Pecking Order

We have quite a few students now. More than 2 and, say, less then 10. We're a big, immensely busy, ward we can take it.
And so the pecking order has developed. You know it had to at some point. Limited chances at the advanced clinical skills makes it first come first served at time. So it's an event that would make Animal Planet or National Geographic happy. We are essentially animals.

And I'm fighting to be alpha female. We have other students doing care management and they only just have their foot in the door. I've been there for 7 weeks now and I have a previous 16 weeks before that, I'm not going to roll over easily. Course that means whoever makes alpha will essentially be the best.

The year 1's and 2's have been on a bit of a steep learning curve, for some this is their first hospital placement. I've been teaching one or two of them a few skills I can do with my eyes shut. Like measuring pre-op patients for TED stockings. Sexy aren't they?
Who wouldn't fancy you in a pair of those!

I hope the claws don't come out too far. Much as the pecking order will fall into place, we need to remember to play nice while we do it. There were 2 drains to be pulled today and 2 management students. One each huh? Nope only one was there quick enough and the other was removed by the staff nurse. It may get dangerous.

Better go get my riot gear on.

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....

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?

A List Of DO NOTs For Nurses

Do Not....

Go to work after only and hour and a half's sleep
Hit on the doctor
Stick the 'finger' up at your boss
Think cheek towards co-workers is a form of communication
Turn up late then disappear to a clinic appointment with a patient
Accuse the consultant of being sexist because he comments on 'women drivers'
Make jokes about impacted bowels
Agree with anything you don't understand
Hit on the doctor (oops said that already... well it needs to be said)
Try to work without some form of caffeine in your system

A Student's Guide to Consultants

Consultants generally come in 3 flavours...

• Pain in the ass - Common - comes as standard with the return of the Mr. prefix
  
• Funny (or trying to be) - Rare but worrying comment often ensue
  
• Up themselves - Becoming rarer through time
  

I would consider avoiding all of them but you will have to talk to them at some point in your training and working life. So you can easily see which of these you would rather tangle with (get your mind out of the gutter!) but to be honest even the funny ones are dangerous.

Maybe it's a basic fear but to be honest I'd rather go be an idiot in front of the ward's SHO (she's so sweet and maybe I have a tiny bit of a crush there). Of course placement thinks that I should be planted in front of consultants as often as possible as some sort of bizarre immersion therapy. Those poor sods having to suffer me. OK it boils down to this... I wasn't in for 2 days and then they ask (read tell) me to be on the ward rounds for both of our consultants. I'll admit this now, I do not know everything about our 20-something patients. I do know a lot about the 10 patients I spent last week working with and I have a handover. Let's go wing it!

Actually it didn't go too badly. Thank goodness. It could have been so much worse....

Most important lesson about consultants? Avoid or at least be polite.... then run and hide.

Quote from today... (finished talking to patient who's ears are stuffed with olive oil drops)
Doc - Olive oil embolism?
Me - I'll refer him to Gordon Ramsay then.

I am...

I am the sister who takes no prisoners and the deputy sister who calls it as it is.
I am the nurse who stopped me from walking out and the one who would have let me go.
I am the patient who is walking out smiling...
And the empty bed with a crying family.
I am the test I couldn't pass and the party when I finally did.
I am breakfast at McDonald's after the night shift and start of the shift coffee.
I am those who have taught me and those I have taught.
I am my reflections on practice and the war stories we trade in placement.
I am sim man and the real patients who let me practice on them.
I am the medbloggers who let me see their daily lives online.
I am the placements that have gone before.
But more importantly the final placement and all the staff who work there.
I am who I am because of everything.

(I am an idea entirely taken from this series of Orange ads)

Edit: This was based on my *other* final placement. I may have to rewrite it in light of my *real* final placement. - WB 27/04/2009

Do Tattoos Reflect Professionalism?

So there we were sitting around on Twitter shooting the breeze with 140 characters of less when Nurse Connect released this article into the world.
This is somewhat a bug bear for me. I do have a tattoo but even now it's covered by my clothes and is never seen when I'm in placement. You also have to remember that this is the UK and we are governed by the almighty NHS and a simple search of google for 'nhs uniform policy' yields loads of documents from multiple NHS trusts on their specific uniform policies.

Basically it boils down to this.... (only taking into account nursing / other clinical staff)
You get a uniform. Normally navy blue is reserved for Ward Sisters (manager), Deputy Sisters, Specialist Nurses (they are in the same band as the management). White with blue binding is for are the general plebs. Theatres, cath labs, ITU, paeds, etc. will have different uniforms / scrubs. OTs, Physios, Speech and Language Therapists (SaLT), etc. have similar uniforms but different colours for the bands (e.g. our SaLTs have gray, OTs have green). Our student uniforms have the uni's name embroidered on to it (this is quite common though so it's not just us), however it is similar to the Healthcare Assistants (HCA) / Clinical Support Workers (CSW) with plain white tunics, so we get easily confused.

• Ladies' Tunic with trousers
  
• Men's Tunic with trousers
  
• Or the rather rare dress usually worn with a belt.

So right beyond the uniform that you may or may not have to launder yourself.... you are expected to....

• keep long hair tied back (and off collar)
  
• keep nails short and clean (no nail varnish)
  
• wear no (visible) make up
• no jewellery (except a plain wedding band)

They have all but told us when to breathe. This is all in the production of a professional appearance.
Some of the policies I have come across cover tattoos as well.

Inappropriate tattoos must be covered at all times. The head of service/department will be responsible for determining whether a tattoo is inappropriate or not i.e. any tattoo with offensive language is deemed offensive. It is acknowledged that some religions/cultures use henna to decorate their bodies at certain times and this is acceptable.

NHS East Kent

Visible tattoos are to be discouraged....

NHS 5 Boroughs

Considering what we have to put up with this all seems acceptable. I wouldn't want to be looked after by someone with swear words scrawled all over their arms (I would assume that back, chest, legs, etc. would be covered by our uniforms). In this area would a Celtic or Rangers FC tattoo be considered offensive? There is a massive rivalry between these 2 teams in Glasgow, this offers a background. But I guess it would be up to the nursing management. However a Celtic tattoo would be offensive to a Rangers fan and vice versa. So I guess it would be.

As a side note there is a policy of non discrimination when it comes to union affiliation / orientations / etc. So when I came back with the mention of my gay pride badge on my uniform I know that nothing can be said to me about it. We are allowed to wear a certain number of badges proclaiming our union or the school of nursing we graduated from.

My point was that as much as that little proclamation of my pride in who I am on a uniform the same as everyone else's is a reflection of my personality, a tattoo is a reflection of someone else's choice in life. (No I'm not saying my orientation is a choice by the way) So why shouldn't people be able to show off a little bit of their personality by way of body art so long as it isn't offensive?

Slow Day

Ever had one of those shifts that just never seems to end?
Man today lasted forever... We discharged patients left, right and centre but we were still not busy. Of course for every empty bed there was a patient to fill it. Only those patients were arriving after we left for the day!

We learned some important lessons.... don't talk about the boss from inside the sluice when she's standing at the station... and when you are the first one to spot she's standing there do NOT, under any circumstances, wet yourself laughing... don't naff off deputy sisters... 'cos it'll come back to bite you on the ass.

We had far too much time on our hands, and idle hands...