Being an independant learner

Seeing as it’s coming up to the summer block placement and no matter if you’re in placement in the community doing a 9-5, 5 days a week or if you’re on a ward still doing 37.5 hours in a variety of shifts, it’s a lot!

So I thought I’d give some little tips about how to keep yourself busy no matter what year you’re in and push yourself to get involved as much as possible! I know that, as I’m a second year doing my elective placement back home, it can a little nerve wracking starting over in a new trust and spending so much time with a team I’ve never met before. But if there’s anything you take away from this ramble then: FAKE IT UNTIL YOU MAKE IT. No one can tell if you’re faking confidence but are freaking out on the inside and you’ll gain the muscle memory to remain calm the next time you do something that scared you previously.

Anyway….

I’m going to first off say that being an independent learner is very different from being an independent student nurse, it’s still okay to observe interactions and ask for some assistance when needed absolutely nothing wrong with that. But i’m talking about sometimes taking the initiative when it comes to what you get out of placement.

Trust me when I say that I know first hand how terrifying the idea of talking to some staff can be sometimes, with a history of social anxiety I’m still not quite over the fear of initiating a conversation with people that I don’t know that well. However one good thing about this career choice is that you basically know that most people (hopefully) are going to be super nice and friendly, always happy to help.

This goes for both ward and community placements, sometimes there will be days when there is endless tasks to do and others it feels like there isn’t anything to do. It’s okay to sometimes take a breather from it all but you don’t want to be seen as the student whose in the office all the time because you’re just too nervous to ask to sit in a ward round or go on a home visit when your mentor isn’t in.

So here’s some tips about how to try to minimise those moments:

  • Bring a notebook and write all the stuff in it!
    I found this particularly easy and well within my comfort zone in both my first and second year placements, I either made notes during the interactions I had or after them. This helped me to remember them more and also helps to get you in the habit of writing things like nursing notes and reflections (portfolio stuff is always a bonus, fill that bad boy up!) You could even simply write down your timetable for the day or lists of tasks to do so you know what’s going on. Also maybe look into bullet journaling because I found this helped to structure my day to day personal and professional life a lot easier. It can be sometimes rare you find a computer to type stuff up on so maybe just wait until you’re home to do this.
  • Ask for stuff to do in meetings!
    Another thing with this job is that there’s always new staff or people on different shifts and if you’re in the habit of just hanging around one person and they all of a sudden aren’t in, you’re kinda at a lost of what to do. Especially because we are supposed to spend a minimum of 40% of our time with our mentor, you need to be around other members of the staff in the other 60%. By asking in the meetings or handovers if there’s anything you can come along to or to shadow it can help you to get exposure to stuff your mentor may not have gone through with you get.
  • Spend time with the MDT.
    So there’s a lot of people involved in the care of one person or in one team or one ward. Therefore it is important to get to know what their job is because in the future you may become a care coordinator or key nurse and need to know the jobs of all the others involved. Some of the job roles you will end up picking up through experience (I actually have a list of terms that I hadn’t heard before and had to research). Spend time with the social workers, consultants, nursing assistants, occupational therapists, psychologists, junior doctors, anaesthetists and even the managers to help understand the pathways to care in each scenario.
  • Research and essays!
    Now then you may be on placement at the same time as completing an essay so if you have extra time, notebook (or access to a computer if you want to type it up) and your mentor is okay with it then why not? Another thing you can do is research the conditions you are coming across if you haven’t learnt about them before or the acronyms you don’t understand, you could read stuff and rewrite it or just copy and paste for your own learning (I have about 40 pages of research just from my placement with an early intervention into psychosis team because there’s so much to go over!) There’s also shouldn’t be any issues with bringing in a book you’ve bought or got from the library to read through and make notes in your own time. It’s up to you how you want to spend time on placement and how busy you want to be but expanding your knowledge should never be a bad thing. You’re always learning in this career, while studying and beyond!

  • Spokes, spokes, spokes!
    This is something which you should definitely want to do, there are so many linking organisations and teams in nursing that you can spend time with. If there’s a particular area that you wanna look into like voluntary organisations, or youth groups, or A&E liaison team or community teams or physical health clinics or even wards in the same building then go for it! Any experience is good experience. You could spend a few hours or a whole week if you’re on block placement. By doing this you understand better the available places to possibly refer people to and could find the perfect place that you wanna work in the future.
  • Ask questions!
    Now then im super bad at this one. I always think of questions to ask AFTER they’ve asked if i have any questions but there’s nothing wrong with a little clarification if you still need to go over something you’ve learnt. Think about questions to do with people’s history or symptoms or why they use different assessments or what the evidence based practice is. It’s always good to ask a question because even the other person  might not know and then you can both learn together!

 

I hope this gives you all some suggestions on how to become a more independent learner and I wish you all the best for your summer placements, don’t forget to get as much out of these experiences as possible but don’t stress if you don’t you have the rest of your career to learn more!

 

by Jess Manning  – second year mental health nurse

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Making the most of your nursing degree

Hello to the lovely new student nurses, cohort of 2018! Welcome to the university of Manchester!!! I hope you are ready for a tough, rewarding, enjoyable and busy 3 years.

As a recent graduate of UoM, I thought it would be nice to make a lil list of how to make the most of your degree. It’ll be a mix of things I wish I had done, and things I’m glad I did!

1.) Join a society- just because you are a nursing student, and therefore not a “normal” student doesn’t mean you shouldn’t join a society! It’s a great way to feel part of university life, make friends and allow time to focus on something not nursing related.

2.) Explore every opportunity- Throughout your degree, you will come across SO many opportunities to enhance knowledge/experience. They can come from the strangest places. I’d highly recommend keeping your eyes peeled and taking any opportunity handed to you! E.g) Nearly 3 years ago, I started as a blogger for this blog. It helped me secure a job, be involved with nursing recruitment and get my name known.

3.)  Reflect regularly- Time will fly by, and soon you will be balancing placement and academic work. It can be hard, and there will be days when you don’t think you can do it. Reflect on them! Whether its a structured reflection, a blog post (join our team!), a poem or whatever- reflecting on your experiences and learning from them will make you a better nurse.

4.) Spoke everywhere!- Once you start placement, you can start doing spokes where you experience a different area related to your placement for up to a week. E.g) if you are on a diabetic ward, you can spoke with the diabetic specialist nurse, the high-risk foot team or research nurses. Spokes help you understand the vastness that is the healthcare sector, and allow you to experience areas you might not otherwise be placed in.

5.) Don’t neglect university- During my degree, I watched many student nurses disengage with university somewhat because they viewed placement as more important. Uni and placement go hand in hand, you need one to succeed at the other!! All that academic work will be useful in placement. Go to seminars, discuss, do the extra reading. It will pay off, and it will make you a better nurse.

6.) Don’t suffer in silence – This degree is not easy. Students are prone to developing mental health problems. So are healthcare professionals. You are both! There is always someone to talk to: your AA, other university staff, your mentor, your PASS leaders, your friends, your GP, your family. Uni has a great counselling service, and Self Help is also excellent.

7.) You won’t like every placement, and that’s okay- Each nursing discipline tries to give students a wide range of placements. But there are issues- the number of available mentors is dwindling, so that can make placing students really hard. No matter where you are placed, you will learn something. Keep an open mind!

8.) Your appearance matters!- Your nursing uniform is therefor you for the next 3 years. Take care of it, keep it white otherwise people will start asking why it’s grey (I speak from experience). Don’t wash your trousers with it on the first wash. Get some comfy shoes, it doesn’t matter if they are ugly. If you need more uniform, go to Jean McFarlane student support and ask for spares. Ordering more is helpful, and not too expensive.

9.) Your life is more than just being a student nurse- It’s very easy to be consumed by this degree, because there is so much to occupy yourself with. But take time for yourself! The more time you have to relax and recharge, the better you will feel.

10.) Feedback!- No degree is perfect, ask anyone. It’s SO important to feedback any issues, concerns or things that you think worked well. Your student reps can do this on your behalf, but don’t feel like you can’t shoot someone an email too. We are all adults here!!

 

Mythbuster- an NQN in community?

Many of us students will have been lucky enough to experience a placement where we felt we belonged. Ever since my first summer block placement in community, I knew it would be my dream job. I was then lucky enough to spend my 2nd year elective and my sign off in community too! 

Even though I was really passionate and excited about wanting to work in community, I didn’t always see it as a possibility. Every time someone asked me where I wanted to work, and I said community, I was met with disagreement.

“You can’t go straight into community”

“You need a few years of ward experience first”

When you hear this all the time, from qualified nurses, it’s normal to feel a bit perplexed. I thought we could work anywhere…?

Well I’m hear to let you into a not-so-secret secret, you CAN work in community as an NQN!

Once I entered 3rd year, I decided to ignore all the advice I was given, and applied for community posts anyway, without a driving license. I got the job! In fact, I was offered two posts in different areas. So I thought I’d debunk some myths around community Nursing….

It’s only for older nurses who want to retire soon as it’s boring!

Hahahahhha! You may not be on your feet for 12 hours straight but you are forever bending into odd shapes in order to do wound care/catheterising/injections in order to fit into the home environment, as well as other challenges. You still have your patients, on your list, and possible added extras too. It’s not a job for someone who wants an easy life that’s for sure! But is any nursing job an easy life? I’ll let you decide…

You have to go to uni again to work in community

Wrong! You can join as a band 5 staff nurse! If you want to be a registered district nurse, you need to complete a year full time/ part time masters, which will make you a band 6. You need community experience (at least 2 years) before undertaking this. It’s massively helpful, and aids career progression, but by no means essential. If this is your aim, mention it to potential employers and ask about secondment.

You need ward experience before you go into community

Nope! This used to be the norm, but not anymore! Newly qualified nurses should have the skills to be able to work in a ward or in community. I personally feel more prepared to work in community once qualified, just as someone else might feel at home in ICU. It’s personal choice!

You de-skill yourself working in community

Incorrect!! And one of my biggest pet peeves. Every nursing role is different, and will require both general and specialised skills. Community nurses need to be able to: work independently, feel confident giving medication such as diamorphine or insulin by themselves (these usually have to be countersigned in the hospital!), provide wound care, support patients at the end of life and their family and many many more skills. This isn’t deskilling! It’s just a different set of skills.  

If you want to work in community, do not lose hope if you are being told otherwise. Attend recruitment events, speak to your preferred trusts and apply for jobs! 

Keep an eye out for more Mythbuster: NQN jobs blogs…

Incontinence 101

Having spent 3 years in various wards, community areas, clinics etc., there has always been one problem which many of my patients have been affected by; incontinence!

Incontinence can be urinary, faecal or both. Incontinence is not a disease, rather a sign of a lifestyle problem, or a symptom of a medical condition. It affects between 3 and 6 million people (!!!!), and many do not seek help until much later. This needs to change!

Types of incontinence

Stress incontinence -not actually related to stress! It means that there is pressure on the bladder due to pregnancy, being overweight, sneezing, lifting heavy objects and some medical conditions (such as prostate cancer). It happens because the pelvic floor and urinary sphincter are weakened.

Overactive bladder- this is when you feel a strong urge to urinate, as your bladder is not relaxed. This means your bladder doesn’t like any amount of urine, so is constantly telling you to get rid of it! This can be caused by the type of fluids you drink, like caffeine or alcohol. It may be due to dehydration, as small concentrated amounts of urine in the bladder will irritate it. A urinary tract infection (UTI) can also cause an overactive bladder, but this is easily ruled out through a urine dip.

incontinence

Functional incontinence- This means that the incontinence is occurring as they are unable to reach the toilet on time, often due to immobility but also caused by Dementia or other physical/mental illnesses.

Mixed incontinence- As the name suggests, this is when there are two causes of incontinence. For example, a mix of stress and overactive bladder. Very common in women!

Total incontinence- This is the most severe, as there is no control over the bladder so there is constant leakage. This can be due to bladder abnormalities, spinal cord damage or bladder fistulas.

Faecal incontinence

Faecal incontinence can be harmless or serious, so it’s important to know all the details! Diarrhoea and constipation are the most common causes. Chronic constipation can lead to a weakening of rectal and intestinal muscles, causing faecal leakage. This is common in people with Parkinson’s.

How can you prevent incontinence?

  • Avoid/cut down on “bladder unfriendly” things such as caffeine, alcohol and spicy/acidic foods
  • Regular exercise (the answer to everything!)
  • Regular pelvic floor exercises
  • Treat any constipation and diahorrea quickly
  • Don’t strain during bowel movements, as this can weaken the muscles which control your bowel movements and only allow small amounts of faeces to pass

Treatments

There are so many options, and it depends upon the persons health and mental capacity, as well as the type of incontinence they have.

Pelvic floor exercises– These strengthen the pelvic floor muscles, which is the most effective treatment for stress or childbirth related incontinence. They are undertaken for 12 weeks, and must be completed 3 times a day (8 contractions each time).

Bladder training- This is a method I’ve been doing accidentally in all my years as a waitress/student nurse (2 professions where emptying you bladder needs to be precisely scheduled with your many other tasks). It involves delaying the passing of urine for 5-10 minutes, in order to force the bladder to wait. Techniques to achieve this include crossing you legs, standing on your toes, distracting yourself or applying pressure to your perineum.

Medicinal- I won’t go too far into detail, as I’m not an expert just a keen observer. Medicinal treatment of incontinence only works for overactive or mixed incontinence, and it is not the first-line of treatment (in nurse-led services). Drugs such as Oxybutynin, Tolterodine, Darifenacin and Festoterodine. These drugs are either immediate or extended release, with extended release causing less side effects but interacting with more drugs. They work by inhibiting the parasympathetic nerve impulses, relaxing your bladder. However, it is highly important to educate your patients about the possibility of urinary retention with these drugs, and a bladder scan is required 4 weeks after starting these treatments.

So that’s your one stop blog about continence! I can highly recommend spoking with your local continence service, whether in hospital or community, as you learn so much!

If you want to get involved in our blogs, email us/ message us on Facebook, twitter or Instagram! 

The 3rd Year Survival Guide

After 3 long years, the September 2015 cohort is finally done! Portfolios have been verified, dissertations are completed and PARE is locked. It’s unbelievable that just 3 years ago, we were starting our student nursing journey. Time has flown! Many of us began this journey with little to no care experience, either coming from school or college, or previous degrees or access courses. It just shows that Nursing is not a career where you need experience, or very strict qualifications. It can be for anyone!

As a goodbye present to the younger years, I asked the ‘15 cohort to impart some wisdom about surviving 3rd year…

Dissertation/deadlines

You’ll be given a little suggested timeline for your dissertation. Try to keep to it as it really helps with structuring everything.

Plan ahead, and try not to leave things till the last minute (unless that is what works for you!)

Remember that your dissertation is YOURS, it should be enjoyable too!

I found keeping a dissertation diary (noting down time/date of session and what you did) is hugely helpful, as it can be easy to forget what you did when there’s so much to do!

Make sure you act on the constructive feedback from your supervisor. If you aren’t getting it- ask for it! 

Placement

You will have to complete your medicines management mini exam at some point in 3rd year. The earlier you do it, the better! It’s a weight off your shoulders, and task ticked off!

Be honest about your academic workload and life commitments to mentors. They should be sympathetic and ensure your off duty works with life.

You will feel like a lot is expected of you as a 3rd year, and that might make you a it terrified. It’s okay! Keep going. Make your own goals, talk to your mentor about it and set your own pace!

Trust me, you will feel SO ready to qualify in your last few weeks!!

Portfolio

Plan how you will meet your exposure to other fields as early as possible, otherwise you’ll have a mad rush at the end of the year!

Don’t leave it till the end of the year. Make you life easy, even if it means spending a weekend or doing it in bits over the year. It will allow you to enjoy your last moments of being a student nurse. 

Advice for student parents

Keep to your deadlines, and try and submit early if possible. Including your portfolio!  Leaves less room for unfortunate occurrences like a sick child.

Make sure your mentor knows that you are a parent,hopefully they will be sympathetic and flexible.

The most important pieces of advice

Talk to your family, family, anyone you trust if you feel you are struggling. You will feel better. Share the burden!!!

Peer support is what will get you through the madness that is 3rd year.  Ensuring that you attend seminars and lectures is a great way of doing this. Don’t lose motivation! 

Having a twitter account (personal, just nursing or both!) is an excellent way of getting advice, learning and networking. You can start by following us

Practice self-care in your own way everyday. Whether its a relaxing bath, a run, playing computer games or walking the dog, you are the most important person to look after. No matter how busy you feel, it can’t come before you!!

So there you have it! The baton has been handed to September 16, and will be yours before you know it September 17!!

If you want to blog for us, or want to request a topic, drop us an email or message on Facebook/twitter/Instagram

The not-so-clinical skills

Placement allocation. A daunting prospect for all! There are, as always, disappointments. Many of these are for valid reasons, such as very similar/the same as another placement, too far away or you’ve experienced it as a service user/you worked there.

But I’ve noticed that many people (including myself previously!!!) get disappointed with placements if they aren’t “hands on” enough. But why?

We all enter into nursing for different reasons, and many of us will prefer “more clinical environments” than others. But does this mean that we should expect these placements throughout our studies? No! Because that wouldn’t reflect what nursing is!

Even with the nursing role changing, the non-clinical skills such as communication, leadership, delegation and teamwork will always be at the forefront of nursing. These skills may seem “soft”, but they are the bread and butter of our practice and are transferable across all jobs!

I’ll use an example of my own.  My first ever placement was on outpatients, and I was gutted! Most of my nursing friends were off living the dream on wards, whilst I was falling asleep in doctor’s consultations. The staff were lovely, but I wanted more! I was convinced that my time in outpatients was a write off, completely pointless to my nursing education. Surprise surprise, I was wrong! My listening skills improved greatly, and, since I spent so much time noting down words I did not understand, I learnt a lot about pathology. Whilst at the same trust later on in my degree, I was able to reassure patients and relatives about the outpatient clinic process. When I held someone’s hand during a painful procedure, I learnt how even the smallest of actions can make a difference. And I still fondly remember when I was present whilst someone was being told they were cancer free, and I cried with the patient and their mother. These experiences and lessons have stayed with me throughout my training, and I am so grateful for that!

Clinical skills can be taught at any time in your career, whether you are in your first year of training or you have been practising for 30 years. But the non-clinical skills, those are harder to teach. They require time, experience and reflection. And remember; your degree is the start of your learning, not the end!! 

Getting a job

The end is in sight, you’re in the last year of your nursing degree and everyone’s either talking about dissertation or if they have a job or not?

Dissertation aside – what if you haven’t got a job offer yet?

 

Students will get job offers at different times through out their final year some may not get an actual offer too. Either way it’s ok! We are all different and have had different journeys through our degree, it does make you a better nurse if you have a job offer and it certainly does not mean you are not as good as your friends if you don’t have an offer!

Try not to feel too pressured on getting a job after all there are lots of reports and figures out there suggest that around 90% of nursing graduates are in work six months after qualifying (obviously stats do vary on location and year to year but it mostly stays a high percent currently). Lots of students get job offers on their last placement but don’t be disheartened if you are not one of these either, every team is different.

Don’t be afraid to accept a few offers too. You don’t have to just take the first thing that comes along. Remember you can always say no at a later time if something better comes along. Ask questions about a job, where it can, what support you get, your first job may be a bit daunting so you want to feel safe and secure in role too.

There are more options out there as well as the NHS to consider too. Some students go into private sector nursing places, agency or bank work, plus there are also options to work abroad, in schools and  local councils employs nurses as do charities. There are voluntary organisations that need nurses and prisons and the armed forces. Lots of options so keep an open mind on your options and location for employment.

Universities offer a career service support, they will be able to help you with interview techniques, applications and support and signpost for job hunting no matter what sector you want yo work in. Help is out there. Check the NHS job site plus general job pages too.

Jobs fairs are usual held in your third year so go along and see what employers are there. You might even get recruited there!

Lots of NHS trusts hold open days. Check their social media pages/accounts for events, go along and find out more, they often recruit on the day there too.

As a newly qualified nurse you are a great asset, you are fresh and ready to start your journey in nursing  and hopefully don’t have any bad habits! You are up to date with new and recent information, research and strategies that will bring a new pair of eyes into a role or department. You choose your job that’s right for you!