves like 2 or 3 staff on the wards, not all nurses.

10.Do you have a senior charge nurse (without her own patient assignment) on every shift to coordinate and back you up. No. But research shows that I should. I used to have a senior charge nurse without her own assignment coordinating and supporting the staff nurses about 5 years ago. Makes a huge difference.

11. Do you ever see your Matron or get guidance and support from him/her? No Mine does not approach the wards.

12. Are you pressured into leaving very ill patients to push multiple discharges or take admissions (which are time consuming and complicated). Does this happen during meal time? Drug rounds? Yes. Yes Yes.

13. Are you given any kind of block of uninterrupted time to see your patients and care plan for them? No. Not at any point in an 8 or 12 hour shift.

14. Have you ever seen a patient suffer a complication (dehydration,pressure sores) or failure to rescue because you or a colleague could not get to him fast enough? Yep.

15. When you fill in incident forms about short staffing is anything done? Not really. They might band aid for awhile or send a letter saying how they are hiring another 18 year old with no experience.

16. Are you able to mentor nursing students,new staff, untrained carers with no experience properly on your ward? No. Hell no. And I am very dedicated to doing just that.

17. Does the physical design of your ward work against you and cause inefficiency? Mine does, it is ancient. But other wards at my very hospital have a good design. It makes a huge difference.

Anonymous said...

I left the madness of ward nursing for A&E, but here are my answers for the ward i used to work on:

1.Qualification: RGN

2.Ward: Medical Assessment Ward

3.Beds: > 28, and a waiting room for new arrivals, waiting for beds. (Emergency admissions, so often poorly ++)

4.Real Nurse staffing per shift:
>2 or 3 RNs. This meant, that on a day with only 2 RNs, and, say 10 patients in the waiting room, the ratio would be 1:18. A good day with 3 RNs meant 1:12.

5.How many HCA's do you have per shift including cadets?
>Usually 3 HCAs. No cadets

6.Does your ward staff by acuity? Do you get another trained nurse to care for your other patients if one of your patients becomes critically ill and needs to be specialed? If you have sicker patients on the ward than usual do you get another RN? Or more HCA's? If you move from 2 patients who need to be fed to 18 patients that need to be fed does your staffing adjust for this?
>NO! We just had to manage. Somehow.

7.Do you ever get sent to staff areas that you are completely unfamiliar with and get expected to take over as the primary nurse for a group of patients?
>Never happened to me personally thank goodness.

8.Does your hospital have a good, solid plan to cover sickness ,staff absence, increased acuity or dependency without pulling from one ward to another or using agency?
>No. If we're short, we're short. And have to work twice as fast to meet as many patient needs as possible, without someone dying.

9.Have you ever in your career worked an 8 to 12 hour shift without a break due to chaotic, unpredictable, dangerous ward conditions? Are your patients in danger in any way when you do take a meal break?
> On my old ward - every shift. Never had time to eat, ever. Now in A&E, only happens occasionally, due to safer staffing.

10.Do you have a senior charge nurse (without her own patient assignment) on every shift to coordinate and back you up.
> No, not on my old ward. Charge nurse took half the ward.

11. Do you ever see your Matron or get guidance and support from him/her?
> No No No. Only saw matron for pressure purposes

12. Are you pressured into leaving very ill patients to push multiple discharges or take admissions (which are time consuming and complicated). Does this happen during meal time? Drug rounds?
> All the time.

13. Are you given any kind of block of uninterrupted time to see your patients and care plan for them?
> No. Only in the middle of the night, when majority were sleeping.

14. Have you ever seen a patient suffer a complication (dehydration,pressure sores) or failure to rescue because you or a colleague could not get to him fast enough?
> Many times, sadly.

15. When you fill in incident forms about short staffing is anything done?
> No feedback, no changes, no extra staff. Thats why I left.

16. Are you able to mentor nursing students,new staff, untrained carers with no experience properly on your ward?
> No time or head space. My mentorhip training was wasted on the ward.

17. Does the physical design of your ward work against you and cause inefficiency?
>Physical design of ward was okay. Lack of equipment was the biggest problem.

Nurse Anne said...

Holy Hell Anonymous. That is infinitely worse than my ward. 38 of them????? With two of you????? And many of mine are more geriatric than acute some days. Amen. I would have suicided myself with some potassium IV if I worked on the ward you worked on.

Anonymous said...

Well I very nearly did Anne. It certainly broke my spirit! The day I decided to leave (imagine when there's only 2 RNs, and one is handing over - that leaves 1 for 38 patients!) There was only me on the shop floor. Me to 38. And, as you often point out, no ward clerk. I got screamed at by 3 relatives within 10 minutes, told I was an uncaring cow because "grandad wanted the bedpan NOW!" Because "Auntie's drip finished an hour ago!" Because "Betty is STILL waiting for that extra blanket" etc etc..
I cried on the way home, and looked for another job - asap. Had only been qualified a year and felt totally burnt out. Ironically, the staffing levels increased not long after I left. Now they get 3 or 4 RNs. Still a ratio of 1:12 or 1:9. Still impossible to give good care, but definately better.

Nurse Anne said...

They should not have been admitting those patients to a ward staffed like that. They should have been forced to close beds until they had more registered nurses.

And the relatives should have been told why their loved were not getting admitted to a bed. "The nurses are already overwhelmed and you silly cows might start abusing them over silly things that she cannot possible deal with while carrying that kind of patient load".

Come on guys. I want to hear more.

Anonymous said...

Very interesting - if mental nurse is reading I would be interested in a similar survey for RMN's.

Sorry I can't contribute to this. Keep up the good work.

Nurse Armadillo.

Glamorganist said...

Dear Nurse Anne,

If you want to try something a little better, and easier to handle, you might have a look at:
http://www.surveymonkey.com/
The free account has limitations e.g. max of 10 questions and no more than 100 responses, but you can get a lot from a carefully written set of questions.

Nurse Anne said...

Thanks Glam,

That's a good idea as the set up on here is pretty poor.

Anonymous said...

1.Qualification: RGN

2.Ward: Acute Medicine/Endocrinology and diabetes

3.Beds: 23

4.Real Nurse staffing per shift: should be 4 staff nurses on an early, 3 on a late and 2 on a night.

5.How many HCA's do you have per shift including cadets? Is your ratio of untrained to trained staff increasing? should be 3 on an early 2 on a late 1 on a night. We don't have cadets

6.Does your ward staff by acuity? Do you get another trained nurse to care for your other patients if one of your patients becomes critically ill and needs to be specialed? If you have sicker patients on the ward than usual do you get another RN? Or more HCA's? If you move from 2 patients who need to be fed to 18 patients that need to be fed does your staffing adjust for this?
Never, I had 12 patients today not one was self caring, 5 needed feeding, 2 PEG feeds, 1 sickie.


7.Do you ever get sent to staff areas that you are completely unfamiliar with and get expected to take over as the primary nurse for a group of patients? Only occasionaly sent elsewhere and I haven't been in charge

8.Does your hospital have a good, solid plan to cover sickness ,staff absence, increased acuity or dependency without pulling from one ward to another or using agency? No. agency is banned now, we get some bank HCA's but very variable in quality. They have sent people to do their first ever shift on a ward.

9.Have you ever in your career worked an 8 to 12 hour shift without a break due to chaotic, unpredictable, dangerous ward conditions? Are your patients in danger in any way when you do take a meal break? The only break I am guarenteed to get is the lunch one when I am on an early, the others depends on how chaotic the ward is. I have got better recently at taking them though, patient care will suffer if I take my break or not. Unless there are emergencies happening I will try to take my break, I have insulin dependent diabetes so really need to try and eat.

10.Do you have a senior charge nurse (without her own patient assignment) on every shift to coordinate and back you up. Late shift one of the three nurses will be in charge to co-ordinate.

11. Do you ever see your Matron or get guidance and support from him/her? I see her every day with her clipboard to ask me about discharges. She will then ring several times a day to see how the discharges are going. Not that she does anything to help get these people out.

12. Are you pressured into leaving very ill patients to push multiple discharges or take admissions (which are time consuming and complicated). Does this happen during meal time? Drug rounds? I can't say no to an admission if I am dealing with an emergency they will still turn up. The bed managers are pushing for discharges. We actually have a really bad rate of failed discharges these past few weeks. People are pushed before they are ready and come back the next day.

13. Are you given any kind of block of uninterrupted time to see your patients and care plan for them? Between 8 and 9 the ward tends to be quiet from other professionals, but thats the window I try to get the drug round done otherwise the interuptions will prevent me from ever getting finished

14. Have you ever seen a patient suffer a complication (dehydration,pressure sores) or failure to rescue because you or a colleague could not get to him fast enough? Yep.

15. When you fill in incident forms about short staffing is anything done? Nothing I don't know if they are even read.

16. Are you able to mentor nursing students,new staff, untrained carers with no experience properly on your ward? Not properly, like I was mentored very well (I qualified 3 years ago so not that long). The lack of time is what puts me off doing the mentorship course the paperwork they have to fill is so much. I rather teach students but not have to do the paperwork.

17. Does the physical design of your ward work against you and cause inefficiency? Terrible,

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