Peru is nearly here!

Woowwwweee! Time is flying! In no time at all I will be making my way across the world to do my 3 week placement in Peru! I’ve had a request by another blogger to write a guest entry about organising my trip to Peru so I’m saving all my exclusive info for that particular blog which I am hoping to link here once it has been published on t’internet but I wanted to write something for myself on how I feel about my trip so that I can: a) vent b) clear my head c) have something in writing that I can reflect on once I come back from my mahooosive trip! d) keep you all wonderful (nosy) readers in the loop 😉 Anyone who knows me and knows me well will also know that I’m quite ballsy and that I’m not usually phased by the idea of travelling on my own, or in fact, doing anything on my own. I mean, I go to the cinema on my own sometimes and that’s seen by many as a quite the adventure! But I am starting to get nervous and I’m not very sure why! If I look at it rationally:

• It will not be my first time flying, I have flown so many times that I have probably lost count. In big planes, smalls ones and some only marginally bigger than my head.
• It is not the first time I have traveled alone. Sometimes I prefer it! Less arguments and no compromises needed 🙂
• It is also not the first time I have flown long haul..and no, 8 or 10 hours on a plane is not long haul for me. I’m talking about trips over the 15 hours mark.
• It is not the first time I have been to the Americas.
• I have traveled abroad for work many many times before (this is how I have managed to do all of the above).
• I speak the lingo. Plus I would also be quite happy talking to a wall so the thought of talking to strangers is not really that scary to me.

But, if i think about it:

• It will be only the second time that I will be flying super long haul (by that I mean over 24 hours flying)  in economy. Ooooh the joys of being a student and not having company expenses to pay for the luxury of space!
• The furthest south I have been in the ‘Americas’ is Mexico or Cuba  (whichever is furthest south) and I have never been to South America. This was sort of the point of going to Peru in the first place as I am a big fan of visiting new countries but still – it’s a big deal!  I have got myself a Peru travel guide to give me a few tips and pointers before I travel!

• I speak Spain Spanish and not South American Spanish – which is really quite different. So I speak the language but I don’t. You could argue that I have a better chance at getting my point across than many others , you could also argue that I also have a better chance at putting my foot in it. I also have no idea what it will be like to speak ‘Nursing’ in South American Spanish. But….I have got myself a lovely book to help me along. I just need to actually sit down and read it now!
• It’s for ‘work’ (or elective placement if we want to be pedantic)  but not work that I actually know how to do. When I used to travel for business I knew what I was doing for the most part. This is totally different. I am still learning and there is real people with real illnesses in a foreign country involved – that has to warrant a few nerves right?
• Although big things (like travelling for hours on my own) don’t phase me, the little ones (asking for directions, finding the bus stop, trying to figure out currency change) do make me feel a little unsettled. I don’t know why, it’s just one of those funny anxiety things that I have always lived with! So that will be fun.
• It will be autumn – everyone keeps saying “ooooh you will have a lovely tan when you get back” No, I won’t. Peru is in the southern hemisphere and it will be autumn. Cuzco is also at the edge of the Amazon and whilst I am not going in the rainy season, temperatures do drop to around 4 degrees at night (Celsius not Fahrenheit for non-metric readers)
• I also feel quite stressed at the timing of my placement. I will be away for 4 weeks in total, including travel time and a stop over to visit my lovely friend in Dallas. That probably doesn’t sound stressful but when I land home I have 3 days before I go on holiday with my other half. In those 3 days I will be getting ready for my bridesmaid duties at the wedding of the year, finishing a presentation for uni and packing for my holiday! Once I return from holiday I have my summative presentation all about Peru, my end of second year tutorial, and also, more packing for my trip to Spain to see my granny. The thought of all the packing and unpacking is making me want to cry.

So yeah…I’m getting a little nervous about it! I also still have so much to do!:

• Buy my luggage – I have a very specific type of bag in my head that I want to take with me. One that is kind of like a rucksack but on wheels.
• Decide whether to take iPad full of films and things or stick with simple Kindle and e-books.
• As above but  iPhone vs simpler phone.
• Sort out a gift for my placement and host family.
• Make doctors appointment for my travel check – including vaccinations if I need any. I’m pretty sure I have everything I need.
• Book my Machu Picchu trip.
• Arrange meet and greet on Skype with host family and mentor.
• Pass placement here in the UK – otherwise I won’t be allowed to go to Peru – no pressure!
• Oh yeah, work my pants off so I have the moment to get most of the above!
• Read my guidebook and phrase book.
• Print out all my documents.
• Pack.
• Start my presentation so that I don’t have to do it all in those 3 days after I come back from Peru.

So much to do! So much to do! I better get on with some of it!

Neeeeee nawwww – my day out with the ambulance service

Earlier this month, I was lucky enough to spend the day with the ambulance service – that is, I got to spend a day driving  (I wasn’t the driver)  – aka sitting –  in an ambulance.

When I originally applied to spend a day with the service, I was really excited…all those accidents and traumas and exciting things to see and do!  As time got closer, I was much more apprehensive, and actually, not really looking forward to it…not sure why! That feeling was made worse by the fact that we were specifically told by the organisers not to phone the ambulance station prior to our day with them, but to just turn up on the day, with our documentation. Just like that.

This is unusual as we are always advised to do the opposite prior to a placement, in order to let placement know we are coming along and give them a chance to prepare and us a chance to ask any questions. I would have liked to have asked about what to wear (warm clothes? layers?), what to bring (fob watch? thermometer? pen and paper?), and where to park. I just wore my student nurse uniform in the end and extra layers. I took my PAD (Practice Assessment Document) so someone could sign my hours and I used Google Streetview to try to figure out where to park. Thank goodness for assertiveness and the internet! I felt like I had achieved something incredible just by turning up on time. Go me.

I was also a little apprehensive because after my 12 hour shift with the paramedics, I had to go straight to placement for a 7 hour twilight shift until 3 am. This made my working day just under 21 hours long. Not doing the twilight would have meant being out of sync with my mentor’s shifts for several days and/or being down on hours so I did not feel like I had much of a choice. It felt ok – it was a busy day but I think that’s better when you have a lot of hours to work! It goes quicker  – plus the lovely paramedic gave me an energy drink to keep me going!

So how did it go?

It was much much better than anticipated. The ‘crew’  (that’s not street talk, that’s what the paramedics are referred as!) did not know I was coming but were welcoming and friendly. Much more so than some nurses at some placements actually. I went out on an ambulance (or van/bus as it’s better known) with a paramedic (D) and with an EMT 2 (A). I hadn’t actually realised that not everyone who drives an ambulance and attends 999 calls is a paramedic. In fact, only about 50% of the men and women in green who attend emergency calls are paramedics. There other 50% are comprised of Emergency Technicians (EMT 1) who are the most junior, and Senior Emergency Technicians (EMT 2). Currently all EMT 2s must top up to be a paramedic but there is no ‘upgrade’ route for EMT 1s. They are all extremely professional and competent, you won’t be any lesser cared for if one attends and the other doesn’t – there is just a small difference of the types of treatment and medications that EMTs can give – plus only paramedics are registered  like doctors and nurses – EMTs are not.  Interesting stuff eh?

We attended a number of calls – though no road traffic accident or serious incidents or traumas. My experience is that, believe it or not, the scary/exciting stuff really only happens on a daily basis in Casualty/Holby City/Grey’s Anatomy/ER. Most of the real life 999 calls generally relate to chest pain (possible heart attack, angina), shortness of breath (asthma, chronic obstructive pulmonary disease), general weakness and unwellness (mostly in older people), abdominal pain, and then anything from collapses to sore hands.

What did I do?

Observed mostly! I had an Observer’s jacket so it was really quite obvious what I was doing there! I helped carry the equipment which made me feel quite powerful actually. I cannot image how big and mighty the police feel carrying all their bits and bobs! I also helped with vehicle checks such as medication counts, stocking it with blankets, sick bowls etc.. and I did most of the observations of vital signs, including manual BP and blood sugars. I was a little rusty at doing manual blood pressures but found myself cracking it again in no time! I was also in charge of doing the 12 lead ECGs. I’m really quite good at doing these now since I do many of these every day in my current placement. I don’t really know how to read them but would be able to see if someone was having a heart attacvk which is the most vital thing. I also learnt a new skill…my main responsibility for the day was working the tail lift 🙂 Up…and down…..up…and down…. When I wasn’t doing one of those very important tasks I was doing the most critical thing of all and I was talking to patients and comforting them.

I was tempted to ask if I could have a go at driving the big ambulance but I resisted. The ambulances can be automatic or manual and as part of core training, all crew members  get driving skills lessons which they must pass but from what I gather it is quite intense so  I doubt A & D would have let me drive anyway! I did however, get to press the button which switches on the blue lights and the sirens .That was fun! I didn’t get to go on the Fast Response cars so I have no idea what they do – other than attend really serious incidents which require an extremely fast response (get it?) …for example, someone losing consciousness.

What have I learnt?

Well, as I mentioned before,  not everyone in an ambulance and wearing green is a paramedic but I will continue to refer to them as that in this blog for now…too many words otherwise! Not that it matters because they are all super skilled and brilliant, though I suppose it matters to them….anyway! They also have a lot of responsibility – from getting to the right place quickly to carrying out accurate assessments –  and managing to do all of that with silly drivers doing silly things all over the place; and then having to climb up trillions of stairs because the lift doesn’t work; or not being able to get into the property and having to phone the police to force entry etc… Much like District Nurses, working in other people’s homes can be challenging, but paramedics also have to deal with other unusual or difficult to reach places. Their work can be anywhere and in general, the crew rarely know exactly what they are going to – the triage (initial assessment) which comes through on the ambulance system is really not very in depth….and yet, time is of the essence! How stressful is that?

There is also a loooooooooooot of waiting around. If the crew decides to take someone to hospital, the crew must stay by their side until they are handed over to nurses and doctors. So if there are no beds in hospital for the patient, then the crew go nowhere! Imagine spending your entire shift standing in a corridor in a hospital with a poorly patient and not being able to go and help anyone else. How frustrating that must be.

So, all in all, I had a super brilliant day and now that I understand just how much they do, I intend on being extra understanding and nice (not that I wasn’t before). You should do the same, if you ever need the ambulance service  – for an emergency that is – please be nice! They do an incredible job and we should all be very grateful that gone are the days when we have to be carted off to hospital in the local mechanic’s van.

Placement Numero Uno – completed!

Wooohoooo! I survived! I have no words to really describe how it feels to know that I have passed and completed my first nursing placement..and that I am still in one piece (ish). For me, this placement has been as much about gaining experience as it has been to prove that I CAN do this. Point proven I think! Not only can I do it, but I can do it really well!! No one needs to tell me that in so many words – I am very proud of myself for what I have achieved and just as proud of my friends who are also going through the same things. Being a student nurse is hard. Really hard…..but I did it! I still have a lot to learn and a lot of things to experience but I’m making progress and that is certainly what counts.

Looking back to my first day I simply cannot believe how much I have learnt and how much I have seen. I have worked early shifts, late shifts, long shifts, weekend shifts and night shift.  It has been 9 weeks of working full time…some days a mere 8 hours, other days a mammoth 14 hours with only 5 hours sleep in between shifts. I have laughed and got shouted at. I have been scared and nervous. I have washed, brushed, shaved, bathed and showered (myself but mostly others). I have cried and wiped more tears than I ever hoped. I have helped patients to the toilet more times than I will probably visit the toilet in a year…if not longer. I have fed food that I wanted to eat myself.  I have washed my hands until the have been red raw, sore and peeling.  I have seen medication being administered in all shapes, sizes, forms and through a range of different routes. I have learnt that bodily fluids are wide-ranging and far-reaching (trust me!). I have met staff who have inspired me to work hard and reach for my dreams. If I have seen it, I have documented it. If I have documented it, I have filed it. If I have filed it, doctors haven’t read it (joke…sort of). It has been tiring and exciting….

Just to give you a final idea of what my placement has entailed:

• Admissions
• Personal care, including oral and eye care
• Bed making
• Recorded observations of vital signs and charted updates
• Repositioned patients and updated chart
• Checked pressure mattresses
• Recorded fluid inputs/outputs
• Recorded diet intake
• Removed cannula and updated relevant documentation
• Daily weights
• Supervised administering of medication including intramuscular injections
• Updated Nursing notes
• Physiotherapist referral – e.g.  after falls
• Occupational Therapist referral – if input required for Activities of Daily Living
• Social worker referral – if assistance required at home/Nursing or Residential home
• Speech and language Therapist referral – if non-responsive/refuses diet and fluid
• Dietician referral – if non compliant with diet e.g. diabetic
• Specialist care referral – diabetic specialist, Parkinson’s specialist, podiatrist etc..
• MRSA, C-Diff, CPC testing
• Given enemas
• Blood sugar monitoring and administering of insulin with subcutaneous injections and sliding scales of insulin
• Last offices
• Pressure, Mobility, Falls risk assessments
• MUST (Malnutrition Universal Screening Tool)
• Mobility, Shortness of Breath, Catheter etc.. care plans Care plans
• Discharges, including transfer letters and booking transport
• Bladder scans
• ECG

It has been…everything! I think I have felt possibly every emotion and every feeling and as I am sat here trying to explain I’m finding it very hard to pin point specific experiences that I have enjoyed more than others. I know I have learnt a lot, I know I feel much more confident as a student nurse, I know that I will keep going and keep working hard and I know that it will all be worth it in the end! I know it’s going to be challenging and that much chocolate will be needed along the way…..

My head is so full of stuff! I am sure that in no time at all I will miss patients and the dynamics of placement. I’m sure that I will recall instances that will make me wish I was back there again. I have had an amazing learning experience and I definitely have to be appreciative of that…Right now though, I think I will enjoy the 12 week break back at uni and being able to do other stuff and maybe even be a little social again! Even if that involves preparing for practical exams and mock exams…

Wish me luck!!!

Night shifts….goodness me!

I was going to start this post by apologising for not having written for nearly a month but then I realised that I have started almost every recent post in the same manner so I won’t apologise…just take it as evidence on how incredibly hectic a nursing course is….. 

I have been SUCH a busy bee going to placement, doing my assignments, preparing my portfolio and doing a little bit of studying when I wasn’t too tired or sleeping…but not to fear…there will be a few new posts coming your way!

Sleep. My darling sleep. Oooooh I was starting to forget what you were! As part of my nursing degree I have to do 150 hours of night duty by the end of the 3 years. University does not really recommend for first year students to undertake night shifts but I thought I would try it out anyway so I could experience the full 24 hour cycle of care on my placement and start chipping away at the night duty requirement. I did 4 nights and my goodness….I won’t ever forget them! I’m still trying to catch up with myself.

Night shifts in my area of practice run from 8.15pm to 7.30am and are very different to day shifts for many reasons. We have one break to be taken any time from around 1am to 5am and I have to say it is a little strange eating sandwiches and a Pot Noodle at that time of night/morning! The wards are obviously a lot darker which gives it bit of an eery atmosphere…and also, it actually gets a little chilly in the middle of the night! I never thought I would say that but it is true! There are also a lot less staff around and some even take a nap whilst on their break….so it is extra super important to work as a team during night shifts. The feel of a night shift is less haste but more intensity.

During my night shifts I unfortunately experienced a number of bereavements. Anyone who has read my ‘Heartbroken’ post will know I really did not deal with it very well the first time round and I was in fact inconsolable and heartbroken….I was so worried that it would be a side of nursing that I would never be able to cope with. However, on these occasions I am beyond proud that I managed to control my emotions and focus on the patient rather than myself. It wasn’t easy. It was really really hard to keep it together. But at the same time, being allowed to do Last Offices (laying the patient out ready for the Chapel of Rest) has been a privilege and very spiritual and I think it has really given me a different outlook. Being born and passing away are the two things a person will only ever get to do once in a lifetime so for me, it is an absolute necessity to get both moments absolutely right. I am grateful for being allowed to be part of it.

I also experienced my first, and hopefully last, absconded (escaped) patient from the ward…he ran, out of the fire escape, into the darkness, fully clothed and with most of his belongings. Luckily hospital security found him before the police came but I can honestly say that it was a very worrying time for all sorts of reasons…you just don’t know if they are confused, alert, hurt or safe..the unknowns are just overwhelming! The relief of the patient’s return was immense…having to then sit and watch their every move whilst they are threatening to do it again definitely kept me on my toes!

I also, fortunately or unfortunately (which ever way I look at it), worked with a nurse who I most definitely would never ever ever ever ever want to be like. Throughout my placement she has referred to me as “student” and made no effort to learn my name or address me by the fact that I am a person with an identity other then being solely a student. Nonetheless, I sort of let that go on the assumption that perhaps she sees so many students that it is just the way she deals with all the changes. However, her behaviour during one particular night shift was so incredibly disappointing and upsetting that I’m really a little confused about the whole episode! I’m not going to say exactly what happened because I am still trying to process it and figure out what to do but needless to say it mortifies me to think there are nurses out there who act like that..though I really feel like I should emphasise that this was only ONE nurse during ONE shift, out of all the nurses in the ward who are the most caring and compassionate people around. Every workplace has its problems and I think it would be a little naive and irrational to jump on the “let’s demonise all nurses” media bandwagon. Nurses are awesome and they work so hard…don’t tarnish everyone with the same brush please……I’m just appreciative to have met her so I can remind myself on how not to be.

It wasn’t all sad or upsetting or frightening – there were many funny moments too including various patients getting into other patients’ beds, falling asleep on chairs and on toilets and also many opportunities to improve my clinical skills – I carried out my first intramuscular and subcutaneous injections whilst on nights shifts and they really were not as scary as I thought they would be!

So…over all… Yes, as a student, working nights it is definitely challenging and having a good mentor to work with and support you is incredibly important and yes, sometimes things get a little wild and it can be upsetting, emotional, scary and very overwhelming but for all that, nights are for the most part, a little more peaceful and they also provide opportunities not available during the day. It can be hard to stay awake and alert when your body is telling you to go to sleep and your eyelids feel like bricks but I also got a chance to talk to the other staff and patients and find out a bit more about them…it was a bit like a bonding session I suppose and I felt much more involved in patient care throughout the night…Working nights shifts has definitely been a totally different learning experience but a very productive and insightful one at that. Good luck to any student nurses out there coping with  night shifts! I can’t say I would always recommend working nights but I would most definitely recommend to give it a go to understand just what a patient, and the staff, go through in a 24 hour day.

 

 

A Day in Placement

I haven’t written in sooooo long! I was starting to feel terribly guilty for not updating my blog but I have been so busy with placement and getting myself a little job that I really just haven’t had time to sit down and be sufficiently focused to write.

One of my New Year’s Resolutions was to get myself a part time job…and I have! not bad considering January has not even finished yet.  It is a flexible working job as an Outreach Ambassador. The role involves engaging with young people from under-represented groups such as those whose parents didn’t go to University, disabled students, and those who have been in Care. Basically I will just get to talk about my own experiences and challenges and hope that it inspires young people to progress onto higher education.  I’m not committed to specific days and times which is brilliant because it should make it a lot easier to fit around my nursing! I think it’s a great opportunity to work in the local communities and encourage others to get involved in something I’m so passionate about…education, education, education! It opens so many doors and the world is limitless when you make use of all the services and opportunities available to you. I’m looking forward to my first event, whatever and whenever  that may be!

So, back to placement. Working shifts is REALLY hard! I have never really worked shifts before so this is a first for me! I much prefer either the early shifts (7am-3pm) or simply a long shift (7am-9pm). The late shift (1pm-9pm) is horrible! I still wake up at 5am and then I meander about just wishing the hours away until I have to go to work. The day just drags and drags and drags. I’m sure some people may appreciate the late start to sleep in and do some shopping or get some other chores done in the morning but it just doesn’t work for me!

Anyway, since I’m using placement as an excuse to not write my blog, I figured the most appropriate thing to do would be to describe a typical long day for me….here it goes!

5.30 am – Alarm goes off, time to get up…..the light gets switched on immediately so I don’t sleep in! Once ready, I walk to the bus stop, usually with a giant cup of coffee in my thermos mug (courtesy of my previous employers!). I could drive into work but I don’t yet have my parking permit for my placement area and I am not paying the extortionate parking rates every day!

7.00 am – Will have already been on placement for around 15 minutes but this is when the handover happens between the night staff and morning staff. Phone starts to ring.

7.15 am – Help the Healthcare Support Workers to sit patients up ready for breakfast. Do any washes which are needed and can be finished before breakfast arrives. I like to wash people’s hair and give them the option to shave, brush their teeth etc… Before breakfast I also do any checks of blood sugars for anyone who is diabetic… Answer phones and patient’s buzzers.

8.00 am – Breakfast time! Help feed anyone who requires assistance. Diet and fluid is so important in a person’s recovery! Reluctance, avoidance or inability to eat or drink can be symptomatic of many conditions so it’s important to keep an eye on this and offer whichever support needed. Answer phones and patient’s buzzers. Start hourly monitoring of patient’s comfort and pain and document.

8.30 am – Join the tail end of the morning medication round with the nurses so I can familiarise myself with the drugs being given, the doses and practice my basic drug calculations. Answer phones and patient’s buzzers.

9.15 am – Continue to help the Health Care Support Workers with making beds, personal care, transferring patients. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

10.00 am – Start the morning observations for patients who are scoring in the Modified Early Warning Score system – in other words, patients whose vital signs (temperature, respirations, oxygen levels, blood pressure, pulse rate) are outside the average ranges and who are therefore to be checked at least every 4 hours. Any one scoring 3 or more, needs to be brought to the attention of the doctors immediately and monitored at least hourly. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

11.00 am – Break time! I get half an hour.

11.30 am – Help to roll, turn or sit up anyone who requires help before lunch arrives. Very important for pressure area care to ensure those who are not fully mobile are being checked, transferred and rolled at least every couple of hours. Answer phones, buzzers, fax social worker referrals, follow up with social workers, handover to occupational therapist, and handover to physiotherapist. Continue to document hourly monitoring of patient’s comfort and pain.

12.00 pm – Give out the dinners. The hot food trolley comes onto the word and we all help give out the hot food. It usually smells pretty good and makes my tummy rumble! Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

12.15 pm – Lunch time! Again, help anyone who requires assistance with eating and drinking. If no one requires help I will join the lunch medication round so I can practice my pharmacology knowledge a bit more! Answer phones and patient’s buzzers.

1.00 pm – The afternoon staff start so it’s time for another handover. Generally if I’m doing a long shift there will be no nurses to handover to but the Health Support Workers still need the handover to understand the mobility and hygiene needs of patients. At this point the ward is very busy with both the morning and afternoon staff still on shift with the doctors doing their rounds. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

1.15 pm – Write nursing notes (kardex) for the patients who I have nursed throughout the day. This would include details of any observations recorded, whether medication has been given and/or taken as prescribed or refused, diet and fluid intake, mobility and hygiene and any assistance given. If needed, I will also update the ward file with any referrals, test results etc.. Answer phones and patient’s buzzers.

2.00 pm – Start the afternoon observations for patients who are scoring in the Modified Early Warning Score system since the morning. Visiting hours also start and I spend some time talking to families and visitors. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

3.00 pm – Lunch break! I get another half hour. The morning staff also finish now. If I was doing an early shift I would also be going home at this time….but…no rest for the wicked! I’m here until 9pm! Continue to document hourly monitoring of patient’s comfort and pain.

3.30 pm – Help to roll, turn or sit up anyone who requires help. Answer phones, buzzers, fax social worker referrals, follow up with social workers. Accompany patients to various other departments such as CT scans, x-rays, discharge lounge… so they don’t get anxious or confused. Pick up medication from the pharmacy. Go to the shop to buy magazines, snacks, drinks etc… on behalf of patients to make their hospital stay a little more comfortable. Take cannulas out and dispose of them safely. Assist with any wound dressings which need changing. Top up linen trolleys with clean pyjamas, gowns, nighties, towels, bed sheets, pillow cases and blankets. Top up ward cupboards with more soap, pads, wipes, toothpaste, hair combs. Talk to patients and any family members or visitors still on the ward. Before dinner I also do any checks of blood sugars for anyone who is diabetic… Continue to document hourly monitoring of patient’s comfort and pain.

5.00 pm – Dinner time! The hot food trolley comes back and we give the dinners out. Generally the dinners are a little smaller than the lunches but they are still pretty good. Fish, chips and mushy peas is my favourite! I’m led to believe the vanilla ice cream is also delicious. I also help with any feeding needs. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

5.30 pm – I join the evening medication round with the nurses. Most medication is given in the morning or at bed time but it is important to have regular medication rounds, particularly for antibiotic and pain killer medication and if intravenous fluid or infusions are prescribed. Answer phones and patient’s buzzers.

6.00 pm – Dinner break for me! Another half hour. My feet start to hurt by this point.

6.30 pm – I start the evening observations for all patients, not just those who are scoring in the Modified Early Warning Score system. All patients must be assessed at least every 12 hours. Any scores will increase the frequency of this. Visiting hours also start at this time so the evening observation round normally takes me a while longer, not just because all patients must be monitored but also because I also stop and chat to all visitors, even if it’s just to say hello and ask if they have come from far. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

7.30 pm – Update nursing notes (kardex) for the patients who I have continued to nurse throughout the day. This would include details of any changes recorded since the morning, observations taken, whether medication has been given and/or taken as prescribed or refused, diet and fluid intake, mobility and hygiene and any assistance given. If needed, I will also update the ward file with any referrals, test results etc..Sometimes I also update the handover documentation. Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

8.00 pm – Night staff start their shift so the third handover of the day begins! Answer phones and patient’s buzzers. Continue to document hourly monitoring of patient’s comfort and pain.

8.30 pm – Help the night staff to get anyone into bed who wants to go to sleep already. Tidy bits and bobs, get rid of any confidential documentation that I may have in my pockets from the day.

9.00 pm – Home time! Bus doesn’t get me to my destination until around 9.40pm and I then have a 20 minute walk so by the time I am home it is at least 10 pm and I am a little tired! Food is not often a priority, but bath and sleep is! I get all my things ready for the next day, make my lunch and go to bed! Night night 🙂

So that’s it! That’s my day! I’m tired just writing about it!

I have to say that I can see why some people drop out of a nursing course after their first placement. It is very hard work and sometimes not entirely pleasant. I have experienced shortages of nurses and healthcare support workers first hand. I have even experienced agency and bank staff walking out after “misunderstandings”  which further increases the risk of being unable to meet patient’s needs. It can be upsetting and demoralising BUT I am happy to say that I’m not likely to be giving up any time soon. I love and respect the people I care for and work with so much.  In the past week alone I have been given comments such as:

“I am so glad I met you, you always come back when you say you will” – Patient A

“You are the only person I have seen smiling today, it has made my day, thank you” – Chaplain

“You have a trusting face, you are doing so well” – Patient B

“First year? You’re doing brilliantly” – Patient C

“Thank you so much for your help” – Nurse

“Thank you so much, we really appreciate it” – Ward Manager

What more can I say?!! The rewards are so totally worth the hard work!

Here we go again…

Second post in less than 3 days! Goodness…what’s going on! Someone would think I was poorly, or trying to avoid doing some reading, or even bored!

So here we go with the New Year’s Resolutions! It’s taken me almost a week to think of them but better late than never, right?:

1. To survive the next 6 weeks of nursing placement (and my next few placements after that!) without bursting into tears again. Or at least, to make it out of the ward before crying in the comfort of my own home. That would be sufficient. Let’s not be greedy.
2. To toughen up a bit. I think I’m too soft and too sensitive…it’s hard to change after 30 years of being this way though. Maybe I should just accept that I will always be too soft and too sensitive? Yes…maybe that can be my resolution. Accept myself as I am. I have to accept everyone else as they are… so I should probably stop beating myself up for my imperfections and just be glad that I am here and healthy…plus who wants to be a meanie hard-ass nurse anyway.
3. To keep on top of my uni work so that I am not rushing towards deadlines. I have never left anything to the last minute in my life but I’m adding this just in case – you never know! Life has a bad habit of getting in the way when you’re busy making plans….better to be prepared than sorry!
4. To pass my first year of my nursing degree. Pleeeeeeeeeeeeeeease!
5. To raise enough sponsorship to do my skydive for the Together Trust – an amazing charity which supports children and young people with disabilities and autism.
6. To be an awesome bridesmaid x2 – Thank you Kate and Emily! Even if the weddings don’t happen in 2013 I’m sure there will be lots of planning and preparations to get on with! I’m so excited!
7. To learn to park my car properly. I have been lucky so far but I don’t think it will always be possible to park across 4 spaces or in a drive or simply to dump my car on the road.
8. To get a small part time job – I probably could manage with lots of scrimping with my student loan and NHS bursary but I like treats. Not just for myself but others too. I like buying pressies and little surprises for people. It makes me feel all warm and fuzzy inside when I help them rip the wrapping paper open. I also would like to go abroad to  South America or Africa for my nursing elective placement in Year 2 of my degree and that costs a lot so need to save up!
9. To start buying myself flowers again and restart yoga and/or zumba – this is part of the point above but I think it warrants its own bullet point. It’s so important to save up a little bit of love and care and treats for yourself!
10.  To be strong and stay positive no matter what and not let anyone make me feel otherwise – I have got this far, and I will keep moving forward. So there.

I think 10 resolutions is a nice round number so I will leave it as it is! In less than a year’s time I will be coming back to this and hopefully be patting myself in the back for having accomplished most, if not all of my resolutions.

I didn’t feel that it would be necessary to write that I want to be happy for the year – everyone should aspire to be happy most of the time and to make those around them happy too – maybe not all the time though because it’s just not normal to be super happy all the time and no-one likes a smug (I think I just invented a new noun) 😉 we all need a bit of a pants day to appreciate all the awesome ones! But we also all need good caring people around us and the odd strange one to remind us of what we want and don’t want.  Maybe that can be my bonus resolution – to be thoughtful and appreciative of those around me and not take them for granted and hope that other people will have the same regard for me.

My first resolution concerns placement. I’m flabbergasted! After 3 months of studying the basics of anatomy and physiology, the foundations of care and clinical skills and the 3 weeks of staggered placement and lots of reflection of practice….this is it! This is what it has been building up to. Starting from tomorrow, for the next 6 weeks, I will be working full time, as a student nurse in my local hospital. That means that the next 6 weeks my life will be dedicated to 5am wake up calls, 14 hour shifts, throbbing and burning feet, washing and ironing uniforms, packing lunches, and lots of flowery smells and interesting sounds. How could I not be looking forward to it? I am counting down the hours!! Hurry up and get here!

I wonder if any of the patients that I cared for before Christmas will still be there or will have already gone home. I love each one of them so much. Each one has their own individual story and they are amazing in their own way. I hope they managed to go home and get lots of love and hugs from their loved ones. Not just because it has been Christmas but because home is where the heart is and that’s where everyone deserves to be. I feel so lucky to have already met such wonderful people. They inspire me every day. What more could I possibly ask for.

Heartbroken

Up since 5am. Worked for 14 hours. Cried for 4.

Heartbroken.

I hope you know that I tried my best to give you a comforting send off. I kept you as warm as I could in that bear hugger that all other patients were jealous of. I know it probably got a little annoying that I kept sticking that thermometer in your armpit. I’m also sorry that I kept clipping the Sats probe on your ear. Even with constant oxygen I still couldn’t record a reading and I needed to keep checking. Your family came to see you. They love you very much. They cried a lot and showed you pictures of the family and talked to you non stop in between kisses and hugs. I asked if you were in pain. You said no. I sat by your side almost every hour of the day. You started to shut down when nurse told you to let go if that’s what you wanted. Your blood glucose levels didn’t improve. Your breathing slowed down. Your temperature dropped even more. I stopped feeling a pulse. I called ward sister. I counted your last breaths. You left us.

I will never forget you. My heart aches for your loved ones. I’m crying for fear that you left feeling some form of discomfort, or pain or loneliness. I hope with every ounce of my being that is not the case.

I was just one of those student nurses that kept hanging around you the last few days. I hope you’re in peace now my beautiful sleeping angel. I held your hand for as long as I could.

Placement and bedpans

Wooohooooo! I am so proud of myself! I have not only survived my first week in placement as a student nurse but I have really loved it! It has been hard and I’m not going to lie…as I’m writing this my feet and head hurt, I’m exhausted and I’m counting down the hours until I can go to sleep. Shifts definitely need some getting used to…the same goes for standing on your feet for 7 or 8 hours. It’s not easy! As every day goes by I have more and more and more respect for my fellow nursing students and of course, for all other healthcare staff!

Before I continue…I just want to reiterate that in order to adhere to the Nursing and Midwifery Council and Code of Conduct on Confidentiality, I will never ever post the name, location or pictures of my placement area, nor the name, location or pictures of any staff or patients which I have worked with or have been under my care. I will not disclose any personal information nor any identifiable characteristics and will always maintain professionalism and respect.

As I was saying….I’m not sure I can remember last time I felt this tired and content. I have learnt so much! To the point that I am a little weepy really….this time last year to the exact day, I was admitted to hospital and I honestly thought I would never get better again. Here I am... Not only am I better but I am the best I have ever been and I am so proud of myself for how hard I have worked, how far I have come and how much I have to look forward to! This week I have learnt that not only did I make the right change of career, but that I also have a bad habit of underestimating myself. My life has changed so much in these last 12 months that it feels a little overwhelming – in the best possible way of course. I hope that I can one day inspire someone in the same way that I have been inspired.

Here is a little snippet of what I have been up to the last 5 days…which may not sound like a lot to most but it pretty much sums up my total weekly hours!

1. Basic overview of admissions and discharges – mostly to do with paper work and referral to social services, physiotherapists or speech therapists.
2. Bed making – with triangular hospital corners 🙂 or with loose corners for inflatable beds. Bed are remade with clean sheets at least once per day, but I have made most beds at least twice per shift. A well made bed reduces the chance of ulcers through friction and shearing and let’s face it, we all like to get into a nice clean bed.
3. Measuring and recording observations – using a noisy machine at the moment: taking blood pressure, measuring oxygen saturation levels (how much oxygen in the blood), respirations (breaths), pulse, and body temperature as well as assessing the level of consciousness to determine a Modified Early Warning Score (MEWS) which can basically help to provide a high level indication on how poorly the patient is. A high score may require emergency care and more frequent observations, lower scores require monitoring at less frequent intervals. At a minimum these must be done every 12 hours.
4. Oral care – specially for patients on oxygen (a dry gas), on restricted fluid intake or on Nil By Mouth. A little bit more care is needed to make sure sores and mouth ulcers don’t develop as the mouth gets very dry.
5. Eye care – the wards are super hot (which I like because it’s cosy) but no so good for the eyes to be sat in dry warm air all day long. Eyes are so delicate…they need looking after too!
6. Hand washing & moisturising – a requirement for infection control for all staff and visitors, but also helping patients to keep nice clean and moisturised hands. It can be really therapeutic for patients to give them a little hand massage. It could make someone’s day to have that little bit of touch.
7. Measuring, recording and monitoring of blood sugar levels – on admission and for diabetic patients during observations and also before meals.
8. Risk assessment of pressure ulcers – also known as Waterlow scores to assess the risk of a patient to develop pressure ulcers – this is a huuuuuuuuuuge topic in the NHS and has a lot of focus so it’s very important!
9. Wound care – I have so far observed maggot therapy (yes…little wriggly worm things!) for a foot ulcer and negative pressure wound therapy – also known as Vacuum Assisted Closure (V.A.C) therapy. Absolutely fascinating!
10. Observing a CT Scan – also known as a CAT scan which gives really detailed pictures of the body. So interesting! But it does expose the patient to radiation so it’s really not too good to have these too frequently or more than absolutely necessary.
11. Observed drug rounds – not random drugs…prescribed medications! Each patient has a specific medication to be taken at different times, in different quantities, in different forms, through different methods! It’s imperative to get it right.
12. Giving Breakfast, Lunch and Dinner and assisting with feeding – I deliver patients food to their beds. I’m told that the food is actually pretty tasty so I assist those who are unable to feed themselves to taste the goodness of food and fluid by giving them a helping hand.
13. Personal care – bed bathing and assisting with self washing. How nice does it feel having a nice warm bath or a lovely fresh shower after a long day? Imagine what it is like for those who are bedbound, or who need a little more help than the rest of us. Freshening up makes everyone feel a little better…patients are no exception..a little spray of deodorant and perfume is also welcome in many cases!
14. Toileting – yes…that does involve taking people to the toilet, or if they are not mobile, assisting with commodes,  bedpans, urine bottles , pads etc..Now that I have experienced this first hand, I’m actually a little offended at ‘all nurses do is wipe bums’ comments. It is heartbreaking to see vulnerable people desperately wanting to  go to the toilet and holding it in for HOURS because they don’t want to make a fuss or simply being unable to stop themselves from going. I will wipe and wipe and wipe until the end of time if it means that someone already unwell, already in pain and potentially at the end of their lives needs relief or a little assistance to make them feel more comfortable. It really upsets me to think that people out there mock the role of nurses (and other health care workers) in assisting which such a basic, natural need.
15. Talking and listening – I have done this more than any of the above. It is of such massive importance. I introduce myself to everyone with my name and ‘student nurse’ title. I have learnt all my patients’ names, and some of the family members’ names too. I always sit or stand at the level of the person talking to me. I say ‘hello’ and ‘see you later’ on every shift. I ask questions, I listen to the responses. I make conversations but also, I just ask if anyone needs anything….even if I’m passing. There are no excuses to not talking or listening to patients and family members/friends/carers, but also to other staff. I make time.

As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may forget your name, but they will never forget how you made them feel. – Maya Angelou

That’s quite a lot really isn’t it? Worth bearing in mind that all of the above (and more that I haven’t yet been exposed to!) generally happens at the same time…bit more than you thought? It’s a lot more than I thought too! Nurses do an amazing amount of work in an incredible short period of time.

I have a week back at uni before returning to placement first week of December. I will keep you posted!

Tomorrow

Who knew Tomorrow would actually get here one day! I knew, of course, but I didn’t realise it would get here so quickly. Tomorrow I start my first day of placement as a student nurse. Tomorrow I will be wearing my uniform and my upside down watch (a.k.a fob watch) for real. Tomorrow is not a dress rehearsal.

It is such a surreal feeling and so difficult to explain… the last 9 weeks at uni have been preparing us for Tomorrow, and yet it doesn’t feel real. Not yet. It feels like it is happening to someone else and I’m watching from the outside. Saying that, I have butterflies in my tummy so I am definitely feeling something! I hope it’s not my tea. Is it apprehension or nerves? Fear or excitement? I have no idea…I think it is probably a combination of all of the above and more.

I remember feeling like this prior to my first day at university, but at least at that point I felt somewhat comforted by the fact that we were all beginners….and I had already met (albeit briefly) a few people from my class. Tomorrow I will be joining experienced nurses, with poorly patients, in a real healthcare location….on my own…without knowing anything or anyone. I think I am m in denial…in reality I’m absolutely terrified and trying to blank it out.

Tomorrow was at least 3 months away last time I really checked…how is it possible that it is already here!?! How do these things just happen?  It is certainly a lesson to be learnt…. to really enjoy every minute of being a student nurse otherwise time will just pass me by.

Talking of lessons, I have learnt  (or remembered) a lot of lessons this week:

• There is such a thing as hemming tape (wonderweb) which can be used to shorten trousers simply by using an iron! Amazing stuff. It could have all gone very wrong as per this picture….Though you will have to imagine that the picture is of a girl (me) without hairy legs…haha!

 

• I’m really not very good with an iron.
• People generally don’t look at others’ feet – which is great because otherwise they would notice my hemming efforts… my trousers are appropriately shortened and tidy by the way…just not quite seamless!
• Irrespective of how old I get, I still care what people think of me and it hurts.
• Soda is a type of bread…it seems it is very popular in Northern Ireland – maybe Ireland too but I haven’t had that confirmed.
• I have made some incredible friends who will make amazing nurses.
• Crying is nothing to be ashamed of.
• Telling people how much you appreciate them is nothing to be ashamed of.
• Hard work is nothing to be ashamed of.
• Table tennis and wine may not be a good combination but it is very funny and it can get very competitive.
• Tomorrow will get here…quickly.

Who reading this has so far resisted singing Tomorrow from Annie the Musical?! Were you not thinking about it? Oh dear….here you go then!

The sun’ll come out
Tomorrow
Bet your bottom dollar
That tomorrow
There’ll be sun!

Just thinkin’ about
Tomorrow
Clears away the cobwebs,
And the sorrow
‘Til there’s none!

When I’m stuck a day
That’s gray,
And lonely,
I just stick out my chin
And Grin,
And Say,
Oh!

The sun’ll come out
Tomorrow
So ya gotta hang on
‘Til tomorrow
Come what may
Tomorrow! Tomorrow!
I love ya Tomorrow!
You’re always
A day
A way!

So…wish me luck for Tomorrow!