Night 3 of 3.

Hurray it’s Thursday!

So let me tell you about my nightshifts; night one began very heavy as a patient deteriorated very rapidly whilst receiving handover from the dayshift nurse. Patient E was found extremely short of breath, very flushed & was becoming more agitated. This was abnormal for him. I rushed to get the observation machine and found the oxygen levels to be low, the blood pressure was high, the heart rate was racing and the temperature was through the roof. One thing in mind- SEPSIS.

‘Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs.’

After given the patient antibiotics, oxygen, fluid through the vein, collected some blood samples and monitored his urine output the patient became stable.

Around 11pm I received a diabetic patient from A&E whose blood sugar was 28mmol (this is high), after supplement doses of insulin given (to reduce blood sugar), the blood sugar was 29.8mmol (higher instead of lower). This patient requested 4 times the amount that was prescribed- this dose is the usual dosing regarding supplement doses of insulin. I then gave a further dose of the prescribed supplement insulin and rechecked again after 30 mins. The blood sugar was 33.4mmol. This patient was in DKA- ‘Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin.

Eventually the doctor was informed of this patient’s blood sugar level & a sliding scale was commenced. This is a continuous intravenous infusion administering insulin & fluid replacement according to the sugar levels to maintain a safe level of glucose in the body.

Once the doctor prescribed it, it turns out the patient was correct after all. He should have had the insulin dose he originally said.

Lesson of the night- patients with long term conditions eg. Diabetes, usually know exactly what doses they require & when they are required.

After this incident was resolved it was time to start my observation round, morning medication round & do the morning washes.

What a chaotic & fast night!

Night two I was taking care of the same patients apart from one new admission from the dayshift. The patient was admitted to our ward around 6pm and his family was by his bedside. I introduced myself and within seconds I was being thrown several different complaints at once. First complaint was he had a Fentanyl patch that needed to replaced that day. I explained to him pharmacy was closed & only for emergencies and unfortunately we do not stock this medication on the ward. Also he had been admitted for 3 days before he came to our ward and it should have been replaced & ordered by the other ward. Second complaint was the other ward took his medications to lock them away in the POD locker as per hospital policy but did not transfer him with his medications. I contacted the other ward and they had no medication belonging to him. I explained I cannot answer for other wards as he came to our ward with no medication and it was the dayshift that took handover which should have been addressed the issue on handover. I advised him to speak to the dayshift the following morning to follow up where his medications have been placed. This is why property checklists are crucial as part of an admission- patients items are often misplaced or sometimes patients don’t have property but try to blame the hospital for losing it. At least if we have a property checklist or clear documentation we can follow this up.

Another complaint was he had not opened his bowels for a week and would like some laxatives prescribed. I explained to him we had one medical doctor on-call overnight and we would only contact him for emergencies and this could wait until the dayshift. The patient could not understand that I could not give out medication without it being prescribed. This caused conflict & he demanded to speak to someone more senior. The nurse in charge that night told the patient and the family exactly what I had explain but as she was a senior staff member it seemed to make the patient and family more settled.

Why do patients wait all day (with lots of doctors present on the ward) to nightshift with all their complaints??- is this night over yet?

After completing my bedtime medication round & observation round & getting all my patients settled for bed, patient F complains of pain whilst passing urine. He is being treated for a urine infection which causes a burning sensation whilst passing urine. I encouraged him to drink plenty of fluids, gave him maximum pain relief and informed the doctor. Unfortunately there was not much else I could do as he was on the appropriate antibiotics already. This was causing him to scream out every 30 minutes keeping the other 5 patients in the bay awake. This meant constant buzzers going off and continuous tea and toast rounds.

The end of the shift is near!

Night three I come into shift to a surprise. Patient C who I have been nursing for the past two nights is influenza A positive!

This means my whole bay is in isolation and staff & patients have been exposed to the flu- note to self: flu season is not over yet.

Another night I am nursing the same patients. These patients are all stable and absolutely knackered after having no sleep the previous nights. I am able to turn off my lights early & help the others on the floor as there had been 6 admissions overnight.

Whilst I am doing my 2am observations, patient D who had made complaints the previous night about his care asked if I had a few minutes to chat as he could not sleep. Three years ago he was diagnosed with cancer which was spreading unfortunately. He had undergone radiotherapy with success & was still having chemotherapy. For almost 15 minutes this patient opened up to me about his emotions & feelings telling me he did not honestly want to keep going through this treatment as he had suffered enough with the pain and restriction of lifestyle but it was his family that had been making his decisions, he was clearly extremely overwhelmed. All he wanted was for someone to listen and to offer some support to him. Another lesson to note to self – not everyone lives in glass houses, sometimes we don’t see the whole picture from the beginning.

Finally another night over and two days off!

Happy Thursday guys!


Palliative or End of Life?

The topic of dying is never an easy subject to discuss.

People are often scared of the thought or do not know how to approach the subject. It is essential that more teaching is done around this subject in nursing school. Within clinical areas there must be support within the team. Although you can never ‘teach’ how to care for a dying patient, we can be aware of what is required to assist in helping care for a palliative patient in the best way possible.

Throughout nursing school, I had a lot of experience when dealing with deaths throughout my placements & part time work through nursing/residential homes. It’s something that never gets easier to deal with and each death that occurs is a totally different experience to each other.

I still remember my first patient that sadly passed away, a moment I will never forget but the support I had from my family, friends & nursing team it made the experience easier to deal with.

If you have an illness that can’t be cured, palliative care makes you as comfortable as possible, by managing your pain and other distressing symptoms. It also involves psychological, social and spiritual support for you and your family or carers. This is called a holistic approach, because it deals with you as a “whole” person.

End of life care should begin when you need it and may last a few days, or for months or years. People in lots of different situations can benefit from end of life care. Some of them may be expected to die within the next few hours or days. Others receive end of life care over many months.

As a nurse when we are looking after an End of Life patient or palliative patient it is essential we provide dignity, support & respect individually. However in a stressful/ busy AMU (Acute medical unit) ward this patient may be placed in a bay with five other patients each with different conditions. This makes it so difficult for us nurses to provide necessary palliative/End of Life care for this patient. It really isn’t the appropriate environment for the patient or relatives to be in. We should be prioritising these patients to side rooms or ‘quieter’ wards.

Remember these patients are someone’s grandparent, parent, brother, sister, friend or spouse.

Whilst being a nurse on this ward I have found myself in this position and it makes me question why I came into nursing. I want to care for patients and providing them the best quality of life as possible. I have came home from a busy shift and after looking after a palliative patient I haven’t been able to provide the best care I possibility could because of the situation I was placed in. I wasn’t able to dedicate my time solely to that one patient or wasn’t able to spend as much time as I would’ve liked too.

As a nurse, it is important to assess and establish the status for our patient. They should not be going through invasive procedures if it’s not necessary. Although this is a medical decision, we often know the patients a lot better than any other healthcare profession and we are the advocate for the patient. If the patient is End of Life we should ensure medications are prescribed and the patients’ needs are met including a persons religion and what they wish to happen. Don’t forget about the family & relatives throughout everything, offer them support and guidance and let them be apart of the decisions when this does happen.

When a death does occur, it is hard not to get emotionally involved- we are human beings after all. Make sure you use the support of the team and there should also be a bereavement support within the hospital. There is also online forums that help nurses cope with situations like this. Don’t bottle things up, it is okay to have a cry and talk about what has happened.

Also remember a hand to hold speaks a lot more than words & often it is the hearing that is the last sense to go.



0710- With a coffee in my hand I return to the ward to begin another shift. Everyday is unpredictable as no two days are the same. We begin by getting an update from the nurse in charge from the nightshift about the events that happened on nightshift- nothing extraordinary.

0800- I introduce myself to my patients. Today I have the female bay- not to my liking as I find females a lot more difficult to look after than the males. I don’t know why this is, maybe they are more demanding, needy?

It’s a busy morning on the ward, I have a palliative patient, two dementia ladies- one mobile, one bed bound. I have a COPD lady & a lady complaining of chest pain. I also have one empty bed. This is surprising because usually an empty bed is sacred in the hospital and never usually vacant for long.

I begin by doing my normal morning medications, most of them have been done by nightshift expect one patient.

I then start my observation round, this includes checking vital signs and then I follow the doctors whilst they complete their ward round.

I discharged one lady (dementia, mobile patient) before 10am, hurray! Management will be happy with this…

1030- Undisturbed peace for 30 mins- COFFEE time.

1130- After having a meeting with the doctors I have to transfer a patient and have another discharge.

I move the bed bound dementia lady to a long stay ward with her daughter & I discharge the COPD lady. Unfortunately my palliative passed away, I will discuss this on my next blog.

My morning has been uneventful. This is extremely rare on my ward especially for a Friday. Although I can’t say the same for my colleagues but I hope my afternoon continues like this.

1600- Time for another break- yes nurses do get their breaks sometimes.

1715- I am feeling optimistic. It’s Friday & I have 1 patient. Will I get another 5 admissions in the next 2 hours? It wouldn’t surprise me.

1735- I can see the porter pushing a female patient with an A&E nurse. One admission for me. This patient is a frequent flyer. She only got discharged last week from the hospital.

She is a diabetic that is vomiting therefore she has been commenced on the DKA protocol which involves having to check her blood sugars every hour and being attached to insulin & glucose intravenously. When I went back to do her blood sugar she had taken out her cannula which was access for the insulin. She refused another cannula. This makes it difficult for us to treat if we have no intravenous access. This was the same situation last week.

1900- Another admission this patient is alert, orientated & independent. Yes! 3 words a nurse loves to hear. This admission is admitted for extra nutrition as she is underweight.

1930- handover time to the night nurse and then I have 2 full days off!

Happy weekend guys!


The Journey Begins…

Good company in a journey makes the way seem shorter. — Izaak Walton

This is definitely a new journey for me- I don’t really know where to start if I’m honest but we shall give it a go.

Being 23, a nurse in an exciting new city there is lots to write about so I hope I can keep you guys updated (and entertained) with all my experiences throughout my journey!

The views & opinions expressed throughout these blogs do not necessarily reflect on any organisation, the NHS or any hospital.