Importance of Listening

Last week I experienced first hand how quickly an infection can deteriorate into something more serious and thought I would write a little about how important it is to listen to your patient as well as looking at their clinical presentation as not everyone is the same.

About 3 weeks ago now a few of my colleagues at work came down with a nasty cold which for most of them lasted around a week. As we all share a small office it quickly spread and I caught it also. I am asthmatic and after just a few days the symptoms quickly spread to my chest causing me to have an audible wheeze, however I am used to this happening and contacted my GP to ask if I could increase my steroid inhalers. I continued to work through it and although I felt rubbish I didn't think it was serious. After a week of wheezing I contacted the GP again by phone as I didn't want to take time off work and asked for a course of prednisolone hoping that would clear it and the GP was happy to give this during the phone consultation as I had given him my observations and although my sats and peak flow were slightly reduced they were not unacceptable.

Then last weekend, I went to my kids swimming class and maybe it was the humidity in the room but all of a sudden I felt awful and could barely catch my breath, I used my rescue inhaler and it helped but I decided that I should probably see the GP the next day as it had now been going on a little too long at almost two weeks. I called and booked off work, fully expecting that I would be seen by the GP and back to work the next day (I have never taken more than two days off in my life before!).

That wasn't to be, the GP saw me and took some observations, at this point my sats were down to 94, my peak flow less than half of my normal and I had a raised heart rate, resp rate and a slight temperature although I had taken paracetamol a few hours before. The gp sounded my chest and couldn't hear anything, told me that my peak flow was still in normal limits, even though I told him more than once that mine is normally a lot higher as I swim a lot and said that my temperature wasn't significant even though it was likely being masked by paracetamol at that stage. He thought that it was an exacerbation of my asthma causing the reduced sats and raised heart rate and he gave me another weeks worth of steroids with instructions to call back for another course if they didn't help by the end of the week. I trusted his judgement and gave the steroids another chance.

Over the course of the week, I felt more and more rubbish and ended up not going back to work as I could barely pull myself up of the couch to get a drink let alone climb stairs to my patients houses. It peaked on Thursday morning when my husband came home from his nighshift as a paramedic and took my temperature, it was sitting at 39 even though I had taken paracetamol about an hour before. I felt really awful but really didnt want to end up in hospital and so I called the GP again and this time saw a lovely young Dr who took all my observations and listened carefully to what I was telling her in regards to my normal levels. My sats were down to 90 after walking to her office but again when she sounded my chest she could hear nothing. She decided that as I was completely against a hospital admission that based on my observations and that she felt that I knew my asthma symptoms better than she could, she was going to give me a week's worth of antibiotics and trust that my husband would monitor and take me to hospital at any sign of deterioration.

I am pleased to say that two days later other than a slight temperature and a small decrease in my peak flow, all of my observations are back to normal and I am feeling 99% better after what has felt like a very long 3 weeks. Had that Dr not listened to me and what my normal levels are as opposed to perceived normal I would probably be in hospital by now and could have had a lot worse outcome.

Observations on Monday

After one day of antibiotics!

So I suppose that the lesson to be learnt is that as a healthcare practitioner it is really really important to listen to your patient...they know themselves and what is normal or abnormal better than you, their physical presentations or any textbook can tell you. 

And from a personal perspective...I will definitely be taking more time to self care if I am ill in future! I've had to have a week off work after pushing myself for two weeks of feeling awful at work and had I seen about it quicker then it may have meant that my body had a chance to rest and recover quicker.

Lynsay x

24 hour nursing in the community

It often comes as a bit of surprise when people find out that the district nursing service is 24 hours and 7 days a week.

Recently my husband (a paramedic) was called out to a patient requiring a catheter change that the out of hours doctor had booked to be seen at hospital, luckily my husband is aware of our service workings due to my shifts and was able to have the patient redirected and seen within their own home, stopping an unnecessary hospital admission.  However not everyone is so lucky and it pays to have an idea of what each service can do and when to make the most of the NHS services.

I thought I would take a few minutes to talk about how our service operates 24 hour cover and what kind of things we would normally do.

Within our area, and this may be different for other areas and trusts, we have a day team based within an area who generally cover the day shift 8am-4:30pm Monday to Friday. Each member of the cluster, along with a few nurses who are specifically employed for evening working take a turn usually once a month to work the evening shift from 4pm -midnight. This is followed by a night service who work the intern shift from midnight until 8am. The day team also work a weekend day or evening shift once a month to allow cover on Saturday and Sunday.

However the work varies considerably depending on what shift is being covered.

Day shifts can cover anything from diabetic care, to wound dressing, to catheter care or even social issues. Whereas the evening and weekend services cover essential visits only, this may be later diabetic care or daily visits for wound dressing and often includes call outs for blocked catheters or breakthrough pain medication and even verifying patient deaths.

I done a weekend shift just a few weeks ago and my day went something like this:

8am start and text to cluster band 6 to let them know that I am about to start lone working. Set up my identicom which gives us emergency help if required and go to my first patient who required diabetic support.

Between 8am and 9:30am I visited another 6 patients for diabetic care, then I returned to the GP practice where our base is for a quick toilet break, filled up my water bottle and gathered stock for my remaining visits.

As we do essential visits only at the weekend, I had a look at my list and went to my next patients home who also required diabetic support at a later time, on arrival they did not answer the door. I was not overly concerned as I know the patient well and it is a common occurrence for them to be out but I contacted the band 6 to make them aware and to let them know I would return later.

I continued to my next two patients, bilateral leg dressings and a medication administration and returned to try and reach my patient again. I still had no answer and was starting to become concerned so contacted the band 6 again and let them know I would contact the patients next of kin. I left a message and moved on to my next two patients, both a daily wound dressing.

After these visits I returned and was still unable to reach the patient or their next of kin so I contacted the band 6 and we discussed what options we had. It was decided that I would try again in half an hour and if there was still no answer I should contact the police to break in to the property just incase the patient was unwell. This is understandably a difficult decision as if the patient was found well then there would be damages caused to the property to gain entry but there is the risk that the patient could be unable to answer the door due to being unwell.

I visited my final scheduled patient for wound care and returned...and after the first knock the patient answered the door! I was so happy to find them well and explained that we had been ready to contact the police...the patient had simply been out shopping.

As my scheduled visits were completed I returned to the office and had my lunch break. After lunch I had plenty paperwork and referrals to do and chase up so I settled down to do those for the few hours before I had to leave to do the afternoon diabetic care visits. During this time we are 'oncall' with the NHS24 service who can ask us to attend to patients for call outs. That day I did not get called out but often we can have a number of visits to go to in the afternoon.

At 4pm I locked up the GP surgery and headed out to the afternoon visits I only had three visits to do as a neighbouring member of staff had offered to go to one of my patients as they were near to one of hers, so at 4:30pm I was able to text the band 6 to let them know that I was finished and heading home for the night.

So there is an idea of what kind of things we do at the weekend, generally call outs from NHS 24 are for a mixture of catheter problems, breakthrough or palliative medication administration or wound care where the dressings have not stayed in place or are wet through and these can happen throughout the weekend or evening shifts.

So next time you need a community nurse you will know that we are always around even if you don't always see or hear from us!

Lynsay x

5 Tips

5 top tips in nursing...

1. Self care - take time for yourself whether that is a 10 minute break or a two week holiday. Make sure you nourish yourself, especially hydration! And talk to someone if you have a bad day or experience. You can't look after others without first looking after yourself.

2. Never stop learning - There is new cpd and evidence published all the time, make sure you keep up to date and learn new things, it's what makes us a great profession!

3. Always treat other staff as you would want to be treated - HCA's, students and all other staff are amazing, take care of them and they will be your back bone in this work.

4. Never dismiss a patient's worries - they know their own body better than you do, often they can pick up that something is wrong long before it clinically shows.

5. Enjoy nursing - despite all of the negative press, it is a great career and you can change so many lives in your job.

Lynsay x

Proud Nursing Moment

My proudest moment is actually nothing to do with nursing and everything to do with my kids, but I do have a nursing moment which sticks out as something that I am proud of...

In my first placement of first year I undertook a 12 week placement on an orthopaedic ward, I had been there for 9 weeks and had progressively seen one of the patients improve after surgery to the point that she was able to mobilize well and was due for discharge the next day. That morning when I came on shift she refused to get out of bed and asked if she could sleep a little longer, so I returned after helping the rest of the bay get washed and dressed and helped her to get up. I was surprised to see her flinching when she tried to sit up and after helping her stand up I promptly put her back into the bed as she was in obvious pain even though she said that she was fine.

I went done a set of observations which were fine except a very slight hypoxia and explained to my mentor that I was worried about the patient. At that time the nursing staff were in the process of making up IV medication so she asked me to contact the doctor and explain my concerns. As a brand new student this was terrifying but I explained to the doctor and he came straight away. However this is where I am proud to have advocated for my patient.

The doctor came and checked her over and found nothing visible that he was concerned about. I explained that she had been fully mobile without pain the day before and that something had changed. He then indicated that he didn't think there was anything wrong but that he would prescribe pain killers and take some bloods. He left the ward at that point but just a few hours later my patient asked for help to the bathroom and by the time I helped her to return to bed I could see that she was visibly paler and in a lot of pain, I done a further set of observations and saw that her saturations had dropped again so I contacted the doctor again and told them that I was still concerned and that the pain medication hadn't worked.

He visited the patient again and asked me to tell him why I was so concerned, I told him that I knew her and had seen her every shift for 9 weeks and that something was not right, she had not displayed pain like this even post operatively. This time he listened and ordered a scan.

I went home at the end of my shift before the scan had been completed but received a message from my co-mentor that evening who had came on shift to say that they had diagnosed a Pulmonary Embolism and that by sticking with my intuition had potentially saved the patients life by ensuring that something further was done.

I was really proud to be able to have advocated for my patient and it made me realize that if we don't, then who will?

5 Words to Describe Nurses

5 words that describe nursing...
In the current climate I am sure that there are many negative words that could be used but I am going to keep away from them.

1. Decision Makers- Nurses are often required to make important and sometimes life or death decisions and need to be able to decide what is most important from the list of tasks all day every day.

2. Educators - Whether it is a student, another member of staff or a patient we are always educating others, this can be through health education or as simply as leading by example.

3. Advocates - We advocate for each and every one of our patients daily.

4. Learners - We are constantly learning, updating our practice and using the evidence base to improve patient care.

And lastly
5. Human - We are still human, we get things wrong, we don't understand, we get tired and burnt out so need to make sure that while we care for others we also care for ourselves.

Lynsay x

Nurses in the family

There are no nurses in my immediate family, most of them are engineers including my uncles and brother and both of my parents are self employed: www.paperlace.co.uk and IM Plumbing Edinburgh

However in my extended family we have my great gran (who is now 100) who was an old nursing auxiliary, my dads cousin who is a HCA in mental health, his wife who is a nurse in our community hospital, their niece (who I think of as a cousin) who is a carer in learning disabilities.

Then from my husbands side, my husband himself is a paramedic and his cousin is a HCA in respiratory.

On top of this, my best friend from school is a cardiac nurse, and my daughter's best friends mum is a student child nurse.

So I suppose that although I didn't grow up with much nursing influence as a child, I do have plenty around me as an adult!

Lynsay x

Hidden or Maybe Not?

Today the nurse blogger challenge asks for your hidden talent.
I probably have a few things that I can do or have done in the past that few people know about, things like learning to fly a plane, kayaking with manatees, playing the bagpipes...but one that is a bit random that I don't think many people will know is that I have certification to teach small water craft safety and instruction... this includes kayaks, canoes, rowing boats and windsurfing and came about when I worked as a camp counsellor for the Girl Scouts. Here are a few pictures of some of our teaching sessions:

Even before nursing I loved nurturing people and seeing the joy on the kids faces when they finally got the hang of something was amazing.

I am really looking forward to seeing everyone's hidden talents today!

Lynsay x

What is my nursing pet peeves?

I am a relatively easy going person and not a lot phases or bothers me.
However, everyone has something that they dislike and for me there are two things...the first is a simple one and it is others not putting things back where they should be, there has been a number of times when I have been searching a patients house for equipment or prescriptions at 8am and its not fun! The second thing that really annoys me is bullying and talking down to others, there is no need for it and no place for it in nursing. We are all the same inside regardless of what we are on the outside and we all have feelings that can be hurt with words...think before you speak and ask yourself if what you are about to say would upset you.

Lynsay x

10 people to follow on Twitter

10 people I love to see tweets from... 10 isn't enough!

1. @stnurseproject - fantastic resource and support for any student or newly qualified nurse.
2. @GGbyrne - Grant is an amazing advocate for student nurses and his tweets are fantastically honest.
3. @Ryandouglas412 - ambulance technician who's tweets tell it like it is and always make me smile.
4. @Ewout1985 - another brilliant student nurse who is going to go far.
5. @Wedistrictnurse - great resource for community staff and even helps with some CPD.
6. @AmannersRCN - always posts something interesting to read, learn or do and is looking for more followers!
7. @bloggersnurse - so you can read all of the fantastic blogs from the nursing community.
8. @tinysunbird - very inspiring speaker at Congress and love to read her posts and views.

And a few non nursing ones who lighten my newsfeed and make me smile...

9. @jasonmanford - as hilarious online as he is in his shows and has been a fantastic advocate for mental health and the NHS.
10. @walkhighlands - beautiful pictures of the Scottish Highlands which make me wish I was there.

Lynsay x

Nurses that inspire me

I could go very cliché and mention all of the amazing historical nurses who inspire me every day, but I won't, instead I am going to say that every nurse that I have worked with during my training has inspired me.
Some nurses have inspired me to be like them, they have been compassionate, friendly and knowledgeable. A few have inspired me to do better than them and to ensure that I don't come across to staff, students and patients the way that they did, luckily these were in the minority! But each nurse that I have met has always had something to teach me, something that they do differently from others that works well and something to inspire me to become.

I hope that someday I can be an inspiration and make a difference to future students.

Lynsay x

5 things I do every shift

The first thing that I do on every shift is to send a text message to my workmates to say good morning, we all text each other as we go straight out to patients requiring diabetic care before going in to the office so it allows us to make sure that everyone has arrived safely and also let's others know that we are about to go into a lone working situation.

The second thing that I do on every shift is visit some of the patients on our caseload that have diabetes, sometimes this is to monitor blood glucose levels and give insulin injections and other times it is to provide support to someone who is managing the condition themselves.

The third thing that I do is head back to the office, we head back during the rush hour as we would get nowhere quickly anyway, the time allows us to handover, to read any urgent emails and to listen to any phone messages as well as to collect our work for the day and any equipment that we may need. I always try to restock my bags and car before going out each day as I never know what I may need.

The forth thing I do every day is patient visits, this can be a mixture of wound care, compression, catheter care, injections, drainage from surgical sites and many other things, every day is slightly different.
We always aim to get our scheduled visits completed before 1pm when we all return to the office for our lunch break, this allows us to do any call outs and care planning in the afternoon, however it doesn't always happen that way.

The fifth thing I do every shift is update our Trak system which is our online documentation, forward any issues on to the doctors, and follow up any patient visits by ordering stock, prescriptions and equipment that may be required and put in my expenses for my petrol. I usually write a list throughout the day of anything that I need to do and I try my very best to clear it by the end of the day where possible otherwise you end up building up a massive to do list which never ends.

A very short insight into my working day in the community.

Lynsay x

The best thing about nursing...

My favourite thing about being a nurse is easy... it is being able to do something that makes the patients life just a little bit easier.
It can be big things such as healing a wound and discharging them or it can be the little things such as making them a cup of tea.

Happy Post

6 things that make me happy, this should be easy but there are a lot more than 6!

1. My kids - my world revolves around these two small people and they give me so much happiness.

2. My family - my husband, parents, brother, gran, aunties and uncles and cousins who are always there for me no matter what. I love a wee day out with any of them and after losing 2 of my grandparents in the last few weeks, the remaining family are more important than anything.

3. My friends - near or far, I love them all.

4. Having a long soak in the bath - always makes me come out in a better mood.

5. My animals - I don't think we should ever underestimate the loyalty and unconditional love that an animal gives

Lynsay x

My favourite nursing topic at the moment is palliative care.
As a community nurse we often care for people that are at the end of their lives within their own homes and a lot of people choose this option as they want to be in their own environment with friends and family around them.

10 weeks ago my grandad died suddenly on the same day that his wife, my gran, was diagnosed with terminal cancer. Sadly just 7 weeks later she passed away as well. Towards the end my gran was put onto an end of life pathway and a syringe driver for pain relief and sedation which allowed her to slip away without pain or anxiety. The nursing staff were amazing and it allowed me to experience first hand the benefits of good end of life care and how it can benefit the family as well as the patient and can turn dying from something scary into something peaceful.

Having so recently experienced bereavement I thought that I would not want to visit patients who were dying or to have to attend the house after the death but I got a call out on my evening shift during the week and had to go as I was the only one available and it made me realize that death isn't something to be avoided, it is part of life and should be embraced as such and the more we discuss and talk about it with the patient and family, the less scary and worrying it becomes for them. So I am focusing on learning all the information that I can about end of life care so that I can help my patients and their families when that time comes.

Lynsay x

Photo behind the blogs

Day 18 of the nurse bloggers challenge is to post a picture of yourself.
Here is a picture of me and my husband at my graduation from nursing last month.

And I have to add this one too...

This was taken at the RCN Congress this year before the end of Congress social with a group of great people!

Lynsay x

5 favourite blogs

I have managed to fall behind a bit so here is day 17 of the nurse bloggers challenge which asks for my 5 favorite blogs.
So difficult to choose only 5!
Here are 5 that I enjoy reading but are definitely not the only 5 that I like!

1. Student Nurse Project at https://studentnurseproject.co.uk/

2. Charlotte at https://diaryofanqn.wordpress.com/

3. Craig at  https://craigsconsiderations.wordpress.com/

4. Dann at https://dannsjournal.wordpress.com/

5. Ewout at https://ewoutsdiary.wordpress.com/

Five very inspiring blogs and amazing nurses/future nurses.

The great debate!

Whether or not nursing should be a degree always seems to be debated, it seems that most people who are degree educated nurses think that it should be a degree while many of those who were educated 'on the job' don't think that it should.

Personally I think it's a difficult question, while I am degree educated, in fact I have two degrees, I feel that there seems to be a great inconsistency in the way that universities teach nursing and that leaves some people at a disadvantage.

I do think that education is very important and it is essential that nursing staff can learn and understand within a secure environment. However for me a large part of my degree was very repetitive with a high amount of overlap between modules and due to this I did feel that I learnt a lot more about nursing from being on placement and from my mentors than I did from the university. However I did already hold a degree in Biological Sciences and knew a lot more of the underlying physiology and disease processes than the university taught the nursing course and without this I may not have found the modules so repetitive. For me, I had a lot of the background knowledge but needed to learn nursing skills and practical application of the knowledge I had so a more practice based education would have definitely suited me better.

On the other hand I have met students who have had a terrible time at their placements and lacked proper mentorship so on the job learning would not be sufficient for them and the university teaching and simulation likely ensured that they are good nurses of the future.

I have mentioned before that my husband is a paramedic, in Scotland this is not a degree program and requires 2 years of study to become registered but does have the option to do further learning to obtain a degree or indeed higher qualifications if they wish to do so in the future. Sometimes I wonder if this would be a better option for nursing and may increase the uptake for students as it is not as large a commitment for people who have undertaken past learning or who may already work in healthcare but who struggle academically.
The introduction of HNC programs and Nursing Associates may feel like stepping backwards to some people but may help those who are not academic to become future nurses and I think they can only be a good thing when we are struggling to recruit as a profession.

It will be interesting to read the other views on this today and to see whether or not the blogger is degree educated or not!

Lynsay x

5 year Goals...

Where to I want to be in 5 years?
It's a long way off and so much can change before then but in 5 years my son will be a teenager, my daughter will almost be a teenager and I will be 37!

Personally I would like to have bought a bigger house as my kids can't share a room forever! And if we are both settled in our jobs maybe get a cat or dog once the kids are old enough to do their part in helping look after it, who knows, maybe we will still have Buddy our rabbit by then too.

Professionally I would like to either have done or be doing the District Nursing course and also be a mentor as I feel it is important to support students who have chosen our profession. I would like to still be active with the RCN (see you all at Congress 2023!) and maybe would be looking to do some further learning by then too.

Lynsay x

Self Care - What are you worth?

Self care is hugely important and that is across every life and not just nursing.
3 self care things that I do daily are...
❤️ Make sure that I get enough sleep, I am grumpy, irritable and don't concentrate well without enough sleep so for me it is essential!
❤️ Stop and top up my fluids regularly, I have a water bottle that I refill at work and take in the car...it's hot driving about and climbing stairs all day!

❤️ I make sure to take my breaks at work, our GP practice has a lovely balcony built for days just like today, having even half an hour to relax and eat something makes a big difference so make sure you take your breaks!

I also love to take a hot bath when I have put the kids to bed after a day at work, it really helps me relax. Everyone is different though, you may like to read or play computer games or have a night out with friends or have a nice holiday somewhere sunny so do what works for you 🏝️❤️

Favourite placement? Can I not choose them all!

Today's Nurse bloggers challenge asks about my favourite placement and I can honestly say that I don't know. I had such a large variety of areas that they are hard to compare.
In first year I done orthopaedic trauma, a care home and district nursing in the city. In second year I done Day Surgery and a Medicine of the Elderly placement.
Then in third year I had a district nursing placement within a very rural community which was the polar opposite of my first year one and then I done my sign off in A&E.
I enjoyed each placement for different things, orthopedics was fantastic for learning basic care, day surgery was great for recovering patients, the care home gave me some insight into out of hospital work, Medicine of the Elderly was great for seeing continued care and for seeing patients with multifactorial conditions, A&E was a bit of an eye opener for me but gave me so much experience especially in recognition of deteriorating patients and community I fell in love with! All of my placements had great staff who were knowledgeable and always tried to help if I had questions so I think I was really lucky and couldn't possibly pick a favourite!

Lynsay x

When did you decide to be a nurse?

My journey to being a nurse has been a bit of a roundabout and I could have saved myself a lot of time if I had just gone with it in the first place as I have ended up coming full circle back to nursing.

I was one of the higher achievers at my school and was always encouraged to be a chemist, a physicist or a teacher but at 17 and just finishing 5th year I knew I wanted to be a nurse and I applied to the university.

This is where things changed, I was offered an interview for the university and it was an open interview with around 50 applicants, we were half way through the day when one of the university staff told us to go and get lunch but to remember to take our folders with our certificates and documents etc so they wouldn't get lost. Myself and about 5 others done this and went off site for lunch and on returning we got yelled at by the head of the course saying that we shouldn't have taken our folders and it was delaying them with the interview. Being a shy, terrified 17 year old with no life experience all I could do was apologize and no one else stood up for us. I was subsequently offered a conditional place based on me passing my exams and by the August I had a place on the course.
But in the meantime I had visited another university open day with a friend from school and completely fell in love with the university and how lovely the staff were. The experience of one staff member had put me off, not only from the university but from the whole nursing course.

I ended up staying on for my 6th year at school and then started at the other university to do a degree in Biological Sciences which after 4 years gained me a bachelor of science with honours. I loved the anatomy and health promotion side of the degree and when I finished I decided to take the opportunity to travel where I worked abroad for a year and met some of my best friends. I gained more life experience in that one year than anything I had done before.

On returning to the UK it was right in the middle of the recession and I found it hard to get a job in science as a lot of funding had been cut, I worked a few retail jobs including a few years for my family wedding company, got married to my husband who I met in 6th year at school, had my 2 kids and bought a house. Then 3 years ago I had a bit of a crisis where I wasn't happy, I felt like life was going nowhere and that my brain was going to mush from not being used. As my husband had just signed up to do his paramedic training after being an ambulance technician for a few years he suggested that maybe I should go and do some more learning... I think he maybe had in mind a night class of something!

The more I thought about it, the more I wanted to go back to university to do nursing and after a few months and a lot of talking I decided to apply (at that stage I thought that they would turn me down) and after a few weeks I got an interview which went much better this time round! And in the September I started onto the shortened program for graduates with a brilliant group of about 30 guys and girls.

Fast forward two and a half years and I am now 5 months qualified and graduated a few weeks ago with a bachelor of Nursing with distinction and I love being a nurse!

If I had went onto the course at 17, I might not be the same person that I am today as I would not have had all the amazing experiences that life has given me and I certainly wouldn't have friends all around the UK and America so in a way delaying has likely made me a more empathetic nurse with a lot more life experience. I guess that sometimes even though you have a plan, life sometimes has a different path for you but if you really want something you will always find your way back.

Lynsay x

What do you eat on your break?

I am lucky in that I work a fairly short shift in comparison to the wards, I start at 8 and finish at 4:30 and have a 45-50 minute journey to and from work each way, I tend to eat breakfast on the way to work in the car so it is normally a breakfast biscuit or a few oatcakes and I have a coffee or some fruit juice at handover at 9am back at the office after my early visits are done.
After that we are back out to do visits and I usually carry a bottle of water and a bottle of diluting juice in the car, no dehydration for me!
As a rule we all try and get back to the office by 1pm and have lunch together, this ensures that we are actually taking our break and can sort out afternoon work, lunch for me varies day to day but I am partial to cous cous and tuna or soup and some raspberries for after.
We usually reconvene back at the office again around 3:30pm before going out on our late visits and often have a coffee and a biscuit or sweet from our donated sweetie drawer.
We are lucky as our GP practice has access to a fridge, microwave and hot water boiler and water cooler so we have facilities to make lunch if we need to, not everyone is as lucky!

Day 10: Best joke a patient has told you

Best joke a patient has told you?

Why was the doctor shouting Measles! Typhoid! Tetanus?
Because he liked calling the shots :)

I'm sure I have heard a few more that are unrepeatable!
Lynsay x

What is inside your work bag?

Good question for today's challenge and mine will be pretty different from a ward based nurse. As a community nurse I carry all of my kit in my car and have two bags that I take into people's homes with me, one is a large rucksack which contains just about everything that I need and the other is my document bag which I carry everywhere with me.
Here is a quick snap of what is in my document bag on a normal day:

It includes my diary - this is like a bible for community staff and helps to organise visits, mileage and to do lists.
It also includes some emergency supplies including extra gloves, apron, syringes and needles, swabs, tapes, batteries and scissors. I always carry my hypo-stop bag which contains testing equipment and sugar products to help my patients with diabetes if needed.
The front pouch of my bag has a few of my own emergency supplies including my rescue inhaler, a cereal bar and a few sweets, my sunray card for accessing the PC and handcream and also a small notebook that contains important codes,  phone numbers and I can write things down if needed.

Over and above this I carry a boot full of equipment, my lunch bag and a few bottles of juice or water and in my pockets I have hand gel, pens, extra gloves, my keys for the office and my work phone which keeps me in touch with my work mates when I am out on visits.

Look forward to seeing everyone else's bags!
Lynsay x

5 current goals is the topic of today's nurse Bloggers challenge. Goals are something that everyone should have but the do not have to be big things, they can simply be making sure that you drink your water that day or make your lunches for the week. Others have much more long term goals such as wanting to have a specific job or plans for retirement!

My 5 current goals are:

1. To become more confident in my decisions at work and once I do to undertake the mentorship course so I can give back to future nurses.

2. To save up some money now that I am earning again and take the kids to America, I would love to visit my friends and old workplace in Virginia and to take the kids to Disney.

3. To complete my rep training for the RCN, I am booked in for December so hopefully a short term goal!

4. To spend more time with my family now that I am no longer trying to balance uni and placements alongside working. We have had a difficult time recently losing both of my grandparents within 7 weeks of each other and it's really made us all realise how important family is.

5. To try and plan my food for lunch and eat healthier.

Can't wait to see everyone else's goals,
Lynsay x

Day 7 of the nurse Bloggers challenge asks for my 5 most motivational songs.
This one is very hard for me as I love music, I love playing it, listening to it and for me music has helped to heal on a number of occasions and is one of my first go to things when I feel down.
I enjoy different types of music at different times and will likely be caught listening to and playing every type of music from classical to rock but with that in mind I have chosen 5 of my favourite songs:

1. Cold Play: Viva La Vida - this song reminds me of a lovely band that I met abroad, lots of good nights with sunshine and beer and it always makes me smile when I hear it.

2. Reel Big Fish: I Dare You to Break My Heart - Reel Big Fish were my favourite band growing up and I still drag everyone to see them when they play Scotland.

3. Less than Jake: Gotta Let Her Go - Again reminds me of an amazing summer where we listened to this album continuously and a friend who I haven't seen in person in nearly 10 years but still keep in touch with.

4. Jimmy Buffett: Breathe In, Breathe Out, Move On - I am a massive parrot head at heart and love Jimmy Buffett after spending time in Key West Florida, this song just reminds me that sometimes you just have to breathe and forget things.

And last but not least...
5. Savage Garden: Truly Madly Deeply - My wedding song ❤️


Lynsay x

Day 6: What do you fear in the future of nursing?

Day 6 of the @bloggersnnurse challenge is what do you fear in the future of nursing.
For me this falls into two parts: self fear and fear for the nursing profession overall.
As a newly qualified member of staff I have many self fears, I worry that I will not recognise that a patient is deteriorating, I worry that I will do something wrong that may hurt a patient, I worry that the increasingly extra paperwork will mean that I don't have time for my patients and I worry about not coping if things get hard. However the more experience that I gain and the more I do skills these fears get easier.
For the future of the profession there is a big fear hanging over us all about staffing, we are already struggling and with many factors including retirement levels and the impending exit from the European union looming these numbers are going to get worse unless we can start to recruit more students into the profession. I remain optimistic that we will work this out and get through it but a lot of changes need made to obtain it first.

Lynsay x

Day 4 of the #nurseblogger challenge: your dream job.
I am a nurse and I think I pretty much already have my dream job. If anyone has had time to read my previous blog posts you will know that I knew before qualifying that I wanted to be a community nurse and I was lucky enough to get a position straight from qualified. I doubt that I will ever take any other course in nursing and hope to continue within district nursing until I retire (although I will be older than some of my patients by then! Hopefully my knees hold out!)
I love community nursing, I enjoy the freedom and autonomy to make decisions even though it scares the life out of me sometimes, I love being able to keep people in their own home with their friends and family around and my team are actually amazing!
Maybe in the future I will go on to do the DN course...but just for now I am happily living my dream job ❤️

Nurse Bloggers Challenge

Ok so I have decided to write a blog about community nursing as a newly qualified nurse and take part in the @bloggersnurse 30 day challenge...not promising that these will be on time or the correct day but I will try my best! 
I missed the first day yesterday but I guess that the above kind of covers that one so I am going to move straight on to day 2 which is 20 facts about me...

1. I am from Scotland and love learning about our history as awful as it sometimes is.
2. I am a mother before I was ever a nurse and family means everything to me.
3. My husband is a paramedic and has been my go to throughout my training for everything! Think he is sick of me asking A&P questions.
4. I must have good genetics as my great grandmother is still alive at 100 years old.
5. I am an activist with the RCN and over the last few years have met some amazing people through them.
6. However, related to my last one, I am not very outspoken and come across as quiet...I tend to listen and think about things before I act upon them.
7. I love music, play numerous instruments including the bagpipes, and believe that music is a fantastic healer.
8. I lived and worked in Virginia, USA before my nursing career and still keep in touch with many of the folks that I worked beside.
9. I am petrified of heights.
10. I am a strong swimmer and although I no longer swim competitively I still enjoy swimming regularly when life let's me.
11. I am a life long member of the girl scouts in the USA and was a rainbow, brownie, guide and young leader of the girl guides here in the UK, my daughter is just starting her journey as a rainbow.
12. I love to travel and have seen many countries including living as an exchange with a family in Hungary.
13. Both of my parents are self employed... something I would never want to do!
14. I was accepted into a nursing program when I was 17 but didn't actually start it properly until I was 29.
15. I am very nervous when I first meet new people and don't do small talk very well but I am a great listener.
16. I love bunnies (especially my pet one).
17. I love anything with flamingos on it (slightly obsessed with flamingos actually)
18. I am still petrified that I have so much responsibility as a nurse and worry all the time that I am going to do something wrong.
19. I love being outdoors and would choose a tent over a hotel any time, when life gets too much or things are too stressful I always take myself a long walk and always feel better after spending some time with nature.
20. I love my job and my team!

Phew, that was hard! Who knew that thinking about 20 things to write about yourself would be so difficult?

I suppose that it has given me a little food for thought tonight as we always ask so many questions of our patients but actually know very little about them in terms of who they really are. I am lucky that as a community nurse I often have to opportunity to see photographs and items within a home that are special to my patients and these often are great openers for chatting and building a strong relationship while giving the care required but on the wards this is often difficult to do.

Take the time to try and think of 20 facts about you and think how many of these things would change you if you didn't have access to them, would that change the way that you treat your patient in the future?

Lynsay x

Can you go straight into community as a newly registered nurse and is it better to have ward experience first?

This is a topic that comes up again and again in student nursing forums and chats, can you go straight into community or should you get ward experience first? The simple answer is that you can and it is entirely up to you if you want to go straight into community or onto the wards first.

For me, I was lucky to receive a district nursing placement as a first year student and I remember being terrified when my mentor asked me on the first day to get her some aquacell and kerramax dressings out...we had done nothing about wound care at university and I didn't even know what she was talking about, so I went through the box and eventually found what she had asked for but I didn't have any understanding about wound healing or even the role of community nurses and my mentor could see that. I was lucky that my mentor in that placement was so good, that afternoon she gave me wound formulary books and guides and told me to take them home to read and also went over the vast role that community nurses play in ensuring continued care of our patients. After a week I was a pro at dressings but still found it difficult being in people's own houses which were sometimes vastly different from my own. Over the six weeks of that placement I learn a lot and enjoyed the work but never seen myself as a community nurse.

Fast forward two years and in third year I was again given a district nursing placement, this one was completely different, it was in a rural setting and all of the town knew the nurses by name. By that point I had a great many experiences and skills under my belt and after a few weeks with my mentor she said that I was doing well and did I want to have my own caseload? Of course I jumped at the chance! The most difficult things were initially stepping through the door to someone's house and not knowing what you may find and also having to make decisions alone but after a few weeks I really had the hang of it and completely fell in love with community practice. I loved seeing the same patients again and again and being able to really build a relationship with them and I loved to see improvement and how comfortable people were in their own environment.

By the time I got to my final placement I had requested district nursing and was disappointed to find I had been given A&E, however now I realize that A&E has given me invaluable experience of seeing deterioration and a range of conditions that are applicable to community nursing.

When I qualified in February I already had a community staff nurse position lined up and going straight into community was the best decision I made, the support and training has been fantastic and I have never felt completely out of my depth. The most difficult part is still having to make decisions often quickly when a patient is deteriorating but I think that is something I will get used to with experience.

So back to the original question...if you love community work and feel that you will be happy there then do not hesitate to go straight into it, there will be scary moments but your skills will be honed to community practice and there is always someone who can help if you are not sure about something. Some people think that ward experience is essential but ward work is so completely different to the community that the only benefit is having experience of skills and in many circumstances these are not applicable in the community anyway.

Lynsay x