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 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 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 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 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 quiet victory

You know that when you see the pulse reading of several patients being bradycardic that just one of them is actually ill and will be needing the type of care that makes us stand up and give the world a smug "You see, that's why you need us" grin. Its just a pity that the promised money from the mayday for nurses campagine has not been as forthcomming from some of the clubs, which is a shame. I was involved in the taking of several ECG's, baseline observations (of all my patients) and monitoring of patients while SpR's were bleeped. Which was nice just to finally have a good blow out on the new placement and really get to grips with a situation. I must admit today did seem more social with the staff, which I feel a lot more happier with as the last week I really was thinking that I would remain socially isolated. The patients themselves were very quiet, I had all my charts done before 11am (Braden scales, Oral hygiene assessment, nutrional assessment etc). Yes, this may have interrupted my normal observations and the medication round which was started at 8am did not get finished until gone 10, but that is one of the examples of where clinical need dictates the priority. This statement is handy as I am to concentrate on that exact subject while managing the bay during this placement. The placement itself was discussed with the zoned academic who came into the CCU to talk to all the students on internship within the division. Normally I would be a quivering wreck of a student come a final tripartite, so decided to be blunt and to ask what the final tripartite would be consisting of. It would appear to be 10 minutes of me linking the competencies to practice. Which I practiced the other day and was able to make a tenuous link to most of them, so give it another few weeks and I should be OK (Still a quivering wreck all the same, but OK none the less).

So, a quiet victory in the fight of everything going wrong.

My short fuse

Began the shift with a new area today and was catching up on the caseload. We were covering a side room for another area and I wasted about 15 minutes trying to find the keys for the drug locker. The morning was frustrating as here I was on the penultimate shift as a student on the ward trying to take some inroads in the patient management and yet again I was being delayed by needless work.

The bay was busy, especially when I was covering the lunch break. I was aware there are two patients who seem to see me attending to a buzzer shout to one patient then make a request exactly the same as the one which the other patient would have made. I.e. one patient wants the commode, so another one does. It was rather annoying, especially as there was one who was pressing the buzzer while I was stood in the bay which caused me to walk out the bay in the totally wrong direction for me to have to see where the buzzer was going off (as you can imagine you never really think a new call will come in via buzzer alert in a bay where you are already in, and when a small illuminated button next to the bed on the reset button is all there is to alert you it's not the first thing I look for).

I find this very annoying as I was wasting time left right and centre by having to do actions which were not needed. Yes, I am aware there are some patient who may not get the buzzer idea but I actually sat down and explained in plain English how and when to use the buzzer. I don't know.

Did another transfusion on one of my caseload. This went well save for the cannula which kept on stopping the flow. The flow returned by pressing slightly down and back on the cap of the cannula. Not sure why but after today I was in no mood to argue. I had a patient go AWOL for 2 hours, though not as bad as the bay next door where the patient stole money and then absconded from the ward. The police are still searching for them.

Some of this evening was spent minding a patient with dementia who was making a good go of trying to beat me up. Few near misses but nothing serious. Tomorrow dawns as my last day on placement 5.

My strawberry jam

I was back in my normal area of the ward today being in charge of the two side rooms and a patient who was to be discharged while covering the bay in a general sense (like when there were breaks etc). One patient in the side room was pretty much independent and really all I had to do was give out meds and kept and eye and called by the room when I had a few moments spare to chat to give the patient some "face time". The one next door was a bit more ill and for a few hours were asked to wear masks while a certain test was performed (which was an interesting thing as I never done that before). There was a problem getting the medication in the form of a liquid which I wanted for the patient as they were having problems with swallowing but made do with crushing the medication down.

I was obsessing about the ward keys having accidentally taken the keys to the bay home the last shift (oops!). I find this odd as I was asked just to bring them back to the ward...and that was it. I was imagining having to do an incident form a get yelled at. All they said was "Oh, that's good that you got them, that cupboard was open all night". Still, as a lucky dip of the "potential fuck up to make on placement" it was not a bad one.

My other patient went home without too much, and today has seen me working quite autonomously in what is a very unusually quiet day. I am turning in to the ward on Saturday when the ward moves to a different ward.

My Finnegans wake

It was with mixed feelings that I was told that the internship placements were put up on the university intranet today. The result is that I am on my second choice, a cardiac surgery ward. Which I absolutely love as the heart is one of my strong fields. However, I am getting too far ahead, so leave me at 4:30 in the central corridor on my break being told this by another student and return to some hours previous when I arrived at 07:10. Today was on the ward, while my mentor was on duty I was allocated to another nurse to act as second nurse. There was one patient who began the day by telling me and the staff nurse to "Fuck off and don't come near me". We left him half an hour and were met with the same reply. As were the junior doctors. The consultant. Two ward hostesses. A physiotherapist. And a visitor. SO there was not a lot we could do. Still I did get the patients medication and observations done and was able to get the bed made and sort them out with getting washed and changed. Just never done it while being swore at before but hey.

I was trying to do the observations with the dynamap again which stopped working near the end but still managed to get my observations done albeit slowly. The day started with the slow fall down to being stagnated trying to square things up, but one I found the sats probe and the dynamap came back to life I was able to make a start on the observations once more. My two side ward patients were both discharged which eased the workload. There was a staff nurse from another department who was with one of my patients when I was covering the lunchtime. I thought it was odd that a visiting nurse would be dealing with the patient in the manner they seemed to be until I was able to deduce this was in fact a visitor and the patient was a relative. I was mildly taken aback with mild panic as I became acutely aware that here was not only a visitor, but one who was also my superior on the job. Thankfully they were very happy, and actually gave me a hand with them. I was able to crack on with the patients who were left. The staff nurse remarked that I had "worked very well" today which was nice (I have never worked in the same bay as the staff nurse in question who originally trained in 1966 and is about to retire!).

The afternoon drifted by slowly and while tiring has left me some time to think. Which is really starting to get to me as I am now comming full circle. The end of the course is comming up and I now look upon this with a mixture of thourghts. The initial one is a feeling of happiness that this whole course of three years is nearly done and this I can rest (I am feeling tired at the moment of the pressure) but also with the uncertianty which all in my positon are facing. Which is even worse for seeing the list, as there are quite afew people on the list from the same hospital as me which will all be fighting for position. And this is simply depressing as there is the rumor running around of the jobs which are going and of those who have been earmarked and the problems which the last cohort faced (60 people qualified but only 8 finding jobs), the future what this holds for me and of my girlfried and how they will fare.

This should be the time to be glad and looking forward to a bright and prosperous future career. However, I am left burt out, dejected, nearly reaching for the fluoxitine, and considering work in a call centre. This is not healthy.

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 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 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 defining moment

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

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

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

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.