Still going

I am still alive and well, sorry for dropping off the face of the planet. I'm on nights at the moment, one down two to go, I'll update this when I'm feeling a bit more human.

Cardiac Arrest

There were several things I had to write about from my last two days at work. Had I updated when I came home on Friday I would have, but something happened first thing on yesterday's shift that will dominate this blog entry.

I was in resus checking the paediatric bay when a call came in that a cardiac arrest was on its way. The patient was a 62 year old male who had had chest pain for 3 hours. When the LAS got to him he looked very unwell so they got him in the ambulance and left straight for hospital whilst the daughter got changed, the undertone from this was that she didn't seem to realise it was serious. Just before they arrived he had a cardiac arrest and was in PEA (Pulseless Electriacl Activity) on arrival. I asked to observe the resuscitation as I have had no experience with a cardiac arrest.

After one cycle of chest compressions (from a very clever machine that looks a bit like a baby gym with a toilet plunger head hanging below) and ventilation (he was intubated and attached to a ventilator) they got a pulse back and began to try and stabilise him with a whole host of drugs. The team worked efficiently gaining venous access, taking blood tests, inserting a blood pressure monitoring line, observing his vital signs and administering medication. They were switching between two main drugs in an attempt to stabilise his blood pressure as it seesawed between high and low. By this point the family had arrived and been informed that he was a in a critical but stable condition.

He oxygen saturations were dropping and the ventilator was unable to maintain them so they began to bag him and breathe for him, he was making his own respiratory effort but it wasn't adequate. He has pulmonary oedema, probably caused by heart failure, and his lungs were filled with fluid and it was only by bagging him that they could maintain his saturations, though this also began to be less effective.

Then he arrested again, the compression machine was strapped on and they began compression/ventilation cycles again. One of his sons arrived in the room to watch, and even as this machine was forcing his chest up and down I heard the son say "Is it serious?", at this point he still had no concept of how unwell his father was, or perhaps it was the shock. They were unable to restart his heart and the decision was made after almost an hour of attempts to cease; his heart was too badly damaged, his lungs wouldn't inflate because of the fluid and he had been hypoxic at too many points not to have damaged his brain.

I excused myself at this point as the family came in to be with him, it took several explanations for them to understand that he had died and there was nothing they could do. Then the wailing began.

In university someone once told me that it is one of the most privileged positions to be in, being with someone when they die. Although this situation isn't exactly what they meant I understand it. It was incredible to see the human body in its final moments and how it fights to save itself. The team worked so well, they deal with this regularly. It wasn't dignified, but everyone in that room fought, including the patient, to save a life.

It doesn't upset me, whatever I feel is insignificant to the loss that family feels. It was sobering, but I do consider it a privilege. We talk about the wonder of birth, death in its own way is just as amazing. Dying is a part of life, I'm not suggesting we be happy about it or necessarily celebrate it, but I think I have a healthy respect for it.

Wheeeeeere's Wally?

Yesterday's shift was good, here are the blogworthy parts.

A little 6 year old girl who had trapped her fingers in the door. She needed to have her fingernail removed and then it was sewn back on. The child was fantastic, the play therapist had prepared her so well and she was fairly calm throughout. Half way through she got distracted from 'Where's Wally' and remembered what was happening... "Have you started yet? Have you started yet?" At this point they'd just taken her fingernail off and she'd not even noticed! Hurray for ring blocks, entonox and 'Where's Wally?'. I'm not keen on nail-related things so I thought it best I watched to try and get over it!

Unfortunately It was almost 2.30, I'd not had lunch, I was feeling a little weak and shaky to start with and standing up in this very hot and stuffy room I came over all "funny". I had to leave the room and sit down as I thought I was going to faint! I was shaking, my head was swimming and I felt sick, I barely made it over to the chair! I had to ask someone to get me a drink of water, but after 5 minutes I was fine.

That "coming over all funny" has only happened two other times during my training, on both occasions I was overdue for lunch and standing up in a very stuffy room. It's not the sight of whatever its happening itself, but the combination of factors. It's good to learn from these things and know what situations to avoid. I've seen far worse, gruesome things and not been bothered because I'd already eaten and the room was comfortable! It's also nothing to be ashamed of, it happens to everyone and it is far better to leave the room and keel over!

Other noteworthy things:
A 15 year old backseat passenger in 30mph car accident, she wasn't wearing her seat belt and was very lucky not to have serious injuries. Her brother had been driving the car and was later arrested.

A stabbing! An adult patient being brought in by helicopter, I was there to observe and I can tell you if was a very disappointing stabbing! One wound to the back, not even bleeding that much! The bloke was sitting up, talking, joking. Very unexciting! Good for him I suppose, though!

Bronchiolitic babies have such a horrible, rasping cry. We had a very sick 6 month old who they were considering intubating because his blood gasses were not improving with treatment. He had previously been intubated for the same condition 3 months ago. They decided to try him on CPAP first, he didn't like it at all but fortunately the play therapist turned up with some flashy, musical toys which settled him a little. When I left he was still in resus with a respiration rate of about 95-100 with a lot of recession and nasal flaring, I expect he will have been intbated because he would tire very quickly with that effort of breathing.

Glossary of terms (for those who are interested!):
Bronchiolitis - a viral respiratory infection of the small airways (bronchioles) that predominantly affects babies under 9 months of age and particularly in the winter months. It is the most common serious respiratory illness among babies <12months.

Blood Gasses - A blood test that gives very quick results on the pH (level of acidity/alkalinity), the level of gasses in the blood, such as carbon dioxide and oxygen, and metabolic results such glucose or lactate.

CPAP - Continual Positive Airway Pressure, a form of non-invasive ventilation that helps maintain a degree of inflation in the lungs to make breathing easier. It the same principle as when you blow up a balloon; once there is a little air in it already it is easier to put more in.

Recession and nasal flaring - both of these are visible signs of increased work of breathing, I couldn't find any decent pictures of this, but simplistically underneath the ribs (subcostal) and between the ribs (intercostal) the muscles retract in on exhalation and the skin visibily moves "in", this also happens sternally.

Respiration rate - the amount of breaths taken in one minutes, in his age group the rate should be between 30-40.

Where's Wally? - A series of picture books where you have to locate Wally in the midst a crowd of people/pirates/astronauts/circus performers/etc etc

Blogging frenzy

I've had a bit of a mad blogging session today! 4 posts, well 5 now! I'd thought about writing about why I became a nurse for a while. Someone recently emailed me asking if I had any advice for her, a paediatric student nurse on her first placement, and I was inspired to write this "series" or "resource" on being a nurse.

I apologise for having to add in the comment verification word thingy! I've had a spam comment and I'm hoping it will act as a deterrent or prevent automated commenting.

Random thought:
We have communal changing rooms at work which I've realsied means I'll have to wear decent (in all sense of the word) underwear everyday.

Oh yes, on my shift on monday we had a screamer like I have never seen before. It becomes very wearing after a while when a child constantly screams (I mean really screams) before you even touch them! She was only abour 3, and apaprently she was frightened, but her mother was entirely ineffectual and more often than not ignored her and in no way calmed her at all, and this was before we even did anything unpleasant (like put a cannula in)! I have to say, after 5 minutes of shrill, loud screaming I wanted to tell her to shut up before I gave her something to scream about! That's me... the compassionate, caring nurse!

Advice and Tips for Student Nurses - Last Updated 30/01/07

Advice and tips for surviving your nursing training. Some of this is quite general and some specific or applying just to children's nursing. Some of these things may seem obvious but they're still worth pointing out. I'll add to this further as I come up with things, for that reason this list in non-alphabetical so new things can be added to the end. Feel free to comment with suggestions of your own.

Click a link to take you to that section of the page: Shoes, Portfolio, Bad placements, Sickness/Absence, Questions, Bubbles, Tongue Depressors, Urinalysis, Placement Essentials, Handwashing, Textbooks - Edited 30/01, Union Membership, Journals.

Shoes - You don't have to spend a fortune on shoes, but a good pair of shoes will last you throughout your training and it is essential that they comfortable and hard wearing. You will be on your feet a lot of the day and do a lot of walking. Think of them as an investment and don't necessarily go for the cheapest you can find.

Portfolio - do keep this updated as you progress through the course, you will need it later when you come to applying for work and it is something you will develop further when working. Don't make the mistake I did of having to catch it all up at the end. A little time as you go along will save you a lot of time later.

Bad placements - You will have placements you don't like and there will be staff/mentors that you don't get along with but from every bad experience you learn something, even if all you learn is that you don't want to work in that clinical speciality or that you don't want to be like that nurse. If you are having real problems do approach a senior member of staff who will be supportive, your link lecturer or your personal tutor.

Sickness/Absence - You will have to make up any sick time you take, unless it's just a few days, I'm not saying go in when you are unwell because for yourself, the staff and patients it is better that you don't. But I know how tempting it is on a bad placement not to go in and think you will make it up later, it is a lot harder later.

Questions - Ask questions. Yes, I know everyone tells you this but it's really important. If you don't understand something then ask, we have all been new and inexperienced. I'm a few months away from qualifying and I still ask questions I feel like I should know the answer to, but it is the best way to learn and often being given an explanation by a real human being in practice will make more sense that the textbook jargon.

Bubbles - As you may have guessed this is geared towards the children's nurses! Do not underestimate the power of bubbles, they can be a fantastic method of distraction or relaxation, but be mindful of the age/development of the child. Oh, and don't blow them in their faces!

Tongue depressor - This is a convenient place to write down your normal observation values, particularly for the paediatric nurses who will have to learn several. Pop it into your pocket and it's always to hand yet subtle!

Urinalysis - There will be time when you are asked to do a urinalysis on the tiniest amount of urine, as it may also need to be sent to the lab you don't want to use too much of it or contaminate it. Using a 2ml syringe and a needle, draw up a little and drop one droplet onto each of the coloured squares on the test trip, you can then return the remainder to the specimen pot.

Placement essentials - At least 2 black pens, inexpensive as they will be lost/borrowed/stolen regularly. A calculator, important for drug and fluid calculations and you could easily be doing these in your first placement. A watch/fobwatch with a second hand, fobwatch is the best. Scissors, you'll find there are never a pair around when you need them. Lipbalm and hand cream, neither of which should be in a pot/tub for infection control reasons - lipbalm in a stick and hand cream in a tube.

Handwashing - You will be told this a thousand times but handwashing is so important, and so many people do it badly. It is one of the most important things in the fight against infection. I know it's a pain to have to do it, and yes you'll feel like you're doing it constantly but it is important. Alcohol handrub/gel is quicker and more convenient but can dry out your hands.

Textbooks - Textbooks can be very pricey, borrow them from the library for assignemnts, but some are worth having at home for regular use. I bought quite a few when I started training, some were worth it an other's not! Here are some suggestions:

• Marieb - Essentials of Anatomy and Physiology. A good biology text, it's not too in depth but gives as much information as you will need.
  
• Huband and Trigg - Practices in Children's Nursing. this book is a great source of practical information for procedures/care both in hospital and the community, I've used it loads for essays. It now has a new edition out under the same titel but edited my Trigg and Mohammed.
  
• Wong's Nursing Care of Infants and Children. This was published last year and replaces/updates Whaley and Wong's Children's Nursing. A good all round text, but I prefer the Glasper and Richardson (which is also cheaper!)
  
• Glasper and Richardson - A Textbook of Children's and Young People's Nursing. I have now bought this book and it's great, I'd highly reccomend it and over the Wong text as it is specific to nursing in the UK and relates back to UK practice and legislation constantly.
  

I would definitely invest in a good biology text, and a good all-round text like the Glasper and Richardson. If you aren't sure about which books to buy check them out in your university library first. It is often cheaper to purchase books online.

Union Membership - It is very important that you join a union. You will receive discounted membership at a student. Our university was visited by UNISON and the RCN, I joined both because they were cheap and had good freebies! But I have stuck with RCN because I personally feel they offer the best support to nurses as they are specifically for nurses.

Journals - I've subscribed to two different journals during my training. Nursing Standard and Paediatric Nursing, I know only get Paediatric Nursing but may opt to take out Nursing Standard again. NS offered a good discount for students and is worth getting for that reason alone. I find PN has some very useful articles and current news. You should be able to access these journals in your university library if you don't wish to subscribe to them. The Nursing Standard and Paediatric Nursing are published by the RCN and if you are a member you have access to their online journal versions, including the archive. Even if you choose not to subscribe to any I would recommend reading one on a regular basis.

How do you become a nurse?

So... You've decided you're interested in becoming a nurse and want to know more about the career, how and where to apply, the different options available to you.

The first place I direct you to is NHS Careers - Nursing, this site will give you more information about nursing as a career, the different kinds of nursing you can do and the training/experience necessary.

There are four branches of nursing; Adults, Children, Mental Health and Learning Disability Nursing. I think all of them require different personal characteristics and strengths so it is important to consider where you think would suit you best. The NHS Careers website can give you more information about the branches.

There are different routes of entry, under-graduate or post-graduate, and depending on the qualifications you already have you can join a degree or diploma programme. Post-graduate study, if you first degree was in a health related subject, will be shorter but at diploma level. Training is typically three years long, and will be 50% theory based and 50% supervised placement based, for post-graduate (modified) study it will take two years.

The first year of training is a Common Foundation Year (6 months for the post-graduate modified programme), after that you will spend two years (18 months for the modified programme) training in branch. Some universities require you to apply to these separately, others require you to choose your branch of study outright. Whichever you do you should get some experience in other branches in the first year and the opportunity to change branch when you go into your second year if you realise you've made a mistake!

To join a degree programme you are required to apply through UCAS and for a Diploma programme through NMAS. Typically for a degree you will be required to have A-Levels, and for a Diploma 5 GCSEs with grades C and above, each university sets its own criteria so it is best to check with the universities you are interested in first.

The differences between a degree and diploma?

• Either way you will become a registered nurse in your chosen branch
  
• Your tuition fees will be paid on both programmes
  
• The bursary you receive is different. On a Diploma programme you receive between £5,500-6,500 per year, on the Degree programme it is means-tested and the upper amount is about half of that of the Diploma.
  
• Once qualified the degree nurse will not be paid more than the diploma nurse.
  
• Both require three years of training.
  
• A degree is considered desirable but not essential when applying for a job, whilst they will choose the best person for the job if you have a degree it may set you above other other candidates of a similar standard.
  
• The training itself is very similar, on the degree programme I believe there is more of an emphasis on management and research but don't quote me on that! Some of the degree assessments will be at a higher standard than the diploma.
  

This information was accurate when I was applying, and from talking to other students and univserity staff little has changed. However it is best to research it yourself on the NHS Careers website and NMAS/UCAS sites.

Links on the right side of my blog to the Nursing and Midwifery Council, Royal College of Nursing, and Nursing Standard which may provide you with more information and current nursing issues.

Why did I decide to become a nurse?

I thought I'd write this as a sort of 'background to me' post.

I suppose the simple answer, and one that not everyone will identify with, is that I felt called to be a nurse, called by God. Put into other words perhaps more easily understood/accepted, it's who I am, through and through, and who I was meant to be. It's not a just job, it's not something to make money (because no one would become a nurse for the money!) it's the person that I am and even if I were to win the lottery and never have to work again I would, because I love what I do.

I first decided I wanted to be a nurse when I was a very little girl. I wanted to be a nurse who looked after old people and did their hair as well! I continued wanting to be a nurse until my mid-late teens where I dabbled with the idea of joining the police force, and when I left school with just AS-Levels that was what I intended to do once I had worked for a while. By this time I had realised that I was good with children and I'd done quite a lot of voluntary work with children of all age groups. I liked children, and they liked me.

My first job was temping in a Child Development Centre in the Occupational Therapy department doing administration. When I was filing I'd quite often browse the notes learning about various medical conditions and looking others up later when I got home from work. After 6 or so weeks there I was offered a job as the Chlamydia Screening Programme Co-ordinator, glamorous hey? I was based in a microbiology lab and surrounded by the hospital environment I realised how much I wanted to be a nurse. I applied in the December, and was offered a place for an April start date, which was fortunate as by now I was hating my job and having a lot of difficulty with the person I worked with. I applied to both Adult and Children's nursing, the adult department didn't offer me an interview and I realised that all my experience with children on a voluntary basis that I'd put into my personal statement was marking me out as someone with a passion for children.

I have loved my training. It's been hard work, great fun, tiring, and rewarding. Of course there are some mornings where I really don't feel like getting up and going in to university or a bad placement, but on the whole I have loved it. Almost three years have passed and I can't believe I'm going to be a grown-up nurse sometime soon! I'm looking forward to going out and working, because I've heard that's where the real learning begins!

Hibernation

I was setting down to sleep before 11pm last night, my alarm went off at 9am and I still felt tired so I turned it off and didn't wake again until 12pm... 13 hours sleep! And I stil fet tired, not sure what that's all about.

Good day yesterday, nothing especially interesting. I attended the psychosocial meeting in the morning, it's a multidisciplinary team meeting about the chidren we've had in A&E in the last week that have ben referred to social services. People live such different lives. What did become apparent was how easily chidren could slip through the net; parents moving around so often that and goign to out of area services make it very difficult for the chidren to stay in the system - they move on before social services or the health visitors can establish involvement.

It's hard to get away from feeling like a spare part, though I know that will improve as the placement goes on. I think because of the nature of A&E you're more dependent on staff than you would be on the ward, it's difficult when it's quiet to find things to do and I hate to look lazy!

The post in which I make a sweeping generalisation

On wednesday, my first day in the new department, I was walking back from the adult A&E area through to the children's side. I sometimes lack a sense of direction and found tiiquite confusing on the first day finding my way around. I frequently walked round with a grin on my face as I laughed at myself for once again walking down the wrong section of corridor and as I wondered what people thought as they saw me walking past them, turning around empty handed and walking back again.

So I was walking back to the children's side when I was approached by a rather disshevelled, shifty looking man in his 20's. My first thought was that he was either a drug addict or someone with mental health problems who'd not been taking their miedication, because I am in no way a judgemental person! Nor do I ever make sweeping generalisations! He asked me where the toilet was, and I was a little unsure so I asked if the nursing staff had told him it was this way. I then figured out where I was going and apologised.
"Sorry, it's my first day here"
To which he responded something along the lines of...
"It's going to be my last day here" and walked into the toilet, locking the door behind him.

I got a little worried at this point at the strange way he'd phrased "It's going to be my last" and I was a little concerned that he'd gone into the toilets to top himself! That perhaps he'd not been told where the toilet was for a reason and I'd just aided him in finding himself a quiet spot!

I then told myself not to be so silly and carried about my business, looking out for him the next time I walked through. Fortunatly he was sitting there looking very alive and well, if still rather unkempt in appearence. Phew!

Informal visits and ketamine

I had my second informal visit today. This hospital (B) is the first one I saw were recruiting, local to me and I was really interested in working there. However my visit today was a disapointment and I left the place with a really negative feeling about it, though I had expected to like it. I can't quite place what it was that I didn't like, but defnitely the person showing me around and his attitude and lack of knowledge abotu the wards, the feeling/impression I got from some of the staff, and the general atmosphere and impression of the wards. Particularly in comparison to the other place (A) where I was very impressed with the environment and the staff, and particularly the person showing me around as he was very knowledgable, seemed prepared for my visit and helpful. The person today was blowing the hospital's trumpet a lot and criticising the place where I had trained, unnecessarily I felt, I didn't feel he needed to make the comparisons. We also spoke to a member of staff who felt she'd been promised a lot in the way of traning when she joined in september but that they hadn't delivered on that. I'm put off applying as I really don't want to work there now so I just have to hope HospitalA offer me a position before HospitalB! Providing either of them do of course.

I'm a bit concerned that I'm not going to qualify on time because I have sick time to make up, and theuniversity are being incredibly slow (as with everything adminsitration) to inform my group of how many hours we'll need to do. At the moment I'm working a lot of 4 day weeks and 2 days weeks, I could easily start adding in extra shifts to make up time and save time at the end if they would inform us.

I need to stop worrying, it doesn't change anything and it's a waste of energy.

Something else about yesterday's shift that I had meant ot write about. I had my first experience with ketamine, not personally experience obviously! We had a little boy with an arm laceration that needed to be stitched and he was given ketamine to relax hima nd make him sleepy. It didn't work 100% but it worked fairly well. Apparently it puts them into a dream like state and they see odd things, but they won't remember it afterwards. This little boy kept saying he could see two mummies, and that his mummy had two supermans whatever that meant! Kudos to his mother. She was brilliant, not all parents deal with that kind of thing well particularly and their stressed/upset/hysterical response usually makes the child more distressed increasing the parents' anxiety and it becomes a bit of a cycle.

Simple pleasures

Obtaining a urine specimen from a very small child can be a bit of a waiting game. You give the parents a pot/bowl and instruct them to undo the nappy and wait, they look at you a little bit strangely but you explain that's the only way to do it and then the game begins.

This morning we had a fairly sick child that we needed a specimen from. We waited, and we waited and we waited. Nada. The child had been sick that morning and not drank much so I thought it would be a good idea to give her a some water to try and get things going. Three minutes later dad stands her up on the floor whislt he rummages in a bag, she promtly begins to wee a little puddle on the floor.
"Quick dad, quick! The bowl!" I cry excitedly.
Dad fumbles around looking for the bowl and no sooner than he has it in his grasp the little girl stops weeing. Doh! Dad and I look at eachother comiseration and lo and behold she starts up again, we get our sample, hurray. Such pleasure from such a simple thing.

Please if you are invovled in a fight be honest about your injuries and method of injury, we're not trying to get you into trouble, it's important for us to be able to assess you correctly. Sitting there non-compliantly grunting "No" and "Just me" doesn't help. Particularly when we know it couldn't just have been you there as you've already admitted to someone punching you in the face and have a mark to proove it.

We had a child in resus this morning in status epilepticus (a seizure that continues for more than 30 minutes, or more than one seizure without recovery in between), I was there to observe and lend a hand if possible. Generally my lending a hand involved passing things, holding limbs for cannulation and documenting observations. This morning, however, I had to explain the IV drug calculation to two qualified nurses when they got a bit stuck. I knew I'd done it correctly, but I'd not eaten since I'd got up almost 4 hours previously and my brain seized up a bit when I tried to explain how I'd done it. I've always been good at maths, it comes naturally, my mother was a maths teacher and I think it was passed via the placenta. However the downside to that is it is difficult to explain soemthing that you "just know" to someone else who doesn't "just know".

There are so many things I could Blog about, I see so many patients in the space of a day that are interesting in some way or another, though perhaps not to my readers! The other effect of seeing so many people is the distortion of time, or my perception of it. The little girl with the urine sample for instance; that excitement happened around 11am, less than 12 hours ago as I write this, yet it feels like days ago.

Oh, and we had laods of really cute (crying) children today. Like the one who fell 8 stairs down onto a concrete floor and had a beautiful swollen, black eye, or that one that pushed a bead into her ear and sobbed as we tried (unsuccessfully) to remove it.

First Day

I always find my first long day a shock to the system, by long day I mean 12.5 hour shift. I'm nackered! Today was good, it's a good department, friendly staff, keen to teach.

We had a trauma call for a 3 year old child who had fallen out of a window from a 4th floor flat onto concrete. Amazngly he seemed to have little injury, a few lacerations to his head, and was soon moved from resus to our ER. As I was leaving they still hadn't cleared his spine/neck and he was still strapped down, but they weren't very concerned about him. Children of that age quite often seem to bounce and come away with little injury. There was some query over how the accident ocurred but when asked the child verified the story given by his grandmother who had been looking after him. The scary thing was that in her panic she had run down to him and picked him up adn taken up him back upstaris before calling an ambulance, fortuantly he didn't seem to have any spinal injurues. The resus bay was incredibly busy with the trauma team, medics and nursing staff as well as several observers including myself who were cleared out soon after he arrived. It must have been very frigthening for that child to have some many people fidding with him and gawping, but he was incredibly brave.

We had several young children with bad asthma and/or chest infections, a very cute little baby with Sickle Cell who came in having had a floppy episode and had another one in the department and was very unwell at one point, he went to high dependany looking a loo brighter than he had before but without explanation for the episodes.

I sat with a Bengali mother who spoke very little English, not uncommon where I work. I find it one of the most frustrating things about the hospital I have trained in; the extremely high percentage of people who speak little English, if any, and rely on their children to translate for them (which in a hospital setting is rarely appropriate). I do find it incredible sometimes that some these people have come to the country, not being able to speak a word of the language, and they are so isolated in their communities that they will never learn to. However, I digress, though that was relevent I suppose to try adn explain some of my frustration surrounding that particular client group. Today I had a wonderful conversation with this Bengali mother, it was limited what she could say to me and what she understood but she was telling me about her child (who has a rare syndrome (Cat Eye Syndrome) and very complex needs) and for once I really felt like I had a connection with my patient/family, something I rarely feel when there is a language barrier.

This was only intended to be a short post, it wasn't even that much of an eventful day! I'm off to join my hotwater bottle in bed and get some much needed sleep in preparation for tomorrow. Apologies for typos. The spell check button I've only just noticed doesn't seem to be working.

Brushing up

I had an IV study day today, it was good - a lot of brain work but should be helpful for practice, and it's something to put in my portfolio.

Tomorrow is my first shift in my new A&E placement and I'm really looking forward to it. Hopefully it shall provide something of interest to fill my blog with!

I'll be off to bed with my A&E notes shortly to brush up before tomorrow. I'm still trying to get these darn acrylic nails off, I've cut them down but after hours of soaking in nailvarnish remover they've still not totally come off so I'll be giving them another soak and scrape tonight. I'm very aware of infection control and of how they could harbour infection, I'll have to be particularly stringent with my handwashing until I can get them off completely.

Today in brief

I'm feeling a bit fed up tonight, I really don't have the motivation to read any blogs or write properly here. I just want to go curl up in bed. Sorry for the blogs I'm neglecting to comment on (MMW particularly), so today in brief...

The informal visit was good, I was very impressed with the hospital, they seemed to quite like me and were very friendly and gave me lots of advice for filling in my application form and the interview. So now I'm in the process of writing my supporting statement, there are 33 items on the person specification to address and it's horrible.

The end.

Tomorrow

I've been at Nat's this weekend, I'll catch up with other people's blog entries tomorrow, I feel like having an early and relaxed night tonight. Tomorrow morning I have an informal visit at a different hospital.

Considering we expected there wouldn't be many jobs around I'm now applying to 2 large hospitals in London recruiting throughout their department, one of which specifically invites about-to-qualify and newly qualified nurses to join them. The one I'm visiting tomorrow would be a bit more of a commute, but it offers an 18 month rotation programme which would be ideal for me persuing a career in A&E. It woudl mean I could spend 6 months in 3 different clinical areas to gain experience, the final one could be A&E.

Disgusted

I am absolutely disgusted at the BBC and it's exploitation of children in cheap entertainment, also known as the show Baby Borrowers. I find it incredibly irresponsible of the BBC to have made this program, and it is taking the world's craze for reality television too far. The Metro covered the show in an article on wednesday which my boyfriend highlighted to me tonight and I felt compelled to Blog about it. I shall shortly be writing a letter of complaint to the BBC and OFCOM.

I do not care whether the parents consented to loaning their children out to make a television show (I wonder how much money they made from this), I personally think it says something about the kind of parents they are, it's a disgrace. It puts the children at risk physically and emotionally/psychologically, the consequences of which could be far reaching in terms of their development and mental health, if not their physical health.

The shows claims that it has taken "extraordinary" measures to safeguard the children, but it only takes minutes for an accident to happen that could result in a child's death, for example a baby being dropped by an inexperienced "parent" or a child unhappy in a stranger's arms, and no matter how much CCTV you have this is not preventable. Despite the many "experts" the BBC have monitoring the CCTV is it not always possible to predict the negative effect this separation could have on a young child.

The Metro article claims that a ten year old child goes unfed for a day, and that one baby had to be removed from one couple after thier relationship breaks down. I will not be able to confirm this as I shall not be watching this program.

Simply I see this as the exploitation of children in the name of cheap "entertainment", children unable to protect themselves and parent's who clearly need a good slap don't know any better, or just don't care.

Right, off to write a strong worded letter.

EDIT: Apparently you cannot complain to OFCOM until the program has actually aired so I'll have to wait until tuesday for that.

Major Incident Training

Today was my Major Incident (MI) Training Day. We were split up from our usualy cohort so we were with people we didn't know from the other branches. I was with one mental health nurse adn four adult nurses. When I arrived I was really looking forward to the day, the others clearly were not.

"What a waste of time this is going to be"
"What's the point"
"I'm not going to learn anything"

Not with that kind of attitude you're not. So that was a little disheartening.

We were given a very short introduction, but the day focussed around a theoretical Major Incident, we were given four trigger scenarios for it. We discussed each trigger and answered questions, then the 8 groups took turns to feed back. We were given 3 resources on MI Procedure and the facilitators wandered around to help us. After each scenario we took time to reflect on what we had learned.

The day required rather a lot of brain power, but I found it a really good way to learn. It was by far the best EBL session I have had, and I really appreciated the learning approach. It looked at all aspects of a MI; from driving past the scene of a crash and what our duties were as a registered nurse, to how the scene would be managed, to how the hospital would manage the influx of patients, to how we would deal with friends and relatives and breaking bad news.

I want my nursing career to be in A&E so I anticipate this will be quite helpful, and at the very least the certificate will look good in my Portfolio!

I'm an exhibitionist

Oh yes, and we also have another Enquiry Based Learning presentation to, umm, present this module. Whilst I don't like EBL I have to say it has improved throughout the course and I've discovered it does have some value!

There are currently only 10 people in my child branch cohort, we did have 18 when we first started the course and 2 of our current members have joined us from other groups so, more simply put, 10 people have left the group in the 3 years. That was a little off topic (but an ineresting side note with regards to attrition rates), what I was going to say is that each module we have to do an EBL presentation to the group, usually in 2-3 small groups. I really don't mind the presenting at all (I'm such an exhibitionist); we have a supportive group, though some poeple loathe it. This module we are required to choose our own EBL subject/scenario and present it to the whole cohort (adult, child, mental health), about 100 people.

It's not the number of people that worries me, but the type of people we'll be presenting to and the disrespect and rudeness that they have shown our lecturers in past joint sessions.

But you know the thing that really gets me? The Med students, dental students and post-grad nursing students have to do something called PBL - Problem Based Learning... "PeBbLe". It sounds much cooler that "E-B-L".

The first day

Well, first day back at university and it feels good to be getting back into. I've got my first shift in A&E on wednesday which I'm very much looking forward to.

Tomorrow we have a Major Incident Training day, apparently our university if the only one in the country to offer this to student nurses. We'll be working with students from the mental health and adult nursing branches. I'm quite looking forward to it, it should be an interesting day. I don't however relish the thought of working with some of the people in the other branches, from past experience there are some very rude and poorly behaved people - most of whom are adults in therr 30/40s who should know better.

But, out with the negative! It should be a worthwhile day, and I get a certificate (Wooo!) to add to my training portfolio. I shall report back tomorrow. We also have an IV study day next week and I'll get another certificate!!

I've done a complete U-Turn regarding next year, and since seeing those jobs advertised at a good hospital only a 15 minutes train journey from where I live have felt that it would be a great opportunity and I'd really like to get some more experience (and money!) before I continue studying. I have an informal visit arranged for next friday, I'll be interested to see what the wards are like and get a feel for the place.

Political rant

On another blog I was just reading someone made a comment asking who the writer would vote for, Cameron or Brown, and I just had to make a post. This is something that I really disike: People consider the Conservatives and Labour to be the only contenders in the general elections, perhaps they are, but only because some people have already decided this and choose to vote for the lesser evil and not the party they actually feel would best represent their interests.

Whilst I understand why poeple tactically vote, I think it's really important that people vote for the party they feel should be in power, not the lesser of two evils; if poeple always do this there will never be any change. What's the point in living in a democracy and having the right to choose from a variety of political parties if it's not exercised.

Take the Liberal Democrats for example, they've not been in power for ages and poeple don't consider that they'd have a chance in a General Election. I know poeple who would vote for them but because they don't think they can win choose to vote Labour or Conservative. If those people actually voted for the LibDems we might see a change in government, but it's a cycle - people don't think they have a chance, so they don't vote, so they don't have a chance.

Now, from reading this you may just think it a Pro-LibDem rant, but it's something that I feel really strongly about. People complain about Labour and the Conservatives, but they don't have the motivation or courage to try and make a change, be that voting for the LibDems or Greenpeace or whoever.

Which brings me finally to a quote I have written on my bedroom wall.

"The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man." Bernard Shaw

Why should we settle? We have reasons to be grateful certainly, when we compare our country and political system to others, but that doesn't mean we should stop striving for change and improvement.

All done!