Monday, 21 April 2008

Warning information overload!

Today i have been on an educational day learning in depth the anatomy and physiology of the deteriorating child including the factors which are involved in the biological processes of the human body. My mind now feels totally bambozzled with information. Throughout the day i was requiring regular glucose boosts just to keep me going...So i am assuming my brain was hard at work trying to absorb all this information and store it somewhere up there.

Yesterday I thought it would be clever to do some overtime at work (Yes, on a sunday in the ED!) I am trying to utilise my skills learnt in my previous course undertaken thus need to spend more time in resus to improve my knowledge, clinical skills and my confidence. Yesterday resus became an extention to ITU. I spent the whole of my shift working together closely with the intensivists which must be said i quite enjoyed. I was able to give timely appropriate care and treatment to individuals. It gave me a warm fuzzy feeling inside and reminded why I entered the health profession. I find the intesivists great to work alongside and really helpful, which was reassuring for myself.

On a low we had a gentleman come in with septic shock, who was moderately unwell suffering with severe hypotension which was not responding to fluid resuscitation, hes BP was in his boots roughly 70 systolic on arrival. I suddenly felt quite out of my depth when i had orders thrown at me from all directions. I managed but was left feeling my whole focus was on the physical aspect of care rather than the nicities - such as communicating effectively with the patient and family, although this was carried out it was at such a minimal level because I was the only nurse in the mad panic of stabilizing the patient - god,what i would do to have 8 arms/legs/tentancles like an octopus! : )! On the other side of the coin the septic patient was only discharged from the ED less than 24 hours ago, one day discharged home next day admitted to ITU. It just reminds oneself of how quickly a patient can or will deteriorate and stop compensating over a short period of time - Could the initial management and presentation of the patient 24hours before have prevented an ITU admission - had we got it completely wrong? Was it a failure on our behalf? Was fate and destiny in play here, was the outcome just prolonged?

It is these kind of stories the media loves to write about and 'paint the NHS' in a bad light, sensationalize all the stories! Lets face it im sure the title ' ED saves anothers life' would not sell papers aswell as sensationalized stories. Once again you can see a businness stroke approach in full play! Although it is more apt to use a business approach in selling papers and less apt to use this when saving lives or at least attempting too!

It must be said though I had conformed to the standards of the 'new NHS' the bosses seemed happy. On a lighter note we should be soon be recieving a new influx of staff, which should help in these kind of situations, one can always wait in hope and anticipation!

I left the department feeling cheery but fatigued both physically and mentally.
Seemingly yesterday seems to have had a positive effect on my self esteem, self belief and confidence. It must be noted though I may have possibly being feeling fatigued more so from my saturday night shenanigans. It just reminds me how things are not as 'black and white' as they are sometimes seen or percieved to be.

Once again I left ED feeling glad to be alive and living life.

Wednesday, 16 April 2008

Life vs Death

So after my long winded answer to DrShroom regarding destiny and fate the other day i really do not have much to say. Arrived at work slightly late by about 2 minutes although plugged in, listening to music seemed to set my mood in a positive light, my work colleagues did not seem impressed with me, although i was not to bothered as i was extremely cheerful for the morning.

Work has been unusually weird with nothing spectacular happening. Although yesterday seemed to be 'death comes knocking at your door day! The first half of the day seemed to be full of CPR or post CPR patients...some passed away and some we managed to save (yay!). Which seems to link quite nicely with my discussion with DrShroom recently -

'Can you really ever contemplate fate without considering destiny? One either looks at destiny as an in alterable pattern of events which are unchangeable and inescapable leading to fate. Alternatively one takes the view point whereby individuals can choose their own destiny by reading the signs which destiny presents to us. I'm more apt to go with the second explanation - i believe there are certain situations and coincidences which happen in ones life which can assist you in making decisions, which in turn effects your life - everyone of us has choices - it is the facts presented and ones intuition which assist us to make a final decision. I'm more inclined to to contemplate it to your whole life but can see it is more apparent or should i say more visible in terms of mortality and soul mates. Fate implies their is no choice and is an outcome but destiny allows for willful participation. If fate is fixed does it matter the pathway of events one takes? Will the result still be the same or can one alter the outcome by altering their willful participation in the events (destiny) leading up to the outcome (fate)? Alternatively will altering ones destiny just prolong ones fate.'

Today's events seemed to be monotonous, as i was today given the 'red dot' - this meaning it was my shift to work on our observation ward which seemed to prove more challenging than usual. It went from an observation ward to a high care setting with the only disadvantage of having just one nurse-me but obviously a cost-effective use of the nurse! One patient who had taken an overdose was de-saturating on air to eight percent had aspirated, another was bradycardic, the other was hypoxic with SATs of 76%, tachycardic, tachyapnoeac and the rest.... Lately i have encountered negative aspects of care delivery. In an attempt to change practice it is highlighted we now must fill out clinical incidents with regards to inappropriate admissions to the observation ward - once again more paperwork - less time with and for the patient's = degrading levels of care delivery.

Although the ED does attract some strange people with inner aspects of oneself written on the outer aspect of their body, namely on on their sleeves. Which amuses me greatly at times. I was challenged today and accused of not being cost-effective with my use of resources..although probably true and agreed with the criticism, it seemed to go 'over my head' evidently i do not seem to place a high priority on cost effectiveness in regards to the use of resources with the department. One seems to place more emphasis on patient care rather than the business NHS which is evolving or being defined as by the ever so loving government of today's society! As long as we save money, hit our target goals, view people as numbers and dish out little of a our time and care to patients we will do well in the 'New evolving NHS - we will all be standardised and programmed like longer will we have diversity and variation in treatment and care delivery.

Ask yourself this, why do people and yourself enter the health care professions ? Is it to care for fellow human beings, a vocation or for status? I would be more inclined to say care for our fellow human beings although things seem to be moving away from working outside the box, caring and treating. These aspects seem to be diminishing or becoming almost 'forgotten' and disregarded in clinical practical today.

Sunday, 13 April 2008

When hell hit the department.....devil style!!

Well, things did not seem to to get better, the night staff looked exhaused when i came on duty and you can tell from those looks - oh i really want to be convince yourself its not that bad and then become quite optimistic with regards to the situation....really how atrocious could it get...?

We had a GP in today who refused to see anything remotely emergency related with regards to minor injuries and would only see medical problems...which leaves oneself wondering the point behind this? The department is slowly sinking deeper and deeper under the sea of patients which seems to keep multiplying every 5-10 minutes, everytime you look out theres been an exponential growth, the sea of patients seems to be evolving and suddenly I feel a very diminutive part of the 'ED ocean'.

I felt like the vampire queen today rushing here there and everywhere, 'stealing' blood from individuals, never truly managing to get a grasp on anything or anyone, as you do. Supposadly stable patients placed in the observation wards prove not to be so stable in the morning after all. An elderly patient who presented to the department yesterday, late afternoon with falls/collapse, shoulder pain and acute confusion seems not to be so well after noting melina after her motions. This made me feel a little uneasy as the the patient was in my care yesterday and i did flag up with the doctor my concerns with regards to this patient and passed on my views on how i felt, in an attempt to be the patient's advocate as she was acutely confused. It left me wondering should i have really stuck to my point, listened to my sick sense and intuition and pushed my point further, in attempt to really ensure the patient recieved the timely pertinent care and treatment she deserved. It was noted the patient was left without review during the 'night rush hour' which to be fair is the way of emergency care, at times, but the patient was obliterated and left in the 'land of limbo', as they do, people view them as clinically stable. Although problem being, the patient was not stable and had a CRP of 165 and urea 9.2, tachycardiac, with a MEWS score of 5 and ended up in resus for a full new assessment, this left a certain stroke of unease about how i could or what i should have accomplished for the patient yesterday, I feel as if i am partially responsible for this individuals deterioration in health.

By 12.00pm there were patients all over-some deteriorating sat on chairs causing the panic station to flash at full speed,but there were no trolleys for them! ambos could not off load their patients and resus was full on within trauma's and the critically ill. Everyone looks very confuzzled - not knowing where to start, which way to go but the question still lies, where were the SHA today or last night for that matter....?

Saturday, 12 April 2008

I am a weird mood today for some bizzare unknown reason. I cant really explain it. It probably has something to do with the fact it is the weekend am once again I am back at work

Well to start off today we were formally told that we must look busy today as the SHA were visting the department, and obviously they are the 'giveaway' money service to those who are in need of apparently next week we will be asking them to fund us for an extra 10 nurses within the department. For starters asking us to look busy...thats just a bit condescending when do we not generally not run around in circles or chase our tail in the ED.......?

Then we get the usual not so interesting individuals that decide weekend visting to to ED is in need. Then you get the primary agencies sending more our way with poor transfer letter kinda explaining im passing this patient to you rather than attempting to sort them out myself...the usual 'get out clause' - a poor example of primary care referral or 'lack of it', stood at the for front of our doors. It is not surprising the medics whose fellow medics carry out things with such little regard for their fellow professionals become frustrated and at times dispair...i do empathise with them at times.

Anyway things can only prove to get better with my less than 12 hour turn around before being back in the ED.

Hyperactivity here i come.....

Well then, here we go, my first account of a day in the life of the Emergency department. Take a deep breath and read on…

Unfortunately, I don’t have a huge amount to report today, it was a fairly normal day –how boring I hear you all say. Where to start… I have been working, living and breathing in the land of small people. How cute! It is the normal time (school holidays!) for the influx and flurry of accident prone children to be presented to the department as well as those who have the potential to deteriorate in front of you, which at times can be quite scary especially if the department is snowed under as is tends to be nowadays. It has been a day of entertainment, where dancing around the wards seems to be normal. Of course, when working with the little ones, you have to be happy, happy, happy, (a concoction of sugar and caffeine seems to do the trick nicely!! ) even when your personal life throws things at you that you don’t necessarily want or need to think about, but one still does, You have to leave any baggage you have in your life at the door and concentrate on the small fragile people that walk into your working environment. Not forgetting the even more so fragile parents who accompany the little people whom also need support, reassurance and constant communication to assist in providing a positive patient experience. It has to be said sometimes this is harder than it should be, but it still has to be done.

Then there was this one incident……This is where I go on to rant about radiologists. It must be said I do at times find radiologists very pedantic and raise my irritability levels quite drastically, with regards lots of, what I would class as ‘minor issues’. In particular today we had a young mother who was pregnant, we all understand and know the underlying harm these rays can cause although when they get to the point of refusing to allow mum into the x-ray room with her other little’ in’ I think this is going to extremes and I wish at times radiologists would make an informed choice which is wholly informed…if you get my drift. Thus I had to step in to assist in x-ray and attempt to find numerous ways to engage the little’ in to lay still for a pelvis x-ray…although bubbles seemed to do the trick nicely, although I did not seem to impress the radiologists with the mess I left behind….oops!!

Today has been fairly busy, as usual… the puppet master was working in the usual ways and the usual 4 hour breach targets are still very much present and part of our day to day life. No longer do you hear or see people asking ‘how is that patient?’ but its all about turning around patients within 4 hours, it does not seem it to matter how you or others go around this as long as you do…never mind how ill an individual is or the level and standard of treatment or care which is being delivered!! One sometimes feels like their sinking at times and is left wondering did I really do everything in my power or provide the best possible care for that individual, and sometimes you leave wondering what if..? Could I have done something better? I have been pushed from pillar to post and received orders from left right and centre but generally tried to stay quite neutral to these issues. Although life goes on and you do what is asked of you in order to provide the best amount of care possible unless you like to play devils advocate, which at times can be my speciality….

This is compromised of late, as outside agencies have been invited into the working environment with an aim to raise the profile of the Emergency Department and capture us ‘saving lives in action’ well supposedly! . This is all very well and good, but having to work to the highest standard possible, without ever taking time for yourself in an 8 hour day (or longer!), is hard. It is hard enough dealing with patients and their families in the tragic situations life throws at us, without have additional interferences and questioning your own knowledge…

Thursday, 10 April 2008

My bubble and I...

So then, an entire new world for me to explore! The idea of being able to express my thoughts and feelings about the Emergency Deparment through the medium of 'the blog' - how terrifically exciting!

Well, I suppose I should introduce myself to you all... I am a of the group of people who look after and care for those who are less fortunate within the healthcare bubble. In other words, I am a nurse. Nursiedoll derives from my students days, where I was christened with the nickname 'Nursie' from my fellow med student aquaintances. The doll part I have adopted through being a member of ED and at times having the feeling of being treated like a doll, or puppet if you so wish. Being pushed and pulled in opposite directions and often running round in circles, as though being controlled by someone of a higher power ... the puppet master of the NHS!

I am beginning my online history because I feel the need to express certain issues regarding the healthcare setting becoming a business opportunity! People seem to be increasingly losing their identity and just becoming a number on a very long list. Statistics should not be involved where people's health is concerned, we are supposed to care, not have to think about targets and producing figures. On a day to day basis, certain situations occur, leaving one to question what direction the delivery of care is heading towards. The need to vent my feelings on certain matters is becoming increasingly vital.

Back to more personal issues, I am from an average background, from the usual 2.4 family - who have their differences. I am the first of my family to enter the healthcare profession and hope to encourage others to do the same - Honest! I am working in an ED department, which can be stressful to say the least and it is my 2nd year within such a setting. You could say I am still on that steep learning curve, leaning on certain people for that extra bit of support! I am a relatively good girl, don't smoke (usually), don't drink (heavily) and behave (mostly)!!

Anyway, I am going to stop discussing myself, as that is not the intention of this page. I will leave you anon, but will return to tell tales of life in ED and to hopefully keep you intrigued with my rantings from the ED bubble... Of course if you are not, I will never have to know...