The journey known as 'The drugs round'

'Understand, just take his hand.
He's the medicine man'

                                      Pantera (1990)

Hello fellow students, nurses and anyone else who reads this blog.

Well it's been 2 weeks since I started my placement on Medical Rehab... What a difference!!! Going from an acute surgical Ward where everyone is running around looking after pre and post operative patients, to looking after long term conditions patients that are undergoing rehab and waiting for social placement is a huge transition. Add to this the transition from Assistant Practitioner to student nurse... It's more difficult than I expected.

The main thing that is different and I'm having to get my head around is the drugs round. This is something new to me. OK, I know the names of some drugs and what they are for... But that's it... Superficial knowledge. This is something that I need to change as I realised that only knowing what system/area drugs fall under just won't do - Cardiac, water tablet, antibiotic...

I started my journey known as 'The drugs round' by shadowing my mentor on my 1st shift while they did the drugs round. We were only on the 1st person when my journey started and my mentor turned to me:'Digoxin, what is it?' This question caught me slightly off guard as I wasn't expecting the this question (I don't know why I thought this wasn't going to happen), lucky for me I new the answer to this question: 'It's a cardiac medication' There you go, I answered the question: 'What type of cardiac medication?' This I wasn't expecting, I thought that 'cardiac medication' was the right answer! Again though, I knew the answer to this as well: 'It's a digital drug.' BOOM! Knocked it out of the park! Dam I'm good! Oh, hang on... What is she doing... Wait... More questions?!? 'Good. Now what does it do, when would I omit this and why?' Now I was stuck. I thought about it and remembered that the patient had AF and so put 2-and-2 together: 'It helps regulate the pulse and brings it down. You wouldn't give it if the person was bradycardic.' And there was my answer, a bit vague, but an answer none the less... But not the full answer my mentor wanted. 'You need to check their pulse, if it is less than 60bpm then you would consider omitting it. But 1st consult with the Ward Dr. Depending on the rate they may also do bloods for digoxin toxicity. ' And there you go, something I never knew... Digoxin  toxicity! And so, that was the start of my journey now known as 'The drugs round'. 

Since that day I've told myself that I need to know more about what medications are commonly used by my patients. This included what the drug was for, what type/category of drug it was, what the drug did, and what the contraindications of the drug were. Me placement is in medical rehad meaning that most of the elderly patients were on cardiac medication, and so I've started to try and swat up on this area. But with sub categories like digitals, Beta blockers, Vasodilators... It's confusing. That said, I've found patterns in the names. Most of the subcategories can be worked out by the end of the name - 'lol', 'pril', 'startine'... These simple has made it so much easier for me to remember what's what.

Right, well that's enough from me for now, I'm going to go look up some more medications. Until next time peeps 😁

Big changes!

Its been about a year since I last did a blog but after reading a friends blog over the 2 months I decided to pick up where I felt off.

Things have changed since my last blog and I'm walking down a new path... I'm now a student nurse!!! As you may remember I was an AP on a surgical ward. I enjoyed my time as an AP and ended up helping all the newly qualified international nurses we had join the Trust. It was hard at 1st, but a good experience. I was also an RCN Learning Rep but I think that role was a little under used by the Trust. I tried to sort things out but without the support I needed it fell a bit short and the main thing I helped with was MNC Revalidation.

I also attended RCN Congress 2016 and was able to get funded for all 5 days. This year was special as it was the RCN Centenary, 100yrs old!!! It was particularly special as a friend was giving a 'topic for discussion' on the new Associate Nurse role and is it all that different from the AP role (the correct answer is 'NO!'). I ended up getting up and talking in front of Congress to support her (and all the AP's out there). Everything was going well until I was in the queue and looked out at Congress... What a mistake that was!!! Being sat at the front in the voting groups I had forgotten that there was a whole audience of nurses behind me! There were about 500+ people... And it was being streamed live on the internet... I almost wet myself in fear! That said, once I was up and my 2 minutes started I got right into the swing of it and let fly (and remembered not to swear! LoL). In the end the 'topic of discussion' was voted to become a resolution, but Chair of Congress said 'No'... 'This should go straight to Council in my opinion'... What the funk!!! Shut the front door!!! This was a huge move for the AP's in the UK. A truly memorable thing.

Anyway, as I was saying at the start... I'm now a student nurse! I had applied for secondment through my Trust but the funding was pulled. With the financial issues arising as of 2017 I said I was going to Uni no matter what... And so I left my job as an AP behind at the start of September and started Uni. Having been an AP I was able to skip the 1st Yr and go right into the 2nd Yr. Amazeballz I hear you say. But going in this route has had it's problems and has involved lots of phonecalls, emails, meetings, interviews and chasing things up, but the main thing is that I got on the degree and skipped 1st Yr.

Well I think that's everything that has  happened since my last blog back in 2015. Its been nice to write this and can't wait to keep everyone up to date with my life as a student nurse.

Shaniepoo out.

Different ways of training

'It's Black and white'

Static-X 2001

I've not done a Judo (or any type of blog) for quite some time due to work being a bit nuts.  Thought my 1st blog back would be Judo based following a trip out to another club that I visit when our club isn't on.  Last night we visited them as our venue was closed due to a freak weather storm that flooded the north west region and so power was lost for 3 days.

Although me and my training partner enjoyed the night we noticed a big difference between he learning styles our club and the club we visited have (I think I've touched on this before).  In the car on the way back we got talking about this.  The main difference was that where we normally dedicate 1/2 the night to Uchi-komi and technical Judo, this club focused more on randori.  The only time they have done technically work/Uchi-komi it has normally been following something that has been seen in youtube, normally 'Ippon of the day' (this has become an ongoing joke between me and my training partner as the opening to this part of the session normally goes 'I was watching youtube last night, and, I saw this technique... son, show em how it's done.').  The problem with this is that not every 'Ippon of the day' is a practical technique to practice, Uke-waza for example.  Here is where our club differs, while their session consists of 90/10% randori:Uchi-komi/technical Judo, we do a 50/50% split of randori:Uchi-komi/technical Judo.  The other main difference is that our Uchi-komi focuses on perfecting the basic (Kumi-kata, Kuzushi, Ashi-waza...), our theory being 'if you can't do the basics right... you can't do the advanced techniques right'.  The club we went to is made up of 90% 1st Kyu and Dan grades, they are big guys for the best part, and strong.  Now strength and power are all well and good, but without technique they will only get you so far.  One thing g I did notice was that there was a common the am in the club... everyone used the same 2-3 techniques - De-ashi-barai, Ippon-seoi-nage (who doesn't like this in their repertoire?!?) and Uchi-mata.  Now I have seen these 3 techniques used by the club's 3 main competitive players (all high ranking players)... and they are awesome! But they are now being used by everyone, but the lack of Uchi-komi means that the techniques are not being working on or practiced. This has resulted in poor entry, lack of Kuzushi and a technique that is all power. This doesn't mean that the throws don't work, one of the guys who used to train with us and uses 'all strength no technique' was able to throw me with De-ashi-barai after spending most of the fight kicking my leg. But I will be the 1st to admit that when he got the throw... it was a cracker. Now this is hard for me to say, but when he got it... he got it good.

To sum it up, my view on Judo is that if you want to do good Judo then you need to get the basics right. You can get just as good a sweat on during an Uchi-komi session as you can in a randori session. It's a technical sport and with good technique... you can throw anyone.

Right, it's 06.30 and I need to finish my triple esspresso and head to work. See you all on the tatami peeps :)

A need for more technique

'It is a necessity for Judoka to analyse not only their own movements to become better,

but also the movements and strategies of their opponents.'

Doug Berninger (2015)

It's been a few weeks since I did a blog, between work being busy and social events ive not had much time to myself.  Today's blog is due to frustration and disappointment.   This is not based at any one individual, but at a geographical area within Judo... Judoka within the North West.

This weekend I was dour area Dan grading.  We had a good turnout of 1st Kyu Jodoka (14 people) and a good mix of sizes (69-94kg).  A large group of these Judoka knew each other as they trained together at 2 clubs (Me and my training partner also trained with them over the summer, a friendly and dedicated group if guys).   Observing me doing the sheets was one of the area squad coaches and a very well respected 7th Dan (I think. LoL).  There was around 34 fights in total with 7 Judoka getting their line up, but only 1 of these being successful.  From the start 1 thing was apparent, the technical ability of the Judoka was... well... DIABOLICAL!  Throughout the whole of the 1st Kyu sheet I had both coaches muttering about the lack of kuzushi, ashi-waza, rotation and overall technique.  Both coaches said that 1 thing was obvious... We need to go back to the basics.  There are lots of clubs that run randori nights, and that's not a bad thing as we all like to have a good fight.  But there is a NEEDS for more technical nights within the area. 

At our club we focus on this quite a lot and try to get our Judoka to understand the reason why we do thing the way we do.  Our view is - 'If you can't do the basics right... how do you expect to do the more advanced techniques?'  Getting back to basic drills and repetitive uchikomi will help with muscle memory, as Neil Adams once said - 'Practice doesn't make perfect... it makes permanent!'  When you get on the tatami and take hold of Uki you want to be able to act and react as if it was second nature.

Following the 1st Kyu sheet was done (only 1 player got his 1st Dan in their line-up) it was time for the Dan grades to get on the tatami.  It was at that point that the action started.  My training partner was meant to be on a coaching course but it had been cancelled, so he decided to come to the grading and try get a few points towards his 2nd Dan.  This was only his 2nd competitive time on the tatami in about 2 years... but he hadn't lost a beat!  Within the 1st fight if the Dan grades the 2 coaches with me were smiled and both commented - 'At last, some technique.', 'More ashi-waza in this first fight than the entire morning!'.  As the Dan grades continued it was easy to spot the difference in the ability of the 2 groups both on a technical level, and a competitive level.  My training partner went on to produce some amazing techniques and win his 5 fights (Ippon number 5 in the picture) on the day to get his 2nd Dan... As his training partner for about 15 years I'm taking 1/2 the credit for this :D

Well that's my rant over.  I'm a huge believer in underpinning knowledge - What, why and how are you doing something.  Until next time people, keep throwing!

Hard times... Reflection

'Its all about

the blood, the sweat, the tears.

Attribute to the strength

built through the years'

Machine Head (1999)

 

 

 

This blog post is a bit of a hard one for me as I need to remember that this is not a platform for venting frustration and ranting.  So I need to reflect on things and see the good as well as the bad.

 

My last few shifts have been difficult and very taxing.  Over the 18 months we have lost a large number of experienced staff, including our Ward manager.  As you can imagine, this has put strain on the staff that remained on the Ward.  This wasn't just happening on our Ward, departments across our Trust were short of staff.  To fill this short fall the Trust look to solve the problem by recruited over 200 international nurses.  This was great numbers wise, but as a lot of these nurses were newly qualified, the skill mix became a problem.  This brings me to my last few shifts.  I am going to go back to my days at Uni and use my favourite form of reflection that I use in at work and also on the tatami when doing Judo - Rolfe et al 'What, So what, What now.' 

'What' - The situation

I walked onto one of my last shifts and looked around the room and didn't recognise half of the staff.  Experience went as follows:

 

Sister - 10+ years

Me - 10 years

RGN (international) - 18 months

2 RGN (international) - 10 months

RGN - 2 months

RGN (international) - 4 days

2 Apprentices - 4 days

2 Cadets - 4 days

2 CSW - 2 months

 

It also turned out that 7 of these were only on till 1.30pm.  I exchanged looks with the Sister and knew that this was going to be a long day (I txt the wifey and told her to put a beer or 2 in the fridge ready for when I got home... I was going to need it).  The lack of experience and language barriers that were present meant that the newly qualified and international nurses were missing simple, but important things.  This is by no means their fault.  I feel that the international nurses are brave and determined individuals.  They have come to a new country with no real family/friends network to support them, new language to learn, new culture and a new social ways of living (I will never forget one of them saying that I was odd for going to a coffee shop on my day off and sitting on my own reading a book with a cracking coffee and awesome slice of cake... she has now seen the light though and goes to the same coffee shop and reads a book. hahaha).  It also turned out that they were the only 2 people on the Ward who could do IV's, and the other 2 international nurses were both need observing still as then were finding their feet, while the newly qualified nurse needed supporting. 

'So what' - Action plan and implementation
Following Handover myself the Sister and the RGN who had the most experience had a conflab in the back to formulate a plan.  The myself and the RGN would each work with one of the 2 international nurses while he Sister would work with the newly qualified nurse.  The aim was not to do the work for them, but to support them.  They would run the bay and we would be there to help and guide them when and where needed.  IV's would be split between the Sister and the RGN.  Come mid afternoon the Sister and RGN were up to their eyeballs in IV's and 1/2 the staff had gone home.  It was at this point that we realised that the newly qualified nurse was on her own in her bay as the people working with her had gone.  The only problem was that she didn't tell us and had spent a few hours struggling to keep the bay in check on her own.  We made sure that the 2 international nurses were coping in their bays and then had a huddle with the newly qualified nurse.  The conversation involved prompting the newly qualified nurse to delegate jobs so that they could get on top of their bay (a conversation very similar to the one in my other blog 'Supporting the future').  A high five and handful of Haribo each (Haribo make everything better) and we got on with the jobs.  These involved medication dispensed, discharging a patient and some wound dressing, this enabled the newly qualified nurse to get on with other jobs and get the care plans finished.

'What now' - Looking to the future
This is where we are now... what do we do to make sure that our new nurses are not left to struggle or feel abandoned.  But on the flip side, what do we do to stop the experienced nurses from feel like they are being stretched to thinly and feeling like they are unable to give the standard of care they want to give.  This is not easy to do and I know I don't have the answer.

Following this reflection of my last few shift I like to think that no matter how bad things seam there will always be a light at the end of the tunnel.  Everyone has felt at some point over the past 18 months like we have hit rock bottom, but it will get better - 'From the ashes will rise the phoenix'

And so we come to the end of what may look like a negative blog, but I look at it as being realistic.  If anyone has the answers then please send them on a postcard to me :)

Back to basics

"Be a simple kind of man.

Oh won't you do this for me son,

If you can."

Shinedown (2003)

 

Well it's the morning after the weekend before... and 26hrs on the Ward as I've been on shift all weekend. 

 

I was working with a good team over the weekend - reliable, hard working and fun to be on shift with.  I got to work with one of our colorectal team, right hand woman to the consultant, and one of my Wards old manager.  She does extra shifts on the weekends (anyone would think that she didn't have enough work to do!) and when we are both on shift at the weekend we normally get put to work together as she works until 15.00 and I take over for the rest of the day with Sister doing my meds.  I enjoy working with her, not only because she is a wealth of knowledge but also because she is fun to work with.  She is great with the patients, laughing and having a joke with them.  A lot of them she has seen in pre-op clinic or in theatre itself so there is a bond before they even hit the Ward.  She always jokes saying 'You have drawn the short straw again.  I will let you do all the work, I don't know why I bother coming in as you end up doing everything. Ha Ha Ha'.  By this she means I normally tell her to go and do other thins that I can't do such as cannulation, prescribing and doing discharge letters as trying to get hold of a Dr at the weekend is like getting blood from a stone.  When it comes to documenting in the afternoon I normally tell her again to go and do something else as I know she has a mountain of work to get ready for Monday and the start of theatre.  'I got this, you go do something more useful.  I'm sure that slave driver of a consultant has left you a mountain of work to do while he is relaxing at home watching the rugby.'  This made her laugh and after 5 minutes of arguing about me not letting her do any of the care plans she went and made me a cuppa and got on with her mountain of work.

 

But as the lyrics say at the top of this blog - "Be a simple kind of man. Oh won't you do this for me son, if you can"  I look after a lot of elderly people in hospital and you find that it's the simple things that can make all the difference.  One of the patients in my bay I had looked after before on a previous admission.  He was a little bit confused on this admission and he was dependent on the staff more.  When he saw me walk in the bay he smiled and called me over.  He remembered my name, always a nice thing as I feel it shows that I must have done something right for him to remember me.  We had a little chat and there was one thing he asked me a question: 

 

'I know it's silly, but is there any chance I can have a shave this morning? It's a simple thing I know, but I'm struggling and I don't have a razor.  Can I borrow your comb as well as I don't have one and could do with combing my hair.' 

 

I looked at him, raised my eyebrow and smiled...

 

'Not a problem, let me go find a razor and we will get you looking good for when your son comes in.  As for borrowing my comb... Do I look like own a comb??? I'm bald... I haven't needed a comb for about 10 years.  I will get you a comb from our store room... unless you want me to shave your head so you can look as good as me?' 

 

He laughed at this, as did the chap in the bed opposite him.  Later that morning after breakfast I got a razor and a comb (not one of mine though) and helped him have a shave and comb his hair.  The smile on his face following this was great, you would think he had won the lottery.  This one action made me feel like I had made a huge difference to his stay in hospital.  I guess this makes me a simple man as well, when something as mundane as giving someone a shave and combing their hair made me feel so good.  It's one thing to be able to give out medication, catheterise and cannulate, but it's the simple things that sometimes have the biggest impact on people, something that me and some of the staff I work with try to emphasize to students and new staff... go back to the basics.

 

Well that's the end of another instalment for 'Trials of a Shaniepoo', hope that this story of how simple things make the biggest impact made those of you who read my blog smile as much as it did me.  Later peeps :)

Supporting the future

'Un pour tous,

tous pou un!'

The three Musketeers (1844)

Well, what a week I've just had at work!  There were 3 main highlights from last week that can be put into 3 categories - Mentoring, RCN and Revalidation.

Mentoring:  As with a lot of Trusts and NHS professional areas we are struggling with staffing levels - Retirement and retention are proving to be a problem.  Due to this we have had a huge intake of international and newly qualified nurses, as well as a large number of agency nurses.  Although this appears to be a bad thing I have found it to be quite a good thing for me on a professional level as it means that as an AP I have been put to good use.  Over the last week I've been working with one of our newly qualified nurses to help her find her feet.  I've found it challenging in some ways as I start to go into auto-mode and just start to work automatously (big word for me!) before realising that I'm there as a support role and have to put the breaks on.  She has found it had over the past 4 weeks as our clinical leaders have been up to their eyeballs in mentoring and supporting the large number of new staff we have and so struggle to get round everyone... step in yours truly :)  I had a long chat with her while on shift and told her, in my opinion, the best way to run her bay.  This involved a number of thing.

1. Use your support worker - As an ex-support worker myself I know how useful these lovely people are and how they form the foundation of the work place.  Use them to the best of their ability, but never... EVER... abuse them.  They are hard workers but if you abuse them they will become disgruntled and not want to help you, thus causing a long and uncomfortable shift.  Always offer to help them and thank them for supporting you... you will be amazed at how nice it is to be thanked and how much more they are likely to want to work with you in the future.

2. Time management - You need to prioritise your workload.  Some jobs are more important than other and you do not have to do EVERY job yourself, if you try to work like this you will never leave the Ward on time.  By prioritising your workload you can ensure an efficient and safe shift.  As above, use your support worker to help by giving them some items from your list of jobs.  This will make them feel valued and show that you have trust in their abilities within the work place.  This then leads to the next item...

3. Delegation - I find this to be one of the hardest things for new staff to do as they don't want to look like they are abusing the staff they are working with.  This takes both items 1 and 2 above into account and will have a huge knock-on effect.  Delegating to your support worker will mean that your time management stays on track.  One thing to remember though, if you delegate a task to someone then you are saying that you feel they are competent in that job - If they make a mistake... you have made that mistake also.  I find the best way to get a newly qualified nurse to delegate is to tell them that I will not do anything unless they tell me.

4. The 'Huddle' - For me this is a vital part of working as a team, and incorporates items 1, 2 and 3 from above.  Every few hours you should have a 'huddle', this can be in the corner of the bay, the back room or by the nurses station.  The 'huddle' is where you and your support worker can get together, pass on things that have been said on Ward rounds, inform each other of situations with patients, and formulate a plan of action.  The action plan involves you deciding how to use your support worker to the best of their ability, managing your time and then delegating jobs.  Here is a conversation from one of my 'huddles' last week and an example of how I try and teach newly qualified nurses how to run a bay. 

'What needs to be done?'
'I need to change 3 wound dressings, I need to do a CHC & STRATA, I have 2 DN referrals to do, I have a dietitian referral to do, and 2 discharges.'
'Ok, While you do all of them I am going to go and have a brew in the back.'
'Err, umm, ok.'
*walk out of the room and then come back in again* 
'Would you like me to do any of these jobs for you?  If you don't tell me, then I wont do them.'
'Err...Yes please...'
'Ok, you know what I can and can't do.  What do you want me to do?'
'Do you want to change that wound dressing...?'
'No, what I actually want to do is go and have a brew in the back.'
*Grins*
'Oh... Ok then.'
'Would, you like me to change that wound dressing?'
'Err... only if you want to.'
'As I said, what I really want to do is go and sit down with a brew.'
'Err... Ok then.'
'I will say it again.  Would, you like me to change that wound dressing?'
'Only if you want to...'
'What did I just say I want to do...?  Delegate.  If you don't tell me... I won't do it.'
'While I discharge one of the patients, can you please change the wound on bed X'
'Yes.  And after that?'
'After that can you do the 2 dietitian referrals.'
'Yes I can.  Now that wasn't to hard was it?'
'No.'
'There you go then.  If you want to get out on time you need to delegate.  If you ask a support worker to do a job and they say 'No', ask them again and ask why they won't do it.  If they still say no and don't have a legitimate reason then tell them to do it - 'I have asked you to do job.  As your senior, I am now telling you to do the job I have delegated to you.'  If they still say no then inform the clinical leader.  You may feel bad about this but that is part of the role for both you and them.'

RCN:  I received an email during the week from my NW RCN Learning & Development Facilitator informing me that she was happy to sign off my 2nd module learning grid.  What does this mean?  It means that I've passed my RCN Learning Representative course... I'm a fully fledged  RCN Learning Rep!!! :D

Revalidation:  During the 2nd module of my RCN Learning Rep course, and following a Ward meeting I've been looking into NMC revalidation.  This doesn't affect me as I'm not a nurse but I feel that as a Learning Rep it is something I can sink my teeth into.  I brought this up a while ago in a Ward meeting asking if people knew what the provisional criteria was at that point in time.  The reaction I got wasn't great as the only people who had the vaguest idea of what I was talking about were the Ward manager and clinical leader in the room.  Following on from this I decided that the large intake of newly qualified and international nurses not knowing anything about the new revalidation criteria would be a great project for me t sink my teeth into.  I decided that the best thing I could do would be to make a simple guide that condensed the NMC's 30ish page document into a bite sized easy reader.  I ended up making a double sided A4 pamphlet that broke down the criteria into individual areas and explained what was needed for each bit.  Before I could start handing this out though I had to get the all clear from my Trust's senior management team to make sure it contained the correct information and that they were happy with i's presentation.  Ward staff I had shown it to thought it was great and quite a few staff from other Wards have come and asked me about revalidation and if they could have a copy.  Well, mid week I got a few emails from our Listening into Action tem, chief of nursing and our Communications team all saying that they supported the pamphlet and that I could distribute it to staff!  One small step for the Trust, one giant leap for Learning Representative Shaniepoo! :D

Right, I've been procrastinating all morning and have jobs that need doing round the house so am going to stop talking and get a shifty on.  Remember guy... Respect your support workers, they are the foundation of your team :)