Student Nurse NOT HCA

A really common occurrence, particularly for students in their first year in practice, is the feeling or impression that you are taking up the role of a Healthcare Assistant (HCA or Nursing Assistant or Auxiliary as they used to be called).

If this is you do not panic!!

study--undergraduate.jpgAn important point I feel it is essential to make is that a lot of the tasks that fall to HCAs in modern units are vitally important to that person’s Nursing care and are highly educational, need-to-know jobs. For example, washing patients or doing observations. The opportunity to wash patients gives you an invaluable period of protected time with that patient to really form a strong therapeutic relationship and hear what it is that is truly affecting or worrying them that day – use this time well! Also you get to see your patient’s skin from head to toe and make observations about their condition or their ability. You get to share some amazing moments with patients for example if they haven’t been able to walk to the shower for some time, being able to facilitate this really empowering event is really very moving. Some patients may have thought they would never be able to get back to that fitness!

Equally when there is a crisis and the senior nurses come to the fore – the first intervention more often than not – is a full set of observations. Being so used to doing them you can put a BP cuff round a patients arm in your sleep means you can do it quickly in a crisis and that builds your confidence when those events happen.

All that said and done – never forget the vital part of what makes Student Nurses different to HCAs. We are here to learn. You are Supernumerary. You may want to help out with the routine tasks of the ward’s running, and that is a really wonderful trait to have and please never lose that – but don’t feel obligated.

I think all Student Nurses develop their own little ways of making sure they get treated as they should be and have access to all the best educational opportunities our wonderful placements afford. As always, with any issue in practice, your first port of call should be your mentor. Some of the best mentors I have ever worked with had a really simple but effective way of making sure I got the best out of my day by taking 2/3 minutes in the morning after handover to set goals for each day.

I know it sounds straightforward, but if you say “I would really like to complete the medication round with you today” and your mentor hears and acknowledges it, the likelihood is, it will happen! If daily chats isn’t possible, aim for a weekly goal, “I was hoping that this week I could do a wound dressing/remove a catheter/remove a cannula/ observe the ward round”. Communication is absolutely key to achieving what you want out of each placement and making sure your mentor is aware of your goals and can properly support you to achieve them.

PEF and all-round Superstar Tracy Claydon uses the alias of “Beryl the Toxic Auxiliary” to discuss the tricky situation that can arise in practice of HCAs who will sometimes excessively delegate tasks to student nurses (often with a scowl on their face). The best way to handle this issue is to proactively set your own tasks – before Beryl can delegate all the obs or turns to you! Maybe try having more of a discussion when jobs are being delegated, such as “OK if I do these obs, can you check turns before I do the meds round with my mentor?” or try taking your own patient(s), obviously under the supervision of your mentor but having the responsibility of that patient you will be busy providing all their care, doing all their documentation etc.

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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).

An Interview with Ian Wilson – Mental Health Lecturer

word-cloud-ianIan Wilson, Honourary Teaching Fellow in the Mental Health Field has given us an early christmas present in the form of this amazing, honest interview about his specialist field – Mental Health, specifically discussing his work in the community with dually diagnosed service users (those with mental health and substance misuse diagnoses). This is a truly insightful piece with some wonderful tips and advice for all fields of Nursing.

ENJOY!!…

 

What do you enjoy most about working in the community?

I enjoy the autonomy of community work. I enjoy being truly collaborative with my service users and colleagues. I enjoy the flexibility and responsiveness that community work offers workers and their clients. I enjoy the equalization of the ‘power balance’ between professionals and service users that community work offers.

What do you enjoy most about working with the university?

Regular contact with students is undoubtedly the most rewarding part of my university job. I welcome the enthusiasm, creativity, professionalism and dedication to mental health nursing that I see students frequently displaying. Because of this student contact I am reassured about the future of my profession and reassured about the future of mental health services.

What do you think is the biggest challenge facing Mental Health Nurses today?

I believe that we MUST maintain and nurture our own professional identity as mental health nurses. We have a unique perspective and a unique therapeutic trust. Both of these things are a huge privilege. We must ensure that this is not diluted.

Even as Student Nurses we can sometimes neglect our own mental health, especially with dissertations looming, what advice would you give students struggling with university stress?

I manage my own stress through regular exercise. I also have a group of friends who I can trust. Some of them are nurses, most of them aren’t. I have different groups of friends for different aspects of my life; my ‘football’ friends; my ‘music’ friends; my ‘work’ friends; friends I’ve known for 40 years or more, friends who have only recently entered my life. I rely on them all for support and encouragement.

How has your role as a Mental health Nurse changed since you registered?

I commenced my career as an inpatient staff nurse (two years). I then moved into community mental health nursing and I’ve done that for 20 + years. During that time my roles have changed and my responsibilities have increased. However, my core values have changed surprisingly little. I would still recognize myself from 25 years ago!

What qualities make a great Mental Health Nurse?

Empathy, unconditional positive regard, honesty, therapeutic optimism, positivity, self-reflection, a genuine interest in other people’s lives, open mindedness, a sense of humour, resilience, resourcefulness, self-reliance.

What made you choose to work with those suffering from drug and alcohol misuse?

I have both personal and professional reasons for working with dually-diagnosed (both mental health & substance misuse) service users. Additionally, I find service users with ‘dual’ problems resourceful, resilient, insightful and challenging. This keeps me going!

f3766f876d143ea85bd35fb7b63cabaf731c5493-3-1.jpgWhat piece of advice would you give Mental Health Student Nurses today?

Take every opportunity that comes your way to promote non-stigmatising attitudes towards mental health service users. Promote acceptance and respect among your colleagues. Use evidence based practice wherever possible. Have confidence to stand up against poor practice whenever you encounter it. Always push to improve services and your own skills and knowledge as a nurse.

From your experience working with service users who smoke cannabis, have you seen a therapeutic effect from taking it as a method of self-medicating and not just for recreational use?

Yes. For instance, a man with bi-polar illness has been using cannabis to regulate his mood. He has been actively attempting to reduce his cannabis use but as soon as he starts to reduce, he experiences a relapse into distressing elevated mood. His answer to this currently is to attempt to grow his own cannabis, which, he hopes, will be high in cannabidiols (anti-psychotic and sedating) rather than high in THC (very psychosis inducing). He is proving to be partially successful. However, in my experience this is unusual. Most of the service users I’ve worked with for many years do not get a good therapeutic effect from cannabis. Quite the opposite in fact. For almost all service users with psychotic illnesses cannabis can be a disaster for their mental health prognosis.

What impact do you think there would be on mental health services if cannabis was to be decriminalised or legalised in the UK?

Taking cannabis misuse out of the legal system and into the healthcare system would enable those people who have problems with cannabis misuse to seek appropriate help and treatment. It would also remove it from the control of organized crime.

From your experience what role does excessive alcohol consumption play in the development of mental health disorders?

This is a complex and multi-dimensional issue. Demographically, 50% of people entering alcohol treatment services have a severe depressive illness. 20% of people have a psychotic disorder (Weaver et al 2003). Whether this is a consequence of drinking excessively, or whether drinking excessively is a causative factor in the development of illnesses is, of course, usually too complex to fully determine.

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Legal Highs come in all sorts of forms and can be bought on the high street

With the rise of “legal highs” and previously uncommon substances of abuse (such as ketamine) in Greater Manchester, has their been a notable shift in conditions patients suffer with as the popular drugs of choice have changed?

I believe that there is now no doubt that many of the newer substances, such as synthetic cannabinoids and highly potent stimulants such as PMA and methadrone are potentially far more dangerous to both physical and mental health. Synthetic cannabinoids, especially, appear to be very dangerous and unpredictable. However, their use, among mental health service users and people in general seems to be increasing year by year.

If you could give child/adult field nurses a few key points to convey to patients they may encounter that they believe might be struggling with drug or alcohol abuse what would they be?

  • Be honest but non-judgmental about peoples’ lifestyle choices
  • Encourage service users to discuss issues of substance misuse in an open and honest manner
  • Listen to what they tell you and find ways of reflecting back what they’ve said
  • Express empathy about their situation in relation to substance misuse. Be especially empathic about the difficulty their substance misuse is causing them and how it may be preventing them to achieve their goals
  • Seek permission to offer information which is neutral, up-to-date, and presented in an accessible form. Check out carefully what they make of this information
  • If they don’t want to change their current patterns of substance misuse, carry on discussing the issue in an open and honest manner, avoid arguing or persuading; offer harm reduction tips
  • Keep the door open to possible intervention in the future

Student Safety: Going to Practice in the Dark

Especially in these cold and dark winter months, the likelihood that your journey to and from placement will be in the dark is very high. It’s not uncommon to see a Student Nurse at a bus stop at 5am, unfortunately, unlike our non-nursing counter-parts, we are just waking up not on our way to bed.

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A Typical Early Mancunian Morning

Because of this antisocial hour, not only early mornings, but sometimes late-night, Student Nurses, myself included have reported feeling unsafe on their way to and from placement. Especially if their journey requires them to walk alone through poorly lit streets or wait at bus stops in town when there might be a few lost souls ambling around slightly worse-for-wear.

I must say that I am very happy to report neither I nor any of my friends have ever had to report an incident or fallen victim to any crime during their commutes to practice but it is vital that we stay vigilant and well-informed of how to keep yourself safe if the occasion calls for it.

It is essential to do everything you can to keep yourself safe for these journeys. That may be through carrying a personal alarm (These can be bought very cheaply on Amazon or from the highstreet), calling or texting friends or family (often other student nurses because they’re the only ones awake at this time of day) and when possible travelling in groups and on well-lit routes. Always ask on your facebook group or in seminars if other students might be travelling in at the same time as you and form a little posse.

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The University is aware of the concern of Students like ourselves and have rolled out a fantastic scheme involving lots of businesses all down Oxford road, many of which are open 24hours, where students can go at any time if they are feeling unsafe or anxious. A full list of participating locations can be found HERE.

Likewise if you’re travelling on a bus and feel unsafe, Stagecoach has a 24 hour complaint hotline and of course the glorious Greater Manchester Police Service are always available if you feel threatened in any way whilst en route to placement or home.

Raising Concerns

Whilst in practice, unfortunately, sometimes we can witness bad practice. It’s not a situation I would wish upon any student nurse or registered nurse for that matter as it immediately puts you in a very difficult position.

Yes, in the perfect world, there would be no internal conflict, you would identify the issue, escalate it to your manager or mentor and trust that it will be dealt with appropriately and with discretion and professionalism. However I know in my circumstance, I was/am struggling to trust that sharing my concerns will not impact upon my learning and education within this ward. This isn’t based upon anything other than my own fear of self-preservation, which makes it harder.whistleblowing

You’re faced with a decision, to voice your concerns and risk an uncomfortable and strained time in practice or say nothing and risk patient safety/dignity/pride. It really isn’t a toss up in my opinion.

The process is intended to be as pain-free as possible. Speak to the relevant individual, be it PEF, Ward Manager, Academic Advisor or Mentor and your concern should be dealt with in a professional and serious manner befitting the circumstance.

I have to say that as soon as I raised my concerns I felt an immediate sense of relief and confidence. Confidence that I had done the right thing for my patient, patient’s to come. I had 3 weeks remaining in my practice area and this was rather terrifying as I thought I would be identified somehow and treated poorly for raising concerns in practice, this I am very happy to report WAS NOT THE CASE. I wasn’t treated any differently whatsoever, I felt supported, trusted and above all I felt like the University was proud of me speaking up when I did.

This feeling was reinforced on Monday when placement allocations came out. A very close friend of mine has been allocated the same placement in which I experienced poor practice. I could have easily ignored the issues in the ward. Easily put them to the back of my mind and they would have continued and other Students would have struggled and felt as conflicted as me but because I spoke out – those issues have been resolved.handshake

I was able to say to my friend in confidence that any obstacles I encountered in practice have been resolved. No placement is perfect but if each student that encounters issues keeps quiet – they will never be perfect.

It can be very easy for student nurses to lay the blame for poor practice areas at their mentor’s feet but we have our part to play as well. Be honest in your placement evaluation and be honest with your mentor throughout your training – if they know what works well and what doesn’t that can only lead to improvements in how they teach and how you learn. So BE BOLD and SPEAK UP, who knows the number of people that will benefit from your honesty in the future.

PEF contact details can be found via this link:

http://sites.bmh.manchester.ac.uk/nursing-mentors/contacts

Welcome Cohort of 2016!!!

To help you along this amazing journey you’re about to embark on we asked the current Student Nurses

“What advice would you give yourself in Welcome Week if you could?”

Here are the gems of wisdom we got back…

 

  • “Revise consistently week by week and make flash cards after each lecture so it’s easier when you get to exams”
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    You keep fit, make friends and completely forget about the stress of uni

    “Get involved in sports and societies. You’ll have more free time than you think, so use it to connect with people outside of the course. Those friendships will be invaluable when times get hard and you’re fed up of talking ‘shop’”

  • “Revise little and often, but don’t make yourself miserable in first year revising”
  • “Enjoy your time before placement starts in January!”
  • “Making friends with people will help you get through the course, especially if you’re not in halls!”
  • “Don’t be afraid to be a typical uni fresher for the first semester and join clubs and make friends.”
  • “Read everything especially the huge amount of info on Blackboard and subject handbooks.”
  • “Go crazy. Have fun always. Eat well and do as many non-nursing activities as you can otherwise you’ll drive yourself (and your nearest and dearest) insane”
  • “Don’t get caught up in a complete nursing bubble, socialising and having fun is just as important as the studying”
  • “Socialise and
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    Live by the Diary, Die by the Diary

    Make friends with people from different courses! Take advantage of living in halls and betting to know lots of different people and enjoy freshers!”

  • “Talk to anyone and everyone – you’re all new to this so don’t feel too nervous to talk to people!”
  • “That you’ll fall into routine pretty quickly so not to panic about all new info thrown at you!”
  • “Get a diary and use it. It helps you organise your entire life! University, placement, work, social life and alone time (you’ll need it) and have fun!”
  • “Don’t sweat the small stuff in first year – enjoy learning and be curious, ask lots of questions and don’t be scared to speak up in seminars! You get more from it and it’s almost guaranteed that someone else is thinking something similar but just hasn’t said it. Also, don’t be scared to ask for help when you need it!”
  • Sport and Physical Activities Fair – Thursday 22nd 10:00-16:00 at the Students Union

 

And from our newly qualified cohort of September 2013…

  • “Take one step at time. Don’t rush things and ask lots of questions. Keep yourself healthy and work hard, it will all be worth it in the end”
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    ASK QUESTIONS!!!

    “Enjoy the course, take every opportunity that arises and experience as much as possible. Three years goes quickly – don’t be afraid of making mistakes, don’t hesitate to ask for help. It’s O.K to cry and it’s even better to laugh. It might not seem it, but everyday in clinical practice you make a difference to somebody’s life and they’ll make a difference to yours. Use this an opportunity to see as much as possible, challenge yourself everyday!”

  • “Keep your health as a priority, if something has upset you then talk about it, get enough sleep, do stuff outside of nursing and try not to be to hard on yourself when you make a mistake”
  • “From my experience, the lecturers are more than willing to give academic advice, as long as you ask for it in advance and at least meet them halfway by putting in the work with wider reading.”
  • “Definitely read the unit handbooks! Also to get biro stains out from exploded pens you can use hairspray or anything else with a high alcohol content. Put something behind so it doesn’t leak through to the other side of your uniform then spray on until the ink dissolves, rinse away then put it in the washing machine to get the last spots out”
  • “Go on NHSP (NHS Professionals, is an agency that arranges work for support staff within trusts. You will be eligible to apply upon completion of your first placement) it means more experience, more autonomy and you can experience wards you want to”
  • “I recommend being very social in the first semester. Meet other nurses but non-nurses too. It’s your friends that get you through this. Just do something that gets you out of the library and out of your halls/house. A sport is a great way to de-stress and make some great friends. Basically become a yes man in semester one. If someone asks you if you want to do something, do it! Do lots and keep busy! If you’re not a big party goer, do a concert, comedy night or whatever with some friends!”
  • “Don’t get hung up on your grades in first year, but developing a system to help yourself with things like pharmacology which you’ll need for your careers can certainly help. I really recommend flash cards and an app like Brainscape is great because you can’t lose them and works great for multiple choice based exams.”
  • Stagecoach_in_Newcastle_bus_19442_Alexander_Dennis_Trident_2_Enviro_400_NK58_FNG_in_Newcastle_25_April_2009.JPG

    Stagecoach Busses FOREVER

    “Vanish oxy is great for white uniforms. If you’re in Fallowfield, don’t go to big Sainsbury’s because it’s a rip off, there’s an Aldi in Didsbury and then you can reassure mum that you’re eating things that once grew from the ground. A stagecoach bus pass almost always pays for itself. Make sure you get loads of free stuff at the freshers fair! One really decent non-stick pot will see you through your first year. There’s a walk in centre in MRI that’s easy to get to just in case. Basically, just enjoy it! It’s a tough career that will challenge you physically, mentally and emotionally. Get some good foundations and friends early on and you will be fine.”

  • “This is a really sad tip, but you’ve got your uniforms for 3 years so look after them, put them on a separate white wash, with a cup of either vanish oxy action or a cup of ACE (you can get either way cheaper from wilkos). And go to placement looking sharp and feeling confident in how you look.”

Out on Placement

Guest Blog written by Emma Wilkes


I think it’s fair to say that most student nurses are nervous before starting a new placement, however LGBT students may feel extra nervous. Whether it’s awkward conversations about your love life, or a worry about what toilets it’ll be ok to use, it’s totally understandable. As a student nurse every new placement involves another coming out and this can be nerve wracking and emotionally difficult.

So here are five tips to survive coming out at placements:11049526_536723163136072_4031043654954708270_o

  1. Don’t feel you have to out yourself immediately – there is no need to introduce yourself as Emma the lesbian and you shouldn’t feel under pressure to do so
  2. But also don’t feel you can’t come out, everyone talks about their partners and children and you should be able to do the same.
  3. You don’t have to tell everyone, it’s ok to just tell people in conversation and leave those who weren’t there to work it out for themselves
  4. If you have any problems or concerns talk to your AA, mentor or PEF, they are there to support you and you should never face any discrimination on the grounds of your sexuality or gender identity
  5. Don’t be embarrassed, be proud of who you are, you have a unique life experience which will be valuable to you in nursing

The University LGBT society have lots going on, although it won’t always be possible to make their Wednesday group they also have things going on in the evenings and weekends. In Manchester you’ll also find the LGBT Foundation who have lots going on and can offer lots of support.FENT__1432160698_here-if-need-us