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 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 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 Sneeze

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

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

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

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

Not that bad a day.

My pre-emptive strike

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

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