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.

planning my shift

These few long days I've just done have been like going on a mining expedition, drilling down into the hows and wherefors of the practicalities of my role. As I drill into the layers of information I need to learn the more displaced matter is flying around, making things, temporarily, more confusing. One of the trickier and more confusing things has been discharging patients, mainly because there are so many things to remember to do and arrange. Lots of forward thinking..where are they going to? Will their residential home accept their current condition? How will they get in? Do they need a care package? Have I informed the next of kin? Has their EDN been completed and has pharmacy been informed of the take out drugs they need? etc etc etc...All this is very time consuming, and I'm already rushed off my feet as it is..oh and don't forget to book transport at the right time for the patient. My morning routine is coming together but there are still things to add on such as beginning to think about and plan all of the above for those due to be discharged. If I note these patients down then I can plan my afternoon activities better. Discharge is time consuming and this will allow me to plan it into my day.

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??