Steep learning curve - see below

The above diagram represents what I feel has been my learning curve during my first week on UMAU. Patients are referred for their GP or through A&E with all sorts of medical problems and conditions that need further investigation and management and there are many, many differing protocols to learn about and apply, such as insulin sliding scales, managing hypos, confused patients etc, septic screening, SOB, chest pain etc etc. My first day on the unit was the first time I administered all my IVs with no supervision, it took me some time to learn about how to administer certain antibiotics and this was quite stressful as I am always on a time constraint. The sister went through my patients in the morning after the docs had done the ward round and we identified who needed what..bloods to be taken, cannulas to be inserted, Trop tests to be done at a certain time and a hundred other concurrent things to do. I was very overwhelmed as this was all quite different from the previous ward. I got through the day somehow and went home and read up on things I didn't understand.It is difficult to enjoy stress but I keep my sights on gaining more confidence with experience. Whenever you first come across something new you learn from it and next time you know what you are doing..for example managing a patient with a peg feed, that was quite scary at first but I think I would manage it ok now. That's why things are stressful at present, every day I go in wondering what I'm going to have to learn on the hoof, and do it fast and right. But I have also learnt to follow my instinct if I suspect a patient needs more specialist input and the REFER, REFER, REFER to nurse specialists and specialist therapies. Anyway, they gave us another brown envelope last week saying that in Nov the winter escalation ward would open and we would all have to re-interview for our jobs on UMAU. I didn't much like the sound of that so did what I was planning to do and applied to the post in oncology. Thankfully I had taken the time to visit the ward, speak with the sister and read up like a mad thing on coherent answers to likely interview questions, it paid off as they offered me the job. I anticipate that the mode and ethos of care delivery is totally different in oncology, not so frenetic with more time building relationships with patients and their families. I will hand my notice in this week and work out my notice for the month. Then start my THIRD job since qualifying.

What do you mean 'the ward is closing in 2 weeks?'

OMG They told me a nursing career can take many unexpected twists and turns but I never imagined things would take a turn so soon in my career. I have been on MAU for 4 months now and last week we were called into the office and given a brown envelope each and told that the ward will close in 2 (yes, 2)weeks time...can you believe it. So all the staff, including band 6 and 7 as well as CSWs are all being redeployed to other wards and areas of their choosing if those jobs are available. However if too many people are going for too few jobs in a particular place then they will have to go to interview and hope for the best. I had opted to go to oncology but I will have to apply and hopefully be invited to interview. I never imagined I would be moving away from MAU so soon. I will let you know how it goes. I will visit the oncology ward on Tuesday to speak to the sister there and try and butter her up! then, once I know more about what they are looking for I will come home and apply for the position. Wish me luck X

Some shifts are one long hard slog

Positve encouragement from the web and colleagues is great and a really useful tool to keep your own enthusiasm and stamina going, but make no mistake, being an entry level staff nurse on a very busy NHS ward is extremely hard work that requires physical and mental focus and stamina. I don't spring out of bed at 5am every day I'm working and bounce in to work. Mostly it is a matter of gearing myself up to the task ahead...13hr shift of non stop effort and responsibility. The secret that I've found that keeps me going is to understand and accept that I'm working within a complex and therefore flawed system which cannot be fixed. I have to just do my best in the circumstances and deliver the best service I can. If I follow policy as closely as possible it affords me some protection from omitting aspects of care or just making mistakes, such as drug errors. Sometimes when we are under-staffed the shift is one long race to the finish. I am often so concerned with completing the paper work fully that it takes away from my time with patients. Ironic isn't it?

First appraisal meeting of my career

Ok, a week ago I met with one of the sisters I'd been working alongside for my yearly appraisal. This is where you get feedback on your performance and have the opportunity to discuss any areas for development and agree on a plan of action for the coming year. I really enjoyed my appraisal, the feedback I got was positive and we discussed strategies for developing my delegating skills when working with clinical support workers. It was decided that I enroll on a course to develop my knowledge further; 'assessment and management of the critically sick patient' was what I felt I needed most at this time. I'm waiting for the start date to be published so I can apply for it. Also I fancy the 'career development workshop', which should allow me to formulate some direction and game plan for my career. The sister told me that all the staff nurses on the ward are encouraged to take up a role of link nurses and asked which field I am most interested in, I looked at the list of options such as tissue viability or cardiac and I found myself strongly drawn to palliative care. I do love this field of nursing because I find it to be one of the most fulfilling and rewarding service nursing can offer. So I am now the palliative link nurse which means I need to enroll on palliative courses given by the Specialist Nurses. I have taken the opportunity to introduce myself to one of them and told her of my interest, so will keep an eye out for these courses to come up. Another objective I have set myself is to send off my application to the RCN to be trained in being an RCN steward. This means I will learn to support colleagues, who are RCN members, through difficult work related disputes and disciplinaries. I am very passionate about this role as I feel the NHS has the capacity to serious mistreat staff who need advise on employment law and NHS policy to strengthen their position. I am very keen to learn to offer this service to colleagues, so I have given myself till the end of July to complete the rather lengthy form and send it off.

Improving on knowledge as well as time management

It is not abnormal to start your nursing career and first job feeling uncertain of your knowledge and abilities. My primary concern in this new post was to learn the routine of the ward and learn about referring to others in the multidisciplinary team as well as escalating my patients to the medical teams when necessary. Learning these things has taken some weeks and now I find that I can just about manage my shift. I am improving my handover s but coming unstuck when others ask specific questions relating to treatment, such as medication. I live in dread of the question..'so, why is this patient on....?'. Currently it's still OK for me not to know the answer to such things as blood chemistry values etc but I want to know these things. So my current plan of action is to read up about specific topics on my days off. I choose one or two areas I need knowledge in and focus on reading a bit in the morning and again in the afternoon to gain more insight and understanding. This morning I read up about Warfarin and INR values and its antidote vitamin K. By placing this pharmaceutical within its historical perspective I feel I understand it well. My message here is that as new nurses our knowledge bases will vary, this does not make one better than the other. The trick is to identify where your particular weakness is and work hard to improve upon it. It is useless to have a nurse who super hot on the sciences but cannot communicate with sensitivity with the patient and their concerned family and conversely nursing isn't all about tea and sympathy to the detriment of sound medical knowledge. There lies the balance of art and science that is nursing.

Adding to my knowledge little by little

I feel at this stage that I am familiarizing myself quite well with the routine and rhythm of a typical shift on my ward. Of course I still need to iron out certain sticking areas during the day, such as the afternoon hour or two while the doctors are reviewing my patients and haven't updated their plan for that patient. The routine is becoming clearer but what I need to learn more about now are the reason and rationale for the investigations and plans of treatment those patients are undergoing. This means expanding my knowledge about medical conditions, such as heart failure, COPD or chest infection etc. So during my 3 days off this week I am dipping into the above book expanding my understanding of all sorts of things. Now I have about 45 mins before sleep time so I will find something of interest to read...

Think before you pick up the phone

Part of developing my skills I need to refer a patient who needs more specialist care to either doctors or critical outreach. This needs to be done on the phone BUT under no circumstances should a nurse just pick up the phone and hope she can recall information about the patient off the top of her head. What is more professional and efficient is to have the nursing and medical notes in front of you so that whatever questions they may ask, such as..'what is the par score?' or 'what is the latest medical plan for this patient?' you can reply with accurate up to date info that is detail rich with all the numbers at hand. This means your patient will get the timely help they need. It was a doctor who gave me this advise yesterday, she said she had been caught out a few times not having been prepared before making a call and being told to call back when she had the relevant information. I must try to remember this good advice.