Heartbeat: Our Hospital at night is all about patient care

August 1, 2019

As darkness falls and the sound of sirens fade, there are still some of our colleagues whose work continues. That is especially so for the out-of-hours team working across Sandwell and City Hospitals.

Running the “hospital at night” service is Matron Rebecca Bloore, who served as a clinical nurse practitioner (CNP) for nine years with the team, before landing her current role as matron for the service.

There are 16 CNPs and they can deal with anything from deteriorating patients to major incidents, a recent example of this is when the IT system failed. Becky, as she is known, says: “It’s a varied job and you are faced with many different scenarios on a day-to-day basis. We’ve been through a lot of changes and we are now relaunching the service.”

The service is the first line of contact for the wards during out-of-hours. Becky explains: “Unwell patients are referred to us via the hospital at night system from clinical teams working during the day. This is discussed at a 9pm meeting which is held every night. During weekends and Bank Holidays, this meeting takes place at 9am in the ED seminar room and is chaired by the CNP.

“The emergency medicine response team (EMRT) also attend these meetings where they flag up their roles for that evening. They will discuss any patients that may have required the EMRT during the day. We go on to discuss the patients referred to the hospital at night service and their care pathway for that night. We cover all specialities, although patients from the medical wards are predominantly cared for by the CNP out-of-hours team.”

Becky explains further: “At Sandwell, the medical wards would be OPAU, the fourth and fifth floor wards, whilst at City, this would be D5, 7, 11, 15 16, and 26. On average we could be looking after around one to seven patients per hospital site. Plus any other patient referred to us during our shifts.

“These are patients who maybe haemodynamically unstable or have other clinical concerns. We are there to make sure they are stable or their condition doesn’t deteriorate. Our role is to ensure they are seen by the right person, at the right time and given the right treatment.”

The role of the CNP doesn’t stop there.

“While we are on the wards we look to encourage and support the teams. This is achieved through discussing patient conditions and working through treatment plans or assisting nurses with competency sign off for skills such as cannulation,” adds Becky. “It’s about the learning and development offered out-of-hours.”

Shift patterns vary from a 5.30pm to 6am (a twilight shift) or the traditional night shift, which, for the team, starts at 6.45pm and runs until 7.15pm. During weekends they will also work 6.45am to 7.15pm.

There are two members of the team per site – one takes the clinical role, whilst the other takes on the role of site manager. At Sandwell they are based in the Bryan Knight Suite, whilst at City, they are at D18.

The site management role sees Becky or one of her team members take over from colleagues within Capacity at 7.15pm, where during a 10 to 15 minute meeting, a handover occurs.

“It is about looking after the entire site,” says Becky. “We deal with capacity and flow, troubleshoot and offer solutions to any issues that arise.  We are also there to support our colleagues in ED and beyond.

“At the end of the day, it is about patient safety and making sure they receive the right treatment.

“We are there to also deal with a multitude of tasks such as complaints and staffing issues too. The CNP team are responsible for the safety of the site and at times it can mean having to move colleagues between wards or cross-site if there is a shortage.”

With the relaunch also comes a new look. The team will soon be wearing new and more distinctive uniforms.

“Previously we used to wear scrubs which I think was received well,” says Becky. “Now we are in tunics and so sometimes colleagues will not realise that we are in a clinical role.  We are in a position to move forward and we are very positive that the new uniforms will make us stand out.

“It’s an exciting time for the Clinical Nurse Practitioner out-of-hours team. We strive for high quality care for our service users and we want to make sure that our colleagues are aware of the service we provide.”