How my day is shaped depends a lot on the schedule I am working. The first month I was here, I worked day shift from 8 AM to 4 PM at the care centre. For most of October, I've been working 2 PM to 10 PM. If I'm working in the morning, then I set my alarm for 7:20 AM. I have some yogurt and muesli for breakfast, and I make coffee in my plunger mug that I inherited from Holly, the YASCer from last year who worked in Cape Town. Then I head over to the care centre for the day. One of the first things I do when I get there is move my car. I park behind the patient van in the care centre driveway at night because it's a little more secure than leaving the car in front of my house, but that means I have to move it in the morning so the van can get out for the day. By the way, I haven't shown y'all a picture of my car yet, have I? Here it is:
It's an automatic, which is very lucky for the rest of the drivers in South Africa.
When I get to the care centre in the morning, Martin and I have a meeting with all the carers and assistants for the day to discuss how the patients were overnight and our plans for the day. The carers change shifts at 7 am (they work 7-7 just like I used to in the hospital in the US), so they have already been at work for a bit by the time I show up at 8. After our meeting, Martin and I get started on our tasks for the day. If we have any specimens to collect for tests, we do that immediately after the meeting. We send all our samples to the Hawston clinic, which is just down the road, and they send them to one of the labs nearby for testing, so all the samples have to be collected by 9:30 AM in order to be sent out that day. Next, we usually do a walk-through of the patient wards. This allows us to see all the patients, ask them how their night was, if they need anything, are having any pain, etc. Usually by the time we're finished with our walk-through, several issues have come up that need to be dealt with. I'm still adjusting to being somewhat in charge here. At home, whenever an issue happened with a patient, I could ask another nurse, or the charge nurse, or a doctor for help. Here, the doctor comes once per week for about an hour, assuming she doesn't have a meeting or something, in which case we may not see her for a couple of weeks. So that means that when a patient's catheter isn't draining, or a patient hasn't eaten meals in two days, or a patient needs transport to an appointment at a hospital in Cape Town, it's up to me to fix the problem (with help from Martin, of course!) So the vast majority of my time at work is spent dealing with issues like those. You'd be surprised how many things like that come up in a day (or in a night!)
There are also things that Martin has to do every week that I help with. On Tuesdays we allocate medications for all of the patients for the entire week. That means we check all of the patient's medication orders and put them into those little pill containers that have days of the week printed on them so that the carers can just take out all the pills that patient needs on say a Monday morning. Believe me, this process can take a while, because many of our patients are on 10 or more medications that have to be given up to 4 times per day. Not to mention that medications have different names in different countries. It took me two weeks to figure out that paracetamol is just acetaminophen (that's Tylenol to you non-medical people). I thought we were giving some super fancy South African pain drug!
The medication cart
At least once per week, Martin and I go through all the patient's charts with a fine-toothed comb to make sure they are up to date and all the information has been charted properly. This is more of a struggle than you'd think, since English is the second language of pretty much everyone we work with. Some carers write their notes in Afrikaans, and even those who write in English use phrases I'm not familiar with. And it's a constant struggle to remind the carers that they have to chart their work! Nurses in the US are so used to hearing 'If it wasn't charted, it wasn't done', but that's not generally a part of carers' training here. I will often look back at a chart and see that the medication page is blank for a whole day. Does that mean the patient didn't get their medication, or someone forgot to chart it? It's my job to find out!
There are all sorts of reports and records involved in all this. Martin keeps a patient register, admission and discharge records, old patient files, supply lists, an attendance register, the carers' work schedule, a book that lists who 'borrows' supplies from us, a duty allocation book, and loads of other paperwork that I can't even think of right this second. I help with all those also.
I have a few projects I'm working on in my down time. I've finished a first draft of the policies and procedures manual I wanted to write, but it's short and sweet right now. I'm sure I will expand it as time goes on. I am also working on updating the nursing care plans we use and writing some new ones. Organization is one of my ongoing tasks. Our supply cabinets just never stay neat for long! I should also mention that I got in trouble with HOPE Africa recently because I don't check my office email very often. So now I'm trying to find time in my day to do that at least once or twice a week!
Organizing the medication stock. That took a while!
Again, the hours that I'm working greatly affect what I might be doing there. You can't do things like make appointments for patients or collect specimens after business hours, so I have some more time for administrative tasks when I'm working the evening hours. One of my most important jobs in the evenings is to oversee the carers' change of shift. When the night carers come on, we do another report like the morning report. If any of my old coworkers from the MIU happen to read this, you will probably think it's funny that I'm trying to implement bedside reporting at night. I'm turning into one of those people. It really makes sense here, though, because none of our patients have ID bracelets or bed numbers or anything like that. You just have to know who they are, which isn't too hard since we have less than ten of them and most of them are here for several weeks at least, but it's still all too easy to get confused about which patient we're talking about, especially when most of the staff members are operating in their second language. So yes, bedside reporting is in! I'm calling it the nightly 'walk and talk' because I just can't bring myself to say 'bedside reporting'.
After work I head next door to my house. What do I do with my evenings? Well, I go for a run at least 5 times per week, usually 6. I have the most stunning running routes around Hawston. Here are some of my favorites:
Sometimes I run on the beach, but only when I'm in the mood for a good calf workout. Running on wet sand is hard.
By the time I finish my run and take a bath, it's dinner time. I'm a little bit of a lazy cook since it's just me. I'll talk more about common foods in South Africa in a separate post soon, so stay tuned for that. Some nights I have dinner with different folks I've met here. When I'm home alone, I tend to leave the radio on a lot for some noise while I'm cooking and eating (did you know that Ryan Secrest comes on in South Africa? He does!) I admit that I've been a little bored around my house at times. My TV only gets one channel, and the vast majority of the programming is in Afrikaans. So I've been reading quite a lot. In the 9 weeks I've been here, I've finished two 1,000 page Ken Follett books, a short novel by a South African author, a bad paperback romance that I picked up for a couple of rand, an even worse Nora Roberts romance, and an actual nonfiction book (which is really out of character for me). Given how slow I read, that's quite a lot!
I almost always end my day by skyping with Jacob. I'm very lucky that my internet connection has been pretty good so far, and that Jacob and I have found a time that works for both of us. He gets to celebrate the end of his work day by talking to me, and I get to climb into bed and hear his voice right before I turn out the light for the night. It's a good deal for both of us.
So there you have it. That is a typical day for me in Hawston. Nothing too mind-blowing, but I find myself very happy here. I have a fulfilling job, I'm spending time with interesting and charming people, and I really believe that I am living where I'm meant to be right now. It's a pretty good deal.