I am writing this from a sunny spot in the garden, with the intention of absorbing as much sunlight as possible before the next stint of night shifts, which start tomorrow. It's always a bit of a struggle when the weather is so good to think that I'll be spending most of the daylight hours in bed trying to block out as much sunshine as possible. That said, the change of pace during night shifts does tend to make up for it and usually provides some relief from the chaos of day shifts. I now acknowledge the need to take things a bit easier before a consecutive stint of night shifts, but I am still figuring out how to best prepare myself mentally and physically to make these nights as easy and stress-free as possible.
One of the most significant changes I have experienced most recently as a nurse has been that we are no longer required to wear masks. I have to admit that I felt a little apprehensive, not only because of the protection they provide, but also because I have become used to hiding behind them and using the masks as a bit of a safety blanket. I find I am having to remind myself regularly to look approachable or to ensure that the expression on the lower half of my face correlates with the upper half, something that used to happen far more naturally! Having completed a few maskless shifts now it really has become apparent that I have become a little lazy, because the expressions that I once made subconsciously are now requiring conscious effort to accomplish. I have also had a few moments where I have caught myself pulling a face, perhaps in response to a particularly unpleasant smell or just a particularly unpleasant person, and had to quickly adjust my facial features before anyone notices. Nevertheless, it has been lovely to be able to communicate much more effectively with patients again and to give other staff members a smile on passing. On the other hand, I was having a particularly smiley day recently enjoying the freedom of no longer wearing a mask and was horrified to look in the mirror after my shift to see that I had bits of dark green herbs from lunch stuck in all my front teeth!
I have now been qualified as a critical care nurse for 6 months and at this stage I feel I have developed a good understanding of the role, so I have started seeking out further ways of enhancing my learning. This week I participated in a tracheostomy workshop, which was really interesting, and it was a nice change to learn in the peace of a classroom rather than while I was also looking after patients as I was able to dedicate my full focus to the session. It was especially enjoyable to learn about something that relates so closely to work and that I was already quite familiar with, rather than learning information that is brand new, but which I might not even end up using. Gaining a better insight and understanding of the roles and the perspectives of the other members of the multidisciplinary team regarding the care and rehabilitation of someone with a tracheostomy was really beneficial. The speech and language team discussed using a Passy-Muir valve, which allows people with tracheostomies to speak with the trache still in place. This is something I had not used before because I wasn't very familiar with them and didn't have the confidence. Having now received some guidance from the speech and language therapist, I feel confident and motivated to use the valves, which will be really beneficial to my patients' rehabilitation. Furthermore, I previously thought that once the valve was in place the individual would very quickly be able to vocalise, but now I understand that it is a more gradual process, one that follows a similar pattern to weaning patients off the ventilator.
Something that stood out during the day of the workshop was when we did a clinical simulation to allow us to practise using the emergency tracheostomy algorithm. As a student nurse I used to find simulations so stressful because they were realistic, unpredictable and usually involved some sort of an emergency situation. During the trache workshop simulation I was surprised at how calm I was, and I wondered if this was because I am starting to feel more confident and accustomed to working in a high-pressure environment. Either way this new-found sense of calm was gladly welcomed. Over the next month I look forward to participating in more workshops and learning as I start the Step 1 competencies, which form part of the Critical Care Education Pathway. For now, though, it's time to set the tools down and enjoy some more relaxing in the sun before the week of nights ahead.