I'm back!

Hi guys! OK I've been back a week I know but it has taken me all this time to catch up on everything that you've been writing.
So yep my registration came through (even though the forms had to make a round trip to the Midwest). I just don't have a job yet. I'm working on that, promise.

I always said that I would tell you guys, around the time of my graduation, my name and what I look like. So here's the first bit of the integration of my split-internet-personalities...
You can all now call me Claire.

Hey

Hi guys!
I'm still alive but have to borrow the internet from the camp so I'm keeping a low profile. There's been a few accidents along the way this summer and I've had the joys of experiencing the American health care system from the patient side twice. I *heart* nurse practitioners!

I wanted to post that my registration came through!! And I'm now an Adult Nurse!

Woohoo to no longer being a student, although I thought it would never happen at some points.
Love WardBunny

Who Da Nurse?

Me that's who!
I got signed off!

Me.... Nurse ....... Qualified...... Finished........ *OK time to quit hyperventilating*




Shit.

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.

I've Found the Love AGAIN!

For those who are eagle-eyed, sharp of brain and generally better at picking up on problems you might have noticed that when things go badly I don't post. (If you didn't, don't feel too bad. I can never see when my friends get haircuts. That's worse!) You really don't need to hear me go on and I don't want to type it as it happens like a bad copy of Nursing Big Brother.
I haven't posted since the first of the month.... It's now the 14th.
I'll leave you to your own conclusions.

Anyway... I'm back and I've found the love I had for nursing way back in the beginning. Which leaves me wondering if I had a period of burnout back there. Personally I think anyone would consider tossing in the towel after 16 weeks leading to failed placement, to be followed by an episode of 'why the fuk am I still doing this' and hitting the wall of 'too exhausted to function' last week.

Weeeeeee I'm gonna be a nurse!! I will be a nurse! I will no longer have to sign 'Student Nurse' after my name!

I'm back baby!

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?

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!

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?

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.

PLACEMENT'S IN!!!!

The news everyone has been waiting for! I finally got word on my make-up placement...
Urology / Surgical at Bigger-Than-Average General Hospital. (Which is miles away and why all my other placements have been at Pinky and Perky, the other smaller general hospitals.)

Oh and I start on Monday! Lots of advanced warning there folks. I have spoken to the Sister and she certainly acted like she knew the whole sorry back story.

Oh and it's 5 weeks not 6 so I can get back to earning money to go back to camp. Woo!

Blood Spatter!

Test you blood spatter analysis skills with the New Scientist.
Clearly I've watched far too many CSI eps and documentaries. I only got one wrong and it wasn't even totally wrong. Saying that sometimes you have to figure out where blood on sheets / floors has come from. The missing venflon isn't always obvious!

With thanks to William the Coroner!

Being Green / Being Mean (the toilet talk)

This is an odd balance...
I can be really stingy. Have to be; my money's running out and with this supposed placement over my head I'm not taking as many agency shifts as I could because I really don't know what I'm doing next week. (Honest he's not given me a placement yet and agency needs at least some advance warning.)
This brought me to an interesting thought do you have to compromise on being green so you can be mean instead? There's a toilet paper advert running that states for every tree they use, they will plant three new ones. We don't use this brand in the flat. We use the cheep as chips, supermarket value brand. This costs about £1 for 12 rolls. The brand planting all the trees costs £2 for 4 rolls. Does a cheep roll wipe less asses than the expensive one? I'm not going to test that sorry. But lets make the scientific assumption that the expensive one is slightly longer and more absorbent. You seem at least to get far more for your money with the cheaper rolls.
(I promise you I'm not obsessed with toilet rolls. Bin bags and washing up liquid are far more obsessional.)
I think I'm starting to see where their money for saplings might be coming from.
So back to the question do we have to choose being green over being mean? I'm sure you are aware that greener / fairtrade / healthy products cost more. They do fairtrade coffee has always cost far more than even Gold Blend (and that's not cheap either). People wonder why the west of Scotland has a crappy health record (our 3 biggest killers are heart disease, stroke and cancer). All unhealthy food is cheaper in the supermarkets than the healthy stuff!

Another point I'll make before leaving. How much waste does your hospital produce in a day? The average (read small-ish) operation produced at least 3 large bags of clinical waste. That's 1 small operation. There could be 10 of those per day per theatre. The wards aren't short of stuffed bin bags either. The least green industry in the UK has to be healthcare. A lecturer once said that 'I'm here to do my job. Not save the NHS money.' She meant that if we had to use expensive dressings, or open 15 packets of something to make sure it was right then we did it. But look at the waste we generate. Sterile packages for surgery are double wrapped and 90% of patient contact materials are all disposable. I'm not for a minute suggesting that we abandon disposable gloves, aprons, sterile packaging and our beloved paper-pulp products. Abandoning these would send infection control into meltdown! There is little or no way to cut down the waste created by the healthcare industry. We have to toe the best policy guidelines and it is never in the patient's best interests to cut corners. So other suggestions? Recycling? Er lets not go there shall we?

So is it a valid choice? Yes lets all save the planet but not when I'm on a budget. People should do what they can. We need to recycle more. We need to cut down on packaging (although maybe not in healthcare). Maybe that's where I could be better since I cannot afford the 'green' bog roll to do it for me.

A First As Student Nurse Blogs Go

If you take a look at the student nurses listed in the sidebar (and I suggest you do). Then all of these lovely people are smart, well adjusted, and get good grades. I on the other hand... fail stuff, mess it up and generally cause havoc where ever I go. Makes for interesting blog posts at least.
So this should come as no surprise....
I've stuffed up my final placement. My fault not theirs. Should really have seen it coming to be honest. So I'm not there yet. Sadly.
I'm getting 6 weeks somewhere else to see if I can pull it back (and maybe put a cap on that problem I have with authority). It'll work out fine. The whole thing wasn't right from the beginning so somewhere new has to be better.
I'll tell you guys when I find out where I going. I put in a vote for acute / critical / coronary care / type places. Don't know if I'll get that but it won't be going back to where I was.

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

Registration

Oh heck we're in for it now. It getting time for us to register. Course my paperwork isn't in yet and apparently my portfolio is part of the crowd that's getting taken in. I'll be working on it for the next week solid to get it up to scratch. I do not like external examiners. It's not a personal thing, just a 'stop staring at my work' thing.

I'm afraid of being in charge of anything greater than my goldfish. I did not study for 3 years to get this far and to bottle it now!

Now is the time to get off my backside and get going. Time to grow up and pull on the big girl uniform.

Ah sod it 1 more week of being a student won't hurt........

Why Do We Do What We Do?

...or why get into nursing in the first place?
I was reading Julie's blog over @ Life in the NHS. there she was innocently talking about a conference and mixing wines. When it all got semi-hijacked in the comments...
Julie,
I would like your honest opinion. I am registered to begin a PgDip in Adult Nursing. It seems fairly random to ask your advice but when I put in ‘life in the nhs’, ‘nurse’ and ‘mother’ into google this site comes up! I have some concerns about nursing and would like the opinion of an experienced nurse. I am concerned about how nursing fits into family life, but also general career prospects and job satisfaction. I have to say, I read the 2005 RCN report into conditions for nurses and it made sobering reading! My family are concerned about work-life balance and want me to think very carefully, but I’m finding it difficult to get the advice I need. Please help!
Many thanks,
Amy
Oh see I have to stick my oar in now....
Hi Amy,
I think you are wise to think carefully before embarking on a career like nursing. This is an exciting but volatile and changing time to be starting on this particular career pathway. Nursing can be a rewarding and exciting career. There has never been a better time to push the boundaries of what nursing is about, but at the same time many (including nurses) believe this puts pressure on the ability of nurses to perform the basic and fundamental skills of nursing. The most important aspect of these are caring, listening, communicating and providing care. There are jobs available in many areas of work which means that it is possible to work full time, part time, to work at night or during the daytime. Acute care has become more stressful and demanding, work in the community more dynamic and acute focused since people stay in hospital for less of else don’t go there at all. There is also lots of work within prevention and health promotion - this will be increasingly important.
I don’t think nursing conditions are bad. Jobs are pretty secure, but the patient in some way or other needs care over the 24 hour period. We have to be there for the good of our patients not for ourselves. Pension is good, there are good holiday entitlements, paid holiday and sickness - you can do worse and reasonable pay. But it isn’t for everyone, we don’t always make good colleagues for each other and there are good and bad nurses around. I wouldn’t change anything about my career, but then I no longer work at the sharp end.
Hope this ramble helps. I might write a post about some of these points.
Regards,
Julie
Julie's reply is essentially brilliant, it covers all the bases, so why am I sticking my oar in? Well I was commenting anyway.
Hi Amy
I’m about a month from the end of my course and it’s been a real eye opener. I wasn’t clear on what the course was really about when I started. I wouldn’t change any of it for the world but that didn’t stop it being difficult and heartbreaking at times.
However few jobs in this life are as varied and ever changing as nursing. There are hundreds of specialities, different ways of progressing, multiple travel opportunities… There really is a niche for everyone.
If you decide to go for it then you will never regret it and will become evangelical about the benefits. But the sharp end conditions are as they seem. We are stressed and pushed and jaded. While at the same time the greatest voice for our patients and with fight to the death to protect it.
For family life… just remember to leave your work behind when you leave. It’s all too easy to take it home. A lesson I learned only after getting pushed.
Think long and hard. But if it’s your dream go for it!
Love
WardBunny
I do really believe in that. If it's what you've always wanted to do then you should just go for it. Sod the reports, the press, the horror stories. Just do what you want to. So many of us dreamed of being nurses so we're doing what we wanted to do.
Of course there's a lot of people who fell into it but that doesn't make them bad nurses. There are people who dreamed of being nurses but are just not good at it.
It's the hardest training and most stressful in the world but it's also the most rewarding job and it definitely seems to make you a stronger person.

P.S.

You might have noticed the ticker at the top of the posts has changed. It now represents the last shift in placement as opposed to the last day in college. The last day is Wednesday but I'll still have some shifts to finish before the last of my paperwork goes in. Still a bit to go....

Bad Blogger

I'm a bad blogger. I feel like a haven't updated in forever. Sorry guys I don't mean to do that.
It's been a mad week. I finished my application for camp but at the same time have yet to finish the portfolio that really should be due in a week. Actually it was due on Friday but I missed my lecturer visiting 'cos I was on a back shift and she came at 9 in the morning. It's a mess, placement's a mess... well everything is a mess right now.

There are no funny comments this time. Just little piles of not yet finished work and me doing everything but.

I'll update with something informative tomorrow..... Well I hope so.

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