– That people die is common in a hospital. But that they die because you don’t have time to do your job or are somewhere else, that’s the big fear, says Erik Engebretsen. He is a senior physician in orthopedics at Akershus University Hospital (Ahus). And was until the new year a trustee for the newest doctors in the department. They have the toughest rotation. Alone on duty Because it is the LIS3 doctors who take night shifts. Six nights a week they are alone on duty. In a hospital that covers an area of around 600,000 people. There are also nurses on duty at night. But only one orthopedist. – Who is responsible for the emergency department, the children’s department, all orthopedic patients at the house, says Engebretsen. If the acutely injured following an accident comes in at the same time as seriously ill inpatients need supervision, the doctor must choose who has to wait. Senior doctor Erik Engebretsen believes that the workload of orthopedists is too high. – There are good people who do the best they can, but they cannot be in four places at the same time. Photo: Erlend Dalhaug Daae / Erlend Dalhaug Daae Hoping to be hit Now he and safety representative Sverre Mjønes feel compelled to notify the working conditions. Also outside the hospital walls. – We have taken this to the highest level at the hospital, says Mjønes. A tip that a colleague was on sick leave due to work pressure led them to ask doctors on the night shift to talk about everyday life. Erik Engebretsen (left) and Sverre Mjønes now choose to speak out about the working conditions for the orthopedists at Ahus. Photo: Erlend Dalhaug Daae / news The answers they received shocked them. Doctors who cry at work. Who has a stomach ache on the way home. Doctors hoping for communicable disease to release guards. – One doctor is hoping for a small car accident before night shift to have a good excuse not to come to work, says safety representative Mjønes. news has seen anonymized extracts from the e-mails: Operation without preparation “Could quite often be called to the operating room for a sterile-covered, anesthetized patient, without having had any time to prepare or read myself, in order to operate on an unknown patient since the others were busy with other operations.”Wanted to be hit”I have many times perhaps not quite seriously wanted to be slightly hit on the way to work, just badly injured, enough to be gone with an okay excuse for a little while.. .”19 hours without rest”I have realized that for a large part of 19-hour shifts you are actually required to have a 3-hour rest period, and I can’t remember having that once during my nights, at least in the last year.”Would have venereal disease “Before the night shifts or weekends where a medical student has to replace one of us in the emergency department, I have wished every day that I got venereal disease so that I would escape…”Hope no one has died”There is so much conflict of simultaneity and places you should have been at once, that it is n Estonia impossible to have any kind of overview. […] Those guards are so intense that you cross your fingers and toes that no one has died.”Stomach ache”Stomach ache on the way to duty and get into the car after duty with a stomach ache because you are afraid you have missed something in messed up or did something wrong. […]I’m really afraid that something will go really wrong. Seen from a patient safety perspective, I don’t think it’s good.”Wait for hours”Due to a concurrency conflict, an elderly patient with head trauma was left in reception for a long time before being examined by a doctor. […] It feels really uncomfortable to know that the patient has been in reception for what I remember as several hours before bleeding was detected and was transferred” – Every single one of those e-mails can be seen as a serious notification case, says Engebretsen. – It is extremely painful reading. The hospital is also visible. – We can’t have it like that, says director Inge Skråmm for the orthopedic department. See more of the hospital’s response at the bottom of the case. Patients in the corridor The problem is simple, according to the supervisors: Too few people at work. Too many people who need help. The department for orthopedics has 71 beds. Generally, there are far more patients, according to Mjønes. Protection officer Sverre Mjønes walks past a bed in the hallway. There are many corridor patients at Akershus University Hospital (Ahus). Erlend Dalhaug Daae / news A new “record” was set earlier this winter. At the time, over 140 orthopedic patients were admitted at the same time. Almost twice as many as they have beds for. That means patients in the hallway. And spread across other departments. Not easy to keep track of the only doctor on night duty. The shift is also very long: The orthopedist’s night shift at Ahus The night shift orthopedist is on duty. In the first hours, it overlaps with other shifts. There are four orthopedists part of the evening, and two orthopedists on duty until 11:00 p.m. at weekends, half an hour later on weekdays. From 11:30 p.m., the night shift is alone at work as an orthopedist for the rest of the night. By then the shift has already lasted eight hours. At 07:30 the morning shifts come to work. Then the night orthopedist has been alone on duty for eight hours. In total, the shift has now lasted 16 hours. The last couple of hours of the shift are, among other things, a morning meeting. Not until 09:30 is the shift over. Then the orthopedist has been at work for 18 hours. Show more On such long shifts, you are actually entitled to three hours of rest time. “Most nights, the guard bed is more or less unused,” says one of the e-mails the welfare representative has received. – I think that on most shifts it’s like that you don’t have time to sleep. And on very many shifts you hardly have time to rest at all, says Mjønes. Heart attack and blood clots Ahus has always only had one orthopedist on night duty. But something has happened in recent years. The patients admitted are sicker than before. Several are older. – And there are many of them, says Engebretsen. Operations are only a small part of everyday life in the orthopedic department. Fortunately, it rarely happens that they have to be performed at night, when there is only one orthopedist at work. Photo: Erlend Dalhaug Daae / news When someone is admitted to the orthopedic department, the doctors there are the first line. No matter what happens: Patients can have heart attacks, blood clots or pneumonia. The two senior doctors believe that the strain on orthopedists is taking a toll on their health: – We are genuinely concerned about both the mental and physical health of our colleagues, says Engebretsen. Want to double night shifts Mjønes and Engebretsen believe staffing must be doubled at night. That is also the goal of the hospital, according to department director Inge Skråmm. He emphasizes that today’s staffing is sound. – But it is not desirable to continue to have it like this. Director Inge Skråmm at the orthopedic department at Ahus says the feedback from the doctors is worrying. Photo: Erlend Dalhaug Daae / news They have taken some measures: Two night shifts on Mondays, compared to one previously. So that only six out of seven nights is the night watchman alone. More employees in the evenings on weekdays. – It is something we will continue with, until we reach the goal of doubling the entire shift, says Skråmm. To achieve that, they need four new doctors. It costs approx. 10 million. – It requires more resources, and we need to work more on that. – Do you simply get too little money to run the hospital? – Now we have NOK 14 billion to run a hospital, but I don’t think we can find a single health manager who says he has enough. Hello! 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– One doctor is hoping for a car accident to avoid night duty – news Oslo og Viken – Local news, TV and radio
