Sunday, 2 September 2007

Staffing Levels

It seems to me that the number of patients is increasing, but the numbers of staff on the floor is the same. Coupled with sickness, annual leave and maternity leave it seems that the care is being put at potential compromise by this unbalanced position.

A&E's tend to have 3 areas, majors, minors and resus. They all need adequate nursing levels. It seems that time and time again that we are short. This means working harder than ever to provide the basics, not having breaks to their entirety (AND UNINTERUPTED) and morale and staff health plummeting. We are told we are over staffed, and the answer is long days. Hmmmm in the current environment E does not equal MC2. Staff will become more tired, stressed and mistakes will naturally occur. Check out the Dr's websites and DofH guidelines for proof.

But hey, I love the job. I thrive on the pressure, but I care about my patients and equally if not more about my friends and colleagues, and their well being.

However shit the department is, as labelled above, as long as there are limited breaches then the problem is not highlighted. Targets are good, but it needs to be taken in context of the whole health provision.

Wednesday, 13 June 2007

Feeding our patients

The provision of nutrition to patients is an important part of nursing care. The provision of many aspects of services has been taken over by Carillion, a private company. As such there is difficulty in providing food to ED patients as it costs money. Wrong isnt it.

Saturday, 5 May 2007

Dead dead dead

Patient from yesterday; died.

Ambulance service brought in a poorly patient. Refused conveyance from the first crew but later called them back. Brought in. Died. I saw the paramedic who went to him initially. I like this guy, he is compassionate, caring, intelligent and gives a shit. He is so cut up about this man who died, but he DECLINED to go to hospital. I tried to console this paramedic but he thinks he did wrong. He did NOTHING wrong.

Patients. The ones who are not sick want to go to hospital, the ones who are sick want to stay at home. Only God knows the time for our exit from this passage we call life.

Friday, 4 May 2007

Goal Directed Therapy: An Urban Myth?

Goal directed therapy for sepsis. An ideal or an unachievable.

Middle aged man, recent urological surgery came to ED with confusion, hypotension and tachycardia. ABG showed a profound metabolic acidosis and WCC of 30. CRP also rather high at 340. Suggested aggressive intervention ie fluids, inotropes +/- vasopressors, central line and other intensive monitoring, such as a PA line. These were not carried out. A newly qualified, but savvy and competent staff nurse was the nurse dealing and was pushing tis but the drs were not going down this route.

The patiet was transferred down to CT. Next thing is the crash bleep announcing an arrest in the donut of death commonly known as CT. The man had crashed, purple plus major style. EMD arrest; chaos et al (except from my newly qualified colleague who was ace), widespread fluid from the man's stomach exacerbated the intubation, but control was achieved. EMD went to aystole and back to EMD. CPR continued and somewhat later an output was gained. Patient CT'd and then the drs argue about the deposition of the patient. For fucks sake, this is a 56 year old, this man needs ITU. he will probably die but he needs the oppotunity to attempt to live. ITU were not convinced, but common sense prevailed and we transferred the man to ITU. I don't hold out too much hope.

My main issue is that as a nurse who is relatively senior and experienced in emergency and critical care I feel so frustrated by the shackles that nursing entails when we have junior drs who have little experience of dealing with such ill patients. They don't take advice fom nurses and this grates me because I see patient care suffering. Goal directed therapy for whatever presentation sepsis, shock et al should be ALL our goals, but I fear that its not going to happen.

Friday, 27 April 2007

Getting Home

Why is it that patients become unable to get home once discharged. They automatically assume the God-given right to free transport home; either a paid taxi, or worse a frontline 999 ambulance. I can have a certain understanding of the little old chap or lady being taken back to their residential home, but grown adults of 18 plus.

Oh but I pay taxes they sqwark, well no shit, so do I. Find your own way home, you should'nt have been here in the first place.

The drunks are the best; what would you have done if you hadn't fallen over and twatted yourself on the head? you ask. Oh, I would have had a taxi or pulled. Right then dickhead, go and find one now.


Monday, 19 March 2007

Take Away?!?

Had a 86 year old post arrest. Flat and not particularly healthy. Shocked a couple of times by the paramedics and once by myself. A rather pro-active medical registrar suggested thrombylisis which was duly given, however the proglonged event lead to a termination of actively treating her.

Then the problems arose. The first two members of the family refused to believe she was going to die, and would not allow extubation til their sister arrived. Fine we said expecting them to be local. But hey no, they were coming from Wales. Didn't they know about breaches. Needless to say I had to try and keep this lady alive til these family members arrived. Cue ventilator and a bit of luck.

The family eventually arrived, and were with Mum. I extubated and 5 minutes later she died, with her family present. It gave the family some comfort.

As I was leaving one of the daughters came up to me and said that they wanted to take mum 'home with them'. Small problem she was dead.

Unfortunately not I said, as she was now the property of the coroner and it would be theft, also unethical and unhygenic. The transportation issue would have been fun too. A longboard and roof rack were mentioned.

Relatives are bizarre.