Politico's unspeak (or My head exploding 2)

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

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

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

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

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

Why I want to shoot the legal eagle

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

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

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

More Nurse Bashing from Dr Rant

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

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

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

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

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

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

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

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

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


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

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

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

My lost nights

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

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

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

That was my night.

my nightingale

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

My quiet night

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

My nightcap

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

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

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

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

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

My Nightlark

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

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

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

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

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

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

Of crumpets and the NHS

A teatime Revelation

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

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

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

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

A job...of sorts

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

My half shifts

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

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

My quiet victory

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

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

Post strike

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

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

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

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

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

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

my demon

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

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

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

my new world

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

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

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

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