Nursing is not like you see on TV
15 Aug 2011 2 Comments
in Being a student nurse, Experiences, Nurse knowledge, Placements Tags: advice, anatomy, Dr.House, Grey's Anatomy, hospital, hospital documentary, hospital drama, hospital ward, house, intravenous, medication, nurse, nurses, nursing, nursing care, nursing television, real-life nursing, student nurse, televsion, TV
This is probably more a rant than a professional blog post, but I just thought it would be useful to point this out. I am tired of a lot of people assuming that nursing is easy, because it really is not.
During the 2 years of training I have had I have come across people who base their opinions on nursing on what they see on the TV.
I regularly get asked if my training is like being in hospital comedy ‘Scrubs’. No, it is not, because I am not a medical student. I am a student nurse and I work a hell of a lot harder than what you see the cast of scrubs doing!
As a successful nurse you are incredibly smart, professional, hard-working and devoted. Your life is constantly filled with literally saving lives, being an advocate and a promoter of independence and researching every different aspect of nursing out there. You will be learning for the rest of your career.
You are NOT constantly giving bed baths and cleaning up faeces. Those things are actually only a small part of your career.
Nursing on TV can be seen in two different ways. There are documentaries that feature the work of nurses such as 24hrs in A&E or One Born Every Minute. These can be very vague about the reality of nursing care, but do give viewers a fair impression.
But then there are fictional dramas based on what goes on inside hospitals such as Grey’s Anatomy, House, Casualty and Holby City.
I’ll be honest – although these television shows may be very entertaining and based on some factual knowledge, they are far from the reality of the running of a hospital and even further away from real nursing care.
Grey’s Anatomy and House couldn’t be any further away from reality – showing doctors completing tasks such as hanging IV drugs, inserting IV cannulas, giving injections… doctors rarely do any of these things – nurses do. Doctors never give medication. This isn’t a stab at doctors; this is just me speaking the truth. Doctors also can’t perform procedures such as every kind of surgery, X-rays, CT or MRI scans and several other things – as you will learn these are all things done by people trained in each specific field such as radiologists or specialist surgeons.
Nurses are regularly portrayed as side characters who don’t really know what they’re doing and take orders from doctors. This is completely untrue. You will find that what normally happens in most situations is that when a nurse finds a patient having a problem, the nurse normally knows what is going on (on some occasions they don’t and the patient requires further examination). Nurses HAVE to learn a hell of a lot about anatomy, physiology, cell biology, medication and side effects and so on. A nurse however does need a doctor to give them the go ahead with certain procedures, or needs a doctor to sign a drug chart to authorise a new drug.
Another point I would like to make – Dr. House, however entertaining he may be, would not exist in reality. I have seen some doctors try to behave like House does, but fail when they have been put in their place or given official warnings. I can’t even tell you how many times I have seen a nurse have to give a doctor a telling off for his/her inappropriate and disrespectful behaviour!
Don’t ever let a TV show fool you into believing that a doctor is in charge of nurses – this is simply not how it works and if anyone is going to be in charge of what happens with patients, it is the senior nurses on the ward/unit.
At the same time I would like to point out that doctors are not useless – that is not what I’m trying to say. I’m just trying to explain that they are not there to make every decision and have nurses kissing their feet.
Quotes from House:
Dr. House: (after his patient collapsed) “This is exactly why I created nurses. Clean up on aisle three!”
Dr. House: “Let her vomit through the MRI, that’s what nurses are for.”
Thanks for reading!
Intensive Care Unit; a learning experience not to be forgotten
12 Mar 2011 Leave a Comment
in Placements Tags: acute, arterial lines, central venous line, death, ICU, intensive care, intravenous, manchester, nursing, oxygen, student nurse
So I’ve just finished a 5 week placement on the Intensive Care Unit (ICU) at a hospital in Manchester, and am currently enjoying a week off. I have done a lot of sleeping. It feels like I’d been on ICU a lot longer than 5 weeks, because the amount I learned was unbelievable.
I am currently studying the Acute Care in Adult Nursing unit at university, so ICU was a perfect fit for that unit. Acute care can be considered as an urgent event in healthcare, whether that means a person being in sudden pain from an injury, or a person choking on a bit of potato.
On ICU it can be things such as a patient’s O2 saturation levels suddenly dropping from 99% to 80%, or a patient going into urinary retention and not being able to eliminate toxins and waste.
The action taken in these situations is the ‘acute care’ given, such as sticking an oxygen mask on someone and giving them 15lites of O2 a minute, or inserting a urinary catheter.
ICU consisted of an awful lot of Intravenous medicine, bed bound patients, urinary catheters, blood samples, chest physio, machinery, ventilators, tracheostomies, suction catheters and death.
It looks a little like this, only the machinery is far bigger:
Above: I could not find the artist of the above image so I don’t wish to take any credit for it – I just really like it.
A typical day on ICU – a whole day of new learning experiences:
At this particular ICU, an early shift would start at 7.30am and finish at 2.45pm. A 7hr shift with a 15min break (I much preferred early shifts as more care was given than on a late shift). You look after 1 patient per shift.
If you want to learn how to prepare IV medicine then ICU is the place for you. Just as I’d finished preparing IV drugs for 9am (aseptic technique, syringes, needles, calculations, potions and all) it would be time for hygiene care to be given. Teeth brushed, Chlorhexidine mouthwash begrudgingly given (it tastes AWFUL), full bed bath and moisturiser massaged into wherever needed moisturising. Sometimes a patient would be hoisted into a chair (if they were conscious) to help them regain muscle strength. Fluid levels, blood gases and paperwork would then be completed.
By the time this was all done, it would be time for afternoon medication. Back to the clinical room! Once the afternoon drugs were completed, any other tasks to be done that day would be completed – this could be surgery, replacement of lines, inserting a tracheostomy etc.
Most patients on ICU have a Central Venous Line inserted for the majority of their drug administration. This is a catheter that is inserted into a large vein in the neck, such as the internal jugular vein:
Above: A patient with a triple-lumen CVL inserted for antibiotic drug use. Image taken from http://bit.ly/gvmQOj
Makes it much easier with CVPL’s as large veins can take the pressure of a lot of drugs being administered several times a day.
There is no doubt that ICU was one of my most difficult placements because of how much I had to learn about the ventilation system – I will not even start going into it. The majority of patients are also admitted under sedation and can be sedated for days – this makes the work heavier and more time-consuming as you are moving a patient’s full weight when they are unable to move. Plus there are a huge amount of wires and tubes going in and out of the patient – a patient can have 3 syringe drivers on at the same time, plus 3 or 4 suspended drips, an NG and NJ tube (you can google the difference), a urinary catheter and sometimes a drain from a wound or an infected bodily organ.
The clinical technology used can be intimidating. Blood pressure cuffs are not used on ICU – arterial lines are used instead to get a constant record of the patient’s blood pressure (check this out http://bit.ly/fy5XWJ). It can also be used to get blood samples so the patient’s blood gases (blood ph levels, CO2 levels, sodium, potassium, glucose etc) can be checked at regularly intervals.
Death was definitely something to get used to on ICU – my first patient died on my 2nd shift. 1 or 2 patients died a week during my time there, some of them not that old and some of them leaving behind people who then had no one to care for them.
Luckily for me, the staff at this ICU were more than amazing. Everyone was very keen to teach me and I was made to feel very involved in patient care. I was given many opportunities to do anything that I was able to as a student nurse, which gave me the confidence to use more of my intuition. Shame that ICU also meant that I was completely knackered most of the time.
If you get a chance to train on ICU, make sure you get stuck in and do everything you are able to do (obviously, administering IV medication is a no-no, as is deciding to mess around with sedation and morphine levels without being told to). You will leave realising that you knew less than you thought beforehand. Unless you’re a registered nurse of course.
ICU could end up being my elective placement in 3rd year 
