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.
Sunday, 28 October 2012
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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