"Why the nurse might not be able to respond right away"

About: Norfolk & Norwich University Hospital

(as a staff member),

I am a nurse on a very busy medical ward in the east of England. I have been looking at the comments about patient care from the Patient Association. On the one side, there is spin and sound-bites about the NHS from the government, and complaints about hospital care on the other. I want to give my story.

I have been nursing for several years now and qualified from university with a Diploma in Nursing Studies. I have worked on several different wards in several different hospitals and can honestly tell you that the majority of nurses are extremely hard working, decent, caring people who want to do the best job they can.

Whilst there may be a few bad apples, the main factor in not being able to provide the care that I would like is the sheer workload I and all my colleagues have to contend with.

An average shift might involve the following:

- Administer approx 300 tablets over 3 drug rounds to 9 patients (on a day shift)

- Set up 6 IV infusions

- Administer IV antibiotics to 3 or 4 of my patients, 3 times a day, each on at least 2 types of antibiotic, which have to reconstituted and prepared (average time 8 mins per antibiotic)

- Set up IV fluids and a syringe pump for a patient needed IV sliding scale insulin, which has to be altered every hour/two hours, the pump and fluids checked and blood sugar/prescription chart/fluid chart updated.

- Update co-ordinator on expected discharges that shift

- Refer patients to physiotherapist/OT/social worker

- Ensure all my 9 patients are washed/showered/bathed - it is my responsibility to ensure this is done even if I don’t wash a particular patient

- Plan, implement and evaluate care for my patients throughout the shift

- Ensure my IV cannula care plans are up to date - and all cannulas removed at the appropriate time, and new ones inserted if necessary

- Ensure catheter care plans are up to date and followed

- Ensure all observations are taken and act on findings, altering frequency if necessary, and monitoring patient/alerting doctor

- Put patients on commode/in bathroom as and when, and ensure they are returned to bed chair when finished, noting type/amount of stool/urine and recording if necessary

- Discharge patients - ensure patient/social worker/OT/doctor happy with discharge, informing perhaps district nurse, care agency, relatives, of discharge and arranging transport for patient

- Clean bed space/locker/chair and check oxygen/suction equipment to ensure bed ready for next patient (who will always arrive within 15 mins). Ensure this is done if I don’t have time to do this.

- Admit patient - check/write in medical notes about care needed, ensure drink/call bell with patient, observations taken and acted on, check infusions/pumps running as per prescription, orientate patient to ward, including whereabouts of toilet and who their nurses are.

- Order equipment such as pumps, air mattresses etc from equipment library and set up equipment when it arrives

- Speak face to face with OT/physio/social worker throughout shift

- Ensure accountability/Kardex sheets updated and signed, including MRSA/falls/pressure areas/nutrition assessments done and up to date

- Speak to relatives on phone

- Speak to relatives face to face, sometimes on their own

- Be with patient when they are given bad news, and staying with them as long as necessary

- Lock medicines away given to me by relatives

- Feed patients/ensure they are fed, food record charts updated

- Set up naso-gastric feeding, ensuring correct placement of tube, connecting feed and running through set. Update NG feed/fluid charts as a result.

- Insert Naso-gastric feeding tube, and arrange with Dr for X-ray to ensure correct placement. Referral to dietician for above if needed.

- Check medical notes systematically at least 3 times a day to ensure plans followed.

- Contact Dr for clarification of notes/prescriptions, and to request more IV fluids be prescribed.

- Go with consultant to patient's bedside during ward round, to advocate for patient, answer questions.

- Update handover sheet for next shift

- Ensure my colleague (HCA) is ok and attends break at correct time, taking over whatever they are doing to ensure this.

- Cover for colleagues on break (all of above!)

There are many more things that need to be done on a shift but this is a snapshot.

I want people to realise that the majority of nurses want to provide the best care that they can but the majority of the public do not realise the sheer number of interventions that nurses (and HCA's) have to undertake. This is why sometimes we are not able to speak with you or attend immediately to your relative.

Please be patient!

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