An update

"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.

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

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.

My roads end

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.

My summersault and My emotional day

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.

My illness

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.

My 2007

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 baited breath

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

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

My half and one

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

My Unnacceptable low

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

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

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

My oddysee

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

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

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

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

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

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

My best efforts

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

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

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

My Challenge

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

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

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

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

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

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

My lost nights

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

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

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

That was my night.

my nightingale

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

My quiet night

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

My nightcap

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

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

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

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

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

My Nightlark

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

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

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

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

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

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

My half shifts

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

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

my demon

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

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

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

my new world

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

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

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

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