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.
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.
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