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.

Diary Summaries Year One

As part of my 'get-my-fucking-act-together-and-organise' routine, whilst waiting for a pointless biology lecture I can not get away with skipping over I've completed my diary summaries for the first year. Read and enjoy: or not, as they're quite dull. I'm really only pasting them here as an online back-up.

Diary Summary: Semester One

My first placement saw me based on a neurorehabilitation ward. Being rehabilitation based, the ward saw the same patients for long periods of time. The placement gave me extensive experience of the workings of an MDT, most of whom were attached permanently to the ward. This gave me valuable insights into the roles of the Occupational Therapist, Physiotherapist, Psychologist and Social Worker. I attended two MDT meetings and became aware of the evidence based practice and clinical governance that would be used within them.

From a nursing point of view, the placement gave me solid experience of essential cares, especially to bedbound patients. The nature of the ward meant I developed my skills in building up relationships with patients on a day-to-day basis. These two basic skill sets would be vital for my further placements. I was also taught more advanced skills, like Neurological Observations and how to effectively tally a Glasgow Coma Scale, skills that would also prove useful in later placements.

Due to the nature of the injuries and conditions of the ward's patients, I was able to complete several sections of my Exposures booklets on this placement. I passed my communication OCSE. I gained an insight into the often complicated area of acquired brain injury, too.

Diary Summary: Semester Two

My second placement saw me based within a surgical ward specialising in gastroenterology. This seemed an ideal second placement as, unlike the former ward, patient turnover was generally quick. Unlike the previous ward, the was less input from a MDT and more input from the nursing team.

From a nursing point of view, the placement encouraged the development of skills relating and communicating with patients who I would only meet for short periods of time. This was a valuable experience that taught me the value of different ways and methods of communication, and posed quite the challenge. From a clinical point of view, there were more things to witness and start to learn: the removal of surgical slips, chest drains and catheters, for example. It was on this ward that I experienced my first patient death. And I worked my first three nights of my training.

Like the previous ward, this placement allowed me to complete more of my first year paperwork, including my Administration of Medicines booklet. I attended special sessions on new techniques and equipment used in NG feeding and special sessions on gastric banding and bypassing for bariatric patients. Otherwise, my time on the ward developed my knowledge of the GI tract and it''s role and function in daily life.

Diary Summary: Semester Three

My final first year placement saw me on a acute medical ward. The balance of MDT and nursing input was more equal in this environment, and there was a mix of long term and short stay patients.

From a nursing point of view, there were further opportunities to learn more about essential care. Given the ward received predominantly cardiac patients, they often needed help mobilising or washing. There was less to do and learn from a clinical point of view compared to previous placements, although I did receive more practice in preparing and administering IV solutions. These would often be diuretic solutions, therefore I also learnt quite a lot about the action and results of these.

I finished up my paperwork for the first year. The context of the ward helped me develop my understanding of the heart, it's A&P and the impact heart conditions have and will have on the growing, ageing British population.

Back to reality

Paperwork has hit me like a steam train. I forgot just how much stuff was due to be printed, completed and triple signed by the end of term.

I have quite a varied palette of talents, but ultra-organisation is not really one of them. But to keep up with the quick pace and massive amounts of paperwork, I've bought a hole punch and lots of folders to sort things through. And I am quite stubbornly determined to not fold (no paper pun intended) but to keep this up. It's not enough to be good, you have to strive to be even better.

Other than that, I miss my last ward. Just the general concept of working is easily missed. I miss working with people. But it's still fun and useful to get out in the real world and meet real, non-sick people. Reminds you what it's all about, in a sense.

In other news, I went back to my hometown for a sibling wedding. I have... family issues, to say the least. So it was not the most comfortable weekend I've ever spent, but it had it's up points. Some old mates, outside of marital affairs, reminded me of why I like them and why I like being me. That certainly made the trip worthwhile.

I almost failed my course and all I got was this lousy t-shirt...

So, yeah. Busy week.

On Tuesday I was told my paperwork was due in on Thursday. That's today. As previously discussed, my current ward has staffing issues. Which means, on Wednesday I had to flutter my eyelashes a bit to get this anywhere near finished. So I worked a whole day Wednesday to meet one of my mentors (I have about seven, thanks to said staffing issues) who was coming in on a night. I begged her to finish the important bits overnight so I could hand it in and be done with it. I got up at 6 this morning to pedal all the way there to pick it up. I had to wait an hour to have it signed off by one of the Charge Nurses. I pedalled all the way back, scanned it, got it signed off and handed it in. Phew.

Except for the sheer amount of pencil I've used, and the fact it's a rush job, it counts as a pass. I'm eternally thankful for said fortune.

Ontop of that, I was supposed to pick up essay feedback a month ago that I forgot about. I've sorted picking it up from the big cheese of the University tomorrow. Hopefully I'm going to get through that with the minimum of interrogation. I might pass, too. That'd be nice. But the resits are at the end of next month, which I'll certainly pass, worse case scenario.

The only other issue today: I found someone's practice placement book today and, after e-mailing them to tell them where it was, had a peek. They've done lots more spoke placements (in other parts of the hospital) than me and have dressed things up more. I mean, they've wrote this big blurb about watching cathertisation happen, as an example. Now, I've saw bits and pieces and took a catheter out myself, I just haven't tarted it up for my book. And insecurities aside, I'm predominantly happy. I'm still a good student nurse, impressing third years I work with, so I can't be doing that bad. A couple more spokes, and I'll quest to get some more skills on ward. Good to go.

Now, I might sleep.

Friday, I'm not in love.

So, two shifts later. I spent a hungover late Thursday shift, with little sympathy from staff or patients.

I decided to bash through an early on Friday, which this mood of mine is the end of. I had a busy shift, in bits. One bedfast patient caught a lot of time from various members of the nursing and student teams, soaking effort up like a sponge. This patient should really be in either rehab (they are, according to rehab teams, not rehab-able) or a home. Not an acute medical bed.

I spent most of the rest of the shift (which I should've spent working with my actual mentor) was wasted down in Ear, Nose and Throat with one of my patients. I've made this jape again and will make it. Our time down there was like a Bob Monkhouse show. Joke, after joke, after joke (Geddit??). Firstly, despite booking the porters in time, they didn't arrive, hence why I had to take the patient down. Then two reception desks were closed, leading us on a merry dance. Then ENT had no idea what we were there for, so I had to explain what was already in the notes. We waited an hour before they came back, asking us more questions about why we were there. Finally, after a while more of uncomfortable waiting, the patient was dealt with.

This is not the first time I've waited forever in ENT. If they know there are always delays, why schedule the appointments so close together? Dolts.

I got back, roped into helping to change that bedfast patient. Just to prove my skills are still immense, I also ran the blood sugars of the patient who I'd pushed and pulled down to ENT for those hours. They were also a diabetic, which is another reason waiting two hours somewhere with no suitable food might be a fucking stupid idea. It was high, so I suggested DGN give the patient ActRapid, which is treatment for high blood sugars. DGN looked at me, stating that ActRapid was only to be used if the blood sugar (BM) was over a score of 20. With an enviably level of humility, I informed her that this patient was to have a lesser dose of ActRapid if the BMs were over 16, which they were. Good to know I was still on the ball after all that.

In other news, my paperwork has almost been started. 5 weeks into the placement. Not a big surprise. In fact, I'll be more surprised when someone actually gets my paperwork done on time within these 3 years. When or if.

Biology

Yes. I actually learnt something (about biology, obviously) today. Which is good, in my book.

But on the negative side I've had my eyes opened to more pitfalls and downsides of my chosen career path.

Nursing is in a state of flux. To use the term 'is' is perhaps wrong as it seems to insinuate that it hasn't always been, which is has, in one way or another. But now is important to me, so that's what I'm talking about.

Articles and anecdotes tell us that there are some nurses out there who plain don't care. This is a bit of a tragedy, but hardly surprising. Public servants have become more tied down by paperwork, depending who you listen to. Paperwork is a blanket term but covers the problem rather nicely.

So, why do we have paperwork? Well, a personal bugbear of mine is this new, American-style sue-culture. Paperwork was created in response to this, in my experience. The sue-culture lead to accountability, and accountability can only be recorded through paperwork.

So that is a very simple way of explaining the root of the problem. It's the same sort of issue for the police. Paperwork Vs Accountability Vs Modern Life.

The Daily Mail routinely trots out the old 'Paperwork takes Bobbies Off the Beat' rhetoric, but through the repeated headline-grabbing-soundbytes there is a grain of truth. Paperwork has became a problem for many important public servants.

On the front of nursing, the problem is not simply paper. Other forms of red tape have been introduced in response to accountability by the giant, hairy monster that is 'Management'. This is adds up to nurses becoming occupied with arguably less important duties, leaving less time for actual caring.

I, personally, am prepared for such hilarity before my first placement. Nursing is hard work - it always has been and always will be. The reasons it has been hard have changed over time, but that's all in line with the changing world we live in.

Any nurses who have recently qualified who aren't prepared for the rigours of red tape and paperwork are, at best, naive. At worst, well... I don't want to be horrible.

Older nurses who have felt it coming over the last decade, perhaps more, have had a choice to make, in my opinion. Either they stay a job which they seem to hold in disdain because of the avalanche of bureaucracy and let patient care suffer, quit the job to go onto something which doesn't involve paperwork (Like what, I wonder?) or just get on with it. From what I've heard and experienced the first of these three is an unfortunately well prescribed choice of path.

In the first few weeks in training, the word 'care' has probably been the most used. I get the impression if you stop actually caring then you have no reason to be a nurse. Why even a small number of nurses - young and old - decide to pursue this course of action mystifies me.

Throughout my working life there have been many occasions when I've thought - or even said: "Not mah problem, luv". And I've laughed about it, or even quite sadistically enjoyed the experience. Because customers can be stupid, plain and simple (I meant the last two as the expression, but it sort of counts, too).

Patients (or clients, as the NHS seems to be leaning towards calling them) are often stressed, scared and distressed. I'm a critical sort of boy, but even in my book this gives them a little leeway when it comes to being a bit stupid.

In the same vein, being a nurse isn't like working behind a till a bar. Life, health and well-being are at stake, rather than... Well, a frozen steak or a spilled pint. Some die hard capitalists might want to argue with me, but I think that's a mostly true statement. When I worked in a well known computer games store I was head of PC Games. If someone asked me about XBox games, then, I would sometimes just shrug it off and half-heartedly explain: "'s not my area, mate,".

You read and may have even experienced nurses doing the same thing. 'Pillows? Not my problem.' 'Oh, I don't handle IVs, sorry.' This kind of attitude within the retail or service sector is regrettable and in a perfect world it wouldn't happen, but it's not the end of the world. The difference in the retail world is that, generally, you're selling something the public wants. And they're probably going to buy it from you, all things considered.

When it comes to nursing, though, this sort of attitude is despicable. It goes against anything and everything nursing stands for. To use the retail analogy, nursing (in itself and as a small part of the greater healthcare pie) is not about the end product. If you wait a while at a bar and get a pint with too much head (ooh er) you're probably going to shrug and get over it. Maybe get served by a different barkeep next time if possible, or - at an extreme - go to another pub. You wanted a pint. You got a pint. It's that simple. Nursing is more about the journey of a patient. In a large slice of occassions, nurses rarely ride in on a white charger and save someone's life. Depending where you're working in a hospital or in the community a nurse is more likely to refer a patient to a specialism or specialised department to 'cure' a patient. As mentioned, though, there is a journey from the moment a patient walks into a hospital to the second they leave - and often afterwards. It's the nurses' job to care for the patient throughout this journey.

Continuity is important, for sure, but the care is much more so. The pint example is a funny one, as there is no real place for the nurse and caring in that experience. You could perhaps chat to the customer as you pull it, giving a quick check on their personal well being, but it's not really the same. Identically, there is often no end product when it comes to nursing. Sometimes a nurse may hand over drugs to a patient, yes, but whereas a customer pops to the bar specially for a drink, most patients do not look for nurses specifically for drugs. Or any other sort of 'official' duty. The care should be of paramount importance, and as soon as staff start forgetting this you know they're in trouble. But still it happens.

Nursing is hard. As mentioned, the reasons for this difficulty may have changed, but the difficulty itself has not. Anybody going into this life choice thinking it will be anything less than hard is in for a shock - and may be part of the 8% drop out rate. Some girls on my course are shocked they're unable to take holidays inside of the academic year. If that's the worst surprise in store for them through these three years I'd count them as lucky.

Go in with eyes open, then. If you're already in and have been worn down by paperwork, red tape or any other modern evils, then do something about it. Get off the pot or piss in it, I say. Don't let the care, and by definition, the patient suffer because of it. Otherwise, what's the point?

(Additionally, thanks to Unity (over at: http://www.ministryoftruth.org.uk/2007/09/23/its-banner-time/) for my shiny new banner. Follow the link to get one for yourself.)