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 generalised anger

I am a tad discommoded tonight as I write this as I was intending to currently be on a night shift. I however turned up onto the ward and found that my shift has been swapped to tomorrow and Saturday [while now trying to remember if they were changed from nights to days or not altered from nights-ed].

Now, it has been almost a month since I last posted anything on here. I think that this blog is less posted then my old one, mainly because I have been away from home a lot an/or too tired to bother writing posts (especially when you write and see "comments 0" which makes me wonder if anyone reads this).

One of the main things that really gets on my nerve is the endless supply of trouble which tends to come with express delivery to the ward. Anything, even the most smallest thing, seems to be on the ward at the speed of light. However, I have see pinned to the notice board a letter written by the relative of a patient and they discuss at great detail the care given by a nurse on a particular day- I happen to be the nurse mentioned. The letter was very pleased and thankful for the care that the relative of the patient received. Did not see that one getting mentioned much!

Trouble is something relatively light for me on the ward. I have put a lot of incident forms in about patients of mine falling, and bar two about one incident, have occurred on nights when staffing levels are reduced (but not the number of patients who are at risk of falls). Pseudo science I know for staffing levels, but I guess with enough prolonged submission the shift will go from anecdote to supporting evidence in the official channels. Apart from a run in with a relief HCA the ward has been busy but no major disasters have occurred save for a minor injury one day. What does wind me up is the fact that the hospital is woefully short of beds and we seem to be a dumping ground for A&E and the AAU as they are driven to distraction by the 4-hour target et al (no doubt some A&E nurse is blogging about how unco-operative wards take all day to have patients discharged and gives them a headache arranging patients beds on wards...).

Biggest problem for me is my other half. She is currently going through a rough time and dispite my trying to be their, she is pushing me further and further away. Oh dear.

My overkill

It has been two weeks since I have been away. It was only on returning and being on shifts that have left me worn out and physically and mentally exhausted that have made me realise that half the problem is that the needless pressure which is placed on the ward has been the reason that we (the ward) have a reputation for being hectic.

Still, when you have 8 patients all with developing complex social problems and the strain which all nurses have on an acute medical ward, something has to break. As I have said, I am only on the ward for a six month contract for the maternity cover. Thankfully I yesterday had a phone call regarding an interview from a job within the speciality I like. I have got it. Now, I can leave, and make a fresh start in Nursing. I cant wait.

New vision for NHS

Yes, I know that I am on holiday but I am not jetting off until Thursday, so I have taken a look at the new vision for the NHS that the Department of health has released.

Now, I have read the beginning, and the forward is by the leader into the MMC fiasco. So, it is somewhat less alarming (I hope) to read of the effect of modernising Nursing careers. Now, visiting health professions and patients may be rubbing their hands with glee as another Nurse bashes the government. Well that will, and will not be happening.

The fundamental problem with Nursing care in the NHS is that too often, both in my own practice as a registered nurse, and from the reports made in media and by other staff nurses, ratios are unsafe. It is impossible for the nurse to always give every patient the same amount of attention. Clinical decision making is an important skill to posses as a nurse as this allows individual nurses to assess and attend/delegate patient care on a rationalised system. The theory postulates that care is given on a basis of need and priority under a guided framework utilising evidence based practice, not in an unco-ordinated and fragmented nature. Textbooks state that clinical decision making is the application of critical thinking. Critical thinking is accepted as being one of the skills that is possessed by people who are trained and taught within higher education, such as universities. The new vision for the NHS welcomes this idea of Evidence based practice, and that Nurses are the professionals that are most likely to shape the experiences that patients have while on wards. While the NMC are currently making a study on the effect of an all graduate profession, it is to a certain extent agreed that better patient outcomes and better quality of thought as a nurse will come from a graduate Nurse. This seems to be a common consensus between the government, the professional regulator and from the profession itself. While there are some very good points to be made by having an all graduate profession, there is one barrier to this.

The sad, and indeed true, problem with having an all graduate profession is the people that would train to be nurses. A degree nurse on the ward is not better then a nurse with a Diploma in nursing in doing their job per-say. This may not always reflect the problems that people may have while training, and the fact that like it or not, the average student nurse is female, aged 26, with one child. I admit, as a Male, 23, with no children, I am far from average (though this does not ergo mean that my perceptions are any less average opposed to the wider professional opinion). As a common factor, the Diploma with its bursary is a far more attractive option with the current rise in the cost of living. While the report may suggest better training, more career pathways for nurses, and a graduate training, there should be other considerations made to accommodate this within the wider pressures that society places upon individuals. A move that could lower the number of people graduating and entering the profession is not a move in a positive direction.

Only other thing is that the report seemed to be very vague:- they want to do things to improve the nursing profession, but the problem is the wording of the report was far too broad and vague in its meaning that it could be interpreted in a number of ways.

My Hospital Drama

Just occasionally, on a 12 hour shift you have a half an hour or so that normally becomes the material of what the TV would have any member of the public believe is about 5 minutes of nearly every show. However, for the first time yesterday that (sort of) happened. I finally had my first compliment paid... by the bed manager who commented that I looked smart with a well presented uniform and for wearing a highly polished pair of shoes (Doc Martins to be exact).

Yesterday I had a patient who effectively ended up being on one to one supervision by myself and the other staff nurse in the bay (there were two staff nurses in my bay, no HCA), and a passing away, followed by the small half hour of "fun", which started with a call to the arrest team in another bay, then a patient falling, followed by A&E leaving a patient in a bay. As the patient was considered better nursed on an electric bed, I along with the other staff nurse assisted the sister and staff nurse from the bay to transfer the patient/do obs as well as checking on the obs for a patient on an infusion done by yours truly. Then it was handover time, and now I am off on holiday.
After that shift, I am glad.

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.

Nurses: We really need you. Now fuck off!

Speaking (or, to be correct here typing) as a male nurse, I find there are many differing perceptions of the Nurse and the role which a Nurse has. I am aware that nursing is and I daresay will always remain a profession which is female dominated (though many long suffering husbands will say that is not the only thing that women dominate).

However, I was amazed to read last week of the news that nurses will be struck off the NMC register far more easier then it currently is. I am not saying that the removal of those who are maverick or take a cavilier approach to their work should not be suspended. However, this means that malicious reports could be used. I had a run in with a manager as I was stabbed in the back by my HCA for... well, I dont really know what there were on about. I remember them saying that 2 patients needed pressure mattresses (I was tied up with a moribound patient and assisting another side room patient initially on the shift and the HCA was covering the bay which is how they found that before me) and so I said "Yes, that sounds good. Have you ordered the matresses?". Well, buggered if I know what the manager was on about but I am fed up of the job and want to leave (not nursing, just the ward:- come back cardiothoracic's, all is forgiven!). Another thing that was winding me up was the manager saying "I dont ask enough questions". WTF? I ask loads of sodding questions, and have worked in the same area on an equally crappy ward (read Nursing Student blof from "My first day-My half time") and have approached staff when unsure. I mean, what the hell am I to ask if I know what I am doing (which is mostly dementia/geriatric care evn though I am supposed to be on a chest medicine ward). Do they wand me to stop a staff nurse and ask "What is the capital of Denmark?

What makes me puzzled is then they come out with "we value nurses" or "respect each other". Funny, seems to me that no bugger respects me and I feel valueless. Worst thing is, I actually was being nice to the ward and never let on for a moment my cyicisim.