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!

My big move

Saturday was the day when the ward moved from the second floor of the hospital to the ground floor. The ward now is the old CCU. Although it was my day off, I turned in for a few hours to help out. The move was simple in its outlay- move the patients, their lockers and the tables- from the bay, down the corridor, into the lift (which was kept open by the head porters and had notices on asking the public to use the other lifts due to the ward move), down the ground floor corridor and to the left into the new ward, then place the patient in the bay area which corresponded to where they were in the original ward. In reality, what happened was that the side room patients were in different side room numbers which caused some people to go to a different numbered bed, and to compound this there was no bed 13 (somebody was superstitious. I kid ye not, it went bed 11, 12, and 14 in the bay). What this meant in real terms was that for every one patient moved, three journeys were involved- one with two people (sometimes only one) moving the patient on the bed, one for the locker and one for the bedside tables. This took time, I moved about 8 patients in some role of the above categories. This was harder then it seems (which with going up the stairs after each run), not to mention taking equipment and supplies between the wards (hoists, dynamap’s-though not sure why as they always are buggered in my bay- chairs, crates with paperwork in were all moved by myself), as well as helping with the patients (buzzers still went off, medication was still given etc) as well as removing cardboard into a cage which was for disposal, taking chairs from the new ward to the ward where that was moving to, and taking the hot-lock for the patients meals down to the catering department with one of the housekeepers as the porters which were plentiful in the morning were talking about some finishing at 1pm, which they indeed did from which time it was impossible to find one for love nor money. I was remarked as being “always walking through the ward pushing something big and heavy” so at least people saw me doing some work (for a change- normally I was in the end so saw little of other staff). I also taped up the new bed numbers (a senior HCA took on the role of assistant ward clerk- and I, having micropore tape in my pocket was able to take on the job of affixing bed numbers, which helped gain an understanding of the ward layout which was handy when I took one of “my regular” patients back to their correct bed as we were all a bit lost with where we all were supposed to be.

I was knackered by the end of it all and had a splitting headache. Still, at least the ward manager thanked me for turning in which is nice. However, when I got home I checked my essay feedback. While I thourght at new essay feedback would show up as an added number, I checked under the original listing (which read Deferred) and it has passed with a good mark which I am happy with.

My strawberry jam

I was back in my normal area of the ward today being in charge of the two side rooms and a patient who was to be discharged while covering the bay in a general sense (like when there were breaks etc). One patient in the side room was pretty much independent and really all I had to do was give out meds and kept and eye and called by the room when I had a few moments spare to chat to give the patient some "face time". The one next door was a bit more ill and for a few hours were asked to wear masks while a certain test was performed (which was an interesting thing as I never done that before). There was a problem getting the medication in the form of a liquid which I wanted for the patient as they were having problems with swallowing but made do with crushing the medication down.

I was obsessing about the ward keys having accidentally taken the keys to the bay home the last shift (oops!). I find this odd as I was asked just to bring them back to the ward...and that was it. I was imagining having to do an incident form a get yelled at. All they said was "Oh, that's good that you got them, that cupboard was open all night". Still, as a lucky dip of the "potential fuck up to make on placement" it was not a bad one.

My other patient went home without too much, and today has seen me working quite autonomously in what is a very unusually quiet day. I am turning in to the ward on Saturday when the ward moves to a different ward.

Have a break, have a compound fracture

I want to write something nice and non-ranting. Then I remember I am a student nurse and that it would be a total fiction.

So, my latest rant is on the issue of falls, and just why the buggery fuck is there no safety measure to stop my ward getting so full that nearly all patients fall (they were dropping like flies the other day). Now, I know money is tight but that's the lamest excuse I have ever heard. All that means is that the NHS cannot be arsed to put in a bit of effort for patients as it means money, and I am sorry but that's what the NHS is supposed to do. So that's really saying that they cannot be bothered looking after patients which begs the question of what in the name of steam powered buggery they want to be doing instead.

The reason there are so many falls is that there are so many patients who at the moment have a high risk of falling. We have 4 staff nurses and 4 HCA's to oversee the 21 "at risk" patients. Common sense never was the NHS strong point but even my neighbours 5 year old will be able to tell you that without a reasonable nurse:patient ratio and a manageable caseload of patients who require supervision at all times there will be dire results. Well, I paraphrased there a bit. Which is why mental nurses petition for nurse patient ratio's is something that should be signed not just by nurses, but by all health professionals, and by every single person of voting age in the land, because until we do, people are going to suffer at the very hands of the system which should be helping them, and like the protagonist in one of Homers tragedies, nurses will only be able to helplessly look on as the disasters unfold with little they can do.

One can only submise here of course. I can still painfully recall what for me will always be the worse mistake of my time in the health filed which was in a call very close to home. Last year, in February my sister gave birth to her first baby, a little girl. I was working a second job back then where I used to work two days a week to supplement my nursing income which was OK as I came out with £1000 per month with the two combined. On the night after the birth, I visited the maternity ward of the same hospital where I now am on placement to see the new arrival. I noticed that initially the baby was very quiet, which is not unusual to see. What I did think odd was that the innate grip response was very very weak and this did register at the time. I then tickled the bottom of the foot, and worryingly this produced hardly any reaction. Now, at this point I was all geared up to yell for a midwife to have a look as something was wrong as while the baby was breathing she was very unresponsive. However, I took one look and my sister and mother and knew the bollocking this would entail and the sort of comments of "over keen" "your not on bloody duty you know" etc, so I kept quiet, but did ask when the next ward round was to be (it was 10am the next day). That should have been the biggest alarm bell. The next day she was seen but nothing done. The following day, the baby went "floppy" and was admitted to the neonatal unit. The original text I received described this as a chest infection and I was happy to go along with that. Back then there was a first aid duty to cover a football match tournament held on a Thursday and I used to get changed and go down to pub with friends after this. I did that without event, though when I returned near 11:30pm the hospital rang saying my sister was on the ward and could we come down as there was something wrong. I was told the information relating to the condition and given what was said that it seemed that there was something metabolic causing the problem. This was confirmed by the on call Neonatal SpR, and after several tests the devastating news was broke (that I felt after that first visit to the NICU), that there had been brain damage caused from the condition and while the baby was now ventilated, a christening was arranged for the hospital Chaplin to carry out in the incubator and a DNAR order was put out. It was to be 5 days later when after clinging to life for just 10 days, I was helpless to do anything but watch as after she was removed from the ventilator she clung on to life for 116 minutes before passing away. I was then faced with the heartbreaking task of informing the staff nurse that she had died, and trying to hold it together while the devastating fall out of the death was dealt with by the immediate family in the moments of the passing. This was done, it was one of those moments when I was relying on all my training to try and help. Nothing has ever been so hard as that day. There were to be several weeks before the official cause of death of Non-Keotic Hyperglyceneia was announced. I was more then happy to have turned my back on my training as a nurse that day, and for 3 weeks could not face going into the university. There was a research essay to be done but after my 10 day old niece died from an incurable condition I was in no mentally fit state to write a load of essay on research (this was the essay which caused me to be withdrawn... the whole even was very vivid and was the major reason I referred). I am convinced that had the staff been there this would have been picked up sooner. The ending is the same I guess, but its the point though!

While there is not much that can be done, that is half the reason a post on the days work is prefixed "My..." Partly as this matched the "scrubs" naming, but also because I wrote "Sleep well, My little angel in heaven" on a bouquet of flowers on her little grave. AS she was nearly the reason I left nursing, it my silent nod to her.

Its just a shame that things seem to be like this.
Its a malaise that is affecting the entire county. I don't drive as I am priced off the road. I want a small bike or other similar mode of transport but dare not actually get anything on finance until I have a job so have to use public transport. Which around here is crap. No wonder people moan about the NHS. It seems that underneath the surface, everything is half cocked.

My typo negative

Same bay, more admissions. The ward has finally gone mad, and we see patients who are more the we can cope with. My bay was the last outpost of sanity in this mad world, so thank goodness this is where I was. It was never easy as there was still no BP cuff on the dynamap, and while my staff nurse said "why do it manually it takes longer" when I began using my sphyg again. In the end it took only the same amount of time as normal, and did not mean me wasting half an hour scrounging equipment. Which was nice.

What was not was the falls which took place, but there is nothing much that can be done when we are at screaming point with overload despite the best efforts of all (and by all I mean everyone from the HCA's up to and including the ward manager, who had come in on her day off to help and sort things out).

Still, away from the wreckage of the ward, in the calm lagoon of nursing students bay atol, work was thundering along. We had out patients up, washed, sat out, beds made and seen by lunchtime, after which I was invlolved in the blood transfusions which were going on. This went well until there was some discrepency on the labels of the blood lables on the unit. This took some sorting out but was done.
I am looking forward to my rest day tomorrow.

My Reckoning

With Monday bringing another shift, I naturally slept in till 6:05. This is a problem as I am supposed to leave the house at 6:10. However, I managed to make my bus, and was even lucky enough to get a connecting bus which randomly arrived at 6:50 from where I have to change, so while I was initially thinking "here comes a crap day" it actually turned out rather well. So, by rather well please read "the hospital failed to explode". The ward was heavy, mainly because the lunatics had taken over the asylum, but then fell ill and had gone to the MAU. Which of course means that somebody with falls, confusion and dementia/other problem should be considered to be sent to the Diabetic/infectious disease ward in the endocrinology division. Oh, hand on, no they fucking don't but you try telling them lot that because somebody seems that they should. That's mainly what we had, which would be great but there were 21 patients out of 31 who had either had or was at risk, of falls. This, is not safe. It is an easy criticism to make of the nurses that patients fall, but this was too many. While there were howls of protest from the staff and the ward managers, there was nothing which any other ward was prepared to do to help us out. There was as a percentage 67.74% patients who had previously has falls. That, is not a good percentage of falls risks. While we know there have been cuts, this is where the chronic shortages are expressed the most, at the times of crisis where things go wrong.

My bay was not too bad. There was a few basic tasks to be done with the bed baths, bed changes, a discharge to sort out and a few BM's to do. I had every intention of setting off to do the observations first thing...only to find that there was no cuff on the dynamap. Lucky for me, this was no problem as fresh from having it on stand by while on a first aid duty with St John Ambulance on Saturday, my sphyg and stethoscope were taken out and given a hammering. Speaking of saturday, my St John ambulance duty was nice. 5 hours (9am-2pm) covering a 24 hour relay walk at a local rugby club with two first aiders and one Ambulance aid, which was unusualy in that while there was one public minor injury, I ended up with a sore backside from sitting on the cold wooden floor of the stand. If only the ward was like that.

After the doctors handover I was able to get to grips with the social workers referrals and faxed a few forms over to different places which took me nicely up to being at lunch. When I returned, there was a new admission (who did not have falls), which killed a bit of time, then I had a blood transfusion to do. So, with all that in place, using only my stethoscope, sphyg, a thermometer and my bare hands, all the relevant obs were done at the required intervals. With which, I then went home.

Then when I tested my BP at home, this came out at 150/100mmHg. Three times. This is not good. That's what it does to you.

My Finnegans wake

It was with mixed feelings that I was told that the internship placements were put up on the university intranet today. The result is that I am on my second choice, a cardiac surgery ward. Which I absolutely love as the heart is one of my strong fields. However, I am getting too far ahead, so leave me at 4:30 in the central corridor on my break being told this by another student and return to some hours previous when I arrived at 07:10. Today was on the ward, while my mentor was on duty I was allocated to another nurse to act as second nurse. There was one patient who began the day by telling me and the staff nurse to "Fuck off and don't come near me". We left him half an hour and were met with the same reply. As were the junior doctors. The consultant. Two ward hostesses. A physiotherapist. And a visitor. SO there was not a lot we could do. Still I did get the patients medication and observations done and was able to get the bed made and sort them out with getting washed and changed. Just never done it while being swore at before but hey.

I was trying to do the observations with the dynamap again which stopped working near the end but still managed to get my observations done albeit slowly. The day started with the slow fall down to being stagnated trying to square things up, but one I found the sats probe and the dynamap came back to life I was able to make a start on the observations once more. My two side ward patients were both discharged which eased the workload. There was a staff nurse from another department who was with one of my patients when I was covering the lunchtime. I thought it was odd that a visiting nurse would be dealing with the patient in the manner they seemed to be until I was able to deduce this was in fact a visitor and the patient was a relative. I was mildly taken aback with mild panic as I became acutely aware that here was not only a visitor, but one who was also my superior on the job. Thankfully they were very happy, and actually gave me a hand with them. I was able to crack on with the patients who were left. The staff nurse remarked that I had "worked very well" today which was nice (I have never worked in the same bay as the staff nurse in question who originally trained in 1966 and is about to retire!).

The afternoon drifted by slowly and while tiring has left me some time to think. Which is really starting to get to me as I am now comming full circle. The end of the course is comming up and I now look upon this with a mixture of thourghts. The initial one is a feeling of happiness that this whole course of three years is nearly done and this I can rest (I am feeling tired at the moment of the pressure) but also with the uncertianty which all in my positon are facing. Which is even worse for seeing the list, as there are quite afew people on the list from the same hospital as me which will all be fighting for position. And this is simply depressing as there is the rumor running around of the jobs which are going and of those who have been earmarked and the problems which the last cohort faced (60 people qualified but only 8 finding jobs), the future what this holds for me and of my girlfried and how they will fare.

This should be the time to be glad and looking forward to a bright and prosperous future career. However, I am left burt out, dejected, nearly reaching for the fluoxitine, and considering work in a call centre. This is not healthy.

Found: The rectum of crap nursing

I have been in a training seminar today. The training was intended for the newly qualified nurses who have gained employment in the hospital. There are many exam's which I have to do, portfolios to pass and have so far spend two and a half years slogging through the sheer head-banging-against-wall frustration which is the modern day nurse training. When I think back over what I have done I soon realise just how irrelevant the training of today's nurses is. I used to think that this was simply because they were trying to make nurse training as far removed from the real world as possible and wanted students to have no clue. Seriously, the most progress we made was in the last half of second year when we were being groomed for the critical care placement and were expected to actually know something about the care of patients. If you look in the dictionary, the definition of nursing is to aid people's recovery through periods of illness or infirmity and help them meet needs which they cannot meet themselves (see the Roper Logan and Tierney 12 activities of living). Today though, I have found the real reason.

The training was for BM monitoring. Now, I thought this was simply the companies making a plug for selling their equipment. Turns out that for once, I was wrong. The reason this was to be done was (and I quote) "Before using ANY piece of equipment in the trust, you must be trained on how to use it...including thermometers". What? A bloody thermometer? The thing you put in the ear and take the temperature with? I am not suddenly finding myself in an alternative dimension of time and space where this is a name for a technical bit of surgical equipment? Unfortunately, no. I really could not believe what I was hearing. No wonder nursing is so disorganised and shit this day and age. I happen to know a fir bit about anatomy and physiology. I spent time studying ambulance aid so know of fractures, cardiac conditions, spinal injuries, the systems of the body, and read up on drugs. In the nursing school, none of that was considered important. BASIC NURSING CARE! Where was that? BASIC does not mean the same as SUPERFICIAL. Though maybe that's typical of the glamour obsessed self serving tossers who are considered "too post to wash" when back in first year I went through 4 vomit bowls brimming with sick to recover a patients lost dentures (which were actually in another vomit bowl back in the bay), yesterday was racking through a bedpan full of loose stool to do a sample and dredge paper from, then did the same for a urine test. Hardly glamorous but then I am a mildly pudgy bloke who wants to genuinely help people. Some nurses must be females who are living in some pink and blond valley in California who must be living the "hello!" celebrity culture who think that doing bed baths, checking observations, doing aseptic dressings, taking BM, Blood's, care of central lines, catheter care, dealing with relatives, talking to patients and working with the doctors and possessing a nursing and medical knowledge base not glamorous enough. I personally don't care about the glamour because I know that without all the non glamour stuff, patients would have a hard time of it. Yes, the cardiac surgeon did a great job on the coronary arterial bypass graft (CABG- and for goodness sake call it a graft in front of one surgeon and not a "cabbage" because I saw one person get yelled at for that)...but also having a relieved patient thank you for showering him after 5 days without having one brings it's own rewards.

I think there was about 3 sessions which really covered basic nursing care/skills. Manual blood pressures? Most staff would go running for a dynamap, which is hardly surprising as in my nurse training I spent only one 2 hour session on manual BP. Yet countless hours listening to people bang on about "Holistic [.sic]" care who spectacularly never managed to mention the patient or just exactly how an example of care meets this "Holistic [.sic] care". Honestly, I have often said that these people have spent too much time in a hippy commune somewhere on the west coast of the USA because there is no way on earth that a massive arterial bleed will stop by telling the patient "Stop bleeding, stop bleeding, oh God, please stop bleeding".

This is the problem. I have had SOME good training. Legal and ethics will stop me from getting sued, covered confidentiality, cleared up consent and keeps me on the legal straight and narrow. Evidence based practice was nice...but went on way, way, way too long and became near irrelevant. Foundations of clinical (in)competence was too short, principles of practice was boring, a full module on nurse education pointless, and even doing an essay seems pointless as it seems after three years of training I am not even allowed to take temperature or do a BM, would be elite as I can do a manual blood pressure and have to fill in a form bigger then the yellow pages just to have got the application. So who does that leave able to do the hands on care.
HCA's that's who.

My philospohical way

Well, the second of three shifts down. Today has been a shift made of many parts. I was back in the bay I was in yesterday with my normal staff nurse and another staff nurse who was covering as second nurse. I was going to take the two side rooms which are attached to the area, and the confused patient I had yesterday. In reality I had the side rooms and was floating about the bay. I put this down to there being three of us on the bay which did give a certain amount of "too many cooks" situation arising. However, I really should quell down such thoughts as that's tempting the doves of fate to shit on me from a great height for Friday when I am sure to write on that shift with "I could not find staff for love nor money...".

However, I have had a few thoughts running through my head today. Like for example the efforts that I went to with two patients to give them assisted feeding, the problem of keeping fluid intake up in patients and the odd bedfellows which nurses and doctors make. Take the nurse and doctor relationship. The historic portrait was of the male doctor and the subservient nurse. Today on the ward the nurses and the doctors have quite a close working relationship and one of the wards decision to have the nurses in to give the SHO's (Or whatever they get called after MMC culled them...FY1, ST2, ect) which meant we all have a bit more of a social time together. I particularly find this is one way to understand each other quite well, and certainly I think the doctors find this easier as they can get the nurse they need who is covering their patients quicker. Which I personally find nice as the more we work together the more we both seem to find that while doctors and nurses may be seen as arch enemy's the more I think about it we are more like schoolchildren in love: Mildly having demographic similarity but neither above pulling each others hair every now and again. Think about it for a moment: Both professions can trace their roots back thousands of years, both are the most prominent in the heart and mind of the public, both have handovers, both take the same crap from the public, both have suffered loss of posts in the NHS.

Loosing posts has meant there were few HCA's on the ward today which is why I was in giving assisted feeding to two patients and was trying to encourage a patient to drink which was the biggest failure of the day as despite my best effort I was lucky to get more then a few sips of water into them and if they had more then 150ml oral all day then they were luck (there were several IV infusions though). Which got me thinking of the new(ish) RCN nutrition focus. 2 of the 3 patients today needed me to give them assisted feeding. I could write an long list on nutrition the importance of eating in hospital but it's 22:05 and I really am a bit tired so cant be arsed to do that (if only I could write this in my essays). I think I may have found the biggest hurdle to this: The patient who refuses to eat. I personally hate doing assisted feeding as my early experiences were of spending 3/4 hour battling to give a patient about 4 spoonfuls of food. Today proved no excpetion which is something I really think we need somebody from Mental health to go through more. We have all I am sure been on a ward where there is a confused person who is shouting. You can bet your bottom dollar that this will eventually be one of three things: "Help", "Nurse" or "Get me out". So if they can figure out all this, perhaps they can figure out how we can better deal with the patient who is through their confusion putting themselves on hunger strike by proxy. If they can do that, I can figure out how not to end up with dinner spat down the front of me.

Woo-hoo I was in the BritMeds

Just checked the Dr Rant Blog and post "My Sneeze" was included in the Britmeds list.

Some of you may know that originally, while I read the Dr Rant blog for a long time I never poasted until early in the year when I felt compelled to reply to a comment, from which eventually this blog was born.

Nice to get some recognition. :-)

My window of opportunity

It was back to the wards today with the start of the new weeks having had a rather good weekend with my girlfriend. I am now spent up just a little. The staff nurse I was with was not my usual one but was however one of the longest serving nurses of the ward. The day was not bad, did a few IV antibiotics, had a playful IVAC device which was causing problems which was compounded by the patient being confused and waving their arms over the line causing it to occlude. The patients were OK really with few complaints needing referring to the medical team. Only two really to write home about happened just after lunchtime when one patient who is on morphine was feeling sick and a confused patient was describing central chest pain which was "Crushing" in nature. The former was soon sorted out by asking for an anti-emetic to be prescribed and the latter although having text book symptoms of Angina Pectoris was put down to being condition related after two ECG's were unremarkable. PRN Morphine and Glycerol Tri-Nitrate (GTN) should be enough to sort out any future events but with confusion it make the job just that more difficult to get right. However, I was in the bay monitoring so was quite pleased to take the opportunity to flex my nursing diagnosis muscles a bit (which is nice as I do think I have been stunted in doing this on the ward as nothing extra ordinary seems to have happened with the patients).

There were few buzzers in other bays either today which is a rare occurrences normally the afternoon brings a steady stream of them. There was only one in another bay which I attended to which was over the top window being open. The windows need a special hook to close and despite my efforts up a step ladder (with me having visions of crashing through a second floor window down onto the pavement below which was very vivid when you are up a ladder) I ended up closing the curtains to stop the draft.

Managed to get off early as well tonight as I had to travel in a taxi over to near where I live with some antibiotics for a patient. Which was nice.

My Sneeze

The chaos theory states that a sneeze in America can cause a typhoon in China. This is quite clearly rubbish or else all of us would be washed away after the flu season and if a butterfly flapping it's wings causes Hurricanes then it should stand to reason that the increase in the temperature of the earth is nothing to do with industrial emissions and all to do with the hot air that came out of Patricia Hewitt's mouth.

Now, that aside today has been one of them days where the smallest thing has caused the biggest fuck ups. Lets start with the never working Dynamps on the ward and the missing sats probe. Once more I attempted the Obs this morning and the damn thing decided not to work so once more broke out my trusty stethoscope and sphygmanometer, recorded the results of all manual obs (BP, Pulse, Resps) and used a thermometer which joined the dynamap in a bit of "Me too-isim" by deciding that 35.4#c is a nice number and wanted to display that for all patients. I wrote all the obs down on the communication sheet 9as is wanted by the ward). The fugure off a manual reading is never really as accurate as a dynamap. So, I decided that with the dynamap on charge and none of the patients about to die in the next half hour looking at their obs, that I could return later with the charged dynamap and chart them on the Early warning score chart (EWOS). Which was fine until I was told there was an audit to be done that afternoon, so I had to go out and chart all the manual BP etc rather then giving the exact figure from a dynamap.

Then we hoisted a patient in a side room out for the physiotherapists. Then, after they moved the patient, causing their dressing to fall off, I had to spend 15 minutes tracking down all the dressings I needed from different places on the ward to do the new dressings (which I changed to a primapore and melonin pad which matches closer the surgical wards on the hospital). This would have been better if I had a dressing bigger then 5cm X 10cm to work with which left a rather patchwork appearance to it. So that made me late for lunch by over 5 minutes. Only to get chastised for not managing time correctly and delegating. I was a bit annoyed by that as the whole reason I was late was that basic equipment and supplies are not found or require a detective to track down something which you should just be able to walk into the treatment room an grab straight away.

Anyway, after luch escorted the family of a deceased patient to Rose cottages, pottered about on the ward and had some kind words passed after staff ate the (squashed in transit) victoria sponge I made yesterday for the ward.

Not that bad a day.

My curious case of the capsised commode

There have been two shifts. I have forgotten most of what I did Monday so that goes some what to explain how unremarkable that was. The only thing wa builing up a rapport with a normally sharp patient which was quite nice.

Yesterday was in. Had a few discharges to do (which meant waiting all day for the pharmacy scripts to be sent and arrive on the ward). Had an interesting case in the next bay which I was roped into helping with which was of necrotising fascitis. Then had my first fall in a long long while in another bay to assist with.

Now, I know at this point some of you have started boiling over with rage thinking that this is just another case of the nurses being shit and neglecting their patients. Which is natural until I tell you that that patient had fall off the commode they were on- by overturning it sideways and precipitating themselves and the contents onto the floor. The brakes were all on, the commode was intact, so lord knows what they had done. I was among the first into the bay and supported the patients head and neck in the neutral position (that St John training paid off). That is the curious thing as I always considered commodes to be as hard as a london double decker bus to overturn.

My pre-emptive strike

Knowing that I was to manage the bay and do the obs on my Fridays shift I went in early with a check of the stock cupboard, and my stethoscope and sphygmanometer to do the obs manually which would save me 20 minutes farting about trying to find a dynamap that probably would not work. That paid off.

Having several dressing changes, a few washes and a patient who's BP dropped to 80 systolic kept me going so I decided to skip my morning break and worked up until lunch which was at 13:40. Bit of a long day when you think that I have been there from 07:00 that morning. Decided that there were several IV's needing to be done so got them done. The biggest thing the really frustrated me was the fact that there were no basic equipment to hand. There were no blankets, no hospital gowns, somebody took the DDA keys on their break so there was access to the controlled drugs, the scales broke and I had to find another set from a adjacent ward, and went to pharmacy and pathology twice via dropping a patient off as the porters went AWOL.
Its more "Crisis management" not "ward management" at the moment. Am back tomorrow after having a nice weekend with my girlfriend. I needed that break.