Pippynurseuk

I'm in community. I'm completely convinced covid was in my area back in January/February, possibly even late December. We had a huge spike in end of life patients, many of them with respiratory symptoms and they didn't follow the usual gradual deterioration which we normally see with patients in their own homes. By the time we got sorted with PPE and all the other changes we brought in for covid; (I think) we were already starting to come out the other side. We did have several members of staff test positive and off sick. I was a bit poorly (nothing dramatic) before testing came in. I'm now curiously awaiting my antibody test results. The things we found most difficult was the constant changes and reorganisation which at one point seemed to happen on a daily basis. Staff were much more stressed due to this than actual covid itself. We had lots of staff redeployed to help us and it often caused more problems than it helped. We did eventually find our groove and hopefully will be better prepared if that second wave hits. All in all we got off lightly and it didn't really hit us as badly as we were expecting. My hat goes off to those working in ICU, ED and covid wards. (my news is that I'm starting my SPQ DN in September so that will be exciting!)

For female catheters I was taught to hold the catheter between thumb and second finger with my index finger underneath the end of the catheter (about 2-3 cm along from the tip) Then use index finger to slightly angle the tip of the catheter upwards. Makes it less likely to slip into the wrong hole. Works a treat.

Thank you Ruby for so eloquently describing what it is like to live with a Mr Hyde. Your description is eerily similar to my experience. Every single line had me nodding and remembering. My Mr Hyde declined to visit me the day after the birth (emergency Caesarian) of my daughter because "he was tired and needed a lay in! (All day)" missing visiting time and then apparently had more important things to do during evening visiting time. We also had many accidents where somehow only my stuff got damaged. The tantrums, the tiptoeing round his moods, the driving, the money....And of course it was always somehow my fault. It took me 12 years to leave. As far as everyone was concerned he was charming, funny, loved his family. Then one day he forgot himself for a few seconds and Mr Hyde came out in front of my family. My parents lent me 2 months rent money and a month later I was out, 2 kids in tow. That was all I needed, someone else to see it and assure me that it wasn't my fault and a little bit of practical assistance. My life is my own now, and it's beautiful. Thankyou again for writing this and painting such a clear picture.

I've said the same thing. I also can't understand why there is no record of a interview with the orientee in the report.

Very interesting. I have occasional synesthesia. When I put my hand under running water (waiting for the water to warm up), when the water temperature changes it clearly changes to feeling a different colour, it suddenly feels silver! Foods also taste certain colours and sometimes I don't like foods because they don't taste the right colour. The food thing doesn't happen all the time though. The water thing happens every single time. the human brain is fascinating.

I've read the report and I have a question. They interviewed everyone except the orientee who was with her. She was a direct witness. Why would they have not talked to her? I suppose it wouldn't have added anything extra, they've clearly got all the facts but even still....

The bit that I just cannot get my head around is that the nurse didn't actually read the label on the vial. I simply cannot imagine ever sticking a needle into a vial and drawing up medication without actually looking at and reading the label. I can certainly see some aspects of the Swiss cheese effect, perhaps she was rushed and overworked, perhaps she was in a role which was not appropriate for her experience, perhaps her orientee was a distraction, perhaps there was a lack of communication and some confusion and she believed somebody else would be monitoring the patient, maybe someone was having a hissy fit over the holdup getting the patient scanned, maybe she was having a spectacularly bad day. .........It takes seconds to read the label on the vial....... I'm from the UK and I work in patients homes not in a hospital so completely different culture. I am curious how technology; automated medication machines, scanning etc has affected nurses thinking and behaviour. What are people's honest opinions, has this created a culture where it's the norm to not read labels on vials? Not judging, just curious.

As a previous poster stated, it's difficult to give advice as different organisations and areas vary widely in how they precept and support new starters. When I started I was given 4 weeks supernumerary. During that time I doubled up with another nurse on my team so that we could carry out visits together, get signed off on some basic competencies and get to know the caseload. That 4 weeks went very quickly! I Had already completed a 12 week management placement with them and I had worked bank shifts as a hca there. It was still a massive learning curve! Looking back i feel I was very much thrown in at the deep end. We were expected to carry out complex end of life visits pretty much as soon as we started. Having said that, I worked with a very good team who were knowledgable, approachable and supportive. Our area does things differently now. We used to do "see one, do one" and then you were signed off for various skills. Now new starters do a lot more classroom based courses and have to be watched several times carrying out skills to be signed as competent. New starters are also a lot more supported and don't carry out really complex visits on their own for a long time (up to a year). You should get training in various extended skills, eg syringe drivers, end of life care, male and suprapubic catheters, vac dressings, venupuncture, IVs, drains, compression. How and in what time frame this happens will depend on your organisation. The most important advice I can give you is ask lots of questions and make friends. Community nurses tend to have close knit teams. Make friends with your team, make sure you've got a phone full of useful phone numbers and be a team player. The team you work with will be crucial to your success. Never ever guess, if you don't know how to do something or more likely, you don't know what to do in a particular situation, phone someone, anyone! Now the tricky bit is that everyone is busy and might not always be able to answer the phone when you need them most. This is why it's important to have lots of phone numbers. Introduce yourselves to all the senior nurses and nurses from other teams. Know your resources and specialist nurses. Know how to get hold of them. Have back up telephone numbers. You are going to come accross a lot of new situations and you will not know what to do. This is normal. People will worry if you are not phoning them with a million questions. Try and find somebody who is prepared to take you under their wing, someone who is prepared to just debrief with you, someone who won't mind if you phone them after work when you realise you forgot to do something or your second guessing something you've done. Hopefully you'll have a couple of "guardian angels"on your team, people who are prepared to drop everything and come and meet you at a patients house when you realise you are out of your depth. I had people like this on my team and I will be eternally grateful to them. I hope I've not made it sound too scary but community is a massive responsibility. Some of these patients you see.....you may be the only health care professional who sees them for months on end. Take notice of everything, how they walk, how they look, their skin, what's in the fridge, what meds they're on, how they're breathing, any changes, assess assess assess. Some of these patients are very complex, they are often very ill! You will be phoning ambulances from time to time! Having said all that I would hope that you would be given a gentle introduction. You will probably start off just seeing stable diabetics and doing not too complicated wound care. Hopefully you will not see very complex patients on your own. Then over time you will gradually be trained on additional skills and gradually add to your competencies. The first year will go very quickly and you will look back and be amazed at how much you have learnt. Don't let anyone push you to do anything you don't feel ready or safe to do. Just remember, in community nursing, your phone is your life line.....If you don't know....Phone a Friend! Good luck, it's scary sometimes but it's a very rewarding job. I love it.

I went straight into community and I don't think it's done me any harm. I did two community placements as a student and loved it, didn't even for a second contemplate working on the wards. If you feel community is your thing, go for it. You'll learn plenty of skills, don't listen to people who say community de-skills you, it doesn't at all. Be warned though, if you're nervous and worried about "your pin", community isn't necessarily quieter or less stressful than wards. It's a different sort of stress but the risks of making a mistake are still there. In fact there is less support, you'll be out on your own, making decisions on the spot. Some of my colleagues who started with me in community have now moved on to jobs in the hospital. Having only community experience wasn't a problem at all for them. Another girl I know did community for years, moved into the hospital and within a year was band 7. Do what makes you happy. Good luck.

This is a bit out there....but was it anything to do with the pens and drawing on herself, absorbing something through her skin?

We are trying to help her with her time management, but she will not listen to suggestions as she already knows everything there is to kenow about nursing! What do you think? this line here stood out to me. This is the crux of the problem.

Similarly, I recently read (from an interview by her mum) that she can now move her arms, legs, turn her head and bend at the waist. You would think that theses videos would be all over her Facebook page and the media (being such a miracle) but no, I guess they just haven't gotten round to posting them yet ...

We had a family member who was quite open about the fact that she was keeping a record of every mistake that anybody made and that she was watching every move we made. She would tell us how she was keeping it all in a notebook and she was going to use it as evidence to make a massive compensation claim at some point in the future. This family member was so intimidating and intense that she made people nervous and I think this actually caused people to make mistakes. The sad thing was; her relative, the patient was actually a very sweet lovely person.

In the uk, the brain stem must not be functioning for brain death to be diagnosed. This is tested with the apnea test (among other things) where on 2 separate occasions the patient is removed from the ventilator and observed for spontaneous respiratory function for 5 minutes. There must be no respiratory function. This may be different from the US definition of brain death. The court reports on this child are in the public domain and are easily searchable and contain information which describes how Alfie's brain stem was still functioning although there was some impairment. I only wanted to clarify this point as this forum is open to the public and I would not be surprised if it comes to the attention of "Alfie's Army". You may not be aware but in the UK this case has caused what can only be described as a colossal episode of mass hysteria. Individuals who have no link to Alfie or his family have taken up the call to arms almost. These people are persistent, and they absolutely believe that there was a conspiracy to murder Alfie. Emotions are running high and the situation on social media has been volatile. Anyone posting on social media supporting the courts and hospitals decisions regarding Alfie is attacked and hounded. There are facebook groups set up simply with the intention of trolling those who agreed with withdrawal of treatment. Healthcare professionals have had posts screenshotted and bounced between various Facebook groups. These people have been harassed and bullied. There have been reports of individuals tracking down people's places of work and reporting them to their bosses simply for expressing their opinion. Doctors and nurses have been called murderers, there are reports of nurses being spat on and the child's father attempted to accuse the doctors of murder in court. Often their argument was "well if he's brain dead, it can't hurt to try and it'll make his parents feel better". This is not accurate. I simply wanted to clear up any confusion and clarify the technical point of Alfie not being brain dead according to UK guidelines. I do agree that that little boy was "gone" and that withdrawal of treatment was the kindest thing that could happen for him.

Just wanted to clarify a point. Alfie was not brain dead, he was in a persistent vegetative state. This was an important factor in the decisions made in Alfie's best interest. Alfie was having seizures which were triggered by movement, light and noise. Although the doctors felt it unlikely that Alfie had any true awareness they could not be sure that he wasn't suffering, hence the decision to withdraw treatment and the decision to not inflict on him the rigours of a journey to another country. But no, he wasn't technically brain dead.