Ready to Quit

I have recently started a new clinical placement and I can safely say that I am not enjoying it one bit. I have spent every shift following my mentor around like a puppy dog, which seems to be here style of teaching. I have also been shouted at every day for the most trivial of things. The majority of the staff on the ward are great and have made me feel welcome but out of two final year student nurses, me being one of them, I got the short straw. My male colleague got THE best mentor ever and I got the rat shite. It sucks.

On my first day I upset the ward sister. Not because I harmed a patient or misbehaved but because I spoke to a Dr. Yes, I spoke to a Dr. My patient returned to the ward after having major abdominal surgery, his blood pressure dropped and he became restless and clammy. I informed the outreach nurses and called the on call Dr. To cut a long story short, the Dr approached me to give me some instructions regarding the patients care, so that I could pass it on to my mentor. When the Dr left and I turned around there she was right behind me, arms folded.

'Why were you talking to the Dr?'

'He was giving me some instructions about Mr Smith for the next few hours'

'But your not the registered nurse'

'but...'

'my office on Friday please'

....and that was that. I had the meeting where I was verbally kicked in the ribs for being an 'insolent' student who disobeyed orders. Hardly fair eh?

I have four more weeks left on this ward, lets hope I survive it.

All that for an upset tummy....

At the weekend I had the pleasure of volunteering and being a member of the nursing team. (Obviously I was out practicing as a student under the supervision of a suitably qualified mentor). This role took me up and down the Southbank several times in order to re-assess patients.

Now, don't get me wrong I love what I do but I dislike being called upon by a member of staff who is equally if not more qualified to assess patients than I am. By this I mean, ambulance crews who are trained to perform certain examinations in order to build a list of potential diagnosis in order to rule each out as the examination goes on.

For example, on Sunday I was based outside of City Hall and with an area to cover that would take me on a 2 mile round trip without a vehicle I was somewhat reluctant to answer minor calls which could be covered by ambulance crews. After all, Nurses do not operate pre-hospitaly so the demand for one would be unnecessary if there were an alternative, say an ambulance crew, near by.

On this particular occasion the call was for a 27 year old female with upper abdominal pain. What would your first impressions be? Mine consisted of, ectopic pregnancy, GI Bleed, numerous Gastric problems, trauma etc etc. The list is endless. Include the fact that that was all the details I had for this patient. Upon arrival, after a mile of brisk walking through dense crowds, I find the young lady laying supine on a stretcher. My initial thought is that she doesn't look unwell, which is usually a good sign!

Her obs were stable and there was nothing significant in the menstrual history to suggest to me that she could be pregnant, no PV/PR bleed and the rest of the physical assessment didn't flag up anything significant. Abdomen was soft and non-tender. So there I was with a young lady with abdominal pain who seemed to be quite anxious but none the less, quite well.

'When did you last eat?'

In a strong Spanish accent.. 'About an two hours ago, some paella'

'Do you know what was in the food?'

'Sea food'

BINGO!

I had just discovered that this lady had a minor case of the poops. Do you think I was pleased about this? No. I certainly was not.

Although, not to discourage you from asking for help if you ever need a second opinion, it is always best to be safe than sorry in these kinds of circumstances. Just don't boast to me all day about being one of 'the' best ambulance crews and then flap over a minor case of the poops!

Blind

'Do you mind just feeding the lady in bed D'...

This is often a question I am asked both as a student nurse and as a health care assistant. Most of the time I don't question the nurse and off I go before their meal gets cold; but on some occasions, and this one in particular, I felt the need to ask why.

'She is blind'

So there was my answer. Pretty simple you would think? Although we could delve into this so much further couldn't we. I want to know why the fact the patient is blind plays any part in her being able to feed herself? Why must being blind render her useless and unable to function as a human being?

The patient in question was an elderly lady. She was in hospital for a few days after a hypoglycemic attack (low blood sugar). Her uncontrolled Diabetes took her sight six years ago and since then she hasn't quite come to terms with it. As I approach her I hold her hand and introduce myself, trying not to shout because after all, there isn't anything wrong with her hearing!

'Oh hello dear, no thank you. If you put the bowl in front of me I shall find it'

I arranged her tray so that everything was in the right place for her. Bowl in the centre, spoon on the right and drink on the left. This made her relax and she was soon gulping down her cornflakes like they were going out of fashion. It was at that point that a thought struck me.

How would i feel/react if I just suddenly lost my sight?!

One day you can see. You are able to interact with your environment doing things independently and then all of a sudden you are trapped in this dark place. unable to see what dangers may surround you or if there is an unsuspecting first year student nurse ready to shovel your food into your mouth! It must be the most scariest thing I can imagine happening to me.

I always thought that what ever happens to me physically wouldn't matter as long as I was alive. However, now I do not want to lose any of my senses.

New Year, New Term

It is not very often that I get to write in this blog. Occasionally I will get the inkling to write something deep and profound but I just can't seem to find the words. Instead, this time I am just going to write about how my life stands right this very moment; and I apologise in advance if it is not as glamorous as it should be!

To begin with I have started my final year of nursing *round of applause*. This excites me and scares me all at the same time which is a new experience. I suppose the thought of finally being responsible for all those patients and to a greater extent, myself, is a thought that fills me with dread. (I get an odd lingering bubbly feeling in the pit of my stomach even as I am writing this!) What excites me is that when I qualify it will be the time my life begins. I don't know where that will take me but I am looking forward to the adventure.

In other areas I am still having a constant battle with who I am and who I want to be, not to mention who everyone else wants me to be! Sometimes, being yourself just isn't enough and most of us find this out the hard way. My family struggle to see where my 'caring' gene came from so I am the black sheep of the bunch. Although I am there for all of them 24/7, this kind of unconditional love for my family is very rarely returned which I am still struggling to get used to. However, I am learning to walk alone.

Boys. What can I say about boys. Well, to be honest I think I would rather do without boys in my life. They make things so complicated and they make you cry. Often it is their fault which they will never admit to and I am left taking full responsibility and feeling like I'm doing everything wrong. The truth is, I have done nothing wrong and have been nothing but nice to them. My current partner would not agree with this!

Ultimately I am having a good time. I am looking forward to a good year and hopefully this time next year I will blog about being a qualified Nurse!

Oooops

In my state of confusion and tiredness last night I have managed to spill Ribeena all over my Clinical Placement Document......

BIG No No....

Help?!

I don't want to die

At 02.30am, you would hope to be fast asleep. However, the other night I was roused from my slumber to find my mother hovering over me.

'Wake up, I don't feel right'

I instructed her to return to her bedroom where I would follow her in and check her over. From one look at her I could tell that she was not compromised in any way. She was nice and pink and was not short of breath or suffering from chest pain. After asking some more questions she revealed that she had indeed had chest pain but two hours previous to waking me up.

'I'm going to die aren't I?'

I was truly lost for words, unable to put on that calm and cool exterior I have managed to perfect at work, instead I just opted for the tactile approach and hugged her tight. Rocking her gently as she let the tears flow for the possibility of not seeing another birthday.

'Your not going to die mum, I won't let you'

I don't think I could bear losing my mother. I'd lose myself.

Just One of Those Days

Today I found myself feeling a bit like Eeyore. Sat under a dirty great big cloud that just rained on me all day. I am unable to pin point what exactly is making me feel like this. Some people can say 'I lost my job' or 'There was a death in the family', but I am unable to give such simple and easy to figure out excuses.

Instead I am stuck in a bubble of confusion and chaos, not quite knowing how I feel about anything. Most of the time I am 'OK', I am able to function and get on with things, but then there are times when I could just find the highest point and scream at the top of my lungs. It is these times when I experience the most immense feeling of frustration. Most of the time for quite trivial reasons, but then other times it is because I have enclosed myself into a false sense of truth. I make accusations, I call everyone a liar and worst of all I push everyone away; usually the people I care most about. I am mature enough now to know that a lot of it originates from my childhood but then also from what I've been through as an adult. I am only in my early twenties but I already feel like I have lived a lifetime.

I tried to make some choices today but I found myself going around in circles unable to find the right answers. I made a few phone calls about jobs, accommodation, further education etc and I have come out the other side none the wiser.

I just don't quite know what to do with myself.

Hiding Place

During handover I stare intently at what has been typed on the A4 page in front of me, underlining the 'important' parts and annotating the jobs I need to do for the rest of the day. Then we move on to the next patient and we do the same again, until all 20 patients have been handed over to the day staff.

What follows is the usual awakening of the ward. The lights are switched on, curtains are opened and patients begin to stir in their beds ready for the day ahead. Some will be seen by the consultant, others may not be so lucky. Then some will venture down to radiology and others to clinical measurements. It is a cardiac ward after all so the possibilities are endless!

All that is left for me to do is learn some stuff, but where do I start?!

Life on the ward for any student is extremely demanding. Your supernumerary status is often breached, you are given a work load that even the trained nurse would run a mile from and you also often find yourself looking for places to hide. My current hiding place is the disposal cupboard. The stench is often difficult to bear but I thought it was worth it.

Lessons

It is official. I dislike nursing homes. I am not going to delve in to the politics surrounding the death traps but I am just not keen on them. I suppose they are like any other care facility, you get some good and some bad. However, I only ever seem to turn up to the most horrendous nursing homes you could ever imagine!

I had spent the best part of my Friday with a palliative care nurse specialist and so far so good. I had met two patients who were having regular reviews and emotional support, and both meetings went extremely well. The last patient of the morning was an elderly lady who had been referred to the palliative care team from a nursing home.

We were led through a maze of corridors to the patients room where we were greeted by an odd looking lady. Why does she look so... oh dear god, don't tell me she's gone before we arrived!

We approached the patient's bed side with caution, looking listening and feeling. To our surprise she took a breath. A sigh of relief made its way around the room and we proceeded to change her syringe driver. Sadly, we concluded that she would not last the night.

I suppose it is meetings like this that make you come away and think long and hard about how you would feel in that situation. If it was a loved one, if it was you even. By dwelling your not helping anyone, and I think I am slowly learning that lesson.

Naive

When we are in the confines of the hospital we take it for granted that we can just 'predict' what is going on in the patients home. 'Assume' that we understand how they live and the comings and goings of family members. It is after all our job to report on patient's who we feel need a little helping hand from social services right?

Since experiencing community nursing these 'predictions' and 'assumptions' have been scrapped. I have realised, the hard way, that nothing will ever prepare you for the kind of ways people live in their own homes. I guess you have a genuine belief that everyone lives the same way that you do. You then find yourself in a bit of a muddle when you come across someone who doesn't.

We were on our daily call out to an elderly gentleman who needs assistance with his insulin injections. My mentor kindly provided a little sit rep for me before leaving the car.

'You know how to give insulin injections?'

'oh yes..'

'ok good. Just to warn you, this gentleman opens the door in his underpants. I hope that he doesn't today but you never know. Also, he is very unkempt so your feet will stick to the floor, and try and ignore the overwhelming smell of stale urine.'

Why oh why did she have to tell me that?!

We entered the flat, and just as she had told me, my feet stuck to the floor as if the carpets were made from syrup. The smell of old urine mixed with the humidity of the flat as you walked in was not just overwhelming but it was lingering, clinging to my uniform and my hair. I just wanted to get out.

The next day I was faced with numerous bed bound patients. They had carers but for the majority of the day they were confined to their hospital supplied bed. Unable to get up to use the toilet, or to quench their thirst with a glass of water. These people were truly alone.

I have another 3 weeks left, so lets see what other revelations come to light.

What do you think?

"You are a member of the ward team that has to decide which patient is to be put in to a side room, but you need to debate and discuss the reasons for and against for each patient..."

It is not every day that you are in the position to make such a decision, one that could potentially be critical for your patient. As student nurses you are often involved in the decision making but the sole responsibility is always left to someone who is qualified and more senior within the team. Occasionally bed managers make the decision for you, but that is a whole different blog post!

"Mr Smith is a 53yr old gentleman who has had an open and closed*. The Surgical team have discovered that is tumor is now at a stage where it is inoperable. He is drifting in and out of consciousness and reaching the end stages of his life. Mr Smiths family are extensive and would like to be with him as often as they can..."

Do you think a dying man should be left to die in dignity in a side room, surrounded by his family and away from the prying eyes of other patients.

OR

"Mr Kemp is a 24yr old gentleman who has ulcerative colitis. He is in hospital because he is due to have elective surgery. He is currently anaemic and is suffering from terrible diarrhoea which is making him self conscious. The smell is offensive and asking for a comode or bed pan all the time is a little embarrasing..."

Could this young man be saved the embarrasment of having to run to the toilet every few minutes. After all hospitals are not places for young people.

OR

" Mr Jones has recently had surgery. Swabs were taken from his wound site and the results have come back positive for MRSA..."

Surely infection control procedures should be followed in order to protect patients from infecting MRSA.

The decision is yours!

I bet I know what your thinking. You instantly chose the dying patient, yes?

Every patient has the right to die with dignity surrounded by the people they love in a comfortable environment, right? Well of course they do. So why not send them home or to a hospice. Hospitals are places for the acutely ill and patients who no longer require 24hr care can be reffered on to other care providers. This does not mean that I advocate pushing dying patients out the door, it is not that at all, but in an ideal world we would love to put everyone in to a side room who deserved to be in there. However, we can not provide that type of service.

The young guy who was quite unwell. Yes, he is young. So what? Age does not play any kind of part in the overall care that a patient recieves. Yes, age is considered in alot of treatments (e.g. contraindications of surgery, drug dosages etc) but saying that he deserves a side room because having diarrhoea is embarrasing for a 24yr old guy is not good enough. Turn the tables a bit, if he was 84 would your opinion be different? I guess you would just give him a bed pan because why not he's lived his life. What if the patient was an 84yr old female? Would your opinion change again?

Some illnesses come hand in hand with some pretty nasty and horrible symptoms. Diarrhoea, vomiting, flatus, oozing, seeping, incontinece, dribbling, sweating.. and the list goes on. All of those things are embarrasing, they all lower the patients self esteem. This is something we do need to take in to consideration but to put someone in to a side room to maintain their street credability is not good enough.

Last but not least, MRSA. This could either be aquired from the patients home before being admitted, or it can be hospital aquired. In this instance it was hospital aquired and at the wound site. Isolating this patient is paramount. He does not require an armed guard but do be sensible.

I could sit here for hours and tell you my opinion on the subject matter, but I guess we all have a different take on things.

What do you think?

Welcome to 2010...

I am on my knee's in front of a patient, dabbing at the large cut on his eyebrow.

'Did you black out at any point? Do you have a headache? How much alcohol have you had to drink this evening?...'

My interrogation carried on whilst all around me were the bodies of wounded strangers. They were sitting in chairs, laying on stretchers and a few were wandering around aimlessly.

Some bright spark decided that throwing glass bottles into the air whilst in the middle of a crowd would be a fun game. The bottles returned to earth crashing into anyone that stood in their way. Slicing into faces, arms, torso's, feet.

I found myself zoning out, blocking out the noise and urgency of other patients whilst I made sure I did a good job on the one sat in front of me. I patched him up and sent him on his way. As i returned to the masses the noise gradually became louder, the crying and whaling of other patients became increasingly unbearable. I had come out of my 'zoned out' state and walked back into reality.

Who will I treat next? Shall I go for the unconscious, unresponsive teenager or the multiple facial trauma? or how about the suspected spinal fracture?

Yes, you guessed it. I chose the suspected axial burst fracture! Wahey! I get to play with some toys, puff out my chest and play with the big boys. hehe.

She was sat in a chair with a nurse holding her head, I retrieved our kit and applied a hard collar. The plan was to slide the long board behind the chair and tilt the chair down until she was flat on her back, on the board, on the floor. I am pleased to say that it went rather smoothly, I had hold of her head whilst the Dr cleared her. She was assessed and we were happy to send her on her merry way, without the added accessory of the spinal board of course!

By this point Big Ben had chimed, fireworks had gone off and it was finally 2010. I did not see midnight but I did see a very nice splatter of second hand kebab that night.

Happy New Year.

Bah Humbug

I know its a bit late but I wish you all a Merry Christmas and a Happy New Year!

Christmas and New year was a busy time for me. I spent some time over Christmas volunteering for Crisis Christmas (Crisis.org.uk) It was an enlightening experience to say the least.

I spent time with people who I would not usually socialise with in any other circumstance. I ate dinner and drank tea with people who could tell you stories that would make your toes curl, but I loved every minute of it. I was seen as an equal despite there being very clear and obvious differences.

My first job of the shift was to stand on the front gate and welcome in the guests, do a quick pat down for alcohol and weapons, if all was clear, send them inside. This sounds easy enough right? Think again!

One particularly loud lady approached the entrance to the centre, I'm guessing because of her extrovert nature the other girls on the gate did not want to search her so dispersed, leaving me on my own. I proceeded to pat her down, after all what's the worst that could happen?

'Do you have anything on you that could harm me or other guests?' I said calmly.

'Are you accusing me of being a druggie?....that's so typical of people like you... you come down here trying to save the world and you think because i slur my words I'm a druggie so I'm going to prick you? ... well you can f**k off!....'

To say I was slightly taken aback would be an understatement. She carried on with her speech for 5 minutes whilst I stood back and let her get it off her chest. She began to calm down and let her friend do all the talking, I approached her (with caution!) and apologised.

'Thank you, I'm sorry I shouted. Its just I'm always labelled you know?'

Sadly, I think we all understand the implications of labelling and stereotypes. Only this time I will take it a little bit more seriously.