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'Nurses have to knowingly carry out detrimental bed manoeuvres every day'

  • Comments (37)

Listening to recent news reports on discharge from hospital at night I wondered where were the nurses representing the needs of a 94-year-old man sent home at 1am in the morning.

The Times news story and the data it was based on was flawed, but it did make me think again about what it really means to be an advocate. Is it possible to represent your patients if you have no power to influence or change their circumstances?

I was reminded of a time - when I was working as a bank nurse at a large teaching hospital - I was asked to transfer Mr Jones, who had dementia and visual impairment, from an acute medical ward to a surgical ward at around 12.30am.

He was one of the great number of “unwanted patients” in a busy hospital pushed for beds. His medical treatment was complete and but his long-standing health problems meant he needed a bit more time to get his social situation sorted before he was discharged home. As I pushed him through the empty corridors he asked time and time again where we were going and as we got to the surgical ward his distress was tangible to the staff who greeted him.

As I told the surgical nurse about his problems I could feel her anger growing. She shared my distress about moving this frail and vulnerable person from a ward where he had become familiar with his environment and routine. Yet we were both powerless to prevent it happening.

When we were told to move Mr Jones I asked the bed manager what would happen if we refused to. She replied: “We will just get someone else to do it”. Down in A&E someone needed an acute medical bed and Mr Jones lost out.

Bed manoeuvres happen every day in hospitals and I suspect many nurses have had to push patients to other wards knowing that it will ultimately be detrimental to their wellbeing.

So where does this leave nurses as advocates? Should they think about the needs of the person waiting for the bed or focus exclusively on their patient? The NMC advises “Advocacy is concerned with promoting and protecting the interest of people in the care of nurses and midwives, many of whom may be vulnerable and incapable of protecting their own interests”.

But how do you do this in a system that is so pushed and underfunded that it demands nurses compromise the needs of patients in their care for the greater good of those elsewhere?

  • Comments (37)

Readers' comments (37)

  • Anonymous

    Thank you Eileen for being honest. Its nice to know how you felt. I suspect its a feeling many of us can recognise. I have to say, transferring frail, bewildered patients to other locations is a common practice. I remember discharging and admitting 17 patients on one shift. every person who could be discharged, had been. That left one patient classed as fit, she was a frail old lady of 90. At the time there was a panic on due to A+E exceeding it's waiting times etc. So one of the senior nurse managers demanded i identify any person fit for discharge. Logically the frail 90 year old was the only one. I was ordered to ask her consultant to discharge her. When i relayed the request, her consultant said, "why are you asking to send this poor women home without support?". I, stupidly, said I was doing as instructed. To which he replied "following orders?. What are you, a Nazi?". That really hurt, but he had a point. So I refused to discharge her, it was a Friday, which meant she remained until Monday. Needless to say my name was sh*t with management. But i was glad i did it.

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  • Anonymous

    I have some experience on both aspects working on the wards and now in bed management. Firstly its not acceptable to move frail patients in the middle of the night. I also have been an advocate for a patient whilst in bed management being discharged out in the evening I kept pointing out that we were not certain that support at home was in place. It's a constant battle and I believe everyone one of us could spend time in bed management to gain an understanding of the pressures, whilst the nurse on the ward is thinking (quite rightly) about the needs of the patient though to be honest if the patient is going to be discharged the next day I don't see a problem. Patients in beds after their medical needs have been seen to is a problem. I would ask then what do you do with the patient in A&E who needs that bed more than the patient whose needs have been met? Its a dilemma I'm afraid we are going to have to get used to, with the squeeze on social care budgets patients who are of need of these will continue to stay in hospital beds unnecessarily. Yes we need to fight for our patients but we also need to see the bigger picture, everyone of us working in a hospital are under the same strain, the same restrictions.

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  • Anonymous

    Yes, you're right, all nurses are forced to make difficult decisions every day, juggling priorities and facing dilemmas. Why should ward nurses be put in the position that they have to choose who is more important - patients on the wards where they work, patients in A&E and admissions units waiting for a bed or patients at home who have called an ambulance but can't get into hospital because they are full?

    The government closed beds without having the number of community beds, rehab beds, nursing and residential homes increased.

    Hospitals don't offer a 24/7 service, patients still have to wait in over the weekend for their op/procedure/test if it's not done on Friday. That causes a backlog and in this day and age is pretty unacceptable.

    Doctors are pressurised into admitting and treating everyone, if they don't they face criticism.

    Patients with 'acopia' or waiting a social sort out should be transferred (or admitted) to community/rehab beds.

    How do you tell someone in an ambulance in the carpark that they will have to wait hours to get a bed because there aren't any left.

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  • Anonymous

    Hospitals should be asked to publish the number of patients who remain in hospital once they have been declared fit for discharge but are waiting for some sort of social input.

    Out of that figure they should state how many patients actually needed social input.

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  • Anonymous

    Anonymous | 17-Apr-2012 10:20 am

    it would even better if the 'input' was provided rather than publishing figures on it.

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  • Anonymous

    My elderly aunt had a phone call from the trust I work in,to come and collect her even more elderly friend and take her home; the call was at 0100 in the morning. Her friend was in for ?abdominal obstruction, but as they had deemed her fit to go home, they then wanted her taken home asap. This lady was 86 at the time, and lived alone and had lots of medical problems. My aunt is quite frail herself, and it was not reasonable for her to take this lady home, but she did so knowing that her friend would get very upset if the staff kept pressurising her to go. There is always a big squeeze on beds, and pressure to get people out asap, even if they aren't ready. Social services have had their budgets cut year on year, and there isn't support available for the huge amount of people that need it.

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  • Anonymous

    All of the above apply and there is no definitive solution; remnembering that the numbers for a lot of trusts include patients who were in for assessment, rather than being in-patients on a ward. Sometimes we have to put the needs of one patient above the needs of the other and we are finding that the buck often stops with us. I wonder sometimes if these patients that are being discharged at unreasonable times (I am presuming they were medically fit), should have in fact been discharged during the day if only their nurse had seen discharge as a priority rather than something that could wait until tomorrow. And before I cause outrage amongst over burdened and stressed nurses everywhere lets admit that we all know someone who does the bare minimum and that not only nurses can be a little laissez faire about patients spending one more day in the bed. OTs, doctors, social services, patient transport and many others are all part of the team and should put their hands up to joint ownership of the problem.

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  • Anonymous

    It's an awful situation to be made to do something both you and profoundly disagree with and the patients are distressed as a result of, let alone unsafe.
    I agree spending time with bed management would be useful to a degree, as would the non clinical bed management spending time with the trained clinical staff.
    However this could all be a lot less of a hot potato of feeling we have to decide what to do with the limits that are imposed on us, but rather insisting that for example, the superrich pay their legal and morally appropriate taxes rather than thinking they are too special. What is actually happening is creative tax avoidance NOT philanthropy. If it was philanthropy there would be a lot less feather ruffling to apparent 'selfless' charity giving!
    For once I hesitate to agree with what this govt is actually doing with this particular reform, and I never thought the day would come for that.

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  • Anonymous

    The question was 'where were the nurses...........' - they were on the wards looking after patients.

    The question should be 'where are the managers who make the decisions that patients need to be discharged home or moved to another ward.............

    I doubt individual bed managers make a decision of who should go where and at what time, if they do then they should be the one who comes and explains the situation to the patient.

    I suspect they are under great pressure to create beds that sadly no longer exist and whose fault is that?

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  • Anonymous

    Can we get more truthful with our patients? Can we say that this is the result of how the country voted, although we may or may not agree, this is all we an manage with what we are given.

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