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Nurse Bel swears at a patient (Nurse Bel does a Bank Shift pt 2)

September 29, 2013

Fresh out of morning report, Bel notices an elderly gentleman struggling to get out of his chair. She glances down at her handover sheet: ‘CONFUSION’ she reads in big letters. ‘STAND TO TRANSFER ONLY – FALLS RISK’. She approaches.
“Hello there” she says. “I’m Bel, I’m one of the nurses. Do you need some help?”
The patient makes a gesture of impatience and tries to push her out of the way. “I need the toilet!”
“OK, don’t worry, we’ll get you there. Megan…” Bel calls over her shoulder to her new student, who is, as usual, scrutinising from a few paces back “…can you fetch Mr Evans a commode? Then we’ll take him to the bathroom”.
Megan is away for what seems like ages. In the meantime, Mr Evans, despite Bel’s soothing attempts at reassurance, becomes increasingly agitated. “Get out of my way will you! I’ve got to get to the toilet!”
“I know. We’re going to take you there as soon as my friend comes with the commode ” says Bel, wondering if Megan has gone to look for a commode in another hospital. She turns on the radio to see if music will distract him, even if only temporarily, but it doesn’t. He is in tears. Furiously grabbing at Bel, he starts yelling to the whole ward “I want a SHIT! I want a SHIT!” The young man in the bed opposite smirks into his lads’ mag.
Finally, Megan rounds the corner, pushing the commode. “Couldn’t you find one?” asks Bel, trying, without much success, to hide her irritation
“Yes” says Megan, plainly hurt at the suggestion that her mission took too long. “But I had to disinfect it first. Infection control!”. Together, they assist Mr Evans to the bathroom and seat him over the pan.
“You’re on the toilet now” Bel proudly announces. “You can open your bowels.”
Suddenly calm, he regards her uncomprehendingly. “Eh?” he says.
“We’ve brought you to the toilet” says Bel encouragingly “like you wanted. Look, it’s a bathroom. Here’s the sink. You can use the toilet now.”
“Eh? What’s that thing? This isn’t no toilet.”
“It’s the toilet. You wanted to go the toilet, remember? Well, you’re in the toilet now.”
“Eh?”
Bel sighs. She squats down so that her face is level with the patient’s. “Mr Evans” she says quietly but firmly “you’re in the toilet. You can have a shit.”
*
Bel goes to break with Liz and Stacie. “Your student not with you?” asks Liz as they sit down in the canteen.
“No” says Bel. “She’s a strange girl – won’t come to break with the rest of us. Always goes off on her own somewhere.”
“Probably scared you’ll infect her with your incorrigible cynicism” snorks Liz.
Bel chuckles. “She does take herself a bit seriously” she agrees. “At her preliminary interview, she told me she was ‘passionate about dignified care for older people’”.
“Aw!” says Stacie. “Bless!” Liz, meanwhile. nearly chokes on her cornflakes.
“Give her her a couple of years” she says when she recovers “and see how ‘passionate’ she feels then! Passionate about finding another job, most likely!”
Bel smiles ruefully. Liz swigs her tea. Stacie, saying nothing, virtuously spreads her toast with low-fat margarine. With sudden certainty, Bel senses danger. Looking up, she sees Stacie’s eyes flick around the table. She sees her lean forward, over her breakfast. She hears the excited, conspiratorial whisper “Soooo….!” that precedes the release of her latest snippet of gossip.  “It’s all kicking off on Jellyby Ward!” she announces. “Did you know?”
Bel stiffens. “Know what?”
“The Ward Manager and one of the support workers have been suspended! There’s going to be a big investigation, it sounds like”. She pauses, then with studied casualness says to Bel “You did a shift down there the other week, didn’t you?”
“It was more like a couple of months ago now” says Bel evasively. A worrying thought has just occurred to her. She wishes Stacie would shut up, but there’s not a hope. Utterly seduced by scandal, her colleague is now discarding any pretence of restraint. She leans in closer. “Was it really bad?” she asks.
Bel fidgets in her chair.  “As it goes, yes, I did have some concerns” she says eventually.
Stacie is all ears. “Well…such as what?”
Bel feels extraordinarily uncomfortable. “Sorry” she says, trying to sound like she means it – “I don’t really want to talk about it”. She looks at Liz, silently imploring her to fill them in on her latest kitchen extension plans.
Liz crunches her crisps. “You talked to Maggie Jones though, didn’t you?” she says.
“Our Modern Matron?” asks Stacie, bewildered.
“Yeah” says Liz. “Bel went to see her about it.”
“Why didn’t you speak to their Modern Matron?”
“I didn’t know who it was” snaps Bel, wishing she could shove Liz’s fat crisps down her fat throat. “Actually, I don’t think they’ve even got a Modern Matron. I think the post was left unfilled after the last person left. To save money…”
“So what did Maggie Jones say?” asks Stacie.
“Oh, the usual. ‘Put it in writing, put it in writing, put in writing…’. Hustled me out of her office after about five minutes, barely spoken to me since.”
“So did you?”
“Did I what?”
“Put it in writing!”
Bel pictures herself as a sandcastle, the warm waves of Stacie’s insatiable appetite for drama washing round its flanks. She knows she will crumble. “Well, that’s just it” she sighs. “I was going to, but it was that day – remember? – when my mum fell over in the garden and I had to bring her in to ED. So half an hour after I’d got home, I was back here again, and it was hours and hours before they decided to discharge her, and she was really shaken up – she’s never been right since, I don’t think – and somehow, I don’t know, I had so much on my plate and I just never got around to it…Oh God, I bet that’s why Maggie Jones has asked to see me this afternoon…”
*
“What concerns me” says Maggie Jones “is that we’re seeing a pattern emerging here, Belinda.”
“Sorry?” says Bel.
“As you may have heard” Maggie continues “some very serious allegations have been made about standards of care on a ward in this hospital and I have reason to believe that although you were aware of…issues on that ward, you failed to raise the alarm. This is a matter we have to look at very closely.”
“You’re talking about Jellyby Ward?”
“I am. Yes.”
“But I didn’t fail to raise the alarm. I told you.”
“Unfortunately, you failed to formalise your concerns by putting them in writing. That…omission made it impossible for me to act – and may put you in breach of NMC rules.”
“Rub it in, why don’t you?” thinks Bel. “I already know it’s all my own stupid fault.” Then she remembers something. She says “What did you mean about a pattern emerging?”
“I mean a pattern of your failure to effectively manage patient dignity.”
“Sorry?” says Bel again.
Maggie Jones dons her glasses and turns to some paperwork on her desk.“This morning” she reads “a witness overheard you swearing at a confused elderly patient. The witness alleges that you  told a male patient it was all right for him to have a…ahem…to have a shit, to put it bluntly.”
Bel is stunned. “Yes I did say that” she says when she recovers herself “but only because all the polite words, all the euphemisms, didn’t get through to him. That word…was the word he had used himself, so I thought, even though it’s not exactly a nice word, he might respond to it. That’s why I said it. I didn’t use it abusively or anything.”
Maggie Jones considers. “You didn’t say ‘have a poo’” she says finally.
“Sorry?” says Bel, for the third time.
“You said you exhausted all the polite words, but you didn’t. The witness agrees that you instructed the patient to ‘use the toilet’ and ‘have his bowels open’ but you didn’t tell him to ‘have a poo’, which you could have used as an…intermediate escalation level. You went straight to the expletive.”
Bel leans back in her chair, trying to take this in. “Are you saying” she asks “that you are thinking of disciplining me because I didn’t use the word ‘poo’? What is this? The kindergarten? I can’t believe I’m hearing this!”
Maggie Jones sniffs. “Your failure to take this seriously isn’t helping you” she says. “You’ve crossed a line. You’ve done it once, so how do any of us know that you won’t do it again?
“Because I won’t!” says Bel “suddenly fearfully aware the Maggie Jones has already made up her mind. “I’m a professional! I used my professional judgement. I thought that’s what you employ me for!”
Maggie Jones places her papers in a folder. “Yes, well, we’ll have to agree to differ on that Belinda” she says crisply. “We shall be investigating both these incidents. I want you to put down in writing an account of your experience on Jellyby Ward, and also your version of the events of this morning, and I want you to do both before you go home.
“You’re giving me fifteen minutes!”
“You’d better get on with it then. Oh, and as of now, Student Nurse Coombes has been assigned a different mentor. You won’t be working with her again”.

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