April 21, 2009

Greetings from London!!
I am coming upon the completion of my fourth month of my London nursing experience. While it seems an eternity in many ways, it is actually flying by. One current aspect that I am thoroughly enjoying, is the fact that the weather has changed and spring is apparent everywhere. I can see how Londoners would be frustrated with tourists clogging the sidewalks. There are large groups everywhere, and they will go right up to the edge of the sidewalk and wait for the lights to turn green. While this is actually a very safe idea, people who work and live in the city don't wait for the light to turn, they cross based on whether or not there are cars. With these large groups with their toes on the edge of the sidewalk, no one can cut through them to cross. Grrrr.......

Work is going well overall. As I found that passing the oral medication requirement was quite a feat of jumping through hoops, I had pretty much decided to not even try the iv administration process. It involves about 75 pages of a workbook, an evaluator going through it (that would have probably been about 3 times), then a hands-on assessment. Then I was talking to the nursing manager, and he said if I got an email from Providence stating that I was US qualified, that would exempt the 75 pages!! He went on to say that they liked hiring nurses from Australia as they came all prepared to work (as well as US nurses, but they don't have nurses coming over from the states typically), unlike UK nurses and other countries. So I jumped back in with enthusiasm, and did several iv passes last night. It requires gloving and gowning up, mixing your medications, then giving. Most antibiotics are made in 10-20 mls of sterile water, then given in 3-5 minutes.
But I have pretty much settled in. I now have a watch fob (a watch that you wear on your chest, hangs upside down so that you can see it when you glance at your chest), and I really like it. I am now comfortable doing "handover", even though I still get amused by it. I am currently working nights, and I am trying to example that it is not necessary to wake everyone up at 645am if they are sleeping soundly, by just talking quietly!! This little old lady had such a hard time getting to sleep last night in her halo, she had been throwing up and had a challenge getting comfortable, that it just did not seem necessary to end the sleep that she had finally found!
Back to handover. I believe I described the process earlier, but a quick review. We walk around as a group, the handing over nurse and the next crew of nurses and assistants, so we are usually about 4-5 people. We go from foot of the bed to bed, picking up the nursing chart and going through sheet to sheet. It covers obs (observations/vital signs), bowels open (bm's), GCS (glasgow coma scale) for almost everyone, regardless of surgery, and often times for the length of their stay (even though it has been a month), pupils, limb strength, nausea, risk of dvt, risk of chest infection, risk of slips, trips, falls, fluid charts, food charts, risk of foley catheter blockage, and any other nursing plan that they have found appropriate. We remind people that they need to be drinking enough or we will need to start an iv. We remind people that they need to have their bowels open. We then pick up the medication sheet/sheets, and we all observe them looking for medications that may have been missed. We do all of this at 745-815am. We can be loud. I can be so easily entertained!
I talked to the nurse manager last night about handover, sharing with him our style is to report by exception. His comment was that report teaches nurses how to think like nurses, that it was a continuation of their education (which is why they like Aussie nurses, as they are completely educated). That he wants his band 5 nurses going through every detail, and therefore, every one does also.
This is also true with medication passing and IV administration. A new nurse does not have those skills and gets that training on the job, and the process can be very lengthy. One of the nurses who I talked to has been there 8 years and has never completed it. It is known amongst the staff who is a grade 5 nurse and on up, and it is determined which nurse can do the more complicated patients, trachs, IVD's (internal ventricular device), IV medications. Therefore, a grade 5 nurse can have less complicated patients, while the higher grade nurses not only do their patients, but may be doing iv medications for the lower grade nurses. Interesting system.
So anyway, I am settling in. I am getting used to the 12.5 hour shifts. I am getting more used to the many, many different accents of my co-workers (African, Philippine, Japanese, Indian, Australian, eastern European.......) I am getting used to living in a dorm-like room and climbing up to the equivalent of 5 floors as the lift is broken, and it will take 3 months to fix it (I am on the fourth floor, the but floors start at zero). I am settling in.
My best friend is the fire educator for the NHS trust. He is from east London, and is completely entertaining with his local stories. He is an expert of Jack the Ripper, and took me, Madeline (my daughter), and her girlfriend from college, on a Jack the Ripper tour. I met him my first day of induction, where he stormed into the room beginning his talk by talking about his ex-wives (he exaggerated, as he only has one ex-wife). But I sat up and paid attention to him, especially as he had followed the cultural sensitivity educator, who had described Americans as being loud and wanting to talk about their divorces. I completely enjoy having coffee with him, as his stories are so colorful and his accent fun to listen to. Dow and I took the train out to his home and went out to dinner with he and his wife. He has also invited us to take a drive and see the blooming of the blue bells in a couple of weeks. He has become an unexpected, delightful surprise.

I have rambled. Thank you if you made it to this point.

Kathy, you asked about skin care issues. Somewhat similar to ours. Air beds are also used when available. Lots of similar dressings. Lots of charting.

I miss everyone like crazy!!!!!!!!!!!!! xxoodb