Catherine Renwick has given us this account of a typical Monday in the life of Ben’s Nurse.
My week begins with an early start on Monday as this is a busy day with a morning clinic which runs until lunch time.
8:15am – Coming into the office early affords me some quiet time before the rest of the team arrives and allows me to:
- Check and respond to emails and post
- File any patient clinic letters/correspondence
- Deal with requests to contact or send patients information received from the cardiology team
- Complete outstanding paperwork for the previous week’s new admissions
- Breakfast is fitted in there somewhere too
9:10am – Stop off at Dr Till’s (paediatric consultant in electrophysiology at The Royal Brompton Hospital) secretary’s office to pick up patient correspondence for those children booked in to the morning clinic.
9:15am – Arrive at clinic; there is an agency nurse in clinic today so I have to explain how things run to the agency nurse. I tell her what investigations need arranging for the patients, particularly those children and babies already on medication who require height and weight measurements in order to determine their precise dosage. All patients attending the clinic need an ECG (a recording of the heart’s electrical conduction system) prior to their consultations, so I teach the agency nurse how to perform an ECG and do the first three with her. I also prepare the consulting room I use to see patients in with the relevant literature I may need during the clinic.
10:10am –Before seeing patients I look through the clinic list and medical notes to identify which patients are suitable to be seen as nurse led SVT (supraventricular tachycardia) follow ups. Usually I would do this at an earlier time but as I have spent time with the agency nurse today this has had to wait. Once the list is complete I give it to the clinic nurse so they know to give these children’s notes directly to me rather than to the attending doctors.
10:15am – I see my first patient who is a 10-month-old infant who suffered SVT in the first few weeks of life. She is taking medication to control the SVT and has remained symptom-free. We therefore plan to maintain the current dosage, effectively weaning her off as she grows. This is usual practice for the younger children – it is effective and reduces the need for altered prescription doses every few months. I arrange follow up in six months and ensure that her parents have my contact details should they have any questions or concerns.
10:40am – I assist a mum whose child had SVT in the first few weeks of life in weighing and measuring her. The child is now doing well at eighteen months old and off medication. I discuss how she can work with the child’s health visitor locally to obtain these measurements in the future and document them in the child’s developmental record book.
11:00am – There is an unusual lull in the flow of patients this morning, which allows me some unexpected time to check my emails and phone messages. Monday is often a day when I receive lots of phone calls and do not get to deal with them until after clinic, so this time is very welcome.
11:40am – I see a further two patients for nurse consultation with SVT; both are teenagers. The first is 15-year-old and suffers continuing symptoms of SVT (racing heart, dizziness, lethargy, light-headedness, nausea, pallor, sweating, and cool peripheries). She needs a new prescription of medication to control symptoms as she is due to start GCSEs very soon. We discuss side-effects and control of symptoms, including who to contact with any problems. I also discuss the care plan with Dr Till who provides the written prescription for the medication, as I am not yet able to prescribe. I arrange follow up in 3 months to review how well the newly prescribed medication is tolerated.
The second patient is a 14-year-old boy also suffering continued symptoms of SVT while on medication. He is suitable and old enough to be referred for a radio frequency ablation (an invasive procedure to stop symptoms by heating up cells in the heart with a catheter). This consultation requires an explanation of the procedure and I also give the patient some written information to take away and read along with my contact details should they have further questions. I refer him to Dr Till for the procedure and a further out patient appointment will be arranged for after he is discharged.
1:10pm – Dr Till saw a newly diagnosed patient with SVT who needs my input, so I meet with her and her parents for a chat. I explain the condition and ensure they understand why SVT occurs, techniques to stop an episode, possibility for medications if symptoms persist, what to do in the event of prolonged SVT, keeping an SVT diary and how to contact me should they have further questions or concerns. I also give them an advice sheet to take home.
1:45pm – At the end of clinic I review the notes of those patients who have not turned up, to decide whether they should be rebooked, and arrange letters to the family/GP/paediatrician if they have repeatedly missed an appointment to clarify if they remain symptomatic and require continued monitoring with further outpatient appointments.
2:30pm – Lunch
3:00pm – By now more emails and phone messages are waiting so I use this time to answer them. Phone calls are usually from parents wanting advice about their child’s health and include:
- ongoing or new symptoms and how to manage these
- travel advice including travel insurance/fitness to fly/letters for airlines
- outpatient appointments
- outstanding investigation and investigation results
- admission dates.
Emails follow this trend but also come from professionals relating to issues such as changes in policies, mandatory training and professional development, conferences and planned meetings.
4:00pm – Once Dr Till’s secretary has typed the letters from the previous week’s clinics, I have to check and sign them so they can be sent out.
4:20pm – I also need to dictate letters in respect of the patients I have seen in clinic today to their GPs, paediatricians, parents and any other professional looking after them such as health visitor or community nurse. The letters detail the consultation and continued plan.
4:45pm – Nearly time to head home but before I do I have some filing to complete.
5:30pm – Home