Monday, 23 November 2015

A Day in The Life of a Third Year Student Nurse.

This blog post will be slightly different from my usual blog posts but still related in the fact that it's a true account of my general day working on the ward as a third year student nurse. It also allows people to see that even while battling with anxiety and panic disorder, I can still work hard to achieve my goals in life. Every day is different and each ward is different but this account is for my 12.5 hour shift on my current placement on a busy Surgical Assessment Unit. (Apologies in advance for the length but it's really hard to condense this sort of post down!)

6.20am - Alarm goes off. I take my medication and lay in bed and scroll through my social media, check my emails and texts.

6.40am - Get up, start getting ready.
I have a uniform provided by my university consisting of beautiful grey trousers which fasten above my belly button(!!), white tunic and blue epaulets. The epaulets are different shades of blue for each of the 3 years training to help staff and patients distinguish how far along in your training you are. I wear a fob watch given to me by my brother on my 18th birthday, my 'my name is...' badge and my lanyard with my student ID on. In my pockets I keep two black pens, a small notepad and a lip balm. My phone stays in there as well while i'm on shift due to students not having anywhere secure to lock their belongings away like permanent members of staff do.
I have to have no nail polish, no jewelry apart from stud earrings and my hair up and off my shoulders for infection control purposes so my go-to hair style is usually either a high pony tail or a messy bun. I very rarely wear makeup to work as I am a bugger for rubbing my eyes throughout the day and it would end up all over my face if I did apply it, but sometimes a bit of coverage is needed, especially when not much sleep has been gained overnight!
My shoes were not provided by the university but this pair are from Skechers and are my third pair of nursing shoes. I have previously owned these Shoes for Crews trainer style ones which I do occasionally go back to as it is good to change up shoes for when you have a long run of shifts - apparently it's good for your feet! My first pair of nursing shoes were these Skechers shoes, and they served me through 6 and a half placements but sadly they gradually got too worn to wear. Admittedly, I was able to get staff discount from a friend who works as Skechers but I 100% think they're worth the money. My feet are so thankful for Skechers so I would highly recommend them for those of you who do long shifts and are always on your feet.

7.10am - Leave my flat for work. The walk to work takes 10 minutes but I like to arrive early so I don't feel rushed. It also helps for particularly anxious mornings when I can take those few extra minutes before the shift starts to focus on the day, prepare for it and get accustom to my environment. 

7.30am - Hand over. This is the time in the morning when the night staff hand over their patients to the day staff. We are given printed sheets of paper with the names of each patient, their age, why they're in hospital, their diagnosis and their plan for recovery. It is particularly important to pay attention throughout handover as this is where vital information about patients are given to you. For example, if a patient is going for an operation, they will be Nil By Mouth in preparation for their anesthetic (they wont be allowed to eat or drink). If you miss this information, you could ruin the plan for that patient and potentially make their situation worse. Hand over is also a chance to say Good Morning to my patients and introduce myself if I don't already know them. 

7.45am - Assisting patients with washing and dressing. I know right! It's too early to be getting poorly, sleep deprived patients up and out of bed to change their bed sheets but it has to be done to allow the day to run smoothly. Some patients are independent and will take themselves to the ward shower when they feel ready to, but for those who need assistance in washing and dressing, this is usually done first thing in the morning. 

8.30am - Alongside a qualified nurse, I will assist in administering the morning medication to the patients. These are all the tablets that the patient would usually take in the morning if they were at home, plus any medications that the doctor has prescribed for their recovery process while in hospital. They can be all sorts of medication from tablets, injections, liquids, IV medication (or drips) or nebulisers to be breathed in. Some patient who have nasogastric tubes or PEG feeding tubes may also need their medications crushing and administering through their tube. Similarly, some patients may need assistance with physically taking their medication, and I will assist with this. On admission, all patients are also prescribed a bottle of Stelisept body wash and a tube of Bactroban nasal ointment which both help prevent the spread of MRSA in hospitals, so during medication round, I ensure my patients have used both. Before all medications are given to the patient, I have to ask the patient their name and date of birth to ensure I am giving the medication to the right patient and ask if they have any allergies in case something has been prescribed that they are allergic to. I have to ensure the medications are in date, are prescribed by a doctor, are being given at the right time, are the right dose and are being given the correct way (e.g. tablet or injection). The medication round usually takes 30-40 minutes depending on the amount of patients and complexity of their medications. 

9.20am - This is usually the time I spend doing any tasks that need doing. In handover, the night nurse will share information given to them by doctors over night to help with the diagnosis and treatment for a patient. Especially on the ward I am on now, there are a lot of patients admitted throughout the night from A&E and so tasks such as urine dips, stool/urine/sputum samples, wound swabs and wound dressings are usually done at this time. I use a tick box system in my notepad to ensure I get all my tasks done. I will also assist patients to the toilet, support anxious, worried patients, patients who are in pain or patients who are vomiting, as hospital can be a very lonely place, especially when you're feeling unwell. Paperwork is also completed throughout the day, including bowel and bladder movements, the changes in position of a patient (even if they're only minor as it helps regulate the risk of the patient developing a pressure ulcer), fluid input and output, and general nursing notes. 

10.15am - This is usually when I get my first break. Sometimes it is earlier, sometimes it is later. It all depends on how hectic the morning has been or how hectic the late morning is expected to be. The good thing about a surgical assessment unit is we have a running update of how many patients we are expecting to be admitted so we can prepare for the amount of work we will be faced with. On my break, I usually have a bag of crisps and a piece of fruit and a cup of tea while flicking through my phone or a magazine. 

10.45am - This is usually the time for admitting patients. The patients presented in A&E this morning will be coming up to the ward around this time and so if there are enough beds, I will begin admitting the patients. The admission process involves asking the patients a series of questions regarding their Activities of Daily Living or ADLs and how they may have been affected by their illness. These include things like whether they can wash and dress themselves, their mobility, their eating habits etc, and the answers they give us help us care for the patient in the best way possible using a personalised care plan. If the patient states they are usually independent with walking but is a bit wobbly since their accident, I will refer them to a physiotherapist who will be able to review and assist the patient. Other information such as past medical history, allergies, regular medication and main personal details are all noted down too. 

Helping patients to the toilet, completing any tasks left to do, or new tasks given will also be carried out throughout the morning. Liaising  with other members of staff such as dietitians, occupational therapists, physiotherapists, doctors, specialist nurses etc also takes place throughout the whole day.

The doctors and consultants will also have a 'ward round' whereby the consultant teams for each specialty (Upper GI surgery, ENT, Plastics, Lower GI surgery, Vascular etc) will meet with their patients and the nurse in charge of the ward and discuss the plan with them on what they think would be best. As a student nurse, luckily I get to be a part of the ward round and have the task of jotting down the new plan of action for each patient. The doctor will usually discuss with the patient how they feel, they will inspect the body part in question and will decide on what would be best, whether that be prescribing a medication, referring to other specialisms or surgery. I will then update the handover on the computer with the new plan for each patient ready for the night staffs shift. 

12pm - Lunchtime medication round. This is where the patients receive all the medications they are due around lunch time. It is the same process as the morning time medication round but usually there are less medication so does take slightly less time. Antibiotics and other IV medication are usually made up and administered on lunchtime medication rounds too, so I am often found in the treatment room mixing us powdered antibiotics with water for injection too -which is one of my favorite things to do. 

12.30pm -  Helping patients with needs, advice, help or education on anything. It is also worth mentioning that there are usually a lot of discharges made throughout the day on a busy ward like this and so I do have to discharge patients  ready for home too. This involves ensuring they have the relevant medication they need at home, giving advice on how to behave at home (e.g. how long they shouldn't drive for), arranging a sick note from the doctor, and educating them on taking their medication or changing their dressings. Referrals to community teams are also made for discharge to ensure the patient is assisted with any further care needs they may need when returning back home. 

3pm - Lunchtime! I usually go down to the hospital shop for a meal deal as my choice of food changes everyday and previously when I would take in ready made pastas or sandwiches, I would end up not enjoying my lunch as I wouldn't fancy eating it. I flick through my phone again and reply to any texts or emails I've had and chat to colleagues.

3.30 onwards - Again, just assisting with patients needs, talking to patients, updating notes, answering call bells, learning new things from doctors and nurses. Sometimes I will be asked to chaperon patients down to X-Ray, to inpatient clinics such as ENT clinic and fracture clinic and sometimes even get to watch operations in theater. It not only relaxes the patient by having someone familiar with them, but it also allows me to learn more about different specialties and follow the patient journey. 

5pm - Teatime medication round. Same as the morning and lunchtime medication round. There are 4 medication rounds a day and three of them occur during the day shift. The night time medication round is carried out by the night shift staff. 

Answering call bells, assisting patients on their travels around the ward or hospital, updating the nursing notes, ensuring all tasks for the day have been completed and assisting patients with their food and drink. Generally just making sure my patients are as happy and as comfortable as they can be.

7.30pm - Hand over. This is when the day shift staff will hand over the updated plan for each patient to the night shift. Same as the hand over process we received in the morning and usually from the same people we are handing back over to, but with new information on what has been done, what needs to be done and how the patients are. 

8pm - I say goodnight to my patients and colleagues and walk home. I usually ring my mum or boyfriend on my walk home as I hate walking in the dark on my own! It also gives me a chance to tell them about my day. Whether it's been calm, happy, stressful, upsetting, difficult, easy, rewarding, boring. It allows me to reflect on it all and release emotions which is a massive part of being healthy and stable within my mental health. 

8.10pm - I get home and shower. I make myself some tea and get straight into bed. Usually, I am shattered and my feet ache. I put on Netflix or some catch up TV on my laptop and watch it until I fall asleep ready to do it all over again the next morning!

I hope this was a helpful and interesting insight into my busy day as a student nurse. Every day is different and because of the nature of a surgical assessment unit, we may have 12 patients one day and it be very calm and not rushed at all one day, and the next there are 30 patients with 6 in A&E needing a bed and you have a list of 18 things you need to get done. Cardiac arrests, falls, patients suddenly deteriorating and the like can also shake up the flow of the day too but I am fully trained in being able to deal with crisis like these and have done many time in my training already. Nursing brings out the best in me and when I am on the ward, I find it easy to put others first and for a moment forget my anxiety and panic disorder. As I spoke about in this post, when I am in 'Nurse Mode', my adrenaline is being used for the right thing at the right time, and I love it. Even though sometimes I can finish a shift feeling very emotional or very drained and tired, the majority of the time I finish happy and proud of not only what I have achieved for myself but what my patients have achieved too.  Writing this has even allowed me to reflect on how proud I am to be able to handle the amount of things I do each day even when spanners are thrown in the works, which they frequently are. It really is my dream job and helping poorly people is my absolute love in life. I am so excited to qualify in 10 months time and get my blues!

Love Luce xo

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