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 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 Unnacceptable low

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

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

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

My Nightlark

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

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

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

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

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

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

My 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 new world

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

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

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

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

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.

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 balance of power

Yesterday did not get a post as I was very tired after getting home. The day was as usual for the ward- hectic, and with a few million jobs to be done after the weekend and the ward move. I was in "area 1" on the ward. Area 51 would be more accurate to describe what was going on in there. There was one patient who has been very abusive to staff, and has some involvement from the mental health team. In the afternoon I sat in on the MDT meeting for the patient. I started the day by phoning the people needed to attend: Next of kin, Social worker, Occupational Therapist, and the Discharge co-coordinator nurse. All agreed the time and said they would be there. I even spoke to the discharge co-coordinator when she came to the ward near 10am and confirmed the meeting as I was discussing one of my patients who is awaiting panel for social services and she confirmed that she would be there at the time specified. So I was a bit put out when after waiting 15 minutes for them to turn up at the meeting to be told by the discharge office that she was only in till 2pm and had left the hospital. Thankfully another member of the discharge team showed up.

The end result was that we needed and official diagnosis made by a psychologist. So, I phoned the mental health link team at the nearby acute psychiatric hospital and they said phone neuro sciences up in my own hospital as they have a psychologist. So, I phoned the hospital switchboard to be put through to the department in Neurology. Well, that's incorrect because what actually happened was that I phoned the number for switchboard on several occasions and the phone rang and rang and rang each time. So, having been given the number of a community mental health centre where the same psychologist works, I phoned them instead. Whereupon they told me that the psychologist is on holiday until the 4th October which seeing as this was supposed to be an urgent referral was a bit longer then what was needed. By now we were steaming up to 4pm and so knowing that bog all gets done with referrals after this time phoned the mental health team back up. They got the same story you got, and then agreed that the Psychiatrist would phone the ward staff up tomorrow (which is today) and would have a word with making the diagnosis. I find it odd as while they were on the ward last week, they came out with the best ever excused for not doing something: "The referral form only asked about the persons cognition" [n.b. this is not the true reason though have altered this for confidentiality]. Well, that's nice but it would be nice if they had bothered putting down WHY the patient was that way in the first place. But no, they will only do what the form says. So, in the future, I will write "Do this (referral x), put down some details don't mess me about sunshine".

After dealing with the insanity of the ward, I had my competencies signed off by my mentor and wrote on the tripartite sheets (there is no official tripartite for placement 5). This went well and all were signed off. There were one or two side points which were not due to them being too specific to have been met on the ward but as its a formative placement that's no worry. So, nice to know that it has passed and now I only ave two days left before moving on.

Speaking of which, went up to the new placement area (Cardiac surgery) and have got my off duty for next week. Seems to be the same as when I worked on the ward next door which did the same but has the Cardio thoracic HDU and took less pre-operative patients. This means that I will be able to get to grips with this type of patient on this ward.

My typo negative

Same bay, more admissions. The ward has finally gone mad, and we see patients who are more the we can cope with. My bay was the last outpost of sanity in this mad world, so thank goodness this is where I was. It was never easy as there was still no BP cuff on the dynamap, and while my staff nurse said "why do it manually it takes longer" when I began using my sphyg again. In the end it took only the same amount of time as normal, and did not mean me wasting half an hour scrounging equipment. Which was nice.

What was not was the falls which took place, but there is nothing much that can be done when we are at screaming point with overload despite the best efforts of all (and by all I mean everyone from the HCA's up to and including the ward manager, who had come in on her day off to help and sort things out).

Still, away from the wreckage of the ward, in the calm lagoon of nursing students bay atol, work was thundering along. We had out patients up, washed, sat out, beds made and seen by lunchtime, after which I was invlolved in the blood transfusions which were going on. This went well until there was some discrepency on the labels of the blood lables on the unit. This took some sorting out but was done.
I am looking forward to my rest day tomorrow.

My 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 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 curious case of the capsised commode

There have been two shifts. I have forgotten most of what I did Monday so that goes some what to explain how unremarkable that was. The only thing wa builing up a rapport with a normally sharp patient which was quite nice.

Yesterday was in. Had a few discharges to do (which meant waiting all day for the pharmacy scripts to be sent and arrive on the ward). Had an interesting case in the next bay which I was roped into helping with which was of necrotising fascitis. Then had my first fall in a long long while in another bay to assist with.

Now, I know at this point some of you have started boiling over with rage thinking that this is just another case of the nurses being shit and neglecting their patients. Which is natural until I tell you that that patient had fall off the commode they were on- by overturning it sideways and precipitating themselves and the contents onto the floor. The brakes were all on, the commode was intact, so lord knows what they had done. I was among the first into the bay and supported the patients head and neck in the neutral position (that St John training paid off). That is the curious thing as I always considered commodes to be as hard as a london double decker bus to overturn.

My 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 weary feet

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

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

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 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.