BendyEm

Easily that bad, staffing-wise. We get on though.

AICU have 24hr medical cover, as we (MHDU) are meant to have. But the doctors we have are also covering at least 3 other wards, and again, aren't necessarily art/central line trained. Because, theoretically, we are "covered" ICU or anaesthetics will only help/get involved if the patient is unwell enough to be an AICU potential. Dietitians don't site NGs with us, though we have a dietitian nurse who helps with PEGs and RIGs, and I'm sure she could site NGs, but again, not a priority and covers the whole hospital. All my patients are awake, (unless sedated for an acute situation e.g. agitation, aggression, or prior to invasive ventilation and an AICU transfer.) It's why I prefer level 2 over level 3 Crit patients, they can (mostly) actually talk back to you!

Glad it's not just me then! I feel much safer using the NGs here, with them being checked with x-ray. But I'd still like to be able to site them myself rather than rely on patchy medical cover. Having spoken to the ward educator, I'd have to do a training package, then site X number of NGs under supervision. But, seeing as none of the other nurses have done the training...who's going to supervise me? If the doctors don't have time to site an NG, how are they going to have time to watch me do it? It's just frustating, I feel like I'm providing sub-standard care to my patients when I know I have the ability to do more.

I'll start by saying I'm UK based, as I've noticed most here are US based. I've been working in my Crit Care area for nearly 6months. We have consistent issues with getting medical cover, and, due to training changes, a lot of the junior doctors we have don't know how to place Art or Central lines (kind of important, ya'know!). So I've become used to treating blind for a few hours until an art-line is in place, lots of real close monitoring and quick responding. What I'm not used to is a patient waiting 16hrs to get an NG inserted after one came out overnight. I get that overnight on a Saturday, an NG that just finished a feed isn't a high priority. I understand that, even though the night doctor promised he would do it, he passed it onto the day team. I even understand that they said they would wait until the patient had been reviewed on ward round. What I don't understand is why that patient missed 3 medication rounds and the start of an increasing feed regime because the doctor was busy. The main reason this annoys me is that I can insert NGs. The Trust I worked at before didn't require a doctor to sign off, and if the pH of the aspirate was suitable and there were no adverse symptoms with a small amount of water, this could be used. I agree, that's not best practise, and a chest X-ray is much better, but surely I should be able to site the gosh-darn thing, so all the doctor has to do is (remotely, if necessary) order and review the chest X-ray . Who sites NGs where you work? What training do you require if you site them? And how is the NG confirmed as correctly sited? I'd like to see if my first Trust was a one off, or if I would be justified in requesting the training from my ward educator.

I've had to be one of 'those patients' against my will a few times throughout my training. Halfway through my training I'd started getting dizzy/passing out and eventually got diagnosed with POTs. In a manual handling session that lasted 4 hours, no drink breaks with poor ventilation, I got a bit dizzy. About 15minutes before the end, I asked if I could take 5minutes in the corridor, with some fresh air. The instructor decided to call the Head of year. The Head of year decided to call my tutor. My tutor decided to call the head of the School of Nursing. All 3 showed up, and after half an hour of trying to explain that "this is normal, I just need fresh air, water and rest." they decided to take me downstairs to A&E. On a wheelchair. In my nursing uniform. Through all the other students that were waiting to use the room next. I spent the next 7hrs repeatedly explaining my condition, and that I didn't want to be admitted. I had tests run, ECGs, fluids given. Only one person believed that it might have anything to do with the POTs. As it was, my flat mates who could have made sure I was safe on the bus had now left, so I had no way home. Eventually I got told "There's no sign of it, but we think you have an ear infection. Here's a prescription for antibiotics and your discharge letter." I checked with 3 nurses, a doctor and the nurse in charge that there was nothing more they needed to do, and she assured me it was all taken care of, and that I should leave ASAP. I took two steps before turning back and leaning over to grab some gauze, and a vomit bowl. There, in front of her, I took out the cannula they'd forgotten (I'd reminded them 6times at this point), dropped it in the vomit bowl and taped myself up with the tape on my lanyard. "I hope I didn't still need that." Then I went at sat in the hallway just outside for an hour before someone could pick me up. Same thing happened again, after qualifying, though now my dizziness comes with chest pains occasionally. Night shift, last 2 hours. I've been feeling the chest pain for maybe 30minutes. Nurse in charge notices when a patient wakes up, looks at me and says "You should go home!" Full monitoring goes on, she calls the night doctor, makes a nurse sit with me. I told her if it continued after the shift I'd go to my GP, but she wasn't having it. I find myself again, being wheeled down to A&E in my uniform, with two nurses escorting me. 12hrs later, fluid, bloods, urine, chest X-ray, 2hrly ECGs (all done by nurses I graduated with) and "You're probably getting an ear infection."