I did it! My first long day in charge of my own bay

Wow, my feet ache like crazy but I'm not mentally tired at all, in fact I feel mentally invigorated....but my feet kill. I was in charge today (with the sister keeping an eye on me). When a patient needed PRN analgesia or had a climbing par score it was me that was in charge of it. My time management skills were fine and I achieved everything I needed to in the time allocated and handed over to the night staff. I noticed my hand over was so much more informative now that I'm solely in charge. Doctors discussed patients with me and all info went through me so I wasn't having to play catch up. Now I just need to organize myself better in the afternoons so that I am on top of discharges and transfers, I have documented the current plan from the ward round and I am on top of the documentation. I am on again thursday, will try and do this then.

It's kind of like learning to dance

And of course dancing (in nursing) is seldom a solo activity. I am making it my business to be on first name terms with the team, I ask them who they are, which team they're in (if they are doctors...and this is quite complicated, still working on that one), what their name is and tell them my name. Once I've done this their expression opens up and we begin to relate to each other like human beings, which is great for my patient as I get clear information. Today I made a point of introducing myself to the pharmacist and requested that next week, when I am in charge of my 7 patients on my own, when he changes the timing of medications to tell me personally if he can. He was fine about it and as we stood there he said 'Oh, this is a good time to do some teaching' and took me through a prescription chart explaining all the amendments to look for next week. Saying hi to staff and introducing yourself open up avenues of communication that may never come about. Today I found myself tentatively dancing quite a few steps - OK, they weren't all joined up and many of them were missing - but it's more steps than I've strung together so far on a shift...AND I'm meeting some wonderful people, both patients as well as staff. What is there not to like??

The path of learning

Every shift I complete teaches me a little further along the road of learning my job on my ward. Today I had my final assessment of drug administration and I passed, which means I can administer meds on my own without being countersigned. Now of course the responsibility of possible mistakes is palpable, so asking when in doubt is essential. When I got home tonight I read up about Acute Coronory Syndrome and Troponin testing as I have heard these discussed among staff and wanted to know more about it. In fact I find that it's much better and more empowering to look things up that I'm not sure about straight away rather than letting it drag. This applies to meds too - I have a little address book that I write meds info in. Overall I feel a little more prepared for my shift tomorrow.

embrace feeling out of your depth

I remember when I went to visit the ward before I attended my interview. Sometimes a throw away remark by a member of staff can contain so much information, clues to what the job may be like for staff. The sister said to me 'it's sink or swim here, you either survive or...'. And now I know what she means. These 2 weeks contain my supernumerary shift with other nurses. These nurses are a great support and they constantly reassure me that even when the 2 weeks is up I will hardly have scratched the surface of my experience. However today, for the first time in my blue dress, I was standing in the throng of nurses, doctors, physios, OTs and other staff, taking a handover and trying to organize management of my patients...and ....I was totally out of my depth. As though I was at the bottom of a deep ocean of murky, inky water with the blurred glimmer of sky and sun far above me. When I made a foolish mistake when I was handing over, the whole collection of people heard, when I tried to back peddle and appear in charge, the whole collection of people heard...in fact my lack of knowledge and experience was there for all to see. It was not a very comfortable place to be. Can you relate? My conclusion is to embrace being prepared to act and speak, knowing all can hear you, and not be too self-conscious. Be prepared to speak up and take risks, which of course includes getting it wrong publicly. At which point be prepared to chuckle at yourself and not beat yourself up too much.

How will I tackle my next shift

I am still supernumerary for one more week and then it's long days and in charge of 7 patients. It is important to set learning objectives for each day otherwise I'll be swamped with the myriad of things that need to be done each shift. These are the things I'm currently not achieving effectively: Delegating to CSWs/other staff. Keeping up with all the changes that happen for a patient on each shift (new plans from doctors, whether patients have been taken to investigations. Getting drug round done within 2 hours..I know. Filling in ALL the nursing notes, assessments, hourly checks, body maps, daily weights etc etc etc etc that need to be done. Finding any time to answer the phone on the ward. Basically keeping up with everything. My last shift was Friday and I've had the weekend off. I have spent so much time reflecting on how to approach the shift on Monday and to juggle everything as well as stay abreast of all the changes, additions and developments that are continually happening to patients...and then be prepared for discharges and transfers, not to mention all the referrals that need to be done. Now some other more experienced staff seam to do this and make it look easy and that's where I want to be soon. So, tomorrow I will ask to take 3 patients and do everything for them. That way I can learn how to do the above mentioned things in a controlled fashion, rather than try to take 7 patients on at once. Will reflect on this on Tuesday.

Last day of induction programme - and a word about confidence

Do you see the above picture as a sunset or a dawn...well, in this instance it represents the end of studenthood and the dawning of a new era in my (and perhaps your) career - and life. Two weeks in and many presentations later I am now on a two week short days stint, working with another member of staff on all the shifts. I have had so much information thrown at me over the last 2 weeks, now it is time to try and assimilate it and, slowly shift by shift, apply it as circumstances require. By this I mean...what to do if a patient's vital signs dramatically, or gradually change. How to respond to a cardiac arrest. What to do when a patient passes away on the ward and many other challenges to meet and conquer. Or perhaps, how to handle an agressive patient or a wandering patient with dementia who is convinced he needs to leave the ward, find the nearest bus stop and go home...even though he hasn't lived at his home address for several years. Yes, nursing is a long list of paperwork and policies to abide by - remember if it isn't written down it hasn't happened. Now, confidence. I love the saying 'fake it 'till you make it' and I think it applies perfectly to my situation. Now I DON'T mean fake my knowledge resulting in unsafe practice, that would never do. I do mean, however, portraying a self possessed and confident manner even when unsure of what to do. One thing I've noticed I have which I think robs me of confidence when I hear it; my voice gets very high pitched and faint when I am nervous which I don't think inspires much confidence. So for the next 4 shifts this week I will concentrate on finding my confidence, meaning even when I feel my nerves and uncertainty welling up inside me I will take a moment to choose to respond to the situation in a calm and measured way, most importantly check that my voice remains grounded. If this lady can do it, so can I.

Two week induction is an essential part of transition

The transition from student nurse to staff nurse is greatly eased by my two week induction programme into the trust. Part of this are 5 supernumerary shifts where I slowly familiarize myself with the lay out and routine of the ward I am working. I have been given many forms to fill in within this time which mainly outline the essential knowledge I need such as admitting patients, discharging patients, transferring patients etc. In this time I have also been inducted into the computer system of the place so that I can access the staff intranet and patient management, emails etc. During this time I have very gradually realized that I am in fact being supported and not just left to my own devices to either sink or swim. The staff on the ward are always approachable and on hand to patiently explain things. Induction is also a chance to familiarize yourself with hospital policies, such as drug administration or blood transfusion. Remember abiding by the policies is the only things able to protect you from making lethal mistakes. They are there to not only protect patient but practitioners also. A very interesting session was about delegation which outlined the demarcation of registered nurses' responsibility when delegating to clinical support workers. Delegating responsibly, intelligently and politely is a skill to be improved upon.

Challenges, challenges

Ok I have established that we are all extremely nervous and it has helped to discover that others are as nervous as I am, however, today - the third day of induction - I have been inundated with various forms, tick lists, policies to read, worksheet for medication test to name but a few. We sat from 9 - 5 just ploughing through all these good things, thankfully led by very efficient and prepared nurses. Now the work really starts because tonight I have to sit and read/sort through everything. Advice: buy whatever folders/dividers etc you need so that your papers are put together like with like. I don't want to be a nurse who can't recall what info was given during induction. I want to action all 3 (lol) lists that I compiled today and get ready for my learning. Tomorrow I start my first supernumery shift, I don't know what to expect or how dedicated/interested my preceptor will be but I will go in with the right tick lists to give myself a structured opportunity to build on my learning. what have I learnt today? That I am responsible for my own success in this job. If loads of papers and info is chucked at me then it is my duty to organize it, familiarize myself with it and complete what is necessary. Another thing I've learnt is some people in that room seamed to understand what was being asked of us so much better than me, they naturally followed every instruction, whereas I really struggled to keep up some of the time. I have different strengths and weaknesses to others' and I must not beat myself up about it.