Found: The rectum of crap nursing

I have been in a training seminar today. The training was intended for the newly qualified nurses who have gained employment in the hospital. There are many exam's which I have to do, portfolios to pass and have so far spend two and a half years slogging through the sheer head-banging-against-wall frustration which is the modern day nurse training. When I think back over what I have done I soon realise just how irrelevant the training of today's nurses is. I used to think that this was simply because they were trying to make nurse training as far removed from the real world as possible and wanted students to have no clue. Seriously, the most progress we made was in the last half of second year when we were being groomed for the critical care placement and were expected to actually know something about the care of patients. If you look in the dictionary, the definition of nursing is to aid people's recovery through periods of illness or infirmity and help them meet needs which they cannot meet themselves (see the Roper Logan and Tierney 12 activities of living). Today though, I have found the real reason.

The training was for BM monitoring. Now, I thought this was simply the companies making a plug for selling their equipment. Turns out that for once, I was wrong. The reason this was to be done was (and I quote) "Before using ANY piece of equipment in the trust, you must be trained on how to use it...including thermometers". What? A bloody thermometer? The thing you put in the ear and take the temperature with? I am not suddenly finding myself in an alternative dimension of time and space where this is a name for a technical bit of surgical equipment? Unfortunately, no. I really could not believe what I was hearing. No wonder nursing is so disorganised and shit this day and age. I happen to know a fir bit about anatomy and physiology. I spent time studying ambulance aid so know of fractures, cardiac conditions, spinal injuries, the systems of the body, and read up on drugs. In the nursing school, none of that was considered important. BASIC NURSING CARE! Where was that? BASIC does not mean the same as SUPERFICIAL. Though maybe that's typical of the glamour obsessed self serving tossers who are considered "too post to wash" when back in first year I went through 4 vomit bowls brimming with sick to recover a patients lost dentures (which were actually in another vomit bowl back in the bay), yesterday was racking through a bedpan full of loose stool to do a sample and dredge paper from, then did the same for a urine test. Hardly glamorous but then I am a mildly pudgy bloke who wants to genuinely help people. Some nurses must be females who are living in some pink and blond valley in California who must be living the "hello!" celebrity culture who think that doing bed baths, checking observations, doing aseptic dressings, taking BM, Blood's, care of central lines, catheter care, dealing with relatives, talking to patients and working with the doctors and possessing a nursing and medical knowledge base not glamorous enough. I personally don't care about the glamour because I know that without all the non glamour stuff, patients would have a hard time of it. Yes, the cardiac surgeon did a great job on the coronary arterial bypass graft (CABG- and for goodness sake call it a graft in front of one surgeon and not a "cabbage" because I saw one person get yelled at for that)...but also having a relieved patient thank you for showering him after 5 days without having one brings it's own rewards.

I think there was about 3 sessions which really covered basic nursing care/skills. Manual blood pressures? Most staff would go running for a dynamap, which is hardly surprising as in my nurse training I spent only one 2 hour session on manual BP. Yet countless hours listening to people bang on about "Holistic [.sic]" care who spectacularly never managed to mention the patient or just exactly how an example of care meets this "Holistic [.sic] care". Honestly, I have often said that these people have spent too much time in a hippy commune somewhere on the west coast of the USA because there is no way on earth that a massive arterial bleed will stop by telling the patient "Stop bleeding, stop bleeding, oh God, please stop bleeding".

This is the problem. I have had SOME good training. Legal and ethics will stop me from getting sued, covered confidentiality, cleared up consent and keeps me on the legal straight and narrow. Evidence based practice was nice...but went on way, way, way too long and became near irrelevant. Foundations of clinical (in)competence was too short, principles of practice was boring, a full module on nurse education pointless, and even doing an essay seems pointless as it seems after three years of training I am not even allowed to take temperature or do a BM, would be elite as I can do a manual blood pressure and have to fill in a form bigger then the yellow pages just to have got the application. So who does that leave able to do the hands on care.
HCA's that's who.

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.

Woo-hoo I was in the BritMeds

Just checked the Dr Rant Blog and post "My Sneeze" was included in the Britmeds list.

Some of you may know that originally, while I read the Dr Rant blog for a long time I never poasted until early in the year when I felt compelled to reply to a comment, from which eventually this blog was born.

Nice to get some recognition. :-)

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 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 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 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.