Exhausted but Learning

The week before the holidays I completed my supernumerary (orientation) period and I wrapped up my induction to the National Health Service (NHS) Foundation Trust.  The foundation Trust, an important detail in the words, is a different type of NHS organization with a stronger local influence and some may say is leading to the privatization of the NHS.

During the holiday week I was christened as a solo nurse. I held my head above water but my arms were flapping the entire time. I have an impending doom feeling at work. Worried constantly I will do something wrong. Miss an important part of the process, a piece to the puzzle I cannot see right now.  Be misunderstood due to the language difference.  Or give confusing information to a patient for the same reason.  

Communication

The other day I asked a patient who had fallen off their bicycle and scraped his legs an instinctive phrase, one I have recited many times, which could have turned out to be a very awkward moment.  I handed him a gown and asked him to “get undress and please make sure to take off your pants”

“Pardon me?” he responded with shocked unsure look.

“Please get undressed including your pants,” and that is when I heard myself. “Oh, your trousers I mean, you can keep your pants on.”  My explanation of having just arrived from the US did not soften the mood. The phrases I once recited without thought I now must alter.

Medications

As I mentioned before, medications are in locked cupboards that require a code to unlock. Inside the locked cupboard is another locked box with the controlled.  The keys for the box and cupboards are held by the charge nurse but get passed around throughout the day depending on who needs them.

You prepare your own medication. I already got my first nick from an ampoule (yes that is the correct spelling or at least in the UK) bottle. Everything seems to be in ampoule bottles and I am still figuring out how to finesse them. We do not have a pharmacist to double check or prepare our medications. This week alone I prepared an insulin infusion, multiple antibiotics, and the trickiest was acetylcysteine for paracetamol (Tylenol/acetaminophen) overdose. The acetylcysteine had to be calculated based on weight. Then drawn up from 5 ampoules, pushed into an intravenous bag filled with glucose. But first I had to create the 200ml intravenous bag since there were only 250ml bag. Talk about thinking things through.

Another revelation is narcotics are given out less frequently. I have not given out more than 10mg of Morphine in the last month, and that was divided between two patients; the first with a sternum fracture after blunt chest trauma and the other for a kidney stone. The first choice for analgesic is paracetamol 1 gram intravenous, which works wonders but is not used in the US due to high markup. How is society different when narcotics are given out more conservatively? I hope to investigate further…

Critical Thinking

I was told by a fellow US nurse working in the UK that once I got here all my critical thinking skills would be pushed aside. “Nurses are more tasked oriented”…. that’s what she said. Like everything this holds some truth, but I feel I do more critical thinking here than back home. Here you do not have a computer or an electronic medical record system (EPIC) to guide your triage. You have a bare box for your chief complaint to be described in less than 500 characters. Your knowledge base must be solid to differentiate a cardiac chest pain versus pulmonary emboli. Choosing those 500 characters carefully, remembering the PQRST of pain assessment.  And you triage based on Manchester Triage System (MTS), which I am still learning, but also on your clinical knowledge. And as many fellow nurses know, not every chest pain is Emergency Severity Index (ESI) level 2.

Even with newness and overwhelming feelings I am still happy to be practicing nursing in the UK. Colleagues often ask me why I came to the UK which is not a straight forward answer but one I will elaborate on another occasion. But one of the key reasons is to care for the patient without the worry about the cost to them. Healthcare here is a human right, one that is given to all. I have had more than one person reply to this sentiment by saying “yes, it is nice to see at least some of your tax money coming back at you.”

I no longer have an anxious patient worried about their co-payment or deductible. Or the asthmatic patient who “bounced back” to the ED because they could not afford the prednisone, and now is in worse condition. Those stressors are no longer existent.

Colleagues

At least ten different countries represent the nursing pool in the A&E including Philippines, South Africa, Australia, Ireland, India, and Burma to name a few. We all choose nursing not for the high pay, nonexistent here, but for the desire to help people heal. We all come with different training and experience and we united to help those in need, a melting pot of nursing. Some with strong community ties bring food for each other and I often walk into the break room with a curry based picnic of sort.

The Hill

I wake up nearly every morning tired and sore from being on my feet for twelve hours, climb on my bike in the bitter cold, wearing five layers to stay warm. I bicycle up the steep hill towards the hospital. Some days I am defeated by gravity early. Others I inch a little further up the hill before I jump off to prevent toppling over.  Slowly I push my bike the rest of the way. I know someday I will glide up the hill as though it were second nature. Until then I will keep peddling a bit further every day. The same goes for nursing. I have a steep learning curve and I know someday it will be instinctive to be a nurse in the UK. Until then I will keep learning and growing as nurse as I care for those in need.