The words you dread most as a patient are not ‘time for your injection’ or ‘what’s a suppository?’ Note – this was genuinely asked of me once BY A NURSE – but ‘I’ll just be in a second’. They will not be a second. They will not be a minute or ten minutes or even half an hour. No, that person will disappear without trace for quite possibly the rest of the day. A nurse once returned to my room a day after I had last seen her with the words ‘Now, where was I?’. That won’t be too much of a problem if they were in fact about to stick a needle in you but it presents slightly more of an issue if they were helping you wash and dress when they uttered that immortal phrase. I was once left half naked and shivering, abandoned on my bed for over an hour by a Healthcare Assistant who vanished promising return “in a minute”.
When you require another person’s help to do anything this timewarp factor becomes by turns infuriating and terrifying. Back when I was in ICU and still on a ventilator, the nurses would disconnect the machine to turn me to be washed. Then, because there were always competing demands on their attention, even though it was supposed to be one on one care, they would get distracted and wander off to do something else. For example they’d realise that their flimsy, plastic apron had torn and they’d have to go and get a new one and put it on. On the way to the dispenser Mildred would ask them where the gauze had gone so they’d go and help her look for it and, all this time YOU WOULD BE UNABLE TO BREATHE. A fellow inmate of mine observed that it should be made compulsory for staff to hold their breath when they disconnected a patient’s ventilator for any reason and not be allowed to take another one until they had reconnected it. I honestly think this is a superb suggestion. When you can breathe easily and are helping Mildred find the gauze the minutes can fly by. When you are trapped in a bed suffocating, every second feels long and, worse, when you don’t know when the air is going to be reconnected, you can’t move and you can’t call for help, every minute is a terrifying aeon.
I also learned the art of asking at the right time and it isn’t when the night shift have just started. Sitting in a chair unmoving for a whole day gets increasingly painful if you have sensation, which I do. By 6pm you would be desperate to lay down but, with their shift finishing at 7pm, the day staff are rushing to get all their tasks done. The night shift have a thousand things to get through as they take over so, if you make the mistake of not lodging a ‘help to bed’ booking with the day shift around 4.30pm so that you are on their list no-one is going to be free to help you until about 10pm. I can tell you that four hours waiting in pain to get into a bed you are sitting right beside is an exercise in fury, frustration and humiliation – not at the staff but at your own uselessness. On the other hand, it is also a superb driver to work really hard at your physio so you get better at transfers.
However, before you assume that hospitals are all staffed by people with terrible timekeeping, let me stress that no-one was more acutely aware of the time issues than the staff themselves. In my time on a spinal ward I had many conversations with harassed nurses and HCAs desperately trying to cover the workload of twice their number as nurses kept on leaving the NHS. Pay in 2014/15 had been frozen for some time and living costs continued to rise. Meanwhile hospital management had changed shift patterns to eke out numbers. Previously, at my spinal unit, the day had been broken down into three eight hour shifts. Now there were two shifts a day – 12 hours each with a half hour overlap for briefing the oncoming shift at each end. In that 12 hours they got two 20 minute breaks – officially. In reality those breaks often didn’t happen, especially at night when we had two nurses and two HCAs on duty. Once upon a time there would have been four of each but with two qualified nurses you only needed two out of the 32 of us on the ward to have an issue and suddenly the nurses would have to forgo their break and work straight through to cover. That’s if hospital management didn’t pull staff out of our unit to cover on general wards, which they frequently did.
We had two newly qualified Spanish nurses join the unit as part of the drive to make up the UK recruitment shortfall via the EU when it was still allowed – one of them got pulled off the ward and sent to cover a ward full of dementia patients on her own for the whole night. She was still in tears about the experience several days later when I spoke to her and swore that if it ever happened again she would resign and head back to Spain.
Meanwhile other trained staff could work in the same hospital for nearly twice the wage choosing what days they worked if they resigned as full time staff and went and worked for an agency – so, unsurprisingly, many of them did.
I had conversation after conversation with demoralised people just running to stand still. Many of them felt that they were no longer able to do the aspects of the job that had attracted them to nursing and healthcare in the first place. I heard of halcyon days when staff could spend time practising transfers with patients, could ensure that everyone had a shower every day, could do patients’ haircuts or give them a shave, could take them on outings to help them acclimatise to being in a chair, could teach dressing and other things to make them independent before they went home. By my time, all of this had fallen by the wayside. I had a shower and washed my hair just once a week and this was because one of the occupational therapists had kindly taken it on as her thing and she was experienced enough to be able to use a hoist by herself and senior enough to ignore the edict that they had to be operated by two staff at all times. The rest of the time I had to make do with a wet flannel wielded out of a washing up bowl of water. If I was lucky, two experienced staff would make short work of this, getting me up and dressed in 20 minutes. Other times it could take an hour if there was just one, less experienced person and especially if that person wandered off halfway through with the line “I’ll just be a minute…”