5. I had an ongoing battle with the cleaners; the ones I encountered in London hospitals werent allowed to clean up vomit, or body fluids, and I wasnt allowed to use their tools (mop and bucket); so, Id 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 dont know exactly how much hospitals save by outsourcing their cleaners to a separate company, but the ones I met didnt 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 Id find things being done in a way that was completely the opposite of what Id 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 wasnt always about the same thing, but a lot of the older nurses confided in me that they didnt 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 thats 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 hadnt had to worry about knocking things over.
Highs and lows of temp nursing
I learnt very quickly that temp nursing is difficult. It wasnt 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 Id 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, Id often end up with a line of work.
Ive lost count of the different hospitals and wards Ive 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 didnt 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 weeks work. But a 65-hour work week isnt 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 youd 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 youre 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 Id 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 doesnt 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, its far from ideal for the patient.
4. Its difficult as a temp nurse to figure out what your boundaries are. Some places would let me administer intravenous medications, others wouldnt. Once I was even reprimanded for helping out with a bed sponge because that was the assistants job, and I was told there were more important things I should be taking care of.
5. Its 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 theyd take any registered nurse as a last resort.
6. Youre on your own. You dont get to know your fellow nurses, and you dont 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 wasnt 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
Youll be looking after beds 1 to 16, Bethany, the charge nurse explained to me.
Ah, 16 patients, isnt that a bit much?
Bethany looked amused at my comment. You wont be alone. Youll have a nurse assistant to help you. Orla usually works on your side. Shes very good, and knows her job.
I wasnt reassured.
I didnt 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 didnt 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 wasnt 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 wasnt always as good as it could be; having only two showers for the whole ward, neither of them accessible by a wheelchair, didnt help. Wound dressings werent always dressed as often as they shouldve been, although I was fortunate to find that Orla was rather proficient at dressing wounds, even though she admitted to me that she wasnt 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 dont suppose I could ask you a favour? Mrs Olsen didnt often ask for much; she was still fairly independent.
Sure, I replied.
I would give anything for a shower. Do you think its 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 wasnt around.
A week, she replied. I havent 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.