Now call me naive, but I genuinely thought that nurses are generally helpful beings, willing to assist doctors in caring for sick patients. There was a mixed bag of nurses on duty yesterday evening. I was very much swamped with tasks, from clerking in new patients to reviewing bloods to taking bloods to reviewing medications. I was very much impressed by one nurse who was willing to take a set of bloods for me, from a difficult to bleed patient that she was used to bleeding. She saved me a good 10-15 minutes for which I was extremely grateful. So my faith in nurses was high around the middle of my shift.
When I finally had a minute to inhale some of my "packed dinner" I was sat in the doctors mess when my bleep went off again. Now I had heard rumours that occasionally handovers are very badly done, but had yet to experience it until this moment. The conversation went along these lines:
- Hello, it's the F1 on call.
- Hello this is one of the nurses calling from the ward, I've got a patient with a temperature of 38.5.
[Dead silence, as I wait to hear the rest of the obs and the reason for the call]
- What are the rest of the obs?
- Um, I dont know, we're just doing them.
- Alright, why is this patient in hospital?
- Um, I'm not looking after them so I dont know.
[Silence, while I wait for her to look through the notes]
- Er.. she has a UTI
- What were her last set of obs like?
- I'll just check. I'm not sure where they've been written down.. I think she had a temperature earlier too.
- So you've called about the spiking temperature, is there anything else that's concerning you about this patient?
- Well, yes, the temperature.
- Ok, I need to know if this patient is unwell enough for me to need to come and see her, so maybe you could ring me back when you've done the current obs.
- Alright, I'll do that.
I looked at the phone in puzzled disbelief, still not sure why I had been called. I wasnt particularly concerned, and was expecting her obs to be normalish and that I probably wouldnt need to review her. Five minutes later the nurse calls me back.
- Her temperature is 38.5. Her blood pressure is 147/85. Her heart rate is 98.
[my ears started to prick up at this point]
Her sats are 94%. Her respiratory rate is 33.
[my ears sprang to attention and I sat up rather straighter]
- Is she on any oxygen?
- No
- Please put her on 28 % oxygen and I'll come and see her now.
It took me a good five minutes to traverse the hospital to the ward, and when I arrived there was an abundance of nurses at the nurses station, all of whom ignored me.
- Hello, I'm the on call F1, who was I speaking to?
- Oh that was me [this nurse looked seasoned enough that she ought to know how to give a proper handover] I havent got around to putting the oxygen on yet! [And she laughed.]
- Right. Where is this patient?
I had been mentally running through my approach to the sick patient on my way there.
1 Do they look sick?
2 Assess airway breathing and circulation and treat stuff as I find it.
3 Further investigations
4 Differential diagnosis and plan
So this patient looked sick, she was obviously breathing fast and was quite drowsy. The nurse hovered next to me, not looking like she was in any rush to apply the oxygen. So I asked her again. I was at this point feeling somewhat frustrated, and concerned both about the patient and the lack of understanding of the clinical situation that the nurses here seemed to have. It was the right thing to do to call me, but they'd done so for the wrong reason and were completely unprepared to give me the information I really needed.
I assessed the patient, decided she wasnt shocked but might have a chest infection, ordered a chest x-ray, took blood cultures and decided to do an arterial blood gas sample. I asked a different nurse to please find me a blood gas syringe and she was singularly unhelpful, and flatly refused to go to the next ward over to find one, in fact saying "you'll have to get it yourself'. Here was me thinking that actually, there are about 6 nurses standing around the nurses station doing nothing, and me running around trying to sort out a sick patient, and maybe if I need a piece of equipment it might be logical, helpful, and safer for the patient if one of them were to go and do it. I weighed up the time I would waste arguing with her versus the stability of patient and went myself. I was not impressed, and was disappointed that my idealistic view of us all working as a team for the good of the patients had been slightly tarnished. Had the patient been much sicker I would have insisted that she go, but it's not (yet?) in my nature to pull rank.
Having done as much as I could I rang my SHO for a more senior review. By the time my SHO arrived, the patient's respiratory rate had decreased to 28 and her sats had improved, so I'd at least fixed her a little bit with the (eventual application of) oxygen.
No comments:
Post a Comment