The other night we were so busy I didn't have the time to make my patient a cup of tea. That sounds ridiculous but I was literally swamped.
I remember thinking, this is the sort of thing people remember. It won't matter to that patient that the lady in the next bed got her pain relief, or that the lady opposite was able to walk out to the bathroom. What she wil probably remember is that the nurse was too busy to get her a cup of tea.
That makes me feel sad. Imagine being so busy that you don't have a couple of spare minutes to make a drink for someone. I couldn't even delegate, everyone was manically busy.
This i guess, is one of the joys of working on an assessment unit. I had 4 admissions within the space of a few hours. Not an excuse and to me, the simple acts, such as making someone a drink, are a priority.
Wednesday, 12 December 2012
Tuesday, 4 December 2012
Blue Pier Project
The Blue Pier Project.
World Diabetes Day- November 2012
I'm sat at home, with twitter updating on my phone. I am following the various WDD hashtags and seeing huge numbers of diabetes awareness tweets.
So like SJP in Sex and the City, I got to thinking.............
I would like to do something to raise awareness of diabetes. I love the idea of various monuments and buildings turning blue for the day. Why not turn my local pier blue? In fact why stop there, why not turn all the piers along the south coast of England blue for next years World Diabetes Day?
I imagine this will be a massive undertaking but I feel quite excited about the prospect! It would certainly create interest and once people are interested they are more likely to listen to your message.
Now, I feel quite privileged in that I follow, and I am, in return, followed by many people from the diabetes online community (the DOC). I have been welcomed into the community as an honorary Type 3 (thats a person who has someone in their life with diabetes!). In return I would love to do something to help these fabulous guys and girls out in their journey for better care and greater understanding of the lifelong condition they live with.
It seems to me, that as a community, their knowledge and expertise is often greatly under-utilised. And from my own experience, diabetes education in pre-registration training can sometimes leave a lot to be desired.
So I have thought long and hard about what could be done that isn't already being done (or that might be being done but isn't very well advertised!).
Here are my thoughts:
So these are my thoughts. Very rough and read at the moment and im contemplating how I can action them. I figured by sharing them I could get some input from others on how to take this forward.
As a starting point, the Blue Pier Project now has a twitter account (@BluePierProject) and an email address - bluepierproject@live.com.
All thoughts, ideas, comments welcome :)
World Diabetes Day- November 2012
I'm sat at home, with twitter updating on my phone. I am following the various WDD hashtags and seeing huge numbers of diabetes awareness tweets.
So like SJP in Sex and the City, I got to thinking.............
I would like to do something to raise awareness of diabetes. I love the idea of various monuments and buildings turning blue for the day. Why not turn my local pier blue? In fact why stop there, why not turn all the piers along the south coast of England blue for next years World Diabetes Day?
I imagine this will be a massive undertaking but I feel quite excited about the prospect! It would certainly create interest and once people are interested they are more likely to listen to your message.
Now, I feel quite privileged in that I follow, and I am, in return, followed by many people from the diabetes online community (the DOC). I have been welcomed into the community as an honorary Type 3 (thats a person who has someone in their life with diabetes!). In return I would love to do something to help these fabulous guys and girls out in their journey for better care and greater understanding of the lifelong condition they live with.
It seems to me, that as a community, their knowledge and expertise is often greatly under-utilised. And from my own experience, diabetes education in pre-registration training can sometimes leave a lot to be desired.
So I have thought long and hard about what could be done that isn't already being done (or that might be being done but isn't very well advertised!).
Here are my thoughts:
- Raising awareness - in particular amongst health care professionals
- There needs to be better integration of services between primary and acute care and other services such Ambulance Trusts (im thinking a sort of link project - similar to those that operate for nurses within some hospitals, but extending this to make it more multi-disciplianry)
- Using the knowledge and expertise of people with diabetes to guide education of health care professionals.
- Support services. In particular a service for what I call the plus 1's or Type 3's - the people living with those with diabetes.
- Events such as world diabetes day - turning the piers blue! Also maybe getting local businesses involved (I'm thinking of places like my health club) in hosting awareness sessions.
- And my personal favourite - a blue flash mob! Ive always said (you can ask my friends and family!) that the world would be a better place if we had more flash mobs!
So these are my thoughts. Very rough and read at the moment and im contemplating how I can action them. I figured by sharing them I could get some input from others on how to take this forward.
As a starting point, the Blue Pier Project now has a twitter account (@BluePierProject) and an email address - bluepierproject@live.com.
All thoughts, ideas, comments welcome :)
Thursday, 22 November 2012
Last breath
Last night I experienced my first death as a registered nurse.
I wanted to write a post about this, not because I haven't experienced death before but because I am experiencing a rather odd set of emotions about the whole thing.
The lady, who i will call Mrs H, was very unwell, she had respiratory failure and was very acidotic. The doctors, along with the family, had decided that a resuscitation attempt would be futile so a do not attempt resuscitation (DNAR) form was in place
Despite this, and the fact that she wasn't expected to survive the night, Mrs H was started on non-invasive ventilation (NIV). This always seems a misnomer to me as NIV is very invasive, ok it doesn't involve putting a tube down someone's trachea as in endotracheal intubation, but it works by forcing oxygen into the lungs under pressure then maintaining a pressure during expiration to keep the lungs inflated. Many people struggle to tolerate NiV, the mask thy has to be worn is huge and I imagine very claustrophobic. But it can be a very effective way of assisting ventilation in respiratory compromised patients.
Anyway I digress, for whatever reason the decision was made to start mrs H on NIV. And she appeared to tolerate it well, was synchronising and there had been a small improvement in her blood gases.
At about 5am, whilst sitting at the nurses station, we heard the apnoea alarm sounding. This is triggered when the NIV senses absent or inadequate respiratory attempts from the patient.
Myself, the nurse in charge and a nursing assistant immediately went to her bedside. We were joined by the on call junior doctor. There was no visible respiratory effort and we were unable to find a pulse, either radially or centrally. We quickly removed the NiV mask. Easier said than done when it is strapped on tightly (it needs an airtight seal to the face in order to be effective-so many straps/fastenings, looks like something from Star Wars)
Then we waited.....nothing. The doctor started checking for heart sounds, we all waited, holding our breath. Then suddenly a gasp, then silence.......we started the process again. Checking for signs of life. A process that never fails to seem brutal; listening for heart sounds for 1 minute, checking the pupils for a reactions.......nothing......"are we all agreed?" asks the doctor. We nod out agreement when suddenly "did you see that? Her eyelids flickered?" Says the other nurse, we all peer at Mrs H and then "sighhhh" she sighs.
By this point it's almost become comical. It seems Mrs H is determined to keep going. There we are, the four of us gathered around her bedside. Unsure what to do. So we wait.
I am holding Mrs H's hand. I'm not sure why , it felt the right thing to do.if it was me I would want a reassuring touch as I took my last breath. The minutes pass. The doctor has her stethoscope to Mrs H'a chest. She shakes her head. Nothing. No more breaths. She had gone.
I feel strange because I feel very little. We remove the cardiac monitoring pads, take down the IV and, being a slightly superstitious creature, I make sure a window is open.
We lay the bed down, arrange pillows ad tidy the blankets. It's weird, although at a glance she could be sleeping. When you look closely it's like something fundamental is missing. Like an empty shell.
We leave the bedside and I return to my paperwork. I feel sort of empty. I wonder what the procedure is for expected deaths in hospital. I consider the practicalities. I think it is maybe this that shocks me. Do I have no heart?
Mrs H was not my patient. And yet I was there at the very end. Of all the big events in a persons life, I was present for this strangers final moment.
She was a person. She was Mrs H. Someone's wife, someone's mother . And I held her hand as she took her last breath.
What a privileged position we hold.
I wanted to write a post about this, not because I haven't experienced death before but because I am experiencing a rather odd set of emotions about the whole thing.
The lady, who i will call Mrs H, was very unwell, she had respiratory failure and was very acidotic. The doctors, along with the family, had decided that a resuscitation attempt would be futile so a do not attempt resuscitation (DNAR) form was in place
Despite this, and the fact that she wasn't expected to survive the night, Mrs H was started on non-invasive ventilation (NIV). This always seems a misnomer to me as NIV is very invasive, ok it doesn't involve putting a tube down someone's trachea as in endotracheal intubation, but it works by forcing oxygen into the lungs under pressure then maintaining a pressure during expiration to keep the lungs inflated. Many people struggle to tolerate NiV, the mask thy has to be worn is huge and I imagine very claustrophobic. But it can be a very effective way of assisting ventilation in respiratory compromised patients.
Anyway I digress, for whatever reason the decision was made to start mrs H on NIV. And she appeared to tolerate it well, was synchronising and there had been a small improvement in her blood gases.
At about 5am, whilst sitting at the nurses station, we heard the apnoea alarm sounding. This is triggered when the NIV senses absent or inadequate respiratory attempts from the patient.
Myself, the nurse in charge and a nursing assistant immediately went to her bedside. We were joined by the on call junior doctor. There was no visible respiratory effort and we were unable to find a pulse, either radially or centrally. We quickly removed the NiV mask. Easier said than done when it is strapped on tightly (it needs an airtight seal to the face in order to be effective-so many straps/fastenings, looks like something from Star Wars)
Then we waited.....nothing. The doctor started checking for heart sounds, we all waited, holding our breath. Then suddenly a gasp, then silence.......we started the process again. Checking for signs of life. A process that never fails to seem brutal; listening for heart sounds for 1 minute, checking the pupils for a reactions.......nothing......"are we all agreed?" asks the doctor. We nod out agreement when suddenly "did you see that? Her eyelids flickered?" Says the other nurse, we all peer at Mrs H and then "sighhhh" she sighs.
By this point it's almost become comical. It seems Mrs H is determined to keep going. There we are, the four of us gathered around her bedside. Unsure what to do. So we wait.
I am holding Mrs H's hand. I'm not sure why , it felt the right thing to do.if it was me I would want a reassuring touch as I took my last breath. The minutes pass. The doctor has her stethoscope to Mrs H'a chest. She shakes her head. Nothing. No more breaths. She had gone.
I feel strange because I feel very little. We remove the cardiac monitoring pads, take down the IV and, being a slightly superstitious creature, I make sure a window is open.
We lay the bed down, arrange pillows ad tidy the blankets. It's weird, although at a glance she could be sleeping. When you look closely it's like something fundamental is missing. Like an empty shell.
We leave the bedside and I return to my paperwork. I feel sort of empty. I wonder what the procedure is for expected deaths in hospital. I consider the practicalities. I think it is maybe this that shocks me. Do I have no heart?
Mrs H was not my patient. And yet I was there at the very end. Of all the big events in a persons life, I was present for this strangers final moment.
She was a person. She was Mrs H. Someone's wife, someone's mother . And I held her hand as she took her last breath.
What a privileged position we hold.
Tuesday, 20 November 2012
Media misconceptions
After a hilarious twitter chat last night about a major UK newspaper and its inability to print accurate stories, I started thinking about the impact of misconceptions on everyday people.
I would consider myself an everyday person, in fact on paper I'm probably now quite statistically 'normal'. Married, 2 kids, dog, cat, middle income etc etc. However, scrape the surface and I'm a walking misconception! I had legoboy at 16, since then I have gone beyond exasperation at the media stories portraying teenage mums as benefit scrounging, council house claiming, asbo rearing drains on society. Apart from a very brief period after I split from legoboys dad, I have not claimed benefits. I did live in a housing association house until I was 23 and bought my first house. Legoboy is a gem, not an asbo in sight! He is a teenager so of course he has his issues but he is more likely to be in his bedroom making Lego animations than hanging around outside tescos drinking WKD!
Legoboy came along to an award ceremony that I was part of after I was awarded an academic scholarship and will be coming along to my graduation next year. I'd like to think I've instilled in him an appreciation of the importance of education. So to blow my own trumpet, I have done a good job so far. I was young and yes there are issues with having a child while you are still a child yourself but this doesn't automatically subject my son to a life of under achievement and crime. And I know I am not an exception- I can think of many examples of young parents who are doing a brilliant job.
So, misconception number 2-being a nurse. I am newly qualified but already tired of reading stories about how, as a profession, we don't care/are too posh to wash/etc etc......
Now I know that in some cases these stories are entirely justified. There are some nurses out there who are an embarrassment to the profession. BUT, there are so many nurses/student nurses out there who care so passionately about the profession and are giving their best to those they are for. You only have to look on twitter to find pages and pages of tweets from health care professionals who are battling to provide care in sometimes impossible situations. So my message to the mass media is this-take the example of sites such as patient opinion and try to provide a more balanced view of the nursing profession. Don't tarnish us all with the same brush.
So my final gripe-diabetes. There is one particular paper who seem hell bent on publishing stories that suggest that all diabetics are obese people whose lifestyles and behaviours are entirely to blame for them developing the condition. Anyone who knows my man in uniform will know he is the polar opposite of this, and I know from talking to others that they have experienced comments from people who seem surprised at their diagnosis because they are not fat! As we had to explain to a family member after my man in uniforms diagnosis-his historic habit of having 3 sugars in his coffee is NOT the reason he developed diabetes. Being fat is not a prerequisite for your pancreas packing up!
Diet is important in blood glucose management but suggesting fad diets could prevent it occurring is insulting. Especially to those with type 1 diabetes- the onset of which is believed to be linked to a virus that causes cells within the pancreas to stop producing insulin. Misinformation is as dangerous as ignorance, so if you want a story about diabetes -particularly type 1- have a look on twitter, there are so many inspiring (and accurate) blogs written by people who live with the condition.
So to conclude my rant:
Being a teenage parent has its issues but doesn't mean you can't be a good parent.
Being a nurse doesn't mean you don't care. I care hugely, that's why I do this. Often the environment makes my job a lot harder. There are times when I come home feeling nothing short of despair because I haven't been able to nurse the way I want to. I always try my hardest. So do many others.
Being diagnosed with diabetes isn't always down to poor lifestyle choices. Type 2 diabetes does have strong links with weight and lifestyle but type 1 does not. Having 3 sugars in your coffee does not mean you brought it on yourself. It also means that you need insulin to survive. And at present Insulin can only be taken via injection (including insulin pumps). No amount of hypnosis/cheese or berry wine will change this diagnosis and whilst diet may help control blood glucose levels the insulin injections are what keep type 1 diabetics alive.
Ok, I'm done!
(This post is for all my pals in Team D, battling to correct a multitude of media misconceptions. If you are interested I would suggest going to the daily mail website and searching for diabetes/teenage parents/nurse-read the articles but also read the comments, you'll soon see why I get so wound up!)
I would consider myself an everyday person, in fact on paper I'm probably now quite statistically 'normal'. Married, 2 kids, dog, cat, middle income etc etc. However, scrape the surface and I'm a walking misconception! I had legoboy at 16, since then I have gone beyond exasperation at the media stories portraying teenage mums as benefit scrounging, council house claiming, asbo rearing drains on society. Apart from a very brief period after I split from legoboys dad, I have not claimed benefits. I did live in a housing association house until I was 23 and bought my first house. Legoboy is a gem, not an asbo in sight! He is a teenager so of course he has his issues but he is more likely to be in his bedroom making Lego animations than hanging around outside tescos drinking WKD!
Legoboy came along to an award ceremony that I was part of after I was awarded an academic scholarship and will be coming along to my graduation next year. I'd like to think I've instilled in him an appreciation of the importance of education. So to blow my own trumpet, I have done a good job so far. I was young and yes there are issues with having a child while you are still a child yourself but this doesn't automatically subject my son to a life of under achievement and crime. And I know I am not an exception- I can think of many examples of young parents who are doing a brilliant job.
So, misconception number 2-being a nurse. I am newly qualified but already tired of reading stories about how, as a profession, we don't care/are too posh to wash/etc etc......
Now I know that in some cases these stories are entirely justified. There are some nurses out there who are an embarrassment to the profession. BUT, there are so many nurses/student nurses out there who care so passionately about the profession and are giving their best to those they are for. You only have to look on twitter to find pages and pages of tweets from health care professionals who are battling to provide care in sometimes impossible situations. So my message to the mass media is this-take the example of sites such as patient opinion and try to provide a more balanced view of the nursing profession. Don't tarnish us all with the same brush.
So my final gripe-diabetes. There is one particular paper who seem hell bent on publishing stories that suggest that all diabetics are obese people whose lifestyles and behaviours are entirely to blame for them developing the condition. Anyone who knows my man in uniform will know he is the polar opposite of this, and I know from talking to others that they have experienced comments from people who seem surprised at their diagnosis because they are not fat! As we had to explain to a family member after my man in uniforms diagnosis-his historic habit of having 3 sugars in his coffee is NOT the reason he developed diabetes. Being fat is not a prerequisite for your pancreas packing up!
Diet is important in blood glucose management but suggesting fad diets could prevent it occurring is insulting. Especially to those with type 1 diabetes- the onset of which is believed to be linked to a virus that causes cells within the pancreas to stop producing insulin. Misinformation is as dangerous as ignorance, so if you want a story about diabetes -particularly type 1- have a look on twitter, there are so many inspiring (and accurate) blogs written by people who live with the condition.
So to conclude my rant:
Being a teenage parent has its issues but doesn't mean you can't be a good parent.
Being a nurse doesn't mean you don't care. I care hugely, that's why I do this. Often the environment makes my job a lot harder. There are times when I come home feeling nothing short of despair because I haven't been able to nurse the way I want to. I always try my hardest. So do many others.
Being diagnosed with diabetes isn't always down to poor lifestyle choices. Type 2 diabetes does have strong links with weight and lifestyle but type 1 does not. Having 3 sugars in your coffee does not mean you brought it on yourself. It also means that you need insulin to survive. And at present Insulin can only be taken via injection (including insulin pumps). No amount of hypnosis/cheese or berry wine will change this diagnosis and whilst diet may help control blood glucose levels the insulin injections are what keep type 1 diabetics alive.
Ok, I'm done!
(This post is for all my pals in Team D, battling to correct a multitude of media misconceptions. If you are interested I would suggest going to the daily mail website and searching for diabetes/teenage parents/nurse-read the articles but also read the comments, you'll soon see why I get so wound up!)
Monday, 12 November 2012
My life with diabetes.
Friday the 30th December 2011. D-Day for my family. The day that diabetes became a part of our family consciousness.
Until that day diabetes was always just something that a patient might have. Something that meant doing a little finger prick test before dinner and maybe calling someone else to deal with medications. I had never cared for a patient with a diabetic complication as the reason for their admission so it was always something that patients had alongside whatever ailment had brought them into hospital.
It seems bizarre now, looking back, that neither of us seriously considered diabetes being the cause of man in uniforms unwellness ( yes I know that's not an actual word!). Despite him having all the classic symptoms of high blood glucose levels: extreme thirst, frequent urination, nausea, abdominal pain, cramps etc. we joked about diabetes but neither of us seriously thought that was the cause of all this (I thought it was a peptic ulcer). On our Christmas Day (the 28th- belated Xmas due to shift work!) he became so unwell he finally conceded and arranged a trip to the doctor.
I can still remember the phone call now, he called from the surgery telling me the GP thought it was diabetes, he was referred immediately to the diabetes centre at our local hospital. When he got home from the doctors grief and horror were written all over his face. I remember trying to reassure him, a stupid flippant comment about how it could be worse.
I can't fault the care given by the diabetic consultant nurse hi saw him, I still have issues with the fact that he was sent home without any further investigation. I guess the hospital were busy and because, on face value, he appeared less unwell than he actually was.
It later emerged he was, at the very least ketotic if not in full diabetic ketoacidosis. The consultant later told us that had the full extent of his condition been realised he would probably of been admitted to high dependency. I still have issues with the decisions made by the medics but as my husband keeps telling me; no harm no foul.
The months following his diagnosis have been hard. He has had long periods of sickness. For someone who always has to be busy this has been a nightmare. He has been stripped of his operational duties because of concerns over type 1's driving on blue lights (another story altogether) and at one point had his car licence suspended as he had lost his hypo warning signs.
I can only imagine what all this has done to him, he is someone who defines himself by his career. It has almost been like a bereavement. We have certainly been through many of the stages of grief: anger, denial, bargaining.
It has obviously been hard for him, why I didn't anticipate was the impact it would have on the rest of us. My daughter, then age 4, was terrified when he first started injecting. E had to make it into a game for her-picking which finger to test from etc.
I am still trying to get my head round it. I have stopped "nagging", I have been told that I don't understand. He's right of course, I dot understand. It's not me it's happened too.
That said, it's unfair to think it doesn't effect me. I joke about a future where I will become his carer because he has lost a leg or gone blind or had a stroke. The truth is the future scares me. Sometimes his attitude towards his management infuriates me. Because it doesn't just effect him. We are a team and its OUR future that will change because of this. I don't want to end up his carer nor do I want to be alone prematurely.
I feel stuck because there is no one I can talk about this too. I don't want to seem negative and morbid but I am scared. I thinks it partly explains my enthusiasm for following all the amazing and inspiring diabetics there are on twitter. It reassures me that life goes on and there are others out there. Now if I could just find some T1 +1's I'd be well away! (Seriously-if anyone can point me in the direction of a support group for panicking partners I'd much appreciate it!).
I hope whoever reads this takes it as it was written-me baring my feelings about this whole thing. I know it could be worse and I am grateful that I am still able to hug/talk to/argue with my man in uniform. The above thoughts are my deepest, darkest fears. And this blog has been my debrief. So thank you for hearing me out. X
Until that day diabetes was always just something that a patient might have. Something that meant doing a little finger prick test before dinner and maybe calling someone else to deal with medications. I had never cared for a patient with a diabetic complication as the reason for their admission so it was always something that patients had alongside whatever ailment had brought them into hospital.
It seems bizarre now, looking back, that neither of us seriously considered diabetes being the cause of man in uniforms unwellness ( yes I know that's not an actual word!). Despite him having all the classic symptoms of high blood glucose levels: extreme thirst, frequent urination, nausea, abdominal pain, cramps etc. we joked about diabetes but neither of us seriously thought that was the cause of all this (I thought it was a peptic ulcer). On our Christmas Day (the 28th- belated Xmas due to shift work!) he became so unwell he finally conceded and arranged a trip to the doctor.
I can still remember the phone call now, he called from the surgery telling me the GP thought it was diabetes, he was referred immediately to the diabetes centre at our local hospital. When he got home from the doctors grief and horror were written all over his face. I remember trying to reassure him, a stupid flippant comment about how it could be worse.
I can't fault the care given by the diabetic consultant nurse hi saw him, I still have issues with the fact that he was sent home without any further investigation. I guess the hospital were busy and because, on face value, he appeared less unwell than he actually was.
It later emerged he was, at the very least ketotic if not in full diabetic ketoacidosis. The consultant later told us that had the full extent of his condition been realised he would probably of been admitted to high dependency. I still have issues with the decisions made by the medics but as my husband keeps telling me; no harm no foul.
The months following his diagnosis have been hard. He has had long periods of sickness. For someone who always has to be busy this has been a nightmare. He has been stripped of his operational duties because of concerns over type 1's driving on blue lights (another story altogether) and at one point had his car licence suspended as he had lost his hypo warning signs.
I can only imagine what all this has done to him, he is someone who defines himself by his career. It has almost been like a bereavement. We have certainly been through many of the stages of grief: anger, denial, bargaining.
It has obviously been hard for him, why I didn't anticipate was the impact it would have on the rest of us. My daughter, then age 4, was terrified when he first started injecting. E had to make it into a game for her-picking which finger to test from etc.
I am still trying to get my head round it. I have stopped "nagging", I have been told that I don't understand. He's right of course, I dot understand. It's not me it's happened too.
That said, it's unfair to think it doesn't effect me. I joke about a future where I will become his carer because he has lost a leg or gone blind or had a stroke. The truth is the future scares me. Sometimes his attitude towards his management infuriates me. Because it doesn't just effect him. We are a team and its OUR future that will change because of this. I don't want to end up his carer nor do I want to be alone prematurely.
I feel stuck because there is no one I can talk about this too. I don't want to seem negative and morbid but I am scared. I thinks it partly explains my enthusiasm for following all the amazing and inspiring diabetics there are on twitter. It reassures me that life goes on and there are others out there. Now if I could just find some T1 +1's I'd be well away! (Seriously-if anyone can point me in the direction of a support group for panicking partners I'd much appreciate it!).
I hope whoever reads this takes it as it was written-me baring my feelings about this whole thing. I know it could be worse and I am grateful that I am still able to hug/talk to/argue with my man in uniform. The above thoughts are my deepest, darkest fears. And this blog has been my debrief. So thank you for hearing me out. X
Thursday, 8 November 2012
My plan to save the earth!
PAPERWORK.
I had an epiphany the other night at work and I think I've figured out a big cause of global deforestation. I blame the NHS. I wonder if there has been any research into the number of tree's sacrificed to the incessant need for documentation within healthcare? I would place money on it being A LOT, many many trees being cut down so we can duplicate patient information multiple times.
I have to confess that the "paperwork" issue I have is not based entirely on my concern for the environment. Having sat down and given some thought to the things that stress me out the most, paperwork tops the list by a long way.
As a newly qualified nurse, undertaking nursing interventions takes me longer than it would an experienced nurse. I don't have a problem with this. I appreciate that I am inexperienced and I need to follow processes, as i gain experience and confidence I am fairly certain it will take me less time to catheterise or to undertake a drugs round. The problem I have is the huge amount of paperwork I have to complete for everything I do. Don't get me wrong, I understand the principle of "if it isn't written down it didn't happen" and I'm as keen as the next healthcare professional to protect my own backside. But when a lot of the work i do is a duplication of information already gathered or it takes me away from being able to care because i have to sit at the desk to trawl through multiple sets of notes, i get stressed.
In order to explain myself I am going to give you a patient scenario, this is not an extreme case, rather this is the norm in regards to the written work that needs to be undertaken during a patient journey.
Meet Mrs Jones, she is an entirely fictional 75 year old female. She lives in her own home and has the district nurses visiting 3 times a week to dress a leg ulcer (thats 1 set of paperwork), she also has twice daily carers (thats the 2nd set of paperwork). She has multiple health issues including COPD for which she has home oxygen and is under the care of the hospital specialist respiratory team (3rd set of paperwork).
One evening her carer visits and finds Mrs Jones very short of breath, naturally the carer calls for an ambulance. Unfortunately, because an effective alert system is not in place, the ambulance crew are not aware of Mrs Jones's oxygen requirements. Luckily they are competent and experienced and treat her according to their knowledge on oxygen therapy for patients with COPD. The carer puts Mrs Jones community nursing notes into her hospital bag and off she goes to the local A and E department.
On arrival the ambulance crew complete their paperwork and hand over the the A and E staff (4th set of paperwork), the staff in A and E complete set of paperwork number 5. All this is gathered together and taken, with Mrs Jones, to the medical assessment unit.
Once admitted to the assessment unit, the nurses complete the admission paperwork. On the unit I work in this comprises, initially, of 2 booklets (one is 4 sides of A4, the other is 8 sides of A4) and a cardex (1 sheet of A4), the doctors then also complete their paperwork (not sure how many pages the clerking notes are but id guess its at least 8). So thats the 5th and 6th sets of paperwork.
On top of this, she may also need documentation of any cannula's put in, a stool chart, fluid balance, catheter, falls assessment, turn chart and wound assessment. There is a new drug chart (which doesn't necessarily take into account any drugs given my the ambulance crew or in A and E - for this you would need to check that specific paperwork.) and if she is on insulin or warfarin there are seperate drug charts for these too.
The nursing notes are kept in one place, the doctors notes in another. Observations such as blood pressure/heart rate etc are computerised so must be accessed via a tablet or main computer. We also have an admission folder where the admission paperwork is kept.
All this for one patient! Now, I am not in any way suggesting that any one of these documents is not important. BUT, i have frequently wondered why we need to duplicate the same information, sometimes up to 4 times. Why cant the doctor/nurse notes be combined, why does poor Mrs Jones have to be subjected to multiple rounds of questioning and examination?
In fact, heres a totally radical idea....why cant we introduce a system where by the patients information travels with them. It can be updated by any member of the healthcare team. This might be in the form of one "booklet" that is started in A and E and is added to, as appropriate, throughout the patients journey.
Or maybe we could go paperless.
I had a short placement in my second year on the intensive care unit. They are entirely paperless. The team add notes as and when required, this means that the doctor can see what the nurse has written, the nurse, if not at the ward round, could see what the continuing plan for the patient is (without having to rummage through mounds of paperwork - which in my experience is almost always elsewhere - normally the doctors office!). The dietician can access it, as can the OT, the physiotherapist, the pharmacist. It is all kept in one place and contains all the information about that patient. From the drug chart through to fluid balance and back to observations etc etc etc.
AND......this could even be extended into pre-hospital and community care too. So that the district nursing notes can be seen by the ward nurse who now needs to redress Mrs Jones's leg, the district nurses can be alerted that Mrs Jones wont need a visit tomorrow because she is in hospital. The ambulance crew could access information about her oxygen therapy and the assessment unit nurse can quickly see which drugs the ambulance crew gave so she doesn't give them again.
I know that people have issues with paperless systems. And I agree that they are not fail-safe. However, from my experience within Ambulance control, I know that with correct procedures in place systems failures can be managed without detrimental affect to patients. Going "onto paper" in the control room always came with a certain amount of panic but the calls were still answered and ambulances still sent.
Im sure that there are many arguments around the best way to manage patient information and every option will have its positives and negatives. For me though, the pressure to complete paperwork will, i think, always taint my experience of nursing because it puts me at a desk rather than at the bedside.
I had an epiphany the other night at work and I think I've figured out a big cause of global deforestation. I blame the NHS. I wonder if there has been any research into the number of tree's sacrificed to the incessant need for documentation within healthcare? I would place money on it being A LOT, many many trees being cut down so we can duplicate patient information multiple times.
I have to confess that the "paperwork" issue I have is not based entirely on my concern for the environment. Having sat down and given some thought to the things that stress me out the most, paperwork tops the list by a long way.
As a newly qualified nurse, undertaking nursing interventions takes me longer than it would an experienced nurse. I don't have a problem with this. I appreciate that I am inexperienced and I need to follow processes, as i gain experience and confidence I am fairly certain it will take me less time to catheterise or to undertake a drugs round. The problem I have is the huge amount of paperwork I have to complete for everything I do. Don't get me wrong, I understand the principle of "if it isn't written down it didn't happen" and I'm as keen as the next healthcare professional to protect my own backside. But when a lot of the work i do is a duplication of information already gathered or it takes me away from being able to care because i have to sit at the desk to trawl through multiple sets of notes, i get stressed.
In order to explain myself I am going to give you a patient scenario, this is not an extreme case, rather this is the norm in regards to the written work that needs to be undertaken during a patient journey.
Meet Mrs Jones, she is an entirely fictional 75 year old female. She lives in her own home and has the district nurses visiting 3 times a week to dress a leg ulcer (thats 1 set of paperwork), she also has twice daily carers (thats the 2nd set of paperwork). She has multiple health issues including COPD for which she has home oxygen and is under the care of the hospital specialist respiratory team (3rd set of paperwork).
One evening her carer visits and finds Mrs Jones very short of breath, naturally the carer calls for an ambulance. Unfortunately, because an effective alert system is not in place, the ambulance crew are not aware of Mrs Jones's oxygen requirements. Luckily they are competent and experienced and treat her according to their knowledge on oxygen therapy for patients with COPD. The carer puts Mrs Jones community nursing notes into her hospital bag and off she goes to the local A and E department.
On arrival the ambulance crew complete their paperwork and hand over the the A and E staff (4th set of paperwork), the staff in A and E complete set of paperwork number 5. All this is gathered together and taken, with Mrs Jones, to the medical assessment unit.
Once admitted to the assessment unit, the nurses complete the admission paperwork. On the unit I work in this comprises, initially, of 2 booklets (one is 4 sides of A4, the other is 8 sides of A4) and a cardex (1 sheet of A4), the doctors then also complete their paperwork (not sure how many pages the clerking notes are but id guess its at least 8). So thats the 5th and 6th sets of paperwork.
On top of this, she may also need documentation of any cannula's put in, a stool chart, fluid balance, catheter, falls assessment, turn chart and wound assessment. There is a new drug chart (which doesn't necessarily take into account any drugs given my the ambulance crew or in A and E - for this you would need to check that specific paperwork.) and if she is on insulin or warfarin there are seperate drug charts for these too.
The nursing notes are kept in one place, the doctors notes in another. Observations such as blood pressure/heart rate etc are computerised so must be accessed via a tablet or main computer. We also have an admission folder where the admission paperwork is kept.
All this for one patient! Now, I am not in any way suggesting that any one of these documents is not important. BUT, i have frequently wondered why we need to duplicate the same information, sometimes up to 4 times. Why cant the doctor/nurse notes be combined, why does poor Mrs Jones have to be subjected to multiple rounds of questioning and examination?
In fact, heres a totally radical idea....why cant we introduce a system where by the patients information travels with them. It can be updated by any member of the healthcare team. This might be in the form of one "booklet" that is started in A and E and is added to, as appropriate, throughout the patients journey.
Or maybe we could go paperless.
I had a short placement in my second year on the intensive care unit. They are entirely paperless. The team add notes as and when required, this means that the doctor can see what the nurse has written, the nurse, if not at the ward round, could see what the continuing plan for the patient is (without having to rummage through mounds of paperwork - which in my experience is almost always elsewhere - normally the doctors office!). The dietician can access it, as can the OT, the physiotherapist, the pharmacist. It is all kept in one place and contains all the information about that patient. From the drug chart through to fluid balance and back to observations etc etc etc.
AND......this could even be extended into pre-hospital and community care too. So that the district nursing notes can be seen by the ward nurse who now needs to redress Mrs Jones's leg, the district nurses can be alerted that Mrs Jones wont need a visit tomorrow because she is in hospital. The ambulance crew could access information about her oxygen therapy and the assessment unit nurse can quickly see which drugs the ambulance crew gave so she doesn't give them again.
I know that people have issues with paperless systems. And I agree that they are not fail-safe. However, from my experience within Ambulance control, I know that with correct procedures in place systems failures can be managed without detrimental affect to patients. Going "onto paper" in the control room always came with a certain amount of panic but the calls were still answered and ambulances still sent.
Im sure that there are many arguments around the best way to manage patient information and every option will have its positives and negatives. For me though, the pressure to complete paperwork will, i think, always taint my experience of nursing because it puts me at a desk rather than at the bedside.
Sunday, 28 October 2012
Tears, team work and taking stock
So I have just finished 2 weekend day shifts. My feet hurt and I feel physically and emotionally drained.
Rather than on the negative I'd like to talk about the positive, of which I discovered a HUGE one.
I had the less acute bay but one of my patients required much more input than the others. She had pneumonia and decreased mobility and due to a back problem was in a lot of pain, especially with any intervention. Anyway, she needed to go for an X-ray and we needed to change her sheet. Moving her with 2 was impossible, 4 was difficult but I never expected the whole team (NA's, nurses and the ward sister) came to help me transfer my patient and change her sheet. Apart from in ITU I have never seen this sort of team work. It was an amazing moment that really made me appreciate my colleagues.
Which brings me on to my ward sister. When I had reached my literal breaking point she took me to the office, talked me through my tears and give me the reassurance I desperately needed. She told me the most important thing was to care for my patients the best way. I can. Crossing every T and dotting every I is important but must not come before the hands on input with those under my care.
I came home after this, exhausted and with feet that felt raw, but rather than feeling defeated I felt supported, and a Facebook message from my wonderful ward sister later that evening made me smile and realise just how lucky I am that at least some of my colleagues appreciate how tough it can be to be the new girl and the newly qualified.
Rather than on the negative I'd like to talk about the positive, of which I discovered a HUGE one.
I had the less acute bay but one of my patients required much more input than the others. She had pneumonia and decreased mobility and due to a back problem was in a lot of pain, especially with any intervention. Anyway, she needed to go for an X-ray and we needed to change her sheet. Moving her with 2 was impossible, 4 was difficult but I never expected the whole team (NA's, nurses and the ward sister) came to help me transfer my patient and change her sheet. Apart from in ITU I have never seen this sort of team work. It was an amazing moment that really made me appreciate my colleagues.
Which brings me on to my ward sister. When I had reached my literal breaking point she took me to the office, talked me through my tears and give me the reassurance I desperately needed. She told me the most important thing was to care for my patients the best way. I can. Crossing every T and dotting every I is important but must not come before the hands on input with those under my care.
I came home after this, exhausted and with feet that felt raw, but rather than feeling defeated I felt supported, and a Facebook message from my wonderful ward sister later that evening made me smile and realise just how lucky I am that at least some of my colleagues appreciate how tough it can be to be the new girl and the newly qualified.
Wednesday, 24 October 2012
When the going gets tough....
Normally I like coming home after a night shift, you're soooo tired but you know that bedtime is soon and nothing beats the feeling of getting into bed after a busy night shift.
Today the house feels empty and somewhat lonely. I wish my little gang were here as I could really use a hug.
It was a nightmare shift.
I had 4 admissions and 3 transfers before 0100, a poorly patient on hourly observations, a patient whose constipation was causing her agonising pain for which I could do very little and a patient who became dramatically more confused as the night went on. I didn't have enough time to care properly for any of them. And I made mistakes. Nothing life threatening (I hope) but something that left me feeling stupid and incompetent.
I couldn't remember how to draw up an IM injection and I missed the fact that my patients IV antibiotics were due at 0300. I hate my total lack of IV knowledge. Not only does it frustrate me and my colleagues (who are already busy enough with their own patients) but I also think its dangerous. I think introducing SUPERVISED IV administration in the third year would greatly benefit newly qualified a. Not that we shouldn't still undertake post-qualifying IV competences. i believe that having a fundamental understanding of the quirks of IV administration would actually make for greater patient safety.
And then all my paperwork mistakes were pointed out and I have been left feeling crushed.
On reflection I probably should of completed an incident form for the late IV antibiotics but by that point I was ready to cry. They were given and it won't upset the next dose. But why is it not specified that they need to be 12 hours apart? Why do morning IV antibiotics have to be given at 6? How am I supposed to know this if no one has taught me?
Right now I am considering a career move, even my first pay check (which I received today after 2 months of 0 income!) hasn't cheered me up.
I can feel my eyes drifting shit now so I shall conclude my debrief by offering a prayer up to the god of newly qualifieds, in the hope that he takes pity and makes my next shift a better one. My poor battered who can't take another crap one just yet
Today the house feels empty and somewhat lonely. I wish my little gang were here as I could really use a hug.
It was a nightmare shift.
I had 4 admissions and 3 transfers before 0100, a poorly patient on hourly observations, a patient whose constipation was causing her agonising pain for which I could do very little and a patient who became dramatically more confused as the night went on. I didn't have enough time to care properly for any of them. And I made mistakes. Nothing life threatening (I hope) but something that left me feeling stupid and incompetent.
I couldn't remember how to draw up an IM injection and I missed the fact that my patients IV antibiotics were due at 0300. I hate my total lack of IV knowledge. Not only does it frustrate me and my colleagues (who are already busy enough with their own patients) but I also think its dangerous. I think introducing SUPERVISED IV administration in the third year would greatly benefit newly qualified a. Not that we shouldn't still undertake post-qualifying IV competences. i believe that having a fundamental understanding of the quirks of IV administration would actually make for greater patient safety.
And then all my paperwork mistakes were pointed out and I have been left feeling crushed.
On reflection I probably should of completed an incident form for the late IV antibiotics but by that point I was ready to cry. They were given and it won't upset the next dose. But why is it not specified that they need to be 12 hours apart? Why do morning IV antibiotics have to be given at 6? How am I supposed to know this if no one has taught me?
Right now I am considering a career move, even my first pay check (which I received today after 2 months of 0 income!) hasn't cheered me up.
I can feel my eyes drifting shit now so I shall conclude my debrief by offering a prayer up to the god of newly qualifieds, in the hope that he takes pity and makes my next shift a better one. My poor battered who can't take another crap one just yet
Tuesday, 23 October 2012
Chilling
Sometimes it's nice to just relax and enjoy my new found free time. I say has been a prime example and I feel thoroughly chilled as I sit and contemplate getting ready front shift tonight.
My man in uniform has had a rare day off today so we managed to spend a lovely morning together, our camping stuff arrived so we had a giggle trying to inflate our new 'self inflating' camp mats. Apparently they don't self inflate on the first go, I thought he was taking the mickey when he was standing there blowing up the self inflating mattress! Nope, I was soon puffing away with him, this caused the dog to become totally over excited and we all fell about on the floor.
We don't often have times like this, when we have something to look forward too and can just laugh. Its nice :0)
At lunch I met with 2 of my newly qualified friends to carry on our plans fr our graduation ball. Next march we are going all out to celebrate our achievements. Can't wait!
When I get home I had a boogy session, I love music so I cranked up the iTunes and danced round the kitchen. Again the dog got totally overexcited!
So now the dog and I are sprawled on the sofa watching a VERY exciting episode of deal or no deal. Deal or no deal is a bit like Pringles. I never fancy the idea of Pringles or DOND but once I start with either I can't stop myself!
So that's where I am right now. On my sofa, with the dog and Noel Edmunds for company. And do you know what? I actually feel quite content :0)
(And if you're interested, the player just death at £19000!)
My man in uniform has had a rare day off today so we managed to spend a lovely morning together, our camping stuff arrived so we had a giggle trying to inflate our new 'self inflating' camp mats. Apparently they don't self inflate on the first go, I thought he was taking the mickey when he was standing there blowing up the self inflating mattress! Nope, I was soon puffing away with him, this caused the dog to become totally over excited and we all fell about on the floor.
We don't often have times like this, when we have something to look forward too and can just laugh. Its nice :0)
At lunch I met with 2 of my newly qualified friends to carry on our plans fr our graduation ball. Next march we are going all out to celebrate our achievements. Can't wait!
When I get home I had a boogy session, I love music so I cranked up the iTunes and danced round the kitchen. Again the dog got totally overexcited!
So now the dog and I are sprawled on the sofa watching a VERY exciting episode of deal or no deal. Deal or no deal is a bit like Pringles. I never fancy the idea of Pringles or DOND but once I start with either I can't stop myself!
So that's where I am right now. On my sofa, with the dog and Noel Edmunds for company. And do you know what? I actually feel quite content :0)
(And if you're interested, the player just death at £19000!)
Tuesday, 16 October 2012
1 in 4
That is the statistic isn't it, 1 in 4 people will at some point suffer from a mental health problem.
I am one of these statistics.
I have suffered from depression for many years. I am lucky in that I can have long periods of time when I am unaffected but when the cloud descends I am left floundering in a world that becomes grey and frightening.
I find it strange that I am ashamed of this. I am a sensible person with balanced views on mental illness. I know it is exactly that: an illness. It does not make me weak, nor is it something that I can "get a grip of".
My most severe episode occurred after my daughter was born. I became withdrawn, terrified of leaving the house and started hearing voices. My man in uniform struggled to deal with me, he is a practical person, his training teaches him to patch people up and he is focussed on tangible outcomes. My behaviour was a mystery to him. From the outside there appeared to be nothing wrong, this wasn't something that could be rectified with a couple of paracetamol and some vitamin C. And there was no obvious cause to my depression, no bereavement, no job loss, nothing that could account for me becoming the person I had become.
I struggled to communicate with him. I honestly think that he was scared of me. He couldn't just pop me in the back of his ambulance and cart me off to hospital. And in his medically-modelled mind Im sure there was a part of him that wanted to tell me to "man up".
Fortunately I had a brilliant, understanding and pro active GP. I think him being married to a consultant psychiatrist probably didn't hurt! He listened and took me seriously. With both drug and counselling input I was able to get through that period of my life.
Looking back over my adult life I can spot times when I was overtaken by the dark cloud. I was lucky That I was able to ask for help from my family and a hope that these times have not impacted on my son. It pains me to admit now hat there were times I was just not capable of caring for him. With the support of family and friends I think he continued to have a loving, if slightly unconventional upbringing.
Now, when I feel the cloud descending I am upfront about it with my man in uniform. He still doesn't fully understand but at least I can try and offer some explanation about my behaviour.
And in the future, maybe I can put aside my embarrassment and be honest with others outside my trusted circle. I'm not at that point yet but I try, whenever possible to confront this part of me with dignity.
I am 1 in 4. And I hope this simple fact will enable me to offer support and empathy to others just like me.
The toxic nurse
As a student I encountered a toxic nurse on every placement I undertook. I have yet to meet a student nurse who hasn't met one somewhere during training.
They are the nurse who takes great pleasure in telling you how rubbish your training is, using phrases such as "I was running a bay by the end of my first year" and "the training was much better in my day", at best these comments are just irritating, at worse they are confidence crushing. Personally I had 3 experiences in which i was reduced to tears by the actions of a toxic nurse whilst on placement.
Unfortunately they are also, very often, the nurse who has appalling interpersonal skills and can leave their patients in tears too. I can go home at the end of a shift and cry to my family, if you are a patient you don't have that luxury. And if you are in hospital, chances are you are unwell. This can make you feel vulnerable enough, what you don't then need is your nurse making you feel like crap.
During a placement in my final year I encountered a prime specimen of toxicity. She was vile towards me from day one, although I am happy to report there was only one occasion when she reduced me to tears and I had to leave work early. Fortunately I didn't have to work with her that often but I remember one incident when I threw caution to the wind and challenged her behaviour. We were caring for a patient who was at the end of life. She had been started on the Liverpool Care Pathway and when her family arrived I sat in with them whilst the doctor explained what was happening (as an aside, this was in fact a shining example of this conversation, one which I have stashed away in my mental file of "how to do things right", a great doctor, shame she is no longer at the trust). One of the relatives brought up the subject of euthanasia, not in the sense of wanting to bump her off but in the sense of a family member who didn't want to see a loved one suffer unnecessarily. Unfortunately, later he also broached this subject later with toxic nurse, who proceeded to go round the ward telling everyone that this relative wanted to kill off his loved one. Having been in the room when this subject was discussed with the doctor and obviously having a more sensitive understanding of the nature of the relatives query, I felt I had to speak up. So I did, I pointed out that she seemed to have misinterpreted the question and that it was actually inappropriate to discuss this with every other member of staff She didn't like it at all. In fact she spent the rest of the shift giving me evil 'death stares'. I did the right thing though and to this day I am proud of myself for standing up to her. Although I doubt she will ever have the compassion to understand the context of the relatives question, at least I stopped her gossiping.
It is always difficult to know what to do in these situations. My husband, the polar opposite to me, is always encouraging me to stand up for myself. Sadly I often lack the confidence to be this direct, in fact I don't know many people who would feel confident in standing up to toxic nurse in this way.
So what is the answer?
Well, when it comes to those "constructive" comments about modern nurse training I have found that agreeing with them often works a treat. For me this is the truth, I feel MY nursing education lacked balance between theory and practice. However, I think this is an age old problem and the training undertaken "back in the day" had its issues too. For a start, the nursing profession has changed radically in the last 10 years, let alone the last 50 years. The rise of the nurse specialists and the nurse consultants is paving the way for recognition of nursing as a profession of its own standing, with its own theory, knowledge and evidence base. We are longer expected to accept doctors orders without challenge and the new generation of nurses are educated to see ourselves as an entirely separate entity to our medical colleagues. We are no longer the doctors handmaiden.
So yes, we may not have the same practical exposure to hands on nursing as our predecessors our nursing education does prepare us in ways that previous, more vocational training, did not. How many "old school" nurses had to undertake modules on areas such as research critiquing? Not many I suspect. This doesn't make either training right or wrong, in fact I think there is still a long way to go before the 'perfect' nursing course is developed.
So ignore these comments, smile and walk away. I doubt there will ever be agreement by staff on what is adequate and appropriate training!
Now, the issue of the toxic nurse who impacts on their patients. The best advice I can give is to encourage them to complain, reassure them that this WILL NOT impact on their treatment and offer support and information to empower them to do this. There are other official routes you can follow depending on the severity of what is happening. Sometimes (and thankfully i have never witnessed this) the situation may require an adult safeguarding referral to be made. If the treatment is in any way abusive this has to be reported. And, I suppose, overreacting to suspicions of abuse is always better than doing nothing.
So, if you are a student and you encounter the toxic nurse, I would highly recommend talking to the ward manager. I appreciate this is not always possible but if it is, they are they ideal person to talk to. It may be that your complaint is the final straw after a long list of complaints and could be the tipping point. If this is not possible then maybe talk to someone at university, you should have a link nurse you can contact or your personal tutor will be able to advise you.
If you are a staff nurse, again I would recommend talking to your ward manager. Not that this becomes any less challenging once you are in blue! If you are a member of a union you can contact your union rep. No on should ever make you feel like crap at work, especially not the people you need to rely as a newly qualified.
So these toxic nurses need to be stood up to, as difficult as that might be. They are not only a danger to junior colleagues and patients, but to the reputation of the nursing profession as a whole. With more emphasis being placed on the importance of transparency, and increasing protection offered to those who whistle-blow, there are increasing avenues through which to report bad practice.
And if all else fails, debrief with people who love you. For me its my man in uniform, my parents and my fellow newly qualifieds. And a hug from legoboy (son) and peanut (daughter) always goes a long way to restoring my equilibrium!
Thursday, 11 October 2012
Hospital: a dangerous place to be diabetic
I have a very personal interest in diabetes care. At the beginning of the year my other half (my man in uniform) was diagnosed type 1 diabetic. He was 29 and this came as a huge shock to all of us. The repercussions of his diagnosis shook our whole family.
Prior to this the patients I encountered with diabetes were just that, patients with diabetes. I have to confess being less than interested in it as an illness.
That very quickly changed as my man in uniform recovered and I realised the inadequacies in care for patients with diabetes.
As part of my final year assignments I developed an information leaflet about the use of blood ketone meters to recognise patients with diabetic ketoacidosis. This development would enable the timely and accurate recognition of dka v's simple hyperglycaemia )
So on my first day on the ward I should not of been surprised to find a potentially fatal insulin prescription error. A patient had been prescribed a massive dose of insulin and a nurse had signed that this had been administered. Thankfully we have an amazing team of diabetic specialist nurses who quickly arrived and set about rectifying the situation (needless to say I didn't give the insulin).
What depressed me even more was the discovery that this was not an isolated incident.
I spoke with the patient who was able to tell me his exact insulin regime and thankfully informed us he had been self administering so had not received the entire vial of the rapid acting insulin he had been prescribed.
The lesson I take from this is: if you are diabetic the chances are you manage your medication independently when not in hospital- if this is the case please please speak up when in hospital. YOU are the expert and the health professional should (whenever appropriate) take their lead from you
(Please excuse any typo's in this post- typing on my iPhone!)
Prior to this the patients I encountered with diabetes were just that, patients with diabetes. I have to confess being less than interested in it as an illness.
That very quickly changed as my man in uniform recovered and I realised the inadequacies in care for patients with diabetes.
As part of my final year assignments I developed an information leaflet about the use of blood ketone meters to recognise patients with diabetic ketoacidosis. This development would enable the timely and accurate recognition of dka v's simple hyperglycaemia )
So on my first day on the ward I should not of been surprised to find a potentially fatal insulin prescription error. A patient had been prescribed a massive dose of insulin and a nurse had signed that this had been administered. Thankfully we have an amazing team of diabetic specialist nurses who quickly arrived and set about rectifying the situation (needless to say I didn't give the insulin).
What depressed me even more was the discovery that this was not an isolated incident.
I spoke with the patient who was able to tell me his exact insulin regime and thankfully informed us he had been self administering so had not received the entire vial of the rapid acting insulin he had been prescribed.
The lesson I take from this is: if you are diabetic the chances are you manage your medication independently when not in hospital- if this is the case please please speak up when in hospital. YOU are the expert and the health professional should (whenever appropriate) take their lead from you
(Please excuse any typo's in this post- typing on my iPhone!)
hello!
A quick intro.......
I have just qualified as an Adult Nurse, i decided to write a blog as a kind of reflection process for me. I am hoping that in a years time I will be able to look back and recognise how far I have travelled since my first few shifts as an actual, proper staff nurse!
I have also realised that i am encountering situations that sometimes I don't know how to deal with. This blog will be a way of debriefing (of course everything will be anonymous and nothing specific will be discussed). I am new to blogging and hope that I will be given some leeway for my typo's/grammatical errors/general ramblings (I have a tendency to write really long sentences - so apologies in advance!).
I welcome feedback, even constructive criticism but I am currently overwhelmed with the responsibilities I now have so please, be kind.
About me.......
I am in my early 30's, started my training after having children, getting married etc etc etc. Nursing wasn't my original career choice but after some wobbles I can hand-on-heart say that I am glad I chose to do it and wouldn't want to change it now. Academically I did really well, despite the trials and tribulations that many people experience during training. I have managed to qualify with what is generally known as an Advanced Diploma. This means I have a diploma in nursing plus some degree level modules. Eventually I hope to top-up to a full honours degree but for now I think I have enough on my plate just attempting to consolidate what I have learnt so far.
I hope that this blog may be of some use to others who are in the same situation as me or who may be about to qualify (if this is you, don't give up - eventually you get there and the relief is massive!). And maybe it will remind others of what it is like to be the newbie. We were all that person once and whilst most people are really supportive there are always those who seem to forget that once upon a time, they were in my shoes too.
I have just qualified as an Adult Nurse, i decided to write a blog as a kind of reflection process for me. I am hoping that in a years time I will be able to look back and recognise how far I have travelled since my first few shifts as an actual, proper staff nurse!
I have also realised that i am encountering situations that sometimes I don't know how to deal with. This blog will be a way of debriefing (of course everything will be anonymous and nothing specific will be discussed). I am new to blogging and hope that I will be given some leeway for my typo's/grammatical errors/general ramblings (I have a tendency to write really long sentences - so apologies in advance!).
I welcome feedback, even constructive criticism but I am currently overwhelmed with the responsibilities I now have so please, be kind.
About me.......
I am in my early 30's, started my training after having children, getting married etc etc etc. Nursing wasn't my original career choice but after some wobbles I can hand-on-heart say that I am glad I chose to do it and wouldn't want to change it now. Academically I did really well, despite the trials and tribulations that many people experience during training. I have managed to qualify with what is generally known as an Advanced Diploma. This means I have a diploma in nursing plus some degree level modules. Eventually I hope to top-up to a full honours degree but for now I think I have enough on my plate just attempting to consolidate what I have learnt so far.
I hope that this blog may be of some use to others who are in the same situation as me or who may be about to qualify (if this is you, don't give up - eventually you get there and the relief is massive!). And maybe it will remind others of what it is like to be the newbie. We were all that person once and whilst most people are really supportive there are always those who seem to forget that once upon a time, they were in my shoes too.
First day blues
I needn't of set my alarm as I spent most of the night half awake. So long before I actually need to leave the house I was up, washed and dressed in my new, blue, staff nurse uniform. ID badge: check, pen: check, nursing reference books (multiple): check.
Let me set the scene further, its mid-september 2012, I have just (as in 2 days ago) become a qualified nurse after completing 3 years of study. This is my first day of my new job. I know I am fortunate to have a job, some of my colleagues have not yet secured employment so I fully appreciate having a full-time, permanent contract.
I shall be working on a medical assessment unit, also known as acute medical units/emergency assessment units etc etc depending on where you work. The general idea of them is that patients who require further assessment are admitted to the ward while they undergo the tests and reviews that will decide which speciality they should be assigned to. This may be a slightly limited view and I'm sure there is more to it than my basic description implies! However, having never worked on, or had a placement on such a unit puts me at a slight disadvantage.
For my first 2 weeks i will be supernumerary, i have been assigned an experienced nurse to work with while I find my feet. Everything about this experience is new to me and I feel somewhat out of my depth. Thankfully there is another newly qualified nurse starting with me so on my arrival that morning I head straight for her for some much needed moral support.
After hastily scribbling out the names of the patients on my ward I head to the staff room for handover. I am introduced to the team and try to resist the urge to run away screaming, I don't know why i feel like this, they all look like perfectly reasonable, friendly people. By the end of handover I am forced to plaster an inane grin on my face to hide my terror. The patients in my bay are ill! This may sound ridiculous but apart from a brief high dependency placement most of the patients I have cared for have been stable. So, on my first day I am faced with trying to figure out how to care for patients who could, at any minute, decide to deteriorate. I console myself with the fact that ill patients are less likely to abscond so I will hopefully not have to face that particular fear today (alongside the fear of the first "arrest" i also have a fear of my patient upping sticks and legging it off the ward).
I try my best, my mentor is brilliant but I find myself making stupid mistakes (like missing an entire page of a prescription chart), I spend most of the day in a blind panic, 2 weeks is not long enough to learn everything i need to know not to kill my patients. I don't think anyone notices though and before I know it, its home time. My feet have never hurt so much (my new shoes, despite my best attempts at breaking them in, have crucified the back of my heels - I shall be wearing plasters for weeks).
I am lucky to have a family who will listen to my ramblings so spend a constructive 30 minutes debriefing with my better half (also a health professional but with many years of experience under his belt). I sleep well that night. I am knackered.
Let me set the scene further, its mid-september 2012, I have just (as in 2 days ago) become a qualified nurse after completing 3 years of study. This is my first day of my new job. I know I am fortunate to have a job, some of my colleagues have not yet secured employment so I fully appreciate having a full-time, permanent contract.
I shall be working on a medical assessment unit, also known as acute medical units/emergency assessment units etc etc depending on where you work. The general idea of them is that patients who require further assessment are admitted to the ward while they undergo the tests and reviews that will decide which speciality they should be assigned to. This may be a slightly limited view and I'm sure there is more to it than my basic description implies! However, having never worked on, or had a placement on such a unit puts me at a slight disadvantage.
For my first 2 weeks i will be supernumerary, i have been assigned an experienced nurse to work with while I find my feet. Everything about this experience is new to me and I feel somewhat out of my depth. Thankfully there is another newly qualified nurse starting with me so on my arrival that morning I head straight for her for some much needed moral support.
After hastily scribbling out the names of the patients on my ward I head to the staff room for handover. I am introduced to the team and try to resist the urge to run away screaming, I don't know why i feel like this, they all look like perfectly reasonable, friendly people. By the end of handover I am forced to plaster an inane grin on my face to hide my terror. The patients in my bay are ill! This may sound ridiculous but apart from a brief high dependency placement most of the patients I have cared for have been stable. So, on my first day I am faced with trying to figure out how to care for patients who could, at any minute, decide to deteriorate. I console myself with the fact that ill patients are less likely to abscond so I will hopefully not have to face that particular fear today (alongside the fear of the first "arrest" i also have a fear of my patient upping sticks and legging it off the ward).
I try my best, my mentor is brilliant but I find myself making stupid mistakes (like missing an entire page of a prescription chart), I spend most of the day in a blind panic, 2 weeks is not long enough to learn everything i need to know not to kill my patients. I don't think anyone notices though and before I know it, its home time. My feet have never hurt so much (my new shoes, despite my best attempts at breaking them in, have crucified the back of my heels - I shall be wearing plasters for weeks).
I am lucky to have a family who will listen to my ramblings so spend a constructive 30 minutes debriefing with my better half (also a health professional but with many years of experience under his belt). I sleep well that night. I am knackered.
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