Why nights are much better than days.

Dr Jr really likes night shifts. Yes, they're 12 and a half hour long (they'd be longer if they were allowed to make them longer). Yes you end up having to deal with ill patients by yourself. Yes you get woken up from moments of snatched sleep by your bleep for the most trivial of reasons ("I have a bag of fluid that'll run out in a few hours time, could you write the patient up for some more?"). It's stressy, disjointed and full of very sick or very mad patients.

Sounds like the perfect horror story, so why do I like it so much? Absolutely no paperwork! By paperwork I don't mean writing in the notes, because that's part and parcel of looking after patients. By paperwork I mean reams of blood cards, piles of radiology requests and meticulous list-keeping. The whole night is entirely about patient care or interacting with patients.

I had a lovely moment with a young-ish gentleman with learning difficulties. He was getting very upset as he had been noisy and the clinical support worker had threatened to call security. I think what she failed to realise is that just because he has learning difficulties, it does not mean he wouldn't get upset at being threatened by security. I sat down with him (on his bed I'll add, with him sitting beside me - sorry infection control, but I will never listen to your complaints about sitting on patients' beds. There's not a jot of evidence and patients much prefer it in my experience. Allegedly there's a paper that says that patients overestimate how long doctors spend with them when they sit on the bed, but that's a whole different story...). We had a very slow conversation; it took him about 15 seconds to formulate a response. He said, in his own way, that he was upset that he had been threatened by security, he was knackered and just wanted to go to sleep now. So I helped him into bed, tucked him in and wished him good night. He was asleep five minutes later.

I'd never get to do this during the day - there's just too much going on, but on nights, you can occasionally snatch a few golden moments like this. And although being thrown into clinical situations can scare you, the whole experience is exhilarating when you get it right, and there is always a reg to offer advice down the phone when you need it, for the times when you're not sure what to do.

That and the fact it's only a four day week. Man, I love nights. And I think it's time to go to bed. Night folks!

(On a side note, Dr Jr was just scared out of his mind when he heard some banging on his first floor windows, only to see a giant brush cleaning them...)

When being in hospital is dangerous

Roland Holbrow will not be the last.

Maintaining anonymity on a blog such as this allows someone like myself, working on the front-line, to tell the readers of my blog how things are on the shop-floor. The Daily Mail is a paper that annoys me, simply because it's sensationalist anti-NHS stance means that real concerns are drowned out but the drivel that comes. You'll find a real concern here.

Dr Jr was covering the wards this weekend. Never the nicest of jobs at the best of times, but for some reason, the hospital was heaving this weekend. The bed manager spent most of the weekend trying to close the hospital to new admissions due to bed pressure. On top of that, half the nursing staff phone in ill. What resulted was utter bedlam, for both staff, and the patients in the hospital.

In a hospital, I respect the nurses more than the doctors. A hospital could survive a week without doctors, most of the senior nursing staff are much more skilled and knowledgeable than many of the junior medics, such as myself; juniors (F1s and SHOs) also outnumber registrars and consultants. Even if patients went off completely, the critical care nurses would easily be able to bring them round. Short of internal surgical problems such as a massive bleed, most patients would survive. The reason I mention all this is when half the nursing staff are off ill, 2/3rds of the total patient care goes off too.

Now why are they all ill? Chronic understaffing. Understaffing to the level it's verging on dangerous, but not quite making it. Managers don't want to be in charge of a "dangerous" hospital, it means more work for them, maybe they'll even have to stay 15 minutes late once in a while. So just enough nurses so that all the essential stuff gets done and the actual bits of care that make such a huge difference to quality of stay (such as feeding, cleaning), just don't get done. When even one nurse goes ill, the whole tower of cards crumble, which stresses the working staff out to the point where they need time off. It's a cycle that continues onwards.

With some wards of upwards of 30 patients with just two qualified nurses covering them, Juniorville Hospital was sheer bedlam. The bed manager was trying to clear as many patients as she could, she directly told me "it's safer out on the street than it is in here this weekend". Oh dear.

Meanwhile, in my side, I had already worked all week and was covering 13 hour shifts over the weekend. It got worse when a registrar and SHO called in sick on AAU and I had to end up covering them both. Yes, a lone F1 covering the job of a SHO and a registrar.

Is this normal show across the land? To be so short staffed on the nursing front and requiring medical staff to frequently change firms because they can't employ enough to cover a team over their rotations? It definitely wasn't where I trained. What worries me more is posts like this from PC Bloggs, who presents a similar picture from our on the beat friends over at the local nick. When you see what cuts have done over there, you just fear for the NHS. I don't believe a single word the government says about ringfencing. The axe will come, and when it comes, as always, it's the front-line staff who take first blood. If my hospital is anything to go by, we are in big, big trouble.

Empassioned bleating that restricting junior doctor hours to 48 a week completely miss the point. The problem is the shortage of nursing staff. The 48 hour week doesn't help situations mind, but if you want more work from doctors, where's the money going to come from to pay them for the extra 12 hours a week they'll probably end up working? If hospitals instead bothered to bolster their nursing staff, they would spend less money due to the lack of need to bring in much more expensive bank staff, especially when nursing stress went down and they didn't have to go off ill as a result.

This is when being in hospital is more dangerous. I fear we're heading that direction if we don't stop this cart now and what's worse, I think the brakes on this thing are shot.