Tuesday, 10 August 2010

Transitions

An excellent and thought-provoking article on the Student BMJ detailing one nurse's experience of becoming a doctor and returning to her department with different workload and demands:

CCU sister to CCU junior doctor

I hope I keep writing long enough to produce something for a journal like the Student BMJ.

Monday, 9 August 2010

Show me where it hurts

"Doctor! Doctor!"

I sigh and without even turning 'round say loudly "I'm a nurse"

"Oh! Right! 'Course you are! Well, I mean, I'm in pain, is there anything I can have? I mean, doctors wouldn't know about that, would they?"

Charleen's unintentional Uriah Heep impression doesn't warm the cockles of my heart. She came to us ?Pancreatitis ?EtOH abuse, known ex-IVDU. Now I am not the kind to refuse analgesia to anyone - pain is pain, you can't judge another person's pain, period - but there is something frankly funny about someone who can sleep all morning after their a.m. methadone and then be unfortunate enough to wake with "terrible pain" in their abdomen and an accompanying limp that seems to have manifest itself. Luckily for Charleen, she IS able to have some Oxynorm. It is as much as I can do, not to roll my eyes to show my lack of surprise.

As I say, pain is pain. I do not tarry to get someone pain-killers, even the more suspect actors amongst our current crop of patients. I do, however, find it rather tiring when people make these grandiose shows of how they are in pain and can't I do something, please, and oh it must have been 2 hours/ 4 hours/ 6 hours since their last dose of oxynorm/ morphine/ diamorphine etc. etc. Just tell me you're in pain. We both know that you've been watching the clock, that you know *exactly* when your last dose was and, yes, that paracetamol will in no way improve the terrible and sudden pain you are in.

Pain is, as my lecturers might have said, a vital sign and the symptoms of which vary from person to person, aetiology to aetiology. Maybe you really are in pain, maybe that potent opioid is just a bit moreish, honestly, I don't care if it's the latter. It just means that I have to go hunt down the CD key, another RN and interrupt whatever it is that I'm doing, so you may have to wait a bit.

I don't want to come across as some cold-hearted bastard, I do really have a personal interest in pain - if I'd stayed in nursing it would be something I could see myself specialising in. Junior doctors don't really understand how to prescribe analgesia in my experience and more often than not don't understand that morphine is not going to solve all kinds of pain - and isn't without its side-effects. This often leads to people being left in pain, whilst I apologise profusely and bleep the doctor to get something more written up. I'd ask of all doctors, when writing the drug chart up, if you can please give me some diclofenac or codeine or dihydrocodeine or tramadol on the prn side, if only so I don't have to see one of my patients in pain and me helpless to do anything about it. I know that some people are not suitable candidates for more potent pain-killers (liver damage, head trauma, renal insufficiency, whatever) but that doesn't mean they have to run the risk of being left in pain.

 I hope I remember all this in years to come, if only so I don't (as has happened to me in the past) shuffle up to an RN and ask, plaintively, how tramadol should be prescribed.

Friday, 6 August 2010

Hobbyist Nursing

"Just when I thought I was out... they pull me back in." - Michael Corleone (Godfather III)


"Oh hey, you're back so soon?"
"Wow, guess you just couldn't stay away, huh?"


The 'phone rang at 7 o'clock, the number said "Blocked" and I knew it was the hospital. I'd been umming and ahhhing over booking a couple of shifts with NHS Professionals next week to get a bit of cash and to keep my hand in, but this was a pleasant(ish), surprise. One of my colleagues apologised for waking me and wondered if I could come in. I stared at the ceiling, counted to 3 and said "yes". Time enough to brush my teeth, grab a clean uniform, pack up my lunch and kiss my wife goodbye. She sensibly muttered something about "having fun" and went back to sleep. I ran to the bus.


Coming back to work felt nice. I'd been getting a little misty eye'd about nursing watching Nurse Jackie and it was great to take handover, plan my immediate to-do's and then start the drug round. I really enjoy going through the obs, the drain charts, looking the patient in the eye, saying "Good morning, my name is AbsentBabinski and I'll be looking after you today". Generally they smile back and say good morning and you get a sense of them.


My heaviest patient was a guy who had suffered a stroke intra-operatively and had been left with reduced strength throughout. I helped him with breakfast and it was nice to be doing this for another person, the simple, important stuff. I guess I'd forgotten in the run up to med school how satisfying and intimate this kind of thing is. We chatted as I spooned up porridge and I then I gave him a wash. My lecturers at nursing school had always waxed lyrical about how we were so lucky to be involved in such intimate aspects of care; I had always proposed the notion that they *really* needed to get back on the wards and find out how things worked. I'm not saying that I totally agree with them now, but pulling bank shifts, it feels like a lot of the pressure is gone and I can practice my nursing care in a different way. I feel like I'm doing it as a hobby which means I can take things to a level of detail that perhaps I couldn't when I was ward staff and dealing with the crap that goes with it.


And it was nice to see everyone again, see one of our junior staff take a shift in charge and, frankly, do okay at it. Probably better than my first time in charge!


THIS JUST IN: My med school have *finally* confirmed my place for this year. After so much jumping through hoops and form filling, I got an email from UCAS today saying the uni have confirmed my place, so watch this space!

Wednesday, 4 August 2010

My new Favourite Thing

I know I'm late to the party with this one, but I've finally started watching Nurse Jackie and I think it's wonderful.

If you suspend your disbelief about a few issues (certainly somethings would be impossible in the UK and they seem like the kinds of things that would be impossible in the US), it's a well-written and touching show. It's bleak, with dark comedy and a troubled protagonist. The titular Nurse Jackie is an RN with a drug problem, two men on the go (one is her husband, with whom she has two children) and dopey - if well-intentioned - student nurse in tow.

The  show really picks up on a lot of things, such as the peculiarities of the relationship between doctors and nurses, the way that nurses are important for making people "better" in a more complete way than the doctors, how shift work can make your real life seem like just something that happens when you're not at work and how you can't save them all.

If you've worked as an RN, you'll feel well represented here, and probably enjoy the dark humour that drives so much of this show. I certainly do.

Monday, 2 August 2010

Getting things done

If you are anything like me you can't remember any of the long list of the real life tasks that mount up when you're not in the hospital trying to remember any of the long list of demands that nursing/ medicine/ general serfdom generates.

To this extent I have spent the last year working with Remember the Milk to try and stay on top of things. It's a nice, spartan set-up with a decent enough iPhone app (yes I have an iPhone, no it is never more than 10 feet from me at any point in the day). It can be a little less than intuitive at times, but rarely is it difficult to use. The only real down side is the cost - $25 (convert that as you please) for a year's subscription. But that is only for a "Pro" account - mainly the reason I have one is for the iPhone app.

I realised I needed a system when I found myself using backs of envelopes to organise my life and when I lost one, I'd lose my plan for the week with inevitable consequences.

I'd also point you in the direction of Merlin Mann, a Californian who makes a living from telling businesses how to get things done better. He's not your usual cheap suit, bad tan, bright smile BS seller. And he does the very (occasionally painfully so) funny podcast You Look Nice Today, a self-proclaimed journal of emotional hygiene.

Statement of Intent

I was, until last Friday, a promising Staff Nurse at a London hospital. Now I am a promising Staff Nurse on Annual Leave and soon to be starting medical school.

Nursing is something I enjoyed and something I was good at. Presumably, I am still good at it - I don't imagine my skills have dropped that dramatically over a weekend (although my leaving do did kill a few brain cells). It was a rare opportunity to do a job that provided a great sense of achievement by just doing my job. You help people get better, you make a positive difference in their lives and you do something for them that they can't do for themselves. And you get paid pretty well for your time.

By no means is it the magical, beautiful, most wonderful experience in the world my lecturers tried to make me see it as, it has its own bug bears and BS. But leaving it to pursue medicine is something I decided to do with a heavy heart, it meant leaving a family and institution that I had come to know and (occasionally) love. I had to do it, though. I was faced with the choice between nursing for the rest of my working days or taking the plunge and finding out if I could succeed in a field that just fascinated me. I would lie in bed staring at the ceiling, wanting my chance to show I could be a doctor. My time as a nurse made me realise that (in the UK at least) so many of the nursing pathways of care would end with "and then I call the doctor" and that wasn't enough for me. Yes, I know that there are all kinds of roles that extend nursing into the junior doctor's role, but that wasn't what I wanted  - and that too would end with handing the job over to someone else when it got interesting. Medicine for me is the other part of the equation that gives you the answer of how people get better and it is something I hope to be good at.

I know that there are people who will understand why I wanted to make the shift as much as there are people who will never understand why I did, why nursing "wasn't enough" for me. This first post isn't an attempt to apologise for my choice. It was mine to make and I made it. This first post is a statement of intent:

- I will blog the things that stand out in my experiences
- I will use this as an opportunity for reflection when things go wrong
- I will try and make you laugh, cry and sigh with the stuff that I see and do
- I will not forget my nursing training or how important nurses and their knowledge are
- I will not break confidentiality (duh)
- I will occasionally, in times of whimsey, blog about past nursing experiences (It's my blog, so nyah)

And finally, I will go to bed at a reasonable time. Ooops.