What happens in a mental health rehabilitation ward – a genuine insight

One night shift in a mental health rehabilitation ward

Here’s what happens on a night shift in a mental health rehabilitation ward; or at least within the Trust I worked for.

I was working a bank shift which means I am on the Trust’s bank of staff who are available to cover shifts on the various wards if they don’t have enough staff. Because I was a student I could only work as a nursing assistant (N/A).

In comes Ayo with her big bag and her big blanket, tutting as always before slumping down into a chair, moaning, “Oh Lord, I don’t need this, I worked an early bank shift on Jasmin (ward).”

Working a night shift and then a late shift is not standard practice. Long hours, fatigue, and lack of rest breaks or time to recuperate between shifts are associated with an increased risk of errors. However, it’s very difficult for Ward Managers to keep track of, if staff members do extra bank shifts on another ward, which many of them do. Is it any wonder they’re tired and burnt out when they’re working three to four bank shifts a week elsewhere?

What happens in a mental health rehabilitation unit during handover

Lisa arrived just in time, as Clare was about to start the handover at nine pm. “Mandy’s not coping with the titration of her Diazepam and continues to scream at medication time. Sasha remains bright in mood and went out with her nurse to buy new underwear today. She asked when Nancy was working next……..” and this made me smile as I’d taken a shine to her too.

“Elsa messed herself today — again, and her clothes were found on the shower floor.” Clare briefly covered all patients on the unit and said her goodbyes. That left Lisa, Ayo, and me working as a support worker.

Ayo was coordinating this shift but before she could even allocate patients and any tasks Mandy was banging on the office door. “I need my medication. I need my medication……” and as I went to speak to her Ayo cried out “No. Let her wait. Everyone have to wait.”

“Ayo, I just want to let her know that she will get her medication soon. It’s not nice that she’s crying and upset. I ………..”

“No!” thundered Ayo and she kissed her teeth, after which she allocated four patients to me, including Mandy and Elsa. As much as I loved working with all the patients, cos they each brought their own joys with them, I noted how I was always given the more difficult patients to work with. Unfortunately, lots of staff on various wards did this but, by rights, being qualified they ought to have taken these patients.

Lisa would be doing medication this night and I was to prepare supper of toast and hot chocolate; no coffee or tea because patients weren’t allowed caffeine before bedtime.

Supper time on this rehab ward

Mandy was given medication first before tottering through to the kitchen, wringing her hands and muttering to herself. “Hello, Nancy. It’s nice to see you again. I’ve had my medication but they’ve cut it down and I can’t cope Nancy. Honest, I can’t. Can I have three slices of toast nurse and will you cut it into quarters for me?” before shuffling over to the large table. I took her hot chocolate over as she was trembling and I could see her ending up with half a cup if she was to carry it.

Edward was next at the counter and he too shuffled away happily with his toast and jam and cup of chocolate. At only forty years old Edward could have passed for fifty-plus as he was always unshaven, his face was weatherbeaten and his grey hair had receded.

Edward had a diagnosis of schizophrenia and since he was seventeen he heard many voices and saw people who were not visible to others. Unless you saw him at mealtimes, you wouldn’t know he was there; he was so quiet. I had to seek him out each week for games night and he came along willingly, as he was actually really good at Scrabble and we both enjoyed the challenge.

What happens at Bedtime

With medication and supper over I went to check on my four allocated patients. All bar Edward were in their rooms and in various states of undress. Mandy wore a long floral flannelette nightgown and ancient slippers and I watched as she carefully folded the clothes she’s just taken off into neat piles. Her room was spotless if not a little cluttered as she collected china teapots of all sizes. and colours. “Night, night nurse. Will you close my door for me?”

Sasha was in bed and snoring lightly. Elsa was struggling with her bra straps so I offered to help. “Fuck off me, you. I don’t need you.” she spat and turned her back on me. “Go on, fuck off.” Then she gave me another of her toothless grins. I think she just liked to test the nurses’ responses. She always made me smile and I told her I’d be back in five to see she was okay.

I did go back because if you say you will, then you must. So many patients are left waiting when nurses tell them they’ll come back and don’t. I think it’s cruel. That just left Edward. He was watching a film in the shared living room, chuckling away to himself. I wasn’t sure if he was laughing at the television or the voices he heard but he looked happy enough.

Staff lacking common sense

Just when I was going to join Edward for a while, Ayo called “Bedtime Edward.” and switched the lights out. I said “He’s watching this film, let him see the end. It’s over in twenty minutes.”

“It’s eleven o’clock and it time for bed. Come, Edward. Come now.” Totally ignoring me, she watched as Edward struggled to get out of the chair and shuffle over to the door.

Once everyone was in bed Lisa checked all the downstairs doors and windows then returned to the office. I asked why Ayo wouldn’t let Edward finish watching the film. “Eleven o’clock lights out,” she mumbled, and at least had the good grace to look a little embarrassed.

Unbelievable. We all have very different body clocks and bedtimes, and had Edward been at home, he would have watched the end of his film before going to bed. I was going to make sure that I documented this in Edwards’s notes and flag it up at the next team meeting.

Staff bedtime too

It was eerily quiet, pitch black, and unnerving as I went to the kitchen to get drinks for myself and Lisa. On my way back to the office, all I could see in the living area was a pair of eyes peering out at me from underneath a blanket.

I whispered “Hello,” but got no response. I crept forward so as not to startle what I thought was a patient but Ayo shrieked “My Lord. Girl, what you doing? You frightened the life out of me.” There she was, feet up with her slippers lying on the floor, curled up on the sofa. “I havin’ my break. Go. Foolish girl,” and she kissed her teeth.

Off I went with the drinks, shaking my head, stunned. I asked Lisa whether this was normal practice, for staff to sleep while on duty and was told that we each get two hours break but Ayo just sleeps all night. “So that would leave one of us on the floor?” I inquired. If both Ayo and Lisa were on a break that would leave me, an N/A, to be responsible for the unit. “Yes, that’s what we do. It’s okay, Ayo always sleeps” she smiled.

“I’m sorry Lisa but I don’t feel comfortable with that. I’m working as an N/A and I’m not qualified if there’s any emergency.”

Staff ignoring poor practice

“Nancy, she’s done it for years. Even our manager knows,” said Lisa sighing and shrugging her shoulders. However, that night neither she nor I had a sleeping break. We both sat in the office, Lisa looking at holidays online and me reading through my patients’ notes. I really enjoyed finding out more about the patients and while it was quiet I could help update their care plans, number the pages in their files, and generally complete paperwork that’s often difficult to do during a busy shift.

The time went quickly and I was so immersed I didn’t hear Ayo coming into the office. However, I heard her loud yawning and watched as she stretched upwards before dropping herself into the spare chair next to me. I caught a whiff of her stale morning breath and body odour! Offering to make us drinks allowed me to make a swift exit and by the time I’d returned, Ayo had wheeled her chair to another desk.

Six fifty-five and the morning staff were starting to arrive. “Nancy, Lisa, you go on the floor, I do handover.” Which is normal for the coordinating nurse to stay in the office to give the handover, while the rest were outside attending to patients. However, I couldn’t help but wonder how a nurse who’d slept all night and hadn’t asked her colleagues about the shift’s events could possibly give an adequate handover. Again, I asked Lisa who tutted and said “Nancy, you’re just a student. It really won’t do you any good to keep questioning your colleagues’ practices now. They won’t thank you and you’ll fall out.”

Nurses ignoring health & safety

“I don’t want to fall out with them but as I’m a student, working as a nursing assistant surely I have an opinion? And I don’t think it’s safe for patients or staff if others are not doing their job.”

“Nancy, it’s just how it is, how it’s been for years and you can’t change it.”

The Nursing & Midwifery Council’s (NMC) Code of Conduct 2015, sets out professional standards of practice and behaviour for nurses, midwives, and nursing associates. Point 3.4 states: act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care. Both Ayo and Lisa had completely ignored all the rules!

Would you be able to highlight where they’d gone wrong? Would you have reported them?

I would later talk this through with the unit Manager.

Note to self: “Folks who never do any more than they get paid for, never get paid for any more than they do”― Elbert Hubbard