Pre-assessment

So at the moment I am on an orthopedic ward and recently I did a spoke visit to the pre-assessment unit. These are a few of the many things I learnt doing pre-assessments. There is a lot of information to gather and it is important not to miss anything!

Always check for allergies/sensitivities. When reading through the notes of one patient who I was pre-assessing I found no allergies recorded. However, on asking the patient I found that he had recently taken penicillin and had a bad reaction causing his tongue to swell. Allergies can develop at any time and so it is vital to always check for allergies! 

– Patients with diabetes should be 1st on the operating list- their BM should be between 6 and 10. A hypo is classed as anything 4 and under and a hyper is 14 +. 

– Drugs classed as complementary therapies should be stopped a week before the operation. I was surprised to learn that:

    Garlic and ginkgo supplements cause increased bleeding

    Valerian and Kava cause hypersomnia (or somnolence) which is an excessive need for sleep

    Large amounts of grapefruit alter hepatic drug metabolism and can cause QT interval prolongation

    Ephedra (diet pills) can cause cardiovascular disturbance

    St John’s Wort can cause sedation, confusion and withdrawal, especially when mixed with a general anesthetic 

– Drugs which can still be taken on the day of surgery are: anti-anginals, anti-arrythimics, anti-epileptics, Parkinson’s meds (except for Selegiline), anti-psychotic, anti-retrovirals, COPD/Asthma medication, beta-blockers, calcium channel blockers, cardiac glycosides, H2 receptor antagonists (ranitidine), immunosupressants, lithium, long-term benzos, long-term opioids, nitrates (GTN), proton pump inhibitors, statins, steroids and thyroid medication. 

– To discuss with the anesthetist/surgical team – anti-platelets (Aspirin 75mg is generally ok. Aspirin takes 3 weeks to get out of the system so if the patient really needs to stop their Aspirin, it will only be effective if stopped for 3 weeks before), anti-coagulants, HRT, combined oral contraceptive, cytotoxic chemo, cytokine modulators (for Rheumatoid Arthritis), monoamine oxidase inhibitors, tamoxifen.

– To omit the day before and the day of surgery – ace inhibitors (ramipril).

– To omit the day of surgery – angiotensin receptor blockers, alpha blockers (doxazosin), anti-depressents and diuretics. 

– For diabetes medication, metformin can be taken on the day usually. However as patients are nil by mouth unless having a minor op, a lot of diabetes medication can be omitted. For example Gliclazide which increases the amount of insulin produced in the pancreas. If patients are not eating then they will not need extra insulin as they will not be taking in any glucose which needs breaking down. 

– Joint replacements always need 2 blood samples which are then crossmatched. This is because there is an increased likelihood of the need for a blood transfusion (although it is now pretty uncommon for joint replacements to need blood transfusions due to cell salvage and surgical techniques which limit blood loss). 2 are taken on separate occasions to make sure the sample is from the correct patient. 

– All patients need MRSA tests. 

-Many patients suffer from “white coat syndrome” – wait until the patient is calm and more relaxed before doing the blood pressure in pre-assessment. Do them manually for more accurate results – also this can be less intimidating for patients than an electrical blood pressure for patients. Sometimes electronic blood pressures can bruise patients and go very tight, also the machines often make noises such as loud beeps which patients can find worrying. I prefer to do manual blood pressures full stop as I think they are more accurate!

– When gathering past medical history from patients, particular conditions to look out for are those which cause excess bleeding such as hemophilia (hemo=blood phillia=love) or if patients are on anti-platelets or anti-coagulants which could cause excess bleeding. Other conditions to look out for are those which affect the respiratory system (especially if patients are having a G.A.) such as Asthma, COPD. Also any cardiovascular conditions – this can effect how suitable patients are for surgery. 

– Also very importantly, ask the patient if they or any close family member (such as mother, father, brother, sister) have had DVTs, strokes, CVAs, PEs. This can increase their risk of having a blood clot. 

– Ask if any of their blood family has had bad reactions to general anesthetics if the patient has never had a G.A. before

Do not bombard patients with information. As many of the patients I pre-assessed had to come back for 2nd blood samples, me and the nurse I worked with agreed not to give too much information verbally as there was another opportunity nearer the time for the patient to ask questions and find out more. Patients can only take in so much info and it can be very overwhelming for them listening to everything. Somewhere I read that patients only remember about 20% of what they are told in assessments. Therefore, it is important to give the patient the hospital number to ring if they have any more queries, also to give them relevant reading with information tailored for them and their particular operation to take home. 

-I met a patient with haemochromatosis which is an inherited iron overload disorder. The patient had to have regular phlebotomy to keep his iron levels under control. Too much iron is bad for the liver as the body runs out of places to store it and so stores it in the liver which can cause scarring (fibrosis) and liver enlargement (heptaomegaly). Fibrosis can become cirrohsis if left untreated. It is a potentially lethal condition. 

– ECGs are done on patients who have caridac problems, also on older patients and patients undergoing bigger operations such as joint replacements. 

– Urine tests are important as you do not want patients with infections having surgery. If urine samples are positive for anything then it is important to send them off for further testing (culture and sensitivity) and so any infections can be treated before surgery. 

– Blood test results:

   Full blood count (FBC) – the most widely used blood test

   Haemoglobin (HB)– low HB can indicate blood loss, anemia, cancers and kidney disease amongst other things

   White blood cell count (WBC) – a high amount can indicate infection

   Platelets – diseases cause an increase in platelets due to inflammation. Platelets help the blood to clot. A high amount increases the    risk of blood clots for patients. A low amount means the blood won’t clot well and so excessive bleeding could be a problem during        and after surgery. 

   Ferritin – low ferritin can indicate anemia. 

 

These are just some of the things I dotted down in my few days on pre-assessment. Hope it is interesting to read 🙂

  

 

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Why nursing should be a degree

To me this a no-brainer. I previously did a marketing management degree and to become a successful marketer, it was expected that in this day and age you must have a degree. My peers who I graduated alongside have all gone on to have marketing jobs – all of which they wouldn’t have been able to get without a degree.

Not that nursing and marketing are similar subjects in any way, I’m kind of comparing apples with pears. However the point I’m making is that if a subject, such as marketing, where you are not saving lives/not looking after ill people/not making literally life-changing decisions on a regular basis is accepted to be a degree level subject (a profession if you will) then why not nursing?

Why the big debate about whether nursing should be a degree? As I argued in a recent twitter debate, to become a doctor, physiotherapist, occupational therapist you must have a degree. Imagine arguing over whether doctors should hold a degree? Nurses are now doing more of the tasks which used to be done by doctors only. After the European working time directive which put a cap on the amount of hours junior doctors could do per week, nurses roles changed a lot. To fill the gap made by less hours of junior doctors, nurses were given more training and could do things such as colonoscopies which had previously been strictly out of bounds for nurses. Nurses were also given more management responsibilities. So surely it makes more sense now why nurses should be educated to degree level? Surely it is important for nurses to know about evidence-based medicine, anatomy and physiology, managing risk and the rationale behind everything they do in practice to a degree level? 

Apparently not to some, including our government. The new apprenticeship to nursing scheme, where promising healthcare assistants will be fast-tracked into nursing seems like a bad idea to me. I know some healthcare assistants who have been seconded and are now studying for a nursing degree – surely this is a more sensible option? By having 2 routes into nursing, you lose continuity. You lose equality. These 2 different types of nurse will have had different educations and are likely to not be seen as equals once they qualify. This is not fair for the apprenticeship nurses. To progress as a nurse, it will be far easier for degree level nurses. Qualifications such as a degree often place you head and shoulders above the rest when you want to progress. A masters even more so. I also wonder if the pay will be equal? 

Forgive me if you think I’m making assumptions here, but could it be that the government would rather nurses were not educated to a degree level? As nursing is now seen as a profession and therefore is a degree level subject, there are certain pay expectations. Take this professional status away from nursing – make it more of a “vocational” occupation and you take away a nurse’s right to a good level of pay. Could it be that the government is motivated to take away this pay expectation to save money? With all the cuts being made to the NHS it would be no great surprise to me. 

I’m not saying nursing degrees are perfect. They are not. One thing I think could be improved is the way placements are either pass or fail whereas academic work is graded. Some nurses may be ok academically, but not great, but may be exceptional in practice. This doesn’t reflect in a student nurses overall degree mark (although it will do in the personal statement) which I think isn’t fair. I know it could be complicated for mentors to have to grade their students, but perhaps with more support (say from a university link lecturer) it could be done. Likewise nurses who do really well academically but aren’t so good on placement would gain a more accurate mark this way. Perhaps this would make degrees more fair and make sure those talented student nurses who are not as academically gifted as other student nurses gain a fairer mark.

I do still think however that to be a student nurse, you must be willing to study. It is a requirement of the NMC that the nurses keep up-to-date with the latest evidence. With a degree level education a nurse will know how to do this. They will be familiar with meta-analyses, randomised control trials etc and will know which journals to look in. Take away the degree and who then will teach nurses how to critically appraise evidence and given them the skill of being able to study? I think it would be unfair to take away the degree from nursing – the idea seems backwards, especially as nursing is becoming ever more complex and requires a lot of skill. I’m not even going to mention the whole “too posh to wash” idea, well I suppose I just did. But I’m only mentioning it once and I’m only mentioning it to ask – really? People actually believe this?! Since when did a degree make someone posh? And who says posh people don’t wash 😉 

Thanks for reading! 

 

Things I learnt in my last placement

For each placement so far I have taken a little notepad with me and written notes – things I’ve learnt and sometimes things which I want to read up about. Over the weekend I was looking at my last notepad and thought it would be a good idea for me to write-up what I wrote. Here goes 🙂

Neutropenia – When you don’t have enough neutrophils in your white blood cells. Means you can’t defend yourself from infections well.

-NSTEMI – Non-ST elevated myocardial infarction – No ST elevation on ECG. Means MI destroyed a small area of the heart.

-STEMI – ST elevated myocardial infarction – ST elevation on the ECG. Means a larger part of the heart was destroyed by the MI. Much more serious than NSTEMI. (The hospital I was in would send patients who had had a STEMI to a specialist hospital in the next city for more specialist care).

Ticagrolol and Clopidogrel are the standard anti-platelets given after a stroke.

– Daily Weights and input/output charts to check for fluid retention.

– Aspirin irritates the stomach and should be prescribed with caution in patients with gastro problems.

– Rheumatoid Arthritis – is a severe autoimmune disease. Arthritis alone is caused by wear and tear or due to an injury.

Atorvastatin 80 mg is given post MI.

– TROP – Troponin test. Troponin is a specific protein found in higher levels in heart muscle after an MI. Test used to diagnose an MI.

– Catecholamines are hormones from the adrenal gland- norepinephrine, dopamine and epinephrine.

– LOC changes – level of consciousness changes.

– Blood transfusion – high temp and chills, stop blood transfusion. Do observations straight away.

Diaphoresis – sweating profusely.

– Potassium chloride – 1st check urine output. Potassium is excreted in urine.

Rhinorrhea – Mucous in nose (runny nose).

– Orthostatic hypotension – same as postural hypotension (incase you don’t know either – low blood pressure when standing).

Acopia – Not coping. “A” means not. Warning: A slang term rather than official term.

– AVR – Aortic Valve Replacement.

-Isosorbide Mononitrate –  Vasodilator, for angina pain (for some reason I always forget what this drug does so keep writing it down!).

– GTN  (glycerol trinitrate) spray – Use 3 times within 15 minutes. 2 sprays each time. Used sublingually (under tongue) as a highly vascularised area.

– GTN – contraindication when aortic stenosis is present.

– Coronary thrombis is the same as an MI.

MI detection

1) Signs and symptoms

2) ECG shows lack of blood to the area.

3) Cardiac enzymes – Trop blood test 12 hours after coming into hospital.

– PPCI – Primary Percutaneous Coronary Intervention – Not done at this hospital. Only done on patients who have an ECG which shows specific abnormalities (for STEMIs).

– Urgent clot-busters – Tenecteplase/streptokinese. kl

Protective cardio diet

1) Omega 3 fatty acids – oily fish.

2) 5 fruit/veg a day.

3) Fat polyunsaturated/monosaturated – olive oil and rape seed.

– Normal troponin levels are below 50 – over 50 and an MI is suspected. Highest recordable level is 50,000. Higher levels of trop don’t necessarily indicate a bigger MI as everyone responds differently and some may produce more trop than others.

– Prolactin is a pituitary hormone.

– Liver decompensation – Liver can no longer rebuild itself and becomes decompensated – basically it stops repairing itself.

– Anti-cholergenic drugs can cause dizziness.

– Syringe driver – need to make sure there is a reduction of 8mls every 4 hours otherwise may not be working properly. Must measure not just look.

Cyclizine reacts with saline (crystallization) so use dextrose or water for injections instead.

– Inverted T wave on an ECG indicates an MI.

– Do an ECG before GTN spray and after.

– Lower limb thrombolysis – use Tissue Plasminogen Activator and Heparin to treat- done with a bolus and infusion.

– In an operation respiration rate and SATS are usually the first sign the patient may be stuggling.

– Beta-blockers trigger asthma.

Apomorphone – dopamine agonist drug used to treat Parkinson’s Disease. Given via injection.

– Brown inhaler treats asthma – Blue inhaler treats symptoms.

Ipratropium nebuliser can be used 4 times daily. It is fine to put Salbutamol and Ipratropium nebs on together.

– Before a cardioversion a patient needs anti-coagulants – Warfarin usually.

– 1st degree AV block – Shows on ECG when there is a prolonged PQ wave. Caused by ischemia/ faulty AV nodule.

– Jugular Venous Pressure – raised can indicate oedema.

– 20% of patients with heart failure have depression.

Cachexiaweightloss due to an illness.

Cardiomegaly – heart expansion.

– Left ventricle failure – leads to pulmonary oedema.

– Right ventricle failure – leads to peripheral oedema.

– Cardiomyopathies- Heart muscle damage could be due to drug abuse (cocaine)/ chemo.

Can you tell I was on a cardio ward?! 

Surviving night shifts

Night shifts…. some people love them, some people hate them. Personally I quite like them – it’s a welcome break from all the busyness of the daytime. The wards are a lot more of the Q word ending with T (which you are banned from ever saying on a hospital ward – we’re a superstitious lot!) and so you have more time to spend with patients and are not as rushed as usual. Although having said that, some night shifts I’ve done have been extremely busy with deteriorating patients and admissions to attend to.

The downside for me is the immense tiredness. The most nights I have done in a row are 3 and I am certainly tired by night 3. I usually find that the 1st night is quite hard, the 2nd is not bad at all and is probably my peak and then by the 3rd night I start to really feel tired. I’ve only ever had hospital placements so cannot say what it’s like in a nursing home or other healthcare settings but this is the routine for a student nurse on a medical ward (from my experience).

7.45 – Arrive on shift, get a general idea of how the day shift has been from the atmosphere on the ward. Get my handover printed if it hasn’t already been done.

8.00 – Handover begins.

8.15/8.30 – Handover finishes. The day staff start to leave.

8.30 – We introduce ourselves to the patients – the ward is split into two with 2 nurses and me on. One nurse has 3 bays, the other has 2 and all the side rooms. I am usually assigned my own bay of patients to care for. Start doing my patient’s observations. Work out when the next observations will be due for each patient. HCA’s team up and assist patients to bed and with personal care.

9.30 – Medication round begins. Some medication is time specific such as epilepsy medication and so may be taken slightly later or earlier. I do the round with the nurse observing me.

10.15 – IVs are done last unless there are any which urgently needed doing. It’s a good chance for me to practice my medication calculations.

10.45 – We are free to help with any turns and toileting the patients may need help with.

12.00 – 03.00 – Go through the patients’ notes and see what doctors/nurse specialists have decided is the plan of action for each patient. Update the handover sheets if need be. Do any observations which are due. Make sure the drug trolleys are tidy and stocked up – a good opportunity for me to test my pharmacology knowledge. Assist with patients’ personal care – turns, assisting patients to the toilet/to use a bedpan/ if a patient needs their pad changing. Go through the crash trolley checklist and check that everything is there and all in date! Make sure B M (blood monitoring) machines have been checked and are ready for use later on.

03.00- 04.00 – BREAK TIME 🙂 I like to go around this time as this is when I feel the most tired and usually by this time I’m up-to-date with all my jobs. I’ve also got some observations to do around 4 and so this is good timing.

04.00 –  Do any observations due.

04.45 – Prepare my handover – add on anything important that has happened overnight for example – a patient has had chest pain and so I did an ECG and beeped the doctor or critical outreach nurse. What the doctor/nurse said and what action was taken. How the patient has been the rest of the night. Or it can be something less exciting such as a patient had an episode of loose stools, the day staff need to know where on the Bristol Stool Chart the stool was and whether I’ve managed to send off a sample yet. Write my patient’s notes – if anything major happened such as the chest pain example, I will already have written in the notes at the time so I don’t miss anything important out.

06.15 – Do any more observations due, check patient blood sugars. Assist health care assistants to meet patient’s personal care needs. It usually gets busy around this time and you’re rushing around!

06.45 – Day staff start arriving. Make sure handovers are printed out.

07.00 – Handover time! I handover my patients to all the day staff. The nice nurses usually let me go 1st so I can leave 1st. The joys of being a student nurse!

07.15 – Finish!

Think I’ve managed to include everything! My top tips for doing a night shift are:

1. Keep busy! If you’re sitting around, time tends to move very slowly. Take some reading with you in case you get a bit of down-time during the shift to keep you occupied.

2. Try and go to bed a bit later than usual the night before you start night-shifts and lie in if you can. If you don’t think you can do this have a nap in the afternoon before your night-shift (I can never do this for some reason!).

3. Take healthy(ish) food to your night-shift. I usually take soup, a small chocolate bar, a banana and a diet fizzy drink. The most tiring night-shift I did was when a nurse brought in loads of junk food; crisps, cakes, chocolate which I binged on. The sugar-low in the morning was awful!

4. Make sure you have somewhere quiet and dark to sleep during the day. You need darkness for your body to produce melatonin (essential for your sleep/wake cycle) – suppressed melatonin has been linked with various cancers, heart disease, impaired immunitythe list goes on. I live with my partner but when I’m on nights I sleep at my mums because it’s much quieter in the day-time where she lives.

5. Try to go to sleep as soon as you get in from a night-shift. If you wake up a few hours later, try to go back to sleep or just rest in bed. Some people get a “second wind” and feel like they’ll be fine getting up but then feel exhausted by the time they start their night-shift. I try get at least 6 hours sleep in the day, 7 ideally.

6. Do not drink alcohol the night before a night shift! I haven’t done this before (promise!) but know people who have and say they feel a lot more tired than usual. Obviously a couple of drinks are fine but not a night-out’s worth of drinks!

So these are my thoughts on night-shifts. They can be a really good learning experience as caring for deteriorating patients at night when there are less doctors and other healthcare professionals around is big learning opportunity. You and the nurses you’re working with have to make decisions without a big team around you – obviously there are always doctors and specialist nurses around, but when they’re on-call for all the wards in the hospital you need to be able to make judgments about your patient and make sure you communicate effectively and so that the patient doesn’t deteriorate any further.  Hope you don’t find your night-shifts too bad or maybe you like them! 🙂

Having a job as a student nurse

A few weeks ago I took part in a Student Nursing Times discussion on Twitter, here it is on storify: http://storify.com/studentNT/we-asked-is-it-feasible-to-work-part-time-during-y?utm_campaign=&utm_medium=sfy.co-twitter&utm_source=t.co&awesm=sfy.co_dYSK&utm_content=storify-pingback. 

The discussion was basically about people’s experiences of working part-time as a student nurse and asking whether people thought it was practical for student nurses to fit in part-time work around their studies. I argued that working part-time on the bank in my local hospital has been a really positive experience for me.

Some people agreed but others didn’t; it was interesting to hear other peoples points of view. One person argued that it could actually be detrimental working as a HCA with others agreed that it can make it harder for student nurses to transition to being nurses if they are used to being a HCA.

This really made me think and reflect on what I actually get out of working as a bank support worker. Here are the pro’s and con’s of having a part-time job as a student nurse – obviously for me this bank support work, however I know a lot of other student nurses in my cohort who do other types of jobs such as bar-work, working in a supermarket etc.

Pros

* You get to choose when you work – never before have I had this luxury! It makes it so much easier for me to fit in part-time work around my studies. When I’m on placement I usually only book the odd shift, perhaps 1 shift every 2 or 3 weeks, but when I’m in theory I’ll book 1 shift a week unless I’ve got a lot of work on then I’ll give myself more days off to complete uni work.

* Weekend rates – if I do a shift on a Sunday I get nearly double pay, it’s great! Saturday is also good pay as are nights. This means if I just do the odd shift on a weekend then I can still make a good amount of money without doing lots of shifts. This way I still have lots of time for studying!

* Good learning opportunities – I’ve learnt loads on other wards and have had the opportunity to build on my nursing skills. On a shift I did recently a nurse let me explain to a patient how to use and attach her catheter leg bag before she was discharged to go home. I felt like this was good practice for me as the patient had never used a catheter before this stay in hospital and so was quite anxious. After I’d explained how the leg bag worked and showed her how to change it and when etc. she said she felt much less worried about going home with a catheter and thanked me. When I qualify as a nurse I will often be explaining to patients how to do things when they’re out of the hospital such as using catheters, taking blood sugars and many other things and so this was definitely good practice for me. I also saw my first epidural catheter being used by a woman who had just had her two original kidneys removed as they were infected. She still had another two kidneys which had been donated to her by family members (when patients receive kidney transplants, the original kidneys are usually left in unless infected – this woman had had 4 kidneys altogether at one point). I learnt how to test the epidural was still working as I observed the nurse doing a sensation test down the ladies legs and up her back to see what she could feel. The lady couldn’t feel sensations up to the right areas and so we knew the epidural was still effective for her and the dosage didn’t need adjusting. I was amazed at just how quickly the woman was able to mobilise after quite a major operation. She had only had the operation two days before and she was already receiving Physio input and mobilisng to her chair for me to help give her a wash.

On another shift recently I learnt about checking PEG tube placement when a nurse checked the PH of the PEG and it wasn’t in the correct range. I was asked to accompany the patient to have an x-ray to check to see if the PEG was still in the stomach and hadn’t either perforated the stomach or moved into the small intestine of the patient. Thankfully the x-ray results were fine and I got to look at the x-ray with the radiographers and the doctor. We could see it was sitting in the stomach. I also realised from this experience how little I actually know about PEGs and so did some reading when I got home!

* Expansion of my nursing vocabulary and knowledge – by working on different types of wards I now know lots of different nursing terms. For example, when working on a gynecology ward recently I saw lots of patients with Hyperemisis Gravidarum which I had never come across before. I found out the condition is a complication of pregnancy which means that patients vomit excessively throughout their pregnancy which results in dehydration, electrolyte imbalances and can lead to malnutrition if not treated. Often you can work out from condition names what they mean – I already knew that emesis was the Greek word for sickness and as most people will know hyper means excessive or a lot and so by putting them together I knew what hyperemisis meant. Other condition names are not so obvious though!

*Networking and job-hunting – By working on different wards I have expanded my network and am now a familiar face on a number of wards 🙂 This will be good for me when I qualify and am job hunting because if I have made a good impression on a ward as bank support worker then wards could be more likely to hire me. I’ve also found some wards which I will definitely be applying to work on if the opportunity arises and some which I don’t think I would like to work on.

Cons

* Exhaustion – Doing a degree in nursing is already tough and on top of that some people have children or other commitments meaning they may simply not have time to work on top of all this. Having said that I know people with children who also work part-time whilst doing this degree – it’s different for each individual.

Struggling to fit into the support worker role – I’m not going to deny that sometimes it can be frustrating on shifts when there are things I could do as a student nurse but can’t do in my role as a support worker. It is important to only do things which you feel confident in doing and have been trained to do. Overstepping your role as a support worker and doing things expected of a student nurse or nurse are not ok as you are not in this role as a support worker.

* Emotional stress – In healthcare we see a lot of things the everyday person doesn’t. We definitely need time to relax and destress – this is really important for our own health. By working on top of doing a challenging degree you can end up putting a lot of extra stress on yourself and so it is important not to book too many shifts even though the money is tempting! I tend to book shifts when I know I’m well on the way with my assignments and have got a plan rather than booking lots of shifts and then panicking that I won’t get assignments done.

Feeling too comfortable in the support worker role – I’m adding this as a con as I can see the point people were making in the discussion. Nursing is a highly complex role now, much more so than it used to be. The support worker role complements the nursing role in many ways, for example as a bank support worker you can improve on moving and handling skills essential for being a nurse, also on your communication skills which are very important. It is important though that you still embrace your nursing side and when you are in your role as a student nurse, still have the confidence to grab all the nursing learning opportunities you can rather than just sticking to what you do in your support worker role. Hope this makes sense!

Finally – don’t feel bad if you don’t think you can fit in part-time work. Everyone is different and has different things going on in their lives. You are not going to be any less of a good nurse if you don’t do bank support work or if you do a different part-time job. Lots of jobs have skills which can be transferred to nursing.

So this is what I think I get out of bank support work. Whilst doing my previous degree I did bar-work which I absolutely loved however, for me, I don’t think this would fit in with my nursing degree. I did lots of late nights and ended up working far too much which really effected my marks in my second year, although I managed to rectify this in my final year and ended up with a very high 2:1. I am not going to let this happen with this degree and so am being much more sensible with booking shifts.

Hope you’ve found this interesting to read, thankyou 🙂

2nd Year so far

I started my second year on placement in a cardiology and neurology ward. We students ended our first year on placement and so from one placement straight on to another one! I was really looking forwards to this placement as I loved being on a ward on my 1st placement and the prospect of a busy medical ward excited me. I also felt a bit nervous, even though in my other placements staff often said I seemed more like a 2nd or 3rd year student (probably due to my skill of sounding confident and calm even when I’m the exact opposite!). I think I was feeling the pressure of being a 2nd year student rather than 1st year. I don’t know if it’s just me but at times I just feel like I know absolutely nothing and I’ve got so much to learn but I suppose that’s why I’m doing this course and it’s 3 years long so I’ve got time to learn. Another worry for me, which is still a worry to me, are my clinical skills – I’ve not yet had the chance to catheterise and have only done a few leg dressings.

I needn’t have worried about this placement though, I got on really well. I think because I am genuinely interested in both cardiology and neurology, my enthusiasm shone through. I got on with all the staff and felt a mutual respect. I improved my handover skills, became pretty good at doing ECGS (and interpreting some of the easier to spot rythms) learnt loads about the heart and various other diseases – I can tell you the difference between a STEMI and an NSTEMI, what a CABG is and why we test TROP levels(I also went on the xmas do with some of the nurses, HCAs, doctors and consultants which was a very memorable night for more reasons than one!!!). I remember my very first shift hearing a nurse handover that a patient was waiting for a cabbage and thinking, what on earth does that mean? Instead of badgering all the nurses every time there was something I didn’t know (and there were a lot of things I didn’t know!), I jotted down words and abbreviations to look-up when I got home in a little notepad I carry with me on placement.

I loved the neurological side of the ward although sometimes I found it really upsetting. It was really hard for me seeing one patient who was the same age as me suffering from up-to 15 epileptic attacks a day. I really felt for this young woman as her illness stopped her having a “normal” life – she had started to work but only managed to attend about 20% of her shifts as her epilepsy was very poorly controlled. This was through no fault of her own – her brain just didn’t seem to respond to the medication in the same way other patients did. The constant fitting was exhausting her and the fits were  starting to last over an hour which to anyone who knows anything about epilepsy is a very concerning development. She was very aware that the medical staff were struggling to come up with treatment options. Thankfully just before I finished this placement I heard that she was being referred to a hospital which specialises in epilepsy and I was relieved as I knew that this would give her a boost to know she still had options and was being given the care and attention she deserved.

Another patient who really touched me (and with whom I worked with a lot) was a man with Motor-Neurone disease (MND). MND is a horribly cruel progressive neurological disease which results in muscle wastage and eventual paralysis and death.  This patient was admitted because he had pneumonia and had also possibly had a TIA (transient ischaemic attack). He communicated by writing notes to us as he could not longer speak as the muscles he used to speak were all wasting away. He also had difficulty walking although he did manage to walk and could quite capably use the toilet by himself and do most of his own personal care. He was such a brave man and would often write us humorous notes which gave us an insight into his personality – sadly due to MND he had quite a fixed facial expression and could barely smile. The notes he wrote us were a lifeline as they allowed us to know how he really felt. He could often be seen sat with a large pair of headphones on listening to the radio and keeping himself to himself. According to his family he was quite an introvert so it must have been a bit of an adjustment coming to stay on the ward. One 13 hour shift I was assisting with the care of this patient with a newly-qualified nurse who I was on with that day. I admired the way the nurse was so encouraging with this patient – he had one last hurdle before he could be discharged – to give up suction and so far that day with mine and the nurses encouragement he hadn’t used it once. As he wouldn’t be able to have a suction machine at home, the MDT had agreed that he needed to have stopped using the suction for a few days before he could be discharged. Me and the nurse ended the shift on a high, the patient had written us a note saying how much he wanted to get back home and was willing to give up the suction so he could hopefully go home the following week, less than 3 days away. I wasn’t on again till the next week but when I came back things had gone rapidly downhill for this patient. I started my shift at in the afternoon and he was sat slumped in his chair – a dead weight and unableto move however much we persuaded him. Me, a healthcare assistant (HCA) and a first year doctor (F1) all donned our protective aprons and gloves and tried to get him to stand up – it was clear he had urinated and defecated and so it was important to get him cleaned up. Normally he was very proud of his appearance and was never incontinent and so this was very unusual for him. I had a sinking feeling in my stomach – I knew something was really wrong and suspected he could have had a huge stroke. The F1 was also really worried and didn’t really know what to do for the best, bless him, he tried his best along with me and the HCA to get the patient washed and cleaned up but the patient just couldn’t stand up and so with the help of a nurse we hoisted him into his bed (with a nod of the head as consent from the patient). The F1 called his registrar as he was unsure what to do next. This is where I wish I had said something – it was decided he would go for a CT head scan to confirm his stroke even though it was clear he had had a stroke and he had a DNAR (do not attempt resuscitation). I knew the patient didn’t like enclosed spaces so I knew instinctively that this CT head scan would be traumatic for him. The nurse accompanied the patient to the CT and apparently it was awful – he struggled lying flat, panicked when he was in there and tried to climb out even though he was very weak and could barely move and so they had to abandon it. I know the doctors were only doing their jobs but this really was not in the patient’s best interests. We on the ward knew him well and I felt I had let him down by not advocating for him. He died two hours later and I’m just sad his last few hours on earth weren’t more peaceful. Thankfully his family had been notified and got there in time to spend his last hour with him. I needed a large glass of wine when I got back from that shift!

On a more positive note I also got to see patients who improved loads. One patient we had had COPD, anxiety, depression and many more comorbidites – her section on the handover was huge! She was in hospital with symptoms which were later diagnosed as Parkinson’s Disease. Slowly throughout my time on the ward she got better and better. She would only let certain nurses and HCA’s assist with her care. I was one of the people she liked and she would always say she was happy to see on shift. I was really happy for her when she finally got discharged and (quite selfishly) missed her when she had gone. I did a spoke day with the Parkinson’s Specialist nurse who suggested I come with her and see the patient in her new home as she had to do a follow-up visit to see how she was coping. I gladly agreed to come along and it was absolutely great to see the patient had really settled into her new home – she looked like a different person. It was nice to see her wearing something other than her nightie and great to see her out of bed and walking around. I felt so proud of her and it was good to have had the opportunity to see the new chapter in her life. Sometimes being on the ward you get used to only seeing people when they are acutely ill and so it was a breath of fresh air for me to see a patient who had been successfully treated and discharged.

Sorry I seem to have rambled on a bit! So I passed that placement and am now in a period of theory at uni. I much prefer our 2nd year modules to our first and am really enjoying it so far. Also it’s nice to have a bit of a break and so some bank shifts to save a bit of money. Next time I’ll talk about what I think about working whilst studying and try not to go on so much!

Thanks for reading.

In the beginning

Hello there

I’ve finally got round to starting a nursing blog! Been meaning to do this for a while. Firstly let me bring you uptodate with how far I am in my training.

I was 23 years old when I started studying nursing, with one degree already under my belt and 2 years of caring experience, I was so excited to get started. I didn’t have a clue what to expect though! Nursing is so different to other degrees and all the caring experience I had was useful – particularly the communication skills I had developed, some basic knowledge about conditions such as COPD, Alzheimer’s and Diabetes and how to deliver good personal care – however I still felt so nervous the first time I stepped onto a ward. 

Year 1

My first placement was in an elderly mental health assessment unit. I absolutely loved this placement. Working with patients with dementia was very challenging at times, although I had had some previous experience of working with patients with the condition and a little bit of dementia training I found I had to be really creative when working with these patients. I remember feeling really upset seeing the way a bank nurse argued with a patient who was really confused. I went over and sat with the patient and I remember the nurse saying “there’s no point” as if communicating with this patient was a lost cause. I sat and chatted with her and we soon started to have a laugh, she relaxed a lot and I found from talking to her that she was upset because she kept hearing other patients talking and was thinking that they were mocking her and gossiping about her even though this was not the case. I think from this placement the most important think I learnt was to never question a person with dementias reality – what they see, hear and feel is real to them even if it is not to you and it is not your right or place to question their reality. This is distressing for the patient and as the bank nurse found, could just result in a pointless argument. I was lucky on this placement to have a very supportive mentor who was really good at her job and had a lot of time for students. She had trained to be a nurse later on in life and could relate to my training as she had trained where I was training. She really believed in me and gave me loads of confidence. I felt like we worked as a team, when the ward was really busy we worked together and got everything done. I feel a bit emotional just thinking about this placement because I miss it! 

My second placement in 1st year was in theatre. It was in an NHS hospital which had been shrunk. Literally, there were closed wards and the hospital had no critical care units or A & E. At one time it did have critical care units but it was argued that the staff in the hospital did not have enough training or access to equipment to keep open these wards safely and so the wards were closed. Day surgery was still carried out at the hospital however and although it might sound a bit daunting having operations in a place where there are no critical care units, from what I saw I would be more than happy to have an operation at this hospital. There were different lists for me to watch – ENT, MaxFax, Orthopaedics, gynae, urology, laproscopic surgery, pain procedures and cardioversions. This is what I really loved about the placement – the variety. There were some really good surgeons who enjoyed explaining what they were doing to any students watching. I got the opportunity to scrub in and assist with operations (hernias mainly and also some ENT and MaxFax) which I found interesting but also very hot and at times I found it hard to be stood for such long lengths of time in one spot. Recovery was something I really enjoyed assisting with, it really helped with my patient assessment skills- knowing what to look for and any concerning signs. Luckily for all my patients they all had good recoveries although some did wake up a little distressed as they had been nervous before going under general anaesthetic. I got to assist with spinal blocks and other blocks and observed the differing techniques of anaesthatists. My least favorite part of the placement was definitely the anaesthetic room. I liked comforting patients and chatting to them before they went under anaesthetic however I never felt totally comfortable in the room, sometimes I felt like a bit of a spare part. Some of the anaesthatists were really approachable and there was one I got on particulaly well with however after the patient had fallen asleep I still felt a bit uncomfortable and a bit of a novice

This placement made me realise how good my communication skills had become, one patient was extremely nervous about having a vasectomy. He had previously been in to have it done but had only had half the operation done because he became so nervous and anxious that the operation had to be stopped. My mentor asked me to sit with him whilst he was having the other half of the operation done. He was again extremely nervous but I sat with him and we managed to talk and joke all the way through the operation. Afterwards the surgeon came up to me and said how good I had been in the operation and how impressed he was with the way I kept the patient calm throughout the 30 minute operation. I felt on top of the world! And the patient was really thankful to me and said I’d made it much easier for him. Also my mentor was proud 🙂 

Another incident which happened on placement really tested my team working skills! One of the older scrub nurse had a bit of a history with one of the surgeons. They just did not see eye to eye. One operation I was assisting by being a runner and helping with paperwork. My mentor was scrubbed in and directly assisting the surgeon and the other scrub nurse I previously mentioned was being the main runner. The surgeon seemed to like me and had asked me to do things in previous operations, this operation he asked me to do something and the older scrub nurse was disgusted. She couldn’t understand why he had asked me the newbie and student nurse to get something for him rather than her. After that, for the whole operation she refused to do anything!! As the healthcare assistant had never done this list before she was sticking with the paperwork (which is an extremely important and an underestimated part of day surgery – it is complicated and there is a strict time limit, also you need to record everything and do the time outhttp://en.wikipedia.org/wiki/WHO_Surgical_Safety_Checklist) and so it was left to me to do everything – find catheters, hang new saline up – which I can do but when you have to do it really quickly it is pretty nerve racking! Also when there are over 20 catheters to choose from and you are asked to find a particular one it can be a nightmare. I just could not believe this scrub nurses attitude – for one I was stood near the surgeon at the time and so it made sense for him to ask me, and secondly I was a student nurse so he had probably asked me so I felt included in the operation and got to do things rather than just watch her do things. I survived though! My mentor felt awful, she said she felt helpless because she was scrubbed in and couldn’t do anything but was proud of the way I just got on with it and didn’t panic. 

There is so much more I could write but feel like I’d be here forever! I’ll update you on how I’m getting along in my 2nd year in my next blog but right now I’m pretty sleepy – did a night shift last night for NHSP as a bank care support worker and I’m knackered