What can nursing give to me?

Becoming a student nurse can consume you. With placement and academic work mixed together, it can often feel like all you do is nursing! On top of that, we often focus on what you can do for nursing. But what about what nursing can offer for you?

Recently, I’ve opened my eyes and seen the reciprocity within nursing. It started with my Nursing Therapeutic module, where we’ve been learning about Muetzels model who says that a therapeutic relationship between a patient and their nurse requires three components. These include: partnership, intimacy and reciprocity. Since we explored how a therapeutic relationship could benefit both the patient and the nurse, I thought maybe nurses get more out of their career choice than I thought?

Confidence! Going into placement takes guts. You are literally throwing yourself into new situations with new people everyday, and that takes a certain amount of confidence. Speaking to the wider MDT use to fill me with dread, but now I basically chasing them around for questions. This has reflected into my personal confidence A LOT. I am more sure of myself, and what I want to get out of situations.

unknown-2Time management. I thought I was organised before I came to uni. I was wrong. I feel I’ve reached a higher-level, as uni has forced me to gain the ability to spread out my work so I’m not over-exerting myself. It’s a VERY good skill, as it’s very easy to become burnt out. Spreading out work helps you fit in the other important stuff that isn’t necessarily related to nursing/uni but is absolutely vital! Get yourself a fab diary and a calendar life will become easier.

Problem-solving. I recently attended an inter-professional workshop with our lovely midwives all about the health needs of refugees. Once we were put into teams, it was like somnurses and midwiveseone lit a spark! Suddenly, adult nurses + midwives + child nurses + mental health nurses were able to outline all these potential solutions to the fictional family we were ‘caring for’. We were more than able to use our combined knowledge to solve the situation with ease!

Honesty. Before uni, I would often be told to do something at work/school and just nod endlessly until they told me to go and do it. What would happen? I would have literally no idea what I was meant to be doing. You can’t really do that in nursing, so you end up asking more questions and understanding where you need support. This not only shows honesty, but it shows a lot of maturity as well.

This is not an exhaustive list by any means, but its great to reflect back on how you’ve grown. I would urge any of you to do the same! Not only is it a useful skill for interviews, but it really helps with realising why this degree is so worth it.

What has nursing given to you? Comment, tell us on facebook/twitter or send us an email!

Mentoring-who has the power?

I am sat here just an hour away from heading out onto placement for a final shift on the ward I have been working on and am pondering the nightmare that is getting paperwork and skills signed off. Finding the time, apologising profusely for the massive amount of writing up of skills I do to justify that I am good enough, hoping the mentor feels the same and signs them…..will the anxiety ever stop?!

Part of my thought process has left me wondering about the power balance in the midwife mentor-student relationship. Ideally there would be no power imbalance and the mentor/student would be engaged in a mutual, respectful and supportive pairing but I feel this is unrealistic and ignores the fact that, as students, we are reliant on our mentors to provide good, honest feedback and ultimately grade us which can mean the passing or failing of our degree. Surely, even with my basic degree in psychology, this puts the power balance very firmly on the side of the mentor?

Students, generally, want to please our mentors and not just for the sake of a ‘good grade’ (I feel this is a little simplistic and patronising) but because we want to do well! As a second year I have not struggled and battled my way this far through a very difficult degree to be mediocre and just ‘ok’….I want to be GOOD and COMPETENT. This means when I am working with mentors I ask a million questions and watch, listen and then ask another million questions because I want to be the best I can be.

I wonder if mentors are trained and updated on the power they hold in the relationship? I am sure they are and every mentor I have been lucky enough to work with has been supportive and encouraging whilst providing excellent constructive feedback when needed. Have I been lucky though or is this standard? I am not so sure……

The issues of boundaries in the midwife mentor/student relationship is interesting. My previous career was in an appropriately, heavily ‘boundaried’ arena and I feel I am acutely aware of boundaries at all times but  there have been occasions when my mentor has been made aware of my personal circumstances when necessary as this will, of course, impact on my practice…..could this be perceived as over stepping a boundary? Or, for example, if I ask a mentor if she is ok because I know her child was ill and she left work early during our previous shift….is this overstepping a boundary?

Is this a little too ‘pally’?

What is ‘too friendly’?

What could be perceived as forging a ‘too close’ relationship with a mentor when you are together 8 hours a day/ 5 days week in a car and in clinic and you have your lunch together and you talk……most people come into this profession because we are compassionate so we reach out to each other as 2 women sharing information about our lives…..is this overstepping a boundary? What should we discuss? Should we limit ourselves to just discussing midwifery at all times? But this feels incongruent and, again, unrealistic.

Also, what of mentor-student relationships that are not nurturing but, dare I say it…..toxic and damaging? Where does that student go? Every student knows that we are reliant on the mentor for passing us therefore, dare we complain if we don’t feel happy? Dare we mention to our PEF, link lecturer, academic adviser, ward manager etc that we are not happy?

We SHOULD do but do we?

What if we are branded a trouble maker?

What if we are considered to not be resilient enough for this degree because we have struggled with a mentor?

What if we still have to work with that mentor and they know we have an issue with them?

What if we don’t have to work with that mentor but one of her colleagues and they know we have complained?

We absolutely MUST speak up if we are struggling as the damage of ‘carrying on regardless’ is insistent and could lead to further issues both psychologically and practically further down the line but I hope that midwife mentors are aware of the power they hold and that forging a good, strong, supportive relationship is tantamount to bringing out the best in a student and that the majority of students just want to be the best midwives we can be!

Thank you to every mentor who has treated me with kindness and compassion-you have modelled how to be an excellent midwife and excellent mentor.

To those students struggling with mentorship-please speak out.

 

“The doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.

First Fears

I’m on my first ever placement since becoming a student nurse. Our first semester is over and there’s been plenty of time to wonder and worry about what going out into practice will be like. I was excited, nervous, and terrified all at once.
Will the service users be happy for me to work with them? Will the staff be okay with me asking lots of questions? What will I learn whilst I’m here? So many questions have been swimming round my head. To be honest, more questions have been cropping up as the weeks have flown by, but I’ve come to realise that’s what nursing is about. How else will I learn if I don’t ask questions?

My first placement is on a non-NHS recovery and rehabilitation mental health unit. The service users are admitted having spent time on acute wards so this hospital is a sort of ‘stepping stone’ in the recovery process for people with a range of different mental health conditions like schizophrenia and bipolar disorder where nurses and support workers help them to develop the confidence and skills to carry out day-to-day activities including self-care tasks and cooking. I didn’t know much about the ward before coming on placement here, and the main thing I’ve learned is to ask anyone and everyone questions. Speaking to staff has been super helpful for learning the clinical skills involved in working as a nurse. I’ve gotten to practice and learn about person-centred care, administering medication and what lots of the abbreviations mean (wow, there are so many!) to name a few. I’ve sat in on ward round meetings where the multi-disciplinary team made up of nurses, doctors, care co-ordinators (basically community-based nurses), service users, family members, and any other relevant professionals get together to discuss medication, discharging patients, and any other developments for each service user. I’ve also potted up tablets for patients and found this a good opportunity to ask about what the different meds do and carry out some drug calculations. A lot of my time has been spent talking to service users, and these conversations have given me a great insight into what it’s like to stay on the ward. I was pleasantly shocked how much rapport with people you can build just by asking them about their day, and they’ll often appreciate the company and conversation.

Don’t get me wrong, it hasn’t all been perfect. I really struggled for a while with this nagging feeling that I was useless, and it creeps up every now and again. At times I’ve felt like a burden to the staff. I mean, I’ve been practically following staff round like a shadow and asking them to explain things that are probably really basic to them. As the weeks have passed my knowledge of how the unit runs has grown massively, though of course there are still things I’m not confident enough to try. Recently one of the nurses asked if I wanted to draw up medicine into a depot injection, but this was my first time even seeing one in person so I asked if I could watch instead. It’s okay to say you’re not ready if you don’t feel it. Honestly, there’s no rush to dive straight into every single thing right away, and although I felt disappointed in myself for a moment I reminded myself that I’ll have plenty of opportunities to practice skills like this in the future. After all, going on a spoke to a depot clinic can be arranged when I feel ready.

Working with the MDT

I am currently based on an acute respiratory ward and am having the time of my life working with the huge multidisciplinary team (MDT).

Why is the MDT important?
In both primary and secondary health care settings there is an emphasis placed on great interdisciplinary working in delivering effective treatment in a timely manner. If this team is not built on trust, effective communication and a good working relationship then they can act as barriers in delivering effective treatment and care. With the demand in the health services increasing, the need and pressures for interagency teamwork is also increasing.

What does this mean for you?
You, as a future registered nurse will be the backbone of the team. Yes you! The nurse seems to have six arms, a brain the size of a watermelon and apparently a bladder like a camel. You will be the key element in linking all the members of the teams together. You have the most patient contact. It is imperative that you develop your communication skills in order to be the driving force in increasing the collaboration between different team members. Are you excited yet?

What does it mean for you as a student nurse?
It is never too early to start working with the MDT now. I know it is daunting; I still hyper-ventilate when a consultant/doctor asks me a question about a patient I am looking after. AND I am a third year! I still panic when I answer the phone and it is the bed manager asking me what our status is. When the dietician changes the nutrition plan and hands over to me because the nurse is occupied. When the physiotherapists, occupational therapist, social worker and all the rest of the MDT ask me any question. I always think I will give a wrong answer or information that may have changed since I last on shift. So yes, I understand we have all been there.

What can you do to overcome these issues?
On my current placement, I have had the chance to put my MDT skills to practice. On my first day, members of the team were introduced to me. I became acquainted with them by having a casual conversation, this eased my anxiety and I became familiar with them. I was asked multiple times to pass on messages, to ask for a drug to be prescribed, to find out the plan for patient X and by the time I knew it my anxieties soon faded away. I began asking the MDT questions regarding their role in the care for my patient, I asked questions regarding my patients care and even requested to be present when they did their assessments.

What can you take away from this post?
1. Ask to be present when the MDT’s are carrying out their assessments because you will understand more about their role and know your patients capabilities. Did you know you can even spend a WHOLE day with them? YES! Spoke = spending a day with a member of the MDT to understand their roles.
2. Your trust and respect will increase with regards to their contribution to getting your patient discharged safely. Furthermore, you will be able to appreciate the pressures they are also under to meet the same objective as you are.
3. Finally, you will lose any anxieties or awkwardness you may have with approaching your team members. Always begin: Hi, my name is Shayma (obviously you would say your name not mine Hopefully unless you are too anxious 🙂 )

I for one have overcome my barriers and anxieties. And if in doubt, fake confidence and hide your anxiety until you make it, we all do it at one point!
That’s it from me, Good luck working with the MDT and please share your experiences with us!

Social Media Savvy

How many times have you been told about “the dangers of social media”? “It’s online forever!”, or my personal favorite “Just don’t put anything on social media and you won’t have any problems!”. Too often it is portrayed as negative, and it is assumed that social media is an evil within nursing. But is it?

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“Look at this silly cat picture”

I am a total social media enthusiast. I’ve used it for well over 10 years now, freely posting funny cat pictures and what I’d had for dinner. But becoming a student nurse altered my habits. I changed my name on Facebook to keep it more private, and ensured that my social media platforms didn’t show my name. I felt as if everything I said may impact my career. That lasted for about an hour on twitter, as I then discovered the huuuge nursing platform available to me! By engaging with twitter chats, reading articles and following other nurses I felt I was part of a wonderful community! The amount of support I have received has been amazing- and I encourage you all to get involved!  Twitter is incredibly easy to use, and you can create an account that can be used purely for nursing.

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Completely appropriate and accurate picture to post 

We should be aware of social media. Many student nurses are part of the generation who grew up with it (like myself) so why shouldn’t we embrace it?

There are, of course, cautions. Many nursing-related accounts post really helpful tips of how to stay appropriate on social media. They include tips like: don’t post anything about patients/their relatives/where you work , don’t use offensive language, be kind and don’t try find patients on social media. Pretty simple right? They aren’t horrible scary rules, and (hopefully) don’t put you off getting social media savvy!

If you want to check out some nursing social media, take a look at these: our Facebook page, our Twitter page, NURSOC education which is fab, surviving student nursing is great for some laughs, the UoM BNurs and Midwifery twitter and of course We Nurses!!

For more social media guidance please visit: the NMC, RCN and everynurse to keep yourself safe and professional!

Student Nurse Advocate

images.jpegAdvocating for patients, in my opinion, is one of our most privileged roles and one we should take very seriously. I have often found, our position as Student Nurses affords us a certain advantage when it comes to patient’s openness right from day 1. Because we are often very hands-on, we know our patients very intimately and they feel more able to open-up to us about smaller concerns they may not feel were important enough to raise with their doctor or consultant for example. This carries a responsibility for us to make sure we take all patient’s concerns seriously and act on/escalate anything that, using our theoretical knowledge, may be of importance to their care. This also takes a pinch of courage to have confidence in your instincts and “back yourself” as we say on the Rugby pitch.

Last week while assisting a patient with his wash (which is often a time when I learn the most about a patient) he told me he hadn’t slept well that evening as he had visited the bathroom over 10 times in the night. This patient was due for discharge in the coming days so this was concerning for me. As an elderly gentleman with hypertension, heart disease and other comorbidities, he was at risk of Falls and if he is going up and down to the bathroom so regularly, especially in the night, he may sustain a serious injury such as a fractured neck of femur. I looked through his drug kardex and found he was on very high doses of furosemide, a loop diuretic that is often prescribed to patients with Heart failure to prevent oedema.Renal_Diuretics.gif

I asked the patient if he was happy for me to discuss this with his doctors and a specialist continence nurse to see if something could be done to help either reduce this frequency or make provisions for his discharge so he isn’t at an increased falls risk, he agreed and I approached his doctor.

This encounter wasn’t entirely successful. When I proposed reducing his diuretics to the doctor, initially his response was “Do you want him to die of heart failure?” – in front of the patient…

keep-calm-and-back-yourself-4Not exactly the response I was hoping for, but I explained my concerns from a Nursing point of view and emphasised I am aware that his furosemide was prescribed for a reason and it is entirely his decision, I just wanted to advocate my patient’s best interests.

This exchange I felt didn’t end on a particularly positive note, so later in the day I apologised to the doctor saying “I didn’t mean to question his treatment I just wouldn’t feel comfortable if I didn’t make you aware of his concerns to see if we could work together towards a solution”. The doctor was much more amicable and smiled and said he understood and would consider what could be done.

Not long after this, the same doctor stopped me and said he had written a letter to the patient’s GP to recommend reducing his diuretics in the community and observe his response. He felt changing his medications the day before discharge might impact on his fitness for discharge. He also suggested trialling Oxybutynin. When I recognised Oxybutynin as an anti-muscarinic (which would improve his feelings of urgency), his face lit up. I have a feeling, he may not have expected me to possess such knowledge.

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So many speech bubbles but 1 shared goal – patient’s wellbeing

Only upon writing this have I realised just how many units of study went into this encounter; Communications, Anatomy and Physiology, Pharmacology, Applied Pharmacology, Nursing Therapeutics, Recovery focused care and Medicines Management all informed my actions in this case. Reflecting on this scenario I am really pleased with the outcomes we achieved. Not only was the gentleman’s GP made aware of our concerns and recommendations but I managed to speak to the Trust’s continence specialist nurse and get her recommendations for interim provisions to help the patient transition into community. I fed all this back to the patient who was visibly relieved and so grateful we had pursued his concerns and formulated an action plan he understood and would work for him.

Advocating for patients is a vital part of the Nursing role and we can see advocacy in the NMC code in various different guises (see 3.4, 4.1, 8.6, 8.7 & 9.3).