Tuesday, 14 August 2007

The rage

Posted by Dr. Thunder:

So, that’s me back from holidays. No time to concern myself with slimey coins anymore. It's nose back firmly against the grindstone, with my least favourite pastime...the nightshift. Nothing breaks you down like being on nights in a hospital. Nothing erodes away at your ability to cope with day to day problems like being on the nightshift. Last night was no different.

When I arrived, I was told that our junior doctor was off sick with a vomiting bug. Fair enough. He's a good guy. He'd come in if he could. He's obviously pretty ill. So, I'll just plod on, and hope for the best.

It was a reasonably calm night, until James arrived in the door. He's a 12 year old boy with a history of bad asthma. Has been on a ventilator to keep him breathing during one of his attacks, and has been hospitalised numerous times.

Like many of these kids, he looked OK initially. We tried him on some nebulisers, which did the trick for a while. I also gave him some steroids. As time wore on, he was needing nebulisers more frequently, so I admitted him to the ward to observe him overnight. The nurses in our respiratory unit are superb. They kept a good eye on him, and called me at about 4am when James' breathing became more laboured.

At this point, I thought James needed Aminophylline. This is a drug that's given into a vein through a drip, and helps with breathing. It's a very good drug, but there are side effects, and the kids feel like crap when they're on it.

So, I popped a drip into his arm so the aminophylline could be started, did some blood tests, and I observed James for a bit. I was concerned he might need to go to the high dependency unit, or even intensive care, as he was beginning to struggle with his breathing. So, I stayed by his bed.

Then the pager goes off. It's one of the wards upstairs. "We have a septic baby up here, whose drip has come out. She's on intravenous fluids and her intravenous antibiotics are due". Why do these things always happen when you just can't leave your patient?!

Then.......brainwave. In our hospital, we have an "advanced practitioner night nurse co-ordinator". I don't know what that is. It's a lot of words, but I'm not really sure how they fit together.

Anyway, her job is to do her nurse co-ordination stuff around the hospital, and to perform "advanced roles". For this she gets paid more than the excellent nurses on the ward, who are helping me to look after James.

So, I asked the nurse who's phoned me to give the "Advanced practitioner night nurse co-ordinator" a bell to see if she could do it. "No probs, doc, I'll do it now". Happy days.

Or not.

5 minutes later I get paged back by the ward upstairs. "The advanced practitioner night nurse co-ordinator says she's busy". "Does she know what our situation is here?" I asked. "yep, but she says she's busy".

So, I rang her myself. I explained the situation. I explained I was about to phone the intensive care docs, as James wasn't getting any better. I explained that this drip that needed to be sited wasn't an immediate life or death issue, but it was important. I explained I was the only doc on for the whole hospital. "I'm sorry, but I'm busy". "Too busy to spend 10 minutes putting a drip into a baby with septicaemia, so she can have her antibiotics?". "yes". "Fine, goodbye".

Now, this person gets paid a lot of money to perform her "advanced roles". Yet, I have never met her, and I've been in the same hospital for almost 6 months! I have no idea what she does at night. I'm sure it's important work, in terms of co-ordinating nursing activity. But if she doesn't have time to perform her "advanced roles" then she shouldn't be taking the paycheque for it.

Which leads me on to the question I have asked myself and my colleagues many times.....Is the usefulness of any single member of the hospital staff inversely proportional to the number of words in their title?

Look at the people that we properly depend on in hospitals...."doctor", "nurse", "midwife", "porter", "receptionist", "physio", "security guard", "lab technician", "ward clerk", "occupational therapist". None of these people have more than 2 words in their title.

Then look at the people who are the greatest pains in the arses in hospitals. Look at how many words they get....."advanced practitioner night nurse co-ordinator", "Diabetes nurse specialist", "consultant physiotherapy practitioner ( I still have no feckin idea what he does, and I chat to him every day in our staffroom!) ". "Surgical services co-ordinator", "primary care paediatric pathway facilitator". I could go on.

Anyway, I digress. James went to the high dependency ward. He just about escaped the ventilator machine this time. I went up and put the drip into the septic baby myself, about 2 hours after it should have been done. It was difficult explaining the delay to her angry mum, but I've stopped trying to defend a crappy system. I just told her the truth. I told her I'd be writing an angry letter to the hospital manger. I wasn't lying. It's gone off in the internal mail this morning.

I feel like Robinson Crusoe this morning. I've started crossing off the days on my calender until I move to New Zealand. It can't be any worse over there than it is here......can it?


  1. Welcome back. Sounds like James was the only winner last night. NZ's gain is the NHS's loss! Keep up the great writing whatever.

  2. The first thing our Advanced Night Nurse Practitioner says when she strolls onto the ward and is asked to do something, is "Why wasn't this done during the day?

    The implication being that things aren't done during the day solely because every doctor in the health service is lazy and inept, and intent on making her life more difficult.

    Another (nicer) nurse practitioner asked me to help her in a pre-assessment clinic when she got out of her depth. Which I was happy to do - but if she's not trained to listen to someone lungs, should she really be assessing them prior to major surgery? I'd rather they had saved the money from her bewilderingly vague job, and used it to put this clearly intelligent woman through full medical training.



  3. Love the blog, just stumbled across it... Nice work.

    Almost appropriate WV as well: poxfalp

  4. Many of these so called 'Advanced Practitioners' have only basic clinical skills and have no academic knowledge to back up their title.
    This frustrates me greatly, as this can increase suspicion and questions the extensive experience and knowledge that I and my true advanced practitioner colleagues posses!

  5. Moving to NZ? I'm jealous! It is so beautiful there. I hope you have a better time in the system.

  6. Hey, so nice to find an Irish med blogger! Good luck!

  7. Wandering Oddyseus6 September 2007 at 15:53

    Did you find out what the 'advanced practitioner night nurse co-ordinator' was actually doing when you were stuck between patiens. Surely you could ask her and then enquire what the clinical director and hospital management felt was a more pressing clinincal situation.

    These people only get away with this crap because we let them.