Charlotte is a colleague of mine who is excellent at her job. She completed her training at University about 6 years ago. She is a wonderful bedside registered nurse. She really stays on top of things and will work a 14 hour day without a break to do her best to ensure that the patients all receive their treatments and orders.
Like the rest of the RN's on the duty roster Charlotte often finds herself as the lone RN for 19 patients when she is on shift. She may have one or two apprentices to help.
Just mixing preparing and administering all of the drugs due at 8AM takes until way past lunch time when you are the lone Nurse for 19 patients.
Not only is medication administration complicated and time consuming but the lone RN will be constantly interrupted by doctors, relatives, patients, pharmacy, social services, path lab etc etc during her attempts to get her patients their first lot of drugs for the day along with a basic nursing assessment. There is no break, no let up from these interruptions.
The apprentices can neither continue with the drugs or deal with the interruptions. Many medics will show up during this time and demand that the Nurse abandon her patients to follow them around on a doctors round for an hour. The doctors don't care if patients don't get their ordered treatments or get cared for by an RN. They just like to monopolise the Nurse's time for the sheer fun of it. It takes until lunchtime for Charlotte to see each patient once and administer the drugs due at 8AM. And that is if you keep it to two minutes with each patient and then run off.
On Tuesday morning Charlotte was receiving handover from the Night Nurse. 11 out of 19 of Charlotte's patient's that day were going to be unable to feed themselves. Charlotte hauled ass that morning. She took short cuts with the drugs and ignored the phone calls from families. This was the only way she would get to a point where she could obtain the ability to feed all of her patients at lunchtime.
Noon rolls around. Both apprentices are off the ward escorting patients to diagnostic tests leaving Charlotte trying to feed 11 people by herself simultanously while handling everything else that is going on for those 19 people. She was grateful that no one was really poorly at that time and that the high priority things (blood transfusions, life saving drips that need to be put together and administered) were under control by noon.
She happily commenced a serious and whole hearted attempt to feed her 11 patients. She started with the first two patients who were next to eachother and tried to feed them at the same time while telling the patient across the bay that she would be there to help as soon as she could.
Enter Doctor Hellboy. He has been told repeatedly not to show up at lunch time to do his rounds so that the Nurses can feed the patients. When a doctor arrives to do rounds he pulls the Nurse away from whatever she is doing for a good hour and a half. But Doctor Penisbreath has a lot of patients to see and not a lot of time and it is very convienant for him to show up for rounds at lunch.
But he shows up at lunchtime anyway. He doesn't care if patients get malnourished as long as they are not his patients. He walked up to Charlotte as she was feeding her first two patients, snapped his fingers at her and announced " I am here for my rounds, come on now" and he walked away expecting Charlotte to follow him. She did not. She continued feeding her patients. He went nuts on her. Absolutely nuts.
"How dare you refuse my ward round blah blah blah how can you know what the plan is with the patients if you don't attend the ward round blah blah blah".
Charlotte held her ground and was able to get most of her patients fed.
The funny thing about this particular consultant is that he has been overheard telling the complaining family of a malnourished patient "These Nurses today cannot be bothered feeding patients, they went to university you know".
What a cock eh?
Same guy declined to give his support to our ward sister when she made a case for getting extra RN's employed so we had enough to feed the patients and attend ward rounds. Therefore we could know the "plan" with the patients and get them fed as well. My ward sister was not only shot down on that request but the medical manager, chief nurse etc laughed in her face and told her she was "exagerrating the ward conditions". None of these people have been on a ward in over 20 years.
I wouldn't bother posting this if it was a one off but the consultants are pretty much on my shit list this week for these same kinds of things. And the next few posts will reflect that.
Sounds like a right git. Are there no senior nurse managers that are supportive? I'm sure you have tried this already but our MAU finally started to put up a screen with the picture of the directorate manager on it and the slogan about taking protected mealtimes seriously. They then blocked the door for an hour and refused to let anyone onto the unit withour prior arrangement ( ie ED admissions). Consultants hated it but thanks to the photo they started to direct their anger at the right person...low and behold MAU were allowed to hire a few more HCAs to help with the feeding. Our Stroke unit now has a little army of helpers that work a few hours a day and their SOLE job is to feed patients...nutrition supporters I think they are called.
ReplyDeleteWhat a total idiot!
ReplyDeleteGet used to it Fairy. Surgeons are worse.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteNo Dino we are not getting any back up with this at all and their is no way they will hire nutrition helpers. Nutrition helpers will cause people to think that Nurse's don't want to "bother" with feeding anyway.
ReplyDeleteLittle does the public realise that there is one qualified Nurse on the ward at mealtime (thanks to asshole managers) and the fucking doctors are monopolising her time and getting aggressive if she doesn't play ball.
Fairy, as Anne says, surgeons are worse, but I bank in theatres inbetween my placements and theyre completely different in their own habitat. The consultants and regs are ok, its the more junior ones who seem to develop god complexes even though theyre not qualified surgeons. They soon get slapped down by the nursing staff in theatre though.
ReplyDeleteBut . . . but . . . what could be more important than a nurse spending time attending to every word and desire of a Consultant gracing their ward?
ReplyDeleteShouldn't you be going, nay leaping, to the Consultant, proffering tea/coffee and biscuits? Chocolate ones?
The only docs I'll do that for are the poor sweet little new f1's who are being abused and run ragged and picked on by senior doctors and some Nurses.
ReplyDeleteAny you Shrink. I'd get you some chocolate biscuits and tea.
But the rest of them I'll kick in the balls.
I've posted a less flippant response here :)
ReplyDeleteGood for Charlotte - now she needs to send an incident report of inappropriate physician behavior to administration. BTW start wearing a tabard with "I AM THE ONLY NURSE ON THIS WARD" on it in big black letters...
ReplyDeleteI've been the patient needing feeding, still able to eat orally (just) but must go slowly, liquids thickened, solids mashed. I don't want to use my PEG for nutrition yet - although it's incredibly valuable for fluids and meds - but after a few days of watching your plate of food cool and congeal, occasionally actually having it removed untouched after the statutory 20 minutes... well, pass the Fortisip, I give up. It's depressing.
ReplyDeleteNurses couldn't believe their eyes when a registrar friend dropped in to say hello and ended up staying and feeding me - I don't think that ward had ever seen such a thing.
It's no fun being profoundly impaired and in hospital.
PS if anybody snapped their fingers at me I'd verbally eviscerate them. Nothing justifies that kind of blatant disrespect (with a little sexism for good measure, often).
ReplyDeleteOh they do snap their fingers. It sounds really cliche but a few of them do it. They don't care what that lone Nurse is in the middle of, they don't care what is going on with her patients. They show up for rounds (we have no idea when they are coming so we cannot plan for it) and expect the Nurse to immediately drop what she is doing to follow them about.
ReplyDeleteAmbulance transport crews, social workers,porters, psychiatrists visitors,crisis team workers, managers, etc do the exact same thing to the Nurse at mealtime.
Everyone thinks that the Nurse exists to service them and that is why the Nurse never gets an uninterrupted moment in her day to do her job.
Ambulance crews are the worst. The worst. They show up and expect a red carpet to be rolled out for them so that they can keep to their schedule. Must be nice to only have to deal with one patient at a time. And they don't give a shit about the fact that the Nurse they are dumping on has 20 patients.
Lets not forget the "theatre club". Love it when the list gets changed at the last minute and theatre DON'T tell the ward.
ReplyDeleteLow and behold the theatre porter arrives slap bang in the middle of the drug round demanding to know why the patient is not ready and checklist has not been done.
End up abandoning drug round and dragging HCA away from feeding breakfast to 90 year old lady to help get patient ready all the
while listening to wisecracks from porter about incompetent nurses.
Escort patient to anaesthetic room where anaesthetist makes remark (in front of patient!) along the lines of "what took you so long."
Hence you are made to feel like a complete moron and any confidence the patient has in you has been completely eroded!
OH MY GOD ANONYMOUS YES!!!
ReplyDeleteUsed to happen to us ALL THE TIME when we were a surgical ward.
We would have a list of 20 patients to go to theatre. First person on the list would be the first one to go. Last person on this list would be the last one to go. Supposedly.
We would ring first thing in the morning and the theatres would assure is that the list was stable.
Next thing you know ( 2 minutes later)the porter shows up for patient number 11 on the list and demands to know why he isn't ready. And pulls the nurse and hca away from feeding the other patients to sort the guy out for theatre.
So we would just get everyone ready at 0900.
Once they came first thing in the morning for number 15 on the list. I didn't see them take him because I was hanging blood on a bleeder. I didn't even know that the guy had been taken to theatre until the anaestatist rang the ward screaming and hollering and wanting to know why patient hadn't had the medication that was prescribed to be given "just as he is leaving the ward for the theatre". The words in quotes are how the order was written.
If we don't know when they are going and cannot stand by their bedside all the time and theatres change the order on the list before telling us how will we actually know when they are going to theatre.
But seriously. Don't get me started about ambulance transport crews and mealtime. Motherfuckers all of them.
anaesthetists are another group of dickheads who pick on nurses for things that the nurses cannot control.
ReplyDeleteIf they don't understand what the ward conditions are then they should just shut the hell up.
Yikes! Where did you get that picture MMN? Am going to have horrible nightmares tonight..:(
ReplyDeleteRe snapping fingers, I remember my mum's headmaster doing a 'come to me' gesture with his finger to my mum. He never did it again..
ReplyDeleteSoooo HATE protected mealtimes!
ReplyDeleteAlso getting tired of 15 year old kitchen assistant asking me why the menus for tomorrow have not been filled in by 10am.
Me: "Sorry, I'm putting up blood on GI bleed. Be a pal and please ask the patients what they want as you are collecting them in. Why don't you ask the ward clerk to get off ebay for 5 minutes and help you?"
Domestic: "NO!"
Me: "ARGGGH!"
One of my colleagues says that if a person is backward they get a job in the hospital kitchen.
ReplyDeleteI have had to ring the kitchen at mealtime because they haven't sent up enough food.
"Well you will just have to come down ere and get it" says the kitchen worker.
But I am giving drugs that are already late, getting an admission and have a patient who just came back from theatre with a blood pressure of 55/30. I am trying to help feed patients and there is a family here who are burning holes into the back of my head because they want me to meet with them for an hour to discuss their mother's condition. And I am the only Nurse up here. I cannot come down to the kitchen.
"Well we are busy here in the kitchen too. If you want your patients to have food you'll just have to come and get it"
I wanted to say I beg your pardon but what the hell is stressful about working in the kitchen?
Your colleague is right Anne. They are either backward or foreign with no basic grasp of the English language.
ReplyDeleteOne of the kitchen staff complained the other week to the matron that we do not take patient nutrition seriously, because we do not leap to the meal trolley with our green pinnies on the minute the bell is rung for protective mealtime.
I take patient nutrition as seriously as the next nurse and if I am not handing out meal trays or feeding patients it is for a damn good reason i.e.
1) Trying to get up gelofusine on hypotensive patient.
2) Obtaining an ECG and vitals on patient with crushing chest pain and a cardiac history.
3) Attempting to inform docs that patient's pedal pulses are absent and their leg is now cold and turning blue.
I would argue that not taking patient nutrition seriously is wheeling the food trolley back to the kitchen and throwing food into bin, when you are fully aware that the nursing staff have not managed to get around to all 30 patients!
Right I've ranted enough for today. Feels great to vent though!
You have a bell for protected mealtimes? WTF? We have the insulting red trays to let us know who needs "assistance" with feeding on the wards. In ICU we have no actual housekeeper so everyday if we do have patients who can eat we have to phone the kitchens and try and book some meals. They get no choice as we seem to get whats left over. Joy. I really wish that Cameroon or one of his chronies would pick a random medical ward and turn up unannounced. Theh they might see what working in the NHS is really like....
ReplyDeleteSeriously, it is like an old fashioned town crier bell. I am not kidding! Come 1200 one of the housekeepers starts ringing it.
ReplyDeleteWe don't have the red trays, but seem to remember this innovation being heavily lauded in Nursing Standard a year or 2 ago as the answer to patient malnutrition. What a joke!
Steady on old Girl! Even in Little Harley Street I don't expect a nurse on the round. On my NHS round I just keep to the agreed time, and toast the F2 if he doesn't know the patient backwards including the nursing details as to fluid balance, nutrition, domestic circumstances etc. If he doesn't know then he will by the following round. I always make sure that the ward nurses are their MSF delegates. Keeps a sweet learning atmosphere all round.
ReplyDeleteyour a legend, redaing your post reminds me why i got the fuck of the NHS and now work in 1:4 ratio australian awesomeness
ReplyDeleteapologies if i sound a little smug
This can't have effect in actual fact, that is exactly what I consider.
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