nursing student's musings

My Dream

2008-03-02T12:35:00.005Z

I had a rather interesting dream the other night. I was out in York with my other half. Having been around most of the shops, and helping her choose a birthday present for her mum, we decided to head home. Good job I was sleeping, this is the average blokes idea of hell (however, it was time with her so it was all good).

I find myself at the train station. The train is late "Tree on the line at Huddersfield". Great, but hey, I only have to wait over half an hour. Lets find the platform. Oh great, its full. Hang on, turns out there is a service to Newcastle about to arrive before my train. Ahh, so this is not too much of a nightmare.

After a few moments, the train arrives and my mobile phone decides to go off. As I am trying to talk, the sound of the train leaving is drowning out the caller. I am dreaming this is along the lines of "Hi, it (whuur whuur whuur) from (huuummm) hospital (lound blast of train horn) interviewed really well (clack clack clack clack) on the ward?"
Now, its just a dream and undoubtedly this is just me getting the big fob off. Oh well, I can see in my dream there is a flight of steps up to a closed walkway where I can talk. After all, this was a hospital where a) I never worked and b) had my first interview on the 7th who phoned me on my birthday (last tuesday) to ask to give me people to phone as referances were slow comming through. Ok, I decided in my dream I wanted to fully explore the horror of this nightmare of being fobbed off. Much in the same way one may fully probe the site of a rotting tooth. I ascend the steps.
"Do go ahead" I say.
"Well, as you have experance of being a student within Diabetes and Endocrinology, we are offering you a job as a Staff Nurse on the diabetic and endocrinology ward in the hospital"
Bloody hell, this is great, lets keep dreaming.
"Yes, of course!"
"Right, well, it will be monday now before I can send the acceptance forms out, and it will be 6 to 8 weeks by the time your CRB check comes back and you can start on the ward".
"Thats no problem, thanks!"
"No problem, thanks for accepting!"
Ok, deep breath. Lets just see how long it takes for me to wake up and come back to reality.
Pretty much walking back down the stairs to find my other half looking at me and saying to her "I got the job" seemed to be a good point to stop dreaming and wake up. Which given that we both had to wait till near 5:20 for that sodding train which was 52 minutes late in the freezing cold and rain made sure there was no doubt about it.

So, 3 years training:Check
NMC Pin Number: Check
Job: Check

What makes this all the more delicious is that while I was turned down by 2 posts, one was going to re-interview me, the job I get was from my first interview.

So, I have moved. You will find me posting on the new blog. Just click HERE to visit!
See you on the new blog!

2008-02-18T17:23:00.002Z

While my step dad was implicated in the news with this incident.

It was very unfortunate my sisters boyfriend and soon to be fiancie is the soldier talked about here. NB He is not the injured one. Though on the news it is very clinical and cold, I happen to be in the middle of this one.

I always hated the policy of new labour. Messing about with the health service was affecting me enough. Now, its personal.

I wonder if I did not pray enough at some point.

An update

2008-02-14T15:14:00.003Z

"I find it odd how I have interviews for everywhere but for the hospital I trained". Nursing student, "interview" 13/02/2008
Ahem. Ok, that statement came back to bite me on the ass. I have an interview on the 25th. I believe this could also be on the ward where I was for placement 5. By that I mean the ward I moved on the 22nd September. This should make the interview interesting:
Interview Chair: "So, do you know anything of the ward?"
Nursing Student: "Aye, I worked here did'nt I"
Interview Chair: "Do you know what patients we look after on here?"
Nursing Student: "Aye, looked after half the buggers meself on here lad"

Anyway, I am acutly aware of it being valentines day, so a happy valentines day to you all.

Interview

2008-02-13T22:45:00.000Z

Today I had the first feedback from an interview. I was interviewed yesterday for a staff nurse in a community hospital in a PCT. The interview went well. I was phoned by the clinical leader today. They said that I had interviewed excellent. I was the joint choice for the post. However, the post has gone to somebody with more post registration experience then me. I know that there is a possibility they were just saying that. However, I have been told that not all is lost. You see, there has been a nurse put their resignation in on the ward. I was told that there will be interviews held again. As less then 3 months have passed the post is not going to be advertised. I may have a chance at this second interview though this is hard to say. I have applied for some more jobs which have become available today.

I am still awaiting the news of the interview which I had last Thursday at another acute hospital. I am not sure how that will work out. The original post advertised was for the MAU. However, there were posts going on the respiratory ward, Haematology ward, Endocrinology and gastric ward. I find it odd how I have interviews for everywhere but for the hospital I trained. Oh well.

And finally...

2008-02-08T13:10:00.000Z

I have finshied the university!

I now need to:
a) Wait for my PIN number/NMC registration.
B) Get a job.

Of for goodness sake!

2008-02-08T12:42:00.000Z

I was feeling quite nostagic this morning. I am posting twice today. The first post is the worst one of the two. I happen to be quite a fan of the Dr Rant team. I am sure this morning they may have been interested to know of one of the lectures were on. Service improvement. Stop laughing you at the back.

Now, I am all for the NHS actually getting better. I freverently belive that the key to achieving this is a genuine team effort of all the staff concerned. I too think that, albeit in a reduced role to professionals, that patients individually can shape the care of the NHS services. I say reduced because an idividual can only provide their own perspective. They will be able to give unique insight into an experance which is theirs, and theirs alone. One mans meat is anothers potato (to use the Colloquialism). That a person may dislike the NHS is to negate that some people may "like" the NHS. Additionally, the phallacy of association certianly will not mean that the NHS is not fit for the treating of patients.

It was with a certian amount of politcal unspeak that we were introduced to the concept of NHS service improvement. To say that this was riddled with the influence of the current admisitration is to be an understatement. I have always considered that a fundamental right of the free nations of the world is the freedom to make a choice of what they do. The freedom of speech is a right that we should not take for grated, even if we are allowing ourselfs to be policitcally lead. To cite a quote attributed to Voltaire "Why I May Not Agree With What You Say, I'll Defend To The Death Your Right To Say It".

One of the main thigns was that there was the mention made of the connecting for health scheme. Yup. thats right. The part of the NHShIT project which is currently costing as much 30% of the GDP of Peru. I dont mind that. It was the patronising tone the DoH adopt "Enablers". Oh come on. The patients are at least the last people of the NHS population to ever a) get a say b) Actually notice c) give a toss. Given that the NHShIT project has double the amount of money being spent then the combined disposable income of Germany, this really is not acceptable.

Also, the use of processes, and "systems thinking". Well, the sort of thinking that has resulted in a computer system which is costing 4 times the economic growth of China from 2001-2008. Also, the fact that the average suggestion box to a health minister seems to be a waste paper basket, how do any of us stand a chance. I recall when there were a few nurses who "suggested" they not have a 0.009% increse which was resisted while the NHShIT computer system cost more money then was taken through taxation, funding and minted during the Ottoman empire.

Or when 12000 doctors "suggested" that the "improvement" of 10000 less doctors was not a good idea. I guess the government were more concerned with shoveling more money into the NHShIT system which the Office of National Statistics have noted as having taken 14 times more money then the economies of the combined westernised nation 1898-2004, adjsted for the mean poverty level of pre-tax profits.

What went wrong...I'm not grumpy!

2008-02-07T16:34:00.001Z

Now, I know that normally all the blogs are full of the woes and moans of the NHS and the fact that it is in meltdown. But today, I want to buck the trend of that if only for one post. You see, I actually LIKE what I do. So, let us think for one moment what drives us to do what we do, apply a bit of starch to the tunic and really take a positve look at what we do. It is rich for me to say that. There again though, I can. I know I have posted some negtive posts. I am aware that there are problems with the finances of the NHS. The thing is though, we all go through that. I can point to the times when I worked in management to days that were terrible.

However, let us think about the positve impact on peoples lifes that Nurses have on people. I am forever trying the think of analagies for situations. One of the ones that I came up with years ago for treatment was to take a pragmatic look at a situation. Say Patient X is admitted to hospital with an exaccerbation of COPD and is not responding well to a treatment of Bronchodilators and 4 liters of oxygen and the doctors have asked the nurse to start therapy of...lets say steroids. Right, now that fact of the patient being in the UK will mean that this seems to be a great horror. It is. Let us imagine for a moment that Patient X was in the middle of the Kalahari desert and miles away from a District General Hospital. You can appreciate there would be no GP to take a house visit, an ambulance to transport to the hospital, no HCA to show the patient to bed, not staff nurse to assess/admisiter medication and attend to, no HO/SHO (FY1-2/ST1-2) doctors to clerk and no consutant for them to be under. Imagine how long the patent would last in that example. Yes, know that the probabilty of the person having a supply of tobacco to get emphysema in the desert is also remotly small but lets try and keep the magic going!

That is the whole reason I wanted to become a nurse. I have been a patient for many years having being born with a condition which fused my fingers and toes. That is why I will willingly give up a saturday or Tuesday night to go on duty (and watch premiership and Leage 2 matches for free) and attend St John Ambulance divisional meetings on Thursdays. It is why I will walk into my bay when I am free and talk to my patient. It is why I take the time to sit next to patients and fill in their risk assessments/write communication sheets with them so that they know what I am writing, and can sometimes give me a better idea. It is why I go the extra mile for the people who I care for on duty. That is why when visiting time comes I leave the visitors to the patient but inform both patient and vistors that I will be walking around to check. It is whay I never think myself an island. It is why I like the company of others. It is why I will ask a busy nurse or HCA if they need a hand. I also think that in trying hard I should help other MDT team members. Which is why doctors will find files presented drug cardex open, why frames and sticks are left out for reach of physiotherapists and why doors are opened for porters and ambulance crews, and why lunches are given out by yours truly. I like what I do. I want to do what I do, and do it well.

That is why I hope that interviews will yield something.

That is why I wrote this blog. Sometimes all you need is a muse.

Major Incident

2008-02-04T23:44:00.000Z

Ah. Sunday. A day of rest. A day of roast dinners. Or, If you were part of St John North Yorkshire and Teesside the major incident workshop day. Ah yes. I am now fully certified in knowing how to deal with a major incident and ran through triage. I even did 2 exercises in magaing it. One was a written list of casualties and what triage level I would put them at. Basically, Green is walking woulded. Yellow: Not walking but obs stable. Red is immediate attention (not walking, obs out of range) and white is...erm, how can I put this. Dead. Unlike a normal situation, anyone needing CPR at a mass-cas situation/Major emergency is left for dead. Its not nice. Trouble is, while you would waste time CRP-ing a body, the patient with femoral bleed could be saved. Hard but thats life.

I have provided a tounge-in-cheek take on the day on the diagram. I wrote the original on a scrap of paper.

My roads end

2008-02-01T18:51:00.000Z

So, as of 13:30 I officially left placement. It was odd. I began the day with finding many people on duty. This was mostly HCA and two staff Nurses working the early shift. I had to wait to find out what team I was working in. It was the bay I was in on Tuesday. There were only 4 patients in the bay and two side rooms to see to. I did the baseline observations and wrote the risk assessments at the same time (there was enough time for this to be done at the same time). There was not a lot to do after making the beds and the morning did seem to drag. Two urgent ECG's were done by yours truly. The visiting SpR was happy with my lead placement and thanked for a "Nice ECG". That was pleasing!

I was searching for an IVAC infusion pump for some of the morning and went two several surrounding departments to source one. It was odd when a Nurse from the ward next door asked when I was finished my training to be able to reply "28 minutes time!". The ward senior sister wrote me a very nice witness statement which I will copy for my upcoming interviews. Next week I have 3 days in the university. Tuesday is the RCN conference, Thursday is a day of information and Friday is a closing lecture and NMC registration day.

My more pressing concern is the fact my Girlfriend last night decided she wanted to try and end our relationship claiming that things "Were not fair" on me and she was "very sorry". I am not sure what to say as this is a blow that I really did not see coming. I know emotions were running high the last few days. Now, not only do I have a job to worry about, I now have this broadside hit to deal with. To say that I have taken this bad is an understatement. I feel sick in the pit of my stomach and I have hardly eaten anything. Come to think of it, I have not eaten much at all this past week. I cannot stop thinking of her, and wonder what it is I ever did wrong to her. Any of the female readers with any ideas of what you would suggest I do please leave a comment. I figure that the best thing will be to give her some space to calm down a bit.

Speaking of the comment and the blog, I realised some time ago that after next week this blog and my ID will be redundant. I do not want to start a new blog yet, so if you have any names for the new blog which I will go on to make, and feel free to leave comment. "Staff Nurse Musings" anyone?

So, if you are a student Nurse, and you are wondering what it is like in the third year, if you are a nurse and were looking for another persons view, or you ever should be a person in the future who was considering Nursing, I hope that my small entries have been both entertaining and useful. I am now at the end of three years. I have passed the course and this time next week will be able to say that I completed my three years of University. I shall be able to put RGN after my name in a few weeks time.

In recognition of that, the video link at the top is the one that finally I choose to accurately reflect the end of the course. I have climbed the mountain of nurse training. Somehow, I have survived.
And to all the people who took the time to read and to post: My profound thanks.

A symbolic moment

2008-01-31T18:13:00.001Z

A symbolic moment has just occured. That moment namely is the last time that I have prepared my uniform for duty tomorrow. I have done this for the past 3 years. Mainly because I quickly realised that being blearly eyed at 6am, 4:45am, 5:30am and 5:25am (times respectfully used throughout placement times, bar the community part of 2nd year when I was able to sleep to the late time of 7:30am. Ah, those heady days of 2006 eh?) resulted in me usually forgetting something important. Yup, tomorrow is my last placement shift.

I have had three years which have been... varied I guess. I have had some interesting times. Some good (like my first sucessfull CPR, Passing my Tripartites, the patients who I was able to help, the great Nurses and other people who I had the honour of working with. Most of all has been meeting the one person who, while I today fret over, has helped sometimes keep me on the straight with the course. My dear Girlfriend. There have been the bad. But do you know what? Mostly it was when my niece died last year and when that caused my to referr on a module. I have had bad shifts. I have had arguments with staff. I have had the abusive patients, and on more then once had to deal with a patient trying to very much kick and punch their way out of the ward. Oh well.

Tonight, all however is calm. I know that my girlfriend has her family with her and will be going home tomorrow (hopefully). I have some applications which I hope will be fruitfull, and there are interviews now comming through. A bursary came today. My RCN subscription has been renewed. My NMC PIN number will be here hopefully within the next 5 weeks. Now, for the final time, I will have to think of a succinct title to cover the next shift post. "My roads end" and "My Final destination" are both vying for position. There were other titles that would have been used for mid-course shifts. "My Bad day" for example never was needed for a title should a monumentally bad shift have occured. I have been trying to think of a single tune to embed as a video like for the post. The second place went to "Fall Out Boy" with the track "Thnks fr th mmrs". For what I settled on, call back tomorrow.

So, "what are you doing tonight then Nursing Student?" I hear you ask. Well, going out for a belated Christmas meal with my St John Ambulance division for a start.

My summersault and My emotional day

2008-01-30T11:32:00.000Z

I have been in for two shifts now. The reason I have not posted until now will be come apparent. On Monday I was back on the ward. I was in an area covering 1 and a half bays. The patients were all light all things considered. There was one patient who required a pressure mattress. Before there was time to even think about this, they became hypotensive. The bed was elevated, and soon their pressure was back to near normal. The bed they were on was jammed. The HCA was having problems getting it back to normal position. I offered to help. When I tried it, the bed was jammed firmly down. However, after one heavy tug, the bed decided to go shooting down, nearly causing me to summersault into it. The bed was soon adjusted and the pressure relieving mattress was fitted. I was not exactly too concerned about the ward though for the day. I am afraid that my mind was more concerned with a patient who was in surgery about that time. The simple reason being, that as it was my girlfriend who was in for her operation, I was worried a lot. That’s putting it mildly! Eventually, after phoning the ward (and giving the attendant long spiel to the nurse about who the patient was, what the admission was for, who I was and to phone me back on the two hospital extension numbers if she did not believe me), I got news she was back from theatre. I asked to have time away from the ward at the start of visiting time, which was granted. I had deliberately missed my breaks to accommodate for this. I will not go into great details here of how she was. I was…shocked really I guess. I know that I see patients every day who are in worse states. The thing is though, as I once remember it being said of a patient: “A patient is a stranger in a bed who, when the time comes to need it, you can distance yourself from”. I simply cannot do that.

Yesterday I cheekily turned up on the hope that they may let visit as 2:30 (I called up near 1pm to ask this). The nurse took one look and said “Just go in now”. I only wish her recovery was better. Somehow, she has come out from the operation with a bad back. My patients were OK, and the nurse knew where I was. The patients were OK, there having been 3 discharges went a long way to helping make that assertion true. I only spent a short time with her. I went back to the ward and got the blood results off. I had cleared all the paperwork near 11am when doing the discharge writing. I then helped a HCA make beds. The staff had remarked I had been very quiet. It was only then, when I really started to talk about things to somebody else that the situation I find myself in now really hammered itself home. I have not found a job as a Nurse, the fact that I was worried about my girlfriend, how I am worried for her recovery, that I wanted to be with her, and most of all suddenly realising ones feelings toward her are more then I imagined, it all became…emotional.

Another Certificate

2008-01-26T20:10:00.000Z

Above: Heartstart FR2 AEDWoo-hoo! I took my St John AED course today! Passed it, and had a comment which read "Good CPR". I know in the grand scheme of things this is hardly up there with say,ooh, a D.Phill in Astrophysics from Cambridge. However, a) An AED MAY occasionally be of use to me while acting as a St John Ambulance volunteer (I however hope not to have to use it in anger. Lets face it, anyone who wants to use one sounds a bit Macarbe). b) I am well aware more advanced equipment/Professionals are in more the adequate numbers in the world. c) I would be loath to come across as a "quacktitioner". However, firstly, the chain of survival (early access, early CPR, Early defribrillation, Early advanced care), you will note how the AED forms part three.

Most importantly, while it may not be the grandest award out there it is mine. Which I am happy with.

A fitting image...

2008-01-25T00:15:00.000Z

From here

My football match

2008-01-24T13:46:00.000Z

I have taken a study week to try and get some time off. I have asked about getting a job in a call centre (so those three years Nurse training look to have gone overboard). I got a letter this morning confirming that I have completed the requirements of the course, pending statutory hours being completed.

Only thing I did was a Football match with St. John Ambulance on Tuesday. I have over the years when with the Red Cross attended calls that are more suited to a "Carry on" film rather then "Casualty". There was one such happening while I was trying to treat a member of the public in the first aid post. I was seeing the patient while being hemmed into the corner by several SJA first aiders who were in their allotted time for a break, and a rather rotund divisional superintendent who was trying to make the tea.

I have started on my latest project for the British Ambulance Society (the details of the history of the local ambulance service) which came in helpful to one of the St John Cadets who is today in Liverpool for a Paramedic interview.

My illness

2008-01-18T15:58:00.000Z

Well, a few day's on the ward and I have neglected to really mention much of what I have been doing. There is still no job, though there have thankfully been a handful more job's posted on the NHS jobs site for my hospital. It would seem that the reason I was not shortlisted for the job on the ward was that there were 47 other student nurses who applied for the post. Yes, 47 students without jobs. I am not making this up, as I saw the pile of application forms. There were over 100 applications made when you add in the registered Nurse's that applied for the post. Good news is that they are going to keep my application if anything else turns up.

Well, I have not been too well, had an ear which was paining me which has travelled down into my neck and swollen a few lymph node's up. I have started taken Ibuprofen and codeine and things are getting better in terms of the swelling and the pain i was in.

Ward wise, I have been given busy teams but I cannot really say it caused much stress, though I put that down to the fact that I plod on gently getting things sorted rather than trying to rush around and get things done in a flap at the last moment. Still nothing really worth mentioning as I was looking after patients who were not going anywhere or having much done yesterday. I have another 3 shifts to do, then a study week which I did not even realise I had to take, then start consolidation on the 5th Feb, then finish on the 8th. Sometime after this I shall get my NMC papers through to fill in after the university write to them confirming I have finished the course, then 10 days-3 weeks later I get my PIN.

I have never felt a mixture of feelings quite like this. I finally have my PIN number and the key to access a job a love, though at the same time face being unemployed and skint.

What's the fucking point anymore?

2008-01-11T20:27:00.000Z

I may have mentioned that I was approached some months back now by the ward sister where I am on. I was told there was a post upcoming and to apply for it. I did. I also applied for 6 other posts over the last 5 weeks. There have been replies from... none. To make matters worse, I have been told that the interview for the ward I am on is being held on Thursday. I only knew because another student asked me if I had an interview. I do not.

Bloody great. I am at the point where I am increasingly looking at finishing the course but having no job to work in. This is annoying. I used to like what I do, but over the past two weeks I have grown to hate the job. Everything just seems to wind up with me being pissed off in extremis, and wanting to bite some buggers head off. This is not healthy. The real problem is that I have been in the sphere of nursing for 3 years now, and I am still waiting for the first good thing to happen to me. I am really beginning to question my faith in humanity, myself, and am asking myself the same questions:
Did I make a mistake choosing nursing?
Will there ever be any hope in anything?
Is there not some other profession which I may be better suited for?

If there was something to work toward then I think that would restore my mood to better levels. I have always worked hard, had good rapport with my patients and put myself personally out of the way in the name of the job. All I have got back is goose egg. I knew when I set out that being a female dominated profession that I would be outnumbered on the ward. The only thing now is that no bugger talks to me, and half the time with conversations on make up and other female-only talk, I just feel like I am all alone, even when there are loads of people around you. That sucks. I honestly do not have the self confidence or belief to go on anymore. I have got nothing left.
I'm cooked.

The end (part 3)

2008-01-07T10:41:00.000Z

Just got the results back from the portfolio. It has PASSED (the mark was about 5 below what I was hoping but it passed OK).

So thats it.

I will DEFINATLY be qualifying as a Registered General Nurse (RGN)in 3 weeks. Three year's of Univesity and I have finally finished. It is very odd feeling to have.
Now all I need is a job...

New Year

2008-01-05T14:21:00.000Z

Ah 2008! A year which began with me being a bit tipsy, not being able to sleep and having a longing to eat a doughnut. No, not sure what sort of omen that is for the coming 12 months. So, I am off until Tuesday when I start the last ever 5 1/2 shifts I will do as a student Nurse. These could also prove to be the last ever shifts I do as a nurse in the NHS if a job does not come crashing around the corner sharpish!

There is a few jobs which I applied for. The dates have only just past for the majority of them so there is still some hope of getting somewhere before the course finishes though at the minute it is hard to feel positive about things. I am having to scour the NHS jobs website looking for job's in the immediate area for any staff nurse jobs which are on the go. There was an advertisement on the university blackboard site where Addenbrookes hospital, Cambridge was looking for staff nurses. Two problems with that. 1) The essential requirement was for current NMC registration, and 2)Cambridge is a long way from Teesside.

Just an observation

2007-12-31T12:14:00.001Z

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

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

My 2007

2007-12-29T21:49:00.001Z

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

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

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

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

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

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

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

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

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

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

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

November
The tripartite and nights dominated this month

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

My return

2007-12-20T01:21:00.000Z

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

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

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

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

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

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

My Final Tripartite (The End: Part 2)

2007-11-28T19:42:00.000Z

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

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

My baited breath

2007-11-26T20:43:00.000Z

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

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

The end (Part 1)

2007-11-25T19:47:00.000Z

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

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

Wish me luck!

My night watch

2007-11-13T16:52:00.000Z

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

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

Remembrance Sunday

2007-11-11T16:11:00.000Z

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

My half and one

2007-11-10T13:28:00.001Z

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

My Unnacceptable low

2007-11-07T20:46:00.000Z

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

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

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

My oddysee

2007-11-05T12:27:00.000Z

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

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

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

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

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

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

My best efforts

2007-11-03T21:43:00.000Z

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

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

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

My Challenge

2007-11-02T20:58:00.000Z

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

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

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

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

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

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

Politico's unspeak (or My head exploding 2)

2007-10-31T22:30:00.000Z

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

2007-10-31T02:01:00.000Z

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

2007-10-29T13:12:00.000Z

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!

2007-10-28T19:09:00.000Z

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

2007-10-25T17:53:00.000+01:00

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

2007-10-23T08:38:00.000+01:00

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

2007-10-23T08:37:00.000+01:00

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

2007-10-19T18:23:00.000+01:00

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

2007-10-18T15:30:00.000+01:00

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

2007-10-15T12:23:00.000+01:00

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

2007-10-14T16:40:00.000+01:00

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

2007-10-12T21:03:00.000+01:00

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

2007-10-10T18:25:00.000+01:00

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

2007-10-09T11:08:00.001+01:00

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

2007-10-05T21:38:00.000+01:00

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

2007-10-03T21:00:00.000+01:00

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

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

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

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

My half time

2007-09-27T22:01:00.000+01:00

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

2007-09-26T20:39:00.000+01:00

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

2007-09-25T15:30:00.000+01:00

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

2007-09-23T12:24:00.001+01:00

(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

2007-09-23T12:22:00.001+01:00

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

2007-09-20T21:06:00.000+01:00

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

2007-09-19T21:13:00.000+01:00

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

2007-09-18T20:42:00.000+01:00

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

2007-09-18T20:32:00.000+01:00

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

2007-09-14T22:18:00.000+01:00

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

2007-09-12T15:10:00.000+01:00

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

2007-09-11T21:47:00.000+01:00

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

2007-09-10T21:10:00.000+01:00

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

2007-09-10T20:25:00.000+01:00

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

2007-09-06T21:02:00.000+01:00

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

2007-09-05T10:55:00.000+01:00

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

2007-09-02T21:00:00.000+01:00

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.

MY CELEBRATION

2007-08-29T22:04:00.001+01:00

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

My Days of my life

2007-08-29T22:02:00.000+01:00

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

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

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

My Stagnation

2007-08-29T22:00:00.000+01:00

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

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

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

My Helicopter

2007-08-25T14:32:00.000+01:00

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

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

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

My weary feet

2007-08-22T20:48:00.000+01:00

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

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

Choose not to choose a career

2007-08-21T20:06:00.000+01:00

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

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

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

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

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

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

My Aardvark

2007-08-20T20:12:00.000+01:00

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

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

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

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

2007-08-19T21:31:00.000+01:00

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

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

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

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

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

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

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

Time (and the lack of it)

2007-08-19T14:40:00.000+01:00

Somebody else who's running out of time, today

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

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

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

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

My defining moment

2007-08-16T22:30:00.000+01:00

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

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

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

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

2007-08-15T18:13:00.000+01:00

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

The daftest test ever

2007-08-15T15:33:00.000+01:00

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

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

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

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

My patience trying patient

2007-08-14T19:53:00.000+01:00

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

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

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

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

My best laid plans of mice and men

2007-08-13T20:58:00.000+01:00

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

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

My weekend administration

2007-08-12T19:57:00.000+01:00

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

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

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

My gremlin

2007-08-10T20:22:00.000+01:00

My Head exploding, today

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

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

My pharmacy

2007-08-09T21:06:00.000+01:00

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

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

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

My first day

2007-08-07T22:26:00.000+01:00

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

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

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

2007-08-06T15:30:00.000+01:00

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

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

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

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

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

Ahh, a good day (At Last1)

2007-08-05T13:13:00.001+01:00

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

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

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

Question

2007-08-03T01:25:00.000+01:00

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

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

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

Confused: A short play by Nursing student

2007-08-01T22:19:00.000+01:00

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

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

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

Kind regards,
Nursing Student

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

Email four: From Nursing Student
Hi,

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

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

Nursing Student

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

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

Hi tutor,

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

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

Email Eight From Tutor
RE: Essay

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

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

The opposite post of the one below

2007-07-31T23:26:00.000+01:00

So, that's my off duty confirmed (Tuesday, Thursday, Friday 12 hour day shift starting at 07:30). So I recon that rather then getting tho 06:25 X56, if I get the 06:06 65 that should mean I get in on the 06:37 63 from the crossroads, so I don't end up late.
Right, that's transport sorted out, now for the money for bus fare.
Oh, that's right, what bloody money!
4 days till bursary (and it better damn well arrive), and the bank WONT let me have a extension of the overdraft as they want me to provide evidence of getting a bursary even though a) I set up the account in April of this year when I was a third year, and b) have not had a confirming letter from the student grants unit and c) to get a letter from the university means using up the small bit of cash I have to go in to get the letter printed from the uni. However, I need that for Friday to get in to hand the essays in. Even if I do go in, guess when the overdraft will be confirmed ? Probably bloody Friday when I get the bursary. Best bit is that they want Proof, and apparently "Paying a bursary in and providing a letter confirming the course finishes in 2008 and the letter stating I had not been removed from the university is not proof enough". WTF? That's like asking to prove its Tuesday today but a calendar and today's paper is not proof.
Another way? Another way of causing me trouble more like.

Hello...Hello...Helloh-dear!

2007-07-30T13:52:00.000+01:00

Hmmm.
Ah
Oh.
Hi I... Oh, hang on, no, no, thats actually just more bloody Motzart.
Great.
Brilliant!
I mean just...Oh, hello there reader, almost didn't see you there. Hmmm? Me? Aye I'm not too bad, sorry, cant talk long, I am trying to get through to the hosptial to talk to somebody about my next placement except all I am getting is the holding tune. Well, while we are here and I am not doing much let's catch up. I've been slogging it out with the long running saga (or farce) of getting my bursary. It really should not be that difficult to get a cheque but it seems that they have made it so, yes, that's right I STILL HAVE NOT BEEN EFFIN' WELL PAID!. Good news is that the bank are going to get back to me on whether I have a £1600 overdraft limit approved (well i AM a third year and that IS the third year limit so fingers crossed).

I am nearly done with the essays (Yay!) and even better have been told that one of the 4000 word essays that I was to submit on Friday is to be handed in on the 21st August instead (which is nice. If the one I thourght was to be on the 5th is to be in for that date then all is well).
Well, i am going to try the hospitl again so will have to go.

Throwing coal onto the fire of pressure

2007-07-22T13:16:00.002+01:00

There was mention of the two essays that has to be done for the theird of August. I was aware of there being two more essays which were to be handed in on the 5th September. Only yesterday I got an email form the module leader of one of the september hand in date modules and was told that they had recieveed email "Regarding the submission of the essay for the 3rd August".

I am not sure if this is one of two things:
1) The original submission date. The module guide never had this in, and we (the group I was in) had to ask. I remeber clearly people saying "5th Septmber the same as the other one".

2) A mistake based on the pathway leaders email casusing confusion.

Fortunatly for me, I had made a small start to the essay, and had written about 750 words of the 4000. After some quick reading and typing on all three, there is 941 words of the 1000 essay (less literature search), 3065 of the first 4000 word essay and now from the urgent writing of the second 4000 word essay, 2385 words. Phew. Now, I need to get offline, and get my laptop down to the PC repair shop as I am writing this to use by using "Safe mode".

Printing with Sir W. Caxton

2007-07-22T13:16:00.001+01:00

It's great, I am trying to write 3 essays and my laptop is buggered and it will be £30 to fix it.

The biggest problem is that I have no way of printing to work direct so now have to email my essays every time I make a ruddy change.

Broken Laptop blues

2007-07-22T13:16:00.000+01:00

It is bad enough having to write two essays out for the 3rd August. The good news is that I only have another 700 words to write for one, and have all but finished the other bar a quick literature search.

The problem is that I cannot finish the latter and have been making headway with the other. The reson being that my laptop has decided to throw its toys out of the preverbial pram and damage its graphics card. On starting windows, it tells me that file ati2dvag.dll has casued the problem and gone into an infinate loop. I have no idea what file ati2dvag.dll is (appart from Google telling me it's to do with the graphics card), though I am sure it should not be going into an infinate loop. I have now emailed the essays to all my email accounts to retrieve them from a university computer and print them out in the university. I hate having to to that, but the probelm is the only way I can get the laptop to work is to start it in safe mode, which has rendered sound redundant, the USB ports not recognised and the graphics annoyingly big. The biggest pain is that several months ago, the laptop touch pad mouse decided never to work again so I have to use a USB mouse to work the cursor. This, is annoyying. Not nearly annoying howver, as the fact that my bursary saga is STILL ongoing. It seems that while the good people at the NHS student grants unit were contected by the university on the 11th July, they are currently 2 weeks behind and so I estimate it as being wednesday before the application is delt with and a cheque issued. The good news on that front is that it will be both June and July's bursary with will go some way to helping me with the overdraft. The bad news is that it comes too late as with -£1411.00 being the current balace, this has exceeded that limit and my balance for withdrawl is "NIL". Unfortunatly, I am paid by cheque, so the upcomming postal strike may well interfere with the delivery. Yes, the sad answer for me is that when it comes to the bursary, I have a lot of bills jockying for position to be paid like a load of airplanes low on fuel circling around a holiday airport. The one thing which will solve that (bursary) is looking like it will be the last horse to cross the finishing line.

So just when it's a grinding point with the finance, the laptop decides to go funny, and will need a qualified repair technician to have a look (be about £30-£60 I think). I have not the words.

Not good news in the news

2007-07-16T21:23:00.003+01:00

Had a quick look at the local paper. This was the leading headline. Its particularly potent as this comes only a week after the Royal College of Nursing (RCN) announced the launch of the "Your not alone campaign"

There is a degree of risk that there will be violence and abuse directed to all nurses, be it physical or verbal abuse. Moreoever, the figures do seem to be getting worse. However, as reynolds comments on his blog, sometimes reports are not made as they are seen as being futile. In this case, there are no known witnessess and no discription so it is likely that once again the culprets will get away with their acts. I have no sympathy for people like that, and hope one day they end up with something horrible (and terminal as well).

In many walks of life, safety measures which have been pointed out are sometimes not acted upon untill there has been a fatality. My fear is that there will be such an event before there is any significant action taken by the Department of Health to combat this.

Insommnia

2007-07-16T21:23:00.001+01:00

Hmmm: 01:29 and I am wide awake.

I really do seem to be loosing sleep over these past few months with the course. I am starting to worry about this. I am not really what you call finaincially well off at the moment, what with only having £40 left of the overdraft to access. I need to take £10 out later today so thats £30 to last me till Friday when the bursary arrives (at least I hope it arrives).

Then I have the essays looming over me. I was not like this before, I have no problem with essays, normally get at least a high 50 mark though normally was in the high 60's. The problem is the research essay as I know how much weight this carries and thats a big worry. I am more then prepared to make a dedication to Nursing. I have shown this dedication by keeping on with Nursing despite having numerous occasions where a lesser person may have walked away and not thourght of a second return. I have been threatened with withdrawl following a failed essay (MITS gained) which happend because of a death of a baby (another event), have felt socially isolated in some placements and have been through so very low times, left a job as a deputy manager to a large buisiness (with the attendant high wage). Yet here I still am, plugging away quietly. Too tired to do much work on the essay, yet not tired enough to fall asleep. I am beginning to feel drained by all the extra pressures from outside the course getting piled ontop of the pressure a university course gives.

I was always glad to get out after the 8 week theory block and be on placement. I did say that having a 20 week theory time would be hard...turns out it was wearing more then anything.

Student nurses patent #11765

2007-07-16T21:23:00.000+01:00

Been meaning to post this one for a while. I know there are pendant alarms in the community, mainly for warden controlled houses where an elderly person if they fall can summon assistance of the warden. Seen that a few times, had a few shouts on the ambulance to calls like that, and a few similar occurrences on the district.

In the hospital, there are panic alarms. Nurses were to wear them in case they are attacked. Never seen one used in anger, though a faulty one went off so will quickly explain. Say a nurse is in a patient bay, and somebody starts beating seven shades of sh-umthing out of them. If they cannot get out (which in real terms means they could end up getting chased), they press the alarm. This rings a buzzer on a control panel, and an alarm sounds which alerts other staff. When the faulty one went off, there were other nurses from the next ward in really quick.

However, what I have been in and really needed an alarm is patient emergencies. Not cardiac arrests, but other such calls. I have twice been left in a situation where there were no staff about (sods law) for a few seconds and on responding to patient buzzers (on most occasions!) I have ended up having to physically support patients to stop the situation worsening. The problem was with this, that in some I was unable to reach and pull the emergency cord to summon help. The first cases, I had not cancelled the buzzer which originally summoned me, so I recall I left it going to attract attention and called out for help, which a passing HCA heard, and got the staff nurse. The other ones I have been have happened with patients being wheeled. I have known them suddenly go unconscious (though one I am pretty sure was faking it). I remember having to look for the nearest buzzer, press it then dart back to the patient to stop them falling from the chair. There were some where vomiting was a problem, which meant it would be unsafe to tilt them back to support them due to the risk they could aspirate on the vomit. This made time of the essence.

What I needed on both occasions was a way of activating the emergency alarm without reaching a bedside. The thing I really wanted was something like the panic alarm but one which could operate on the same signal as the activation of the ward emergency system (preferable the buzzer). The panic alarm is a security measure and would give an inappropriate response. The illustration above is what I think it could look like, with a flick back cover to avoid accidental pressing.

Now, will that work?

The scare mongers are out to confuse us!

2007-07-16T17:11:00.000+01:00

There are many times when I have had shifts which have been...how can I put this delecatly...crap.

For one reason or another, be it a bad tempered nurse, an angry patient, loosing equipment, or any other situation where the manure hits the midden, there are shifts where you just long to see the night shift arrive, or get to leave early, change, get out the hospital and on one or two really bad shifts, find the nearest pint of Guinnes to nurse rather then a patient.

Things go wrong. That is life. It is not the best thing and should be the situation which is avoided as much as possible though to bury heads in the sand and deny that things go wrong is to my eyes more unprofessional then to think ahead and be kept on your toes. So, I was rather alarmed to read this report on nurses taking drugs to "get them through shifts".

I am inclined to be a bit sceptical: the person making the accusations was already in trouble, and why are there no adequate controls made to examine the levels of medication in the hospital already in place. Nurses do have a busy, physically demanding job (save for the lazy ones who are glued behind the station). If this is true, then there are a number of worrying things to have considered at the hospital, and really should be proved at other sites to ensure that this is not happening elsewhere. You cannot be considered competant to nurse patients if you are off your tits on drugs, or wasted on alcohol.

*Apparently the RCN has sent ballot papers to nurses employed in the NHS regarding the taking of strike action. 74% of nurses support strike action according to figures collected by the Royal College of Nursing*

Not much

2007-07-12T18:34:00.000+01:00

Have been in and had tutorial regarding essays and have generally been cracking on with work so not much to write about. Blogging not really a priority as you can imagine.

Nursing novices

2007-07-11T00:02:00.000+01:00

Have been reading through an interesting nursing book which is for an essay of 4000 words length concerning the use of clinical decision making in nursing using an analytical framework. A situation has to be described and written of. The reading I have done is the context of the junior staff nurse who is newly qualified, they are considered a novice nurse and they do not have the experience of dealing with patients to be able to make any intuition which if considered to be derived from acquired skills.

Clinical decision making is to enable the nurse to decide the best course of action for delivering care and treatment to patients and the best way to do this. The type of method which is used can be defined by using the cognitive continuum theory as defined by Hamm (1998). The theory suggests that thinking is neither purely intuition based nor purely analytical based but is based on a continuum somewhere between the two (Hamm 1998, cited in Thompson and Dowding 2005 p12). According to the cognitive continuum, the main determinants of whether the individual practitioner uses an intuitive or analytical approach will be based on the position of the task on a continuum which is ordered from the most rigid, scientific experiment evidence through to sheer intuitive decision (Thompson and Dowding 2005 p12). In the essay, treatment is the choice of dressing for a pressure ulcer.

However, it just seems so odd to think that while as a first and second year student, we very rarely were in a position to make these assertions but learned much from the study that we did in learning contracts for the placements that along with the competencies as set by the NMC that we never seem to have in the two years ever appreciated the gravity of the choices that we face. After reading and considering my past nursing, it makes me realised that even though we may be novices, that knowledge and interpersonal skills are of the uttermost importance.

Now, I am 3 weeks away from being on a ward (first time since January 2006 mind you), and suddenly feel very apprehensive about all of it. Novice? Crikey yes! Knowledgeable? Well, anatomy and physiology check, nursing code of conduct, check, general nursing theory check, self belief in being able to not become a quivering wreck for the first shift... oh dear.

Found: Nurses fob watch, circa 2005

2007-07-10T13:48:00.000+01:00

Back when I first started the university, I was given a fob watch. I quietly managed to loose the watch after first placement and did not resister this until needing at for the second placement.

A friend of mine gave me a spare one which worked for all of a week, then I got myself a new one, then found another one that another family member went and got for themselfs a while back.

I managed through wearing only one watch misplace the others.

Now I have found them all, and have a room which is getting cluttered up with all my old equipment and bits and pieces from the past 2 years placements. The most embarrasing one is finding a photo taken during my first placement: Ahh, simpler times. Its amazing how you can feel a bit nostalgic after only 3 years.

Back in (in more ways then one)

2007-07-08T21:55:00.000+01:00

Ah, yes.

We went a bit quiet back there for a bit, did'nt we

The last post was about the "30" mark. Yes, well I was withdrawn on the grounds, though I launched an assessment review and thay concluded that due to my personal circumstances at the time that I would be reterospectivly awarded mitigating circumstances for the module and re admitted.

So, that was a total of 27 days on the dole (well, from the 6th June).

So, what have I learned?
1) Appreciete what I am doing even more (though I love my job even more then ever now)
2) Always have a bit of self beliefe
3) A bit of fear is sometimes a good thing
4) You never write as passonatly as when your entire life rests on it
5) Im nearly £12500 overdrawn (Opps)
6) Boredom results in you making a website (www.freewebs.com/ambulancegallery)
7) That the most progress you can make with administration is in face to face meetings which are far more effective then the computerised/non contact system.
8) Deciding to join the St John Ambulance brigade was a good idea.

So, there we go. 3rd August for 2 essays to go in, and to start on the 6th August on a new placement in infectious diseases.

When it all went wrong, yesterday

2007-05-24T15:46:00.000+01:00

Oh Buggery buggery f**k f**k.
Ah. Read the last post
Then consider the mark.
30.
30!
Bloody 30!
What in the name of steam powered buggery d'ya mean 30?

Thats what the essay got. The same essay which was referred twice before. That was awarded 30 before, though this time had a load more references. The complaint was the rational not clear. Not clear. I wanted pain management in palliative care to compare syringe drivers to subcutaneous morphnine to deterime the superior method as research. I was told to change it to "family involvement" and to use 3 papers from the part 2 essay (which passed).
Then the feedback complaned about the papers [already bouhnd to use as they were part 2] and the rational was "not very clear". Too bloody right it wasn't clear matey, thats generally what happens what you are left bewildered by conflicting information.

Soooooooooooooo...what to do, what to do, what to do.
Have compulsory withdrawl- Hope not
Re-do the work in a different form- Maybe (fingers crossed)
Re-attept (with MITS being in could be allowed)

In response, I have been to the local PCT to see what HCA jobs they have. One. In the community. Which needs a car. I have only this morning applied for the driving theory test. The deadline is tomorrow. Bugger.