May 17, 2011 (Tuesday) - Night Work: 2011-Style

The first night shift I ever did was Wednesday 14 August 1985. Back then we had very strict instructions as to what work we could and couldn’t do during night shifts when there was only one person in the lab. That night I was called into the lab on four separate occasions. I did three emergency crossmatches, seven emergency blood counts, one emergency clotting screen, and I was finished and in bed by 12.30am.

Nowadays we have very different instructions as to what work we can and can’t do during night shifts when there is one person in the lab. Our instructions are that we do absolutely bloody everything and anything. And between the emergency work we do the routine work. And when that’s done we do the admin.

So last night I went into work at the start of my shift at 7.45pm. I worked constantly until I made a conscious decision to stop. At that point (at 2.30am) I walked out for a cup of coffee (leaving chaos and mayhem for ten minutes), and I finally got myself straight at 5.30am. During that time I did not stop at all. To be honest I didn’t stop after 5.30am either, but from 5.30am onwards I had a sense of being in control; that had been lacking earlier.

During that time I did (about) eighty urgent blood counts, forty urgent coagulation investigations and one malarial screening. I did clerical data entry work on several hundred requests, and once the data entry was done I started on the routine work. I went through (about) one thousand routine blood counts, several hundred ESRs (I lost count), and screened about seventy five blood films. And I then produced hard copy reports on all the work that I’d done.

I then set up and performed daily maintenance on eight assorted analysers, and did the daily chuck-out, produced and circulated the minutes of the staff meeting, and reviewed one of my student’s homework.

And seeing how it was me on last night, someone else did all the blood transfusion work. Heaven only knows how anyone could do both the haematology and the blood transfusion.

And from a purely mercenary point of view, the change in the rate of remuneration over the years is interesting. In August 1985 I was paid (about) ten hours money for the night work I did then. Last night I got four hours extra money, but was graciously allowed to take the day off either side of the night as paid leave.

But this isn’t just a rant about how crappy my night shift was. This is CPD – intended to “contribute to the quality of the author's practice and service delivery” and to “benefit the author's service users”

Having had to get off my butt and do some work (for a change), I’d like to reflect on night work. How can we change practice to benefit the service users. I am well aware that some of my turnaround times for the urgent work last night weren’t quite what they might have been.

Back in 1985 the system was hopelessly wrong; blood counts would only be done under conditions agreed by consultant medical staff, and requests were often vetted by senior medics. Which was no help to the junior medics who needed the guidance that a blood test can give.

Is the system any better today? Clearly not. Having removed any restriction on what blood tests can be done at night has led to staff being swamped with an unmanageable workload.

So what is the answer? Back to a system in which blood tests are performed under only certain circumstances? More staff to cope with the workload? Not doing one thousand routine blood counts single handed?

I don’t know what the answer is, but I do know what the answer isn’t….