Saturday, 6 March 2010

Dehydrated: 12 hours of Hell

Had a lovely shift recently.

25 patients to one Nurse.  That Nurse was me.  My only help was an agency carer with no experience who could not do any lifting due to a back problem. Yeah. WTF.  I complained to the supervisor of the hospital.  When he informed me of the even worse staffing situation on other wards (worse!) I realised I was in for a long shift.  This was the staffing for 12 hours. For the last hour I was alone. And compared to other wards I was damn lucky I only had 25 beds and less overall acuity.

Two cardiac arrests.  Mostly down to failure to rescue.   I caught the first one as he was deteriorating just by luck I had a gut feeling to check in on him again. Now he wasn't talking.  I fast paged the senior medics.  I didn't think he would arrest quite yet but I like to prepare for the worst.   I was alone with an agency carer with no experience.  When I realised we might have an arrest I told the carer that we might and asked him a few questions to prepare.

Me:  Do you know how to put the arrest call out?

Carer:  No.  What is that?

Me: "Do you know how to do CPR" ( I could run to the phone and put the arrest call out if he could start the cpr)

Carer: "No"

Me: "If I yell the word CRASH you run your ass to the phone and dial xxx. Then you say "Doe Ward".  You have 5 seconds to do it, don't fuck up.

Thank goodness the registrar was up there 30 seconds later, and then  the patient really really deteriorated.  I am so lucky I caught onto it when I did rather than just finding a corpse in that bed.  I only got a chance to check back in on him by abandoning the turns, toileting round, and leaving people covered in shit.  I just got a feeling in my gut and heard a little voice telling me to watch him. By the way,why does the 85 plus crowd play in poo and facepaint with it?  I guess if I ever see 85 I will find out.  It's not always the confused and dementia patients who do this either. 

Two people fell out of bed whilst I was dealing with the crash.   They were , of course, left on the floor. Thankfully they didn't get hurt.And another one arrested.  That one was an expected death but a DNAR was never signed so we needed to attempt resus.  It failed.  But the first guy ended up in ITU.

People were extremely dehydrated.  I didn't get a drink or a scrap of food for 12 hours either so I was empathetic.  But even so, I still couldn't get around to them all and do anything about it.  God help them, the oncoming shift staffing was terrible as well.  At least I can get home at the end of the day and have a coffee.

So many people do not get the drugs they need and are prescribed.  This was even the case on the shift preceding mine.  Either the drugs are not there or the patient has some kind of problem that we cannot work around in the way that we need to in order to give the drug.  It's not as if we say "oh yeah, I am just not going to bother with that".

 Rang switchboard after I handed over and demanded that the chief executive get called (at home if necessary) and ring me back immediately.  I was half out of my mind at this point.

 Do you think he called me?

Yeah right.

Day off today.  Mr. Militant Medical Nurse is doing the cooking and the cleaning and nursing the nurse.


Anonymous said...

Dehydrated? Did the 25 odd patients has a saline drip?

Julie said...

I wonder if it's time to fess up with relatives and tell them to come in at meal times to feed the patient. Wouldn't that be better than pretending that you're coping? In Italy, this is what happens and the relatives also provide the food. Just an idea; I'm doing this with a relative of mine at the mo. What do you think?

Nurse Anne said...

Sure. Saline drips run out. Can't put another one up without a prescription.

Of course you can ask or tell the docs to come but it takes hours and hours. A lot of these people have terrible veins as well.

Nurse Anne said...

Confused patients also pull out drips 25 or 30 times an hour. Unless you can stay with them at all times to prevent this, you are screwed.

Nurse Ratchet said...

Jesus Anne - 1 trained and 1 HCA for 25 patients? Stop it stop it stop it. Blow whistles, leave before it's all your fault. That is insane.The Chief Exec must be informed, via a very public media - ring him/her, invite them to come and see how shit it is, threaten to go to the papers - mention Panorama and that should do it. You will be the one facing the "fitness to practice " hearing, not the managers.Jeez I feel for you.

Nurse Anne said...

Nurse Rachet The Lad I WAS WORKING WITH WASN'T EVEN TO THE LEVEL OF AN HCA. He could not do observations, fluid balance charts or BM's. And he refused to lift due to his "bad back".

Dino-nurse said...

Your Trust sounds like a sh** place to work. Then go to the union and the local rag and state your reasons for leaving. Encourage relatives to put complaints in writing about lack of trained nurses, citing the Patients Charter. Ask them to send a copy to whoever your local MP is.
I understand your frustration only too well. Our Chief exec is another buttwipe who is only interested in covering their ass. They have no clinical background and care little about anything other than government targets and keeping foundation status. We have had two consultants resign recently and the Trust lawyers have gagged them good and proper. One is ready to retire so is taking the brave step of going to the press anyway. The other has another 20 years to go so is not feeling quite so brave. I'm thinking about taking early retirement. The NHS sucks.

Nurse Anne said...

I wonder if I should just go to a nursing home to hold me over before we move. The pay is shite but so much less hassle. I do like the elderly when I can take care of them properly. No acute patients, just send them out to hospital.............

Anonymous said...

It's time to go. I'm with Nurse Ratchet and DinoNurse. Get out before something really bad happens and you end up taking the fall for it. You work for bad people. That is obvious. Any job is better than this one. And go to the press. Got to your elected officials. Get your documentation together and go way public. Talk to an American press organization, too. It's time for the NHS to be globally shamed. But first, GET OUT!
Casey in the USA

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Anonymous said...

Why do you keep working there?
Nurse in the US (whose patient acuity you admire so much) had to walk out before things changed.

Nurse Anne said...

I don't admire your acuity but your ratios are a little better.

The next hospital is an hour or two away and worse. It is also an NHS hospital. So no change. If you knew what the price of gas here was you would not tell me to commute.

No private hospitals in the area. The doctors offices in the community are all NHS as well and there are no jobs/vacancies.

I am thinking about applying to a Nursing home but the pay is so bad there I will have trouble paying my mortgage.

Have young children and partner is locked into his job locally. Housing market is not helping us to sell up and move.

So that is why.

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Elenora said...

Here, I do not actually think this is likely to have success.

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