Wednesday, 25 January 2012

The Violence

Once upon a time in the spring of 2010 ( I think) I was scheduled to work a night shift from 8 at night until 8 in the morning.   This wasn't unusual because all staff nurses have to work night shifts once in a while.  Sometimes we work a whole week of nights.  Other times our night shifts are mixed into the same week as day shifts.  Our work schedules have no regular pattern and we get very little notice of what we are going to be scheduled to work.  

On this particular night I came into work at 7:40 PM to start getting my report sheets with my patients' info together so I could be organised and not miss anything.  I learned that on this particular shift I was going to be the Nurse for beds 1 to 15.  Beds 16 to 30 were going to be covered by Jenny.

Jenny is a wonderful Nurse.  She is about 60 years old, trained in the old days, and had been doing this job since before I was born.  We just love her. 

The staffing for the shift consisted of myself (a younger RN), Jenny (an old fashioned trained RN), and Kayla a care assistant.

Jenny and I are both RNs.  We both do the same job for the same pay despite our backgrounds.

In my section I had beds 4, 8, and 11 empty.  They had been empty for about 45 minutes as three patients were discharged around 7PM.  I know that A&E is always full and at anytime I would be getting a phone call that admissions were coming into those beds.    I was going to have to handle that as well as handle the other patients I already had.  Predicting when those new admissions were going to come in is impossible.  All I knew is that I had to rush meds, assessments, infusions and everything else that needs to be done for my already present patients as fast as possible so that I could deal with the admissions.  I hoped that they wouldn't come until after I saw all my patients.

Jenny was taking over beds 16 -30. In her section beds 19 and 28 were empty.  There had been a death in bed 19.  Bed 28 had become critically ill around teatime and the day nurse had just arrived back from transferring her to ITU.  The patients in beds 16-30 had no care for about 3 hours at this point.  The day nurse had to deal with the critically ill patient and then transfer him to ITU.  So Jenny also was going to be getting admissions at some point too.  And she also was going to have to catch up many things. The nurse who had my soon to be team of patients tried to help out with beds 16-30 but it wasn't enough.

I dread admissions. Admissions are pretty complicated and require an hour or two of focused attention to ensure that you don't miss something important i.e. a doctors order for blood, an allergy, etc.  There are thousands of things that the Nurse has to think about with an admission. Usually when admissions come to the ward it is very unclear what is going on with them and what they require.  It takes a bit of detective work on the part of the Nurse to find out and act on it.  Has this patient had the IV bolus that the admitting doc ordered?  Why are no pain meds prescribed?  I can see in the history that he has chronic back pain and takes meds at home..but no pain meds are prescribed?  His hgb is 5 but no one has prescribed blood. Call the doctor and see if he wants it given otherwise get yelled at for not asking.  And on and so forth.   Too make a long story short, admissions are a bitch.

Jenny found the day nurse who was caring for patients 16-30 and started getting handover from her.  I found the day nurse who was caring for beds 1-15 and started getting handover in a different room from Jenny.  If both of us listened to the information on all 30 patients we would be in report forever and that would just slow us down even more. 

Straight in the middle of report (handover).  The bed management people phone.  "Your two new admissions are coming within 10 minutes, we have yet to assign your other empty beds but A&E is full, so we soon will be." she says. 

"We only have two staff nurses (me and jenny) and one care assistant (kayla), can we please have more staff" I ask.  "No, dear" she says, and hangs up on me.
"Great" I say.  I haven't even got through report on my other patients yet, let alone seen them.  But new patients are sent when it is necessary for the sending department and not when it is safe for the ward nurse to take an admission.

At that moment Jenny comes flying into the room where I am getting report.  She looks white as a ghost.

"OMG, what just happened" says me. The look on her face made me assume that someone either just died or fell or was in the process of crashing.

"My new admission for bed 19 is here.  It's Jimmy".

Oh no no no no noooooooooooo .  Jimmy has been here before. Many times.  He's an alcoholic with a massive psychiatric history and he tends to kick the shit out of people.  Jenny informs me that he is getting admitted into her bed 19 for detox and a possible GI bleed. 

Jenny and I run onto the ward.  Bed 19 is in a bay with 5 other patients.  And that is the bed that bed management has assigned to Jimmy.  Bed 20 has a man dying of cancer. Bed 18 has an elderly man with confusion and fall history who has been diagnosed with a blood clot and is on a heparin drip that needs to be closely monitored. Bed 17 is a brittle and non complaint diabetic on an insulin drip.  Both heparin drips and insulin drips require close monitoring by the staff nurse.  Bed 16 has a young man recovering from pnuemonia. Bed 15 was a renal patient. And of course there are still my 15 patients and Jenny's other patients in the bed 16-30 assignment as well.

The porters dumped Jimmy into bed 19 and walked away. Thank god in heaven he looked asleep.  Jenny and I checked him over quietly to ensure that he was breathing. Then I flew to the phone and called bed management. "how can you dump a violent patient onto a ward with frail, vulnerable, medically unstable patients and hardly any staff" I yell.  "Look Anne, stop whining, put on your big girl knickers and deal with it" says bed management.  And then they hung up on me before I got another word in.

Now Jenny and I were raging.  We called the nursing supervisor on call for the hospital. While we waited for him to call us back we finished getting report on our other patients so day shift could go home.  They had been there for over 14 hours at that point.

Now it is 9PM and no patient has had any care from the last few hours of day shift and the first hour of night shift.

The nursing supervisor comes to the floor.  Jenny and I explain the situation.  "What do you want me to do about it" he says as he shrugs his shoulders.

Now I am breaking out into a cold sweat.  My hospital has no security team.  Jenny, Kayla the carer, and myself were on our own. 

I asked the supervisor just what the heck we were supposed to do when Jimmy wakes the hell up and starts beating patients and smashing the place.

"RUN. Go to the nearest ward and call 999".  he says.

And then he continues with the following statement "Jimmy already broke bones in the ED about a month ago when he was last here, it took 7 members of staff to hold him down. He is sleeping now because they gave him stuff but yes, it is going to wear off.  He spent time in jail for holding an ex partner hostage and torturing her for about a week.  This is the kind of bloke you are dealing with. Just run.  RUN"

I then ask him what I am going to to if Jimmy starts attacking the other patients in that bay. This is a very likely scenario with an alcohol detoxer because they go nuts.  And Jimmy is a violent thug on top of being a detoxer. "I'll have to try and tackle him I guess" I say.

The supervisor shook his head at me. "Come on Anna, he'll kick your head in. If you see him start to stir and wake up, just run off the ward and call 999.  I am sorry, I tried to stop them from admitting him to your ward.  I did. Im sorry. Bed management overruled me and the hospital manager on call has refused to pay for any kind of security. I can't help you any further. I'm sorry you have to deal with this".

And with that statement the supervisor turned around and walked away.  He had to deal with worse things going on in A&E. I'm serious.

"Let's pray that he doesn't wake up till morning when day staff comes in" whispers Jenny. 

I still had 15 patients to attend to and by 10 PM all of the new admissions were rolling onto the ward simultaneously.   Jenny started with her lot by seeing to her patients on heparin and insulin drips.  Those kinds of drips are not something you fuck around with and neglect. That's right, she had to go into the bay that Jimmy was in.  We should have gone in together but I was so concerned about my other 15 patients and the new admits that I just didn't go with her. 

And bed management, those rotten sons of bitches.  They still sent new admissions to the ward and denied us additional staff even though they were very well aware of what the situation was.

At about half past 10 I was with my patient in bed 1. I had gone to her first because she had something going on that needs to be checked every 15 minutes.  It is a med ordered by her doctor. I was listening to her bitch about "not being cared for during the past hour by you lazy nurses and didn't get my pain meds" when I hear a dull sound.  It sounds like a thud, like a body hitting the floor.  Then total silence.  Then I heard a shout and a door slam.

Oh shit.  He woke up.  I guess I should add at this point that we had earlier called the physician and asked him to prescribe additional sedatives for Jimmy so that we could administer them if the shit hits the fan. He never called me back.

So I hear this dull sound and I go running towards bed 19. As I ran out of my bay one of my patients shouts this at me "I'll have your job if you don't give me my meds and tuck me into bed in the next 30 seconds.  I ignored her and just ran while thinking "God I don't even know if my new admission who is bleeding out is even still breathing, and you want me to tuck you into bed, you crazy bitch" and "god why do I have these nasty thoughts, guess I'm burned out"

 I run to room 19. Jenny is on the floor, propped up against a wall.  She had been punched so hard in the face she is insensible.  She is conscious though.  Jimmy and the young pneumonia patient are locked in a full on fight.  I learned later that Jimmy had got out of bed and got Jenny from behind.  The patient witnessed this and tackled him. Jimmy got away from him, grabbed Kayla and started heading for the door.  I took off to the nearest phone to call 999.  Jimmy had dragged Kayla into a bathroom and locked the door.  Then he came back out and headed towards me on the phone.  When he left the bathroom, Kayla re-locked the door for her own safety.  I ran out the door over to the nearest ward.  It happened to be an ITU that was locked. I banged on the door.  A staff member opened it.  I could barely talk. 

I just said "detoxer. beating staff. please call 999".  She ran to the phone and and called the cops and someone else came back down to the ward with me.  I was so afraid for the frail patients in that bay, especially the man dying of cancer. I think the unit I ran too  must have called the supervisor and the medical doctor on call because they were on the ward within minutes.  The medical doctor took one look, mumbled about not wanting to prescribe benzos to someone with liver problems and needing to call his consultant, and then ran off.  The pussy.

The sup and the staff member from the unit had tracked Jimmy to the treatment room where he was sitting on the floor weakened and vomiting blood.  It isn't uncommon for alcohol detox patients to have gastrointestinal bleeds.  Now I knew that he would need a blood tranfusion, that psychiatry would not see him because of his medical issues, and that he would be staying here on my ward. Fuck.

The police came quickly.  I was seriously impressed at their response time.  Like 5 of them showed up.  At least something in that town was well staffed and able to handle an emergency.  The hospital wasn't.

Kayla sat with Jenny. While the police and the nursing sup were with Jimmy I quickly checked on the most unstable, unwell patients (paying particular attention to those with potentionally dangerous meds infusing).   Bed management called at this time and wanted to know if they could send another admission.   "The hospital is on alert as there are no beds anywhere and lots of patients in A&E."

"I haven't even seen the last admissions that you sent to me, nor my other patients. We have no more beds, and a nutcase smashing the place up, I am down a nurse because she got punched in the head.  Do not send me another admission.  My ward is closed" I yelled.  The fuckers sent one up anyway.  A&E was busy, people were on trollies and targets were being breached.  When targets are breached the government fines the hospital, thus taking vital funds away for things like...ummmm...SECURITY AND NURSING STAFF.  

But they sent her up anyway. The people in bed management are not nurses or doctors, they don't care.  New patient was a precious 70 year old with an even more precious daughter who arrived on the ward yelling at me about the wait in A&E and demanding food for herself and her poor starving mum.  Neither of the two of them looked like they were malnourished.  Believe me. God, if they are yelling about lack of food now, just what the hell are they going to do to me when they find out that A. there are no beds to put mam into and B. There's an out of control violent person on this ward. That daughter is going to kill me. Unless Jimmy kills me first.

And it was around that time that the police told me that they had to leave.

Jimmy, however, was staying.

Do you guys want to hear the rest or is it all too insane?  This is the reason  I never posted this back in 2010.

disclaimer. If you think you know any of the people involved with this, you are mistaken.  Names and info have been changed to protect confidentiality.


Isabelle said...
This comment has been removed by the author.
aliby said...

of course we want to hear the rest! Oh, and glad to have you back!

Nurse Charli said...

Oh my god, this sounds like my worst nightmare!!

Anonymous said...

Sounds like my ward at times, in particular Friday nights..

Its a scary situation to be in, I've been punched, bitten and kicked before and higher up don't seem to give a crap about it just if A&E are breaching..

Ah the joys of a gastro ward..!

Anonymous said...

I want to hear the rest. What happened to Jenny?

Nurse Anne said...

Jenny actually worked out the rest of the shift. She really should have gone to A&E though. Going to post part two soon. Just been working a lot. Take care.

NHS Nursing Student said...

more!!!! good to have you back :)

Anonymous said...

i am so glad to know there are other very very pissed off and angry nurse out there, i was wondering if everyone had gone complacent, this is a joy to read and makes me feel very normal again, thankyou nurse anne for making me feel that its ok to be fucking pissed off. i hate managers, i hate cleaning audits.. i ike things tidy and clean but when you've been scared so badly by ur managers to make sure the bloody windowsill is clean that u are actually worrying mor about that than how clean your patients are there is seriousley something very wrong in our nhs. i also hate hca's tho think ur not actually working when ur doin the drug round or documenting( usually done after the shift has finished when the hca's have raced off home).

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