Senior managers in the NHS should have to spend one month of every other year shadowing nurses or SHOs (FY2s) in ‘busy’ departments*. They should endure the joys of shift work, endure the joys of nights, understand what it’s like to work when a department is staffed by 70% agency due to sickness**. It might make them treat the clinical staff better***.
Incidentally, it’s not that I have anything against agency staff**** – one of the things I like about where I work is that we treat our agency staff decently, it’s a very friendly department; but when you know where everything is, you know how everything works, and you – at least theoretically – have a commitment to your department it makes a big difference to the deparment’s running. On two consecutive nights we had similarly high patient numbers, the night with high agency numbers was painful and exhausting. The night without was just tiring.
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So those of you who know me, know I did nights over the entire Xmas week – Xmas, for me, this year, falls on the 30th of December :)
It’s been interesting. Perhaps nights are different than days, or perhaps because of the recession, but I saw far less dumping of unwanted relatives than I’ve seen in the past. Much less of “granny can’t cope at home” or “Oh, no, we can’t come and collect him…” – which is always one of the most awful things about Xmas in the health-service. However, despite the pleading of the NHS we still had a lot of people rock up with stupid ass things. My favourite was a bloke with a cough who came in by ambulance. I didn’t quite understand why the normally sensible tech had brought him in.
I kept waiting for the ‘short of breath’ (apart from when coughing), ‘low Sats’ or ‘sharp pain’ in the hand-over, but it never came. He’d had cold like symptoms and now had a nagging dry cough. His SaO2 was 98%******. Nor was there any suggestion that the tech in question had suggested that hospital might not be the best place to take his cough, or that he’d demanded to come in. So I don’t know why he came in, I know he got a set of obs (all normal) and a listen to his chest and got sent home – whereupon he whined about how he was going to *get* home (no, we won’t pay for transport). It’s rare that a patient comes in to Majors in the hospital and doesn’t get bled… he was one of the few.
Boxing day was the worst though. Here’s some advice for people next year. If you don’t like your family, don’t go and spend the day getting drunk around them. It seems to lead to an exceptionally high level of assaulting each other. Also, that hard white stuff that the snow turns into when it melts and refreezes. The stuff that’s all shiny? That’s called ice – it’s slippery. Your shopping can *wait* until it’s gone. No one died from a late Xmas present.
Oh, and if you’re caught breaking into somewhere (when drunk), get beaten up and come to A&E – please don’t try and charm the (lesbian) nurse. It just makes her uncomfortable.
Thanks.
* Medical/Surgical admissions wards (the wards that usually take the brunt of emergency admissions), A&E, ooh and elderly care (just because they’re almost invariably run on minimum staffing with extremely demanding patients).
** I’ve worked a ward which was being run on 100% bank staff – so all staff who knew the hospital, just not that ward. It’d been open for a day, having been closed for 6 months, it was quite…interesting. Felt bad for the patients.
*** This also comes about from watching an entire season of Cardiac Arrest – it’s interesting because it’s written from a doctor’s perspective – I wonder how the current crop of doctors sees nurses (and whether it’d be different if it were commenting on A&E nurses who, largely, are part of the same team as the doctors).*****
**** I do agency, so I can’t really complain.
***** A&E and probably ITU, and possibly theatres (and maybe medical/surgical admissions) have a bit of a different relationship with doctors than wards. Most wards the doctors trundle through on their rounds and only come back when they have a job to do. A&E, ITU et al, all have a different relationship because the doctors are there all the time, and so when (on those depressingly rare occasions) it’s quiet they chat. It certainly feels different, the relationship.
****** A measure of how saturated your blood is with oxygen. Flawed, in so far as if you’ve lost most of your blood what’s left can still be saturated with oxygen… But for most things an adequate and useful measure.
