Location: South Wales
It’s one of the post-war reconstructions, this hospital of ‘mine’ for the night. So that means, despite its new (cough cough – 60’s) buildings, the site itself is more suited to 1901 – the year of its initial construction – and not 2019 – the year I and a dozen other staff walk towards it now. Essentially, the city has grown around it, terraced housing up to its perimeter, traffic jammed along its entrance routes, and why’s this a problem for me?
Parking. The first challenge of the night. You see, it’s 18:45. The middle of visiting hours, which means the hospital car park, and surrounding streets, are fully packed – parked bumper to dinted bumper, wing-mirror to scratched wing-mirror. Luckily, I’ve worked here before, I have a secret spot. I plod up the road towards
the hospital. Looking around it’s easy to spot the other staff walking from their own secret parking spots, the tell tale sign of black trousers and black trainers, faces set hard, still waking from a groggy day-sleep, mostly women, mostly 30+, occasionally a uniform poking out beneath the bottom fringe of a coat, dark green for nursing assistants, sky blue for nurses.
Dread builds inside as my feet carry me closer, only the fag I drag on abating the anxiety a little, one puff at a time… and now its finished, the fag and the walk, the hospital is before me. So, we’ve a 60’s build that over the last 50 years has grown a few architectural tumours, some neoliberal 80’s concrete offices there, that A&E wing has had a noughties facelift of blue fascia panels there, it’s an ad-hoc jumbled labyrinth is this place. I cast my fag to the ground outside the entrance, I know, I really shouldn’t, but it’s hard to bother wandering over to the bin when there’s already another 200 butts littering the floor, what difference will the addition of my extra-slim filter tip make?
A sloped walkway of scuffed and polished linoleum, down into the bowels of the concrete. A neon lit underbelly, lifts either side of me – their steel doors clenched shut, a few green and blue clad staff waiting patiently or, happily delaying the inevitable. I slip through a door onto the staircase and take the steps two at a time. Up, up, up, fourth floor… and onto the ward, ahh, no. The door is locked. There must be a wanderer. Buzz buzz and a little waiting waiting. The familiar zzzz ing sound of the door unlocking, a push and a shove, and I’m in.
I’ve worked on this ward once before. So I recognise a few of the day staff hurrying about their last tasks of the shift. I pass them as I stroll down the corridor towards the end of the building and the staff room there where my fellow night shifters will be waiting for handover. As I stroll I cast my eyes into each bay, trying to gauge the general condition of the ward, if it’ll be a busy night, who the troublesome patients will be. ‘A’ Bay is first on my left as I walk in, six beds, elderly women, most lounge in the straight backed chairs by their beds, some with two or three relatives sat around. A TV plays The Chase at the end of the bay. I stroll on. B Bay, six elderly men, most of them lounge on their beds which are inclined to sitting position. Bradley Walshes voice echoes disturbingly out of sync between the two rooms and then C bay – four women, and D bay – another male bay of four, another echoing Bradley Walsh. A man in a smart red dressing gown hovers about here. He’s well groomed, Mediterranean-looking, casting his eyes up and down the corridor, confused and looking for something? A young, exhausted looking, nursing assistant hovers by him, I grin a knowing smirk at her in sympathy, she grins back tired, so here’s our wanderer.
‘Hello mate’ I say with a polite nod of deference as I pass him – always best to get on good terms with the confused patients early on. ‘Hello young man’ he replies, and I carry on, around the corner, and into the staff room.
Handover: One shift relaying to the next the condition of each patient and the most important notes from the day. Different wards have their own style. This ward uses the traditional – each nurse takes it in turns to handover ‘their’ patients to all the night staff. A typed up A4 printout, double-sided, sometimes 2 or 3 pages, lists each patient + condition + discharge details + nursing plan + etc + etc.
As the door swings open I get a glimpse into the future – two young women in green, no blue. $#!%. Cant get much shorter staffed than that. Hopefully the others are just late, but I’m cutting it fine myself, it’s already one minute to seven. Oh well – at least my hope’s in the right place – the mortuary is just a few floors below.
‘Ahhh thank god!’ one of the women shouts out as I walk in. ‘He’s worked here before haven’t you?!’ she asks while looking between me and the woman sat beside her. It makes a big difference – if the agency staff know the ward a little already – I’d just earned myself a little immediate respect.
‘Yeah’ I reply grinning, and then ‘it’s not just me is it?!’ meaning – where the hell are the other nurses?
The one who’d spoken first, a bit of a bigger woman shall we say, hmm she’ll need a name – lets call her Michelle, she’d been on last time I was here. She was good, brilliant even, the kind of nursing assistant who really should be a nurse, the kind that made the distinction between blue and green seem so ridiculous, the kind I could rely on. If it was really going to be just me nursing tonight, and so by default – in charge of the ward, then she’d be in charge behind the scenes.
I was taking my seat as she answered ‘Well there’s supposed to be another agency nurse but she isn’t here yet’ her tone suggesting she didn’t think she ever would be ‘here’.
But the door opened behind me, and turning my body to look, a little relief, as in walked a nurse and another HCA (health care assistant), and then behind them one of the day staff and we all sat round the table and handover began. When it begins with ‘Sorry but…’ you know it’s going to be a long night. It often goes ‘Sorry but it’s been chaos today, so if things aren’t done, well, we only did what we could…’ or something like that.
The day nurse sat down and began ‘Sorry but…’
32 patients. 30 minutes to discuss each of their complex cases to a point of understanding. Impossible of course, but we do the best we can, for me that means not letting my mind wander onto doodling all over the handover sheet.
32 patients divided between 2 nurses = 16 each. A few months ago I would have gaped in shock as we split the responsibility between us – well I had gaped – but I was used to this by now. South Wales. No funding. No staff.
The three health care assistants are divided as so – one takes half the ward, another takes the other half and the third ‘specials’ our wandering gentlemen. ‘Specialling’ being the colloquial term for one-to-one monitoring.
The other agency nurse isn’t happy. She’s scowling as I walk away, but what can I do? I think it’s ridiculous too, but I just want to get on with it, start getting on top of my medications and what not. I walk away, straight over to the trolleys of medical notes. In handover it’d been mentioned that one of my patients was quite unwell, the family were there and wanted to know what the progress was, but the day nurse hadn’t had time to check. I’d said I’d do it first thing, appease the family. That’d save me some time in the long run, the less relative-nagging the better. Before I could even get to the trolley a woman in her 60’s, short grey hair, blue anorak, stopped me and asked if she could have some information about her mothers condition, no one had given them an update for days she said. I doubted that, and surely there were better times to ask for one than 19:35 after all the medical team had gone home, but, you keep those thoughts to yourself and say only ‘ahhh yes, is Doreen you mum yes? I’m just going to have a look now for you, I’ll see what the last thing the Dr’s said was and come and let you know’
5 minutes flicking through the patient notes until I was comfortably aware of the history and the most recent entries from the medical team and then brisk strides over to the patient and their family. ‘Hi, so I’ve had a look through the notes and..’ and I give them everything I can, everything everybody else hasn’t had time to tell them and after more than ten minutes talking with them they let me go nodding sincere ‘thank you very much’s’ and I turn away and then…
‘excuse me!’ By the next patient bed a very large man sat beside, presumably, his mother is leaning out of his chair towards me and continues, as I turn to him with a smile and a friendly ‘are you alright mate?’, ‘Yeah, could you tell me how my mums doing? doctors haven’t told us anything!’
‘Yes, I’ll have a quick look and let you know mate’. I hurry back over to the notes trolley, starting to get a little anxious already. It’s almost 8 o’ clock and I haven’t even started any of my jobs yet. I find the notes and I’m flicking through but… really I’m listening to the sounds of an argument from down the corridor… the shrill voice of indignant staff members? I look out to see the other agency nurse walking towards me, past me, towards the staff room… and out of the staff room, her bag and coat draped over her arm. She hurries past, down the corridor and… gone.
Michelle comes down the corridor towards me, ‘did you hear that?’ she asks, and then before I can answer ‘all I said was “we work together to do the turns” but she said she didn’t have time because she had too many patients to give medications to and then said “16 patients is too many” and left’.
Well she was right about that, our evaporated nurse. 16 patients was far too many. 32 though, was absurd.
‘Im gonna ring the nurse in charge’ said Michelle (thats the nurse in charge of the hospital) and I was about to thank her for sorting it out but then from behind… ‘excuse me’, I turned and, leaning out of the side room by the medical-note trolleys, a woman, clearly a relative, asked again ‘excuse me do you know who’s looking after my mum? she’s struggling to get her breath’
“Ahh thats me’ I said, with a reassuring smile and, stepping over to the doorway, ‘I’ll come and have a look’ and walking into the room, while dragging the handover sheet out of my pocket and quickly glancing for the patients name… cubicle 3, cubicle 3, where was cubic 3?! flapping the paper over, ahh yess, Annete. ‘Hello Annete, how are you?’
She was, struggling to get her breath. ‘One second’ I muttered with a smile, ‘just checking your history’ my eyes scanning along the handover.. hmm.. this was my lady who was dying, the one they’d said looked like she was about to pass days ago, then bounced back, then been about to pass, then bounced back, and glancing up at her I could see, yes… she’d bounced back again… her eyes were wide and she gasped as she talked with her daughter repeating in a panicked wheeze ‘I’m struggling Barbara, I’m struggling Barabara’ and her daughter placed a hand on her arm and said ‘calm dowwwwn mum, the nurse is here now’.
I spent 20 minutes in there, taking her observations – blood pressure, heart rate, breathing rate, oxygen levels, temperature – writing all this down – setting her up with oxygen and then a nebuliser – thats medicine given through the oxygen mask, anything I could think of to help her breathing and all the while chatting with Annette and her daughter, keeping my voice level, jovial and friendly, inside worrying about what to do next, until I’d done all I could do and, while the face mask pumped a little oxygen and medicine through, I left the room saying ‘I’ll be back in 10 minutes to see if that mask has helped’.
Walking out of the room I noticed the other patients medical notes lying open on the trolley. I’d forgotten I was halfway through that. I scanned the last thing a Dr had written and looked into the bay where her son had been, but he’d left, so had most of the other relatives.
Michelle came over to me. ‘I’ve spoken to the nurse in charge, they’re trying to find another nurse to come up’. Another relative came over to us. ‘Excuse me, could you help my mum onto a commode? I think she’s dirty’.
How could you say no to these things? How could you even be annoyed with the family for asking that? It was a bare minimum to be able to expect to be cleaned when needed, helped to the toilet when needed, told how an ill relative was doing when asked. They just didn’t understand that for us, it was constant. I went with Michelle to help this lady who half an hour ago had not been one of ‘my’ patients but now, now I was responsible for every patient on the ward.
Fifteen minutes later – we need not go into the details as to what took so long behind those curtains – I came back to my lady in the cubicle. The mask had pumped in all the medicine, had probably finished five minutes ago actually, and so I took it gently away from her face and began taking her observations again. We score each result and add them up. 0 = all good and no intervention. 1 or 2 or maybe even a 3 can be scored without any need for concern. The score was a 5 which wasn’t good. The lady was dying, there is no way to put it other than bluntly, but as long as I was expected to carry on taking these observations, these ‘vital signs’, I had to act on the result. I told the daughter I’d call the nurse practitioner and left to sit at the nurses station. I dialled in the number through the bleep system and sat waiting for the call back. I couldn’t leave the phone now, if they called back and I wasn’t there to answer it would have been a waste of all our time and so I sat and flicked through my handover, mentally writing a list of things I needed to do. It was 20:30, and I still hadn’t started anything yet, and it looked as if I might have 32 sets of medications to give.
Two minutes later and a call back. I explained the situation. ‘Okay I’ll come and review her’. That, had been easier than I had expected, a good nurse, that was lucky, I hadn’t had to plead for Annette to be seen.
‘Nurse’ I turned around ‘sorry I don’t know your name’ she said. It was the HCA specialling Robert, our wanderer for the evening. We swapped names while both casting glances over at Rob who was clearly agitated, moving from door to door, opening them and shouting into stacked cupboard and empty bathroom alike ‘hello… helloooo…’
‘Is there anything you can give him?’ she asked. Sandra, her name I knew now. I fetched his medicine chart and scanned through it. ‘Yeah I can actually, but I remember him from last time, he wont take his meds so we put it in his tea, (I believe that’s illegal but what was the best thing to do? not do it and have him wander his way through the night, knackered enough to eventually fall and break his hip, or slip him a little sedative and hope he got a good nights sleep?) but I can’t do it yet, I can’t leave the ward until another nurse comes’
to be continued…