Just an observation

I was out walking the other day when I happed to take a photo of the building above. While it is now a private house, the lettering on the side reads “Miners Accident Hospital, 1883”. Two things immediately struck me. One was the thought involving the NHS, and tunnelling out from the financial crisis (it’s be 2 year FFS!).

The other was how while we in the NHS are told that the idea of there being specialist hospitals that will be designed to provide care in the community as if this was a new and innovative idea, here was an example of this from 1883. You can almost imagine a person having a broken leg outside the gates whit the matron walking out and saying “You broken your leg?”
Person: “Yes”
Matron: “You a miner?”
Person: “No”
Matron: “Oh, well bugger off then!”.

My 2007

This is the end of the year and the end of my time as a student is drawing near. It will be another 29 days until I will be officially finished as a student Nurse (in case any of you were ever bothered I was/am a student at the University of Teesside, Middlesbrough). So, given that not only is this the end of the time as a student, I am also at the end of the year 2007. So, what was 2007 for me?

January
Nothing remarkable for the first half of the year as the first week was spent on annual leave. The second week was the return to the final placement of second year (Critical care placement) in the ICU. The week was spent with patients on my three shifts (though I cannot recall much now what happened). The week after was my final tripartite for second year. This I passed, I remember being very nervous about the second year one, and was sent out to a cardiac arrest in the hospital with the arrest team and thought that was less nerve racking. The 2 weeks after was on my elective with the North East Ambulance Service NHS trust. That was enjoyable.

February
The first 2 weeks were study time and I prepared my portfolio. They went in on the 19th and I started 3rd year. This was a time when the attitude changed with the university toward the student groups (from “oh, don’t worry you are only a student” to “Right, your managing bays and other students when you go out next”). It sowed and I remember I ended up being late two days thanks to traffic (some did not even make it in to university). I met my girlfriend this month.

March.
The portfolio passed this month. Not a lot to report for March.

April.
The semester continued with the addition of the independent learning module coming online. There was no a lot to recall, I did have a weekend in York with my other half, and records suggest I had the blog by now.

May
I was asked to hand in an essay and this was worked on while I queried the MITS which had been applied for. This was met with a stern look and a mark of 30. That was not good. Some of the modules drew to a close as the final seminars were had.

June.
I was kicked off the course due to the 30 mark for the essay from second year. Thankfully, I still had some old paperwork and approached the student union with a view to appealing against the decision. It was agreed that I had a case and the assessment review was put in. I immediately started looking for work and was accepted for employment in a call centre. I also joined St John Ambulance.

July
Back on the course on the 3rd. I got the letter which while written on the 3rd only reached me on the day I was being asked to go into the university to meet with the pathway leader and 3rd year module leader. This went OK and I agreed the date’s to submit essays (3rd August). The essays were worked on, till one module asked for submission on the 3rd which was not originally intended. This took some sorting out.
August

A new placement was on the infections disease and diabetes ward. This is well document on the blog.

September
The placement was worked through and the essays all passed. One later needed re-submission though this was the one which I was asked to write in less then a week.

October.
The internship placement began in a old division. I did get a bit downhearted by this at first by slowly it did get better

November
The tripartite and nights dominated this month

December
The application for jobs started in earnest this month as did attending st john ambulance duties having passed the members first aid course.

My return

Hi! Been away for a bit. It has been a combination of being tired, being away with my other half's house, and having the internet connection go down.

Well, what have I been up to. Well, lets start with the post I wrote for the last shift I was to write about:
My rapid reaction

The day began with me working ona new bay area with a different nurse to usual. The patients were OK. Two of them barly had time for me to say "Hi" before the theatre porters turned up and whisked them away to theatre for surgery. At 07:40, they really were early! That left me with one patient who was re-admitted afew weeks ago, one who I recall being verbally abusive one night to me, two post op patients and three patients in the bay next door. I began with the medications round. There was noting to remake for the first hours save for an early ECG on one of the aformentioned three who was feeling a bit unwell. Nothing showed on the ECG, and to be honest they were feeling OK by the time I had got the ECG monitor (which was about 5 minutes altold). There was a break taken (which is when I usually have my breakfast on a morning- porridge oats to keep me going through the day).

Shortly after making the beds, the bey was given a new admit. The patient as OK at first, and was seen by the doctors on the ward round. I had been in with another patient (can't recall now what it was), when I did my check of my patients. The new admit was looking a bit off colour (pale) and was was sweating and felt feaverish. I went and grabbed an ob's machine, and put on a pair of gloves. I was glad I donned the gloves. While there was a nomal temp, the blood pressure was below 60mmHg systolic! No wonder they felt unwell! Now, as I was in a bit of a hurry, I did the ambulance service trick of scribbeling patients obs onto the gloves (with the time noted as well!). I then went direct to the nurses station where my staff nurse and a senior nursing sister were going through some documents. I said interuppting them "Can you help me with the new admit. They are not well, BP [less then 60mmHg], Pulse is [reading] and resps are [elevated figure] (n.b. actual figures witheld for confidentiality- this is my musing on what I was doing after all!). Anyway, the on call registrar (or whatever they call them this week SpR, ST1, FTSTA3, GHTYS, RHAY4, XIOTI, OR ZYZZYX).
Anywho, the patient was sent back to the department. It was during this time where I did several things I was happy with. 1) Taking an accurate manual BP, and 2) being able to talk to and reassure the patients relative and explain to them what was happening to the patient at the bedside.

Anywho, that aside there has been over two weeks in which I have passed two essays and I worked with the ward sister who was very happy with my work, got sent home off one shift last week for having a massive coughing fit less then 5 minutes after arriving on the ward (bit annoying as it takes me over an hour to get in first thing in the morning!) and have now finished for the festive period.

At the moment I am applying for jobs in my local area in the fading hope I may actually get a job. Not that that is exactly something I personally feel positive about. I have been thinking about the armed forces perhaps, though the Navy require 2 years post reg, the army and RAF are a bit less strict though not sure whether they are more after part-time postings. Oh well.

My Final Tripartite (The End: Part 2)

I had about 2 hours sleep last night. To say that things were playing on my mind is a bit of an understatement. On waking at 5:30 and going into work, the ward was found to be full. I was allocated back to my usually area of patients. There was one new one who was a medical sleep out, and one patient to write the Nursing Discharge letter for as they were to go to a community hospital. That was written out and several ECG cards and phone Call's made before I set off to make the beds with a HCA.

That done, the ward settled down to being a day where there were small obs occupying my time. This went on clear up until 3:30pm which was the time for my final tripartite meeting. The meeting went well. The net result is that I have now passed all the third year competencies and therefore I have passed my Internship placement and have now to submit the Portfolio and the essay to the University on Monday for marking. Following this, I must eak out 4 weeks of service before returning for consolidation week to the university.

My baited breath

I am still obsessing over the tripartite to be held Wednesday. Being on the ward is doing little to calm my nerves either, and I am getting palpitations thinking about it. Today began with there being a staff nurse short so for a few hours there was a team of patients who was split between two staff nurses so there were 12 patients to each staff nurse (eek!). Fortunately one of the senior sisters from next door was on an office day and was free to come around to take the team for the afternoon. My patients was quiet with one who went to theatre and then required post op observations to be done in the afternoon which were unremarkable. This was along with one patient with chest pain (ECG was NAD).

I mentioned to my patients that I have the tripartite on Wednesday. They all gave me a vote of confidence and said they were more then happy with my care. Its something I suppose

The end (Part 1)

I am a tad nervous at the moment. Ok, that's a bit of an understatement. "Absolutely bloody terrified" is strolling over in the right direction. At this moment in time I am passing by the scary house, around cape fear and into the calm lagoon of sheer terror.

Because this is the beginning of the end. Yes, on Wednesday, I am facing one of the biggest tests of my life so far. Namely, the final tripartite meeting of the internship. This is it. The big one. The terminal end of the Nursing course. In the meeting, I have to present evidence of Manual Handling, CPR, Venous Cannulation, Male Catheterisation, Venepuncture, IV drug administration, Fire lecture and so fourth. I am also required to pass 17 competencies and benchmarks as laid down by the University in conjunction of the NMC. I then need to submit with the portfolio, 2 learning contracts and a SWOT analysis (already done), a medicine log and all dialogue sheets. This is a daunting prospect. I mean, heck all final tripartites are bloody awful, but this is the daddy of them all. I can only hope my 4000 word essay on an reflective account of an episode of care nets a good result. I have gone from being the bottom of the nursing post as a first year and have climbed up the mountain which is Nurse training and I am now in the rarefied atmosphere of the summit.

Wish me luck!

My night watch

I came on duty to find a hectic ward. There were several staff hurrying about and there was near non stops buzz of phone calls being received. There were several INR’s causing problems from patients who had been discharged a few days ago and there were a long list of jobs for the SHO to do. It was quite clear that while there was still the day SHO on duty that this was going to be left to the night staff to sort out, and thus at handover time the long list was handed over. There were several patients who required there to be blood samples taken by the doctor as there were some patients who it had been near impossible to get anything from. I was allocated initially to the taking of observations. This is a new one for the night shift as before only the ill patient’s had their baseline observations done in the evening but now this is for all patients. There were some very odd readings on the charts, though these were more a case of a normal abnormal reading if that makes sense. Moving on from the observations I was on the medication round and there was little to note from that barring two patients who were waiting for the INR to be prescribed and one who was going to have to wait until near midnight for there to be Aspirin given.

There was a new admission from A&E who had a high blood pressure, and so these were done manually as the machines had been playing up on the ward and were next to useless. I was then asked to do an ECG on the post PCI patient and that was done with out too much issue. On returning back down the ward to the nurse’s station, one of the patients had taken a coughing fit. The staff nurse then gave them simple linctus which did the job of sorting the cough for a little while. It was a short while later when the coughing returned that there was some bright red vomit brought up by the patient. There was initially some concern of this, until it was realised that this was most likely to be the red cough mixture. The patient then presented with some diarrhoea, which was put down to there being several days worth of laxative treatment rather then there being something nasty as the root of the problem (i.e. C Diff). The patient with the high BP was checked again on both arms which showed there to be a high BP still running. The on call medical registrar arrived on the ward and this was checked again (there was about an hour in the intervening period in which I was sat writing out an essay and cracking on with portfolio work between shouts to the buzzer for commodes and checking patients). I was about to leave when the patient told me that they had been in hospital before and were reluctant to have said anything about the high BP which has brought them into hospital. I immediately stopped packing my sphyg away and sat down and asked them what was the matter. The said that they were unsure about what was happening and how long their stay in hospital would be. I explained what hypertension is, and that there was going to be an ECG and a blood test done in the morning on them, and what that was going to entail. They thanked me for taking the time so sit and explain to them what was going on. It is these small moments that really make you have a nice warm feeling inside, when you walk away thinking “I really made a difference there to how that patient feels”.

Remembrance Sunday

Today, it being the 11th, was the annual Remembrance day. I was out this morning with St John Ambulance and was in the parade down the division's town high street to the Church.
It was freezing cold (and raining for the first 5 minutes) but that's not exactly bad considering the fact we were there to remember people who have been killed in conflict. Was in the church service, and frankly was glad that there were other people around to drown out how bad I probably sounded (though thankfully I can not see Simon Cowel on X factor ever wishing to hear my and my regular crew mate's rendition of "Jerusalem").

My half and one

Why when is it that you do a half shift it seems to last just as long as a 12 hour shift. Never mind, Thursday was a relaxed day really with me taking my new patient from the day before to theatre and I am pleased to say they are making a good recovery. The ward has been quiet really, though I am not sure if there has been something put in the hospitals water supply as there has been a few short tempers on the ward (nothing affecting me but I have seen it). I would write out a report if there had been anything interesting happend but the past two days had only 3 things worthy of note.
1. One of my patient's left just before lunchtime yesterday. He still had not got back near 4pm.
2. The doctors have been really pissy lately
3. I was commended for using my initative by staff yeasterday over the prescription which wanted 1g asprin 4 times daily. It was for a condition which the Rheumatology department in my reconing would be able to help us with. I was nonplussed to recieve the reply of "I don't know" regarding the dose, though was a little bit better to be told my idea for the tables (3x 300mg asprin plus 1x 75mg tablet = 975mg was about the nearest we could get) was the same as what they did. The then took the slow route (checking the BNF) which concurred that for anti inflammitary properties 3.6g daily or more must be achieved for anti-inflammitary effects.

My Unnacceptable low

Having finally lost patience with the local public transport system, I took matter’s into my own hands and decided to get a bus at 05:45 from where I live and then walk the 40 odd minute journey to the hospital from the nearest point that I can reach. This worked and got me in reasonably early.

The day started off with a hectic play with the bed allocation as there was an acute shortage of beds compared to expected patients, and the unusual step was taken of having to cancel operations (first time that has occurred in a while). It meant that my mentor and I were unfortunately unable to really get to grip’s with our patients until gone 9am. I began by apologising to the patients for this delay (after all, it seemed the least I could do for them). When the medication rounds were out, there were some patients who were due for discharge and some that needed ECG and so I did that.

One frustrating thing was a patient who was awaiting the all clear to go by the doctor was kept waiting for a few hours while we were told "Will be there in 30 minutes" which went on for 2 and a half hours, only for another doctor to turn around and say "Just discharge them, they don't need anything as they are not on medications".
Following the discharges, no sooner was one bed ready then another patient was put in. I was able to get to grip’s with the patients admission, and secured some alternative dressings due to an allergy.
Today has been more fragmented then what it has been busy. That’s the way sometimes I guess. Though for some strange reason, I had the Knacks "My sharona" stuck in my head. Perhaps that was a warning, as line of "Come a little closer, close enough to look into my eye's sharona could comicially be substituted for "Keep back, at little bit, incase someone squirts gel in your eye's sharona", which was the rather comical (and eye stinging) accident today. So maybe I should call this "My industrial injury"?

My oddysee

Sunday's are a bit problematic for me to be on the ward on time for shift, as basically there is no connections to the hospital at that time of the morning. Being cold and knackered and having a 2 3/4 mile walk to reach the hospital was only improved by the rather pleasant leafy lanes which I took. There are many thing's which can be considered a quintessential "Englishness", and believe you me, a wooded road in Autumn is one of those things.

Anyway, when I arrived at the hospital and changed, I went onto the ward where there had been only a few starts made to the shift. I began with the medication round, which is one of the large task's which will dominate my life as a staff nurse Again, I was able to improve on the time to do the round, which was more because I was with the same patients again as I was on Saturday. Familiarity never bread indifference. I noted my chest drain patient was better, but also there was no Thoracic care plan in the file. I popped to the ward next door (who handle a higher proportion of these patients) and started them off on one. With all my patients up, we went down the ward and made the beds. I don't know what it s about Sunday's on ward's but there is almost a more social atmosphere about the place. Monday to Friday it's all busy, but there was a definite relaxed feel to the place.

The ease of a Sunday meant that when the co-ordinating Nurse for the day asked us to take our morning breaks, it was decided to go to the cafe and grab something to have rather then whatever we bring in. Nice.

On leaving about 20 minute's later (I love weekends) the patients had just finished tucking into their rather ample breakfasts, and so I got up to dare with the risk assessments. Then we dealt with a chest pain call out, which showed an ECG change. The on call doctor attended the patient, and we set up a GTN infusion. This is worthy of note as a GTN infusion can mean different things to different ward. The area I am in uses the GTN infusion at a rate of 3.8 ml's per hour (about 15mcg per minute) for the treatment of chest pain. However, some area's use this for the management of blood pressure (there are different rate's but 3.8ml tends to be the common one).

It was about this time I recall taking a call from a HCA who worked with us yesterday from next door. I was told that one of my patients who has deafness had a relative calling from abroad. It basically turned out that the only way from them to talk was to use a speaker phone. Despite the searching of the division for one, it seems that one thing we do not have was a phone like that. Thankfully the family brought one in and it was arranged for them to go into the sister's office to take the phone call.
One of my patients were for discharge, so I spend some of the morning doing the discharge paper's and the District Nurse referral's, which took me up to lunchtime. Following lunch, and the 2pm medication round, I went through the competencies with my mentor, which all are nearly passed (there are some which relate to skills which are impossible to pass on the ward at the moment).

During the course of the discussion, we touched on how there had been no patients with confusion or Short Term memory loss, and I had also thought that I had never seen any patients who share the same GP surgery as me. Guess what my new admission for the afternoon had and which GP surgery they were at? Anyway, after that admission, things became very quiet on the ward. Apart from my re-writing of the admission board (which looked very drab) nothng really of note happened untill I went of duty.

My best efforts

Today being a Saturday, there seemed to be a calm washing over the ward. Certainly, there was less of a rush and hustle and bustle as experienced during the week, chiefly due to there being no new admissions. My bay were quiet. I began by doing the medication round, and have to say that I was able to beat my last time of doing the round. It is a documented fact that new Nurse's tend to have medication time's of 40 odd minutes for the medicine round whereas seasoned Nurses have this down to about half that. It does take time (especially rummaging for tablet's in the rather untidy drug cupboard), taking the tablet's to the patient, checking date of birth and asking if the patient has any known allergies (the ward is a stickler for staff doing this, and given the few seconds this takes I suppose is worth it). This resulted in me doing a Dalteparin injection, and taking 25 minutes to do the round. One of my patients is a bit bed bound, so I did a full bed bath, change of gown, sheet's and a shave to have the hygiene needs met and the patient made comfortable to assist with breathing. The risk assessment's were next, and were completed and signed before I tidied the drug cupboard.

The morning soon wore on to a quiet afternoon with the odd nurse call shout to wheel patients on the commode's and a few phone calls to answer taking up most of my time. As there was another nurse who was after a bladder scan but was turning up blanks with a spare scanner from other wards, I phoned up my old placement area and was able to gain the use of one (quite literally as they knew and trusted me). That was a run there and back, and a rummage in the emergency drugs cupboard with a nurse who saw me making my way back (all this really is a drug cupboard with supplies of common drugs which may be needed for patients if pharmacy are shut).

After a few more shout's on the ward to patients, and the medications done twice more, the day drew to a close with me having taken the lead for this day with some quite good results.

My Challenge

Back on day's today. I entered the ward and was given a handover which was to indicate a discharge, a few post op patients and a few medical patent's to see to. The first event that took my attention was the two patients in the bay with D&V. Yes, it's outbreak time again! It was a relief that this seemed to be an isolated short episode so there was no need for a full scale lock down. The medication dispensing for the morning was done by yours truly (supervised) which went a bit quicker then the past weeks.

After making the bed's, checking some blood result's, I did a bed bath on a patient, which took me up to the time where I was invited to attend a hospital meeting (I'm going up in the world). It was the monthly meeting regarding mortality, so I am afraid that will have to be forever my little secret as that's confidential. All I can say is that it was a side that I have never seen before of the behind the scene's running of the division, and it was quite interesting to be in.

Comming back, one of the patient was needing a discharge letter doing (they had medication and the like sorted), though there was a shortage of SHO's as there was sickness with one being off. Now, at this point, I am sure some of you will be aware of the problems faced with job lossess is something that has bled over into medicine. Given the immense difficulty in the shortage of one SHO, how can a good standard of medical cover be given if there is a drive to reduce the number of doctors? I still firmly believe that MMC is the medical equivilant of the cut's in nursing post's which is being done to save the NHS money. Anyone with alternative evidence which opposes this, please leave comments.

Anyway, there was eventually (after having to appease a volunteer driver) the discharge letter done, and so I went into the bay, stripped the bed, then dressed a bleeding leg wound from a surgical patient, then on the asking of another staff nurse, asked one patient some qusetions for a dietician referral for my mentor. I really did feel sorry for my mentor today. She is a very experianced staff nurse, but one of the problems with today was that due to there being several accumilation of circumstances made, she was unable to stay with me all the time. This however meant that I was bale to assume a bit of observation on the patients and was taking some of the workload on (barring medication dispesing). The phone on the ward was none stop today. Due to there being calls from relative's who were asking about patients in other area's as there were some nurse's busy with different patients, I have been asking the nurse's if they are free how the patient are, and asking the patient themselfs. Normally as a student there is a great reluctance to take the phone (well, we were fed pleantly of horror stories back in first year on the introductory lecture on our first day in university, and during the law and ethic's module). Quite a step forward.

Did some post PCI ob's on another bay to help out as we wereshort this afternoon of a staff nurse. The afternoon was when I was at my most busy. After there were pacing wire's removed, I did the pbservations and the pre and post wire ECG's, had a run down to radiology for one patient (three journey's- one down with patient, one with medication and one to bring them back again with staff nurse).

Today has been the kind of day that a blue backsided fly would describe as being "a bit hectic". Which explains my 10 minute lunch and lost tea break.
Only another two shift's to go!

Politico's unspeak (or My head exploding 2)

If I end up writing in a very quick and typo filled manner please forgive me as I read this tripe on the number 10 webshite, and frankly my head is about to explode. So, rage factor 10, here we go... (itallics by the webshite, bold by Nursing Student, legal proceedings by some fancy arsed solicitor)
A fuckwit says:
The Government believe nurse leaders should have the freedom to determine their own staffing ratios according to local conditions. They are best placed to make decisions based on many complex factors, not the least of which is that health care today is a team-based activity, and patients are best served when the staff involved in their care work together to meet their needs.
Well, you cuntimint, if that is your view, then why in the name of steam powered buggery did you take this power away from the ward managers and leave it so that there is a staffing decided on not by the ward manager but by a computerised programme that refuses to consider maternity leave, sickness and calculate 2% level for staffing eh? The nurse on the ward is the one who knows how many staff are needed, no bugger else matey boy. Why do you try and fob off what was a damn good idea by posting a response which is in direct conflict with the current front line situation? Is it due to the sheer ineptitude of the Nursing profession, or more to do with a government that would have us believe that video piracy is the sole cause of terrorism, and not a short sighted and badly misguided foreign policy?

The Government's view is that imposing minimal levels for nursing staff to patient ratios could be detrimental to patient care. The number of staff at any one time will vary according to skill mix, clinical practice and local factors. Furthermore, the introduction of any minimal level may be seen as being the norm, with NHS Trusts no longer aiming for an optimal level.
Wrong again fuckface! The current trend is for there to be unsafe ratio's of nurse:patients and this is harming the patients. There is no evidence to back your claims. In fact, current best evidence suggests there are better patient outcomes with set nurse patient ratio's. Oh, and before you pull a fast one, you slimy lot will not be pulling the wool over my eye's with these ratio's either. I have seen how there have been critical care bed's with their enforced ratio's closed because of there being a cut in nursing post's, so don't think for one minute you would get away with that. I've got my eye on you sunshine. As for skill mix, what bloody mix of skills? You have robbed nurse's of job's and made an under staffed, low moral militant workforce. Nice job, dickhead!

Workforce planning is a matter for local determination as local workforce planners are best placed to asses the health care needs of their local population. The Department of Health continues to ensure that frameworks are in place to enable effective local workforce planning.
Bullshit you have culled nurse's back to the bone nationally. The only frameworks which are there is to have a way of the top echelon's of NHS management being able to blame front line staff for your screw-up's!

Since 1997, the NHS has seen record levels of investment - from £34.7billion in 1997/98 to over £90billion in 2007/08 to £110billion by 2010/11 - and a period of significant expansion in the workforce. The number of qualified nurses, midwives and health visitors has increased by almost 80,000 to over 398,000 in England. The last few years has seen more nurses working in the NHS than ever before.
Which sodding planet are you on pal? Take a look out the window and look at the real world. The figure's you suggest while being a nice arbatory figure are a great work of fiction as the only finance that matters is the ruddy black hole the size of Belgium which has been created. As for the record numbers, there are now less nurse's on the front line, and new graduating nurse's being left on the unemployment scrapheap. Take a look around you, and if you try and say that anything I have just said is rubbish, then I will call you the biggest egotist that ever bleeding well lived.

This unprecedented growth in the workforce has been the key to driving down waiting times and improving the delivery of treatment and care across the NHS.
No, your misguided and dangerous obsession with target's have lead to what amount's to a STATISTICAL reduction in times, though as a great man one said "Statistic's are like bikini's. It's not what they reveal what is important, more what they cover up".

Why I want to shoot the legal eagle

NSM's mate was not hurt in the making of this poster, and incase you want to know, it was supposed to look like he had fallen down stairs, not passed out drunk... there again though knowing him.
I have been thinking about litigation recently. No, I am not getting sued (yet!) but there have been two insurance claims which got me thinking about this. The first involves my now elderly grandparents. Last year, they were run over by a car. They were not seriously hurt but enough to warrant a few days in hospital and some light treatment. Anyway, they have still yet to here anything off the various departments they went through to finally finish everything. The second is one of my oldest mates (in terms of how long I know him, not his age). A few months back, he was driving home from work when he crested a brow of a steep humped bridge and to his consternation saw a Mazda sports car which had suddenly braked in front of him. He was doing about 20-25mph when he did an emergency brake. He was still braking when there was a small impact at a speed of about 5 mph. The net result was a small dent in the other car in the boot lid which was about 5 mm deep and 15 cm across. The owner was out (I kid ye not) looking at the damage saying “I’ll need a new rear spoiler” [not damaged], was checking the wheels because “they could be out of alignment” and concluded that “the car was still drivable” in a manner which more suggested he had been in an 80mph smash or rolled the damn thing as opposed to getting a small dent. Now, my mate being the sort that he is was mortified by the immediate few seconds, and was anxious to know that the driver was OK. He was assured that he was, and insurance details were exchanged and that was that. Then, he got a letter months later saying that the other driver was claiming compensation for injuries occurred in an accident despite the fact that a) the driver was unhurt, b) was OK to drive to another UK country, and c) go on a Skiing holiday 2 weeks after. What injuries? Being a twat? Hey ho, what did my mate’s insurers do? Did they demand a medical, reports from doctors and a new medical to be done? Nope, they handed cash straight over.

Yes, I know it’s easy to get annoyed. My suggestion of taking some hospital headed notepaper and writing a letter to the persons address stating they had to come to the hospital’s GUM clinic because they had been identified as being the carrier in several STD cases reported on the week of the accident had to be vetoed after I realised that was slightly illegal (PS FOR THOSE OF YOU WITHOUT A SENSE OF HUMOR I AM JOKING!).

But, supposing that was a nurse who did that. Supposing I was a patient who claimed all sorts which could not be proved or disproved either way? There would be a great gulf in what we experience. One could be the long, drawn out and properly conducted sort, the other being the one where a mouthing patient automatically wins’s without question. There are problems out there, I know, but seeing as the definition of “bad care” was re-written 2 weeks ago in Kent, I wish there was less of a blame culture in this country so that Doctor’s, Nurses, Paramedics, Physiotherapists and all other health professions could do what they do best and thing “What’s best for me to do to this patient?” rather then “Now, what would I be sued for IF I do this?”. For example, years ago (1996), a first aider if he/she saw an injured child (say, laceration to the upper leg), they would go over, elevate the leg, apply direct pressure and put on a dressing with a triangular bandage. Now, they would be done for battery, sexual harassment and end up on a register. Don’t believe me? Think about this then: In 1996, if a man was walking down a street and he tripped and fell flat on his face and two people laughed at him, what would be the difference to today?
Well, in the former he would simply stand up, brush himself down, throw a dark look at the onlookers, then continue walking.
Today, he would lay out the ground, demand an ambulance and claim he has neck pain, end up (guess where) in an NHS hospital (so ambulance =£150, Basic 2 day stay in hospital £1500, charges for follow up appointment’s £800 total cost to the NHS = £2450 that would not have happed 11 years ago). Then he would try and sue the hospital (for anything), then sue the council for the injury, and claim for psychological damage against the two people who laughed at him. Which considering all he needed to do was to look where he was going and pick his feet up seems excessive. What do you think?

More Nurse Bashing from Dr Rant

I used to like the Dr Rant blog. Worryingly though, recently there has been a certain amount of Nurse bashing coming from here. Now, if this were Dr Crippin's blog, I would pass this over as he hates everyone and everything which is not a GP. However, I have been very bemused by the recent hate campaign started over there.

If you would to be a member of the public and were to get all your information from there, you would have it believed that today, Nurse's are only wannabe Doctor's who have abandoned Nursing. There would be some truth in that if it was not for one very large point: That's bollocks.

Yes, there are SOME nurse's who work in "extended roles". Argue the toss over at the Dr "Anti-Nurse" Rant blog, or in Dr "I-want-to-exterminate-every-fucker-but-a-GP" Crippin because all the crazed missives lack one point. The Dr's who have posted them clearly have never spoken to a real nurse. There are SOME nurse's (approximately 3% of the Nurse population) who work in extended roles. The true (and speaking as a student nurse in clinical practice) picture of ward nursing is the vast majority of nurse's are top end Band 5, Low band 6 level STAFF NURSE. Not "quacks", not somebody randomly prescribing, but your common-or-garden NURSE. Nothing fancy titled, you standard NURSE. Anyone who thinks that being a Nurse is somehow not glamorous enough misses the point that as a nurse you are the one professional to have constant hand's on care of the patient and the person in the hospital who the patients can identify with. I like that side of things. I like being able to talk to my 8 patients and keep them happy, give them a stay as comfortable as possible while giving medications, changing dressings, explain what will be happening to them on the ward, and yes, changing sheet's, commode wheeling, bed bathing and taking of baseline observations. I am not alone in that. I am by no mean's the only student nurse (or qualified Nurse) who does such a thing.

SO to portray Nurse's as being second rate doctor's to me paint's a picture which to improportional to the real world, and every time fails to acknowledge to fact that the few Nurse Practitioners, Nurse Specialists, and so on have undergone much rigorous training, and in some cases role's which still sometimes do not stray within a mile of a "doctor's" role (such as Tissue Viability, Countenance advisor, from my experience the Spinal Cord Injury Liaison Nurse's who were specialist's were there to provide a link to the hospital as an almost district nurse approach to see former patients and talk to them to see if they needed any more nursing interventions). The latest craze of Nurse DNAR is one thing that really annoy's me, as this was something placed onto nursing, not something that was wanted (and beside's in real term's I cannot see this being decided by a nurse very often save for in palliatve care in the community where there are few doctor's to hand. I have known situation's which have occured where there has not been a DNAR placed on a patient dying from cancer who would otherwise have a DNAR beforehand, but that's a rare thing).

Arm the large guns Nurse's. We are under attack!

The Year 2007
The NHS is in Crisis.
Infection run rife through hospital's.
Patent's die in their own soiled bed's.
Minister's deny all knowledge
Chief executive's have gone to ground.
On these grey battlefields, the blame is on...
The Nurse.

Yes folks, we are under attack. And why? Fuck knows. One thing is for sure though, and that as a profession we are under great attack, and have lost respect. An RCN pole was recently for there being industrial action, though this stated was not for strike action. I however think there should be an all out nursing strike where there are no more nurse's on the ward's or in the district. Why?

Because there is too much Nurse bashing going on. Non Nurse's need to be taught the value of Nurse's because at the moment Nurse's are like the battered wife of the NHS. The Medical profession have no respect politeness or consideration for us. Read Nurse Anne's blog here and here and there is a doom like picture portrayed by the media.

90 death's from C-Diff would be the one time where as a profession we could have stood up and shouted, nay, yelled all our concerns on the closed ward's, short staffing and the like of nursing and the danger to patients. There is one problem with that. The perception of health care is based on the 1960's NHS. Doctor's still all wear white coat, Nurse's are nothing more then handmaiden's, Paramedic's are just "ambulance driver's", though interestingly enough rather then having docile patent's these day's they all come in yelling "I have rights's" or roughly translated
Patient: "I WANT SEEING NOW! OI, YOU NURSE, FETCH ME A BLANKET, NEvER MIND THAT PATIENT WHO HAS STOPPED BREATHING! Now where's my consultant? Hmm,who is this young whippersnapper? SHO? THE BLEEDIN' SHO! I DEMAND MY CONSULTANT!
[Stage left, Consultant]
Patient: Ahhh, Dr Consultant Old chap, how are we eh?


It make's my liver fizz that patent's, the one's least likely to have a clue shuffle onto the telly and say "It's like, dem nurse dun wanna do fing's do der patent, an I fink that like, is not right". Cut to the nurse saying "We have been short staffed and have not been able to do our full range of care or be able to provide a decent service". You would see that, though you would have trouble hearing it over the reporter going "BLAH, BLAH, BLAH, BLAH". It's annoying. A Doctor would not get the same treatment, nor would any other industry (ie law, banking etc). So why us? The answer is that we are seen as a soft target. The year 2007 is no time for soft targets. We cannot, nor should not, be soft.

We need to shout, draw attention and educate the public as to the real problems of today's nursing. Until the public realise that why we kick up a fuss is because there are nurse's and nursing students (like me) who genuinely care for the patent's under our care and that there a false cutback's being made that is harming the patients and that we use these blog's as a vehicle in which to inform what is happening, thing's will get worse.

It would seem that there will be no support from Doctor's either. So, we are alone. Let us rise to this challenge, and if we fail, we fail without going quietly.

My lost nights

One thing I have noticed about working nights is the feeling that you are never away from work apart from when you come home to sleep. Which is more or less what happened over the past two nights. The first shift was taken by taking 3 admissions into the area where I was working. An unremarkable night followed with nothing more then routine work on the ward. I did however find the time to re-mark out the ward admission board as it was badly worn and looked a bit untidy so about 3am re-marked out the lines and put the patients names in again (it all looked very neat).

Last night was a bit busier as I came on duty and inherited a few post op patients and two pre op ones, and so in the hour before handover did a few ob's and skin preparation on the pre op ones. For those of you who do not know what that is, it is a simple allergy test which is done by taking Chlorohexadine, Betadine and an alcohol wash used on the ward which is put on a cotton ball, then taped to the patient. The idea being that if the patient is going to be allergic to any of them, we find it out on the ward with a small amount rather then in theatre with large amounts. One thing that did get me riled a bit was being stopped by one of the senior member of staff. It would seem that while my evaluation notes which I had written the previous night (variations of "Patient asleep overnight, no problem's raised, no reported pain, all medications given as prescribed") had been counter-signed, the risk assessments had not (I mean the Braden scale for pressure ulcer, MUST score etc). Now, I was a bit puzzled by this as a)My last (medical) ward, HCA's would fill them in. It would seem on surgery this does not happen. Frankly, I think this is the opposite to how it should be as medicine had confused, elderly folks who have risk of pressure sores (I remember patients with Braden scores of 16, 17 odd) while in surgery most are scoring 23 (i.e, low risk as most, nay all, patent's on the ward are mobile, continant, lucid and with good skin condition with respect to skin integrity). I only found this out later, as I was wondering what they were getting at with my filling it in.
b) No complaint was made with the way it was filled out.
c) The scores were correct.
I was trying to figure out the angle of the comment. Was it that I was being set up to look like a first rate shit by being put in a situation where I would go and berate my mentor, or that I am considered too incompetent after three years of university to fill in a simple risk assessment. My last area were happy for me to wander around and do the charts (I was praised by my previous mentor and both the ward sister's for the attention to detail on the charts. While I would like to say that I am a diligent hard working student with a fastidious attention to these risk assessments, the real reason is that I used to get bored on the mornings about 11am and probably would get bollocked for not doing anything so used it to occupy my time as anything that gave me time with the patients and something constructive to do for them which was worthwhile was what I was after. I will use the former though in an interview.) Answers please to the comment's section of this post.

Starting off, I went through the patients with my mentor and I was given a set of bloods to do, 4 BP checks and some bloods to print. The first item on the list started with the patients vein collapsing (bugger! and normally I had such a god track record as well), so I opted for a black vacationer needle and an adjacent vein. That one worked (albeit slowly filling the three sample bottles). My BP's were unremarkable (save for one which was that high I broke out my sphyg to do it), and printed the bloods off without issue. The night then settled down, with a few chest pain calls (with ECG's done) and the commode calls, files to write and bloods to do. We have a system on the hospital (called ICE) which prints out all the blood forms for you. Our printer was not working right so I went and pulled all the patients note's to get the patient labels and attached them to the blood forms and the bottles for the phelbotomists. Only to be told afterwards that we did not need to do that as they have their own set to do. Oh well.

That was my night.

my nightingale

Starting shift with a very full ward was a massive change in only 12 hours. Still, there were a few going and some patients who were comming off other wards of the hospital. I was back with the same area of the ward that I had been working in the last night. The bays were now full of patients who were new. One was a bit ill, however while there were some concerns, my staff nurse was a bit miffed when the patient was moved to the HDU...for hardly any reason appart from by the sounds of it the consultant's patients have been going a bit haywire. However, my other bay was a bit more serene with one patient who we sorted out for surgery. Appart from waiting ages for the X-ray department to take them to X-Ray (after 11pm), the evening was serene with a run to the blood bank and the medication round with the attendant injections to be done occupying most of the time. The night settled down after 10:30pm,with enough time for me to sit and write some essays out (and these two posts). Frankly, that was my night.

My quiet night

Sunday's never are the most busy day's to be on a ward, and the night shifts are usually even quieter. So, naturally I should be on night sift Sunday. The shift started off with...well, me having a cup of tea. Well, have to get your priorities right. After starting the shift proper after visiting time ended, the start was to get out the tea trolley and get the tea out to patients (nutritional intake and that, it is a contemporary issue of the RCN at the moment). The next job on the list was to check the blood sugar levels of the diabetic patients (IDDM and NIDDIM). This was an unremarkable even, but the main reason that I was pottering around at the start of this shift doing that was that there is no HCA on the ward. However, then we got to grips with the drug round at 22:00, which went without too much first though there was a few injections to do which kept me going. There are not many jobs which a student nurse can do, though having the injections to do is one that I have commonly been given to do. This is nice as it is getting near the time ehien I will be qualifying. For the rest of the night, there was no work really to do, save for a handful of shout's on the buzzer for a commode, and there was a playfull telemetary set which CCU seemed to be phoning about with the signal going down. The patients were OK and it was to be 6am when we got the surgery patients up and showered that there was any planned work to do. Once they were up, showered, consented, checked on the checklist and ready to roll, I was sent off duty.

My nightcap

Having bypassed the idea of waiting around for the shift to start yesterday evening I went straight into the ward at about 6:20pm. The joys of the public transport system. While I was supposed to be "night staff" I assisted the day staff for the final hour of the shift with there being a dressing change to kick things off. I like Tagaderm dressing, its a very useful one to use. However, there is a new one being used which is too small for the purpose, and has two sides of tape to remove which has the net effect of crumpling the dressing up and sticking it to the gloves in one easy movement. Not quite sure if that is a good design to use (ergonomics and all that). Anyway, when I was back in the bay I was covering the night before, two patients went home at about ten to 7. Knowing I would be lumbered with changing the bedding over at the start of shift, I got the beds changed as I knew we were likely to get medical sleep outs and decided to get it out the way before starting officially. Handover came and went without there being too much problem. One thing that annoyed me was that there was a side room patient who put a complaint in over last nights shift, citing that they were left alone in the dark. I have one word to describe this: Bullshit. I was not covering the patient, and I along with the nurse for the patient spent a lot of time in talking with them. As for being left in the dark, seeing as this was what the patient ASKED us to do, I hardly see how this is grounds for complaint, and if there was a problem it was never mentioned either Wednesday night or last night (in fact all concerned never raised any problems, both patient and family were very polite about things so it does not seem to equate out. still, as the saying goes, "you can please some people all of the time, and all people some of the time").

On commencing the shift the first thing was that we lost our one Health Care Assistant to the Neuro ward. I then took over giving out drinks and checking the BM levels of the diabetic patients who were on the ward. The loss of the HCA and having a staff nurse away collecting a drug from another ward meant that I attempted my first solo bed change with a patient in situ. It worked. There was nothing to note from that, then we got the call from the night sister saying there were two patients to come up from A&E. At this juncture, let me begin by saying that I fully understand that A&E are kept going and that the governments obsession with the 4 hour rule must keep them run ragged. I never have worked in A&E (my critical care placement was in the ICU, though having crewed ambulance's brought many patients into the department) though I can empathise with the department. However, when a patient was brought up with alleged "chest pains" nobody was impressed. The patient was heavily intoxicated, loud, unsteady on their feet, nearly falling, spitting thick, viscous phlegm onto the floor of the ward (when not wiping it on their trousers). This paled into insignificance compared to the stench of the patient. Now, I will happily look after any patient like this (I have done before). But I do disagree that given the fact that where I am had several first day cardiac patients, two patients with acute cardiac pain and other post operative patients that it is not exactly appropiate to send somebody onto the ward like that. The ECG was clear, observations stable and the only thing wrong was that the patient was...well,they were drunk. Talk about airborne pathogens. I know that it is very easy to say that I am being judgemental but if somebody is carrying lord knows what bacteria on them and you think about them being airborne, it is an infection risk to the post operative patients. Add to this the fact that they were wandering around hardly helped. Finally they were given an infusion, so after moving them from a bay into the one last side room that was left on the ward, we got a drip stand and I set the infusion up. I accidently put the top up so that it was higher then the door. I only realised the error afterward, though as a bi-product after trying to try and persuade them to got to bed (this was at about 2am!) it was a welcome thing (The drip was high to strectch over. It's hardly ideal but it can be an effective measure to try and prevent patients from wandering and getting into trouble. I kept an eye out, but by then having spilt three tea's on the floor, precipitated most of the dinner which was offered earlier in the night onto the bay floor, having wandered into other patients bay, caused two patients to vomit due to the stench, I was more concerned that this one patient was the bacteriological equivalent of the H-Bomb on the ward.

Nights are a pain to chase up results. When you are trying to chase three up, it gets worse. My staff nurse phoned the path labs to check a patients blood results to be met with the reply of "What sample, you have not sent one". My staff nurse said that it had been taken near 6pm by the day staff. While they were both arguing the toss, I went and checked the sample collection point. There, I found 5 blood samples, including the one that was being asked for, and even worse and group and save for a patient who was going for surgery among the sample which were doing a good job of separating out into plasma. Then, when trying to access an antibiotic level, nothing turned up (though on the instructions of the SHO the IV was given with the antibiotics by me anyway- my first solo setting up of an IVAC pump).

The night was steady away after that. One person went onto telemetry, a few wanted to go to the loo, and I even managed to grab an hours sleep. After writing up the charts as needed, I got off at 7am, and have had a very welcome day sleeping.

I am back on for 4 nights in a row then Sunday, Monday, Tuesday, Wednesday so I am going to try and bring my laptop with me to do my university essays because I will struggle to find time otherwise.

My Nightlark

The annoying thing about working a night shift is that you spend the entire day waiting to go to work. I was due to go to meet a tutor at the university for a essay and so could not afford much in the way of a lie in yesterday. I normally try to get up late to keep going through the shift. However, despite this I was still left waiting over half an hour to see the tutor due to late running tutorials. Eventually, the time came for me to go to work. I decided to set of a bit early just in case I was caught up in the rush hour traffic. As it turned out I was not, so ended up at the hospital at 6:10pm. A whole hour and 5 minute before the start of shift. It's at times like this that I really hate. You've changed into your tunic and trousers, everything is hunky dory. Which is what I was facing. Then I realised I had not shaved before leaving and not wishing to look like a werewolf after 2am, I brightly remembered that I keep a razor in my bag for such an occurrence. So, I was able to pass 10 minutes shaving. So, that still left me with over 50 minutes before I was supposed to be on the ward, which given the one meter distance from the changing room to the ward doors was not going to take that long to walk. Normally if I knew the ward better I may have wandered onto the ward, but there were two reasons I did not do this. One, half the time there is little to do while on days at this time, and secondly, I was considering the situation of being moaned at for turning up early and staff nurse accountability for me etc. Then I looked at my shoes...hmmm, could they be polished. Normally, its not the sort of thing that bothers you, but when your trying to kill time its EXACTLY the sort of thing that does. So, a quick clean passed... 3 minutes. I was getting nowhere fast, so decided to go a grab a coffee. No sooner had I entered the ward, one of the staff nurses came into the staff room, greeted me and said "Are you free to give us a hand at all? Only there are two patients going to theatre and its hectic out there".

It was one of those rare moments where such a sentence actually sounds good to hear. Indeed, before the official start of the shift, I did 2 ECG's. a care plan, two shouts to a buzzer and swapped a patients paperwork over. The the handover came, which showed there was nothing remarkable. Until we were sent a medical sleep out patient. Having got them admitted and squared up, the next job was to get sorted out for the medication round, check a patients blood for theater, and get the patients settled. That worked well, then at about 11:30pm we were told we were to take two more medical sleep outs because there were patients in A&E needing beds. At shortly after midnight, the two patients arrived, and without much ceremony went straight to bed. Whereupon, for the rest of the night, all the patients in the bay I was covering and the side rooms were asleep save for one near 2:30am who wandered to the loo and needed directing back.

This was fortunate as there was on bay which had 3 patients who needed ecg and the on call SHO through the night. This was about the only thing we required, as well as an occasional call for a side room patient who required help with position changes. It was one of those rare moments where things worked very, very well. The staff nurse went to the patient who was not well, I as the student did an ecg and a full set of obs, asked the usual questions when talking about chest pain (where it is, what it feels like, have you taken your GTN etc). Then the SHO turned up, politely listened to us, looked at the ECG, made his decision, prescribed medications as needed, and even stayed around while it was started, and we all talked quite Merrily away. For that small 30 minutes, while we covered MTAS, MMC, the freezing of nursing posts and the common ground shared in this mess, and the great thing was that we all worked together. If only this sort of thing could be maintained (ie, the clinical staff having the hand on the tiller rather then an anonymous minister somewhere in whithall) makes you wonder how much better the wards would be.

I was given a break shortly after 3am. I dosed in the staff room for a bit, and think even managed 3/4 hour sleep. One thing that did strike me during this time (I could hear the conversations between the SHO and the nurses following what I guess was another chest pain call) about the comments that people make about wanting a GP throughout the night. It just seems that when you look at what was going on in the acute hospital, that really I cannot see where a GP can really help a patient at 04:25 when there are no other serves open and most folks are asleep.

Anyway, after coming back to the ward, there was more checks made for the bloods of patients, the evaluation sheets written in (all of mine with "Sleeping well when observed. No problems reported overnight") which summed up what mine were doing. At 6am I took a blood sample from a patient and then did the theatre checklist and got the patient the pre-med. After that, the ward went quiet and following the arrival of the day staff, went home. Where I spent most of the day asleep.

Now, for tonight I am back there again. Talk of circadian rhythm.

Of crumpets and the NHS

A teatime Revelation

A while back, there was a TV advert for crumpets where the company (Warburtons if memory serves me correct) had a competition for the most original answer for where the holes in the crumpets came from. I recall there being one suggestion the golf shoe wearing leprechaun's were the reason behind the holes (maybe a tricky through play perhaps?). My suggestion was that an oxidizing reaction of the ingredients took place producing bubbles of air and that really they should have know that without asking members of the general public to write in, though this was not what the company were intending I think.

So, by now your thinking "what on earth are you doing talking about crumpets, Nursing Students Musing?". You would be right because normally comparing anything to do with Nursing, Hospitals, University or the NHS to crumpets is normally the same as comparing stamp collecting to being an extreme sport.

However, yesterday I was struck with the sudden urge to wonder why the crumpet hole mystery could not be applied to the NHS. You see, I remember a time when nurses were short but recruitment good, finances were not the over burdening worry which they are today, there was no such thing as a Doctor worrying when being told their career had been "modernised". More worryingly is the fact that nobody seems to be able to appropriate the blame for this mess. Staff blame the managers, Mangers blame the government, the government blame the patients, the patients blame the staff and having reached an infinite loop philosophy and reason knock off early at this juncture and go to the pub.

So while this crumpet baker may have wanted a children's story, perhaps we can run a competition open to everyone: "Why is the NHS the way it is?". Most credible answer wins the satisfaction of...erm...a job well done.

A job...of sorts

My first post as a Registered nurse
I have been (sort of) given a nursing post. As Divisional Nursing officer with my St John Ambulance division. This basically means that in the eyes of SJA, as well as my training received with them, I am also registered as a health care professional (HCP) and then have assumed responsibility for the treatment of patients by the SJA volunteers. So, if there was a spinal case with a femoral bleed, I may see to that and direct the ambulance aid crew and be asked to review patients from First Aid members. This will be very unusual, though anything that can get me 6 months post registration experience is more then welcome. Also means I get to wear some grey epaulettes.

My half shifts

Yesterday I was on the "early" shift which was basically an 07:15-13:00 shift. Oddly enough, I was more tired from this shift then the normal twelve hour shifts. Anywho, to concentrate on the ward. I began by being directed off taking the obs and being on the medication round, which went without too much of note before moving on to taking a caseload of patients and doing the dressings on them and a few referrals being filled out.

Today was much of the same save for it being a 12 hour shift. I started by doing the medication round but withheld one Digoxin dose as there was a low pulse rate then bleeped the registrar as there was another patient who went into fast AF. One of the medical sleep outs were to go home, so just at the 11th hour, as is the case you get the dreaded phone call from infection control. When they phone up you know its to tell you the patient has a water infection, and true to form our patient did, though thankfully nothing that requires a further stay in hospital due to their being asymptomatic. I had to take the note over to the respiratory ward to be signed by a medical SHO (which is the exact opposite end of the hospital to where the ward I am on is). So I did. Then I had a new admission from CCU, took the handover for them, did the admission obs, the ADL assessment, Braden scale and had to bypass the weight due to the patients mobility. Unlike some people, If I am unable to do an aspect of admission I put down why that is so. The writing on the admission sheet was very long indeed to get all the details down, but needs must when the devil drives. After lunch, phoned the respiratory ward back up as the first time I phoned the SHO was away from the ward and by then the script had been written as needed. So wandered back over with that. Then on returning to the ward, was told that there were two discharges to be done, and so did the paperwork while awaiting the medications to arrive. My staff nurse phoned pharmacy up and said that they were refusing to dispense the discharge script for my sleep out patient as there had been a script sent a few days ago to the original ward they had come from- where I had been twice. So, as there were some to be collected, I went back to the opposite side of the hospital via pharmacy, and after packing the patient up and waiting at the entrance of the hospital for them to be collected, went up to be asked to return to pharmacy to drop a carbon page off a script by another nurse which they wanted down urgently. So I did. This would have been about 3:30pm, and when I dropped it off was told not to wait as it would be a while. Both the staff nurse and myself were taken aback when a rather brusque call came through from pharmacy saying the medication was late as it had been sat on a trolley since 2:20pm. Answers please on how that happened.
For the afternoon, nothing was noted save for a ECG and BP check on a few patients.

My quiet victory

You know that when you see the pulse reading of several patients being bradycardic that just one of them is actually ill and will be needing the type of care that makes us stand up and give the world a smug "You see, that's why you need us" grin. Its just a pity that the promised money from the mayday for nurses campagine has not been as forthcomming from some of the clubs, which is a shame. I was involved in the taking of several ECG's, baseline observations (of all my patients) and monitoring of patients while SpR's were bleeped. Which was nice just to finally have a good blow out on the new placement and really get to grips with a situation. I must admit today did seem more social with the staff, which I feel a lot more happier with as the last week I really was thinking that I would remain socially isolated. The patients themselves were very quiet, I had all my charts done before 11am (Braden scales, Oral hygiene assessment, nutrional assessment etc). Yes, this may have interrupted my normal observations and the medication round which was started at 8am did not get finished until gone 10, but that is one of the examples of where clinical need dictates the priority. This statement is handy as I am to concentrate on that exact subject while managing the bay during this placement. The placement itself was discussed with the zoned academic who came into the CCU to talk to all the students on internship within the division. Normally I would be a quivering wreck of a student come a final tripartite, so decided to be blunt and to ask what the final tripartite would be consisting of. It would appear to be 10 minutes of me linking the competencies to practice. Which I practiced the other day and was able to make a tenuous link to most of them, so give it another few weeks and I should be OK (Still a quivering wreck all the same, but OK none the less).

So, a quiet victory in the fight of everything going wrong.

Post strike

Image from Beau Bo D'or
So, postman pat and his militant mates want to indulge in a spot of 1970's working practices by going on strike. Now, usually this would be a post which would focus on the vicissitudes of my Bursary arriving by post and that my bank card has developed a large dent in the chip. Which has caused it to stop working my delay which will be caused by the strike. Then however I began reading into the strike a bit more. Now, anyone who is told that there is the loss of 40000 jobs expects would be every bit right to feel upset and get a bit riled about it. What I have to find very amusing is some of the figures which are getting quoted. Lets start with the wage that the post people (PC culture: Is shit isn't it) are on. Now, I am not an expert on the personal specification for a post person. I am guessing though however that you have not had to go to university to be a post person, or have spent 2 years in college taking relevant A levels or a City and Guilds course. So, basically, you are taking about a job which a school leaver can do. No, wait a moment. Lets be specific here, your doing the job which an 11 year old with a paper round does, except for a bigger area. With the notable and noble exception of the 14 year old surgeon from India, most people in the NHS are highly qualified professionals. Even the support staff have to attend university and college to take their NVQ's. So, I was taken aback when the figure for a postal worker was revealed to be [drum role here]...£17000 per year.

Oh. Now, I was on £12500 when working as a manager. I know health support staff get about £13000. Newly qualified staff nurses get £19500. So, I am sorry, but you lazy lot can damn well wake up, and join the rest of the 21st century. I mean, I will get only £2500 per year more then you:- £208.34p per month before tax. Now, lets just think here for a moment. You left school, probably never went to college, you have not had to go through the grueling 3 years of university and have to have the responsibility for patients lives on your neck, or be accountable for treatment given, liaise with relatives, and have several statutory acts of Parliament governing what you do in your day to day job. Nor have at each of these stages had to out do your peers to be selected for a place. So, in real terms, £17000 is very, very good money for somebody in an "unqualified" job.

Now, this being said, I would like to examine some of the quotes coming from the postal workers and apply them to nursing
"We have to get up early"
So what? I am up at 5am tomorrow to be away for a 12 hour shift. My bus driver will have been up equally early to take the bus out. Let's not forget here Nurses have to work nights. But then again, we appreciate many other people work nights. So what? Just deliver later if you want a lie-in as anybody who works usually has left before the post, and anyone who is off is probably asleep for a few hours longer anyway.

"We have to work over 30 hours"
FFS! I have to do 34.5 hours and I am an effin' student! Perhaps the old Junior doctors who did 100 hour weeks will feel sympathy for you? Maybe the old me who worked 10 days of anywhere between 10-13 hours solid will be bothered.

"Staff are kept behind even when all the work is done!"
Oh for gods sake, visit any ward 15 minutes before handover!

"In effect, the wage rise demanded is 27% while the current offer is 6.9% over 2 years".
Nurses got 1.9%. What the hell are you wanting? You do realise that at the current rate, you lot would get £24000 while nurses would get £20000? I am sorry posties, but there is no way in hell are you lot worth more then £20000. And IF you do not like your current set up, I suggest you look for other jobs which you would be a valid candidate for. And when you realise you would be very, very, very luck to get over £14000 in it, I suggest you get back to work, and let the rest of us NHS types moan about the state of our job. Otherwise WE may go on strike...and then everyone will have something to actually worry about.

my demon

So that's another shift down. The mix of discharges and new admissions meant I only had 5 patients all day to see to at any one time. I began by doing the obs, two dressings and a district nurse referal, filled in all the paperwork for the daily assessments, and then did the patients files, went for a tutorial which resulted in me being a staggering 2 hours away from the ward, and then doing post PCI observations on a patient and prepering for their return prior to that, and monitoring the bay and admitting a transfered patient.

I am really starting to feel that I am loosing the fight now with it all. I have been told that despite asking for MITS on an essay to get me right that it will not be accepted. I don't know, I had a death which took me a heck of a long time to get over, then I had the trouble over the 1000 word essay, then had to fight to get my place back on the course, and now after all that have to start by chasing after essays again which were rushed out. I am beginning to get very drained by it all, and with there being no hope of me finding employment in January I am even beginning to question my wisdom of not giving up in 2006 training to be a nurse. I tried, really I have. I have stuck on when all the odds were stacked against me, and I kept on trying to go on, and on, and on. Where most others would have walked away (and believe you me there were times when I was very tempted to do that), I always kept on going and tried to "keep the faith" as it were. However, not I am just passed myself but I am beginning to feel the strain of it. Being where I am on placement hardly helps. The staff are mostly female and I just feel very unhappy as I am socially isolated on the ward, I have nothing in common with any of them and half the time it's like I am all alone even when I am in a room full of people. This is not healthy. The only people who actually give me any time of day are the patients, which thank god I am on a surgical ward and not a medical ward with confused folks or else I would not be on the course.

Right now, I think I really need a good pick me up and a sign that not all is lost, because at the moment I cannot see much hope in anything.

my new world

Had the first day of the new placement start. This is a surgical ward with a few cardio patient and some medical patients under cardiologists. The past two days have been keeping me steady away with work but I prefer this to the wards where I was hectically busy on the few hours of the morning with hardly anything on the afternoon to occupy my time with the patients. While it is possible to use this time for reading policy documents and so forth I usually find that as soon as you do that, something crops up that takes may attention.

These have been interesting times though and there has been a wide variety of work to be done. I have enjoyed my last two days, busy as they are. The initial day started with a patient being preped and consented for surgery and taking them down to the operating theatre for the anaesthetic nurses to take over, and there were tow journeys made that day. I went back and dispensed the medication (under supervision). The bay was full of independent patients which makes a change, though there were more dressings and ECG's and hourly observations to be done, as well as referrals to be made for the discharge. After the morning was done with, I was given an orientation to the ward, and the sister gave a small fire talk and showed the location of the fire panels, extinguishers and so on so that's part of the fire talk out of the way. This may seem irrelevant but as the alarm kept going off it was needed to assess the problem.

The afternoon was spent co-ordinating the new admissions and doing the nursing assessment. Today was much the same, save for going to the cardio lab to watch a PCI (Percutaneous Coronary Intervention) being done for an angiogram. Had a few in for them today, one who took a few scans (with the appropriate referral), had several ECG's, Observations to do post op. As there were 16 admissions to the ward, I was over the bay that took some, and was doing the Nursing admissions for some patients. While I was asked to go on a break this evening while I was doing one Nursing assessment, I got the details down of the patient who manages independently and got around the time problem by filling in the form over a tea break. Had to take a venous blood sample today as well, first time in a while and that went fine with no problems. In the last 5 minutes of the shift, I did a BM, Did an aseptic dressing to a patients leg, and removed a venflon. Shows how busy I have been.

The only razor in the toffee apple of the day was that while 2 essays have passed, one that was supposed to have been MITS and extended has been thrown back. Bugger. This now means having to go in to see if they have accepted the extension of the essay with MITS (its a throwback to when they buggered me about) or if one part has been thrown back. Either way I am annoyed at the whole thing. I don't mind the MITS being refused if they see fit, I just with the university had not messed me about originally to bring about this situation. In saying that, my new average mark has been announced as being 58. Not that bad.

My half time

So as of 15:20, I finished my placement. Which is nice as that was a few hours off having covered for the ward move. I will miss the early finishes as a student. Speaking of which, I have handed in my first letter of application and CV asking for a job to the ward sister where I have been for the placement.
For the shift I was in charge of doing all the drug rounds and dispensing the medication and doing the controlled drugs. I know this will be a bore for any qualified staff but it was with the final push which I was left to happily work during the lunch break with another nurse to pop their heads around the door to keep and eye out. While normally this would be daunting, I was OK with it. I do think that a lot of the situations which people do not want to deal with wind up being bad only thinking they have to face a situation or on the way to a situation (i.e. cardiac arrest). I remember back in first year when on a community elderly rehab ward I was on my third shift as a student and being told to go to the mortuary to see a dead body to sort the paperwork out with the funeral director. Since then I have seen a fair few. Back then though, Internship was a distant thing, but now it is looming up just 5 days away.

Back to today. Gave a phosphate enema as the doctor prescribed it back on the 24Th but it still had not been given, so you can imagine the mess I had to clear up after nature ran it's course. Also had loads of bad baths as night staff did hardly any.

I was trying to get some controlled drugs signed out to 2 of my patients for pain relief who had PRN prescriptions for Oxynorm and Oromorph. One staff nurse said "get it out ready and the controled drug book open and I will be with you in a moment". 10 minutes later I was still stood in the treatment room like a right berk waiting. Thankfully my mentor got back from lunch and signed them out with me. Annoying. Then I did an ECG and was told to go off duty. I left a "Thank you" card and some chocolates to the mentor and one for the ward. They thourght I was very kind. While I was going to head home though in the true tradition of me actually going above the call of duty did a prescription drop off instead. This came about as there was another bay who discharged one of their patients to a rehab home but the patient went without tablets. I told them that the town where they were is in the next town to my St John Ambulance division, and so was sent in a taxi to the town then walked to the town centre where I indulged in a hot tikka and a few pints to celebrate the end of placement. I then walked the 3 miles to the town along the sea front to the St John Meeting. It was there that the iredness kcked in, though thankfully the meetinfwas on the upcomming training day for me (the next two Sundays) and some AED work. Not a bad way to end the half way mark of the placement season.

My short fuse

Began the shift with a new area today and was catching up on the caseload. We were covering a side room for another area and I wasted about 15 minutes trying to find the keys for the drug locker. The morning was frustrating as here I was on the penultimate shift as a student on the ward trying to take some inroads in the patient management and yet again I was being delayed by needless work.

The bay was busy, especially when I was covering the lunch break. I was aware there are two patients who seem to see me attending to a buzzer shout to one patient then make a request exactly the same as the one which the other patient would have made. I.e. one patient wants the commode, so another one does. It was rather annoying, especially as there was one who was pressing the buzzer while I was stood in the bay which caused me to walk out the bay in the totally wrong direction for me to have to see where the buzzer was going off (as you can imagine you never really think a new call will come in via buzzer alert in a bay where you are already in, and when a small illuminated button next to the bed on the reset button is all there is to alert you it's not the first thing I look for).

I find this very annoying as I was wasting time left right and centre by having to do actions which were not needed. Yes, I am aware there are some patient who may not get the buzzer idea but I actually sat down and explained in plain English how and when to use the buzzer. I don't know.

Did another transfusion on one of my caseload. This went well save for the cannula which kept on stopping the flow. The flow returned by pressing slightly down and back on the cap of the cannula. Not sure why but after today I was in no mood to argue. I had a patient go AWOL for 2 hours, though not as bad as the bay next door where the patient stole money and then absconded from the ward. The police are still searching for them.

Some of this evening was spent minding a patient with dementia who was making a good go of trying to beat me up. Few near misses but nothing serious. Tomorrow dawns as my last day on placement 5.

My balance of power

Yesterday did not get a post as I was very tired after getting home. The day was as usual for the ward- hectic, and with a few million jobs to be done after the weekend and the ward move. I was in "area 1" on the ward. Area 51 would be more accurate to describe what was going on in there. There was one patient who has been very abusive to staff, and has some involvement from the mental health team. In the afternoon I sat in on the MDT meeting for the patient. I started the day by phoning the people needed to attend: Next of kin, Social worker, Occupational Therapist, and the Discharge co-coordinator nurse. All agreed the time and said they would be there. I even spoke to the discharge co-coordinator when she came to the ward near 10am and confirmed the meeting as I was discussing one of my patients who is awaiting panel for social services and she confirmed that she would be there at the time specified. So I was a bit put out when after waiting 15 minutes for them to turn up at the meeting to be told by the discharge office that she was only in till 2pm and had left the hospital. Thankfully another member of the discharge team showed up.

The end result was that we needed and official diagnosis made by a psychologist. So, I phoned the mental health link team at the nearby acute psychiatric hospital and they said phone neuro sciences up in my own hospital as they have a psychologist. So, I phoned the hospital switchboard to be put through to the department in Neurology. Well, that's incorrect because what actually happened was that I phoned the number for switchboard on several occasions and the phone rang and rang and rang each time. So, having been given the number of a community mental health centre where the same psychologist works, I phoned them instead. Whereupon they told me that the psychologist is on holiday until the 4th October which seeing as this was supposed to be an urgent referral was a bit longer then what was needed. By now we were steaming up to 4pm and so knowing that bog all gets done with referrals after this time phoned the mental health team back up. They got the same story you got, and then agreed that the Psychiatrist would phone the ward staff up tomorrow (which is today) and would have a word with making the diagnosis. I find it odd as while they were on the ward last week, they came out with the best ever excused for not doing something: "The referral form only asked about the persons cognition" [n.b. this is not the true reason though have altered this for confidentiality]. Well, that's nice but it would be nice if they had bothered putting down WHY the patient was that way in the first place. But no, they will only do what the form says. So, in the future, I will write "Do this (referral x), put down some details don't mess me about sunshine".

After dealing with the insanity of the ward, I had my competencies signed off by my mentor and wrote on the tripartite sheets (there is no official tripartite for placement 5). This went well and all were signed off. There were one or two side points which were not due to them being too specific to have been met on the ward but as its a formative placement that's no worry. So, nice to know that it has passed and now I only ave two days left before moving on.

Speaking of which, went up to the new placement area (Cardiac surgery) and have got my off duty for next week. Seems to be the same as when I worked on the ward next door which did the same but has the Cardio thoracic HDU and took less pre-operative patients. This means that I will be able to get to grips with this type of patient on this ward.

Why students should get a PIN number

(Above) A pill for every ill...

I have finally had a bit of a revelation on how to make nurse education better which I would appreciate a few moments of your time to tell you of. I am sure that some may have read my post of how I was in a training seminar that made my head explode. Here is why. You see, far from being a grumpy “Its all shit” kind of person, my anger stems from my passion for nursing. Think about it, we are not perfect, but we are the profession who are at the patients bedside, take the basic needs of the patients who need assistance, dispense and administer medication, provide support to both patients and relatives, and do take a role in the dressing of wounds, taking of blood, observations and the setting up of infusions. I am sure that most Doctors would agree that Nurses are an essential part of the care of the patient after they diagnose them, that the physiotherapists would like us to keep them doing exercises as planned by them and so on.

My analogy today comes from my St John Ambulance division. We have Patient Report Forms (PRF) to fill in when we treat somebody. This includes applying a plaster. To get around filling in a PRF for just a plaster, as long as we give the person asking for a plaster one to apply themselves (after asking to make sure they are not allergic to them), we do not need to fill the form in. Its that simple.

Back to the post. The reason I was so annoyed was the fact that I feel unhappy with the way that nurse education being dumbed down. This is NOT the fault of the university nor of my home trust. The fault is that of the blame culture that we now live in. This (with the deepest respect to any American readers) is an Americanisim that frankly we can do without. I am nearly at the end of three years of training and there has been £40000 of the over burdened British taxpayers money spent on training me. I am a very pragmatic person, so I do think that training should be a process of taking an individual who does not possess the specialist knowledge or skills to do a job and equip them with the rudimentary knowledge to do this with the minimum supervision. It would seem that at the moment because of the sheer volume of litigation faced that the best which can be done is that we [student nurses] are trained in a knowledge base which is very good but lack some of the skills which are expected as a staff nurse. The fact that after three years I am not qualified to even take a temperature is something that makes my liver fizz. It’s an insult to the intelligence of all students, after all by attending university for three years you have shown some degree of intellect, rational thought and that you are not a dithering simpleton. So you can easily see my argument of “Just what is the aim of three years of hard study?” as this seems to be simply nothing more then a paper exercise to say “I would like to be a nurse, this paper says you can train me up”.

Which is where my local ambulance service has a good policy for recruiting its new university trained Paramedics by advertising the posts as trust positions. The trusts advertises for student paramedics and then when the candidates are employed by the trust they then start with the next intake and come out with a job- much like hospital secondments but for all levels. If the problem is with the trust officially training you as an employer, if you work for the NHS trust and use the equipment as part of your training, ergo you are familiar with the equipment and would not have completed your training without using it. This is too straightforward only if you are seconded.

So, today, I give you my latest bright idea: Give third year students RGN status and pin number which is valid for one year and one year only, which to keep the RGN status and pin number must mean completing the third year of study and gaining the accredited qualification. This PIN number should ideally be issued when the student enrols for their third year (to do so at the end of second year would affect those taking a year out). Think about it. How many times do we hear student being told “You cannot do task X because you are not registered”. Quite a few I wager. I have said before, there is no sudden transition made from dithering simpleton student on a Friday afternoon to uber-knowledgeable staff nurse on the following Monday, so its not the time spent which is the problem. The problem is that nobody wants to risk their registration number for a student making a mistake. This is understandable. The idea that a student would panic over having accountability is not an argument which much substance: just what would anyone making that point think the individual would do WHEN they qualify. No, the sooner we stop thinking as nurse education as being an academic essay only but the foundation of the building of the next generation of staff nurses the better, and all the better for the lost art of basic nursing care. The public argue there are nurses “too posh to wash”. Very good, but it’s normally the students who are given the basic nursing care to do while training: tell them they have an RGN status and have to give Mrs Smith a bed bath; they will hardly have many grounds to refuse. Of course, they may not have the time to do such a task when qualified but instil the right attitude to mould them and the rest falls into place (with any luck).

This would allow students to give out medication, take responsibility for patients, and learn how to use equipment. An exam of their safety and competence on drug rounds (done without the student knowing to reduce stress) to allow unsupervised drug dispensing will develop experience for this task which is one most performed by the staff nurses. There is no legal requirement on who dispensed medication; it must be however on the written instruction of a doctor or other appropriately licensed prescriber. Once more, as a registered nurse the student would do this, and if a person has never done medication rounds before they will be only at the same level of a student (and just as incompetent). The idea of affixing a registered status to somebody will not automatically make them competent in a set task (as has already being highlighted, newly qualified RGN staff are not allowed to take a temperature or BM’s without post graduate training so imagine a drug round…). So, give a 3rd year one year to finish and remove the “non registration” inhibiting factor, and let the students grow!