New Ward

So I'm settled on my new ward. Gastro Medical and Surgical. Its an interesting place to be. I've experienced a surgical ward on my first placement, and a medical on my second. Caring for both sets of patients in the same place is interesting.

Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.

The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.

I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.

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*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.

**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.

Suits

One of the key issues with working in healthcare is you spend most of your time covered in sick peoples bodily fluids. Obviously this is just part of the job and it doesnt really bother you. However when you get out of the hospital you cant help but feel the need to clean thouroughly and get into some very clean cut, neat clothes.

In short I honestly need more reasons to go out wearing suits. Unfortunately there are only so many weddings you can go to. I dont know if this is just because I have come from a job where you spend most of your time in suits/neat uniforms.

BLS BS!

As a student nurse I am required to sit through three hours of bls training every year. As a member of St John Ambulance I tend to keep my skills sharp much more regularly than that. Unfortunately the two sometimes conflict.

During my Basic Life Support training yesterday the nurse stated emphatically that should you have a patient with a possible spinal injury and they vomit into their mouths you are not to do anything. In short you sit back and watch the patient suffocate. In St John we are taught that Airway, Breathing and Circulation come first, as long as those are secure you can start taking care of other injuries. In this situation with sja or any other first aid organisation it would be appropriate to put the patient in the recovery position (in the absence of a suction unit) regardless of the risk caused by a possible spinal injury. The rationale is that if you move them the MIGHT die or suffer paralysis, if you dont move them they WILL die.

After taking some pains to explain my moral objections to the former concept being taught as protocol for 'healthcare professionals' I went above the trainers head to her boss. who supported my arguement. Unfortunately the trainer had already drummed this faulty concept into five groups before us.

One a more positive note I went to see my new ward today. Its a gastro medical and surgical ward and I'll only be there for six weeks. The ward seems wonderful, the staff were very friendly and welcoming and whilst the specialty is not a real passion of mine I still find it fairly interesting. I think this is just the placement I need after the mess with my last one.

Back to Work

Due to all the hassle regarding my last placement I requested my exit forms from my academic tutor. She said "No", she was point blanc refusing to let me leave. So I attended a crisis meeting where it was agreed I'd spend a further week on the ward and my mentors would no leave my sight. This worked well and I got all my proficiencies signed off. Unfortunately me handing my documentation in late was an immediate fail ....or so I thought. As my academic tutor was so determined not to loose me she arranged for all my paperwork to....go away. It was very nice. Even had I completed the placement normally there would be a mountain of paperwork for me to sign but shes taken care of all of it. She also felt that I needed something to bolster my resolve. Something to hold on to and help me through the harder times. She told me I am guarenteed a placement in A&E in my third year. The day we accept the offer to start the course at the university they have the whole three years of placements mapped out. Its nearly impossible to change their plans and we are not allowed to know where our placements are other than the next one. So she bent a few rules but It has helped. I get my dream placement at the perfect time.

So I'm in a fairly good mood. The university are bending over backwards to ensure I stay (which I may be taking advantage of a bit). However I have two assignments due in soon so I am currently sat in the library trying my hardest not to start them. I have been fairly socially active with the other memebers of my course recently and some of them raised a point that my 'intellect is very intimidating' my immediate reaction to this was to laugh. Then I realised I have a fairly broad knowledge of most things, but very little in depth knowledge of anything. I know enough to know I dont know anything but the range and variety of my knowledge must present very differently to how I thought it did. I found this information very unsettling.

My first assignment is on Long Term Conditions. I had chosen Chronic Lymphocytic Leukemia but my academic tutor suggested this might be showing off a little. So I have decided to write one on COPD. I am still planning on writing the same assignment on CLL but I wont submit it. I find the condition facinating and writing this assignment will cause me to efficiently explore the medical and social implications. Is it sad that I do things like that?

Explaining All

So all of my fellow nursing students are in lectures. I'm on placement and in lectures. This is exhausting me. As so many people keep asking me why this is I thought I'd just post it on here and direct them all to it. Makes my life a little easier.

In order to pass a placement you have to have certain proficiencies signed off by your mentor who is responsible for guiding your education on the ward. I got through 11 weeks of the placement, there were two more to go and my mentor came up to me and said 'I cant sign your proficiencies off....I've never been behind a curtain with you and a patient'. She was quite correct, she just set me tasks and I got on with it either myself or with another nurse. Two weeks was not enough time to be observed doing all of the required things, she'd effectively failed me on this placement. She had never seen me do a damn thing. I explained that I felt it was unfair I was being punished for this and removed myself from the ward pending a chat with my academic tutor. My academic tutor got me into negotiations with the ward and I am back. Making up time sort of. However I could not be granted an extension on the handing in of my documentation for this ward because the university do not condone having a student in full time lectures and full time work at the same time(however unofficially this was the deal that was cut for me). This is why I am exhausted. And it seems I've failed the placement regardless of weather my proficiencies are signed. Where this leaves me I have no idea.

Understaffed

My ward is Acute Medical Respiratory. Due to the critical nature of most of our patients Our standard compliment is Four trained Nurses and Three healthcare assistants.

One shift recently there were two trained and one healthcare assistant(and myself but i'm 'supernumerary'). The ward sister got so pissed off with the EMAU sending us critical patients with our limited staff level and no warning that she locked the doors to the ward. The next morning there was only one trained on. These shifts were hell, I was doing things a student nurse shouldnt be doing without supervision. However we got through the shifts with no problems and I realised I always feel closer to my colleagues when we are massively understaffed. The nurse I worked with both shifts was wonderful, we communicated volumes through a simple glance at each other, I knew what she was going to need before she needed it and she knew what I was thinking. Its a level of teamwork I have not experienced in some time.

Sometimes in this job its the people you are working with that makes it worth doing.

Lack of Posts

I've not really been around for a while, this means I've not written or read many blog posts. There are two very good reasons for this, firstly the insane hours student nurses have to work. and I am now Engaged. This means my time is even less my own ;).