Reflecting (because every nurse loves a good reflection)

Did you know my blog has lasted longer than my nursing career did??

A failed career in Sports Science- well it was a career that never started thanks to my lungs resulted in me falling into nursing. I never thought I would be a nurse. If you were to ask people what I would end up doing as my career (albeit short) it would not be nursing. It would most likely be something to do with sport.

I can honestly say I have enjoyed every single minute of my nursing career (there may be a few exceptions but generally). From day 1 at uni to what turned out to be my last day (I wish I knew it was at the time).

I have looked back and have some key highlights from over the years.

First Year Student Nurse-

  • The first day of uni and sitting in a lecture theatre with about 250 students and not knowing anyone, wondering if I had done the right thing.
  • Pulling on my student nurse uniform for the first time and feeling so proud
  • My first hospital based placement in the Renal ward and working out that Cat was actually my cousin.
  • Fainting on the ward after a patient split their head open and being fed toast by Sheila the ward clerkess who also kept asking if I was sure I was not pregnant!

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Second Year Student Nurse-

  • Being a student nurse on the high dependency ward, having an asthma attack on the HDU ward and then later that day being a patient on the ward.
  • My ITU placement at the Western General where I got to see brain surgery and also on night shift looking out the window of the break room and seeing my bedroom window. It made for really long night shifts.

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Third and final year student nurse

  • Once again fainting but this time in theatre while wearing a lead dress as it was radiology. It was an 8 hour operation to stent a renal artery and it was very hot so down I went, stumbled out of theatre and fainted again in one of the consultants offices!!
  • Being terrified that I wouldn’t pass my degree as I could not revise properly because my grandpa was seriously unwell and had major heart surgery in the lead up to the first lot then was on palliative care at home and died just before my final ones. Thankfully stuff must have sunk into my brain and I got my degree with distinction.
  • Management placement in renal and always being told I ask a lot of questions, but also always asking people to test me as I was applying for jobs so wanted interview practice. Turns out that practice was not great as had an awful interview but thankfully got the job.
  • The day I got told I had a job on the renal ward I was on nightshift and remember Laura the other student nurse from my year also had an interview but neither of us knew if the other person had got the job so we were super awkward around each other till we both knew!!

Of course the biggest highlight of my time as a student nurse was graduating and getting a distinction in my degree which meant I could go on an register to be a staff nurse with the Nursing Midwifery Council.

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I had 3 years of being a student nurse and then 7 years being a renal nurse where I spent all my time in Renal. Oddly I hated learning about the kidney in school and spectacularly failed my Biology AS Coursework which was about the kidney!! I was not much fussed for the kidney at uni either but once on the ward I found it fascinating. I think its because I am a practical learner!

It has been really hard to pick just a few highlights or memories that have stuck with me from my time as a staff nurse on the renal ward.

  • Pulling on the cornflower blue uniform for the first time and sitting in handover waiting to be given my first patients. I was so scared. I kept thinking what happens if I do something wrong or kill one of them etc. I had millions of scenarios going on in my head all negative of course.

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  • Every nurse will remember their first cardiac arrest. I heard the arrest buzzer go off and I was standing next to the crash cart when it happened, so I grabbed the cart forgetting to unplug it from the wall and off I went. I didnt get far before I jerked back and knew I had forgotten to do something fairly vital!
  • I did a bank shift on the transplant ward. I knew about kidney transplants as had dealt with patients who have had failed transplants etc but never really spoken to someone with a new transplant and one that was working. I was curious. It turns out that patient taught me a huge amount. Firstly they don’t take your old kidneys out if they don’t have to and then when asked to see what their scar was like and helloing them pull their jumper up thinking the scar would be at the back I was shocked when they started unbuttoning their trousers. Transplanted kidneys go in the pelvis!
  • Catching a patient who had really horrific bloods and lots of fluid on board munching on lots of crisps. When advising the patient that perhaps they shouldn’t eat them as they are so high in salt and this will make them super thirsty etc. I was told that it was ok because they were cheese crisps and not salted ones!! I must say I couldn’t help but laugh.
  • In the ward you get given 4 patients a shift on day shift. Either one bay of 4 people or 4 side rooms. I had a bay of 4 people this particular shift. We were also due for an inspection this same shift. I start to get all my patients up and washed, go for my break with one patient left to wash. Come back from my break to find water pouring out from under the bathroom door, one patient not in their bed so I think they must be washing themselves. Next thing I see is the clinical nurse manager coming out the bathroom soaking wet with the patient. She had decided to be helpful and wash my patient before the inspection. I was very grateful to her for doing this by my goodness she made a mess!!
  • There is of course the Christmas parties, tea parties and just general camaraderie of being part of a team.

When my lungs got too much for me to keep working on the ward and when patients were offering up their beds to me as I looked so unwell I was given the chance to move to the Community Dialysis Team. This was a job I loved. I could spend time with patients, work their treatments around their life and felt I could really make an impact to their lives. Of course there are some memories from this role too

  • Being back in my own clothes and everyone calling me Dr- I think because I wore chinos and a shirt or chinos and a polo shirt.
  • My first day being shown the ropes and managing to burst a bag of peritoneal dialysis fluid all over a patients bed (I was mortified).
  • Coming into work but not feeling great, which was then made worse by people smoking at the doors so I ended up in quite a bit of difficulty to the point that my boss found a wheelchair and basically ran with me in it to A&E. So embarrassing and terrifying (not the attack but the wheelchair driving!!!)
  • Seeing patients transform as they start dialysis and really getting to know them, and help them get their treatment optimised so it can still fit in with their lifestyle so they can pursue their hopes and dreams.

Over my entire career there is one moment that stands out above and beyond everything else and that would be when the whole renal team and chaplaincy worked together to pull off a wedding for a patient who was still very young but had to withdraw from dialysis because all her access failed. The wedding was put together in an afternoon and each department did their bit to being their bit of special to the event. It was lovely to see everyone doing what they felt was right from decorating the rooms with the christmas lights, to getting 2 beds into the side room, sneaking in some beer and champagne to celebrate the marriage. It is not only an event that is a moment in my career I won’t forget but in my lifetime I won’t forget.

In this blog post I could go on and on and write about so much because I have really loved my time as a renal nurse. There have been lows but then there are lows with all jobs.

The biggest low for me is that it has come to an end and I couldnt really say goodbye. My last day as a nurse I didnt know it was going to be my last day. Often when people leave their jobs they know they are moving on and retiring so can say goodbyes. I didnt. I have so many people who have been so influential in my career and so many patients that have shaped me as a nurse that I would have loved the chance to thank them and say goodbye.

For now I am no longer working as a renal nurse. I might one day be able to go back and practice again once my health is in better shape but for now my career is on pause and who knows the it will resume again.

For now this is me…..

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Critical Care does PPI

Tuesday evening I had a fantastic time. It was the first meeting for the Critical Care Patient and Public Involvement Group in Edinburgh.

Patient and Public Involvement (PPI) in Scotland is no where near as organised as it is in England and funding is woeful, so to establish and run a group is a huge undertaking but for us as patients it makes a huge difference. We see the dedication of the organisers to make life better for those in the PPI group.

I have been really privileged with this group as I have been able to help advise the group organiser and how to do it and was invited to speak alongside Allison who I do a lot of talks with for the first meeting. Having been involved in the set up of the SPEAK Asthma group, it was good to be able to advise on this one and work with the group lead.

It was great for the initial meeting to have a combination of patients, clinicians, researchers, advisors all chatting about involvement and research. What I did find is how difficult it is to define and explain PPI to patients but also researchers. It was clear some researchers thought PPI was more about patient recruitment than involvement but also that they have their clear idea of their research and how it is going to be done which is good however if this is their thinking then PPI is not going to work especially if the patients do not think the method of research is going to be beneficial. The key thing with involving patients in the research process is listening. You must listen to the patients and their views. You may not agree with what they say and think because you have research under your belt then you have the expertise but it is patients you nee to recruit so if those you use for PPI don’t think it is a good design then you can be pretty sure that your participants won’t be interested either.

However not all the researches were like this and some of their research has been really well thought out and they explained it in a manner that everyone could understand and get a real feel for the project. It is a real skill to be able to translate from academic speak to everyday speak so those who can they have the art!!!!

Having a unit like Critical Care want to set up a PPI group is really positive. Medicine is advancing so much and improving patient care and treatments. Patients in critical care are pretty unwell so often hard to speak to them about research and get them involved because when your there you are not in the best of health and research is the last thing on your mind. It was clear at the first group meeting though that the patients really valued the expertise in critical care and by them getting involved in PPI is them giving something back to the unit that looked after them.

The tricky thing is reaching out to those patients once they leave critical care or the hospital as even once out critical care and on a ward they may still not be feeling great so would not want to be given loads and loads of information as they are still processing what has just happened. If anyone reading this has ideas of how to gain more people for the PPI group (ideally in Edinburgh) please leave me a comment.

The exciting part is that there was such a positive response and watching everyone interact was great. A first meeting for anything is hard and you never know what to expect so for the organisers it has been a success I would say. It is sad though that they have had to put so much work in and I am sure many many hours of unpaid time to set up and organise such a group and event that it is not always possible for areas to do that or have the staff dedicated to setting up, running, facilitate and maintain a group.

The benefit is though that if the group can be advertised and grow then others might set groups up for their research areas having seen the positive impact PPI has had for others. The more groups then hopefully the more publicity and PPI may have more of an agenda in Scotland and research groups which would perhaps result in more funding and PPI groups can have a network across the whole of Scotland and all types of research can get enhanced by PPI and not just be a tick box exercise!!!

The Intensive Care Unit

I have written often about being admitted to intensive care or the high dependancy unit or being reviewed by critical care staff and it always something I have just sort of dealt with and not thought to much more about it. That was until last night. I couldn’t sleep for tossing and turning thinking about how many times I have been in ICU or HDU or had the threat of going there.

Why all of a sudden has it bothered me??

Yesterday was the first meeting of the Critical Care Patient and Public Involvement Group (which I will write more about in a post of its own). A room full of patients who have been in ICU or their relatives, Drs and Nurses from ICU and then researchers whose area is critical care.

Naturally when you have a group of patients together you are naturally going to ask how you are linked with the group and I guess what your story is. In the discussion part of it there were 2 other patients who spoke of their experience being in ICU and how it was awful, the worst time of their life and how the Drs and nurses saved their life because their life was in their hands. It was a traumatic experience for them and they have got through it. I heard the saying “surviving ICU” a lot.

“Surviving ICU” was what bothered me and kept me awake. I think maybe I under estimate how bad my asthma is or maybe how sick I get or how dependent on medical staff I am to get me better. I know that my asthma is severe and I know there are many more hospital admissions, HDU admissions or ITU admissions ahead of me and I think i sort of accepted this maybe. It was not until that group discussion that I realised just how traumatic it is, life threatening it is, and how it is not run of the mill to go in and out of critical care. At the time I was able to keep my emotions in check but when I got home and set up my nebulisers that it really hit me. The other people in the group had a one off experience, this is what ICU is meant to be like ideally a never experience but if it is going to happen then once is more than enough not once or twice a year sometimes more.

In my working life you hear about people going to intensive care, its not looking good for them or statements that you mainly go out ICU horizontally not vertically. I think for me I have always come out of ICU so would never dwell on the experience of being admitted. I cant say it is a pleasant experience not being able to breath and having the most toxic drugs that make you feel horrendous to make you better but it gets better, I go to the resp ward recover and get back home. It is how it goes and has been for the last 14 odd years.

So after that meeting and hearing others speak about ICU it has almost given me a fear. In the back of my mind I know there are only so many times you go to intensive care or high dependancy and get out but so far I always get out and sometimes bounce back but then get out again. I think it is the emotions that I could see on the other patients faces when they recalled their experiences that it hit me that maybe I don’t have the right emotion to it. The fear they had and the gratitude to the Drs for saving their life was clear to see. Its not that I don’t appreciate what the Drs do but I guess I just never wanted to admit that Im going to intensive care because its the safest place and I might just be that unwell that action needs to happen quickly. Every attack I have I am terrified that it might kill me and that asthma may just win the battle and Im sure I have surpassed that thought as it is very over dramatic and im young so it won’t happen but seeing younger patients have that fear of death and the unknown.

I have never really expressed my fears of my asthma to those close to me. I try to give the outward opinion that its fine, its life, its been long enough now I should be used to it. I would like to be able to have a conversation with people about asthma and death but would worry they think I am just being over dramatic and its never going to happen. Maybe I should though as a comment  that occurred really hit me and made me think about how those close to me feel and thought about my asthma and health. Recently a very close friend died, my mum was away, I was home but she read a text out loud and said “oh my god she’s died”. My step dad thought it was me that had died not the friend. This really hit me that if they hear something about someone dying they go to me and think it is me. I try so hard to keep well and take my medications etc but its still not good enough. I always knew they worried about me doing to hospital but never thought about the dying aspect of it.

What I find so difficult and I think it includes the whole critical care thing is that in the past I have been rogue with managing my asthma. I was young and didnt understand it and didnt want to accept it so I would increase medication so I could do something only to crash and burn and end up in hospital. That changed after a consultant had a go at me (they were just stern and didnt mess about but i felt awful so took it worse than had I been well) which I well and truly deserved but I stopped messing about and accepted not being well and accepted what I could and couldn’t do. The point I found so hard was that despite this change in behaviour and management I was still ending up in ICU or HDU but not having the good bit beforehand which I had before. To this day I still really cant accept the ICU or HDU admission for nothing. I get it if I was to go and play a game of football have a bad asthma attack and need critical care- I deserved it, I did something my body cant handle but now I try my best and still end up going there and that is the hard bit. Where before if I hadn’t been doing anything attacks would mean hospital and a respiratory ward where now it is resus, critical care and then respiratory ward. With this development what happens when it gets worse……

Lots to think about.