Heading for the Deep South

Howdy!
I'm here in Houston, Texas where I've spent the last couple of days in the Jane and Robert Cizik School of Nursing (so named because they donated 25 million to the nursing school, gives you some idea of how things work here).

It's part of what's known as the Texas Medical Centre and covers an area of over 2 square miles - one of the biggest in the world. It consists of 21 hospitals, 4 medical schools, 7 nursing schools and a whole host of other health related facilities - it's immense!
I met Dr. Martina Gallagher at the beginning of the week who showed me around and talked me through how they do things at Cizik. Martina is an Associate Professor of Nursing and Clinical Director in the University and has a lot of contacts n the surrounding hospitals. On day one we went to MD Anderson, a world renowned cancer hospital and research facility. Debbie Cline runs a nurse extern programme there and is also the project lead for their Magnet Programme.
For anyone who hasn't heard of Magnet, it is a recognition programme run in the US for hospitals who truly value nursing talent. It's hard to earn and hospitals must show a commitment to education and development through every stage of a nurses career to be granted Magnet Status. It is something that has recently been introduced in the UK and NUH are vying to be one of the first hospitals to obtain Magnet Status. MD Anderson are applying for their 5th Magnet term.

Fanceh

It was great to discuss this with Debbie as being a 5 time Magnet awarded centre must mean that they are doing something right for their nursing staff and happy nurses mean happier patients!
It was great to discuss the residency programmes they have in place for newly graduated nurses (externs) and how much they encourage nurses working on research, positive change and continuing education.

Martina, myself & Debbie

I also spent some time with some of the Martina's nursing students this week and we had a really interesting discussion about the differences in healthcare around the world. I felt like I knew a lot because of what we see in the media but some of what they told me is staggering. It's relatively common, for example, for a homeless person or a person without insurance or means to pay for their care to be put into a taxi and sent to a drop off point near a homeless shelter. Sometimes still in their hospital gown or even with a cannula in, disorientated, confused and clearly not fit for discharge. Now obviously I'm in a big city and things like this happen more in big cities and I don't want to paint everyone with one brush but it beggars belief that this can happen in the 21st century. What it comes down to though is money. Profits. Business plans and bank account balances coming before patients. And what can a newly qualified nurse do in this situation? Advocate for the patient and refuse to discharge? Of course, that's exactly what should happen. But in a country without the same employee protections and rights that we take for granted in the EU (Brexit is coming for us...) do that too many times and you're out on your backside. Most people have health insurance through their work. Lose your job, lose your health insurance and you're not too far from needing a homeless shelter yourself.
This is corporate America.
And I don't want to get all preachy here but this is what is in danger of happening to the NHS. With bits of it discretely being sold off here and there nice and quietly things are starting to be run like a business. With the people who have control over what happens to the NHS all able to afford private health care (there are VIP floors on the hospitals here in Houston that you must have federal access to even work in, people like the Bush family get looked after in the penthouse) privatising it and making a profit is music to their ears.
It is one thing I have always noticed living in England as an outsider. You have no idea how lucky you all (y'all? Too much?😂) are. It seems to just be totally accepted that free, excellent healthcare is the norm when really it is the exception. Sure, the NHS has it's faults BUT IT'S FREE! I couldn't believe it the day I landed in Exeter and I still can't believe it now. Anyways, sorry, this always gets me going as I don't want the UK to lose one of the best things about it!
Although it's not all bad over here, one of the things I'm very jealous of are their patient to nurse ratios - 4:1!!! And that actually happens! Staff shortage isn't the problem over here but, in fairness, they've got enough to try to tackle by the sound of things!
So tomorrow, I head to Memorial-Hermann Medical centre in the morning and then back to the nursing school in the afternoon to give a presentation to some of the faculty and students about my trip and what we are trying to achieve in NUH. Yikes!
Before I go I do have to mention my Greyhound journey to get here. I've heard such nightmare stories about them - they're late, people on them harass you, they're dirty etc. But I decided to do it anyways! It's a bit of a right of passage for European travellers in the States and the longer the journey, the better! Mine took 3 days, with one night in a motel (I stayed in a motel and didn't get murdered! Woo!) and one over-nighter on the bus itself and it was grand! Now, partly I just lucked out. None of my buses were delayed but I met many people who had been waiting hours so I can only thank my lucky stars mine were on time. It also meant that I got to drive through the desert of Arizona and New Mexico which was honestly like something out of the old Westerns we used to watch on TG4 at home!

I changed in Dallas for Houston and had a couple of hours there so I got to go the JFK Memorial Plaza then wandered down to Dealy Plaza alongside where he was actually shot and The Grassy Knoll where conspiracy theorists say a second shooter was situated. I wouldn't have seen any of that if I'd flown!

John F Kennedy Memorial Plaza

With that in mind and bearing in mind the amount of flying I did at the start of this trip I was loath to get on another plane so have now booked Greyhounds, megabus or Amtrak the whole way up the East Coast (after a weekend in New Orleans via bus, naturally!) through DC, New York, Boston and back across to Canada! It may be mad but as Frank Sinatra said, I did it my way😁

Kate

West Coast Adventure!

Hello from San Diego!
At the end of my last blog I was heading off to San Francisco on the Amtrak (which was amazing!) and just arrived in San Diego late last night after my first day on the infamous Greyhound buses! I've been trying to avoid flying as much as I can as I'm not much of a fan anyways but you also miss so much by skipping huge areas that are so much fun to pass through on the bus. For example when we changed in Portland (Seattle to San Francisco leg) I stepped outside to get some fresh air where the man beside me promptly soiled himself (I know this because he announced it loudly) and then vomited before lighting a cigarette, grabbing his skateboard and heading off with his mate without so much as a pause. Now would I have seen this if I had flown!? I highly doubt it!😂 Apologies to anyone from Portland reading this but it was literally the only thing that happened while I was there, I even bought a fridge magnet in the station to commemorate the occasion!😂
Anyways, the Amtrak was brilliant and really comfortable, even in coach for 23 hours!

Quick stretch stop off the Amtrak in Oregon!

When I got to San Francisco it was straight down to business. I dropped my bags off and headed straight to UCSF where I would be spending a few days working with nurse practitioner Roseanne Krauter and her colleagues in the ENT dept. This visit and my visit to St. Paul's in Vancouver were actually made possible by a colleague of mine. Prof O' Donoghue is one of our ENT surgeons in Queens who has put me in touch with friends and colleagues of his all over North America which has been such a huge help on this trip. I mean, I did buy him a muffin from Costa to say thanks but I thought a mention here wouldn't go astray either! Thanks Prof😁

I spent my first day shadowing Rosie and Dr. Limb whilst they saw their patients. So Rosie basically sees any patients that aren't for surgery. So patients with vestibular issues, follow-up appointments post-op or patients who are having or have had radiotherapy/chemotherapy. It was great to see the nurses role being utilised so well as in my experience all of these patients would be seen by a doctor rather than a nurse. Of course Rosie being a nurse practitioner helps as she has the extra qualifications and experience necessary for the role but it was great to see! 

I also spent some time with an amazing RN called Michelle who showed me around the rest of the building and clinics. She mans the emergency line which patients can call with queries and concerns regarding a surgery or anything really. One call really made me realise how lucky we are with the NHS. A patient needing a hearing test before their next appointment, due to changes in their insurance, can now not have it done on the day before their appointment as their insurance now states it must be done by a doctor. In UCSF only the audiologists do the hearing test (which makes perfect sense to me, I know who I'd prefer doing my audiogram! No offence to any doctors but there's a reason these guys do what they do, they're good at it!) so now everything has been delayed for this patient because what their insurance covers dictates everything they do. It was the same with a patient who has had frequent tumours in the past needing a CT scan - it can't be ordered until they double check that the insurance covers it. The messing around and time wasted on admin and red tape because of the cost of healthcare otherwise is crazy!

Imagine having had cancer and then having to jump through all these hoops while trying to check that you don't have it again! The last thing anybody needs! People are just so used to it here though, they just get on with it because there's no other choice really.

I should also mention my hosts in San Francisco although I didn't actually meet them! Last year's scholar, Alix, stayed with Sasha and Lauren Cuttler and put me in touch with them when I decided to go there. Although they were away on my dates they still let me stay in their home where I met Harpo, their dog and couldn't get lost trying to find their house if I tried due to this sticker!

I threw myself into it once again at the weekend to try to see all the sights San Fran has to offer. Walked the Golden Gate Bridge, caught a trolley car, went to Pier 39, popped up Coit Tower and went to Alcatraz and Angel Island over the 2 days.

What a difference a day makes!

I've always wanted to go to Alcatraz but by the time I booked the only thing left was a combined tour of Alcatraz and Angel Island which ended up being a bit of a hidden gem! Angel Island is beautiful and was the Ellis Island of the West coast back in the day as well as a quarantine centre during the plague and a missile post during the Cold War! I also hadn't known about the Native American occupation of Alcatraz Island back in 1969 which basically kick-started most of the Indian rights activism that we are familiar with today. Definitely worth a trip to both for anyone heading to SF!

The Rock

Repping in my Uni of Notts jumper on Alcatraz!

I am currently in San Diego where my hospital visit fell through at the last minute. It's been a bit of a blessing in disguise though as San Francisco was fairly hectic and I've agreed to do all sorts of things in Houston which seemed like a great idea at the time but now that it's a week away doesn't seem quite as doable. This includes giving a presentation to the faculty of the university I'm visiting so actually having some unexpected time here in San Diego to prepare said presentation is extremely welcome!

I spent all of yesterday on Greyhound buses and aside from the 20 miles to the border (and you never know, I might pop down just to really finish the job!) I've travelled the entire West coast of America by bus or train! Woo!

My next trek, which is absolute madness, is from San Diego to Houston. It'll take me 3 days to get there by Greyhound but to be honest I don't mind the long journeys once the bus is actually going. They stop regularly to let you get off and stretch your legs and get food etc. It's more that they literally couldn't give 2 hoots about where you're going and when you need to get there and regularly run 3-4 hours behind with no apology. Both my buses yesterday were delayed by hours but I managed to play the Irish/woman travelling alone card and blag my way onto other buses. The accent is an absolute life saver at times not to mention that it's usually middle aged men at the station who think you are a bit of a damsel in distress. If only they knew!😂 Either way, something worked and I got to San Diego before midnight so I'm counting it as a win!

In Houston, I'll be spending almost a week with the nursing students and staff of the Cizik School of Nursing at UTHealth. That's if I ever make it on the bus, let's hope my luck holds out!😊

Slán go foill

Kate

Clothing Optional. No staring and/or gawking please.

Little bit more low key this week, I've only moved city once!
Before I left Vancouver I had one more day with the nursing students at UBC. I had been especially looking forward to attending the pharmacology lecture with them seeing as I just finished my prescribing course before going on this trip. A lot of it was much the same just with A LOT more class participation! Students are keen on this side of the world! I had just been lulled into a state of half listening to familiar material when they started talking about the 7 rights of administering medications. Seven!! As any nursey people will know we learn the 5 Rights; Person, Drug, Dose, Time and Route. In UBC they teach a standard 7 which include our 5 and add Right Documentation and Right Reason which I couldn't argue with! They actually round it up to 10 with Right Technique, Right Education (for the patient) and Right Follow-up but the initial 7 are what they use to teach on the wards. It's all logic we use in the UK and Ireland but I think that from a teaching point of view the 5 Rights sounds a bit snappier and still contains all the vital components! Still, I have to admit to being a bit short-footed and defensive for the first few minutes when I thought that they taught twice as many as us!

With a group of term 4 patients in Skills Lab

There was also a lot of talk about generic drugs vs branded drugs. I didn't really get what the big deal was but I guess as it's almost all generic drugs we use in the NHS it's not an issue we have to deal with. In the US and Canada it is often only the branded drugs that have been through stringent trials and regulation. This is done by pharmaceutical companies who brand and set prices for the drugs etc. Every drug is licensed by their company for a set number of years (currently 20 years) and after that other companies can sell it under it's generic name. The problem is that there is no regulation with what these companies do with the drugs so ingredients and amounts can be different. Even minute differences can make a huge difference and be extremely dangerous as I found out listening to students discussing theirs and their families own experiences taking a medication they thought they knew but caused serious issues due to tiny differences in the make-up of the drug.

Once I had finished for the day I decided to take a walk around the massive campus. You can see the ocean from most parts of it so I figured it was pretty close and seeing as I had basically no free time in Vancouver I thought I'd take advantage of being so close to it and go for a stroll. After walking what was probably a couple of miles I came to the entrance to a national park at the edge of the campus, once you go in a bit their are steps down to the beach so off I went! Little did I know that it was 500 steps and when I got there without paying attention to any of the signs I ended up on a nudist beach with quite a few people availing of the facilities! Considering I'd climbed down half a bloody cliff to get to the beach I was in no hurry to climb back up again but I honestly didn't know where to look!🙈

If only I'd read this sign on the way down!

Don't get me wrong, I've been a nurse for 6 years - I've seen plenty of people without their clothes on but usually I'm expecting it plus they're not usually frolicking on the beach!😂
Also almost nearly died getting back up to the top again but it was a beautiful beach and a very unique(!) experience so it's all good😆

St. Paul's Hospital

On Friday I spent the morning in St Paul's Hospital in the city centre of Vancouver. I spent the morning with Irena, the only registered nurse in the ENT department! She showed me around and I couldn't believe the differences in the nurses role in our 2 departments! In NUH we have 8 RN's (and that's not including management roles) who run nurse-led clinics and the emergency clinic alongside a junior doctor. Trache changes, dressings, nasal fracture reductions, removal of foreign bodies and so on are all nurses roles in Queens. In St. Paul's there is one registered nurse which is crazy! Because of that all of the above tasks are done by reisdents (equivalent to registrars) which puts extra pressure on their clinics. But another huge difference is the amount of invasive procedures they do in Outpatients. Polypectomies, turbinate reduction, myringoplasties, tonsil haemorrhage management are all done in clinic! Those are all done as day cases in theatre on our side! Although even though we have more nursing staff which takes the pressure off, they had noticably more and better equipment in clinic so I guess it depends what you use your budget for. It seems no one can have the top notch equipment AND the staff! Typical.
Oh and I got to have my sense of smell tested which was really cool because it's a test we don't offer on the NHS so it was really interesting to experience it. Mine is above average, just fyi - woo!🎉

The Alligator forceps in St. Paul's. We call them Crocodile forceps!😄

After a hectic time in Vancouver I had 4 free days before my next visit in San Francisco so I stopped in Seattle where I am now, with the first series of Grey's Anatomy on Netflix as I type! Although I'm more of a Frasier fan myself! I didn't really think about it too much and didn't know what to expect but I'm so glad I came here, it's just the most amazing city. Really laid back and a great place to try to get back on top of my sleeping pattern! I even went to my very first baseball game on my first evening in Seattle to watch the Mariners play the Yankees and it was class!

I've had a great few days here exploring and spending all my money in the tonnes of amazing bookshops dotted around the city.😥
Also, lots of people have asked about the hospital from Grey's Anatomy. The hospital it's based on, Harbour View Medical Centre, is here and I did pop by but it's not the one with the famous entrance that everyone sees on screen. That one is in LA, sorry guys!

Seattle Grace is based on Harbour View Medical Centre but the entrance is in LA!

Tomorrow I head to San Francisco on the Amtrak, this one takes 23 hours and I've had more than one person tell me I'm crazy! But I've stocked up on American snacks (living the Gilmore Girls dream with milk duds, red vines and reeses cups!) and I have tonnes of reading material, surprise surprise! And I honestly can't wait to get a train down the West Coast of the US!
2 cities, 2 hospitals, 1 university, 1 nudist beach, 12 books and a partridge in a pear tree.
Until next time!

Slán😊

Kate

A Tale of 5 Cities!

Well, I have definitely put the travel into travel scholar this week!
Since my last blog I travelled back to Cebu City with Gareth, we hit a crazy storm when we were getting near to the bus station, with a crack of lightening hitting right outside my bus window so close I felt the zing of it up my arm! There were honestly waves rolling down the street in front of us in some parts of the city! They know how to do storms in the Philippines, that's for sure!
We flew to Manila that evening as we were both flying out early the next morning, Gareth back to the UK and me to Hawaii.
I had a 10 hour layover in Osaka, Japan so did a bit of wandering there for the day. Long enough to get a fridge magnet anyways! The minute I left Osaka they were hit with the worst typhoon in 25 years! I swear to God I'm cursed! Well, I'm definitely bad luck for the people I leave behind everywhere that's for sure. At home they're pretty much following my trip by tracking storms around the world🙈
Luckily, I did just miss that hurricane in Hawaii and the one that was coming in held off until I left. Phew!
I was in Honolulu for Labour Day and the long weekend so not the most ideal time for a visit but I hadn't been able to resist stopping off as I wanted to visit Hawaii's very own QMC! I stumbled onto the fact that they have a Queens Medical Centre (different queen, sorry guys) when I was planning my trip and seeing as I work in one myself I couldn't pass it up! I hadn't actually realised that Hawaii used to have a royal family until it was deposed of in the 1890's, became a US territory in 1898 and eventually it's 50th state in 1959. Although I wasn't able to attend clinics or ward rounds etc. due to the bank holiday I was lucky enough to get a tour of the hospital and it's amazing grounds.

I also got to tick another major thing off my bucket list by vising Pearl Harbour last Saturday. I was in early as I hadn't reserved a ticket but that was no problem as I basically didn't sleep a wink the whole weekend due to the worst jet-lag I've ever had! The best bit was definitely going on the USS Bowfin, also known as The Pearl Harbour Avenger, a submarine which went into service a year to the day of the attack. It was like it had never been touched and was honestly one of the coolest things I've ever seen. I also got to go on the USS Missouri which is where WW2 officially ended when the Japanese signed their surrender on it's decks in Tokyo Bay on September 2nd 1945.

The USS Arizona Memorial which is above the ship where 1,177 died & 1,102 are still entombed

Ok, sorry, went a bit off topic there! This isn't meant to be a history lesson😂 I stupidly decided to hike Diamond Head on my last morning in Hawaii, again after no sleep which was a bonus as getting up for your 5am alarm is no problem if you're already wide awake (thank God my middle of the night was the middle of the day in Notts though. Don't think Gareth would've been as cool with my steady stream of 'Hiya!' & 'I'm STILL awake!' texts if they'd been pinging away all night!)! It was well worth it though to get these amazing views of the island before I left.

So, yesterday I arrived in Vancouver - my last city for the week thank God! I headed out to do a food shop for my Airbnb to save some money and ended up in 3 bookshops on my street and $40 worse off (dammit Kate!) so that didn't go to plan🙈

I spent today in the nursing school at the University of British Colombia (UBC) and it was great. They only do an 18th month Masters course here done in 6 terms so I spent this morning with the term 1 class who are just starting out and this afternoon in the skills lab with the term 4 class who were learning about IM injections.

Students here are really keen and were very interested in my project and in chatting to me which was great! We got talking about why everyone went into nursing and one thing that kept coming up was the drug abuse problem in a certain area of Vancouver. There is about a 10x10 block radius with huge problems with drug addiction and mental health problems. Many of the nursing students worked as social workers there or volunteer and felt they could make more of an impact if they could go back there as nurses. As we talked about it I was just so struck by their attitude to the people they are helping. There is literally zero judgement or blame. Obviously I don't know about the rest of Canada but they have been working really hard here for years to get rid of the stigma and shame surrounding drug addiction and trying to normalise it just like alcohol and cigarette addictions. There are Safe Site Clinics all over the city so that addicts can at least inject safely and get given a once over and also access help if they are ready for that step. 

They also came up with a Naloxone kit. Naloxone is a drug that quickly reverses the effects of other drugs and is often used in cases of overdose. Here, they have a kit with a vial of Naloxone, syringe, needle, gloves, instructions, alcohol wipe and a mouth piece in case the person needs to be resuscitated. This is given either to the addict themselves and they are thought how to administer it correctly or to a family member or friend they live with or close to. There is also a Youtube video called 'Towards the Heart' that they encourage the person and their family/friends to watch for further education. I honestly thought it was one of the best things I've ever seen. It just sums up the attitude here which is that these people are not the drain on society that they are often treated as. They have an addiction and don't need our judgement or derision but our help and compassion.

Here, it doesn't matter how or why they ended up in this situation, what's done is done - now what can we do to help? It was an absolute breath of fresh air.

Tomorrow I head back in - I've got pharmacology in the morning. As I recently qualified as a prescriber I'm really interested to see what the differences might be here. It's also really sad how bizarrely excited I am about a pharmacology lecture - 10 years ago Kate would actually not recognise me.

Sorry about the long spiel but it's been an equally long week! Oh and no visible wild fires in my immediate vicinity - maybe the curse is broken? Or is it too soon to say...!?😂

Right, time for bed - I'm definitely not planning on repeating the Hawaii experience here in Canada!

Oíche mhaith

Kate