So I arrive onto the clusterfuck "surgery suite" at 0800. There was a list on a table of patients due to arrive. Two were already there pissed off that there was not a member of staff there to greet them. The list had 11 people's names on it along with the names of each of their consultants. Names I didn't recognize. What the list did tell me was the general order that they would be going to theatre in and what they were having done. There were 3 charts on the desk. That means 8 charts are missing. The charts provide me with names, dates of birth, hospital identity numbers, past medical history, whether they had pre op assessments etc etc. These are all things that I need to get pre op bloods and all the paperwork done etc. I was guessing about the pre-op bloods. The two patients now there did not know if they had any done. Great. Each patient all need 5 forms filling in for admissions, tpr forms, operation checklists, consent forms, care plans, make identity wrist bands out for each one etc etc. All patients were told to come in by 9 AM. The last person on the list was scheduled to go to theatre at 3 PM.
The list tells me that the first person on the list is the first person I need to get ready. But you have to move fast because theatres change the order on the list without communicating that to the ward staff. They might just show up at 9 AM to take the patient that is last on the list, and he better be ready. So it is a situation where you move as fast as you can to get everyone in gowns, the admission and pre op paperwork which must be sorted before they can go the theatre, bloods for group and save etc. Make sure that they are consented, venflon are in and any pre op medications are ordered and available to give. Once the doctor has prescribed them you have to harass and chase pharmacy for the drugs.
But without charts it was impossilble. The first thing I did was tell the patients to change into theatre gowns and sit down while I went to the phone and rang around to look for the notes. No one had a clue so I had to leave the surgical suite and hunt them down from the wards that they were supposed to go to. The "never worked in a hospital before" care assistant was useless. She was offering patients cups of tea!! They are all nil by mouth for their operations for christ sake!! She couldn't even do pre op blood pressures. The patients thought she was a "nurse" and of course laughed at a typically stupid nurse who didn't know that they weren't allowed to eat.
By 09:30 they were all there and I had all 11 notes. I was running my tits off trying to get everyone ready along with bloods paperwork and other problems that need sorting before theatre because any one of them could get called to go 1st thing. I started with the people who were scheduled to go first on the list and went from there. Many of them hadn't been to pre assessment and hadn't been consented which means I had to figure out which docs to page, what there page numbers were and tell them that patients were not consented. At our hospital they must be consented before theatre, and a senior doc has to do it.
By 10:00 I was getting there. I had established a good rapport with the patients and my 1st one had got to theatre, everything done for his operation. Yay me. I hadn't forgot as much as I thought about surgical. I was having to move quickly though.
At about 10:15 a timid looking young woman walked into the surgical suite. I asked her name. She told me it was Miss Doe. Her name was not on the list. She was just an extra 12th patient that they sent to me with no warning. She handed me a letter from the hospital that told her to arrive at 9 AM for her termination of pregnancy that was scheduled for today. She apologised for being over an hour late. Poor thing. No wonder she looked horrible. I felt so bad for her. I had no notes for her. And I had to spend 10 minutes finding them.
And as I explained in part one I have no idea at all about abortions or gynae...do they do it by giving them a pill to induce miscarriage? Do they operate? Do they do it by sticking a coat hanger up their vagina? Damned if I know. I have not a clue.
If I had some warning the night before that I was going to be looking after gynae patients I would have been on google looking stuff up until 2 AM. But there was no warning. At 10:15 Miss Doe showed up, she was an hour late, I had no notes or drug chart for her and I know nothing about gynae. Site manager confirmed that she was indeed going to be my patient and so were a few other gynae patients as the gynae ward was full.
Her notes had just arrived on the ward. No pre-assessment. No consent. No nothing and a blank drug chart to boot. Shit. I had just stepped over to the nurses station to ring the gynae ward and ask what I am supposed to do with this girl. First I was going to ring the gynae team and see if they had any orders. I got through to the gynae team secretary as the docs were not answering their bleeps. The only thing she could tell me was that the gynae consultant knew this girl was coming to the makeshift surgery suite and was on her way down.
No shit, I couldn't believe my luck. Having the gynae doc here so quick would give me the guidance I needed. At 10:25 the gynae consultant walked onto my surgical suite. The patient had been there 10 minutes. The consultant immediately picked up the patients notes, glanced at the drug chart and threw it into a wall. We had the following exchange in front of all the patients, including Miss Doe. Consultant gynaecologist is in caps. because she was screaming like a banshee.
"WHY HASN'T SHE HAD HER PRE- OP PESSARY"
"Um. Her what?" "She has only been here a few minutes and I don't have her...."
"STOP WITH THE EXCUSES. WHY HASN'T THIS WOMEN HAD HER PESSARY. YOU SHOULD HAVE CALLED US TO COME AND PRESCRIBE IT RIGHT AWAY.
NOW YOU WON'T GET THE PESSARY FROM PHARMACY AND THAWED OUT IN TIME FOR HER OPERATION. HOW DARE YOU. HOW DARE YOU NOT GET THIS SORTED WHEN YOU KNOW HOW PAINFUL HER T.O.P. WILL BE WITHOUT A PESSARY TO SOFTEN HER CERVIX. WHY WOULD YOU DO THIS TO A PATIENT.
"YOU NURSES DO NOT KNOW HOW TO PRIORITISE. YOU DON'T CARE IF PATIENTS ARE IN PAIN BECAUSE OF SOMETHING YOU DIDN'T DO.
I couldn't really get a word in edge wise. She went on and on with the above type of stuff for about 10 minutes. I honestly do not know where all of that poison directed at me came from.
But it did dawn on me that they must give termination of pregnancy patients some kind of vaginal pessary to make things easier. It sounded like the things come frozen and need to thaw first. It sounded like it needs to go in a few hours before the procedure to maximize the effect. Doctors don't always remember to prescribe thing (happens with a lot of things) and depend on experienced nurses to know it needs to be prescribed. They expect the nurse to know and call them and tell them that the patient is here and hasn't been ordered her whatsitcalled yet. And we cannot obtain anything important like that without a prescription from the doctor written on the drug chart.
Now I didn't know anything about a pessary until the gynae consultant from hell started shooting her mouth off. But had I had just a few more minutes with the patient I would have been able to get one prescribed by a doc and obtained from pharmacy. The gynae ward nurses would have given me a heads up. If only I had ever got a chance to phone them in the 10 minutes I was aware of Miss Doe's existance....well the 3 minutes out of 10 where I wasn't chasing after her notes as well as sorting my 11 other patients out. We nurses help eachother out a lot via phone when one is floated to an unfamiliar area. I had a gynae nurse on the phone to me once as her ward was taking medical patients and she didn't have a clue. I clued her into many things that the doctors will not write or communicate with you but expect you to do.
The gynae consultant from hell had her gynae junior doctor with her. Throughout the consultants tirade the junior doctor folded her arms across her chest and glared down at me, and every few seconds she added her two pence worth whilst nodding her head. "yes what you have done is very bad, very bad indeed, very cruel towards the patient, very cruel indeed". All within earshot of the patients of course.
Now I am perfectly capable of standing up for myself but really I couldn't get a word in edgewise AT ALL and I was not going to stoop to her level. I had never seen, heard of, or worked with this doctor before.
We had 12 pairs of eyes, merely a few feet away focused on us. Those eyes belonged to my 11 patients and the 12th patient, Miss Doe who was listening intently. Had they not been there I would have called that consultant a stupid bitch to her face, kicked her in the cunt and walked away. But they were there. I got the prescription, I got the pessary, I thawed it out and it was in the patient plenty of time before she went to theatre. She was fine. I managed to pull everyting together for everyone else as well.
But the rapport I had worked hard to establish with those patients that morning was ruined. For the rest of the day they looked at me as if I was some incompetent bitch who wouldn't get them what they needed.
Wow gynae doc, what a way to make sure that the blame for any fuck ups caused by the unorganised chaos in this hospital will not be attributed to you. Kudos and applause, even if you are a total bitch.
When I blog on here I often changed details. No details were changed here . This happened just as I wrote it, it happened to me, it happens a lot to registered nurses and it is definitely militant medical nurse raw.
But at least it wasn't a fuck up in some area that was really critical and acute, as happens to many floating nurses when doctors don't bother to write out orders or strike out prescribed drugs that shouldn't be given .............drugs that are still prescribed on the drug chart to be given. The nurses actually do get the heat for that you know.
This stuff happens all the time, and it is the reason registered nurses throw such temper tantrums when they are asked to float.
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