Back to the Medical Ward. Yay.
My 13 hour night shift was due to end at 0700; at which time I have to be ready to give report to the oncoming Nurse.
Starting at 5AM I had to:
Start a magnesium infusion, give calcium gluconate and start an IVI with K then an addiphos infusion and take off a whole load of other doctors orders for a patient with deranged U+E's. The addiphos probably won't go up till day shift. He could have crashed at any moment with a K that low and I didn't want to leave him. He had bloods done over night and the results came back at 04:30. The doc wrote the new orders just afterward. I had to run around like a nut just to find some magnesium to start and of course document every aspect of all of this. All had to go through a central line. As you know this is time consuming.
I needed to get vital signs and obs on all 19 of my patients by 7 AM. If you wake the patients up before 6 to start getting all their obs they get angry. If I didn't start before 6 they would never got done and we would potentially miss the signs of a deteriorating patient.
I had to IV fluids on someone with renal failure. I had noticed his rubbish output at midnight but it took until 04:30 to get the doctor as he was the only doc on for multiple wards. Bloods hadn't been done for days on this patient and I needed to draw them.
I was also trying to keep the 02 on another patient, a confused patient who was desaturating without it and kept taking it off his face. He has disorientation secondary to sepsis so he could not understand me when I asked him to keep it on. He needed a mask rather than a nasal cannula.
At this time I also had to obtain,, mix, and administer 15 (yes fifteen) IV antibiotics for 8 patients that were prescribed them. This has to be done by 0800. Day shift starts at 0700 but doesn't even get out of handover until nearly 0800 so they can't do it. I had to do them and finish them by 07:30 AM.
I had 5 patients ask for controlled analgesia during this two hour window. This again is very time consuming. The system for obtaining and administering controlled drugs is a joke.
During this window I also had to be up to date on the current status of all my 19 patients. For example any little thing that changed with them on my shift I need to be onto right away. Examples of this include changes in observations, neuro observations. fluid balance, blood sugars etc. I had 5 diabetics. I need to act on every little thing and document it and it all needs to be done right now.
I had to act on the fact that I just noticed that my patient who is being treated for a UTI is completely unresponsive with a low BP. Had to call the doctor and wait for him to get around to calling me back. Fast IV fluids ordered as well as a million other things that needed to be done ASAP.
Two patients who needed IV antibiotics woke up and pulled their IV cannulas out. Two others pulled out their urinary catheters. It was like a blood bath for all 4.
I needed to monitor the patient on the IV insulin infusion closely. His blood glucose still isn't right. Something is wrong about this. Her consultant wanted her to stay on this infusion over the weekend. All night long I had told the house officer that the insulin infusion and the iv fluids that get hung with them were running out and that he needed to prescribe more so that I could hang more on the patient. The only time the doctor came was at 4:30 in the morning. I handed him the chart but he put it down and "forgot" to prescribe it before he got bleeped away somewhere else. Called him again and he said that he couldn't "come back to your ward" for awhile.
I had to deal with the fact that a patient woke up in agony with a blocked catheter. It needs irrigating. It was draining a few hours ago.
Remember all this is what got thrown my way between 5 AM and 7 AM. I was the only RN for double digit patients.
There were two lots of IV frusemide to give. 80mg. They need to be set through a pump. Got to watch those BPs because even though they are borderline (and I wouldn't give it if they were a smidge lower) these two chaps really need it.
I didn't want to leave the side of any one of these patients. But my god. Just standing in the treatment room mixing and preparing all these IV drugs is extremely time consuming.
I had to leave a few of the antibiotics for day shift. Day shift was so busy that they didn't give the 8AM meds that I didn't give until nearly noon.
I got a phone call at 0600 to take a direct admission from A+E as there are no beds anywhere else. The A&E nurse gave me report on my new patient. He is a drunk and combative alcohol patient who fell and hit his head. They want neuro obs every 15 minutes. He is sleepy but when he wakes up he knocks stuff over and hits. I didn't want to take this patient because the only empty bed I have is in a bay with 5 nice but frail confused elderly men. He will need a lot of admission stuff doing as soon as he gets to the ward i.e. paperwork to get his admission orders sorted.. The rest of the admission paperwork and all other legally required documentation I will knock out after my shift ends by staying over unpaid.
And that is just some of it. If I went into all the knowledge I have to have to manage those things we would be here all day. If I fucked any of that up just this much I could be held responsible for someone's death. Nurses are legally responsible for delivering the orders given by a doctor and monitoring patients. And my list reflects my doing just that.
That was my lot to carry and carry alone. I was the only qualified Nurse for those
The only help I had was a teenage cadet called Beth. There was nothing in the above list that she could help me with. Nothing. She cannot even do observations/vital signs or check blood sugars. She is not a Health care assistant or a Nurse. I wish I had that lovely HCA from the surgical ward with me. He was mint. Beth refused to empty the catheters so that we could monitor an accurate fluid balance because "that's gross".
Between 5AM and 7AM this is what Beth had to do:
Change a few beds
Help people to the toilet.
Answer call lights and tell patients that the Nurse will be there as soon as possible. This confuses them since they think that she is a Nurse. She is wearing the same uniform as me after all.
Serve hot drinks at 7AM (she puts a trolley together and just blows past anyone who appears to be asleep rather than waking them up and encouraging fluids).
I would rather just do the drinks myself but....you have seen my list of jobs happening at this time.
If anyone pees or drinks she needs to measure it and write the value on the fluid balance chart. She didn't bother because she doesn't understand the point. As a matter of fact I asked her to do just that whilst my arms were loaded with IV meds, vital signs equipment, and new admission orders. She just rolled her eyes at me and said she was "too busy" because she was "serving drinks".Doctors and Nurses could kill a patient if they don't have an accurate fluid balance. Serving drinks took her all of 5 minutes since she ran past any patient who was sleeping or quiet. Then she sat at the station on her mobile.
Beth cannot help me with anything on my list as she is not a Nurse. But I must help her change those beds on top of everything else otherwise we get the cries of "those damn new fangled to posh to wash RN's leave all the real work to the care assistants". And I just don't want to fucking hear it.
And at 07:30 she will be out the door on her way home regardless of what is going on in that ward. She is not a Nurse, she is not licensed. What does she care? I will still be giving report. Giving report on 20 patients takes a long time. Who is looking out for my patients while I am handing over? Beth will be on the Bus. She doesn't understand what I have on my shoulders with those patients...she doesn't even understand what addiphos, deranged U+Es, hypoglycemia and sliding scale insulin means. She has no idea what a Nurse does she just sees me flying in and out of rooms. She tells the patients that she is a "real nurse" and a "nice nurse" because she is the one who serves them tea. And they suck it up. Most of what I am doing for them goes unseen by them.
Cadet Beth is real pissed off because she had to do the bed changes on her own mostly. She will piss and moan to anyone she who will listen about how she was left to do all the real work (8 out of 14 bed changes; I managed to assist with 6 of them) because the Nurse "wouldn't help her". The patients will tell her that she is the "nice nurse" who was kind enough to provide them with a drink and say "some others cannot be bothered with that because they think they are so high and mighty". And the patients will say this too Beth whilst looking daggers at me. They have absolutely no fucking clue what needs to be done to keep them alive and who is doing it.; They get that the doctors are the brains who prescribe treatment. And they get that nice
Beth was on her way home at 07:30. I was still there on the ward tying up legally required loose ends at 9:30. They stopped paying me at 07:30. I think that without the new admission I may have made it out of there by 8:30 but nevermind. My daughter was late for school. Again.
Fuck this shit. I want a clipboard job. And when I leave I will be replaced with another cadet. And when that happens there will be one RN to 40 beds rather than one RN to 20 beds.
I love bedside Nursing but this is just too damn much. It isn't Nursing that is the problems it is the working conditions. The day shift nurse will be in for it. When the consultants come in and see that the fluid balance charts are blank from the night shift (thanks Beth, you worthless slut) they will smackdown on the Nurse who happens to be standing the closest to them.
Imagine how different things would have been if this was the scenario: Instead of just Beth and I for those 20 patients IMAGINE IF we had the recommended ratio of one nurse to 4 patients. Imagine if each of those 4 patients were sharing one Nurse rather than all 20 sharing one Nurse and one cadet? Imagine if each Nurse was able to do total care for her 4 patients......everything from dealing with IV infusions to changing their beds and encouraging a drink of tea.
I would stay in the job if that was the case. But it will never be the case here. NHS hospitals do not want to hire qualified Nurses to work at the bedside. They do not want to pay for that.
When I finally left the ward at 09:30 I was near tears. I was so rushed during those hours I was terrified that I made a mistake and killed somebody. I was afraid that maybe I hung the wrong meds on the wrong patients. I was afraid I missed somethingm like a low BP or a patient who had stopped fucking breathing. OMG I hope that patient finally kept his 02 mask on. I was afraid that one of the patients would go down to PALS and tell them about how I was the mean nurse who ran past them as they were shouting for help (I had to). Oh but that Beth, she was lovely and made us tea....