- Introduction
This booklet is intended to be a general guide to ward 3 Rheumatology and is designed to apply to both newly qualified staff and previously experienced staff nurses starting a new ward/specialty. On the first day, a new nurse will be met by our Rheumatology Nurse Educator, who will be responsible for orientating them to the ward routine and the role of the preceptor within this specialty. You will be allocated a preceptor, normally an E grade Staff Nurse who will work a minimum of two shifts per month with you. There is more intense supervision in the first two weeks with the preceptor working as many shifts as possible with the preceptee.
Working this closely enables the co-ordination of the development of clinical skills and knowledge, especially in relation to the specialty and also the effective review of set objectives (discussed later).
The preceptor will – Coach
Teach
Act as a role model
Set clear and concise objectives
The ward has general expectations of new members of staff, which are met by setting clear and concise objectives. The preceptee also has the opportunity to set their own objectives in addition to using those enclosed later within this package.
( Learning Objectives/rheumatology competency framework).
- General Ward Information
13 bedded mixed sex ward, specialising in Rheumatology. Within the ward there is also a dedicated Day Case unit.
The ward is exempt from the on call medical receiving rota, but is on call to receive rheumatology admissions 24 hours per day/7 days per week. However the majority of our patients are normal pre-planned or list admissions.
Patients are referred to the unit via G.P.’s and are given outpatient appointments at Woolmanhill, Orkney , Shetland or Elgin. Patients may also be referred from other areas within the hospital that have sought rheumatology constancy, the medical receiving unit (AMAU) and the accident and emergency department.
Occasionally we receive decanted patients from other medical wards within the hospital. This provides staff with opportunities to develop their general medical nursing skills.
The unit is a teaching ward for both medical and nursing students. Student nurses come to the ward during their medical placements, for either 7 or 8 weeks. During the first and second years of their nursing programme they are supernummery, in years 3 and 4 they become counted in the wards staffing ratio. Any student nurse on placement to rheumatology having completed their first clinical placement may work any shift over 24/7. It is ideal if students on placement, mimic their supervisors off duty, incorporating night duty and weekend working if necessary. Occasionally adaptation or stand-alone students in addition to medical students come to ward 3.
As with all wards, ward 3 have an effective multidisciplinary team. The Rheumatology Unit prides itself in having a successful multidisciplinary approach to assessment and rehabilitation of our patients. Each member of the team has a very important role to play in the success of managing disease progression and rehabilitation. As a member of the nursing team, individuals are expected to work closely with a number of different professionals; therefore, communication and skilled liaison skills play a very important role.
3.The Multidisciplinary Team
The majority of our multidisciplinary team can be located upstairs within ward 6. This of course excludes our Resident House Officer, who occupies an office within the ward (outside the infection unit – code: C2568X).
- Medical Staff
Dr Alan G. Macdonald (Consultant Rheumatologist) heads the Rheumatology Service.
Ward 3 has 4 Consultant Rheumatologists –
Dr J.A.N. Rennie (JANR) Bleep 2495, Secretary ext.: 54746
Dr A.G. Macdonald (AGM) Bleep3131, Secretary ext.: 54614
Dr C.J. Eastmond (CJE) Bleep2496, Secretary ext.: 52289
Dr D.M. Reid (DMR) Bleep2497, Secretary ext.: 51154
Professor Reid is also an honorary lecturer in Rheumatology, therefore can also be located in the medical school.
Three Registrars, a Senior House Officer and a Resident House Officer form the remaining medical team.
The Registrars operate as follows:
Dr David Crosby (2216) – for Dr Rennie’s patients
Senior House Officer (2319) – for Prof Reid’s patients
Dr Kumar Vinod (2829) – for Dr Mcdonald and Dr Eastmond’s Pt
Resident House Officer (2404)
2.Nursing Staff
The nursing team is formed of a mixture of trained and untrained nurses who rotate both between the rheumatology ward and outpatient clinic at Woolmanhill. Sister Hardy the Clinical Nurse Manager in Rheumatology heads the team.
All nursing staff within the ward are dedicated to providing the highest standards of care for the patients, and in order to maintain these standards, ongoing educational development is encouraged amongst staff with study time and funding occasionally being made available. In addition to workload we lead impromptu teaching session. An education program is currently under development for a Wednesday afternoon. All staff will be expected to contribute to this teaching program and may be required to present a short topic in rheumatology.
A Nurse Educator supports ongoing staff development and the delivery of nurse/patient education within the specialty. She is located within the day case area and welcomes staff enquiry’s. – Louise Brodie ext: 51055
All staff work day and night rotation with the present system being E grades working 3 months night duty per year whilst D Grades and auxiliaries work approximately 4 months per year rotating at monthly intervals. However this may be altered from time to time as a result of staff sickness or maternity leave etc.
Another important member of nursing staff is the Hospital Bleep Holder : Bleep 2118. The hospital bleep holder is available to support nursing staff in the following issues 24 hours per day/7 days per week. She is a senior nurse of G Grade or above with relevant hospital clinical and management experience.
- To maintain legal and safe staffing.
They hold a record of exactly what staff is available in each area and whether bank staff have been ordered or redirected. If someone in your area phones in sick the bleep holder should be notified in an effort to identify staff in an area which may be quieter and available to help or to order bank staff to cover. Basically anything that affects staffing levels within the ward needs to be notified to the bleep holder –
-sickness and returns from sickness
-patients being specialed or in need of 24 hour supervision
-trained cover
- A source of information for the following incidents (legally they need to be notified as they are in overall charge)
-fire
- bomb threat
-missing patient
-incidents/accidents
-complaints
-drug error
-temporary bed closures/opening
Bleep holders should also be contacted for guidance, staff shortages, excess staff, break cover and sickness.
If ever in doubt and senior guidance needs to be sought Bleep 2118.
AORC – Tel: 01224-555403 ext:55403
Nurse Advisor in rheumatology is Mrs Anabel Smith.
The arthritis and osteoporosis resource centre is located at Woolmanhill Hospital and is available both as a rheumatology helpline and drop in facility for patients and carers or multidisciplinary professionals requiring information or advice concerning arthritis or osteoporosis support. The helpline is 24hrs; the centre is open Mon-Fri 0830-1630. There is also a specialist nurse advising in osteoporosis located here, although she is employed in a research capacity, and funded through the university.
3.Other Multidisciplinary Professionals
We have a dedicated rheumatology physiotherapist and occupational therapist that are responsible for maintaining joint mobility, energy conservation and joint protection. The gym is available for patients’ use with these professionals upstairs. Occasionally it may be necessary to take patients to the occupational therapy department downstairs to assess their activities of daily living in a home environment.
Physiotherapist – Lesley Davidson ext. 54751/2
Occupational Therapist – Toni Langmead ext.: 54751/2
They are each assisted by junior physios and O/T’s on a rotational basis.
After 1700hrs and at weekends there is no physio or O/T cover. Physiotherapy will only be honored under medical staff’s request and in exceptional circumstances.
Pharmacist – Alistair Duncan : Bleep 3400
The ward pharmacist visits the ward daily (Mon-Fri) to advise on drug prescribing and to provide nursing staff, medics and patients with any drug information they may require. He will also order any non-stock drugs on a daily basis and provides a ward stock up service x2 per week on a Tues and Friday. However if any drugs are prescribed following his visit, he will require to be bleeped with your requirements. Out with normal pharmacy hours, try and obtain any drugs you require from other clinical areas. Only urgent non-stock orders can be placed after 5pm at night and at weekend’s ext. 53182, bleep 2166 (Emergency only).
Dietitian – Gail Mckay: Tel : 52935
Nursing or medical referrals are usually for calcium assessments for patients with osteoporosis or on long term steroid therapy, which can result in hyperglycemia and weight increase. Occasionally as a result of the disease process or in wound management, patients will require high protein supplements or specialised diets. There is a wipe board at the nurses’ station on which we write any dietary requirements and can be used as a reference.
Social Work Department ext.: 53510
Many patients experience social and financial difficulties due to their illness and may give up work or change their living arrangements. When asked a social worker may visit patients and can offer advice and support regarding benefits and facilities available. They can also suggest the help of the Citizens advice Bureau who visit the hospital each Tuesday morning.
Liaison HealthVisitor Liz Dunn Bleep: 3204, ext: 54369
Liaison health forms are completed by nursing staff if patients are over 75yrs, in receipt of services, live alone or require aftercare/rehab. Contact Liaison regarding discharge arrangements if services or aftercare is necessary.
4.Nursing System
Within ward 3 we adopt the concept of named nursing through a team nurse approach. Our patients are divided into 2 teams dependent upon which consultants are responsible for their care. Sister Hardy is the overall co-ordinator of the two teams and in her absence, her deputy Senior S/N’s Cobb, Duguid or Edwards (F Grade Staff Nurse’s). Each team adopts team leaders – usually the most senior nurse from that team on duty that shift and it becomes this nurse’s responsibility for overseeing the work of her team members and delegating responsibilities within the team as she sees fit. Team members work under the direction of the team leader, although all trained staff are independently accountable for assessing, planing, prescribing and administering nursing care as part of the team.
Where at all possible patients should be nursed by their named nurse and student nurses will be in the same team as their practice supervisor. If possible it would be most appropriate for the team leaders of each team to accompany each consultant on their ward rounds, i.e. Red team nurse – accompany Dr Rennie and Prof Reid and vise versa. This would improve the accuracy of communications.
Named Nursing
The introduction of the named nurse initiative into ward 3 took place in 1995, and has been working reasonably well ever since, improving the quality of patient care and interaction by prompting continuity and individuality. Named nurses are allocated to patients upon admission and ideally that nurse should be the one admitting, orientating, prescribing and discharging the patient from hospital care. Naturally, a red team patient will have a red team named nurse. Decanted patients will also have a named nurse attending to them. Appropriately, this responsibility usually becomes that of the nurse who receives them initially onto ward 3. Each patients named nurse is documented within their nursing kardex and at their bedside. It is the responsibility of each named nurse to introduce themselves as soon as possible to their patients.
Principles of Named Nursing
a)To ensure continuity and responsibility for patient care. It aims to encourage partnership between nurse and patient.
b)Accountability for directing and co-ordinating the patients’ plan of care and ensuring that the care plan is carried out.
c)To establish good communication with relatives and others in the health care team.
d)Patients should be familiar with the associate nurse or who to approach in the event of the named nurses’ absence.
Further details can be found in the booklet ‘The Named Nurse National Guidelines’ a copy of which is given to all new members of staff on induction.
Holidays
All new members of staff will be allocated a specified amount of annual leave, which requires to be taken between 1st April and 31st March. We suggest, in order that everyone’s request for annual leave can be met as fairly as possible, you take one week in spring, 2 weeks in summer, 1 week in autumn and 1 week in winter. Public holidays should also be taken as near as possible to the actual public holiday it fell. Public Holidays may be allocated at the discretion of Sister Hardy. There is an annual leave planner at the nurse’s station for you to select your preferred holiday dates. We also have a request book, in which you may request particular days off if required. This system will only work fairly if each member of staff making a request considers how essential it is and what impact it will have upon their colleagues i.e. Extra day’s off at either side of annual leave, possibly biting into someone else’s holiday break.
Ward Round Timetable
Dr Rennie 0900 Tuesday and Friday
Dr Reid 1000 Tuesday and 1400 Thursday
Dr Macdonald 0900 Monday and 0830 Thursday
Dr Eastmond 1400 Tuesday and 1015 Thursday
It is the responsibility of the trained nurse responsible for the Red team on duty to accompany Dr Reid or Rennie on their ward round, whilst the green should accompany Drs Eastmond or Macdonald. When this is not possible the responsibility will be assumed by the co-ordinator on duty. ie.Sister or Senior S/N.
Consultants also have a weekend on call rota, which can be viewed at the nurse’s station. Each consultant normally does a ward round on a Saturday morning when they are on call between 0900 and 1000. Any patient admitted to rheumatology at a weekend without a consultant will automatically become a patient of the consultant on call.
5. Patients Property
On admission to hospital, patients are advised to keep no more that ten pounds on them and have any expensive jewels or bank cards sent home with next of kin as the hospital takes no responsibility for the safety of their property. Patients who wish to keep their money with them have the opportunity of placing their deposits in the ward security box (a small safety deposit box secured to the floor of a locked cupboard with only the nurse in charge holding the keys to access this) if they wish. If patients have more than thirty pounds for safe keeping then their money must go to the general office for storage in the hospital safe. The receptionist holds the paperwork for this procedure and this facility is not accessible at weekends. Either way the patient is issued with a receipt and can withdraw their money as they wish. It is important to make patients aware that any funds they place within the general office safe will be returned to them in the format of a cheque. When admitting patients, there is a place on the hospital admission documentation on which you should highlight whether monies or belongings have been placed in the ward safe or general office. In addition to this you should also document whether you have explained the hospital policy regarding storage of valuables to each patient. Patients can submit claims if property is lost at the hands of a member of staff, ie.clothing inadvertently going to the hospital laundry. If there is a suspected theft on the ward, then an incident report requires to be completed by the nurse in charge and hospital security must be notified in addition to the police. Patients are welcome to bring in their own electrical appliances ie.shavers, hairdryers… however these must be inspected by the hospital electrician and given a safety sticker prior to usage in hospital so there is minimal risk of electrical fires.
6.Routine Ward Tasks
A pharmacy technician performs the ordering of pharmacy twice weekly, routine stock item replenishment arrives on the ward on a Tuesday and a Friday. The trained nurse on night duty normally assumes the responsibility of storing these drugs, as stock requires time to be rotated with those reaching a nearer expiry date being stored in front of those with a longer one. Night duty normally allows the time necessary to perform this task. Controlled drug order book should be completed by the nurse in charge and sent to pharmacy on a Tuesday and Friday with anticipated ward requirements – particular attention should be paid to this on a Friday with the weekend approaching, as difficulties are often encountered with the dispensing of controlled preparations over a weekend.