This picture is actually a lie - personal stethoscopes are a no-no on this unit, so mine is gathering dust on my desk :-(
If hospital stuff bores you, click on through to the other side.
One of the biggest questions - and reasonably so - before I started here was: how exactly do the scopes of practice break down? I knew certain things, like the fact that nurses managed all the respiratory equipment in the absence of RTs, or that, this being a teaching hospital, there would be MDs at varying levels that roughly corresponded to the resident/fellow/attending arrangement I was familiar with. Nearly everything else, though, I was clueless about - who starts IVs? Who makes judgment calls about what? Do nurses have more autonomy, or less? I'd had hearsay leading my expectations in just about every possible direction, and, while nervous about starting work in this fog of uncertainty, was looking forward to at least figuring out some answers to my questions.
Now, to be fair, I've only got two shifts under my belt at this point, but so far, I'm barely clearer than I was a week ago. The odd thing is, I'm not sure there are any hard-and-fast rules. Placing IVs, for instance, is nominally a medical task, as are venipunctures and arterial sticks. However, there was a flyer in the break room inviting nurses who'd performed these tasks to some sort of class, or event, or something, where - as far as I could tell - they'd be able to get some sort of certification in these skills. I know that there's a similar scheme in place at UCLA for nurses who are interested in, say, learning to place PICCs, but this somehow seemed different. Maybe it had to do with the apparent blurring of the medical/nursing boundary, or maybe it was because this seemed sort of ex post facto - "you've done it before, therefore you must be capable of doing it, therefore we will certify your capability."
It could be, though, that things are just done with a degree less formality 'round these parts. The NMC's requirements for continuing education follow a similarly relaxed (to my mind) pattern: instead of keeping a bunch of certificates recording your attendance at n hours of classtime, you create your own "portfolio" of learning experiences you've had and how they'll contribute to your practice. It can be as informal as spending an hour talking to someone with expertise on a topic related to your field - basically, if you can prove it should count, it counts.
Hopefully I'll be gaining better, or at least more, insight into the whole thing before long. At any rate, enough blathering about abstracts. What's the work actually like?
Well, as you could probably glean from my previous post, I'm just starting to realize exactly how spoiled I was at UCLA. Say what you will about private insurance and healthcare costs in the US (and you'd almost certainly be right, too, don't misunderstand me), but it absolutely made for a cushy working environment as far as supplies, equipment, etc. are concerned. Add to that a brand-new building and the muscle of the CNA to back me up, and yeah - it wasn't too shabby. Not that this is third-world nursing by a long shot; things are just a smidge thinner all around over here.
However, any material lack is more than made up for by the attitude of the staff I've met so far. The old "keep calm and carry on" slogan has been beaten to death at this point, but it really does sum up the English mindset so very, very well. They make do, and do it cheerfully. I actually found myself working alongside the matron herself - the manager of the entire unit - when another nurse had to go home sick the other day. And not only did she chip in, and do it with a smile, but she found time to help me here and there when I needed it. She made us tea, for crying out loud. In between beeps, nappies, and feedings, we took three minutes and had our cuppa. And it was brilliant. If I can learn to find the joy in small, simple pleasures like that, I will be a better person for it. And it will certainly save my sanity to some extent, given how pedal-to-the-metal the job is the rest of the time.
So, in summary, I've been lying low and recuperating for the past couple of days. One more day off tomorrow, which I will spend picking up my rental bike (yay!) and then attempting to not be killed by cars, trucks, or other cyclists (not so yay!). I have already developed a love/hate relationship with the buses around here, so am looking forward to being a-wheel again. Anticipate more pretty pictures coming soon!
Morning outside my window. This room isn't all bad.
