Lovin my days off.

I have to be quite honest. I actually dislike work at GOS very much. It is absolutely archaic and despite me trying to keep an open mind, I continue to come across & work with very patronizing, victorian-age nurses. Some examples.
Nurses do not listen to breath sounds or chart them, except the "physios" i.e. RTs. When I asked why...word for word, this is the answer I was given. "Not everyone has completed the respiratory module, so they wouldn't know what they were listening for."
Nurses do not feel for or chart pulses. or bowel sounds. or any other abdominal assessment. or a palpable liver. or print off rhythm strips. I saw pulses being charted once--this was on a patient with black feet & he didn't even have any! Instead, we are required to do monotonous, menial, useless tasks like stand at the pumps & spend 30 minutes calculating by hand the drug rates (remember they don't program the pumps, even though they have the software to do it), HOURLY I & O's, a monstrosity of loose-leaf paperwork, charting ridiculous things EVERY HOUR like 25 vent settings even though they haven't been changed (usual rate, PEEP, etc, but also the i-time, the apnea alarm setting, the Pip hi & lo alarm settings---FOR REAL???), drawing up each & every oral med from a bottle, as well as mixing up IV gtts. If you need a saline flush, you get a syringe, a needle & draw it up from the vial...every bloody time.
The med room is a nightmare. Say, for example, you need to give your po lasix. You shuffle off to the room, look in a cupboard full of about 50 other bottles, find the right one (took me about 1/2 hr the other day to find 4 bottles I needed), bring it back to your bedspace, draw it up, double check it (unless you have completed the drug administration module...then you are above the law!!! this is includes IV meds....scary!), give it, then bring the bottle back. Now....if it's an IV med, you must put on a plastic apron, wash your hands, clean a plastic box with alcohol (apparently making it sterile), go thru the whole process of diluting the powder, pulling up your correct dose, double checking it, etc. You should be getting the picture. The focus is very task-oriented. Not assessment oriented. The bigger picture is completely lost when your day is spent doing these strange rituals. I asked who does long-term trach teaching for a patient that is getting one in a few days & got a blank look.
Some other strange facts. They don't use or like dopamine. Instead, every patient comes from "theatre" i.e. OR on milrinone & "adrenaline" i.e. epi. I would love any medically-educated person to educate me on this, because in my mind, they are simply going to equal each other out, & only create a higher HR, increased oxygen demand, worsening CO, etc. I also had to ask 3 nurses the other day where vasopressin was in the drug room (it's in the fridge under the name pitressin). For a CICU, I really would have expected more people to have HEARD of it!
I could go on & on, & in fact, I will over time on the blog. I should throw in a few good things....
A patient needed peritoneal dialysis. Another needed the CRRT circuit changed. One of the nurses came over & set it all up herself. One of the talents they do have. Never mind the fact that PD is all done by hand, every 15/30 mins.
Another interesting fact....all plasma blood products used in pediatrics are shipped in from the good old USA...due to the risk of contracting vCJD (mad cow disease) from the plasma here. They pay heftily for it...1 unit of pooled cryo costs £250 (500 dollars!). Don't worry...I'm not eating the beef!
Finally....the surgeries & ages they do them are very fascinating compared to US usuals. I have seen 2 Glenns be done around 7-8 weeks of life. And, most unusually saw an 11 day old TOF repair!
Enough about work. The lack of internet in my room means I'm not writing on here as much as I would like. (It's turning into a really good way to vent!) Hopefully soon...after I get my bank card here, I can get it.
I have been having a SUPER time on my days off. I've been busy every night & the social life I missed so much in Seattle is alive & well in London. Have been clubbing at Ministry of Sound, wandered Portobello Market, lots of drinks & dinners, had a very posh "welcome back to London Christy" party at a place called Loungelover (Madonna rented out the whole thing one year for her birthday), and have even seen a celebrity....Tara Palmer-Tomlinson (google her...she's famous for nothing, a socialite...think Paris Hilton). She was buying flowers in a head-to-toe Chanel outfit, in 5 inch heels....stumbles out of her Audi convertible, almost falls over on the cobblestone street...which is what caught my eye to begin with, gets back in her car in her massive sunglasses, lights a "fag" i.e. cigarette, and speeds off.
Moral of this story is....I am in complete awe of Deb Ridling. As much as we gripe about changes all the time....at least there IS change! We are on the cutting edge of evidence-based practice & should be proud of the how efficiently & smoothly those changes are put into place.
Til next time.