Thought for the day :"Someone took my step ladder yesterday. Please bring it back, or further steps will be taken."
and so the clocks changed yesterday..
Mine to a quarter to eleven..
or
And so a short Welsh Lesson - The Araf (endangered species)
And with regard to Supermarket sales ... seems there are different interpretations of what is allowable..
Just another mixed message really..
And with mixed messages in mind ... I saw this and have copied in full...
A sobering post for a Sunday - From July 2020.. not seen an update
My name is Chelsea and I’m a ITU Nurse.
I’m also a newly qualified nurse - I literally left Uni last year and began my job in the September.
My background - I didn’t always want to be a nurse. I wasn’t cut out for that sort of compassion or care. I dreamt of being a PT, an athlete, anything that was sports driven.
Until my boyfriend had a bike accident, that then left him in ITU. He later succumb to his injuries and passed away. The nurses looking after him, changed my life. Shining light kind of moment - I want to be just like them kind of thing.
Granted it took me 4 years to build up the courage, battling my PTSD, severe depression and anxiety to even apply to uni. But I did it - and Sept 2019 I got my Pin as a registered nurse.
Now, if you
1) think covid19 was made up, a conspiracy or the numbers have been made up as a scare tactic or
2) you actually believe wearing a face covering will cause ‘respiratory arrests’ ‘acidosis’ blah... stop reading. Because this isn’t for you. Or even
3) you have the view of ‘its their job’ - back away from your screen.
You’ve seen in the news about the public sector pay rise? That nurses aren’t included, nor the junior doctors, physio’s etc (I use etc as there are so many people being forgotten in all this and it is used lovingly and not to cause offence)? Honestly, I'm so glad that others are being recognised for their input and help during this - the teachers who put in extra work for children of key workers, who sacrificed their home life to entertain little ones every day and try give them the education they need and deserve, to the police, military - anyone receiving this recognition. Honestly you deserve it. And the NHS will not shadow that or take it away from you.
We agree’d to a 3 year pay deal, that had the options of being reconsidered earlier than the final date if there was a change in circumstances. Covid19 should really be considered as a change in circumstances. I mean being told that you’re already ‘unskilled’ and watching people clap to STOP pay rises... was hard enough. But to have everyone else recognised for their vital contributions and lay something that was agreed in 2018 - is inexcusable.
You realise that most nurses didn’t get to see your claps on a Thursday? That’s handover time. And due to covid19 if their handover time was earlier - they were usually late because of how busy it was and still missed it.
I saw one. Because it so happened I had come off of nights the night prior.
So! My life during covid19 starts off with the busiest winter that my hospital has seen in ITU. We have 10 beds. We are funded for 7/8? We had to open an escalation centre that we stole from our day surgery unit to give us a further 3 beds.
Which in itself is hard - looking after seriously sick patients away from your actual designated and designed ward and without the continuous presence of doctors.
That wasn’t enough.
We had to then stole half of the recovery room, which usually houses patients post surgery whilst they wake up.
Going up to 16 patients. Remember - at this point. I’m THREE MONTHS qualified.
Learning is hard, steep, and in-depth. You’re suppose to be trained over the course of a year as a newly qualified, with study days and help from mentors etc. I couldn’t attend some of those days because we didn’t have the staff to look after the most patients our ITU had ever seen.
Now I know ITU is hard. I picked it.
I knew what it entailed, well partly.
I have to maintain my patients artificial airway. They either have a tube in their mouth or in their throat.
They’re then connected to a ventilator.
Every single setting on that machine, every button - changes something drastically.
From the fio2, PEEP, PS, PC, TV, MVE, PEAK, RR, PF ratio, ... one button, one alteration or mistake... literally can stop this person breathing. Cause respiratory distress, arrest.. trauma? anything.
Did you know I have to move that tube in their mouth every hour to stop pressure sores developing in their mouth? And I still have to brush their teeth and give oral care?
I have to suction down their throat and clear their lungs? Or suction their actual mouth for extra secretions?
And record all this data hourly.
To ensure that this patient is comfortable with this tube... I have to medicate this patient.
I have to keep them in an artificial coma.
Titrating the drugs to their optimum levels.
Some are measured mg/hr, mcg/hr, mcg/kg/min..
some have limits on maximum dose per hour you can use.
Some have really severe side effects.
Such as noradrenaline. Which can literally cause your fingers and toes to become necrotic.
I have to monitor someone’s glucose - whether you’re diabetic or not, and correct it if needed with insulin or dextrose.
I have to give diuretics but not allow your body to become too negative, I have to give fluid challenges to ensure you’re not vascular depleted.
I can help your kidneys with the use of a dialysis machine. Literally filter your blood of toxins your body can no longer remove without help of a machine. This requires constant blood tests to ensure that you aren’t collecting dangerous toxins or you need additional support from the machine.
I can use a machine to check your cardiac output and interpret it to make sure that you have enough fluid vs a drug that’ll help squeeze your heart instead.
I can read an ECG and tell if you need additional supplements such as potassium. Do further tests for magnesium, phosphates etc. And deliver those.
I can feed you through a tube down your nose, and ensure you absorb it. But it’s okay I can give you medication to also help that - these require me to do daily ECGs though, and interpret the data of your QTC to make sure it’s not affecting your heart.
Now. If that’s not enough. Covid happens.
Now remember our record was 16 patients?
Try doubling that.
We worked in our ITU,
Escalation centre
Recovery - we took the whole thing.
Next - we took over operating theatres.
3 patients in theatre 6
3 in 5
3 in 4
2 in 3
We stole theatre staff, recovery nurses, ODPS, ward nurses, retired nurses, health visitor nurses, anyone we could relocate to help us.
March - I’m 6 months qualified.
I’m now the most qualified ITU nurse in my theatre.
I have people who have never looked after a ventilated patients before asking me for help. Please don’t silence my alarm if you don’t know why it’s alarming. I know it’s loud and annoying but it’s telling me everything I need to know with enough time before I need to panic.
Now - covid patients weren’t just sick. Weren’t just needing help to breathe. These patients were all sorts of ‘new’. Nothing made sense!
These patients COULDNT be ventilated. We needed to paralyse them to literally be able to take over their breathing properly! No amount of sedation worked! Their lungs were fibrous and acting like elastic under tension.
Side note - if your patient wasn’t sedated enough compared to paralysis - they could be silently awake, but completely paralysed. Knowing everything happening to them. But unable to do anything - not even breathe. Every time you start rocuronium you need to remember that. If you’re withdrawing treatment - TURN THE ROC OFF FIRST. And wait before you do anything else.
Back to it. They were so unstable that you try roll them, which we usually do 4 hourly to prevent pressure sores - they desaturated to numbers so low that you would usually see some hypoxia brain injury after.
We couldn’t roll these patients without risking that. So you know what. You don’t roll.
So we couldn’t protect their skin integrity. You just watch them, and feel guilty.
Nursing school 101 - pressure sores are PREVENTABLE. Roll your patient. Skin care and hygiene is your best friend.
Now covid went against everything a nurse knows and holds dear.
Our ITU never had pressure sores. Until covid. Some had grade 4’s.
Maggot therapy.
Vacuum dressings.
These patients were also clotting, and sending off clots to their kidneys, liver, heart, brain. Covid made your blood super sticky!!!!
People were having strokes whilst being sedated, going from fit to multi organ failure in days. I’m trying to save these people, knowing they could possibly wake up with complete left side paralysis? Never talk again? Never be them again?
Now you know about these past medical histories etc?
You realise what that is?
that it could be Type 2 diabetes?
Hypertension?
That was it for some.
None of this thinking they were super sick, with lists longer than my arm, and that’s why they didn’t make it. No.
Literally things that happen with age. Poor diet? That 120/80 you’re happy you got - THATS PREHYPERTENSION.
I was probably hypertensive the entire time with anxiety.
Did you know We had to use the old anaesthetic ventilators. None of us had used those before. Those big bellows you see in films going up and down rhythmically. Those.
That was scary.
I’m use to a single touch screen button (hello modern technology) to deliver 100% o2 if my patient needs it. This has a switch to a bag, a button, dials to titrate o2 with normal air. And if I didn’t monitor the crystals in the bottom my patient would retain their own co2 and I wouldn’t know why.
New found love for anaesthetists and ODPS - these machines are NOT designed for prolonged use. But they helped us keep our patients alive. By literally guiding us and helping us look after the machines so we could do our job.
Now. All of this is made worse by PPE.
I’m hot.
It’s hot.
And intense and I’m working hard because tonight, I have 3 ventilated patients. By myself.
I have a gown on.
2 sets of gloves
An apron
An FFP3 mask
A hat
A visor
And no air con.
But I’ve got this. I can’t do my hourly checks because I am one person.
My super sick patients now have 2 hourly because it is physically impossible.
Where are the other staff?
Sick.
You’re watching these people struggle to breathe on machines and then being told your close friends at work, your mentors, your seniors are spiking temperatures. Some being admitted to hospital. Some not being able to come back to work for weeks.
Some ending up on your ventilators. It’s okay. I’ve got this.
I’m an ITU nurse right?
CPR wearing that get up. Is TOUGH. 27mins. I cried that day.
We lost 3 patients in 12 hours.
I held the hand of so many people as I turned off their ventilators because their families couldn’t be with them and no one should die alone. No one. I tried my best.. and then once my day had finished, I had to come home to my dad who is immunosuppressed. Who doesn’t understand boundaries. “Kevin stay in the other part of the house!”
*knocks on bedroom door with dinner*.
Proning. What an experience that is. And doing it Daily. The complications of that were scary before you even approach the patient.
So I’m going to flip my patient - who has a tube down their mouth to help breath, who is on medication for sedation, paralysis, to keep their blood pressure up.. from laying on their back - to laying on their front.
Seems easy?
Well it’s not. And requires like 8 people.
8 people.
We don’t have enough people as it is. So we now develop a proning team made up of everyone.
There are consultants, there are experts in their fields, there are physios and then I don’t know who else.
Honestly I couldn’t thank these people enough. More people would have died if we didn’t have a proning team. But now, people spent 23 hours laying on their front. Pressure sores on their faces. Potential of going blind? New complications of not being able to breathe we never expected.
We are finally back into one unit now. I’m still less than a year qualified. And I’m still running on adrenaline expecting this second wave. Those still reading, I know you’re thinking that she picked this job.
She knew what it meant.
And you’re right! Give me those complex drug calculations and ventilators. Oh and the scrubs!
But a pandemic? I didn’t pick that. The world didn’t pick that.
Honestly thank you, to the ward nurses - your lives got flipped upside down.
The physios who became best friends.
Consultants who literally got down and dirty with us.
To the domestics who cleaned furiously for us.
OT’s To literally orientate our patients when they’re waking up like 70 days later.
Every
Single
Person
Who
Helped.
Oh communication team made up of medical students, who updated the families because... I couldn’t. I couldn’t leave my patient. Not like this!
Matron who literally had to facilitate all this, with people who knew nothing about ITU. Being in ITU. Looking after ITU patients. Whilst her own ITU staff were sick, in hospital, or newly qualified, or working to the point they broke.
To the countless companies sending food, goodies, moral support !! Oh my god that was incredible to come to after not having a break for 6+ hours ... mmm... food!!
Did you know they’re offering support for the nurses to stop PTSD, or anxiety or just to help up digest what we saw? Psychological support for just doing your job?
But it’s okay.
We got a deal in 2018 for the pay.
We got clapped thursdays.
We all know that’s not enough, but we will still turn up for work.
We can’t leave our patients.
We can’t strike.
They’ll always mean more to us than pay. And the government knows that. Abuses that.
540 NHS staff lost their life doing ‘just their job’ - today the NHS staff walked through London protesting, to be heard. To be listened to. To be acknowledged. To be paid fair.
Sign the petition for us. Because we aren’t just here for covid. We’re here for life.
And just put your mask on - please - for that hour you go shopping.
I’ve been wearing mine since March 6th. 13+ hour days. Developed a nice grade one on my nose, my friends faces bleeding from using a rubber respirator....
And We’ll be like this for the foreseeable future.
Now that we have the stocks to do so anyways.
Oh and I’m pissed my graduation was cancelled! All that and I don’t get to wear the hat and gown. Bastard virus. (I understand there was more lost but humour me).
Signed, your registered ITU nurse. We will always continue to monitor.
a long read but...
In Ffynnon News.. finished another wall after the last Llanelli Run - had a few more instruments to sort out, so filled a few patches ......
Raining this morning - clearing the ducks and Susie had to bring my waterproofs down .. Now it is sunny and I am tempted to go and look at some concreting - but maybe tomorrow is another day...
Maybe I should procrastinate ..
Cheers!
No comments:
Post a Comment