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.

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!

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.

Vindication

Almost.

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.

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.

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.

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.

My First Ambulance Placement

Indeed, on Monday I spent a day with the Ambulance services, touring around this fair (unnamed) county. It was enjoyable. I put some effort in, where I was allowed, and (unlike in ICU) it was appreciated!

The crew were tip-top. They were both technicians, which (to paraphrase them) meant if we were sent to any RTAs or the like we were pretty much fucked. Technicians are somewhere below Paramedics. They can't give out strong medication, etc. But one of the technicians I was working with had passed all the exams and was just waiting for a 'medic spot to open up. It's all about the money, as usual.

Anyway. Despite this excellent book and the attached blog and the warnings thereof, we received no pointless calls! All day! I was almost shocked.

We went to a couple of falls of old people who were frail enough to require a trip to hospital. We attended one patient whose shoulder had popped out of joint, for the 35th time, and was in intense amounts of pain.

Could someone from A&E tell me why such a patient wasn't given morphine when the patient was brought in? Weird, I thought.

We attended an old dear with dementia who had been found half collapsed in the street. The police gave them some water as we turned up. The patient's offspring also arrived, someone with the patience of a saint. This elderly patient gave us various stories and wives' tales during our little check up. This patient also refused to go to hospital, despite appearing in massive amounts of pain, at points. There was a large amount of paperwork to fill in for someone who a) declined a trip to hospital and b) didn't appear to have capacity to make such a decision. The offspring signed it off, we put them both in their car, and waved them off.

That is a whole different kettle of fish. Although the old dear received some help at home, it didn't seem like enough from what we could gleam. And it's funny, but not shocking, to think of paramedics dealing with the fallout from shit government policy.

It was a good day. I gained awareness and a bit more of the love I've lost on ICU. For helping people, etc.

Good news..

... and the bad news.

More feedback from my day calling the shots.

Positive:

Improvements in mouth care, eye care, ANTT, dressing changes.

My planning began well, especially given there are only some things I can plan for. It was my second long day and my first ever day planning a day for a patient. I kept an eye on infusions, which is something I haven't been too good at before. I planned for turns and the like in advance.

Negative:

I think too 'medically' and need to take a step back from this.

My planning became less effective as the day went on and our patient deteriorated.

I was too rigid and set towards set times, when working on ICU involves doing some things early, some things later, not necessarily on the hour.

Basic cares still need improvement.

I need to not talk to doctors without speaking with nurses first.

---

These are the views of my associate mentor. I'll talk about how I feel re: them later, but just wanted to get them down. It is the end of my last two long days in a row, I'm teary and generally irritable. I'm conciously accentuating the positive and eliminating the negative, as the song goes, and will reflect again soon.

Progress, though, is important! It should be noted I also directed all medical questions from the family to someone else, which is more progress.

Right now, though, I hate this placement and parts of me hate nursing because of it.

I do need some sleep, though.

Positivity!

So yeah, I'm bouncing back.

I had a good shift today. My removal of another central line was good, if a little methodical. My planning was more than adequate. I worked more things through than I usually do. And! I even managed to keep my mouth shut to various people and played the good little student nurse.

I'm happy. This placement is up and down and today is an up.

My associate mentor said she's going to e-mail my main mentor informing her of my solid progress. At the same time, working with her tomorrow, she plans to give more authority for planning and implementing to me tomorrow. Which I'm looking forward to, big-time!

Negative Feedback

Indeed, I received some less than positive feedback today.

It was delivered nicely. Almost apologetically. I'm worried, but I would've been *very* worried if it was delivered in a stern sort of way.

Anyway. For almost two years now, I've been pretty up on my A&P. And my time with cardiac rehabilitation had me talking, at an easy to understand level, with patients and their relatives. It's a trend I have continues, since my last mentors seem to like it.

However, this is not how it's seen on ICU. There have been some queries and complaints made about me overstepping my bounds and doing this too much, which has been pointed out to me. I don't think, with two weeks left, this is a failing thing.

Personally, I think it's better to be keen than not interested. Obviously, if my behaviour would've become dangerous to patients, then it would've been too much. I was warned, for example, for giving internal suction when my mentor wasn't really watching. Someone has trained me, though, and I have done it before. More than once. So is this my fault?

Either way, I'm reining in my exuberance. It's a fine line to walk, and I'm not entirely happy with my progress, but it is progress.

And my patient today was very happy with my nursing. So I must be doing something right.

Interesting times.

As the old Chinese curse goes, this is not always a nice thing to say.

It's Tuesday, right? My days are all off kilter. Tuesday. I like Tuesdays! I'll get to them later.

Monday was the aforementioned interesting. Sunday, as you may or may not remember, involved me following a patient with some neurological problems into surgery. I was with this patient again for the whole of Monday. From a nursing perspective, my mentor was very good in letting me plan out the day and - for an hour - we stuck to it. Then the doctors arrived and announced the necessary (if fucking irritating) plan of letting this patient off sedation.

For those not educated in the fine arts of critical care, this involves turning off the sedation and waiting for the patient to react, which is often by coughing and choking. With this ability to protect one's airway, the ET tube can be pulled out and replaced by a face mask ('weaning'). Patients are generally confused when 'waking up' from sedation, which is usually fine. It lasts for a little while and they settle down. Sometimes you have to be firm with them in order to keep the face mask on them and oxygen going into them, essentially life preserving treatment (the idea of taking someone from ventilation down to simply breathing room air is not often a good one for patients in ICU).

This patient had quite the chequered history. I am mentioning no names or no real details here, therefore am not breaking confidentiality I rush to remind readers. The patient was involved with the police. The patient had a history of drug and alcohol abuse, the former of which meant we needed visors, to start with. The patient was agitated on the cessation of sedation (try saying that ten times fast). This continued and continued until we couldn't keep a mask on this patient with just two nursing staff and one doctor. We, with effort, swapped them to nasal specs (those tubes which pop up each nostril) and the patient seemed to relent at pulling at them.

This was the beginning of problems. The patient was also riddled with lines used for feeding, medication and monitoring and the patient decided to turn their wrath on these lines next. This reaction is not uncommon, as the feeling of intrusions into the body isn't very nice. However, they're all vital so, short of sitting on the patient, I managed to keep them in for a bit.

By now, the patient was swearing, shouting, digging nails in and generally being abusive to us. This is not uncommon, but is hardly helpful. The doctor had left by now, leaving myself and my mentor to try and keep the patient from from hurting themselves.

This is a big issue within nursing. You can talk about the right to autonomy as much as you like in the class room, but should someone be autonomous in causing themselves large amounts of damage in (and out) of a hospital bed?

Anyway. An hour after this and the patient is still agitated, still physically and verbally aggressive. My mentor and I (after consulting the information at hand as well as the patient family, who simply laughed off the aggression as something apparently hilarious) decided the patient was actually quite orientated and just a bit of a nasty. The patient began, from then on, to verbally and physically refuse cares. During this drawn out period we were punched at, kicked at (he missed, just about, with one on each), bitten at, swore at and successfully scratched on more than one occasion. With the help of another nurse we managed to pin the patient down for long enough to change his trousers, clean up his entire body (the patient had had a bowel movement and spread it all over themselves, their catheter and their femoral central line. Faeces staying around this area? To call that simply 'an infection risk' would be like calling Nick Griffin 'a bit old fashioned'.

During this time, we were shockingly nice. Vocally and in general. My mentor continued to give the patient pain relief, despite being told - in no uncertain terms - to 'fuck offffff!'. We continued to put our bodies into the line of fire to keep the patient in bed and generally safe. We removed all the lines as quickly as possible and were generally worn out by the end of the shift.

We weren't, for the record, allowed to place 'boxing gloves' (i.e. the act of bandaging the hands) on the patient. The coordinator said, because there were two of us (I'm not supposed to be in the numbers, remember), we weren't allowed. I viewed this, as well as the whole lack of staff and support as a shocking let down for us. As did my mentor and the nurse who helped us, and we all filed incident reports after shift. Otherwise nothing'll get done. Nothing will get done regardless, but at least we tried!

More on this later.

It's not brain surgery...

Actually it is. What I saw, today.

It started off as a normal long day of a shift. My associate mentor is still off, so I was placed with a Band 5/6 and set about working. Or trying to. Despite the fact that Annoying-Band-7 told us our patient was ready to be moved into a side ward due to an infection, he really wasn't. In fact, the night nurse had no idea he was moving.

That put us back about two hours, with a patient who was already quite sick. Sedated, ventilated and bed bound. With a history as long as your arm and a very poor prognosis. A history of strange behaviour and substance abuse. After a day of helping provide care to this quite Level 3 patient, of which I was mostly successful, and then got to go and watch him in surgery.

I got to scrub up, which was more than interesting as an experience, and then I got to watch the worrying experience of cutting open a head, drilling through the skull and taking out flaps. It was... an eye opening experience. Which, given what was happening to the patient, was probably quite a luck event. I'd rather have my eyes opened than my skull...

Another two long days down and out.

And I'm tired. The random nurse I spent the PM working under let me off an hour early, for which I was thankful. Tired but happy, I got home in one piece and drank some tea. Only then was I ready to write this.

It was a good day. Hilariously, none of my mentors were around to see it. But I planned well, I pushed on with my essential skills (a trachy-dressing, with some assistance and minor mistakes) as well as planning the day and going through with my plans. Management-tastic. A good day.

I have the day off tomorrow, in which I'm shopping for more of my packed lunch and going the bookies. Not in that order. And then I'm going to curl up, cat-like, and sleep.

"The breach" indeed!

What a day. 15 hours today and 15 tomorrow. I'm only coming online whilst I eat my supper, which is much needed after such a day.

It's really my fault, in a sense. I started the morning with the physios, spoked, as it were. I thought that'd make for a quiet shift.

Idiot.

I joined up with my mentor soon after and helped look after an old dear with dementia and a broken, operated-on hip. The patient was, as it can be termed: "pleasantly confused". If you didn't mind telling the patient, once every three minutes, that they were in hospital: they were a ball.

Then lunch. Lunch included my interim interview, in which my mentor let me know my ability to provide basic care wasn't proceeding along as much as my knowledge and ability to fit into the team. I was annoyed/upset at first, but then I figured: a) I have over half my placement to work on it and b) ICU sets trends essential care. It'd be silly if I thought I was up to their standards already, especially since I haven't been in a ward all year.

So, onwards and upwards. From 2PM upwards, I had a new nurse to work with (who worked me like a dog) in the admission of a patient. This is something, as previously blogged, I haven't had a chance to do. I took a big part in this, and it was a busy one.

The scary part was when we were changing this patient's sheets, later, and turning the patient, too. I took charge of changing the sheets, cleaning up the patient, whilst two nurses held the patient, mid-roll. When rolling a patient, the ventilator generally starts to alarm as breathing is interrupted. Very quickly, however, we realised the patient was going blue. Not just blue. Grey! I shit you not, straight to grey. So the nurses reacted quickly, bagged them, insisted the patient wasn't going to let themselves down so easily, and brought him back from the breach. Amusingly, once the patient was sorted out, a Band 6/7 came in to shout at us for talking whilst moving a patient. We were not talking about going out and getting pissed, or reciting Hitler's speeches. We were just chatting. Yet, apparently, you have to be robots.

After that, I finished most of the paperwork, which was an experience in itself, and handed over to the night staff. Exhausted, the nurse I was working with told me I'd performed really well and let me go. Hopefully she's checked all that paperwork, because I was, rather adorably, muddling through. I feel good, though!

Back into breach once more.

This is my last day off. I'm celebrating with gingerbread right now, whilst later on I plan to go out and learn some more dancing the NMC wouldn't approve of.

This post got me thinking on mentors. Mentors, like it or not, build new nurses. University certainly doesn't. University teaches abstract ethics which are applied to theoretical situations (if you're lucky) and informs how to lift boxes and place them down correctly. The fact that we had many sessions on this and only one on how to move a patient? Pretty sad. Anyway. I'll hop off my soapbox for a bit and get on with the issue.

I recently commented on the above blog post in relation to the idea that mentors are overworked and struggle to teach students under their guidance due to this shortage of staff and large workload. I don't mean to say this is bollocks, but it sort of is. Let me elaborate:

I have had many mentors. Well. Five actual mentors so far, and probably about fifteen more who I have worked under due to staff shortages, etc. I have had good and indifferent mentors. Noone I would honestly view as deliberately *bad*, which is certainly a good omen for nursing education, but there have been some who simply aren't that bothered. Like they tolerate you following them, trying to soak up knowledge like some hungry piece of floating plankton, but aren't willing to help.

Were these types overworked? Maybe. But, in the cases I have experienced, they seemed more apathetic. These are the types of people I always guess might sell half of their human rights and civil liberties for a free parking space and this attitude can seep into patient care. Thus: I don't agree with their politics or professionalism. One of my favourite tutors always tells us that, although students should challenge actual bad and dangerous practice, it's more about leading by example with best practice, candor and professionalism. And that's what I try to do.

So, there are the not-so-good mentors. What about the good ones? The inspirational ones? They're worth waiting for, certainly. I'd say, to become part of this elite group, one needs to be knowledgeable and on-the-ball. One needs to be able to say *why* they're doing something (as a good student should always ask). A good mentor also needs to treat a student like an adult. Older, younger: doesn't matter. A nurse I worked with recently spent a lot of the night asking if I was happy with the treatment we were giving. Whether I said yes or no, she'd ask me why. This is proactive and works with me, big-time.

The mentor's job, however, is not to drag a student along. My comments are sort of sullied by the fact that I'm one of those killed cat (read: curious) types who is always asking questions. And to do things, too, or join in on other procedures. I am driven by many things, but one of the driving forces is a sense of disgust and dismay at those nursing students who lean against the nursing station all fucking day, scratching their arses and whining about nothing interesting happening. If a mentor is faced with someone so lazy, disinterested and unsuited to nursing, it must be a challenge.

As a final point, the clinical environment the mentor is based in is important. Standard medical wards are often understaffed and a good student nurse can, under supervision, end up with responsibility for a couple of beds (drugs not included) which is excellent experience. A critical care ward, on the other hand, involves a lot less of that type of responsibility. The student might be more hands-off and student and mentor must be a bit patient (no pun intended).

In conclusion, I refuse to accept that poor mentoring can be blamed on overwork alone. Overwork plays a role, but so does the character and skillset of the mentor, the type of clinical environment as well as the history of student nurses they've worked with.

More Placement Thinking

I had these really current and up to date posts typed up in draft form and thought Blogger saved them for me. I was wrong. So I'll be quick, instead.

I am in the middle of a mini-week off. I spent four nights in work, adapting temporarily to the life of a vampire nurse. Stealing pinpricks of blood and walking around silently.

It was a mixed week in the end. There were a few less than hum drum moments in which I thought nursing wasn't for me after all, and there were more than a few moments in which my faith in the profession was reinvigorated. The nurses I was working directly under, one my main mentor, one a complete random, were helpful in this. They told me how I was fitting in with the team well and coming off as competent, to say the least, which helps.

All a bit vague, I realise and apologise.

To be honest, I think I thought ICU was going to be a more intense experience than it has been. Maybe I'm getting off easy. Or maybe I'm emotionally hardier than I thought.

That's being 25 for you...

I'll get back here with more specific things soon. Right now, I'm enjoying a mini-week off, due to the glory of how my shifts are arranged. Time off is almost as important as time on, after all...

Second Week, ICU and bedpans.

This post isn't really about bedpans. It's just better if these things come in threes.

Although, come to think of it, my patient today (my third one, something I'll touch on in a bit) did think the bedpan/bowl I was holding with a hat. We decided it'd pass for formal wear if it was painted black.

Well, sort of we. They are a funny one.

I post today for various reasons. My mentor gave me a few hints of things to reflect on, and I will choose to reflect on here, in my trademark glib manner before putting pen to paper and going all serious and shit.

The long and short? A Band 7 spoke to my associate mentor, and I, like we were pieces of shit on their boot. Backstory:

We started the day in a side ward, with one patient who had been placed there with a suspicion of C. diff, although by the time we came on shift she had quite formed stools, so we were happy. This patient was a bit... mobile around the bed. And unresponsive to commands, but generally well. Quickly as possible, we did all the transfer stuff for a step down to NeuroHDU.

This was all the more rushed as there was a patient in surgery, awaiting the bed we were clearing. Excited, I was going to see an admission and discharge on one day! This stuff is important so you're not completely clueless, really.

The fly in the ointment was a logistical one*. There was a member of the nursing team close to finishing their supervised placement who it was said would take point on the admission. My actual mentor said I could still be there, though, and that was agreed by all the staff on the floor to be a good idea.

However, Band 7 comes along and - with one of those laughs you want to swap, in your head, for the sound of rancid, jagged nails down a blackboard - gives this: "I didn't realise you had a student with you!" (When she hadn't actually popped out from behind the nurse's station since start of the shift). They proceeded to tell us their brilliant plan involving my associate mentor supervising the admission and the new nurse doing it. We kinda looked at each other and said: 'That's what's happening, yes, we thought.' They proceeded to say how that meant three people would be far too much. We replied with what we'd all discussed on the floor and they said, I shit you not: "This is *my* plan. Two of you."

Enough said. Moron.

A patient I wasn't looking after, someone who has been in ICU for a while and is making some progress, decided to pull out their tracheostomy tube today and refuse to let it stay back in. It brought up an interesting ethical dilemma, as I discussed with my mentor. Patient autonomy is important, naturally, and yet there's an issue as to whether a patient can make an informed choice on below 85% oxygen saturation, something which was happening. The patient had been in ICU for over a week, too, and there's also the issue of ICU-created psychosis, which is more common than I'd thought. My third patient today had it, but - as mentioned - they are a bit of a funny one, either way. I reckon, with the ability to breathe and talk, they would probably be a bit odd. In a nice way.

The medics, in this case, decided to remove of the trachy-tube and replace it with a trachy-mask, even with the risk of desaturation and respiratory distress. They also removed their arterial line in an effort to make them feel less tied to a machine. It was very difficult the patient grievance when they could not actually talk. The patient was was mouthing something about having waited 5 days for something, but it was unclear. An accelerated step down from trachy-mask to uncuffed tube to fenestrated tube would end up with the patient being able to articulate, verbally. Only then would someone be able to decide if his ability to stop such treatment was an informed choice. And I think, ethically and professionally, the medics made the right choice.

The patient was uncooperative to the nurse, but I don't think the nurse in this case was very understanding. They displayed what I thought was a short fuse and seemed bereft of empathy. I go onto nights tomorrow so it'll be interesting to see how the patient in question is doing then, either way.

*Logistical flies in ointments are the worst kind.

ICU, one week down.

Indeed, my first week of placement on ICU is finished. Sadly!

I'm enjoying it, thus far. It's difficult, y'see, in a challenging, rather than dangerous and horrible, way. As a taste, for the first day, I witnessed back-to-back tracheotomies and helped on the second, which was not entirely by-the-book. You'd think holding a tube would be pretty easy, but it's really not. The doctors were awesome, though, talking me through all the curves.

I'm a bit tired, after two Long Days in a row. Suffice to say, I've learnt a lot already. I like my mentors (associate ones) and I like the staff I've met.

The first patient I had, in shaky writing (since they were one of the trachee'd patients), expressed disbelief it was only my first day. It was sweet.

Sexual Health

Teenage Pregnancy: up.

Sexually Transmitted Infections: High.

School Nurses: Low.

Sex and Relationship Education: Low.

It's not fucking rocket science, New Labour!

I'll get to a decent post soon, but this has annoyed me.

Been long enough, I know.

I've been busy!

News:

I had an exam last week, which was entertaining. I feel good about it, as exams go, and so am not too worried. A few people on the course didn't even answer all 5 questions, which is worrying, if you ask me. It was about a MI patient, and MIs are going to be more common when we qualify.

More News:

My next placement is on ICU. I am terrified and excited all at the same time. On top of that, I am one of six students who will be working there for various periods. Means I'll have to be on top of my game. Which I fucking love.

More later.

Men

The BBC today are running two articles on men and childcare.

Which is a nice change. However, the first of these articles highlights two major problems related to sexism. Firstly, people working in the childcare sector are massively underpaid, especially when they are reasonably skilled workers. This is linked to the fact that the majority of these workers are women and women are massively underpaid in a patriarchal system, but also linked to the idea of 'value' for the 'role', I suppose. Secondly, pushing for men to go into the jobs and actually providing encouragement is a massive job, not something one slips into a statement from an organisation. Paternity time has increased under the Labour government, which I'm vaguely thankful for, but until a more equal scheme comes into play in which mother and father can divvy out a pool of parent-time between them, I don't see how men are going to be actively encouraged into such a job, or indeed encouraged to care. Sad, really.

Back to the salt mines.

Christmas and New Year are over, 2009 is so far treating me well. I had a mock exam on Wednesday, which went relatively smoothly, although it formed a warning. The warning: Examiners talk bollocks. When I read the mock answers, I mean. I will have to bear this in mind.

But no, obviously I'm still alive. Not much to say, but I'm sure I will do once this new term starts rolling along.

I was going to comment on how much I dislike non-socialist feminism today, but am too happy to moan. I'm sure I'll wax lyrical some other time.