Well, my enthusiasm for passing the IV skills assessment has vanished. I got Bobbi to send an email stating that I am qualified to administer IV medication, but the manager said as far as he knew, it could have been sent by my best friend. He is right, it could have been.
Cheers!
Friday, April 24, 2009
Tuesday, April 21, 2009
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
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
Wednesday, April 8, 2009
April 8, 2009!!!
Greetings to All!!!!
Please excuse the delay in posting. I find myself thinking constantly about what I want to say about my experiences, and I am always challenged with how to share and express myself about what I am doing and seeing. It is all so profound. I love the opportunity of being able to meet so many people of so many different cultures through my job, both as patients and coworkers. As I have said earlier, Britain has recruited nurses from many other countries, including India, Philippines, and Africa. They come over as nurses in their home country, then spend approximately six months in England doing an overseas nursing program, which includes a lengthy work/study program in a nursing home-like setting. Then they continue to build on their skills in the hospital setting, adding medication and iv skills to their studies.
Coming over as an American nurse, I did not have to do the six month program, but rather a 20-day program that I was able to do here in Portland. But I was stripped of my skills and had to do the study programs including medications and iv training, the later I have still not done.
I am learning more differences all the time. The other day I had a patient who I suggested could use a muscle relaxer, and was talking to the pharmacist about it. He thought I was suggesting a low dose of diazepam, as he was not familiar with a category of medications known as muscle relaxers.
Please enjoy the attached pictures, which include some equipment used by the physical therapists to help people work on standing. They also use a tilt table, basically a table that people are strapped onto, they the table tilts to put them in standing position!!
Also, a picture of the medication cart with its contents. It is so nice having medications available for distribution. I also included a picture of one of the bays of patient beds, and you can see how good it is for patients to be able to visit with each other.
Also included are some pictures of Madeline and her girlfriend from college, Katee, who came over for spring break. If anyone is wanting to come over, you better do it soon, as my time is winding down. I have to say, I am so looking forward to returning to Providence Portland and being with my coworkers!!! I miss everyone so much!!
Enjoy!!!!
Please excuse the delay in posting. I find myself thinking constantly about what I want to say about my experiences, and I am always challenged with how to share and express myself about what I am doing and seeing. It is all so profound. I love the opportunity of being able to meet so many people of so many different cultures through my job, both as patients and coworkers. As I have said earlier, Britain has recruited nurses from many other countries, including India, Philippines, and Africa. They come over as nurses in their home country, then spend approximately six months in England doing an overseas nursing program, which includes a lengthy work/study program in a nursing home-like setting. Then they continue to build on their skills in the hospital setting, adding medication and iv skills to their studies.
Coming over as an American nurse, I did not have to do the six month program, but rather a 20-day program that I was able to do here in Portland. But I was stripped of my skills and had to do the study programs including medications and iv training, the later I have still not done.
I am learning more differences all the time. The other day I had a patient who I suggested could use a muscle relaxer, and was talking to the pharmacist about it. He thought I was suggesting a low dose of diazepam, as he was not familiar with a category of medications known as muscle relaxers.
Please enjoy the attached pictures, which include some equipment used by the physical therapists to help people work on standing. They also use a tilt table, basically a table that people are strapped onto, they the table tilts to put them in standing position!!
Also, a picture of the medication cart with its contents. It is so nice having medications available for distribution. I also included a picture of one of the bays of patient beds, and you can see how good it is for patients to be able to visit with each other.
Also included are some pictures of Madeline and her girlfriend from college, Katee, who came over for spring break. If anyone is wanting to come over, you better do it soon, as my time is winding down. I have to say, I am so looking forward to returning to Providence Portland and being with my coworkers!!! I miss everyone so much!!
Enjoy!!!!
Tuesday, March 17, 2009
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!!
Monday, February 23, 2009
January 23, I am in Boston!!
Yeah, I made it to Boston. I had gone down to Argos on New Oxford, a store where you go in and look up your items in a catalog, enter the item number in a machine to see if it is on stock, pay for it, then have it brought out to you. So basically, you do not see the item until after paid for. To return the item, it has to be unused and in the original packaging. So anyway, I was needing a piece of luggage as the one I came with was broken. Long story short, the phrase you get what you paid for was resonating in my head the following day when I rolled my new piece of luggage to the Russell Square tube station as one of the wheels fell apart!! Basically, I drug that piece of luggage from London to Boston!! anyway.......
It is so good to be here. I checked into the Bulfinch Hotel here in Boston, and Kate and Leslie joined me. We ordered out pizza, pasta, supplied our own wine, and watched the academies. I did not make it to the end, though, and it is now 6am and I found out the final results online. I loved the movie, Slumdog. In my opinion, this years movies were all quite good.
I am going to Portland tomorrow, and I so look forward to seeing everyone!! Cheers!!
It is so good to be here. I checked into the Bulfinch Hotel here in Boston, and Kate and Leslie joined me. We ordered out pizza, pasta, supplied our own wine, and watched the academies. I did not make it to the end, though, and it is now 6am and I found out the final results online. I loved the movie, Slumdog. In my opinion, this years movies were all quite good.
I am going to Portland tomorrow, and I so look forward to seeing everyone!! Cheers!!
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