A day on ITU

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The shift pattern on ITU is the same as the shift pattern on HDU (You can read my day on HDU post here) :

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

Just like on HDU, there is no ‘typical’ day on ITU as every day can be different from the next. Below is one day that I experienced on ITU.

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On ITU, the staff nurses’ have 1 patient each for the whole day (1:1).

07:45 – 10:00 – The nurse in charge checked the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses completed bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points were working and checking the infusions to ensure there is enough left to last a couple of hours. In ITU, there are also ventilator settings and alarms that need to be checked to ensure they are working correctly. After all these checks, the patient was assisted with personal hygiene needs and repositioned. Pressure areas are checked and patients on ITU are repositioned 4 hourly, with pressure areas checked on each reposition. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or a change in ventilator settings, depending on how the patient is responding to their current treatment plan. Sedation holds may begin around this time to allow the patient to have time to respond, sometimes the patient is not ready to fully break from sedation so the sedation may be restarted and a sedation hold attempted the next day.

12:00 – 18:00 – Again it’s hard to fully describe what happens in the afternoon as every day is different. Obs are usually completed hourly on ITU, they may be 2 hourly if the patient is self ventilating and being transferred to a ward. Obs on ITU include fluid input and output. Fluid input includes any medications given by IV or through a NG tube. Fluid output includes blood taken and NG tube aspirations as well as urine output. Every hour the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Patient observations are monitored closely and medications/oxygen can be adjusted accordingly. If a patient is responding well to ventilation, the ASB rate, PEEP or oxygen % may be adjusted to see how the patient manages. Extubation may occur if the patient is responding well to treatment but this will be planned in advance and discussed in the days leading up to the decision. ABG’s will be taken and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E, HDU or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Love,

T x

A day on HDU

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My first placement of year 2 is 6 weeks on ITU/HDU. At Derby university in second year, we have two hub placements. One is for 6 weeks and the other is for 12 weeks. We also have a spoke placement where we spend 4 weeks.

The shift pattern at my placement is:

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

There are 1/2 days but I won’t be doing any of these during my placement block.

There is no ‘typical’ day on HDU as every day can be different from the next. Below is one day that I experienced on HDU. Other areas/trusts will vary and I would love to hear about your typical days on placement!

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On HDU, the staff nurses’ usually have 2 patients each for the whole day (2:1).

07:45 – 10:00 – The nurse in charge checks the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses also complete bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points are working and checking the infusions to ensure there is enough left to last a couple of hours. After all these checks, the patient is asked if they would like to have a wash and a fresh gown. If the patient declines, they are re-positioned and a skin check completed. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or transfer to a ward such as respiratory or stroke wards, depending on the patient.

12:00 – 18:00 – It’s hard to fully describe what happens in the afternoon as every day is different. Obs are done hourly or 2 hourly, depending on the patient. Obs on HDU include fluid input and output. Fluid input includes any medications given. Fluid output includes blood taken as well as urine output. NG tube aspirations are included in the fluid output also. Every hour/2 hours the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Personal care needs are met as needed and re-positioning is carried out regularly if the patient is unable to do so themselves. Patients observations are monitored closely and medications/oxygen can be adjusted accordingly. Equipment may also be changed if needed, such as changing a patient from a nasal cannula to an oxygen face mask. ABG’s may be taken in this time and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Look out for further blog posts in my HDU/ITU series!

Love,

T x

Receiving a new placement allocation

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February 18th 2018 I was on a night shift on my year 1 hub placement. At midnight, my first placement allocation of year 2 was due to go live. I nervously logged on around 00:30 to find it said access denied! I was so disappointed to not be able to see my placement allocation, it said it was a medical ward but did not have the name of the placement area, at this time I thought it was just mine saying this. I kept refreshing the page throughout the night but it didn’t change. The next day, I realised that all my cohort had the same message. After some emails and phone calls to the placement team from other students, we were told it would go live the next day.

Later on that evening, I saw a Facebook status from someone in my cohort about their placement allocation. I was so nervous to log on again and check as there were a couple of areas I would have preferred not to have been allocated due to them being similar to my first year hub. I logged on to the placement allocation area and it was there.

I HAD BEEN ALLOCATED ITU/HDU FOR 6 WEEKS!!! 🎉🎉

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I was so excited, this was an area I had hoped to receive as a placement but didn’t think I would. After the excitement, the usual doubts set in. I was worried that I would be at a disadvantage having been in a community hospital for first year. I didn’t think I would have the knowledge necessary to have a good placement on an acute ward, especially one as specialist as ITU/HDU. I had two weeks at university between being on placement as a first year and going back to placement as a second year. I wondered how much more knowledge I would be expected to have being a second year on placement.

I walked in on my first day and I was terrified. I felt so overwhelmed, I had no idea what any of the machines were for or how the paperwork was filled in. I was worried I didn’t know an acute ward routine and that I would have a bad placement. My mentor was lovely and put all my worries to rest straight away. They do not expect you to know the machines or the routine as you’ve never been there before. She talked me through the daily checks and morning routine. There was a NQN on my first day as well and she was great at making me realise there’s nothing to be worried about and that even if you’re qualified and choose to work on ITU/HDU, you won’t know everything and it is all a learning curve. During my first shift, comments were made to me about applying to work there once I qualify and these have since been mentioned on my following shifts as well, so I must be doing something right! The feedback from my mentor has been positive and I feel like I know the routine a little more now. I am a quick learner so I seemed to pick up the paperwork side of things quickly and by lunchtime on the first day, I was completing the hourly obs on my own meaning my mentor could concentrate on other areas of patient care.

On my first night shift, I was drawing up a vial of Pabrinex and managed to get it all over the floor and myself! Luckily, my mentor and another staff nurse had a good laugh about it and that put me at ease. They said everyone manages to get it on them once during training, which was a relief to know I wasn’t the only clumsy one! I had 2 weeks on HDU and I am now doing 4 weeks on ITU, I have followed my mentors rotation. At my trust, the staff nurses employed on ITU/HDU do a rotation, they spend 8 weeks on HDU and 16 weeks on ITU.

I seem to have fitted into the team really well and can definitely see myself applying to work there, I just need the job to appear on NHS jobs now 😊

Do you know where you would like to work yet? Let me know!

Love,

T x

End of year 1!

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I can now officially say that I am a second year student nurse! There have been times throughout this first year that I thought I would never be able to say that, I haven’t found the assignments to be particularly challenging but I have doubted myself in every way possible this year. Is my writing good enough? Am I good enough on placement? Will I ever have the right amount of knowledge to qualify?

I’m sure these are thoughts that a lot of us have had and will have again throughout the next 2 years of our journeys!

I am excited to get started with year 2 and get some more assignments, it seems like forever since I had anything to research and write about 😂 Although I may not be saying that once I get the dreaded research assignment!

My first placement of year 2 will be on ITU/HDU for 6 weeks, with 2 weeks annual leave in between. However, I won’t be off for the 2 weeks as I will be working at my bank job. I do have a visit to Harry Potter Studios to look forward to on the 6th April though!

I have so many expectations for second year, mainly due to what other students have said and things I have read on Internet forums. I am worried about the year 2 blues (although I worry about everything as you will know if you follow me on twitter, so that is nothing new 😂). I know I have a fantastic support network around me to get me through if the year 2 blues do hit.

I doubted myself so much at the beginning of the course and I still do now,  it’s a confidence thing and I think I’ll always be the same. I’m not the kind of person to admit to feeling like I’m good at something and would always rather play my skills down instead of shouting about them. Despite some amazing feedback from both my year 1 placements, I still have doubts about my abilities. I can see how much I have grown throughout this first year though and hope to continue to grow throughout year two.

In year 1, I achieved grades between 70-98% and would love to keep this high standard up throughout year 2 now that the grades start to count towards my final degree classification. I make no secret of the fact that ideally I want to qualify with a first so I need to keep focused on that goal.

During first year, my future focus has shifted from ward work as I now feel this is not where I can see myself in the future. I still have a passion for cardiology though so I’m keeping my fingers crossed for a placement on the cardiology ward at my placement hospital. My next placement is something completely different to my year 1 placements and I am excited to get started on there.

Let me know how you found year 2 and if you have any tips for me 😊

Love,

T x

*Book review* Clinical Placements

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Clinical Placements by Kirstie Paterson and Jessica Wallar (edited by Kath MacDonald) is part of the pocket guides for student nurses collection of books. These are little pocket-sized books that aim to provide useful information to student nurses. Subjects such as intensive care, general practice, older person care and many other areas of nursing are currently under development so please look out for them in the future!

The foreword of the book discusses how the book came to be written and can be seen below. It was written by recent nursing graduates, reviewed by students and checked by a clinical supervisor.

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There is a list of common abbreviations which I know I would have found so helpful before starting placement as the first time I looked at a handover sheet it appeared to be in a different language!

There are four sections to the book: Getting there; Settling there; Being there and Moving on from there.

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  • Getting there includes tips for preparing for your first placement, information about the NMC code of conduct and guidance on social media usage.
  • The settling there section talks about your first day, how to work with your mentor and how to improve your communication skills with the team and patients.
  • Being there is about your time spent on placement and the common assessment tools you may come across within your placement area. Personal safety on placement is covered and drug calculations as well.
  • Moving on from there includes a fantastic FAQ section featuring common questions I know a lot of student nurses will have thought about.

Throughout the book there are links to the NMC code of conduct and handy pages around patient assessment tools such as NEWS and Waterlow. These would be useful for any student nurse on their first placement. There are also spaces for students to make their own notes.

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I would recommend this book to anyone starting university as a student nurse soon, I haven’t seen a book of this size with this much information in before, it is small enough to be kept in your pocket or your bag during placement shifts to be used as a guide should you need it. It is also a great read before starting placement which would help to alleviate any of those nerves around starting a placement. The book is designed to make placements more enjoyable and less stressful – I would say it definitely does this! It would be perfect for first placements but would also be handy for students further into their training to keep as a reminder guide.

If you would like to purchase this book, you can find it here. The book is currently priced at £9.99 and published by Lantern Publishing ltd. You can also purchase direct from Lantern Publishing here.

Self care

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You may hear this term and think what is self care? To me self care is about looking after yourself and making sure you regularly take time to do things that you enjoy. Sometimes it’s easy to get caught in a placement/uni and sleep cycle with very little else. It’s important to take time for yourself to recharge and refresh. How can we look after our patients if we don’t look after ourselves first? Here are the things I do for self care 😊

  1. I try to have one day a week where I have no plans and can just relax, catching up on tv or reading a book. This is not always easy around uni/placement/work but I usually have at least an afternoon off.
  2. Taking a long soak in a hot bath with a face mask on. I like to do this as it relaxes me and helps me to destress.
  3. I like to have at least 6 hours sleep on a night as I feel rubbish throughout the next day if I don’t. If I can have more than I do as it gives my body that extra bit of rest!
  4. You are not being selfish if you recognise that you need a day to yourself or you just can’t reply to that text/email right now. There is nothing wrong with taking time out to care for your mental wellbeing, sometimes you need the time away to concentrate on you. Don’t feel guilty if you need to rearrange plans or you turn your phone off for an hour.
  5. Step away from social media. This can sometimes be easier said than done, but even if you just ‘mute’ negative people it can have a positive effect on your social media time and your outlook.
  6. Calling a friend for a quick chat. It really helps to know that support network is there. Talking about things other than uni/placement helps to take my mind off any worries I have as well.
  7. Making plans for the months ahead. I always feel better if I have something to look forward to that isn’t uni/placement. D7B5D714-7624-4A8F-B55F-9F8CB9C4AF06I have a Harry Potter Studios tour, live WWE wrestling show and a live autopsy booked in already for this year 😊.
  8. I enjoy exercise (even though lately I haven’t done enough of it!), it really helps to brighten my mood and makes me feel more energetic afterwards. It is also a good destresser.
  9. Music. I love listening to music and Spotify has been a lifesaver. From cheesy 80s dance to pop punk, there is something on there for every mood.
  10. Gin. Gin is always the best part of self care. Cheers!

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Love,

T x

Assignment planning

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Here are the tips that have helped me gain a first (70%+) in each of my first year assignments 😊

  • As soon as the assignment is set, write the deadline in your diary. I always write in a reminder a month before the due date as well.
  • Print the assignment brief/crib sheet off and read through the learning outcomes to ensure you know what the assignment is wanting. Also print out the marking guidance to check your final assignment against.
  • Soon after the assignment is set, sit down and make a plan of when you would like to have sections completed by.
  • If you have no idea how to make a plan for yourself, Kent University have a resource called ASK : Assignment Survival Kit. You input your start date and deadline date, it generates a plan for you with dates on to have different sections completed by.
  • Begin by finding relevant sources of information that you may use within your assignment, create a reference list with these on as you find them. It’s much easier to compile your reference list as you go along, instead of leaving it until the end.
  • Try to find references from a range of sources. Use reputable internet sites, journal articles and textbooks to give you a wide selection of resources. This also shows that you have taken the time to read around your subject instead of just using what a google search brings up.
  • There is no limit on the amount of references, I aim to have at least one every 100 words.
  • Print internet resources out so that you can highlight key points that you would like to paraphrase, this saves time returning to the website constantly. I write the reference on a sticky note and attach to the printed out resource.
  • Write your assignment in note form. Use headers such as ‘Intro’, ‘paragraph 1’ etc and just bullet point what you think you will include in these sections.
  • Write a draft and then leave it a few weeks before you look at it again. This helps to look at the assignment with ‘fresh eyes’ and spot any errors or information that is missing.
  • I write my introduction first, others write the introduction once they have wrote the main body of the assignment. Either way is fine, whichever works for you!
  • Aim to have the assignment finished around a month before the deadline, this allows time to edit and check all the references a couple of times before it is due.
  • Before submitting, check your reference list matches your in-text references. I also check that any internet links are correct and link to the correct websites.
  • CEB3DD45-5B50-42C6-813C-D3FF225DFC19This option on word will alphabetise your reference list if you highlight the full list and click it.
  • If you are going to buy one book for university, make it the Cite Them Right book. It has many different referencing styles in and I find it better to use than the website.
  • About 2 weeks before the deadline, I’ll submit my assignment into turnitin, minus my reference list, so I can see the similarity score and change anything that needs changing. I will then submit with my reference list attached.
  • Around 2 days before deadline, I will read my assignment for the last time. I will make any last minute changes and then submit for the final time.
  • If you have a couple of assignments due around the same time, try to complete one in at least draft form before you start another one. Some people can have a few assignments on the go at once, but I like to complete one in draft form before I start on another.
  • Try to complete as much as you can whilst you’re on theory time at uni, as the last thing you want to do after a placement shift is work on assignments.
  • Read your assignment out loud as this helps to pick up on any grammatical errors. Choose someone else to proofread it if you can (not the best idea to choose someone in your cohort however much you trust them!).
  • An hour a day is better than nothing!

If you’re a last minute person, you may not feel these tips are useful for you. What I would say is even if you only gather your sources of information so you have a draft reference list, this will save you time whilst you’re writing your assignment. You may find that you need more but at least you’ll have a selection ready to be used.

Let me know if you have any other useful tips!

Love,

T x

My 2018 goals

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3 days into 2018 and I finally have the chance to do this post! I’ve set myself a few goals for the following year, a couple of which centre around self care (something I am guilty of neglecting more than once in 2017 🙈).

⭐️ I have always loved reading and find it a good way to relax. I have set myself the goal of reading 52 books in 2018, I have a bookshelf full of books I just haven’t had chance to read yet so I’m hoping to get through all of those. I have downloaded the Goodreads app to keep track of the books I’ve read and want to read. These are the books I purchased over Christmas:

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⭐️ Every day in January on Twitter, I will be posting something that has made me feel positive that day. I can often focus on the negative feelings around situations instead of concentrating on the positive ones. I’m hoping by doing this post everyday it will encourage me to be more positive about things. I’ll be using #Januarypositivity to collect my posts together if you’d like to follow them!

⭐️ In February, first year comes to an end. My goal regarding this is to pass my first year hub placement which then allows me to progress into second year. I received good feedback at my mid-point interview so I’m keeping my fingers crossed for a pass 🤞🏻

⭐️ During first year, I received grades of 70% and above on all my assignments. I’m hoping to continue this throughout second year when the grades start to count towards my degree classification. I’ve heard some horror stories about second year from other student nurses but I’m looking forward to being back at uni and starting some new modules.

⭐️ I plan to take more time for me this year, I am guilty of putting uni and work first, often working more hours than I should around university. I find it difficult to switch off from uni/work and 10 months in I still don’t have the work/uni/life balance sorted 🙈 I have a brilliant partner who is very supportive but I sometimes feel that I neglect him for uni/work so I want to make more time for him throughout 2018 as well.

⭐️ I love following the slimming world plan and find it fits in well with uni/placement so I’m hoping to lose at least 4st following the plan throughout 2018.

⭐️ I often find people take advantage of my kindness and willingness to help, I want to make more time for the friends who make the effort with me and rid myself of some of the ‘toxic’ friendships I have encountered in 2017.  2018 will be the year that I learn to say no and treat people the way that they treat me.

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Let me know what your 2018 goals are ❤️

Love,

T x