Student Nurse Blog Week 16
December 8th 2004
Well, this week has been a return to clinical placement. We have two weeks on placement before we get two weeks Christmas holiday plus one weeks independent study leave (Not Holiday!, but still a week off from Uni and placement!
This week has been good. I did an early shift on Monday and it was quite busy, but I was able to do my first full admission on a patient - including all the risk assessments, nutritional assessment, and the care plan!
Yesterday I worked a late shift and that was much better. Both yesterday and Monday I was on the Stroke Assessment Units (SAUs - male and female) end of our ward, which is in three sections. Yesterday I was able to admit two patients on my own, again a full admission including all the assessments and care plans. In the evening I was able to watch a dressing get changed - it was on a patient’s leg that had liver damage. A large part (around 90% of the leg below the knee cap) was necrotic. The patient was waiting for an anaesthetic assessment (due to the liver damage) with regard to a skin graft on the leg. It was very black and needed a good clean with saline, then redressing. At the end of the shift I then helped one of the nurses do the 10pm drugs on one of the SAUs, where I was able to learn a bit more about the statins group of drugs (cholesterol lowering).
Today I worked an early shift and had quite a busy morning, but although it was busy I didn’t seem to get anything major done. It was just essential things such as washing patients, dressing and toileting. Although I did notice a pressure sore on one patient, reported it to the nurse and then (after she had seen it) put a dressing on it, then documented it. The patient whose dressing I watched get changed yesterday needed it changing every day. So today I was able to change the dressing and clean the wound myself (whilst supervised by a nurse), plus I had two other student nurses watching me!
The week seems to have gone really well and everyone on the ward is really supportive of us student nurses. Tomorrow I am out on another community placement and then on Friday I am on a late shift. On the Friday I am working with the Junior sister who wants me to take on a couple of patients of my own all shift.
I suppose it’s a good learning experience. I am off on Saturday and doing an early on Sunday. I am working next week, but have next weekend off, so I can return to Somerset on the Friday after my early shift.
I will update my blog next on Friday or Sunday. Till then, Matt
What a mad few days I’ve had!! On Thursday I had my community placement. This was at a centre run by a NHS PCT. It was located next door to a special school for children with learning disabilities, physical disabilities and special needs. The centre was staffed by paediatric physiotherapists, who looked after children both in the community and at the school. The school had children from nursery age all the way up to college age. It was great; I had a tour of the school, met some of the children, watched two children have physiotherapy sessions in the hydro pool and then observed and interacted with an older child who was having physiotherapy in his class room.
The best part was I found out that this community placement was linked to my next community placement, a Children’s Developmental Centre (CDC), as a lot of the children at the CDC would have been referred to attend the school. I am due to attend my community placement at the CDC on Wednesday of next week. The CDC also linked in with my previous community placement, which was with a Speech and Language Therapist based at a Health Centre in Malvern. She would sometimes refer some of her paediatric clients to the CDC if she thought they would benefit from it.
It is so nice to finally see how these community services link in with each other, as well as to gain experience of their individual services by visiting them. I think this kind of thing is very important for me, especially as I want to specialise in emergency medicine, because it will give me a better idea behind the effect on the children from their environmental and social background, as well as how to communicate with them if they have physical, learning, or behavioural problems ordisabilities.
Yesterday (Friday) I worked a late shift with the Junior Sister. There was another student (2nd year) on and the idea was that we would each be given our own patients for the shift. This would give us the opportunity to have some experience of hands-on total patient care and management. When I arrived on shift we all had to have a hand-over for the entire ward. Usually, we work in at least two or sometimes three teams. This didn’t happen. The Junior Sister was the only trained member of staff on for the late shift and there was only one trained nurse from the early shift who could stay until 330pm. At 430pm we were due to get another trained nurse. So for one hour we would just have one trained member of staff on the ward. The 2nd year student was given four side rooms along the corridor and I was given the other four rooms along the corridor. Among my patients I had one who was very poorly with a BP of 70/37 and a CVP line in situ. We were waiting for a High Dependency (999) ambulance to transfer him to another hospital where they had a CCU bed available.
I had another patient who was due to be discharged to one of the rehabilitation wards. I checked the very ill patient’s BP again and reported to the sister, then I photocopied his nursing notes, made sure I had a photocopy of his medical notes and completed a discharge letter. This all went into an envelope and was placed with his CXR (to ensure the CVP line was in correctly), ready for his transfer. The sister phoned the other hospital to hand the patient over to them and then checked that the transport had definitely been booked. Because the Junior Sister was so busy, I also looked after the two Stroke Assessment Units for her.
It was a very busy shift indeed. I checked on all the patients. Then the ambulance crew turned up for our highly dependent patient, so I helped them transfer him onto the trolley and off he went. We started to get the room cleaned up ready for the next patient (who was already booked-in for that room) and then went to do the dinners. I helped out with the meals and then another ambulance crew turned up for the patient who had to go to a rehab ward. I helped them to transfer her, whilst the sister phoned the ward to hand the patient over. Because the patient was staying within the same hospital complex, her original medical and nursing notes could go with her. I filled in the transfer/admissions/discharge book with her details and the high dependency patient who had also left the ward. Then I needed to get that room clean, take off the pressure relieving air mattress and deflate it. I called the pressure-relieving storeroom and left a message for them to collect the mattress. Then I phoned the help desk to arrange for a porter to bring a normal mattress down to the ward for the bed.
I then changed a patient’s leg dressing on my own. I did this after checking with the junior sister. The reason I did this on my own was because of the following reasons. Firstly I had watched a nurse change the dressing on the Tuesday. During this I had spoken to the patient about the dressing. The patient was very knowledgeable due to the fact that he had had the leg wound for a while, had the dressing changed on a daily basis and had seen the dressing changed many times. On the Wednesday I had changed the dressing under the supervision of a nurse. Therefore, I felt that I was competent and capable enough to change the dressing on my own; especially as the patient could guide me if I needed it, and the patient’s wife was also there to assist (she normally helped out with the dressing changes). I changed the patient’s dressing and both the patient and his wife commended me on the job I had done. Later, when they saw the junior sister, they also informed her how impressed they were with the job I had done. I felt very pleased and proud about doing a good job on changing the dressing. I felt very pleased when the patient told me how well he thought I had done. I also thanked him for his praise and teaching me so well on his wound and the situation behind it. I thanked him for allowing me to change his dressing. After I had cleaned up and secured the clinical waste bag I checked that both the patient and his wife were okay for everything before I left them alone in their room.
So far I had transferred two patients and I had two empty side rooms (both of which already had patients booked to go into the rooms). The patient whose dressing I had changed was actually under the care of the medical team who looked after the ward next door to us. We had arranged to transfer the patient back to that ward, so I went into inform the patient that he was moving back to his original ward. He seemed quite pleased at the news, but I explained that it wouldn’t be for another half-hour or so, as I had other nursing tasks still to do. As soon as I got time, I went to the ward next door and found a nurse to hand-over to. The nurse had two stroke patients on her ward and thought that we would be doing a straight swap, but I wasn’t under that impression and explained that to the nurse. She said that the patient’s bed was all ready and to give her a hand-over anyway. So, I handed the patient over to her. Then I went back to the ward to inform the patient that he would soon be moving. I bleeped the bed manager. Once she phoned back I explained that the other ward thought we were doing a patient swap and she told me we weren’t. I then took the patient round to his new bed on the other ward and explained to the nurse there about the conversation I had with the bed manager. When I came back the sister was going on her break. She had already told me about the two new admissions we were expecting. I was supposed to phone medical short stay to let them know we could take their patient. However, before I had chance to do that the Day Case Unit phoned and told me they had finally got a porter. They asked if I was ready to take their patient, so I told them yes and decided to take that patient first. When the patient arrived, I took a hand-over for her and then settled her into her side room and made sure that her and her husband were okay.
I then had to check on my patients again – including those in the two stroke assessment units – to make sure everyone was okay. The hca’s were brilliant and supported me very well. Once the Junior Sister returned I explained about the new patient I had admitted, and put her hand-over details onto the computer hand-over sheet, as well as entering her into the transfer/admission/discharge book.
On the ward we also had (on my side) a patient with difficult behaviour, who had learning disabilities. Just after tea-time she started to ‘play up’ like a naughty child and kept leaving her room. Unfortunately, when we tried to walk her back she would keep dropping to the floor. This happened a few times until the junior sister threatened to call security. So the patient promised to behave. However, she didn’t, so we got security down. They didn’t stay long and the patient was off wandering round again. This caused great problems, especially at one point when a relative told me a patient was trying to get out of bed. By the time I’d got to him he was half out of bed, and then I was called away to deal with the other patient. We phoned security again and then the sister helped me with to get the other patient back into bed and check him over. From that point until just before the end of the shift we kept calling security, who would come down and see the patient pretending to be asleep (which we told the security about) and then they would just disappear again and the patient would then start wandering again and we’d get her back to her room and call security again and we’d go round in a big circle again. Finally, security decided to stay with her until we could get a doctor to write up some strong sedation for her (which was discussed with the patient who agreed, as she didn’t like being so tense and not able to sleep and didn’t like ’playing-up’, but couldn’t help it as she felt tense).
The whole shift was very busy – much busier than we had first anticipated. However, I was still able to look after the patients I had been assigned, with the support and guidance of the junior sister (who did a brilliant job despite the huge pressure she was under with the staff shortages). The hca’s were a great help to me and also gave me support.
During the shift there were a few times where I felt quite overwhelmed with the situation of things. It is easy to see just how stressful things can get for nurses. I was lucky. Even though at one point there had just been one trained nurse on the whole ward for about an hour, there were two student nurses there to help out (including myself). I tried to imagine just how I would have felt during that shift if I had been a newly qualified nurse and had just one other trained nurse on with me. The thought terrified me. Although it didn’t put me off nursing – and although I realised that by the time I qualified I’d have had two and a half years more training behind me – it still made me realise just what a stressful and pressurised job I was going into. Matt
Catch up with Matt in the Nursing Forum.
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