These are all the nursing-related things I've been loving in January :)
1. EKG/ECG book by Dr. Russell - So easy to read and understand when rhythms are not my best or favourite area.
2. Greatest Showman soundtrack - This is the greatest soundtrack, all the songs are amazing, and make me feel so motivated for the world. If you need a little inspiration, This Is Me...!
3. Weak Nails Cream - I found this in superdrug, hunting for something to help my nails that crack and split all the time at work. When I have annual leave, my nails grow so much and are so strong, and then bam, work. I've been using this every night and really like it.
4. Sleepy - I got this for Christmas in my stocking, and using it for sleeping before nights, coincidence or real, but I have slept before my first night every time I've used it (which is not normal), could be psychological but I approve.
5. Yogurt Rice Cakes - As I'm attempting to reduce my chocolate intake, I've been finding new snacks, and found these. So yummy. And actually, the yogurt coating tastes like white chocolate. Winner.
6. Multi-coloured pen - My ultimate fav. I love a multi-coloured pen for work, and being Cath Kidston? Just the best. We need black, blue, red and green for our charting, but I like to use the others for my shift planner to make it pretty.
Anything you've been loving this month?
Every shift you need to write an account of all the things you've done to your patient, or what your patient has done to you. It is your log and proof of your shift. If anything ever goes to court, your notes will be pulled up, so you gotta make them good. Protect that pin always. How I wrote my notes on the wards were very different to how I write my notes now on PIC, and that's what I'm going to go through today. If you a student nurse, your mentor may start to suggest you practice writing notes, and get the feel of what you'd like to write. I always encourage my students to read through different peoples notes, see what they think is better or worse, and then compile their own.
Firstly, I start with saying I've done my safety checks, my patient assessment and that they are nursed in a safe environment, this means, cot sides are up on the bed, all lines are secure and have a name band.
Airway: What's your airway doing? Is it patent, have an EndoTracheal (ET) tube in, or a tracheostomy? What size, if it's cuffed with water or air. What kind of tapes have they got, red elastoplast, neonatal or adult fixations, or for a tracheostomy, velcro or tie tapes.
Breathing: Are they breathing by themselves, or have help, and I go through any settings for the ventilator, oscillator, airvo, humidified etc. Chest sounds on auscultation? How much oxygen they're in, if we weaned anything on my shift, or maybe they've been extubated. Discuss any work of breathing, secretions, saturations, respiratory rate, chest x-rays or swaps sent. Have we moved the ET tube, or just redone the tapes. Blood gases?
Cardiovascular: Warm, well perfused, pink or blue? Capillary refill time both centrally and peripherally. How their heart rate, blood pressure (is that arterial or non-invasive?), central venous pressure (CVP) and temperature is hanging out. Are we cooling or warming, core temperature and skin temperature too. Chest open, or chest closed (if cardiac post-op), what inotropes are they on, have we weaned these today, or gone up. Everything to do with chest drains, work out mls/kg/hr for your shift for the fluid lost, is it on suction and what colour? Have we given any volume or blood products, and for what reason. If the patient is being paced, discuss the pacing settings, the wires and any plans.
Neurological: Pupils equal and reactive to light (PEARL), and what size they are, or have been in the shift. Glasgow coma scale (GCS), sedation and comfort scores. What pain relief/sedatives are they on, I discuss if we've changed any of these during my shift, and any extra pain relief we've given, and why. Have they been settled, slept or agitated and awake? Specific neuro-monitoring, if they have a bolt in, ICP, CPP, CFAM, given hypertonic saline? Have they had any seizures, if so, what are they like, how did they stop.
Fluid: Allowance they're allowed, and how are they receiving it - feed, (via NG, NJ, PEG), IV fluids or parenteral nutrition (PN). What are the lengths of any tubes in situ, aspirates (colour, pH, anything odd). Vomits or nausea. Urinary catheter or nappies, work out mls/kg/hr for shift for the urine output always. What is our overall balance, and aim? Given any diuretics, are they oedematous? Bowels opened, stool amount and laxatives. If they are being filtered and settings.
Other: Have any medications been omitted, and why? What access have we got, lost or gained any in the shift, and any extravasations. If a line is stiff or blanching and you've told the medic and they are happy to continue, write this; cover yourself. Any wounds or pressure sores noticed. Have the family visited, been appropriate and attending to cares? If not, have you called them and updated them. Social issues, or other professionals been today. And if they've been weighed or heighted.
This is just how I've figured out to do mine, I'm sure it'll change and I'm sure I've missed some things. If you have anything you add to yours, let me know, I'd love to be better! I keep a flashcard of this on me at work so I can flip through when I'm writing them. Those 5am note sessions would be rubbish without it.
Whether you are buying a present for yourself, a friend, a new shiny nurse, or one who has been through the lot, these are some of the essential (and cute) gifts you can find!
Badge reels are a must! They make your ID badge look so much cuter, I'm a big fan. These are from a shop on etsy, and where I have got mine from but there are a few different ones around and loads on eBay too.
These ridiculously cute names badges are from Catherine's Creations, based in New Zealand, the are about £9 a badge plus postage so can be quite pricey. I looked at them constantly during nursing school but couldn't justify buying a badge for that amount. Once I qualified, and I got my first pay check I decided to treat myself to one and I still wear it everyday now! Getting tempted to buy a few more ☺️
Notebooks are so useful for any nursing student (or nurse), to jot down any condition or medication they haven't heard of, or to write down any procedure they've witnessed to remember how to do it next time. I had so many scruffy notebooks during nursing school, I love looking back over them to see what I learnt in different placement. I have one now because nursing is a always learning job and I see things I've never seen before on a weekly basis. The first 3 notebooks are from Paperchase, and the 4th is from Lisa Angel.
Doesn't need explaining much, nursing is such a demanding job, constantly walking around the unit or wards, or around the hospital that you definitely need a decent water bottle. I love the camelbak and that's what I'm using at the moment in a 1litre style. All the ones shown come in loads of different colours too. The last one has been popping up around our unit a lot recently, it's a 2litre bottle!
I am a bit of a snacked eater rather than big meals at work, so I am always on the hunt for cute lunch boxes. I love that these have 4 different sizes, all match and can be tucked away within each other once I'm done. When you're working 13 hours, you need to bring a lot of food! All these shown are from Paperchase.
Fob Watch & Hand Cream
You cannot go to shift without your fob watch! I have done it before when I've left mine at home or I'm a different bag and it's super annoying. I have since brought a few cheap silicone ones from eBay that I keep in bag for extras too. Some hospitals only allow the silicone ones, others don't have any rule as long as they can be cleaned with a clinel wipe.
When I first started out at nursing school, I didn't really take much notice in keeping my hands hydrated and looked after, a bad mistake! Using the hand gels and constantly washing your hands can really damage your sling and nails. I found that my nails would split lengthways leaving them so so weak and thin. I love the baseline healthy hands and stronger nails moisturiser, really affordable and smells amazing. I try to remind myself to use it when I go on breaks and after work. A lot of my colleagues really rave about the Body Shop he,p hand cream too!
Stethescope & Socks
Having a stethoscope isn't a necessity from my experiences but it is useful and cute. On ICU we use stethoscopes multiple times a shift but plain black ones are provided for each bedspace.
I've recently started to wear compression socks to work because my ankles have become so swollen after a long day, I'm not totally convinced by them yet but so many nurses swear by them.
These are a few cute gifts I've seen around and screenshot for those horrible shifts where I want to treat myself ☺️. The poop mug is a classic, Bristol Stool Chart is very important to remember, why not have it on a mug! The last one is so so cute! Personalised stickers to give out to your patients, I found these and going to order some straight away. Probably more geared towards paediatrics, although if I was in hospital, I would definitely appreciate one.
I hope these gave you a few ideas for any nursing people you have in your life. Or medical people in general! If you have any other vital nursing gifts, leave me a comment.
Studying takes up such a large part of nursing school, and still takes up a large part of my life now as a qualified as I try my hardest to soak in all the knowledge around me. Along the journey I've been on I've found things that work the best for me, hopefully they might be useful for you as well...
I love looking at those self care tips articles on Pinterest and tumblr, learning how to do things a bit better. But I hate when they say to go to sleep and wake up at the same time everyday. I get that yeah maybe it's good for you, but what about the shift workers of the world?
Here I've got my routine for day time sleeping and some simple tips to make the whole process nicer.
The night before my shifts start I try and stay awake as late as possible. I'm rubbish at this because I'm such an early going to bed person, but I try! And normally make it to just about midnight. I then sleep in as late as possible, normally 9 or 10. I get up and out of bed and do a few simple things. I like to take the dog for a walk around the block, tidy the bedroom, iron my uniform, get snacks ready for the shift and watch a few vlogs. I make sure my bag is all packed and my uniform is on the radiator. Around midday I have a shower, wash and moisturise my face and get into clean pyjamas. Get into bed at 1pm, maybe put on an episode of a show or read my book and then turn everything off by 2pm to try and sleep. Sometimes it's hard and my brain won't switch off, but sometimes I'm able to get an hour or so nap in. Either way I stay in bed until half 5 so I hope it helps to preserve some energy.
When I get back from a night shift, and I'm working again that night, it's all a bit easier because I am normally exhausted! I get home, jump in the shower and get into bed, literally the best feeling ever. I try and read or play on my phone but I'm asleep within minutes. I wake up quite a lot but I can get back to sleep if I have my eye mask on and don't pick up my phone!!
Other helpful tips I've found work for me...
Having a hot water bottle: Me and my other half are opposites when it comes to warmth in bed, I love to be warm and cosy with fluffy blankets around me, and he likes coldness. You just gotta work with what you love, but for me, you can’t beat putting a hot water bottle into your bed.
Tidying up around the house: I feel so much more relaxed for a nap if I know my room/ house is put away. I plan for a quick tidy up every morning of my first night shift for this reason.
Calming noise: I've tried using a white noise app to help me drift off for a nap, sometimes this works, and even if I struggle to sleep, I quite enjoy the noise, and feel like my body is calming down a bit.
Diffusers: This is the same for the oil diffuser we have in our bedroom. I put it on most days I'm trying to sleep and really enjoy it. I regularly use lavender and rose.
Hot chocolate: Or your warm drink of choice, being a chocoholic I love hot chocolate. On those winter mornings when I finish, I'll get into bed all ready to sleep and drink my hot chocolate reading my book. Kinda perfect to go off to sleep.
Black out room: We invested in blackout curtains because before the room was so light during the day! It was ridiculous. It is a dream with blackout curtains, you can crawl into bed and not see anything around you, it feels just like night time. I go a step further and wear my eye mask as well, just for added darkness. Definitely recommend.
If you have any tips that help you sleep during the day, share them below, I love finding new ways to make night shift nursing easier.
05.55: Alarm goes off
06.30: On my way in on the bus
07.15: Get to the staff room and sort out all my equipment and things that come to my bedspace with me. Eat my breakfast bar, find out my allocation and chat to my colleagues.
07.30: Out we all go to our bedspaces and get handover from the night team
08.00: Night nurse for our patient gets to go home and I complete my safety checks before anything else - you never know when something is about to go off. Never trust the cute little children! I introduce myself to my family for the day if they're there and do my 8am charting.
08.15: Make my full plan for the day, when all my drugs are due, if any of my infusions are going to expire/run out on my shift, when cares are due etc.
08.30: Complete my full nursing assessment top to toe and everything in between. As I strip down my patient to look for work of breathing, listen to their chest and bowels and check for any markings, I do all my cares as well. Change their nappy, clean their faces and change my probes around. Check my ET tube for water build up, zero my arterial and central venous pressure lines and do a blood gas (paired if a cardiac patient); just so I know what I'm working with from the start of my shift. Make sure all my cannulas are patent and my catheter is fixed well. When I'm finished messing around with my patient, I try to use blankets and toys from home to make them look cute and presentable for when their parents/family turns up.
09.00: Back to charting and checking for the 6am blood results.
09.30: Morning ward round comes to the bedspace and creates a plan for the day, extubation, theatre, changing oxygen therapy, weaning ventilation or having a chilled day of staying as we are.
10.00: Fit in a breakfast break
*For now, I just continue to do my hourly charting, give all my IV (and sometimes NG/NJ) drugs, checking how to make them up, what the dosage is, where they are allowed to be given, over how long and be diluted into how much etc. And try to draw up any infusions that are due on my shift. I watch my monitor a lot, and watch my patient a lot more. Suctioning when they cough, giving sedation if they're too wild, decreasing the sedation if they're too sleepy - as our plan for the day. Reassure family, and explain the monitor and ventilator the best I can; what the numbers mean and what we'd like for their child.
13.00: Involve family in care and repositioning, this is done every 4 hours. Maybe sometimes every 2 hours if the have a high tissue viability risk, or 6 hourly if they're a crazy neonate! I encourage the parents to have cuddles, it can be nerve-wracking for me on the inside having them out of the safety of bed but it's so beneficial for everyone.
14.00: Maybe a cheeky lunch break
*Continue my charting, drug giving, suctioning, feed giving, monitoring life. Along with a blood gas. Attempt to start my notes as I know I'll be interrupted with something.
16.00: Afternoon ward round, tick off the things we complete on our to do list, anything we couldn't do, and anything new for the rest of the shift. Take evening bloods if wanted.
17.00: Back to cares, or a larger wash and sheet change depending on what was done in the morning and the state of the patient/bed.
18.00: Normally the busiest time, lots of drugs are due now and with the majority of IV anti-biotics having to go over 30 minutes due to extravasation risk, it can take a while to get through everything.
18.45: Fit in a dinner break somewhere around here
19.00: Try to finish my notes and sort out handover paperwork
19.30: Make sure my desk is stocked well for the night team. Also make sure my patient looks good and cute, and my bedspace is clean and clear.
19.50: Do my 8pm charting and ensure fluid balance is all correct
20.00: Night team make they're way out to the bedpsace and handover
20.30: And home time! If I got all my notes all up to date, otherwise I stay and make sure they are the best.
21.15: Arrive home in need of a shower, comfy clothes and probably bed!
The thing with paediatrics is that your cute little people can sense when you have a plan and when all your drugs are due, and decide to go a bit crazy. There are a ton of things I do on my shifts that you can't plan for...
Welcome to the beautiful world of nursing. It is so so beautiful; there is so much joy and wonder in this life, and I cannot wait for you to experience it.
We see people, like really see them. We see people at their absolute worst, fearing for their life, or the life of their most loved one. And we get to be the person there for them, to be a comfort and to guide them through the journey of this life. Isn't that such a blessing?
We look after babies and children, who are so wanted and loved, cling onto life, and parents cling onto us to keep them standing. We encourage parents have that first cuddle with their baby, to clean their faces and imagine the wires aren't there. You have to hold onto the blessing of your life to help get through the moments you think you can't put one foot in front of the other. When those babies who are so precious pass through this world and where parents fall to the floor with hearts broken into a thousand pieces.
It will be petrifying, being the person holding death away from the patient you've come to love. You study for that moment, you don't study for the next test or essay. You study to fight every damn day to keep people alive, to give them comfort and to hold their hands.
In the moments where you are scared, and you can't see yourself ever becoming the nurse you envision, keep your faith in yourself, keep the heart you have and bring it forwards. You will grow and grow every shift. We were all there on our first day of nursing school, and first day of placement, petrified. And what I've learnt, is that the horrible shifts, and the horrible staff and the patients who you cry on the way home about, will impact you the most and will build you to be the best nurse you possibly can be.
Remember every single shift for the rest of your nursing life will impact you, and even on your last shift before retiring you will learn something new. Do not be afraid to say you don't know something, we can never know everything. But we can be motivated to find answers when they need to be found. Ignore anybody that looks down on you, from band 9 managers to housekeepers, we need each other to all do our jobs, there is no hierarchy. Treat our colleagues equally, use their knowledge and share yours. Continue to believe that being a nurse can be the best life in the world, and each day you have the ability to change somebodys life for the better. You have so much power to create comfort and show compassion and leave this world brighter.
So take that step forward, become a beautiful nurse, we are all here for you.
You know when you go into a shift and you see you've been allocated to be in a cubicle, its part of the unit, we have cubicles for loads of different reasons and someone has to be in there every shift. But when it's you, your heart does a very small sigh; it can be isolating being a box for 13 hours, being let out for your little allocated breaks only. That being said, I have been in a cubicle for a lot of my shifts recently, with the same patient, and I've started to feel a part of their family. Families like being in cubicles, they feel more relaxed, less being watched and can't see the crazy things happening on the unit. I've started to realise that I get to sit and watch this young patient and their family interact, laugh, hold each others hands and immerse themselves in the patients care. It's like you can feel the love and magic in the room. I'm going to remind myself of this magic when I'm next placed into a cubicle. Magic of love is so powerful.
When I qualified as a paediatric nurse a few backs now I had a dream of working in ICU. I did a placement as a student and I absolutely fell in love with it. So when I started as an actual qualified nurse I was so upset that I hated it. It was scary, I didn't know any of the people there, and I couldn't believe that I was being left with a child in a coma, on a ventilator and I had to keep them alive, and me sane for 13 hours! Man did I cry a lot. I was looking for other jobs, emailing people about new positions and was set on leaving. But around 6 months into it, I started to enjoy it; started to have a few shifts where I felt like I knew what I was doing. And it became more common for me to enjoy my shifts than not enjoy.
I'm now over a year into it, and I can honestly say, I love my ICU world, my ICU family and the amount of knowledge out there inspires me more. I still get nervous walking through the doors wondering where I'm going to be allocated, but I have survived every shift I've come in for - this is what I tell myself.
I see these new nurses join the group, and go through the same horrible shifts and feelings that I went through and thought maybe it's just an ICU thing, not that I was too rubbish or emotional. I've decided to try and make it a bit easier for those new paeds ICU nurses - and hopefully other nurses or healthcare professionals in other types of units/wards.
In reality, as ICU nurses, your team is everything. They run to you when the emergency buzzer goes off, help you do cares of a child that has passed and let you cry with them when you're overwhelmed. They also make the slooow night shifts fun!
People are everything.