Post by Caleb Hutchinson on Apr 7, 2016 0:56:35 GMT
There's nothing like nursing
the acutely unwell
Get out of bed, have a shower, eat breakfast, brush teeth, get dressed properly, go to work and visit friends. First thing in the morning things always seem like they’re heading up, life always looks good. Depending on the day, the routine of the day changes slightly, work influences it mostly, if it’s a work day, heaven’s knows what’s going to happen. I walk into work, well, stroll in actually, noticing all the day shift team walking in with me, I assume it’s going to be a good shift; we’re over staffed for the amount of patients we've got. Yeah, this means we will split the ward down the middle and having more patients to each team, but it also means we have more staff members on each time, which means I can spend more time with my patients and get to know them better, providing a better standard of care, actually having the time to ask them what their likes and dislikes are, instead of just going on some care plan that was written three weeks ago. Handover takes a whole entire half an hour, looks like they've had a busy night with new admissions, I’m assigned to team two, which seems to be the heavier team to be handed over, I don’t mind though, at least it’ll keep me busy all day and give me things to do. After hand over I grab my colleagues I'm working with and ask which of them wants to assist me with doing the personal care for the patients.
Patient in bed 3 needs a pad changed but patient in bed 5 is having severe respiratory distress. It’s almost like the world is testing, just to see how one would cope in the stressful times and how I prioritise my priorities. On one hand, it’s extremely undignified to leave poor Mrs. Smith in a soiled pad and bedding, but on the other hand, Mrs. Jones needs assistance with her breathing and fast. Not even a second goes by and I've made my decision to leave Mrs. Smith until later when I can delegate to another colleague, or ask one of them to take over with Mrs. Jones so I can get to Mrs. Smith and apologise profusely about the delay, knowing it was just a matter of time until her family is told. Am I sorry though? That is the question. Mrs. Jones’ respiratory distress has been caused by an anxiety attack, nothing that she couldn't fix herself, but in the face of an potential emergency situation, isn't it always best to preserve life and act as if it was a case of life or death? Looking back at the beginning of the situation I should have noticed it wasn't the beginnings of a complete respiratory collapse from the word go, I've left Mrs. Smith in a soiled pad for no reason, except to calm down Mrs. Jones, someone else could have done that easily if I had simply called them into the room.
I finally get my gown on, my gloves, my second pair of hands, one of my sweetest and most experienced colleagues who I admire a lot, she has pearls of wisdom for every situation, without her I couldn’t do my job half as well, she’s guided me through many bedside emergencies. Why isn’t she on the higher wage? Things this lady has taught me during my time on this ward has made me ever so grateful to have a team that is so supportive; during my first cardiac arrest she was there to hold my hand through it, I had never had someone’s heart stop on me before, I was petrified, I thought I was going to freeze up at any given moment, but her kind words of encouragement helped me through. The patient survived, by the way, went against all the odds and made it to discharge. Anyway, back to Mrs. Smith. I apologise to her, explaining I had a potential emergency with another patient, she didn’t seem too unimpressed but she didn’t seem overly understanding, either. This was going on my record definitely. While cleaning up her behind I notice a small break in the skin, fantastic, just what I need. Pressure damage, or moisture damage, either way it means a lot more paperwork. Not like I’m behind already. When was this lady last repositioned? Mrs. Smith is an all care frail 87 year old lady, not for resus, admitted with acute lower respiratory tract infection and urosepsis, so of course, she has been catheterised, has IV fluid, antibiotics and due to her lack of enthusiasm with food, the doctors have written her up for a dietician review for a potential naso-gastric tube, one of the more less comfortable things that a patient can experience. I apply the appropriate creams to Mrs. Smith’s behind, I don’t want to go down a dressing route just yet, it’s not broken down enough for that, and I discuss a new repositioning regime with my colleague, I suggest three hourly, but my colleague suggests two hourly and states her reasons; the lady puts up a good case, so I instinctively agree with her. Who’s the one who’s been through all the training courses again? It’s me, but practical experience over theory usually wins.
It’s 10 AM. I haven’t even started looking at doing the lunch menus with my patients yet, I’ve got doctors giving me new prescriptions left right and centre, thankfully I have a second pair of hands on my team today, so they’ve cracked on with the drug round for me. I’m staring at the clock and my ever-growing list of things to do, how am I possibly supposed to fit all of this in before lunches come in? I ask one of my colleagues if they’re free to help me, alas they aren’t, they have a patient who’s running a temp of 39.4, tachycardic at 146 irregular, respiratory rate of 29, and a blood pressure of 74/54. Wonderful, they’re for resus too. I position the crash trolley closer to the room of the patient, it’s always better to be safe than sorry. During a cardiac arrest, seconds count. Not minutes. The quicker we get the crash cart in, the quicker we can begin ALS. CPR will only get someone so far, and even then it’s likely not to work without the drugs and the intubation. I’ve strolled off in my own little world, I snap back into reality, not even sure where I was going or what I was doing, I have patients pressing their call bells in all of my rooms that me and my two colleagues are covering for the day. The ward sister is on a huge rampage, too. “WHY HAS MRS. SMITH BEEN BUZZING FOR TEN MINUTES AND NO ONE HAS ATTENDED TO HER?!” Mrs smith? I’ve only just changed her and got her comfortable, what could she want now? I go back to her to find out she had simply laid on the buzzer by mistake, which is when I hear an almighty thud, bang and crash from the room next door to mine. With that my legs begin moving like an Olympian.
I enter the room and find one of my colleagues knelt down next to one of our other patients, Mr. Rogers. A larger framed man who was almost ready for discharge, but had stumbled and fallen over. Not going home any time soon now, the doctors are going to want to keep him in and make sure he doesn’t have another fall for 72 hours at least, and he’s such a highly dependent patient that he doesn’t qualify for a step down ward. We begin to take observations, and as the fall wasn’t witnessed by staff, neurological observations too, all while assessing the man for any broken bones. We establish that everything seems normal, so we bring in the hover jack and hover mat, a wonderful piece of equipment which inflates underneath the patient from ground height to bed height, and the hover mat allows for a patient to be glided over onto the bed from the hover jack, all at 1/3 of the patient’s weight. Paperwork. Everything seems to amount to paperwork today, and it’s supposed to be a ‘good day’ as we are ‘overstaffed’. Lunch time soon follows, for the patients anyway, not one of my colleagues, nor me, have taken a break yet. We’re hungry, we’re thirsty, and we’re holding in an almighty wee that we know is seconds away from opening the flood gates, but we persevere with it. I’m busy handing out meals when one of the support workers shouts out “I need some help in here!” from bed 9, she’s choking. I had handed over days before she needed a swallow assessment from the SALT team, but obviously they hadn’t got around to her yet and they hadn’t put a soft diet in place. Seconds feel like hours while with every strike on the patient’s back we are sure we can hear movement, but it’s not enough. Heimlich manoeuvre doesn’t bring much joy either, so we add suction into the equation. Finally, her airway is cleared once again, and with that, I instruct strict puree diet only until reviewed by dieticians and SALT.
Finally, I can go for a break. I sit outside, cigarette in hand, admiring the irony that I’m constantly telling my patients the dangers of it and they need to quit, but it’s my only escape, and it’s the only thing keeping me relatively sane. As I blow out smoke and take a sip of my coffee, I feel as if I can breathe properly. The break is short lived, I’m needed back on the ward, I need to turn Mrs. Smith and check my other patients while I’m at it, I have a total of 14 patients today, 11 of which are double ups and repositions, 8 of which are incontinent and at least 3 of them have pre-hospital pressure damage, and one of which is currently in theatre for a laparotomy. I’m an acute medical ward staff member; I don’t deal with surgical patients, why are they coming back to me? I have no idea what I’m doing to care for them. That being said, we do have one member of staff who’s fresh from a surgical ward who I can rely on to help me with this patient’s post-surgical care. Every little silver lining.
Back on the ward. It feels like I’ve walked into some sort of post-apocalyptic pandemonium, we have security on the ward, two patients restrained, a family member being restrained and my ward looks like someone has set a bomb off. I don’t even want to ask so I just begin to pick up the things on the floor. I’ve not even taken my jacket off yet, do I really get paid enough to put up with this shit? My face must speak a thousand words right now, from ‘Oh my god what happened?’ to ‘What the fuck are you playing at’ and ‘if you were really that unwell and needed to be on an acute ward, you couldn’t have done that.’ Maybe that’s not the right thought process to be having, but I am only human and those un-nursing thoughts do come into my head, along with my extremely dark sense of humour. Some good news had been received though, the previously extremely unstable patient had stabilised and seemed to be making some sort of amends, but they were nowhere near out of the woods, anyone with experience knew that this was either their big hurrah before arresting, or they were actually making a recovery. Only time would tell on this one.
Finally, it hit four PM. The time that everyone looked forward to, it was finally time that all the cleaning had been done, all the patients turned and the only thing to do for an hour or two was answer buzzers and catch up with anything you’re behind on, for me, this meant paperwork. I had to remember everything I had done, every breath I took and every word I uttered to my patients that morning, over lunch and the afternoon, and then on top of that I had to do an incident report about the patient who choked, about the skin break on Mrs. Smith and Mr. Rogers. Mr. Rogers! I completely forgot to check his neuro obs at three! I hastily grab a pen torch and bound over to his bed, he’s conscious that’s good. I begin taking obs on him to find his GCS has dropped from 15/15 to 13/15. Not a good sign, he hadn’t been put in for a scan yet, either. With that I bleep the doctor, informing them of the new obs readings and advise a head scan, the doctor completely agrees with me and I’m told that the paperwork will be put in ASAP.
Sometimes it’s good to have a doctor who is willing to listen to you, it shows that they don’t all think they’re above nursing staff, and I’ve even seen doctors look at patients and ask a support worker for their opinion on the patient’s condition. It’s not uncommon for a support worker to notice things that nurses and doctors don’t, after all, they get the most patient contact. Nurses aren’t nurses anymore; the support workers do most of the nursing care. It’s a shame really, most nurses I know said that if they knew what it was going to really be like when they signed up, they would have never bothered doing their degree and stayed as support worker, yeah it’s a lesser wage, but it also means more patient contact and doing what you signed up to do, and a hell of a lot less responsibility.
Finally, it’s home time. I’ve finished handing over the hectic day I’ve had, I’m going through my paperwork one last time to ensure I haven’t missed anything. Leaving the ward I hear one of my good friends calling me, I turn around to see her waving goodbye to me, one of my favourite people to work with, it’s a shame we’re rarely on the same shift as she’s a night shifter and I do a mix of both to fill in whatever gaps necessary. It takes me a whole entire half an hour to get home, my feet feel like they’re on fire and…Why do I need to wee so badly? That’s right, I’ve been holding it in since 10 AM, a whole 11 hours I’ve been holding that. I practically sprint to the bathroom and let it out. The relief is astronomical.
Walking around the house on auto-pilot, almost as if a mindless drone, over taken by some other force, or some other being; it’s the only way to describe the bedtime routine. I pop my anti-depressant and lay on my bed, too tired to even think about checking my e-mails from the day, or about cooking dinner. The only thing I’ve eaten all day was a sandwich quickly on the ward kitchen in between jobs. Why do I do my job? Because I love looking after people. Could I get better pay and better hours? Probably, but I love my acutely unwell patients. Yeah, I might moan a lot about the job, but I wouldn’t change it for the world, in actual fact, if I ever lost my job, I don’t think I know what I’d do.
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muse - my life at work
sat here and thought seriously about my job, and began jotting a few things down, next thing I know, I've got this.
MADE BY VEL OF GS + ADOX 2.0
