Humility

I hadn't expected to find being a qualified nurse so different from being a student nurse.  But as well as qualifying, I also moved hospital; and so many things are done differently at this hospital to the ones I trained at (often done in a better way, too).  

These past six weeks have been an exercise in humility as I have had to re-learn how to do some of the simplest things that I assumed I'd already mastered as a student:

• a new type of catheter bag that empties with a tap not a valve;
• beds that have completely different controls (and that work reliably, unlike the ones at my last hospital);
• a macerator rather than a bedpan washer (infinitely nicer and more hygienic);
• completely different cardiac montitors that have integrated ECG machines - no more going hunting for a portable ECG machine, wheeling it back to your patient, plugging it in, connecting it all up and then finding that it has run out of paper - here I just press 'print' on the monitor;
• a whole different system of ordering food for my patients;
• completely new prescription charts, fluid charts, nursing notes and observation charts;
• wound dressings that I've never come across before;
• cleaning everything with old-fashioned chlorinated water, rather than anti-bac wipes. 

My new colleagues have been so friendly and supportive.  It didn't take me long to feel a part of the team.  However, I still do a double-take when I catch sight of myself in the mirror and I am wearing the royal blue scrubs of a Staff Nurse, not the grubby white tunic of a student.  Sometimes I feel like a capable, qualified nurse, and sometimes I don't.  Sometimes I know what to do and sometimes I don't.  I work much more slowly than the other nurses, and that is another lesson in humility, because in order to be safe, I have to ask for help more often than others.

I have at least one moment in every shift where something suddenly happens, an alarm goes off, my patient deteriorates, and I mentally shriek to myself "Fuuuuucccckkkk!!!".  But either it is something I can quickly fix myself, or I need to call for help and another nurse is by my side in moments showing me what to do.  I learn more each day than I ever thought possible.

And that's the joy in this new job.  Intensive Care is a stressful place to work, but its also so very interesting and fulfilling.  Patients are at their most vulnerable and at their most sick, and it is deeply satisfying to be able to nurse them one-on-one and give them really good quality care for thirteen hours at a time.  I am using my brain as well as my heart, and I love that.

10 things

• About a month ago I realised that working as a nurse feels completely normal now, rather than strange and new.  This is A Very Good Thing, as it means I no longer feel overwhelmed, but I still retain my excitement and enthusiasm.

• I have just nine shifts left as a student.

• I am making time to run, although I am starting to realise that I can't always go running exactly when I want.  Such is life though - anyone working or looking after children, or both, has the same problem.
• Yesterday, when the coach at my running club said that our session for the evening was "Chats", I assumed that this meant running and chatting.  So I set off, cheerfully chatting to the person next to me.  It turns out that "Chats" is actually a loop of over 8km, which includes the long Chatsworth Road in Hackney.  And it also turns out that the lady I had started chatting to is very experienced, races competitively most weekends, and runs at a much speedier pace than me.  My good manners and sense of pride meant that I couldn't bear to either stop chatting or drop away from her, so I ended up running over 8k at my 5k pace, whilst discussing analytics methodology in the publishing industry.  An amazing achievement.
• I bought some new lunchboxes from Lakeland.  This yogurt-and-granola pot is my favourite, and means I can quickly re-fuel with much needed carbs during my 15 breakfast break at work.  Plus, how cute is the tiny honey pot?

• Cam is in Year 10, and has test after test at school at the moment.  Some of them are progress tests and some of them are official GCSE assessments.  He's characteristically laid-back about it all, but it strikes me as being pretty relentless.  I made him a chocolate cake yesterday, and when he came home from school and ate a big slice with a big grin on his face, I was so pleased.

• I read Gone Girl last week and didn't like it one bit.
• I've had some good walks lately - just locally around Epping Forest, Hackney and Walthamstow Marshes and the Olympic Park on my days off.  The damp, misty, golden autumn colours and smells just take my breath away.

• One of the first things I am going to buy when my salary comes through in January (the first money I've earned since 2009 - oh my), is a new pair of walking boots.  Mine are ten years old and the sole is coming away from the boot on the right foot; they are not really very waterproof anymore.

• There is obviously a very long list of Things I want To Buy when I am earning again.  

Lanyard love

Every nurse loves a lanyard.  We use them to display our security IDs and keep our computer access cards safe.  They ensure we have rolls of tape handy and hold little aide-memoire cards that we've been given.  The paediatric nurses like to cover theirs with colourful stickers.

My current one in use is the big chunky black one on the right.  I got it for taking part in a virus testing week which my trust was promoting early in October.  When the research nurses came to visit us to tell us about the campaign, the first question anybody asked was "Do you have any lanyards?".  Happily, they'd ordered plenty so most of us in A&E are wearing them at the moment.  And these are very good quality lanyards with a nice big clip and a long, wide strap.  They sit really neatly around your neck.

The A&E Porters all have black HEMS lanyards with little red helicopters on them (HEMS is the emergency helicopter service, which is based at our hospital and which we're all very proud of).  People really covet the HEMS lanyards, and if they were ever being given away there might be ugly scenes as I can imagine people might be tempted to snatch.  I don't know how the Porters got theirs!

I also have a blue NHS one (which my friend Sue bought off Amazon - I somehow thought you might have to prove you worked for the NHS to get one, but no).  Its a little too flimsy for A&E use, so it's retired at the moment but may well get used again in the future.

I have a very pretty Cath Kidston one too.  Cath Kidston is on to a good thing with her branded lanyards as pretty much every single nurse I know owns at least one.  I don't use this red one for work any more because it doesn't have a break-away clip at the back of the neck.  Many  drunk or agitated patients find a lanyard very tempting and will pull on them, so you really want a break-away clip.  Happily Cath is now taking this into account and her new range of lanyards has safety clips at the back.  I love this midnight blue one with stars, and this spotty pink one.  I would love it if Kaffe Fassett or Orla Kiely started making lanyards.

Amazon has a few decent ones too.  I like this blue one that simply says NURSE - it could be good when I am in my new job where everyone wears scrubs and it's difficult to remember who's a doctor, who's a healthcare assistant and who's a nurse.  There's also this excellent pink one with an integral nurse's watch in it.

On my lanyard I carry my ID card, which I need to get in and out of the staffroom, the wards, and all the different parts of A&E (Resus, the Clinical Decision Unit, Paediatrics, Majors), a roll of transpore tape, a blue tape measure (mainly used for measuring wounds or measuring people for anti-embolism stockings), and a card on pressure ulcer prevention.  Its always the last thing I put on when I get changed, and once it's round my neck I know I'm ready to start work.  It's my daily medal, and it tells people who I am and what my job is.

Seen in A&E

We do three or four twelve hour shifts a week, and we see EVERYTHING.

• A nurse covered in white splashes of plaster of paris.
• A patient being kept nil-by-mouth before going to theatre for emergency surgery, trying to sneak a swig of beer from a can in his bag.
• A bike helmet, crushed like an eggshell.
• A floor awash with urine.
• Doctors and paramedics in bright orange helicopter jumpsuits.
• Relatives crying and hugging each other.
• A passport drenched in blood.
• Porters pushing trolleys around with incredible skill.  How do they never hit anything?
• Nurses and doctors crowded around the radiographer, who is looking at a patient's brain scan.
• Nervous looking medical students.
• People practising walking down the corridors with crutches.
• A linen skip full of discarded red ambulance blankets.
• A nurse talking to a patient about cupcake recipes as she puts a needle in his vein to take blood.
• A man handcuffed to a trolley, escorted everywhere by two tall policemen with crackling radios. 
• Many, many people whose problems will be solved by going home, taking a paracetamol, and seeing their GP next week.

The new, blue, hospital behind the old one

The new normal

I am back at work; charging so very fast towards mid-December when I will qualify.

It is good to be working again, and to feel useful and skilled, but I'd forgotten how busy and chaotic everything can seem when I am working.  I am trying to remember to use my commute as a way of easing in and out of the working day. 

These past three weeks, I've been working in Hackney - very close to home.  I commute by bus, which is far more frustrating and unreliable than taking the tube, but has more interesting views.

 

I'm tired, energised, busy, constantly carrying around a heavy bag of books and clothes, losing track of which day it is, spritzing hairspray on my up do, texting the children to remind them to do their chores, feeling full of purpose...and also starting to feel a little bit as though this is the new normal.  And this is A Good Thing.  

Back to it

These days I don't feel as bereft as I used to when the children go back to school in September.  The silence in the house is still deafening, and I miss their wild enthusiasms and crazy logic spinning through my day, but these days they really need to get stuck back into school by the time September comes around - and more importantly they want to get back to it too.  

Olivia has left primary school and is now at high school with Cam, which they are both very pleased about.  I am delighted too because the days of the school run have finally come to an end.  To celebrate, I have waved them off to school each morning this week still in my pyjamas - standing on the doorstep, with a cup of coffee in my hand, as I watch them walk up the road together.  Utter luxury.

In one more week I go back to work too.  I'm really looking forward to it.  I have just fourteen more weeks of placement, and then I will be qualified - so exciting.  Yesterday, my parents-in-law sent me these tiny little nurse figurines to mark the final stage of my training.  They are sitting by my desk, reminding me of everything that is still to come.

         

Oncology experiences

The longest placement of our course is for twelve weeks, towards the end of our third year.  We can ask to be placed in a particular specialism, and the university and the hospitals it partners with try to accommodate our requests.  I asked for oncology, and was given it.

It was a tough placement.  So much is expected of us by this stage in our course.  Our mentors are assessing whether or not they are happy for us to join the register of nurses, and we are acutely aware that in a few weeks or months (if our mentors are satisfied with our abilities) we will be newly qualified and practising independently.  We are trying to learn as much as possible while we still can, but also prove that we already know how to be safe and work as a graduate nurse.  We have seen so much by this stage of our course (after a Saturday night shift in A&E I truly thought I'd seen everything) - but of course we haven't seen or experienced a fraction of what there is to see.  People's bodies and minds still shock and surprise me.  This placement was when I properly understood that I will never stop learning.

And then there is oncology itself.  Cancer is a very complex disease that evolves and changes over time.  It can be cured and managed better than ever before - but not always.  It affects everybody differently, and touches a person's family, friends and lifestyle too.  

In my first week on the ward, one of the Macmillan Nurse Specialists said that I must make sure to spend a morning with her in one of the outpatient clinics before the end of the placement.  "You will get a very one-sided view of cancer by working on a ward," she told me.  It wasn't until the penultimate week of my placement that I got a chance to take her up on her invitation and join her in the outpatient clinic.  On the ward I cared for people who were very sick - either because their disease had progressed and they were close to end of life, or because the treatment they were receiving was making them extremely unwell, even though it may have been killing the cancer.  However, in the clinic I met a much greater number of patients who were either living a completely full life with cancer and whose symptoms were completely under control, or whose cancer had been cured or removed - by the often harrowing treatment we gave on the ward - and who had been in remission for many years.  Many of these people were the beneficiaries of the enormous amount of reasearch and experimentation that goes into oncology in this country.  It was helpful to be reminded that the very unwell people I was nursing on the ward, were just a small proportion of the number of people affected by the disease.


I had so much to think about and a great deal to say while I was on placement on this ward, but was unable to express it - partly due to confidentiality, but also because there was just so much to process in my mind.  I took even more photos than usual on my commutes, and tried to spend the time on the train really focusing on my nursing skills, and reflecting on my new life as a nurse.  I didn't get enough sleep because the shift pattern on this ward was unusually relentless, and I didn't run for the same reason.  To be able to give of yourself - as you need to do when you are a nurse, and in many other professions - you need to be able to look after yourself too.  I ended the placement with a new determination to make more time for running, sleeping, reading magazines and baking cakes - all those good things which recharge my batteries and keep me content. 

Although I'm not going to be working in oncology when I qualify, I wonder if it might be something I return to at some point in my career.  As well as being the toughest placement I've done, it was also one of the most satisfying.  I had days where I came out of work on such a high because I knew I'd left patients feeling better at the end of the shift because of something I'd done.  And quite simply, that's what it's all about.

   

A new identity

A few weeks ago I was offered my first nursing job - and last week, after much dithering, I accepted it.  At the end of this year I will become a registered nurse, and then I will be working on the ITU at my local hospital.  ITU stands for Intensive Therapy Unit and is what used to be known as Intensive Care - it is where the very sickest patients are cared for, and each patient gets one-to-one nursing care, 24 hours a day.  I have so many emotions whirling around my head about this new job:

• pride - I've got a great job, in a specialism I desperately wanted to work in
• fear - I'm going to be a qualified nurse, responsible for the care of very poorly patients
• excitement - I'm going to be a qualified nurse, responsible for the care of very poorly patients
• motivation - I need to revise all my knowledge of acute nursing care, and learn so much more
• eagerness - I want to start now
• sartorial disappointment - I will be wearing scrubs rather than a traditional nursing uniform
• nervousness - can we put the brakes on, please? I've loved being back at University.

But mainly, with the knowledge that I have a good job waiting for me at the end of the year, I have relaxed and started to enjoy myself more.  I have always enjoyed nursing and been certain that this was what I wanted to do, but there has also been an underlying tension - could I really do this?  could I be good at this?  what effect was my change in career having on the family?  I was surprised to find that this tension disappeared when I finally sent the email to accept the job.

"Yes, I have a job in ITU," I tell people.  I'm getting used to saying it.  I have a new identity.  In my head I say to myself "I am an ITU nurse" - trying it out for size - and it feels right.

 

10 things

• I baked some strawberry buns with lemon buttercream icing - just because I'd spotted the Cadbury's mini eggs in the supermarket and thought some little buns with mini eggs on top were just what I needed to bake to celebrate the arrival of spring.

• As well as mini eggs we have many large hen's eggs at the minute.  Bertha, Adelaide and Ethel are all laying an egg a day, and 8 year old Queenie is thinking about laying again (8 years old is an epic age for a hen).

• Cam sits his first two GCSE papers on the same day in May as Olivia's Year 6 SATS test; and later that same evening, Olivia is playing in a music festival.  I have written it all in the calendar and am trying not to think too much about the collective stress levels that day.
• Cam then has a three and a half week gap before he sits his final paper.  GCSE timetables are insane.
• My geraniums loved the mild, wet winter and are all blooming again.
• Working in A&E has been by far the best part of my course.  I have loved every, single minute of it and am so sad it comes to an end next week.  I have arranged to go back for another 5 week placement this autumn.
• When I work a long day shift, Olivia stays up so that she can ask me, as soon as I walk through the door, "What were your most exciting patients today? Did the helicopter bring in anything dramatic?" - she's all about the blood and guts, this one. 

• I have re-arranged the bookshelves downstairs, and am slightly startled to note that I have five whole shelves of cookery books.  I always considered myself to be very picky about which cookbooks I own; only the really good ones, which I use regularly, are bought.  Turns out there are more great cookbooks out there than I realised.

• I am knitting myself a pinky-orangey-red beanie hat.  I anticipate this being worn very often.
• I am no longer the tallest in the family.  Cam has overtaken me.

Confidence regained

Fresh, white uniform drying on the line

My nursing course has reached a new stage.  The teaching at University has now finished, and from now until I qualify at the end of December, I am out on placement (with a couple of holiday breaks in there too).  I have three stripes on my epaulettes, and the nurses I am working with expect much more from me now that I am in the final part of the course.

I didn't feel remotely ready to finish the teaching element of this course.  In the last week at University I became less and less convinced that I could ever work as a nurse.  The sheer enormity of what the job entails seemed overwhelming, and as we crammed in the last few bits of theory I felt derailed and uncertain that I could do this.  But after just one week back on placement, this time working in the frenetic and dramatic environment of one of the UK's biggest and busiest emergency departments, I have regained my confidence.  

Nursing is such a practical, hands-on job and when we are out on placement we are constantly doing - washing, giving medication, carrying out procedures and observations, documenting, assessing, making comfortable, feeding, communicating, soothing and investigating.  Since I started back in September 2012, I have learnt how to do all these practical skills, and become gradually more competent in them without even realising.

The theory is crucial too - medicine always needs to be based on the best available evidence, and without the theory to underpin the practice we are in danger of carrying out tasks ritualistically and unthinkingly.  We need the teaching and critical thinking skills that the University element of our course has given us, but on their own they're not much use.  I love placement for bringing the theory and the practice together, and I think that is ultimately what I love most about nursing - I get to use the academic side of my brain, whilst also doing something that is completely hands-on and practical.

Working in A&E is fascinating.  You see every possible type of person and condition you could ever imagine, along with things you never even thought possible or wanted to see.  I have never known a 12 and a half hour shift pass so quickly, and even three weekend nightshifts in a row didn't wipe me out as much as I thought they might.  At 4:30am, on the third night I cleaned and dressed a massive cavity wound in the foot of an elderly homeless patient who amazingly slept through the whole procedure and then woke up at the end to inspect the quality of my bandaging, say thank you and give me one of the broadest grins I have ever seen.  We had a laugh and a quick chat, which left me on a high for the rest of the shift, and I thought to myself, I can totally do this job.

Arriving at work for the start of Saturday's nightshift

Leaving work on Sunday morning, and heading home to bed

  

Thoughts on January

The first daffodils of 2014

For me, January has a clean, fresh feel to it.  It doesn't seem like the start of the year - for me that will always be the new school year in September - but rather, January is a tidying up and a re-grouping.  A shake of the shoulders, chin in the air, and carrying on with a renewed sense of determination.

Back at University today

A new term started for me today: a new module, new reading lists, new tutors, one new pen and no new notebook (so restrained of me), plus all my lovely nursing friends together again.  But, alarmingly, it's my last ever term of teaching on this course.  After this, I have placements until July, then the summer holidays off, and placements again up to Christmas, when I qualify.  Qualify!  It's pretty scary to even write that word. 

So I am enjoying the sense of calm and resolve that this time of year brings for me, and trying not to think too much about my time at University coming to an end.  I am grabbing as much fresh air as I can, looking out for the first British daffodil bunches in the shops (Waitrose had some this week!), running, baking bread, and reading novels.

 
And I'm also filling up all my spare days with plans of nice things I want to do while I still have a bit of time on my hands.  Its January now, and I've got the time and inclination to fritter away 20 minutes photographing blood oranges; but before I know it, it will be December and I'll be a fully qualified nurse.  Fewer blood oranges and more actual blood, I should imagine.  Not long now.
 

Where I was 2013

This year was a busy year.  I got used to working again.  I started to feel like a nurse.  I started to run - and I kept on running.

In March I had a lovely day with blogging friends, and Kristina gave us all handmade socks!

My parents and I took the children to the Cutty Sark over the Easter holidays

I knitted socks that matched my surgical textbook

In June I had a picnic in Victoria Park with some nursing friends

In August we went to see my parents in France, and I spent most of the time dozing in the hammock

I won some new running shoes!

I knitted some pink socks - started in the spring, finished in the autumn

Still running - I bought myself a running skirt and some fancy socks

Walking to university for lectures in October

Graham and I do parkrun every Saturday morning.  In almost-matching blue shoes.

A morning on the sofa after a long shift the day before

November leaves in London

Excellent, forgotten tights - found at the back of my sock drawer

Heading into university for the last time this year - to hand in my second year portfolio right before Christmas

Seasonal tights!

It was a good year.  A year of consolidation rather than new beginnings.  I tried to keep family life more or less the same, and incorporate work and study into it rather than let nursing dominate everything.  I didn't always manage it but it got easier as the year wore on.

It has been a peaceful but productive year, which is how I like it.

Ending the year in Norfolk with my brother's family

New Year's Eve beach walk in Norfolk

I ended the year with my brother and his family, who we don't get to see very often, in Norfolk.  We walked along sandy beaches under the vast empty skies, chatted, laughed, and eased into each other's company.  It was a perfect end to the year - with family... outdoors...relaxed.  Just how I like it. 

Graham and Cam - the same height now

Happy New Year!

~~~~~~~~~~

See all the previous Where I was posts here:
2007
2008
2009
2010
2011
2012