what have you done today, to make you feel proud in A new era

i woke today to a ridiculous report on the news that patients who are looked after by nurses with a diploma are more likely to die than those looked after by nurses with a degree. what a complete and utter load of bollocks.

in the uk, up until last september, when they announced all nurses would be trained to degree level, students had the option of becoming a registered nurse with a diploma or a degree. essentially, there was very little difference in the training, to complete the diploma you had to complete your academic work to level 5 writing, and to gain your degree you had to complete your assignments at level 6 writing, and submit three extra assignments, relating to research.

i know full well that as a patient, you couldn't care less whether your nurse is able to write academically at level five or six. it's irrelevant, it doesn't make you a better nurse, it just means you are able to complete academic work at a higher level. i know full well that the majority of the people i trained with were more than capable of getting their degree, but that the majority of the people i trained with had financial commitments that made them choose diploma, where you are granted an automatic bursary, compared to degree, where you are eligible to apply for a means tested bursary, which by no means guarantees that you'll receive any financial help.

i had opted for diploma, because i knew that in the third year the uni i was at would give me the opportunity to complete extra work and gain my degree. as it happened my mum was diagnosed in the last six months of my training, and all thoughts of the degree work went out the window, it just wasn't a priority. all i wanted was to get through the last six months and qualify.

all of my colleagues are working towards their degrees, completing modules to gain the extra points needed to top up to degree level. and i defy you to tell me that any of the people i work with provide substandard care. i work with the most aspirational, inspirational, bunch of people. they are committed, and compassionate, and so entirely highly trained. we're the only ward in the hospital to look after central lines, we're the only ward in the hospital that has both an inpatient and outpatient service, plus twenty four hour self referral service, providing advice to our patients at all hours of the day and night. we're the only ward in the hospital to administer chemotherapy. we look after our haematology patients, we look after acutely ill oncology patients, because although they receive their chemo at the centre of excellence down the road, that centre provides no acute service for post chemo patients. we routinely receive patients who are stepped down from ITU, we take care of end of life patients and their families. and we do it well. i defy anyone to come to my workplace and tell us we're not adequately trained, and more patients will die in our care than in the care of a bunch of nurses who are trained to degree level.

we have all undertaken extra training, specifically related to the care of our patients, to ensure they are as well looked after as they can possible be. we take complete pride in our jobs, and the fact that we do them well. we're the only ward in the hospital that doesn't receive complaints from patients, because we give them no cause to complain. essentially, they're spoilt! our haem patients, it's like a family, we know them, we know their loved ones, and we've known them for a long time.

take today. one of my ladies made the bravest decision a person can make, and decided she wished to stop all active treatment. she's been in several times lately, we've pumped her with antibiotics, made her as well as we can, and sent her home. she's ended up back in after a couple of days each time. her husband said today that in six weeks, she's spent five days at home.

we all know when we're reaching the point with a patient where we're going to have to have some heartbreaking conversations about how they think things are going, and what we recommend in terms of ongoing care. my lady today made that decision for herself. she said that she's had enough, she wants some peace now. but that she doesn't want anyone to think she's given up. we told her that she's fought a long hard battle, and we've used every tool in our arsenal, and it's time to accept that we know she's not given up, but we know her body has. i think she felt more settled straight away once we'd said that.

so today was spent comforting her and her family, speaking to our specialist nurse, her consultant, palliative care team, reassuring her that yes the antibiotics have been stopped, commencing a syringe driver for symptom control, reassuring her that although she's made this very brave choice today, and we've commenced a syringe driver, it's not intended to finish her off, but to ensure she has adequate symptom control around the clock.

it must be so difficult for her to relinquish control in this way. she's always been fastidious about her medication, she's been our prime candidate for our self medication programme on each admission because she's so, organised, with her medication. i told her that she has to put herself in our hands, that we know what we're doing, and i promised her that myself, and all the girls on the ward, would make sure she was well looked after.

i was so late leaving tonight, i had neglected my paperwork in order to make sure she was settled and spent some time catching up at the end of my shift. as i was about to leave she shouted me in, so i spent a few minutes just sitting at her bedside, chit chatting, holding her hand. i know that now that everything has stopped, she'll decline quickly. some people linger for a long time, but she's tired, she's at peace, she's made the decision for herself and she's ready.

i realised when i was documenting what i had done for her today the complete inadequacy of words. in her notes i had written: Mrs L has today decided she wishes to stop active treatment. antibiotics discontinued, syringe driver commenced, PRN doses offered, patient settled and comfortable at this time.

how does that even begin to express the enormity of her decision and what it means for her and her whole family. it came down to four lines in her notes, the end of a lifetime, 56 years of life, reduced to four lines. it doesn't feel like enough really.

xx