Most hospitals (as far as I know) have a medical assessment unit (MAU). If you need to be admitted to hospital due to a medical problem (i.e. not surgical, physically traumatic or related to pregnancy) then you will likely end up on this ward after you've been seen in accident and emergency.
I work in our MAU a lot. They have staffing problems and a rapid turnover of what staff they do have. It's accepted that nurses and auxiliaries either love or hate it. I fall into the former category, although sometimes I wonder why.
This is an example of my latest shift there...
0625 cycle to work. My booked time is 06.45 - 1930.
0650. The wind is really strong when I was cycling in and I end up walking for some of the journey to avoid being blown off my bike. Consequently I'm late. However, the bank has confused the times and I'm actually 10 minutes early. Just enough time to run to the vending machine in (a very quiet) A&E. Chocolate and diet coke are breakfast.
0700 receive handover from the nightstaff. Every bed is full, and I'm helping 2 staff nurses look after 12 patients. Sounds easy, really isn't.
0725 handover done, meet my staff nurses for the day. One of them, E, is a nurse I've worked with many times before on this ward, and we get on really well. Time to start washing the patients. Slight problem. A lot of the patients are acutely unwell and can't really get out of bed, so need a blanket bath. Those that can get up either have a wash in a chair beside the bed (as do those on cardiac monitors) or fight each other for the small number of bathrooms. Beds are made.
0800 breakfast arrives. Due to infection control implications, beds can't be made while patients are eating food. Have just enough time to go and help the auxiliary on the other side of the ward with some of her beds and patients. She returns the favour while her patients are eating.
0830-1030 all my patients have had a wash, had breakfast and had their beds and clothing changed.
1030. Time to start doing the observations round. Blood pressure, pulse, respirations, temperature and oxygen saturation levels are done and documented for every patient. This gets interrupted a lot on this ward due to patients needing the commode.
1100 while helping a patient off a commode I can hear shouting and swearing coming from the bay next door. A patient has just come in from A&E and is 'kicking off' at nursing staff. I go and see if they need a hand behind the curtain. It's an interesting sight. All I can make out is a thrashing patient being restrained by nursing staff. Rather wrongly, I can hear him spitting in the face of one of the female staff nurses, and some of it hits me in the arm. It's not a pretty sight.
I give them a hand until security arrive and join the throng. Staff from A&E and MAU are arguing with each other about who this patient should really be with, and words are said. I beat a hasty retreat to get my lady with the commode sorted again.
1120. My ladyandthecommode's family are not pleased that I had to leave their mother sat on the side of the bed after taking her off the commode, and even less pleased that I had to leave the commode in situ (although covered over). I explain in broad terms that I needed to help the staff out, but they weren't very understanding. They complain about the patient in question swearing loudly and why did we allow people like that onto a ward with the elderly. Not really very much I can say.
Between 11.30 and 13.00 I manage to get the 10AM observations done, and then have to escort a patient to MRI.
1400. The next 2 hours are spent coaxing my patient into having an MRI and consequently having to go into the scanning room with her to hold her hand. I've got to say, it's the first time the underwires on my bra have moved like that! I feel proud, however that my patient manages to have the scan. She tells all the staff that she wouldn't have gone in without me, which makes me smile.
16.30 back to the ward and time to try and replace my cartilage stud, which had to come out during the MRI experience. Have to get E to repierce it for me.
1635 - get my first rest break of the day. Yes, you read that correctly. After a bar of chocolate and a can of diet coke all day, I get the first chance to eat at 16.35. We're meant to get an hour a day of rest. It doesn't happen on MAU.
1700. One of my patients has perforated her bowel. She is 90 years old and the prognosis isn't good without surgery. There is much to-and-fro about whether to operate or not. Eventually the decision is against surgery. She will probably die, and quite soon. She hugs and kisses myself and the staff nurse, saying how wonderfully we have cared for her. We both have a tear in our eye when we head back to the nurse station.
1800 - spitting patient needs a cannula removing from his arm. None of the nurses want to do it, so I offer. Security are hovering near my shoulder. I figure that if he does hit or spit at me, at least I've tried and learnt from the experience. Ironically, he lays there like a kitten and the cannula comes out without any problem.
1805 and time to start the Obs round again. Finish just in time to hand over to the night staff, dip 3 samples of urine and send 2 off for analysis.
1930 head outside and hope my bike is still locked up. Time to cycle off into the night to my second job, and do the hospital thing again at 0700 the next day.