Loquax

I work in a pediatric oncology/neurosurgery ward in Sweden. A typical day looks something like this: We begin with a report from the night shift. Then I make a list of medications and cytotoxic drugs for my children (we usually have 3 or 4 children per nurse). The pharmacy prepares the cytotoxic drugs, we prepare all antibiotics and everything else. Next, I change all continous i.v. infusions (e.g. 5% dextrose) and finish the in/out-lists. All is entered into our computerized patients records. I also try to look at the dressings of the CVC:s. About then, it's time for the daily conference with the physicans, and after that I usually get a lot of work to do with blood samples, changes in medication and so on. Much of the time is also used for teaching, both children, siblings and parents and social support. We spend much time talking, both with the ones we have on ward and on the phone with the ones who are at home. The afternoon shift starts at 1330, and before then I try to have updated all papers and written the shift report. Worst thing: Most of the children that dies are sent at home and they usually pass away in their own bed. It's very hard to understand (emotionally, not as much intellectually) that they are really dead, since last time you saw them, they were quite well and just left the hospital as if they were sent home after finished treatment. I have at least five or six children that I cannot understand have really died. Best thing: Families. Yesterday, I spoke on the phone with a mother who lost her son about a year ago. That hour of conversation taught me more about life than three years in nursing school. I wish I had known more about the different treatments and drugs and so on. It's a very complex field and at school, we had two hours of pediatric oncology. Not much. But we've got a fairly good library at the ward, so I still read, read and read (I've worked here for two years now). Emotionally, it's been more intense than I ever thought it would be. There have been times when I never before been have so happy at so terribly sad at the same time. But I bet it's the ward most prone to laughing at our hospital as well. And I've never been so engaged in my patients before - I use to call when I've got days off just to see how 'my' children are coping. Sometimes I think it's dangerous and that I'll get burnt-out, but on the other hand, I guess it's better making a quick call and then feel ok, compared to spending the whole day beeing worried. It's simply the best place to work.

At my ward, it really depends on what I'm doing. Days when I'm working with the patients as well, I wear a scrub. If I'm in the office working with rostering or salaries all day I might just wear jeans and a college sweater. There is no dress code as such at my hospital.

I have worked on two different units (one cardiology ward and one neurosurgery intensive care unit) which both used self scheduling. I'm a great fan. We actually used a computerized system (called TimeCare) which I'll try to describe. The process of creating the schedule is divided in two parts: first everyone enters their personal schedule they actually want. We used to do the schedule for two months at a time or something like that. It's possible for everyone to block a number of shifts (called 'veto') if you simply can't work (cause it's your birthday, you've got your nitting evening school every tuesday or whatsoever). That all ends up in a draft schedule. When all individual schedules are entered, there will be an excess of nurses some shifts and a shortage on other shifts (the manager have to set up the limits: every Monday morning we need five nurses, every Monday afternoon we need three and so on). That's the second part of the process: everyone voluntarily changes a few shifts to make the schedule fit. If there still are differences and some shifts are unmanned, the boss makes the last few changes. The system is very easy to use indeed, and many Swedish hospitals uses it. It's actually translated into English as well (see their web-site: http://www.timecare.se/documents/documents.php?category_id=105). Best of all, it gives you the freedom to make you own personal schedule. I used to concentrate my work in order to get a whole week off, and that was just splendid. /Anders

We've got module in our patient records computer system that takes care of most of the calculating. We have separate lists where we record all volumes of i.v. infusions (no measuring of injections, only infusions) and every morning we input yesterday's total volume in the system. It works very fine for us. The computer could actually record the i.v. volumes itself using the electronic medication records (where the total volumes are input when the physician orders the drugs), but we've got a separate system for cytotoxic drugs and they are not connected to each other, so we still use the manual records for the i.v. to avoid confusion.

I'm the Swedish equivalent to an assistant nurse manager (in Swedish: Sektionsledare) at my ward, which is a pediatric oncology and hematology one. My responsibilities are as follows: - filling gaps in the roster (causes agony now when everybody has vacation) - reporting vacations, sick leave, maternerty/paternerty leave and so on into our HR management system - solving different minor problems during the day, e.g. troubleshooting computers, mending the pneumatic tube system, comforting the secretary when she gets cross... I'm also responsible for creating a procedures manual, we desperately need one. Most of my time is however spent as a 'regular nurse', i.e. I take care of the children like anyone else on the ward. One or two days a week, my boss and I switch so I'm in the office and he works on the floor. We've had _great_ difficulties in sorting out what responsiblities I have and which ones belong to my boss. /Anders