Advocacy is one of the most important and under utilised component of a Nurses job. It sits at the very core of our being, the reason behind every action, and heart behind every conversation with a Doctor. Recently, whilst caring for a patient, I didn't exercise my right to advocate for them, and as such they have continued to be mis-managed. For confidentiality reasons I will not disclose particulars of the patient, but will instead refer to them as Jeff. I have come up with a nemonic of ABCDE to remind me of the components of Advocacy, and I hope they will help you too.
I have started my placement in the Intensive Care Unit (ICU) of one of the hospitals in my region. Like most ICUs they run on 12 hour shifts, specifically for the one I am placed at 0700 till 1930 and 1900 till 0700. On the surface this seems great, over 3 weeks you work 10 days and are still counted and paid as Full Time, you have 11 days off over the same period, there is no such thing as a late-early, and the likelihood of being asked to stay back is greatly diminished. Though all of these things are true, and I will expand on some in a moment, there have been some interesting issues develop along the way.
Anyone who has been following my social media on Facebook or Twitter, and those who have been reading my blog for longer than a week will know I have Depression and Anxiety disorder. This has meant that I have had a course of ECT, been on a myriad different medications, and see a psychiatrist and psychologist on a regular basis. All of this is done with the hope that I can continue to exist with some sort of sense of "normality". As part of that I endeavour to continue to live my life as though my mental illness didn't exist, I study, I parent, I work, and I try to be there for my friends. Sometimes things don't always go to plan.
This week I had the inordinate pleasure of attending the Badging Ceremony (Pinning for our American brethren) of a group of Nurses I mentored during their time at the University. I also had the honour of being the keynote speaker for the event, which was a new and exciting endeavour I hadn't yet experienced.
Over the past Five Weeks I have completed my Acute Care Placement for my Diploma of Nursing, to catch up on the day by day click here. Over that time I learnt may very valuable lessons, what many tasks drains can be used for, the effect of different sound care products, the differing cocktails of anaesthetics, and how diverse the multidisciplinary team really is. But given that most of that can be learnt from a book or educator I will leave those particular lessons to them. Instead, I will focus on the lessons that are picked up along the way, shared by other nurses and learnt from the patients themselves.
Day 25, my FINAL DAY of my Acute Care Placement, my final day in Theatre and my final day as an EN student. All in all, a momentous occasion. I saw my first set of Dental surgery, completed the last of the task book, enjoyed a nice lunch out provided by the facility and very un-ceremonously completed my placement.
Day 24 of my Acute Care Placement. My second last day at the facility, a return to the Operating Theatre and a series of new experiences. I had the privilege of sitting in on an abdominoplasty and bilateral brachioplasty first up this morning, then spent the afternoon in recovery while the three theatres were rushing out patients every 20 minutes.
Day 23 of my Acute Care Placement, hump day of my last week, my second day in Theatre, and the day I had my final performance appraisal. Not a huge day according to the lists, with the exception of the Eye Surgeries, of which there where 27. But it was still a big day when you consider the implications of a potentially negative appraisal.
Day 22 of my Acute Care Placement, and my first shift in the Operating Theatres of the facility. I was assigned one of the three theatres and given specific instructions of Blue is Bad, don't touch blue. I was also left a little bit to my own devices as to what experience, what to get out of the day and who to follow around. I decided to make the most of it and get as close to the action as possible.
Day 21 of my Acute Care Placement, my last day on the Mental Health ward and my first exposure to Electro Convulsive Therapy (ECT). It was the first day on the ward that I felt truly in control, I knew what was expected and what to do fully. It is a shame that it has taken the four days t find my groove, but I am glad I found it in the end. I am also intrigued by ECT and TransCranial Magnetic Stimulation (TMS), both of which can be used to treat severe clinical depression, both use electricity but in different ways.
Day 20 of my Acute Care Placement, my first AM shift and my second last shift in Mental Health. The day was certainly busier than the PM shifts have been of late, read day 18 and 19 to catch up, but still very different from the busy of Surgical or even Medical. I have started to see the report I have been developing with some of the consumers bearing fruit as I move around the Ward, they have begun to open up and actively talk with me about their issues, feelings, and psychosis.
Day 19 of my Acute Care placement, my second night on the Mental Health Ward, my last Afternoon shift of placement, and the start of my last Late-Early swing for placement. The afternoon was similar to yesterday, quiet, controlled, and so much different to what I have experienced thus far. The advantage I had tonight was the company of a 40 year veteran of Psychiatric Nursing as my RN for the shift.
Day 18 of my Acute Care Placement and my first shift on a Mental Health ward. I didn't quite know what to expect from this afternoon. I didn't quite know what my role was going to be. I know that I was going to be dealing with complex and numerous medications, emotions that were on a knifes edge, and triggers from consumers that vary from noises, to visual cues, through to hallucinated triggers.
Day 17 of my Acute Care Placement and my last shift on the Surgical Ward. The ward was packed, and I mean not a bed spare, hot swapping patients within an hour of discharge, sending them onto other hospitals for rehabilitation. Proper busy. As a final shifts and pseudo send off from the ward, it was finishing on a high note.
Day 16 of my Acute Care Placement, and my second last day on the Surgical Ward. Not knowing what to expect from a Monday evening, I didn't go in with any level of expectation, when I arrived I went through the list of names and beds, checked against the surgery list and endeavoured to plan out the evening as best I could. That was almost useless. Theatre by the end of my shift, was operating nearly four hours behind. Patients were only being seen at times we thought they would be returning. This made for a slow and disrupted afternoon.
Day 15, the end of the third week of my Acute Care Placement, and my first afternoon shift on the Surgical ward. I didn't know quite what to expect from an afternoon shift on Surgical, however with an emptying ward, no new admissions, only two theatre cases and most of the patients being day three, I wasn't anticipating a busy shift.
Day 14, for my Acute Care Placement and a return to the Surgical Ward, for what was is my last AM shift before a three day stint on the PM. The ward was surprisingly empty, compared to the chaos that was yesterday. There were several discharges, a fair spread of second day orthopaedics and abdominoplasties, and a day two TURP. I would have the inordinate pleasure of being assigned the patients at the end of the passageway, the furthest point away from the Nurses Station.
Day 13, Hump Day for my Acute Care Placement and a return to the Surgical Ward, for what was promised to be a busy day. And it didn't disappoint. The ward was full, there where four patients on the waitlist for a bed and 90% of the patients on the ward where only One Day Post Op. I was assigned two patients at the end of the ward, and assisting the RN and EN with the other six, where possible.
Day 12 of my Acute Care Placement and my return to Surgical Ward. After a wonderful, if not busy 8 days in Medical (Days 2, 3, 4, 5, 6, 7, 8 and 9). Today saw me be assigned a patient to be responsible for, a new admit, and a support role for the RN on the ward. It was listed to be a busy day, with the return of an Orthopaedic Surgeon and a two patient wait list.
Day 11 of my Acute Care Placement and my return to Surgical Ward. After a wonderful, if not busy 8 days in Medical (Days 2, 3, 4, 5, 6, 7, 8 and 9). My day was less about assigned patients, as I was buddied with another EN, and more about getting things done, getting exposed to some new procedures and supporting the team.
Day 10 of my Acute Care Placement and the first day on the Surgical Ward. After a wonderful, if not busy 8 days in Medical, I and the rest of the Students, have been rotated to different Wards. It was also my first experience of a Late-to-Early swing, finishing at 2300 the night before and starting again at 0700. I am not going to lie, I was a little rough around the edges this morning and could have very easily gone back to bed. But, I persevered, arrived early and eager to do my best.
Day 9 of my Acute Care Placement, my last night on the Medical Ward, and what a night. The night started much the same as any other, we had enough staff, we were in control, everything was running ok. Then an overflow surgical admission hit our floor, and a new medical admission, then the Theatre was ready for their new patient, and a patient was hypertensive with no action helping, Doctors came and went with their new orders, and the night somehow... vanished.
Day 8 of my Acute Care Placement, and I'm still on the Medical Ward, though not for much longer. Today was one of those days where I should have gone back to bed and rolled out of the other side. I had to try hard to focus, and if I didn't, I would forget what I was doing and miss a step. Today was also one of those shifts where you walk on the ward to almost chaos, staff are blurs, voices can be heard from everywhere and the paperwork is still sitting in the nurses station. I should have taken that as a hint that it was going to be an interesting shift. I did not.
Day 7 of my Acute Care Placement sees my Second Late shift on the Medical ward for my Facility. The staff are becoming more familiar as I work with nurses I have previously, the processes are beginning to become more streamlined as I continue to work with them, and even the Patients are beginning to become a little more familiar, as some of them are in for a long stay.
Day 6 saw the return to the Medical ward, however, this time was the Afternoon shift, 1430 till 2300. The shift began with a in room handover of the all patients, and then oddly, 30 minutes after beginning the shift, afternoon tea. I was assigned three patients, two of whom were on contact precautions, and one with a Intravenous Antibiotics, which I am one allowed to monitor and report on, not actually hang and administer.
Day 5 and the end to the first week of the Acute Care Placement, so much learnt and still so much to go. This week has seen so many polished skills, improvements on time management, patient care, and assessment ability. The facility and its staff have been extremely accomodating, patient, and nurturing towards not just myself but the other students as well. The staff afford every opportunity to be exposed to new procedures and give the students a go, often at the expense of efficiency, but never at the expense of patient care.
Day 4 of my Acute Care Placement was an Introduction into routine, management and additional skills. I was given two Patients to by the NUM as my case load for the day, with the additional instruction Anything else interesting that comes up, which tickled my curiosity and intrigue just a little. The patients I had assigned weren't overly difficult, but had large amounts of medications and high level personal cares. I also had the opportunity to complete a surgical admission, and see it through to handover at the theatre doors. I had the opportunity to insert a Indwelling Catheter on a female patient for the first time.
Day 3 of my Acute Care Placement saw a complete shift from yesterday, there were two RNs on Shift, plus the Nurse Unit Manager (NUM). It made life so much easier for skills, assessments, medications, procedures and patient care. I was free to do more with the patients as I had the supervision I needed to legally perform the tasks. I seem to be learning more and more everyday, which I expect to do for the rest of my career, and it seems that no matter how much I seem to learn, it still seems I don't know enough.
Day 2 of my Acute Care placement saw me finally hit floor, after a brief 2 hour induction into ward routines, paperwork and documentation. The induction was good as it gave us all an understanding of the different paperwork and documentation requirements of this facility. The Medical ward, in which I am completing my first 8 shifts, was in a little bit of chaos as it was combined with the Surgical ward until early this morning, at which point all of the patients where returned to the Medical ward, with little to no handover and several new admits.
Day 1 saw us all complete the Mandatory Training for the facility with a number of other staff. The day ran for approximately 9 ½ hours and covered everything from Emergency situations, CPR, Manual Handling, Infection Control, Aggressive Behaviour Management, Electrical Safety, WH&S and an overview of Company, which included a brief talk from the Facility CEO.
As regular readers will know I am coming to the end of my Diploma of Nursing studies, which culminates with a five week Acute Care placement, totally some 200 hours. As I did with my Aged Care placement and my Community Care placement, I will be documenting my thoughts, interactions and reflections on my experience. Unlike my last two placements, I will not be summarising after the fact, but in fact giving a daily summary of experiences, emotions and lessons learnt.
Five Community Care Reflections - A look back on the week that was
A reflection on my Aged Care Placement, given my looming Community Care Placement