Major Incident

Ah. Sunday. A day of rest. A day of roast dinners. Or, If you were part of St John North Yorkshire and Teesside the major incident workshop day. Ah yes. I am now fully certified in knowing how to deal with a major incident and ran through triage. I even did 2 exercises in magaing it. One was a written list of casualties and what triage level I would put them at. Basically, Green is walking woulded. Yellow: Not walking but obs stable. Red is immediate attention (not walking, obs out of range) and white is...erm, how can I put this. Dead. Unlike a normal situation, anyone needing CPR at a mass-cas situation/Major emergency is left for dead. Its not nice. Trouble is, while you would waste time CRP-ing a body, the patient with femoral bleed could be saved. Hard but thats life.

I have provided a tounge-in-cheek take on the day on the diagram. I wrote the original on a scrap of paper.

A symbolic moment

A symbolic moment has just occured. That moment namely is the last time that I have prepared my uniform for duty tomorrow. I have done this for the past 3 years. Mainly because I quickly realised that being blearly eyed at 6am, 4:45am, 5:30am and 5:25am (times respectfully used throughout placement times, bar the community part of 2nd year when I was able to sleep to the late time of 7:30am. Ah, those heady days of 2006 eh?) resulted in me usually forgetting something important. Yup, tomorrow is my last placement shift.

I have had three years which have been... varied I guess. I have had some interesting times. Some good (like my first sucessfull CPR, Passing my Tripartites, the patients who I was able to help, the great Nurses and other people who I had the honour of working with. Most of all has been meeting the one person who, while I today fret over, has helped sometimes keep me on the straight with the course. My dear Girlfriend. There have been the bad. But do you know what? Mostly it was when my niece died last year and when that caused my to referr on a module. I have had bad shifts. I have had arguments with staff. I have had the abusive patients, and on more then once had to deal with a patient trying to very much kick and punch their way out of the ward. Oh well.

Tonight, all however is calm. I know that my girlfriend has her family with her and will be going home tomorrow (hopefully). I have some applications which I hope will be fruitfull, and there are interviews now comming through. A bursary came today. My RCN subscription has been renewed. My NMC PIN number will be here hopefully within the next 5 weeks. Now, for the final time, I will have to think of a succinct title to cover the next shift post. "My roads end" and "My Final destination" are both vying for position. There were other titles that would have been used for mid-course shifts. "My Bad day" for example never was needed for a title should a monumentally bad shift have occured. I have been trying to think of a single tune to embed as a video like for the post. The second place went to "Fall Out Boy" with the track "Thnks fr th mmrs". For what I settled on, call back tomorrow.

So, "what are you doing tonight then Nursing Student?" I hear you ask. Well, going out for a belated Christmas meal with my St John Ambulance division for a start.

Another Certificate

Above: Heartstart FR2 AEDWoo-hoo! I took my St John AED course today! Passed it, and had a comment which read "Good CPR". I know in the grand scheme of things this is hardly up there with say,ooh, a D.Phill in Astrophysics from Cambridge. However, a) An AED MAY occasionally be of use to me while acting as a St John Ambulance volunteer (I however hope not to have to use it in anger. Lets face it, anyone who wants to use one sounds a bit Macarbe). b) I am well aware more advanced equipment/Professionals are in more the adequate numbers in the world. c) I would be loath to come across as a "quacktitioner". However, firstly, the chain of survival (early access, early CPR, Early defribrillation, Early advanced care), you will note how the AED forms part three.

Most importantly, while it may not be the grandest award out there it is mine. Which I am happy with.

My football match

I have taken a study week to try and get some time off. I have asked about getting a job in a call centre (so those three years Nurse training look to have gone overboard). I got a letter this morning confirming that I have completed the requirements of the course, pending statutory hours being completed.

Only thing I did was a Football match with St. John Ambulance on Tuesday. I have over the years when with the Red Cross attended calls that are more suited to a "Carry on" film rather then "Casualty". There was one such happening while I was trying to treat a member of the public in the first aid post. I was seeing the patient while being hemmed into the corner by several SJA first aiders who were in their allotted time for a break, and a rather rotund divisional superintendent who was trying to make the tea.

I have started on my latest project for the British Ambulance Society (the details of the history of the local ambulance service) which came in helpful to one of the St John Cadets who is today in Liverpool for a Paramedic interview.

My 2007

This is the end of the year and the end of my time as a student is drawing near. It will be another 29 days until I will be officially finished as a student Nurse (in case any of you were ever bothered I was/am a student at the University of Teesside, Middlesbrough). So, given that not only is this the end of the time as a student, I am also at the end of the year 2007. So, what was 2007 for me?

January
Nothing remarkable for the first half of the year as the first week was spent on annual leave. The second week was the return to the final placement of second year (Critical care placement) in the ICU. The week was spent with patients on my three shifts (though I cannot recall much now what happened). The week after was my final tripartite for second year. This I passed, I remember being very nervous about the second year one, and was sent out to a cardiac arrest in the hospital with the arrest team and thought that was less nerve racking. The 2 weeks after was on my elective with the North East Ambulance Service NHS trust. That was enjoyable.

February
The first 2 weeks were study time and I prepared my portfolio. They went in on the 19th and I started 3rd year. This was a time when the attitude changed with the university toward the student groups (from “oh, don’t worry you are only a student” to “Right, your managing bays and other students when you go out next”). It sowed and I remember I ended up being late two days thanks to traffic (some did not even make it in to university). I met my girlfriend this month.

March.
The portfolio passed this month. Not a lot to report for March.

April.
The semester continued with the addition of the independent learning module coming online. There was no a lot to recall, I did have a weekend in York with my other half, and records suggest I had the blog by now.

May
I was asked to hand in an essay and this was worked on while I queried the MITS which had been applied for. This was met with a stern look and a mark of 30. That was not good. Some of the modules drew to a close as the final seminars were had.

June.
I was kicked off the course due to the 30 mark for the essay from second year. Thankfully, I still had some old paperwork and approached the student union with a view to appealing against the decision. It was agreed that I had a case and the assessment review was put in. I immediately started looking for work and was accepted for employment in a call centre. I also joined St John Ambulance.

July
Back on the course on the 3rd. I got the letter which while written on the 3rd only reached me on the day I was being asked to go into the university to meet with the pathway leader and 3rd year module leader. This went OK and I agreed the date’s to submit essays (3rd August). The essays were worked on, till one module asked for submission on the 3rd which was not originally intended. This took some sorting out.
August

A new placement was on the infections disease and diabetes ward. This is well document on the blog.

September
The placement was worked through and the essays all passed. One later needed re-submission though this was the one which I was asked to write in less then a week.

October.
The internship placement began in a old division. I did get a bit downhearted by this at first by slowly it did get better

November
The tripartite and nights dominated this month

December
The application for jobs started in earnest this month as did attending st john ambulance duties having passed the members first aid course.

Remembrance Sunday

Today, it being the 11th, was the annual Remembrance day. I was out this morning with St John Ambulance and was in the parade down the division's town high street to the Church.
It was freezing cold (and raining for the first 5 minutes) but that's not exactly bad considering the fact we were there to remember people who have been killed in conflict. Was in the church service, and frankly was glad that there were other people around to drown out how bad I probably sounded (though thankfully I can not see Simon Cowel on X factor ever wishing to hear my and my regular crew mate's rendition of "Jerusalem").

A job...of sorts

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

My half time

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

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

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

My Reckoning

With Monday bringing another shift, I naturally slept in till 6:05. This is a problem as I am supposed to leave the house at 6:10. However, I managed to make my bus, and was even lucky enough to get a connecting bus which randomly arrived at 6:50 from where I have to change, so while I was initially thinking "here comes a crap day" it actually turned out rather well. So, by rather well please read "the hospital failed to explode". The ward was heavy, mainly because the lunatics had taken over the asylum, but then fell ill and had gone to the MAU. Which of course means that somebody with falls, confusion and dementia/other problem should be considered to be sent to the Diabetic/infectious disease ward in the endocrinology division. Oh, hand on, no they fucking don't but you try telling them lot that because somebody seems that they should. That's mainly what we had, which would be great but there were 21 patients out of 31 who had either had or was at risk, of falls. This, is not safe. It is an easy criticism to make of the nurses that patients fall, but this was too many. While there were howls of protest from the staff and the ward managers, there was nothing which any other ward was prepared to do to help us out. There was as a percentage 67.74% patients who had previously has falls. That, is not a good percentage of falls risks. While we know there have been cuts, this is where the chronic shortages are expressed the most, at the times of crisis where things go wrong.

My bay was not too bad. There was a few basic tasks to be done with the bed baths, bed changes, a discharge to sort out and a few BM's to do. I had every intention of setting off to do the observations first thing...only to find that there was no cuff on the dynamap. Lucky for me, this was no problem as fresh from having it on stand by while on a first aid duty with St John Ambulance on Saturday, my sphyg and stethoscope were taken out and given a hammering. Speaking of saturday, my St John ambulance duty was nice. 5 hours (9am-2pm) covering a 24 hour relay walk at a local rugby club with two first aiders and one Ambulance aid, which was unusualy in that while there was one public minor injury, I ended up with a sore backside from sitting on the cold wooden floor of the stand. If only the ward was like that.

After the doctors handover I was able to get to grips with the social workers referrals and faxed a few forms over to different places which took me nicely up to being at lunch. When I returned, there was a new admission (who did not have falls), which killed a bit of time, then I had a blood transfusion to do. So, with all that in place, using only my stethoscope, sphyg, a thermometer and my bare hands, all the relevant obs were done at the required intervals. With which, I then went home.

Then when I tested my BP at home, this came out at 150/100mmHg. Three times. This is not good. That's what it does to you.

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.