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The EWTD rules for doctors in training from August 2004 state that
the maximum shift length is 13 hours with 11 hours minimum uninterrupted
rest and a maximum working week of 58 hours.
Previously we had large numbers of doctors 'resident on call' working
up to 72 hours a week. This can no longer be the case as 2 separate
rulings by the European court have ruled that all time spent in
the hospital has to be treated as working time. Since there are
in effect fewer numbers of junior doctors around we have had to
look at alternative means of delivering care. At GSTT we have introduced
the Hospital at Night Team concept; this strengthens the team approach
to care by promoting the responsibility for all patients based on
competence and skills and not on the specialty of the doctor or
nurse.
The Site Nurse Practitioners are the leaders of the Hospital at
Night teams. They are highly experience nurses who have a key clinical
and managerial role for the hospital throughout the 24 hour period.
Additionally they coordinate the clinical handovers with the Hospital
at Night teams on both sites at 8am and 8.30pm. This ensures that
the HAN team are aware of the sickest patients in the hospital and
enables them to plan the priorities for review from the very beginning
of each shift.
The ward nurses are key players in the hospital at night. They
need to have the clinical skills to be able to support the HAN team
and undertake extra roles to ensure continuity of high quality care
for our patients.
The Heads Of Nuring/Midwifery and ward sisters and ward nurses have
identified the gaps in skills knowledge prior to August 1st and
have made a concerted effort to get the nurses skilled up in Venepuncture
and Cannulation, Male Catheterisation and ECG Rhythm recognition.
This will be part of an ongoing process of identifying the skills
that patients require and matching that with the competences that
individuals have not necessarily based on the job title of either
doctor or nurse.
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