Tuesday, 20 April 2010

Mixed Sex Wards.

The government has maintained that these wards must be disposed of as soon as possible. The Nurses must do more to prevent patients from being admitted onto wards where their dignity will be compromised by sharing facilities with members of the opposite sex. 

Yesterday I had 5 male patients who were ready to go down to stepdown beds (the few that exist, we don't have enough) that were available at the tiny cottage hospital up the road. 

The consultant for these five patients determined that they were medically fit (they were) and that they needed further rehab and care while social services sorted out their home care/residential homes.   The acutely ill patients MUST to come to my hospital to get the care they need.  The cottage hospital is merely stepdown.  So we try to get stable patients who need looking after up to there.

I rang the bed manager to let him know that we have 5 men who could go to  Daisy Cottage hospital. 

"Excellent" he says.  Medical admissions is bursting at the seams with patients for you to take.  And Green ward over at Daisy has 5 beds!"

Too good to be true I thought.

So I rang Green Ward at Daisy Cottage Hospital to handover the 5 male stepdown patients.

As I started to handover the first patient, John Doe,  the Green ward Staff nurse informed me that they are nightingale and only have female beds and one bathroom.

They are under pressure to not mix up gender-designated accomadation.  The male ward at the cottage hospital was closed to admissions.

We got off the phone and I called the bed manager as the staff Nurse at the cottage hospital did not want to accept my 5 male patients. Or, at the very least, she wanted time to shuffle things about to get appropriate beds somewhere else for either her females or my males. There are only three wards there.

The bed manager was livid.  "Goddamn them, they will take those patients, and they will take them now, A&E is breaching.  I'll ring them.".

And 2 minutes later the cottage hospital nurse called me back to accept handover on my male stepdown patients. 

And my 5 male stepdown patients went to an open plan female ward.  The Nurse there told me that they are threatened with discipline for mix sexed wards and that whenever this happens they fill in incident forms but nothing ever gets done.

The government says that the ward nurses are responsible for maintaining dignity.  And that ward nurses are to take the blame when patient dignity is compromised.  They say that ward nurses must take the lead in avoiding mixed sex wards. 

I know that the bed manager sounds like the bad guy here, but he didn't have a choice.

The problem here is lack of facilites, poorly designed wards, and a health service that has been slashing the  number of acute and stepdown beds for years.   

If they want to avoid mix sex accomodation they need to start re-designing and building and they had better get off the Nurse's backs while they are at it.

50 comments:

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Nurse Anne said...

LMAO. Maybe I should change the title on this one.

The Shrink said...

LOL

Fantastic, so that's why your wards are so full, huh? :-)

Glamorganist said...

Does the persistence of the Spam comment above, and your comment immediately following it, indicate that you approve of such junk? If so, it rather devalues the rest of the blog, don't you think?

Nurse Anne said...

I don't approve of it but it sure is funny.

Glamorganist said...

No, whatever comments spam is, it's not funny. Cynical, offensive, opportunistic, parasitic... but not funny. It kills blogs and alienates readers. I've been reading your blog since you started but I won't be back.

Nurse Anne said...

Okay. Have a nice life.

Dino-nurse said...

So many hospitals in the UK are modelled on Nightingale wards, this is going to be a long standing problem. My own Trust is a brand spanking PFI- wards are designed with bays of 4 beds but in total we have no more siderooms that we did when we were on 3 separate sites. ICU is exempt from the rule at the moment as it would be callous to refuse admission due to the sex of the patient in the next bed/opposite bed. We are always bedblocked due to lack of female medical beds...we now have 40 less medical beds in our sparkly new hospital than we did in our 3 old hospitals, not to mention the loss of surgical beds and rehab beds. Not sure how the Trust thinks this is the nurses fault but I'm betting it will be.

Anonymous said...

And it's up to already overstretched nurses to audit the whole mixed sex thing and how often which units breach

Anonymous said...

I really feel for the bed managers sometimes, its a thankless job. What doesn't help matters is hospitals being assessed on how well they get patients out of the ED within the 4 hour target. Its not their problem if beds are blocked by social admissions who are waiting for placement because theres no rehab beds, nursing home beds, care package funding being bitched about between people, relatives who are not interested in helping care for their "loved ones" and so on. If as a trust enough patients are breaching then you are failing. Surely its a sign that the social sector is failing in being able to provide adequate placement?

UCL Med Student said...

Is it a female thing to be particularly annoyed at mixed wards? I've had some really funny times on mixed wards made good friends.
[As a patient]

Dino-nurse said...

It comes down to whether or not you mind being seen in a nightie by the opposite sex, UCL med student. Also, imagine being an 80 year old unmarried woman in a bed opposite a young male IVDU/ALD type of patient who is thrashing around, swearing and refusing to stop showing his willy to the world. Most other countries have had single sex wards for a very long time. Its only in the past few decades that the UK model had moved to mixed sex wards due to lack of cash/forward planning in the 1970s. Real problem is the lack of thought regarding who funds long term care and the unbelievably complex process that this involves. No one wants to pay so the PCTs fight it out to the bitter end. Result is eldery or vulnerable patients being kept on acute wards, increasing the chances of them picking up an infection and also delaying acute admissions from ED or discharges from ICU/HDUs. Its gotten to the point where I am now sending some ICU staff on a study day to understand the paperwork etc that is needed to discharge such patients as it won't be too long before they are fit enough to be sent home from us. Unheard of 10 years ago but sadly a reality in the 21st century due to a complete lack of intermediate care facilities.

ICUnurse said...

Dino-nurse - in the last year I have personally discharged 8 patients home from ICU, in 2 different hospitals. And I only work part time.

Dino-nurse said...

Its ridiculous. Lack of funding and forethought has led us to the situation where ICUs are caring for wardable patients. My trust is currently threatening to cut ICU beds because of this- staffing levels are thought to be too high to care for these patients so the dolts think that there are not enough patients that need ICU level care. Summer is a coming and our level of admissions usually drops off (so the dolts will be rubbing their hands with glee and slapping each other on the back for being soooo clever) so we are to lose 4 beds...yes, 4 ICU beds. Come winter we will have 30% fewer ICU beds than we had last year...and we barely coped with normal admissions (not including pigflu) but they reckon that we will manage. So I have the task of deciding how to redeploy current staff. Many of the band 6s will of course not keep their grade outside of the ICU and most of the band 5s will opt to go to other trusts rather than go out onto a general ward. so come winter, I will be left with too few staff and a poor skill mix....again. Agency will be called on again, we will overspend again and next year no doubt we will lose even more beds. I hate it. Management couldn't run a chimps teaparty.

capgras said...

well i dont think ICU nurses should worry about discharging patients home: they should be PLEASED most ICU patients just cost a fortune and then die horrid deaths gagging on ET tubes and shitting into flexi-tubes. it must make a change to dress a patient in their own clothes and put them in a wheel chair and watch them get into a car and be driven home............ by the way, what ever happened to that website NHS Blog doctor? you know the one with a G.P called crippen? did he die or retire or get outed or what?

Not Long Now said...

Oh dear...... did Glamorganist leave his/her sense of humour at the door during their visit? Or maybe they are the recipient of one of the ever increasingly common humour-bypass ops performed by the Diversity brigade.

I've just popped over from Gadget's blog.... I like your style Anne. Keep it up!!

Anonymous said...

So the staff nurse in the "tiny cottage hospital up the road" is threatened with disciplinary action for mixing the sexes on her ward... and still allowed the transfer to take place. How bizarre. Why didn't she just say NO and refer the bed manager to HER manager?

Nurse Anne said...

Bed manager outranks the ward manager. The nurse at the cottage hospital could have held her ground, but that would have stopped acute admissions from getting care and caused the hospital fines for breaches.

Anonymous said...

So who's actually in charge of the "cottage hospital"? Not a ward staff nurse, obviously. Who, on one hand threatens to discipline ward nursing staff for allowing wards to be mixed-sex and on the other hand then allows the mixing of the sexes to take place?

Nurse Anne said...

Whoever is in charge of the cottage hospital for that shift knows not to fuck about and stop acute patients from getting where they need to be or cause the trust to get fined due to breaches.

No one wants to mix up the sexes on the same ward and we all take patient dignity very seriously. But lack of beds and targets means that we have to break our own rules.

Anonymous said...

So who's actually in charge of the "cottage hospital"? Who makes the policy that, according to you, says that nurses can be disciplined for allowing the sexes to mix in their wards and then insists that the nurses break the policy? I really don't understand what's going on here. What you write makes no sense.

Dino-nurse said...

You are missing the point,Capgrass. I'm not complaining about discharging patients home from the ICU, I am merely pointing out that there are not enough free general ward or rehab beds to take our patients when they are well enough. Whilst its nice to have patients who are well enough to go home, the unit is not equipped to deal with them...they lose out on OT and physio input, not to mention being surrounded by other patients who are not so fortunate which is depressing. Much is made of the positive impact that being with patients who have similar problems to you can have. This is also lacking on an ICU as we have such a broad spectrum of patients. As a final point, why do you have such a negative view of ICUs? A very small percentage of our patients die "horribly" as you put it. Those who cannot be saved are allowed to die in the same way as on any other ward- with adequate pain relief (morphine, fentanyl, MST and antiemetics as needed). We support their families in the same way as any other ward. Most of the pointless CPR events happen outside of the ICU because people are not proactive enough with signing DNARs...often the patient then comes to the ICU to die a few days later. Yes, we are seen as the last hope for some patients but many spend only a few days with us without needing invasive ventilation thanks to the increased uses of NIV and intervention at an early stage on the wards by outreach personnnel. We also take many elective patients who need only 24-48 hours to stabilise after cardiothoracic surgeries. In an attempt to make the unit seem less clinical,we have recently bought TVs as we were never equipped with the PatientLine style units that other wards were given, as well as some boardgames, DVDs and I am trying to persuade the WRVF to bring the shop and library trolleys onto the unit once or twice a week. This will improve things for our patients but they would still be better off on a general ward.

UCL Med Student said...

Thanks dino nurse for that very measured reply and I now have a much better idea of why it is a problem...

I'm not quite sure how it's turned into a debate about ICU though!

ITUs obviously play a critical role in...critically ill patients!

Tor Hershman said...

Last year my doc switched, and his office confirmed, my LDLs and HDLs.

Anonymous said...

Anne,
I just wanted to say, Thank You Thank You Thank You!!! for finally ticking off Glamorganist! I am ecstatic that we no longer have to endure her nasty, argumentative, mean-spirited, "Let's blame the nurses" diatribes. Thank you so much! So lovely to see her go!

uknurse said...

The trust i work at has posters up on the walls, of doctors and nurses saying "We will do all we can to prevent mixed sex wards!"

Since when have these sort of decisions had ANYTHING to do with clinical staff?!

Yes, we do care ...but a bed is a bed to the hospital management. Even if its in a cupboard.

Ulla said...

This is so funny. Here, in Denmark, we have always had rooms with 2, 4 or 6 beds, and they have always been one sex only. Now, we are experimenting with mixing the sexes to create a better environment for everybody (or some such). Ha. It's probably for practical reasons of some kind

Anonymous said...

I have missed your posts lately, Anne - I hope you are well, best wishes.

Anonymous said...

Anne, where are you? Missing your posts and hoping you are well.

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Anonymous said...

Anne, hope you are okay x

Nurse Anne said...

I am fine. I am burned out.

Anonymous said...

I'm hearing you Anne. My trust is making so may cut backs that it is becoming increasingly impossible to provide good care. Staffing is being cut even more than before, although management types seem to be popping up everywhere, stock and equipment is running lower than before and we spend so much time trying to track essential things down, begging, stealing and borrowing from other departments. Its so demoralising, because the public think its because nurses don't care. If only they had half a clue. Keep strong Anne, look after yourself x

Dino-nurse said...

Just returned from a very demoralising unit meeting. we have to cut nearly £250,000 from the ICU/HDU budget in the next 12 months not to mention how much is being cut in other clinical areas. They have already closed ICU beds and 2 wards. I am meeting with the matrons and other senior sisters Trustwide on friday to see where do we go from here. I have no idea.

Nurse Anne said...

Dino or anyone else,

Do you want give me a hand over here? I am a bit to bitchy and cynical to get my point across. I said that when nurses are continuosly getting interrupted to answer phone calls with no controls over how many calls are coming in that it impacts badly on patient care

And I am getting told that I am "lacking in compassion" and that "I don;t want a son to ring about his mum"

Is there anyone who can actually explain it to these people.

http://thejobbingdoctor.blogspot.com/2010/06/where-is-she.html

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