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.

I can't really give pros and cons but didn't want to read and run. My only experience was going straight into community, I knew that was what I wanted to do and had no interest in working on a ward first, I would have hated it. I may well be wrong because I've never done anything but community but I always imagine that you might be a bit better supported on a ward. My experience was that I was pretty much thrown in the deep end, partly that was down to the pressures on our service and the way things were being run at the time. And then just the fact that you are out there on your own with only a phone as a lifeline. (You can guarantee that when you need them all your colleagues are too busy to answer!) on one memorable occasion when no one was answering I just phoned a random ward at the hospital just to speak to someone who knew what they were doing! On the other hand the state of the NHS at the moment there's no guarantee a ward is going to be any better. Sometimes I'm a little jealous of the girls who have worked on various wards just because they bring a different element of knowledge. It's nice to have a skill mix where you've got one person who's really knowledgable about kidney stuff, one person who's really knowledgable about surgical stuff, another person whose an expert on orthopaedic stuff. Having said that when we have newcomers come to us from the wards they still have to learn our job from scratch because it is just so different. The basic foundations of nursing, assessment, time management, problem solving etc etc you will learn anywhere. I just felt that I might as well be learning all that stuff in the context of where I wanted to spend my career. I was also pretty confident, like 99.9% sure that community was what I wanted to do long term. If I did ever change my mind and want to work in the hospital, I appreciate that I would find it very different and have a steep learning curve but I do know people who went into community straight from qualified and then successfully made that transition into hospital. Basically I'm rambling and I think what I'm trying to say is there are pros and cons of both, do what feels right for you. edited to add, try and speak to some people who work in the places you've been offered, that may well make your mind up for you.

I have seen under resuscitation status "DNAR (do not attempt resuscitation), would only like to be resuscitated if her life depends on it". I'm imagining the doctor who discussed this with the patient gave up trying to explain/educate and just stated the patients wishes.

Hi I did my management placement in community and have stayed there happily ever since. Community nursing is fab, not easy but fab. Don't worry about your competencies, you'll have ample opportunity to achieve them all. Yes you will have your own small caseload and go out to patients on your own but you will still have a mentor and you should still be visiting more complex patients with your mentor. You should be seeing end of life patients, patients requiring insulin, new patients and more complex wounds with your mentor. You will be replenishing syringe drivers with drugs such as morphine and midazolam, administering insulin and will probably give some IM injections, so that will cover medicines management. You will be carrying out pressure ulcer risk assessments, skin assessments, musts, obs (all ours are done at least 4 weekly) and various other assessments. When visiting patients with wounds you will be giving them advice on diet and nutrition, mobilising, pain control, as well as patient education on their wounds. You will be educating about leg ulcers and pressure ulcers. You will probably see some poorly patients, sepsis is very common in community patients, you may even have to ring an ambulance! There is a good chance you will come accross some challenging situations and possibly need to use some conflict resolution skills. Then there's catheters, pleurex drains, pegs etc etc. While I was on my management I would generally spend the morning with my mentor then go and see my own patients in the afternoon or vice versa. Also community nurses tend to stay in contact by phone or text message. Ask your team to let you know during the day if they have anything interesting and then you can go and meet up with them. As a third year student I would be expecting for you to give anything a go under supervision (within your uni and placement guidelines of course). I would expect you (after a few weeks) to independantly carry out simple wound care safely and ask the patient relevant questions eg how do you mobilise, what is your diet, how much to you drink. I would expect you to give simple advice eg keeping legs raised for oedema, repositioning for pressure ulcer prevention, eating healthily for wound healing. I would expect you to be proactive in learning about different dressings and the basics of wound care. I would expect you to give medications safely and in the correct manner. I would expect you to show a reasonably confident and reassuring face to patients. I would expect you to make an effort to build relationships with patients. I would expect you to communicate with your mentor and your team effectively. I would expect you to behave considerately compassionately and professionally. Mostly I would expect you to show enthusiasm and be motivated and proactive in your learning. I would not expect you to know everything and I would not expect your clinical skills to be smooth as silk, fumbling is fine! I would expect you to be safe and that means asking when you don't know. Generally show willing, show interest, be a team player and get stuck in. Most importantly, when you go out on your own, remember your most important piece of equipment is your phone. Anything you are not sure about...phone someone from your team....ask the question, be safe! They will be expecting you to phone and ask questions and will worry far more if you are not asking questions. Make sure everyday that you are armed with several people's phone numbers. Don't just have your mentors tel number, it will be typical bad luck that when you need help, your mentor will have her hands full and be unable to answer. All in all don't worry, you are going to have a wonderful placement. Hope you love it as much as I do.

I got 10 home visits, 5 of which were bilateral legs plus an urgent call to a malfunctioning vac which when I got there turned out to be working fine, hence a wasted 40 min round trip. As I sprinted through the office to grab supplies I did spy a few lonely cakes and pens on a table but no nurses around, all out on visits trying to squeeze 10 hours work into 8. I think I might have got a flea bite too! Lucky me. Happy nurses day!

Carrying out pressure ulcer risk assessment on 90 something yr old lady in her own home. Totally with it mentally and very sweet. Offer to order her a pressure relieving cushion which she declines stating "no thank you, I think they're for old people, I'll have one when I get old.

We use this in the uk, Entenox (air and nitrous oxide), I'm guessing this is the same thing. It's our main source of pain relief during labour. I would imagine it's fairly common for family members to have a cheeky little go on it, I've certainly seen it happen on our documentary "one born every minute," partner has a little go, maybe gets a bit giggly for a few seconds.......however I think the situation actually self regulates itself......you try wrestling that stuff away from a labouring woman!! I don't work labour and delivery so I wouldn't know if there is an official policy on avoiding diversion. Different culture however and probably just more relaxed about it. what I can tell you is that it does very little for the pain, just takes the edge off a bit. It does give you something to concentrate on though during contractions which is probably as effective as its pain relieving capabilities.

They're bound to ask you a couple of "tell us about a time when you......" Type of questions, think back over your placements and and have a few standout situations in mind covering situations you dealt particularly well with or situations which were particularly challenging. Think about what you learnt, what your strengths and weaknesses were. Then when you get that sort of question you should already have something in mind which fits and which you've already thought about. They will want to know that you are safe. If they ask you a scenario where you wouldn't be 100% confident, answer is phone a friend! Say that you would speak to your band six/manager/experienced colleague. If you can't get hold of anyone, phone the hospital, get advice from someone on an appropriate ward. They will want to know that you are enthusiastic, I take it that you really enjoy community since you are going for that role, so let em know how much you love it! Do your research and find out what their philosophy/buzzwords are and get that in there. Im not sure what the hot topics are at the moment in interviews but I'm in community and things which we discuss and consider important are; sepsis, pressure ulcers, quality end of life care, safeguarding, communication, teamwork, lone working safety. Good luck, I'm in community and I love it.

My dumbest moment was as a student on placement in ICU. I was carrying out mouthcare on a sedated vented patient. The patients eyes were half open. As I did mouthcare suddenly the patients eyes rolled back a bit in in her head. More than slightly freaked out I waved manically at the nurse who was with me (she'd just popped out of the room to get something) . When she returned I explained about the eye rolling thing. Calmly the nurse asked me what was worrying me. Me, not so calmly...... "I don't know if she just died, how would I know if she died when the machine is making her breathe....." nurse patiently points to the normal sinus rhythm on the monitor and very gently asks me whether it's normal for dead people to have their hearts beating in a lovely rhythm

British staff nurses earn between £21000 and £28000 per year, (which I believe is around 26000 to 34000 dollars) see NHS pay scales 2

We were taught to take gauze from sterile field using clean hand and then literally drop it into dirty hand so you do not touch dirty hand. Then dirty hand is used to clean wound. Clean hand goes back to sterile field to get next gauze, drop, repeat and so on.