*Book Review* Being a nurse by Lauren Philpott

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*DISCLAIMER* This book was gifted for me to review, I have previously worked with the publishers before which you can see here and here.

Lauren is a children’s nurse who qualified in 2014. Lauren runs a blog called Graduation to Revalidation which talks about how to survive your first 3 years as a qualified nurse and you can find her on twitter at @grad2revalnurse. Lauren wrote the book after looking for other books which described the way newly qualified nurses feel and finding there were none available.

Lauren writes in a way that is like talking to a friend or mentor, making you feel comfortable and supported. The book contains sections on how to cope with a bad day and first day nerves. As a third year student nurse, I worry about first day nerves especially as I am going to work in a trust that I haven’t had a placement in and this section of the book really resonated with me as I’m sure it will other third year student nurses.

The book is written in an informative way without using jargon and confusing language, containing hints and tips from Lauren herself on each section. My favourite section is how you know when you’re ready to progress, I have a career plan which I would like to stick to and this section was really interesting to read.

This is a book that would be good for all student nurses to read, especially third years who are close to qualifying or newly qualified nurses!

Love,

T x

Nursing isn’t all about grades…

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‘Your grades do not define the kind of nurse you are’ and ‘You do not need a first class degree to be a good nurse’ are some of the things I see on twitter on a day-to-day basis.

You know what? They are correct.

Grades do not define the kind of nurse you are out in practice, in fact some people are very open about ‘struggling’ academically but thriving out on placement. We all have our strengths. You also do not need a first class degree to be a nurse, completing the degree is what ultimately matters not the classification.

BUT….here is where I harp on about my own opinion on this subject.

I often hear ‘you cannot be good academically and out on placement’. WRONG. You can be good at both, without blowing my own trumpet I am reasonably strong academically and receive fantastic feedback on placement, something which is similar with many student nurses I know. People need to stop pushing this narrative where you have to be good at one or the other. You can be both, please stop saying that people who are good academically make rubbish nurses. And yes I have seen this more than once. It is simply not true.

Grades do not define you as a nurse. BUT there is no shame in owning the fact that you want to achieve a first class degree. If you want this and you know that you are capable of it, do not let anyone shame you into thinking you should not be talking openly about this. For those of us who already have a future career plan mapped out, it is important for us to achieve the highest degree classification we can, just as I’m sure it’s important to many others. I will not be made to feel embarrassed about admitting this because I will have worked hard to gain whatever classification I receive. We should all be striving to achieve the best that we can do, not just aiming for 40% ‘as long as we pass’.

People all have different academic levels, I can write a good essay but that doesn’t mean that I am more intelligent or better than another student nurse. I often feel ‘inferior’ in lessons because there are members of my cohort who know more about the clinical side than I do, based purely on our different placement experiences. Someone may know lots about respiratory conditions, having spent 13 weeks on there. I know very little because my placements have not included that experience…however, give me a cardiac situation and I’ll be on it. We shouldn’t feel inferior to our other student nurse colleagues just because they received a ‘better’ grade or know more about a condition than we do, we should be sharing our knowledge and experiences with each other. Acknowledging each other’s strengths and pushing each other kicking and screaming to the end 😂

We shouldn’t be knocking people down who have a plan in mind and are honest about this. We should be supporting everyone around us, regardless of end goal or future plans.

Nursing isn’t defined by grades…but that won’t stop me being here striving for that first class honours degree 👍

Love,

T x

How to survive long shifts on placement

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Comfortable shoes – this would probably be my number 1 tip for placement! Most ward shifts will be 12+ hours and there is nothing worse than sore feet when you’re on shift. I have Clarks Unloops and find them to be very comfortable, I wear them for placement and 14 hour shifts at my care home job and my feet are always fine. Some people don’t like Unloops, it’s just about finding what shoes work for you. Others recommend Sketchers Go Walks.

Compression socks – standing up for most of a 12+ hour shift can cause achy calves and lower legs, wearing compression socks can really help to avoid this.

Plenty of water – keep a water bottle close by if you are able to do so. Some wards allow water bottles at the nurses station or in a cupboard out of sight. If you are not able to do so, you are allowed to use quiet times to quickly nip for a drink of water. It’s important to keep hydrated especially on long shifts.

A good nights sleep – this helps concentration and also helps you to feel ready for the day. Try to get an early night before a placement shift.

A good breakfast – being hungry doesn’t help concentration or mood (I find this anyway 😂). Try to have something filling such as porridge or toast, this will keep you going until you go on your first break.

Ask your mentor for 5 minutes if you need them, especially on your first placement your mentor will be understanding if you haven’t done long shifts before.

Prepare uniform, bag etc the night before to stop morning stress – you don’t want to be rushing around in the morning getting all your things together and running the risk of forgetting something, prepare your things the night before and you can take your time getting ready in the morning without the stress.

Baby wipes and deodorant – you can use these on your break to freshen up and wipe your face on a night shift if you are feeling tired. Wards can be warm and having deodorant in your bag can be useful for freshening up as well.

You do adjust quickly – after a few long shifts, your body will start to adjust to them and you will start to find them easier.

Don’t over-rely on caffeine – this applies more to night shifts. It can be easier to think that drinking caffeine all night will make it easier to stay awake, this is often not the case. You can ‘crash’ and feel more tired , try to keep hydrated with water and stop drinking caffeine around 4am to help you get to sleep when you get home.

Speak to your mentor if you are struggling – if you are finding the shifts difficult or struggling to cope with 2 or 3 in a row, talk to your mentor. They can split your shifts up (where possible) or possibly spilt a shift so you can do 2 1/2 shifts instead of long days all week. Most mentors will be understanding, especially if it’s your first placement and you are not used to doing long shifts. Ward shifts do tend to be 12+ hours but you do have plenty of placement time to adjust to them.

A long, relaxing bath – I find there is nothing better after a long shift than a red-hot bath with plenty of bubbles and a face mask! This might not work for everyone but find the one thing that helps you to unwind after a long shift.

Mints/chewing gum – I always keep these in my pocket just to freshen my breath after a break (not recommending that you chew gum on placement, just to freshen your breath and then dispose before returning from break). You can even take your toothbrush and toothpaste!

Utilising quiet time – I know this may be rare on some placements, but if you do get a quiet hour in an afternoon use the time wisely. I like to get the BNF out and make notes on common medications used in that placement area, or speak to a patient with a condition you don’t know much information about – patients will often be very knowledgeable about conditions they have managed for years.

Let me know if you have any other good tips!

Love,

T x

How to use Discord

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As you may have seen, I have created a server on Discord called the Student Nurse Academy. This server is for all student nurses and newly qualified nurses to get involved with. There are text chat rooms where you can ask advice and support on things such as assignments and placements, allowing you to receive real-time support from other student nurses. You can also chat socially with other student nurses from around the world! I know that many of you may not have been on Discord before so I have created this step by step guide on how to use it that I hope you will find useful!

  1. Create a Discord account – download the app on your phone or computer and choose a username (you can change this later on). Remember to verify your email to allow you full access to the servers chat rooms.
  2. Customise your account – you’ve verified your email address and now you’re good to go! Add a profile picture of your choice and connect apps such as Facebook or Spotify if you wish to do so! blog picture 2
  3. Join the server – you can join the server through the invite link, this takes you straight to the introductions chat for you to tell us a little bit about yourself! Your servers will appear on the left hand side of the screen.blog picture 1
  4. Start chatting! – join one of the chat rooms on the left hand side of your screen and write a message. All the chat rooms are text chats, except coffee club which is a voice channel. You can jump in there and chat with other student nurses, kind of like a big Skype call 😂 If you don’t feel comfortable using the voice channel, stick to the text chats! If the chat names appear in bold, this means there are messages in there you have not seen.blog picture 3
  5. Build friendships – the main aim of this server is to bring student nurses together and to create friendships. Asking for advice is important and a part of this server, but gaining a support network is the main aim. You can chat about anything you want to in the general chit-chat ward, from what pets you have to what Harry Potter house you belong to (I’m a Slytherin for anyone interested 😂). I’ve made many friends through social media and want to help make this a possibility for other student nurses.

Why not use Facebook/Twitter/Instagram like we are now?

I wanted to create an area where student nurses can just chat, a little bit like a Whatsapp group but without needing to share your phone number with ‘strangers’. Twitter/Facebook/Instagram require a little bit of work from yourself to start conversations, you need to post a status, tweet or picture for people to interact with, that’s if your friends see them with the current algorithms. Here on Discord, you can just jump into a chat and join in. Discord is a safe place where you don’t even need to divulge the university you study at if you do not wish to. Discord is easy to use and you don’t even need to receive notifications if you’re easily distracted like me. Pop in and out of the chats whenever you want to and interact with people. You can @username to direct a message towards a specific user and react to people’s messages. You don’t even need to download an app, you can just use this when on a computer through the web interface.

Feel free to ask any questions you may have!

Love,

T x

You must work on a ward…..

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This age-old narrative is rearing its head again and again. ‘I want to work in the community but people say I must work on a ward for at least a year’, ‘I want to specialise as a newly qualified nurse (NQN) but some say I should work on a ward first to hone my skills’ and such nonsense is heard and seen every single day in university or on social media. I feel that statements like this are dampening the dreams of student nurses for no real reason.

NEWS FLASH!

There is no reason to work on a general medicine ward first before moving on to another post if you do not want to. Yes you will develop your skills as a NQN and build your confidence during your preceptorship. BUT…the skill sets used in areas such as the community, in a GP surgery, theatres, a nursing home or in specialist areas such as critical care are very different to the skill set used on a general medicine ward. Contrary to belief, you will not ‘de-skill’ going into these areas!

So you spend a year on a general medicine ward and then move to the area you actually want to work in…and guess what? It’s like starting over again. You need to develop all the new skill sets and hone the ones you already have to your new area. Why not cut out the middle man and develop these from the beginning of your time as a NQN?

We spend a long and hard three years at university…why should we ‘settle’ for an area we know we don’t actually want to work in when we have fallen in love with an area that is right up our street? As a student nurse, or even a qualified nurse, the world is our oyster and we can apply to work in most areas now as a NQN, so if you have dreams of working in an area like critical care or a GP surgery there is nothing stopping you. There are more and more areas accepting applications from NQN now and I can only see this increasing in the future. If general medicine is your thing that’s fab, but for a lot of us working on a ward is not what we want to do and that’s fine as well. You are at work for a large portion of your week, why spend the time unhappy?

I am often criticised for wanting to go straight into critical care, I hear things like ‘it’s too specialised you’re not a good enough nurse as a NQN to work in such a specialist area’ or ‘why would you want to start in a place like that when you could spend a year on a ward first’. Working on a general ward is not for me, I’ve known this for a long time and it won’t change. Yes critical care is still a ward, but its a different kind of routine and style of nursing to general medicine wards.

Don’t be afraid to talk about where you would like to work, if someone attempts to shoot you down don’t feel like you need to explain yourself. The most important thing is finding the job that suits you and if this is in an area other than a ward, hold your head up high and know that you are making the right choice for you. Ultimately this is all that matters.

Nursing is not one size fits all and that’s the real beauty of it.

Love,

T x

The mentor that changed everything

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This post does not by any means suggest that my other mentors haven’t been amazing, because they have. I have been extremely lucky that every mentor I have worked with up to now have taught me so much and have always been fantastic to work with. There is just one mentor who changed everything for me.

Rewind back to the end of year 1, to me receiving my first placement allocation for year 2 and seeing HDU/ITU. I hadn’t been on an acute ward in my training yet and I was starting my acute experiences in one of the scariest places, A&E being another one that fills me with dread.

I spent weeks panicking (a common occurrence with me as you will know if you’ve read my other blogs 😂) and worrying that I really did not know enough to be trusted with this kind of placement. I was going from year 1, in a placement that I was actually quite confident in due to previous experience to my first acute ward. I did not have chance to visit the unit before starting placement so I walked in ‘blind’. The first thing I saw was all the machines and I must have looked terrified because one of the NQNs said ‘It’s not that scary once you get started, don’t look so terrified you will be fine!’. I met my mentor and she took me into handover. From the first moment she was welcoming and kind, I instantly warmed to her and felt a little less nervous. I picked up the handover sheet and was convinced it was in another language, I didn’t understand half of the actual handover and worried that this would happen every morning.

I started my placement with 2 weeks on HDU, so the ratio of patients is 2:1. My mentor started by showing me the crash trolley and the airway trolley. We then moved onto the bedside checks and the observation charts. By lunchtime, I was feeling confident enough to record the observations myself and my mentor was happy for me to do so. The next week passed so quickly and my mentor knew so much, the knowledge she had blew me away and I remember thinking to myself that I would never know all the things that she knew. At the end of my second week, I had 2 weeks annual leave for Easter. When I returned, I was on ITU.

I asked over and over if I was doing ok, if I was where I should be and was doing everything I should be. I was doubting myself as I always do and thought I didn’t know anything. My mentor encouraged me all the time to complete skills that she knew I could do, she had faith in me and taught me things that have since come in very handy on my other placements. The day she told me I was having my own level 2 patient in ITU, I remember thinking no, no way I’m not good enough. This is not happening I will mess this up big time. And guess what? I didn’t! I felt confident in the bedside checks and the observations, she provided me with support and encouragement and actually made me believe that I can do this. The next few days passed and I became more confident with everything, using my own initiative to complete tasks that I could do. Then my mentor said I was taking care of a level 3 patient. WHAT?! No, no thank you I do not know what to do and the ventilator scares me to death 😂 Of course I wasn’t on my own I had her supervision but I was allowed to complete tasks by myself, keep track of medication times and assess changes to care based on ABGs. She pushed me to make decisions based on my own knowledge without ever making me feel ‘belittled’ if I didn’t know anything or needed to check something.

Before this placement, I had absolutely no faith in myself at all and thought I wouldn’t make it as a nurse. This mentor completely changed my way of thinking. She showed me so much support and encouragement that it was impossible to continue doubting myself. She taught me so much and I genuinely think that if I become even half the nurse she is, I will be very lucky. She constantly made sure that I was feeling comfortable and gave me every learning opportunity, involving me in ward rounds and procedures such as intubations and tracheostomy procedures. I felt welcomed from day 1 and completely fell in love with the place, which is partly due to my mentor and the faith she had in me. The feedback she gave me made me cry and I always look back on it if I’m doubting myself and feeling low. To reiterate, I can say that I’m very lucky and all my mentors have been fantastic and I’ve learnt so much from them all, but there was something different about this woman. In 6 weeks, she took me from a nervous second year student believing she would never be a nurse – to a semi-confident (only because I’ll never be fully confident!) second year knowing that she could do this and that there was a good chance that she would qualify! I now feel slightly jealous of anyone who receives that placement in the time we have left on the course 😂

Let me know any stories you have of mentors like this!

Love,

T x

Common equipment used in critical care

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Monitor – Every patient requires a monitor which allows for continuous monitoring of observations. These include blood pressure, heart rate, respiratory rate and oxygen saturations, CO² and temperature can also be added on to the monitor.

Ventilator – A ventilator can assist patients’ with their own breathing, or completely take over the control of a patients’ breathing. This allows their body to rest and recuperate. The patient will either have an endotracheal tube or a tracheostomy. A tracheostomy tube allows the patient to receive full support whilst awake. If the patient has an endotracheal tube, they will be sedated.

Arterial line – An arterial line is inserted into an artery and this enables constant monitoring of blood pressure, through being connected to the monitor. They also allow access for frequent blood samples and ABGs. The arterial line can be inserted into the radial, brachial, femoral or pedal artery. The most common ones I saw in critical care were radial ones. The arterial line is sutured to the skin to keep it in place.

Central line – A central line is an intravenous line, inserted into one of the larger veins in the body. They are mainly used for administering medications, IV fluids are also given through central lines. Central lines are usually inserted into the jugular vein, but they can also be inserted into the femoral or subclavian veins.

endotracheal-tube-500x500Endotracheal tube – This is a plastic tube that is used during mechanical ventilation. The tube is inserted into the patient’s trachea, often the tube will be cut to a size recommended by the Dr carrying out the intubation. A bougie may be used to guide the insertion of the tube. Once inserted, the tube will be attached to the ventilator via ventilator piping. There is a cuff on these tubes that will be inflated to prevent movement of the tube, cuff pressure is checked regularly to ensure there are no leaks.

Indwelling urinary catheter – All patients within critical care will have a urinary catheter in place. This is to ensure accurate monitoring of urine output for the patients fluid balance records. Urine output will usually be recorded every hour.

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Vas Cath – A vas cath is a specialised central line that is used only for dialysis. Placed in the jugular, femoral or subclavian veins. I only saw one of these in my time on critical care and it was placed in the femoral vein.

 

Product_PicWindow_Carefeed-AdultNasogastric tube – This is a flexible tube that is inserted through the nose and down into the stomach. The NG tube can be used to provide nutrition via a ng feed and to administer certain medications. The NG tube is aspirated regularly to check if the patient is absorbing the ng feed and to test the ph level of any aspirations collected. The position of the NG tube should be checked and recorded regularly by measuring the length of the tube visible. Before using the NG tube, the guide wire should always be removed.

tracoe-twist-ref-301-tracheostomy-tubeTracheostomy tube – A small tube placed into a hole made in the neck, allowing access to the trachea. A tracheostomy is used when a patient is being weaned from ventilator support. These are temporary and will be removed when the patient no longer needs them. The inner tubes are cleaned every 4 hours.

Intravenous infusion pumps – Used for any medication that is administered through a central line. The amount of medication infused every hour is recorded on the fluid balance chart. These are the ones used in my trust, others may vary.

 

Let me know if you’ve seen any other equipment on your critical care placements!

Love,

T x

 

 

Common medications used in critical care

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I often see posts from students who have received placement allocations in critical care and are wondering what to read up on. Here are a list of the most common medications used in critical care that I hope others may find useful.

Sodium Chloride 0.9% (also known as normal saline) – every patient will usually have this on ITU, it is a source of water and electrolytes. Used for replenishing fluid and restoring/maintaining the concentrations of sodium and chloride ions.

Hartmanns fluid – used to replace body fluid and mineral salts. A mixture of sodium chloride, sodium lactate, potassium chloride and calcium chloride in water.

Propofol – sedation used in ITU for critically ill patients on ventilators. Propofol is given continuously via IV infusion.

Alfentanil – used as an opioid analgesia. Suppresses respiratory activity in patients receiving invasive ventilation. Acts within 1-2 minutes and has a short duration of action. Often used alongside sedation such as Propofol.

Noradrenaline – a vasoconstrictor used to treat hypotension. Norad is administered continuously via IV infusion into a central line.

Atracurium – a muscle relaxant used to paralyse. Dose is calculated on patients’ ideal body weight, not actual body weight. Able to be used in patients’ with hepatic or renal impairment due to the way it metabolises. Atracurium relaxes the vocal cords to allow intubation.

Vasopressin – often used as support for other vasoconstrictors, such as norad.

Ranitidine – reduces gastric acid output. Ranitidine is mainly used to stop stomach acid coming up from the stomach while the patient is under anaesthetic or sedation. It can also help to clear up infections within the stomach, when taken with antibiotics.

Remifentanil – used for sedation. Has a shorter onset duration than Alfentanil. Remi is often used overnight for patients who are not quite ready for extubation.

Digoxin – is a cardiac glycoside which increases the force of myocardial contraction and reduces conductivity within AV node. Digoxin helps make the heart beat with a more regular rhythm. Digoxin is used to treat atrial fibrillation.

Quetiapine – antipsychotic. Used for the treatment of ‘mania’ episodes.

Haloperidol – antipsychotic. Mainly used to ease agitation or restlessness in elderly patients.

Furosemide – diuretic. Used in critical care to offload a large positive fluid balance or if the patient is not passing an adequate amount of urine per hour.

Aminophylline – used to treat reversible airway obstructions.  Aminophylline is usually given via IV infusion and is used to treat the acute symptoms of asthma, bronchitis, emphysema, and other lung diseases. Will often be given to patients who become ‘wheezy’ if nebulisers do not appear to be helping. Aminophylline belongs to a group of medicines known as bronchodilators.

Clonidine – used as a sedative agent when weaning patients off stronger sedation.

Tinzaparin –  an anticoagulant used to prevent blood clots in patients with reduced mobility. As the patients in critical care are often sedated and bed bound, all patients will be administered tinzaparin or a variant of this.

Antibiotics – The common ones used are Co-Amoxiclav, Tazocin, Meropenum and Clindamycin.

Love,

T x

 

Information was collated through talking to consultants, critical care nurses and further research through the BNF.

 

 

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