Friday, 12 February 2010

A Tale of Two Shifts

Don't worry.  I am not going to go all Dickens on you.  I am longwinded enough already.

Once upon a time in January 2010:

Monday Early Shift:

Two staff nurses (and 2 untrained agency carers with their fingers up their  noses) for 30 patients.  Nurses receive written warning from managers that we must attend ward rounds and drop what we are doing to attend them as soon as the consultant steps foot on the floor.  Staffing is not an excuse to miss them.  There are 8 different consultants.  Was on ward rounds from 8:30 until 11:30.  Didn't even get half of the 8 AM tablets started until half past 11.  That means that 4 hours into my shift I hadn't seen most of my patients at all.  The ones I did see only had me in the room long enough to throw their tablets at them. Then the next lot of consultants came at 12:15 and kept us until well after 2 o'clock.  They don't move very fast, these consultants.  I don't think anyone was fed.  Sometimes 3 of them will show up at the same time and all stand there talking at once demanding that the lone nurse follows them around.  We don't know when they are coming and can not plan for it.

I was supposed to finish work at 3 PM.  I left at 7 PM.  Unpaid for 4 hours.  I accomplished nothing in the 12 hours I was there and barely saw my patients. Patients deteriorated.  Tablets were rolling across the floor.  God knows who had what, or if they ate, drank, voided, were turned or if there were any new orders from the medics.

This is the norm these days.

This is the norm before people start calling in sick.

Thursday Early Shift:

A miracle happened  Thursday and I enjoyed it immensly because it may never happen again before I leave.

We had 4 experienced staff nurses and 2 experienced health care assistants to 28 patients.  Two of the four staff nurse (myself and Jane) had also been on Monday AM.  Our ward sister was also there on a management day and we actually had a ward clerk to answer the phone for part of the morning.

I had 7 patients to medicate for the 8 AM drug round, which I accomplished by 9 AM even
 though I took the time to assess them and help them with their breakfast.  There were no longer an IV's.  But no one was for discharge due to social cirmcumstances.   At 9:15 I was bedbathing and care planning. Only 3 consultants showed up for rounds.   Everything was done and ready to go.  The health care assistants finished off the bed bathing etc while I organised and implemented all the consultants new orders.  I got a lot of extra things done as well.  I took a 45 minute lunch break to make up for the 4 hours unpaid  and lack of a lunch break on Monday.  While I was eating my patients were cared for by another RN.

I feel very refreshed, like I just had a long vacation.

What were the patients' and the consultants view of all this?  "Oh you nurses are so much better than the ones who were here on Monday. Those lot either ran around frantic (Jane and I) or had their fingers up their noses (agency carers)"

Um, we are the same nurses who were here on Monday with a lot more in the way of help and resources!!

Now wonder management gets away with short staffing.


The Shrink said...

It's not rocket science, is it? Nurses need enough time to nurse, so management needs to resource wards accordingly.

I've the opposite problem in my corner. An 8b Nurse Consultant, half an 8a Modern Matron, a 7 ward manager/sister, half a 7 OT, half a 6 social worker, 2 band 6 RMNs, 1 technical instructor/OT assistant, 2 or 3 support workers and 8 patients. Physio and chaplaincy come and go, too, but aren't part of the rota'd numbers. Better than 1 to 1 staffing. On a regular assessment ward. No forensic or high risk patients, it's not a PICU or anything.

But trying to change this and support poorly resourced areas is like suggesting I want to roast and dine on their first born child.

Nurse Anne said...

The letter from management was in response to a letter that went out from a group of doctors complaining that the ward rounds were not being attended by a nurse.

The docs mentioned short staffing in their letters and asked management to do something about it.

The response was "a Nurse must be allocated to attend ward rounds regardless of staffing levels as doctors have complained"

Not to hard to allocate someone since there is rarely more than one staff nurse.

Glamorganist said...

Dear Nurse Anne,

I know you hate the Daily Mail but this time they're not blaming the nurses (although the Director of Nursing's response is incredible). The comments are interesting too, fairly balanced:

Anyway, you really couldn't make it up... even the maddest things begin to appear normal after a while...

Anonymous said...

One of the problems is that ward round routinely coincide with drug rounds. If there was more than a skeleton crew of nurses maybe someone would be able to attend the ward round - although there are other issues as well (such as none of the drug charts being available, on our ward the main problem is that all the charts are lined up waiting for pharmacy).

But I must say, as a doctor, without a nurse there to hand over to (on our ward we do a round without nurses but grab them if we need to ask them something, and they grab us before the round starts if there are any issues - only possible because we have a small ward) it can be impossible to handover all the jobs that need to be done by nursing staff and things inevitably get missed.

HCAs are essentially invisible when you're a doctor, they can't do anything useful and you can't rely on them to hand anything on to the nurses. The other day I was seeing a patient in status epilepticus and the HCA refused to do a BM (or to give me the single BM kit on the ward) because she was 'busy' doing routine BMs! (although on that ward the nurses are no better, the one for that bay spent 15mins bandaging the emergency i.v. access I obtained while the other refused to draw up any lorazepam because she was doing the drug round for her bay!)

Not that I'm having a go at nurses, yesterday I was at an arrest where the ITU outreach nurses (unsurprisingly) and surgical ward sister (more surprisingly) were far more decisive and composed than the medical arrest team.

Nurse Anne said...

We have the same problem withe the HCA's. They'll tell anyone who will listen that they are the real nurses but everything seems to go over their heads. I asked one to help me sit up a patient who was having breathing problems, she was near the supply cupboard and I asked her to grab the obs machine that was right next to her and bring it over.

"I am handing out menus, do it yourself" was her response.

We do have some older experienced hcas who are absolutely fabulous. Two of them I think. But to many othes are young kids and agency crap who have nothing but attitude.

Nurse Anne said...

That's really bad about the lorazepam. A patient like that is a reason to interrupt the drug round absolutely.

I don't have any problems with the junior docs, when they ask me to do something I do it with a smile and ask them if they need anything else. If it ever happens that I need to say that I cannot, they know that I am in a situation where I really am unable to abandon what I am doing because they know me and they know I don't screw around.

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