Late

This morning I finished work at 0800.

This morning I left work at 0845.

0745 and everything is looking good. All the obs have been done, the breakfast has been given out, I've even made a few beds and washed a patient. With a bit of luck the hand over will finish quickly and I'll be able to leave on time.

0750 a buzzer goes of so I go to investigate...patient wants some sugar for their porridge. Not a problem. I grab a packet from the kitchen and the patient is happy. Quick peek into the office, they're halfway through handover...not too bad.

0755 another buzzer sounds. The other HCA has got her coat on and is moving towards the door (I hate it when they just leave...subject for another post maybe!). I go to see what is the problem, I'm praying it's something simple. Room eight is buzzing.

I go into the room and I'm greeted by the sight of bed three trying to get out of bed. He has dementia and is in hospital because he fell at home and fractured his NOF (Neck of Femur). Fortunately for him, one of the other patients saw what was happening and it was he who sounded the alarm. I move (with haste) towards him and assess the situation. He's too far over the edge of the bed for me to get him back on my own. He's too large for me to "catch him". He is going to end up on the floor.

I grab the pillow from his bed and position it under his bottom. I then let him slide to the floor. I have no choice. I kneel down and grab his head before it hits the bed or floor. He's had an "accident" I know this because my knee now feels wet. I don't want to look.

He's not wearing his gown, he managed to slide out of that. His dressing is oozing, his colostomy has started to leak...it's not a great situation to find yourself in.

I ponder my options. first I pull a blanket off his bed and use it to cover him. I can't move because he is leaning against me. There is nothing for me to prop him against and I can't lie him on the floor...it's wet, cold and dirty. I can, if I twist my body and stretch my arm just pull the emergency bell so I do.

Two nurses come charging into the room thinking it's a resus call. When they see me they both sigh. One turns off the alarm and leaves. The other passes me another gown and says
"We'll just finish handover and then we'll be right with you."
"But...erm..."
"Just be a minute"
"Oh..." this is said to myself because she's already gone back to handover.

15 minutes...I timed them, the two nurses return to me. These are not the nurses I was on with last night, I don't know their names and they don't know me. They bring the hoist round and together we get the patient onto the sling, lift him and put him back on the bed. The nurses have largely ignored me and as they go to return the hoist to it's home one tosses a thank you over her shoulder.

I could leave, I've done my shift but I can't. I know they are short staffed this morning. No HCA's means this gentleman will have to wait for the nurses to come and sort him out. It's only another 10 mins of work to get him comfortable and clean. The whole time I'm with him I expect a nurse to come in and take over. I don't see them.

0845 as I leave I can see the nurses busy with their IVs and Drugs.



As nurses become more and more qualified and are given more responsibilities they become less involved with the hands on care of the patients. HCA's exist mainly to fill this void. As a result the nurses are so used to HCA's doing things like sorting out patients such as this one that when the HCA's don't turn up or if they're short staffed the nurses are often so busy with their other responsibilities that they can forget patients such as this one. It's not their fault. They have too much to do we need more staff but every year budgets are cut and as a result patient care is compromised.

Working for the Bank (pt2)

So working for NHS Professionals is a really flexible way to work. It does however have it's downsides.

One of my biggest problems is the lack of continuity. It can be very hard to get shifts on the same ward so you end up working in different places day to day. This may not sound like a big deal but every ward at my hospital has a different speciality. You find that each ward is run differently and it means that you never really know what is expected of you. For me this is frustrating. I am a very organised person and I like to know exactly what I am required to do so that I can manage my time and make sure that it all gets done.

Some wards will allow HCA's to have a lot of responsibility, especially if they are confident of your clinical skills. Other wards may not be happy for you to do things and can get upset if you try to do them. I personally have a lot of skills that most HCA's don't. I can perform EGC's, Bladder Scans, suction trachs, remove cannula's, fit ted stockings and several other things. I know that these may seem like little things but I have been trained and certified by the trust that I am proficient and safe to perform these. Whilst many HCA's may have picked these skills up on the job, few have been properly trained.

When you walk onto a new ward, you are working with people you don't know and may never see again. Interpersonal skills are really important as you have to work as a team. I have to be able to rely on the nurses and they have to trust me not to make any mistakes.

I guess the trade off for having the flexibility is the unpredictability!

Working for the Bank (pt1)

No, I haven't had a career change...

I simply work for NHS Professionals. In their own words

"NHS Professionals Special Health Authority works in partnership with NHS Trusts to provide high quality flexible staff to Acute, Primary Care and Mental Health organizations across England.

As part of the NHS we are in a unique position to offer staff the flexible working arrangements they want whilst ensuring Trusts achieve the best value possible for their flexible staffing spend."

Now it sounds like a wonderful idea...when a ward is short staffed, they can call NHS Professionals (NHSP) and request "high quality flexible staff." In fact from reading their website you may think that they are the knights in shining amour that have come to save the sinking ship HMS NHS...but you'd be wrong.

When I started working as a HCA I was just 18 years old. Wet behind the ears with no real idea of what a HCA was. NHSP as it is now didn't exist.

I started working as a HCA because I wanted a career as a doctor and I figured the experience would be good for me. You don't really want to embark on a medical course if you haven't any clinical experience. (I think that dropout rates for medical schools could be lowered by insisting on students doing some work in hospitals before they start, but that's a subject for another post!)

When I inquired at the careers office at my local hospital about what jobs an unqualified wannabe doctor could do part time they suggested HCAing. One of the instantly attractive things for me was that I didn't have to commit all my Saturdays to working. The nice careers lady explained that the hospital ran a service that provided cover for wards that were for whatever reason short staffed. I could call and book shifts when I wanted them and there was very little commitment. Although they couldn't guarantee that I would get shifts when I wanted them it didn't matter. It was perfect. During the holidays I could pick up extra shifts and if I had plans I didn't have to worry about letting them down I just wouldn't book shifts.

I signed up there and then.

Granny Smith

So last night I had a night shift. I start at 2045 and finish eleven and a quarter hours later at 0800. It's not a long shift, but it is exhausting.

I happened to be on a Care of the Elderly ward which are notorious for being particularly heavy. There is a growing problem in hospitals of bed-blocking Grannys. They come into hospital for a reasonably straight-forward problem, falls or confusion are common as are dehydration and chest infections. However once in the hospital, getting them home becomes a real problem.

Let's look at a case study...

Granny Smith lives on her own. When her daughter visits her she seems a little confused today. Her daughter is concerned and calls the GP out. GP visits and diagnoses a chest infection. Nothing to serious but as Granny Smith is living alone it's probably a good idea to get her admitted to hospital so that she can be monitored while she recovers. Granny Smith is referred to the hospital and transport arranged. So far, so good.

The nice ambulance men come to her house, pick up all her things and then take her the short distance to the local hospital. When she arrives she bypasses A&E and goes straight to the Medical Assessment Unit (MAU). Here she is sat on a trolley while she waits for the MAU doctors to assess her and decide whether she needs to be admitted while her chest infection is treated. Some observations are done (Blood pressure, oxygen saturation's, temperature, heart rate and respiration rate), bloods are taken and a chest x-ray done. After being seen, the decision is made to admit her. Due to the chest infection she is having some problems with her oxygen levels.

A few hours after arriving in the hospital she is sent to the respiratory ward. Antibiotics are started and she is given some fluids as she was slightly dehydrated.

Fast forward a week and Granny Smith is still on the respiratory ward. She has been in a six-bedded bay for a week and her chest infection is clearing. The antibiotics have been working. However because they have been working, Granny Smith has now not opened her bowels for 4 days now (constipation is a common side effect of antibiotics). Also because she has been sitting or lying in her bed for most of the last week she is not very steady on her feet. When the laxatives she was given start to work she tries to make it to the bathroom on her own. Unfortunately on the way her legs give out and she slips.

She is hoisted back into bed, cleaned up and declared "unsafe to transfer." This means that until she has been reviewed by the physio therapists she should not be allowed out of her bed in case she slips. So far everything has been straight forward. Unfortunately today is a Friday. Physiotherapists do not work over the weekend so over the next two days Granny Smith will have to stay in bed...still worse things could have happened...

On Sunday the nursing staff notice that Granny Smith's bottom is looking a little red. They apply some sudocream as they pop her onto her 4th bedpan of the morning. When they remove the bedpan, 15 mins later, some of it's contents spill onto the sheets. They are short staffed but go to get a fresh set of sheets. On the way back to the bed they get waylaid by several other patients before finally getting round to changing the wet sheet under Granny Smith.

By now Granny Smith has been in hospital for 9 days. Her chest infection has nearly cleared up. She has been assessed by physiotherapists who have referred her to the occupational therapists for a kitchen, bathroom and stair assessment before she can be discharged. She also has a bit of a sore on her bottom but a dressing has been applied and it should start to heal once she's out of her bed.

Granny Smith manages to pass the occupational therapists' assessment and the nursing staff can begin to think about discharging her. When they tell her daughter the good news, she is concerned. Who will look after the dressing on her mother's bottom?

The hospital liaise with the district nurses to arrange a daily visit to redress her sore and it is decided that Granny Smith will go home tomorrow.

Overnight Granny Smith develops a temperature. In line with Trust protocol blood cultures are taken and paracetamol given to try and lower her temperature. A UTI (Urinary Tract Infection) is suspected and a urine sample is sent to the labs for confirmation. She will not be going home today.

It is a known fact that the longer a patient is in hospital, the more at risk they are of contracting hospital acquired infections. These will include MRSA, C diff, Winter Vomiting Virus, UTI's, Chest Infections and many others. They are also at risk of pressure sores. With staffing levels at an all time low, we don't have the time to get people as mobile as they could/should be. When there are three members of staff looking after 30 patients it's just not possible to spend 40 mins walking each patient round the corridors of the hospital. Pressure sores are so easy to contract (especially in older people where the skin quality is not very good) but they are so hard to clear up, partly because of their location (usually on the bottom) and also because the patients that get them tend to be incontinent which makes the problem worse.

This is not an actual case-study, more a combination of many different patients that I have seen in the hospital. Sometimes they get passed from ward to ward, speciality to speciality spreading different infectious diseases as they go before finally ending up on a "Care of the Elderly" ward where we try desperately to get patients into a position where they can go home.

Why Why Why???

So...

Why a blog?
Why me?
WHY NOT!!!

I have been working as a Health Care Assistant - HCA for 3 years now. I started when I was studying for my A-Levels and have continued to work part time (during term) and full time (during holidays).

I don't know everything...not by a long way! However I think that I have an insight that other people who don't work in the NHS don't have.

Despite what I may write and what you may think, I love my job. It's varied, challenging, different and you never know what to expect. However, as with every job there are days you have to ask yourself "what am I doing here?"

I guess you could say that this blog is meant to be a bit of therapy for me. Living in a household where no-one else is in the healthcare industry let alone working in the NHS, tales about work are not always welcome as over the dinnertable conversation! This blog will let me vent my feelings about the work that I do.