Sunday, 2 August 2009

Still Alive (x2)

Yes. I'm still alive and - better than being alive - I'm still a nurse! For now.

I'm currently in the middle of a placement which has had ups and downs, although the first two weeks involved working with the finest Band 6 I've studied under, who also loved how I do things, told me to ignore ICU's criticism and keep on being proactive.

I might end up back in surgery in the future, actually. Scrub is certainly enjoyable.

Anyway, more later. Sunday looks to have a little sun in it, which I might actually enjoy, given half a chance.

Tuesday, 7 July 2009

New Placement

So, I started my surgical placement yesterday. I actually ended up working a little scrub today, before the procedure became quite out of control and ruined. I was pretty good, though. Used some initiative, thought things through.

Scrubbing up and working with the as-sterile-as-possible area is quite terrifying, I freely admit. Although I'm getting better and am determined to make my clinical skills spotless this time around!

I've also moved out, which is a bit of a nightmare.

I'll write more soon!

Thursday, 4 June 2009

Still Alive

Yes, I'm still alive. And still a student nurse, just about.

I was just signing on to wade into the debate on feminism and The Apprentice and whether the firing of Deborah was part of the patriarchal backlash.

It was first brought up by Jane Moore, a self-confessed feminist . Ignoring her, this very valid arguement that some behaviour in socially acceptable in men and unacceptable in women. This is a valid point in several debates, given we live under patriarchy and all.

The theory would carry more weight if there was a man left in the last five contenders who was abrupt, rude, ruthless and in-your-face. But there wasn't. In fact, most of men cut from this cloth were weeded out early on, so rather than take a solely feminist tack, it might be best to look at other factors. Woman or not, Deborah does rub people up the wrong way. Even her references didn't like her, y'know?

Anyway. It's a funny old thing. The 'business world' is still ran by white men who like to employ white men. Women are discriminated against particularly for various bollocks-reasons. Bolloc-easons if you will.

I actually like Deborah and I think she should've won the whole thing. Rudeness aside, she'd be a good person to work with. First off: she'd be too busy stabbing you in the front to stab you in the back and that's something I love. She has a can-do attitude and a love for business that made most of the other candidates look dull and passionless in comparison. But was it a matter of the style in which she rubbed people up the wrong way that lost her the deal in the end. And I'm not sure a man would've survived if he acted the same.

Friday, 1 May 2009



As well as confusion from my personal tutor, my peers have all turned out to be perplexed as to *why* I was failed by my last placement. That's a total bonus.

And half a week in University got me back into the swing of things. Action plans will abound, soon, and my next placement will be quite utterly useful. My skill and talent will actually be appreciated, according to my peers and my gut.

More soon.

Monday, 27 April 2009

I'm not alone.

That is to say I am not the only one who is confused in respect to my recent placement failure. I have just got back from seeing my personal tutor who was very understanding, and quite perplexed to the noted criticisms levelled against me. A visit to the ward might be in order, although I wouldn't go with them. I'd prefer not to see that place again for a long time, although it appears it might remain a weight around my neck for longer than I thought.

My tutor half suggested I should try handing in a PMC form in respect to the fact that a) no mid-term plan was completed, partly joined with b) I was given no targets to aim for in these things I supposedly hadn't made enough progress in. There is the issue that the ward didn't contact the University (until too late) and certainly didn't speak to my personal tutor. This is a bit contentious, though, as this is also my responsibility. I could argue I didn't think there was a massive problem at mid-term, but that is equally dodgy.

I don't think I will. A PMC would be a drawn out process with but a slim chance of success. I'd rather save a PMC for an occasion which really deserves and warrants one. Instead, my personal tutor and I have agreed I should be proactive. I'm going to put together action plans and PDPs in relation to the things I am supposedly not proficient in. My personal tutor is going to take them back to ICU and make sure they actually pin down some issues instead of making vague, wishy-washy judgements, and then I'll move on to my next placement with these improvements to be made.

My chin is firmly in the up position. I don't think I'll fail to retrieve any of the 5/20 areas I still "have difficulty" with, and these action plans and PDPs will make doubly sure of that.

Sunday, 26 April 2009

Failure et al.

As the title suggests, my performance has been evaluated and has been awarded a failing mark. And I'm miffed, pretty much.

If I have failed this placement then it is only fair to reason it has failed me, too.

I'm irritated about the feedback given, more than anything. I have not worked with my mentor very much. Less than once a week in real terms, so that's less than a tenth of my time on the ward. My mentor aimed second hand anecdotes as reasons as not to pass me. Not only were these anecdotes second hand, they were recycled, mostly, from the past 'little chat' which now, the way she phrases it in my paperwork today, was more of a disciplinary meeting. Little did I know.

To say I spoke to relatives about a complex procedure and gave them the wrong idea sounds terrible, but it's not as simple as it sounds. For example: The nurse I was working with had already discussed the procedure (the removal of a JP drain from the patient's head) earlier in the day. I went out to fetch the relatives from the waiting room, and they asked me whether the drain was out. I told them yes, since I'd took it out, and explained what I did. A week later, when my mentor told me this wasn't on, I said I would stop doing it. Which I did. My lips were sealed to next of kin and friends alike. Yet I was still taken to the cleaners with it at my final meetings.

Another occasion, on which I asked a doctor to prescribe our patient some potassium due to a dip in the patient's potassium levels, after discussing this with the nurse I was working with (who was there when I asked) was brought up. Again, I thought I was being useful but the ward didn't think so. That's fine. I didn't do it again.

I don't mind making mistakes, or being taken to heel because of them. I learn from my mistakes and don't do them again. If I do this, and am still criticised for them... what's the point in changing?

Although it was said that I was clearly keen and a hard worker, I was essentially told I should've been doing /less/. It wasn't documented how I helped various members of staff pin down violent patients when I should've been doing less. I wasn't even thanked much at the time for helping out. But that's as maybe...

I was told that, although my skills in basic care have progressed, they haven't progressed enough. There was no quantitative level indicated, so I'm not sure where I should've been. It was implied, for example, that I should've been quicker doing my drugs. I know people on the unit who, working on their own, perform their drug administration at slower rates than I did. This is ignoring the fact that I have to wait for two nurses to check the drugs, which often takes a while. I don't mind being told I should be more efficient with it, but if speed was the problem, there should've been goals set and targets to reach, in my opinion. And I'm not at all convinced not being very quick on the draw when it comes to NG meds counts as unsafe practice. Ditto for my time management skills. They've progressed, but not enough: how much is enough? Especially when there are a lot of things I, myself, cannot do on a shift.

The thrust of her criticism was also pretty flawed in my opinion. I was told I was too keen to do things and get involved in things I may not have a huge amount of experience in half way through my placement, so I adjusted my practice to be less forward. I get told at the end of my placement that I'm too cautious and taking too long to do things, like give meds. Seems contradictory to me...

A major part of the criticism revolved around my mentor not feeling I practised safely. One event in particular, actually, in which I gave closed, tracheal suction to a patient. At the time I was not aware I was breaking any rules. I had, in fact, been taught the technique by one of my associate mentors. I was innocent and foolish enough to think this meant I could... do it.

Another example of this: Bottom bags of catheters, when full, need to be emptied. With my associate mentors (who I spent the other 9/10ths of my time with) I was doing this quite simply by turning the tap and emptying them into a cardboard receptacle to be disposed of. I did this with my mentor, and was looked down on for not using an alcowipe on the exit port, which is apparently trust policy. I witnessed one of my associate mentors doing it the former way, no wipe, after this telling off. I informed her of policy and she just laughed.

Similarly, one of my associate mentors criticised me one day when I was leading the planning with a patient because I didn't listen to the patient's chest, via stethoscope, at the start of the shift. She said this would be a good exercise in getting used to chest sounds, linking what physios said to actual sounds in your head. 'Good idea!' I thought, and have started to do it when I get a spare minute.

Today, my mentor pulls me up on it. She says I'm not trained to do it, that I wouldn't know what I was looking for and basically implied I was being pointless. When she asked who advised me to do it, I took a little amusement in telling her it was one of her own nurses. Just a little.

I could bring up other examples of this, as it happened a lot. In hindsight I think I should've been less diplomatic and, when given a telling off for doing something I'd learnt from someone else, just pointed the finger.

The bottom line is: I should've kept my head down, spoke when spoken to and generally been a gutless whelp. If anyone was to ask me how to get through ICU, that's what I'd advise. Sticking your head above the parapet is not appreciated. As it has been in all my other placements. And I don't think I'm going to change what I do, overly, in the next placement I have. I have to get retrieval marks now, for the 5/20 areas which I still have 'difficulty' with. I can do that.

I could go on about how the feedback was unjust, but I'll be doing that to my personal tutor tomorrow. As well as planning my future acts to make up for this slight dip. My mentor has already contacted Uni with her concerns and to get guidance on what to do. I have my turn to speak to the institution tomorrow, it seems. And I'm positive about it. My chin is utterly up.

I'll end this ranty post with the point that, near the end of the interview, my mentor said: "If you were on any other ward, you probably would've passed..." which, to me, demonstrates a sense of arrogance or disregard for other clinical environments (Probably why some people don't like ICU staff, I'd venture). This mentor hadn't read my first placement of this year, never mind the other three, all of which I've passed. Quite a pertinent point to end on.

ICU is different to anywhere else in a hospital. This doesn't make it better, in any sense. There's no qualitative judgement to be made in that case. Student nurses can't be as involved as they can be in a normal ward. That's par for the course. And I ruffled a few feathers as I adapted to life on ICU. They act as if you're supposed to be an observer and yet complain when you don't make any progress within seven weeks. Or they did to me. Maybe I just didn't /get it/. 7 weeks isn't a long time, in my opinion, and I think I made some progress. I will take on board some of the ideas levelled against me, and attempt to improve. I am in no way saying I had a flawless placement. But that's their fault, as well as mine.

Saturday, 25 April 2009

Penultimate Shift

It was two days ago. I'm late, so sue me.

And due to a toothache I'm not feeling recovered at all. But I'll trundle on.

It was a good shift. A shift which started with one Level 2 patient and ended with a different 2/3 patient. The story of the latter was somewhat sad, although I'll find out tomorrow just how sad it turned out.

The patient had a medical history as long as my arm, for starters, and was no spring chicken. These two things set off warning bells, in my head, at least. This patient was brought into A&E and then into ICU due to a quite tenacious case of community-acquired pneumonia. Placed on CPAP for a long, long time. CPAP basically comprises of a spaceman-style facemask. Something you are basically strapped into. You might get a break once every four hours, if your oxygen levels are up to it, but generally you're stuck in it. And it's like hanging your head out of a car window at 70MPH (although without the risk of it being knocked off comically by a signpost). Trapped in, blown at. And you can't drink, eat or talk to any useful degree. Not pleasant.

On the plus side, it is very, very effective. The patient was improving. There had been fears the patient would have to be sedated and intubated if their condition worsened, which was entirely possible. The doctors were optimistic (this is, as previously mentioned, rare). The nursing day was going well. We were on top of things, would you believe! And then, of course, something happened.

After having a few visitors, the patient decided they'd had enough of the mask. We spent a little while trying to convince this patient that keeping the mask on, as difficult and awful as it can be for the whole day, would be the best thing to do. As a compromise, my mentor decided to step him down to a normal face mask on high, high flow oxygen.

And we watched. The patient seemed happier, the family were a lot more worried, but the consultant said we'd see how it went. And within a half hour their saturations were holding well, blood gases weren't terrible. My shift ended then and so I'll see, on Sunday, how it panned out. Well, it goes without saying, I hope.