Thanks to Glamorganist for drawing my attention to this article
http://www.dailymail.co.uk/news/article-1250502/Now-MORE-female-patients-kept-hospital-store-cupboard-surrounded-blood-stained-bins.html
This isn't scare mongering. It is true. I have seen this very kind of thing with my own eyes. Female medical patients always get the least in the way of resources, staff and facilities. It is TRUE TRUE TRUE. Any stable patient, including surgical patients waiting for an operation can end up in a cupboard of course. But mostly it is female medical patients who are actually medically stable that get the honour.
You know I hate the Mail. But credit where credit is due and all that.
They force us to wake them up at 3AM because they want to transfer these patients to a holding area that may or may not be staffed with real nurses and get the acutes from a&e onto our ward. The holding areas are staffed with people who can handle a medically stable little old lady who is waiting for a bed. But they cannot handle the acutes from a&e and mau who are breaching the targets because we have no beds.
"Nurse Anne, just refuse to wake patients up for transfer to a cupboard" you say? I did that once because I knew that the little old ladies' families would have me for breakfast when they found out that gran was moved to a day surgery suite not equipped to handle medical patients at 3AM. The site manager did it herself (moved Granny) behind my back while I was with another patient. I was wrong to refuse however. The acute patient needed the bed more. The acute patient could have died without the bed. Gran would not have. I just didn't want to get bitch slapped by Granny's daughter. Of course I was the one left to tell the daughter that she was moved at 3AM.
Do we really have to put people in supply cupboards or hallways?
At my hospital they go to a storage hallway that is used as a day surgery suite 9-5 monday to friday. There are no commodes or bedpans. No linen. The drugs that medical patients are usually on are not there. I would find it extremely uncomfortable to sit in there all day and all night and I am a fit and healthy middle aged woman.
This is how it usually goes:
The hospital has been on alert all week because of a lack of beds. This kicks into high gear overnight when a&e clogs up with drunks. At 1 AM the bed managers realise that there are now more sick patients in a&e who need to be admitted than there are free beds in the hospital.
75% of the ward patients are medically stable and do not need to be in hospital. But they cannot be discharged.
The manager opens up a cupboard or a hallway to take these A&E patients. But she doesn't have any RN's to staff it because there isn't even enough of them on the wards to even cover ward patients. There is only one RN on each ward and those wards are full of people who need an RN. She only has untrained carers to pull off the wards and use. The sick A&E patients cannot go to the cupboard staffed by the carer. The stable ward patients waiting for discharge who aren't on any IV's or anything can go to the cupboard, staffed by the carer and the really sick patient in A&E can go to the ward with the RN. The stable patients are okay for awhile with a babysitter rather than a nurse. Of course they think that the babysitter is a nurse anyway so they are none the wiser.
The stable ward patients may have dementia, they may not be able to walk or feed themselves. It isn't due to sickness, just old age. They are waiting weeks for the social workers to see them as required before they can be discharged. They have to be declared medically stable and ready for discharge for the social worker to even think about finding time to show up onto the ward and assess. Then they have to wait weeks for a nursing home to be identified. Once that happens we wait weeks for the nursing home to come and assess the patient. In the meantime a stack of paperwork has to be filled in by the staff nurse and sent to social workers.
One nurse to 15 patients does not have time to dick around and only will attempt to do that paperwork if she gets all of her patients nursed properly. If the paperwork gets done it is because we stay over after the end of our shift to do it after a new staff nurse takes over from us. The delays in filing the necessary paperwork delays everything else. I know people think that staff nurses are sitting around doing paperwork all of the time. But in reality we blow 95% of it off and only do the crucial forms....like the ones you need to get life saving drugs that you require immediately. And that 5% is very time consuming.
Once the nursing home asseses the patient they let us know whether or not they will accept her into their facility. After that happens more forms have to be organised and completed by the RN-who has 150 meds to give and patients screaming for help. I once a saw a community social worker phone the ward and order the RN to have a long and complicated care profile form filled on for a patient he was trying to place. The RN did not have time to do it because of patient needs. An hour later, the social worker arrived at the hospital and was on the ward. He backed the RN into the corner and told her that if she didn't make these forms a priority than she wasn't a "real nurse". She was the only RN for 14 patients that day. 10 of them were acutely ill. The patient in question was stable and fit. She just needed placement in a care home because she was forgetful.
The social worker sat with a cuppa and stared the RN down until she did it. Well, actually I did it for him because my patients were okay and I felt like I could leave them long enough to fill in the profile and get the social worker off of our backs. Once upon a time we had hospital social workers who did this stuff. Now we have community social workers and hospital discharge nurses who just order the sole staff nurse for 15 needy patients to do it. Whether a patient is going home with carers 4 times a day organised by the SW, or to a care home, or to a nursing home the staff nurse has to complete a whole lot of paperwork to set any of it in motion.
That brings me to the next problem
No only is the discharge process for medical patients a mess but the fact that there are no stepdown, rehab, or nursing home beds available EVER also slows things down. Even if the nurse blows off her patients to do the social workers job for her, the fact that there is not enough community care /carers and beds really slows things down as well.
The community carers will go in 4 times a day but not at night and that is when Gladys really needs someone. The residential home has no beds but won't take Gladys because she needs two staff to walk rather than one some of the time. The nursing home won't accept her because they think she is to fit to be there. The rehab facility won't take her because she is incontinant. And there are no beds at any of these places anyway. Oh and even if there was, I don't don't have the time to sit on my ass and fill in forms for social workers to set the process in motion. It is going to take me 8 hours just focusing on the drugs to get my really sick patients treated.
In addition to all these stable patients being babysat on acute medical wards we have another problem. They have reduced the number of hospital beds (PFI anyone?), they have NOT increased any care beds, nursing home beds, rehab beds, or community carers that see to people at home. The number of elderly people out there is dramatically increasing. And we have targets that mean that 98% of patients who come through the door must be treated in an artificially compressed time window. If they are not, the hospital is punished by losing even more funding, which stops them from having any hope of actually adding more beds. They only get funding and money if they can meet these targets. No one thought to give them the beds and the staff and the support so that they could actually meet the targets. The targets have to be met before they can get any funding or have any chance of being able to build beds. Fail at the targets and your hospital actually gets fined rather than funding. So if you fail at the targets you have no chance of getting money to build the beds that you need.
Therein lies the problem.
When everything finally goes through 6 weeks after granny was declared medically stable and fit for discharge and she gets that care home bed there is another form we have to send off to the SW. Then we can arrange transport. Two days later granny will be back in a&e because of a "funny turn" i.e. a mechanical fall described by nursing home staff as a collapse and increasing confusion. She will get bloods, ecg's, a ct scan etc so that the medics can cover their asses. Maybe it looks like she brewed a nice hospital acquired chest infection while she was here two days ago. IV Tazocin is ordered.
And another little old lady who is on the ward awaiting a care package on discharge will be shoved into a cupboard to get granny number 1 out of A&E before she breaches the targets. It is decided that granny can't go back to the care home now, she actually needs a nursing home. So the whole entire process has to start again with the hospital RN working for the community social workers and filling in forms for social services.
The hospital chiefs CANNOT admit this stuff to the surrounding community because if they do, their heads will role. So they come out with garbage like "uncaring nurses" "Incompetent doctors" "too many staff off sick" and they tell the members of the public who complain that "The ward sister will call a ward staff meeting about your grandma being put in a cupboard so that they understand that this should not happen. We strive to provide the best service and are sorry about your disappointment". What a joke. Half the wards don't even have ward sisters because they retired/ran away screaming and the managers will not promote or hire anyone to "save" on labour costs.
If you have read all that well done. Can I just say something to any consultants who may be reading this? It really doesn't help matters AT ALL when you walk onto a ward and say in a loud booming voice for everyone to hear "I discharged Mrs. Smith two days ago. Why is she still here? Why haven't the nurses bothered to organise a nursing home for her yet?" Seriously man, Fuck you.
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