March 17, 2009

Apologies to all for delay in posting. I went to the U.S. for two weeks, and then came back to London with my daughter Madeline. Later, we were joined by one of her college friends, and the two of them spent their spring break with me in my little room. It was so much fun having them here, and they were constantly busy doing the sights of London. A high light for me was seeing the musical Oliver at the Drury Lane Theater. Even though we had the last row in the house, on the third level, it was quite a treat to see it. Afterwards, we waited outside the cast door, and the headliner of the play came out and signed our tickets, Rowan Atkinson, otherwise known as Mr. Bean.

Going home was well needed. I had so many thoughts and concerns in my head, that to be able to talk about some of it with my Providence co-workers was very therapeutic. I have come up with some strategies on how to maximize this nursing experience, to realize that medical practices can be very different, and that my part is to be an observer and appreciate the differences.
One of my first surprises was the capacity in which new nurses perform. I began the position with 14 shifts of supernumerary, or rather, working with a preceptor. My expectation was that upon completion, I would be a floor nurse working as I would at home. I soon realized that was not the case, that I could not pass medications until I had completed a lengthy work book and then passed a skills test. Apparently, this usually takes 4-5 months, and in the meanwhile, I could not pass medications without a nurse observing me in the process.

Let me explain the medication passing process:

The medications are hand written on a three-fold sheet. The handwriting can be a challenge in itself. Some patients have as many as 3-4 sheets.
The medications are kept in a trolley that is locked with a skeleton key. The trolley has no overhead lighting, so when it is nap time from 12pm-1pm, or in the evening, it can be very difficult to see the many boxes of medication. Then comes the job of finding the boxes of medications that you need. It is required that the expiration date be read every time you dispense that med, and that can be very difficult with the decreased lighting, as they are microscopically stamped on the cards. When I realized that it could take 4-5 months before I could do this process on my own, I decided to become proactive, get the workbook done, redone, and redone, get scheduled skills test and get it done!!!

So I can now pass oral medication!!!! Whew!!! To be able to give IV medication involves the same process. I have decided that I am content relying on a band 6 nurse doing my work, as I am especially uncomfortable giving phenytoin in a peripheral line, as they do not use phosphenytoin.

To be able to take these skill tests requires that a clinical nurse facilitator assess you, and it can take a while before they are available to schedule you in.

When I was home talking to my nurse friends, it was so wonderful to be around my peer group who have the same nursing process skills. Example: we have the concern of infection with foley catheters. The concern here is having them blocked, or rather, occluded, and the care plan is for exactly that. Another example: I had a patient who they were charting as having pressure ulcers on the top of her feet. Anyway.

I believe my experience from here forward is going to be much more enjoyable, as my perspective has changed.

Enjoy a few pictures of my house guests!!