My hymn called faith and misery

For those...anoyying pains
In less then 12 hours hours, I will be starting a new job. I shall be a Staff Nurse in a Cardiac Catheter Laboratory. Yes, I am going to be back in Cardiothoracics and I cannot wait for it.

Well, I am leaving acute medicine. It is with a mixture of thoughts and feelings that I leave the ward. I was not happy on there, that is true. There was a low moral on the ward, and I was happy to add to the general malaise by never having any shifts that every actually made me think "I really liked that". There was bad start to my internship placement when I was in Cardio last time as a student-mostly the bad feelings was that I really did feel like an outsider. Once I felt accepted, and had re-established my comfort zone, things were fine.

Things have not been fine elsewhere though. The ongoing relationship with my girlfriend has ended once and for all, as things have gone past the point where things could be salvaged. I regret that happening, but I know that the best thing to do is to move on, and see if I can find somebody else. Another thing that really annoyed me was a total- idiot- who went on a dangerous ego trip while on duty with St John the other day and basically started running the duty even though they are not supposed to duty manage (not trained for the role) and even though they were supposed to be "non-clinical" decided to go off to see a suspected medical emergency. This was odd as no-one radioed it in, and when a steward directed us to the call, we found them and somebody else in with the "patient" who then gave me and the AFA I was with a load of lip. YOUR ONLY A BLOODY FIRST AIDER, SO EVEN THOUGH YOU MAY THINK I'M "JUST" A NURSE, I'M A DAMN SITE MORE KNOWLEDGEABLE THEN SOME HALF-WIT WHO DOES A WEEKEND COURSE THEN THINKS THAT THEY ARE BETTER THEN A CONSULTANT IN TRAUMA MEDICINE! I have a code of conduct, accountability, professional registration, 3 years of UNIVERSITY training, and the ever present fact that I deal with acute patients every day I am at sodding work. I can recognise my limits, and work within them, but these idiots have not got a clue sometimes, nor any of the above mentioned qualities. Yes, you may be good at bandaging, but over-empowering the under qualified to think that they can make decisions which should only be made by those who are trained and qualified professionals is dangerous. On one call I was at, I said to the patient to have a check from A&E by a DOCTOR have have a small check done because I KNOW THAT TO NOT DO WAS TO MAKE A CHOICE ABOVE MY TRAINING. When I'm not sure, I ask a doctor, another nurse or arrange the patient to be checked elsewhere (I once told a patient to follow up with either a GP or practice nurse and wrote a continuation sheet for the follow up appointment as I needed to go to greater depth then the PRF allowed. I did that as I was aware of the NHS services the person would need to access, and had a good knowledge of how the follow up should work. I only know that because of my NURSE training. A 16 hour course alas, does not. For now, I am annoyed at SJA. They expect Doctors, Nurses and Paramedics to treat them as equals (they are not), but then show no respect to their superiors. Dangerous.

My struggle

At work, I have had the first experience of the pain in the arse relative. That's a bit of a hot potato, remember there this is my private thoughts on nursing. Seriously though, I am back in tomorrow and I am not going to be surprised (or indeed bothered) to find that there has been a complaint put in by a relative. I am sorry, but I am not going to be bullied by a relative who is ACTIVELY LOOKING for a reason to complain, rather then those who actually complain because they have been the unfortunate person on the receiving end of things when they go wrong. Now, I am not going to give too much away, but when you are trying to deal with a patient who had just taken a serious and unanticipated turn for the worse, I cannot, and will not, attend to another task which can wait when failure to act with the clinically priority patient could result in a cardiac arrest. I am not, and will not, accept that a complaint of attending to something when the same said relative was asking where I was the day before when starting up THE EXACT SAME SODDING THING. Nor is is reasonable to complain when an increased risk means that awaiting at SHO on call means a 35 minute wait for me to keep the patient safe. I am astounded as to the lack of respect that is shown to the medical services by the general public. A further example of this was out on duty on Friday night with St John Ambulance. I had a casualty who was a fair distance into woodland at an event. Having treated, I asked for a carry chair to be brought, and we struggled to get the patient out to a road. I requested the ambulance meet us at the roadside so we could transfer the patient. On reaching the road, there was a lot of cars. None of which were prepared to make way for the ambulance coming the opposite way. I went down to meet the driver, and we decided that the best thing to do would be to take the ambulance stretcher out and wheel it past the car. While we were getting the stretcher out, one cheeky bitch wound down the window of her car and said "Can you move forward, I cant see?". FFS, IF you see an ambulance crew getting a stretcher out, you know its for a patient, and seeing as the driver of said car was parked way back from the road, what was wrong with driving forward a little bit and asking the police who were guiding traffic out for help? It was only on my asking a steward to stop the cars from coming down the road that we were able to safely transfer the patient.

If any member of the health service was to be as rude to the public as what the public are too us, people would be struck off.

Musing on my final hours till work

There are a number of things which as a student Nurse I often thought would be beyond me. In the early days of training, the notion of ever wearing the blue slides of a staff nurse on my tunic was one of them. In 36 hours time, that however is going to become a reality. It shall be my first proper shift as a staff nurse (albeit a supernumerary one). I am going to pick my uniform up tomorrow. I hope by then that the trousers will have arrived or else there is going to be a quick think of what to wear Thursday. I am not sure how the trousers had not arrived by last Friday, but I was told that there are "orders being delivered all that time" so fingers crossed that all works out well. Starting my first day without trousers would be bad, not to mention embarrassing all around if the ward manager demands I wear uniform issue trousers only. My girlfriend has laughed a lot about that.

Of course there are all the thousand and one other worries that I now have:- Will I like the ward, will I get on with most of the staff (I am guessing there will be one person who will rub me up the wrong way), will the other professions be OK, what will my caseload be like, and will I (after the 3 months away from ward Nursing) settle into the ward OK. I have worked at the hospital, and I am comfortable with all that. I am sure that most of this is just nerves before shift, but if it all goes pear shaped, I could be in for 6 months of hell.

On the positive side, I have nursed patients with the conditions as medical sleep outs before, and had a few emergency cases with St John related to the area. I have met some of the staff, one of the FY2 doctors was on my internship ward for a while, and one of the consultants on the ward was holding clinics when I worked on an out patients department while in second year of training. The good points outweigh the bad.
Unfortunatly, having to be up at 5:15am for days is a pain.

My bust blood vessle

How I have manged to keep my head from exploding over the last few days is both beyond me and a testament to my self control. I have been told that my start date for the ward of Hospital B is to be the 1st May. I am not sure if I am going to work Thursday, Friday and Saturday but I really am not fussed-it is nice to think that the start time for me is actually less then 6 days. I am not sure what I am to wear though as only my tunic has arrived (I think the patients would not be pleased if I turned up wearing only a tunic and boxer shorts- though that may raise a laugh).

Anyway, I should be glad to be here, as my mate and I were nearly killed in the ambulance the other morning (more of that later). I was out on Tuesday with my mate and his girlfriend to take a St John Ambulance (Renault) down to the county HQ to pick up a Land Rover based ambulance. The Land Rover is the only one which has a tow bar fitted for towing First Aid posts. Once we picked the Landie up, we went back to the main HQ of my area (the original County HQ before two counties merged in 1999). There, we saw the first aid post. I thought that the FAP we were to use was an old caravan. The one we had was in fact an ex-mobile office. To say it was a mess is an understatement. We could write in the dirt inside the cupboards in the clinical area, and the fridge in the staff part had black mould inside it. Most of the response bags were full of out of date bandages and dressings. In one there was only a triangular bandage, a bottle of mineral water and a trauma dressing. What use would THAT be in an emergency I wonder? It took the three of us 5 hours to clean and re-stock it.

On Wednesday, me and my mate took the Land Rover, with the FAP on the back and had to take it on a 50 odd mile trip to the event where it was being used. Wednesday was the set up day. We were going along without too much problem, when about 3 miles away from the destination a lorry (the class 2 HGV type) pulled out across the road right in front of us on a corner. If my mate had not had the time to straighten the wheel up and do an emergency brake, that would have been one heck of a crash (the FAP on the back tends to want to flip the Land rover over. Imagine the post flipping up and over on a busy road in rush hour and falling on top of cars...). Anyway, we got to the location still alive and set up the post. The day was quiet and there was only one person who I saw (minor injury). While I seeing to that, my mate and another first aider who had met us at the event treated another person.

Yesterday, I was there. I started off in the firsts aid post and we had only just started when me and a fellow member who took induction together had two patients. One was sent back to event while the other I advised to seek the attention of their GP or practice nurse to follow up treatment. It was while with the second one that I got very annoyed with an ambulance service EMT who was working the event with St John who kept butting in and interuppting wanting to know how long we would be. I asked if there was another patient, though it seems there was none. They seemed to think good patient care can be delt with in a dismissive manner. Arse.

Thats about the highlights. The end to an arsey week was me arguing the toss with my divisional superintendat about me wearing a Fob watch. The hospital and the latest research suggests that wrist watches should not be worn. This is the opposide of SJA policy. Gun to your head, where DO you sit on the debate?

My dwindle

Two duties over the course of the weekend. The good news is that it seems that my bad spate of patients with St John Ambulance is coming to an end. Last Wednesday I was at the international match for the under 18 side. There was a shortage of members at the game and I ended up covering both the First Aid post and a corner at the opposite side of the field (where I was for the majority of the game). There was no injuries (bar one which was seen by another corner and required no real input).

Saturday saw another premiership match. I was deployed to the first aid room of the stadium. Over the course of the last few matches this has been where within a few moments of the gates opening there had been at least one person present. In fact there was nobody seen in the first half and it was near full time before there was anyone presented. The person who did complained of pains. I had a look at them and could not find anything seriously wrong and suspected there was nothing more then a minor ailment that was causing the problem. However, to be on the safe side, I asked for the duty Doctor to attend. In due course, he did. Unlike certain other medical bloggers, I believe the type of person who joins a volunteer organisation which consists primarily of volunteer First Aiders is not like some of the anarchic opinions offered on the blog sphere. Indeed, the Doctor listened to my handover, agreed that I seemed to be on the right lines and carried out a full diagnostic check to back up our findings. That done, a recommended prescription was given and I administered the medication to the patient. That concluded the match.

Today, I was covering a half marathon. I was put with another St John Ambulance volunteer, this time somebody trained to Ambulance Aid 1 standard. As there was a Paramedic and myself there, it was decided that I would form a response team for the far part of the course. We were due to mobilise to a roundabout on a closed road, before moving to a leisure centre. The first part went well (the roundabout bit near the start). At 11:30 we were told that we were going to be picked up by an event mini bus and taken to the second deployment point. After being picked up, we overheard there were patients. These were being seen to by both the ambulances that were on duty. In the meantime, we were driven down a road that turned out to be gridlocked and we sat for over an hour in this state. This was not good as we were the only people left free to respond to a call. Indeed, there was a message come over the Marshall's radio of a patient at one of the points, though there was no message passed to St John. I did radio it in but there seemed to be no immediate need for us. After a while, we were told by the radio to alight near where we were and take up position there. By this time most of the runners had passed us in the mini bus anyway, so we were treated to a quiet hour and a quarter while the last runner came up. After a run back in the ambulance which was following the last runner, I got off duty (with a free tee shirt).

In the world of my job, I have decided that "Hospital A" are really not for me and have told them I shall not be taking up the post. I have been treated better by the other hospital. They have been far more pro-active and welcoming, and the kind of ward that does that is the kind that normally will try to take care of its staff. While it is only a 6 months contract, I have been successful in the post for the community hospital near me. By the time the paperwork is all sorted, I am hoping that this will be roughly time to finish and change jobs.

My brief work

Well, that's another St John ambulance duty, this time the league one side. Only one patient, with queried fracture to limb. Only required a second opinion from a paramedic. Advised to attend A&E to get seen to. That was the duty, which otherwise saw a dismal performance by the home side.

I am back there on Wednesday when the England under 18 side are against Austria (so time to polish up my GCSE German perhaps?) and also now have 30 days till I have induction.

My knowing when to quit

Today is freezing and has been snowing. Of course, it's JUST the weather to go to a Football match on duty with St John. I walked to division the other night as it was a pleasant evening. Today is a total opposite.

Well, with an early kick off time, we were required to get to the stadium for a much earlier briefing then usual. The complement was of 24 first Aid qualified St John members, 5 Ambulance aid members, two Nurses (including me) and two Doctors. I was sent to a first aid post with two ambulance aiders and two first aiders. The room was set up and when the corner teams left, it all went quiet. For about 5 minutes. Then we had a person present. After asking the basic few questions that we always ask, ie whats wrong, any pain, what symptoms are etc, it soon became clear that the problem was a medical one. Now, I may be good a patching up wounds and looking after people who have been seen and need care. However, I am not trained to diagnose. Knowing this was defently "not one for me" I unceremoniously asked for the duty Doctor to come over and see the person as this was clearly a job only Doctor would be suitable for. So, with them on their way, I set about doing the observations, and gave a handover when they arrived and thus, the patient was seen and assessed and the apropiate steps taken for them. With this going on, there were other people who came in over the course of the match. Both of these were seen by the other people in the first aid post (after all, this is a team effort and there was no reason for me to stick my ore in).

With an uneventful last part of the match, the last call of the day made to the post was simple, and there ended the match. The journery back in the snow was cold, and traffic was a bit heavy. Still, all is well that ends well. Today also is a great way of knowing when to quit while ahead.

40 days

Annoyed? No, I'm just f"&king rabid at the moment. "Oh yes" they said "Have a job with us" they said. Oh really matey boy? Just what they forgot to mention is that the fourth bridge will take less time to paint then I will have to wait to start either sodding job.

I have already gone through the CRB check and how that is stopping everything. Now though, there is another spanner in the works. Induction. I have no idea what I am supposed to cover, and frankly hope it better be worth my time as opposed to a day being told something which anybody who has worked on any ward in any hospital already knows. So, where are we up to:
"Hospital B":- After taking 3 weeks to arrive, the letter confirming my tempory post, CRB check and occupational health decleration have been sent off-on the first postal day mark you. Undoubtedly, they too will want to have their own CRB check as opposed to the recent St John Ambulance CRB check which arrived a few days ago. I cannot fathom out why they are so obsessed with a CRB with their own name on the top when a check arrived a week ago that is just as good. Their argument? "They are only valid on the day they were printed". Nice, but I am pained to point out it took 7 days for the St John Ambulance CRB to arrive (more of laying into St John Ambulance later in this post). A small point is that when a CRB check comes to my house, the body requesting the check actually gets the check 24 hours later...or 48 hours after the valid period. Can you see the flaw in their reasoning? Yup, the CRB with their name on is, using their own criteria, invalid. I have a uniform on order, though am not going to collect it until I have reason to believe that they can give me a start date before the other hospital. In addition, they sent me a letter stating to attend trust induction... on the 2nd June! If that is how long they are going to take, then they are definatly dead in the water.

Hospital A on the other hand were phoned by me on Tuesday. I have not heared anything from them so wanted to check see what was happening. As you may be aware, the CRB went in to them on the 5th March. The check can take 3-6 weeks. It is at [drum roll here]...stage ONE. Basically, it's arrived at the CRB building. Thats it. Now, what really annoys the hell out of me is that the CRB is a government body (it is subsumed from part of the Home Office). They also get paid for each CRB. So why is it then that it takes 6 weeks to effectivly search the CPS computer database which is like google search for criminals? Lets remember here a few other govenment bodies:
Job Centre Plus:-Department of Work and Pensions: 2 weeks to clain Job seekeres allowance.
DVLA- Department of Transport- How long do you think it will take them to contact you if you fail to tax or SORN a car when the tax is due? Proberbly 3 working days but not 6 bloody weeks thats for sure!
On the up side, they have said that I must attend induction...then one for me being [another drum role] 12th May. Yesterday, that was 40 days. Anyone recall Noah and his flood? 39 days from today. Jesus, in that time I could have seen a job advert, applied, been interviewed and put in 4 weeks notice and STILL have a day or too off. No wonder the NHS is in a staff crisis if this is how long Nurses have to wait. I mean, think here for a moment. I know "hospital B" are at screaming point with their Nurses. There is a real chance that I am going to turn down that job offer. Not only have they been short prior to my arrival, they have been short during these few weeks. If/when I turn down the job offer, they will be shorted for an even longer time as well. I know they my job there was to cover for maternity leave. The kid will be having its 10th birthday before I get on the ward at this rate.

Now, for St John. 3 weeks ago, I had my interview with the county Nursing officer. I was phoned up on Tuesday by another divisions superintendant who was wanting to know if I was free to work as a Nurse in an ambulance working out from a hospital in another county to where I live. I said yes to it. Only to find that county have no record of my Nursing registration. They think it is a bottleneck between my divisional superintendant (who has since assured me that paperwork is with NHQ and will chase it up) and county HQ. Aparrently the "checks" take time. What effing checks? You have my PIN number, go on the NMC website and use the employers checking service! What is it with me and paperwork? I have 39 days of this hell to endure!

My frustrating week

It has been an interesting week for me. The job hunt is still on, and I am trying to not loose my temper. This is however, difficult. Having spilt with my Girlfriend on Tuesday, and have finally got my St John CRB check back, I was hoping that it would be a week to make up some ground on commencing a post. Not to be. I went into the ward of "Hospital B" (see posts below) and indeed, they have sent me in to order my uniform, and started getting a security badge. "Great" I thought "all I need is that contract they were going to send out and I will be well away". Yeah, right!

Yesterday, I was sent a letter from the hospital. Who, have only now decided to write to me saying that there is a job offer for me. While the ward sister has written on the occupation health form that I am to start in April, the letter states quite clearly that I cannot start until all the pre employment checks are through. The CRB form was actually within the envelope which had the letter in. Adding insult to injury, was the statement that I am down to attend the trust induction... on the 2nd June! FFS! I know the media bang on about the high number of Nurses who are due to retire, at this bloody rate even I will be an OAP before I start a damn job! I am going to have to call back into the ward and sort this out. I would say "Hospital A" are going to be back in the running, but even they are staying quiet so both offers seem dead in the water at the moment.

So, after a frustrating week of progressing in a mainly backwards direction, I have thankfully kept some of my skills up with St John Ambulance. This weeks duty was the league 1 side who were at home. Having got there and found there was an argument shortly after arriving, there was a lot of people needing to be spoken to. This resulted in the corner teams deploying early, and me grabbing my lunch and standing underneath some metal steps for shelter out of the rain. After finishing and wandering to the corner, I noticed there was no county ambulance at the ground. When the team intended for the corner came out, and went in an informed the duty manager who in term spoke with the ground manager. Thankfully, the ambulance turned up at 3:20pm. Turns out one forgot they were going, and the other did not realise they were at the match. Oh well.

The game was uneventful, and I busied myself with preparing the first aid post and leaving my equipment on a dressing trolley. This saves me having to rummage through my first aid bag. I asked the controller (a division superintendent) if there was any way of lowering the back of the bed in the first aid post. I remarked that if there was anyone who needed to be laid flat that I was not sure how to do it. I really wish that I had not said that. About an hour later, near the end of the match, the radio went off with a rather hurried "Sierra Papa to control [radio hiss]". That is the call sign for the stretcher party. They were not raised by radio. Another corner team radioed in with the fateful message "Stretcher party have mobilised to pitch, casualty expected, over". Yup, when me and the duty manager went out, sure as anything, there was the stretcher team picking an injured player up on a "Furley" stretcher, and they turned to face the exit to the first aid post. Damn! Normally, most players get sent to the dressing room, only if they need the bed do they get sent to the First Aid post. Well, I went back in and thankfully got the bed flat before the stretcher reached the post.

My hectic duty

Old photo taken at the football stadium I was at today.

There is a division one side who are a county duty for St John Ambulance. This brings my total number of duties to three within four days. I was expecting this to be a quiet day. In all the times I have been attending, there has only ever been one casualty, and that was pretty minor at that.

After arriving slightly late having being caught in the traffic, I was told that I was going to be in the First Aid post. There was a Paramedic crew who arrived about 10 minutes after I did. There was nothing much to report and the game kicked off. After about half an hour, a steward came into the first aid post with a causalty who had slipped and fallen and had a leg injury. I treated with Ice pack and the Paramdic had a look in at the patient as well. Just as we were about to discharge the patient, a st john ambulance member came in and was found to be having an asthma attack. Eventually, an ambulance was called to evacuate them to A&E. Just as the ambulance crew were about to leave, a call came over the radio of a collapse in the stands.

It was a child who had collapsed. They too were taken to the first aid post and were looked after by the Paramedic crew and myself. Following the arrival of the parent, it was decided that it would be best if an ambulance was called to take them to a hospital with Childrens services. This took place just at the end of the match.

Following this, me and the duty officer went to the town's A&E department to check on the member who had been sent up. They were doing better and we spent an hour with them before leaving once we found out they were being kept in and that relatives were on their way.

I am back there on Saturday. I hope that it will be buisiness as usual. At the moment, I shall be going to the ward for a rest.

My jinx

Yesterday, I was covering a football match at a local stadium with St John Ambulance. Having being picked up by my mate in the St John Ambulance, after picking up another first aider, we headed for the stadium. Arriving, we found there were plenty of St John Ambulance volunteers on duty. This was including another Nurse who is a St John Ambulance member, and a Doctor who is in St John Ambulance. There were a number of county ambulance paramedics and EMT staff in the ground. I met one of the EMT who I worked with while on the ambulance service. It was nice to catch up with him. While we were preparing for the briefing, a person came into the first aid room who needed attention. Following their dispatch (I had nothing to do with them) the briefing sent me to a first aid post. Having being joined by a First aider who has just started their Nurse training and the St John Ambulance crew, we waited for the match to start and prepared the first aid post. After the corner teams had left to take up position, it was a matter of minutes before the biscuits had been found and I was about to have one. Then, just as I had literally taken on bite, a first aider burst into the room and announced "I have a casualty here with eye injury". Quickly hiding the offending biccie into my pocket, I donned a pair of gloves and set about seeing to the patient. There was a few moments spent writing my report out and all was well. After two of the members went to get something to eat, my mate came back in with some free pies (one of the division first aiders happens to work on one of the catering stands and gives SJA volunteers free pies). I had just taken one bite when there was a knock on the door. Normally this is just kids messing about. When my mate went and opened the door, we found that it was actually a person wanting treatment. Strewth!

While he was dealing with that, and I filled in the PRF, I heard another person come in and heard conversations about an accident. I looked around the screen, and saw a person who was injured. Thankfully, they were in the competent hands of the Paramedic crew who were in the stadium.

After both patients left, and the room was tidied up, I set back to having my lunch. I was reluctant to actually eat anything else as it seemed that every time I was having something, a patient was turning up. I hate to think what would have happened if I had gone for something larger, such as a burger. Stadium exploding was high on our reckoning.

As we had lost time, the first half was over. Having some of the corner teams come in for a refreshment break gave a few new faces. At the start of the second half, they deployed back to their positions. We settled down for what was to be an uneventful second half. We ended up getting bored and playing hangman. The game ended with nothing more then a snow shower. After being stood down, I went and changed my top over in the ambulance and then went and met my girlfriend and had a meal then went back to hers. As I left home at 12:40 yesterday and got back near 2pm today, it would seem that I cannot claim 26 hours on duty. Shame as it is supposed to be "door to door" times that we record.

My Road Race

It being Good Friday, there was a St John Ambulance divisional duty to cover, a 10k road race. I was aware there was a race but was initially told it was a cock up and it was relating to a duty next month. It was not which is why it was last night at 10:30 pm I said yes to doing the duty with one of the new cadet members (who happens to be a mate as well- I was on my first placement when he was there for 2 weeks works experience).

Personally, it would have been nice if it was a better day for the race as it was bloody freezing cold. The sun was out when we made our way to the start of the race. When we arrived, we quickly found there was only 1 PRF (Patient Report Form- a document used by ambulance services for recording the details of casualties) and one ice pack between our two first aid kits. Thankfully, my other mate in St John (Divisional officer) had phoned up, but we both missed the call. I phoned him back and found he was phoning in to see how things were. I told him of the situation re: PRF and the ice pack. Thankfully, he was at the division building about to take a St John Ambulance down to Harrogate where there is a contract between St John and the hospital. He brought the ambulance down and I took some Ice Packs and Crepe bandages as well as yellow clinical waste bags as some PRF's. Having already spoken to the signing in Steward, we were told that another official would speak with us before the start of the race. In due course we were approached by an official from UK Athletics. The steward asked me to find him after the event to fill in a first aid report for the UK athetics new policy.

With everything ready to roll, the runners set off and we followed to the half way point and stood around freezing while not a lot happened that needed our input (this was good). After moving again to the finish line and freezing while waiting for the final runners to arrive, we headed up to the start point, signed off all the forms without too much hassle. Though I did get a free coffee out of the day.