Nights

Right, where to start? I feel like I've been AWOL for weeks. Firstly, I have a job interview on the 16th of February, my first nursing interview and for a job I would really like. I've got some preparation I need to do for that, including writing my portfolio (that I was supposed to have maintained as I went along).

I've found out that I shouldn't have any time to make up at the end of the placement which is a relief, one step closer.

Nights have been good. The first was horrible as I'd been up since 11am and started working a 8pm that night, we literally had about 10 patients all night so it dragged and I have no idea how I made it through! The second one was much better after a good day's sleep and looking after my own (lovely) patient until 3am. The third flew by and now I'm trying to adjust my nocturnal pattern.

We have the most amazing doors in our A&E department. They seem to miraculous cure children.
[Mum] He's been crying inconsolably for hours.
[Baby] *giggle* *gurgle* *smile*
[Nurse] He's a lot happier now, must be our magic doors.
[Mum] Really, he wasn't like this an hour ago.
At which point the parent usually makes an embarrassed apology and we tell them not to worry we'll check them out anyway. Invariably, as they have no other symptoms than crying, it's because they had a tummy ache or there's is nothing detectably wrong with them.

We had one 3 year old brought in in the early hours of the morning, she'd had an ear infection and been spiking temperatures for a week that were well managed at home, but the previous night it had spiked really high and had not been controlled so the family called the LAS. When they arrived they handed over that she'd had a temperature of 40.4DegC with them. With us it was 36.4. The explanation? In the last 10 hours mum had give 6 doses of paracetamol as "it wasn't working". Fortunate they did call the LAS and come in really or I think they would have continued to overdose their child. So we did some health promotion, sang ibuprofen's praises and sent them over to the out of hours GP.

We often try to stream patients to the Walk In Centre during the day, and our of hours GP at night, when they present with something that is neither an accident nor an emergency, we have criteria for doing this. During the day the department can be quite busy and it's far better they are seen in a more appropriate setting. At night the department is often very quiet, and for many hours empty, but we will still stream the patient tot he out of hours GP. If the GP is busy we will sometimes see them in the department, they are quite flexible.

On the one hand I feel we should just see them anyway if we're not busy, why send them somewhere else where they may have to wait when we have a doctor sitting reading a magazine. On the other hand I feel that it's an important issue of education. People use the A&E department inappropriately and will continue to do so if we just accept everything that turns up.

We had an 11 year old Sickle Cell patient turn up in crisis around 20.30. She had only taken paracetamol at home, without much effect and was scoring her pain at 7/10. Sickle cell patients have a pain relief protocol that is followed in hospital and at home. She should also have been given Ibuprofen and Codeine at home but her mother hadn't and just brought her in instead demanding stronger pain killers to be prescribed. What did we do? We referred to haematology (as all SC patients automatically are) and gave ibuprofen and codeine.

2 hours later she reported that her pain was a lot better. The haematology Registrar was busy with a very sick patient on the ward and had not yet been down. The mother decided to self discharge. But throughout the 2 hours they were there she complained constantly and demanded pain relief (that wasn't needed) and wanted to know why she wasn't being seen and said her other daughter had school the next day and she couldn't be waiting around in A&E all night. Essentially she was blaming us for something that was her own fault; she could have (and should have) been at home doing exactly what we were doing. We suspect she was trying to get in and out of the department with stronger pain killers early so they didn't have to come back in the middle of the night. Incidentally she didn't return that night. It is unfortunate that the Reg was busy elsewhere (how inconsiderate of the ward patient to be so ill!), but it was her own fault that she was waiting in the department for that time when she could have been treating her at home, instead she blamed us loudly in front of all the other patients.

I'll leave it there as this is getting to be a long, ranty entry. I'm sure there have been other blogworthy things but I shall save those for another time.