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'There are not enough staff and there is not enough time'


Trainee nurse Claire Aubrey wonders what will happen to her quality of care when she qualifies and has less time with patients

I have started thinking about time. There is not enough.

As a trainee nurse it is worrying to think about how much is going to be lost when I qualify due to the fact that I will not be supernumerary anymore. I began thinking about this just last night when I was sat with a patient on a night shift for at least a couple of hours. The patient has severe dementia and, as a result, is frequently agitated. She becomes distressed with little provocation, if any, and she has severely swollen legs which also cause her a great deal of pain, adding to her distress. To be honest, it seems that what she most frequently wants is just a little company to ease her mind and to talk things through. She also needs a little prompting to relieve her own pressure areas during the night so that parts of her body do not fall asleep and cause further discomfort.

However, all this takes time and time seems to be the one thing nurses do not have.

I sat with the lady last night, holding her hand, and waiting for each time that she roused so that I could prompt her to have a little wriggle and settle back down, reminding her that it was night time and she needed to sleep. She accepted this every time without problem and I felt very content to help give her a better night’s sleep than she had had in quite a while.

On other nights she has begun shouting – she is confused and frightened when she wakes up. Her legs give her pain and if she has not been moved in a while she becomes uncomfortable but unsure of how to relieve herself. If it were me, I would shout. She shouts for help and it is help that she needs. She is quite right. However, there is not a student on every night shift and, unfortunate but true, there are not enough staff and there is not enough time to sit with this patient continuously.What can we do?

I had the same problem on CCU with an anxious patient who needed someone to be with her, just for comfort and for small talk.

A seemingly simple task but when time is an issue, can it still be done? I wrote about this patient in a recent care plan assignment, and in the evaluation, made mention of the fact that I was able to be there for support during her stay but, had I not been there, I am not sure what would have happened. Being in her presence and comforting her worries for significant periods seemed to be a great part of her actual care plan as anxiety was one of her main nursing issues. However, if there is not enough time for this, how can we be giving the patient the right care?

My final example is another patient on the mental health ward who is unable to feed herself and needs assistance every meal time. I was told by certain staff that she would shake her head and I should push the food into her mouth as she was “just messing around” and she would “chew forever” if I did not hurry her. Already uncomfortable with the idea of this situation, I sat with the patient and gave her her first mouthful which she accepted and began to chew. Admittedly she did chew for a very long time but so what? It did not bother me to wait and when she was finally ready, she accepted the next mouthful of her own accord. At no point did I push it into her mouth.

Eventually, I had the meal taken from me in order to for someone else to get on with it quicker. Although I do not condone this, especially as I was supernumerary and it did not matter if it had taken me all afternoon to do it, I can see how this kind of scenario arises as staff feel so much pressure to get through every activity in order to get all the other jobs done within their timeframe. And it worries me because, while I have the luxury of my supernumerary status at the moment, how will I cope ethically when I qualify with a busy ward and my principles?

I suppose only time will tell and for the moment I am happy to have time. I am content to be what I am needed to be to give patients that little extra if I can, even it is just having a chat or holding their hand. I will enjoy it while it lasts.


Readers' comments (4)

  • Simple answer, it will disappear. IF you let it.

    Always remember that Nursing is 24 hour care, and it is not your place or your job to make up for the shortfall of staff caused by management.

    Do not allow anyone to tell you that you need to do more, or berate you for not doing enough. Do not compromise your level of care simply because there is too few staff and other staff/management moan at you to do more.

    So go into your shift, do what you can for your patients to the best of your ability, and what you cannot do or safely delegate, hand over. You cannot do everything.

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  • But surely there has to be something that gives? Using the patient who required fed as an example. Sitting with her and taking two hours to assist may not be feasable when your other staff nurse on the ward is perhaps involved with neuro obs and you have a drug round which is required. So the patient who needs assisting with food either gets rushed and food "pushed" into her. Or she doesnt eat as much as she should. Missing out drug rounds, leaving people soiled or unwatched (leading to falls) because you have been assisting one patient with her lunch all afternoon just wouldnt stand up.

    Good article. It is something that I have been thinking about on my own placements. We have a good staffing ratio on my current ward but we also have catering assistants who seem to run round the ward in an almighty rush to collect in trays even when there are 8 patients who require assistance. If you are not careful they will steal the food away from patients before we get a chance to help the patients eat. I feel like screaming at them sometimes.

    I am also aware that I will have less time to just talk to patients when I qualify. It is a sad thought.

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  • you will have to do lke the rest of us, hope for a kind hearted student!

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  • Sad but true unfortunately, time and tasks. I felt as you did whilst I was training 2 years ago, but I have always adhered to what I feel is good patient care when it comes to nutrition, hygiene or just plain company. Give a patient holistic care in every aspect, not just physical. Bells will continue to ring, drug rounds will still need to be completed, but treat every patient as if it were your nearest and dearest on that bed. Enjoy the rest of your training, you are in the most wonderful profession ever!

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