I'm not evolved enough

What was I thinking!!! What point is there getting my masters??? One class and I was ready to tell the tutor where to go.
"You haven't learned how to think critically" explained Mrs Crump. "Ah, I'm still not sure what you mean by thinking critically" I explained.

We were dealing with a scenario where I'd been working in an east London hospital on an Agency shift. I'd been left with eight acute patients, no handover, and a nurse assistant who called in sick. I was in the emergency room as well.

I'd complained but like the typical nurse I pulled through the shift for the sake of the patients. I know I didn't do as good a job as the patients deserved, but there was just too much to do.

"You didn't deal with the situation as you should have" explained Mrs Crump. "If you'd been thinking critically, and by that I mean taking control of your thinking and the situation, you would have made better decisions" said Mrs Crump.

I shook my head "So what was the right thing to do? Your explanation still hasn't helped me. I'm sorry, I just don't get it. I use common sense, and just try to do what is right. I did think of walking out but..."

I could have walked out, but as an Agency nurse filling in a random shift, I'd have been in dire straits. The agency nurse always gets the blame and never has any real support when the shit hits the fan.

Mrs Crump is the typical nursing tutor, idealistic but not practical. She's probably never done an Agency shift in a random hospital, they just didn't do it back in her day. I don't think she has thought 'critically'. It hasn't occurred to her that in some situations there is no right way, sometimes you just can't win no matter what you choose.

I didn't go to another masters class. I've been put off, or maybe it was the 4000 word essay that put me off. Oh well, never mind.

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Trust no one, part 2

I was woken early from my sleep by the phone. It was only nine o'clock and I had been asleep only a hour. "Were sorry to call, but it's urgent" said the woman on the line. It was Sheryl, one of the nurses from the agency. "What's wrong, what's happened?" I asked. I wasn't worried yet as I was couldn't think of anything that I had done wrong. "It's about last night. The hospital is furious" Sheryl said. "Can you give me some idea what it is all about?" I asked, still not too worried at this point. "You'd better come in, it'd be easier that way." It wasn't the answer I wanted. "Listen, give me some idea, or I'm not coming in. I should be asleep, and you want me to spend the next hour traveling to your office, worrying what on earth I have done." After several seconds of silence Sheryl spoke. "They said you prescribed and gave your own medicine, and the wrong dose as well." I felt my stomach lurch. "I'll be right there."
When I arrived at the office I was immediately taken to the manager, Miss Smith. She was very direct and didn't waste any time. "According to the charts you gave a patient voltaren 100mg. She was prescribed only 75mg twice daily. Plus you wrote on the chart that you gave 100mg. You're not supposed to write on the chart." I couldn't believe it. "I phoned the doctor, he prescribed it over the phone. I even phone the night nurse supervisor to make sure that it was ok to take a verbal order." Miss Smith nodded her head, "But what about the 100mg of voltaren? !00mg twice a day is too much." "But she missed out on her morning dose, and we had no 75mg suppositories, so we gave her the 100mg. The doctor did say it was ok." Miss Smith didn't look too happy at my words.
"And can you name this doctor involved, or the night supervisor?" asked Miss Smith. My mind was a blank. I'd had to phone three doctors as well as two night supervisors, none of whom would come to the ward. I shook my head. "Well then you're going to have to find out the doctors name. We've also contacted both night supervisors and both deny ever receiving your call and state that they do not allow verbal orders over the phone." I was struck speechless. My head was in a whirl. I felt that this wasn't really happening. Surely I would wake up in bed and find it was all a bad dream. "Well screw them, screw them all, this is bulshiit, utter lies" I was in a rage now. I have rarely felt so utterly full of wrath. For the first time since I had seen her, Miss Smith looked sympathetic. Perhaps she actually believed me. "Is this normal protocol? Am I supposed to carry out my own investigation? Am I supposed to ring around the hospital and interrogate the doctors and nurses. You've got to be kidding. It's my word against two senior nurses. I don't stand a chance. They are covering their own butt, that's what they are doing."
Miss Smith did believe me, and over the course of the next 24hrs the matter was dealt with. I was not to work in that ward again, or to be in charge again. I do find it ironic that I had never been asked to be in charge and was not only put in charge without my prior knowledge, but was left without another registered nurse to work with.
Eight years passed before I worked at that hospital again, this time in the emergency department, and guess what, they do take verbal orders, hospital policy does allow it. But I no longer take any verbal orders. I learned my lesson the hard way. When you're an agency nurse, you can't trust anyone, especially when the shiit hits the fan.

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Trust no one, part 1

Four years as an agency nurse in London means four years of trusting no one. My worst experience happened at one of London's most prestigious hospitals.
I turned up to work the night shift. The agency had said the hospital was desperate for another nurse. Not exactly encouraging words to hear, but I knew not to take offense. I took the job.
"Thank goodness you're here. It's very good of you to come at such short notice" said the nurse in charge of the afternoon shift. "Have you worked here before?" she asked. I shook my head. "Well I'll show you round then give you a handover." She then introduced me to Sheena and Irene, two nurse assistants that were on for the night with me. Sheena was from another ward and had only worked the occasional shift in the ward. She was only slightly familiar with the place, while Irene was an agency worker as well and had never even set foot in the hospital let alone the ward. "Ah, where's the other nurse?" I asked, naturally assuming that I had another registered nurse to work with. The charge nurse looked a little surprised, "Ah, didn't the agency tell you?" she said. I shook my head. "We couldn't get another nurse. You're our RN. You're inc charge tonight." I felt like I was in some kind of bad dream because this just couldn't be happening. I took the tour de farce with the charge nurse then began my shift.
Sister Grant in the side room was an seventy something nun in need of some pain medicine. According to her drug chart she had not been given her morning dose of voltaren. Voltaren is a analgesic similar to Ibuprofen. The drug was to administered as a suppository, or bullet up the backside. I was presented with several problems:
1. I was not going to near the private parts of a nun. She would be horrified.
2. She was prescribed 75mg of Voltaren twice daily. According to her chart she had missed the morning dose. The patient also said she had not had it.
3. We only had 100mg suppositories. I could give her the 100mg as she had missed her morning dose, but would need to get the prescription changed.

I tried to solve the problem by phoning a doctor. I called the medical doctor on duty that night to come and change the prescription. He said that I needed to call the surgical doctor as it was a surgical patient. I then called the surgical doctor who said it was a gynaecology patient. I called the gynae doctor who told me that because he was a private patient, originally under the care of a surgical consultant, I should call the surgical doctor. Needless to say I was rather confused.
After ten minutes I finally managed to get a doctor who agreed that she was his patient. He was the medical doctor. It turns out that Sister Grant began as a gynaecology patient, which unsurprisingly turned out to be a general surgical problem. The surgical problem was solved but she then developed a medical problem, and was then transferred to the medical team. The doctor then said that he couldn't come to the ward as he was too busy and offered to give me a verbal order to give the 100mg voltaren suppository. I said I'd call him back as I wasn't sure if I could take a verbal order.
I then tried to phone the night supervisor for some advice. I was put through to the first advisor, who advised me that she was responsible for the other side of the hospital and gave me another number to call. I finally got through to the correct nurse supervisor. I explained the situation with Sister Grant. "Can I take a verbal order?" I finally asked. "Yes" she said. I called back the medical doctor and said I would give the 100mg voltaren suppository.
I asked one of the assistants to give the suppository and the problem was solved. Or so I thought.
My real problems began the next day.

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