The interesting thing about my changed work practices is that I'm now much closer to my patients.

I don't mean I feel like holding their hands or buying the Christmas presents, I mean I'm physically closer to them.

Which seems strange, after all the back of an ambulance is certainly more cramped than the examination room that I use to diagnose, treat and educate my patients.

The problem is that I find myself having to get much closer to my patients to examine them.

As an example - if I were to pick up a healthy looking person with a sore throat and a cough, I wouldn't get too close to them. I'd plug them into the machinery of blood pressure, oxygen levels and temperature, then take a seat across the way from them while they coughed and spluttered and made out to be much sicker than they really were.

Now, however, I find myself getting very much up close and personal with my patients - if someone comes to me with a sore throat and cough I need to know what their tonsils look like, whether they are pus-ridden, what their breath smells like. I need to look in their ears, I need to feel their lymph nodes. And so on and so forth.

I was always convinced that when I left shift work I would stop getting ill - and several of my old colleagues have commented on how healthy I look when compared to my time on the ambulances. And this is true - I do feel a lot better.

That was until an outbreak of a viral upper respiratory tract infection became a rather popular reason to attend the UCC.

(And as an aside, are viral URTIs rare in SE asia? I only ask because a lot of the people I see are from there and, while the demographics of Newham are in their favour, I wonder if the reason they pitch up to hospital is because they have had no experience of such things in their homeland. In a similar vein, I would guess that chickenpox is also rare there).

So, I've been seeing a lot of these viral URTI patients. And getting close to them.

And now I have the bloody thing. During my four days off which, I swear, were going to be spent doing interesting and productive things, but which have now been spent drinking lemon tea, lying on the sofa and wondering if this really is just an URTI and not the first stages of The Himalayan Coughing Yak Death-plague. Of Doom.

Thankfully I'm feeling a little bit better now, just in time to return to work tomorrow.

(I suspect that in six months time I shall be immune to everything).

One of the advantages of working in an Urgent care centre, rather than on the road (only one, there are many other advantages), is that you should be able to get off on time. Unlike the ambulance service, you choose when to see patients (although you do try to see them as quickly as possible), so if you have only three minutes to go until the end of your shift you just don't call in a patient - instead you tidy the room, fill out a bit of paperwork, or make sure that your hands are spotlessly clean for going home.

Of course, while this is true, sometimes the real world has something to say on this and things go a bit wrong.

For example - if I have twenty minutes to go, I can call in that abdominal pain patient knowing that I should be able to finish assessing, treating and writing up the notes. Where it goes wrong is when the patient gets fifteen minutes into the consultation before springing a horrible surprise on me - such as the real reason why they are in my room is because they took an overdose of tablet 'x', they just haven't told anyone else. Anyone like the triage nurse who would have then sent them to the much more appropriate ED...

In that case you have to do a lot more assessing, a lot more writing up and then refer to the medical doctors - the medics, in my experience, are much quicker at answering their bleep than the orthopaedic doctors - of course the ortho's may well have someone's legs up behind their ears while they replace a hip, so they may be a bit busy.

Either way, you then have to fanny around printing out notes and front sheets and so on and so forth because, while the UCC is paper-free, the rest of the hospital isn't.

And that is why I'm typing this after leaving work over half an hour late.

So, y'know, ignore the spelling and grammar eh? This is a first draft typed before I collapse into bed.

I think I need to practice my time management skills.

(My patient didn't overdose, but they had something even more tricky wrong with them and they still needed referring to the medics. I've changed the actual circumstance to respect confidentiality).

I don't think that I've properly explained exactly what my new role is. In part because, much like my old job, what initially seems quite simple (For ambulance work - go to a sick person, pick them up and take them to hospital, try not to let them die) is actually fairly complicated.

I currently work in a hospital building, tucked just behind the A&E department (sorry 'E.D'.) while the entirety of the hospital is funded by one structure, the Urgent Care Centre (or UCC) where I work is funded by another completely different group (it gets even more complicated as this group is about to merge with another group...)

The short version of what I do as a NP (nurse practitioner) is I see patients with minor injuries and illnesses, and then I make them better.

This is massively simplified.

There are two main roles in my new post - 'triage' and 'working in the back'. When I triage (which lasts for around four hours of my shift), along with an ED nurse, I see patients as they enter the hospital and book in at the ED reception. Sometimes they want to see the UCC, sometimes they want the ED. It's my job to decide where the patients go. For example, someone with a verruca may well come to the hospital expecting to be seen in the ED (because, of course, a verruca is an emergency) - I will instead direct the patient to the UCC where someone who is 'working in the back' will tell them to get some verruca cream from the local chemist.

Sometimes someone will come in expecting to go to the UCC, but will end up in the ED. A recent example would be the chap who turned up with a 'cough', who actually had a rip-roaring case of pneumonia and would need admitting to hospital for some rather powerful drugs.

Once more I simplify - partly for sanity sake, partly because this is a quick overview, and partly because at the moment there are huge political ructions going on at pay grades far above mine as to the best way to see and sort all the patients that pitch up at the hospital.

'Working in the back' is where you actually see, assess and treat the patients you may well have triaged only half an hour ago. Little two-year-old Timmy with a cut to his head will be called into an examination room where I'll assess him to make sure that he isn't going to drop dead from an undiagnosed fractured skull. I'll then clean the wound, glue it shut and then educate the parent (or Timmy if the parent is a bit dim) about how to look after the now neatly glued wound. I'll also tell them that if Timmy decides to have a seizure or collapse unconscious they should think about bringing him back as the head injury is obviously a bit more serious than I originally thought.

I then type up the notes on the computer system (because we are a paperless system. Mostly), discharge the patient and then call in the next one.

Repeat that for the rest of my twelve and a half hour shift.

This is a picture of one of the examination rooms.

As far as scope of practice goes - we are a mix between the old A&E minor injury department (broken bones, twisted ankles, bumps to the head) and a restricted GP service (sore throats, urine infections, sick children and emergency contraception). In fact a lot of people treat us as a GP service - and that is one service that, for several reasons, we often can't provide - but I'll write more on that later.

I haven't blogged in over a month? Really?

It's strange really back in the day I could write three or four posts a day, saving them for later, and yet during this month I've only occasionally thought of blogging.

There are, to be honest, a couple of reasons why I've not been blogging.

• My new job. I'm enjoying myself. Well... 'enjoy' is perhaps too strong a word, after all I am still working in the NHS. However it seems that a fair chunk of the reasons for my writing (in the past year or so at least) was anger. Anger at the system, anger at inconsiderate patients, anger at watching the ambulance service circling the drain. With my new job I'm a lot less angry. For one, I'm not swearing as much - which is good because I don't think that the ambulance messroom language would go down too well with some of my new colleagues. But with that lack of rage I've been less likely to have a burning need to write something. I've noticed that I've been avoiding watching any TV news because it would get me angry and I would not have constructive output from it - I'm not a politically intelligent blogger, and I certainly didn't want to turn this site into a constant outflowing of 'Dave Cameron is a oily ****rag who if he wanted to make the world a better place would shoot himself. Slowly' or 'Nick Clegg is a lying **** who has killed the Lib Dem party and should be forced to live out his life in student digs, begging for charity'. It'd get boring incredibly quickly, and my computer would break from all the anger flecked spittle I'd be spraying at it. So, I've been a lot less angry - and that means a fair bit of my muse has packed her bags and buggered off to sunnier climes. Damn that 'happiness' and 'job satisfaction' - it's ruined me.

• The return of my depression. Which is perhaps an illogical thing to say after admitting that I am happier and less anger filled. But it's a weird thing depression, in my case more about a lack of energy, a desire to withdraw from the world and a slight, but nagging, suspicion that I would be better off dead* rather than sitting around crying**. Everything in my world can be going wonderfully (and at the moment, both personally and professionally, it is), but when those brain chemicals decide to slosh around my skull in one way rather than the other it can really bugger you up. Thankfully my depression is, I suspect, what most people would call 'pitifully minor'. So I can often just muddle through the day with just general feelings of shittiness.

  Interestingly, when I'm at work, although I'm watching the clock tick down to the end of my shift, while I'm there I'm often in a fairly good and energy filled mood. Perhaps it's the uniform.

• I've been rather busy - trying to get my brain up to firing on all three and a half cylinders and pointed back into the general direction of being a nurse. It's quite a thing to blow the dust out of the crevices of my mind and see what sorts of knowledge and skills are still tucked away up there in a cardboard box marked 'Misc. odds & sods'. Skills like steristripping wounds are still there as if I had been using it every day, which is strange as I was expressly forbidden from doing such things in my time in the ambulance service. The risk of course is that while my mind and memory muscle may still recall these skills - medical practice may have moved on. I don't want to be seen as the sort of practitioner who thinks that bleeding patients is still acceptable practice. So I've been reading up and reading around, and asking questions and generally trying to cram as much into my brain as possible. Having come from a job where on the job training was often being given a sheet of A4 to read, this has been taking up a reasonable amount of my daily energy quota.

• Along with the mental settling into my new job, I've not felt confident enough to write about it (although my new boss has asked me if I'm writing nice things). Mostly because it takes a certain amount of time before you can get your feet under the table and understand most of the driving forces that mean something is done one way rather than the other. I'm still of the mind that when you are new in a job you should 'keep your eyes and ears open and your mouth shut'. So what great insights am I going to bring to this little corner of the NHS when I'm still learning what boundaries are already in place, what I can push, and whether I have the completely wrong end of the stick about a situation?

• Confidentiality has always been incredibly important, personally as well as professionally. But now I'm sitting in one place it is a lot harder to obscure some of the identifying attributes of my patients and the stories that they tell me. And it is the stories that I am told which are often the most interesting thing about my job, but as these stories are, by definition, very individual you can perhaps see my problem in trying to relate them. Over the last month I've been collecting stories in enough numbers that I can now start to mix and match and mash together some stories to remove all identifying marks.

• I'm not sure that people are that interested in Urgent Care. For the large part I'm seeing patients for a very short period of time, and for illnesses that are normally self-limiting and are almost certainly not life-threatening. Writing about it this while keeping it at least vaguely interesting is fairly tricky - that's why 'Doctors' has to throw in the occasional kidnapping or explosion to keep the viewers engrossed in the lives of the GPs. There are no explosions at my workplace - although we did have a leaking water pipe last week.

So those are the excuses.

I do, however, have a plan - and it's one that involves me writing a lot more. I'm going to do the best I can to write every day that I'm not at work (so that's three or four times a week as a minimum) - partly to keep my brain active, partly because it's a therapy to be able to let off steam, and partly because I enjoy it.

The plan also involves me writing every day for at least this week - and then... well... there will be a bit of a change...

*No, I'm not actually suicidal - too far too sensible for that.

**Although that does sometimes happen - it's why I'm steering clear of alcohol for the foreseeable future.