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Nurse Journal: Working in the Respiratory Ward- Challenges & Lessons

Updated: Jul 1, 2020

By Ralph Sinson

Life takes its toll on most people suffering from various respiratory conditions—be it a COPD, Asthma, Bronchiectasis or End-stage Lung Cancer. The bleak sense of feeling on their end warrants someone to listen to their concerns and provide comfort in times of sadness. As the extent of their disease worsens, meeting the demands of their care exponentially increases.

I am Ralph, a Respiratory Staff Nurse, currently working at one of the NHS Trusts in England. I would like to share my experience as a Nurse in an Acute Respiratory ward.

Let me begin by sharing a bit of my experience back in the Philippines. I was a Theatre Nurse for 5 years at one of the government hospitals in Metro Manila. I have no ward experience prior to my deployment here in the UK. But even with no ward experience, I was optimistic that I will be able to learn & adjust to my new work.

When I first saw the ward where I will be working at, all I felt was excitement. The environment feels vibrant. I can see nurses and doctors going in and out of treatment rooms, phones ringing, staff discussing care plans in front of the computers. I like the busy vibe and was looking forward to working, with high hopes for it to be smooth sailing.

Three months since my induction, I was able to pass my OSCE. But even if I have passed the exam, adjusting to my role was not as easy as what I was hoping it would be. Being a theatre nurse in the Philippines, I had to double my efforts as my job in the respiratory ward is totally different from what I was doing-- from the routines, protocols, and priorities. I was fortunate that I have a supportive ward manager and Sisters. They have guided & helped me throughout the transition period.

Being a respiratory ward nurse has its own unique challenges. These helped me become a better and more resilient nurse. Let me share with you few of these challenges and lessons that I have learned:

Admissions in the Acute respiratory ward can be steady during summer months. However, it is entirely a different story during the winter season. Our ward becomes one of the busiest wards across the Trust.

I can say that December was the busiest month. I have witnessed shifts where we had to prepare 30 IV medications. You can just imagine how busy those days were! Routine activities such as turning the patients, doing observations, giving a wash, serving meals, performing urgent and non-urgent special procedures such as ECG or removal of chest drain, documentation are just few of the things we need to do as nurses for each patient. These have taught me how to be more organised. Knowing which tasks to prioritise and executing it with the right amount of speed has helped me in in this role.

Another challenge I face as an Acute Respiratory nurse is the management of poorly patients. Most of our patients who are poorly need close monitoring. Unless the patient is on a DNAR status and is on IPOC (Individualised Plan Of Care) which is equivalent to a palliative treatment for End-of-Life care, a high National Early Warning Score (NEWS) is indicative that something is wrong with them—these cases are not unusual in our Ward. Patient’s mobility also increases the level of care needed. For instance, bed bound patients need two or four hourly turns to prevent pressure sores.

Condition of our patients can also change radically – thus close monitoring is required. I, once, encountered a patient independently mobile with oxygen on nasal specs. He seemed to be normal. He can communicate without any signs of struggle. After few minutes, his condition has changed drastically. He started gasping for his breath. His oxygen level has desaturated fast. Incidents like these have taught me to be extra vigilant and observant. I have also learned that it is key to stay calm under pressure, to allow you to think & respond properly.

Caring for patients with mental health problems can also pose an additional challenge. In our ward, we have patients who have dementia, some also have experienced delirium or confusion, making them susceptible to falls and may require closer observation. These patients need to be monitored on a 1:1 basis in ECO (Enhanced Care Observations) Bay. Taking care of these patients with such needs has also taught me how to be more understanding & patient.

I can say that I am still in the process of learning, but I can say that I have grown since I started in this role. My experience as an Acute Respiratory nurse has made me tougher and taught me lessons which I can apply not just at work but in my everyday life too.

Working in the Respiratory Unit is challenging but I can also say that it is a totally rewarding experience. Providing the best quality care to patients transcends to a deeper fulfilment and feeling of contentment. With every extra compassion and commitment, I give to my patients as a Respiratory nurse, I have always lived in the principle of “Value what you do and add value by what you do.”

About the Writer:

Ralph is currently working as a Respiratory Staff Nurse in one of the NHS trusts in the South of England. He is currently being trained to be a Charge Nurse. He is planning to undertake the Respiratory Course undertaken by the Trust for further learning and development

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