Final Report > Chapter 9: The Paediatric Cardiac Surgical Service in Bristol > The paediatric cardiac surgical service in Bristol > Nursing care at the BRI
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Nursing care at the BRI
23 There was a national shortage of RSCNs [17] during the late 1980s and early 1990s. There were only two RSCNs who worked at the BRI in Wards 5A and 5B.
24 From April 1992, Ms Catherine Warren, who had trained as an RSCN while at the BRI, rotated between Wards 5A and 5B on those days when children underwent surgery. Otherwise, she worked in the nursery with the other RCSN, caring for children pre- and post-operatively. [18]
In the operating theatres
25 The nurses in the operating theatres were Registered General Nurses (RGN) or State Enrolled Nurses (SEN). In 1994 it was decided to create two distinct groups: anaesthetic nurses and scrub nurses. The aim was to provide continuity by ensuring that the anaesthetists were working with the same staff. [19] Prior to this the staff were multi-skilled and worked both as scrub nurses and in the anaesthetic room. [20]
26 The nursing team for each operating theatre ordinarily comprised an anaesthetic nurse assistant, a scrub nurse and a circulating nurse. In addition there would be an allocated sister-in-charge who would not be supernumerary and would often have an active role in the theatre. [21]
27 Staff numbers were decided by the theatre manager in accordance with the guidelines of the National Association of Theatre Nurses. [22] In 1984 there were approximately 11 nursing staff who covered the three Level 4 operating theatres of the BRI. [23] After the expansion of cardiac care in 1988, staff numbers increased, although Ms Kay Armstrong, then a theatre sister, stated that ` ... it was very hard to find out from management what our staffing allocation should have been.' [24]
28 Ms Armstrong commented that: `The sisters were responsible for the day-to-day running of the theatres but did not hold the budget or have any control over the staff numbers allocated to each theatre. This was very frustrating as we were frequently understaffed without the power to do anything about it.' [25]
In the ICU
29 The Intensive Care Society was of the opinion that, in relation to paediatric intensive care during the period covered by our terms of reference, it was `essential' that `a senior nurse with several years experience of paediatric intensive care [be] in charge of the unit ... a minimum of one trained nurse to one patient is usually required throughout the entire 24 hour period.' [26] This meant that the establishment at the bedside should be 6.4 whole-time equivalents per patient per 24 hour period. This 6.4 to 1 ratio was endorsed by the Paediatric Intensive Care Society. [27]
30 Despite national staffing shortages, Julia Thomas, Sister in charge of cardiac surgery ICU 1982-1988 and Clinical Nurse Manager of the Cardiac Unit 1988-1992, told us that the staffing level was 5.4 whole-time equivalent per bed, reflecting the case mix of adults and children being cared for.
31 Fiona Thomas, Clinical Nurse Manager of Cardiac Surgery between 1993 and 1996, told us that when she took over in 1993 the whole-time equivalent nursing ratio for the whole ICU was `about 5.4 full-time equivalent per intensive care bed.' [28]
32 The evidence which we received was that it was common for there not to be an RSCN on duty in the ICU at the BRI, [29] and that it was `extremely uncommon' for there not to be a skilled ICU nurse above E Grade level with considerable experience caring for children in this setting. [30]
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Footnotes
[17] Registered Sick Children's Nurse (RSCN), formerly part 8 of the UKCC register. Following the implementation of Project 2000, nurses educated in the care of sick children are registered as `R.N. Child', now part 15 of the register
[18] WIT 0114 0012 and T32 p.76 Fiona Thomas
[19] Ms Armstrong enrolled on the anaesthetic course in 1993 in preparation for this split
[20] WIT 0132 0006 Ms Armstrong
[21] WIT 0132 0041 Ms Armstrong
[22] WIT 0132 0011 Ms Armstrong
[23] WIT 0132 0002 Ms Armstrong
[24] WIT 0132 0003 Ms Armstrong
[25] WIT 0132 0003 Ms Armstrong