Outside the Box

When we think of Nursing, or for those outside the field, Nurses, we tend to think of Hospitals, Doctors Surgeries, and Aged Care Homes. But, as my recent furor with the job  market will attest, there are plenty of unknown opportunities. I was unaware that some Schools still employ Nurses, there is the Prison system which employs on site Nurses, the Meat Works employs Nurses as I will bear witness to, along with some Mine Sites, Cattle Stations, and of course the Military. My advice to you, as the potential Graduate Nurse, or Re-Deploying Nurse are the following three things; Look Wide, Ask Everyone, Talk to People.

Nursing Imagery

Nursing Imagery

Look Wide

As I have hinted towards already there is a large and varied workforce in which to select from when it comes to Nursing. Each one has its own pros and cons, and you as the Nurse will have to weight those up for yourself. For example, I would trade salary for time with family and availability to volunteer. So a Monday to Friday, Dayshift, or at least rotating roster were you can plan more than two weeks ahead, was worth more to me than an extra couple of dollars an hour. To this end, when you have decided what you want out of the job look everywhere, even places you wouldn’t expect. Look outside of Seek, Job Search, or the local Paper, jobs these days are also advertised on LinkedIn, Company Websites, or even FaceBook. Look in places that you would not have normally considered like Schools, Meat Works, the Military. Apply for EVERYTHING as you may not be successful your first few interviews, regardless of experience.

Dreaded Job Hunt

Dreaded Job Hunt

Ask Everyone

Don’t be afraid to ask around, ask those in the field, ask your friends, ask your acquaintances, or do what I did and ask FaceBook. Whatever your tactic for this particular portion is, be ruthless. Don’t be afraid to ask people you haven’t spoken to in a while, don’t be afraid to ask people if there is a job at their workplace, ask if they have heard anything, ask if they know someone who knows someone who might know about a job. The point being ASK EVERYONE!

Social Callout

Social Callout

Talk to People

While I was looking for a Registered Nurses Job one of the things I took it upon myself to do was to email EVERY SINGLE GP Clinic in my Hometown, Rockhampton. I must have sent out 30 emails to all of the Practice Managers with my Resume and a Written Reference. Some wrote back to me fairly quickly with a Dear John email stating they didn’t have any positions at the time. I had two interviews, and a call back for a third after I accepted my job at Teys. I also applied to the Three Hospitals Nursing Pool, and directly to several of the wards. None of these places were advertising for Nurses, none of them were asking for my application, and most of them at least wrote back to me in some form or another. As I mentioned in Ask Everyone, most of the Nursing jobs secured, especially in a small town such as mine, will be by who you know. With a little bit of what you know as well. The job I ended up with wasn’t advertised, was a suggestion by a mate of mine, and started with an unsolicited email to the HR manager of Teys. So Talk to People, it may land you the job you didn’t even know existed.

Never Know Who Will Have the Job

Never Know Who Will Have the Job

These are three quick and helpful hints to assist you with your Job Hunt, whether it’s for a Graduate Position, a Re-Deployment, First Enrolled Nurse Job, or Re-Entering the Workforce after a sabbatical. Don’t be afraid to pick up the phone, drop an email, post on Social Media, or do the classic walk around with your Resume. When it comes to Employment it may not come easy, you may have to work for it, but it will all be worth it once you are working in the best profession in the World.

Maintain the Rage

Luke Sondergeld

 

Weight Loss Since January 1: 5kg

12 Hour Shifts

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.

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The Roster

I have to admit, the idea of 12 hours shifts, 11 days off in 21, and never having to work a God for sake Late-Early again, is awfully appetising. I adore the fact that the days you work, in which you seldom get anything done anyway, are just a little longer. I do enjoy the possibility that you are handing over to the person you received handover from. On the surface it seems like the dream, but there is a catch. So far I have been doing nothing but day shifts, which involves getting ups at 0530 to get ready and leave the hour by 0630 to be at work ready to go by 0700. The day then proceeds thill 1930 when I depart, walk to my car and drive home, arriving somewhere between 1945 and 2000. So far in this day I have not seen my children or wife awake, on arrival only my Eldest and Wife are still awake. No biggie, spend some time with them, wind down then off to bed, to get up at 0530 and do it all again. As you can see, there isn’t a lot of family time going on. There is  a lot of just surviving. Working, eating, sleeping, working. When I first arrived to ICU the Facilitator made a remark about working 12 hours shifts and how you shouldn’t expect to get anything else done on those days as you are just doing what you need to do to get to the next shift. I scoffed when she first said it. Now that I am living through it, she isn’t far from the truth. You wouldn’t be able to engage in any drawn out, meaningful activity. Normally I eat my dinner with my wife, we talk about our respective days, she returns to her school work, I read for a while, then sleeping for the next day. It took me by surprise. So though on the surface the roster seems really good, just keep in mind, you are almost useless for 10 days out of 21.

Plan Your Sleep

Plan Your Sleep

Self Care

The need for self care is incredibly important while undertaking 12 hour shifts. You need to make sure you are adequately fed, a mistake I made on the first day, just catering for lunch and that was it, didn’t make that mistake again. Staying adequately hydrated, which I know as Nurses we are notoriously bad at but we need to make an effort to do it. Getting enough sleep, and I mean good sleep not naps on the couch or two or three small naps, I mean a good solid 8 hours, which when you do the math leaves you with 4 hours for EVERYTHING that isn’t Work and Sleep. Supporting the home front, for those of us that aren’t single and have a partner and maybe children, you need to make sure that they feel adequately loved and supported. It is all too easy for us to say that we are tired, and worked a long day, and were on our feet all day, but your partner has also worked all day, cooked, cleaned, organised the finances, or performed ALL the other homely duties that aren’t getting done because of the 12 hour shifts. You should also engage in a ‘Me Activity’ on your days off. This could be hiking, swimming, boating, painting, or stacking rocks, whatever your chosen ‘Me Activity’ is make sure you take the time to engage in it, it is all too easy to just work to live and live to work.

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The Shift

Talking about working 12 hour shifts could not be done without actually talking about, the shift. I can only talk on the Day shift presently but as I engage in Nights I will be sure to add my thoughts. But, the shift, putting aside the obvious thing which is it is 4 hours longer then a normal shift, is divided rather nicely into roughly 3 hour blocks. Each shift you have a single 20 minute break and two 30 minute breaks. They are usually taken around 1000 for the 20 minute, 1300 and 1700 for the 30 minutes. This gives you Morning Tea, Lunch, and if you wish an Early dinner, I tend to simply enjoy a coffee and the extended break time for my 1700 break. This break pattern helps divide up the day and ensure you aren’t too intently involved on the floor for too long without stepping aside and breathing for a moment. It allows for a little bit of the aforementioned Self Care with regard to diet and hydration, it also allows for a brief period of contact with loved ones to make sure they are adequately supported, and gives you a moment to switch off from the intensity that is ICU.

shift-work

As you can see there is a lot to consider with regard to the 12 hour shift, and Nurses have made entire careers around it. I would love to hear some of the stories from those out there that do live the 12 hours shift day by day and what secrets they would like to share with regard to surviving the shift, self care, and days off.

Maintain the Rage

Luke Sondergeld

Emergency Department

This week, and subsequently the week prior, saw me completing my two week placement in our local Emergency Department. Originally, I was merely excited to just get a glimpse of the chaos and mayhem of ED. Having now spent the two weeks in ED…. I WANT MORE!!!

Emergency Department

Emergency Department

A while ago I wrote a piece call Medical Nursing, whereby I reflected on the exposure to different sections of Nursing and how they impacted me. In the conclusion I stated I felt that I was more a Medical Nurse than a Surgical, namely due to the chaos and distant style of Nursing that it tends to be. I then surmised that a Medical Nurse is responsible for the growth and healing of a Patient and not just bandaging them up to get out of the bed. This is the same thought I had towards ED, prior to my placement. However, upon arrival I noticed a few things;

  • The chaos of ED is a finely balanced ballet of Nurses and Doctors
  • The pace is clearly defined by those Nurses and Doctors
  • ED isn’t all gunshot wounds, mass trauma, and gallons of blood
  • Bed blocked is a very real and serious danger
  • There is more care given to one patient in four hours then some receive in a week
  • Nurses and Doctors work together as equals, not superiors and subordinates
  • Everyone is learning, Nurses and Doctors alike
  • A litre of blood can pour out of someone’s nose
  • A baby being born is truly magical
  • Drugs, illegal drugs, are bad
  • Mental health is not an isolated issue, its part of the patient
  • Not everything is running around
  • No-ones opinion is invalid

Theses are just some of the things I noticed while working in ED, and all of these things showed me that its not an adrenaline junkie’s hot spot, and only suited to those mad few, it is a high intensity, knowledge pushing, crucible that produces some of the most well rounded and knowledgable Nurses and Doctors that anyone would have the pleasure to work with or have work on them.

Emergency Nursing

Emergency Nursing

With all of this being said, like some five year old in a candy store, I still have a six week placement in the Intensive Care Unit of the same hospital. I could fall madly and deeply in love with the 12 hours shifts, organised structure, and relative peace of ICU. Or I could simply be left longing for the high speed rush of ED.

Where will all of this take me, I don’t know. I will float like a leaf on the wind, and land were I will serve best. I have the capacity to be a great Nurse wherever I am, and I can take great joy in every section, if I do so chose. Only time will really tell. My career, based on my current retirement age, has the potential to be 38 years long. Making 40 years of Nursing in total. I have the time to be able to move around if I am not comfortable in a section. Or simply fall in love with one, study my Masters in that area, and strive and thrive in the environment.

Only time will tell.

Maintain the Rage

Luke Sondergeld

Good Death

Over the past couple of weeks I have been reflecting on palliative care and what it is to experience a Good Death. I have had the honour of being a nurse to several patients in their final days and moments, and to my glee they have all experienced what I would call a Good Death. This also triggered thoughts surrounding my family losses in recent years, and the ones that are to come. More broadly this raised the discussion around assisted suicide and the moral, legal, and ethical issues surrounding the idea.

Some people will find it unusual or even confronting to read the fact that I had glee in my heart when dealing with someones death. Please realise that it warms my heart to see friends and family surrounding someone, who is comfortable, in no pain, well presented and cared for, all in their final moments on the planet. For me I define a good death by several factors. Firstly, comfort; the patient should be as comfortable as physically, emotionally, and spiritually possible. If this means Morphine infusions so be it, if it’s aromatherapy so be it, 12 pillows, a heater, their favourite blanket, if it can be arranged and not be a danger to them that’s what I will do. Secondly is pain; unfortunately most of us won’t meet the end of life without pain. My job as a nurse is to liaise with Doctors and ensure that the pain is either eliminated all together, or kept to an absolute minimum. Thirdly, well presented and cared for; the patient should have their hygiene needs met, new clothes as appropriate, hair attended, mouth cares attended, clean pad if appropriate, and generally look like someone has actually cared for them. Finally, family, and this can be a tricky one. Nobody can force family to be in attendance. Nobody can force family to be civil. We can facilitate an environment whereby the family don’t feel the need to clash, bicker, or argue with one another. The family of the patient should be able to say their goodbyes in a fashion that suits both them and the patient. Nothing will fill a person with regret quicker than not seeing a family member in their final moments, and having to apologise at the funeral.

Nan

Nan

A couple of years ago I lost my Nan and my Aunty within the same week. My Grandfather lost a Wife and his Only daughter. It was a rough week, and an emotional roller coaster. My Aunty suffered a massive brain haemorrhage and spent over a week in ICU before being declared brain dead. Within 24 hours of her passing she saved 6 lives as an organ donor. Please register to donate your organs here. My Nan was moved to palliate care after 4 days on a medical ward deteriorating. She spent 3 days on the ward before being called back to God. In those three days she was surrounded by family, memories, stories, and a whole gambit of emotion. She was prayed for, prayed over, and had the last rights read to her by the local chaplain. She was kept comfortable by some of the most attentive nurses I have ever met – one of the driving forces behind my choice to become a nurse. She was part of a going away party the night before she passed whereby her husband, sons and their family at pizza, drank beer, and reminisced over stories old, and not so old. There was laughter, there was tears, there was acceptance. We left Nan that evening and returned in the morning. That morning the Cheyne Stokes pattern kicked into high gear, we all knew it was close. We gathered around, and there was an absolute silence, and she slipped away. I led a prayer for her as she was taken back to be with God, and then the inevitable emotional release hit all of us like a ton of bricks. There was tears, and hugs, and silent nods of acceptance. My Nan passed without pain, well presented and cared for, surrounded by her family. She experienced a Good Death.

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In the effort to ensure that everyone has the opportunity for their Good Death, the conversation around Assisted Suicide or Euthanasia was bound to come to the front. My viewpoint is simple, everyone has the right to choose the way they want to die, how it looks, who is there, and what is involved. I am happy to facilitate all of that, just don’t ask me to push you over the edge. I can appreciate the fact that some people are in immense amounts of pain, and that their final days could be potentially agonising, though I am not convinced that a medical and pharmaceutical care plan could not deal with the pain. I also appreciate that some people won’t have a quality of life that they are accustomed to in their final days. I am not convinced that a well structured and considered Nursing care plan could make their final moments as dignified and for-filling as possible. I know that this subject is both currently controversial and emotionally charged, however it is something that needs to be discussed. It is also something that is unlikely to simply go away.

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With all of this said, the best way to ensure that the patient, a family member, or even yourself experiences a Good Death is to talk to your friends and family. If you want to be an organ donor, register and tell people so they know. Have an Advance Health Directive drafted so your wishes, should the terrible befall you, can be executed. Talk with your friends and family about your wishes and how you would like to be treated. Be informed of what is available in your region for palliation. Can you be palliated in your own home? Do you need to go to hospital? Would you need to travel to be palliated? These seemingly macabre things are considered as irrelevant or too distant to warrant discussion, but accidents can happen to anyone, or a sudden and fatal medical episode could befall you. Set yourself up properly for a Good Death.

Maintain The Rage

Luke Sondergeld

Medical Nursing

I have been Nursing for about a year now, which isn’t a lot in the grand scheme of things but never the less, and I have had the pleasure of experiencing Mental Health Nursing in two different facilities, Medical Nursing in two seperate facilities, Aged Care Nursing, Community Nursing, and Surgical Nursing. Though this only scratches the surface of what nursing is available with; Oncology, Cardiac, Emergency, Intensive Care, Renal, Respiratory, Rural and Remote, and Midwifery just to name a few. I have recently been reviewing my career and what each section has taught me, showed me, and revealed to me about my nursing.

When I first started my career I was almost exclusively employed in the surgical ward of my Hospital. I thoroughly enjoyed the work. It was fast paced, I had a tonne to learn, the staff were great, and I was able to meet new patients almost every shift. This was amazing, for the most part, but I felt that something was missing. Occasionally I would float to Medical and Mental Health, and though this was great exposure I didn’t really get a chance to experience the whole ward and what it meant to Nurse in these sections. My time in surgical felt very much like a revolving door, every day saw the discharge of one patient just to be replaced by another, that patient would stay overnight then would be gone again. It was something that I never got used to, it was something that I never felt comfortable with, it wasn’t the way I liked to Nurse.

medic treating patient

My exposure to Mental Health Nursing is varied. On one hand I was floated to Mental Health at random times which was great for a small taste of Mental Health but I never really had the opportunity to perform all of the duties a permanent Mental Health Nurse would, and for very good reason. My placement for Mental Health showed me a whole new side of Mental Health Nursing involved with involuntary mental health orders, and forensic mental health orders. This changed the behaviour of the client drastically compared to that of a voluntary client. Following everything that happened mid last year I no longer float to the mental health ward, to which I am thankful.

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When I returned from leave I found myself permanently assigned to the medical ward, at first I was a little miffed, I had always considered myself a surgical nurse, but never the less I gave the new role my all. What I did not expect was the learning, the experience, the joy, and the mental exercise that I would get on a day to day basis. I began to see what one of my nurse-mates said which is surgical is like the sports jocks, and medical is more like science geeks. Surgical pushes you as a nurse to be constantly one step ahead, be organised, and know what the next step is. But when it comes to medical its noticing the little things, the comments made by the patients, the changes in behaviour, the myriad of medications, and the effect of medications, bowel status, and fluid intake has on the human body and behaviour.

person using black blood pressure monitor

This last week I found myself back in surgical again, and I began to realise something…. I am not a surgical nurse. I am a medical nurse. I love taking care of people, I love watching as someone improves, I love encouraging patients to do their best and stretch themselves. I never thought that I would find myself saying those words, I thought I would be the speed freak chasing the quickest nursing with the quickest turn around and the least amount of physical time with individual patients. I was so sorely wrong. So what does this mean for me in the future? Currently I will continue to enjoy my time on the Medical ward of my workplace. In the future, I still don’t know. It could be a full career on Medical Wards, Intensive care, maybe even palliative. Only time will tell.

Maintain The Rage

Luke Sondergeld

 

Day 1

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.

Though the day may not have been clinically interesting, as most of the material was fairly standard, although good for a refresher, it was interesting to hear about the company, its values and its culture. The company has a great culture of supported, safe, client centred care. They believe in their employees and treasure their skills, experiences and opinions. The policies and procedures of the facility are often sent out to the staff to ask for feedback, input and commentary. It serves any workplace well to have input from the people who are actually using the polices to test them first.

From day one the facility has set an excellent tone for professionalism, courtesy, input, support, and mentorship. All of these values and ideals are ones that I not only appreciate, but attempt to emulate as a leader, mentor and employee.

My previous apprehensive feelings have been mostly alleviated by the attitudes of the staff and their attitudes towards education and students. I look forward to my coming eight shifts in the Medical ward, and the lessons that will be learnt.

Until tomorrow, Maintain the Rage

Luke Sondergeld