Sunday, February 28, 2016

Tough times at a Rest Home in NZ

New Zealand 2016
Working as an Enrolled Nurse in a Rest Home in New Zealand, is almost the same as working as an RN, depending where you work, that is.
For the first year here, I was employed at a Rest Home, as an Enrolled Nurse, but was told that I could not give out medication. There were, however, 2 elderly HCA's who had been giving out medication for years, and they were considered as Seniors. This was just accepted. They would assert themselves accordingly, and quite frankly made ones life a bit of a misery.
The other Enrolled Nurse employed there was not allowed to either.This was due to the fact that our Clinical nurse manager somehow felt we were 'not ready'. She was a real bully, and even reduced our two bubbly Rec Officers to tears, at different times. I doubt anyone has actually come out of her office dry faced. Oh..except the two wicked witches, their hearts were stone already.

As we weren't allowed to do meds and dressings, we literally worked as HCA's, 
The day would begin with a long and tedious handover, given by an RN who had recently arrived from India, and hardly knew any English. The bitter-faced HCA's would put their two cents worth in, by barking orders at us in between his comments.
By the time hand over was over, we all knew which resident had not emptied their bowels for 1, 2, 3 or 5 days, and who we needed to make sure that happened to for the day.We would grab out beepers, which strapped around our waists, and also a thick canvas patient ' lifting belt, which was kept on us at all times, and used to strap around a patient's waist when it came time to move them. 
Those bleeping bleeepers never stopped this incessant bleeping all shift. The residents would become anxious with the incessant bleeping, and although you could turn them onto vibrate, this was not allowed.
After handover we would go to our relevant assigned areas for the day, and give out the breakfasts, dishing out the glorious smelling warm oats porridge. I remember once dishing up two small spoons for myself and glugging it down, as I hadn't had time for breakfast that day. (They soak the oats in milk all night, which makes it dreamy creamy. I still have to try that for my girls.)
Some residents need to be fed, and then began the showers and getting everyone up and ready for the day. We each had 7/8 residents to attend to. I became a pro at showering someone thoroughly, and was complimented by my residents on this ability, which made me feel quite proud.
I was amazed at how one resident could squirrel, she was admirable in that regard. You could find absolutely nothing that matched when it came time to dress her, and she became quite abusive if you suggested that you would like to look in her bag. 
It was the forbidden zone. Interesting items always turned up there, a nurses bleeper, missing dentures, mismatched shoes and last weeks chicken drumstick.
Sometimes, if a resident was on day 5, desperate measures of manual intervention had to be carried out, much to a certain residents relief, it is times such as these where I felt I was making a small difference to someones day.
In between doing all the cares, and lunch we had to wash and fold the laundry. and put it into the linen cubicles to be put away the next day, also our job. We would be literally exhausted by the end of the day, as it was non stop moving. Although the hard work didn't make it stressful, it was the nasties we had to work with. My Kiwi and Phillipino colleagues and I had some great laughs throughout this year. Most of them are RN's in their own Country, but have to save in order to complete the CAP which will enable them to work within their scope. 
I now work at a lovely rest home, which is Christian-based. I am working within my scope of practice as an EN, and loving every minute of it. 
A good manager never bullies, but rather guides and shows appreciation. 
I have learnt myself what it takes to be a good manager, as I have HCA's working under me, or rather, with me. We are all equal, we just have different roles. Nobody deserves to be barked at.

An introduction to misdiagnosis...or was it?

South Africa, 1993. 

I was a student nurse at a large government training hospital, and was working on nights in the Medical ward.
It was 19h00, and the beginning of a 12 hour shift. A middle aged African woman had been admitted via Casualty with gastritis by the previous shift, and was in obvious agony. Looking at her I made a mental note to avoid whatever caused gastritis at ALL COSTS. 
Her moans of agony continued as the evening wore on, so the RN called the consultant in. 
Whilst he was obtaining some history in the nurses station, the patient gave a really loud scream, which was sure to wake even the dead. 
I was told to run and give her her pain medication, the RN handed me 2 tablets.
The woman was writhing in pain and sweating when I got to her room. 
I was frightened for her, but tried to calm her, and gave her the medication.
She was shouting in Zulu (she didn't speak any English).
The RN came running in,followed by the Consultant, and told her to please keep her voice down. "Thula Mama, thula...." Thankfully the RN knew some Zulu. 
But the patient was inconsolable. 
The Consultant palpated her abdomen, and made the discovery that the patient was in fact pregnant, and was giving birth. 
The RN sent me to get a receiver, and towels, whilst she helped the Consultant with the patient. 
A small 24 weeker slid out of her just as I entered the room. 
He was perfect, and still breathing, his little tongue was even moving around his mouth. I so hoped all would be ok, and now the patient would be alright. 
But reality set in, as she didn't even want to look at her son. And the small foetus was placed into the cold receiver, still moving.
I was told to put the receiver into the sluice room, and leave it there. If the foetus was still alive in the morning then it would be taken to NICU. 
I was going with the motions, and following orders. I wished I could have saved him, he was perfect. 
The mother had, it turned out, given herself a herbal abortion.

GASTRITIS: Inflammation of the lining of the stomache. NOT to be confused with pregnancy!