On this particular shift we had 2 RN's and 2 care assistants for the shift. That was the entirety of the ward staff. No ward clerk to answer the phone.
There were 15 patients that needed to be fed. The entire ward consisted of 30 patients.
Between 6 PM and 6:30 PM thirteen people rang for commodes. This takes at least 20 minutes for each patient as you have to find a commode, get two staff to transfer the patient onto it, transfer the patient back to bed and then wash the commode for 11 minutes between patients as specified by the infection control bitches. They should do it themselves. It might help them lose some weight.
Between 6 and 6:30 five people needed analgesia.
Between 6 and 6:30 two new admissions were sent up.
Between 6 and 6:30 four IV pumps beeped and alarmed because of empty bags, pulled out lines, occlusions, and air in the lines. Time consuming to fix.
Between 6 and 6:30 one confused patient fell. She thought she was late for her bus.
Between 6 and 6:30 seven phone calls came in from family members who tried to talk my ear off and refused to get off the fucking line so I could get all the way back down the ward to my patients.
Between 6 and 6:30 one hundred and seventy drugs were due to be given. 170. Most were not on the ward. Many needed careful and time consuming preparation.
Between 6 and 6:30 one man had chest pain. It looked pretty classic. I had to page a medic (when I could actually manage to get a line out between relatives phoning). Get observations, GTN spray, an ECG, bloods and 02. I had to ignore the food trolley, and the call bells to do this and run past frail patients who were left with a tray of food that they couldn't manage to feed themselves. When the medic came I had to give a load of other stuff to the patient, and organise a transfer to CCU as well as hand him over to CCU and ring his family and answer all of their questions. I was quickly losing the ability to feed any patients. I found myself wishing that these poor bastards would let me get off the phone as it was mealtime.
Between 6 and 6:30 recovery demanded that either myself or the other RN working with me escort a patient back to the ward from theatre.
Between 6 and 6:30 a consultant showed up to do rounds and his junior doctor snapped his fingers at me to let me know they wanted me to follow them around as they reviewed each of their 11 patients.
By 6:25 one care assistant managed to get all the trays handed out. Then she started on the first feed. And it was then that kitchen started demanding all the trays etc back so that they could get them washed, sorted and get home on time.
I am not exaggerating. If anything, I am being conservative with all this.
The productive ward fuckos have given us some new ideas to try in order to help is avoid malnutrition in our patients. I wish I could scan the letter onto this blog. They gave us 5
1. They will be buying red trays and red tops for water jugs to help the nurses identifty who needs to be fed.
2. We are getting this giant laminated flow chart/ map of the ward that we have to fill in every mealtime identifying who needs to be fed in red marker. If someone doesn't get fed we have to colour in their block with a green marker and if they are able then we colour in that block with blue pen. If they are NBM for whatever reason we use a purple marker.
3. All staff have to drop what they are doing and participate in meal delivery. This is a dig at RN's who often leave meal delivery to the assistants because we have unavoidable ill patients, orders, and drugs due at mealtime. The assistants cannot help us with orders, drugs, and ill patients. ( I really don't think that they ladies crying for commodes and the man with chest pain would have appreciated being ditched at mealtime.)
4. We are to complete a nutritional care plan and audit. A "nutrition score" must be calculated for every patient over the age of 60.
5. Doctors will be told NOT to do rounds at mealtime. (They have never complied with this rule on any other occasion so why the hell would they start now?).
Management thinks that they have covered their assess with these 5 objectives. They can turn around and say "we have done this and that to help our nurses stay on top of malnutrition and be more efficient at mealtimes."
How completely dumbass is all of this?