It does make it confusing for me at times sorting out who is coming and going but it is beginning to make sense. The nurses have the same issues with the hematologists not letting go. it seems it is world wide problem!
Palliative care is often consulted for pain management and does see pats. I am still sorting out how this works.

So I started with hospital orientation Feb.26 you know-fire safety-infection control-vision-strategy etc. Pretty generic stuff but a good overview. Nursing orientation was a day long then I went to the unit. A day with the nurse specialist Wendy who is lovely and keen to do things for a reason and not just beacuse that is how it is always done.Since then I have been buddied with a senior nurse Mon-Fri and mostly days (0645-groan to 1515) and a couple of afternoons (1430-1100). I won't have to do nights (1030-0700) for a few months. The shifts are 8.5 hours, full time is 40 hours, not 37.5. The overlap makes for a smoother handover (report) because someone is always on the unit while the next shift is checking charts and meds. There are hospital uniforms of shortsleeved blue tops and navy blue shorts, pants or skirt. The head nurse is called Charge nurse and wears a white top instead of blue. The BMTU also has the option of scrubs which most of us wear. ( therefore need to be there earlier to allow time to change- not so good for me who likes to hug the pillow as long as possible!!)

So I get up at 5:45 have breakfast, dress and walk~20 minutes to the hospital. Change, listen to handover while drinking tea provided by the hospital. Then out to review charts after patients assigned. There are usually 5 nurses at least on days, 4 on afternoons and 2 on nights. The charts are divided in two. One is like the med kardex and holds the vital sign sheets, med kardex which the doctors write the orders directly on-so there is no transcription at all. All the iv fluids, blood products and meds are "charted" (ordered) on these sheets which fold over.Some patients have up to four sheets. When the spaces are filled up on one page the DOCTORS have to rewrite the whole thing. This is usually done by the house surgeon (our old intern and not a surgeon at all !) We also have a registrar (resident) and consultant ( staffman) assigned to the unit all the time. There are 5 consultants who rotate to various parts of the service on a monthly basis (sounds familiar). Diagnostic tests aren't actually written as orders-the md just fills out the requisition and faxes it himself and files the req on the chart. The doctors are much more self sufficient here. I was actually discouraged from bringing the iv cart to a patients room so they would be used to getting it themselves even thoiugh I was going right there!

Early mornings are busy with Bloods to be taken form hickman lines (all pts undergoing chemo / transplants have these put in), they have to be flushed, all lines changed, Then check blood reports on computer to know who will need platlets or blood products thatt day and get those ordered and running. Everything is run on a pump but I had to learn how to calculate drops in the iv test I did. I always seem to make the pump alarm at least once an hour!!. One poor fellow had a pump for fluids, one for TPN (severe stomatitis), a morphine pump (the syringes are mixed by pharmacy and kept in narcotics cupboard) like a syringe driver but larger and locks so it has to be unlocked to change the rate, also a similar syringe driver but not lockable for his immunosupressant. The nice thing about the Hickman of course is that it can all be disconnected when necessary.

I am getting comfortable with the flushing and management of theses lines but it is nerve wracking at times to keep it straight the order you do things. We do have Graseby's here as well but apparently they have to be taken out of service by the end of the year because they don't meet some standard which I think has to do with them not being lockable. I am not sure if this is the case in Canada as well.

I am not sure what happens at home on the unit but here we double check and sign every IV fluid, blood product, IV medication and oral narcotics, ativan and potassium. But we don't have to double sign Blood group and Cross stuff!! that may come though because I heard today that the Blood service had to request 480 repeat samples last year because of improper labeling.

So that is a start. I'll follow up with a few more lines on the weekend.

written by  RTW2009 on March 25, 2009 from Christchurch, New Zealand
from the travel blog: RTW/2009
Send a Compliment

---

Hi

I read this one a couple of weeks ago....

something exciting must of happened since.

Glenna - I don't understand half of what you said but it sure sounds like you save a lot of lives - literally and figuratively

It is finally (hold breath) getting a bit warmer here. Snow is forecast in Toronto for next week. Calgary has had 4 snowstorms over the past week.

looks like I have a job until December - Christmas present.

Hope all is well with you two

keep us posted

xoxoxo
eldest sister

written by  Patricia Smith on April 2, 2009

comment on this...