Friday, 15 June 2018

First few weeks in paediatric A&E!

I'm coming to the end of my second week in paeds A&E now and I'm really enjoying it. One of my favourite things about the placement is that I'm learning a lot every shift. A nurse commented to me the other day that I seem like I've taken to it like a duck to water, and I hadn't really realised until she said it, but I feel like I'm starting to get to grips with this placement fairly quickly. I think a big part of that is that it's quite easy to be independent, which has been great, and I think it's a great placement to become more confident in my skills, so I'm glad I got it as my sign-off.

I managed to organise planning and carrying out my snapshot assessment within the first week, so I'm already getting through my portfolio stuff, too. I've actually found it slower and stranger to adapt to having time off between shifts without actually having to study for exams or write my dissertation or essays than I have actually being back on placement, and slowly I'm picking up hobbies again. What things did I like to do for enjoyment before I started this course?! Feel like it was so long ago! I've started reading again which is great, and I like the fact I'm slowly getting my life back (but it's a been a real time management act trying to fit in seeing and doing things with my boyfriend who works Mon-Fri and I have loads of weekends on this rota!).

I've had some interesting experiences already, one of which was spending a few hours in Adult Resus (where the unstable / most sick adult patients in the emergency department go to). I was able to observe the care of an older gentleman who had had a subarachnoid haemorrhage (bleed on the brain - a stroke) which was leading to brain herniation (commonly called 'coning'). This is when the bleeding causes pressure on the brain, and the build up of pressure forces the brain through the small gap at the bottom of the skull where it meets the spinal cord. This meant that his heart rate and respiratory rate was becoming slower and his airway became unsafe. I was able to see the team intubate him and get him ready for transfer to a hospital that would be able to potentially carry out neurosurgery on him, which was interesting to see, especially how it's different to when critically ill children get retrieved. The experience that stood out for me most however, was the opportunity to witness the sharing of bad news with the family - something I've not seen in my three years of training, but I'm really grateful I was able to be a part of. The breaking of bad news, (which is usually more of a process rather than a one-time thing, especially as family members often need information told to them over a period of time rather than all at once), is an area I really want to look into more, but it was really valuable to witness it done in a way that I think was really good, as far as the adjective 'good' can be used to describe something like that.

Tuesday, 5 June 2018

Nearing the end...

I can't believe I've made it to this point in the course. Last week I submitted my dissertation (77 pages!) and tomorrow I start my last ever 12 week placement in paediatric A&E. It's funny to think that when I started this course I wanted to be an A&E nurse and really wanted a placement on A&E, and it's taken me until my last ever placement to experience it (and a first job lined up in PICU instead).

Just 12 weeks left. I'm a little more nervous for this placement than previous ones for some reason - probably knowing this is the placement where I've actually got to be a nurse (an actual nurse - not a student for much longer!) more than any other, my last opportunity to be properly supernumerary and take advantage of the opportunities that offers me. I know I'll be fine after I've settled in for a few weeks, but this is really it. This degree has been the most difficult thing I've ever done and to see a light at the end of the tunnel is exciting and very strange. 

I've been thinking over all the placements I've had, and how I've changed through this course. In first year I had the children's ward, a special needs school and health visiting. In second year I had brain injury rehabilitation, NICU/special care baby unit and a children's assessment unit. And this year I've had community children's nursing and the children's ward again. It's odd to think I didn't enjoy ward nursing much in my first year in my first ever placement, and actually really enjoyed it when I went back there as a third year. The difference in how I felt was huge - like I kind of knew what I was doing, had so much more confidence with medications, with how a hospital works (although they're still confusing places sometimes!), and, importantly, like I was an actual, proper part of the nursing team. It's easy as a student to feel out of your depth and like you don't really belong, getting in the way all the time, but I've had some really great placements where I've felt really included and it's improved the experience and my own learning and confidence so much.

Really hoping I'm going to enjoy A&E, and will check in soon!