Nurse B.

Things That Suck About Nursing

NB. Picture is fairly unrelated but I thought it was so awesome I had to incorporate it.

Ok, so I know a lot of people who follow me on here are starting nursing courses or thinking about it and may be pretty nervous about it. So, I figured, I’d do a post on the things that I think suck about training to give the truth about the course and the kind of worst-case scenario things that could happen so that people can read it and think - actually, yeah, I could handle that.

1. Seeing suffering and death. The fact is that not all patients will be cured easily, and some not at all. Depending on the environment you choose to work in, you may see some horrific injuries that result in death or permanent disability, debilitating illness, people in intense amounts of pain, and the suffering of their friends and families alongside that. It is difficult to deal with. You will definitely cry at least once during your training. 

Silver Lining: You will come to realise that although people are suffering in whatever way, you are doing your part to alleviate that suffering and people really appreciate it. Knowing that you made the most difficult, painful time of someone’s life a bit easier, a bit more comfortable - it’s rewarding and teaches you to appreciate everything you have while you have it. It will be an emotional rollercoaster looking after these people, but when you remember why you’re nursing and put their comfort above your own, you can look back and feel proud that you were able to help and that is so fulfilling.

2. Work is hard. There will be days when you’ve already worked three days straight and your feet are killing you and the patients are all demanding and your colleagues are stressed and you’ve been yelled at and thrown up on and you’ve got a headache and you’re hungry and you’ve still got SO MUCH TO DO before you go home. 

Silver Lining: These days, where everything is stressful and there are no high points, are incredibly rare. There will always be the one colleague who helps you out, the one patient that makes you laugh, the one patient’s relative who sincerely thanks you for doing something. So whilst every job has its down days, please see the silver lining to point 1: you’re still doing an incredibly worthwhile job, making a difference, and damn, you can feel like you’ve earnt those four hours you spent sitting on the sofa watching junk TV on your day off.

3. Part of the job is, well, gross. You will see vomit, and excrement, and sputum, and have to do jobs you think you should be paid a LOT MORE to do. You may be shocked by what can come out of a person, feel nauseous for weeks afterwards, and occasionally have to leave the room in case you pass out. 

Silver Lining: Ok, it’s gross, but it’s also really embarrassing for the patient to have someone else help them with these incredibly personal and private tasks. The level of trust they put in you as a nurse is a privilege and if you can respect their dignity and behave like a professional throughout any kind of embarrassing job, they will appreciate it and trust you all the more. And, once you’ve dealt with any kind of bodily produce once, you can handle it again.

4. Rude people. Some patients, or their families, or even people you work with, are unpleasant. They may be aggressive, blame you for things you didn’t do, yell at you or just make your working day much more difficult. All you want to do is headbutt them in the face.

Silver Lining: Again, you’d meet these people in any job, but the difference is that most of the people you meet who are being assholes are usually doing so because they’re super stressed, scared or anxious. So if you do your best to help them out, in my experience they generally seem to calm down. And if all else fails, I’ve found that saying ‘there’s no need to be rude’ paired with a stern look helps you stay professional but puts them in their place. As long as you haven’t given them a reason to be rude.

5. There’s a lot to learn. Sometimes it can be overwhelming to think about how much you need to know to keep people alive. All the anatomy, physiology, pharmacology, policy, procedures, skills and psychological aspects of work may be incredibly daunting if you’ve never done anything like nursing before (I hadn’t), and it’s scary to think of the amount of responsibility you’re going to have as a qualified nurse. Will you be able to remember it all? Will you know what to do in every situation? Can you handle the pressure?

Silver Lining: Honestly, probably not. At least not right away. I am currently terrified because there’s only one year until I qualify. BUT what I keep hearing from all the nurses I know or work with is that it just takes time and experience to find your feet. In twenty years’ time, you won’t be stressing because you need to give this medication and you’ve never drawn it up before, or freaking out because you’re not sure exactly what the pancreas does (that has never happened to me… ahem). Everything will fall into place, and if you get stuck, ask. And it’s as easy as that.

Those really are the worst points I can think of in nursing. Although I’m sure everybody’s got things that annoy them or stress them out to do with the job, I think 99% of nurses would agree that the fulfilment you get from knowing you’re doing a beneficial job and achieving something good with your life outweighs those days where you want to kill everyone. Hopefully this hasn’t scared anyone but just given a better picture of the highs and lows of nurse training! Any other suggestions or comments?

Scans!

Your handy-dandy guide to what scan does what in very basic terms.

CT/CAT Scan (Computerised Tomography) - A very detailed x-ray made by sending several x-ray beams simultaneously through the body via a large donut-shaped machine. Used for creating 3-dimensional images of originally the brain but now practically anywhere on the body. Particularly useful for locating bleeds or aneurysms, tumours and internal injuries as well as finding bone fractures and looking at certain lung diseases. Can also be used during biopsies. 

MRI Scan (Magnetic Resonance Imaging) - A scan that uses magnetic fields and radio waves to produce a picture of the inside of the body, but does not expose the patient to radiation. As the scan is so detailed, it is very useful in diagnosing many health conditions such as Alzheimer’s, dementia, cancer, atherosclerosis and damage to organs and tissues. Due to the strong magnetism used in the scan, patients with metalwork in their bodies should not undergo an MRI scan.

DXA/DEXA Scan (Dual Energy X-Ray) - Used to determine how much calcium is within the bones in diagnosing osteoporosis or assessing effectiveness of treatment. This measurement is referred to as BMD (bone mineral density).

PET Scan (Positron Emission Tomography) - detects a radiotracer (a radioactive substance), introduced into the body as a radioactive version of a molecule such as water/glucose, etc. The breakdown of the molecules will be shown on the scan in different colours/brightnesses to illustrate how the body is functioning. Particularly useful in diagnosing or assessing diseases such as Alzheimer’s, cancer, epilepsy and heart disease. Patients must receive the radiotracer either by injection or inhalation 30-90 minutes before the scan and then relax until the substance is able to travel around the body. The scan itself can take around 30-60 minutes.

Ultrasound - Uses sound waves to create pictures of organs or structures within the body. Often used during pregnancy to monitor the development of the foetus, but can also be used to look at organ defects, aneurysms and internal damage.

First Aid at Home - Dealing with some common illnesses and injuries

I wanted to do a post on this topic because I sometimes feel like as a student nurse, I get taught to cope with serious illnesses and injuries, but slightly more common mishaps (the kind that you’re bound to get someone going, ‘You’re a nurse! What do I do?’ in) are often overlooked. So here’s some basic first aid! Enjoy.

Basic Life Support

Although you rarely need it in your everyday life, it’s one of those things you REALLY ought to know. Just in case.

I was going to write out a humongous list of steps of what to do if you discover an unconscious casualty, but then I found this video:

http://www.youtube.com/watch?v=uCDa-AhrjHo

and this video:

http://www.youtube.com/watch?v=AGznNGtT4xw&feature=relmfu

which explain the steps a lot more efficiently than I would have. 

Nosebleeds (Epistaxis)

1. Sit down and pinch the top of the nose.

2. Lean forwards and breath through your mouth. Leaning forwards prevents blood from running backwards down the throat.

3. Stay like this for around 20 minutes in order to clot the blood. Stay upright (do not lie down) as this will decrease the blood pressure in the nose and reduce the amount of bleeding.

4. Place an ice pack on the area to reduce swelling. 

5. Do not undertake any strenuous activity, bending or blowing your nose for around 12 hours after a nosebleed. If nosebleeds happen often, see your GP as there may be an underlying cause.

Burns and Scalds

1. Remove the cause of the burn/scald as quickly as possible (i.e. by pulling the casualty away from a fire, for example).

2. Remove any clothing, jewellery, etc around the burn/scald but do not remove any item of clothing or anything that is actually stuck to the burnt area.

3. Cool the burn/scald with cool-lukewarm water for 10-30 minutes. Do not use cold/icy substances or creams/greasy substances and this can damage the aea further.

4. Ensure the person is still kept warm to prevent hypothermia (this step is only really necessary if cooling a large area in cold/lukewarm water, particularly if the casualty is elderly or a small child).

5. Cover the burn/scald with clingfilm (place a layer on the burn, do not wrap it around a limb, for example) and administer painkillers such as paracetamol.

If the burn/scald has caused blisters, is deep or large, or other symptoms are experienced by the patient such as shock, exhaustion, heatstroke, etc., further medical advice should be sought. This also applies if the patient has an electrical/chemical/infected burn, or has inhaled smoke, or has other injuries or health conditions.

Choking

1. Ask the patient to cough as effectively as they can (although people normally don’t need to be told this if they’re choking…)

2. If the item causing the blockage doesn’t budge after a good cough, administer five ‘back-slaps’ with the palm and heel of your hand in an upwards motion, directed between the patient’s shoulder blades. Check to see if the item has been dislodged between each slap.

3. If the item is still not dislodged, stand behind the patient and place one hand (in the shape of a fist) in the area above their bellybutton but just beneath the ribcage (on women this is usually just below the bra strap). Place your other hand over the top and push in and upwards in a rapid motion. Repeat up to five times if the item does not come out.

4. Repeat the back slaps another five times, followed by abdo-thrusts another five times. Repeat this entire process five times and call for medical assistance if the item is still not dislodged. Continue until medical help arrives, but as the patient’s airway is blocked it is likely they will pass out if the item continues to prevent breathing. In this case, it is necessary to start CPR (see the link to the second video I posted under Basic Life Support).

Anaphylaxis (Allergic Reaction)

Anaphylaxis is a medical emergency! If someone becomes very unwell or collapses following something like an insect bite or accidental ingestion of a known trigger, call for an ambulance and tell the operator you believe they are experiencing anaphylaxis.

In severe cases of anaphylaxis, an injection of adrenaline must be given. Usually people with a known allergy will have a kit on hand which they can administer or you can help with. 

If the person is experiencing difficulty breathing, help them to sit upright, perhaps leaning over the back of a chair to help expand the lungs.

If they are experiencing hypotension (low blood pressure, feelings of light-headedness or dizziness, tiredness, etc) get them to lie flat and elevate their legs.

If the patient becomes unconscious, place them in the recovery position.

In milder cases of anaphylaxis where the patient is experiencing skin reactions to a trigger (rash, itch, etc), adrenaline is not usually needed but antihistamines and steroids may be required. All cases of anaphylaxis should be treated as an emergency.

Stroke

Using the FAST guide (face - is their face drooping on one side? Can they smile?, arms - can they raise both arms to the same level? speech - can the person not speak correctly, are they slurring, can they not understand what you’re saying?, time to call an ambulance) to identify if you think someone has had a stroke, call an ambulance as this is also a medical emergency.

Bleeding

If someone is bleeding severely, medical help must be sought ASAP to reduce symptoms of shock and effects of blood loss.

Wearing gloves if possible, check there is nothing embedded in the wound. If there is, apply pressure around the object but do not push on it, and pad well around the item before bandaging to prevent the object from becoming embedded further.

Apply and maintain firm pressure on the wound, preferably with a clean pad or cloth, and then bandage the area firmly. If possible, raise the area to reduce blood flow. 

If a body part has been severed (like a finger), wrap it in a clean material such as clingfilm or a plastic bag and keep it cool. Try not to put it in direct contact with ice to reduce damage to the skin.

Fractures

Medical attention should be sought for fractures, sprains, etc. so call for assistance if you are unable to take the patient to hospital yourself (i.e., if the patient has a broken arm/wrist, etc, they can be taken to hospital in your own car or via public transport, but if they have a broken leg or something that prevents them from walking easily, call for an ambulance).

Try to keep the patient/affected area as still as possible until they arrive at hospital. If the patient is showing signs of shock (clamminess, weak pulse, shallow breathing), lie the casualty down and raise their legs above their heart, loosening any tight clothing, and call for urgent medical assistance.

Do not give the patient anything to eat or drink as they may require a general anaesthetic at hospital.

So those are some very basic guidelines on what to do in a few more common medical emergencies. If you would like more info, check out the British Red Cross website which has more scenarios and lots of other really useful information:

http://www.redcross.org.uk/What-we-do/First-aid/First-aid-tips-and-videos