Ward Placement - Haematology/Oncology

My first placement as a second year was for 10 weeks on the 'cancer ward' much like everybody called the urology ward the 'willy ward'. The way that people spoke about the big C word made me expect to see the Grim Reaper working as the ward manager. I later found out that this was almost true. The ward manager didn't go around killing the patients, she was probably the coldest person I have ever met. She had eyes like the demon headmaster, I was scared to look at her. It wouldn't surprise me if she banned smiles on the ward.

Much like my placement in the first year, I was assigned 2 mentors again. One of them I had worked with previously a few years ago when I was an HCA. He was brilliant and constantly tested my knowledge of haematology and oncology, I had to do my homework. The other mentor only worked nights so I managed to avoid working with her for the whole 10 weeks. I'm not working nights. While I’m a student, nights are for partying or sleeping, not working.

I was quickly introduced to the ward and I must admit, I was a little bit scared about working on this ward, purely because it was like going into the unknown. I had cared for patients with cancer, but I had never cared for cancer patients.

There was a difficult HCA that worked on the unit and unfortunately, I could not stand her. Her first words to me were that she does not think that 2nd year students should be allowed to work on the unit as they are not experienced enough. My reply - "Nice to meet you, so how did you get a job on here?" What a way to greet a student that’s new to the ward. What she did not know is that I had done my homework like a good boy and had learnt how to deal with cantankerous people such as herself. I asked her as many questions as I could, questions that I knew she would not know the answer too. 1-0 to me... who's the big I am now? I'd be surprised if she knew what Haematology actually meant.

After working a few weeks on the ward, I had settled in and found my feet. I had become a master at drawing up IV drugs and on top of that, I managed to get a fair amount of my skills signed off for my workbook. Once I had learnt the basics of Haematology, I was given the opportunity to sit in on one of the haematology clinics that was run by the consultant. Have you ever been in a really awkward situation before where you just don’t know how to react? Well, I have never felt so awkward in my life and it was in this clinic....

I sat at the side of the consultants desk, he sat in the middle and the patient came in and sat on the other side. The patient had been newly diagnosed with acute myeloid leukaemia. Before the patient came into the room the consultant had looked up his blood results on the computer and muttered that they didn't look good. I really should have taken this onboard because once the patient had sat down, the consultant greeted him, told him that his blood results were not good and that the cancer will kill him, he was going to die. No beating around the bush for this consultant, no maybes, no hesitation, just straight out.. "You are going to die from this"... Shit did I feel awkward at that moment, it felt like a surprise party with a twist, the surprise was certainly there, but I didn't hear anyone cheering. I sat on my chair in complete silence, the consultant was silent, the patient...silent. It was an awkward fucking silence and I didn't like. The patient let out a deep breath and made eye contact with me... SHIT what do I do? Do I look away? Do I hold the eye contact? Do I smile? No don’t smile... the man has just been told he is going to die, what is there to smile about? I broke the eye contact and looked at the consultant. While I thought this silence went on for about 5 minutes.. it was actually more like 15 seconds. Then the consultant went on about what happens next. I took a deep breath.. can you please warn me next time you're going to say that to someone Dr No Bullshit.

Dr No Bullshit turned out to be a great consultant, I learnt so much from him. He was definitely the mastermind behind Haematology and I quickly came to realise that his no bullshit approach to delivering bad news was probably the best way as it means the patient has no way of misunderstanding.

Overall, I found this ward to be very rewarding. Some patients literally go through hell and somehow pull through. It leads you to believe there is some hope and when things are at their absolute worst, they can get better and you can enjoy life again. Sadly though on the other hand, not everyone does pull through, young people die from cancer, it can be a killer. It can be an emotional place to work and the nurses their proved to be a fantastic and very supportive team, doing everything they can to make patients happy and comfortable in their last stages of life. Gold star to this ward.

So I say, live your life, and make the most of each day, because you never know what may happen tomorrow.

The Student Nurse

Back To School

Pack of 10 black Bic medium pens

A4 lined paper notepad

Pack of 10 Hb pencils

Pencil Sharpener

Eraser

Ring bind folder

Mars bar

Pot Noodle x2 (buy one get one free)

Crisps

=

My receipt from Tesco, on my first day of my first year.

This year there is no such thing, none the eager enthusiasm of a first year student.
Now I am the disorganised but experience second year. After a blinding summer of fun, it's back to school for me.

The class reforms into its groups of the first year, thankfully I'm still in with the cool kids, only this time the class has shrunk (no-one said this was going to be easy) and I feel a sense of achievement for making it to the next level.

We are no longer the first years; in our place are a new bunch. They are easily identified by their shiny new (but empty) folders and the apprehensive expression on their faces, but the main giveaway is their ID badges, which they wear allll the time, because it says 'I'm going to be a real nurse'. Fresh faced first years full of enthusiasm. Bless.

The lecturers greet us with the same knowing grins they had in the first year, we are not so apprehensive this year, but that grin was a clear signal that maybe we should be.

It was made clear that this year is going to stretch our academic skills and we can't fuck it up. The introduction hit me with a solar plexus punch, knocking the wind out of me... the gauntlet had been laid down, nothing nice, nothing pretty. Every move we make is going to be watched and we are going to be assessed on absolutely everything from changing dressings, removing sutures, to how we tie our shoe laces (mine are Velcro...winner). I feel like we are training for the Special Forces. It's time to get serious.

After each of the lecturers have taken it in turns to scare us into working hard this year, we settle into the day-to-day routine of lectures from 9 to 5. The middle-aged women who slightly fancy the lecturers are still here, and have increased their daily quota of lewd commentary. It's a game of innuendo bingo with them. Apparently the average man thinks about sex every 6 seconds, these women don't think about anything else. To them it's funny, but I'd rather have someone kick me repeatedly in the groin than have to listen it. I think the rest of the class would agree with me on that, the class screws up its collective face and tries to ignore the verbal pollution that spews from their faces (even the lecturers wince in unison).

Death by Power Point is back, only the program has changed since last year, the university has upgraded to the new version and the lecturers struggle to use it, mildly entertaining at first, until I realised that all the time they spend looking for the slideshow button actually increases the amount of time I have to sit there and imitate a nodding dog as I struggle to keep my eyes open.

Thankfully we’re back on the wards soon, hopefully it will be a breath of fresh air (well... as fresh as it ever gets on the wards). I've missed patient contact, giving 'holistic care' and 'promoting independence' (buzz words still going strong).

The second year is underway and its full throttle from here on in.


The Student Nurse

Never Off Duty

The moment you sign up to train as a nurse, you sign up to a lifetime of responsibility. You become the first point of call when your brother gets a paper cut, your neighbour’s kid falls off a climbing frame or your grandfather gets a cold. Even when your friend’s dog has eaten a box of Quality Street or their goldfish is lying sideways at the top of the bowl. For some reason, everyone expects you to know everything about every medical problem known to man and beast. I tend to have a few well-rehearsed answers to these,

"Go to A&E"

"Visit your GP", or

"Why are you asking me? Phone the vet or flush it down the toilet."

Nursing is one of those vocations where you can never really leave your trade at work. People just seem to collapse, choke on chicken bones or fall off their bikes in your presence.

I was out for dinner one night when I had my first real experience of working whilst off duty.

An elderly gentleman collapsed into his food on the table next to me. I waited for a few seconds to see if anyone else would rush to his aid, no one moved, so with a sigh I got up and went over. He was conscious but a bit clammy and short of breath. I ran off the usual spiel of questions; medical history, any medication and all the rest of it. He had no heart conditions, no diabetes and had never suffered anything like this before. By now he was alert and said he was feeling fine, so I prescribed him one 'visit your GP' followed by an ‘if it happens again, get yourself to A&E’, for good measure.

I went back to my table and continued to eat my dinner. 3 minutes later I overheard a lady from the table saying

"...ask that boy to take him outside..."

‘Oh great’ I thought, ‘now what?’ Not only was I just about to massacre my main course, but that lady just called me ‘boy’. I asked if everything was ok, but took one look at the man and realised it was far from it. He was covered in sweat and had turned grey, then he started having small convulsions. It was time to get this guy on the floor (and create a big scene in the middle of the restaurant), as I started to manoeuvre the suddenly very heavy man on to the floor, another guy introduced himself and said that he was a doctor (Thank god for that, I was already shitting myself, not really knowing what was going on, now I could hand over all responsibility). Together we put the man on the floor and got the waiter to call for an ambulance. Within a couple of minutes the colour had come back to the man's face and he wanted to get up. The paramedics came and did a few checks on him, he was ok, and they went off.

It turns out that this man had a vasovagal reaction (see here for more info http://www.medterms.com/script/main/art.asp?articlekey=7713 ).

The staff in the restaurant were really impressed, and the manager came over to thank me and said my meal was on the house.

Suddenly I didn't feel so bad about being perpetually on duty.

The NMC requires us, as student and registered nurses, to help out in any situation where our assistance may be needed. For instance, if someone collapses in the street, we are obliged to go over and help that person out. The problem comes when we go and help the person and we make a mistake, causing them any kind of injury or worsening the original problem.

We can get in a massive amount of trouble with the NMC and even sued, if we try to help someone and it all goes wrong. If we choose not to help, however, and it gets reported, again, we can get in a whole lot of trouble.

My advice is be careful who you tell about being a nurse, and if you do get involved, always refer to one of the 3 golden lines.

Make sure you keep your back covered and stick to the basics, hand the responsibility to someone else as soon as you can and wherever possible, pretend it never happened and get on with the rest of your day off.

The Student Nurse

Learning Disabilities - A Nursing Issue?

Do we as nurses or nurses to be, need to have specific training in learning disabilities?

I had to spend 2 weeks on placement in a residential home for 6 ‘individuals’ (remember those buzz words) who all had severe learning disabilities (None of them were able to verbally communicate using words). It was something that I was really not looking forward to and had got myself into that mindset of thinking that it was going to be 2 weeks from hell and I just was not going to enjoy my experience. I could not have been more wrong, I ended up having a great time over the 2 weeks. The staff were all really friendly and always up for a bit of fun and morale in this establishment was high (which makes a welcome change from working in the hospital).

What made me think I was going to hate this placement so much?

Well, I allowed myself to listen to what others were saying about not wanting to do this placement, and fell into the deadly trap of stereotyping. The stereotype of someone with learning disabilities; they dribble an excessive amount, they are loud and unpredictable, they are a little bit scary because we as ‘normal’ (what is normal?) people in society, do not really know how to handle or behave around them. I went to their home a little apprehensive to say the least and now, I regret having such thoughts and attitude towards this placement.

After my first day was out of the way and I had learnt the names of the residents and some of their characteristics and preferences, I quickly realised just how wrong I was in my stereotypical thoughts towards people with learning disabilities. My eyes had been opened.

I was fortunate enough to be able to go out of the home with some of the residents on a few of the days. The carers try to let the residents lead an independent life as much as possible. Some of them go to college to participate in activities, or they go to the supermarket food shopping. I even got to go to the pub with 2 residents for lunch. Result.

Trains, planes, fire engines, and anything else with bright flashing lights and lots of noise, these guys loved them. No seriously, they loved them, to the point where I ended up thinking if I have to see another book or magazine about steam trains, the steam would come out of my ears or I was going to actually start biting my hand and head butting the wall. They seem to be on a continuous never tiring loop. When they wanted to show you their book on trains, they would not stop pestering you, screaming at you constantly until you read it page by page. They wanted to share their excitement about their interests with you. I found it hard to be enthusiastic about it once I had seen every page of the book 47 times over and over in a day. It kept the guys happy anyway. Did you know that the earliest steam rail locomotive was built in 1804 by Richard Trevithick? You do now.

Some people may say that the guys are unlucky to be born so brain damaged that they don't have a good quality of life. That’s what I first thought, then when you seen that they get enjoyment out of almost everything they do, life becomes one big party to them. They even get free holidays to places like Spain and the carers get paid to go and they get given a spending allowance. The lucky, lucky bastards.

So back to my original question, do we as nurses or nurses to be, need to have specific training in learning disabilities? My answer to that is no. Nurses do not need to have specific training to learn about learning disabilities. I see learning disabilities as a social problem and not as a health or medical problem. Yes, people with learning disabilities do tend to be prone to developing more medical conditions, but these medical conditions are no different to the conditions that you or I may develop and are treated in exactly the same way. However, I feel that the placement has actually given me an understanding in how to adapt my communication skills to cater for the individuals needs. I do feel though that these skills can be learnt from the experience of working on the wards and although the 2 weeks on a learning disabilities placement was a rather enjoyable experience, I do feel that it is not essential or fundamental to nurse training.

If there was one major thing that I learnt from the 2 weeks, it is not to stereotype. We all know we shouldn’t really do it, but often that doesn’t stop us from thinking, that if someone is wearing a hood, they are going to give us abuse or because if someone is blind, they can’t do anything for themselves and we often do things for them when they are quite capable of doing it independently.


The Student Nurse

Baby Bouncing

I had to spend 2 weeks with a Health Visitor to cover the Child Unit of Learning. This for me was 2 weeks of shit, baby shit, and it stinks. In case you have not noticed, I am not particularly fond of little parasites that poo, wee, vomit and scream constantly; it is worse than having to listen to a child learning to play the violin or nails scratching down the blackboard.

For the 2 weeks that I was attached to a health centre, I had to shadow a Health Visitor on all of her trips to go and see little vermins and their emotional rollercoaster mothers who since having their bambino have become the world’s most extreme man haters. The real old fashioned ‘burn your bra’ feminists. I could feel the ‘man hate’ as soon as I stepped foot inside their properties. I can understand why having a baby can dictate a woman to hate her male partner or just men in general, after all we are lucky in a sense that our hormone levels do not go off the scale like a woman’s during and after pregnancy, and it seems that we have it easy.

Not every mother we visited was of the post natal depression type, anti-men and all that jazz. Some mothers were incredibly proud of their baby, a little too proud. New mothers please note; just because you are proud of your newborn, does not mean that I want to hold it, feed, it or hear about every little burp, smile or fart that it has produced since entering the world.

In the health centre where I was based, they have a baby drop-in weigh and measure sessions. This is a great service provided by the health centre and it is run by the Health Visitors. It provides a good opportunity for the mothers to all converse with each other and swap tips on how to care for their babies. It gives an opportunity to check the baby and make sure they are growing at a ‘normal’ rate. I found this mildly entertaining, it was almost like a comedy sketch to see the mothers competing with one and other to prove that they have the best baby.

“My baby smiled at just 3 weeks.”

“Yes well my baby had already built a rocket for NASA and had written an autobiography called ‘Beyond The Womb’ by then.”

Silly, but entertaining. Seriously, the competition between mothers was great. It definitely was my highlight of the 2 weeks.

I had to observe in an immunisation clinic where the 4-5 year old children go to get their pre-school jabs. The nurses in there were great, they seemed to have this incredible ability to gain the child’s trust almost immediately in order to give them the vaccination. How did they do it? Bribery is how. Children will do anything for a chocolate button and a sticker of a butterfly.

I spent a morning in an infant school with the Health Visitor. We had to run checks on the children’s hearing using special equipment that produces a range of high pitch and low pitch sounds. The child would have to clap when they heard the sound, some children got this right, some could not grasp the concept of clapping when they heard a sound, they just clapped all the time (at least they were enjoying themselves), and some children went shy and did not want to respond to the sound so they would have to be retested another day (or they could just have a hearing difficulty?).

So with those 2 weeks of experience under my belt with the Health Visitor, I now know 2 things; I by no means ever want to become a Health Visitor; and I have learnt the real value of contraception, I do not want a baby for a long time.

The Student Nurse

Ward Placement - Urology

My main placement of the first year was on a surgical ward that specialised in Urology. It is known to most as the Willy Ward. I however, do not refer to it as the Willy Ward as 50% of the patients on the ward do not have willies, they have vaginas, and we call them the female patients. The other 50% happen to be male. A large percentage of these male patients have can what only be described as massively swollen cock and balls (not a medical term) they look like they are trying to smuggle in grapefruits between their legs. How can they be classed as willies? So in my opinion only about 20 percent of the patients have a willy (penis, just to be correct), the others have abnormalities, so I would call it the Urology Ward.

While working on the ward, I was assigned two mentors, one was a sister and the other was a senior staff nurse. At first, I thought I was lucky to have a sister as a mentor, someone who obviously has a lot of knowledge and experience in nursing, someone I can learn a few tricks of the trade from, someone I could possibly charm to let me go home early. Unfortunately this is where being a first year student put me at a disadvantage. The impression I got was that being a first year, you are not valued as important as a second year or third year student. It is assumed that you do not know anything about basic care and the sister (my mentor) would think that most of the work that she was doing was too advanced or important for me, so I would be paired up with the Health Care Assistants (HCA’s).

On a positive note, the HCA’s on this ward were fantastic and they were the ones putting the real work in to keep the ward running. Now seeing that I have a few years under my belt of actually working as an HCA, I managed to fit well, I was back to doing what I was used to.

I would laugh sometimes at some of the older HCA’s on the ward, they would assume that I am just a dumb student and do not know how to wash or move a patient up in their bed. I would play along with their game, and let them tell me in great detail how to put a slide sheet under a patient, or how to empty a piss bag (catheter bag). I would keep asking them questions all the time, making them think twice about what they were telling me, as sometimes, they were doing things the completely wrong way. The best part is when I would thank them for teaching me and let them know that I actually was an HCA for just a few years before becoming a student. Who is the dumb one now? You should see their faces.

My other mentor, she was great. She would let me do everything and there was a good reason for this, she was lazy. She was at that stage of her life where she had been a nurse for 40 or so years and was about to retire, she was wise that if you have a student, you can get them to do the work for you (slave to the staff nurse). My duties included, making her coffee, taking things to the pharmacy or the pathology lab (anything where she would have to walk), making her coffee, wash all the patients, make her coffee... can you see the pattern? I was a good student, I can make a good cup of coffee.

Most of the staff on this ward were fantastic, caring, empathetic individuals who take a lot of pride in their work, there are just a few that have become a bit lazy over the years and have get no joy from being a nurse anymore. It is time to move on if you are like that, become a farmer or a bus driver but do not continue to be a nurse if you do not enjoy it.

Overall working on the Urology ward has made me look at the colour of my urine every time I wee, making me ask myself questions. Am I dehydrated? Because my urine is very dark, although I have been drinking a lot of orange Tango recently. It was an experience of being the nurses slave and the friend of an HCA, an imaginary voice to the doctor who proceeds to ignore you, a lot of horrific sights that would make any man wince, and going home thinking that I smell of piss.


The Student Nurse

Fresh Faced First Year

As I have only just started this blog and I am just about to enter the second year, I would summarise the first academic year as an immense amount of fun, stress, hair pulling, late nights, early mornings, pointless handouts, good lectures and death by power point. The list goes on.

The year started in the class room, the lecturers were grinning at the new intake of students, smirking at the fear in our faces, the fear of what to expect and what is expected of us in our first year as student nurses.

The class of 30 quickly developed into its small groups, smokers huddled together at the back squinting to see the whiteboard, the ultra-keen middle aged women at the front who always think they are right and slightly fancy the lecturers, the return to work mums whose children have all grown up and they have found themselves at home and bored and are looking for something to do with their lives, then you have us, or the group I fit in with, we are the cool kids, the ones who don’t give a shit about anything but care about everything, all in our twenties, fervent to learn and even more eager to have fun. That is the class, 3 guys and 27 women, it could not be any better.

The year consisted of practical stuff such as administering medication, washing and dressing, and feeding. Once I had got that out of the way, I would make my way to the hospital to start my shift on the ward and give the individuals the ‘holistic’ care (there are many buzz words in nursing, holistic being one of them) they required, while ‘actively supporting’ (buzz word) and promoting their ‘independence’ (buzz word). I had to do a practical 12 week placement on a surgical/urology ward, 2 weeks with a Health Visitor and 2 weeks on a learning disabilities placement.

The year also consisted of 2 exams, 3 essays, 3 workbooks, and 1 dreaded white folder also know as the Common Foundation Practice Portfolio. It takes a year to complete the portfolio and virtually everything you write in it has to relate to European and national guidelines, policies, protocols and procedures and then be signed off by a staff nurse.

More to being a student nurse than you first thought? Keep with the programme, this is only the first year. Pass it and you can move on to the second year where all the new fresh faced first years apprehensively look up to you.


The Student Nurse