I had about 2 hours sleep last night. To say that things were playing on my mind is a bit of an understatement. On waking at 5:30 and going into work, the ward was found to be full. I was allocated back to my usually area of patients. There was one new one who was a medical sleep out, and one patient to write the Nursing Discharge letter for as they were to go to a community hospital. That was written out and several ECG cards and phone Call's made before I set off to make the beds with a HCA.
That done, the ward settled down to being a day where there were small obs occupying my time. This went on clear up until 3:30pm which was the time for my final tripartite meeting. The meeting went well. The net result is that I have now passed all the third year competencies and therefore I have passed my Internship placement and have now to submit the Portfolio and the essay to the University on Monday for marking. Following this, I must eak out 4 weeks of service before returning for consolidation week to the university.
Wednesday 28 November 2007
Monday 26 November 2007
My baited breath
I am still obsessing over the tripartite to be held Wednesday. Being on the ward is doing little to calm my nerves either, and I am getting palpitations thinking about it. Today began with there being a staff nurse short so for a few hours there was a team of patients who was split between two staff nurses so there were 12 patients to each staff nurse (eek!). Fortunately one of the senior sisters from next door was on an office day and was free to come around to take the team for the afternoon. My patients was quiet with one who went to theatre and then required post op observations to be done in the afternoon which were unremarkable. This was along with one patient with chest pain (ECG was NAD).
I mentioned to my patients that I have the tripartite on Wednesday. They all gave me a vote of confidence and said they were more then happy with my care. Its something I suppose
I mentioned to my patients that I have the tripartite on Wednesday. They all gave me a vote of confidence and said they were more then happy with my care. Its something I suppose
Sunday 25 November 2007
The end (Part 1)
I am a tad nervous at the moment. Ok, that's a bit of an understatement. "Absolutely bloody terrified" is strolling over in the right direction. At this moment in time I am passing by the scary house, around cape fear and into the calm lagoon of sheer terror.
Because this is the beginning of the end. Yes, on Wednesday, I am facing one of the biggest tests of my life so far. Namely, the final tripartite meeting of the internship. This is it. The big one. The terminal end of the Nursing course. In the meeting, I have to present evidence of Manual Handling, CPR, Venous Cannulation, Male Catheterisation, Venepuncture, IV drug administration, Fire lecture and so fourth. I am also required to pass 17 competencies and benchmarks as laid down by the University in conjunction of the NMC. I then need to submit with the portfolio, 2 learning contracts and a SWOT analysis (already done), a medicine log and all dialogue sheets. This is a daunting prospect. I mean, heck all final tripartites are bloody awful, but this is the daddy of them all. I can only hope my 4000 word essay on an reflective account of an episode of care nets a good result. I have gone from being the bottom of the nursing post as a first year and have climbed up the mountain which is Nurse training and I am now in the rarefied atmosphere of the summit.
Wish me luck!
Because this is the beginning of the end. Yes, on Wednesday, I am facing one of the biggest tests of my life so far. Namely, the final tripartite meeting of the internship. This is it. The big one. The terminal end of the Nursing course. In the meeting, I have to present evidence of Manual Handling, CPR, Venous Cannulation, Male Catheterisation, Venepuncture, IV drug administration, Fire lecture and so fourth. I am also required to pass 17 competencies and benchmarks as laid down by the University in conjunction of the NMC. I then need to submit with the portfolio, 2 learning contracts and a SWOT analysis (already done), a medicine log and all dialogue sheets. This is a daunting prospect. I mean, heck all final tripartites are bloody awful, but this is the daddy of them all. I can only hope my 4000 word essay on an reflective account of an episode of care nets a good result. I have gone from being the bottom of the nursing post as a first year and have climbed up the mountain which is Nurse training and I am now in the rarefied atmosphere of the summit.
Wish me luck!
Tuesday 13 November 2007
My night watch
I came on duty to find a hectic ward. There were several staff hurrying about and there was near non stops buzz of phone calls being received. There were several INR’s causing problems from patients who had been discharged a few days ago and there were a long list of jobs for the SHO to do. It was quite clear that while there was still the day SHO on duty that this was going to be left to the night staff to sort out, and thus at handover time the long list was handed over. There were several patients who required there to be blood samples taken by the doctor as there were some patients who it had been near impossible to get anything from. I was allocated initially to the taking of observations. This is a new one for the night shift as before only the ill patient’s had their baseline observations done in the evening but now this is for all patients. There were some very odd readings on the charts, though these were more a case of a normal abnormal reading if that makes sense. Moving on from the observations I was on the medication round and there was little to note from that barring two patients who were waiting for the INR to be prescribed and one who was going to have to wait until near midnight for there to be Aspirin given.
There was a new admission from A&E who had a high blood pressure, and so these were done manually as the machines had been playing up on the ward and were next to useless. I was then asked to do an ECG on the post PCI patient and that was done with out too much issue. On returning back down the ward to the nurse’s station, one of the patients had taken a coughing fit. The staff nurse then gave them simple linctus which did the job of sorting the cough for a little while. It was a short while later when the coughing returned that there was some bright red vomit brought up by the patient. There was initially some concern of this, until it was realised that this was most likely to be the red cough mixture. The patient then presented with some diarrhoea, which was put down to there being several days worth of laxative treatment rather then there being something nasty as the root of the problem (i.e. C Diff). The patient with the high BP was checked again on both arms which showed there to be a high BP still running. The on call medical registrar arrived on the ward and this was checked again (there was about an hour in the intervening period in which I was sat writing out an essay and cracking on with portfolio work between shouts to the buzzer for commodes and checking patients). I was about to leave when the patient told me that they had been in hospital before and were reluctant to have said anything about the high BP which has brought them into hospital. I immediately stopped packing my sphyg away and sat down and asked them what was the matter. The said that they were unsure about what was happening and how long their stay in hospital would be. I explained what hypertension is, and that there was going to be an ECG and a blood test done in the morning on them, and what that was going to entail. They thanked me for taking the time so sit and explain to them what was going on. It is these small moments that really make you have a nice warm feeling inside, when you walk away thinking “I really made a difference there to how that patient feels”.
There was a new admission from A&E who had a high blood pressure, and so these were done manually as the machines had been playing up on the ward and were next to useless. I was then asked to do an ECG on the post PCI patient and that was done with out too much issue. On returning back down the ward to the nurse’s station, one of the patients had taken a coughing fit. The staff nurse then gave them simple linctus which did the job of sorting the cough for a little while. It was a short while later when the coughing returned that there was some bright red vomit brought up by the patient. There was initially some concern of this, until it was realised that this was most likely to be the red cough mixture. The patient then presented with some diarrhoea, which was put down to there being several days worth of laxative treatment rather then there being something nasty as the root of the problem (i.e. C Diff). The patient with the high BP was checked again on both arms which showed there to be a high BP still running. The on call medical registrar arrived on the ward and this was checked again (there was about an hour in the intervening period in which I was sat writing out an essay and cracking on with portfolio work between shouts to the buzzer for commodes and checking patients). I was about to leave when the patient told me that they had been in hospital before and were reluctant to have said anything about the high BP which has brought them into hospital. I immediately stopped packing my sphyg away and sat down and asked them what was the matter. The said that they were unsure about what was happening and how long their stay in hospital would be. I explained what hypertension is, and that there was going to be an ECG and a blood test done in the morning on them, and what that was going to entail. They thanked me for taking the time so sit and explain to them what was going on. It is these small moments that really make you have a nice warm feeling inside, when you walk away thinking “I really made a difference there to how that patient feels”.
Sunday 11 November 2007
Remembrance Sunday
Today, it being the 11th, was the annual Remembrance day. I was out this morning with St John Ambulance and was in the parade down the division's town high street to the Church.
It was freezing cold (and raining for the first 5 minutes) but that's not exactly bad considering the fact we were there to remember people who have been killed in conflict. Was in the church service, and frankly was glad that there were other people around to drown out how bad I probably sounded (though thankfully I can not see Simon Cowel on X factor ever wishing to hear my and my regular crew mate's rendition of "Jerusalem").
Saturday 10 November 2007
My half and one
Why when is it that you do a half shift it seems to last just as long as a 12 hour shift. Never mind, Thursday was a relaxed day really with me taking my new patient from the day before to theatre and I am pleased to say they are making a good recovery. The ward has been quiet really, though I am not sure if there has been something put in the hospitals water supply as there has been a few short tempers on the ward (nothing affecting me but I have seen it). I would write out a report if there had been anything interesting happend but the past two days had only 3 things worthy of note.
1. One of my patient's left just before lunchtime yesterday. He still had not got back near 4pm.
2. The doctors have been really pissy lately
3. I was commended for using my initative by staff yeasterday over the prescription which wanted 1g asprin 4 times daily. It was for a condition which the Rheumatology department in my reconing would be able to help us with. I was nonplussed to recieve the reply of "I don't know" regarding the dose, though was a little bit better to be told my idea for the tables (3x 300mg asprin plus 1x 75mg tablet = 975mg was about the nearest we could get) was the same as what they did. The then took the slow route (checking the BNF) which concurred that for anti inflammitary properties 3.6g daily or more must be achieved for anti-inflammitary effects.
Wednesday 7 November 2007
My Unnacceptable low
Having finally lost patience with the local public transport system, I took matter’s into my own hands and decided to get a bus at 05:45 from where I live and then walk the 40 odd minute journey to the hospital from the nearest point that I can reach. This worked and got me in reasonably early.
The day started off with a hectic play with the bed allocation as there was an acute shortage of beds compared to expected patients, and the unusual step was taken of having to cancel operations (first time that has occurred in a while). It meant that my mentor and I were unfortunately unable to really get to grip’s with our patients until gone 9am. I began by apologising to the patients for this delay (after all, it seemed the least I could do for them). When the medication rounds were out, there were some patients who were due for discharge and some that needed ECG and so I did that.
One frustrating thing was a patient who was awaiting the all clear to go by the doctor was kept waiting for a few hours while we were told "Will be there in 30 minutes" which went on for 2 and a half hours, only for another doctor to turn around and say "Just discharge them, they don't need anything as they are not on medications".
Following the discharges, no sooner was one bed ready then another patient was put in. I was able to get to grip’s with the patients admission, and secured some alternative dressings due to an allergy.
Today has been more fragmented then what it has been busy. That’s the way sometimes I guess. Though for some strange reason, I had the Knacks "My sharona" stuck in my head. Perhaps that was a warning, as line of "Come a little closer, close enough to look into my eye's sharona could comicially be substituted for "Keep back, at little bit, incase someone squirts gel in your eye's sharona", which was the rather comical (and eye stinging) accident today. So maybe I should call this "My industrial injury"?
The day started off with a hectic play with the bed allocation as there was an acute shortage of beds compared to expected patients, and the unusual step was taken of having to cancel operations (first time that has occurred in a while). It meant that my mentor and I were unfortunately unable to really get to grip’s with our patients until gone 9am. I began by apologising to the patients for this delay (after all, it seemed the least I could do for them). When the medication rounds were out, there were some patients who were due for discharge and some that needed ECG and so I did that.
One frustrating thing was a patient who was awaiting the all clear to go by the doctor was kept waiting for a few hours while we were told "Will be there in 30 minutes" which went on for 2 and a half hours, only for another doctor to turn around and say "Just discharge them, they don't need anything as they are not on medications".
Following the discharges, no sooner was one bed ready then another patient was put in. I was able to get to grip’s with the patients admission, and secured some alternative dressings due to an allergy.
Today has been more fragmented then what it has been busy. That’s the way sometimes I guess. Though for some strange reason, I had the Knacks "My sharona" stuck in my head. Perhaps that was a warning, as line of "Come a little closer, close enough to look into my eye's sharona could comicially be substituted for "Keep back, at little bit, incase someone squirts gel in your eye's sharona", which was the rather comical (and eye stinging) accident today. So maybe I should call this "My industrial injury"?
Monday 5 November 2007
My oddysee
Sunday's are a bit problematic for me to be on the ward on time for shift, as basically there is no connections to the hospital at that time of the morning. Being cold and knackered and having a 2 3/4 mile walk to reach the hospital was only improved by the rather pleasant leafy lanes which I took. There are many thing's which can be considered a quintessential "Englishness", and believe you me, a wooded road in Autumn is one of those things.
Anyway, when I arrived at the hospital and changed, I went onto the ward where there had been only a few starts made to the shift. I began with the medication round, which is one of the large task's which will dominate my life as a staff nurse Again, I was able to improve on the time to do the round, which was more because I was with the same patients again as I was on Saturday. Familiarity never bread indifference. I noted my chest drain patient was better, but also there was no Thoracic care plan in the file. I popped to the ward next door (who handle a higher proportion of these patients) and started them off on one. With all my patients up, we went down the ward and made the beds. I don't know what it s about Sunday's on ward's but there is almost a more social atmosphere about the place. Monday to Friday it's all busy, but there was a definite relaxed feel to the place.
The ease of a Sunday meant that when the co-ordinating Nurse for the day asked us to take our morning breaks, it was decided to go to the cafe and grab something to have rather then whatever we bring in. Nice.
On leaving about 20 minute's later (I love weekends) the patients had just finished tucking into their rather ample breakfasts, and so I got up to dare with the risk assessments. Then we dealt with a chest pain call out, which showed an ECG change. The on call doctor attended the patient, and we set up a GTN infusion. This is worthy of note as a GTN infusion can mean different things to different ward. The area I am in uses the GTN infusion at a rate of 3.8 ml's per hour (about 15mcg per minute) for the treatment of chest pain. However, some area's use this for the management of blood pressure (there are different rate's but 3.8ml tends to be the common one).
It was about this time I recall taking a call from a HCA who worked with us yesterday from next door. I was told that one of my patients who has deafness had a relative calling from abroad. It basically turned out that the only way from them to talk was to use a speaker phone. Despite the searching of the division for one, it seems that one thing we do not have was a phone like that. Thankfully the family brought one in and it was arranged for them to go into the sister's office to take the phone call.
One of my patients were for discharge, so I spend some of the morning doing the discharge paper's and the District Nurse referral's, which took me up to lunchtime. Following lunch, and the 2pm medication round, I went through the competencies with my mentor, which all are nearly passed (there are some which relate to skills which are impossible to pass on the ward at the moment).
During the course of the discussion, we touched on how there had been no patients with confusion or Short Term memory loss, and I had also thought that I had never seen any patients who share the same GP surgery as me. Guess what my new admission for the afternoon had and which GP surgery they were at? Anyway, after that admission, things became very quiet on the ward. Apart from my re-writing of the admission board (which looked very drab) nothng really of note happened untill I went of duty.
Anyway, when I arrived at the hospital and changed, I went onto the ward where there had been only a few starts made to the shift. I began with the medication round, which is one of the large task's which will dominate my life as a staff nurse Again, I was able to improve on the time to do the round, which was more because I was with the same patients again as I was on Saturday. Familiarity never bread indifference. I noted my chest drain patient was better, but also there was no Thoracic care plan in the file. I popped to the ward next door (who handle a higher proportion of these patients) and started them off on one. With all my patients up, we went down the ward and made the beds. I don't know what it s about Sunday's on ward's but there is almost a more social atmosphere about the place. Monday to Friday it's all busy, but there was a definite relaxed feel to the place.
The ease of a Sunday meant that when the co-ordinating Nurse for the day asked us to take our morning breaks, it was decided to go to the cafe and grab something to have rather then whatever we bring in. Nice.
On leaving about 20 minute's later (I love weekends) the patients had just finished tucking into their rather ample breakfasts, and so I got up to dare with the risk assessments. Then we dealt with a chest pain call out, which showed an ECG change. The on call doctor attended the patient, and we set up a GTN infusion. This is worthy of note as a GTN infusion can mean different things to different ward. The area I am in uses the GTN infusion at a rate of 3.8 ml's per hour (about 15mcg per minute) for the treatment of chest pain. However, some area's use this for the management of blood pressure (there are different rate's but 3.8ml tends to be the common one).
It was about this time I recall taking a call from a HCA who worked with us yesterday from next door. I was told that one of my patients who has deafness had a relative calling from abroad. It basically turned out that the only way from them to talk was to use a speaker phone. Despite the searching of the division for one, it seems that one thing we do not have was a phone like that. Thankfully the family brought one in and it was arranged for them to go into the sister's office to take the phone call.
One of my patients were for discharge, so I spend some of the morning doing the discharge paper's and the District Nurse referral's, which took me up to lunchtime. Following lunch, and the 2pm medication round, I went through the competencies with my mentor, which all are nearly passed (there are some which relate to skills which are impossible to pass on the ward at the moment).
During the course of the discussion, we touched on how there had been no patients with confusion or Short Term memory loss, and I had also thought that I had never seen any patients who share the same GP surgery as me. Guess what my new admission for the afternoon had and which GP surgery they were at? Anyway, after that admission, things became very quiet on the ward. Apart from my re-writing of the admission board (which looked very drab) nothng really of note happened untill I went of duty.
Saturday 3 November 2007
My best efforts
Today being a Saturday, there seemed to be a calm washing over the ward. Certainly, there was less of a rush and hustle and bustle as experienced during the week, chiefly due to there being no new admissions. My bay were quiet. I began by doing the medication round, and have to say that I was able to beat my last time of doing the round. It is a documented fact that new Nurse's tend to have medication time's of 40 odd minutes for the medicine round whereas seasoned Nurses have this down to about half that. It does take time (especially rummaging for tablet's in the rather untidy drug cupboard), taking the tablet's to the patient, checking date of birth and asking if the patient has any known allergies (the ward is a stickler for staff doing this, and given the few seconds this takes I suppose is worth it). This resulted in me doing a Dalteparin injection, and taking 25 minutes to do the round. One of my patients is a bit bed bound, so I did a full bed bath, change of gown, sheet's and a shave to have the hygiene needs met and the patient made comfortable to assist with breathing. The risk assessment's were next, and were completed and signed before I tidied the drug cupboard.
The morning soon wore on to a quiet afternoon with the odd nurse call shout to wheel patients on the commode's and a few phone calls to answer taking up most of my time. As there was another nurse who was after a bladder scan but was turning up blanks with a spare scanner from other wards, I phoned up my old placement area and was able to gain the use of one (quite literally as they knew and trusted me). That was a run there and back, and a rummage in the emergency drugs cupboard with a nurse who saw me making my way back (all this really is a drug cupboard with supplies of common drugs which may be needed for patients if pharmacy are shut).
After a few more shout's on the ward to patients, and the medications done twice more, the day drew to a close with me having taken the lead for this day with some quite good results.
The morning soon wore on to a quiet afternoon with the odd nurse call shout to wheel patients on the commode's and a few phone calls to answer taking up most of my time. As there was another nurse who was after a bladder scan but was turning up blanks with a spare scanner from other wards, I phoned up my old placement area and was able to gain the use of one (quite literally as they knew and trusted me). That was a run there and back, and a rummage in the emergency drugs cupboard with a nurse who saw me making my way back (all this really is a drug cupboard with supplies of common drugs which may be needed for patients if pharmacy are shut).
After a few more shout's on the ward to patients, and the medications done twice more, the day drew to a close with me having taken the lead for this day with some quite good results.
Friday 2 November 2007
My Challenge
Back on day's today. I entered the ward and was given a handover which was to indicate a discharge, a few post op patients and a few medical patent's to see to. The first event that took my attention was the two patients in the bay with D&V. Yes, it's outbreak time again! It was a relief that this seemed to be an isolated short episode so there was no need for a full scale lock down. The medication dispensing for the morning was done by yours truly (supervised) which went a bit quicker then the past weeks.
After making the bed's, checking some blood result's, I did a bed bath on a patient, which took me up to the time where I was invited to attend a hospital meeting (I'm going up in the world). It was the monthly meeting regarding mortality, so I am afraid that will have to be forever my little secret as that's confidential. All I can say is that it was a side that I have never seen before of the behind the scene's running of the division, and it was quite interesting to be in.
Comming back, one of the patient was needing a discharge letter doing (they had medication and the like sorted), though there was a shortage of SHO's as there was sickness with one being off. Now, at this point, I am sure some of you will be aware of the problems faced with job lossess is something that has bled over into medicine. Given the immense difficulty in the shortage of one SHO, how can a good standard of medical cover be given if there is a drive to reduce the number of doctors? I still firmly believe that MMC is the medical equivilant of the cut's in nursing post's which is being done to save the NHS money. Anyone with alternative evidence which opposes this, please leave comments.
Anyway, there was eventually (after having to appease a volunteer driver) the discharge letter done, and so I went into the bay, stripped the bed, then dressed a bleeding leg wound from a surgical patient, then on the asking of another staff nurse, asked one patient some qusetions for a dietician referral for my mentor. I really did feel sorry for my mentor today. She is a very experianced staff nurse, but one of the problems with today was that due to there being several accumilation of circumstances made, she was unable to stay with me all the time. This however meant that I was bale to assume a bit of observation on the patients and was taking some of the workload on (barring medication dispesing). The phone on the ward was none stop today. Due to there being calls from relative's who were asking about patients in other area's as there were some nurse's busy with different patients, I have been asking the nurse's if they are free how the patient are, and asking the patient themselfs. Normally as a student there is a great reluctance to take the phone (well, we were fed pleantly of horror stories back in first year on the introductory lecture on our first day in university, and during the law and ethic's module). Quite a step forward.
Did some post PCI ob's on another bay to help out as we wereshort this afternoon of a staff nurse. The afternoon was when I was at my most busy. After there were pacing wire's removed, I did the pbservations and the pre and post wire ECG's, had a run down to radiology for one patient (three journey's- one down with patient, one with medication and one to bring them back again with staff nurse).
Today has been the kind of day that a blue backsided fly would describe as being "a bit hectic". Which explains my 10 minute lunch and lost tea break.
Only another two shift's to go!
After making the bed's, checking some blood result's, I did a bed bath on a patient, which took me up to the time where I was invited to attend a hospital meeting (I'm going up in the world). It was the monthly meeting regarding mortality, so I am afraid that will have to be forever my little secret as that's confidential. All I can say is that it was a side that I have never seen before of the behind the scene's running of the division, and it was quite interesting to be in.
Comming back, one of the patient was needing a discharge letter doing (they had medication and the like sorted), though there was a shortage of SHO's as there was sickness with one being off. Now, at this point, I am sure some of you will be aware of the problems faced with job lossess is something that has bled over into medicine. Given the immense difficulty in the shortage of one SHO, how can a good standard of medical cover be given if there is a drive to reduce the number of doctors? I still firmly believe that MMC is the medical equivilant of the cut's in nursing post's which is being done to save the NHS money. Anyone with alternative evidence which opposes this, please leave comments.
Anyway, there was eventually (after having to appease a volunteer driver) the discharge letter done, and so I went into the bay, stripped the bed, then dressed a bleeding leg wound from a surgical patient, then on the asking of another staff nurse, asked one patient some qusetions for a dietician referral for my mentor. I really did feel sorry for my mentor today. She is a very experianced staff nurse, but one of the problems with today was that due to there being several accumilation of circumstances made, she was unable to stay with me all the time. This however meant that I was bale to assume a bit of observation on the patients and was taking some of the workload on (barring medication dispesing). The phone on the ward was none stop today. Due to there being calls from relative's who were asking about patients in other area's as there were some nurse's busy with different patients, I have been asking the nurse's if they are free how the patient are, and asking the patient themselfs. Normally as a student there is a great reluctance to take the phone (well, we were fed pleantly of horror stories back in first year on the introductory lecture on our first day in university, and during the law and ethic's module). Quite a step forward.
Did some post PCI ob's on another bay to help out as we wereshort this afternoon of a staff nurse. The afternoon was when I was at my most busy. After there were pacing wire's removed, I did the pbservations and the pre and post wire ECG's, had a run down to radiology for one patient (three journey's- one down with patient, one with medication and one to bring them back again with staff nurse).
Today has been the kind of day that a blue backsided fly would describe as being "a bit hectic". Which explains my 10 minute lunch and lost tea break.
Only another two shift's to go!
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