Collaboration: the future of our NHS- #nurswivesunite

13151090_226356241076122_2131036156_nI write this not to highlight the negatives of our current NHS in crisis, but to address how we can collaboratively work together to save our glorious institution.

I don’t need to talk about our failing health service, I don’t need to talk about the millions of pounds needed from the money tree to keep our beloved institution a float. I don’t need to talk about what the NHS means to Britain and its people, I don’t need to talk about the pressures, the constraints we as healthcare professionals all face.

What we need to talk about is how we can change the future.  I don’t think I’m wrong in saying this is without question the hardest time ever to train to be a nurse or midwife.

We’ve lost our bursary, some of us have lost our passion, our dreams of delivering the care we want to.  Who do we thank for this? Is it a question of politics? Or has our health service just reached a tremendous plateau of increased life expectancy, a rise in population, increased complex care which have become a potent mix given the current economic climate.

How do we adapt?

Collaboration that’s how!

Collaboration– “A purposeful relationship in which all parties strategically choose to cooperate in order to achieve shared or overlapping objectives.”

I love this definition, it epitomises what I believe is at the heart of what we all signed up for; whether you are a student midwife or student nurse we all have overlapping goals, we all CARE.

 We all want to deliver the best care possible whereby it be to a baby on neonatal unit, an Alzheimer’s patient, a child, a patient on a high dependency unit, a labouring woman, they all deserve the same amount of care and compassion.

 We are governed by the code (NMC 2015), we all follow the code, are regulated by the code, we all follow the same overlapping objectives -care, compassion and empathy.

As a whole we are truely invincible.  We have the power to stand up and fight. We have the power to change OUR NHS !!!

Let’s get to know one another, the roles we represent, the care we provide and how we can support each other.  Once we are fully united then I believe we have the power to transform and adapt to the future of our glorious glorious service.

 

Enabling quality of life in very difficult circumstances, by Kate Plant

19964730_1773600412654889_568888045_nA thought provoking guest blog, second year CYP student nurse Kate Plant shares her experiences and insights into palliative care from her DILP summer placement…


Before starting my nursing degree, I volunteered as a Sibling Support Worker at my local Children’s Hospice. So, I already had some idea about how special these places are. But it was not until I undertook my Elective Placement there that I realised how rewarding a nursing role, in the provision of Palliative Care, can be.

The first thing I noticed was the difference in pace, compared to my previous placements. I was used to dashing around on hospital wards and barely having a moment to drink. So, when I was offered a cup of tea on my first day (half an hour into my shift) I was completely taken aback. But, obviously, there were more significant differences than having the time to quench my thirst. A patient would be allocated both a nurse and a care support worker, on a 2:1 basis, due to the complexity of the patient’s needs. This 2:1 care gave nurses time to listen and understand what really matters to the patient and their family. There was no rushing around. The environment was relaxed. Families would allow a nurse and other staff members to enter their lives in very difficult circumstances and build strong relationships with them. This is where the satisfaction came in.

CYPIn addition, I have by no means observed doctors, nurses and care support workers work together as well as within palliative care. There was no division but instead, a sense of unity. This enabled a pleasant atmosphere to bloom within a setting which, stereotypically, has connotations of being constantly surrounded by upsetting situations. All staff members were part of a team, encouraging a family atmosphere so families were as comfortable and happy as possible. Staff were able to take away a families’ everyday stresses so children and their families could treasure the remaining time they have together as a family, however long this may be.

The thing that struck me the most was the parent’s enormous strength to keep a pleasant face for their terminally-ill child and their other children, in one of the hardest times they can ever face. A parent’s strength is aided through their ability to effectively plan, with help from compassionate and empathetic staff members, any wishes they have in the care their child receives before death. This includes preferred place of care, spiritual and cultural wishes and anticipatory symptom management planning.  With such a wide array of resources available at the hospice (including sensory rooms, adapted garden swings, music rooms, parent bedrooms, bereavement rooms – the list could go on and on) these wishes were almost always met.

TOGETHER_LIVES_RESIZE_800_450_90_s_c1_c_cLast year, the ‘Together for Short Lives’ charity reported a national shortage of children’s palliative care nurses which is negatively impacting on the care provided to children and families. I truly believe if other students and qualified nurses were to gain a deeper understanding and/or even experience how rewarding roles in Palliative Care can be, this could help bridge the care gap. After all, you’ll never regret making a difference in the quality of care a child or young person received, during their last moments of life.

Behind closed doors: a student nurse in general practice

When I first considered nursing as a career, it wasn’t the adrenaline-filled excitement of A&E or intensive care that attracted me; neither was it intricate technical knowledge of theatre nursing or the busy variety of working on a ward. From the outset, community-based or practice nursing had always been my ambition. Maybe I’m slightly odd, but I love chronic conditions and the idea of helping people to manage those has always been appealing. I was also attracted by the autonomy of practice nursing and opportunity to work towards advanced nursing skills like prescribing…and I can’t lie, the lack of nights or weekends didn’t seem too bad either.

Research online suggested that I would need at least two years experience, preferably in A&E, or even a masters degree before moving into general practice. I wasn’t put off, but as a mature student it felt like there were a lot of hurdles to overcome before I could realise my ambition of becoming a practice nurse. I didn’t think for a moment that I’d spend time as a student nurse in general practice – so when I tentatively checked our placement allocations earlier this year, I was over the moon to find out that I’d been placed in a GP surgery nearby.

My mentor and the whole nursing team at the surgery couldn’t have been more welcoming. I discovered that I was their first nursing student and that the surgery is leading a project locally to encourage more GP surgeries to offer placements to student nurses. Like other areas of nursing, there have been difficulties recruiting practice nurses for a number of years, partly down to current practice nurses reaching retirement age, alongside fewer newly-qualified or experienced nurses choosing practice nursing as a career. As such, surgeries like the one I was placed at want to promote general practice as an attractive place to work; they see placements for student nurses during their training as a key part of that strategy.

Over the 12 week placement I got a real insight in the role of the practice nurse. My mentor, who was also a prescriber, led on the management of chronic conditions like hypertension, asthma and COPD, which encompasses advanced assessment skills, prescribing and lifestyle advice. This was on top of bloods, smear tests, contraception advice and of course, lots of injections; a workload shared with another skilled nurse who also took care of all child immunisations and travel vaccinations. They both worked closely with an experienced care support worker who took care of ECGs and spirometry, among many other things. Meanwhile, an Advanced Nurse Practitioner also based at the surgery leads on emergency consultations, seeing everything from chest infections to mental health crises. It was fantastic to see the varied role of the nurse in general practice and just how valued they were by patients.

The first few weeks of my placement were spent observing however as the placement progressed I was encouraged by my mentor to start leading consultations under her supervision. This was nerve wracking at first, but my confidence soon grew. I was eventually given my own clinics to run, taking on straight-forward asthma reviews and blood-pressure checks. It was fantastic having my own room and calling patients in from the waiting room. I loved talking to people about their health, explaining how their medication works and making a plan together that we hoped would help them better manage their condition. The most rewarding part was seeing patients return. One man said his life had been transformed by a steroid inhaler I had encouraged him to start using, saying that he no longer felt breathless or worried about his asthma. The opportunity to get to know your patients and equip them with the tools and knowledge to improve their health and quality of life, has to be one of the best parts of practice nursing.

The pressures on GP surgeries were clear to see, as they are in many other parts of the NHS, however my time in general practice revealed just how crucial practice nurses are in supporting the everyday health needs of individuals. Practice nurses are highly-skilled practitioners in their own right who make a valuable contribution alongside GPs and the rest of the team in a surgery. Hopefully more GP surgeries will start taking on student nurses during their training so that more can gain experience in this often-overlooked area of nursing. Of course it’s not everyone’s cup of tea, but I loved my time in general practice and feel that student and newly-qualified nurses have so much to offer to this area.

We would love to hear your views on nursing in general practice – is it a career path you would consider as a newly-qualified nurse? Share your thoughts below!

Mysterious midwife? Vs obstetric nurse

So at the end of this week I will have finished my nine week community placement and I am absolutely gutted! 😩

Community to me IS midwifery- community encompasses the entire midwifery continuum. From booking to postpartum the community midwife is highly skilled in all areas of midwifery. For those who are unaware of what a community midwife does an average day from personal experience is a full antenatal clinic dealing with a wide range of medical, social issues, recognising safeguarding problems- including domestic violence, mental health problems, poverty amongst many many more.

Postnatal home visits, parent education, meetings with multidisciplinary agencies, phone calls from colleagues, anxious women, the hospital…. the list goes on!!!!!!!

One of the most beautiful amazing things we get to advocate in community is homebirth. Indeed research tells us that giving birth in the comfort of your own home with your family, partner, home comforts round you increases oxytocin- the hormone of love, childbirth, bonding and feeding which will therefore lead to positive outcomes. Of course some women are not suitable and we throughly risk assess all women in our care at booking to determine plan of care for delivery, providing the woman with the most upto date evidence based practice.

Of late, being an avid tweeter I have become increasingly alarmed by a small but growing consensus of people who believe midwifery has no place in contemporary society. These people believe it to be an ideology, a fantasy, a dream concept. I was very disturbed to read one post attacking midwives for our quest to promote normal birth as being for our own selfish gains. Believing that promotion of normal birth, home delivery to be nothing more than a ridiculous ideology that no longer features in a medicalised world.

This is the very reason why I feel midwifery is not just underrepresented but STILL in 2017 the average joes’ knowledge of childbirth and maternity is so poor that it is very easy to whip up so much negative hype- particularly on the back of terrible tragedies such as morecombe bay.

Why is childbirth seen as such a mysterious entity??? Why compared to most industrialised countries do we have abysmal breastfeeding rates?

Who do we blame for the increasing trend towards the medicalisation of child birth and the entire maternity care package?

Its somewhat of a wicked problem but all I know is the role of the midwife is to show care and compassion, to recognise deviations from the norm and REFER!!, promote normal pregnancy and labour. To be a midwife you need to care, care about the woman you are looking after, the baby in utero. Our strive for normality in childbirth proves how much we care! We want the very best outcome for the gorgeous ladies and babies we look after.

So please help spread the word-……..Midwifery is a vocation not a cult!!!!

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!

Scary new experience?

After my first week in A&E, I had a sort of epiphany. A realisation that I probably should have had sooner – better late than never though I guess!

Though this is more a state of fact than advice, I believe it’s worth writing about to enforce the idea for students either just entering practice, or returning 2nd/3rd year students that may feel the added pressure and expectation from staff.

We are student nurses, we are in practice not to fill staffing numbers, or to be ignored, but instead to learn. We are going to come across new things that we are not always prepared for, we are going to be asked to perform jobs we’ve never done before and we are going to see things that we are unaccustomed to. Trying to learn, help patients and also work within our competency limits is a skilful juggling act that we all become experts in. However, though we love to be students and learn new things, it doesn’t stop us getting that anxious ball in our chest or the extra shine to our faces when it’s a brand-new experience.

To get to the point… Whilst in A&E this week I saw my first emergency situation, it was around 6am when we got that call from the Paramedics and I have to admit I got nervous! All these thoughts went through my mind like ‘what if my presence interrupts care?’ and ‘what if they ask me to get something and I don’t know where that is?’ I hope I’m not the only one who worries about these things.

The patient was going to arrive in 5 minutes, clock is ticking, heart is pounding. I’m looking to my mentor for guidance, she’s looking at me with reassurance and then the patient is brought through the doors into resus. I’m trying to take everything in, first looking at the patient’s presentation, then the parent’s reaction to the scenario. I thought about how this must look to them, their child out of reach, people rushing around them, alarms buzzing, lights flashing, indistinguishable equipment being used. Within seconds my attention went to the wonder of this team, everyone so confident in their role, assured in their tasks and skilled through practice. I became involved in this team in my own time, taking over observations and documentation when appropriate.

After the stabilisation of the patient I stood back and that’s when it hit me, what was I so nervous about? Why was I so nervous for this new experience? I am a student nurse, I am not counted in their staffing numbers, I am not expected to take over care because well, I’m not needed to. This brilliant medical team ensured this patients survival. I had been worried about being put in terrifying situations where I would be a hindrance to care due to my lack of experience in this area. That was never going to happen. I suddenly felt this weight leave my shoulders and felt the need to reassure other students who may be having similar worries. We are students, we are here to learn and staff understand this. It is always scary being in a new situation or being asked to perform a task for the first time. However, we should get comfort from the fact it is ok not to know the answers, it is okay to want to step back and watch if unsure. It does not matter if we are in a new experience because the professionals around us are experienced, we are here to learn. So, we should always say yes to experiencing something new! We should all simply remember, if we do not know an answer that’s ok, if we’re nervous that’s expected. Just be honest with your team, because everyone in this team has been a student too.

Top Tips for Your First Placement

 

There is only two weeks until the first year placements start!!! Not only has this made me super nostalgic (and panicky because I’m halfway through my degree now), but it gave me the idea to write down some top tips.

Be YOU. This may sound like the cheesiest advice ever, but it’s true. With every placement, I’ve started this year, I’ve been quiet and not myself at all for the first few weeks because I’m so nervous. But what I’ve (finally) learnt is that once I started acting like me, I felt so much more relaxed. Make jokes, smile, talk to your colleagues. The secret to making it through any shift, even when you’re not having a great day, is with the people you work with! PLUS, the more you act naturally on placement, the easier it will be to feel more and more like a proper nurse, not just some clown in a uniform.

Throw yourself into every opportunity (if you’re comfortable****). I made a habit of not saying no to any task that was handed to me, just so I could experience everything. Sure, I didn’t always want to walk down to the Pharmacy and ask (for the 8th time that day) where our medication was , but it helped! I got to know the hospital, understand the breadth of the role that the pharmacy has, and take a little breather from the business of the ward. Even boring tasks help you learn something, even if all you’ve learnt is I’m not a mad fan of this!

****Sometimes, you aren’t ready. There are times when you will be asked to do something (like giving an injection) and you might not feel ready. That is OKAY! Talk to your mentor, learn the methods and take some baby steps. You get to decide when you’re ready!

Don’t beat yourself up for making mistakes. They happen all the time. We are learning and working! You’ll do things wrong sometimes and that is okay. Whoever is teaching you should walk you through it anyway.

Talk about your day! One of my favorite times of day whilst on placement is going home and getting it all off my chest. Since I live with non-nurses, I often filter out the gory bits (bless them) but it really helps to process the day and reflect.

Get your paperwork sorted out on time! Both of my first-year placements involved me panicking because I didn’t talk to my mentor about paperwork. I thought it would make me look pushy. It doesn’t. 99.99% of the time, your mentor might have just forgotten or they might have a plan of their own. Just talk to them! If issues arise from there, talk to your PEF and AA.

And finally- GOOD LUCK! This journey is hard and can be frustrating, but there will be so many days when it’s so so worth it.

If anyone fancies trying their hand at blogging their experiences with placement, why not give us an email, a Facebook message or a tweet? We’re always on the lookout for more student nurse’s and midwives!