Productive ward: releasing time to care is back in full swing on my unit.
Apparently the ward would run as smooth as silk if only nurses understood how to tidy cupboards and work more efficiently.
The physical ward layout (appalling), the chaos, the constant interruptions and the massive lack of qualified staff make the idea of working efficiently a joke. The closest we can come to being efficient is taking dangerous short cuts just to ensure that we can actually assess everyone and get all the drugs out and administered without a fatality. All registered nurses are forced to do this on a daily basis because of the working conditions that they cannot control. Anyone who says that this isn't true is a liar.
Even if we could tidy and reorganise the cupboards we would still be up and down that ward constantly, wasting precious minutes. The thing needs to be redesigned and rebuilt to be truly workable. Half our supplies are always missing and require the ward staff to abandon patient care to obtain things constantly throughout the shift. Productive ward isn't going to fix this mess, it just puts more culpability onto the nurses. Pharmacy, and equipment /central supply are 9-5 Monday to Friday. And even during 9-5 they are fucking useless. They cause is more work than any patient ever did. Their worldview is that the lone RN on a ward with 20 something patients is there to make their job easier. God how I hate them.
Let me give you an example of something that happens about 100 times during an 8 hour shift. The lab calls me at 4PM and tells me that my patient's most recent blood results are barely compatible with life. My job is to inform the doctor who is covering. He orders a medicine. Of course pharmacy won't allow us to keep it in stock. To get the medicine I have to ring pharmacy, leave a message, wait for them to call back and then argue with them for about 15 minutes. They are pissy because they are supposed to finish work for the day at 5PM. They stomp their feet and say that they will not bring said drug to the ward. I have to walk the written doctor's order for the drug to pharmacy.
I get there and they ignore me for another 15 minutes while I bang on the glass. I. am. Serious.
They say that they will ring me as soon as the drug is ready. I reiterate the fact that I need this drug NOW. I cannot sit there however. I have many other things going on with my other patients that are almost as high a priority.. 30 minutes sat in pharmacy could seriously harm my patients who are now nurseless. Pharmacy promises me that they will bring the drug to me asap. If I send a care assistant rather than go down there myself it is bound to get all fucked up. 99% of the time we cannot get through to them via phone as they have it permanently on voicemail.
Back to the ward now. I need a special pump to deliver this med that we also are not allowed to keep on the ward as per central supply's dumbassness. I call central supply. A grumpy man who is obviously eating something chewy answers the phone. I tell him what I need. Very slowly he responds with "Well you will just have to come down here and get it".
But I cannot. I am hoping to get this drug administered ASAP as soon as that slut from pharmacy gets her ass here (and she had better hurry I swear to god).
I tell Dick from Central Supply that I am in no position to leave the ward (yet again) and my care assistant is trying to stop my alcohol detoxer from attacking the other patients (so am I while I am on the phone).
He chews whatever the fuck he is eating and slowly responds with "sigh sigh siiiigghhh. I will bring it up if I must. You had better go around your ward and find every piece of equipment that belongs to central supply. Clean it and label it before I get there and put it on a trolley so I can bring it back with me. I don't wanna make two trips. I'll be there in 15 minutes so have it ready for then."
Yeah right Dick. I am chasing pharmacy right now. There is now only myself and a care assistant on the ward. The other RN is now in recovery picking up her post op patient and the other care assistant had to escort a dementia patient to the CT scanner because the staff down there don't want to deal with it. I have a patient who has blood results that show that she needs this drug infusing via this particular pump NOW. I have an alcohol detoxer who is beating the care assistant, trying to beat other patients and myself and we cannot get her doctor to come up here and prescribe sedation. I have 20 other patients as well. I had over 15 IV antibiotics due in the last hour that I haven't even begun to mix. I have a que of angry relatives that want to know exactly what it is we are doing for their loved one. I will certainly be ignoring Dick from Central Supply's request.
And pharmacy still is not here. I ring them. I get voicemail. I can't go down there and neither can my care assistant.
You leave one person on the ward and a crash occurs you are fired.
Now the doctor who prescribed the drug for the patient with scary blood results is on the ward. He looks at his patient. His face turns the colour of a tomato. He glares at me. "Why the hell hasn't the drug I ordered been started yet? What the hell are you doing? Do you not understand that it is priority?" he screams.
Yes I do doc. But I cannot give what I don't have or pull syringe pumps out of my ass. I have already been ignoring many sick people over the last hour trying to pull this together. By the way...do you see that patient over there beating the healthcare assistant? See the scratches on my arm? Her doctor is tied up somewhere...will you prescribe her some sedation? Benzos not appropriate I know...how about haldol...anything?
"No. Not my patient. Get the anti -scary- blood- results- drug up now and call security for your combative patient."
The he left. We did call security actually. Those are the porters. They informed us that they are too busy.
OMG where the fuck is that slut from pharmacy. Their phone is still engaged. I cannot leave the ward. Dick from central supply showed up with the pump, took one look at the alcohol detoxer who was licking the floor and trying to hit anyone who came near and left quickly.
Now I have my pump. But where oh were is that slut from pharmacy.
I run to the end of the ward and peer down the hallway. There is the slut from pharmacy. She is holding what looks like the box containing the drug I need. She is stood talking with her friend from medical records that she has obviously run into on her way here. I walk over to her. I grab the box out of her hands. "Is this for ward R" I say. "Yes" she says whilst looking shocked that I just grabbed something out of her hands roughly. And off I go back to my ward whilst shouting "I needed this an hour ago".
"Those nurses really have an attitude don't they" she says to her friend.
Now I move at the speed o0f light getting the drug out mixed, ,measured, drawn up and doing my maths calculations. My other RN is back from theatre and quickly she checks my arithmetic. I get the drug up and grab a set of obs on my patient. Finally after over an hour of bullshit she is getting the treatment that the doctor ordered. What if I had dropped the ball on this an hour ago? What if I hadn't notified her doctor of her blood results or stayed on pharmacy's ass, multitasked, moved quickly and ignored my other patients calls for help to get this patient her treatment? The brilliant doctor and his brilliant treatment orders go nowhere if they are not implemented. And implementation of treatments is totally the domain of the registered nurses. It takes knowledge and you have to fight! Diagnosing and prescribing (the doctors domain) is only the first step of a very complex process of caring for hospital patients.
Now I brace myself to settle down this detoxer (she has already taken a chunk out of my upper arm) so we can get back to caring for all the patients...but in 10 minutes it will all start again and we will be looking for things.
This is how bad things are during 9-5 hours. You should see what it is like trying to get what you need out of hours.
But they want us to understand that if we tidy cupboards on the ward all will be well. Productive ward will not in any way shape or form deal with the bullshit from central supply and pharmacy. It will not address the fact that we are running these wards with so little staff that we can barely address 1% of what we should be doing. But this is their "solution" to problems that they do not understand.
Now that productive ward is back in full swing our ward sister has been forced to put a cork board up at the nurse's station. On it she has been forced to put little motivational messages. We are supposed to add to these messages by writing our feelings onto the board. The messages say things like:
Releasing time to care: I will understand that I am here for the patients
Working more efficiently so every shift will be a joy!.
Helping the ward to be more organised so that we can spend time with the patients.
Every single member of ward staff is supposed to grab a colourful marker, some nice paper and add their happy visions about the productive ward to this board. I haven't added mine yet. Do you guys have any suggestions for me?
I was thinking about stealing this from mental nurse and posting it on the happy happy joy joy board.
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