Confessions of a Male Nurse (10 page)

A different world

After my first year of nursing in London I knew which wards, or even hospitals, to avoid, as well as knowing which hospitals and wards were great to work in. Fortunately, the nice places outnumbered the bad. But even in the places that I liked, I had to get used to a different style of nursing. Naturally there were always going to be differences in the system I had left behind in New Zealand to the British system.

1. The major difference was the patient to
   registered
   nurse (RN) ratio. I was used to working with one RN for every six patients. In the UK I often had 10 or 12 patients, with just one nurse assistant to help me.
   
2. I found it difficult to delegate tasks, especially the unpleasant ones, to a nurse assistant. I was used to doing it all, from the highly skilled stuff, to helping someone off of a commode. It was also hard knowing exactly what each assistant could do as it varied from place to place. I’d find myself doubling up on certain aspects of patient care, such as wound dressings, which some assistants would do, while others wouldn’t. Back home, I was used to one nurse assistant for the whole ward.
   
3. Another shock was working 12-hour shifts. Not all places in London scheduled like this, but most did. Back home I only ever worked an eight-hour shift, maximum. In the UK, if you did a run of three or more days, it sometimes felt like you practically lived at the hospital.
   
4. I find the small things can make a big difference, so the lack of wheelchair accessible showers in London was a real nuisance. I was used to any patient who could at least sit in a chair being washed in the shower, every day. In London, the few showers I saw in the wards were small, enclosed spaces, often with standing room only. I think this came about because when these hospitals were built, people didn’t shower, they bathed. It’s not possible to have all of your patients bathe every day. I soon felt I could never get my patients as clean as I would like.
   
5. I had an ongoing battle with the cleaners; the ones I encountered in London hospitals weren’t allowed to clean up vomit, or body fluids, and I wasn’t allowed to use their tools (mop and bucket); so, I’d end up wiping up vomit with a towel. I remember trying to open the cupboard where the cleaning equipment was stored, and finding it locked, with the cleaner refusing to open it for me. I don’t know exactly how much hospitals save by outsourcing their cleaners to a separate company, but the ones I met didn’t seem to take pride in their work.
   
6. Then there was the fact that London nursing was truly an international experience. There could easily be two, three, four or more nurses from different nationalities in a single ward, and it was sometimes a challenge to find common ground. Generally the care we provided was the best we could give with the resources we had, but occasionally I’d find things being done in a way that was completely the opposite of what I’d been taught.
   
7. I had developed some habits in the care of my post-operative patients that I struggled to keep up with in UK hospitals. I was used to all patients who came back from theatre having a complete bed-wash, linen and gown change that evening. I was not alone in not always getting this done, and I found other nurses who felt the same. It wasn’t always about the same thing, but a lot of the older nurses confided in me that they didn’t get the time to do all the basic things that they had been taught to do.
   
8. Another habit I had been forced to learn was to keep rooms spotless. I found it frustrating to find patients’ rooms cluttered with flowers, chairs, leftover cutlery, magazines, books, dentures, and that’s to name but a few things. Whenever I walked into a bombsite I was always reminded of how messy a nurse
   I
   used to be, until one day when this all changed. The nurse manager said I needed to be tidy, clear the surfaces, remove spare furniture, because it was a hazard for the night staff. She also said that if there were an emergency, people needed to be able to get into a room quickly. I turned up for work the next morning to find my patient had died, but the arrest team complimented the nurse (me) for having such a clean room, they hadn’t had to worry about knocking things over.
   

Highs and lows of temp nursing

I learnt very quickly that temp nursing is difficult. It wasn’t long before the disadvantages appeared to outweigh the advantages. In total I spent four years working in British hospitals. The first two were spent working as a relatively junior nurse on the wards, and after a four-year break back in New Zealand, I returned to London and spent two more years working as an experienced emergency room nurse.

Sometimes I’d spend no more than a day at any given hospital, but if I liked a specific place, or if the nurses in a particular ward liked me, I’d often end up with a line of work.

I’ve lost count of the different hospitals and wards I’ve been in, and although it became easier to adjust quickly to a new environment, it was always a challenge.

Highs:

1. I had some very interesting and unusual placements. These included walk-in STD clinics, teenage cancer units, and even sporting events. I ended up learning a little bit about a lot of different things.
   
2. I was always free to say no. If I didn’t like a place, I never had to go back.
   
3. I always earned more than the regular staff. If you had the training, and could get work in an emergency room or intensive care unit, the night shift paid £30 an hour for a 12-hour shift. You could take home a cool £1,200 after tax for a week’s work. But a 65-hour work week isn’t sustainable, and the few times I did this, I ended up taking most of the next week off.
   
4. If you are looking for a permanent job, then temping is a great way to find out which places you’d like to work in, before committing.
   

Lows:

1. Irregular hours can create havoc with your body. Being able to pick and choose your own work hours may sound great, but you’re not really as free as you might think. Work often had its peaks and troughs, and I could easily find myself working two days one week, and in a desperate bid to make up the hours I’d work five, or even six days, the next.
   
2. When going to a new place, I often felt like half my time was spent looking for equipment, trying to track down elusive doctors, looking for patient medications which never seemed to be on the drug trolley, figuring out which nurses I could turn to for help, or avoiding those who were hostile.
   
3. As for patient continuity, it doesn’t exist for the temp nurse, unless, of course, you get a regular line of work. Having no continuity is not only difficult for the nurse, it’s far from ideal for the patient.
   
4. It’s difficult as a temp nurse to figure out what your boundaries are. Some places would let me administer intravenous medications, others wouldn’t. Once I was even reprimanded for helping out with a bed sponge because that was the assistant’s job, and I was told there were more important things I should be taking care of.
   
5. It’s easy, however, to find yourself out of your depth. On several occasions I ended up in a placement that I did not have the skills for. This usually came about because the hospital desperately needed a physical body to fill a spot, and they’d take any registered nurse as a last resort.
   
6. You’re on your own. You don’t get to know your fellow nurses, and you don’t form much of a bond with your colleagues. You can feel isolated, and miss being part of a team.
   

Mrs Olsen

Fortunately agencies also help provide long-term jobs. Often the rates are negotiated. I took my first steady job after my initial year temping.

Tracy had wasted no time in finding me a job for three months. It was on the outskirts of London, quiet, often described as a great place to raise a family. Apart from not being at the family stage of my life just yet, the thought of a quiet place appealed to me.

As part of the job, I would be provided cheap accommodation, only a ten-minute walk from work. I was sold. No more falling asleep on the tube. No more getting lost trying to find the right ward . . . or even the right hospital. No more being woken up at 5.30 a.m. because the agency desperately needed a position filled, even though I had said I wasn’t available for work. This job sounded just what I needed.

Alabaster Ward was like any other surgical ward I had worked in before, except for one minor difference . . .

‘You’ll be looking after beds 1 to 16,’ Bethany, the charge nurse explained to me.

‘Ah, 16 patients, isn’t that a bit much?’

Bethany looked amused at my comment. ‘You won’t be alone. You’ll have a nurse assistant to help you. Orla usually works on your side. She’s very good, and knows her job.’

I wasn’t reassured.

I didn’t like to complain, especially before even starting work, but I was seriously worried. ‘But only two registered nurses for 32 patients. It seems a lot of work.’

Bethany genuinely didn’t seem to see a problem. I could only assume that this must be all she had ever known. It was the afternoon shift, and this was a common staffing level. The morning shift was a bit easier as there were three registered nurses (RN), bringing the ratio down to about one RN per ten patients, with a nurse assistant each.

I did what every other nurse does when put in a difficult position: I got on with the job and survived, although things were far from perfect. Medication wasn’t always on time. Patients were occasionally not ready for theatre when the porter came searching for them, irritating the surgeon by forcing them to wait an extra ten minutes. Patient hygiene wasn’t always as good as it could be; having only two showers for the whole ward, neither of them accessible by a wheelchair, didn’t help. Wound dressings weren’t always dressed as often as they should’ve been, although I was fortunate to find that Orla was rather proficient at dressing wounds, even though she admitted to me that she wasn’t supposed to do them.

Things like feeding patients, walking them, sitting and talking to them were often left to Orla, as I would be busy doing the things that only registered nurses can do, by which I mean giving intravenous medicines and keeping on top of all the intravenous fluids. Or, if a patient was on a blood transfusion, 20-minute observations. Or, if someone was fresh back from theatre, then they required even closer monitoring. When I had the intravenous meds out the way, I had to dole out the oral meds for 16 patients. Often the drug trolley was lacking in several medicines and a drug round could easily be delayed for half an hour trying to track these down.

The list of things to do was endless, but as much as I suffered under the strain, it was always the patients that suffered the most.

Within my second week on the job I met Mrs Olsen. She was 45 years old, diabetic, and two weeks earlier had had half her right foot amputated because the circulation had died and the tips of her toes had begun to turn black. Poor circulation is very common in diabetics, often as a result of too many years of having high blood sugar levels, which causes damage to blood vessels.

Mrs Olsen had the most unusual foot surgery I had ever seen. It was as if she had placed her foot under a guillotine and had it amputated, about two inches back from where the base of the toes should have been. What surprised me was that there was no attempt to sew the ends together. I could only presume that this was normal procedure, but every time I dressed her foot it had hardly changed. There was a bloody, open stump of a foot staring at me.

‘I don’t suppose I could ask you a favour?’ Mrs Olsen didn’t often ask for much; she was still fairly independent.

‘Sure,’ I replied.

‘I would give anything for a shower. Do you think it’s possible?’

‘How long since you had one?’ I asked, curious to know if any of the other nurses had taken her to the shower when I wasn’t around.

‘A week,’ she replied. ‘I haven’t had a proper wash since the operation.’

If making Mrs Olsen happy meant taking the time for a shower, then that is what I was going to do.

I went in search of a chair that would fit in the shower.

Orla intercepted me before I had accomplished the first part of the mission: ‘Mr Davenport is back from theatre. The nurse needs to handover now, she’s really busy.’

Mr Davenport had just had some of his bowel removed, as well as a large cancerous growth. He had a pump full of morphine, with a cord and a button attached, which he could press to give himself a dose. It’s called patient controlled anaesthesia, or PCA.

His observation chart showed that his blood pressure was low and the doctor had ordered ten-minute checks for the next hour. But worst of all was his respiration rate, which was low, because of the morphine. A normal respiration rate is 16 to 18 breaths per minute in an adult. His were ten breaths a minute.

I responded to the low respiration rate by removing the button for the morphine pump from Mr Davenport’s hand. I called in my assistant to help as we got him washed, changed the bed, replaced his dressing, all the while keeping an eye on his breathing. By the end of the hour, his respiration rate was up to 12 breaths per minute. It was still on the low side, but high enough to be considered safe.

An hour later I returned to Mrs Olsen.

‘I can see you’re busy. We’ll try the shower another time.’

Mrs Olsen wasn’t angry, and didn’t seem surprised, although there was obvious disappointment.

‘We’ve still got time. We could even do it in the afternoon.’

I was determined not to let her down.

But I did let Mrs Olsen down that afternoon.

Fortunately, the next day none of my patients were scheduled for theatre.

‘Is lunchtime okay?’ I asked Mrs Olsen, already knowing what the answer would be.

Mrs Olsen agreed and when lunchtime came around, instead of taking my break, I began preparations for the shower.

I encountered my first obstacle.

‘I can’t find a chair that will fit in the shower,’ I said to Mrs Olsen. ‘Do you think you could stand?’ I asked.

Mrs Olsen was not deterred.

‘As long as you’re there to hold me, we’ll be fine.’

I wheeled her to the entrance to the shower. I briefly left her sitting there as I went in search of Orla. There was a six-inch step that Mrs Olsen would need to hop over, and I didn’t want to risk her falling.

‘I’ll go at the front, you at the back,’ Orla ordered me.

Once she had seen the task in front of us she eagerly joined in.

‘You’ll be sure to catch her if she falls.’ Orla was only half joking, but Mrs Olsen was in fine spirits and thought the whole situation amusing. In fact, this was the most energetic I’d seen her.

With Mrs Olsen squeezed between Orla and me, we got her over the next hurdle and into the cubicle.

‘I can’t get out,’ Orla said, her head peering at me from behind Mrs Olsen’s back.

‘We can all have a shower together,’ said Mrs Olsen, making us all laugh.

‘I’m going to squeeze behind you. Suck in,’ Orla said, as Mrs Olsen pressed herself against the wall, making just enough room for Orla to squeeze past.

With Orla out of the way, the shower began in earnest. Mrs Olsen rested one hand on my shoulder while she held a black, rubbish-bin bag off the floor. The clean rubbish bag was the most practical thing to use to keep her foot dry.

‘That’s bliss,’ Mrs Olsen crooned. ‘Turn it up a bit please.’

I turned the heat up a notch.

‘Perfect. I could stay in here all day.’

We stayed for ten minutes, before I wrapped her in towels and, with Orla’s help, eased her over the now wet, slippery step and wheeled her back to bed where she could get changed.

‘I feel like royalty.’

Mrs Olsen had not stopped at just having a shower. She hadn’t put on her old hospital gown and instead put on her own clothes from home. For the first time since I had met her she had make-up on, and perfume. From that moment, it seemed as if Mrs Olsen’s perspective had changed. She began focusing on the future, on getting out of this place.

I finally began to see a change in her wound. It did begin to heal. It dried out and slowly crusted over, although it still took a very long time.

Mrs Olsen continued to make an effort with the small things, like putting on some perfume, or her own clothes, a touch of make-up, or doing her hair nicely. She began to ask questions about how she would cope at home, and exactly what resources the hospital would put in place while she recovered. She also made more of an effort to get out of bed. And although she wasn’t exactly nimble, she eventually managed to take herself to the shower and wash herself, although I did, of course, make sure everything was set up.

She was a new woman.

A positive attitude can have a huge physical impact on healing. It may not be the happy, positive thoughts that do the healing, but in Mrs Olsen’s case, the right attitude helped motivate her to make an extra effort.