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 Helicopter

It was an interesting shift Friday, mainly because I was working with a different staff Nurse after mine phoned in Sick. Had one patient who was not very well, and another who was on the End of Life Care Pathway (EOLCP). During the course of the sift, I was doing the work of a HCA as there had been a sick call. I am by no means complaining of Nursing in the role of the HCA as often a Staff Nurse will occupy a floating role to do this, but the most exasperating thing with this is that I am supposed to be on management placement at the moment, but have had only 3 days of actually doing anything like that.

I did have a good shift though, I decided that a patient would be better off having assisted feeding as they were not managing well with eating or drinking (several changes of gowns had occurred by the time lunch had arrived so I was not taking chances). Took another bay's patient over to CCU, and had a mild bit of excitement when I went outside to phone my girlfriend up as there was a large RAF Rescue Helicopter on the Helipad, several Police cars and a Fire engine. I am not sure what it was all about but it looked interesting enough, especially as there was a TV crew filming..

Apart from that just had a jaunt up to a nearby city with my Girlfriend who wanted some shopping, and I have a few ideas for my Christmas shopping (which I will have to do early this year as last Bursary is in December). So, now need to crack on with the essays!

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.

Choose not to choose a career

It was never going to be the best of days when it's foggy, and you get really nervous before your driving which went really well until some twat in a white van came speeding around a corner right at the moment when my view was obscured over that of the examiner who made an emergency brake to save the vehicle getting ploughed into by somebody deciding that 40mph in a 20mph zone it fine. Tosser, I fervently hope that from now until the end of time all your itches are unreachable and that somebody writes something obscene in weedkiller on your front lawn.

That aside though, the real reason I am annoyed is that I have to spend £48 on a new test. Seriously here. Let's just examine what would have happened should that van never shown up. Well, for one I would then need a car. Which I don't have any more. So I would have two choices. One, get an old banger for less then £500 that would make me skint, or got to a dealer and have a finance arranged that will mean me paying from now until the end of eternity at 6 billion% APR. That the idea of paying £170 a month is not bad is true- for now. However, in January I will be needed to have a job, so without bursary payments and the employment being questionable to actually land myself with such a burden as that would be the type of decision made by somebody who has the financial sense of an otter. If I don't have a job, I don't have money. The problem there is that I need to get a job. So, where do I look. The easy answer is in my local Acute hospital where indeed there are some jobs at the moment, but 5 months in the NHS can see many changes. So, where else do I go? Well, there was a hospital about 20 miles away that used to serve as a pretty major hospital. That was until the powers that be decided that a really good idea would be to close most of it's facilities and turn it into effectively a rather large first aid post. This, I think is not what I am after. The next main town from that is shedding it staff. It employ's 6000 staff, though to meet budget cuts is cutting 12450 posts giving -6450 staff. This will not leave good job prospects.

So, it's very easy to say "Then emigrate". Yes, I am aware that Australia needs nurses, but without 2 years experience post registration, they will politely tell me where the exit is.

"Move to another area of the country". Yes, because ALL the other counties have just LOADS of posts for newly qualified nurses. Oh, hang on a sec, apparently they don't. Moreover, where am I supposed to get the money for accommodation? Thin air?

So, that's why today is of no bother to me. If I had passed, it would not have made the slightest jot of difference because I cannot afford to buy, nor can I afford to finance, the purchase of a car. Given the fact there are no posts out there, I am not surprised there are reduced numbers of applicants to Nursing. Do you blame them? If somebody was to ask me what to do at university who wanted a high brow course, I would tell them to take Analytical Chemistry or Astro-physics. I have not much of an idea of what they would do save for using a mass spectrometer or utilise astrology, but one things for sure: If you were to waste three years of your life to end up without a job in Northern England, which one would you rather say in the pub: "I studied Astrophysics and I am going on to do my D.Phill at Oxford" or "Worked down't 'ospital".

The NHS may be the biggest employer in the area I live, which goes some way to explain away the high unemployment levels. Some Nurses were saying "Would you do it all again". Given the fact that I have worked my backside off for three years without much hope of a job, I would have to say the answer would be: "No, not really".

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.

There was nothing wrong with the patients care...the notes say so!

Now, a little while back I wrote about political unspeak would never work for me. Now, I was saying then how there was absolutely no way on earth we (the nurses) would get away with saying such a load of rot as found elsewhere in politics. Over on the Dr Rant blog, I have been having a rather good discussion regarding how patients and their relatives have their say with one thing that came out being the fact that quite often relatives never really have a say on how they think their relatives are receiving care.

Granted, there are some legal issues in discussing a case of a patient with relatives and of consent issue. The Nursing and midwifery council (NMC) in the Code of Conduct state in clause 5 "As a registered nurse, midwife or specialist community
public health nurse, you must protect confidential information.
5.1 You must treat information about patients and clients as confidential and use it only for the purposes for which it was given. As it is impractical to obtain consent every time you need to share information with others, you should ensure that patients and clients understand that some information may be made available to other
members of the team involved in the delivery of care. You must guard against breaches of confidentiality by protecting information from improper disclosure at all times". So, in effect, all patients must give consent before the nurse tell their relatives anything, which is of course not fully practical as relatives will always like to know what is happening to there loved ones. So, in practice we make sure the patient is happy for us to give out this information and keep people happy. One of the big problems with this is giving information over the phone as there have been times when there has been a patient in a hospital where the wife phones up, the nurse tells the information only for the husband to say the they were getting divorced and he did not want to have the wife know what was happening. So, we get consent.

While on the issue of consent the NMC state that in clause 3.4 You should presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can use it to make an informed choice.

3.5 Those who are legally competent may give consent in writing, orally or by co-operation. They may also refuse consent. You must ensure that all your discussions and associated decisions relating to obtaining consent are documented in the patient’s or client’s health care records.
3.6 When patients or clients are no longer legally competent and have lost the capacity to consent to or refuse treatment and care, you should try to find out whether they have previously indicated preferences in an advance statement. You must respect any refusal of treatment or care given when they were legally competent, provided that the decision is clearly applicable to the present circumstances and that there is no reason to believe that they have changed their minds. When such a
statement is not available, the patients’ or clients’ wishes, if known, should be taken into account. If these wishes are not known, the criteria for treatment must be that it is in their best interests.

Which leaves the relatives in the dark. Which is a problem as we then never seem to gauge the opinions of the relatives until you find somebody who ends up having bad treatment. Then, and very rightly so, they make their views known. What will then happen? Will there be a white steed riding onto the ward (using the hand gel first) to sort everything out to turn the ward into a beacon of care?

Erm... no, not really. The TV show scrubs has twice portrayed what I imagine both the public and myself see the complaints system as. Once it was a bin, the second time the complaints were fed through a letterbox which leads straight to a paper shredder. Of course, if the aggrieved relatives DO get a reply, you can guarantee it will be a great fob off.

It is true that relatives will be the ones who will make the complaints on behalf of their relatives, but one thing the system seems very bad at is getting the views of the relatives known as they are the ones who will know the patient to give staff information on, and also more likely to expose the weaknesses of the ward that staff cannot see.