Sunday 18 November 2007

Handover Fun

One day I was the only registered nurse for 18 patients (worse than normal number of 15) for all of my shift from 0730 until 2130 hours. At 2100 my relief comes in. She has been off duty for a week and does not know the patients. She is a newish pool nurse. I need to give her a detailed report on each and every patient. She will be in charge of their care on night shift. Even if I only spend 2 minutes per patient during the report session, handover will still take 36 minutes. But two minutes per patient will not even scratch the surface in telling her everything she needs to know and handover to the day staff so they know. Three of the patients are acutely ill right now and have some really complex things going on. Most of them have relevant past medical histories that would take longer than 2 minutes to handover.

I had an admission at 2100 so I start handing over at 2115. The oncoming nurse cannot touch a patient until she gets report and knows about them. Doing that is begging for litigation. We really need to get started with this handover.

2115 hours
I start handing over at 2115, at 2116 a patient requests pain meds so I administer them, on the way back to handover a patient requests the commode so I help her with that. Phone call comes in from lab that new admit has an HB of 6. Eek. Call doctor. He orders a group and have blood tonight etc etc. It will take a lot of time in itself between getting the blood from path lab, setting it up, moniter for transfusion reactions etc.

2130 hours
take patient off the commode and settle her into bed. She asks for a drink, my HCA's are tied up with a confused patient so I get this lady her drink. Can't handle complaints from patients saying that the nurse couldn't even be bothered to get someone a cuppa.

2135 hours
back to handover room. I was halfway through the first patient so I continue. I am in here and there is no RN to care for my patients whilst I am handing over.

2136 hours

phone rings. Angry relative wanting to know if the nurses "bothered" to change mum's nightgown today. He gets nasty. He obviously is in a bad mood and wants to kick out. Probably a regular reader of The Times who thinks there are lots of nurses up here eating the patients food and discussing politics since we are too academic now to wash and don't care about patients.

2138 hours
back to handover. we tick on nicely until...

2145 hours

I realise that patient who has an infusion of IV insulin is way over due to have her sugar checked. This is not something you can put off until later. It will need checking again in an hour. HCA's are still tied up so I do the BM. She asks for commode while I am there. I am useless at saying no.

2150 hours

back to handover.

2200 hours
I am just in the middle of telling on coming nurse what we need to do for a patient that has a drip with a med that she has never seen before....explain what we need to watch for, labs that are getting drawn in the night that she needs to stay on top of...

Visitor (who shouldn't be there at this time but has special permission) bursts into handover room. Demands that I get up off my ass and clean his mother up.

I am concerned with time at this point as it is way past the time that the night nurse should have started her assesments and drug rounds. Lateness could fuck things up royally for these 18 patients. 9PM meds have not been started yet. I see the HCA getting someone a pillow. I point her out to the visitor and say that I'm sorry cannot help you now...can you ask that young lady over there. He tells me that he didn't ask her because "that nurse looks busy meanwhile you nurses are sitting in here chatting" I resist the urge to punch his ignorant face.

2205 hours
It takes less time to sort out patient than to argue and explain to the visitor why I can't so I go to help her with assistance of oncoming nurse. It takes 5 minutes to clean her up and 20 minutes listening to the visitor and patient tell us what useless slags we are for not being at her bedside all the time, all shift. Arguing back is pointless.

Back to handover. Ten call bells are ringing throughout the rest of handover. This is more than 2 HCA's can handle. If we go out there we will never get through this. Ever. Things are getting desperate now. I fly through the rest and say a silent prayer that I am not forgeting anything critical.

Phone call from patient's cousin who wants to know the ins and out of everything we are doing for his loved one. I have no choice but to be abrupt with him.

I finish handover and realize that the hourly blood sugar check for the IV insulin patient is a little overdue as well as 100 other such things. I go to check it so night nurse can get started. Get stopped for 3 commodes on the way back to nurses station. The night nurse and HCA are tied up. One patient starts telling me off as she has been ringing for 15 minutes and asked why we couldn't be bothered to see to her.

Path lab has blood ready. That was fast.


Head Home. I have been here since 0715 this morning and have been unpaid since 2130. I WILL be deducted on hours pay for lunch breaks I didn't have. Phone call comes in. I let night nurse get it. It is a relative screaming because their loved one was left to starve yesterday. Patient was NBM for an operation. Don't these people have anything better to do at this time of night other than stopping nurses from seeing their patients and interrupting them whenever they try to hand over critical info to the oncoming shift? WTF? During the day the phone never stops ringing due to this shit. At least there are less calls at this time.

I am going home. I am tired. Fuck the paperwork I haven't done. They can pull my registration for all I care at this point.

0400 hours

Wake up to see what why my baby is crying and it suddenly occurs to me that I forgot to tell oncoming nurse about a patient who should be NBM from midnight for a FBS test in the AM. Call work since she probably won't have time to look at the charts causing the patient to get breakfast. I am not the only nurse who calls in the middle of the night with this kind of stuff. There is way too much info to keep track up and no time to stop and review and take stock. At least this was relatively minor.

How different would things be if there was at least one other RN on duty with me to cover problems while I was handing over? You should see what it is like when we are one RN to 35. There was another RN on duty on the ward but she was even busier with her 18 patients. I don't know what time she got out. Her patients were on the other end and we didn't really see eachother.