Here you go. (not looking my best after a 12 hr shift) The hot, polyester uniform I am forced to wear OUT IN PUBLIC! Nope--not pregnant or fat, just a lot of fabric to deal with. I'm looking on the bright side...it brings out my blue eyes. Now....a little background. There is a paler blue uniform...they are the Band 5 nurses. The dark blue I wear is Band 6--meaning I'm smart & have experience. Then, there is a darker blue (with a white stripe on the sleeve) who are the "sisters." They are the smartest of us all (apparently) (or could be interpreted as the most disgruntled, senile, bitter among us). I knew this uniform & I weren't going to get along well when, on my first shift, one of the sisters tells me that the rate of yeast infections went up dramatically when they started wearing it. YIKES! And...again, I did not make that up. Hard to believe I'm not lying one bit in this blog, isn't it!?
There is good news here. I have put up such a stink (and...have found an ally in one of the "practice educators) that, within weeks, I'm hoping to see some positive changes that I can count as being influential in in bringing to Great Ormond Street. First, they are looking into having a weight-based code sheet printed at every patient's bedside. Currently (and the last 100 years) there is a table with a variety of intubation blades, ET tubes, boxes of adrenaline & other drugs (in glass vials) and some other knickknacks that comprises the code cart. On it, you will find a blue laminated piece of paper with drug doses based on a flowchart of weight ranges. (I'm hoping on one of my dreadful night shifts I can sneak my camera & get pictures of this beast.) If someone arrests, I'm told the doctors yell out the drugs & doses they want drawn up, and the nurses then get into action & draw them up. I have yet to see this in action.
The next positive change I'm working on is establishing a report sheet similar to the one we use. I have received absolutely appalling reports (or handovers in this country) that told me nothing particularly useful. I'm hoping to reign in those thoughts & organize it by systems! There is never a mention of things like: allergies, ET tube size, vent settings, lines & where the gtts are running, etc. Basically it's name, diagnosis, fluid balance, meds & family info....that's all you'll get, unless you ask for more.
I have asked more than one nurse this question---"what's the lasix gtt running at?" and they will not know the answer until they have pulled up the drug page on the computer & look! (remember...they don't program pumps...it runs on mls/hr & that is all) The project of programming the pumps is gonna be a big one, but not one I'm afraid to fight for! I have already mentioned it to a few managers & since they are getting new pumps in July, it will be a prime time to work that one out!
Another project I have in mind will be to get pre-drawn saline flushes. I could save the NHS MILLIONS of pounds. I have already compared costs. A pre-drawn syringe goes for about 89 cents. Compare that to a pound for a needle, at least 50 pence for the syringe & at least another pound for the vial of normal saline. Yep. Give me a break.
So....I'm feeling good that they are open to suggestion. And, today, after work, a nurse who had previously been very condescending & pushed me around to see what I got, came up & gave me a compliment about how I did a great job yesterday with a pt who ended up on ECMO that night... saying that I was "very precise" and gave great care. I didn't mention that, duh, I'm part of the dream team!! :) (that's a shout out to my girl Maree & the Kurtzmans)
On a side note that came up yesterday....they don't use nesiritide here at all, got some strange looks for mentioning it. And, one of the doctors asked if we use the "NIRS thing" in Seattle & I said, "yep, on everyone." Got a gasp & another round of strange looks! From what I gather, they have one or 2 machines & bring them out on the sickest kids only. Would've saved about 8 SVO2's on my patient yesterday! The concept of minimizing line accesses is a new one. But remember...the NHS is broke. That is always the dilemma, but I figure with the money I'm going to save them on saline flushes, they could afford 3 NIRS monitors by the end of the year!
Finally....there is a massive summer music festival called Glastonbury. It takes place on a cow farm. Camping for 4 days. Great music. Jay Z to indie to big DJs. What's the dilemma? Do I go or do I stay? I have quite a few friends going. But....princess here, doesn't like the sound of no shower for 4 days. Hmmm.
1 comment:
Lovin'the pics!! As someone who's crossed the atlantic a couple of times, I too have found it a difficult adjustment. But reading your last entry makes me have to say (particularly for our overseas readers) that every PICU in London is not practicing in the ways you've described above - our unit still has lots of change and improvement to make, but it's exciting to see it happening. We can't all be the leaders in the world medicine and nursing...some of us have to take cues from the frontrunners and follow. And it's always interesting to see that there are different ways to do things, some negotiable and some not - but many lead to the same outcome!
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