Sunday, March 20, 2011

I am enjoying a lazy Sunday although this mornings lie in was only until 07.15. It's a bright day and spring, despite some overnight frosts and fogs over the past week, really does seem to have arrived. Daffodils, lots of bird life and some weak sunshine. Even the cats appear more lively and showing more of an inclination to go outside.
 Happily I wasn't called out the other night and slept like a baby. We don't often get called out but when we are it is usually an all nighter beginning with an assessment in A&E (ER in the States). It can end up in an admission to a mental health unit and this is often where the fun and games begin. If a bed is not available in our usual in-patient unit which is 26 miles away, we have to look further afield including one unit which involves a round trip of 100 miles. Arranging a mental health act assessment at 2 or 3 am, plus police and ambulance,working with the family, etc... can take several hours although the AMHP will have to deal with the practicalities if a mental health act assessment is required. But most of the emergency services will generally take someone to the police cells if it is warranted or one of the bigger A&E departments which has a MH unit on site. The A&E our team covers is small and there is no MH unit attached to the hospital.  However, covering 600 square miles and being the only mental health nurse on call at night with no access to doctors, etc... means we have become very adept at managing mental health crises. The paperwork also has to be done with the usual equation of 1 hour assessment = 2-3 hours completing paperwork, even if the assessment results in no further contact.

 The fun and games continue the following day because we are a small team with only seven nurses and having been out all night one is not allowed to work the following shift (European work time directive). Finding staff to cover at short notice and once again we enter the fantasy realm occupied by management. If I am up all night and I can't find a replacement for the following ten hour shift, I can't leave my colleagues short staffed especially if I am the only senior nurse available. But if I stay on duty and a mishap occurs because I am tired, it is my responsibility and managers are very quick to pin the blame on the individual practitioner... me. They will point to policies pointing out my responsibility. Amongst the team we identified the easiest option: the two immediate managers are qualified practitioners so we hand the responsibility to them. After all, if I have worked a ten hour shift followed by several more hours overnight without sleep I can't make a rational decision. Their latest wheeze is that we have "already worked that shift overnight for which you will be paid or take time off in lieu" which is fair enough. I am more than happy to shaft managers who will not allow the team to fill the three job vacancies so as to save money on the orders of the senior trust managers, so I gleefully hand over the responsibility to them and I head for my bed and sleep. So much for not cutting front line staff because they aren't but, they aren't replacing staff who leave so they can happily state no jobs cut. String, chewing gum and staffs goodwill are now keeping things going. It doesn't bode well... rant now over. No wonder lots of long served staff are seeking early retirement. Why stay in a job where managers, the public, politicians and the media are keen to throw ordure at you whilst also threatening to cut pay, pensions, etc... Funnily enough there is no sign of any managers jobs or their large empires of administrators being rationalised.
TTFN.

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