Category: 2025

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Placement 3.1, Emergency Department

“You have been amazing tonight.”

Last shift of placement tonight. Tonight, I will go through my final ANSAT (Australian nursing standards assessment tool) with my facilitator. I’m expecting it to be pretty straightforward – my interim ANSAT at the halfway point was solid, and I’ve only improved since then.

This placement has been incredible. I’ve found the thing I want to do – emergency nursing. Emergency nursing is fast and seems chaotic, but it’s highly logical and pattern recognition is important. During this placement I spotted a patient with early signs of sepsis because I saw the patterns forming in their vital signs, before they even met the criteria for sepsis. There’s a lot of if/then decision making, for example if my patient has come in because they’ve had a fall, I need to do vital signs and a Glasgow Coma Assessment like I would with everyone, but I also need to do neuro obs and pupil assessments to check neurological function. If they complain of chest pain I’ll order bloods including troponin levels, I’ll do a full respiratory assessment, do an ECG and put them on telemetry to monitor heart function. And so on. These are things I would have had to think about four weeks ago, now it’s almost automatic. And importantly, I understand why I would do those things.

Emergency nursing seems to be thinking all the time about what could happen next, and looking for information and interventions before we get there. It’s also super collaborative between nurses, doctors, and other allied health staff. Unlike wards where doctors swoop in, do their rounds, and leave, doctors and nurses work side by side and talk to each other to assess and plan. One doctor in paeds not only introduced himself to me (me? a nursing student?) when he would plan care for patients he would ask the nurses, ‘is that plan okay with you? Do you think that’s an appropriate plan?’ He would even check in with me and say ‘what about you Cat? What do you think, is that plan all right with you?’ As well as working so closely with doctors, nurses also have more autonomy in ED – we can order certain tests that are otherwise normally only ordered by doctors, such as blood tests and cultures, and can dispense stat doses of certain medications for specific presentations including a limited selection of analgesics, sedatives, and antipsychotics.

Last night I worked in an area I hadn’t worked in before. Its name is an acronym and I don’t remember exactly what the acronym stands for, but it’s an area to help manage the flow of patients from the ambulance ramp into acute. We take handover from paramedics and manage them until we can get them into acute, so we’re working in a small area with less fancy equipment than most of the rest of the ED (apart from the waiting room). Nurses have a high level of autonomy in this area, and everything moves fast. I discovered that being able to touch-type quickly is actually a prime requisite for ED nurses in this space, and ended up taking handover from several ambos just by virtue of being able to get all the info down quicker than anyone else. As I did that, I found myself becoming quite interactive with the paramedics, asking further clarifying questions that I likely wouldn’t have thought of a month ago. Then I’d hand the information over to my RN or the other RN concisely.

I feel like I’m going to hit the ground running on my next placement, and by the end of it I’m going to be ready to start working as a graduate nurse. I feel like I’m thinking like a nurse, my skills have developed out of sight this placement. I was already doing well with soft skills and theory but my hard skills are so far ahead of where they were four weeks ago. Although my regular student nurse job is going to feel pretty ordinary by comparison, I already know that I am going to approach it so differently after the experiences of this past four weeks.

Over my four weeks of placement I worked primarily with two nurse preceptors. Both were awesome teachers in very different ways. One of them was friendly and effusive and went out of her way to check what I knew and explain things I didn’t. We worked together collaboratively as team nurses – the flow was easy and we’d chat about all sorts in between tasks. My other preceptor though is very reserved in demeanour. He’s softly spoken and matter of fact. He offers very little in the way of non-verbal cues: he’s not closed off, he’s just understated. When he laughs, it’s a quiet chuckle and a slight upturn of the mouth. When he’s stressed, he just seems a little more focused on what he’s doing but his tone of voice doesn’t change. Kind of amazing really, but for someone like me, who is frequently anxious and often unsure I’m interpreting social cues accurately, this is incredibly difficult to work with. He would quiz me on aspects of patient care or pathophysiology and I mostly knew the answers, but I never felt like I quite measured up. When I could have done something better, he’d say, ‘okay, next time if that happens come to me first.’ I said to Dan at the time, it felt like he was saying to me, ‘I’m not mad, I’m just disappointed’.

I know, from experience, that when I don’t understand social cues I assume the worst. I always do. Conditioning is a hell of a thing. And all through this placement I’ve said to myself (and Dan), I know this is me talking, I am sure he doesn’t think poorly of me the way I feel like he does. I’ve been working hard mentally to stay in a place where I acknowledge I feel bad about our interactions, while still recognising that just because I feel dreadful  doesn’t mean things are dire. It’s okay to just let the anxiety be and just keep doing what I’m doing because I’m sure he’d tell me straight out if I wasn’t performing.

Anyway last night toward the end of the shift, our last shift together, out of nowhere he said to me, “You have been amazing tonight. I mean, you’re always amazing. But tonight was exceptional.”

Friends, I think I said ‘thank you’ but honestly I’m not sure because I just about coughed and fell over. He just turned back to the computer and continued going through patient charts ready to handover to the next shift.

I’m looking forward to tonight’s shift. The pressure is off, because my assessment is done. I’m just going to get in there and be the best nurse I can be tonight. Maybe I’ll even be amazing. I guess we’ll see.

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March/April update

So. My grand plans for March veered quite some way off track.

A lot of this was down to the impact of Tropical Cyclone Alfred. Not the direct effects of the cyclone, which turned out to be a bit of a fizzer in my neighbourhood. But the preparations – staying at home, prepping for disaster, existing under the weight of impending doom – stirred up some forgotten feelings from the early days of the COVID pandemic. Plus, that week or so all my routines went out the window, and while I have known for a long time that my routines keep me together, I really found out just how much I rely on predictability and normalcy to deal with whatever else life throws at me: that is, quite a lot.

For the last month or so, I’ve been in a depressive phase. This happens now and then, it’s one of the features of having bipolar malware installed on my operating system. Usually though the funk lifts after two or three weeks. This one has been at least five so far, since TC Alfred, though if you were to ask my partner, he’d say I was even a bit wobbly for maybe a couple of weeks before that. Alfred just tore the tape off the box and shook everything out I guess. I’m still picking bits up.

So things are hard right now, and by that I mean doing anything is hard right now. I’m not feeling negative about myself, which is a nice thing, but I just feel overwhelmingly flat and I’m struggling to care about most things. I’m keeping up with work, which is positive, both because I would quite like to keep my job but also work brings structure, and structure is helpful. I’m mostly keeping up with uni – I have a couple of assessments due late next week and while I wouldn’t say I’m on top of them exactly, they’re in progress and getting them done and submitted is achievable. I’ve been having difficulty with things like washing my hair – I’m usually a twice a week kind of shampooer and I went for two full weeks without washing my hair recently. That might not sound like much but it’s a pretty significant symptom in my world.

My great plans around eating healthfully and abstaining temporarily from booze are out the window for now, but I have been successful the past couple of weeks with getting to the gym and lifting weights. Weight training is powerfully good for my mental health, so I figured I’ll just forget about food and focus on that for a while. I’m talking to myself about going to the gym as being medicine, and it’s important not to skip doses. That helps.

I think the depression is lifting, finally. I haven’t had a downswing last this long in many years. I’ve thought about why this time might have been so persistent, and honestly it may be that there’s no reason at all. Depression doesn’t need a reason. But there are plenty of factors that might be at play. Perimenopause is one, because it messes with everything. My job is another – I mentioned before that my job provides structure and it does, but it’s not the kind of structure I used to get from a 9-to-5 desk job. It also compromises my sleep patterns when I do late or night shifts, which I generally deal with pretty well but it is still probably a contributing factor. Being in my final year of nursing studies means I’m in a transitional period, and that alone is a bit destabilising. I’m in a place where I’m having to make a few big decisions which is a little bit stressful. And so on.

I thought I’d write about it all because I think it helps to share, sometimes. I’ve found my friends usually want to know when I’m not feeling okay, because it gives them an opportunity to be supportive – and I’ve also found it’s good for me to accept support now and then too. Also, I don’t see a lot of people talking much about experiences of managing bipolar disorder as a long-termer. I’ve been diagnosed for a bit over twenty years now I think, and taken lithium for most of that time. I’m an old hand. Being depressed is just something that happens now and then and usually I just breathe deep and try to be a little kinder to myself for a while, and it passes. It always passes, and knowing that is a gift. Exercise usually helps me too. Finding motivation to exercise when you’re depressed is hard and for some people it’s insurmountable, but again I have the benefit of experience to help nudge me along – I know it works because I’ve lived it, many times. 

Anyway. Checking in on my goals for 2025:

1. Solstices, equinoxes, and cross-quarter festivals.

Mabon kind of came and went without much fanfare, but I did think about it a bit and as a result I’ve been more tuned in to the change in seasons, I think. Next is Samhain and I have some thoughts about how I will acknowledge that, using it as a prompt to remember people I’ve lost and reflect on what they have given me in life and beyond. I’ll probably also meditate a bit on grief and how it holds open space for people we’ve loved.

2. Pee more/eat more beans

Doing well at peeing more – I’ve been very strict about going for a pee every time I have a break at work. Beans, not so successful, though I have recently been eating cold tofu quite a bit which probably sort of counts. Plus it’s delicious.

3. Chamber orchestra/ballet

I played in my first chamber orchestra concert! I’m going to take a break in term 2 – there’s just too much going on with uni. I’m also considering leaving chamber orchestra for a bit and instead playing with the Queensland Medical Orchestra. It’s a bigger orchestra so more interesting instruments, their repertoire is probably more my style, and helpfully, they have fewer rehearsals in the lead up to each concert which means committing will be a bit easier for me.

I haven’t managed ballet yet this year but I feel like if I keep at the gym thing, that kinda counts too.

4. Booze: 75 days for drinking

Slightly ahead of where I’d like to be, but still more or less on track. I’m up to 24 days so far. I’ve also decided that even if I do end up going past 75 days this year, I’m still going to keep track, because it will give me a start point for next year. Progress is progress.

5. Reduce choices

This is a gradual process but I’m getting there. I am finding every time I manage to simplify something, I appreciate it and I enjoy the ‘new normal’ that results. 

6. Graduate!

My next steps (apart from getting assignments done) are to complete this semester’s 4-week placement, and then get my application done and in for graduate programs next year. I will need to make some decisions in the coming weeks about my preferences. My preferences for hospital and health districts are easy, it’s my specialty areas that are making me think. Once I’ve done my placement I’ll have a good idea about whether I want to go for an emergency department role or stick with general medical. I might be over-thinking the process (moi??) but I’ll work it out one way or another.

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You’re speaking my language, baby

Yesterday there was a patient in the room I was working in whose first language is Spanish. The patient speaks English perfectly well but occasionally lapses into Spanish. Usually I just say ‘en Ingles, por favor!’ and smile and the patient smiles and switches back.

Anyway my RN was working with that patient and trying to communicate simple instructions to help them move to another room.

The patient asked the nurse several times, ‘Como se nombre?’ My RN kept trying to gently explain what they needed from the patient (‘this way, this way, here is your walker’) and the patient kept repeating their question.

I called out across the room: ‘Do you want to know the nurse’s name? The nurse’s name is…’

The patient was delighted. ‘Ah!’ they said and smiled. My RN said, ‘oh, do you understand Spanish, that’s great!’

I said ‘No, not really. I just grew up watching Sesame Street.’

Now the patient knew their nurse’s name – at least for the moment – and they were able to focus and follow instructions about walking.

I’m learning more and more that having even just a few words in another language can help break big communication barriers. I had a Bosnian patient once with almost no English but they loved that I said ‘da’ and ‘ne’. The rest we muddled through with language cards. I have had a Samoan patient who was endlessly grateful that I pronounced their name correctly (tip: in my experience, for most Pasifika languages, if you just pronounce all of the consonants and all of the vowels you’ll be pretty close, Maōri has a few tricky sounds like ‘wh’). That patient said, ‘you are the only person who says my name the right way’ which went such a long way to helping us work together positively.

I haven’t yet been able to follow up on my Auslan studies this year the way I planned to. Committing to weekly classes around student nursing schedules is remarkably difficult. But I am going to persevere. I’ve joined an Auslan social conversation (and op-shopping!) group and I’m looking forward to heading out for coffee with them next weekend 🙌🏻

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February update

Given I’m having feelings about many social media platforms, I thought I might try reviving my blogging habits. So here we are: an update for February.

I started working at a major tertiary hospital here as a student nurse about four weeks ago. I expected it to be challenging and it is, but sometimes in ways I don’t expect. I expected that I would be working with patients who have much more complex health conditions than I’d worked with previously, and I was absolutely correct. Be careful what you wish for, as they say. I have my first night shift tonight so that will be interesting too. Night shifts are part of the deal with nursing, so it’s a good way to get started putting into practice good sleep and eating habits while doing shift work.

Checking back in on my 2025 plans and priorities for a bit:

1. Solstices, equinoxes, and cross-quarter festivals.
I mostly did thinking about Lunasa on 1 Feb, but it was a good opportunity to take stock of how I’m investing my time and energies this year, and what I want to ‘harvest’ from it. Starting work as a student nurse was fitting and I did quite a bit of planning.

Mabon is next: the middle harvest festival at the equinox. I’m thinking about organising a get-together with some like-minded folks that evening to celebrate. Study will be moving into the hectic phase of semester by that point, so it will be important for me to prioritise balance in work, study, and social lives in the lead up to Samhain.

2. Pee more/eat more beans
I am doing well at prioritising listening to my body and not putting off pee breaks, gradually building new habits. I’ve been prioritising eating more vegetables which has been good. In March, I’m going to spend a month being quite strict about what I eat and I’m choosing to have an entire booze-free month. Kind of a reset.

3. Chamber orchestra/ballet
I haven’t yet been to a ballet class this year, mainly for financial reasons. I’m earning far less as a part-time student nurse than I did as a full-time public servant, so I don’t have the discretionary funds to do whatever I want all the time. Also, part of the reason I don’t have funds for ballet classes is because I rashly decided to get another multi-session tattoo which is in progress. I’ll post pictures when it’s finished, but it’s mostly done and it’s healing well. So once my tattoo is complete, I can reconsider ballet classes. I’ve kept up my gym membership though, so getting in there more often is just about prioritising. Just gotta do it.

Orchestra, I’ve been going to most rehearsals and I have made sure I have our March concert date free in my diary, so I’m on track for 2 performances this year.

4. Booze: 75 days for drinking
I’ve chosen to drink alcohol on 11 days so far this year, so I’m on track to keep it at or under 75. I am keeping a list!

5. Reduce choices
Still working on this. Part of my strategy has been to write out processes for shift work, basically lists of what I need to do before my shift (what kind of meal/snack to pack, take meds before PM shifts, grab my transit pass before AM shifts, etc). Less thinking on the daily and more box-ticking. I have also set up an area in our study with my work uniforms, so that when I start early or finish late I have what I need in a room where I’m not disturbing anyone’s sleep.

I’m also doing a year-long project to cull my wardrobe. I’ve tied a scarf to the hanging rail – everything starts hung to the left of the scarf, anything I wear this year gets hung to the right. At the end of 2025 I’ll take stock of what’s still on the left, and likely donate it all.

6. Graduate!
My next student placement will start in April – four weeks at a busy emergency department. Over the past week and a bit I’ve passed the two assessments required before I can attend placement. I had to re-sit one of those assessments, which is a first for me. I understood the reasons our group didn’t meet the required standard and was able to take that feedback on board and run with it for my second attempt a few days later. In a way it was probably good that I had to re-sit, as my performance was much better overall. I went much more in-depth with my learning and I’m more confident with my result than I might otherwise have been.

Study is otherwise going well so far. I have about 5 weeks of classes starting this week, then it’s self-paced learning for the semester. On paper it all looks very manageable, but I suspect that particularly once I get into placement it’s going to get a bit hectic for a while. I just have two semesters to get through and it’s done though. We have a group assignment this semester which I always loathe, but I’ve found a group of mature aged students to work with and I think they’re going to be good colleagues.

So that’s where we’re at towards the end of February. The first couple of months have been good so far and I’ve been working steadily through my plans for the year.

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2025: goals and priorities

Me setting goals for 2025

1. The shape of my year: I’ve decided to observe the major pagan festivals – solstices, equinoxes, and cross-quarter festivals. I feel like I want to be more in touch with the passing of time in the natural world and pay more attention to the seasons. It also means that every 6-7 weeks I’ll have a point at which to pause and take stock and that feels like a useful interval for regular check-ins.

Next festival in the southern hemisphere is Lúnasa, the first of three harvest festivals. It will be a good time to think about what I am ‘harvesting’ this year – to take stock of where my energies are going, what I’m committed to this year and what I’m investing in. This lines up with the commencement of study for 2025 and my starting a new job as a student nurse, so plenty to reflect on and journal about.

2. Pee more and eat more beans on toast: these are two simple ways I want to prioritise my health this year. The first is to be mindful of my body and help develop my interoception. When I am on nursing shifts it’s easy to push my body’s needs aside to focus on patient care. This year I will build mindful habits (like taking regular pee breaks) to prioritise my body’s needs even when work is busy.

Beans on toast makes me happy, it’s a simple, delicious breakfast. It’s high fibre and low fat. It’s also a breakfast I will eat at home rather than at work, as I need to sit down at a table and take my time – so it’s a way of being mindful about eating. The idea is to extend this mindfulness to eating in general, but I’m going to start with beans on toast.

3. Perform in two chamber orchestra concerts this year and go to ballet classes regularly: music brings me joy, and it always has. I bought a viola last year after a 25-year hiatus, and joined a local chamber orchestra. The orchestra performs four concerts each year – this year I want to do at least two of them. Work and clinical placement makes attendance difficult sometimes so I’m not aiming for four, but I think two is a good goal.

Ballet is physical exercise which is a good goal in itself, but moving to music also fills me with joy. It feels good to try to make even simple exercises beautiful and flowing as I perform them, and although I am not innately graceful, ballet is a way to embrace being quite bad at something while slowly building skill and enjoying the process.

4. Drinking more mindfully: you can definitely have too much of a good thing. As I get older, I still enjoy drinking alcohol for a range of reasons, but it does tend to get in the way of other things that are important sometimes. This year, I am choosing to limit the number of days I drink alcohol to 75, preferably at social events that include food.

5. Reduce choices: I’m plagued by decision fatigue. One way I am reducing choices is to cull my wardrobe more savagely. I’ve discovered I love jumpsuits – one item of clothing and I’m dressed! (Dresses don’t quite hit the mark in the same way for me because my glorious thunder-and-lightning thighs mean if I wear a dress, I also need to choose a second garment to wear underneath so it really is as many decisions as wearing a top and pants.) Anyway with this in mind, over the course of the year I plan to strip my wardrobe down to as few pieces as I can manage. And not just my wardrobe: anywhere I can reduce choices, especially by reducing ‘stuff’, I’m going to make those changes. (Except guitars.)

Over the past year I’ve found myself imposing little routines in several places and it makes my life so much easier. For example I pack almost exactly the same thing to eat at work every day. They’re pre-packed food items but they’re not unhealthy: instant porridge, ready-to-eat lentil curries and rice. I don’t think, I just stash them in a bag and go. My scrubs live on a separate rack in the study, so everything I need to get dressed early in the morning is right there. And I wear the same pair of boots pretty much everywhere, work and play. It gives me room to think about things that matter.

6. Graduate! This is the big one, this year I’m finally going to graduate and be registered with AHPRA as a registered nurse. Part of this goal is to secure a graduate placement. I’m in a very strong position, if I perform well as a student nurse this year, to obtain a grad position in a big tertiary hospital. I have three more units that will contribute to my final GPA this year, so I’m aiming for at least a 6 in each of those units. They’re third-year subjects so it’s going to be a challenge but I am up for it. If I can keep my GPA high I’ll also be awarded my degree ‘with honours’ which has been a consistent goal over the past four years.