The end of the line?

"I seldom end up where I wanted to go, but I almost always end up where I need to be."

Douglas Adams

Each university is different; some allow re-sits of exams - some do not. Mine does. One resit on each exam, a second attempt before you're off the course - which is lovely! However for me, this was not enough. I recently didn't do well on a resit, and when I say I didn't do well - I mean I did catastrophically badly!
So - now my place on the course rests in the hands of 1 man, and 30 minutes in his company. The exam was a practical, and in those 30 minutes I had to prove to one man that I was (a) competent, (b) safe and (c) had two brain cells to rub together.  I failed on all three counts alas.

What this means for my future in nursing I don't know, this all happened on my most recent placement so while talking to a 3rd year: Nurse D, he pointed out that I'm 2/3 of the way through and I'd be an idiot to give up now - and that to give up now would be to waste the last two years of training. While Sister S on the ward agreed she also said that if you're struggling with your 1st and 2nd year then 3rd year will be no easier - and that to go through all this again would be heart breaking and soul destroying if it led no-where.

So I'm at something of a crossroads - do I stay on the course that makes me happy but that might cost me a lot of money for me to fair? Or do I take alternative option - ditch the course and give up the thing that makes me very happy and chose a path that might cause me a lot less heart ache and I might be very good at ... who knows! Who knows what I'll decide to do - or what the future holds.

I have honestly no idea what to do - but hopefully a trip home for three weeks will clear out my head and help me make the decision!

The sixth sense (or how all nurses are a little bit psychic)

In the world of nursing there is a long accepted "nurses intuition" or sixth sense, which means that even when all the evidence points to the contrary we can often look at a patient and say:

"Now ... I don't like the look of him."

Not in the sense that we think are patients are ugly you understand, but in that once you've seen a fair few sick people everyday for a few years, you start to get a feel for when someone's taking, or about to take, a turn for the worse. They could have perfectly health observations but something about that patient tells you to do an ECG or bleep a doctor or at the least keep a closer eye on them for a while.

Which is great, psychic nurses - excellent!

This becomes a difficulty however, when you realize that a patient looking "a bit iffy" isn't exactly quantifiable, we live with a medical system, and I work within one, which relies on things being quantifiable and score-able. In the NHS we have the EWS or Early Warning Score system, which gives you a score for the patients observations, which ideally is 0 - anything above a three and a doctor must be informed.

If you are curious - an EWS chart!

Which is great, it's a fairly fail safe way of monitoring a patients overall health and spotting a problem quickly. However, it really doesn't account for the sixth sense, in which many nurses, doctors and other health care professionals can look at an outwardly healthy patient and know that there is something up. If you can't justify investigations then the general consensus is that you shouldn't be doing them, which is fair enough - you don't replace your car's battery just for fun, or re-tile your roof just for the sheer hell of it. So why would you do an ultra-sound on a patient with no signs of cardiac problems?

But I worry, surely we're ignoring a vital skill that health care professionals pick up subconsciously, a vital skill bred from long experience and acres of knowledge. We're in danger of forgetting that that patient is a human being, with a very complex body that can do all sorts of crazy stuff to confuse us, and see them as a car - which doesn't need to go to the garage until that red light starts flashing. Tools and charts and scoring systems are good, when used in conjunction with common sense and humanity. But rely on them solely and you will a) loose the heart of the NHS and b) miss out on excellent medics who know something is wrong - but can't do anything about it.

Bad placements and failing (again)

I have mentioned before on a few occasions the "bad placement", that thing that most (if not all) student nurses encounter at one point or another. I was a little cocky and smug about the fact that although I have had placements that I have enjoyed less than others I have never had a really bad placement. However, this semester this all changed:

***

First off, and this part was no-one's fault, I was pitched from pillar to post and back again due to a missing mentor, a secret reshuffle of placements and a bit of miss communication. After all this, a week into my placement I was moved from my nice, if a little dull, placement in a doctors surgery to a team of "district nurses" about 7 and a half miles away.

My somewhat temperamental baby 

So - off I set on my trusty steed to the office where I was told I would meet my mentor a "district nurse" - I arrived 15 minutes late due to a left turning that I made for no apparent reason, to meet my mentor D. I was quickly corrected and told that despite being informed that this was a team of district nurses - I was actually going to be working with a team of health visitors (HVs).

Now, for those of you who don't know (this included me prior to this placement) the HVs are the nurses who take over from the community midwives when your baby is 14 days old, and will continue to monitor the child's health and development up until the age of 4, when school nurses take over. 

I am an only child ... we wont go into my in-depth
knowledge of Balamory.

As an adult nursing student I felt a bit lost, the other student on the placement was a children's nurse and so was at an advantage to me, in that she'd spent 18 months working with children and learning how to interact with parents and children while my involvement with babies and their families was few and far between. I have friends with babies and small children and while I can do playing with Lego, and singing along to Balamory (really showing my age here). My medical knowledge of children and their development ect. is patchy at best. And I felt out of my depth pretty much straight away and I will be the first to admit that I didn't address that as well as I should have done. In fact I dealt with that pretty bloody badly by going a bit quiet and rabbit-in-the-headlights-y. 

The placement was not only completely outside of my comfort zone it was also a total baptism of fire, I like to think of myself a reasonably un-shockable young woman, I am used to people destroying themselves or being destroyed by others but some how in all of this I had completely neglected to consider people who harm children. They are always so pure and un-complicated to me, children, they have the whole of their lives before them and they are filled with possibility - and who could want to hurt that? Now I'm not naive, I'm not unaware that people do hurt children, however I suppose I always thought in my safe, if complicated, family that occasionally bad people hurt children, but it's rare and they are bad people. Black and white, crystal clear and simple.

I was wrong.

Sometimes hurt and destruction is born of love, the mother who can't see she is hurting her child, the abusive father who really does believe that it was all a mistake and will never happen again. And everything in between, from the people who haven't got the capacity to care for their child, no matter how much they love them and would never actively hurt them, to the people who are poor decision makers and believe the lies of the people they love. This struck a chord regarding my own family, and while that isn't something that I'm going to go into right now, this made it very hard to deal with some of the cases I had. 

It taught me that I have a long way to go before I can really be detached and view every patient I see and case that passes through my hands with total detachment and impartiality. And on the flip side is that a good thing? Should we, as health care professionals want to be detached? Or is our humanity part of what makes us good nurses? I have no idea in truth, but I think being truly impartial and un-shockable is probably a good thing.

I hated that placement, I am sorry - but I really did, I felt physically sick most days and lost every single moment. I had a bit of a run in with my mentor D, which again I wont go into for the sake of professionalism but - give me half a bottle of wine and you might just get it out of me. So all in all ... not an overall success.

***

Talking of not succeeding, you may recall (or maybe you have better things to remember) I spoke a long time ago about a three hour exam this semester. 

Which has now been and gone

YAY!

And I've had the results back

So much less yay

I failed, I essentially drowned the patient in saline and then didn't create a good therapeutic relationship with her father which is a massive failure on the whole. But it's OK, it's all cool - I have a re-submission, one last chance to save myself before I'm chucked back into the sea of would be nurses.

So that's just ... bloody brilliant!

The truth of being a student nurse!

Night shift = 4am coffee and
biscuits

Nurse P - pretending to be
patient for simulation!

The truth of being a student nurse is a complex thing, this isn't meant to scare any prospective nurses out there, however I think that it's important to know what the reality is before you get stuck in.
For those of you not in the know, I'll do a quick heads up of what's what!

• In the UK, to train as a nurse you must be 18 years old (or 17 1/2 in Scotland)
• You must do a 3 year degree course through a University, either a BSc or a BN
• All Nursing and Midwifery courses (as well as a host of others) are funded by the NHS
• You must have completed either 6 months full time or 12 months part time working as an HCA or a support worker before you start the course
• The course will be 50% theory and 50% practice
• Although you are not qualified you must still adhere to the NMC Code
• CRB checks will be carried out on all applicants
• Although you cannot be held accountable for your actions in practice, you can still be taken off the course if you are found to be of "poor character" 

So there we are! I'm going to address these - and more stuff besides - in as much of an order as I can!

Because you are doing what is essentially an academic course at a university (a list of universities offering Nursing can be found here.) you do need to be prepared for the work you will be required to do, this means academic essays, exams, practical exams ect. This is not a reason to be deterred, but it is something to be aware of, the world or nursing and the work we are expected to do is very different from a) what we traditionally did, and b) what the media often portray that we do.

A number of health care courses are NHS funded, including; chiropodist, dietitian, occupational therapist, orthoptist, physio, prosthetist (these guys are awesome - they make legs!), orthotist, radiographer, audiologist, speech and language therapist, dental hygienist, dental therapist, nurses and midwives. At the moment social work is also funded but there are rumors that that may change. However, the lure of what is essentially a free degree shouldn't be too tempting, because you are tax payer funded they make you work for your money, while I can't speak for every university - mine makes us sign in for every lecture and if you don't attend - you will be asked to leave. 

Jeremy Hunt - Health secretary

Last year Jeremy Hunt, Tory health secretary (former culture secretary - which led to an unfortunate spoonerism on BBC radio 4's Today Program) decided that nurses were "too posh to wash", which is utter bollocks first off - but secondly and more importantly means that all nursing students much now have completed the requisite number of hours as an HCA or a support worker before they can do their nursing. I happen to think that this is entirely stupid for a few reasons; I have never met a nurse who can't be bothered to wash a patient - but I have met many who can't because due to red-tape and staff shortages haven't got time to help the HCAs and support workers to do washes, also being a student nurse is a massive financial burden for 3 years, you are living on £6000 or less a year (dependent on household income) and the only way many people can afford to do it (including myself) was to work every shift going for a few years before starting, being a support worker for a year or 6 months is not enough to pay the bills and save up for training.

Lectures - YAY! Now I love uni, but we get a lot of lectures on very complicated stuff. There's a look of despair and terror that you see in everyone's faces after we've left a 3 hour lecture on neuropathic pain, like shell shocked war veterans we sit about eating our butties and drinking our coffee and wonder what in the name of christ we're all doing here. As well as all that jazz, there's also simulation sessions - some are a riot, like learning to put a patient on a bed pan (my friends turned me ... and then rolled me off the edge of the bed and laughed!), some are interesting, like learning how to do CPR, and some are just bizarre - like the simulation day I spent dressed as a patient while being treated by other students. As well as all this you'll be going on placement, for each placement there is a whole host of documentation to be signed off and photocopied and woe-betide the student who forgets the last crucial signature! So far I've had:
 - Surgical

 - Neuro-rehab
 - A&E
 - District nursing (coming soon) 

so hypothetically you should get a good variety! As part of being on practice you must experience the 

"24 hour cycle of care" - which is just a fancy way of saying NIGHT SHIFTS basically! Night shifts are fine, if you're on a ward where there is stuff going on at night - if you find yourself on a ward where everyone is essentially quite well, eg. orthopedic surgery then it will be dull as ditch water - which is where 4am coffee comes in. My favorite thing about going on night is that you get to watch everyone else in traffic - off to work, and go home to your bed. When you're on nights - you will always avoid the traffic!

The NMC Code - you will know it back to front, inside and out soon enough, it will guide and terrify you in equal measure ... OK, perhaps I'm exaggerating a little! The Code is essentially the bible written by the Nursing and Midwifery council, it out lines what is expected of you as a nurse, the standards that you must maintain and to break the Code is genuinely a serious matter. By going on the NMC register (which is much like the GMC register for doctors) you are promising to abide by the code - and to follow it's rules:

• Make the care of people your first concern, treating them as individuals and respecting their dignity
• Work with others to protect and promote the health and well being of others in your care, their families and the community.
• provide a high standard of practice and care at all times.
• Be open and honest, act with integrity and uphold the reputation of your profession.

CRB checks are very unexciting to be honest, but necessary. When you apply for the course you will be asked to declare any criminal records that you have, which is then checked with a CRB when you begin. They always say that they assess everyone on a case by case basis, so don't feel like you have to lie to get in. Far better than to have a chance to explain yourself than be thrown off the course before you've even begun for lying on your CRB declaration. As I said, they're assessed a case by case basis, so if robbed a car radio 15 years ago then your probably OK, but if you glassed a bloke in the face last Wednesday then there may be some issues!

So I guess that's your lot - I hope it's been informative for anyone thinking about starting their nursing, it's a big leap, and a lot of work - but as far as I'm concerned, 100% worth it!

A&E - or - how I was saved by organised chaos

For those of you from over seas - A&E is Accident and Emergency in the UK, and what is probably better known as an Emergency Room in America ect. Before Christmas (yes - this is overdue) I had a month on A&E as my placement, which was brilliant - I absolutely loved it!

I am one of those people who believe that it isn't a crisis until it can't be fixed by WD40 and gaffa tape! So I feel that A&E is perfect for me, it's all about "sorting stuff out", a patient comes in and we "sort them out" before they are either sent home or moved on to somewhere else in the hospital, we have 4 hours to patch them up, get them in a safe position and then we ship them on.

I learnt so much, there are moments when I feel helpless and hopeless and A&E just made me feel so hopeful and helpful! I was making a difference to people's lives at the moment when they need the most help in the world, either though grief, or through pain or suffering, through sickness and injury we are there, we will sort things out. Or that's the idea anyway!

In my time as a student nurse, I've seen patients die and although sad, in my case it was patients who were, not to put it crudely, dying already, the end was inevitable and expected. However on A&E I had my first experience of unexpected death, and unexpected sickness.

"We've all had days like that, haven't we? You make one small mistake, and because of that you make a bigger one. You leave your wallet by the bed. Then you go up to get it. You trip over the rug, you break your leg. Next thing you know, you're in hospital with a fatal infection. Just because you forgot your wallet."
Waking the Dead: Subterraneans  

I encountered many things in A&E, from the bizarre toilet brush in an uncomfortable place, to the common place accidents that taught me that no-one should be allowed to open a packing case before midday, from the un-eventful vomiting bugs, to the terrifying and family destroying diseases coming to a head. I learnt quickly that things happen every day that we can't predict, we make millions of decisions every day that effect us in a variety of ways, short term and long term.

"Life is fragile.
We're not guaranteed a tomorrow so give it everything you've got."

We can predict no-thing and we can't just let life pass up by, assuming that there's always tomorrow, because as I stood there doing chest compressions on a woman who had had a heart attack, I know that her husband hadn't woken up that morning imaging that he had only hours left with her, I know that when he had slept next to her the night before he hadn't know that it was the last time he would do so. In the same vein the woman who fell of a trapeze didn't imagine when she woke up that morning that she would spend that evening in surgery, and the woman who saw her son off to work after breakfast, didn't  imagine that by 9pm that evening she would be agreeing that his ventilator could be switched off.

Life has a way of throwing up the most unexpected hurdles, and just like any other hurdle we can either jump over them and continue onto the next hurdle, or they floor us and there is no recovery.

The perfect relationship? The perfect home? The perfect job?

And all this, all of it - it saved me, while on placement you're constantly looking for the thing, the department that inspires you and that you know you want to work in. 99% of us are always looking for that perfect something, the perfect relationship, the perfect home or the perfect job - and for student nurses it is exactly the same. Every placement we are assessing whether this is something we'd want to do when we're qualified, sometimes we have an enjoyable placement, but we couldn't do it for the next 40 odd years, sometimes we have a god awful placement, and sometimes we have a brilliant placement and we know - 100% that this is what we want to do. And that's how I felt on A&E, I felt completely reassured and confident in my choice to be a nurse, I was doing enjoyable jobs; dressings, IV's, neuro obs, ECG's ect - there was no routine and I loved that! No knowing what was coming through the doors, and I loved the unknown, the surprise, and the fact that I was making a minute by minute difference.

Now I don't want you to think that I only enjoyed A&E for some kind of adrenaline kick, I don't at all, the un-known is scary. But whereas on a ward I found it all too easy to feel lost and useless and bored in the endless shifts of drugs rounds, ward rounds and 6 hourly obs, in A&E there is no routine, you can be doing 15 min obs on a patient in cubical 1, while running through an IV on someone in 2, while awaiting bloods on someone in 3, everything is happening and you can see a patient improve or deteriorate under your care and nursing very quickly, and you have to be able to react to that in an instant.

Just to clarify, I am not knocking nurses who work on wards, they are brilliant - they are putting in the time to slowly build a patient back up to health! We are all superstars, it's just that some of us are superstars who like the slow and steady, and some of us are superstars who like the fast and furious.  

A call to arms to protect the NHS.

There would be no Breaking Bad in the UK .... that may be or may not be good NHS propaganda!

This comes as my first post of 2014 - and I feel like it's important that this is a message that gets out there.

Nye Bevan (1897 - 1960) Labour Health minister 1945 - 1951, MP for Ebbw Vale 1929 - 1960
Clement Attlee (1883 - 1967) Labour Prime Minister 1945 - 1951, MP for Limehouse 1922 - 1950

In 1948 Aneurin Bevan (Health Minister) in Clement Attlee's Labour Government founded the NHS, a fantastic institution. I wont bore you all with my opinions, you can read them here! But suffice to say I am a massive supporter of the NHS, the principle that health care is free at the point of access is brilliant and I can't comprehend anyone who doesn't support that.

Nor do I understand the Tory party's decision to systematically dismantle the NHS, and what I understand even less is our decision as a nation to just sit back and let them!

Now, for those of you who either aren't into politics, or who aren't from the UK and into our politics, here is Nurse P's fun fact file before we kick off!

• All hospital & GP's surgery's  are free to attend and free to get treatments from.
  
  Everything from cancer treatment to antibiotics, from heart attacks to freezing off warts!
•  Eye check ups and glasses are free or subsidised (dependent on the price of the frames usually) for all children, those on benefits, those in full time education and retired individuals.
• Dental care is subsidised by the NHS, you will be charged a one-off fee of either £18, £49 or £214 dependent on the treatment required and regardless of how many appointments it will take to complete the job.
• The Tory party (the right wing Conservative party) are currently in power, on a technicality, in a coalition government with the Lib-Dems (the central Liberal-Democrats) in the 2010 General Election.
  At the time they promised that in all the cut back that they would make they would not touch the NHS and that NHS budgets would be ring-fenced. That has not happened.  

  

  Cameron's election campaign in 2010

• The Tory party are BIG fans of privitising public services!
  
  1979 - British Petrolium (BP)
  1983 - Associated British Ports
  1984 - British Telecom (BT)
  1986 - British Gas
  1989 - Water
  1994 - British Rail
  2013 - Royal Mail
  
  (A brief list - and completely non comprehensive!)
• The NHS is being systematically broken up and sold off to the highest bidder.

Post being (almost) elected - Cameron's election posters were ... improved!

So - that is my simple fact file, and they are all facts. Even the Tories fully admit what they're doing ... well behind closed doors that is! And not only are they trying to break apart our NHS they are doing it with the

help of an orchestrated media campaign. The media oligarchs who run the right wing press in the UK are intent on informing us how shit the NHS is, how we have no-choice but to opt for privatisation if we want a functioning health service.

Case in point here is a selection of headlines collected from the British tabloids. And as you can see, they are pretty determined to make our National Health Service seem as poor as possible so that the inevitable introduction of a pay as go system.

I've said before and I'll say again, the NHS is not perfect, it is full of problems and needs work to keep it alive and working well. However at it's core is a really important principle and it's one that we as a nation need to defend and look after and protect because it's a brilliant thing that we should be proud of.

So this is my call to arms, to protect the NHS - lets not let it go like we've let the others go. Please, lets fight - because we should be furious and angry and we should be on the streets screaming them down and fighting for our right to health care free at the point of access.

A clip from BBC Radio 4's News Quiz