In my last post I wrote about how our patients, having gone from being slept out on other wards within our unit, to being bussed out to spare beds in our other mental health hospitals every night. I ended with things couldn’t get any worse.
Documenting risk in ‘bussing out’ patients
Our ward staff had been completing incident reports for weeks, months even, documenting the risks of bussing patients out but were wondering what the point was. Staff were reminded, “if it’s not documented — it didn’t happen.”
Unfortunately, our local Service Managers weren’t listening and were ignoring the risks and the quality of patient care by bussing them out like cattle going to slaughter each night.
We needed these incident reports to show that even under these extreme circumstances, we were doing everything possible to maintain high standards of patient care and reduce any risk.
We also needed Senior Management at Head Office to be aware that our verbal complaints were being ignored by middle management, who were essentially putting patients and staff at risk.
While we often had to sleep out 4-5 patients each night (20-25% over our regular capacity), those patients returned each morning and had to be cared for all day with the same number of staff. So instead of two qualified and two unqualified staff for up to 20 patients, we had the same amount of staff for 24-25 patients.
Weekly staff team meeting
Despite our continual complaints, verbal and written, via the minutes from our weekly Wednesday team meeting (which we cc’d to all the powers that be), our concerns were still being ignored. Therefore we invited our Modern Matron (my boss) and the Area Nursing Director (his boss) to attend a team meeting.
Staff were encouraged to speak for themselves in these meetings — if they wanted change, they needed to express their concerns. They needed to say “we have too many patients to cope with, the patient’s are getting agitated about being bussed out every night and the risks of this practice are too high.”
Our dimwit pen pushers (Dpp’s), who’d decided that sleeping patients out was a good idea, sat silently and had to be prompted for an answer “How long will this go on for?”
Dpp’s glared at me, glimpsed at each other then their shoulders went up in a couldn’t care less shrug and our Nursing Director humphed, “not any time soon.”
“Ah, okay,” I smiled, “We’ll document this in the minutes”. Not another word, just a look of disgust and they both left. “That’s why we complete incident reports, ” I chuckled, addressing the team, “they haven’t got a leg to stand on if anything happens, we have the documentation.”
The dreaded annual cost-cutting in mental health
By now, it was December and the annual cost cutting was announced — our unit had to save money somehow otherwise we’d go over our budget at the end of the financial year, which is end of March in the UK.
Our Dpp’s had an amazing idea, which was to cut ward staff at night — immediately. Instead of 3, each ward would have 2.5 which meant that each ward would share a member of staff – who would go back and forth between two wards?
Our concerns were voiced to our Dpp’s in a team meeting and ignored. I would be off for four days now and staff were given strict instructions to complete incident forms each night. Again this was documented in the minutes of the meeting.
Accident waiting to happen on a mental health ward
Just imagine, it’s now Friday night. One qualified nurse is ‘doing’ medication for 20-25 patients, ensuring that the sleep outs were ‘done’ first. The other qualified nurse is checking all our patients are where they’re supposed to be and still breathing. Then she’ll make hot drinks and toast for the patients before they go to bed.
In the meantime, the unqualified nurse is rounding up the identified sleep outs before eventually walking them down the dingy corridors to the bus waiting out the back. It’s our ward’s turn to accompany patients on the bus to our other hospitals and to give a handover to the staff there. This could take 2-3 hours.
By around midnight, the unqualified nurse was on her way back from our other hospital, things had settled and one qualified nurses decided to take her break. Manish, the other nurse, went round the ward to complete the half hourly checks on patients when he saw a young male patient, Iki, loitering near the female area.
High risk patients on acute mental health ward
Iki was a young lad with a diagnosis of paranoid schizophrenia and had just recently been re-admitted on Section 3 of the Mental Health Act (MHA 1983) following a breakdown in the community.
He told Manish that he wanted to have sex with one of the young female patients and when Manish said that he couldn’t do this, Iki became agitated. Manish suggested some medication to help him sleep and Iki agreed, so they started towards the medication room, down a long corridor. Manish stepped forward to unlock and open the meds room door …………..
I got a telephone call at home around 2 am that morning and returned to the ward before going over the general hospital where Manish now was.
I’m sorry I need to stop here but I’ll continue in the following post. In the meantime, I’d be interested to know what might you and your team have done in the same circumstances. Would you do something differently?
If you or anyone you know is experiencing mental health difficulties, please see your GP. If you are having suicidal thoughts, please talk to someone immediately. In the meantime, this Useful Mental Health Contacts may be of interest.