MY CELEBRATION

JUST HA THE NEWS THAT THE ESSAY THAT CAUSED ALL THE TROUBLE BEFORE HAS PASSED. THERE IS A WEIGHT OFF MY MIND!

My Days of my life

Having being ever so slight knacked after the shift yesterday today was not as bad. I damn near was hallucinating that I was still at work last night while in bed. Made good progress today as there was some feedback on the referrals made, one of the patients who was mostly asleep yesterday had a 40m-mols/l of K+ in 1000ml Normal Saline infused via IVAC by yours truly, did a few PEG feeds today and was able to feed and give thickened fluids to one patient thanks to the SALT referral being seen today. The Department of Health were in the hospital today. Thankfully they only went to the ward next door to me on my floor.

One of the doctors was asking about the patient from the same home I was at last year. They seemed to appreciate the information I was able to give, which is always nice to get a sense of job satisfaction.

Did my first handover tonight of my patients, then went with the medications needed for the patient I referred yesterday to the community hospital. It seemed so odd going back to my roots as a first year after exactly two years to the day I finished my very first placement. I really enjoyed working on that ward, as it was all about basic nursing care up there.

My Stagnation

The shift was the first where I was let loose on the patients and they in turn had me inflicted upon them for their care for the 12 hours where I was on duty. The first part of the ward is a two bay which is permanently closed due to historically the ward having too many falls which for safety reasons resulted in the closing of the bay. That will bite me on the ass later in this post. For now it is the storage area of the beds and mattresses. It also has the BM box, drug cabinate for the pharmacy pack for the adjacent bay. The adjacent bay can occupy a maximum of three patients who are shared with the first bay some distance down the ward and is next to the main entry doors and the few side rooms at the front end of the ward. It occupies an outlying part of the ward and you really do think that you are isolated on this far outpost. There were three patients who I was to cover. Two from nursing homes, and an admit via AAU (Acute Assessment Unit). Two had been bed bathed, one was still to do. Two were bed bound, and all needed all basic nursing care carried out. I dispensed under supervision all the medications needed as required and did a PEG feed and medication, referred to several allied health professionals during the course of the morning. There was much to be done in seeing to these patients which is where the care that I was able to give became really slow and stagnated as I was relying on assistance for the patients and there were other issues evolving during the course of the shift. One was the new admit who was unable to remember any of the medication they take, or even know where their GP surgery was. Fortunately there is the computer in the hospital that was able to tell me where they is (with the help from the ward clerk). I got the GP phone number, and (at 08:36 according to the time noted on a note entered on the computer) phoned as requested a fax to the ward ASAP with the medication so the Doctors could write up the prescription on the drug cardex as apprioiate. This was done...after the fax came over at 13:04. It was nice to see a fax sheet with my name on it...feel like I am going up in the world.

Then there was the father of one patient...who is a Doctor. Imagine how I felt, the newbie on the ward having to talk to not only the relative of a patient, but one who, I pretty much guess to be a consultant. Thankfully, back in second year I was at the home for a week where the patient originated from as part of the short community placements. That experience did help the next day.

Then the bombshell. One of my patients was "queried positive for gram positive cocci from the lab". That's Methacillin resistant stapphylococcus aureous. MRSA. So, I look at the board. Side rooms free...erm...none. Then it seems that there is an MRSA patient in another bay awaiting a side room, a patient on their last legs who were all jockeying for a side room, and I was the third nurse after one. One patient was going to go to the community hospital where I was for my very first placement as a student nurse. I filled in the referral for there as that was some extra experience. My bright idea was to put my queried MRSA into the two bed bay/store bay...that was when I found out why it was shut. The whole day became very stagnated in terms of the progress made. I was shattered after that.

My Helicopter

It was an interesting shift Friday, mainly because I was working with a different staff Nurse after mine phoned in Sick. Had one patient who was not very well, and another who was on the End of Life Care Pathway (EOLCP). During the course of the sift, I was doing the work of a HCA as there had been a sick call. I am by no means complaining of Nursing in the role of the HCA as often a Staff Nurse will occupy a floating role to do this, but the most exasperating thing with this is that I am supposed to be on management placement at the moment, but have had only 3 days of actually doing anything like that.

I did have a good shift though, I decided that a patient would be better off having assisted feeding as they were not managing well with eating or drinking (several changes of gowns had occurred by the time lunch had arrived so I was not taking chances). Took another bay's patient over to CCU, and had a mild bit of excitement when I went outside to phone my girlfriend up as there was a large RAF Rescue Helicopter on the Helipad, several Police cars and a Fire engine. I am not sure what it was all about but it looked interesting enough, especially as there was a TV crew filming..

Apart from that just had a jaunt up to a nearby city with my Girlfriend who wanted some shopping, and I have a few ideas for my Christmas shopping (which I will have to do early this year as last Bursary is in December). So, now need to crack on with the essays!

My weary feet

I really will one day find a discharge that does not involve expending the sort of energy that would cause Hercules to give up. However, there was a discharge and I was involved in trying to get some items back from the cashiers office which the patient had left in A&E. I phoned down to A&E (remember here I am on the second floor of the hospital which is also the top floor). After a bit of a wait, I was given the property book number. So, I phoned the cashiers office, and gave the details I had. I was told to get the book from A&E, and bring it to them to sort out. Let's just say that between arguing with A&E and the cashiers this took over a hour and a half, several walks around the hospital, and the involvement of the staff Nurse on the ward, and two matrons to sort it out. I was bloody knackered after that.

Rest of the day was not that bad though, I was able to get most things sorted out though really had a quiet day today. More just one where I was back and forth which makes a change. Tomorrow it is mostly discharges to do. Heaven help us all.

Choose not to choose a career

It was never going to be the best of days when it's foggy, and you get really nervous before your driving which went really well until some twat in a white van came speeding around a corner right at the moment when my view was obscured over that of the examiner who made an emergency brake to save the vehicle getting ploughed into by somebody deciding that 40mph in a 20mph zone it fine. Tosser, I fervently hope that from now until the end of time all your itches are unreachable and that somebody writes something obscene in weedkiller on your front lawn.

That aside though, the real reason I am annoyed is that I have to spend £48 on a new test. Seriously here. Let's just examine what would have happened should that van never shown up. Well, for one I would then need a car. Which I don't have any more. So I would have two choices. One, get an old banger for less then £500 that would make me skint, or got to a dealer and have a finance arranged that will mean me paying from now until the end of eternity at 6 billion% APR. That the idea of paying £170 a month is not bad is true- for now. However, in January I will be needed to have a job, so without bursary payments and the employment being questionable to actually land myself with such a burden as that would be the type of decision made by somebody who has the financial sense of an otter. If I don't have a job, I don't have money. The problem there is that I need to get a job. So, where do I look. The easy answer is in my local Acute hospital where indeed there are some jobs at the moment, but 5 months in the NHS can see many changes. So, where else do I go? Well, there was a hospital about 20 miles away that used to serve as a pretty major hospital. That was until the powers that be decided that a really good idea would be to close most of it's facilities and turn it into effectively a rather large first aid post. This, I think is not what I am after. The next main town from that is shedding it staff. It employ's 6000 staff, though to meet budget cuts is cutting 12450 posts giving -6450 staff. This will not leave good job prospects.

So, it's very easy to say "Then emigrate". Yes, I am aware that Australia needs nurses, but without 2 years experience post registration, they will politely tell me where the exit is.

"Move to another area of the country". Yes, because ALL the other counties have just LOADS of posts for newly qualified nurses. Oh, hang on a sec, apparently they don't. Moreover, where am I supposed to get the money for accommodation? Thin air?

So, that's why today is of no bother to me. If I had passed, it would not have made the slightest jot of difference because I cannot afford to buy, nor can I afford to finance, the purchase of a car. Given the fact there are no posts out there, I am not surprised there are reduced numbers of applicants to Nursing. Do you blame them? If somebody was to ask me what to do at university who wanted a high brow course, I would tell them to take Analytical Chemistry or Astro-physics. I have not much of an idea of what they would do save for using a mass spectrometer or utilise astrology, but one things for sure: If you were to waste three years of your life to end up without a job in Northern England, which one would you rather say in the pub: "I studied Astrophysics and I am going on to do my D.Phill at Oxford" or "Worked down't 'ospital".

The NHS may be the biggest employer in the area I live, which goes some way to explain away the high unemployment levels. Some Nurses were saying "Would you do it all again". Given the fact that I have worked my backside off for three years without much hope of a job, I would have to say the answer would be: "No, not really".

My Aardvark

It was never going to be the best of days when you fail to get to sleep until 03:50 ish and then have to be up again at 05:30. However, this being the weird and wonderful world of Nursing Student that is precisely what happened. Then, when I arrived on the ward, we were casually told that a patient had died. One of my one's I looked after. Then it turned out they had just arrested so somebody bleeped 2222 and the arrest team arrived...who after a few tries at resus confirmed what we had thought that the patient had gone. This was rather sudden as just a few moments beforehand they had been up and talking. I had nothing to do with that call but it was shaping the day up nicely for what was to come.

Then there was the problem of the missing mentor. I had turned up, though the staffing and the placing seemed to be devoid of the mentor. Which is odd as I thought that due to my being off tomorrow for my driving test that it was Thursday I was to take as the away shift. Anyway, I was soon sorted out with a different bay and a small caseload to deal with. One of which was doing all basic nursing care on a patient before taking them down for a scan. After they refused to have a venflon replace by the SHO, we trudged down to radiography with the small venflon in. Well, there was hell to pay down on the department. Which then became the icing on the cake when the patient denied ever refusing having the venflon removed. Either way, one of the radiographers replaced the venfon, the scan was done, and we went back to the ward then I went for lunch.

When I got back, there was a new patient waiting in my bay. From a nursing home, with full dementia, deafness and a whole list of problems with conflicting information. I phoned the home to get the admission assessment details, then spent all the rest of the afternoon watching the patient to stop them getting out of bed which would have made them fall, ripping the catheter out and trying to attend to the other patients as best I could. There were 8 patients. We did get to keep folks happy, but there was the problem. In keeping people happy we were running around at full capacity, and there is no way in hell if that arrest happened this afternoon that we would have coped. So the next time you hear of the cuts in nursing posts not affecting patients care, don't believe it for one second. We tried our best today and were knackered, worn out, and running at full tilt with sod all capacity to deal with anything major or any new patient issues. Which is where the claim stems from. Yes, the cuts may not be affecting the care on the surface, but scratch below that and you will see that it only works because us Nurses are working flat out for our patients. We may be working well like an organised ant colony, but that's through sheer altruism and good will. And that good will can only last for a finite time.

There was nothing wrong with the patients care...the notes say so!

Now, a little while back I wrote about political unspeak would never work for me. Now, I was saying then how there was absolutely no way on earth we (the nurses) would get away with saying such a load of rot as found elsewhere in politics. Over on the Dr Rant blog, I have been having a rather good discussion regarding how patients and their relatives have their say with one thing that came out being the fact that quite often relatives never really have a say on how they think their relatives are receiving care.

Granted, there are some legal issues in discussing a case of a patient with relatives and of consent issue. The Nursing and midwifery council (NMC) in the Code of Conduct state in clause 5 "As a registered nurse, midwife or specialist community
public health nurse, you must protect confidential information.
5.1 You must treat information about patients and clients as confidential and use it only for the purposes for which it was given. As it is impractical to obtain consent every time you need to share information with others, you should ensure that patients and clients understand that some information may be made available to other
members of the team involved in the delivery of care. You must guard against breaches of confidentiality by protecting information from improper disclosure at all times". So, in effect, all patients must give consent before the nurse tell their relatives anything, which is of course not fully practical as relatives will always like to know what is happening to there loved ones. So, in practice we make sure the patient is happy for us to give out this information and keep people happy. One of the big problems with this is giving information over the phone as there have been times when there has been a patient in a hospital where the wife phones up, the nurse tells the information only for the husband to say the they were getting divorced and he did not want to have the wife know what was happening. So, we get consent.

While on the issue of consent the NMC state that in clause 3.4 You should presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can use it to make an informed choice.

3.5 Those who are legally competent may give consent in writing, orally or by co-operation. They may also refuse consent. You must ensure that all your discussions and associated decisions relating to obtaining consent are documented in the patient’s or client’s health care records.
3.6 When patients or clients are no longer legally competent and have lost the capacity to consent to or refuse treatment and care, you should try to find out whether they have previously indicated preferences in an advance statement. You must respect any refusal of treatment or care given when they were legally competent, provided that the decision is clearly applicable to the present circumstances and that there is no reason to believe that they have changed their minds. When such a
statement is not available, the patients’ or clients’ wishes, if known, should be taken into account. If these wishes are not known, the criteria for treatment must be that it is in their best interests.

Which leaves the relatives in the dark. Which is a problem as we then never seem to gauge the opinions of the relatives until you find somebody who ends up having bad treatment. Then, and very rightly so, they make their views known. What will then happen? Will there be a white steed riding onto the ward (using the hand gel first) to sort everything out to turn the ward into a beacon of care?

Erm... no, not really. The TV show scrubs has twice portrayed what I imagine both the public and myself see the complaints system as. Once it was a bin, the second time the complaints were fed through a letterbox which leads straight to a paper shredder. Of course, if the aggrieved relatives DO get a reply, you can guarantee it will be a great fob off.

It is true that relatives will be the ones who will make the complaints on behalf of their relatives, but one thing the system seems very bad at is getting the views of the relatives known as they are the ones who will know the patient to give staff information on, and also more likely to expose the weaknesses of the ward that staff cannot see.

Time (and the lack of it)

Somebody else who's running out of time, today

Finally, I have finished two essays. One for Tuesday, and one for the 5th september, so it will be now simply a case of checking for typo's, double checking the reference list and making sure it all makes sense.

So now I have to write a 3000 word report up for palliative care in the community. There are two problems with this. 1) I have not got to hand the plan of a report from which I am supposed to write the essay to the structure of. 2) The tutor I need to speak to has an email address listed which no matter how I try it bounces back to me.

So, I have decided the easiest way to proceed is to get the two nearly done essays out the way and then focus all my energy between tomorrow and the 5th september on doing the report (I have the source references to hand so there will be some structure to start with and then all I need to to is to find other references as they are needed while writing). I am also awaiting the results of another essay which I am really wanting to hear back that I have passed.

There is only one problem with all the above plan. I am supposed to work 3 shifts a week. There is I know 4 days where I am off duty. The problem is that you then need to write the three day off as I am too tired to do much after being up at 5:30am for a shift that lasts 12 hours. Then there is the first day off which usually involves me catching up on all the sleep I have lost over the work days (I am terrible at getting off to sleep at night- I have done a few 12 hours shifts on only 3 hours sleep). So, you call that three days between now and the 5th September to get cracking on an essay. Good job I can work fast.

My defining moment

I once said that there was never any time where I felt that I have had that one defining moment in Nursing. Well, today was as near as I have been in a while. Today I was with my usual caseload of patients and all was proceeding smoothly. All the patients had their medication given, been washed, and were all in good spirits. I was to go for my morning break at 10am but after working through doing a flush and an IV line did not in fact start the 15 minute break until near 11am. I made my usual round of the patients, told them that I would be away from the bay but that the HCA would be keeping an eye on them. I make a point of this informal chat as it allows the patients to be aware of my whereabouts, and for me to know that they do not need anything in the immediate time.

Well, when I returned, all was well bar one patient who seemed a bit quiet. I was making another patient comfortable in the chair with the pillows when something made me take a look at the patient mentioned before and think "Somethings not right here". The patient looked a bit pale and seemed to be breathing heavily and rapidly. I went over, asked if they were OK and they seemed very distressed. They said that it was due to the new tablets they had had that morning (though this was several hours ago at the time). I was concerned that this could have been an allergic reaction so immediately started following the accepted protocol of laying the patient down, getting a set of obs and getting help. I got the patient onto their bed, got the dynamap which was next the patient, took a full set of observations, took down the information from the patient who was reporting SOB and chest pain. I alerted the HCA who put the patient on oxygen, and while I was doing the ECG the HCA called the staff nurse and the doctors to come down. All was well in the end, but it was one of those moments where the training really started to kick in. It was interesting to say the least.

Took the doctors ward round in the afternoon which was uneventful, though was the first one I have ever done which was a tad nerve wracking. In the afternoon I had a vist from the tutor in the essay which caused all the confusion who was really helpful. He said that considering the essay was bashed out that the standard was good. It would not pass at the moment as there was little mention made of the future implications of the subject, but said that if that was written in the same way as the rest and the current content tidied up that it would get well above 60 based on his opinion at the time (subject the change though).

NHS moral: How can we improve it asked Alan Johnson MP

Its a long list and it starts with "£1 million".

The daftest test ever

Look at the above image. Notice something? Yes, the answers are correct but have been marked wrong. That was the same questions as set on the universities online formative drug calculation test. I am not saying that we should not do the tests, but what use is that? It means that even though you are right, you are wrong. Cynically I think that's a microcosm of the university, but until I get a reply back from the module leader, I am buggered if I am going to do it again as that's TWICE the thing failed even though the answers were correct.

Yes, I know that drug calculations are a big part of the latest target for improvement with all sorts of crazed missives going off saying that you should get 100% in drug calcs to pass and other such far fetched rot (its an exam so factor in performance anxiety, stress, when the hell did you have to do 30 calculations straight off the bat in the ward and so on the arguments are soon see to be too much "Blue sky thinking" not "Real world thinking").

Words fail me as to how we are on one hand expected to know this but then marked down by the computer on the answers. If it's right, its right. If it's wrong, its wrong. There is no road between.

To paraphrase Dr Rant, the daftest exam ever or I'm a little teapot!

My patience trying patient

Given the fact that this morning it was raining quite heavily it was nice to be at work. Today was a return to the same bay where I was covering yesterday, though this time I was covering the role that is normally associated with the duty HCA (though I was not being used as a substitute, simply having the floating task as I had been joined by a male colleague student nurse who is an ex-HCA from the same hospital having served for 13 years in post). This was nice as I was able to undertake a few different tasks on the discharge of several patients in the catchment area of the ward for discharge by ambulance this afternoon. What made this even more unusually is that it was my dear old mother who was the ambulance crew who took one patient off another bay for us. I know that she has complained that she has gone up onto wards and has been told that a patient is in "Bay 2 bed D" which of course means nothing to the ambulance crew, or find that control send them too early for the ward staff and that the patients are not ready and/or need medication sorting out. Today, bar one patient was was handed to mother as pathology were causing delay, all ours were ready and waiting and also meant that several new admissions were sent straight into us which sped up other wards.

One annoying things is that the patients I had yesterday were starting to get a bit wearing by them wanting one thing, changing their minds, then wanting the original request before deciding they really wanted the second option all along. There was a few moments today when that was really starting to try my patients as there were some in particular where the effects are more behavioral rather then illness based. I was more involved in the observations of patients, and even did a manual BP today which is a rare thing (though the second one I have done on the ward).

The patient was shouting out nearly all day (I did investigate as initially I thourght it was one of my side room patients. The one thing that did get to me was that the person was repeating the same name over and over again which was the same as my own...definatly something haunting about hearing an invisable voice you thinks calling to you).

Still, cant complain as the day was steady and productive and cant really moan about that shift. Of course some of that steady and laid back gait which people thourght I was exhibiting today has a far more benigne reason. You see, I normally walk quite fast, but this morning I had to hurry as I thourght I was running late (I wasn't in the end but at the time I thourght I was). Anyway, I managed to make a small skin tear on my right heel, so anything over "moderate amble" speed meant the "Oh bloody hell thats stinging" pain sensation, so the net result was a gentle amble through the ward. This while done for my own comfort also made some think that I was taking a calm and collected approach. I must admit it was a bit more therapeutic then my normal "Mad man tearing on another errand" speed that sometimes is used. I think that we all managed to get the patients seen too with good personal care but also got through very smoothly. Now I am home, I am cracking on with two essays and the letter asking about jobs.

My best laid plans of mice and men

It SHOULD have been easy: Two patients, and a third to oversee. One needed a discharge doing. Let me just say this: Even seen Peter Snow's swingometer on the election nights? Pretty much that's how the discharge went for the unfortunate patient and the family. It has meant getting back to doing the basic nursing care on the patients (washing, making beds, catheter care, feeding and fluid balance) which was a change.

Today has been a steady day apart from that. Didn't take much in the way of breaks though but that was partly through my own choice. The morning break I was called out to see to something and plodded on past that, and for lunch I went to the cafeteria thinking people had already gone. I had my lunch then nipped back up as I then wondered if the staff had been late going down. Lord knows where they were but I ended up missing them as it turns out they were sat at the back of the canteen, not the middle as I thought. Still, I got some work done which was good.

My weekend administration

This is my last day off having managed to have the weekend off the ward. I am back on tomorrow. The weekend has been up and down. Was out for a few hours last night and went to see a mate of mine as well as my girlfriend, and have been trying to sort out paperwork. Unfortunatly I have cut it fine for renewing my library loans but I think I have managed to avoid going over (not that having to pay £2 is a big deal).

I have been trawling CINAHL and the British Nursing Archive for some articles for an essay and fine tuning the next two submissions.

I am tonight going to start to write up my letters for application to the NHS trusts for the January qualifying. I am not sure what to put in the letter but will have a think. The trouble is "Gimme a job" being written in a fancy way usually means trying to sell yourself and I am not normally that vain. The plan is to go to all the departments in the hosptial and put a letter into the ward manager, write to the local PCT and fill in a generic application form to approach on three fronts in my own area, then go to a hospital in the next county to ask for a job. I have been told that my grandparents are wanting to move to the other end of the county, if that happens then there is always chance that there can be application made to other areas as well which will be nice, and I also want to contact a private aero-medical firm where I know the operations director. Then I will search Nursing standard and the NHS jobs website.

My gremlin

My Head exploding, today

The third day on placement. The first bad one. Definitely an unenjoyable one where there were some things that were unpleasant. The low point was being pulled up by a staff nurse over them thinking I was trying to skive. Part of the reason for that was the second thing that went wrong, which was a patient kicking a trolley out which ran over my foot and has left me in a great deal of discomfort. Imagine you have a great deal of pain and you can barely walk, after you have just set up 2 IV infusions, handled a phone call, taken a blood reading and need to pass this onto a college and you just sit down to explain these urgent messages when somebody walks past and tries to reprimand you because your "Sat down when we were busy answering buzzers a few minutes ago". Well, I heard them buzzers too, though next time check my location first as if you'd done that you'd have realised I was in fact dealing with my patients when that happened. Don't jump to conclusions about me as I have the ammo to fire back that today you abused the position of student nurses by using them to cover for your shortage of HCA's, and also the fact I went with only 1/2 a morning break and a short lunchtime and no evening break to get my patients seen (and a few discharged home).

Hardly nice when rather then going off duty I was doing my best to hobble over the ward (and got two blisters in the process).
The zoned academic was on the ward today so quickly managed to have in initial tripartie with her, so thats one less thing to do.

My pharmacy

Today ends my second shift on the ward, and this has been a mixed bag. A good shift was had today, and a definite "feel" for the ward is starting to emerge. The day has been quick to pass (though my feet have registered a mild protest). The morning was a doddle, as I escorted a patient on oxygen to have an X-Ray. The radiographer was a tad annoyed at the patient arriving as apparently there had been no card sent down to the department though was more then happy to do the x-ray (though they had a major incident last night at the hospital to deal with so it's understandable). With the x-ray done, me and the patient had a fair wait for the porter to arrive to get us back to the ward.

On the Ward itself, I was giving out the medications, doing fluid balance charts and was once more getting to grips with the infusions. Went well bar one which occluded. I think i am going to put that i my learning contract for the placement. Had a run over to the orthopaedic ward for a vacume dressing canister, met one of the ambulance care assistants who I knew. I must have walked fast as the staff greeted me with "You were quick" despite me talking for 5 minutes! Had a run out later on down to the main pharmacy for a collection of tablets for a new arrival and a discharge, so that was a nice change (I like volunteering for the off-ward jobs as it gives me a break from the same four walls).
The day was good, one good thing was there there were two patients who were a bit more dependant on us nurses and it was refreshing to be able to carry out basic nursing care on the patients who are on a ward. I realised I have not had patients like that since August 2005 when I was on a community hospital.

The annoying thing was that there is a patient who keeps pressing the emergency cord and not the buzzer in error when they use their bathroom, which means we all kept dashing out from the bays expecting it to be a genuine alarm only to end up being told it was a false alarm.

My first day

TODAY was the first day back on the wards. The ward is as I was told a diabetic unit (the infectious disease bit seems more sidelined at the moment due to low patient numbers of this nature). The ward seems really nice, and the staff lovely. The work was divided between a 6 bedded bay and a small two bay unit further up the ward. There was plenty of work to do, and today was the day where I was also in carge of the dispensing of medications including tablets, nebulisers, IV antibiotics (both infusion and bolus administration). I stumbled upon an infection control issue today as well, mostly due to the normal situation I find myself in when I try to do something for the first time without direct supervision and find equipment missing. The one for today was thus: I was required to give Tazocine 4.5mg to a patient as an IV infusion of tazocine 4.5mg reconstituted in 20ml sodium chloride. The solution is then added to a 100ml infusion bag of saline. Now, the first problem was the before lunch the drug was not in the pharmacy cupboard (there was one Tazocine 2.25mg and that was it). So, I went to lunch (this was one hour before the prescribed time), and on returning to the ward found the pharmacy delivery had arrived. The Tazocine was available in the correct dose. Then I found that there was no 100ml saline bags in the boxes. There was a choice of either 50ml or 250ml that was relevant. I had to choose the 250ml. Now here comes the interesting part. To remove the excess, I had to snap off the white port and withdrew 130ml to waste, leaving 120ml in the bag using a 50ml syringe (the first cock up there was when I opened the first 50ml syringe to hand only to find it to be a bladder syringe AFTER opening it) then withdrawing 20ml from the bag to reconstitute the Tazocine with. Now, the drug was mixed, and the whole thing injected into the bag. The yellow labels were affixed and filled in with all appropriate information. Then, this was taken to the patient and the blue end removed for insertion of the IVI giving set. What I said to the infection control link nurse who was standing next to me at the time was what had happened and why I did what I did. I swabbed between the different withdrawals, and as the blue end was running to the patient did not want to withdraw from that end as if anything nasty got left behind (bit of Staff. Aureous etc) it would cause a bit of trouble, but in the situation I was in, is there any other risk involved in doing such a thing by using different needles to go between the ports.

The unfortunate part of the day was when I met an SHO who was working on the ICU the same time I was there last year. It turns out he did not survive the Mass Medical Cull and has had his career "Modernised" and is now out of a job though was at a conerance at the hospital. Not very nice thing to see happen as he was a good doctor and a great person to work with. The human face of the MMC farce.

Of the weather, new placement and how the end of the world not happening means more work for me!

Today See's a nice day. Take a look at the above photo, that was taken all of 3 minutes ago from my bedroom window with my digital camera. I'm a tad annoyed at that, mainly because all of June and July was rained off, which also coincidental was when I was off. Of course, tomorrow I am going to have to start working in a placement area so you lucky ones who are off have the nice weather (thus of course nicely proving that, yet again, I was right in saying that the weather would pick up in August when I go back to work).

But, for the serious part. Tomorrow See's the return of student Nurse to the wards. That by itself is normally nothing that would attract a great deal of attention. I have had some time away from the wards seeing as the second year training results in there not really being wards worked on (though that in itself boils down to practicalities of training. There are sometimes the slight drawbacks with the course, though the only problem I have with the lack of ward experience for over a year is that it will take some more settling in then may be expected. I know this to be a worry shared by many of the others within my cohort). I admit there are a number of things all vying for my attention. What to expect in terms of the patients and the staff, what will happen on the ground on the day to day running of the bay where I am to manage, will I get on with the staff OK, am I going to have a pleasant student from first year to work with, will I mange not to make a total fcuk-up of the ward on the first morning, and will I be able to not be totally knacked from a lack of sleep.

Then of course, there is the problem with the heat. Yes, it's warm and I think today's temperature while not exactly at the "Heat wave setting" is just as warm as I like it (I like many others find it hard to sleep at night if it's too hot). Of course, I have been told that while the ward is down as being infectious diseases, but it is not 100% used for this purpose. The reason being is simple: there are not many people in the county where student nurse lives who have a horribly disfiguring disease, nor do the good denizens decide to visit the far flung corners of the world and come back with something nasty. Avian flu is tossed around like a ping pong ball on speed, though to days news worries more on the foot and mouth outbreak. Bovine patient rarely happen in acute medical wards, and even if Daisy should decide to be admitted, its not communicable to humans (a Zooanosis for the medical term), so I'm ok there. Ebola is always a risk, though is the most deadly disease since the last killer virus was isolated in a lab, killing nobody. I know there are those who will know that Ebola potentially is dangerous. The thing really is nasty- Firstly, the immune system of the host is attacked. Whereas something like HIV will happily stop at shooting the immune system to smithereens then allow something else to finish the host off, Ebola ploughs on till there is nothing left. The blood beings to clot, damaging the liver and kidneys, the collagen fibers are destroyed and the hosts organs liquefy. Save for the stomach which is vomited up. Though BBC news has nothing about a man walking out from the jungle with bloody eye's and his stomach in a bag so panic over.

Thus, as you can guess, there are a few other patients show horned in. These are the diabetics. Yes, diabetes is a very bad thing, the leading cause of blindness, and limb amputation in the population of working age. It will be these same people who will be on the ward. The same ones who may well be kept laying in bed awake at night, slowly using up their prescribed insulin, and letting that glucose level go down, down, down instead of sleeping. I know 99.999% of people will be fine, though the potential is there (and just my luck it will happen, so if I write it down I may be proved wrong).

So, in someways, therein lies the situation. As there is no immediate threat of there being some sort of widespread pandemic, we take on diabetic patients. So, that means then I actually have good chance of getting to grips with working with patients to practice good nursing care. Nice!

Ahh, a good day (At Last1)

Ahh yes, come to daddy you beauty!
There is nothing more pleasing when I was presented with this cheque on Friday which was hastily paid into the bank. At the moment the balance is -£399, though as the cheque is not fully clear (i.e. allowing any withdraw ls until Monday) I still cant fully use it, but at least I have it. Additionally, I was sent a new award letter. The nice news is that it seems I may be paid again on the 17th August so things are looking up a bit now on the cash front. As I had the award letter, I took a gamble with the bank and they have sent the documents off to their lending centre for approval of the third year loan.

Regarding the essay which laft all concerned confused, I did thrash an essay out and went to submit. However, when all came to all, the email sent from the university seemed to inaccurately have the module down for 3rd August when this should in fact have been a totally different module. have handed in the essay which caused all the problem before. This new version was done with the original seminar documents emailed to me so I was made aware of the expected content. I have "tighted up" the content alot so now hopefully will pass. Fingers crossed.

Today I have just trawled the DoH website for the NSF for diabetes and related documents so will have a casual nights reading of them in readiness for Tuesday when I have my first shift on the new ward. Given that there seems to be an overflow of Diabetic patients onto the unit, I want to refresh my knowledge and have some up-to-date reading done to prepare myself for entering the unit. Still feel nervous as I have not been on ward for nigh on 18 months but I will try my best. I may outwardly seem to drift on, but I in fact do put a fair degree of thought and consideration into things. Not saying it works all the time, but it's as near as dammit.

Question

Is it really worth it anymore?
In another 9 hours the essay that nearly ruined my career will be submitted. I am hopefull that this will pass, but I have had such a hassle with this other essay that I am really worn. I am really tired of this all. I mean, where is the job at the end of this? There really is little prospect, I have always asserted that I doubt that there is a job at the end of the course for me (and many others). The third year has been a demoralising exercise and really I cannot take much more of the constant kick-in-the-teeth experiance which the course has descended into. Course, today is friday but heaven knows when my money will arrive, when hell freezes over or there is aerial bacon seems to be the two hot favourites at the moment.

Take the latest problem. I am being asked to submitt an essay today that is not infact due to be submitted until september 5th. I have mentioned this, and all I get is a terse reply saying to hand the essay in. Well, they want an essay in a week then fine, you get an essay in a week. So this will more then likely defer.

Then, I will go to the studnent union and kick off on the matter.
But, who will be made out to be the c**t?
Yes, well done you guess right.
I may be back on the course but I really am just past my mental tolerance level. Just when you think you cant go any lower some bugger comes along with a jackhammer to add a few extra foot.

Confused: A short play by Nursing student

The following is a mystery play for the reader to solve...
Within this short play there is a student Nurse (the protagonist), a module leader, another student nurse and a tutor. The story takes place as a series of emails which are sent, and the reader must decide what the outcome is.
Email one: A week ago: From Module leader
Dear Nursing Student,
I have received an email from the pathway leader regarding your submission of the module essay on the 3rd August.
Regards,
Module leader

Email two: A day or so later: From Nursing Student
Sent: Mon 7/30/2007 14:10
Hi Module leader,

Thanks for your recent email. I am a little confused as to the submission date, as I was told that it was the 5th September originally. I am to be submitting an essay on Friday that was originally to be submitted on the 26th June. I have written most of the essay and can submit, though just want to clarify with you as the leader when to submit.

Kind regards,
Nursing Student

Email Three: From Module Leader
The hand in date is 3rd August and I understand that Pathway Leader and Another module leader informed you of this.

Email four: From Nursing Student
Hi,

Yes, I think I may have been getting confused with your module and that of another module.

At this point, enter Nursing student #2
Email 5: From Nursing student
Hi Nursing student #2
Hope you are well.
Just a quick question, what is the submission date for the module, i got an email saying it was the 3rd august

Nursing Student

Email Six From Nursing Student #2JUST GOT BACK FROM HOLS SUBMISSION IS 5TH SEPTEMBER. YOU HAVE GOT PLENTY OF TIME.

Enter Module Tutor
Email Seven: From Nursing Student
Sent: Thu 7/26/2007 11:27 AM
Subject: Essay

Hi tutor,

Just a quick email regarding the 4000 word essay and the 1000 word reflection. I had some time away from the university in June and have been trying to get the essays which are due sorted out.

I have been working on the essay, and have 2500 words so far on this. I got an email from module leader saying the essay was due on the 3rd August, though I have the date as being the 5th September. Can you email me back with the date of submission, and any way I can have a tutorial please).
Kind regards,
Nursing Student

Email Eight From Tutor
RE: Essay

dear Nursing Studnent, am on leave; in tomorro at uni thurs 2nd august, then off til later when im back in for 4 days...im on *********** txt me tomorra when im in work.............Tutor

Question: What conclusions do you draw from that?
Answer: Sadly, at the moment I don't know which is bugging the hell out of me as this is happening in real life at the moment and is not a work of fiction.