Technology - friend or foe?

Medical science these days has a lot of impressive machinery designed to keep people alive and make life easier for personnel. In many cases, it is a modern marvel and really does save lives. And yes, it can certainly make our life easier!

But - have we lost that "nursing sense" in the process of creating, and using, these technological miracles? Do we rely too much on what the screen says, instead of using our own assessment skills, and our very own, highly tuned senses? Have we forgotten about, or ignored, our own intuition because "the machine said so?" What has happened to hands-on nursing? I know I have been worried about a patient before even beginning my obs, and I'm usually right. You can often see just by looking if they are unwell or not - the machines should be used to confirm your suspicions, not just as a routine thing because you have to do obs 4 times a day. Have we taken the "nurse" out of nursing?

A few recent cases spring to mind that make me wonder about all this technology.

A patient with an irregular heart rhythm would always show up as bradycardic on the obs machine, whenever her obs were taken. EVERY TIME. Another nurse initiated a "rapid response" as the heart rate was in the red zone on the chart - those who use SAGO charts will know what I mean. This meant interrupting the doctor at his rooms, meaning he would need to come over to the hospital and assess the patient. Upon palpation, the patient's pulse was of an acceptable rate - its irregularity tricked the machine, as is often the case. The doctor was not impressed. It is also difficult to get accurate blood pressure readings on such patients. One thing I always do is to check any anomalous readings manually - and I notice that not all nurses do this. It's one of the basic things I've been taught along the way, and it surprises me that not everybody does it. Machines are renowned for being inaccurate the further away from normal things are. And besides, if you really want to be sure of something, do it yourself!

Another case was a patient with abdominal pain who was x-rayed, and that x-ray interpreted at the time to show faecal impaction, despite the atypical symptoms and the doctor thinking otherwise. This patient was then subjected to various methods to "get things moving" so to speak, which are not pleasant. The next day when the official report arrived from the radiologist, it described no impaction. It was a normal x-ray. The patient's carer was most upset, as you can imagine. I do not know what the eventual diagnosis was, but they left the hospital most disgruntled about getting two different stories, and being subjected to treatment which really was unnecessary. While this case was a more difficult one to understand without the use of technology, it highlights that once again, intuition is lost to technology, and is not always correct. It is open to interpretation, like everything else.

Have we lost our intuition, and our holistic assessment skills? Surely we can see if things look good or look bad? They spend three years teaching us about critical thinking, judgement and assessment skills, yet once we go out in the field, in many cases this is all forgotten, and the easy route of using the machine rather than our brain takes over. We are still the ones who have to figure out what those numbers mean for our patients, and it's this part of the equation that makes the difference between nurse, and skilled nurse. We can all push a button, but can we all put the pieces together to form the right picture? And can we all gather the RIGHT information to build that picture? I hope so, because people rely on us to get it right.

Are all these machines better than doing it the old-fashioned way? I truly wonder. I'm sure it's possible, on some wards, to get through an entire day without even touching a patient, and that truly scares me.

Old-fashioned respect.....

I always try to treat my patients with respect, no matter who they are or what their story is. Sometimes this is difficult - such as the repeat drunk who comes in regularly in withdrawal, people in police custody etc. These people do create judgemental thoughts on our part, even though we try not to. I had a student placement in a jail, and it made me realise that they are all just people. Sure, they've done the wrong thing, but they are still people. We don't know how they got there, we don't know why the drinker drinks to excess. It does not make them any less worthy of our attention and respect than any other person. In giving them this respect, we hope that we can make a small difference to them. They might not know how to address their issues, and by creating trust and respect we might be able to crack the surface and offer some assistance without it being rejected.

I've noticed a few strange looks from other staff when I address patients by their surname - ie Mrs A, Mr B etc. Part of this is because in a small town, everyone knows everyone, and are often on a first name basis. I've noticed that many of my colleagues seem to know the "business" of a lot of patients, and will make judgement calls based on this. I don't believe this is appropriate, as the hospital environment is a very intimate setting, where the patient is very vulnerable, and what has happened on teh "outside" is generally not relevant to our provision of care. Being from elsewhere, I do not know these people, most of them I've never met before, and so I address them more formally until we are more comfortable with each other. I feel that this is important to create the necessary trust in me - it's a small gesture of respect that gives them the idea that I don't just think of them as "another patient," I see them as a person worthy of my attention, and that they are in control. Another facet is that most of them are older than I am, and I have been raised to respect my elders. I grew up calling adults by their surnames until I was given permission otherwise.

I believe this is also a part of my issues with some of the other nursing staff. Many of my colleagues are of a similar age to my own parents, and I find it extremely difficult to "talk back" to them. While they might be assertive, even aggressive, with me, I simply cannot return it - it's not part of my make up at all. Some of them, I think, have picked up on this and do push the limits of what's acceptable at times. This has been one of the most difficult aspects of working as a new RN - I am now apparently "in charge" of people who are my elders, and have 30 or 40 years nursing experience as ENs. Legally speaking, it's my butt on the line even if they make an error. Yikes. And I seem to get all the paperwork......blergh. But I am pleased to say that there are some wonderful staff who have really helped me out in some tough situations, and my thanks to them.

So please remember this:

Moving forward.....

I imagine my fellow new grads are, like me, beginning to look to their future careers again. It's time to start researching and applying for RN2 programs if you want them, and/or begin to look into where we would like to go in the future. Today I finally submitted my application for a student midwife position for next year, which as my friends know, is the reason I did nursing in the first place. That's not to say that I don't enjoy nursing - I love nursing, but my heart still lies in midwifery.

 This did mean I had to do more darn selection criteria responses, yuck! The things are just awful, I am never sure what to write - it's a fine line between selling yourself well and sounding like you are right up your own arse. And fancy limiting me to 750 words when I can rave on about myself all day! *wink* Writing those criteria answers was tough. I agonised over them for several late nights. I think my uni assignments are easier! But it's done now, my references are on board and I can only wait for the selection process to go through over the next couple of months.

On another note, you probably noticed in my last post how disgruntled I am at times with the culture of the workplace. I will be interested to see what happens when the mid year new grad starts work in a few weeks time. I won't be bottom of the food chain any more, so I am curious to see if they treat her the same way I have been treated. And if they do, I will be the first to step in and at least try to prevent it, or to support her if she needs it. In my experience it's the subtle, almost subliminal stuff that does the most damage, and it is often difficult to recognise, particularly when you are new to something. I have noticed that nurses who came to the facility after me, but with prior RN experience, are treated very differently. I am not going to stoop to that sort of behaviour. I don't need to put other people down to make myself look good. I am always going to be a hardcore nurse - see impactednurse.com for the details. Who's with me?

But on the flipside, I am beginning to be noticed by some of the people that matter, which is the most important thing. Yay. An agency staff member was doing orientation today with management, and asked for me to show her our IV pumps - apparently I am known as the guru of the new IV pumps! I got a chuckle out of that. I'm also often called upon to explain or fix computer "things."  It makes sense though - if it's new or technological, the new grad will know all about it. (Although, I am certainly not Gen Y, so not as technology minded as some of my younger counterparts! Tee hee.) Now all I need is some of those nursing iphone apps........*sneaks off to app store*

"Just a new grad"

I think if I hear that one more time, my head will explode.

A couple of months ago I was talking about how I felt in control and increasing in confidence. This is still true, however I am finding certain aspects difficult to wrap my head around. We are expected to function as part of the team - but what if that team won't accept me? It very much depends on which staff are on - some seem to think I'm capable only of menial tasks like making beds or emptying pans. The things I am "allowed" to do changes with the tide, it seems. Some days I don't know if I'm coming or going! You'd think I got my registration from a Corn Flakes box! The changing standards are frustrating. While these basic tasks are important, yes, and I have no problem with doing them, I am still an RN and capable of the full scope of RN practice. Grad programs are meant to be about developing your practice and consolidating your education, after all. I have even had people turn and walk away when I have asked them to assist me with something. It's like they don't quite know what to do with me, like I'm an inconvenience. There even seems to be a thing among some staff that new grad RNs are automatically lazy and must be hounded to do every shower, bed change and linen bag swap in the place. Anyone who knows me understands that I am definitely NOT lazy!

I have been speaking to some of my colleagues about how I would like to try some other areas, such as theatre and ED. My fellow new grads are now into their second rotation, and yet I am still doing the same thing. I am not unhappy with what I am doing, however being the ambitious soul that I am, I want to experience more. It's what I'm here for. The problem is, many of my colleagues do not agree. The usual response to my discussions is "you're just a new grad." Ah, yes, bottom of the food chain! And I am supposed to integrate into this team?

But seriously folks, what has being a new grad got to do with it? New grads work in EDs, they work in theatres, they work in critical care in many places. Everyone started with no experience in a new area, whether they were an experienced nurse prior to it or not. Even our students work in all areas. The only way to learn is to experience......and the grad program is about learning different aspects of nursing. There are staff ready and willing to have me rostered with them and show me the ropes, yet others continue to block me. I swear that I did more as an AiN, before I graduated! It's most disheartening. I can only look at it as some kind of possessional thing - ie, it's OUR domain and YOU don't belong here. I passed my final practical assessment in a far busier ED than this one, and immediately prior spent 4 weeks doing theatres, so I know I can do the job, and I think I've adapted to rural nursing quite well.

It's no wonder people leave! To be made to feel you aren't good enough, when you are busting your backside to do your best, can really cut deep. Why would you want to be surrounded by people like this? I don't know. But you know what? It's their loss, not mine. I am keen, willing to learn and adapt, full of ideas and VERY ambitious - and if they don't want that, if they want the same old thing, if they want to stagnate, then so be it. What happens when all their "experienced" staff retire? Once the program is finished, I have the choice to stay or go, provided there are positions available. That choice is not yet made of course, but the culture of the workplace is always one of the biggest factors in any job. There are always people you don't get along with, which is to be expected, but to be openly discriminated against is disheartening to say the least. I see it as the biggest barrier to my professional development at present.

Not that everyone is like this, far from it. Most of them are great! The problem is, you remember the bad ones.....and how they made you feel. And it only takes one on a shift.......Although, it was nice to hear that the students prefer to be with me. Apparently I'm a natural teacher, so there you go! (And the person who told me that WAS a teacher, so should know, lol.)

And here's a cartoon to brighten your day :-)

Uh oh, I'm a teacher now?!

Hmm, so I haven't written for a while.......no real reason, just busy as always! Assignments, kids, horses, and working hard of course ;-P

This past week was my first with student RN's buddied up with me. The students were first years, and like sponges, eager to learn and asking lots of questions. I must admit, I think I felt a bit like them - a bit nervous and unsure what to expect! I'm not used to being the teacher - especially when I'm so new at this myself. I hope I didn't lead them down the garden path.......they came back the next day so I couldn't have been too bad. I guess it's just another progression on my path from "baby nurse" to "real nurse."

 I had a very sick patient on that day so I am guilty of forgetting my student was there at times. (Sorry). She was ok though, being first years they were told to "observe" and couldn't really participate in a lot. They were there to experience what we do. My first year placement I was allowed to do oral medications (under supervision), whereas these students don't do meds until second year. I was surprised that they did not know what S8 meds were or about the "locked cupboard" though. Different uni, so I guess they all do things a bit differently. Still, it must be so frustrating to just "watch" all the time and not participate. I know when I had mentors on placement that made me just watch, it irritated me no end!I wanted to DO stuff!

I must say though, it was actually nice to have a one on one patient. Even though she was so ill and took most of my focus the entire time, it was good to be able to concentrate on only her, and not have to think about the 15 or so others in the ward as well - one of the pitfalls of team nursing that I have found is trying to keep track of everyone, patients and staff! It's hard to remember what everybody needs done, and then keep up with the other nurses to figure out who's done (or not done) what for them. But I have to admit, doing meds for the entire ward has certainly improved my knowledge of medications! And my ability to decipher the special heiroglyphics the doctor's use on the chart - oh wait, that's called handwriting? Who knew?! ;-P

Just what is on our shoulders.......

Thinking about a post on impactEDnurse.com made me wonder - do people really understand what it is a nurse does, and what the implications of our job are? Do they see us as bum-wipers and vomit-catchers, or do they see us a the professionals we would like them to see? Do today's nurses display the professionalism expected of us? Do we still appear to be the "doctor's handmaiden" or are we showing the world that we are a profession of our own?

Some days I wonder.

I handed over recently that a particular patient would need to be turned later in the night. The other nurse replied "oh, he can turn himself." This shocked me a bit. The reason the patient was there was because he was unwell (der!) and to be judged as able to turn himself, without this nurse ever laying eyes on him, is completely unprofessional. If he were to develop a pressure area, where would this nurse stand if she had not turned him - and documented that he'd been turned? Not to mention the pain that may be caused by staying in one position for too long.

We had an awful arrest just last night, which will be a Coroner's death, and probably the first that actually shook me up a bit. While it's very sad, foremost in our minds now, is thinking back over things and wondering if we did everything right. A mistake could mean a visit to the Tribunal, de-registration.....or worse. A split second decision can mean far more than a simple correction in the notes! An accountant makes a mistake, he can just recalculate and it's fixed. A nurse makes a mistake - someone may die, and that nurse's life will be forever impacted by that mistake - not to mention the family of the deceased.

It's appropriate that the last 2 days I've had a student EN with me and was talking about documentation (and therefore covering your own butt!) with her. Sometimes it takes something like last night to bring it home to students and new grads just what their registration means, and how easily it can be lost.

 How nice it would be if nurses could "just nurse" - without all the complications! But then, I think we'd still have the same attitudes, the same bullying, and the same doubtful practices we see now - probably worse. Accountability is here to stay, for good reason, but boy does it complicate things! And really what does "just nurse" actually mean?

How to educate the public on a modern nurse's role? I have no idea. But every one of us must remember that to be accepted as more than "handmaidens," we need to be people of integrity, showing professionalism in all that we do, showing the world that we do possess knowledge of our own, can think independently, and be responsible for ourselves.

But don't forget the basic, fundamental nursing care along the way. It's the little things that make the difference between a nurse and a GREAT nurse - the one the patients remember long after they go home.

Slowly but surely.....

So it's now 2 months down the track......and I think I am starting to get the hang of things. It took a flat out, scary day such as today to tell me that yes, I do know what I'm doing, and I think the trust in me from both myself and others is increasing.

Today was just flat out. We are on "critical beds" - in other words, there is not an empty bed in the place. We are full. I spent most of my shift looking after a very sick patient in our High Dependency room - something I could not have imagined doing just a few short weeks ago. I'd been told on my first day or two that I wouldn't have to look after that room yet, so it was a bit daunting to say the least. Add to that, the patient's family were getting rather upset that he hadn't been transferred out despite our best efforts. I wish I could just send them all where they needed to be immediately, but unfortunately we cannot create beds out of thin air, even in major hospitals! Not even for private patients - I'm sorry people but a private health fund doesn't give you preferential care, it's still on a needs basis. The sickest people are seen first, that's how it works.

The other RN, being the midwife, spent the entire shift in maternity as it was also full and there was a lady in labour, so here was I, thrust into a full on RN role whether I liked it or not. The buck stopped with me - I had to look after this very sick patient, plus the other 20-odd patients with the help of the EN (who was wonderful I must say!). We called in another RN to help, but even so, it really was flat out. It seemed that every time I went to do something, someone would ask me a question, or need S8 drugs from the locked cupboard, or need their IV antibiotics, or their cannula was leaking - those small but necessary tasks designed to divert your attention!

Last week was one of those weeks where I doubted my ability to do this job. Just a lot of niggly little things, where it seemed that nothing was ever easy, lots of those days that erode your confidence without you even noticing. Today freaked me out when I realised what was on my shoulders. But the only thing to do is get your head down and bum up and do the job you trained for - and remember that you are only human and must prioritise your tasks. A patient won't be really inconvenienced if they miss out on a shower today, but if you miss their pain relief, that's a problem. There were some hiccups during the day, but overall it went well, despite our limitations! The hardest part was not letting the sick patient's family see how nervous I was in that room. I think I should be nominated for an Oscar after that performance!

Pic: Ambulance Service of NSW

My sick patient was successfully transferred to the major tertiary centre via air ambulance at the end of the shift, and was also the first transfer I handled completely myself. I spent the whole shift freaking out that if something went wrong with this person, I would not know what to do, so the paranoia is not gone yet, but today has certainly proven to me that I can do this job. Whether my resolve stays this certain tomorrow, who knows!

One of them days.....

I often get asked how I deal with the death of a patient. In all honesty, I can't tell you. I just deal with it and move on, I don't do anything in particular. You do sometimes get staff asking if you're ok, but interestingly, recent research has shown that a formal debrief is not helpful, and I've never felt the need for one.

If I've been looking after the patient for a while, especially with lots of family involvement, I do allow myself to get teary. I'm still human after all! I'll even give the family a hug, and let them know by that simple action that I understand, and that I am there to support them through their grief. If necessary, I'll take 5 minutes to myself to process, then it's back to it. It's just part of the territory, and everyone reacts differently.

Having worked in aged care, death has not been a new thing to deal with in this new role. But days like today do test the resolve of anyone. To lose three in one day is rough - no other way to put it - following on from one on the last shift too. It's very emotionally draining. None were unexpected, but it doesn't make it any easier.

It also disturbs your whole plan for the shift. I don't mean this to be selfish or disrespectful, but even one death puts your whole day off, as you have tasks to do with the deceased, not to mention looking out for the family - and they may often spend a good deal of time coming and going to pay their respects. It makes time management difficult, and you often feel like you've been running around all shift with the weight of the world on your shoulders, and the physical tiredness adds to the emotional drain.

Another not so nice thing to have to deal with is bed block. You still have an occupied room that may be desperately needed by someone else. This hasn't happened in this country setting, but with the pressure on hospital beds these days, you can bet there are places who need that person to leave ASAP. Imagine being told you have to leave because someone else is coming in ..........ugh. Awful. I hope I never have to deliver THAT particular piece of news.

I do not regret my choice of career, but boy, there are some really tough days, that's for sure!

The hierarchy issue

Those in the business will understand how a new Registered Nurse can be (legally speaking) higher in the hierarchy than an Enrolled Nurse of 20 or 30 years experience. This is an interesting phenomenon, and one that takes a while to get your head around when you first start. We are used to learning from EN's while on placement, and even as a New Grad, they are a brilliant source of information.

But EN's report to RN's. That's how it works. Time in the job doesn't matter in this instance. While we may still listen to the EN's, and ask their advice or help with something, the ultimate responsibility rests with the RN.

If an EN notices, for example, a patient's obs are in the yellow zone - they go to the RN. In other words, me. Then I get to make the decision on how to proceed. Usually this means reviewing the patient, making a note of the issue, and re-checking the anomalous reading in half an hour or so. I may initiate interventions, such as pain relief, or back to bed for a while, or withhold/give medications. Sometimes it means a phone call to the treating Doctor. Whatever the decision, it is mine to make.

This has caused me some anxiety, as most of the time, the EN will clearly know what to do (and usually do it), and reporting to the RN is just a formality. I may not necessarily know what to do. I'm still a little afraid of getting something really wrong - which I know is silly as there are plenty of experienced staff to help me. I haven't made a wrong decision yet, but it weighs heavily on my mind that a little error or omission on my part could end in disaster for somebody - and then I am up before the Tribunal.

Because the EN has reported to me (and documented this) it then falls on my head. Even if I report to the doctor and they decide not to do anything, it still falls on me, as the RN is the one there with the patient, and it is my job to give the right information for the doctor to make their decision - if I miss something important, it's my fault. If something goes wrong, I am the first line of intervention for that patient. Equally, if I choose not to inform the doctor, it rests with me. Even if I asked the EN for advice and followed it, it's my decision in the eyes of the Coroner.

There are days when I do not think I am cut out for this. It's bloody scary! So much rests on everything we do, and the only person who will protect my registration (and therefore my career) is me. Nobody else - as they will be protecting their own butt. It's a tough lesson to learn, but in health care in today's society, it's every man for himself. We may work as a team, but everyone is always protecting themselves. They have to.

My advice? Something given to me on one of my first days. Whenever you do anything, no matter how innocuous it seems, document. Don't wait for the end of the shift, you'll forget something. And when you do document, imagine the Coroner is reading it. Keep that foremost in your mind - yes, it is frightening, but it sure helps keep my mind on the job!

Mmm....chocolate!

Nurses get a lot of chocolate! At least, they do in our hospital! Not a day goes by without a box of chocolates arriving from a grateful patient.....it's a wonder my arse isn't as wide as the state of NSW by now. Naturally I end up sitting closest to the box and everyone knows I have zero willpower when it comes to chocolate......

So when a big fruit basket arrived, we all thought it was such a lovely gift.....(and perhaps the patient's family who sent it thought the nurses were fat enough? Nah, they own the local fruit shop!) We naturally searched further and what did we find? Chocolates hidden at the back! Aaaaaahh..........

So to all the patients out there - yes we LOVE our chocolate! It's about the only gift we are actually allowed to accept :-) Although a nicely worded letter telling everyone what a wonderful nurse I am would go down well too ;-P

Now, for some comedic relief......

In our hospital, on a busy day, once a bed is stripped, it's left for the porter cleaner to remake. Imagine the sight of a big burly bloke, who has never made a bed before, trying to wrestle our tiny little sheets over a big air mattress........classic!

I was reading about bullying in nursing, and came across this blog by Phil Baumann on Health is Social. It hits in on the head, for me anyway. Some people take nursing, and themselves, far too seriously.

Most of us have heard the term "nurses eat their young," and it's a rare student or graduate that hasn't experienced it at some point. I certainly have! And on the other hand, you often see nurses joking and laughing at work, which some people see as inappropriate. Many people believe that nurses need to be "serious" as nursing is a "serious" business.

Without a sense of humour, a nurse would quickly become sour. I could not do this without being able to share a laugh or joke with my colleagues. You certainly cannot make jokes about a patient or their condition, as this would be completely inappropriate, but to have a laugh with your colleagues is, in my humble opinion, imperative to keeping your sanity in a tough profession. Many patients also like having a laugh with you, although you do need to remember that you are representing your employer, and nursing as a profession, when you interact with your patients. Keep it appropriate!

As Phil says, being "serious" is not the same as being "responsible," and it is the latter that is important for nurses. Being serious is emotional and personal - being responsible is to do with assessing, understanding, and taking the right actions. Serious = create anger and blame, responsible = find a solution.

I brought this up because I too am experiencing bullying. Not just at myself, but at a patient. And this is totally unacceptable and unprofessional. I'm not going to relate the entire incident, but would just like to say that a patient's comfort is always of high priority in nursing care. Just because the nurse thinks something should, or should not, be done, is not the key here - if the patient requests something in their own care plan (that is not unreasonable) and is documented to be done, then it should be done. One nurse does not have the authority to arbitrarily change something and then tell the patient that too bad, this is how it is. Consultation and respect are required, especially when the patient clearly tells you that changing things would make them uncomfortable. To not be allowed to speak on their own behalf is belittling! In this instance, the current regime was working, however the nurse wanted to change the care plan. They felt that the current strategy was impairing healing, however to do so would cause discomfort and distress to the patient. While it may have been of better clinical value, the stress and discomfort caused may well negate that value. The patient clearly made their wishes known at all times.

Never forget your patient (or your colleague, or your student) is a person. They have feelings too.

And don't take yourself too seriously. :-)

Found my bogie....literally!

Every nurse has that one body fluid that they can't handle. I've discovered mine. I have suspected it for a long time, but it's now official - this nurse cannot handle sputum! Hearing a patient with a big productive cough, then hoiking it up and spitting it out makes me gag. And then, sometimes, they'll pass you the tissue to get rid of.......or worse, a specimen jar where you can see it!!!!! YUCK!!!!! I find nothing worse than someone sitting in an emergency waiting room, coughing all over everyone and not even bothering to cover their mouth. Way to spread your germs people!

You can give me profuse diarrhoea, projectile vomit, pee all over the floor......just keep the big wet coughs away from me! (Unless it's a kid - for some reason I can handle paediatric sputum, but not adult. Meh.)  And do not EVER think of giving me a patient with a tracheostomy to look after - NO WAY. I think I would faint if I had to suction a trachy. Ew. Somehow I don't see myself ever working in a respiratory ward! ;-)

Time Management
One of the biggest things a newly graduated nurse may find difficult is time management. You can always get help with a skill if you're unsure, but managing your patients and their priorities is yours, and yours alone. Just how do you decide what is more or less important?

I've found that the team nursing environment here makes that a little more challenging. With allocated patients, I found it a simple matter of using a grid on paper to note down what needed doing at a particular time, such as medications, then fitting in other tasks in the gaps, and this worked well. I knew what needed doing, and when it needed doing. I'd need to think about what had to be done, what should be done, and what would be nice to get done if I had the time. Sometimes I'd need help deciding the priorities, but I was usually pretty close.

So do we give this now or later?

Here however, everybody looks after everybody, so it is a bit different - sometimes I can plan to do something and find it already done, or someone else may say they are going to do something but not end up doing so, for whatever reason. I find we constantly refer to the in-charge, and to the others on duty to figure out who's done what, and what else needs doing. Sometimes the ED nurses will come up and help too, if they are having a quiet day, adding just a little more confusion! There are some nurses who like to get out of doing certain things, and leave some jobs for everyone else, so that also has to be factored in. Some in-charge nurses are very proactive and set the tasks (as well as check up on what's been done), others are more relaxed and let you do your own thing. Sometimes it's tricky if the in-charge is the midwife and she is attending a birth the whole shift - but you find a way around it.

I guess as I get to know everyone's quirks I will be able to plan more effectively. I don't think I'm doing a particularly poor job though, I always seem to get everything done. I know a lot of student nurses read the blog, so my only real advice for you is to never be afraid to ask for help! You soon get into the swing of things, and only time in the job can really give you the insight to "know" what comes next. Make sure you jump in to do things at every opportunity - don't be a wallflower, even if it's a really bad arrest. The only way to learn is to "do" so make sure you "do" whenever you can! You might not know immediately what needs to be done, but even just being the scribe or the gopher makes everyone's job easier, and gives you a bit more experience that you might have otherwise have missed out on.

Town mouse, country mouse......

It's interesting to see the difference between nursing in a big hospital and a small country one. Separate wards for each specialty, critical care units, doctors on the ward 24/7, specialists in abundance, all the major services nearby, on-site pharmacy, and access to plenty of staff, plus good education makes the city hospital a fine place. The country hospital looks like the poor cousin in comparison - no doctor (of any kind) on site, one ward which takes all comers, no pharmacy on site, very limited radiography services, and the list goes on. Most of the nurses tend to be locals who've worked there for 20 plus years, with a few younger/newer ones thrown in. Resources are stretched really thin.

But for this nurse, it's a great place to be. My fellow graduates in the big hospitals may have all the luxuries and expertise available to them, but they are limited to the specialty of their current rotation. If you're in orthopaedic, you do only orthopaedic. If you're in renal, you do only renal. If you have your heart set on a specialty, then that's fantastic for you. I, on the other hand, in only 3 weeks, have taken part in "general" nursing (including pre- and post-op), palliative care, high dependency, and paediatric nursing, as well as the odd assistance to the midwives with maternity patients. It's exciting, but boy can it be scary at times!

Nurses here are "jack of all trades" and they truly have to be. The scope of practice is so much broader, and the nurse is often the real decision maker. On the flipside though, is the greater accountability. With more responsibility in terms of scope of practice, comes more responsibility in terms of your own actions.

It's very interesting to note the differences. It's something I'm definitely still adjusting to! Sometimes, with the lack of resources, you have to be a bit creative in your thinking, since not everything is available immediately as it is in a big hospital. But that's all part of the challenge that is rural nursing.

Why me?!

As if it wasn't hard enough to learn and adapt to this new role - it's just been one of those dreadful days where nothing went right! It started off so well......nice and quiet, and with the NUM on the floor so I could ask questions and practice plenty of skills! However, the ward went from really quiet to full on busy in the space of about an hour, and somehow it was my fault that everyone turned up and the in-charge didn't know who was going where.

Now I don't mind getting in trouble when I have done something wrong, it's how you learn, but what I am finding frustrating is that somebody will explain something to me, so I'll do it, but then I get dressed down by someone else for doing it that way! Or, even more irritating, nobody will own up to something and it's automatically assumed that the new grad did it. (Such as accepting patients!) Or sometimes they expect me to know something and if I don't, I get the old "why don't you know that" spiel. Aaargh. It felt like everyone wanted a piece of me today - and as I am still learning, and in a completely unfamiliar facility, I often have to rely on them to show me the way. I will admit I wanted to just run out of there and hide today! However, I will also, in fairness, say that it is only the minority of people, as most of them are so willing and accommodating, but you know what they say....one bad egg.......

We all know that nurses are there to help people. But how far does that extend? When do you draw the line between "helping" someone and pandering to their every whim? None of us want to be a "helicopter" nurse, especially for a fully grown adult patient who can, and should, do as much for themselves as possible - and quite frankly, we don't have time for it. I have no problem with assisting people who really need it, but there are some patients who just push it too far. Some of these patients know they are doing so, and others don't.  And on a flat out, busy day, these are not the type of patients you really want to have taking up your precious time.

One in particular springs to mind, and though I can't go into detail, let's just say they had a problem on the lower half of their body, but there was nothing wrong with their HANDS!

This patient was on IV antibiotics, which were given at the same time each day, as you do. As they had constantly complained of pain at the IV sites (which were changed at the correct intervals and monitored every shift), we ran the antibiotics over an hour instead of 30 minutes to try to avoid irritating the vein too much. As I entered the room to set up the IV, the patient's mother informed me "they haven't had a shower and needs the toilet." The patient complained about having an IV running for an hour so they "couldn't do anything for themselves." Well, they'd been lying there for a few hours with only a capped IV cannula, plenty of time to do those things! Mother then complained that nobody had helped with lunch. This person (in their 20's) even expected somebody to put the soap (soft soap from a dispenser) on a washer while they stood there and showered! 45 minutes later, I was able to connect the IV line.

Now, seriously, how far does nursing care extend for a fully ambulant, young and fit patient? I don't think doing everything for this patient is in their best interests - what will happen when the time comes to go home and there are no nurses to do their bidding? As I said before, there is nothing wrong with their hands! Pain relief had been given which the patient stated gave good effect, so with the pain issue out of the way, there was really nothing that I was aware of that stopped them doing things for themself. They could quite easily get up and go for a walk, visit the loo, or whatever took their fancy, even with the IV pump!


I realise this post sounds a bit judgemental, which is something we are trained to avoid. But just where do you draw the line between helping someone and being taken advantage of? We do not have time to do every little thing for everyone. It just isn't possible.

And now it begins....

Supernumerary time is over. I am now expected to function as a fully fledged RN. This is scary! I knew there would be some transitional problems, and I've found them! So for the moment, RN means (for me) Really Nervous! :-P

My first medication round on my own was sloooooow! As the doctors here use brand names on their charts, I spent a good deal of time looking up the MIMS to find out what each drug was! This is good practice anyway, but to find some that I knew already, just under a different name is frustrating! And being a country hospital with no pharmacy, finding nil stock was more than frustrating.......however, they teach us to problem solve and that is what I did! "Oral" doesn't always have to be a tablet! And PO can be substituted for PR, right? ;-)

IV drugs are a little different. They, well, not scare me exactly, but make me more than a little nervous. Putting something straight into someone's bloodstream is not exactly an every day task for most people, and can have disastrous consequences if something is amiss. Even after the second RN checked, I think I re-checked every drug about a million times, and it felt odd to not have someone over my shoulder as I administered the medication. I'm paranoid about making a mistake without a mentor over my shoulder to give me instructions! This is probably a good thing, as complacency has no place in a hospital, especially in today's society. I know time in the job will increase my confidence, but I feel like I'm just keeping my head above water right now!

Something else I have found strange is writing notes. Prior to this, I have written as a student nurse and an AiN, and had an RN to counter-sign. But to write those two letters, R and N, after my signature feels quite odd. They aren't just a couple of letters you can just add on once you graduate. They mean far more - writing "RN" after your name implies an enormous responsibility, and accountability for your own actions. Its not just a job - you are dealing with people's lives and wellbeing every day, and one small mistake can snowball into something nobody wants to think about.........

No wonder I feel a little nervous!

Hoorah Hoorah Hoorah!!!!

Just a quick post today - after all the frustration, I am finally REGISTERED!!!! Although according to the website it doesn't start until Monday.......but it's there and I have a registration number! So now when the keys are tossed my way, I can actually catch them..... ;-P

The garbage problem.....

Ok, so you're used to this recycling thing right? Two bins, one for rubbish, one for recyclables. So what is THIS?!?!?!?!

(Ok, sorry about the sideways picture, I have no idea why it did that, and I'm too tired to fix it right now.) But what's with the THREE bins?! Thankfully it is written on the lids - red for rubbish, yellow for cans, jars and bottles, blue for paper products. It certainly threw me a curve ball there for a while! Now I just have to train the rest of the family in proper recycling separation techniques, and recycling receptacle roadside placement, and all will be well. I wonder if there's an evidence base to guide me? ;-P

Then there's the phone lines that were chewed apart by the former tenant's dog........but that's another story! And we won't get started on the Austar installation-that-was-meant-to-happen-but-didn't either......oh the joys of moving!

Ok this one's upside down!!!! What the? Anyway, here's the cat "helping" me pack the dishes away - I probably shouldn't put this up as we have an outside pets lease and I wouldn't want to get evicted after less than a fortnight.......but it was too cute not to! Just stand on your head to see it properly. ;-P

Today was another of those 100km drives for an education day. Of course, somebody forgot to book me a car.......so I was left standing forlornly in the carpark for a bit! However, the country "network" kicked in and one of the cars came back to get me so all was well. Love helpful country people! A little stressful at the time, but as with most situations, it's now rather amusing! We'll just find someone to blame who is on holidays ;-) (Joke, people, that's a joke.)

The drama with the registration board continues, although apparently by tomorrow morning my name will appear on the Register of Practitioners. We shall see. After numerous attempts at emailing (as the recorded phone message tells you to call back later as they are too busy) with only an auto-responder reply, I decided to brave the phone again. Several times I was put on hold and then promptly hung up on. As you can imagine, I was not impressed by this at all! It's downright rude. Anyway, to cut a long story short, I finally got through to someone, an actual person! Wow. They first of all asked me why I hadn't called earlier (don't go there!) and then told me my application had not been assessed yet. NOT BEEN ASSESSED?!?!?!?!?! When they took my money two months ago and told me it was being assessed?! It took all my self control not to explode at the poor girl on the other end of the phone. Then she tells me they are processing applications in order of employment start date - a completely transparent story, obviously designed in an attempt to placate all the angry graduates! The board does not know our start dates, they do not know the facility we work in, so that isn't even possible. I also know of graduates, yet to start work, who are already registered. The next excuse was that they only received confirmation from the university today - another obvious fabrication as I also chased the university to send my paperwork in a hurry! I really didn't want excuses, I just wanted to know what was going on so I can be paid properly and do the job I trained for! I can tell you, I'll be checking the Board's website every hour tomorrow! The other issue with all this, is that I can't be accepted into my post-grad course until my registration goes through - so my plans are really getting messed up right now!

Registration issues aside though, I am enjoying things so far. It's a very different world to the one I trained in, and there are so many things to get my head around, but every staff member has been so supportive and helpful - so I haven't felt too lost. Three deaths in the first fortnight has been a bit heavy, but it goes with the territory I'm afraid. Most of the senior members of staff have asked me if I am all right after a big arrest the other night, and this has been a surprise! Not that other places don't offer you a debrief - but to have several people approach and see how I was doing is a new experience for me. Just shows the different culture here, and it's great.

Oh, and yes, I am fine, it was not my first arrest, and I am savvy enough to realise it's all part of the territory. So you needn't worry about that, there will be plenty more blog posts to entertain you. :-)

Well the first week is over and I survived it! 40 degree temperatures, and aircon that is, to put it nicely, "ineffective." Although, in this heatwave, I don't think there are many aircons that are going to work well!

The frustration with registration continues - I am still not registered and therefore still not able to receive the RN wage, plus I can only work within the scope of an AiN. Which means that everything I do, I have to stop and think "am I allowed to do this?" In many cases, the answer is no, and I am finding it difficult to be a part of the team when I am constantly second-guessing myself in this way. The team here is fantastic - all helpful and accommodating, and it's very lucky I am supernumerary at present otherwise they might all be feeling as annoyed as I am! The scope of practice for an RN is very different here, when compared to a tertiary or referral hospital, and I am really keen to get in there and start doing things. Aaaargh! I did everything asked by the new Board - I sent in my pre-registration in November, they charged my credit card in mid-December, and emailed me a couple of weeks ago to tell me my registration was being processed - but still nothing. So they'll gladly take your money but not provide the service. Typical. Imagine what it will be like in May when everyone Australia-wide (including us new grads!) renews their registration! Yikes. There is another nurse here who sent in her renewal in December and is also still waiting.

 In other news......this week also included some testing moments for me. The week closed with my first death in this facility. Having worked in aged care, deaths are not new to me, plus I experienced plenty on my placements. This was a new experience though, as being a country town, everybody knows everybody. As it's a team nursing environment, all the nurses were involved, and the support given to the family was fantastic. I think there were more nurses than family in the room for a while! Things are not so fast-paced, so you have the time to give people attention, and when you have a death, or the patient is close to it, no matter where, you go from caring for one patient to caring for a patient PLUS a family, and it's never easy. It's probably the hardest part of the job. To complicate this one, down in the other end of the ward were two patients who were neighbours of the patient who passed, and kept asking about him. Naturally confidentiality does not allow staff to discuss other patients, but it was tricky trying to keep them from running up to see what was going on.

It made me think about the small town issue though. I imagine there will be times when nurses here will have to care for their own acquaintances and perhaps family to some extent, and probably care for them when they pass. It's not as simple as in a big hospital where you tell the NUM you know someone and they just assign you elsewhere. Obviously with team nursing you can avoid them as much as possible, but the patient or their family is going to seek out that familiar face and there will be a time they will find you.........what to do then? And out in the community, people will know you're a nurse and ask for advice. An interesting year awaits me for sure!

I've also never encountered the bedside handover before. I'm still in two minds about it. I like the idea of including the patient, but I worry about the confidentiality issues it brings up. I think it is easier to give a proper handover when you are standing there, as you have the patient there to jog your memory of what occurred on that shift, rather than just a sheet of paper with their name. But you also have another patient in the next bed listening to every word you say...........and I don't think I'd like people discussing something embarrassing for all to hear! There may also be visitors present, so you may have half a dozen people listening to how your haemorrhoids were treated today! Hmmm. The curtain is not a wall, although we often think that it is. I've noticed that some of the nurses here are less than fastidious about patient privacy - which was one of the only things picked up on in my final assessment, so remains something I am rather picky about. But being the new kid on the block, it is not the time for me to jump in and tell people that I don't like how they do things - all that would achieve would be alienation and a tough year for me. But I can remember, and reflect on things, and improve my own practice - because the only person who will protect my registration is me.

The culture shock hasn't been too bad though, not yet anyway, and everyone has made me feel welcome and helped me out immensely when I was a bit lost. I have another week of supernumerary time, and competency assessments, and then I am on my own, but with a great team to support and teach me along the way.

You know you're in the country when.......

.......you go to the toilet and there are half a dozen crickets in there! And I mean IN THE BOWL!!!! Won't they get a surprise! I hope they can swim. (And avoid missiles from above!)

So yes, today was the first day of the rest of my life. Not a very exciting one though, I must admit. I started by driving 100km, and discovered I had misjudged the time it old take to get there by about half an hour. Whoops. So I sat around for a while - ha, you thought I was late didn't you?! Then the excitement begins - orientation is filled with paperwork, computer work, more computer work, some computer work for good measure, and oh, did I mention computer work? And tomorrow will be just as thrilling. I don't really mind it, but it just makes for a long day.

Then I walked out into this wall of heat. I've forgotten just how hot it can get up here. Although, I don't find it unbearable, probably because it's dry, and I'm used to humidity. Luckily the ute has good air conditioning! It does not, however, fit under the carport in the nurse's quarters! I realised there may be a problem when I saw the height of the roof, so cautiously backed the tray under, then got out for a look......well, maybe if I took off the roofracks......but it's too bloody hot to be fiddling around with them. And besides, I'd have to put them back on again! So I just parked it in the driveway (out of the way) instead. I hope I'm allowed to.  I'm only here for one night, so if I get in trouble, I can just play the innocent visitor card and all will be well. :-)

Oh yes.......if you really want to know - Miss Honey did get on the float yesterday, although she did leave me a lovely gooey, slippery, smelly mess inside it as revenge. Who'd have horses, huh?!

Tomorrow's the day!

Well, folks, tomorrow is the big day, the day where I leave my old life behind. I've been trying to put the final touches on the house, pack bags and boxes, sort out what I need to take with me, plus had numerous people invade to pick up their ebay purchases! (Why do they all think that everything they see at my house is for sale?) My stomach has been doing backflips a fair whack of it too. I also had to drop my husband and some mates off to his farewell - now how is it that HE manages to have a night out with mates and I don't even get a piddly little card from someone? YEAH, THANKS FRIENDS!!!!!! I'm sure you'll all miss me just soooo much. </sarcasm>

I guess it's not really surprising, I've always been a bit of a loner. I do make friends, but very few close friends, (except the four legged kind). I've never really been the type to be "in the club" so to speak. My friends went out to nightclubs - I went riding then home to a Star Trek video or a good book. (I promise I'm not a complete nerd, really!) I'm sure my parents will tell you I have always tended to do my own thing.......this worries me a bit though, with moving to a new place. I'm sure I will make friends, but will I really fit in? Only time will tell. If nothing else, the country life will provide an opportunity to spend time with my beautiful children, and for them to try out different things.

First things first though - the immediate problem is whether the horse will get on the float! She flatly refused on Wednesday, so I suspect it'll take some time to convince her that this white monster is not going to swallow her up, never to be seen again. I'm allowing plenty of time just in case........I'm sure Miss Honey will know that she just HAS to go in tomorrow and will refuse accordingly. If it was just floating practice, she'd go right in. It's Murphy's Law of course!

So here's hoping it all goes well. See you all in 400km - when I've finally begun my new life as a REAL NURSE!

Well here I go......

Well it's a week to go until I start my New Grad job.....and things are far from settled!

I'm moving my family to a new town, where we know nobody - no family, no friends, nothing! I don't know how my husband will adapt to the country life, only time will tell on that one. I'm more interested to see how he enjoys being the stay-at-home parent.....now that is going to be the real tester! He's quite keen on the idea, and I can't wait to say "I told you so" when things might not go as he planned! Although with our eldest starting school, I rather think he'll have it just a smidge easier than the past couple of years have been for me.

Our house isn't sold and the bank won't give us a loan, due to an incompetent so-called "home loan specialist" (but that's another story) so we are going to be living in a rented house the size of a shoebox, at least for a while. But it's a roof over our head I suppose. Rentals are at a premium due to the mines in the area, so I guess I shouldn't complain too much......but I will, because it makes me feel better momentarily! It's a big move, with 3 kids, a dog, 3 cats, 3 horses and a load of furniture that will not fit in our new, teeny tiny house! Which, I might add, has no garage or shed to store it all in. Oh, fun.

Oh, and there's the small fact that we don't get the keys until the day after I start my job......and I will be 100km away doing orientation! Minor detail.......but I have got the power, phone and all-important Austar sorted! This leaves my husband to do the loading of the truck on his own while his mother babysits the kids, then we'll have to unload it together after work one day, and he gets to drive back in the truck to return it, pick up the kids and bring them up! I know somebody who is going to be very sick of driving! Not that I escape - I have 2 trips to Tamworth and back to deliver my horses to their temporary home - and it's going to be 42 degrees!

I am still waiting on my registration as a nurse. There was a stuff up with my grades coming through from the university, and while that has been fixed, I am still waiting! Those who know me personally will understand my frustration at "all things university," so this new problem is just another in a loooooooong string of events. And, while the new national nurses' board has charged my credit card, they are yet to actually register me. It's the same in so many things.....happy to take your money, but provide the actual service? Well, maybe next week..........I mean, it's not like they are moving 400km away and spending thousands to take up a new job, are they? I made the effort to send in my pre-registration so it was easier for them, surely it can't be that difficult to look at my results and see that I passed? (With a GPA of well over 5 I might add!)

But I am pleased that I have been accepted into the graduate entry Bachelor of Midwifery. After all the dramas this year with the cancellation of the GradDip, I looked further afield, and found a great program at a new university. I've always wanted to be a midwife, it's why I did nursing (as a stepping stone) to begin with. I enjoy nursing as well, but my passion lies in midwifery. So in addition to new town, new job, and new life, it will be new university and further study as well!

Am I mad? Perhaps, just a little. Am I stressed? You bet!

But am I excited to begin this new chapter in my life? Absolutely. In a month's time, we'll be sitting in our teeny tiny shoebox home, drinking whatever alcoholic beverage the budget allows, wondering what all the fuss was about. And I will be a REAL NURSE. Now that is a scary thought. :-)