Thursday, 21 February 2008

One day that turns into two...

So, I'm working quietly along yesterday... Well. That's a lie. I was working very hard, and effectively.

You see, yesterday (on my early shift) a bank nurse had cancelled and NHS:Professionals (yeah, right) didn't let us know. So the Ward Manager sort of took over the bank shift, which left us one nurse down, effectively. I jumped in the bay to give a little assistance.

Before yesterday I didn't really know the WM. Ward Managers, by the way, are Charge Nurses (I refuse to use the highly sexist 'S' word) but a little bit more concerned with running the ward than the patients. It's a necessary job thanks to the buearocrification of the NHS, and I previously thought that perhaps our WM was good at that much had lost touch with actual nursing.

I was happy to be wrong on this occasion. On top of being just a tiny bit fit, she is an awesome nurse and a very good teacher - at least the way I like to be taught. She pushed me as much as I like to be pushed, but was always aware of what I was doing and whether it was going to go wrong, with a helpful push in the right direction.

Then, delightfully for me, she was shocked at my apparently immaturity (year and semester -wise), giving me another ego-filling 'I thought you were a third year' treatment. Happy, I was.

She complimented my assertive nature, and we had a discussion about how it's necessary within a ward.

Anyway, after building up a rapport and then realising after the early shift they'd be understaffed again, I volunteered to stay onto a full day, working under her valuable guidance.

And the day was a busy one. Good god. Four admissions into our bay alone, as well as doctors, EWS (Early Warning Scores; a piece of evidence-based practice used to alert nurses to deteriorating patient vital signs) going through the danger barriers and angry patients. And all this fuelled by chocolates and black tea.

It was lots of fun, but I was happy to see my bed. I wrote a list, before I got to sleep, of all the things I performed in the long day (which spans from 7am to 9pm). I'll place the list here, as not to forget:

- I prepared, spiked and started (including programming of the feeding machine) a bag of TPN. TPN is short for Total Parentenal Nutrition. This is basically a specially prepared and medicated solution that goes straight into a patient's veins, especially useful if their bowels are totally inflamed or they have had some kind of resection/removal.

- I mixed granulated feed (the name of which I've forgotten) with sterile water (soaking myself in the process, woo) and then set it up to be fed through a distal feeding tube.

- I practised non-sterile dressing. This occasion was useful as it allowed a patient to be discharged quite quickly. If they had waited for a registered nurse, not a supernumerary like myself, they would've been there another hour.

- I had plenty of fun talking to Doctors, who always seem a bit shocked when a student nurse speaks to them. I'm not arsey, like. I'm polite, but assertive. One patient was on a EWS of 3, which involves intervention from a medic within 30 minutes. This one I spoke to was sort of "I have to do next door..." but I, and the WM I was under, were nicely insistent.

- I removed my first cannula. I'd witnessed it once before, and I'm being taught on a very fun 'See one, do one, teach one' ethic. I performed this one under the supervision of a lovely support worker, who advised me of two tips: Hold cotton wool over the site with the cannula still on. And then pull it out, not up. It went well, in my eyes.

- I witnessed my first ECG, which didn't go to well. The machine that serves most of the hospital looks like something out of Life on Mars, so I wasn't surprised. Still, very interesting. One day I might know what the results mean, too.

- I talked my first patient through a discharge summary. This isn't rocket science, but it is a test of communication skills. And a vital step, even if a patient does want to be discharged ASAP.

- I learnt that I didn't know everything about Tinzaparin. I thought I was pretty good at injecting if, but there is always room to improve. For example, I now know the bubble should go in after the liquid to help with dispersal. I'm also supposed to go in vertically for the most desirable effect.

- Two more juicy bits of information. Supplements should, apparently, never been taken with meals as they are just that - supplemental. Additionally, mouth wash is never given with hot drinks as the drinks ruin any after effect the wash has by... well. Washing it out.

- She also helped me adapt my naive writing style as to protect myself and the NHS. Using seemingly innocuous words like 'stable' won't stand up if you ever have to go to court ("What does stable mean?!" the lawyer would scream "Is your idea of stable the same as someone elses?" Etc.). So vagueness is out. Additionally, you have to write everything as the patient's advocate. It can never even seem to look like you've forced the patient to do anything they wouldn't usually do. No decent nurse would ever do this, but some writing could make it seem like they did, which is dangerous.

The WM complimented me on a good day, calling me 'excellent' (which did my ego no harm). Thursday morning and I would be called 'our wonderful student'. I'm clearly aiming to be the poster boy of male student nursing.

So. Wednesday over. Sleep. And what do you know, but Thursday crept around the door. Getting up was not easy, but worth it.

Another hard day. I stayed in the same bay, despite the fact that I'd be working with a nurse I didn't really know. However, she's newly qualified and they're generally fresh and interesting to work with. She was no exception to this rule.

My patient who had been scoring a high EWS hadn't improved much overnight, so we had to keep a close eye on him. Not close enough, unfortunately, as he soiled himself quite explosively. I haven't actually performed much patient cleaning on this ward, and didn't really get a chance as the nurse I was under did most of the work. Which was, really, fair play as she wanted to get him washed and back to bed as quickly as possible.

The other gents in the bay were generally, okay. One old fellah (he lived through WWII) was experiencing lots of pain, which was sad, but I helped facilitate all necessary tests for him and his EWS was low, so not a huge amount to worry about.

One of my favourite patients might have been fast tracked to going home - they live a long way away from this hospital, so that should be awesome. It occurred through a bit of luck, which patients within the NHS could do with more of.

I had an awkward scenario with a patient off in a side room. Previously, I'd had quite a good relationship with him. Today I went in to explain something to him, but we agreed to postpone it until he'd finished eating. He had major GI problems, so any eating he does is very valuable.

Anyway, his wife turns up. And I reason 'He wanted five minutes, so I'll wait until they're up and let her in.' It was out of visiting hours, so I was by-the-book in the right and my gut told me I was, too.

He shouted at me soon after, to which I was a bit disheartened. I was tempted to not see him again on the shift, but thought that was hardly finding a solution to the problem. So I had a chat with him. He told me his wife worked long hours, was very busy and so couldn't make normal visiting hours. I apologised, telling him I'd know such facts for the future, and we ended in some kind of resolution. So I was happy.

One thing I could've done better was caring for a young patient with a history or mental problems. I didn't spend much time with them, however they were lucky enough to have a 24-hour carer and were relatively independent, in a side room and stuff, so I'm not sure I could've done much more. No point blaming myself if I couldn't.

My final act of the day, which ran almost an hour over my scripted hours, involved escorting a patient I'd never met down to an outpatient appointment. The patient was older than me, and rather nervous around people they didn't know. I successfully chatted with them, making them feel at ease, and trying to calm them down when it turned out we'd waited an hour to be told it was the wrong doctor someone had booked them in to see. Good grief. I wheeled them back up and said my cheery goodbye.

Not before the ladies from one of our bays gave me a birthday card (it's my birthday tomorrow). I felt a bit lost for words, which is rare.

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