Finding your feet in third year: a lesson from A&E

*Disclaimer: this post includes description of a traumatic situation which some may find distressing* 

When I started 3rd year, I was excited! I had a fantastic end to second year, and I truly felt ready to enter my final year of my degree. But with that excitement came the endless worrying about jobs, dissertation, and work for other modules. When placement began, I realised I felt like a complete novice again! Despite only having two months off over summer, I felt like I couldn’t remember how to do anything on placement (clinically speaking). I was even putting on blood pressure cuffs the wrong way. Everyone asked me what year I was in, and saying “I’m in third year, but I don’t know what I’m doing” every time was ruining my confidence.

It wasn’t until my 5th shift when I finally started to feel less on edge. I was working in resus (for the most critically ill patients in a&e), and we had an man with chest pain and fluctuating consciousness. Since he was in a bad way, a few anaesthesiologists from ICU came to set up mechanical ventilation for the patient. It was really fantastic to see everyone working together almost seamlessly, and including me in their decision making. I was given little jobs such as getting supplies or checking the observations but it was all I could really help with at the time. After a very long trip to CT, it was clear our patient was deteriorating. As soon as he was back in resus, our patient went into cardiac arrest. The nurse I was working with asked if I had done CPR before, and if I wanted to get involved. To my own surprise, I agreed. I have been learning CPR for well over 5 years now, so I knew that I could help in some way. Each person did 2 minutes of CPR, whilst keeping an eye on the defib heart monitor. Due to the patient being on a hospital bed, we all had to stand on a stool in order to reach, which I found really bizarre!

I wish I could accurately describe the feeling of trying to save someone’s life, but I can’t. There was so much adrenaline rushing around me, but all I kept thinking about was how I was currently involved in the worst day of someone’s life.

During CPR, the doctors confirmed (through an echo-cardiogram) that there was nothing left we could do. Myself and the nurse went to work on ensuring our patient was at peace, and ready to be seen by his family. They were in shock and declined, which I understand. And our day went on. I had a debrief with the nurse, and a HCA who had also performed CPR for the first time, which was lovely. We spoke about how CPR is so different from how it is often portrayed. I had never thought about the fact that you won’t be able to reach a patient without standing on a stool, or how someone must time each session of CPR.

Despite being a high-pressure and sad situation, it helped me a lot. I did something I had never done, but had extensively prepared for. If you feel like you are back at square one, despite being a third year, I challenge you to think about what you do on placement. I think there is a tendency to see progression as acquiring new skills, but sometimes its about putting our current skills to use in a new situation.

 

 

Advertisements

My ‘lollipop moment’

Have you ever had your life changed, even just a little bit, by a total stranger?

Several months ago, my boyfriend showed me a TED Talk called Everyday Leadership. The premise of this talk is about ‘lollipop moments’, when a stranger makes a difference to your life. The speaker, Drew Dudley, was lucky enough to be told by the person he helped, and how much of a difference he made to her life. The really interesting point that Drew also makes is how we often don’t realize that we make these differences to people!

I had my ‘lollipop moment’ today, at the Freshers fair whilst I was working at a stall. A woman approached the stall with her friend, and recognized me immediately. She told me that I had talked to her before her nursing interview this year, and helped her feel a little bit less nervous. I didn’t remember this moment until she reminded me!

I think the concept of ‘lollipop moments’ applies to nursing really well. Although it may sometimes feel as though we are endlessly doing paperwork and working in areas horrendously understaffed, we are making a difference. Somewhere in the world, you have changed somebody’s life for the better, just by doing what you love!

Have you ever had a lollipop moment, or did someone change your life for the better? Let us know by commenting, tweeting us or write your own blog post and submit it to enhancingplacement@gmail.com

Handling complaints: what I never learnt as a waitress

I have never been good at receiving complaints. Before I started my nursing degree, I worked as a waitress for 5 years. It was not uncommon to deal with customer complaints on a daily basis, and I would always just say “I’m really sorry about that. I’ll speak to my manager” which was always a fail safe. 98% of the time, the customer didn’t want to speak to me anyway!

Image result for waitress

Accurate picture of me listening to customer complaints

But that changed when I started my nursing. Suddenly, whilst trying to make small talk with patients, I was being confronted with complaints about care they had received in the past or at that very moment. I couldn’t get away with my usual spiel because care complaints are more specific, more personal. You have to say something, and sorry doesn’t quite cut it.

I remember, very vividly, the first time I saw a nurse deal with a complaint efficiently. The patient in question was raising her concerns about the referral system for district nurse visits after a stay in hospital. Her care had been delayed due to this. The nurse I was working with listened to her very carefully, occasionally (when appropriate) asked for more detail and did not seem flustered at all. She then thanked the patient, said she would follow this up but urged her to voice her complaint at PALS.

PALS stands for Patient Advice and Liaison Service. It is confidential, and designed to provide support for patients, relatives and carers.

I was amazed at how calmly the whole situation went. Although the patient was upset initially, she was clearly at ease by the end of the visit, and I felt it was due to her being able to voice her opinion. And she was actively encouraged to talk about her concerns as Image result for complaintsit helps the NHS grow as an organisation! And it inspired me!

Since this event, I feel as though I have been inundated with patient complaints. Sometimes I feel as if there is a secret sign on my head that says please voice your thoughts at me!. I have now had endless practice at being calm and friendly, with some situations leading to me having to be a little firm (I will not be shouted at). I find that listening a lot, speaking barely at all, seems to work. Asking them to expand, answering questions when needed, and most importantly not denying their claims. It is extremely important, I think, to acknowledge that not every care interaction is perfect or goes to plan. We must embrace feedback, negative or not! Whether it comes from a staff member, a patient or a relative; complaints should be listened to!

Always speak to your mentor or a staff member about a patient’s complaints. 

Community Matrons; the role we need

I bet you’re thinking, what is a community matron? It sounds very official and a bit scary…but you couldn’t be more wrong!

Within the community healthcare team, there are a wide range of roles. I am currently based with the district nurses (can you tell I love community yet) and I wanted to see how it all fits together. I had never heard of the community matron role, until I met my placement’s local one. She gave me a really fabulous explanation of her job, and I spent two days with her!

Community Matron’s are the Advanced Nurse Practitioners in community. They work alongside the GP’s, District Nurses, Social Workers, Occupational Therapists, Physios etc. to ensure that more vulnerable patients living in the community do not end up in hospital needlessly. Using their amazing medical/psychological/social care assessment skills, they are able to provide support for patients with chronic conditions such as *COPD or heart failure. This is an absolutely fantastic, and much needed role, within the community. They provide extra support to all the healthcare professionals in community.

Whilst working with the community matron, I got a really good idea of what there job is. It’s a very diverse job! One patient we met, the wife was concerned about her husband’s medication. As the main carer, she felt as if not all the medication was necessary and did not understand the need for them. We were able to sit down and have a long discussion about the home environment, how they are coping, and of course review the medication. At the end of our visit, the patient’s wife thanked us profusely for helping her understand. She was much calmer, and felt as if her questions had been answered. One hour made a huge difference to herself and her husband!

Another example was an elderly lady who had *COPD and recently had a chest infection. The community matron ensures that this lady, as well as many other patients with long-term conditions, always have antibiotics in the house, and teaches them to recognize signs of a chest infection. This means the infection is dealt with quickly, it encourages self-care, and reduces the potential stress on GP and A&E services! During our visit, the matron taught me how to listen to chest sounds and undertook basic observations. This is to keep an eye on the chronic conditions her patients suffer from.

This is only a small insight into the work of community matrons, and I could easily sing their praises all day! Personally, this is what integrated care should look like.

I would wholly encourage anyone, no matter what stage in your training, to get a spoke with a community matron.

 

 

 

*Chronic Obstructive Pulmonary Disorder

The joy of community nursing

Community is often painted as marmite- you either love it or you hate it. But is that strictly true? Surely there is something about every placement that can be enjoyable, and not so enjoyable!  I will first admit that my heart lies in community. I knew within the first few days of my placement in first year that I wanted to work in the community. So I thought I’d make a little list about why it’s just so amazing. 

You have to expect the unexpected! You aren’t in the relatively controlled environment of the hospital, you’re in a patient’s home/room. Anything can happen, even trying to stop the pet dog from jumping on the bed during catheterisation!

It really is community based nursing. No matter what area you work in, you’ll know the people, their attitudes and the roads like the back of your hand. It’s really refreshing to be moving around constantly instead of endlessly walking around a ward or clinic.

Improvisation is key! Can’t find the correct wound dressing? Come across a new skin tear? Can’t access the patient’s house? Better make it up! I’ve seen some amazingly ingenious solutions which I’ve then stored in case I ever come across it again. It’s one of the best ways of learning!

Community nurses can be a lifeline. Many patients you will visit in the community are elderly, some of which are very isolated from society due to mobility issues, lack of family or the fact that they live in rural locations. Often, community nurses are the only people they interact with in the day, and they appreciate their presence immensely!

The patient-nurse relationship is very different! As soon as you enter someone’s home, you are entering their territory and you follow their rules. I feel that this allows patients to have a larger role in care decision-making. It is what holistic nursing is all about.

Community nursing is not for everyone, but never underestimate it’s ability to build up your skills!

If you’ve had a community placement, and you’re feeling creative, why not write us a blog post? Simply send us an email at enhancingplacement@gmail.com. We always welcome new content!

Be Resilient, Stay Brilliant

Student nursing takes many different skills: patience, compassion, dedication, the ability to plaster a smile on your face for 12 hours even when you’re exhausted, and more. But there is one skill I never thought would be so useful; resilience!

Resilience is when you’ve made a simple mistake and you can feel the embarrassment creeping up, but you carry on caring and learning. It’s what makes you keep going when someone doubts your ability. It is what you use to take in constructive (but sometimes not!) criticism on an essay, a presentation or an act of care. Resilience is the ability to bounce back!

I didn’t realize how important resilience was until I was having an incredibly busy day on my last placement on an acute medical ward. Myself and my mentor had ended up with a few very poorly patients, an astonishing amount of paperwork, delayed transport for a patient and some awkward available beds mix ups. To help out, I offered to call a unit an explain that patient they were transferring to us needed to be delayed slightly, due to late transport. I was greeted with what I describe as understandable anger and frustration. I spoke as calmly as possible, explaining that we were sorting the situation and that the patient would not be delayed much longer. The nurse I spoke to continued to berate me on the phone, and eventually hung up.

Luckily, within 10 minutes, we had managed to sort the entire situation out. No more angry phone calls for the day! I spoke to my mentor about what had happened, and she reassured me that it was just a tough situation and not to take it to heart. I still get slightly annoyed when I think back, but I have to remind myself that we are all just looking out for our patients. Sometimes that comes across in different ways! I think if I was a qualified nurse, I would have had a better understanding of how to deal with the situation. But I know for sure that I will not forget this phone call.

Remember; if you have experienced a situation like mine, please talk to someone about it! Whether it is your mentor, a fellow student, the PEF, your AA, friend, family dog etc. Difficult situations should be discussed, and you are allowed to vent. I can highly recommend writing a reflection about it!

Have you had any moments of resilience? Let us know in the comments, or on Facebook/Twitter. Or, if you’re feeling creative, write us a blog post!

 

 

 

 

 

 

 

Tops Tips for Staying Cool

As you have probably noticed, we’re currently experiencing a bit of a heatwave at the moment! This may mean ice cream and sunbathing for some, but for us student nurses it isn’t much fun! From stuffy uniforms and buses hotter than hell, to rushing around Image result for warm weatherensuring patients are hydrated whilst being dehydrated yourself.

So what the the top tips for staying cool in a heatwave?

  1. Sun cream!! Especially if you’re on community or commute via walking/cycling.
  2. Keep hydrated***. It’s obvious, and we all harp on about it, but the day will drag more and the heat will hit you harder if you don’t keep drinking cold water or juice. Make sure you have a bottle or jug nearby to remind you, or drink with your Image result for patient drinking waterpatients so you both get the benefit!
  3. Don’t over-exert yourself. You are the most important person to take care of in your life! Make sure you take regular little breaks for drinks + a sit down. I know it can be hard, but you’re no use to your patients if you aren’t on top form!
  4. Change into your uniform when you get to placement. It prevents you starting your shift in a sweaty mess, and allows your body to cool down on your way home.
  5.  Avoid too much caffeine. I know this sounds barbaric (I can’t survive a shift without coffee) but caffeine is a diuretic. That means you’re going to the toilet more, which leads to more water loss. Try not to overdo the coffee intake!
  6. Try and get some sleep! Nothing is going to make a hot day longer + harder than lack of sleep. If you need a fan, get one! I know I couldn’t cope without mine.
  7. ***Know the signs. Dehydration can be bad news, whether its staff or patients. Make sure you know the signs (headache, dry mouth, not urinating a lot) and keep an eye out. Let someone know if you or a patient is suffering.

Have you been coping with the heat? Send us any tips/tricks via email, Facebook or Twitter !