Well it’s finally come!  My placement ended on Friday and funnily the last few shifts have been the calmest since I’ve been on the Ward!  Final sign-off was a bit of an exercise as I needed to get my document counter-signed as my mentor was out of date.  But it was all completed on Thursday and this morning I submitted my PAD/OAR to the SHS Helpdesk.  So now I wait to find out for confirmation that my placement hours and work are acceptable.  If I’m unlucky, I’ll be repeating the process in a few weeks.  But lets not think about that!  Killing time now as we have some closure lectures and activities at the University which begin in half an hour!

So what does it feel like that I’m finished?  In the last few weeks this theme was explored at PPD and in conversations but until last Sunday, as I went into my final week, I hadn’t really thought too much or felt anything at all.  As I dosed off last Sunday though, the thought that crept through my mind was, “Wow, three more shifts and you’re eligible for registration with the NMC!” , or thoughts to that effect!  I think sometimes, I just plow ahead and do things or become fixated on completion – I had forgotten about GOT, which shows how focused I’ve been!  With my PAD/OAR handed in I’m more forward looking and beginning to do some background work on the care of the elderly which is where my first acute rotation will take place.

Reflecting on the last 4 years … It’s been generally good.  Hated my second year at University, a lot of things unravelled in my personal life which reflected in my grades!  Placementwise it was brilliant as I got my first taste of Psych Liaison but also saw in a private hospital what would could be classed as the Dickinsonian treatment of women with mental health issues.  We are the sum of our parts the experiences that we live and the latter point helped fuel my Dissertation.  This final year has seen me at my most wishy-washy, not feeling the love with older adults than really enjoying it later on, to the point that this is where my first job will be based!  This last placement has been brilliant as it helped hone my ward based skills, so I’m feeling pretty confident going into my new job.

Quo vadis? … I’m going to be spending much of August working with my dissertation supervisor exploring whether we can convert my dissertation into a published article in an academic journal.  In parallel with this will be paid shifts across ELFT as I try to get my finances in order for holidays in September.  As mentioned, September is the celebratory holiday – booked a few days out in Budapest with the other half, and in the planning for a walk in the woods by myself.  Than its my first day at CNWL on the 2 October!  I may be back here to talk about my first year of work but if I don’t, its been a pleasure and I hope I have helped tipped the scale and I’ll see you on the Wards!

OK, we are almost there!  Since last I wrote here I have had my OSCE result back, clear pass, yippee!  In OSCEs you never know, you could forget the tiniest of things and it could have been the critical skill that causes you to fail.  Luckily for me, it’s all over and now I just get to do it for real 😉 … The other item on the tick box was my dissertation, the piece of work that caused me endless sleepless nights!  Results are back and I did well on it and there may be potential to take it forward to publication.  I’ll know a bit more on this in a few weeks when I have a sit down with my supervisor to see what needs to happen next.

So this just leaves my final or signoff placement at the PICU before I say good bye to this phase of my development.  So what is this signoff placement about?  In mental health it revolves around you transitioning from the student role to that of the RMN.  On my shifts I am either coordinating or medicating!  … Just kidding, its much more but activities do span these two key duties.  Thus on a typical shift in the coordinating role, the aim is to take the handover and identifiy any risks to staff or patients for the day ahead.  What are the risks?  In the PICU some of the patients, due to their illness, may span the spectrum from vulnerable to violent and what the coordinator needs to do is ensure that these risks are mitigated by ensuring staffing levels and allocation to patients is appropriate.  Further, care plans are being done and are not some words on a piece of paper and dynamic updates to care plans are made throughout the day via the “safety huddle”.

The other side of the coin is the medicating of patients.  One of the key roles of the PICU is the stabilisation of patients and in psychiatry this is achieved primairly through the use of antipsychotic medications.  Often patients in a PICU may be presenting with psychosis for the first time in their life and may be naive to the effects of these types of medicines.  Thus as a medicating nurse, and as a nurse in general on the ward, there is a duty to monitor the advent of any side effects which can range from oedema of the feet through to death in the most extreme of cases.  Additionally as the person responsible for dispensing medications, you are the last check in the case of an error being made on the prescription.  Thus one of the key skills is an understanding of maximum doses in a 24 hour period, contraindications and interactions.

Standing between these activites is a range of tasks which supports the stay of the patient on the ward.  This could be mopping up urine from the floor (something I was doing at 4am this morning!) or having a one-to-one with the individual you have been assigned to for the day.  On the administrative side there is the admission paperwork and discharge paperwork to complete; care plans to write or update; and the referrals to make on the paitent’s behalf.  In the global community of London there is often the booking of translators and the “googling” of cultural informaiton to help make an individual’s stay on the ward a bit more personalised.

So what’s left for me?  I have one more shift this week and 3 more weeks (or nine shifts) before I need to hand in my PAD and OAR on the 24 July.  Once those are in and there are no issues to remedy, that’s it, I’m done!  So wish me luck in this final stretch and I hope to have my next entry shortly after I drop off my stuff on the 24th!