Organ dontation, to opt in or to opt out, that is the question.
I am on the regiser as an organ donor, I'm also a blood donor between piercings, tattoos and foreign travel. Clearly I am a pro-dontation so I don't doubt this affects my opinion on the subject.
Personally I would be happy to see the introduction of an 'opt out' system of presumed consent. We need to increase the number of tissue and organ donors in the UK as we currently cannot meet the demand. I think that there are many people who would be happy to donate but just never get around to making that decision and registering. Where as, if an opt out system were in place, I expect those who do not wish to do not would feel quite strongly about this and be motivated to opt-out. I also feel that organ donation should be in the hands of the individual, not the relatives.
However there are problems with presumed consent. Is it informed consent, as is required for consent for other medical procedures, and how can we ensure it is informed consent? Making the material available for the individual to read does not necessarily mean they will (though personally I feel that's their choice).
How easy will it be to opt out and will that wish be respected. As with all things there is the risk of abuse. What if a person chooses to op out in the last moments of their life, can this be verbal withdrawal of consent, must it be written? What about children? Would the responsibilty lie with thier parents, and at what point would they be able to make their own decision?
Those are jsut a few of the issues that spring to mind and clearly it's an ethical minefield. (Life would be a lot easier without ethics I often think!) However I think it's worth considering the issue fully. On first thought I'm compeltely in support of the system. When I think further on it I see the difficulties that may arise. However ultimately I am in favour of it.
Suing hospitals for compensation is my next port of call. It's the recent story with Lesley Ash being awarded £5million that has prompted this and I've been considering for a while what I wanted to say about it.
*deletes all the heartless things she wrote*
Undoubteldy Lesley has suffered and I don't deny that there was negligence on the part of the hospital however it is an absolutely atrocious anount of money for one person to be awarded. Ultimately it feels rather like revenge on her part. But more importantly the part that bothers me is people taking much-needed money away from a FREE healthcare system. At the end of the day money doesn't bring back the dead, won't make you walk again but it will make a difference to patient care.
I'm not saying the hospital shouldn't be held accountable in some way, and change should be implemented, but compensation is only good for one thing, satisfying the greed of the individual. (I know that in some circumstances a person may be unable to work as a result of negligence, they may therefore be unable to keep up with rent etc, but that is a very different situation to suing for £5million, more money than you could ever need, even then it feels wrong to be taking money away from the service.)
People make mistakes. Nurses make mistakes. Doctors make mistakes. Surgeons make mistakes. This is human error and generally speaking not malicious, we are doing our best in an over-worked, under-staffed, and under-appreciated system. The NHS is a FREE healthcare service, and whilst we should be striving to maintian high standards of care, people should spend more time being grateful for what we've got and less time working out how much money they can get out of it.
Please feel free to comment on this. I know I'm being rather opinionated, possibly narrowminded and almost certainly heartless, but nursing and the NHS is something I feel passionately about.
Showing posts with label Nursing. Show all posts
Showing posts with label Nursing. Show all posts
Monday, January 21, 2008
Thursday, January 17, 2008
Suicidal
A few months ago I was working a night shift and I was allocated the care of an 11 year old boy who was currently in A&E awaiting the arrival of an RMN. The reason for admission was that he was suicidal and had made attempts on his life that day.
We didn't really feel that our ward was the most appropriate place for this young man, usually we try to put these children into cubicles for some privacy and peace and quiet, unforutnatly the only cubicles on our ward are too far away from the nurses station and out of sight to be able to closely observe him. We decided to allocate him in our second bay in a bed opposite the nurses station. Not ideal as there were 4 other young children in that bay.
I tried to ready the bed space removing an items which could be used to harm himself, not an easy talk considering every bed space has a suction unit with lengths of plastic tubing and the child next door was an on IV infusion with long power cables coming out of his machine and plugging into the socket right next to this child's bed. I made the space as safe as possible, got a not-too-comfy chair for the RMN, pulled back the curtains and waited for the call.
When I got downstairs to the A&E department I was told that he was with his mother and the RMN in a room just out in the corridor. Then ursing staff weren't able to give me a very good history as he had been seen by the on-call psychiatry team almost immediately and they had had little to do with him. The story was that the boy had twice that day tried to run out in front of a car but had been stopped on both occasions. His mother had brought him into hospital because she was concnered abotu this and his recent behaviour. He has recently lsot a friend, and relative a little while ago and he dad was currently in prison.
I took the paperwork and joined the young man, his mother and RMN in the side room. I introduced myself and explained I was there to take him up to the ward. At this point he completely refused to come with me, said he wanted to go home, that he didn't need to come into hospital, that his mother had tricked him there.
So began an hour of negotiation. I explained to him that he wasn't in any trouble, but that his mum had been worried about him and that's why she had brought him in, and that we just wanted to keep an eye on him overnight.
He told me that he was fine, there was nothing wrong and that he didn't need to be there. Now his mother joined in, at times being constructive and helpful and at other times frustration getting the better of her and she would lose her temper with him.
She tried being the authorative parent, saying she had made the decision as his parent that he needed to be there and he would do as he was told. She tried explaining that she was concerned about him and about what he had done today. She got angry and told him how he was upsetting her.
I watched a lot of this, intervened when I felt it would be helpful, tried to placate mum when she got angry. Simon (not his real name) became increasingly frustrated, saying that he wouldn't do it again, that he didn't need to be here, said no one would believe him when he said he was okay. He slammed his fists into his lap, got up and banged his fists against the wall then sat in the corner of the room.
I tried to explain that it wasn't that we didn't believe him or thought he was lying, but because of what happened to day it was my job to make sure that he was okay, and that whilst he might feel okay at the moment and feeling one particular way sometimes this can change and we needed to make sure he was safe overnight.
Between angry outbursts and protestation he would become withdrawn and tearful refusing to make eyecontact with anyone in the room and not registering when someone spoke to him.
Every now and then the RMN would chime in with helpful comments such as "You're wasting time down here" and an inappropriate moments (e.g. mid conversation) "Let's go up to bed". I did my best to ignore this and manage to refrain from telling her to be quiet or giving her the "evil eye".
Simon was convinced that his uncle was going to come in and take him away, he kept telling us this and his mother explained that this wasn't the case and that his uncle would say he had to stay.
Almost an hour after arriving in the department I left the room to give him a few moments with his family (oh an the lovely RMN) whilst I had a discussion with the A&E nursing staff.
"You're still here?!"
"Yes, and I can see what you mean about the RMN" (They earler had described her a bit "odd")
"You know she came out of the room before you arrived asking for us to sedate him as he was upset?"
"I'd probably need sedating if I had her looking after me."
Although the child was upset, it was "normal" upset in my eyes, I would probably feel exactly the same way in his situation. He wasn't violent or aggressive, jsut very frustrated and did calm down. I felt that I had been making progress with him and that he was becoming more resigned to being admitted, however I now didn't feel the bedspace we'd allocated him was appropriate and that he needed a more private space.
We contacted the bed manager and reallocated him to a cubicle on our adolscent ward close to the nurses station. Although he was below the age the unit would usually accept we felt it would be better for him and they would be able to provide better care there.
I went back to explain to Simon and his family that he would be going to a different ward with a nice private room of his own where he could get a better night's sleep. His uncle had by now arrived and was whispering in his ear, he didn't stop when I entered the room or after I stood there for a few moment (which I found a little odd). I said goodbye to Simon without a glance or acknowledgement that I had spoken and hoped on my way upstairs that I hadn't traumatised the child too much.
He was admitted to the adolscent unit next door where I was told he had a good night's sleep, was seen by CAMHS the next morning and discharged. I don't know if he had any follow-up in the community.
We didn't really feel that our ward was the most appropriate place for this young man, usually we try to put these children into cubicles for some privacy and peace and quiet, unforutnatly the only cubicles on our ward are too far away from the nurses station and out of sight to be able to closely observe him. We decided to allocate him in our second bay in a bed opposite the nurses station. Not ideal as there were 4 other young children in that bay.
I tried to ready the bed space removing an items which could be used to harm himself, not an easy talk considering every bed space has a suction unit with lengths of plastic tubing and the child next door was an on IV infusion with long power cables coming out of his machine and plugging into the socket right next to this child's bed. I made the space as safe as possible, got a not-too-comfy chair for the RMN, pulled back the curtains and waited for the call.
When I got downstairs to the A&E department I was told that he was with his mother and the RMN in a room just out in the corridor. Then ursing staff weren't able to give me a very good history as he had been seen by the on-call psychiatry team almost immediately and they had had little to do with him. The story was that the boy had twice that day tried to run out in front of a car but had been stopped on both occasions. His mother had brought him into hospital because she was concnered abotu this and his recent behaviour. He has recently lsot a friend, and relative a little while ago and he dad was currently in prison.
I took the paperwork and joined the young man, his mother and RMN in the side room. I introduced myself and explained I was there to take him up to the ward. At this point he completely refused to come with me, said he wanted to go home, that he didn't need to come into hospital, that his mother had tricked him there.
So began an hour of negotiation. I explained to him that he wasn't in any trouble, but that his mum had been worried about him and that's why she had brought him in, and that we just wanted to keep an eye on him overnight.
He told me that he was fine, there was nothing wrong and that he didn't need to be there. Now his mother joined in, at times being constructive and helpful and at other times frustration getting the better of her and she would lose her temper with him.
She tried being the authorative parent, saying she had made the decision as his parent that he needed to be there and he would do as he was told. She tried explaining that she was concerned about him and about what he had done today. She got angry and told him how he was upsetting her.
I watched a lot of this, intervened when I felt it would be helpful, tried to placate mum when she got angry. Simon (not his real name) became increasingly frustrated, saying that he wouldn't do it again, that he didn't need to be here, said no one would believe him when he said he was okay. He slammed his fists into his lap, got up and banged his fists against the wall then sat in the corner of the room.
I tried to explain that it wasn't that we didn't believe him or thought he was lying, but because of what happened to day it was my job to make sure that he was okay, and that whilst he might feel okay at the moment and feeling one particular way sometimes this can change and we needed to make sure he was safe overnight.
Between angry outbursts and protestation he would become withdrawn and tearful refusing to make eyecontact with anyone in the room and not registering when someone spoke to him.
Every now and then the RMN would chime in with helpful comments such as "You're wasting time down here" and an inappropriate moments (e.g. mid conversation) "Let's go up to bed". I did my best to ignore this and manage to refrain from telling her to be quiet or giving her the "evil eye".
Simon was convinced that his uncle was going to come in and take him away, he kept telling us this and his mother explained that this wasn't the case and that his uncle would say he had to stay.
Almost an hour after arriving in the department I left the room to give him a few moments with his family (oh an the lovely RMN) whilst I had a discussion with the A&E nursing staff.
"You're still here?!"
"Yes, and I can see what you mean about the RMN" (They earler had described her a bit "odd")
"You know she came out of the room before you arrived asking for us to sedate him as he was upset?"
"I'd probably need sedating if I had her looking after me."
Although the child was upset, it was "normal" upset in my eyes, I would probably feel exactly the same way in his situation. He wasn't violent or aggressive, jsut very frustrated and did calm down. I felt that I had been making progress with him and that he was becoming more resigned to being admitted, however I now didn't feel the bedspace we'd allocated him was appropriate and that he needed a more private space.
We contacted the bed manager and reallocated him to a cubicle on our adolscent ward close to the nurses station. Although he was below the age the unit would usually accept we felt it would be better for him and they would be able to provide better care there.
I went back to explain to Simon and his family that he would be going to a different ward with a nice private room of his own where he could get a better night's sleep. His uncle had by now arrived and was whispering in his ear, he didn't stop when I entered the room or after I stood there for a few moment (which I found a little odd). I said goodbye to Simon without a glance or acknowledgement that I had spoken and hoped on my way upstairs that I hadn't traumatised the child too much.
He was admitted to the adolscent unit next door where I was told he had a good night's sleep, was seen by CAMHS the next morning and discharged. I don't know if he had any follow-up in the community.
Monday, January 14, 2008
Steep learning curve
Once again I cannot believe how long it has been since my last post. The weeks and months seem to be flying by me at the moment, and work is keeping me busy.
So a catch up before the main focus of this post. I worked Christmas Eve and Christmas day and all in all it wasn't so bad. Everyone was in good spirits, we had several Father Christmas' visit and we got half the unit on home leave for the day.
I had a very welcome three day break in Cornwall over the New Year which left me feeling refreshed and ready to work.
Last week I started on a new ward. It is an adolescent unit. I have so far worked for long days there and it is the reason for my post title.
The first two days were spent looking after a teenager who had been involved in a gang-related fight. It is a whole different world to the one I grew up and live in, though not unfamiliar because of the kids my mother works with.
He would swing from being polite and well mannered to being angry and refusing to cooperate. On several occasions he left the unit unaccompanied which is against our rules as we are unable to ensure their safety if they do that. Despite reprimands, explanations and assurances he wouldn't do it again he did. He would also try some of the most unbelievable lies to get permission to leave the ward, and then would become angry when we wouldn't let him. He was never verbally abusive to me and I never felt threatened by him, I actually quite liked him. Soon his anger would blow over and he would be cooperative again, now allowing us to do his antibiotic. I made him a hot chocolate and got him a packet of biscuits after one particularly difficult argument and as I sat watching him dunk his biscuits I realised that despite the bravado he is little more than a boy. He has had a really difficult home life, has been excluded from several schools, is now involved with a gang, I'm fairly sure carries a knife and is in trouble with the police, he also has some degree of mental health problems and anger issues. He is not accepting the help he is being offered and it's really sad to think where this young man may end up, because beneath that hard outer shell he is a nice boy.
On my third and fourth days I looked after a young woman who has had many previous admissions for confusion post seizures, and she has been non compliant with her medication. We had a registered mental nurse (RMN) (which makes me giggle) to watch over her, which makes my job a lot easier. Initially I didn't have a lot to do with her and was busy with three other patients but as the afternoon wore on I became more concerned about her behaviour which didn't seem like confusion you may have post-seizure but a lot more like psychosis. I was told she has presented like this before but it still didn't seem right to me. She had delusional thoughts; that she was a witch was the most common. She was having auditory, visual and tactile hallucinations; people calling her name, a man trying to strangle her. She was convinced she was dying and would not believe any reassurances that she wasn't and didn't have cancer, AIDS, wasn't having a heat attack. She became increasingly distressed and said she wanted to kill herself.
Although she had been seen by CAMHS and psych in A&E there wasn't really any plan for her, and fortunately at this point we had a brilliant psychiatric doctor come and review her. She straight away recognised our concerns and finally someone seemed to be taking this more seriously. She prescribed a very small dose of Lorazepam to try and help with her anxiety as she was highly agitated and distressed. This was given quite late in the day and the night staff reported it really helped calm her and she went to bed.
The following day we had more members of the mental health MDT assess her and the decision was made to transfer her to an adolescent mental health unit for assessment and observation. Unfortunately my patient didn't want to go and with her parents permission she was sectioned under Part 2 (I believe) of the mental health act - a process that I had not encountered before and took several hours, needing two different doctors to assess her and signs a document and the the Approved Social Worker to complete the last part.
We then had to wait over an hour for transport. When they were scheduled to arrive my patient was ready and had been persuaded and accepted the move to another hospital. Unfortunately the hour and fifteen minutes we spent waiting for transport saw her agitation increase and once again she refused to go. I was concerned she was going to try and leave the unit and was becoming a little aggressive, but we managed to persuade her back to her bed (having wandered up and down the adjacent children's wards with her) and when transport actually arrived (and I made them get rid of the trolley they wanted to strap her to!) she actually went quite peaceably.
So as my title suggests those four days were a very steep learning curve for me. At this point I would like to thank MMW for her blog. The knowledge and insight I have gained from reading it really did help me with the care of a patient that was totally outside my realm of professional experience.
So a catch up before the main focus of this post. I worked Christmas Eve and Christmas day and all in all it wasn't so bad. Everyone was in good spirits, we had several Father Christmas' visit and we got half the unit on home leave for the day.
I had a very welcome three day break in Cornwall over the New Year which left me feeling refreshed and ready to work.
Last week I started on a new ward. It is an adolescent unit. I have so far worked for long days there and it is the reason for my post title.
The first two days were spent looking after a teenager who had been involved in a gang-related fight. It is a whole different world to the one I grew up and live in, though not unfamiliar because of the kids my mother works with.
He would swing from being polite and well mannered to being angry and refusing to cooperate. On several occasions he left the unit unaccompanied which is against our rules as we are unable to ensure their safety if they do that. Despite reprimands, explanations and assurances he wouldn't do it again he did. He would also try some of the most unbelievable lies to get permission to leave the ward, and then would become angry when we wouldn't let him. He was never verbally abusive to me and I never felt threatened by him, I actually quite liked him. Soon his anger would blow over and he would be cooperative again, now allowing us to do his antibiotic. I made him a hot chocolate and got him a packet of biscuits after one particularly difficult argument and as I sat watching him dunk his biscuits I realised that despite the bravado he is little more than a boy. He has had a really difficult home life, has been excluded from several schools, is now involved with a gang, I'm fairly sure carries a knife and is in trouble with the police, he also has some degree of mental health problems and anger issues. He is not accepting the help he is being offered and it's really sad to think where this young man may end up, because beneath that hard outer shell he is a nice boy.
On my third and fourth days I looked after a young woman who has had many previous admissions for confusion post seizures, and she has been non compliant with her medication. We had a registered mental nurse (RMN) (which makes me giggle) to watch over her, which makes my job a lot easier. Initially I didn't have a lot to do with her and was busy with three other patients but as the afternoon wore on I became more concerned about her behaviour which didn't seem like confusion you may have post-seizure but a lot more like psychosis. I was told she has presented like this before but it still didn't seem right to me. She had delusional thoughts; that she was a witch was the most common. She was having auditory, visual and tactile hallucinations; people calling her name, a man trying to strangle her. She was convinced she was dying and would not believe any reassurances that she wasn't and didn't have cancer, AIDS, wasn't having a heat attack. She became increasingly distressed and said she wanted to kill herself.
Although she had been seen by CAMHS and psych in A&E there wasn't really any plan for her, and fortunately at this point we had a brilliant psychiatric doctor come and review her. She straight away recognised our concerns and finally someone seemed to be taking this more seriously. She prescribed a very small dose of Lorazepam to try and help with her anxiety as she was highly agitated and distressed. This was given quite late in the day and the night staff reported it really helped calm her and she went to bed.
The following day we had more members of the mental health MDT assess her and the decision was made to transfer her to an adolescent mental health unit for assessment and observation. Unfortunately my patient didn't want to go and with her parents permission she was sectioned under Part 2 (I believe) of the mental health act - a process that I had not encountered before and took several hours, needing two different doctors to assess her and signs a document and the the Approved Social Worker to complete the last part.
We then had to wait over an hour for transport. When they were scheduled to arrive my patient was ready and had been persuaded and accepted the move to another hospital. Unfortunately the hour and fifteen minutes we spent waiting for transport saw her agitation increase and once again she refused to go. I was concerned she was going to try and leave the unit and was becoming a little aggressive, but we managed to persuade her back to her bed (having wandered up and down the adjacent children's wards with her) and when transport actually arrived (and I made them get rid of the trolley they wanted to strap her to!) she actually went quite peaceably.
So as my title suggests those four days were a very steep learning curve for me. At this point I would like to thank MMW for her blog. The knowledge and insight I have gained from reading it really did help me with the care of a patient that was totally outside my realm of professional experience.
Tuesday, December 18, 2007
False Economy
False Economy. A phrase that I've seen used a lot recently, one I've used myself. It means something that initially is cheaper but works out to be more expensive in the long term. It's something I feel can really be applied to nursing, I was going to say particularly the ward I work on that the moment but I have seen in on many wards.
Staffing. We are under staffed. We regularly have shifts where on 4 of 6 slots are filled. Sometimes as little as 3, and on a good day 5. The last couple of shifts I worked were fully staffed, a rarity, and it was wonderful. We don't have enough staff, but they won't employ more full time nurses. This however is a false economy, because with all the shifts being filled by bank and agency it would have been cheaper and far less stressful to employ another full time staff member or two.
I can't believe how many days have passed since I last posted. Time is flying by and Christmas is nearly upon us. Unfortunatly I have to work Christmas day this year, which I have to admit I'm very disapointed about, however you gotta do what you gotta do and we'll just have to try and make the day special for all the patients.
I wanted to draw your attention to a charity my hospital is involved with. Facing the World.
F A C I N G T H E W O R L D is a children's charity. It has been set up some of the UK’s leading craniofacial surgeons so that children in desperate need, living without hope in the world’s poorest countries, can have access to the very best surgery that can transform their faces and radically change their quality of life.
If you only look at two things on that website please look at the short film linked on the main page, it's in the bottom blue box with the dial up or broadband link. I would also reccomend that you go to the Case Studies page. I think what this charity does is amazing, and it is one of the few charities that has really moved me.
Staffing. We are under staffed. We regularly have shifts where on 4 of 6 slots are filled. Sometimes as little as 3, and on a good day 5. The last couple of shifts I worked were fully staffed, a rarity, and it was wonderful. We don't have enough staff, but they won't employ more full time nurses. This however is a false economy, because with all the shifts being filled by bank and agency it would have been cheaper and far less stressful to employ another full time staff member or two.
I can't believe how many days have passed since I last posted. Time is flying by and Christmas is nearly upon us. Unfortunatly I have to work Christmas day this year, which I have to admit I'm very disapointed about, however you gotta do what you gotta do and we'll just have to try and make the day special for all the patients.
I wanted to draw your attention to a charity my hospital is involved with. Facing the World.
F A C I N G T H E W O R L D is a children's charity. It has been set up some of the UK’s leading craniofacial surgeons so that children in desperate need, living without hope in the world’s poorest countries, can have access to the very best surgery that can transform their faces and radically change their quality of life.
If you only look at two things on that website please look at the short film linked on the main page, it's in the bottom blue box with the dial up or broadband link. I would also reccomend that you go to the Case Studies page. I think what this charity does is amazing, and it is one of the few charities that has really moved me.
Wednesday, December 05, 2007
'Tis the season
The Bronch season.
Bronchiolitis is a common respiratory infection that affects young babies and children. Their bronchioles (smallest airways) become infected by a virus,becoming inflamed and causing a build up of mucus. Some babies become very unwell with this condition and this can mean admission to hospital.
Initially it presents as a common cold which then worsens and affects their breathing. They develop rapid breathing, a rasping cough and a raised heart rate.
In some children these symptoms worse and they have increased difficulty in breathing. They have a rapid respiration rate, will be using their accessory muscles to aid their breathing, this can be very tiring and lead to exhaustion, in this case they will need support in hospital. They may also struggle to feed as they find they become too breathless.
Treatment. We give oxygen. We sometimes give inhalers, though these don't always work well. CPAP - a form of non-invasive ventiliation to assist breathing. IV fluids to correct/prevent dehydration. Nasogastric tube feeding until we can reesatblish breast or bottle feeding.
I hate Bronch season with a passion. Bronch's are incredibly hard work.
a) They may be on oxygen. Hopefully you get a set of nasal prongs in and hopefully get them stuck down and then hopefully they won't keep trying to pull them out. If they're on oxygen they require hourly observations and being on a sats monitor.
b) Sats monitors are a great tool for nurses. They allow us to continously monitor the childs heart rate adn oxygen level. When there's a good trace. Which there usually isn't because the child is kicking it's foot around and doesn't like have the plaster attached. You will also notice that monitors increase parental anxiety. They become number watches, obsessed with the heart rate and oxygen levels, but they lack the experience to intepret the machine and it's readings, to knwo when it's accurate and when to be concerned. They require more reassurance and will frequently buzz for you worried that their child's oxygen level has dropped. Of course there is the opposite extreme. The parent who has seen you silence the machine before and think it's okay for them to do the same, not realising that you're also making an assessment when you do that. You then pop along an hou later to discover the child's oxygen levels are too low. Sometimes they even turn it off without telling you, because the alarm was annoying them.
c) NG feeding. This may be a continous feed or a bolus feed. Blous feeds take a considerable amount of time on an already busy shift. If they're very unwell we have to reduce their feed because the expanding stomach restricts the lungs ability to inflate, and if they're really very unwell we may stop feeds altogether and rely on IV fluids for hydration and the occasional comfort feed. This leads to d)
d) Irritable. Bronch babies, when they are unwell, are some of the most irritable and unsettled children I have come across. They feel rubbish, they're tired phsycally from the effort of breathing, will probably not be sleeping well and they're hungry. They are some of the hardest babies to settle, a nightmare for the parents and in turn for the nruses when the parents are at their wits end and asking you for a solution (or jsut ignoring thier child)
Where I'm working we put Bronch's into double bays. They're infectious, but with the number of Bronchs we have we double them up as they both have the same illness. Unfortuantly we so often seem to have one sick one and one slightly better one. Sick baby and mum keeps slightly better baby and mum up all night, causing frustration for everybody. Then slightly better baby goes home, and sick baby becomes slightly better baby and we get a new sick baby in and it begins again.
Hospital is the worst place to get a good night's restful sleep!
Bronchiolitis is a common respiratory infection that affects young babies and children. Their bronchioles (smallest airways) become infected by a virus,becoming inflamed and causing a build up of mucus. Some babies become very unwell with this condition and this can mean admission to hospital.
Initially it presents as a common cold which then worsens and affects their breathing. They develop rapid breathing, a rasping cough and a raised heart rate.
In some children these symptoms worse and they have increased difficulty in breathing. They have a rapid respiration rate, will be using their accessory muscles to aid their breathing, this can be very tiring and lead to exhaustion, in this case they will need support in hospital. They may also struggle to feed as they find they become too breathless.
Treatment. We give oxygen. We sometimes give inhalers, though these don't always work well. CPAP - a form of non-invasive ventiliation to assist breathing. IV fluids to correct/prevent dehydration. Nasogastric tube feeding until we can reesatblish breast or bottle feeding.
I hate Bronch season with a passion. Bronch's are incredibly hard work.
a) They may be on oxygen. Hopefully you get a set of nasal prongs in and hopefully get them stuck down and then hopefully they won't keep trying to pull them out. If they're on oxygen they require hourly observations and being on a sats monitor.
b) Sats monitors are a great tool for nurses. They allow us to continously monitor the childs heart rate adn oxygen level. When there's a good trace. Which there usually isn't because the child is kicking it's foot around and doesn't like have the plaster attached. You will also notice that monitors increase parental anxiety. They become number watches, obsessed with the heart rate and oxygen levels, but they lack the experience to intepret the machine and it's readings, to knwo when it's accurate and when to be concerned. They require more reassurance and will frequently buzz for you worried that their child's oxygen level has dropped. Of course there is the opposite extreme. The parent who has seen you silence the machine before and think it's okay for them to do the same, not realising that you're also making an assessment when you do that. You then pop along an hou later to discover the child's oxygen levels are too low. Sometimes they even turn it off without telling you, because the alarm was annoying them.
c) NG feeding. This may be a continous feed or a bolus feed. Blous feeds take a considerable amount of time on an already busy shift. If they're very unwell we have to reduce their feed because the expanding stomach restricts the lungs ability to inflate, and if they're really very unwell we may stop feeds altogether and rely on IV fluids for hydration and the occasional comfort feed. This leads to d)
d) Irritable. Bronch babies, when they are unwell, are some of the most irritable and unsettled children I have come across. They feel rubbish, they're tired phsycally from the effort of breathing, will probably not be sleeping well and they're hungry. They are some of the hardest babies to settle, a nightmare for the parents and in turn for the nruses when the parents are at their wits end and asking you for a solution (or jsut ignoring thier child)
Where I'm working we put Bronch's into double bays. They're infectious, but with the number of Bronchs we have we double them up as they both have the same illness. Unfortuantly we so often seem to have one sick one and one slightly better one. Sick baby and mum keeps slightly better baby and mum up all night, causing frustration for everybody. Then slightly better baby goes home, and sick baby becomes slightly better baby and we get a new sick baby in and it begins again.
Hospital is the worst place to get a good night's restful sleep!
Tuesday, December 04, 2007
Structure
Well after MMW's suggestion I'm writing a post on the structure of nursing. This is based on the heirachy where I work now, though I think it will be fairly similar all over - it certainly was similar where I trained.
So, there are three types of nurse you'll come across on the ward.
Staff Nurse, someone employed permanently by the hospital - that's me.
Bank Nurse, someone who has signed up to the hospitals internal nursing agency - that can also be me - usually someone who already works in the hospital and wants extra shifts.
Agency Nurse, someone who works for an external nursing agency. Sometimes they're good, often not too bad but slightly more a hinderance than a help, and occasionally absolutely awful.
Why would someone want to work for an agency? Agency nurses get paid higher rates than Staff or Bank nurses, (Bank nurses earn slightly more than Staff Nurses) - the ward waits as late as possible before "putting the shift out to agency" in the hope someone cheaper will agree to do it.
Less responsibility.
Agency nursing is flexible; you can work which shifts you choose.
However the downsides to Agency nursing:
Shifts may not always be available when you want them
Depending on where you work you will be unappreciated and looked down upon, you also run the risk of being given the difficult patients or those no one else wants to look after - I don't believe this is true of where I work now, I think we treat our agency nures fairly well, that's why we have some regulars who keep coming back to us.
On the ward I work on we have 20 beds, this closes to 15 over the weekend. On week days we (hopefully) have 6 staff, on week nights 4 staff, and on weekend days 4 staff and weekend nights 3 staff. At night you can expect to care for 5 patients, if fully staffed. On days 3-4, if fully staffed.
Some of the patients we have require a lot of nursing intervention, 1:3 may not sound like a lot but depending on the patient the workload can be very heavy, and day shifts are always busier than nights. That being said, nursing 5 patients overnight can also keep you very busy. We have a lot of jobs that are supposed to happen on the hour, an example of the hourly jobs you may have to do for 5 patients overnight could be: 3 pump readings, 3 sets of observations, 1 set of inhalers (on some hours rising to 2), giving a feed hourly or two hourly, plus on various hours on top of that IV antibiotics (which I'm not yet trained to do), observations for other patients, medications. I often find that I'll have just finished my hourly jobs just in time to start the next hour.
However, I have trailed off the topic for this post. Sorry for that rather boring interlude! Back to structure.
Band 5 - This is a Staff Nurse, generally speaking, in their first 5 years of nursing, after this point to progress through the pay scale you would have to move up a Band. You have lower and upper Band 5's, which represent the old D and E grades, basically those with more or less experience. These lettered grades were removed with Agenda For Change, but we still refer to them.
Band 6 - This is a Senior Staff Nurse, in some places they may be called a Junior Sister or Charge Nurse. They have more responsibility than us lowly Band 5's, which is one reason why some nurses choose not to move onto Band 6 despite reaching a cap in their pay. Where I work we currently have 5 Band 6's, two of which are very part time (2-4 shifts a month).
Band 7 - This would be the ward Sister, or where I work Ward Manager. The Ward Manager is similar in role to Sister but as far as I can work out is less clinical and more office based. We have one Ward Manager.
We have recently had a Modern Matron come into post, in the last few weeks, this is a very new position for us and I'm guessing it is a Band 8 position. He previous was a Ward Manager, and now manages the whole of children's unit with Ward Manager's in each ward.
Now, that is our basic structure for ward Staff Nurses and Managers, but there are a couple more "important" roles. During the day we have a Paeditric Bed Manager, and you've guessed is he manages the Paeditric Beds. He keeps tabs on all the beds and cubicles available across the unit and the demand for them in A&E. Any child admitted during the day needs to go through him, and he makes the decision about where to allocate them. At night this role is filled by the Site Manager, who has the unenviable job of being Site Manager/Bed Manager for the whole of the hospital. They need to keep track of the admissions, discharged, allocations and transfers as well as any staffing issues that may arise. Our last key person is the Senior Nurse (not to be confused with Senior Staff Nurse). This person carries The Bleep, and their responsibility is staffing; if someone calls in sick they have to speak to the Senior Nurse, they have to be aware of staffing across the unit and make decisions about where to send nurses to cover if we're short staffed. This is usually a Band 6 or above nurse, though some of our more experienced Band 5's will also do it. This is also on top of thier normal patient workload as staff nurse that day or night. Oh, and we have a shift co-ordinator in charge of every shift, this can be almost anybody who's been there at least a few months!
So that's how it all works. Kind of! I know this was probably a bit of a long winded and boring post, but I think understanding what goes on "behind the scenes" will make my blog make more sense!
So, there are three types of nurse you'll come across on the ward.
Staff Nurse, someone employed permanently by the hospital - that's me.
Bank Nurse, someone who has signed up to the hospitals internal nursing agency - that can also be me - usually someone who already works in the hospital and wants extra shifts.
Agency Nurse, someone who works for an external nursing agency. Sometimes they're good, often not too bad but slightly more a hinderance than a help, and occasionally absolutely awful.
Why would someone want to work for an agency? Agency nurses get paid higher rates than Staff or Bank nurses, (Bank nurses earn slightly more than Staff Nurses) - the ward waits as late as possible before "putting the shift out to agency" in the hope someone cheaper will agree to do it.
Less responsibility.
Agency nursing is flexible; you can work which shifts you choose.
However the downsides to Agency nursing:
Shifts may not always be available when you want them
Depending on where you work you will be unappreciated and looked down upon, you also run the risk of being given the difficult patients or those no one else wants to look after - I don't believe this is true of where I work now, I think we treat our agency nures fairly well, that's why we have some regulars who keep coming back to us.
On the ward I work on we have 20 beds, this closes to 15 over the weekend. On week days we (hopefully) have 6 staff, on week nights 4 staff, and on weekend days 4 staff and weekend nights 3 staff. At night you can expect to care for 5 patients, if fully staffed. On days 3-4, if fully staffed.
Some of the patients we have require a lot of nursing intervention, 1:3 may not sound like a lot but depending on the patient the workload can be very heavy, and day shifts are always busier than nights. That being said, nursing 5 patients overnight can also keep you very busy. We have a lot of jobs that are supposed to happen on the hour, an example of the hourly jobs you may have to do for 5 patients overnight could be: 3 pump readings, 3 sets of observations, 1 set of inhalers (on some hours rising to 2), giving a feed hourly or two hourly, plus on various hours on top of that IV antibiotics (which I'm not yet trained to do), observations for other patients, medications. I often find that I'll have just finished my hourly jobs just in time to start the next hour.
However, I have trailed off the topic for this post. Sorry for that rather boring interlude! Back to structure.
Band 5 - This is a Staff Nurse, generally speaking, in their first 5 years of nursing, after this point to progress through the pay scale you would have to move up a Band. You have lower and upper Band 5's, which represent the old D and E grades, basically those with more or less experience. These lettered grades were removed with Agenda For Change, but we still refer to them.
Band 6 - This is a Senior Staff Nurse, in some places they may be called a Junior Sister or Charge Nurse. They have more responsibility than us lowly Band 5's, which is one reason why some nurses choose not to move onto Band 6 despite reaching a cap in their pay. Where I work we currently have 5 Band 6's, two of which are very part time (2-4 shifts a month).
Band 7 - This would be the ward Sister, or where I work Ward Manager. The Ward Manager is similar in role to Sister but as far as I can work out is less clinical and more office based. We have one Ward Manager.
We have recently had a Modern Matron come into post, in the last few weeks, this is a very new position for us and I'm guessing it is a Band 8 position. He previous was a Ward Manager, and now manages the whole of children's unit with Ward Manager's in each ward.
Now, that is our basic structure for ward Staff Nurses and Managers, but there are a couple more "important" roles. During the day we have a Paeditric Bed Manager, and you've guessed is he manages the Paeditric Beds. He keeps tabs on all the beds and cubicles available across the unit and the demand for them in A&E. Any child admitted during the day needs to go through him, and he makes the decision about where to allocate them. At night this role is filled by the Site Manager, who has the unenviable job of being Site Manager/Bed Manager for the whole of the hospital. They need to keep track of the admissions, discharged, allocations and transfers as well as any staffing issues that may arise. Our last key person is the Senior Nurse (not to be confused with Senior Staff Nurse). This person carries The Bleep, and their responsibility is staffing; if someone calls in sick they have to speak to the Senior Nurse, they have to be aware of staffing across the unit and make decisions about where to send nurses to cover if we're short staffed. This is usually a Band 6 or above nurse, though some of our more experienced Band 5's will also do it. This is also on top of thier normal patient workload as staff nurse that day or night. Oh, and we have a shift co-ordinator in charge of every shift, this can be almost anybody who's been there at least a few months!
So that's how it all works. Kind of! I know this was probably a bit of a long winded and boring post, but I think understanding what goes on "behind the scenes" will make my blog make more sense!
Monday, December 03, 2007
Return
I've been meaning to write ni this for a while now. Thank you MMW for your comment, it was a kick up the arse, I'm sorry it's taken so long to write since then.
Since I last wrote I have completed my nurse training, started working a staff nurse in a busy SW London hospital, ended a 4.5 year relationship and began a new one.
I've wanted to write so often recently, but this has usually been following a bad day at work where the madness of the NHS boils my blood! I still LOVE my job and it's partly for this reason that I've not written. I don't want this to become a negative "The NHS is Bad" blog.
However, I suspect many of my posts will remark upon the state of the NHS and nursing today. I will endeavour to include something positive, because the job is not all bad and there is still a lot of reward in it.
I was recently asked a question about the current NHS, red tape and political correctness. I've decided for my first post I shall copy my reply in here.
Sometimes I feel that the paperwork that has sprung up from politically correct government think tanks and public inquiries impedes nursing care. It detracts from what is important; caring for the patient, not just doing tasks, but caring for them, being with them and supporting them. I wonder why a paitent's ethnic origin is important to document, as far as I'm concerned everyone should receive the same high level of care and be treated individually. 4 hourly waiting time in A&E, if a patient isn't transferred/discharged within 4 hours they "breech" and this is a terrible thing. I think they explode or something like that. I frequently run (literally) down to the A&E department to collect patients before they breech and at the cost of my own patients on the ward: their pain relief has to wait, their dressing change has to wait, their feed has to be late. I'm sure as far as the governemnt is concerned this is good nursing: the patient in A&E isn't waiting more than 4 hours, but would an extra 15 minutes really make a difference?
But then I think about Victoria Climbie (if you've not read the Laming Report I sincerely reccomend you do, it's not pleasant reading but I believe awareness is the start of prevention). That child suffered terribly and was failed by so many people and services. A lot of systems and paperwork have been put in place since then with the aim of protecting children and preventing the reccurence of such a tragedy. Surely this a good thing. Yes, it's a pain in the arse when you have 5 different referrals and telephone calls to make, but if it can prevent a child's death or maltreatment then it's worth it in my eyes. Whether it would have actually made a difference in Victoria's case I don't know, personal accountability has to come into it at some point, beyond whether you ticked boxes and filled in a referral form. But we're trying.
So, after that long-winded and off track response I agree with Doc: Too much red tape is a bad thing, not enough is worse. The difficutly is trying to find the balance. In the NHS most red tape is aimed at improving patient care. Or am I being naive? Perhaps it's aimed at improving the hospitals bank balance. Whether in reality patient care is improved, I think you'd need to look at that on a case by case basis.
I'm going to leave it there for now, though this is something I will come back to.
MMW: Please give me time to catch up with you blogs! I'm incredibly out of the loop, I can only apologise.
Since I last wrote I have completed my nurse training, started working a staff nurse in a busy SW London hospital, ended a 4.5 year relationship and began a new one.
I've wanted to write so often recently, but this has usually been following a bad day at work where the madness of the NHS boils my blood! I still LOVE my job and it's partly for this reason that I've not written. I don't want this to become a negative "The NHS is Bad" blog.
However, I suspect many of my posts will remark upon the state of the NHS and nursing today. I will endeavour to include something positive, because the job is not all bad and there is still a lot of reward in it.
I was recently asked a question about the current NHS, red tape and political correctness. I've decided for my first post I shall copy my reply in here.
Sometimes I feel that the paperwork that has sprung up from politically correct government think tanks and public inquiries impedes nursing care. It detracts from what is important; caring for the patient, not just doing tasks, but caring for them, being with them and supporting them. I wonder why a paitent's ethnic origin is important to document, as far as I'm concerned everyone should receive the same high level of care and be treated individually. 4 hourly waiting time in A&E, if a patient isn't transferred/discharged within 4 hours they "breech" and this is a terrible thing. I think they explode or something like that. I frequently run (literally) down to the A&E department to collect patients before they breech and at the cost of my own patients on the ward: their pain relief has to wait, their dressing change has to wait, their feed has to be late. I'm sure as far as the governemnt is concerned this is good nursing: the patient in A&E isn't waiting more than 4 hours, but would an extra 15 minutes really make a difference?
But then I think about Victoria Climbie (if you've not read the Laming Report I sincerely reccomend you do, it's not pleasant reading but I believe awareness is the start of prevention). That child suffered terribly and was failed by so many people and services. A lot of systems and paperwork have been put in place since then with the aim of protecting children and preventing the reccurence of such a tragedy. Surely this a good thing. Yes, it's a pain in the arse when you have 5 different referrals and telephone calls to make, but if it can prevent a child's death or maltreatment then it's worth it in my eyes. Whether it would have actually made a difference in Victoria's case I don't know, personal accountability has to come into it at some point, beyond whether you ticked boxes and filled in a referral form. But we're trying.
So, after that long-winded and off track response I agree with Doc: Too much red tape is a bad thing, not enough is worse. The difficutly is trying to find the balance. In the NHS most red tape is aimed at improving patient care. Or am I being naive? Perhaps it's aimed at improving the hospitals bank balance. Whether in reality patient care is improved, I think you'd need to look at that on a case by case basis.
I'm going to leave it there for now, though this is something I will come back to.
MMW: Please give me time to catch up with you blogs! I'm incredibly out of the loop, I can only apologise.
Tuesday, April 10, 2007
Band 5 Interview questions
So this is a list of Band 5 Interview questions based on those my collegaues and I have been asked, and those I had been prepared for. I'll update this when I remember more.
Questions
Tell me something interesting about yourself
Tell me something about your training so far
Why do you want to work for this department
Why do you want to take part ina rotation programme
What do you think the changes will be when moving from student to staff nurse
How do you feel about the change from student to staff nurse
How do you maintain professional boundaries with patients and other staff
What is the MDT and what does it mean
Describe two elements of the NSF
What were some of the reccomedations made by Lord Laming's report
What was the most challenging part of training to be a nurse
What criticism have you received and how have you learned from it
Talk about two situations that you have felt vulnerable in
What is clinical governence/What is your role in clinical governence
What is your role in risk management
What piece of literature/research have you read and how it has changed your practice
What makes a good communicator
Why might a neonate be admitted to intensive care or special care
What is family centred care
What skills are necessary for good team work
Scenarios
You walk into a cubicle and see a nurse slapping a child, what do you do?
A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
You notice a bruise on the back of a child when examining them. What would you do?
You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
Patient prioritisation scenario
3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
Questions
Tell me something interesting about yourself
Tell me something about your training so far
Why do you want to work for this department
Why do you want to take part ina rotation programme
What do you think the changes will be when moving from student to staff nurse
How do you feel about the change from student to staff nurse
How do you maintain professional boundaries with patients and other staff
What is the MDT and what does it mean
Describe two elements of the NSF
What were some of the reccomedations made by Lord Laming's report
What was the most challenging part of training to be a nurse
What criticism have you received and how have you learned from it
Talk about two situations that you have felt vulnerable in
What is clinical governence/What is your role in clinical governence
What is your role in risk management
What piece of literature/research have you read and how it has changed your practice
What makes a good communicator
Why might a neonate be admitted to intensive care or special care
What is family centred care
What skills are necessary for good team work
Scenarios
You walk into a cubicle and see a nurse slapping a child, what do you do?
A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
You notice a bruise on the back of a child when examining them. What would you do?
You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
Patient prioritisation scenario
3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
:D
I have a job!
:D
The interview was last week, and I thought it was a really difficult, high pressured interview and although I had been well prepared by one of the Sisters in placement I really wasn't sure how it went. A friend also went and said she found the same, very difficult questions and very intense.
I got a phone call today saying unofficially I would be offered it next week when my references had come through.
:D
I'm adding a new resourcey type post for Band 5 interview questions based on the ones I and my friends have had and that I have been prepped for.
I was away in Cornwall for a few days with my family, travelled back by coach over last night and did a presentation today in university, which went well. It was a really good break, the weather was beautiful and I've not had a holiday with my family since the summer so it was good to spend time with them too.
I'm going to post a political/general rant in a bit, regarding two articles I had read in the Metro. I bet you can hardly wait!
:D
The interview was last week, and I thought it was a really difficult, high pressured interview and although I had been well prepared by one of the Sisters in placement I really wasn't sure how it went. A friend also went and said she found the same, very difficult questions and very intense.
I got a phone call today saying unofficially I would be offered it next week when my references had come through.
:D
I'm adding a new resourcey type post for Band 5 interview questions based on the ones I and my friends have had and that I have been prepped for.
I was away in Cornwall for a few days with my family, travelled back by coach over last night and did a presentation today in university, which went well. It was a really good break, the weather was beautiful and I've not had a holiday with my family since the summer so it was good to spend time with them too.
I'm going to post a political/general rant in a bit, regarding two articles I had read in the Metro. I bet you can hardly wait!
Sunday, April 01, 2007
Productive
Well. I have had some really good shifts recently. I'm really feeling like a (fairly) productive member of the team. I'm able to do so much more than when I started; looking after patients who are a little more unwell and going to be admitted, assess/triage. I have shifts to make up, and will be doing an extra 6. On one hand I wish I didn't have time to make up on the other I am learning so much from this placement, so much more than I would have if I had made up the shifts elsewhere, or not taken the time at all.
We've not had any really interesting cases recently. I've seen a couple of good dislocated fingers, fingers bent in strange positions. I did a dressing on a 2 year old who had ripped two of their finger nails off... owwww... I'm not good with nails.
I may just be easily amused, or having a giggly day, but had a few funny conversations with parents who speak bad English (as most of our parents do). It makes it so challenging sometimes, but it can also be funny.
A child came in, mum started out by telling us he'd had an operation on his nose a few months ago (that turned out to be a tonsillectomy) so we assumed, naturally, that there was some problem related to this. No, he'd fallen over and bumped his forehead.
Nurse: "How did it happen?"
Mum: "Today"
Nurse: "No, what happened, how did he do it?"
Mum: "Today"
After about 6 different phrasings of the question we established how it had happened.
Nurse: "Has he had any medicines today?"
Mum: "No"
Nurse: "No Paracetamol? Calpol?"
Mum: "Yes"
Nurse: "At what time?" *points to the clock*
Mum: "2-3"
Nurse: "Which is it, 2 or 3?"
Mum: "1"
We eventually, once again after asking several times, that he'd had 1 teaspoon at 2pm. I really do just find these conversations amusing sometimes.
One thing that really annoys me, and please if ever you see a doctor doing this tell them not to, they stab a child (with a needle) and miss the vein so they use an alcohol wipe to press on it to stop the bleeding. You're already hurting and distressing the child, must you rub alcohol into the wound? It stings! It only takes a little organisation to bring gauze over, it's just so unnecessary, and does make me cross.
Finally, I have a job interview on Wednesday for a job I applied for back in January. I'd heard nothing, and to be honest I thought it was a rubbish application, so I didn't think I'd been shortlisted. I don't really know a lot about the job, the advert wasn't very specific about the clinical area, but that gives me something to ask about on the day. Later that night I'm catching a coach down to Cornwall to join my holidaying family for a long weekend.
We've not had any really interesting cases recently. I've seen a couple of good dislocated fingers, fingers bent in strange positions. I did a dressing on a 2 year old who had ripped two of their finger nails off... owwww... I'm not good with nails.
I may just be easily amused, or having a giggly day, but had a few funny conversations with parents who speak bad English (as most of our parents do). It makes it so challenging sometimes, but it can also be funny.
A child came in, mum started out by telling us he'd had an operation on his nose a few months ago (that turned out to be a tonsillectomy) so we assumed, naturally, that there was some problem related to this. No, he'd fallen over and bumped his forehead.
Nurse: "How did it happen?"
Mum: "Today"
Nurse: "No, what happened, how did he do it?"
Mum: "Today"
After about 6 different phrasings of the question we established how it had happened.
Nurse: "Has he had any medicines today?"
Mum: "No"
Nurse: "No Paracetamol? Calpol?"
Mum: "Yes"
Nurse: "At what time?" *points to the clock*
Mum: "2-3"
Nurse: "Which is it, 2 or 3?"
Mum: "1"
We eventually, once again after asking several times, that he'd had 1 teaspoon at 2pm. I really do just find these conversations amusing sometimes.
One thing that really annoys me, and please if ever you see a doctor doing this tell them not to, they stab a child (with a needle) and miss the vein so they use an alcohol wipe to press on it to stop the bleeding. You're already hurting and distressing the child, must you rub alcohol into the wound? It stings! It only takes a little organisation to bring gauze over, it's just so unnecessary, and does make me cross.
Finally, I have a job interview on Wednesday for a job I applied for back in January. I'd heard nothing, and to be honest I thought it was a rubbish application, so I didn't think I'd been shortlisted. I don't really know a lot about the job, the advert wasn't very specific about the clinical area, but that gives me something to ask about on the day. Later that night I'm catching a coach down to Cornwall to join my holidaying family for a long weekend.
Tuesday, March 06, 2007
Almost there
I feel that I should post as I have neglected my blog for so long!
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
Friday, February 16, 2007
Interview
I had my interview today for the job I really want. There was a short maths test, a written patient prioritisation question and then the interview consisted of lots of different nursing scenarios and questions about what I would do.
The maths test: I'm good at maths, it's never been a problem for me during my training, and the test wasn't difficult. I made a couple of stupid errors that I corrected when I noticed (like there are 4 3's in 12, not 3 as I originally put) but at first on two easyeasy questions I really struggled. I knew the answer in my head easily, but you have to show your working and I went a bit brain-blank when I tried that. Got there in the end.
The prioritisation scenario: 3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
After that in the interview I was asked questions such as 'Why do you want to apply for a rotation programme?' 'What do you understand to be the meaning on clinical governance?' 'What child related legislation/policy have you read recently?' and then I was given a variety of scenarios and asked what I would do.
I didn't at any point think "Oh my goodness, I can't answer that!" though there were some that I struggled with through lack of experience, but they were very helpful and would prompt me. I kicked myself when I came out remembering loads of things I could have said, but I think that's normal. It's a bit of an anti climax really and I couldn't say whether it went well or not, I just don't know. I suppose it wasn't disastrous!
One really off-putting thing was that all 3 of my interviewers were making notes and they had these forms with tick boxes and at times I could see boxes unchecked so would know there was something else I needed to say but just couldn't think of it!
I refuse to think about it now, I can't change anything. I'll hear wednesday at the earliest.
The maths test: I'm good at maths, it's never been a problem for me during my training, and the test wasn't difficult. I made a couple of stupid errors that I corrected when I noticed (like there are 4 3's in 12, not 3 as I originally put) but at first on two easyeasy questions I really struggled. I knew the answer in my head easily, but you have to show your working and I went a bit brain-blank when I tried that. Got there in the end.
The prioritisation scenario: 3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
After that in the interview I was asked questions such as 'Why do you want to apply for a rotation programme?' 'What do you understand to be the meaning on clinical governance?' 'What child related legislation/policy have you read recently?' and then I was given a variety of scenarios and asked what I would do.
- A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
- You notice a bruise on the back of a child when examining them. What would you do?
- You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
- You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
I didn't at any point think "Oh my goodness, I can't answer that!" though there were some that I struggled with through lack of experience, but they were very helpful and would prompt me. I kicked myself when I came out remembering loads of things I could have said, but I think that's normal. It's a bit of an anti climax really and I couldn't say whether it went well or not, I just don't know. I suppose it wasn't disastrous!
One really off-putting thing was that all 3 of my interviewers were making notes and they had these forms with tick boxes and at times I could see boxes unchecked so would know there was something else I needed to say but just couldn't think of it!
I refuse to think about it now, I can't change anything. I'll hear wednesday at the earliest.
Saturday, February 03, 2007
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.
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.
Tuesday, January 16, 2007
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!
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:
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.
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?
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.
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!
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!
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