The aim of this essay is to reflect of my experience at Critical Care Unit whistle I redeployed in Critical Care Unit (CrCu) in April 2020 and stayed there for eight weeks. I would reflect on in relation to my practice to the skills and knowledge, the significant events happened while working in CrCu, takeaways from the experience and lesson learnt, skills and knowledge gain, mentoring basic skills to other redeployed nurses , assistant nurse practitioners and health care assistants in the first wave of Covid-19
Before the coronavirus pandemic started, I had been working at ward 2B neurosurgery. I was quite new to my job; I had barely begun my 4th month and was not quite completely accustomed to the way things worked in my job yet when the coronavirus pandemic got serious and I was redeployed to the critical care unit. My colleagues and I did one day of training, which explained the basics of critical care before we started work in the ward.
In the beginning I found it very challenging as I was put in the deep end, Area 5, where the entire COVID-19 positive and I had to wear the full PPE.
On my first night, I was given a patient who was intubated and on ventilator, the CrCu nurse who supervised me, was looking after next bed, she was too nice as whenever I stuck either with vent setting or any infusion bolus of blood gases, she comes and sorted out, rather than explaining or teaching me, even though I asked but she made excuses as she was busy and did not have time to teach or explain, which was very frustrating for me as I was not learning the skills.
However, I managed to learn hourly basis observation of vitals, fluid balance and respiratory, but it took me about 40 to 50 minutes to do the observation and next one due.
I could be much better if my supervisor taught me or explained when I asked any questions regarding patient, for example, blood gases if she taught me how to do it or she let me do it under her supervision then I would gain confidence to do own my own next time as blood gases are done quite frequently. However it took me longer to learn to take the bloods from Arterial line and then how to process in the blood gas machine. It was learning lessen for me how to teach nursing students and other Assistant Practitioners (Aps) as when I worked next week with one of the Assistant Practitioners, I asked her to do under my supervision.
As in the beginning I mostly worked in the bays but then they started to change nurse 2 to 3 hours so that nurses working inside can work outside Covid bays, so I worked few hours in Covid bay and outside, giving medicines, doing blood gases or giving other equipment.
Working as outside , preparing medicine and giving other apparatus , like in my initial days I was not familiarised with so many things, nurse asked me for transducer and I was struggling to find my the stock cupboard.
What are the takeaways from this experience /lesson?
• Team work & management
• Leadership skills
• Compassion
• Resilience/stress management
• Effective communications with patients, patients’ relatives and MDT staff
List of the skills and knowledge you feel you have met.
Ventilation
Interpreting observations
Infusion pumps
Suctioning
Tracheostomy management
Proning Patients
Arterial Blood Gases (ABG) (taking and analysing)
ICU drugs
Invasive line management
The following significant events happened during my stay in the Critical Care Unit:
1) It was very stress full night as I experience 1st death with Covid-19 and patient was not very old. As ventilator switched off patient died in few minutes, it was very emotional situation as the relatives and close family were not able to see the patient, they wrote an email which was read one of the nurses before switching off the ventilator, it was very emotional email, touched every body’s heart who were there. The patient body was washed and was rapped with the shroud. After that patient’s body was put in a bag and zipped up. A form was filled with all patient indemnification and put on the bag. Patient death was confirmed by the doctor as witness it was signed by me and one of nurses with alongside with me. This was the first time I did the last offices as newly qualified nurse. The nurse whom I was working with was experienced who explained me all the protocols and policy of the hospital when patients dying due to Covid-19. I gained the knowledge and skills which helped me to deal with other deaths on the CrCU. I believe I would be able to teach to other newly qualified nurses of nursing student how to do the last office and also how to cope with metal stress ( S5K5). As I was very stressed and drained due to this event and it was difficult for me to cope with mental stress but the senior nurse who was supervised me, did not realised my situation or did not ask me for break or not dealt my mental stress. If I were the supervisor or mentor I would deal with mental situation of my students, give them break or take my student in private area and discuss the situation and give my student encourage to deal with the situation.
2. A redeployed nurse working along with me on a patient who was very regressive and irrigating, patient had tracheostomy, central juggler line, had arterial line as due to tracheostomy patient was not allowed to drink water, we were just wetting her mouth with sponges, but he was kept asking to drink a water. Patient got into very aggressive mood and punches the nurse working with me and then he pulled out the arterial line. It was difficult to handle him; however we managed to bandage the arterial line as it was bleeding so fast. After an hour he started to pull the central line and at the same time trying to take of tracheostomy, patient was also swearing. It was very stressful situation; the colleagues nurse was so upset and starts to cry and said that she could not manage and was on the wrong place. I took her on the corner and asked her to sit on chair and tried to calm her down and discussed the matter with nurse in charge and sent her break and then asked her to work as a runner outside the Covid bay. Afterwards I documented all the incidents.
3. Incident: Bloods samples were sent to path lab with wrong labels due to miscommunication. I was working with Staff Nurse, KS as she was in the red bay (Covid 19-positive) bay, took blood sample from bed 16, while she handed over she told me the bed number 16 as she was mask and visor on, I understood bed 15, as result of this miscommunication I printed off the bed 15 bloods labels. From this incident we learnt a lesson that always prefer written communication to avoid these errors instead bed number, write down the full name of patient, date of birth and NHS number.
The experience and skills I learnt from Critical Care Unit enhanced my knowledge and practice to guide students in my area as while we were redeployed to Critical Care Unit, they updated our previous area like High Dependency Unit. After finishing Critical Care Unit my manager sent me to ward 2A, High Dependency Unit where I got the opportunity to guide students in Tracheostomy Care, look after Arterial line, how to set up TPN feed, PCA, other infusions pumps and most important thing how to stay positive, and how to beat the stress.