Not to leave out all the CCU,ITU, and A&E nurses but your units are a completely different structure.
I am hoping to hear from RGN's who work in (or recently worked in) general surgery, general medicine, geriatrics, --any large ward really.
I have learned a lot from my own blog via comments/emails etc. I have learned that things on my ward are much easier and better than some other wards. I have learned that we are a hell of a lot worse off than some others. In short there are wards functioning well in the NHS and others that are hell on earth. I am in the middle-purgatory perhaps.
I will start this. Please continue in the Comments Section on this Post. I hope I get some replies! This is totally anonymous, I have no idea how to find out where or who you are.
1.Qualification: RGN
2.Ward: Acute Medicine/general Medicine/Geriatrics/Surgery
3.Beds: 18-30 depending on if they open our second hallway in a bed emergency or if they give it to surgery.
4.Real Nurse staffing per shift: sometimes one RN, sometimes 4 Rn's. We might get lucky and have 4 nurses to 18 patients show up one day but one will usually get taken away to staff another unit. I have seen 1 RN to 30 in my time. 2 nurses to 18-30 patients is the most common number. Not good considering 1-6 is safe only for non confused non acute patients. My patients are acute and confused. Mostly confused.
5.How many HCA's do you have per shift including cadets? Is your ratio of untrained to trained staff increasing? We have either 1,2,3,or 4 HCA's per shift. One will get sent away if we have 3 or 4. And as with nurse staffing, these numbers have no bearing on patient acuity. We can have 30 beds,with really sick dependent patients with 2 nurses and 1 HCA or we can have 18 stable geriatric patients with 3 nurses and 3 HCA's.
6.Does your ward staff by acuity? Do you get another trained nurse to care for your other patients if one of your patients becomes critically ill and needs to be specialed? If you have sicker patients on the ward than usual do you get another RN? Or more HCA's? If you move from 2 patients who need to be fed to 18 patients that need to be fed does your staffing adjust for this?
Not on my ward. Not by a long shot.
7.Do you ever get sent to staff areas that you are completely unfamiliar with and get expected to take over as the primary nurse for a group of patients? Yes
8.Does your hospital have a good, solid plan to cover sickness ,staff absence, increased acuity or dependency without pulling from one ward to another or using agency? No. Mine only gives us untrained carers from agencies, not nurses. To cover RN sickness they pull staff and leave one ward short to cover another short ward.
9.Have you ever in your career worked an 8 to 12 hour shift without a break due to chaotic, unpredictable, dangerous ward conditions? Are your patients in danger in any way when you do take a meal break? Yes. I recently ditched 12 hour shifts because I am getting to old for this shit. When I do take a meal break it leaves like 2 or 3 staff on the wards, not all nurses.
10.Do you have a senior charge nurse (without her own patient assignment) on every shift to coordinate and back you up. No. But research shows that I should. I used to have a senior charge nurse without her own assignment coordinating and supporting the staff nurses about 5 years ago. Makes a huge difference.
11. Do you ever see your Matron or get guidance and support from him/her? No Mine does not approach the wards.
12. Are you pressured into leaving very ill patients to push multiple discharges or take admissions (which are time consuming and complicated). Does this happen during meal time? Drug rounds? Yes. Yes Yes.
13. Are you given any kind of block of uninterrupted time to see your patients and care plan for them? No. Not at any point in an 8 or 12 hour shift.
14. Have you ever seen a patient suffer a complication (dehydration,pressure sores) or failure to rescue because you or a colleague could not get to him fast enough? Yep.
15. When you fill in incident forms about short staffing is anything done? Not really. They might band aid for awhile or send a letter saying how they are hiring another 18 year old with no experience.
16. Are you able to mentor nursing students,new staff, untrained carers with no experience properly on your ward? No. Hell no. And I am very dedicated to doing just that.
17. Does the physical design of your ward work against you and cause inefficiency? Mine does, it is ancient. But other wards at my very hospital have a good design. It makes a huge difference.
If anyone can take the time to give me honest answers here I will really appreciate it. If your ward is great, let me know and if not let me know.
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