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 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 Sneeze

The chaos theory states that a sneeze in America can cause a typhoon in China. This is quite clearly rubbish or else all of us would be washed away after the flu season and if a butterfly flapping it's wings causes Hurricanes then it should stand to reason that the increase in the temperature of the earth is nothing to do with industrial emissions and all to do with the hot air that came out of Patricia Hewitt's mouth.

Now, that aside today has been one of them days where the smallest thing has caused the biggest fuck ups. Lets start with the never working Dynamps on the ward and the missing sats probe. Once more I attempted the Obs this morning and the damn thing decided not to work so once more broke out my trusty stethoscope and sphygmanometer, recorded the results of all manual obs (BP, Pulse, Resps) and used a thermometer which joined the dynamap in a bit of "Me too-isim" by deciding that 35.4#c is a nice number and wanted to display that for all patients. I wrote all the obs down on the communication sheet 9as is wanted by the ward). The fugure off a manual reading is never really as accurate as a dynamap. So, I decided that with the dynamap on charge and none of the patients about to die in the next half hour looking at their obs, that I could return later with the charged dynamap and chart them on the Early warning score chart (EWOS). Which was fine until I was told there was an audit to be done that afternoon, so I had to go out and chart all the manual BP etc rather then giving the exact figure from a dynamap.

Then we hoisted a patient in a side room out for the physiotherapists. Then, after they moved the patient, causing their dressing to fall off, I had to spend 15 minutes tracking down all the dressings I needed from different places on the ward to do the new dressings (which I changed to a primapore and melonin pad which matches closer the surgical wards on the hospital). This would have been better if I had a dressing bigger then 5cm X 10cm to work with which left a rather patchwork appearance to it. So that made me late for lunch by over 5 minutes. Only to get chastised for not managing time correctly and delegating. I was a bit annoyed by that as the whole reason I was late was that basic equipment and supplies are not found or require a detective to track down something which you should just be able to walk into the treatment room an grab straight away.

Anyway, after luch escorted the family of a deceased patient to Rose cottages, pottered about on the ward and had some kind words passed after staff ate the (squashed in transit) victoria sponge I made yesterday for the ward.

Not that bad a day.

My Days of my life

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

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

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

My Stagnation

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

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

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

My Helicopter

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

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

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

My 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.

My best laid plans of mice and men

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

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

My pharmacy

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

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

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