Weekly Handover (7)

Weekly Handover is a day late this week, because I got drunk forgot. Sorry.

Thanks to Grumpy RN for giving me the links to some nursing blogs that I’ve included in this round-up.

Healthcare Assistant

Baby Blue Pyjamas is doing 360 appraisals.

Have you ever heard the expression If you can’t say anything nice don’t say anything at all. Well the SHOs have 360 appraisals to do, asking 12 people what we thought of them. One of the SHOs who shall remain nameless, asked me to fill one out for him or her. I do not have much faith in this Dr, but s/he sat over me while I filled it in. So I could not write bad things. So I decided to say nothing. Not what I should have done I guess, but I could not be honest with him/her sitting over my shoulder. Should I have filled it in honestly warts and all? Oh well.

Also from Baby Blue Pyjamas, a hectic shift in A&E.

A gent was brought in under police arrest; he was discharged and collapsed in the car park. He was competitive, aggressive, and not at all helpful. He had been in custody for 24hs and had been given insulin by the custody nurse. He then skipped his supper, and went hypo. Hence the combativeness. We got some glocogon into him and some 50% dextrose into a hastily inserted canula. He proceeded to rip it out spraying hep blood all over the nursing staff. Or mainly me. He came round and calmed down. I’d met him the night before and I thought we had a rapport. He spoke to me, but his eyes were a little wild. He went off to AMU.

Student Nurses

Didn’t Want to be a Doctor is in at the deep end.

My mentor was back in, in a what-is-possibility-common-place scattered state. I shouldn’t complain, though. I got to practice some medicines and making up an illoprost. Little did I know that I was also going to have to monitor said illoprost all day long, which, officially, is not a job I should be allowed to do. But the patient would’ve gotten sick otherwise, and it was good experience.

I was doing a lot of work usually reserved for a registered member of staff in general, actually. The ethics of this are messy, in general, but at the end of the day I think it’s a good way for me to learn. And I make sure I could never make some death-dealing mistake, so it’s less of a big deal than it might sound.

I know too many Newly Qualified Rookies who have never done certain tasks throughout their careers that I’ve done already, so I’m going to keep on doing so.

Meanwhile, The Oracle is back in lectures.

In some slightly bizarre news I had a really interesting psychology seminar today. I even had useful and constructive input into it- can you believe it? This time last week I’d had a right old strop (yeah, typical me) about how utterly shite it was. I’ve completely changed my tune. It may have been down the the truly inspiring lecturer we had today- its a shame it was only because our usual one was off sick.

Northern Nurse attends her first cardiac arrest.

The cardiology SHO asks me to put in a guedel airway and start bagging. I’ve never done either before except on a mannequin. This is it, sink or swim time. I head for the crash trolley that’s suddenly appeared at the foot of the bed, and grab an airway and the ambubag. I don’t notice until I start inserting the airway how much my hands are shaking. I’m not conscious of feeling nervous, and I know exactly what I’m doing, so I don’t know what’s causing it. I connect up to the oxygen and start bagging.

Staff Nurses

One Nurse is stepping outside of the comfort zone.

For the past four and a half years, I have worked (I am including my nurse training in this!) in what has been pretty much the same speciality of nursing, and in the same trust, using the same documentation, working with the same type of patient, with the same kinds of illness. I had found myself a nice little comfort zone and I was wrapped up in the middle of it.

Last week, to prepare me for my new role as an intensive care nurse, I stepped out of it. Well, fell out of it might be a better way of putting things!

Not only was I off to a new trust, I was off to nurse on a ward whose speciality I didn’t really feel 100% comfortable with. This was going to be fun!

A&E Charge Nurse

Mouse Thinks deals with the aftermath of a motorcycle accident.

We got the red call through on the radio and called down the trauma team, but it very quickly became clear that he was dead. Traumatic cardiac arrests rarely have successful outcomes in my experience and you don’t go head-on into a tractor at seventy miles per hour without doing some serious damage. It wasn’t long before we switched off the machines and started removing the tubes and lines we’d just put in. As we rolled him off the spinal board, inside his leathers his smashed leg bones crunched and flopped and bowed horribly in my arms. One of the paramedics brought in his helmet, the inside flecked with blood and bone and brain. I felt sick.

Nurse Practitioners

Grumpy RN has had to deal with a false allegation.

I was called to reception to have a word with the policeman where he informed me of the outcome but then said that the toe-rag was accusing me of assaulting him and his girlfriend was backing up his story. I was horrified, and tried to explain that the last time I hit anyone was 1969 when I was 14 and at school, where just occasionally you do have to hit people. Policeman was all apologetic but said I would have to make a statement and come down to the police station. I can’t go anywhere, I’m in charge of this department we are short staffed as it is. then I remembered, we have cameras, surely that would show that I was no where near him. At this point the policeman, my colleague and the reception staff who were listening to this all burst into laughter. B*st**ds!! They were winding me up, the policeman blamed my colleague and said that he had been asked to do it by him and had quite happily gone along with the gag. Must have been a slow night.

It Shouldn’t Happen in Health Care emphasises the importance of taking a history.

Little girl tells mummy she put a bead up her nose. Mummy looks and can’t find it, they rush to the hospital. Wait for a few hours and then the Doctor hears the story of a little girl who put the bead up her nose. He too can’t see anything…

Now perhaps I’m a bit of a tough nut, had this been my patient (or child), I would have gone down the “well as long as your chest is fine, I don’t think we need to worry too much, you’ll snort it back, swallow it and poo it out”

But I’m talking about the super keen shiny new registrar, who decided an Xray was necessary. Exposed the young girl to some radiation and guess what….Nothing showed up.

Now the lesson here is simple…..if a child tells you they’ve put something up their nose, take a history detailed enough to find out if she then took it out again. With tears in here eyes the little sweetie said…

“Everybody asked if I’d put it up and I did, but nobody asked if I’d got it down again!”…

News From Unscheduled Care discusses Paul Gascoigne’s alcohol problem.

Whilst working in A&E I’ve lost count of the number of times patients with drug/alcohol dependencey have presented in ‘crisis’. Often with well meaning friends/family who are determined that this time he/she will ‘kill the beast’ and return to sobriety. I’ve also lost count of the number times I’ve walked out of the back door of the hospital and seen said ‘convert’ drinking, smoking or shooting up.

The main problem, in my opinion, is the medicalisation of these social/behavioural problems, I suspect it is often more about shifting blame/responsibility than it is about seeking treatment. Whilst Mavis’ sentiments about Gazza’s predicament is laudable. I can’t help thinking that the lachrymose Geordie needs to buck up and take some responsibility for his lifestyle and it’s inevitable result.

Nurse Manager

Life in the NHS celebrates Nurses Day.

Sadly it would be my guess that few people in the UK know that it is Nurses Day today, for goodness sake many people don’t even celebrate national days like St Georges day but if you come across a nurse today, perhaps rather than criticising them for perceived wrongs with them and their profession, congratulate them, after all nursing isn’t something that just anyone can do, but then of course I would say that, because I am one!