Tuesday, April 22, 2008

Nurses Need Hospital Training

Does this sound strangely familiar?

Hospital bottleneck stymies nurse plan
Siobhain Ryan | April 20, 2008 - The Australian

GOVERNMENT needs to put the brakes on plans on massively boost nursing numbers until they solve the worst shortage in hospital training places the profession has seen, John Daly, Chair of the Council of Deans of Nursing and Midwifery (Australia and New Zealand), said.

Professor Daly, speaking on the sidelines of the 2020 Summit in Canberra, said in some states such as New South Wales, nursing undergraduates were already unable to do the hours of practical clinical training in hospitals required to complete their courses.
"This is the worst we’ve seen it, and it’s not just in NSW. The Deans of Nursing and Midwifery are saying it’s a problem across the country," he said.

The Rudd Government’s health policy relies heavily on its promise to ramp up the number of nurses and other health workers, announcing last month it would train up to 50,000 new frontline health professionals.

Pre-election, it also committed $81 million towards putting 9,250 extra nurses into Australia’s hospital system.

But Professor Daly said governments had to address existing bottlenecks in supervised clinical hours in hospitals, and expand training opportunities for undergraduates in GP practices and community health, if it was not to exacerbate the crisis.

"Let’s be very cautious before we rush to increase them any further before we resolve this clinical training problem," he said.

Firstly, this is what happens when you take training out of the hospital system for nurses - when they realise it is a good thing, they can't get back in.

Secondly, student nurses could get plenty of clinical training on-the-job if they returned to working junior nursing positions, but that sort of makes universities redundant - what would you do with all the clinical educators and nursing preceptors?

Lastly, this sounds like exactly the same issues that postgraduate doctors face in getting their specialist experience! Doesn't anyone ever learn?

NB This diagram is a little out of date but nonetheless relevant.

Sunday, April 20, 2008

Ward Fashion

Paging Dr has had some discussion on fashion amongst medical students and junior doctors. In Australia, we don't generally have the advantage of covering everything with a white lab coat. I'm no fashionista, and I recognise that there is a great deal of variety in how people choose to dress.From a practical standpoint, These are my tips for fashion in the clinical environment:

  1. Wear something easy to change. Especially if you are going to enter theatre, you don't want to have to spend forever getting changed.
  2. Wear something stain resistant. Blood, pus and goo are regular staples on the wards. You want something that you can wash, or dry-clean without breaking your budget.
  3. Wear something comfortable, or which will become comfortable. You will be working long days, and do not want to have to keep taking things on and off all the time. This is especially true for footwear. Not many of us have a luxury of an office or a locker. Having said that, if you get one, hold onto it for dear life.
  4. Avoid short skirts or low necklines. Unlike TV shows, hospitals are not a pick-up venue. You are here for work or study, and there are no janitor's closets for you to have a quickie in. Apart from what your colleagues might or might not think, you also have patients to think about. One of my interns once complained that she could not insert any male IDCs, because they would always have an erection when she came to do it. I had to explain that showing your cleavage every time you bend over might not be helping. Also remember that geriatric wards are often full of disinhibited old men. Nurses learn very quickly not to lean over in short skirts. You should too.
  5. Do not dress more formally than your registrar or consultant. Especially if you are mature-age, you do not want patients to think you are the boss. It is embarassing for you, the consultant, and the patient. On the other hand, if your consultant likes to prance around in leather jackets or looks like a frumpy old housewife, then anything goes.
  6. Avoid jewellery. Bling does not make you look more professional. Bling makes it difficult to wash your hands or to wear gloves. Bling has lots of crevices where blood is hard to clean out. Bling has a tendency to disappear.

    Don't worry if you can't remember the rules. Sooner or later you will work them out, but there might be a few unpleasant experiences along the way.

Friday, April 18, 2008

SurgeXperiences 19

As every new inbound link is precious to me (mainly because I don't have that many) I have agreed to host one of these Blog Carnival thingies in the next few weeks. This is somewhat of a problem since I tend to just write what I think, and don't go around reading other people's blogs all the time unless there is something specific that catches my eye. Does that make me a hypocrite?

In any case, I suppose the fact that I am hosting a Blog Carnival means I am obliged to start promoting it. And I will have to read all these submissions.

So, here you go: SurgeXperiences Issue 19 is out at Marianas Eye. You can view it here.

Sunday, April 13, 2008

All Gloved Up and Nowhere To Go

My experience is that about one in 20 examination gloves (not to be confused with surgical gloves) have a fault of some sort - breaking while being put on, unexpected size discrepancy, holes present already in the glove, deformed glove or adherent to another glove.

I must admit, however, that I am not a big glove wearer. Cringe if you will, but I do not wear gloves to examine groins, scrota, or feet. I only go to the trouble of donning them if there is an ulcer, wound, pus, or (potential) intertrigo (commonly known as skin-fold porridge). I am, however, an avid hand washer and user of alcoholic hand rubs.

I also do not wear gloves when putting in IVs or taking blood. A poorly fitting examination glove is completely useless to me as protection against a needlestick injury. If non-sterile surgical gloves were cheaply available I'd consider wearing them - but poor quality examination gloves only make my job more difficult and dangerous.

From The Australian - Examination gloves fail lab testing

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