*I recommend reading this blog post before this one to know more about the role of a HCA and why I became one!*
In this blog post I hope to share my experience of my first week as a HCA…with no previous experience…on an infectious diseases ward…amidst the tailing end of a pandemic 🙂 Of course to maintain patient confidentiality, I will not be giving any information which will identify patients.
I’m working on an infectious disease ward, which only has side rooms. In conventional hospital wards in the UK, the wards are laid out in bays with four beds per bay and they are only divided by curtains. If they need to use the toilet, they have to go to the communal one that all the patients on that ward share. These wards usually do have a couple of side rooms though, for those patients who also have an infectious disease but need to stay on that ward, or if they’re particularly disruptive to other patients.
In an infectious disease ward, all the patients have a contagious illness and so need to be isolated from each other. This means there are no bays and only side rooms, each with an en suite. The doors should all be closed, but this makes it difficult to keep an eye on patients so those particularly at risk of falls have their doors propped open. My ward has 25 side rooms along one long corridor. I kind of like it because I feel like I’m in Grey’s Anatomy 🙂
Shifts for the nursing team are on a long day/long night rota, so day shifts are 07:30-20:00 and night shifts are 19:30-20:00. These overlap for half an hour for ‘handover’ where the staff on the previous shift inform the new staff of how the patients have been doing, what needs particular attention and any tests that need to be done during that shift. Because each shift is 12.5 hours long (!), full time staff work three shifts a week. You can also become a bank staff member and do more shifts if you’d like (more on this in my previous post).
I have just completed my first three shifts and honestly feel like I’ve been an HCA for months. I’ve learnt so much already and feel at home in the ward. All the colleagues are so nice and helpful, and all the patients I’ve interacted with so far have been so sweet.
It wouldn’t be a typical first day in the NHS without your ward manager being on annual leave and no one else knowing you were turning up. Ha. I had a very brief tour of the ward by one of the other HCAs and then changed into my uniform. The first week is the local induction where you are partnered up with another HCA and essentially shadowing them. My ‘buddy’ for the day, an experienced HCA, introduced herself to me and passed me a handover sheet. We stood by the ‘computer on wheels’ with the nurse and HCA from the night shift who gave us a brief background on the patients we are looking after today.
The 25 patients are split into sections of five, with each section being managed by one nurse and one HCA the entire shift. I was initially shocked at how many members of staff there were on this one ward. I struggled to remember everyone’s names. Their name badges were often covered with aprons and faces covered with masks and visors, so I often needed to ask their names again which was embarrassing.
My first job was washing all the patients who needed assistance, changing their gowns and changing the bed sheets. It feels quite satisfying getting all the equipment and supplies ready for washing, and then leaving the patients nice and clean all tucked up and cosy in bed.
Breakfast arrives at 8:00. Some patients need help feeding and I had a 93 year old man who cannot feed himself at all. The nurses told me he has been very difficult recently and has been spitting at the care assistants trying to feed him…so I was a little scared. But for some reason he was absolutely fine with me feeding him and finished off all his porridge! He couldn’t speak well so most things he said came out in mumbles. I later kind of learnt how to interpret what he wanted but it was so difficult and it must have been so frustrating for him to not be able to communicate what he needs. When I was feeding him, he saw my name tag through my see-through apron and said “HOLLIE!” and then winked. That was the first word that he said that wasn’t a mumble and that I could understand. The next word was “shave!” and my buddy and I gave him a shave later that day. He looked ten years younger and a lot happier, and a bonus was that his chin was much easier to clean when tea dribbled down.
I then helped patients go to toilet, either by using the commode, bedpan or changing their pad. Some patients only need assistance walking to their toilet. I coped with this better than I thought I would and have already got used to it. It’s just a natural part of being human and I feel so sorry for them not being able to go to the toilet themselves. You have to make it out like it’s not a big deal for the patients to not feel so embarrassed. The only good thing about wearing all the PPE is that the masks and visors really do help with the smell!
The clock struck 11:00 and it was time for my morning 20 minute break, where I had a snack and chatted to some other HCAs in the mess. In the whole 12.5 hour shift, we only get 1 hour break split up as 20 minutes in the morning and 40 minutes around 4pm.
We had one patient in her 80s with dementia who was found fallen over in her care home. She spent the entire day talking to herself or people she thought was in the room. Although it is extremely sad at how confused patients with dementia are, some of the things they come out with make you chuckle. Whenever she caught my eye she’d say “when the man with the iron mask comes up to you and offers you money, don’t take it, you hear me? He’ll spend it on marijuana!”. She also kept shouting at a man she called Simon and Dave interchangeably, who she believed shot her son and her dog. Some things make you worry about what they must have been through in their life as I doubt these things come from nowhere. Perhaps her husband had an affair during their marriage as she often looked at me and turned back to imaginary Simon and said “I understand why you’d prefer the young girls [pointing at me], and not an 86 year old like me… I always knew you preferred her!”.
She later was found trying to walk out of the ward so ended up needing ‘specialed’ which means constant 1-1 supervision.
Lunch arrived at 12 and I had to feed the 93 year old man again. After he had his shepherd’s pie, I had to give “mouthcare”, which is essentially brushing his teeth with something that looks basically like a mini sponge on the end of a stick.
I soon had my lunch break. I was exhausted and it was hard to comprehend that I still had four hours left of my shift. I was very disappointed at the lack of vegan options in the staff canteen but treated myself to a soy milk latte in the hospital Costa.
Dinner then passed; feeding the patients definitely makes time go very quickly because it can easily take up to 45 minutes if they have a high risk of choking so you have to feed them slowly. After dinner, the rest of the shift is very chilled. It is just a case of waiting for call bells when patients need to use the toilet, and cleaning equipment.
I had an eventful but no doubt interesting first shift!
When I turned up for my second shift, the night nurse told me the woman with dementia was transferred to the dementia ward. It was where she needed to be (I think her COVID test came back negative so she no longer needed to be on our ward) but I was sad that I wouldn’t hear her funny stories today.
I was still looking after the same section of patients that I had yesterday, so I fed the 93 year old man his porridge again. Amongst his incomprehensible mumbles I made out “thank you, you’re very nice”. AW.
He was slightly irritable today though and was shouting “HELP!” whenever his door was shut. When I’d open it and check if he was okay he’d just stare blankly at me. Another HCA joked that we should put a cardboard cut out of me in his room and he would be okay. When I later got home that day and knew I had the next day off, I was sad to think of someone else feeding him his porridge and shepherd’s pie tomorrow :'(
A new patient arrived overnight, a man in his 50s with long covid (having shortness of breath and lung damage months after having COVID-19). He brought in his Kindle and was reading a book to pass the time and I had a chat with him about how great Kindles are.
As it was my first week, I needed to have an appointment with Occupational Health to have my first Hepatitis B vaccine dose. This was at another hospital so I was allowed to leave and get that done and come back.
Today was a much less eventful shift but I felt that I was getting to grips with everything and felt much more confident.
I had a day off the following day before coming back on Friday. I intended to have a lie in and relax, but the late shifts mean that it is very difficult to switch off before bed and I dreamt of answering call bells and walking down hospital corridors. I felt restless and the next day I was too tired to do anything.
The HCA who was my ‘buddy’ for my first two shifts was off-duty today so I was paired with another HCA who I met on Tuesday. This was actually great as I got the chance to see how someone else approaches things.
Four out of my five patients were COVID + so I had to be extra careful with my PPE. One was in his 40s with no previous medical history and was doing quite badly.
I also had another two patients with dementia and the night staff said they’d been trying to get out of bed all night. One is particularly at a high risk of falling over and was found the other day on the floor as she tried to go to toilet by herself. It’s sad because these patients don’t realise how confused and frail they are and still think they’re able to do things by themselves. I had to keep an eye on her to make sure she didn’t try and get out of bed by herself. After a restless night it seemed she was going to spend the whole day sleeping so at times it felt futile to be watching her when she’s sleeping. It’s very tempting to think she’s not trying to get out of bed and walk off, but I eventually caught her suddenly wake up and swing her legs round the side of the bed and hoist herself up.
I was so thankful I caught her and eased her back into bed because if I didn’t I’m sure she’d been found on the floor again. Someone so frail and ill and due to go back to her care home very soon does not need another fall. But what was so sad is that she thought I wasn’t letting her go to the toilet, because she believed she was able to walk and go their herself. I explained she’d have to use her bed pan or a pad, but she was getting confused and still trying to get up. It took ages for me to explain why she wasn’t able to take the risk of walking to the toilet, but she eventually said “ooh alright then”. I wondered whether other people were ever this patient with her.
I later came back and checked whether she had gone to toilet and she hadn’t, meaning she hadn’t passed urine or had a bowel movement all day. This wasn’t surprising because she hardly ate anything by looking at her food chart. When lunch came round, I encouraged her to eat a bit of her meal. The catering staff come around in the morning and take all the patient’s orders for lunch and dinner but I think if the patient is asleep or not very responsive, they just pick a random option for them. She had been given fish pie today which absolutely reeked when I peeled the cellophane off. I got a little spoonful and popped it in her mouth before she started retching and I started panicking that she was choking. I was shouting “spit it out!!” and she spat it out on a tissue I was holding out for her before she said “What on Earth was that?!! That was disgusting!!” I laughed because she simply hated the taste of the fish pie which I did not blame her for. I gave her a sip of orange juice to take the taste out of her mouth but she still kept muttering “horrid…horrid”. Note to the catering staff: don’t pick fish pie as default when the patient doesn’t say what they want!! I then fed her a pot of strawberry yoghurt which she seemed to absolutely love.
The second patient with dementia was hallucinating a lot today. Whenever I came in to her room she’d say “aw you’re twins!” and was seeing two of me. She looked at her hands and said “ooh that’s dangerous!” I asked “what’s dangerous?” And she replied “There’s a blade on my hand, I’m sorry about all the blood!” There wasn’t a blade and there was no blood anywhere 🙁
She kept shouting “NURSE!” whenever anyone walked past but when you went in to see if she was alright she’d ask if we could take her back to her room. She didn’t understand where she was. All the staff ignored her because they knew she was confused but it did not sit right with me to ignore someone shouting, so whenever I was free I went in and tried to reassure her she was fine and held her hand until she didn’t look so terrified. I’m sure all the staff did the same as me on their first shifts and later became tired of it, but I don’t think I would ever pass the opportunity to comfort her if I wasn’t rushed off my feet.
I also looked after an elderly lady with COPD who was taking small little gasps for breath with her mouth open like a fish pulled out of the ocean. Her mouth was getting very dry so I often came in and offered water. I can often tell when no one has offered them water in a very long time because the moment the straw hits their mouth they drink the whole glass in seconds.
She was also getting very bad pressure sores on her lower back and heels of her feet, so we changed her mattress to an air mattress. For immobile patients, we have to use a sling and a hoist to lift the patient in the air while we change their mattress and then gently lower them on to the bed again. I had a two hour training session on how to use this equipment which scared me then, but now I’ve done it on three patients, I’ve got the hang of it. I have to admit it is very funny to see a little frail old lady in a sling being lifted into the air, I think they secretly find it very fun and probably a highlight of their day.
I came back from my morning break to find a relative crying and discovered her mum, a patient who has been on this ward with a range of issues, had sadly passed away. I never personally interacted with her but did always check through her window to see if she was alright so this was very sad. One of the HCAs then asked me the dreaded question “could you help me wash her?”. This was a big moment as she would be the first ever dead body I’d see in my medical career.
Two other healthcare assistants and I washed her and prepared her for the mortuary. Despite being very frail, three care assistants were needed because her body was now obviously limp and heavy to manoeuvre. One of the HCAs spoke to her as if she was still alive though, apologising when we were having to roll her over which I thought was very sweet and respectful. It was definitely a strange and upsetting experience but I am dreading the next time when I’ll have to do this to a patient I grew to know well, as although this was incredibly sad I felt detached because I hadn’t cared for her. The little things like her wedding ring we were asked to leave on, her slippers and her dressing gown beside her bed touched me. But as I guess all healthcare professionals learn to do, we all moved on and the room was quickly filled with a new patient to look after.
One of the most satisfying parts of the day though is when a patient is being discharged home or when they’re being transferred to another ward. The job of the HCA is to collect their belongings together and get them ready to leave. It is so sweet to gather together their glasses case, the book they were reading, notes from their family (which often for confused patients say something like “MUM YOU ARE IN HOSPITAL. YOU’RE SAFE XXX”) and their favourite socks all in a bag for them. One patient today was being moved to another ward and I helped her get ready. She had been in our ward for a few weeks and apologised that she had so much of her stuff everywhere over the room. She asked what ward she was moving to and the nurse wrote it on a piece of paper for her. She put it in a compartment of her handbag and she was ready for the porters to come and take her. As I said my goodbyes and left the room she went “oh where did I put that piece of paper again?!”
All the patients have their call bells they press when they’d like assistance with something. All the HCAs are meant to answer all the call bells even if they’re not from your patients. I answered a lot of other HCA’s patients calls because they were either busy or didn’t get there before me so it felt like I was managing 10+ patients by myself at times. When I left to go home, the nurse in charge of those patients thanked me for my help today and then the HCA shouted “YESS HOLLIE YOU’RE SUCH A TEAM PLAYER”. I felt a bit of recognition and a little less bitter about the fact I did most of their work that day : /
I love the last two hours of the shift after dinner when the patients are snuggling down to sleep. The sun is setting beautifully through the windows, and there’s a wistful atmosphere on the ward. I draw the curtains in the patient’s room and make sure they’re comfortable before turning the light off if they’d like. If they had a bad day and were in a lot of pain, I’d hope that tomorrow is a better day for them and say goodnight. I leave my shift on the bus home feeling a sense of satisfaction I can’t imagine many other jobs giving.
This has been one of the most enlightening weeks I’ve ever experienced, and I feel as though these three shifts have changed my perspective on a lot of things. I hope you’ve enjoyed reading about my first week as a healthcare assistant, I have deliberately left out a lot of things I had to do which I’m not sure would be pleasant reading!
My induction week has officially ended and so next week I will get my own set of patients. I feel a bit nervous but the other HCAs and nurses are there to help me and I feel confident in all the technical things I need to do now.
The Conscious Medic