The second I walked onto the ward I knew something was wrong.
I’d been qualified seven months, one of those incredibly keen, yet still incredibly unsure, nurses.
“Hi Fran,” Rachel smiled at me as I walked into handover, ready for the late shift to start. “So… err… Ann and Michelle are both sick. You’re the only qualified on this afternoon.”
She went from being my best friend, who’d just signed off my preceptorship paperwork, to my worst enemy.
I was 22 years old, how could I run a busy acute mental health ward? I wasn’t old enough to make decisions!
Yet for some reason, the trust was happy to let me take full responsibility of the keys and keep 20 patients alive for the next 7 hours and 23 minutes.
A nurse-to-patient ratio of 1:20 is not unusual in mental health, it should be, but it’s not. I survived the shift, as did all my patients, and I got through it the next time it happened, and the next. But the care that I and the three HCAs working with me gave was not what service users should expect.
No-one could use their escorted section 17 leave as the HCAs were permanently on special obs and I wasn’t able to leave the ward in case there was an emergency. I had to cancel the one-to-one sessions I’d planned with my named patients to prioritise giving everyone their medication and when a doctor arrived on the ward and wanted a chaperone while he saw a patient I had to say no, I needed to discuss prn with a service user who was clearly escalating.
In theory, when NICE’s new safe staffing guidelines come into force, this sort of experience will be a thing of the past. Fewer than two registered nurses on a ward during any shift, day or night, will be deemed a “red-flag”. This will “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.
Some of you reading this will be asking “but where from?” Nurses don’t grow on trees, if one ward is short-staffed, it’s unlikely that another has an abundance of nurses sat around twiddling their thumbs.
But the guidance makes it clear that it is unacceptable for acute wards to be run with fewer than two registered nurses. That acknowledgment is a huge step towards safer wards and safer patients. The red-flag events will still happen, but maybe if they keep being pointed out, trusts will be forced to do something.
Please report your red-flag events. Let your trust know the guidance isn’t being followed. It’s five minutes that you can’t afford to spend on paperwork but if it puts pressure on your trust to make wards safer then it’s worth it every second.