My gremlin

My Head exploding, today

The third day on placement. The first bad one. Definitely an unenjoyable one where there were some things that were unpleasant. The low point was being pulled up by a staff nurse over them thinking I was trying to skive. Part of the reason for that was the second thing that went wrong, which was a patient kicking a trolley out which ran over my foot and has left me in a great deal of discomfort. Imagine you have a great deal of pain and you can barely walk, after you have just set up 2 IV infusions, handled a phone call, taken a blood reading and need to pass this onto a college and you just sit down to explain these urgent messages when somebody walks past and tries to reprimand you because your "Sat down when we were busy answering buzzers a few minutes ago". Well, I heard them buzzers too, though next time check my location first as if you'd done that you'd have realised I was in fact dealing with my patients when that happened. Don't jump to conclusions about me as I have the ammo to fire back that today you abused the position of student nurses by using them to cover for your shortage of HCA's, and also the fact I went with only 1/2 a morning break and a short lunchtime and no evening break to get my patients seen (and a few discharged home).

Hardly nice when rather then going off duty I was doing my best to hobble over the ward (and got two blisters in the process).
The zoned academic was on the ward today so quickly managed to have in initial tripartie with her, so thats one less thing to do.

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.

My first day

TODAY was the first day back on the wards. The ward is as I was told a diabetic unit (the infectious disease bit seems more sidelined at the moment due to low patient numbers of this nature). The ward seems really nice, and the staff lovely. The work was divided between a 6 bedded bay and a small two bay unit further up the ward. There was plenty of work to do, and today was the day where I was also in carge of the dispensing of medications including tablets, nebulisers, IV antibiotics (both infusion and bolus administration). I stumbled upon an infection control issue today as well, mostly due to the normal situation I find myself in when I try to do something for the first time without direct supervision and find equipment missing. The one for today was thus: I was required to give Tazocine 4.5mg to a patient as an IV infusion of tazocine 4.5mg reconstituted in 20ml sodium chloride. The solution is then added to a 100ml infusion bag of saline. Now, the first problem was the before lunch the drug was not in the pharmacy cupboard (there was one Tazocine 2.25mg and that was it). So, I went to lunch (this was one hour before the prescribed time), and on returning to the ward found the pharmacy delivery had arrived. The Tazocine was available in the correct dose. Then I found that there was no 100ml saline bags in the boxes. There was a choice of either 50ml or 250ml that was relevant. I had to choose the 250ml. Now here comes the interesting part. To remove the excess, I had to snap off the white port and withdrew 130ml to waste, leaving 120ml in the bag using a 50ml syringe (the first cock up there was when I opened the first 50ml syringe to hand only to find it to be a bladder syringe AFTER opening it) then withdrawing 20ml from the bag to reconstitute the Tazocine with. Now, the drug was mixed, and the whole thing injected into the bag. The yellow labels were affixed and filled in with all appropriate information. Then, this was taken to the patient and the blue end removed for insertion of the IVI giving set. What I said to the infection control link nurse who was standing next to me at the time was what had happened and why I did what I did. I swabbed between the different withdrawals, and as the blue end was running to the patient did not want to withdraw from that end as if anything nasty got left behind (bit of Staff. Aureous etc) it would cause a bit of trouble, but in the situation I was in, is there any other risk involved in doing such a thing by using different needles to go between the ports.

The unfortunate part of the day was when I met an SHO who was working on the ICU the same time I was there last year. It turns out he did not survive the Mass Medical Cull and has had his career "Modernised" and is now out of a job though was at a conerance at the hospital. Not very nice thing to see happen as he was a good doctor and a great person to work with. The human face of the MMC farce.

Of the weather, new placement and how the end of the world not happening means more work for me!

Today See's a nice day. Take a look at the above photo, that was taken all of 3 minutes ago from my bedroom window with my digital camera. I'm a tad annoyed at that, mainly because all of June and July was rained off, which also coincidental was when I was off. Of course, tomorrow I am going to have to start working in a placement area so you lucky ones who are off have the nice weather (thus of course nicely proving that, yet again, I was right in saying that the weather would pick up in August when I go back to work).

But, for the serious part. Tomorrow See's the return of student Nurse to the wards. That by itself is normally nothing that would attract a great deal of attention. I have had some time away from the wards seeing as the second year training results in there not really being wards worked on (though that in itself boils down to practicalities of training. There are sometimes the slight drawbacks with the course, though the only problem I have with the lack of ward experience for over a year is that it will take some more settling in then may be expected. I know this to be a worry shared by many of the others within my cohort). I admit there are a number of things all vying for my attention. What to expect in terms of the patients and the staff, what will happen on the ground on the day to day running of the bay where I am to manage, will I get on with the staff OK, am I going to have a pleasant student from first year to work with, will I mange not to make a total fcuk-up of the ward on the first morning, and will I be able to not be totally knacked from a lack of sleep.

Then of course, there is the problem with the heat. Yes, it's warm and I think today's temperature while not exactly at the "Heat wave setting" is just as warm as I like it (I like many others find it hard to sleep at night if it's too hot). Of course, I have been told that while the ward is down as being infectious diseases, but it is not 100% used for this purpose. The reason being is simple: there are not many people in the county where student nurse lives who have a horribly disfiguring disease, nor do the good denizens decide to visit the far flung corners of the world and come back with something nasty. Avian flu is tossed around like a ping pong ball on speed, though to days news worries more on the foot and mouth outbreak. Bovine patient rarely happen in acute medical wards, and even if Daisy should decide to be admitted, its not communicable to humans (a Zooanosis for the medical term), so I'm ok there. Ebola is always a risk, though is the most deadly disease since the last killer virus was isolated in a lab, killing nobody. I know there are those who will know that Ebola potentially is dangerous. The thing really is nasty- Firstly, the immune system of the host is attacked. Whereas something like HIV will happily stop at shooting the immune system to smithereens then allow something else to finish the host off, Ebola ploughs on till there is nothing left. The blood beings to clot, damaging the liver and kidneys, the collagen fibers are destroyed and the hosts organs liquefy. Save for the stomach which is vomited up. Though BBC news has nothing about a man walking out from the jungle with bloody eye's and his stomach in a bag so panic over.

Thus, as you can guess, there are a few other patients show horned in. These are the diabetics. Yes, diabetes is a very bad thing, the leading cause of blindness, and limb amputation in the population of working age. It will be these same people who will be on the ward. The same ones who may well be kept laying in bed awake at night, slowly using up their prescribed insulin, and letting that glucose level go down, down, down instead of sleeping. I know 99.999% of people will be fine, though the potential is there (and just my luck it will happen, so if I write it down I may be proved wrong).

So, in someways, therein lies the situation. As there is no immediate threat of there being some sort of widespread pandemic, we take on diabetic patients. So, that means then I actually have good chance of getting to grips with working with patients to practice good nursing care. Nice!

Ahh, a good day (At Last1)

Ahh yes, come to daddy you beauty!
There is nothing more pleasing when I was presented with this cheque on Friday which was hastily paid into the bank. At the moment the balance is -£399, though as the cheque is not fully clear (i.e. allowing any withdraw ls until Monday) I still cant fully use it, but at least I have it. Additionally, I was sent a new award letter. The nice news is that it seems I may be paid again on the 17th August so things are looking up a bit now on the cash front. As I had the award letter, I took a gamble with the bank and they have sent the documents off to their lending centre for approval of the third year loan.

Regarding the essay which laft all concerned confused, I did thrash an essay out and went to submit. However, when all came to all, the email sent from the university seemed to inaccurately have the module down for 3rd August when this should in fact have been a totally different module. have handed in the essay which caused all the problem before. This new version was done with the original seminar documents emailed to me so I was made aware of the expected content. I have "tighted up" the content alot so now hopefully will pass. Fingers crossed.

Today I have just trawled the DoH website for the NSF for diabetes and related documents so will have a casual nights reading of them in readiness for Tuesday when I have my first shift on the new ward. Given that there seems to be an overflow of Diabetic patients onto the unit, I want to refresh my knowledge and have some up-to-date reading done to prepare myself for entering the unit. Still feel nervous as I have not been on ward for nigh on 18 months but I will try my best. I may outwardly seem to drift on, but I in fact do put a fair degree of thought and consideration into things. Not saying it works all the time, but it's as near as dammit.

Question

Is it really worth it anymore?
In another 9 hours the essay that nearly ruined my career will be submitted. I am hopefull that this will pass, but I have had such a hassle with this other essay that I am really worn. I am really tired of this all. I mean, where is the job at the end of this? There really is little prospect, I have always asserted that I doubt that there is a job at the end of the course for me (and many others). The third year has been a demoralising exercise and really I cannot take much more of the constant kick-in-the-teeth experiance which the course has descended into. Course, today is friday but heaven knows when my money will arrive, when hell freezes over or there is aerial bacon seems to be the two hot favourites at the moment.

Take the latest problem. I am being asked to submitt an essay today that is not infact due to be submitted until september 5th. I have mentioned this, and all I get is a terse reply saying to hand the essay in. Well, they want an essay in a week then fine, you get an essay in a week. So this will more then likely defer.

Then, I will go to the studnent union and kick off on the matter.
But, who will be made out to be the c**t?
Yes, well done you guess right.
I may be back on the course but I really am just past my mental tolerance level. Just when you think you cant go any lower some bugger comes along with a jackhammer to add a few extra foot.

Confused: A short play by Nursing student

The following is a mystery play for the reader to solve...
Within this short play there is a student Nurse (the protagonist), a module leader, another student nurse and a tutor. The story takes place as a series of emails which are sent, and the reader must decide what the outcome is.
Email one: A week ago: From Module leader
Dear Nursing Student,
I have received an email from the pathway leader regarding your submission of the module essay on the 3rd August.
Regards,
Module leader

Email two: A day or so later: From Nursing Student
Sent: Mon 7/30/2007 14:10
Hi Module leader,

Thanks for your recent email. I am a little confused as to the submission date, as I was told that it was the 5th September originally. I am to be submitting an essay on Friday that was originally to be submitted on the 26th June. I have written most of the essay and can submit, though just want to clarify with you as the leader when to submit.

Kind regards,
Nursing Student

Email Three: From Module Leader
The hand in date is 3rd August and I understand that Pathway Leader and Another module leader informed you of this.

Email four: From Nursing Student
Hi,

Yes, I think I may have been getting confused with your module and that of another module.

At this point, enter Nursing student #2
Email 5: From Nursing student
Hi Nursing student #2
Hope you are well.
Just a quick question, what is the submission date for the module, i got an email saying it was the 3rd august

Nursing Student

Email Six From Nursing Student #2JUST GOT BACK FROM HOLS SUBMISSION IS 5TH SEPTEMBER. YOU HAVE GOT PLENTY OF TIME.

Enter Module Tutor
Email Seven: From Nursing Student
Sent: Thu 7/26/2007 11:27 AM
Subject: Essay

Hi tutor,

Just a quick email regarding the 4000 word essay and the 1000 word reflection. I had some time away from the university in June and have been trying to get the essays which are due sorted out.

I have been working on the essay, and have 2500 words so far on this. I got an email from module leader saying the essay was due on the 3rd August, though I have the date as being the 5th September. Can you email me back with the date of submission, and any way I can have a tutorial please).
Kind regards,
Nursing Student

Email Eight From Tutor
RE: Essay

dear Nursing Studnent, am on leave; in tomorro at uni thurs 2nd august, then off til later when im back in for 4 days...im on *********** txt me tomorra when im in work.............Tutor

Question: What conclusions do you draw from that?
Answer: Sadly, at the moment I don't know which is bugging the hell out of me as this is happening in real life at the moment and is not a work of fiction.