Saturday, 17 May 2008

My new consideration

*In an effort to stremline services, Staff Nurse musing will only be published on a three day-shift basis. This is generally because staff Nurse M is knackered after shift and usually cannot be bothered doing much except eating, showering, and going to bed*

I dont know what it is, but I have felt drained this week. I think part of it was that I have squeezed a lot into the 7 days. Well, lets go over what I have been up to.
Saturday 10th May: St John Ambulance duty at a Junior school football tournament. Now, I was OK being up early for this one as the school it was being held at was a few miles away. Hey, this could not be a busy duty right? Nope. Have a guess how many people I saw, and how many in total. Go on, guess...5, 6, 0? Nope. I saw 14, the total number of people who required the attention of the St John Team was 43. These were (all bar one) very minor stuff- ice packs for sprains, people kicked, sprains etc, but enough when there were only 6 people, and no ambulance, and the fact that we ended up sending somebody back to division to get more gloves, ice packs and patient report forms.

Sunday 11th May
Last match of the premiership season. I saw three people in the match before the somewhat down-playing message of "A disturbance in the south stand" turned out to be a near riot which resulted in several injuries. As there were only the crowd doctors on duty, the first aid post I was in was asked to take a head injury, even though while waiting the other post phoned to ask if I could attend a "cut finger". Evetually, ambulances were arranged to bring the injured people who required hospital attention to A&E.

A half shift as I was due to do a course on wednesday. I opted for the late shift as this is better for me. I worked on a shift which required many social care referrals, some basic nursing care, some uneventful drug rounds and one new admit from a home who took alot of my time.

Course day run in conjunction with the ICU on acute management of patients. Basicaly the ABCDE approch to dealing with the ill patient. Sort of along the lines of the advanced first aid. There was talk of us now being able to prescribe 0.9% saline under patient directive in an emergency only (for rapid infusion over 10 minutes, not like parental fluid therapy), though I checked and my ward does not subscribe to it. I know the aim was to give a framework to structure patient assessment/management. One think that struck me was the way it almost sounded like being "Don't think outside the box, but feel free to think wholly within the flow chart". Who needs clinical knowledge when a flow chart will mean a trained monkey can do the job of a nurse eh?

I lumbered into a twelve hour shift on a different bay. 7 patients, two planned for discharge friday, two for thursday. One was... how can I put this... challenging to deal with. Mainly with the way they just sat and said/did nothing. I dont mean that the person was paralysed or could not speak, I mean they literally just sat there. What topped it off was the arrogant expression they wore constantly. It was a relieve to send them home.

I also had my first enema to do since being a student, the result was 1000% sucessfull, and I spent many a happy hour cleaning faecal matter up for most of the day from my patients.

For some reason, everyone had a shit day. I mean that both physically and metaphorically. Highlights included an infection being traced down, the other staff nurse I am preceptee for doing the two dischages (which I may add took hours of her time), a patient who "fell" twice (or as I imagine, actually laid on the floor deliberatly to try and stop going home), some washes, a transfer, and everyone being very depressed.

Thursday, 8 May 2008

My Nightmare

I am regretting the choice I have made, and also that while I had an interview for the ward that I interned on I did not get the job as I was second (to somebody who has been qualified longer as a staff nurse. Its nice but not much compensation).

I have been in Nursing in some form since 2005. Last night was beyond a shadow of a doubt the worst shift I have ever had to work. As I write this my gut feeling is to try and find another ward to work on as I seriously do not even want to go back.

Last night I was originally only going to have a normal "Day" team. I.e. One x6 bed bay and x2 side rooms. As the ward next door was short, the other staff nurse was sent next door, and I inherited all 16 patients. This was not a problem, what happened next was.

The main problem is that with a high number of dementia patients on the ward, there is one in particular who I am the nurse for. Unfortunately they are very confused and get very aggressive. I am bound by the code of conduct to maintain patient confidentiality and thus I will abide my that. However, what did culminate was the patient literally running off the ward, being found by the night sister in a different area, and being confused. I was running between a dying patient and somebody with SOB, while watching over my other 14 patients. Not a great start. I had already asked the SHO for advise re:sedation and was told that there was nothing they would be able to advise. By the time this happened, the night sister had the patient back on the ward. The end result with the whole incident was me, the doctor, the night sister and my HCA being hit by the patient, and having to forcefully inject sedatives for their own good.

I hate this job.

My Two nights

Bank holiday Monday and Tuesday were two night duties for yours truly. The compliment of nurses in the night is reduced to two staff nurses and two Health Care Assistants (HCA). This results in there being 16 patients to each Nurse/HCA pairing. One takes the top end, the other the back. I was assigned to the top end of the bay to where I had been for the three day shifts.

I began on Monday by being talked through the routine for the ward in the evening-this is different for the night then the day. After having the hand over, I was back with a slightly larger caseload of 6 patients. The side rooms were with my preceptorship mentor. I began with a medication round. There are a lot of nebulizers used on the rounds as well as tablet medications. In addition, some of my patients request a lot of PRN medication so it is usually worthwhile noting of they mention anything while I am doing my preliminary check of the the bay at the start of the shift. The round was done, and there was then the IV antibiotics and the controlled drugs to be done near 10pm. Rather then people doing these separately, usually there are the two nurses in at the same time to check the controlled medication and the IV antibiotics to save waiting.

This was the way for the two nights which for me were tied up dealing with a patient who has predominantly mental health problems associated with advancing years. This was to be the bigges factor the the shift last night (see above).

Saturday, 3 May 2008

My two days

Seen patients, several passed away on ward, beaten up by patient with confusion, cornered by mental health patients, managed to go off duty with keys, got security badge, spent most of time on medications, bed baths, Dynamap buggered, assisted when first on scene to emergency on ward, commoding and paperwork. Feel knackered.

Patients seen to appreciate care so not all fully lost.

Sums up the life of a modern staff nurse really. Florence would be spinning in her grave.

Thursday, 1 May 2008

My Genesis

I was in the hospital changing room this morning. I had just put my uniform on, and looked in the mirror. I saw a staff Nurse in the reflection. It was with mild horror and a smidgen of excitement that it turns out the staff nurse was me.

Yes, this is my first "proper" shift as a Staff Nurse after qualifying. I was initially bloody terrified. I mean, I have never been on the ward, and now people would not be looking at me and saying "Have you seen a staff Nurse about?". Nope, this time it would be "oi, you!". Oh dear.

Well, having been greeted and given the mandatory cup of tea, I was introduced to the staff Nurse who I was working with (who shares my last name). We agreed that rather then me shadow fully, that I would take the bay patients and work observing initially, and then take on a small caseload myself. We started the drug round first off. That was the first big step. Before, as a student nurse, if I did medications they had to be checked and countersigned by the registered nurse. When we started, the other staff nurse said "Have you got you PIN through?". I have, so the round was left to my own devices. The round did take 40 minutes. Now, before you all snigger and think "Daft bloody newbie" I may point out the first patient was bad at swallowing and so I was the one who gave the tablets literally, and with two of the patients there was no medication sent up with the overnight admissions. This necessitate my going through the ward drug cupboard and ordering several medications from the pharmacy department. It was at the same time, one of the wards consultants came into the treatment room who also has my last name as well. That was rather odd. Anyway, that done, I did the washes. Two were straight forward while one was a patient who needed changing.

The day wore on with the same pattern emerging. I did some dressings, some patients needed turning, some were admitted, all had paperwork done/risk assessments completed/nursing plans put into notes e.t.c. One change I found was if one of my patients asked for PRN medication. It was a massive change to be able to say "Right you are" and then get it there and then for them rather then play "Hunt the Nurse". This happened several times.

All in all, the day was steady. The ward manager spoke with me several times to ask how I was getting on. She thought that I had crammed a lot into my day. I did say that my approach to work is to initially ask when unsure. I have worked for 3 years to get my PIN. I would much rather be ridiculed for asking about something that seems trivial rather then have the ward manager come to me and say "I need a word with you as you should not have done..."

One thing I have found of today is that while I checked, double and quadruple checked my medications and drug cardex, I am still full of nagging doubt. About what, I really don't know. I think it is the after effect of the nerves wearing off. I am back in tomorrow.