Off to work for eight this morning and it’s a gorgeous day. No huge commute here – one of the joys of working on a small island! I am working a split shift today, which is from 08.00 hrs to 12.00 hrs and then returning to work at 16.00 hrs until 20.00 hrs. It’s a very old fashioned shift but I changed to it today because we didn’t have registered nurse cover in the evening, so my turn today. We are constantly short staffed so we have all been working extra shifts to ensure there is safe cover. I shall have a moan later because I was due to go out this evening but by the time I finish work it will be too late. Grr.
All the staff gather in the office to get handover from the night staff and receive updated information on our patients’ conditions plus news of any new admissions during the night. We have had one admission overnight, a poorly visitor who is desperate to go home but is not well enough to travel. They requires intravenous (I/V) antibiotics but do not have travel insurance and is worried about the cost of treatment. They are from the EU and thought that they would be covered with insurance. One of my night colleagues is working very hard to persuade them to stay but we cannot force them to.
There have been a few patients requiring treatment in the emergency room during the night – all were as a result of Alderney’s Summer festival. Too much sun and alcohol is a common feature during the holiday season! A nurse’s work in Alderney is varied and we have to be skilled in many aspects of nursing. We provide routine inpatient care, palliative care, emergency care and community care. It is an interesting job and can be a particular challenge on night duty, with responsibility for looking after our long term in-patients as well as providing cover for the emergency assessment room with only 3 staff on the night shift. Anything and everything can come through the hospital doors and we have to be prepared – we do pull together and work really well as a team.
I am in charge of the morning shift today, so after handover, I go up the ward to say hello to all the patients and make sure our lovely band of nurses, carers and housekeeping staff know what needs doing. We have a brilliant team here and it’s a very friendly place to work. My staff nurse colleague is off to work in our out-patient area doing pre-operative, oncology and other speciality blood tests and ECGs which we do each morning. We look after the patients who would otherwise have to go to Guernsey for their tests. It helps us nurses too because we get to keep our skills up and also keep in touch with all our patients.
About 09.00 hrs our ward clerk comes to tell me we have an emergency admission coming in from the community. The doctor is on the way but I will start assessing the patient as soon as they arrive. I can tell they are very ill when they arrive. They look pale and drawn, and they are in a lot of pain. I take them straight into the ward, and settle them in. I measure the patient’s vital signs (blood pressure, pulse, breathing, oxygen levels and also take blood tests and insert a cannula in their hand (a tube through which intravenous antibiotics or fluids can be given). We do not have doctors resident in the hospital but we work very closely with the local GP practice.
My colleague joins me and we are so concerned about the patient that we start making preliminary plans to organise a transfer to Guernsey. The ward clerk completes the documentation and I organise the nursing care plans and talk to the Airline, warning them we may have a transfer but the patient is yet to be seen by the doctor. Charter flights take a lot of organising to arrange. Outside of normal office hours the nurses have to organise without admin help. We also need to find a nurse escort to accompany the patient and with the skills to monitor the patient and be familiar with all the equipment. As we are short staffed on this shift I ring one of our off duty nurses, who is very generous at helping us out time and time again. She agrees to be on standby. We are still monitoring the patient and once they are assessed by the doctor we are told that the patient has been referred to a specialist in Guernsey for emergency assessment. The emergency flight is organised for 11:30. I check all the kit needed to go to Guernsey with the patient. We always have it ready and packed but it must be checked carefully each time. The patient is very anxious but pleased that a nurse will be travelling with them. A family member is on the way to the hospital and will be traveling with them. I ensure that they bring identification for the patient as they may well be returning on a scheduled flight once their treatment in Guernsey is completed. I ensure that an ambulance is booked to collect the patient and also to meet the ‘plane in Guernsey and take them to the hospital. The relative has made arrangements to stay with family members in Guernsey.
10.30 hrs. There’s no time for a tea break so I have a cup of tea ‘on the hoof’ in the office while updating notes. I do a ward round with the doctor whilst keeping an eye on our poorly patient. I have left a nurse with them to ensure their condition is monitored closely. We explain to the poorly visitor that if they have intravenous antibiotics it will help their condition and they will be able to travel home sooner. They agree to stay and I organise for the treatment to be commenced.
Two of our Healthcare Assistants (HCAs) have been sent out to provide care to a service user who still lives in the community – we provide a community nursing service too! I suddenly remember I haven’t ordered my lunch and I should have done it by now. I quickly make a detour to the kitchen for quick grovel – the staff are used to staff being ‘delayed’ and they are very tolerant. Another bonus of working in a small team!
11.00 hrs. I go up to the ward again to make sure everyone is ok. The service users all are well and looked after and one of the bonuses of working on Alderney is that we get to know our patients and their families really well. I sort a few problems, update the care plans and then discuss methods and needs of treatment and care with our new HCA who is working alongside a much more experienced colleague. I sort out an off-duty problem and then take a very emotional and distressing call from a relative of a patient – they are not living in Alderney so are very upset that they can’t visit their relative as much as they wish to. I provide support as much as I can and offer to take the mobile ‘phone to the patient’s bedside so that they can talk to their relative – this puts their mind at rest. They are visiting Alderney soon and I promise to meet up with them and discuss their relative’s condition and treatment plan in detail with them.
Next thing the ambulance is here to take my emergency patient to the airport for their charter flight to Guernsey. My patient is carefully wrapped up warm in a duvet type sleeping bad with all the drips and tubes safely tucked away. The ambulance volunteers and escort nurse load the emergency bags and equipment onto the ambulance. We say goodbye, and ‘see you again soon when you are feeling much better’. Once the patient’s condition is treated and stabilised they will most likely return to The Mignot Hospital in Alderney to complete their recovery. The patient has relatives in Guernsey and they have also been contacted and will meet the patient at the hospital in Guernsey so they are not too scared to be going away for treatment. Guernsey is only a short flight away – about 15 minutes – but it is still an arduous journey when feeling poorly. The winds are light so it will hopefully be a pleasant flight and not too bumpy.
And, all of a sudden it’s after 12.00 hours. The lunches are already being given out and I quickly strip the emergency patient’s bed and organise for our housekeeper to clean the room. I take a call from the GP who informs me that another emergency patient is coming up to the hospital for assessment. I quickly check the assessment room and inform the nurse who has now taken over the shift. I say good bye to the morning shift – and then I go off duty until 16.00 hours. I get to the kitchen late (again) but the staff have kept my lunch for me – what would I do without them! After lunch I will go and enjoy the sunshine for a couple of hours.