Students Guide to Acute Inpatient Wards

I’m almost certain something like this has been done before, but I can’t be bothered to trawl through the archives to check. So, here are a few of my thoughts on coming to the end of a placement on an acute ward.

Firstly, I want to point out that I appear to have found the most undersubscribed acute ward in possibly the entire history of mental health. In my entire time there, it has never been full and has been running at about 60% occupancy much of the time. I can almost hear some acute nurses weeping into their cans of Red Bull at the thought of this, but anyway, I’ve almost certainly had it easy and it’s still been a massive eye-opener. It has been the placement I’ve learnt the most from, and if it didn’t have the potential to hold 21 patients (and a completely psychotic ward manager) then I would be begging for a job there when I qualify. Personally, I think 9 patients is a nice number for an acute ward. Y’know, so you actually have time to speak to some of them on a daily basis.

So, some things to know (as based on my very limited experience):

1. Most acute wards are open, with informal patients free to come and go. Huh? What locked door? Oh, that. Don’t worry about that. That’s to keep undesirables out. Y’know, like drunks and PD’s*.

2. Know where the kettle is and where the biscuits are kept. This is probably what will keep you going through a shift, since you won’t get a break. Failing that, be prepared to steal regenerated crap off the trolley at lunch time and scoff it whilst standing in the kitchen in between phone calls.

3. It is very, very important to learn which ones are patients and which are staff ASAP. Attempting to give a member of staff meds will get one of several reactions; they’ll give you a bollocking, take the piss, or take the meds. Similarly, telling the ward manager she needs an escort to take her out for a fag is often met with unpleasant consequences.

4. If you do make a mistake, own up immediately. Yes, having to phone on-call doctors and managers is humiliating. But not as humiliating as getting caught covering your ass and getting struck off the register before you’re even on it.

5. Don’t let the nurses take the piss. When they tell you to ask the 6’2”, newly admitted, agitated schizophrenic who’s sat on his bed smoking to please put the fag out, insist on taking backup. There’s confidence, and then there’s stupidity. There’s also a reason they’re getting the student to do it, and it’s called self-preservation.

6. You will almost certainly get a complaint made about you at some point. Pray it’s of the “X cut off my arm whilst I was asleep” variety and not something remotely believable. Regardless of how ridiculous it is however, it will still be investigated. You single-handedly threw a patient out of a 4^th floor window? Someone from PAL’s will be round to grill you for an hour about it while you gently smack your head off the wall.

7. However, the patients will largely be the least of your problems. Family politics are a complete minefield; in the same day you will be both a saviour and a bastard for keeping their loved one inside. Fair enough, it’s a stressful time. In the families opinion, the patient will always be taking too much or too little medication. They’re not always wrong, but being shouted at by a small but vicious 80 year old woman who thinks her daughter needs MORE DRUGS does make you wonder what you’ve signed up for. Frankly, I do believe medication should be a family affair. In fact, medicate the lot of ‘em. Lorazepam for all

8. Coming in a close second to family members in the making-you-want-to-cry stakes are the doctors. Some are really, really excellent and should frankly be worshipped. Some make you want to bludgeon them with, say, a patients dismembered arm. They are skittish creatures; if they do venture onto the ward keep them there with cups of coffee and biscuits until they have written down everything you’ve told them to. Then try not to be surprised when they refuse to discharge a stable patient because they are scared of getting a complaint from the poor sods family. Some however are just in league with Satan, and will do the exact opposite of whatever you suggest because you are a nurse and they are The Consultant. Quite rare these days I believe, but still about.

Of course, this stuff isn’t confined to acute wards by any means, but the nature of the work means that everything is just more intense. The high level of patient turnover means you spend half your time reading incomplete risk assessments off the electronic records system and trying to remember which one Janet is.

Having said all this, I have loved the placement. Coming from long stay rehab wards, it has been very nice to see people actually get better. I’ve seen people come off their meds, get very ill very quickly (e.g. trying to climb up the wall to get to the sky) and then within a week of admission be well enough to be discharged. I like discharging people. It feels nice.

*That’s a joke, of course. They will often let you back on if you come back drunk.