My Dream

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!

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.

A symbolic moment

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 football match

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 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 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.

Politico's unspeak (or My head exploding 2)

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

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

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

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

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

More Nurse Bashing from Dr Rant

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

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

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

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

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.

A job...of sorts

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

My half time

So as of 15:20, I finished my placement. Which is nice as that was a few hours off having covered for the ward move. I will miss the early finishes as a student. Speaking of which, I have handed in my first letter of application and CV asking for a job to the ward sister where I have been for the placement.
For the shift I was in charge of doing all the drug rounds and dispensing the medication and doing the controlled drugs. I know this will be a bore for any qualified staff but it was with the final push which I was left to happily work during the lunch break with another nurse to pop their heads around the door to keep and eye out. While normally this would be daunting, I was OK with it. I do think that a lot of the situations which people do not want to deal with wind up being bad only thinking they have to face a situation or on the way to a situation (i.e. cardiac arrest). I remember back in first year when on a community elderly rehab ward I was on my third shift as a student and being told to go to the mortuary to see a dead body to sort the paperwork out with the funeral director. Since then I have seen a fair few. Back then though, Internship was a distant thing, but now it is looming up just 5 days away.

Back to today. Gave a phosphate enema as the doctor prescribed it back on the 24Th but it still had not been given, so you can imagine the mess I had to clear up after nature ran it's course. Also had loads of bad baths as night staff did hardly any.

I was trying to get some controlled drugs signed out to 2 of my patients for pain relief who had PRN prescriptions for Oxynorm and Oromorph. One staff nurse said "get it out ready and the controled drug book open and I will be with you in a moment". 10 minutes later I was still stood in the treatment room like a right berk waiting. Thankfully my mentor got back from lunch and signed them out with me. Annoying. Then I did an ECG and was told to go off duty. I left a "Thank you" card and some chocolates to the mentor and one for the ward. They thourght I was very kind. While I was going to head home though in the true tradition of me actually going above the call of duty did a prescription drop off instead. This came about as there was another bay who discharged one of their patients to a rehab home but the patient went without tablets. I told them that the town where they were is in the next town to my St John Ambulance division, and so was sent in a taxi to the town then walked to the town centre where I indulged in a hot tikka and a few pints to celebrate the end of placement. I then walked the 3 miles to the town along the sea front to the St John Meeting. It was there that the iredness kcked in, though thankfully the meetinfwas on the upcomming training day for me (the next two Sundays) and some AED work. Not a bad way to end the half way mark of the placement season.

Why students should get a PIN number

(Above) A pill for every ill...

I have finally had a bit of a revelation on how to make nurse education better which I would appreciate a few moments of your time to tell you of. I am sure that some may have read my post of how I was in a training seminar that made my head explode. Here is why. You see, far from being a grumpy “Its all shit” kind of person, my anger stems from my passion for nursing. Think about it, we are not perfect, but we are the profession who are at the patients bedside, take the basic needs of the patients who need assistance, dispense and administer medication, provide support to both patients and relatives, and do take a role in the dressing of wounds, taking of blood, observations and the setting up of infusions. I am sure that most Doctors would agree that Nurses are an essential part of the care of the patient after they diagnose them, that the physiotherapists would like us to keep them doing exercises as planned by them and so on.

My analogy today comes from my St John Ambulance division. We have Patient Report Forms (PRF) to fill in when we treat somebody. This includes applying a plaster. To get around filling in a PRF for just a plaster, as long as we give the person asking for a plaster one to apply themselves (after asking to make sure they are not allergic to them), we do not need to fill the form in. Its that simple.

Back to the post. The reason I was so annoyed was the fact that I feel unhappy with the way that nurse education being dumbed down. This is NOT the fault of the university nor of my home trust. The fault is that of the blame culture that we now live in. This (with the deepest respect to any American readers) is an Americanisim that frankly we can do without. I am nearly at the end of three years of training and there has been £40000 of the over burdened British taxpayers money spent on training me. I am a very pragmatic person, so I do think that training should be a process of taking an individual who does not possess the specialist knowledge or skills to do a job and equip them with the rudimentary knowledge to do this with the minimum supervision. It would seem that at the moment because of the sheer volume of litigation faced that the best which can be done is that we [student nurses] are trained in a knowledge base which is very good but lack some of the skills which are expected as a staff nurse. The fact that after three years I am not qualified to even take a temperature is something that makes my liver fizz. It’s an insult to the intelligence of all students, after all by attending university for three years you have shown some degree of intellect, rational thought and that you are not a dithering simpleton. So you can easily see my argument of “Just what is the aim of three years of hard study?” as this seems to be simply nothing more then a paper exercise to say “I would like to be a nurse, this paper says you can train me up”.

Which is where my local ambulance service has a good policy for recruiting its new university trained Paramedics by advertising the posts as trust positions. The trusts advertises for student paramedics and then when the candidates are employed by the trust they then start with the next intake and come out with a job- much like hospital secondments but for all levels. If the problem is with the trust officially training you as an employer, if you work for the NHS trust and use the equipment as part of your training, ergo you are familiar with the equipment and would not have completed your training without using it. This is too straightforward only if you are seconded.

So, today, I give you my latest bright idea: Give third year students RGN status and pin number which is valid for one year and one year only, which to keep the RGN status and pin number must mean completing the third year of study and gaining the accredited qualification. This PIN number should ideally be issued when the student enrols for their third year (to do so at the end of second year would affect those taking a year out). Think about it. How many times do we hear student being told “You cannot do task X because you are not registered”. Quite a few I wager. I have said before, there is no sudden transition made from dithering simpleton student on a Friday afternoon to uber-knowledgeable staff nurse on the following Monday, so its not the time spent which is the problem. The problem is that nobody wants to risk their registration number for a student making a mistake. This is understandable. The idea that a student would panic over having accountability is not an argument which much substance: just what would anyone making that point think the individual would do WHEN they qualify. No, the sooner we stop thinking as nurse education as being an academic essay only but the foundation of the building of the next generation of staff nurses the better, and all the better for the lost art of basic nursing care. The public argue there are nurses “too posh to wash”. Very good, but it’s normally the students who are given the basic nursing care to do while training: tell them they have an RGN status and have to give Mrs Smith a bed bath; they will hardly have many grounds to refuse. Of course, they may not have the time to do such a task when qualified but instil the right attitude to mould them and the rest falls into place (with any luck).

This would allow students to give out medication, take responsibility for patients, and learn how to use equipment. An exam of their safety and competence on drug rounds (done without the student knowing to reduce stress) to allow unsupervised drug dispensing will develop experience for this task which is one most performed by the staff nurses. There is no legal requirement on who dispensed medication; it must be however on the written instruction of a doctor or other appropriately licensed prescriber. Once more, as a registered nurse the student would do this, and if a person has never done medication rounds before they will be only at the same level of a student (and just as incompetent). The idea of affixing a registered status to somebody will not automatically make them competent in a set task (as has already being highlighted, newly qualified RGN staff are not allowed to take a temperature or BM’s without post graduate training so imagine a drug round…). So, give a 3rd year one year to finish and remove the “non registration” inhibiting factor, and let the students grow!

Have a break, have a compound fracture

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

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

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

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

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

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

Found: The rectum of crap nursing

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

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

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

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

My philospohical way

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

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

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

My window of opportunity

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

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

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

My pre-emptive strike

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

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

Choose not to choose a career

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

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.