Nurses. Ugh. What are they good for?
Who would want to be a nurse? I mean really. The shifts. The pay. The constant criticism in the press. The physical, intellectual and emotional challenges of caring for people. The risk of assault and abuse. Sounds like a mug's game, mate. Except it's my game. I'm a nurse and I can't think of anything I would rather do. What do we do though? What are we responsible for? We are scientists and detectives and mothers and comedians. This is what we do.
Middle of the night: Wake up in time for work. Put an ironed uniform. Do your hair neatly. Eat something.
7.30am: Take a handover of all the patients on your ward. It could be 22 people or 58. Note their medical history and reason for admission. Note their care needs. Can they move independently? Can they eat independently? How can they go to the toilet? Do they have fluids or medicine running intravenously? What investigations are being done for them? When are we getting them home? What else will you be in charge of today if a patient crashes? Their airway or breathing? Their circulation? Their disability or possible exposure?
8am: Take a bedside handover of the patients who you will care for directly. It might be 4 people or it might be 8. It might be more if you're short staffed. Note all the above but in greater detail. Plan your day and prioritise your workload.
If everyone is stable, your first task will be administering medication. There will be a combination of intravenous, oral and even rectal medicines to be given. Do this accurately for up to 8 patients. Check that the doctors and the pharmacists wrote the right doses in the drug charts. They don't always. You are the last checkpoint before a drug goes into a patient. It's your responsibility to make sure it's the right drug, at the right time, in the right dose, through the right route. Oh and that you've given it to the right patient. Some days you might have two ladies called Mary Smith lying next to each other. Do not get them mixed up. Oh and make sure everyone has eaten something for breakfast by now unless they're nil by mouth. Help the people who can't feed themselves. Make sure everyone has water and they can reach it. Document all of this.
9am: If you're lucky, you will have finished your medication round. If not keep going. Don't make any mistakes even though you're now running late. The lucky nurses will start getting people out of bed, helping them to wash and making the beds, tidying the bay and ensuring everyone is comfortable. If you get this all done before lunch, have a break. If you have more than 2 bed bound patients who need full care, hope you have a healthcare assistant available to help and maybe another nurse. You might be on your own though. You might not be able to get everyone clean and comfortable before lunch. You might not get a break. Everyone might need to go to the loo at the same time. Who do you prioritise? Who will you chance to leave sitting in their own urine? More than one of your patient's is likely to have dementia, try to keep them calm and dodge any spitting, pinching or kicking. Some of your bed bound patients will weight 50 kilos. Some will weight 150 kilos. Try not to hurt your back when you help them to move. Document all of this.
10am: Although you're watching all your patients the whole time for any sign of deterioration you will need to monitor their vital signs throughout the day. That's temperature, pulse, blood pressure, respiration rate, oxygen saturation and urine output. This takes about 5 minutes per patient depending on how much they want to talk to you while you're doing it. 5 x 8 = 40, so this will take 40 minutes even if you're doing it very quickly. Check if anyone is in pain. Not every patient will tell you. Do this every hour for critically ill people, 4 to 6 hourly for people you're a bit worried about and 8 hourly for people who have been stable and are headed home soon. If you have to give a medication that might change a person's blood pressure or pulse or blood sugar, take their observations first so you can tell if they still need the medicine. Then decide whether to give it. Document all of this.
12noon: Serve lunch. Don't forget to test the blood sugar of every diabetic patient you're nursing. Which might be more than half of the ward. Meal times are protected so make sure everyone has eaten before you start your next medicine round. Even though it's due at the same time as lunch. Document all of this.
2pm: Monitor everyone's vital signs as you did at 10am. Is everyone comfortable? Has everyone been to the loo?
3pm: Make sure you've done all your wound dressings and other lower priority tasks. One complicated wound dressing could take you half an hour. You might need 2 nurses.
4pm: Take a break but don't forget to Document all of this. Keep an eye on your fellow nurse's patients whilst they're on their breaks. Add that to your patients. That's 16 people to monitor.
5pm: Protected mealtime. Repeat as with lunch.
6pm: Medication round. Repeat as with 8am, 10am, 12noon and 2pm.
7pm: If you didn't get a chance to Document all of this. Then Document all of this.
7.45pm: Handover everything you've done to the night nurse. Exhale.
8pm. Go home unless you've not Documented all of this. If a patient was critically ill during your shift you will be staying late.
Whenever you get home: Eat your dinner in the manner of a hungry desperate snake. Whole. Go to the toilet because you probably didn't get a chance during the day. Lie down. Scream about all the hard things at your partner without breaching any patient’s confidentiality.
Middle of the night: Wake up. Panicked. Did you remember to refer that patient to the physiotherapist, the district nurses, the speech and language therapist? Did you screen that patient for MRSA? Did you support your student nurse? Did you sign for that medicine? Did you listen to your patients? Did you make enough tea for everyone? Were you too blunt with that family member? Did you allay everyone's fears as best you could? Did you remember to Document all of this? Try to sleep.
After Mid Staffs it feels like everyone is calling for nurses to be more compassionate which is understandable but if I am any more compassionate I will burst. I'm not an exception. Like most nurses, I love to comfort people but look at my timetable and tell me how many minutes in the day I have to do it. Tell me how I can be more compassionate without more nurses. Tell me why the nursing profession is 90% female and almost 50% immigrants from outside of the EU who we know have less equality and less of a voice in our society but are doing this vital work in the face of constant criticism. Tell me how the government can justify not giving us our 1% cost of living increase because we're working harder with fewer nurses. Tell me. What are we good for?