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

This kind of thing only happens in films ...

You know that perfect scene in the film? 

The one where the boy finally declares his love for the girl ...

I actually love Andrew Lincon a little

Or the friend in the cafe gives the protagonist the perfect pep talk ...

The film that makes me grateful
for every decision I've ever been
allowed to make!

And the hero makes the right decision and someone is saved ...

"Oh you're Celtic? ... There's lovely"

All of these are cracking plot devices, don't get me wrong I love a good love declaration/pep talk/happy ending, but they're hardly realistic. Life happens bit by bit and very few of us will ever have our faith realigned in a perfect pep talk, or unburden ourselves in the snow on christmas eve to our dream partner, or ever have the chance to save an entire family and change history.

However, I did indeed have one of these strange only-happens-in-a-film moments recently:

I was sat on a train, on a spur of the moment trip home after a few hellish days, straight off a night shift still in uniform sat quietly with a book and bottle of squash. I had been giving myself a bit of a hard time and thinking about dropping out of the course a bit, mainly because I kind of lost faith in myself and started doubting my own knowledge to the point where I was making mistakes because I was second guessing myself. Anyway, feeling a bit shitty and wandering what the point was I was considering dropping out and was content with sloping off home to work my way through an assignment and then I met this woman, who was sat opposite me and who spotted my uniform, that was unsuccessfully hidden under my cardigan. And she changed everything.

She was a midwife, who had qualified two years ago at my own university, and the hour or so we sat and talked convinced me that I am absolutely on the right path, with a mixture of anecdotes which remind me of the good times, and her own stories of training which reminded me that the second year is a long hard slog that no-one enjoys and only the ones who can persevere through it are meant to get through it.

A strange moment of pure co-incidence, where a total stranger who I just happened to sit opposite helped me out and at just the right time when I was at my lowest eb where I needed to be and which was the right path (or track - geddit!) for me.

I shall finish by saying - trains are awesome, I love trains. I've met cool, lovely, funny and just plain odd people travelling around the place, always talk to people on trains because how many other times in life are you going to spend a few hours sat with a group of total strangers, unable to leave and all in exactly the same position?

The makings of a good nurse: practical or theoretical!

Textbook good nurse:
Florence Nightingale 

What does make a good nurse? 

Answers on a postcard please. Because, really, truly, I don't know! You see the problem is, what is on paper as a good nurse  doesn't always translate into a good nurse in practice.

The nursing courses today are all degree courses, which is fantastic in empowering nurses and giving us a broad skill set that means we can work as skilled, well trained healthcare professionals. However, it also makes the occupation much more, exclusive. Suddenly people who would make awesome nurses, who could more than cope with the drugs calculations, the dressings, the comforting patients and the long hours, but can't write an essay to save their life, or reference an article for that matter. Does that make them a bad nurse? Or unsuitable for the occupation?

Not in my opinion, but then again I'm biased. I am terrible at essays, I love my lectures, love my placements and without sounding like a smug idiot - I think I'm a damn good nurse. Obviously I'm a second year nurse - I've got a long way to go, but I feel that I do do a good job when I'm on duty. I make sacrifices for the work and I love it (not making sacrifices, I mean the job!) but arguably I may never make it to being staff nurse because I really struggle with my written work.

Is it fair? Is it right? And is it the best way of selecting the best nurses in the country - especially when I for one know student nurses who are piss-poor at placement and awesome at exams and therefor are going along like super-stars ... when actually they might not make the best nurses.

Just to show that I'm not an embittered old harpy - I also have some lush friends who are brilliant on placement and brilliant at their assessments and will make brilliant nurses!

Back in the saddle!

So here we are - a brand new house, with a different set of house mates and a brand new year. Year 2 - which I promise you is totally terrifying! I am now 1/3 of the way through my course - 2 years away from being a qualified which is proper proper scary.

My scared level right now!

Obviously with each continuing year and semester, what the hospital and the uni expect from you becomes more and more, and so I find myself - a year in, and not entirely sure that I'm ready to be a second year. But hey - how do you know how something's going to go until you dive in!

So aside from being petrified about what the future holds what else is happening in Nurse P's life? Well I've discovered that a dangerous thing to say in my house is "Anyone fancy a brew?", a tolerance/love of Coronation street is vital in the house, and I'd forgotten that Cheerios are lush when your drunk!

Student nurse placement haul!

This is going to be my run down of all the stuff that in my opinion are "must haves" for the student nurse on placement and quite a few are things that I hadn't thought off before I started so hopefully this'll help you too!

• Your Uniform
  
  Might seem a little obvious, but you'd be surprised how long it takes for your uniform to arrive from your universities uniform supplier. It took me several months, and I actually had to use a non university-logoed tunic for my first placement because it was taking them so long to get the logoed ones sent out. So be prepared! You can also get a rebate on the cost of your uniform from the uni, but remember to get your application in before the deadline ... unlike me!
• ID + holder
  
  Depending on your university and depending on the trust you are training will affect the type of ID you
  
  need. For example my trust wanted us to use our normal uni ID for hospital ID, whereas other student nurses with other trusts needed them to get a special Trust ID for student nurses. Any induction days at your trust should tell you about this, but make sure you have what you need. And make sure you have a durable ID holder: some hospitals don't let you use lanyards, and some are fastened with clips kind of like a clothes peg which I don't like because I found it dragged my tunic pocket and annoyed me. There's a kind called a lever clip which I prefer because I found it kept my ID flat against my hip. Similarly if your ID is a hospital ID which opens doors to department and wards then you might want it kept on an extendible ID holder so you don't have to take it off your uniform to use it on doors.
• Pens!
  If you ever want to know how a smoker feels when trying to find a cigarette at 3am then try not having a pen for 5 minutes on the ward. There's a desperation that takes you over as you hunt and hunt and hunt and no-one else seems to be lurking about with a spare pen. So always have a pen in your tunic, and if you want my advice, then always keep a spare in your bag so that that morning when you over sleep and forget a pen - the it's not the end of the world!
• A good quality stain remover
  Your uniform WILL get grotty, and grubby and manky. From general dirt, medication spills or in my

  

  The night shift where my pen
  decided to explode!

  case biro ink! You kind of want to look as presentable as possible for most of the time, so I would recommend investing in some good stain remover. Especially since your uniform will most likely be white, bleach is also pretty good, but it's more or a high maintenance cleaning method as it's a kind of keep an eye on your washing kind of method!
• Lunch box and water bottleYou might be buying lunch at the hospital or you might be bringing a packed lunch, either way I'd recommend having a Tupperware box and a water bottle. Many housekeepers run very strict staff fridges, mine wasn't alowed to hold plastic carrier bags which is why even if I was buying a sandwich from the shop I would shove it in a tupperwear box, you may also find that your houskeeper on the ward requires you to put your name and todays date on your luch - and that's just easiser with tupperwear! Some people are a bit funny about drinking tap water so there are some really funky water bottles you can buy with a kind of built in water filter in the cap. I have never used one so I can't really recommend it, but I know loads
  
  of people in yoga use them and love them so ...
• Jewellery retainersThis one's quite a specific one! But for those of you with any piercings that are facial then you might want to invest in a piercing retainer. If you haven't seen them they're flesh coloured studs that make your piercing almost invisible and because they're flexible they're really safe.
  Depending on your hospital they might be totally cool with you having a facial piercing, or like mine they might not be cool at all! Mine isn't so I wear one in my nose piercing but it's up to you, although it's something worth looking into and considering buying.
• Hair and MakeupOne for the girls among us perhaps! General rule of thumb for nursing staff is that your hair should be above your collar, you'll see plenty of people disobaying this rule, but the only way to escape a bollocking is to follow it. Also - quite aside from any kind of infection control it makes me gag to think of my hair hanging into a wound or something! So I always wear my hair in a bun, a normal bun tends to fall out in my hair so I use a bun doughnut, it was about £2 from Tesco and I wear it every day - so I can't really recommend it highly enough!
  Also invest in a good quality moisturiser and foundation, I'm not one for high end brands or anything - but I haven't found a foundation that stays as well over a 12 hour shift as Bobbi Brown's Skin foundation SPF 15. And the combination of no air, hot wards and long hours with little sleep wreaks havoc on my skin - so make sure to invest in some kick ass moisturiser. I love Simple's light moisturiser but go for what you love!
  
  
  

So I hope that that list is all right for you all - it's not all encompassing and it's not total, and it's just my own personal list of what I felt is needed most on placement. So feel free to comment on what other things you think might be needed, and a massive good luck to anyone starting their nursing course this September!

Just jump in!

This was a piece of advice that I gave to a nurse starting her first placement, on my latest placement I was faced with so many opportunities to try out new skills that I had observed, like making up IV's, catheterising, dressings and passing NG (naso-gastric) tubes. But a lot of these things i.e. the NG tube, will happen occasionally and not on a lot of wards, so if you get the chance to do one - then do it!

A properly placed NG tube on an X-ray

Over my 10 week placement, but the time I reached my 9th week I had seen two NG's being passed, and while on a night shift one needed doing. So - putting on my best confident in this face I asked to do it. It was terrifying, it's easy to put an NG down the trachea instead of the oesophagus for example. (For the record - that is a bad idea!) And obviously, shoving a tube down someone's nose isn't much fun for them, and a lot of people have really strong gag reflexes, some people will try and hit you, scratch you and kick you, but after a point it becomes more important to get the tube down to their stomach to feed them than to avoid being maimed. With the 12 hour shifts and the missed breaks and the poor pay, half the fun of nursing is getting to be a martyr and striding into the house at 8am after a night shift to proclaim: "I got kicked in the stomach tonight but at least Mr Smith isn't going to go into a diabetic coma on my watch!"

Edith Cavell .
A WW1 British nurse, executed for helping Allied soldiers escape occupied Belgium. 

So my tip to the lovely student nurse I met on my (now former) ward, was to just jump in, if you see someone about to do something that you're interested in, then go on and ask if you can watch. I've watched:

• Chest drains, ( I actually became part of Dr Williams' Chest Drain Dream Team!)
• Lumbar punctures,
• PICO dressings,
• A Bronchoalveolar lavage,
• Seen some really funky wounds,
• Passed an NG tube,
• Removed cannulas 
• Watched a load of X-Rays

and many many more things besides. Speaking to the fellow student nurse, she was nervous and was a bit unsure about how to get to do stuff. I tried to reassure her and now I'm trying to reassure you guys too - the way to gain experience is to nag, wheedle and blag your way into watch procedures, because once you've watched once or twice, you can offer to lend a hand for the next few, and after that you can ask to do them yourselves.

Experience breeds Competence

I've now finished that particular 10 week placement, and it's now onwards and upwards, that pesky assignment that I was worried I had failed I passed so I'm clear to move onto the second year! I've moved out of halls (or the prison-cum-psychiatric hospital that my Mam christened it) and into my new shared house which is very exciting, it's going to be fun if a little difficult, we're all very different people with big personalities, different interests, different senses of humour and everything so I'm sure sparks will fly but we're all really close friends and we all love alcohol and bacon so I'm sure that things wont be too bad!

The idea that I'm now a second year student nurse is terrifying, 1/3 of the way through my course, my Mam pointed out that I left high school and started 6th form 3 years ago - and in 3 years time, I'll be a qualified in my blues, hopefully doing everything right (ish)

I'll speak to you all soon, and if any of you are particularly interested then my next post is going to be a "Student nurse haul" blog post, about what you will need for those of you starting your training in September.

Moving on and my addiction

"There is no standing still because time is moving forward."

Greg Lake

It's not something I've ever really considered, when you think of nursing you think how great it is to be helping someone, or how hard it is when there's someone you can't "fix" or the paperwork pisses you off, or the hours get you down. But I never really considered how we as nurses are expected to just move on.

Treat a patient for weeks, months or years - grow close to them and their family and then to lose them and within hours to be treating a totally new patient as if the previous were never there.

I lost a patient over the weekend, I worked Saturday - and Monday. At Monday handover we were told that we had lost her the night before, by the time drugs rounds had started the room was being fogged and by tea time we were admitting a replacement. And that's meant to be fine: we've lost A and in her place is B. You don't think that when you become a nurse - you don't imagine that you're going to be in a position where you just have to switch off and over so quickly, and it's hard - it's so hard, because it's not the kind of thing that we're programmed to do, we're meant to care, we're meant to care and yet we're meant to just move on without being emotional, and that's inhuman and hard.

So on I move, I smile and I welcome chat away - and then when I get home I think: think about how this works, I drink my tea I eat my pasta I watch my tele and I think.

"This is my life, I  can either think; there's one person who I did everything for to make their end more comfortable, I learnt from treating them, and here's a brand new person - who needs my help and who I can transfer all this new knowledge to. Or I can jump - go and leave and take myself  off and become a temp again."

And I've chosen - I'm staying. If you don't move on and fight it out and keep going then you're never going to get anywhere. Nothing worth having comes easily.

I am an addict.

I don't take drugs, I don't drink to excess, I'm not a sex addict - I'm a courgette addict. I mean I've always liked courgettes, but recently someone told me that courgette, prawns and tomatos make a lovely pasta sauce so: off I go and make some very nice pasta sauce with courgette in.
 And BOOM! I'm now on my 3rd week of eating courgette with everything - every single one of my tea's these 3 weeks have consisted of courgette with something - anything - as long as it's courgetty!
Agghh - it's so delicious! I'm going to assume that this is an OK addiction, I mean if you look at alcoholism, heroin addiction, smoking and hardcore courgette addiction and I'm pretty sure that mine'll come out the safest!

Nurse P's top 10 tips of being a nursing student!

So, it's occurred to me that the majority of you reading that will either be prospective student nurses or current nurses. So I thought I ought to do some kind of top 10 run down of tips since I'm almost at the end of my first year.

10 
There are no stupid questions.

This one's not just for nursing, pretty much anyone can benefit from this one. But in nursing, for that is what I know,  it is particularly important. Firstly in lectures, you're going to learn a lot of stuff ... or rather you're going to be told a lot of stuff that you're going to be expected to remember, and asking questions - helping you to understand the wider picture of the patient, the condition and the body. And when you're on placement ask questions, I don't mean be pestering and pulling on your mentors sleeves, but ask what condition a patient has then you can research it, ask the physio what it is they're doing, ask where things are because there will come the day when a doctor grabs you at the nurses station and says "Can you bring three blue cannulas to side room 8 please?" and you're going to have to fetch some and know where they are. Same goes for asking how something works, when your mentor asks you to set a litre of water to run through it helps if you're not staring at the machine like this!

9
It might feel like it's all hopeless - but it's better than you think.

Oh my God, it's not going in and, I'm going to be shit at this and OH MY GOD I DON'T UNDERSTAND! I'm prepared to put good money on every-one of you reading this will either have thought that at one point in the course or will do at one point or another. Yeah - we all have, I have, I will again, it's going to happen - live with it! Try not to feel as if it's all entirely hopeless, things, in my experience, tend to come together in time. Sometimes that thing that seemed like double Dutch to you in that lecture, suddenly makes sense once you attend the relevant seminar, or once you have another lecture a fortnight later that pieces the pieces together or even once you're on placement and you see that thing that makes no sense to you, in the flesh and suddenly you get it!
And there is no better feeling than something going wrong on the ward and going onto automatic pilot and knowing exactly what to do and sorting it. And I found that I knew exactly what to do once, just because the stuff that had been taught in lectures has seeped in and stuck without me even knowing and I was very proud of myself.

8. 
Buy a stethoscope. 

They are like gold dust, if you get asked to do the obs on your bay, and you can't find a stethoscope - you're screwed, so buy one and make it bright! Because when someone tries to steal it and spends the rest of your shift wandering around with it around their neck, it helps if you can spot it. I recommend Littmann stethoscopes - they are ace, genuinely the best ones you can buy, not cheap but like wine and shoes good things rarely are!

7.
Be positive.

Yeah a confused patient just tried to hit you as you were wiping their bum, yeah you're 10 hours into a 12 hour shift, yeah you're tired and hot and your feet hurt. But try to be positive, some days are going to be shit and some are going to be amazing, some will make you want to cry and some will make you want to sing with joy. But no-one, especially not the patients are going to benefit from you hating everything. Off load onto other student nurses when you get home, with a glass of wine and last nights Corrie, but the time when you're at work is the time to extenuate the positives. You might forget about that patients you looked after for 3 days 2 years ago, but chances are they wont forget you, and the aim of the game is for them to remember you as that cracking nurse who was really helpful and supportive, as opposed to that miserable bitch who walked around with a face like a slapped arse. Take your break alone, outside and let your armour fall with a cup of tea, a packet of crisps or a cigarette (whichever floats your boat - or all three!) and recover if needs be, but your patients need you to be strong, so try to be.

6.
You're not a normal student - so don't try to be.

You're at a uni - with many students attending it, and chances are you will bump into them, live with them, end up being filmed by them for course work, have sex with them or maybe even marry them! But the time will come when you realise that you're not like them,  they're different! Because all those stereotypes about binge drinking during the week, lie-ins and missing lectures are possible for them.

• Nurses have long years, a normal student will usually finish in or before June, and return late September or October. A nursing student will finish in the middle of August and start back at the beginning of September. And forget a 4-6 week Christmas and Easter, it's two weeks for us.

• Whereas a normal student will often have a 2 or 3 day week, a nursing student will have a 4-5 day working week in lectures, not to mention those pesky periods on placement with 5:30 starts.

• Due to some very specific training from the NMC guidelines, you can't really miss lectures, you'll have to sign a register and if you don't turn up then it's bye bye! 

I'm not saying that being a nurse is dull, or boring or anything even vaguely like that, I mean what other course means you spend your lunchtime laughing about catheters!? But if your flatmates are going out on the lash on a Tuesday night while you have 9am lectures the next morning, suck it up, swig some Horlicks and settle down to watch tele. You can still go out an have fun, trust me - I've drunk enough to feel a bull on occasion, but just remember that while you're both here to get degrees yours is a professional qualification and as a result you get to have a lot less mid-week fun. On the plus side you will quickly become the human equivalent of Eastenders Wiki page!

5.
Stop trying to look sexy - it's not going to work!

This isn't a vendetta against fake eyelashes or anything don't worry, I love my falsies for a night out! But in your uniform, when on placement,

don't think you're going to look like her, because you wont, I mean for a start the tunics make you look like a Moomin, the trousers make you like like your applying for a Simon Cowell look-a-like competition and those shoes ... well, if I say lesbian police-woman then you get the idea! But you know what, that ugly tunic and those trousers that come up weirdly high are actually really comfy, don't flash your arse when you bend over a patient and are loose enough so that you can bend and stretch. (The also have massive pockets that are great for stashing stuff in!) Those shoes are ugly as hell and as comfy and supportive as though you were standing on cherubs covered in silk wrapped feathers. It's the girls who come in with freshly curled hair, eyelashes that could knock out Joe Calzaghe they've got so much mascara on who start to slide down the warm sweaty slope first, you might not look sexy - but if you look no wors 12 hours after you started the shift than you did than when you started - then go and give yourself a pat on the back!

4.
Don't fall at the first hurdle.

What's this? You've failed an exam? Well - I'd give up now if I were you.

Yeah - not really - don't fall at the first hurdle, we all fail exams and think "OK, so this isn't for me, I'm off home." have a good cry, drink a lot of wine or eat a lot of cake, shout, rage, dance on your own with your ipod in but don't give up. Or at least not because you've failed an exam, if you come to realise that the course  and the occupation isn't for you then maybe you should re-think your options. But we all fail at least once and it's hard and soul crushing and we all wonder about dropping out. But remember why you started all this,   if you fail more than once and have to take a year out then that might be the time to consider your options, but until then - don't start to apply for the temp work just yet eh.
(For the record this also applies to placements, you might get a shit one where the nurses hate you, the patients hate you and you just want to curl up into a ball and weep, but for each shit one you're pretty much guaranteed 2 good placements. And while you're loving your next one - that annoying friend who loved their last one will be crying into the pillow because they hate this one!)

3.
Be appropriate.

I add this one with caution, because appropriate is a kind of a how long is a piece of string thing. What everyone thinks is appropriate is different, I mean I have no issue when doctors and nurses pop out for a fag break, but some other people do. However some things are probably universally thought of as inappropriate:
(these are all things that student nurses I know have done)

• Telling patients how shit faced you got last night/will get tonight.
• Telling lecturers how you used to be into drugs but you're "not in that scene any more"
• Telling people loudly in the staff room how much you hate Matron or Sister, hate them if you like but keep it schtum!

2.
It's poo - get over it! 

This one seems obvious for nurses, but you'd be surprised about how many people struggle with this, everyone has something that makes them retch and want to vomit, be it blood, poo, urine, fluid from a stoma bag, sputum, pressure sores ect. (For the record mine's sputum - cleaning out a trachy tube makes me want to do exorcist style vomiting.) But in the nicest possible way you need to deal with this and get on with it, it'll still disgust you and you'll still shudder but it needs doing, your patient needs you help them as best as you can - so you need to the job in hand. My top tips for getting through are:

• Grin, this helps stop the gag reflex - you'll look a bit manic and insane grinning wildly but hey, go for it it's worth it for not retching over a patient's face!
• NEVER NEVER NEVER inhale through your nose, I made this mistake once ... never never never again.

1.
Remember to laugh.

This is actually me - I'm really hairy when I don't shave.

You are on your way to having some of the best times of your life, some of the funniest incidents will happen to you when you're on the wards, you'll see the most bizarre things, have the oddest things said to you. And the best way of coping with all the bad stuff, the heartbreaking, the painful and the soul destroying is to look at the great, funny and bizarre stuff and to laugh, laugh on your own, laugh with the doctors, laugh with the nurses, laugh with fellow students and laugh with all your mates who are already concerned about your sanity, and will be even more so now!

So I hope that my 10 tops tips and advice for prospective and newly starting student nurses have been of some assistance, please do tell me in the comments section if there's anything you feel I've missed out!

My God I'm stressed!

So ... I'm stressed! And it's not often that I say that, I'm the kinda gal who goes, "Nah I'm fine!" or "Ach, it'll all be OK.", "Worse things happen at sea!" is another perennial favourite. It's not that I don't worry, I do, and I panic and get a really sexy red chin when I'm not chilled out. But over the years I've become the one who sorts issues out, I'm the girl who's there with the hugs and tea bags. 

Are you worried/nervous/upset/angry? Then come to my house, I'll make you tea, I'll crack open the cake tin (because I am the only person since 1963 who own's a cake tin) and you can talk things through. Nurse P will make everything better. 

And because I may be a nice and kind person, I'm also irritatingly honest and fairly stingy with compliments so when I tell you that you're a wonderful person and that all the pain is worth it because you're going to be brilliant at what ever it is you're trying to do, (be it soufflé making, nurse training or learning to drive) it tends to have the desired effect, in that people buy me cake and make me tea and pick me up when I'm sobbing with heartbreak or alcohol.

Because who wouldn't love that face and coat!

So when I'm stressed, I downplay it, I'm emotionally constipated about things that really worry me, whereas bad boyfriends, bad patients and bad shit in general my upset me, and I can talk about  'till the cows get home. If it worries me or is stressing me out then expect me to hole up in my house until through a combination of tea, cooking arse-kicking food and watching re-runs of Jonathan Creek gets me back on track. 

I'm stressed because I have a great deal on my plate at the moment , first off that assignment that I failed a while back - my re-write has not started looking better than the shite original and not passing it second time around means good bye nursing course, hello going back to being a receptionist where my line manager hates me and always told me I'd make a bad nurse. Secondly my new placement, 12 hour shifts are OK, the work is great (obvs loads more piss, shit, and vomit than last time - but I love it!) and the patients are lush sooooo - what could possibly be bothering me. WELL! 

"The human body is the only machine for which there are no spare parts."  Hermann M. Biggs

1954 Morris Minor saloon 

We have a patient on the ward, they are dying and I'm sorry to be so blunt, but this patient in their early 20's is dying - and by all rights they probably should have already died. It's only through medical intervention and their families un-ending support and belief in their relatives ability to recover. Which they wont - doctor's have been pumping their body full of anti-biotics and blood transfusions and everyone, all the doctors and all the nurses know that this person is simply not going to recover, not through lack of trying or because we're cruel but because the human body is an incredible thing but like any machine, which is of course essentially what it is, there is only so much it can take. Think of a Morris Minor car, an absolute beast of an engine, a beautiful car and a rarity. In 1954 they were 10 a penny,  a very common car, but now rarer than hens teeth. There's only so much a car can take, only so many times the gear box can be changed and the fan belt replaced and the rust covered and the pain touched up. We are but machines, very clever and complex machines but engines none the less and there is so much we can take. When I see this patient and I care for them and I watch the doctors doing yet more blood and nurses set up another IV of antibiotics, part of me aches to say: "Just let go, let go and let your child rest in piece, it may seem in human and cruel but it's not - it's the kinder thing to do than to just keep this going. There is no quality of life, there is nothing of your child to save." Perhaps I'm cruel, perhaps I'm heartless, perhaps I would understand if I were a mother. 

But I'm not a mother, I'm a nurse and I see how much this family wants their child to be healthy again and I respect and understand that, but as a medical professional I can also say with the same mind that understands all of that, that there are wishes and their are facts. And in my line of work sometimes we have to work with wishes over facts, however unhelpful such wishes may be.

I don't want to dispirit you all - so in some rather better news, I've just passed my final exam of my first year! Woop Woop - which is making my stress a little better, as is my recent discovery of YooMoo frozen yoghurt in my local Tesco, I personally recommend the Tropicoolmoo flavour it's very VERY nice, and the perfect thing for when I get back from the crazy humid heat of the ward to my nice cool house! I love summer as much as the next man, but in the hospital the heat is something else. And here's a photo of a celebratory ferret - to celebrate passing exams and discovering frozen yoghurt!

Until next time: au revoir!