AnnaMary

Everything you said above. We also get elderly patients from home with general deterioration, not coping at home and waiting for placement with 24 hour nursing care. They come in with dehydration, malnutrition, screwed up electrolytes and pressure sores from being on the floor of their bathroom for 3 days. Usually these are elderly people who live alone with no one to check in on them and notice that they are going downhill and cannot care for themselves. Acute confusion query cause. COPD is a biggie and so are diabetic emergencies. CHF is also big. Collapse query cause. We take GI bleeds, pancreatitis, and palliative care when there is no room at the hospice. UTI's. Pneumonia. Here in England nursing homes usually do not give IV meds or fluids of any kind so any unwell patient who needs that kind of thing or an xray etc has to get admitted to hospital. Overdoses. ETOH detox. CVA's and TIA's when there is no room on the stroke ward.

On an acute medical/care of the elderly ward we have 25 patients with 2 nurses and 2 care assistants. That is an early shift. So yes you do have some help with ADL's but not enough IMHO.

I do a mix of days and nights and find them both stressful. But on days I can never go more than 2 minute without having to run to the nurse's station to answer the phone. 9/10 the phone calls are from relatives who are not next of kin and no we don't have a clerk to answer the phone. Sometimes nights have less interruptions from family members meaning that you can actually get on with taking care of the patients at times.

The nurse patient ratios (on general wards in the UK) are a sick twisted freaking joke. If you go to my profile there is a link to a blog about all this. If the powers that be will not even admit that you need a certain number of nurses on the ward...well then what can we do but try and educate people.

At my hospital all nurses do one week of nights a month. We all know what nights are like. No one is allowed to do permanent nights and no one is allowed to do permanent days unless they have a medical reason. No shift wars on my ward. One day I might come onto days and the night nurse may have left things in a mess. But I know why they are a mess because I nursed that very same team of patients on nights 3 days ago. Three weeks later when she is on days and I am back on nights she cuts me slack as well. It is sad when people cannot see things from another perspective. All shifts suck whether they are days or nights.

The thing about pharmacy is that they don't have to deal with the screaming abusive patients and relatives. In England we discharge our patients with at least a weeks supply of their prescribed medicine provided by our hospital pharmacy. The pharmacy is overwhelmed with regular inpatient meds, restocking wards, and discharge drugs (DD's) The senior doc will come around and tell the patient that he is discharged at 0900. But he will leave his junior doc to actually write the discharge orders. He won't release the junior doc from ward rounds until late in the day. Once the junior doc is able to write the discharge meds up, we have to leg it to pharmacy so that they can fill the order. Takes them more than 4 hours usually. We have to go back down there to get them. Our pharmacy is so overwhelmed they have stopped answering the phone so if I want to communicate with them I have to go down there. Patient has been sitting there dressed and packed up from 0905 onwards and is now really ****** off, screaming at the nurses for being made to wait for their dd's. If we know someone may be discharged we start chasing the doctors up to write the dds as soon as possible but it is pretty low on their priority list. Total chaotic mess. If I have a lot of discharges I spend my shift chasing after junior docs and pharmacy for the dd's and getting screamed at by medically stable patients...all at the expense of the acute patients. It makes me ill to think about.

No you are not missing anything. Sometimes we have more than 12. This is in the UK and it is normal for medical wards.

I work in general medicine in the UK. Same problems with pharmacy and every other department....horrific nurse patient ratios etc. I have never been so scared as I am when I am at work.

The nurses themselves started creating and printing handover sheets and management put a stop to it. We hand write everything that we hear in handover.

We are lucky if we have 2 nurses and 3 hca's. That is for an early. Lates are 2 and 2 if we are lucky. Nights are 2 and 1. My managers has not been allowed to hire more staff for a long time. Usually they will float one of our HCA's away to staff another unit. We take acute medical, general medical, and care of the elderly.

I worked on an acute assessment, general medical and care of the elderly ward that was 35 beds. We had 2 RN's per shift. It nearly killed me and ruined my family life. I cannot believe the lengths that management was going to in order to avoid hiring nurses and staffing that ward. Patients suffered horrifically. They even got rid of our care assistants and replaced them with 16 year old "cadet nurses" who weren't even allowed to take vitals. The vast majority of our patients were on pages of meds and required total care. The mobile ones were confused. The "cadet nurses" were put in the same colour uniforms as the RN's. It just gets worse with the intentional short staffing by management and the response of the British newspapers, hospital managers, and public has been to hand out "dignity cards" to the nurses. It is obvious that basic care is not being met. But no one seems to connect the dots and see that these nurses are overwhelmed. They are constantly being accused to "not caring" and being "too posh to wash". Can you imagine taking care of between 12 and 18 acute medical total care patients? The dignity cards are going to be handed out to the nurses to remind us that dignity and basic care are our jobs and that it is not very nice to leave people waiting for the bedpan for more than a minute. They are also asking the public to remind the nurses that patients suffer when they are not fed. Sometimes on that ward I had 15 feeds simultaneously by myself with acute admissions during meal times. It's unbelievable.

Sofaraway, Just curious, what kind of ward are you working on and what are your normal staffing levels like? We can be anywhere from 25-35 beds with 2 RN's and 2HCA's and we got shot down on the idea of having printing handovers. I think it is way too much. Obviously it is good if you can know everything about every patient but how realistic is it for us to be able to do that safely?

I feel so bad about your situation. So many nurses are working in these hell holes...and made to feel guilty about all the things that don't get done. That NP and DON should have to walk a mile in your shoes. People always moan about how crap nurses are, if only they knew about these kinds of working conditions and how much it takes to survive a shift with that kind of a patient load Thepeople you work for sound insane. Poor patients. Poor nurses. I hope you can get out of there and find something better.

Thanks for you reply. Yeah taking report on 36 patients takes so long. So we split the ward and each took report on half and were responsible for our "side" of patients. This has lead to visitors, doctors, and patients having an absolute fit at the nurses for not having all the update info on all of the patients in an instant. There are only 2 or (3 on a good day) of us for the whole ward for god's sake!! Any more?

I am just curious about something and I was hoping that med surg nurses could help me out. My understanding is that it is dangerous for a primary nurse to take report on anything more than 12 patients. I thought that the ideal number was 4-6 patients. If you work on ...say a 36 bed ward... does every single member of nursing staff take report on all 36 patients at the beginning of the shift? Does that sounds incredibly time consuming to you? Personally I think that it is way too much information Say you have 3 nurses coming into work for a dayshift on a 36 bed med surg ward. That's it. Three RN's for the whole unit. Would you have each nurse take 12 patients and just get report on those patients or would you try and have everyone listen to report on all 36? You do not have a charge nurse. Just the three RN's. I know the first thing that people will type is omg I wouldn't work in a place like that at all!! But seriously. How many patients do you take report on and how many do you think is too many? Was is the best way to deal with the situation I am describing above?