Degree v Diploma

So nursing is to change to being an all-degree profession from 2013. Not a huge surprise. Mental Nurse is having a proper discussion on it if you want to know more, because you know what?

I don't care.

Frankly, I don't give a damn what they make us do to be nurses. To be brutally honest, I'm hoping it will put some of the thicker applicants off doing it; you can be as caring as you want, but if you can't scrape a third in a degree with three attempts at every essay then there's no fucking way you should have people's lives in your hands.

Of course, the argument is that being able to write an assignment doesn't make you a good nurse. This is true. Assignments only show how well you can write assignments. However, if you still can't pass one on the third attempt after receiving feedback and support from tutors - and often just being told straight up what the hell to write - then that to me shows an inability to learn from your mistakes, to listen to and act appropriately on new information, and just an incredible density that means you should not be allowed to dish out potentially lethal drugs to sick people.

So I don't care. What I do care about, a great deal, is money. Of course.

I'm currently filling in a 26 page form begging the government to give me a pittance towards my living expenses, in order that I might qualify as a MH nurse and thus be graciously allowed to spend the next forty fucking years caring for people whom a fair percentage of society don't actually give a shit about.

You want to make sure people still go into nursing when it's all degree? Make sure they don't have to default on their mortgage to do it.

Parents, eh...

...they cause you nothing but stress.

Yeah, this isn't hugely mental health related, so feel free to go read something that has less of me getting stressed in it.

Ok. So regular readers will know that my mum is a falling-apart 54 year old who is already on her third hip replacement. Today, she had some more surgery; just a minor exploratory op for some womens' problems. The thing is, she is pretty sure she stopped breathing whilst under the anaesthetic; she heard them talking about it as she was coming round and woke up in the higher dependency bit with two nurses, rather than the recovery room they had told her she would be in. She didn't ask about it, though, and no-one has said anything to her. She's fine now, but it's making me a bit concerned cause she will almost certainly need more surgery in future given the crumbling nature of her joints. So I guess I'm after some reassurance from some doctors/proper nurses that this isn't likely to happen again. Please. I hope.

Otherwise, we had to submit dissertation topics today; was very short notice given that we only got the criteria half an hour before. After some negotiation with the bloke who I hope will be my supervisor, I'm going to investigate the effects of physical restraint on female patients. This is alongside the stuff on female sex offenders that I'm doing as a smaller essay. Am up to my eyeballs in women, basically. So, if anyone has any useful literature on either of these topics, my email address is at the bottom and it would make me love you forever :o)

I don't usually plug things, but....

...this could be useful for some people.

Someone from the Guardian has very kindly asked me to be a student 'expert' (hah!) on one of their live Q&A sessions about careers in the NHS tomorrow. I can't do it, unfortunately, due to my attempts to forage my own career in the NHS tomorrow afternoon. However, I did offer to plug the session, to make myself feel better. So, if you have any questions about getting an NHS career, then go here and some more helpful person will try and answer them.

Just...urgh.

Like nearly everyone else in Britain, I'm ill. I have a stupid cold. It's been developing very slowly over the last week, and I think I've had nearly every symptom of a cold seperate from every other symptom. So for three days I had a sore throat, then that went and I got a cough, now the cough has gone and I have a runny nose and hurty sinuses. All, however, were underpinned by a general feeling of crappiness. I would have rather had everything together and gotten it over with by now, but instead I think it's going to drag on.

So, forgive me if I'm a bit quiet lately but I just have very little energy and what small reserves I do have are dedicated to Uni work. I'm doing an essay on female sex offenders, which turns out to be quite topical, but it's pretty heavy going ploughing through the literature.

On the plus side, feeling crappy gives me a very good excuse to avoid taking any shifts at work. Avoidance is necessary right now because both ladies wards are, not to put it too finely, up the fucking pole, and the staff are dropping like flies. The thought of restraining with a dripping nose is not too appealing, although possibly the threat of being pinned down and having snot dripped on you might be a deterrent to any patient contemplating kicking off.

So, to summarise: Ill, skint, and buried under a mountain of sex offender literature.

Living the dream, people.

H is for...

So, I've got my next placement sorted...I'm going back to where I work. I'm choosing to see it as the logical progression given where my interests seem to lie (i.e. forensics) and not just that I'm taking the easy route. Which I am. I've really enjoyed some of my other placements, and if the local acute wards ever go to 12 hr shifts then I would seriously consider applying to work there. But for now I just want to not be stressing over starting somewhere new and having to go there five days a week whilst also fitting in bank shifts and trying to do a dissertation. Being at work means 4 days off a week, first choice of bank shifts (cause I'll be able to hunt down the almighty Rota Woman and harass her) and the absence of freaking out with those 'new starter' nerves (ohshitohshitohshitwheredoIparkwheredoIeatluncharetheygonnabenicetomearghhhhh!).

Sound like I'm trying to justify it much?

Also, work is probably the only place in the area that is going to be taking on staff when I qualify since they are expanding and are about 40 RMN's short.

Yeah, still justifying it.

So, while I wallow in the feeling that I should really be making more of my training, here's H...

Hygiene (Personal and Environmental)

I may have mentioned before, but patients have a varied relationship with hygiene. Some border on obsessive in their bathing, whilst others prefer to moulder in their own filth until their clothes become physically attached to their skin. Most fall in between. If a person becomes so dirty that it is offensive* (usually about the time you start to gag when they enter the room...or even the building) then we bully them into the shower in the nicest possible way. On these occasions HazMat suits would be useful, and it would be nice if in the summer months we were just allowed to hose them down in the courtyard. Damn Human Rights Act.

Strangely, some of the people who would prefer to kill rather than change their clothes tend to be fastidious about their environmental hygiene. Patients are expected (read: nagged, usually fruitlessly) to clean out their room at least once a week, but all other areas are cleaned - again, with varying degrees of success - by domestics provided by a contractor. Some of the long stay wards absolutely reek of lavender-air- freshner-with-a-hint-of-stale-urine.

We have a lot of mice, which provides endless entertainment on a night shift when you're teamed up with the type of person who screams and jumps on a chair at the sight of something two inches long and furry. A well-placed dustball in a draught can have hilarious results at 4am.

*Which, to be fair, can apply to some staff as well. Wonder if the Human Rights Act prohibits hosing them down in the courtyard.

Hostages

We get a very basic level of training in ‘how not to piss someone off when they’ve taken a hostage’, from both a negotiator perspective and a hostage perspective. Role-play is often a great experience for staff, giving them as it does the opportunity to vent any frustrations they may have on the poor bugger who gets to play their hostage. All in the name of realism, of course.

Actual hostage situations are very rare, but are obviously very serious. One staff member who was involved in a pretty nasty incident 20 years ago never worked again after developing PTSD. Basically, we always, always phone the police; they have better training, and weapons, and body armour. Apparently they are going to be giving people proper hostage negotiation training soon, which is the kind of thing it sounds fun to go in for until someone barricades themselves in the quiet room with a pool cue and a terrified member of staff and it's you they call...

Hostel

Scary places where patients are discharged to in the hope that they won’t offend again. Quality varies massively, from the 'this is fantastic I want to live here forever' to the 'you can just kill me now, there's no fucking way I'm spending even a night there'. The quality of the supprt they give can make or break a patients chances of surviving on the outside. They are always, always underfunded.

Handover

This is when the nurses huddle in the office and talk about the X Factor for half an hour. Occasionally a patient may get a mention if they did something particularly exciting, although usually little short of murder and/or suicide will warrant interrupting the argument about the merits of Jedward. If you need their attention during this time, you best come armed with biscuits.

High Security

Where patients go when they are very naughty. There are three high security 'special' hospitals in England; Rampton, Broadmoor and Ashworth. We send them our most violent patients and they keep hold of them for a few decades years until they are burnt out/medicated into a less threatening state, at which point they send them back and we attempt to resocialise them into not being afraid of the outside anymore.

The hospitals themselves have security more akin to a prison. They have been subject to massive investigations over the years, with complaints ranging from the mass abuse of patients by staff, to the staff being completely under the thumb of the patients to the extent that sadistic paedophiles were being left alone with child visitors (see here for a snapshot, but the entire report makes for disturbing reading if you have the inclination). Things have allegedly improved now. Certainly, a lot of our patients that come from there seem to want to go back.

And on that cheery note, I'm off to revise antipsychotic drug classifications. Diphenylbutylpiperidine, anyone?

G is for...

Not much, actually, so this may be brief. This is probably a good thing, as I have tons of other stuff I should be doing; revision for a pharmacology exam, an assignment on a topic of my own choosing (which is sadly exciting - yes I'm easily pleased), a fanfic to finish and a dissertation topic to find. Some of them are much more appealing than others, but it makes me tired just thinking about it all. And given that I've been surrounded by people coughing and spluttering inconsiderately in my direction, I think it's safe to say that my sniffles and headache are the beginning of an impending cold. Bah.

Anyway, onwards with G. I really couldn't think up much for it, so am open to adding a few extras if people want to make suggestions.

Gardens

Our unit has a few courtyards which are mostly used for smoking, hiding contraband in and, in the case of one patient, locating insects for use as a nutritious snack. Some of the courtyards have bits of grass and some plants. One of them has been turned into an allotment, thus we grow our own veg for patient cooking sessions and to sell to staff at christmas (big bag of mixed veg for a quid, bargain*). We also have ducks, chickens and a variety of small furry creatures which get used as a kind of 'pet therapy' and way of encouraging responsibility in people. I should probably add, maintenence of the allotment is on a voluntary basis; we don't make patients work the fields anymore. Maybe when the Tories get back in, who knows.

*Money goes back into buying stuff for the allotment, despite the staff's sneaky efforts to take a cut; patients may not be out there in all weather compulsorily, but the staff pretty much are. The unit did buy us some one-size-fits-none all waterproof jackets though, so now I am expected to try and supervise the collection of eggs whilst fighting to see out from underneath my massive, massive hood.

Guilt

Is a strange thing in secure services. We spend half our time helping some patients to feel less guilty about what they did, and the other half trying to make the rest feel any guilt at all. Some patients will never feel guilty about their actions, and so are very unlikely to ever get out given that an absence of empathy for their victims is a pretty good indicator of recidivism. If they're clever, they'll learn to fake it. Those are the scary ones.


Ground Leave

What you have when you are allowed out of the building but have to stay in the hospital grounds. It's about as exciting as it sounds. There is a map stuck on the office wall with the perimeter marked and the suggested route for walking round it. It takes about 15 minutes, so you can usually do two laps in your half-hour leave, which some people do. Others just head straight to the rec hall to get a cup of scalding yet watery 'tea'; at least , when it's open, as it's staffed by volunteers so the actual opening hours are incredibly variable. If you fancy a gentle introduction to mental health services, see if your local hospital needs volunteers in the patients cafe*; you will quickly find out if you are cut out for working with mentals and will meet some very interesting people. You will also see lots of staff hanging around; usually all sitting at a table with staff from other wards, trying to hide their radios** and look unobtrusive whilst they watch to make sure their patients don't do a runner/buy any drugs/hurl their tea-flavoured water at anyone. You will also see them turn a blind eye when said patients sneak outside for a cigarette (banned on hospital grounds)....until a known 'grass' walks in and they suddenly wrestle the fag out of their hands and start pretending they'd only just noticed they were smoking. Letting your patient smoke in the grounds is a disciplinary offence. Which personally, I think is pathetic. But I'll save that rant for when I get to 'S is for smoking'.

*Patients cafe= cheaper than staff cafe. It's not a segregartion thing; if patients fancy paying extortionate prices for the same food they get served on the ward then they are welcome in the staff cafe.

**Staff escorting patients in the grounds take walkie-talkies. Each ward has a security call sign and staff have to 'radio in' periodically to let control know they are alive and unmolested. If they radio that they need help, control will gather a respose team and send them out to assist. That is, if they can find you. And if it's not raining. Or snowing. Or a bit windy.

F is for...

Favourite Patients

Having 'favourite' patients is highly unprofessional. Of course, that doesn't stop it happening in just about all mental health settings. Professionals are human too, and it's very difficult to remain totally objective without becoming a robot. Robot's aren't known for their therapeutic engagement skills. The trick is not to let it interfere with how you treat everyone.

Strangely, favourite patients aren't always the ones who follow the rules and do everything they're told asked to. In fact, staff will usually have different patients they each like better; there is rarely anyone on a ward who is universally hated, no matter how difficult they are. A patient I struggle to get on with for whatever reason might get on much better with other members of staff, and similarly one of my 'favourites' is someone who everyone else rolls their eyes about a lot. You can never know how someone is going to react to you, but there are some ways to ensure you won't be anyones favourite...

1. Make malicious complaints. And I do mean malicious; valid complaints won't (usually*) get you hated, despite what you might think. If you are complaining because there weren't enough staff to take you out on leave, we won't take it personally; in fact, we will probably side with you because a complaint coming from a patient will have more oomph than one from staff. If, however, you are complaining about something that never acutally happened (and you're not delusional) which could land someone in serious shit, then yes, people may take a dislike to you.

2. Assault other patients. I'm not talking about attacks by patients who are acutely ill; I'm talking about the ones who plan it, who pick on weaker or more vulnerable targets. That pisses us off. We get quite protective of a lot of our patients.

3. Attack staff. Again, not relevent if you are acutely ill. But if you know what you're doing, and do it anyway, then eventually you're just gonna alienate everyone. Which may be what you wanted, but it will just make things harder for you in the long run. We will still (hopefully) be professional in our dealings with you, but no-one is going to go out of their way to do anything for you.

4. Make comments about our family/loved ones. I have been called a lot of names, and had some very personal remarks made about me, my body/face, my sex life etc. Fine. But when you start making comments about peoples children (eg. loudly hoping they die horribly, or worse, talking about what you are going to do to them when you get out) then that gets people's backs up. Patients on our unit know that if they really want to hurt Mr Door, then it's me they need to go for, either physically or verbally. Luckily, he's not upset anyone enough to try it. I'm pretty sure he'd kill them if they tried, so it's probably a good thinh he's trying for a career change.

Anyway, back to favourites. In forensics, things get a little weird. In order to work with this particular client group, you have to be able to detatch yourself somewhat from their crimes. You can never forget about it completely, of course, but just in order to be not only civil but actually therapeutic in your interactions requires you to put it to the back of your mind.

Through ignoring the crime, though, you end up liking people who have done some nasty stuff. Because people that do nasty stuff aren't always nasty to be around. Some of them are actually quite funny, intelligent, charismatic people. And so your favourite patient might be a killer, or a sex offender, or maybe just a plain old bank robber.

This is weird enough, but then you have the odd moment of clarity. You remember their victims, and their victims loved ones. They probably hoped their abuser/killer etc would spend the reast of his life in a dingy cell being thoroughly miserable. They were unlikely to think that they would end up on a (comparatively) comfy ward being liked (again, comparatively). I don't know about anyone else, but that doesn't sit comfortably.

One of the patients I have a particular soft spot for is a man convicted of murder. I know I'm of a similar age to one of his victims. I'm pretty sure this victims family would be devastated to think that I occasionally go out of my way to do 'nice' things fro him. In this case, the 'nice' thing is to occasionally bring him crayons and scrap paper in, because his brain is so fucked that all he does is draw the same few symbols over and over again on whatever he can egt his hands on. There is possibly some sort of karmic justice going on there. Mr Door has been known to put songs on patients mp3 players using our home computer. At the end of the day, it's not a prison and they're there for treatment, not punishment. But it's still hard to reconcile, and I sometimes wonder if I should be more 'professional'.

Ok, I'm stopping there before I get in too deep and confuse myself.

*Of course, this is based on where I work. Can't speak for other places. But I would hope patients feel able to make valid complaints without threat of retribution these days...Naive? Me?


(In)Famous Patients

Every now and again, we get a patient admitted who is 'famous', or possibly more correctly 'infamous'. This usually means they have been in the local paper under the headline 'madman goes on naked samurai sword rampage'. Occasionally, they have made the national news, and we did have one patient who got a mention in a book and never let us forget it. Of course, staff behave professionally in these situations and will make sure to take turns to go and gawp at them. There is often a memo sent out reminding us not to talk to reporters and giving the number of the Trust PR office, who are apparently better at saying 'no comment' than the rest of us. We also have to screen the newspapers before they go onto the ward, and don't usually let them on if they have stuff in about a patient. A procedure that often proves pointless when said patient's face is then splashed all overthe BBC news along with every little detail of the crime.


Fence

It's about 15 feet high. It's the bit that actually looks like it belongs on a prison. The other security methods tend to be a bit subtler; the windows are barred, but not in a particular jail-style way, and the locks aren't very imposing. All the glass is toughened and shatter-proof; neither of which, it turns out, will prevent a truly determined man from putting his head through it.


Female Services

Women get a raw deal when it comes to secure services. They are in the minority, which means that instead of having separate wards for, say, acute and chronic patients as they do for men, everyone gets lumped in together on one messed-up ward. It's not a great combination, as the acute patients inevitably require more nursing input and so there's an unfait distribution of care. The private sector appears to do better than this, seemingly they have more specialist wards. But then, we send them all of our nightmare patients anyway, so it kinda makes up for it.

I could do an essay about female servies, and in fact, have. See here for more discussion of it.


Firesetting

Often people in forensic services like to burn things. Sometimes the things are inanimate objects; sometimes the things are other people. Sometimes the things are themselves. Either way, lighters are highly restricted (each area has a ward lighter and patients can earn the privilege of having one during the day) and matches are banned. Most often, if you find a contraband lighter, the worst that was planned for it was lighting a sneaky fag in the toilets. Most patients couldn't be arsed with setting fire to anything cause they'd have to get off the sofa to evacuate.


That was F. I'm sure I had other things to include, that got deleted in the Big Format Fuckup. Hey ho.