Life as an A grade

[pharmw]

Fooled you...I am far off an 'A' grade student although I do have a GEP offer to start this Oct.

Now when I say 'A' grade as I am sure most of you have guessed I mean the old grading system 'A' grade = Healthcare Assistant = any jobs that the nurses wont do and beyond! So I have been working for NHS Professionals for 2 and a half years in this role whilst at uni and as I write, now beyond uni. For those of you looking for experience I would highly recommend it due to the fantastic flexibility it offers. So I recently quit my role as a Medical Information Officer simply because it was a 62 mile drive away!! and I have now opted to go back to the wonderful life of an 'A' grade.

I will begin this blog with details (confidentiality assured) of my last shift on a wonderful acute medical ward. You see working for NHSP involves contacting a call centre via an 0845 number and requesting shifts for the coming week. There are often many available - nice to have the choice I hear you say...but I prefer to work nights (more money) and it is normally a choice between elderly medicine/care of the elderly/acute or general medicine - in a nutshell the shifts that no one wants!

Anyway I get dropped of at the hospital to begin my shift on an elderly medicine ward - which is not all that bad because I had worked there on the previous night (2 shifts in a row on the same ward is very rare) and I knew the patients/staff albeit only from the previous night.

When I arrive I discover that there are 5!! yes 5 empty beds (30 bed ward) and a student nurse has opted to do a voluntary night shift to make up his hours for the week which means staff nurse x 2, HCA x 2 and 1 student nurse!!! - some wards struggle to have this much manpower in the day - let alone night!

My mind is full of thoughts about sitting down by 10pm to drink the standard 6 cups of tea with very little to do - barring a crash of course...and then it happens - the wonderful night nurse practitioner informs me I will have to go to ward x (acute medicine)... to 'help out' but I can return when all is settled.

I walk through the doors of ward x into what only can be described as a train wreck of a ward - there are even 2 house officers and 2 SHO's helping out the very stressed 2 staff nurses. The staff nurse looks up from her pile of IV's and mumbles a hello then says 'I suppose you would like a handover then'
erm would be nice 'yes please'.

After the worlds fastest handover I get told to 'look around the ward myself and find out where everything is...but be quick'.

I begin with the standard tea round - I use this as a time to get acquainted with the patients. So here we are side room 1 - patient 1 - ETOH recovery I ask in the most polite voice I have 'would you like a drink' reply = 'yes tea...I will smack you ya know come here I will smack you' as tempting as this sounds I drop off the tea and retire from the room - backed up by a house officer!!I take a new approach I move down to the bottom of the ward to respond to a call. Here I find a lovely elderly gentleman who has used his bedside chair as a toilet - no worries I tell him and transport him to the toilet where he tells me stories of his youth and wishes me the best of luck with medicine. Upon returning the patient to his bed and cleaning his chair I wash my hands and re-start the tea round. The remaining tea round is uneventful until I reach the ladies side of the ward. Another call and I abandon the tea trolley - nurses are no where to be seen I reach the source of the call to find another elderly gentleman in his birthday suit in the toilet - the thing is he has severe dementia and managed to climb out of a 'secure' padded bed. After finding him a pair of NHS standard issue pyjamas we walk back down the ward singing as we go (not sure of the song). I continue with the tea round. Meanwhile a rather impatient - patient has helped herself to tea which is rather worrying considering she has crippling arthritis in both hands!! I continue on past the patient who informs me of the location of her will because she 'will not be here in the morning' - some truth in this because she is due for discharge the following day, and onto the very irate male staff nurse who barks at me to fetch 2 commodes for his patients - I carry out this order post haste only to be greeted by some wonderful female patients who keep me smiling. These patients then decide they cannot pronounce my name so ask me if they can 're-name' me...they decide on David. All the other patients are too ill or asleep so I begin my obs and BM's round. Upon completion I help one and then the other nurse get 'their' patients into bed...this concept has always fascinated me I understand that wards get divided into teams fair enough but when they are short staffed surely its wise to help each other oh well who am I to say.

I am writing far to much in one go so I will split it into two parts.....

[pharmw]

The ward settles down ish for the night. Its midnight and I get myself a cup of tea. Neither nurse can pronounce my name so I suggest David. It soon becomes apparent that these nurses have a strong dislike for each other and I am stuck in the middle....by the way there is no chance of me returning to the overstaffed elderly medicine ward.

Its quiet too quiet and then the patient in the 'secure' padded bed gets out again and this time he is swinging...like Rocky...I duck and dive weave and block and finally manage to get him back into bed. The staff nurse then has a 'brilliant idea'...we wheel his bed around to the front of the nurses station. Now this patient will not sleep, I don't think he has ever slept and its a constant torrent of abuse and singing and no sleep. This would not normally be that much of a problem but I personally like to walk around the ward at least twice an hour to check on everyone and the nurses keep bickering over their notes and don't seem to care/want to keep an eye on him. There is another factor in this, a very poorly female patient who is on hourly obs (should be half hourly) who requires a great deal of care - the trouble is her bed is out of the line of sight from the patient in the padded bed and one nurse wont help because the poorly patient is not on 'her side' of the ward!! Now picture the scenario the female patient is very ill so ill that I move the crash trolley close to her bed. She has every line imaginable attached to her and is still quite coherent but is obviously in alot of pain - she also needs oxygen badly but is refusing the mask or nasal cannula. The patient is having a blood transfusion which does not seem to be going through - the staff nurse has no idea what to do and does not seem concerned that her sats are 71%!! I then remembered a trick I learnt from paediatrics...I tape the oxygen mask to the patients pillow so that a stream of oxygen is blowing across her face her sats rise to 92%. What annoys me is that why should an 'A' grade - the bottom rung of the medical team have to make this decision? Meanwhile the patient in front of the nurses station is arguing with the patient from room one - the one who stated that she will 'smack me'. I approach cautiously and mange to diffuse the situation with the patient who kindly offered me a smack asking me to keep her company in the side room once again I retire from her room. Things go from bad to worse and the poorly patient has now pulled her transfusion line out of her arm and there is blood everywhere!! The staff nurse is a little more concerned now but still continues to moan about his colleague!! We change the patients sheets/gown despite her lack of co-operation. It is then I hear a conversation involving laughing coming from the next bed...I peer round the curtain to find the young female patient in the next bed on her mobile to her boyfriend!! Now I don't have as many issues with mobiles in hospitals as I should but what amazed me is that at 2.15am in the morning this patient can call her boyfriend and laugh away without a care in the world when the patient next to her is for want of a better phrase 'circling the drain'!! Hospitals and patients continue to surprise me.

The rest of the night is taken up with this and the angry padded bed patient - who after reading his drug chart I discover has been prescribed haloperidol - but the nurse was to busy to dispense it!!!

Morning comes and the usual toileting washing scenario takes place. I perform a final round of obs and BM's and then leave without anyone acknowledging my existence - maybe this is how it feels to be F1?!

[pharmw]

I was hoping to have another anecdote following the shift that I was due to work tonight....however I am feeling somewhat under the weather so in the interest of patient safety and my own well being I have had to cancel.

The surprising thing is the NHSP call centre assistant was very understanding - which is far from the norm!

Anyway I was due to work on the renal ward this evening - somewhere I am very familiar with having worked numerous shifts on before. The last time I worked on this ward a patient crashed on me 15 minutes before the end of my shift - talk about a wake up call!! and you see the strange thing is this patient had just been on the commode - which is exactly where the other two patients that have crashed on me have been. So far and thank goodness in roughly 5000-6000 hours of hospital experience (I worked it out) I have only had three crashes - each one is terrifying...but you do find yourself becoming more adjusted. Its the house officers I feel for attending their first crash call - one day that will be me so I can completely sympathize with how they feel especially when I find one in the linen cupboard after the crash I mentioned earlier - hell I think he was brave enough even making it onto the ward!

Next to A&E I am sure the first crash call is one of the most intense moments a junior doctor can face - the sudden realisation that its you in charge...as a HCA the most difficult it gets is bagging the patient or putting in the crash call and remembering the ward you are on!!!!

Junior docs out there tonight attending that call - I admire you, and look forward to the day when it is me sprinting through hospital corridors.

[pharmw]

Update time...there seems to be a few interested readers so I will keep this blog going

Anyway my last shift was on the ward/department that I purposely avoid - however I was fooled into thinking...well I don't know what I was thinking..but I ended up working a late shift on what was essentially EAU - the 'dumping ground' for all the accident and emergency arrivals.

I arrive on the ward...question 1 - Staff Nurse 'Can you cannulate?' Me 'No'...question 2 'Can you do bloods?' Me 'No'.... question 3 'Can you do ECG's?' Me 'No'...staff nurse looks very annoyed...I look very embarrassed. The thing is NHSP will not and have not trained me in these tasks simply because of...money!! however there are some people out there who do have these skills and should work these shifts but NHSP refrained from telling me about any of these on the phone...so I have to look like a fool and a spare part!!

Now this ward does exactly what it says, to give it its correct name the Multiple Specialties Assessment Area..patients arrive have basic obs carried performed by myself. get seen by a doc and are then sent home or admitted..simple.

However you always get the 'How long do I have to wait?' and 'Will I be staying in?' questions with varying and often increasing degrees of anger. I end up having to pacify a very annoyed and proud elderly lady who is waiting for a doctor to see her. This lady is a huge name dropper 'My daughter this' and 'My son that' and is more than happy to express her disgust at the state of the NHS in a loud commanding voice for all to hear!!...I tell her a bit about myself and explain that I am starting med school in October which she loves after saying that medicine is a 'good honest profession'. Job done.

Just then and it literally happened like this another elderly lady who is suffering with very severe dementia collapses in the doorway of her side room cue a world record sprint to her aid. All seems fine apart from the patient complaining of knee pain. I spend the next 2 hours with this patient until we decide to move her down to the bottom of the ward...an area with beds for those that will be staying longer than the supposed 24hr limit! Now here lies the big and nasty looking male patient and I mean nasty who expressed lets say his concern over being near this female patient...what the hell do I say? I tell him that she is lovely which she is but it does not seem to work so I retreat! His notes describe a previous in hospital arrest on a ward.....nice!

Rest of the shift well there is much to tell but I doubt your interested and I could go on forever In comes the young lad who 'Had a fight mate innit' (his words) and has a very badly broken nose, In comes someone I sort of know with a very embarrassing condition and then right on time In comes the very entertaining great, nice, funny bloke - just as my shift ends!

I leave the hospital and walk home through an already buzzing city centre and wonder how many party people will end up finishing their night in the Multiple Specialties Assessment Area.

[pharmw]

I have been neglecting this blog as of late so I thought I would update seeing as I always pester Marc to update his and I have had a request to keep it going - which was nice .

Anyway my situation has changed slightly and I am now working full time as a Pharmacovigilance Assistant so I am not working as many HCA shifts as I did previously - however I am still working occasionally to save money for my tuition fees.

I recently worked on a neuro rehab ward and it was a great shift. This was like no other ward I have worked on before. Very few patients and loads of enthusiastic nurses!! Now there were some very sad cases on this ward mainly RTA's and stroke victims with a chance at recovery. It is difficult to see human beings in this situation and it really gives you some perspective. Now I am not exaggerating when I say that the nurses on this ward were enthusiastic one in particular, a male charge nurse could re-define the term 'doing it by the book' much to the annoyance of his team. I have to admit that when I heard about this via the usual route of bitching before he arrived on the ward I thought I would also get annoyed with this way of working...however I was wrong and it was actually a refreshing change. Now don't get me wrong nurses do a very tough and excellent job but there are alot of corners cut which (don't get me wrong again) are sometimes necessary but often put the patient and the carer in a potentially dangerous situation. I am specifically talking about the incorrect use of hoists or the lack of slide sheets and other care aids which are designed to help the patient and the carer. This particular charge nurse made full and correct use of all these and it did actually help....alot!!! So these patients got full and fantastic care, the ward was clean, the staff were happy and it was a genuinely great shift which in amongst all the chaos and negativity which constantly surrounds the NHS and more recently MTAS makes me realise why I am going back to university for 4 years.

If I could advise other HCA's I would tell you to work obscure shifts on random wards or departments for three reasons 1 - it gives you a break from the norm and whilst every patient is different the HCA position soon becomes quite repetitive, 2 - it puts you out of your comfort zone and can be a great challenge and 3. you might stumble across something you really like!

BUT there is a flip side to every coin and here is my story.

I once worked a shift in the diabetes centre - still in the hospital it is a clinic for diabetes sufferers. Different clinics are run throughout the week and I would be working in the foot clinic. Not bad I thought something different. Anyway I turned up to the centre with no clue of what I was supposed to be doing only to be greeted with a community nurse and a student physiotherapist who also had no idea. We sat in the waiting area and pondered what we would be doing. 45 minutes later the staff turn up and with no introduction tell me that it will be 'extremely busy' and that I 'need to work fast - or there will be trouble' (I swear this is what the opening line was) so after repeatedly asking I am shown what to do. Here is how it went, patient walks into consultation/treatment room, I open sterile pack, I make sure saline packs are warm, I leave room, procedure happens, I put used sterile pack into bin spray down bed etc and its on to the next patient. Now I know busy and no doubt will have it re-defined as a junior doc but this was not busy it was just boring and could of been done by the receptionist who sat on her arse all day!!!! S0 after 4 straight hours I asked the podiatrist if I could observe the procedures - cue stage left the most cocky podiatrist I have ever met!! Without even looking at me he told me to and I quote 'step into his office' and 'see where the magic happens'. I enter the room where an elderly patients foot is on full display complete with a outgrowing bone!! Just then the student physio and comm nurse open the door and also ask to observe to which the podiatrist says again without looking 'I suppose so, it is hard to ignore a genius' - In a comical sense it would be funny, it would put the patient at ease but he is completely serious!! So we all watch the 'genius' reshape this patients bone and before I begin my menial duties I jokingly ask the podiatrist if he felt the pressure because of his audience to which he replied 'what pressure! - you see I have never panicked and everyone at uni looked up to me' I learn not to comment anymore. So the day goes on with me doing my job in silence - no break - no cup of tea or even water and then a patient arrives a little early so we begin to talk.
Patient 'How long have you been a podiatrist?'
Me 'Oh no I am not a podiatrist I am a HCA'
Patient 'What is that then'
Me 'Breif explination'
Patient 'Funny job for a man isn't it..are you one of those'
Me (ignoring the last comment) 'I intend to become a doctor'
Just then the podiatrist walks in and asks me why I want to be a doctor because AND I QUOTE 'it is such a dead end job and very unskilled unlike podiatry' in response I say well maybe I will consider podiatry which the podiatrist laughs at and says 'you are not cut out for it, because it is harder to learn than medicine'. I leave the room and finish the shift gutted at the fact that I will never become a podiatrist !!!!

I still see this guy walking around the hospital and occasionally he speaks but only when he is (final quote) 'not thinking about difficult procedures...unlike doctors who have it so easy'!

Next time I am gonna ask for his autograph.