Pond Crossing Differences

I'm looking for a little input here.
The last post showed that nursing in UK isn't really the same as nursing in the USA, although it's the same job. The training isn't.

So to clarify a couple of things....
In the UK we don't sit a board exam at the end of the course (like the NCLEX) before we are placed on the register.

We do have to renew our registration every year to continue being a registered nurse and able to work.

I can be in charge of as many as 12 patients (in this current placement) (with a nurse shadowing me) per shift. These are general surgical patients (or even the rehab patients from my last placement) and not those requiring high levels of care (2 patients to 1 nurse) or ITU care (1 patient to 1 nurse).

Our courses are specific to the area we will be employed in. Cellar Door will be a mental health nurse and is on the mental health branch training (you don't mind being an example do you?). I will (someday) be an adult / general nurse and am on the adult branch. There are also separate branches for paediatrics and learning disability nursing. Midwifery is a separate course altogether.

The majority of nurses in the country are employed by the NHS. Only 25 to 30% are employed by the private sector.

Anyone see any more differences?

The Stethoscope Tag

I was tagged by both Little D, S.N. and Undergrad RN for this one.

Here are the rules:

1) Post a picture of your stethoscope

2) Tell what you love about it
3) Tell what you hate about it
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and don't forget to leave a comment on their blog telling them that you tagged them!

So they are both about to have a WTF moment.

We don't have stethoscopes as nurses or student nurses over here. Actually that's a little inaccurate. We do HAVE them. We just don't use them so prolifically.

From what I can tell Student Nurses / RNs across the pond (like we do just not as often) use them for measuring BPs and listening to lung sounds and heart rates. We don't commonly take manual Blood Pressure measurements. For some patients we have to but mostly we use digital machines like Dinamaps. OK mine doesn't have a thermometer on the side but it's just the same thing.

I have done manual BPs but not in a long time. When you have say 12 patients under your care and you need obs on all of them it's not really enough time to do manual BPs.

As for listening to hearts? I've done that. I've heard the sounds of mechanical heart valves. But again we don't do any of this routinely.

Lung sounds? Only in my ITU placement so far and really only then because of the risk of Ventilator Acquired Pneumonia. So there you were checking for air entry into the lungs at the top and bottom and any other noises like crepitus.

If you're looking for a stethoscope on the average ward around here you better start by finding the crash trolley. There'll usually be one hanging off of that.

I remember working the neonatal clinic in an outpatient's department as agency one day when I walked into the consulting room and the docs stethoscope was lying on the desk. He caught me staring at it and I said "That's a tiny stethoscope."
"It's for tiny patients." He replied. See because I'm working with adults most of the day it's easy to forget that we start of as little human beings, who need equally little equipment.

Sorry guys I don't have my own stethoscope. I have a pen torch for doing neuro obs and measuring tape for sizing TED stockings if they count as specialist equipment.

I have no-one to tag I guess. Unless of course Cellar Door has a stethoscope moment she would like to contribute?

Update Fail

Sorry guys! I've even been tagged and I've still not updated.
I'll post later honest.

I Gonna Do A Cuddy

I'm gonna do a Cuddy on the FY1's tie if he doesn't get a tie clip!

For all those who don't understand there's a scene in House (season 1, episode 4 - Maternity) where Dr Cuddy gets mad at another doc while swabbing the place for not having his tie clipped and well she cuts it off. Granted his tie was trailing into sinks and all sorts of waste. An infection control risk.

Yea I had a moment when, after having spent all day cleaning the ward, I went ape about our poor FY1 and his long sleeves, watch and tie. Poor sod. Sorry doc. I won't really cut your tie off. Well I might if it gets in someone's wound.

And yes I can find a House related moment for EVERY medicine related moment.

Confessions of a Nurse

Anyone in the UK catch the Dispatches documentary - Confessions of a Nurse?
Please tell me you did. Much of it is true, least from what I heard from around the web and throughout my course.
Disturbing.

Patient care

• 42 per cent of nurses and midwives interviewed say they have either been in or witnessed situations where patients have been put in unnecessary danger
• Over half (57 per cent) of the A&E nurses interviewed say they have witnessed situations where patents lives have been put in unnecessary danger
• Almost half (53 per cent) say they have seen colleagues perform medical tasks that they are not qualified to do
• 44 per cent of the nurses and midwives we polled say they don’t always stick to the rules
• Over a third (37 per cent) think that patient care in the NHS has become worse in the past five years

Impact of understaffing and long hours

• Half (51 per cent) of all the nurses and midwives interviewed say that they are exhausted most of the time
• 29 per cent say long hours and exhaustion prevent them from doing their jobs properly
• 83 per cent of the midwives surveyed say they have been in situations where they have had too many patients to look after properly
• 70 per cent say understaffing prevents them from doing their jobs properly
• One third (33 per cent) say they would leave nursing and midwifery if they could

Behaviour of nurses

• 43 per cent say they have seen other nurses shout at patients (13 per cent admit they have themselves shouted at patients)
• 44 per cent of nurses and midwives interviewed admit to calling in sick when not really ill
• 40 per cent admit to browsing the internet when they should be working
• 36 per cent admit to coming to work with a hangover and unable to concentrate on the job properly

We can't care properly for our patients if we are under staffed. There are no great revelations to be had there. Not for those in the NHS anyway.
Bet you the patients will be scared now.
Go watch it on 4od if you can....

Yesterday Was Far Better

Never had a day like it... Being told that I'll pass if I keep doing my job that way I am! SCORE!

I love my placement. Placement is now past the halfway point and it flies past. Course working only 3 days out of 7 does make it feel like that. I also feel rather lazy. The eagle eyed might have noticed that I've not done a whole lot of swimming recently. Yea I need to get out more on that front. It might have something to do with the minor factor that I got a monthly pass so the motivation has gone out of it. You know what I mean. All those gym memberships that run for a year but only see a single month of visits.

Anyway I have a range of news stories that have filtered past the news feeds in recent days.

The paramedic who was attacked by yobs throwing fireworks while the woman, who was suffering a heart attack, lay dying. What is the obsession with attacking the emergency services? I really don't get it.

There's an inquest currently happening into the deaths of 10 elderly patients at a single hospital. What got me was the recollection of one patient's son who was told that his mother was there to die. that not the kindest way of breaking something. Even worse he believed that she was there to rehab after a stroke. So why is a woman in rehab dying? Who really knows. However all 10 patients were under the care of the same doctor; who is now under suspicion for over prescribing sedation.

Lastly there was a study done on wither religion makes a difference on patients wanting resuscitation at the end of life. Can't really comment on this personally because I've not really seen it happen first hand. I know for a fact that families have a huge part to play in the resus status of patients. Maybe they should and maybe they shouldn't. Who really knows? A lot of the fight comes from the person themselves and their inner strength. So does that imply that those who are not as religious have less inner strength? Is this evidence to back up some of the claims that religious speakers make?

And in the culture section of today's news announcement I need to get my ass over to Edinburgh. A Turner exhibition starts next week! A selection of his Italian works and his paint box and pallet. Hows cool is that?

Right I'm off to enjoy what may be the best weather Scotland will see all year!

This Ain't Theatre You Know

So I go in to help the doc. The patient is just back from theatre and needs something checking.
Oh then he asks me to wipe his brow.....
There a few words to describe my expression - 'gob smacked' perhaps? Or a classic Scots 'glakit'?

Sorry doctor this is a ward. Nurses here don't wipe brows unless they belong to the patients.

Still stunned by the question.....

Then he tries to wipe his forehead on MY sleeve. Oh no you don't sonny! I will get your fevered brow a paper towel but that is as good as it is gonna get.

I am not your wife / mother / scrub nurse. I will not be your handmaiden. Can I go back to my sick patients now?

Doing Something Right....

I think I must be doing something right. I got stopped by the deputy sister. She was wondering where my obs were..... Ah well you see....
Bugger.
I had a huge pile of things to do (it seemed that way anyhow). Halfway through an admission I stepped out to check the medical notes and one of my other patient's happened to be sick. Well the nurse I was working with was busy. So hmm what do I do? Drop the part done admission and find a sick bowl? Yep that would be it. My patient was OK, in case you were wondering.
So then I get caught with a missing set of obs. I was going to do them, honest. Right after the sick patient was seen to. So she asked me what I had to do (you know communication, team working, etc.) but when I listed everything it was actually rather short. Which I didn't understand. But I had loads to do? No, apparently not. Weird.

I'm going to have to start writing to do lists at work. Well it worked for the SHO on the last ward. I started the day with 7 patients..... I ended the day with 2..... In total 8 different people.





NO! HALT! I didn't hurt any of them! Promise! They were discharged home. Every last one.

Wonder how tomorrow's going to pan out?

Tired...

2 very long days.... 12 and a half hours each.... 4 hours sleep between......
Very, very tired. Sorry folks.
I'll try to get out of bed tomorrow.

Management of Care (contains swearing)

This management is all kinds of shitting weird.
I am fuked. It's impossible to juggle 12 patients; 1 critically ill, 2 going to theatre, 2 back from theatre, 1 awaiting reviews, 1 discharge..... Ah crap. I keep getting lost!!
I should be better than this.

My mind melts about 6 hours in. I'm getting a little better but hell's bells I'm surprised anything gets done with me some days! I was helped out a lot. I still have 3 and a bit weeks to improve.

Maybe I'll get there. I'm not passed yet. Fuk this is harder than it looks.

Random Word Splats

LGBT Staff and Patients

So how many open LGBT staff do you know? How many patients are open about themselves? How many have introduced their partner?

A new report released by the University of Leeds about LGBT issues and support. A quick breakdown of the students and staff they asked showed that universities are not as open as they seem. Especially for staff. Actually, today on a similar thread CB was talking about lecturers not being open and accepting of students with mental health issues.

So why are universities, where you would think that you could be any person you wanted to be, are so closed off to the most vulnerable of students?

My last uni had a large supportive network for their LGBT students. The current one has nothing on this campus. Well nothing visible. The flip side of this is that old uni had no obvious provision for students requiring special help. Most of the learning disabled students seemed to get their provision direct from the school they studied within. Current uni has on-site counsellor and dedicated department for special needs students.

There is no standard. Aside from discrimination policies. And we've all seen how well that worked for me.

But back to relating this to health care.... How many Lesbian, Gay, Bisexual, Transsexual staff do you work with? How many are out?

The NHS is still institutionally homophobic. Only 2 NHS trusts made it onto the Stonewall top 100 this year. That's pretty poor considering the numbers of police squads and councils. The BBC reported that there is an extremely low level of screenings done on Lesbians for cervical cancer. Once upon a time I was told that I didn't need one... cos you're gay, you don't sleep with men (That by the way is total BS). Time to change that! It shouldn't be this way but perhaps it's not at the top where the problems lie.

While you are thinking about the staff, how many have made openly homophobic comments? How many have referred to something as 'gay'?

Is this were our problems lie? I think so. Let's take my last placement as an example. At the top the Sister and one of the Deputies knew and were supportive. 2 nurses and a CSW knew and didn't bat an eyelid. But there were at least 4 homophobic comments in my presence (none directed at me but I try to keep a low profile). How can LGBT staff feel comfortable about themselves when they know they can't really talk about it?
Don't give me that "you don't have to talk about yourself like that" nonsense. I sat through a break where 3 people talked constantly about their up coming weddings. How would they have taken it if I had talked about a civil partnership? (Not that I have anything to talk about in that respect though.)

There 15 mins of thinking and I found the root of the problem. People.

Bugger can't fix that by myself.

First Day Nerves

I never sleep well the night before placement. Sometimes before agency shifts as well. So I really only got 2 hours of sleep that night.
I was totally out of my depth for the first 2 hours. Then I got going! It was brilliant. Hanging fluids, doing admissions, taking hand overs on returning surgical patients! Weeeeeee. At least I haven't forgotten everything from my only surgical placement over a year and a half ago.
Whither I recognise any of the staff from Monday tomorrow is another matter. I dislike 12 hour shifts for that reason. I can do the work for that length of time but it takes a couple of weeks to get to know the staff and until then it's like the first day everyday.
More news after tomorrow's shift.

I Like Challenges!

I challenged Cellar Door that for every word of her essay I would swim a metre. Not sure now this would be a challenge for her, since she has no choice on the essay but I like to think she wants to see if I can do it. Or maybe she wants to see me suffer? I had already set a target of 10 kilometres in 3 months before I fly out. This was perfectly plausible; on the basis of 300m, twice a week for 3 months.

I could have just absorbed the 3,500 words (metres) into that 10,000.....

Oh no I much more determined than that!

Total distance = 13,500 metres in 3 months.



Above the posts there are 2 countdowns. Total distance and time left..... Let's see how this goes huh?

P.S. Post on my first shift of my last placement coming tomorrow. Promise.

Unforeseen Idiocy Ahead

Right this going back to camp thing....
I love camp. I would live there if I could. A green card and a job and I'm yours for life.
Problem is when I was there the last time I managed to pass lifeguarding. Waaaaaay back in 2005 when I was younger, stupider and thinner. Well sort of, that would imply that I am now older, wiser and fatter...... 2 out of 3 isn't bad.
I can swim and I'm damn good at it. Just can't do that much. And I might have put some weight on since the start of the course. I've put on 3/4 tunic sizes since then. Course, our tunics were modelled on aliens from the planet Zog or somewhere because they really don't fit any human I've met.
So during the interview up crops the 'you were a lifeguard that last time' and 'you know snorkelling'. To which in my 'talking management / interview BS' mode I replied with "I would LOVE to do that again!". Complete with exclamation point and emphisis.

Idiot.

The fitness test before training?

• Swim 300 yards (essentially 300 meters! Although it's a little shorter than that.) continuously.
• Starting in the water, swim 20 yards using front crawl or breaststroke, surface dive 7–10 feet, retrieve a 10-pound object, return to the surface, swim 20 yards back to the starting point with the object and exit the water without using a ladder or steps, within 1 minute, 40 seconds.

Oh it gets worse.... That was just the basic pool qualification.

• Swim 550 yards (about 500 meters) continuously.
• Starting in the water, swim 20 yards using front crawl or breaststroke, surface dive 7–10 feet, retrieve a 10-pound object, return to the surface, swim 20 yards back to the starting point with the object and exit the water without using a ladder or steps, within 1 minute, 40 seconds.
• Swim 5 yards, submerge and retrieve three dive rings placed 5 yards apart in 4–7 feet of water, resurface and swim 5 yards to the side of the pool.

Welcome to the waterfront / pool test!
Time to get my lardy ass to the swimming pool. I could do the 300 meters (12 lengths of a 25m pool). It's the incredible 'Titanic can move faster' pace I swim at. I will not be last to finish this time around. Oh and I can't drag my body out of water to help myself.... well not yet.

I have 3 months and a new swim suit..... just where did I put the towel?