Friday, June 26, 2020

Becoming UKRN - things you should know before you come here (Filipino Nurse in the UK)

This blog is intended for my fellow filipino nurses and other immigrant nurses who are about to work in the UK soon. As of this time of writing, I only have a total of  16 months experience as a nurse but I was lucky enough to have been assigned to the toughest surgical ward in the universe. So might as well share some relevant information (that I know so far) so you can gear yourself up before battle!

Your uniform will be provided to you once you arrive. The dress code follows infection control standards such as the following:
1. Shoes - they should be black in color, leather or rubber type that will protect your feet from blood or fluid spills. Preferably without shoelaces as they are more difficult to be cleaned after use.
2. Hair - should be tidy and off the collar
3. Bare below the elbows - no wrist watches, bracelets, nail varnish or fake nails (you can buy a fob watch instead)
*Your uniform must not be worn outside hospital premises to reassure the public (as it is perceived as an infection risk).

Your work hours depend on your assigned area but mostly it is a 12 hour shift, either long day (from 7:30am to 7:45pm) or night shift (from 7:30pm to 7:45am). You will work 3 days in a week but one week is 4 days (per month), so that's a total of 13 days in a month.

You will be given a few days to get settled in your accommodation and a designated day to go the bank to apply for an account which will just take a few hours to be processed. The next week after you arrive, you will have one week of induction period. It's a classroom type of sessions where you will be oriented with the trust values and policies, and do some basic trainings to prepare you to start working in the ward. The following weeks after that, you'll work as a healthcare assistant in your designated area and some of those days will be allocated for OSCE review. The job of a healthcare assistant is washing patients, giving commode or bedpan, emptying catheter or stoma bags, feeding patients, checking blood sugar and observations (aka vital signs), and things that the nurse will ask  you to do for the patient.

Once you pass the OSCE, you'll have your NMC pin and you will start to look after a bay of patients (usually 5-7 patients). But before this, you will have 'supernumerary' days where you will just have to shadow a senior nurse and learn from them what's the usual RN routine.

A.) Long Day
      7:30am to 8:00am - Handover from night staff (Questions to ask yourself during handover - Were the night meds and early morning meds given? Should I be concerned about their latest observations? Do they need fluid balance? does any of my patient in DNACPR status? anyone on catheter, central lines, drains, stomas, etc? How's their mobility? What's the current plan for my patients and why are they still in the hospital?)
     8:00am to 9:00am -  Medication rounds and wash patients / check bedside oxygen and suction if available and functional incase patient will deteriorate
     10:00am to 11:00am - Routine Observations check
     11:00am to 11:30am - Huddle with nurse-in-charge
     12:00pm to 1:00pm - Lunch / medication rounds
     1:00pm to 5:00pm - 30mins to 1 hour break / carry out doctors orders and other nursing procedures such as wound dressings, making referrals, admissions or discharge, etc
     5:00pm to 6:00pm - medication rounds, finalise fluid balance and other monitoring
     7:30pm to 7:45pm - handover to night staff

B.) Night Shift
There's not a lot of drama going on during night shift. The usual nursing task during the night is to look after your patients and do the following:
      - CD check - 2 registered nurses count the controlled drugs and check for any discrepancies, and sign the CD book
      - one RN checks the crash trolley and ensure all equipment are available, functional and up to date

OTHER NURSING DUTIES that will take some of your time while at work (aside from the usual routine above)
1. Wound care and dressing change
2. NG tube insertion / NG feeding
3. Suture or clips removal
4. Answering phone calls from relatives
5. Drain or catheter removal
6. Filling up district nurse referrals
7. Giving controlled drugs (since you need to find another RN to do it with you)
8. Changing stoma bags and cleaning patient when the bag leaks
9. Giving enemas
10. Filling up admission papers and doing nursing assessment checks for new patients
11. Discharging a patient and chasing doctors for discharge summary
12. Following dementia patients wandering around the ward
13. TPN (Total Parenteral Nutrition) administration / blood administration
14. Wiping bum
... and many more!

1. Controlled drugs - some of these drugs could have the same name but with different action. For example oxycode modified release or oxycodone immediate release. Make sure you're going to give the right medication. Also, sometimes pregabalin is given instead of gabapentin. Maybe because they seem to sound alike. Any controlled drug should not be left unattended outside the CD cupboard.

2. Blood administration - before collecting the blood from the blood bank, ensure patient has a patent IV cannula, observations are checked and infusion pump is available. Observations to be strictly checked 15 minutes after the start of infusion and after transfusion is done.

3. Bedbound patients or with limited mobility and underweight - they are prone to pressure ulcers and skin should be properly checked every shift, air mattress to be used and regular repositioning done.

4. Diabetic patients on insulin - they are prone to hypoglycaemia (blood sugar less than 4) and that is life threatening. Ensure that you're giving the right type of insulin. They can also have constant high blood sugar and proceed to diabetic acidosis if left untreated.

5. Post-operative patients - surgeries could lead to complications and close monitoring can help prevent it. After receiving patient from recovery, observations needs to be monitored at least every 30 minutes to every hour until stable (depends with your hospital policy too).

6. Possible Septic patient - If patient is breathing faster than his/her normal rate or is having fever, check his latest blood results for infection markers (CRP and ESR). Make sure to inform doctor and they might need to prescribe antibiotic and do some other stuff. Septic patients could easily deteriorate so we don't really want to delay treatment.

7. DNACPR - it is a serious incident if you do cardio-pulmonary resuscitation to a patient with DNACPR status because it will look like you did not respect their decision (if they made the decision). Some people would just like to die in peace.

*Is the patient not eating well or had significant weight loss?  - refer to Dietitian / start food chart
*Does the patient has a serious wound that you're not sure how to manage? - refer to TVN (tissue viability nurse)
*Is the patient still with pain despite all painkillers being given? - refer to Pain team
*Is the patient diabetic and is having constant abnormal blood sugar results? - refer to DSN (Diabetes Specialist Nurse)
*Is patient is having swallowing difficulties? - refer to SALT
*Do you think the patient's current health condition has changed and he/she lives alone and might have problems with his/her ADLs (Activities of daily living)? - refer to PT/OT (Physiotherapist/Occupational therapist)
*Is patient having high NEWS (National Early Warning Signs) score or deteriorating? - refer to doctor and Outreach or critical response team.
*Patient going home with a surgical wound or catheter? - send a district nurse referral

There's a lot more than these and you will learn more as you go along the flow of UKRN life. Anyway, I hope you learned a lot from reading this blog. See you next time!

Becoming UKRN - things you should know before you come here (Filipino Nurse in the UK)

This blog is intended for my fellow filipino nurses and other immigrant nurses who are about to work in the UK soon. As of this time of writ...