Terrible night

Terrible night, terrible terrible night. 

Worse than I had earlier imagined, of course it can always be worse still ... but this was still a bit of a doozey! Exacerbated by my own tiredness, a shitty skill mix, lazy /neglectful staff and general feelings of annoyance (... because of too many shifts & not getting my own way)

I feel there will probably be some ramifications from it all, there has to be.

I arrived to the now traditional utter bedlam, this has been made worse with the start time of seven o'clock when it is very much still going on. The children's surgical ward (217) next door were down to two qualified staff on the night shift, originally they were to be supported by PICU but this was retracted due to ITU admissions as sometimes happens. Help was then to be sent from NNU but that was then also subsequently retracted due to admissions there. Both these events took place prior to the arrival of the night staff. They then look towards us to support, which obviously we were unable to give without reducing staffing to dangerous levels considering the current dependencies of many of our children.

 217 felt that because they were down to two qualified staff and three HCSW’s they should close to admissions and the decision was made to redirect all trauma & surgical admissions to us, along with the usual medical admissions. Scrutiny revealed that they only had nine inpatients, a greater staffing ratio than we ever had on 12b for similar numbers of patients. Sometimes situations can not be rectified and you just have to take a deep breath, suck it up and get on the best you can. Throughout my career there have been numerous times when situations and staffing has been far from ideal; your upset and compromised  and feel you are providing substandard care but there is nothing further you can do in that moment.

We were busy; we currently have some fairly demanding children and their parents who are equally demanding. I think we would have been in an altogether better place had the mid-shift person remained but they were given time owing and allowed home at six o'clock (six hours before they were due to finish). I don't know who made the decision but I find it deeply unnerving that the decision is made before the arrival of the night staff on the ward (and before the evening admissions started to roll in) when it has such implication on the night staff.

 Of course the co-ordinator knew our staffing levels. Subsequently I had to justify a decision not made by myself to send the mid-shift home and its knock on effect to other areas within paediatrics; being unable to support 217, delays in swift admission of patients and ongoing difficulties . I believe the paediatric coordinator, based in the Children's Assessment Unit, contacted the manager on-call and the site manager to enquire about available staffing elsewhere, which obviously received short shift. Again deeply embarrassing & frustrating, and not my decision.

We supported 217 overnight as able, but in truth they required very little. It must be said that it's hard enough to manage the ward with four qualified staff without the addition stress caused by resolving & brokering other areas problems. I no longer have any management responsibility or am paid to deal with all this shit, yet it frequently gets laid at my feet.

I had to report it to my manager, sorry if I'm talking out of turn. I certainly wasn't telling tales or making waves, irrespective of who made it, the decision to send the mid-shift nurse home at 6pm was a really foolish one (... in my opinion)