Confessions

"Most people go to work and sit at a desk. I go to work and just have a roller coaster of emotions"

- Louise, Paediatric Staff Nurse, Confessions of a Nurse.

Channel 4 have been taking part in the British fashion for documentaries about groups of public sector workers with the series Confessions of a Nurse. Mostly I watched it out of solidarity for my peers, and while I enjoyed it well enough it felt incredibly superficial. I had a constant feeling that the purpose of the show was part X-factor-style back story and part documentary about what nurses do... sort of.

Last night (so this afternoon for me) was an episode about Children's nursing. Or more specifically, two nurses, one a male Ward Manager and one a female staff nurse. The ward they worked on looked like a stressful place, I've never seen a unit so (edited to look like it was?) filled with abandoned babies and overdosing teenage girls, and I hope I never do. There was very little explanation of what children's nurses do, instead the episode focused on the two nurses' own family lives and how tough the social admissions the ward seemed rife with were. I'm not saying I would do any differently, of course, just that from the show you could easily think Child Nurse was a synonym for Counsellor or Child-minder.

In my career so far my favourite patient, the one I still think of fondly, was a case of 50% physical and 50% social care. She came in having a Sickle Cell crisis, and through the week she was with us I spent a lot of time watching and doing the scary, painful, and invasive medical procedures she needed, and even more time babysitting, or therapeutically playing "doctors and nurses" with her, or drinking tea and talking sport with her dad, or helping her mum with her care.

I don't think this show gives an accurate representation of the life of a real children's nurse, but watching it I was reminded of the most important moment in my career so far - when this little girl was discharged and her dad came over and shook my hand and thanked me, not any other nurse or doctor, for everything I had done. Nursing is a social profession, and children's nursing even more so as you treat whole families that might have just one sick member, and anything that brings exposure to that is a good thing. So take it with a pinch of salt, but go and watch it to see one side of the greatest job I can imagine.

"Do the kids on the ward ever see you as a father figure?"
"I fucking hope not!"

- Paul, Paediatric Ward Manager, Confessions of a Nurse.

Tiredness kills, take a break.

I am shattered.

Today was a long shift.

Today I watched two people die, very close to each other both in time and location. My first full blown resus and there was no space for passive observers. I performed chest compressions, did fetching as needed, and virtually collapsed with nerves. The patient did not survive, but the experience and the training will come forward with me for the next time, and the time after.I hate being a student, who can't do anything, who knows nothing and who feels like he will never get the hang of it. But however crap I feel right now, and however awful the experience would rate objectively, I feel like it was beneficial.

Right now, however, I am tired, and feel dirty, and can't get the image and feel of a human life ending in front of me in such an... undignified way out of my head.

I am sorry to the patient for whom there was no good outcome. But thankful to them, the medical, nursing, and paramedic teams who today taught me something that you cannot learn in class.

Clinically Competent

Yesterday I had my last day working at my part time job in air cargo handling. I left with a thoughtful leaving gift, a lovely card, some excellent new skills and experience, and some extremely tempting job offers. It was the right time to leave, as much as it was a difficult thing to do. I don't know yet if I was right to get a non-clinical job over the last 8 months when I could have been a part-time HCA and pulled in about the same money, but I think it was the right choice.

Working away from health care gave me skills that most people might struggle to develop in just a few months:

I've worked in supply chain / logistics, working to meet shipping deadlines and get packages where they need to be when that could be any where in the world.  

Meeting service deadlines, having the right tools in the right place will be a useful skill.

I worked in HR and helped design and implement new filing systems, review large quantities of personnel data and sort it appropriately.

Privacy, data management, and people skills are always vital to nurses.

I worked in finance and revenue control, finding leaks then planning and implementing strategies to fix the problem and reclaim the revenue.

Knowing how to read and write a budget, how accounts and invoicing work, and a knowledge of cost saving will be skills nurses will need more and more as we take an increasingly middle-management role.

Some of my friends spent the year emptying catheter bags, changing dressings, and cleaning bed frames. They gained patient care skills, clinical experience, and a better insight into the world of health care. Right now, they might be ahead, but I'm hopeful that as I progress in my career it will be more than the income that makes me look back on my part-time job fondly.

_______________________________________________

I've started to think about the nurse that I want to be, and the experience that I want out of the next few months. My main resource has been a document published by the RCN on clinical competencies in children's emergency care.

Below are the competencies the expect of a band 5 nurse, who is qualified and has had some experience in emergency care. I'm not going to mess about here, aside from number 5 those are the skills that I am expecting myself to be thoroughly proficient in after 3 months. It's a huge ask in many ways, but if I aim high I might just make something of myself, and there's no shame in missing a goal when you set the bar high.

Nurses will be expected to achieve competences in:
1. The assessment, recognition, prioritisation and evaluation of children with serious illness/
injury and the accurate recording and documentation of clinical observations.
2. Apply effective communication and listening skills which are age appropriate for children and
young people requiring treatment.
3. Understand the rights of children and young people to consent/refuse consent to treatment.
4. Paediatric Basic Life Support competence by completion of an approved course.
5. Administration of intravenous drugs and fluids.
6. Assessment of pain and administration of oral analgesia to children using Patient Group
Directions.
7. Treatment of simple wounds, plaster application
8. Recognition of child abuse/maltreatment and identification of vulnerable children and young
people by completing level III training as defined by the Intercollegiate document Safeguarding
children and young people: roles and competencies for health care staff.

I am nervous. I am terrified. I am far out of my depth. I am going to do really well. Wish me luck, and expect an update soon.

The final final countdown

In less than two weeks I have my first shift as a trainee paediatric accident and emergency nurse. My exams are done (I think they went well) and my coursework submitted. So now it's just me, my copy of "Emergencies in Paediatrics and Neonatology", and two weeks of paper-pushing to make up the money to survive the next six months.

There are a few things about the coming placement that are stressing me out, so here we go:

• I think I want to be an A&E nurse when I qualify, and have a whole career working in emergency nursing, but that idea is really all made up. I've never worked in an A&E an only know about my interest in emergency care from the more extreme experiences I've had in general areas. So maybe I'm going to be awful. And maybe I'll hate it.
• I haven't been in a hospital for 8 and a half months. That is a very long time to have no practice or experience. The student I'm on placement with for the next 3 months has been working as a part-time health care assistant and I've been managing revenue and investigating budget deficits. So i have the steepest learning curve - within 3 months I need to go from knowing nothing and having no confidence to a competent and practical nearly-professional nurse.
• I haven't been super well lately, so now will take my shattered and tired body into a mad, fast paced unit. Bugger.
• At the end of the next 6 months I will have to exhibit management skills, clinical knowledge, care-plans galore. Right now I can't even remember to iron a shirt the day before.

I have high hopes for my next placement. I'm pretty sure it will go well, and I will be OK. I just can't get my head around how I'm going to get there from here.

Exams

So, there is a lot I need to write about here. Loads is going on in my career and training right now, but I'm busy and stressed and having problems talking about it. SO! Here is the shortened version:

• I'm about 6 months away from finishing my studies.
• I have two exams, today and tomorrow, and then it all comes down to practice.
• This blog was rated 30th on a list of top nursing blogs HERE. Sure, it's not a particularly pretigeous accolade but I'm surprised and happy with that.
• Very soon I'll be writing more. In the meantime here is a photo of my new best friends:

It's official

I am one exam, one OSCE, two short essays, one 3000 word essay and 24 weeks of placement away from (hopefully) being a registered children's nurse. This means three things, essentially:

1. I am considered to have many if not most of the skills needed by a children's nurse already.
2. I am likely to be capable of learning the remaining skills I don't have within 6 months.
3. I am terrified.

This year I have two 12 week long placements, which is great because it means I really get the chance to be part of the team. Our modules include management skills (running a real ward with real patients and staff who know more than I do :-S) and medicines administration. Best of all, the placements are in the two areas I was really interested in working this year, A&E and NICU.

I love the idea of being an emergency nurse; the environment suits my skills and interests and I'm generally pretty stable under pressure. Additionally I'm book smart and can generally multi-task pretty well. Right now I view the idea of being a Nurse Practitioner / Advanced Practitioner in Paediatric Emergency Nursing as my 'dream job'. Until now, though, I haven't worked in an Emergency Department and have no way of really gauging how I'll do, so this placement is either going to be reaffirming or a real eye-opener.

When I worked at the NICU last year I was thoroughly happy. Like A&E it's a fast paced, high stress area with loads to know, do, and remember. Because I loved it, I asked to go again and had my wish granted with my final sign-off placement being back in the unit I was placed in before. This is tough - I'll be there with our class's best student as she completes her studies and gets signed off and will have to shine on my own merit as a safe, competent, and professional nurse whilst dealing with the obvious comparison that she is, quite honestly, better than me.

This year comes with a surprising amount of pressure, stress, and anxiety - problems which will no doubt haunt me for the rest of my career. Aside from the negative words I can use here though, the biggest thought in my head is excitement. Soon I won't be reading and writing, I'll be doing. Soon, I'll be a nurse. A real nurse.

Wish me luck!

Jobsworth

The biggest problem with my course is that we can spend as long as 8 months out of placement (because of the way dates line up / the length of placements). Whilst I enjoyed my summer break / spent it working and wishing the new term would start, and I enjoy classes and studying it makes for a long time when we're effectively de-skilling.

This year we hit placement as third year students. Third year student nurses are mere steps away from qualification. They're knowledgeable, confident and experienced, and they are pretty much capable of doing the job of a registered nurse, with appropriate supervision of course. When I finished my last placement I was feeling good about my practice. I was taking the steps from second year to third year in terms of my abilities and my confidence. When I start placement in January or February next year I'll have been out of the wards nearly 8 months. I won't have dealt with a patient or their family for that long, won't have hooked up an enteral feed, or taken BP from a squirming toddler, or even taken a temperature for that long.

I'm not saying I'll be useless when I get back to it. This is stuff you don't forget, and my knowledge base and skills are growing every minute I spend in class, but it feels emotionally like a set back. In my first placement I had a mentor that was often a little surly and stand-offish with me and embarrassingly I've only just realised that it was because she was nervous having to teach and having her own skills put under the spot light. Confidence in oneself is hard to find from nowhere, which is why, when students at my college go back to the wards it's staggered - 3rd years first, then 2nd years some weeks later, and finally 1st years. It's staggered so no one has to perform for their peers and settle into the new environment at the same time.

I feel awful that I never realised how my mentor felt, and that I was such an irritating student (I still am, but at least I know it now). So if you're reading this and preparing for placement take a read of this years top tips (and maybe last years too HERE) and stop worrying:

• There is no shame in being new to nursing, new to a ward, and on your first ever placement. Have you found yourself stood by the nurses station completely unsure what to do? We all did that, and sometimes still do. It gets easier as you get better.
• When the crash alarm goes off for the first time 90% of students freeze. Next time you might go and observe. Maybe after that you'll help somehow. You aren't expected to run a resus situation for a long while yet. My classmates and I laugh about how pathetic we were in these situations now, but it took this long before we were confident enough to even admit it to each other.
• Listen to the news papers when they report on how nurses are uncaring. Then go out and make sure you're never that way. Ward culture can be tough, and some places will get you down. But placements are short and you should definitely not let it break your spirits or passion for helping others.
• Don't feel stupid using a stethoscope, or a manual sphigmomanometer or any other tool of our trade. Some nurses don't believe that nurses should be skilled in that way, but it's out dated and most nurses and even other members of the team will help you learn.
• When you do badly? Learning opportunity. When you do well? Learning opportunity. Everything in between? You got it!

The Student Nursing Times has some articles about placements (subscription only, for the most part, but some free articles too) that are worth reading. And once again - Enjoy it!