Saturday 12 June 2010

Weekend Admissions and DEATH

Shit pic because it's American but I love the slogan.

I would just like to add a thing or two to this daily mail article.

The true story here is the fact that the hospital does not want to PAY for any kind of staff (especially senior staff) to work out of hours.  They just don't want to pay for it.

Many senior nurses (and myself) have REQUESTED REPEATEDLY to work nights, holidays, and weekends as it fits around our husbands 9-5 weekday jobs. 

During the week when my spouse is working it is impossible to get nurseries that fit in with a nurse's random ungodly shift hours.

  I would save hundreds and hundreds of pounds a month and a lot of stress for myself if they would allow me to work all weekends and nights.

I want the  weekend shifts and the weekend and holiday nights.


They will not allow me to do all nights at the weekends and weekends generally because I am senior staff.  At least I get some.  If I was a SISTER I would be banned from doing any of them. But no fear of that since they are refusing to promote anyone due to costs.

I only get them once in awhile.  The Ward sisters and other staff nurses who are senior to me are banned from working nights, weekends and holidays.

I would imagine it is the same with the medics.  Maybe some medics out there can enlighten me.

Don't any of you believe that this situation exists because staff do not want to work unsocial hours.  Far from it.  I would only want to work weekday social hours  if I could work 9-5 which is impossible as an acute care Nurse.

Nurses are middle aged women with kids.  Most of them are in my shoes, rather than wanting to go out and play on a Friday night.

I'd also like to add that I am pretty damn annoyed that the DM is focusing on medics and not discussing how a lack of senior experienced nurses at ward level harms patients.


TonyF said...

Now, if you were a useless ball kicking tosser, you'd be on holiday in South Africa pocketing thousands for doing nothing worthwhile.

Tax the bastards back to the national minimum wage, and give the money to people who actually deserve it.

TonyF said...

Now, if you were a useless ball kicking tosser, you'd be on holiday in South Africa pocketing thousands for doing nothing worthwhile.

Tax the bastards back to the national minimum wage, and give the money to people who actually deserve it.

TonyF said...

Bizarre, I have an echo....

Anonymous said...

I have come here via the link on Jobbing Doctors site. I have also just posted a response to my last comment on Jobbing Doctors Blog. A&E nurse was kind enough to reply. I am saddened that you haven't. Perhaps as no other relative could be remotely 'blamed' for my dad's death by encroaching on nursing time that I am of no interest to you? I think this is sad and think that perhaps you have an agenda?

My dad died because a nurse did not think my fears were founded. Perhaps as you said nothing would have changed if she had done her job properly -but at least he might have had a chance.

I think you are just interested in yourself. I understand that you are working under pretty grim circumstances and I am sorry for that -but using relatives an an excuse for something that is beyond their control, that is staffing levels is not right.

I am just young and have a lot to learn -but I know right from wrong.

Nurse Anne said...

I just saw your comment over at jobbing doctor. I hadn't had a chance to go back there yet today.
You are still not, in any way, shape, or form comprehending what we are telling you about relatives.

I agree with you that the nurse in that situation with your dad should have been on the ball. I don't agree that your dad would still be alive if she had been. He was killed by a major stroke, not a nurse.

To put in perspective for you I will tell you a story.

A colleague of a friend once collapsed at work. This woman who collapsed was a registered nurse and she was 28 years old and in perfect health. She collapsed in the middle of her shift in an operating room at a major American hospital. When she collapsed she was surrounded by her colleagues and good friends who were experienced nurses and doctors. She collapsed and 5 minutes later she was not breathing. They started working on her right away.

She died right then and there and left a husband and 2 very young children. They did work on her for awhile but it was futile. I am not sure what killed her but I think it was cardiac related. And that is easier to deal with then a massive stroke. And I am sorry but no NHS hospital is going to trump the hospital she collapsed in as far as care goes.

I knew someone who was the nurse in theatre the day that the wife of that particular hospital's chief medical doctor died on the operating table delivering her first baby. The patient's chief medical doctor/husband was there when it all went to hell and when word got around so was every other senior doctor in the hospital. They were knee deep in blood. She died too. Point is that there is not always a solution.

I am not defending the actions of the nurse in your situation. I would love to know what was going on in her head. What happened to you doesn't change the fact that nurses are spending up to 40 minutes out of every hour on the phone with relatives rather than caring for their patients.

WE could reduce this if we could get one relative to ring for information rather than everyone who has ever known the patient. Look at it this way. If I am the sole nurse for 20 patients and they each have 5 family members each ringing throughout the day as well as stopping me during visiting hours how much care do you think the patients are getting? Sometimes we will have 13 different people ringing for one patient. And that one patient will have his daughter at the bedside that I have just explained everything too as well.

Everytime the phone rings I am having to stop what I am doing and walk a long way away from the patients to answer the phone.

They also need to understand not to ring at mealtimes because I cannot answer the phone 10 times in the 20 minutes I have to get everyone fed, and still feed the patients.

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

Saying all this does not mean that I don't want to communicate with relatives. It means that there needs to be some kind of control over how many interruptions the nurse is getting. This can be done without witholding info from the families.

The NHS is unique. In other countries I have worked in the hospital does not allow these kinds of phone call enquiries about patients to get past switchboard unless it is legit.

The person ringing to get info on the patient has to give a password to the switchboard operator before they will put you through to the nurse's station on the ward. If you are the named family member then you have the password. And it is your job to tell the rest of your family what the nurse's have said to you,a nd they do not have the right to ring as well.

If this isn't good enough you can make an appointment (along with your whole family) to speak to the medical team at an agreed time.

If you give your password to other family members leading to the nurse taking multiple unnecessary phone calls there are consequences. They will revoke your priviledges. This is for patient safety, not to annoy the families.

Nothing wrong with mentioning a question or concern as long as you are the main family member, or if you are visiting a patient and think that something is wrong with the patient. But the kinds of interruptions we are getting from relatives goes way beyond that. It's a constant hammering from too many people who do not respect the fact that I can't stay and chat to them while my other patient is biting is tongue off due to a seizure.

When a&e charge nurse told you that nurses lose the plot a bit due to stress and overwork he didn't mean that they stop caring. He means that their minds go into total meltdown. They are keeping track of so much information, so many people's needs, and fighting off so many unnecessary interruptions that their brains are going into meltdown.

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

The important thing to remember is that management is not going to help us out here. They are not going to staff the wards, or give us someone to answer the multiple calls coming in.

So we go to plan B to reduce the number if interruptions that the nurses are getting. We ask the relatives for cooperation.

1. One family member rings and disseminates info the the rest of the family.

2. If you ring or stop the nurse to ask a question you must keep it to less than 5 minutes. It's interesting to hear about your life, your medical problems or the patient's childhood adventures 60 years ago but I can't listen to it right now. IF you need more time than that to get to grips with the patient's situation then you can make an appointment to speak to the team or I will stay after my shift (unpaid) to speak to you. Once my shift ends there will be another nurse to continue on with he patient care. And that means I can talk to you without neglecting anyone.

3. No backing up the nurse againt the wall and refusing to let her get down the ward to her other patients until she gives you your mom's scan results. We are not lying when we say that the results are not back. We are not lying when we say we cannot access them anyway. We are not lying when we say that we have other patients to tend to. And believe me, you want scan results coming from a doctor not a nurse. Believe me.

4. Please ask why the patient is on a fluid restriction rather than accusing us of trying to kill him via dehydration. I will give you a nice little teaching lesson about sodium levels.

Oh how I could go on.

uknurse said...

Good to see you back Anne. I have added my thoughts over at JD's.

Dino-nurse said...

I especially enjoyed the comment in the Daily Fail about how consultants "don't want to work" at weekends...hmmm....if only the public knew the restrictions that the Trust places on these senior doctors...this weekend, ICU as always has a consultant on, as does ED....everywhere else is covered by a handful of SpRs and F1/F2 docs...medicine in particular fars badly- today I waited for 5 hours for the SpR for all of medicine ( nevermind that there should be 5 separate firms) as he had nearly 100 acutley ill patients to review BEFORE he got to the 60 or so outliers....the poor little F1 was having to cover the remaining 250 who were not as ill. Just as the SpR finally arrived on ICU to review a patient he knew nothing about, his crash bleep went off and off he

Nurse Anne said...

I am really annoyed about those arrogant daily mail bastards who work 8 hour days calling the doctors lazy. The doctors (all levels) work their tits off and then some. I wouldn't be able to keep up with the docs and I have done 16 hour shifts.

Dino-nurse said...

Yes, I find it quite worrying that the Press in general seem to have it in for doctors whilst painting nurses as angels all the time. We are not. The F1 yesterday covering medicine looked like death when she came onto ICU to use the ABG machine (for the 20th time or there abouts) yet she still managed to smile (God knows how). She took one of the CCOT nurses back to MAU with her to help out in the end. He was actually on his way home as they only work til 4pm on a Sunday but is always ready to muck in (unpaid at the moment). If I ended up as a patient on MAU ANYWHERE in the country I would be very afraid....a little knowledge of how the system is falling apart is a very dangerous thing. I wonder how many IR1s are not being done because we realise that on the whole they are ignored if the solution is to increase staffing levels?

Julie said...

Good to see you back MMN. This post explains something for me; a relative of mine was in hospital and I noticed that at weekends there were hardly any nurses about, just HCAs. One Saturday that I was up, I could have sworn there was only one RN on and the rest were HCAs. This was for a ward of 20 odd geriatric patients. She looked very stressed..

Anonymous said...

True. My Mum was in hospital over the weekend. The Registrar told her she could go home at 8am, as soon as the jumior doctor managed to do her discharge papers. Mum was still there at 5pm, bored and getting irritated. As a nurse, I was able to tell her that the poor junior doc was part of a team of only 3 doctors, looking after probably about 150+ patients throughout the hospital, and A&E, that day.

Discharges become very low down on the list of priorites when the 3 doctors are dealing with sick people, A&E gets backlogged, patients breach the 4 hr target, then the hospital gets fined for it!

You couldn't make it up.

Nurse Anne said...

Also anonymous the Junior doctor covering the weekend is extremely reluctant to make a decision about discharge without the back up of senior doctors. I don't blame them.

Consultants say this and that to the patients. This is a problem because the consultant is so far removed from the process.

A consultant will say to a patient on a friday afternoon something like this "if your bloods are fine you can go home first thing tomorrow morning".

And he will not write this in the notes. This means that the staff who are actually there on the weekend (nurse AND doctor) have no documented back up that the patient can go. They only have chinese whispers to go on.

Not only can the junior doc not leave sick patients to sort out a healthy discharge but there is a lot involved in the process. He has to write discharge orders (time consuming), we have to fight with pharmacy to fill the orders and half the time they are not in on saturday. There is very little in the way of hospital transport and nothing in the way of social services or care, or district nursing if the patient needs any of that support and it wasn't organised the week before.

The consultants understand none of this because they are so far removed from the entire process.

So Mr. Consultant says to the patient "Yes you can go home" and 10 minutes later my sweet little granny is sat on the end of her bed with her suitcase packed and her nice outfit on with a smile of excitement on her face. And I have to break the bad news:

"8 hours from now the consultant will release his junior doc from the ward rounds and only then can he write your discharge long as he has no sick patients. And by then pharmacy will be closed and cannot do your medications."

Dino-nurse said...

Oh so true Anne :0)
Is your Trust pushint the "home in time for tea" initiative yet? Oh how we laughed when we attended the meeting- compulsory for every grade of staff APART from the doctors. Ho hum. Not that it has any direct on the ICU docs of course as they don't do discharges (or so they think!). However as we seem to be discharging more and more patients home due to lack of ward beds, the general docs (med and surgery) are digging their heels in over doing discharge paperwork for us saying that its ICUs job. The gasmen say its not. Guess who's caught in the crossfire?

Nurse Anne said...

Those dickhead managers. They don't even let the junior docs off the rounds until tea time to do the discharge orders. And by then pharmacy is shut.

So the best thing to do is get the doctors to do the discharge paperwork and then obtain the discharge orders the day BEFORE discharge.

One problem with that. The medics are so stressed with today's sick patients that they sure as hell aren't going to take kindly to you ringing them to do tomorrow's discharge. I can understand that.

Have you ever had one well patient ready for discharge and their ten relatives assualting and harassing you because the consultant said they could go? But the junior doc hasn't written the discharge orders yet and therefore you cannot get the drugs to send them home with, or legally send them home?

So then your ring the doctor to remind him that this patient is sitting here waiting for his discharge stuff. (doc already knows but family is breathing down your neck, literally). Then the doctor loses the plot and starts screaming at you because you just called him away from a GI bleed and two dying septic patients to ask him to come and do discharge orders.

So you go back and tell the patient and scary relatives that no, the doctor cannot come yet. And then they start screaming at you with the "oh dare you make us wait, this is ridiculous" shit.

They should get sent home without their meds for all the bitching they do about how long they are waiting for the weeks supply of free one's dispensed from the hospital. The first time they complain about how long they are waiting for their cheap/free drugs they should get billed for the drugs along the lines of what people have to pay in the usa pay for drugs. It's not like what they pay in taxes cover the cost of that stuff.

Then you finally get the discharge orders from the doc and pharmacy is closed. If you are lucky enough to get the discharge orders at say lunchtime and abandon your patients to run the orders to pharmacy it is usually 4-5 hours before you get those meds and see the drug charts again. That means that if the discharge patient needs a pain killer you have to leave your patients, leg it to pharmacy in order to get the drug chart and thus delaying pharmacy completing the order.

Love doing this for 7 people on top of having 7 or 8 extrememly ill people.

And for some goddamn reason they think that screaming at the nurse and saying "it's your arse if we don't get discharged in the next 5 minutes " or my favourite

"my uncle is on the board of directors, I'll have your job if you don't speed things up"

is somehow going to speed up the process. God love them. I know I don't.

Anonymous said...

If it's any consolation, I am a consultant and I still write Xray and blood request forms and discharge orders even now. A day in advance, sometimes on a Friday for the next day (though the last time I did that it got lost and I had to write it again on Monday as no junior docs at all but by that time it was too late and the discharge was delayed by a day, but you can't win sometimes). And when my juniors are stretched I leave my paperwork and help them. And I love your blog, which is an accurate account of all the diffficulties that nurses on an acute med/geriatric ward have to deal with, but my pleas to management to increase nurse staffing have fallen on deaf ears for 10 years

Nurse Anne said...

We feel bad for the doctors too.

And the docs don't bitch and moan like the nurses do. They take their lumps like men. Even when they are technically female.

Anonymous said...

Keep up the good work blogging.And nursing of course...!

Ali said...

Welcome back Nurse Anne ! Bloody TTO's and discharge forms - drive us all crazy. We're trying to get the docs to do "one stop ward rounds" - if there are 2 F1's on a team then one writes the TTO's as they make the decisions to discharge - very boring for the poor F1 who is constantly running to keep up with the ward round, but effective when it works - still doesn't stop poor Granny packed and ready to go for 8 hours though waiting for the damn drugs to arrive, especially when no-one's changed the ward name on the drug chart from MAU and that's where they've been sitting for 6 of those 8 hours.......

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