You have to work on a ward before Emergency…. or do you?

Whey-hey-hey!

In this post I’ll be talking about this weird little stigma of not going into an acute or specialty area of nursing straight out of nursing school, and my experience with this.

So, as we all know, I’m a lucky lucky girl who was successful in gaining a full time graduate position in a tertiary emergency department. The nursing workforce in Australia, though claiming to need all hands on deck, has a very high rate of unemployed graduates. So, to put this into perspective for you all, this emergency department took 8 successful applicants out of 600. That. Is. Insane. The entire hospital I work at however, took around 100. This indicates that ward nursing is easier to gain employment in, when compared to specialty nursing, right?

It shouldn’t be

Over the years, I’ve had many nurses tell me not to do things. Don’t open an ampule that way, don’t label an IV like that, don’t chart things before you’ve done them, don’t tell the patient about their negative results, etc, etc. Some things were helpful, some, not so much. One thing I heard a lot, is “Don’t go into ED/ICU/NICU/ETC in your grad year”. I, of course, being a curious creature, would always ask why. Oh you’ll struggle, they would say, or you’ll kill someone, or you won’t have any time management skills! I honestly didn’t have a single clinical facilitator who said they would recommend going straight into a specialty area before trying some form of medical or surgical nursing. This was very disheartening, to say the least, especially during the job application process where I had a major internal struggle of whether to even apply if everybody said I couldn’t do it and shouldn’t try.

I’ve been working for the last 5 months, doing 2 of the most blasphemous things I possibly could have done; working full time, and in the emergency department. I’ve loved every minute of it. Sure, it’s been a hard road of adjustment, but it would have been hard in a ward too. It drives me insane when people look down on ward nurses, and see ward nursing as simply a stepping stone to a “better” place to work. Everybody advised me to just get a job on a surgical ward, and to choose part-time employment, and then leave after a year to go into emergency and possibly full time “if I felt up to it”. Why? Why aren’t the wards considered the place to be? If everybody left the wards, there wouldn’t be any senior nurses left there and the place would be run by inexperienced new grads like myself. Each ward is a specialty in itself and has it’s own challenges, relative to the workload and type of patients it receives. Sure, a ward nurse might not be skilled at inserting an IV cannula in an arrest situation, or looking after a ventilated patient, but I would be pure crap at coordinating an 0800hrs med round on time, with 5 patients, chronic medications which I haven’t seen in yonks, and doctors trying to do their rounds and changing orders as I’m giving them!

To all the new nurses out there, if you want to go for a specialty area, just do it! The worst that can happen is that you don’t get the job, or you do get the job and simply need a bit more education and assistance before finding your feet. You WILL find your feet though, and that is what I want to stress to everybody. Finding your feet can also mean discovering that that type of nursing is not for you, and that is perfectly okay too. The best thing that can happen is that you get the job, and fall completely in love with your new career, as I have done.

Look out for my next post, on the job application process and things to do to stand out from the crowd especially when specialty areas are so competitive to get into!

Peace out, sistas!

I’m feeling 22….

I TURNED 22 YESTERDAYYYYYYYYYYY!

Okay, enough excitement. I’m 22! That’s officially past all the typical “growing up” milestones!

I spent the day at work, which was honestly right where I wanted to be. I was greeted with millions of hugs and birthday wishes from my coworkers and ended the day with a box of chocolates from them! Throughout the day, other staff members who came into contact with me all wished me a happy birthday. I legit wanted to cry at this kindness. You have to understand, I work in a tertiary busy emergency department in which there are 250 nursing staff members alone. I’ve only been there for 4 months. For people to know it was my birthday, or even if someone told them, and for them to make the decision to seek me out and wish me a good one just made my day. My… birthday ;).

In other news, I was also completely spoiled by my beautiful boyfriend, and family, who got me way too much money and a NutriBullet blender. *swoon!* I’m an abid fan of infomercials and the Nutribullet is something I’ve wanted since I knew what chia seeds were! I think I’m going to go on a blended food diet in excitement! 🙂

10 signs you know you’re a (new) emergency nurse

Even though I’m new to nursing and the emergency department, I feel as though I’ve already begun to develop my own little niches and knacks which help me fit in with the rest of the crew. Hopefully someone else can also relate!

1) You always come home with things in your pockets
I feel like this is an obvious one, but it’s so true! Every shift, I come home with at least 2 IV flushes, extra pens (or no pens!), needle caps, tape, and the entire stockroom of alcohol wipes! Thankfully I’ve not yet come home with a medication or two, but I’m sure that when my Padawan Learner time is up, I’ll bring home the pharmacy too!

2) You’re always in a rush!
I don’t think this will stay with me forever, but I feel like I’m always walking at such a fast pace, and always doing something, even when I’m not. If, heavens above, I have no patients, I still feel like doing something and fluffing about restocking and doing something to keep busy because I feel like I almost don’t know any other way to work.

3) You know the “Q” word is taboo and you don’t dare utter it
Instead, things like “Oh this is a NICE shift” and “what a pleasant day” are said, so as to not disturb the balance of the universe.

4) You’ve learned that some things just don’t belong in hospital at all, let alone in the emergency department
This was highlighted to me when I first looked after a patient who hadn’t tried taking pain relief prior to coming into hospital, and felt perfectly fine as soon as I handed him a couple of paracetamols, and was subsequently discharged.

5) You’ve also learned that while no patient seems to understand this, you still treat them as any other patient
This includes tending to their physical, emotional, and psychosocial needs, and even if they have only come here to score some over the counter pain relief, you give it to them with kindness.

6) Doctors are not scary
This took a lot of convincing myself privately and a lot of willpower to accept, but it’s true. On wards, nurses don’t see doctors very often, mostly during rounds, if the doctor bothers to share their plan of care with you. In ED, this couldn’t be more different. Doctors are EVERYWHERE! I don’t pretend to remember their names at all and no doubt they forget mine constantly too, but they’re at least there, and they’re very nice.

7) You’re able to not only calmly discuss embarrassing accidental mishaps and certain body parts, but can do so with a straight face.
This I discovered today at work where it seemed the patients were having a silent competition on who could shove what up where at the best angle.

8) You catch yourself looking at other peoples veins and how best to cannulate them
My partner particularly hates this one, since I used him as a guinea pig while I was learning…. and missed.

9) You’ve been coached on the mantra “trust no bastard” and find yourself living by it
Patients lie, doctors lie, nurses lie, everybody lies. And even if they forget, omit, leave out, or whatever, something, that’s in the same boat. If a patient is texting on their phone, laughing, and says they’re in 9/10 pain, they’re lying, and will only get basic analgesia until proven otherwise.

And finally 10) You still continue to love your crazy, hectic, unpredictable job
I couldn’t imagine working anywhere else right now 🙂

I don’t know what to do with my life now

I have recently (by recently, I mean 5 minute ago), finished the final episode in the Australian mini TV series, Anzac Girls

I have been completely taken over by that sinking feeling one feels in their heart when a gripping book or show is finished. I’m now sitting here writing this, wondering how I can ever go back to real life after experiencing the amazing hold of such a show.

If you haven’t seen this show, get the hell off my blog and go watch it!

anzacgirls

This show follows the lives of the above nurses throughout WWI and their journeys through war, hardships, love, and friendship.

6 episode, 5 nurses, 4 years of war, and one honourable career; nursing.

I literally cried in every episode. I know, I know, I cry in everything, so that’s really not a good measure of the emotional hold of a show. But listen… The things these nurses have to go through, the suffering they experience, and the compassion, kindness, and empathy for others that they show despite this, honestly makes me feel so proud to be part of a such a beautiful profession.

I feel like all nurses forget this sometimes. Nursing is not just a job. It’s a career, and one filled only with those who can fulfill it. Nurses are the front-line for patients, advocating for them, placing their needs and comforts before their own, providing a kind heart and a shoulder to cry on, and showing compassion to those who feel they do not deserve it. I love being a nurse, and depictions like this show serve as not only a reminder of how far this profession has come, but of how far we still have to go. I want to be a part of this, to coach new nurses, to change clinical practices for the better, and above all, to provide the utmost care for my patients, whoever they may be.

Watch this show people, you won’t regret it.

Laters sisters.

A different kind of death comes a-knocking!

Are you there Internet? It’s me, Sick Snotty Sally.

You heard right, ladies and gentlemen. I’m sick. It’s only a cold, but by God I feel horrible. I’m actually surprised that I hadn’t managed to catch anything earlier in my limited career. I mean, it took me NINE WEEKS of full time work to catch a cold. That’s pretty good, I think, considering I work with patients for whom a tissue is a sacred object, never to be used, and covering their mouth while coughing is obviously not the way of the future.

Me calling in sick to work last night

So while lying in bed contemplating my sick life, I started thinking about this one thing patients do that drives me slightly crazy. It’s not even anything major, I’ve learned how to work around it, and I realise that most of the time it stems from misunderstanding or lack of education. When someone is brought off the ambulance trolley into one of my allocated beds for that shift, the conversation goes something like this:

Me: Hi there, I’m Sick Sally, I’m one of the nurses here, I’ll be looking after you today. What’s brought you in for a visit?

Patient: Hi! I’m the Patient, I started having chest pain this morning and called the ambulance.

Me: Do you have any past medical history?

Patient: No, no, fit as a fiddle, love!

Me: Are you on any regular medications?

Patient: *Rambles off a list the size of the Nile River which includes a statin, a couple of B-Blockers, an ACE inhibitor, some oral hypoglycaemic drugs, and of course some Lasix*

NB: This is only a snippet of my assessment of the patient, and does not by any means portray the extent of my conversations

I always have to remind myself that not everybody in the general population will understand what “past medical history” actually is, and its’ worth in our assessment. I’ve realised that a lot of people genuinely believe that chronic conditions like heart disease and diabetes, simply vanish when you start taking antihypertensives and metformin. Whether this is the fault of the GP who is responsible for their day-to-day care and complaints, for his lack of patient education in the illness and medication, or whether the patient has simply not understood the severity of the situation, I don’t know. All I know is that I have that same damn conversation probably 30 times per shift.

I’ve since started asking that question a little differently, and probing further and further until I get the answer that appropriates the presentation and type of patient for whom I am caring. I realise, of course, that there are people that have never been sick enough to be brought to hospital in their life and previously, their worst complaint has been a cold. Unfortunately though, in Australia, heart disease is our biggest killer which means that most of the population have current symptoms, are on the verge of diagnosis, or have been diagnosed with the risk factors, like hyperlipidaemia.

So, I start by saying “Do you have any past medical history”, their reply is always “no”. I then say “have you ever been diagnosed with anything by a doctor”, “ever had any surgeries?”, “ever spent any time in hospital?”, and only then follow up with “are you taking any medications regularly?”.

It’s honestly as if this is some big secret and patients are playing a game with me to see if I can guess what history they have. But in reality, it’s just a lack of understanding and I always strive to explain this to my patients, if not to motivate them to take initiative of their health, but to also save other nurses from this annoying as hell covert little game.

I hope this helps someone in their assessments. As Dr Gregory House says, “everybody lies”. That includes the cute little old lady who’s sitting patiently knitting in her bed, and the 14 year old boy who fell off his bike. Once you realise that, nursing is little bit easier.

Until my next post,

Catch ya!

So I think I love my job

Having just finished another week of work, I thought I’d check in.

This is my third post on this blog, and I’m kind of excited about it. I love knowing that I have this little eloquent way to express my feelings, frustrations, and hopefully share a funny story or two!

Every day I feel more and more confident in my role as a registered nurse. Every day I’m asking less and less obvious questions and I’m coming to the team leader with a plan, rather than an astonished deer-in-the-headlights look about what to do! I’m feeling very nursey, if I do say so myself. Hashtag nurselyf.

In two weeks, we get students. REAL LIVE STUDENTS! I’m so damn excited for this. I know, I know, I really should focus on my own practice and it’ll be hard af with a student to monitor as well, and that I’m nowhere near confident enough to teach someone. Please… minor technicalities!

I have such a strong passion for teaching, and nursing, and the combination of the two just makes my little heart swell with pride! God I sound like such an emotional sap… Though in the wise words of Hermione “just because you have the emotional range of a teaspoon, doesn’t mean we all have!”. You get my drift, I’m keen.

Anyway, I’m out for now. I think I’ll try and post weekly at least on here, or when I have something awesome to tell the world! Until then, peace.

When death comes a-knocking!

I had my first death today.

Not my first, actually, since when I worked in a nursing home during my university studies, this was not out of the ordinary. More like, my first death as a registered nurse, solely responsible for my patients for my 8 hour shift.

It wasn’t an unexpected death, and being a new nurse, I hadn’t previously confirmed death before. By this I mean, listening for a lack of bilateral breath sounds and air entry, checking pupil dilation and lack of response to light, and feeling for a carotid pulse. I’m such a textbook.

So here I am, with a palliative patient in the emergency department, totally not expecting to deal with this shit, and then this patient goes and takes his last breath. It’s actually crazy to me that I’m sitting here writing this while someone died in front of me. I would totally be able to see Thestrals now!

And so, I put some telemetry on this patient so that we could monitor his rhythm from the nurses station without overcrowding in the room beside the bed, and as soon as I connected the last lead, I saw asystole. I froze, and said “I’ll just be right back” to this patients family member. I got my team leader into the room, and she talked me through confirming a death. And then I said those little words. Those five little words that changed someone’s life forever.

I’m so sorry, he’s gone.

It’s definitely true what is said about nurses. We go from nappy to nappy; one minute we’re bringing a new life into the world and hearing a baby cry for the first time, and the next, we’re listening to the last breath taken by another human being, holding their hand as they leave this world.

Dear Internet

Why hello there!

My name is Lillian and I’m a registered nurse. I graduated in December 2015, and began working in a busy Emergency Department in January, 2016. I’m 21 years old, and I feel so out of my depth.

I finished a shift a couple of nights ago and came home feeling absolutely defeated. Don’t get me wrong, I’m so incredibly in love with my job, but honest to God, I feel too young and unprepared for this shit.

I’ve decided I need a way to escape my thoughts, and put pen to paper, or rather, fingers to keyboard. This blog will give me just that. I hope I can entertain you along the way, but even if I am able to make another new nurse feel like they are not alone, I’ll go to bed happy.