Day Two

Second day and I am still figuring out me way around the ward, the rooms number sequence jumps around as the ward is almost figure eight shaped with the reception desk in the middle. When the call bell lights up above the desk with the room number that is calling I have to walk round the ward mentally before I can figure out where the room is.

Attended handover again today, a lot of the nurses get on well and its a nice atmosphere to start the day in. There does seem to be little cliques of nurses, particularly the enrolled nurses (ENs) who stick together and all obviously have decades of experience, the new grad RNs who get higher pay and responsibility than the ENs, making both groups slightly defensive and resentful. Already I can see there is a lot of political play.

First job of the morning was for the nurse and I to assist a man to empty his ostomy bag as he struggled seeing what he was doing and had uncooperative hands. This was my first real interaction involving offensive body functions and as the nurse drained the bag into a jug I was momentarily taken aback. The odour was very strong and thick and permeated throughout the room and corridor. I focused on keeping my best poker face, we had been told to watch and monitor facial expression as clearly they could hurt the patients feelings and were unprofessional. But shortly I stopped focusing on my own reaction and took note of the patient. He was clearly embarrassed and distressed through the whole process, he appeared queasy and struggled to reseal the bag at the end. I was immediately ashamed of my initial reaction and felt only for the man who sat there frustrated with himself as the nurse gently explained how to fold up and seal the ends of the bag. As much as this now sounds like a badly written sob story, this was a big event for me. This man who had been diagnosed with cancer and gone through difficult and painful treatment had now come to us. His rehabilitation sounded simple compared to others. He had to learn how to live with his colostomy when others had to relearn how to walk. But I realised that to this patient it was the massive step before he could go home. 

My preceptor said to me afterwards that teaching the steps of ostomy care was the simple way of beginning to teach a much more difficult lesson, helping the patient regain confidence, independence, and dignity.

So another level of understanding and it wasn't even 8am.

I was allowed to perform the obs today by myself. Everything went smoothly until the 5th and final patient who was very thin and consequently had a much smaller upper arm. I attempted to change the blood pressure cuff attached to the machine to that of a smaller size, however somewhere in the process the machine stopped working and when I turned it back on was greeted with ERROR display. I returned the machine to its spot and worried obsessively until another nurse said they are highly temperamental and it happens all the time. Relieved I didn't now owe the hospital several thousand dollars for equipment I charted the obs. This was a joy in itself, the observation charts, as with all paperwork, are legal documents and very official looking. I felt rather important and awfully like I was on House or Grey's Anatomy, minus the ridiculously dashing doctors. 

I emptied a night (urine) bag and measured the output, then I observed a line removal, and the rest of the day seemed like it would be fairly steady. That is until I hear yelling and the sound of the emergency bell going off down the corridor. My heart skipped a beat and I was ready to run in and do CPR (I jest of course), then it all quietened down. A short discussion with the nurse at reception revealed that we had a new patient admission from a medical ward. She had come in to hospital for an operation which was now all sorted but due to the anesthetic she now had post-op delirium. I was surprised to discover that this is relatively common in older patients who can simply take days or even weeks to recover from anesthetic induced delirium (strangely it is also worse if the patient has a UTI). This new patient, understandably further confused by the change in environment, had become violent threatening staff and other patients with cutlery and a walking stick. She had been calmed and placed under the care of a special, a carer specifically trained to watch one patient during the whole shift to ensure no harm comes to the patient or others. 

Witnessed an ugly situation of a patient with very reduced quality of life who has expressed his wishes to go to the hospice essentially to pass away. However his family are holding on and creating barriers at every turn to delay the process, not for love of the patient but because they are arguing over money involved in the patients will et cetera. An extremely sad thing to be a part of, the family's attitude disgusts me and I want to go up to them and shake them all. I simply cannot understand how people can think like that. Alas I am unable to act in any way other than be a positive presence in the patients day, and here I think that at this stage a smile is my greatest weapon.

Later on medication rounds I spilt a cup of liquid panadol that was sitting on the table. Reaching to pick up the patients glasses I knocked the panadol all over the floor in a massive sticky white mess. I was red faced as I tried to clean it up (an extremely difficult task, it stick and slimed on everything) but the patient burst out in rolls of laughter and seemed delighted she didn't have to take the foul tasting stuff. From then on she was given a better tasting crushed form of panadol, so silver linings and such.

Daily reflection - I didn't think I would enjoy work with the elderly, but I am loving it so far. They are used to people caring for them and for the most part seem comfortable with nakedness which has in turn made me more comfortable. They are very funny and endearing, I suppose that when you get to that age you are wise enough to take everything with a bit of humour. One patient is barely skin and bone but loves the radio and has the cheekiest smile, another winked conspiratorially at me before passing wind in the preceptors face, others are fiercely independent. But  no matter who you are attending to you are immediately viewed as a nurse. The student part of your introduction seems to fall on deaf ears. So although the patients and their families think you know everything you have to remind yourself that you haven't even scratched the surface.

Day One

Tuesday, June 4th 2013. The very first day of my clinical placement. I start my first of six weeks of placement on the afternoon shift working 1430 to 2300. I'm quite relieved to start on the pm shift as I get a week of adjustment before the 0700 morning starts. Today was a day of orientation and nerves.

I arrived at the hospital and went in through a back entrance. Immediately I got lost, I could have been anywhere in any hospital in the world. The blue linoleum corridors stretched and crossed each other endlessly and the signage that crowded your view when you walk in the main entrance was few and far between at this distant corner of the hospital. I wandered getting more and more flustered and feeling sure I was doing circles until I happened upon an enormous green sign directing me to my ward. I walked in and up to the wards reception desk, dozens of nurses and patients continued with their business without even a glance. I wondered if I was indeed in the right ward, I didn't expect a welcome party but perhaps just someone who knew I was coming? Approaching the desk and feeling foolish I said I was there for my clinical placement, the nurse pointed me to the charge nurse, a gruff looking woman who reminded me of girl guides. The charge nurse showed me the locker room and then left me to get ready. I wondered why the two other student nurses who were also on the ward with me weren't there. Thankfully one soon arrived along with our clinical lecturer. The clinical lecturer is a nurse who is employed by the school to oversee our time on placement. The other student it turned out was sick which was pretty bad luck on the first day. We followed the nurses who were piling into the side room for handover. As they began to discuss the patients and go through the list my mind became blank. I had no idea what #NOF, SOB, HPU, NGT or TDS meant let alone the names of some of the medical condition the patients presented with. It was literally another language and shorthand they were conversing in. It all sounded very important and serious as the nurses divided the list of 30 or so patients between them. Ideally each nurse would have the care of four patients, the load of difficult (ie hoist) or easy patients spread evenly, this is best practice. However we were told that nurses are often looking after five or six patients due to lack of staffing. We three (temporarily two) are there to ease the weight on the nurses shoulders for the next six weeks while learning all we can of the art and science of nursing.

After handover our clinical lecturer gave us a tour of the hospital including the best entrance to use (turns out I had used a staff entrance which was supposed to be locked), fire exits etc. Despite the tour my sense of direction is still pathetically waylaid by the corridors and so I have decided to always use the main hospital entrance from now on. The C/L also walked us through the clinical experience handbook which is to double as our portfolio during placement. At this stage it seems all too wordy and irrelevant like those gag-making questions they ask you in job interviews, I hope it shows its use in time.

Paired up with my preceptor (RN) for the day I followed her on her rounds of doing the observations (ie vital signs) and medication. The obs here are a bit different to what we have been taught, they are all done by a machine. So instead of taking the blood pressure, pulse and temperature manually you can hook the patient up to the machine which does it all. I practiced introducing myself to people the way we were taught, and smiling a lot. Its great to watch the different ways nurses interact with the patients, something I'm quite unsure of having had limited experience. Its hard to be comfortable and friendly, still maintain the nurse role and not be condescending, but I am sure it will come with time and practice. At this stage I greet and smile and people generally seem happy.

I helped the nurse to move a patient up towards the head of the bed after they had slipped uncomfortably low. Using a slippery sheet and my memory of practicing said move four months ago we got it done. It involves a great deal of rolling side to side on the patients behalf to get the sheet under them before we can haul them north. We also learnt a way to stand whilst doing it to keep your back safe but it has since slipped (punny) my mind. The rest of the night seemed to be taken up with helping people wash and change for bed. I soon learned where the hospital nighties are kept after running back and forward many times. Then once everyone was settled we had a milo and the nurse wrote up the patient notes. The last hour or two were relaxed and quiet, we sat around, chatted, and answered the occasional call bell.

My main reflection for the day is - the single most drilled in thing we are hounded about at school is infection control, ie hand washing. We are taught it, practice it, and are beaten around the face with the importance of hygiene. And so it should be. You will understand my surprise then when observing the nurses during the shift that they seldom washed their hands at all. Food for thought.

Beginnings

The approach of my first ever clinical placement in my first year studying for a Bachelor of Nursing has been a daunting time indeed. Aside from the masses of paper work (preparation for becoming RNs I assume), multiple practical tests and medical hoops to jump through, there was a fair bit of mental preparation and nerves to attend to. Having passed all the academic prerequisites, and my medical tests for immunity and MRSA were all cleared it became a waiting game. Initially I was assigned to a nice looking rest home, the only drawback being it was a three hour walk away for a car-less student, and buses didn't run early enough.  Happily before I has too much time to fret and pull hair I got another email from the clinical coordinator saying I'd been moved to a ward at the local hospital, a mere 20 minute walk from my flat. Although lecturers tell you otherwise, there is a certain advantage to being placed in a hospital ward over a rest home. The variety of what you will see and experience, the part each ward plays in an immense healthcare system, the level of care given to patients, and the amount of responsibility afforded to the student. I considered myself extremely lucky to not just be washing bedpans for the next six weeks, my only concern being that the ward is a rehabilitation centre for 65 years and over. Care for the elderly has never been an area that has appealed to me, believing it would not contain the same joy or excitement of a pediatric ward or emergency department. Having seen elderly members of my own family go through the system with immense struggles, difficulty and sadness for the patient and relatives, it seems difficult and depressing with little hope of a happy ending. I'm not naive, I understand that all areas of nursing involve heartbreak and death, it's an integral part of both nursing and life. But in the back of my mind I worry that the positive will be outweighed in this setting where the final stages of life are played out. Still I am very excited so we will just have to see, I am ready to take the first steps.