Wednesday, November 7, 2007

Trust no one, part 1

Four years as an agency nurse in London means four years of trusting no one. My worst experience happened at one of London's most prestigious hospitals.
I turned up to work the night shift. The agency had said the hospital was desperate for another nurse. Not exactly encouraging words to hear, but I knew not to take offense. I took the job.
"Thank goodness you're here. It's very good of you to come at such short notice" said the nurse in charge of the afternoon shift. "Have you worked here before?" she asked. I shook my head. "Well I'll show you round then give you a handover." She then introduced me to Sheena and Irene, two nurse assistants that were on for the night with me. Sheena was from another ward and had only worked the occasional shift in the ward. She was only slightly familiar with the place, while Irene was an agency worker as well and had never even set foot in the hospital let alone the ward. "Ah, where's the other nurse?" I asked, naturally assuming that I had another registered nurse to work with. The charge nurse looked a little surprised, "Ah, didn't the agency tell you?" she said. I shook my head. "We couldn't get another nurse. You're our RN. You're inc charge tonight." I felt like I was in some kind of bad dream because this just couldn't be happening. I took the tour de farce with the charge nurse then began my shift.
Sister Grant in the side room was an seventy something nun in need of some pain medicine. According to her drug chart she had not been given her morning dose of voltaren. Voltaren is a analgesic similar to Ibuprofen. The drug was to administered as a suppository, or bullet up the backside. I was presented with several problems:
1. I was not going to near the private parts of a nun. She would be horrified.
2. She was prescribed 75mg of Voltaren twice daily. According to her chart she had missed the morning dose. The patient also said she had not had it.
3. We only had 100mg suppositories. I could give her the 100mg as she had missed her morning dose, but would need to get the prescription changed.

I tried to solve the problem by phoning a doctor. I called the medical doctor on duty that night to come and change the prescription. He said that I needed to call the surgical doctor as it was a surgical patient. I then called the surgical doctor who said it was a gynaecology patient. I called the gynae doctor who told me that because he was a private patient, originally under the care of a surgical consultant, I should call the surgical doctor. Needless to say I was rather confused.
After ten minutes I finally managed to get a doctor who agreed that she was his patient. He was the medical doctor. It turns out that Sister Grant began as a gynaecology patient, which unsurprisingly turned out to be a general surgical problem. The surgical problem was solved but she then developed a medical problem, and was then transferred to the medical team. The doctor then said that he couldn't come to the ward as he was too busy and offered to give me a verbal order to give the 100mg voltaren suppository. I said I'd call him back as I wasn't sure if I could take a verbal order.
I then tried to phone the night supervisor for some advice. I was put through to the first advisor, who advised me that she was responsible for the other side of the hospital and gave me another number to call. I finally got through to the correct nurse supervisor. I explained the situation with Sister Grant. "Can I take a verbal order?" I finally asked. "Yes" she said. I called back the medical doctor and said I would give the 100mg voltaren suppository.
I asked one of the assistants to give the suppository and the problem was solved. Or so I thought.
My real problems began the next day.

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