Final Placement

Anyone who has seen my Facebook feed this week would know that I finished my final placement for my Bachelor of Nursing this week. This means that I no longer have to wear the Teal uniform of choice, I no longer have to practice under someone elses registration, and I no longer need to work for free. But despite all of the finality, and the opportunities that lies ahead, the journey to this point has been both enjoyable and enlightening. Every department had its own secrets to share, every shift had a lesson to be learnt, and patient a mystery to resolve.

luke sondergeld - rockhampton9

During my time studying to become a Nurse I have had placements in many different facilities and many different wards. My placements where in Aged Care, Community nursing, Acute nursing in a Surgical and Medical ward, Mental Health nursing in an Inpatient facility, another Surgical Placement, another Acute care Ward placement, Emergency Nursing, and Intensive Care Nursing. Each placement, and subsequently each ward, has had a profound impact on both my learning and clinical practice. The first placement in Aged care taught me compassion above all else; to treat every patient as a person and not a condition, to take solace in the small tasks for each person, and never be in a rush to be done with a patient. Community care showed me how easily a simple condition can become something far more sinister, and how people can be so accepting of the worsening of a condition under the guise of convenience. My first Acute nursing placement showed me the importance of time management and good communication. Mental health nursing firstly showed me that despite common misconceptions, it is not an easy option, and showed me the difficulty we face when our own mind fights against us. The Emergency placement showed me the wonders of critical care, the pace, the broad spectrum of ailments, the need to maintain nursing skills to the highest level. Intensive care taught me the importance of taking my time, the little details matter just as much as the large one, and the need to show compassion and tenderness to those who need it most. Every placement had something unique to share, I am blessed to have had these opportunities and I trust these experiences will serve me and my patients well in the future.

IMG_2140

38 weeks over 3 and half years, 190 shifts, 1520 hours, every single moment a new opportunity to learn, grow, and develop my skills and knowledge base. Looking back over my placements its hard to believe that so much time was spent in different wards, for so many shifts, with so much to come out of them. I have always had the mentality that you should endeavour to learn something new every day. It helps fight stagnation and keeps you growing as a person, a nurse, a father, or otherwise. Every shift may not have taught me about a medication, a disease process, a new technique, a new piece of equipment, or even a new practice, some days it was a different way to show compassion, a new way to engage with my patience, or even a new way to deliver bad news. I feel it is important to keep the practice of learning something new every day, and not just from fellow nurses, out doctors, or the patients, but from family members, the wards man, the kitchen staff, or the stores staff, each have invaluable information that could make your life a whole lot easier.

IMG_8954

Every patient is not just a human being who has befallen an illness or ailment, and they are most certainly more than just these. Each patient is a story, a journey, a life. Every patient deals with their ailments differently, they develop comorbidities and often take them in their stride; to see near life ending events as something trivial as they have survived them and moved on. We as nurses can never assume that two patients who have the same conditions will act the same. And for this I am grateful. Every patient also has a life of stories, stumbles, triumphs, and complications. These life events can not only help build a better picture of the patient you are currently treating but also give you insight into how others may develop their illnesses. We need to take the extra time to spend with our patients to collect these little gems as we go about our day.

All in all, the placement process has been enjoyable. I’m not going to lie, I am glad I will no longer be working for free. I am truly thankful for all the staff, patients, others involved in my placements and the learning they imparted onto me. I will do everything I can to ensure the information is used to the betterment of my patients.

Maintain the Rage

Luke Sondergeld

Advocacy

Advocacy is one of the most important and under utilised components 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 for the future, and I hope they will help you too.

3304097_orig.jpg

Always

As some of you are aware I am both an Enrolled Nurse, and a student Registered Nurse. I am also on my last placement before graduating at the end of the year. I felt that because Jeff was a patient of mine, whilst under supervision, as a student I couldn’t or shouldn’t raise my concerns and subsequently Advocate for them. I was wrong. As Nurses we should always feel empowered to Advocate for our patients. It doesn’t matter if you are a LPN, EEN, AIN, GRN, RN, CN, or NUM you should feel comfortable to stop what is happening and Advocate for your patient. I have been beating myself up since the event, and cannot seem to console myself regarding my inaction. Jeff continues to be, in my opinion, mismanaged because I, and others, feel that we cannot raise our voices and say STOP, this isn’t in the best interest for the patient. STOP, we need a different course of action. STOP, we are not caring for and treating this patient, we are treating our own conveniences. I wish I had spoken up, but now I know what a difference it could have made, and how lousy it feels when I don’t, I will never step down from Advocacy again and I will encourage others to do the same.

1288705349-0_600

Back Up

When Advocating for a patient we should remember we aren’t just individual Nurses, we are part of a team, and we are stronger together. That wasn’t supposed to sound like a chant for a Union, but there you go. If we don’t feel strong enough to confront a Doctor directly, enlist help from other Nurses in the team, bring in the Supervisor, the Shift Coordinator, the Clinical Educator, the Clinical Facilitator, or even the Nurse Unit Manager. Together you can approach the Doctor and Advocate appropriately, it will look less like an idea from a solo Nurse and more like a considered idea, and it is good to know that you are justified in your Advocacy when you have the assistance of another. This won’t come across as “Ganging Up” if done correctly, and could be the component you need to successfully Advocate for your patient.

Nurses-Support-Young-header-KING

Considerate

As Nurses we pull some pretty long and random hours, with things like Late-Early shift, overtime, Double Shifts, and a myriad of other whacky ways the roster seems to wind up. Our job is physically demanding by being on our feet all day, lifting and rolling patients, performing care, and everything else we do in a shift. Our job is also emotionally and mentally draining with supporting the patients and their families, dosage calculations, evaluating observations, constantly assessing a patient, and somewhere in all of that is Advocacy. Now, we all know what we do is demanding and exhausting, we justify the extra coffee, the second bar of chocolate, or ignoring the phone on breaks because of it. We flay ourselves over jobs missed, or errors in judgement, and we feel terrible when things are late. Now, our Doctors may not be there for the hands on cares, the lifting and rolling, the supporting the patient during mobility, but they are carrying the burden. The Doctors are trying to manage a massive patient load, the medications, the investigations, the outcomes, the families, and the demands we as Nurses put on them. The Doctors are under the pump all the time. They can’t ignore the phone, their breaks are constantly cut short, they are the ones that get to explain to the patient and their family about a poor prognosis. They have a huge burden to carry. When we advocate for our patients we need to be Considerate and keep in mind these burdens. Don’t Advocate by telling them they are wrong and should be doing it a different way, or calling into question their education. Come along side of the Doctors and show them what you are seeing and suggest the alternative course of action.

Imprimir

Don’t forget the Patient

We shouldn’t forget that the reason we advocate is for the best outcome for the patient, as such we shouldn’t forget to include them in the decision making process. It may be entirely necessary, and entirely justified to discuss your concerns with the patient prior to stepping up in front of the Doctor. Some patients, despite the best intentions you may have won’t want to take differing actions to what the Doctor has ordered. This is why it is important to discuss your concerns with the patient, or if the patient is unable to then a discussion with the next of kin may be appropriate. This seems simple, but can be just as difficult, if not more difficult to achieve. Discussing with a patient that the care that has been prescribed isn’t the best, and a different action would be better, can be seen as conniving, sinister, arrogant, or just plain rude. A polite tongue and respective tone when discussing this matter will need to be adopted, and under no circumstances should the Nurse belittle or bad mouth the Doctor, or professional prescribing the care. We are all a team, we need the Doctors just as much as we need them, nobody wants to be seen as “That Nurse” and as such we shouldn’t behave that way.

AdobeStock_65647548

Evidence

Whilst we should advocate for our patients, always, we need to make sure we have the evidence required to back up our claims. This can be something as simple of observations, blood work, an x-ray, comment made by family or friends of the patient, or statements made by the patient themselves. We may also have written evidence from Journals, textbooks, Research Articles, or recently attended workshops or conferences. It may be something as simple as showing the doing guide from MIMS or the product information leaflet enclosed with the medication. We as Nurses need to be prepared when confronting Doctors in relation to our patients, it may not be enough for us to simply say “I am not happy, we need to do something differently”. Being educated, well read, up to date, best practice using badasses we are we need to show the Doctors that we know what we are talking about, and that we need to be listened to.

These five components; Always, Back Up, Considerate, Don’t forget the Patient, and Evidence or ADCDE, will help you remember what needs to be considered when Advocating for your patient. Don’t end up where I did with Jeff. Don’t be afraid to stand up and be heard. Don’t think that you are just a Nurse. You are the patient Advocate, exercise the right, but do it properly.

Maintain the Rage

Luke Sondergeld

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.

il_340x270.1331952971_5rp6

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.

rbz-nurses-week-01

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