Thursday 6 January 2011

Update 2

It occurred to me that I didn't mention the surgical ward.

It couldn't have been more different to the medical ward if they'd all spoken Dutch and burst into Guys and Dolls every few minutes.

The first person I saw as I walked onto the ward, was someone I'd known so long, she was practically an old friend. Lindsey, the HCA has worked on the bowel surgery ward ever since I've been availing myself of the facilities. Once - I can't remember what had gone wrong now - she held my hand for three hours as I cried in pain, crying with me.

We got to the nurses station and there was Sarah. Ward Manager, indomitable patient advocate and frighteningly efficient house auction addict. (??!?) Katrina, the staff nurse, Sam the HCA - familiar face after familiar face. Doesn't that say a lot about Sarah? Everyone was smiley, everyone was calm, but most importantly of all, everyone was friendly.

I can't sit here, hand on heart and say things didn't go wrong - twice it took an hour and a half to re-fill my Patient Controlled analgesia pump, discharge took the best part of Christmas day - but the difference, the vital, vital difference, was that it never felt like my fault. When the drugs were late, someone was on the phone to pharmacy constantly, in the end, sending a nurse down to wait until they were ready. When the HCA was busy, she apologised when she came back with a cup of tea we hadn't even asked for. (In the middle of the night, when pain made sleep unlikely for most.) Then she scuttled off and came back with earplugs, as she'd noticed I stuff tissue in my ears for peace.

I asked an HCA to check on me half way through my first shower and she duly called through the door  bang on the 5 minutes I asked her to.

Perhaps most importantly, Sarah acted as pain advocate, just as she always does. Funnily enough, I'd seen the pain nurse in the lift a week or two before. She asked how I was (I've known her for years too, but with rather more trepidation.) I told her I was awful, had been shoving needles into my thighs for weeks, but not to worry, she was bound to come and see me 24 hours or so after major surgery and tell me it wasn't a good idea, I might get abscesses, I ought to try a night or two just on paracetamol, blah, blah. I'd tell her she might have suggested it before the massively painful operation and in the end, we'd agree nothing would change, because it's too complicated.

Staggeringly, that's exactly what did happen, just as though she'd never seen me before in my life. Luckily this time I'd asked the medical world and their dogs to write letters about my nasty morphine allergy, my history post surgery of doing just fine at stopping the pain killers and sent her off to read them all. Just at that moment (Xmas Eve) St Sarah of Cambridge came onto the ward with presents for the staff and stopped by for a chat. No sooner had the words "Oh dear, I'm having the pain battle again" left my lips, Sarah was off and a duly chastened pain nurse returned mumbling something about pain teams in the future and left me alone. **

So, no arguments, no nasty nurses, no lazy slackers, no sense that if something went wrong it must be the patient's fault, no bullying, just an attempt to deal with an impossible working life with compassion and humour.

Problem is, when you see one ward doing it......

**I've been BEGGING to see a pain team for over 15 years, it just seems beyond them when I'm not actually causing any problems for anyone again.


  1. Sue,

    You have climbed to 116 in the best/most popular political blogs in the UK!


    I am off to check if POlitical Betting have dropped out of the top 100

  2. Political Betting is 105 sue... neary there

  3. Again this doesn't surprise me in the least.

    We have talked a lot on militant medical nurse about medical wards vs surgical wards.

    I once worked on a surgical ward. Never was I so happy. I was one RN to 6 young, sensible, reasonably healthy stable patients having minor to moderate surgery and we had all the equipment and to resources we needed. We had a charge nurse without an assignment to back us up and we always had clerical support.

    Then that unit was shut and my colleagues and I were moved to medical wards. That is when I began blogging.

    On surgical wards not only do the nurses have less patients but their patients are less confused, less ill and less demanding. If the surgical ward nurse with only 5 easy patients gets an admission of a demented elderly patient pulling out his lines and tubes and spreading shit everywhere she sends him to a medical ward where the Nurse already has 20 such patients.
    Medical ward nurses are NOT allowed to dump a patient somewhere else because they cannot handle him.

    If a patient becomes medically unwell on a surgical ward he immediately gets sent over to the overwhelmed already medical nurse who already has more patients and more difficult patients than the surgical nurse has.

    There is a lot that surgical nurses don't have to deal with.

    A drug round on a surg ward is simple since most of the patients are not as acute or chronically ill as medical patients. It took me 15 minutes to get through the 8AM drugs on my 6 patients in the surgical ward. It takes me over an hour to get through the 8AM meds for 6 patients on a medical ward. And I have about 16 of them.

    Surgical patients bring money into the hospital. Medical patients cause the hospital to lose money. It was explained to me that this is the reason for the discrepencies.

    Surgical ward nurses also think that they are superior to medical nurses since they get better patient feedback and make less mistakes.

    I thought this too when I was a surgical nurse. My eyes were really opened when I went to work on a medical ward.

    Once another surgical ward at my hospital was shut and their nurses were sent to my ward to work. They were making wisecracks about "now we are on a medical ward we will do nothing but babysit and hand out commodes" and "It will be like a nursing home".

    I came in for a night shift the next day and two surgical nurses had been on for the entire medical ward alone during the afternoon and evening. They were in tears. They couldn't manage the demented, the high patient load. One of the patients deteriorated with a severe medical condition and they didn't know what to do. They couldn't figure out a lot of what needed to be done and patients really suffered.

    The wisecracks soon stopped after they got a taste of general medicine.

    HCAs on a surgical ward have a smaller easier work load and get paid at band 3. HCAs on a medical ward break their backs and get paid at level 2.

    There are no geriatric wards anymore. Geriatric patients go to general medical where they are mixed up with critically ill patients, psych patients, hospice patients,surgical patients who had a medical emergency on the surgical ward and social admissions for acopia etc etc.

    In short there is less chaos in surgery and what chaos that exists is easy to control. The surgeons round twice a day on the surgical wards. The medical consultants twice a week.

    So you perceptions are very accurate.

  4. "There are no geriatric wards anymore. Geriatric patients go to general medical where they are mixed up with critically ill patients, psych patients, hospice patients,surgical patients who had a medical emergency on the surgical ward and social admissions for acopia etc etc."

    and I should add to this that surgical wards deal with the same thing and over again with little variation. They refuse to accept patients that dont fit into a criteria that they don't want or do not feel like they can handle. Medical nurses are unable to do this and have to take anything and everything no matter how overwhelmed they all ready are.

    Surgical nursing was fin but general medicine has made me burn out and lose my mind.

  5. Lovely to hear of a ward working so well! In general the surgical wards seem to do much better than the medical wards...possibly related to the targets/funding set up by New Labour I'd think? BG Xx

  6. Eoin - I don't know how you do that, lol, but I'm glad you do!! I can't believe I'm only 12 ranks behind Smithson. Are there any other juicy ones within vision?
    I wonder what it is I'm doing these Wikio folks like?

  7. Nurse Anne ... Your long post makes me want to 'weep and scream' ... It is just typical that the harder, less congenial, the more back-breaking a job, the less you are likely to be paid and the less control over what you are expected to do.

    I have a lot of contact with mental health nurses dealing with the gamut of disorders, delusions and unhappinesses. Their work is on the same level of difficulty and has a much in common with your description of the frustrations of the medical ward, but they will always say but we're not 'proper nurses'. Personally, I think that none of them should work more than a 3 dy week because it is so stressful that they are all burning out. The same clearly goes for medical ward staff too!

  8. Oh so true Anne. Medicine is the blackhole of well, medicine lol.
    On a more serious note- google "medical ward" and "foundation trust" and the number of closed wards seems to be growing. My own foundation trust lost an entire ward when the former hospitals merged. Last winter we had to open 2 entire wards to cope with the influx- pushed our agency budget through the roof. This year, had the powers that be learned anything? Of course not- yet again medical wards are full to bursting and the backlog is impacting on everything else. Our admissions units are warzones, quite literally. This is the same UK wide. If you really want to raise awareness Sue, you need to be pointing out that in general surgical patients are younger, fitter and spend on average a week or less in an NHS hospital bed. If you have a chronic condition, by and large you will be treated on a medical ward unless you need surgery. Our ICU emergency admissions are generally medical in origin- chest infections, GI bleeds, DKAs, epilepsy complications- the list is endless. Most surgical admissions are either elective ( because they have need for 24-48 hours ventilationn) or due to unpredicted bleeding (although obviously life threatening, fluid resus normally sorts this out quite quickly and they come to us for monitoring and inotropes.)Surgical wards do not do inotropes...however medical wards are expected to manage. Any surgical patient who develops a "medical problem" will be turfed to medicine...the chest infections, UTIs- generally elderly and mostly leading to confusion and agression... Generally speaking, medical patients take longer to recover and require more input from nurses, physios, social services etc...Surgery can make money for a trust and medicine cannot. Medical wards literally suck the life out of you ( staff and patients). What we need is guaranteed SAFE RN TO PATIENT RATIOS. I cannot stress this enough. 1 RN to 6 patients would be a step in the right direction. Ideally this should be reduced to 4 in an acute setting. A little story happening in an average trust every day- allegedly...28 bedded medical ward has 3 RNs on duty along with 2 HCAs. So each RN gets just over half an HCA and 9 and a bit patients. Ward has 6 bays of 4 beds and the rest are siderooms. So each RN has 2 bays and the siderooms are shared, so to speak. In one bay we have a confused old man who keeps climbing out of bed, the trust have helpfully provided a buzzing mat that goes off everytime he does this. There is also a very sick young diabetic in DKA in the next bed with multiple drips, sliding scale insulin and he should be on half hourly observations (minimum). Thats just one bay. The RN for this bay will should basically never have to leave the bay. In the other bay she is responsible for we have a GI bleed who is actively bleeding, having transfusions and has just been started on inotropes. He also needs a MINIMUM of half hourly observations. So the RN will bust her tail trying to keep up to date with the GI bleed and the DKA and hope that the old guy doesn't fall out of bed. As for the other 6 or so patients she is responsible for, well....need I go on? Oh, and halfway through the shift the ward will lose an RN and an HCA to "help out" on a medical ward with even worse ratios. In the bad old days we would have created an "obs" bay and put all the medically unstable patients here, next to the nurses station- and we would have had 6 RNs/ENs on duty. The DKA patient would most likely have been transferred to the ICU. This is the biggest problem today- patients are older, sicker and more complex. Many of those on medical wards would have been in the ICU 20 years ao. Unless we get safe ratios we are heading for the biggest fall imaginable. The NHS will dissolve into "social enterprises" that are still private in nature...and if you were the CEO would you want to waste all your resources on the medical blackhole? Didn't think so....

  9. Dino I could have written that same post.

    They have closed wards then are opening hallways during a red alert and pulling from already short staffed wards to staff it. My ward is having some offices and such converted to beds. We are going from 30 to 40 beds and thye have promised us agency staff to staff it.

    AAU is a warzone with no staff.