What to take on your first ever day of placement

Planning for placement can be tricky when going for the first time. Having had no healthcare experience prior to my first placement on an elderly medical ward, I had no idea what to expect or what I might need to bring with me for my first shift. Two years on, there are now staple items I never leave for placement without. Aside from the essential lip-balm and hand cream, here are my top tips on what to bring for your first shift:

Directions to placement google maps

Your first challenge of the day is to get to placement safely and on time, which could involve an early morning trek across Manchester. If you’re familiar with Manchester, or have had a test run, this should be a doddle, but if not, it’s a good idea to make sure you know the address of your placement as well as making a note of the bus times or directions – just to avoid a panicked Google search at 6am on your first day. I’d also make a note of the phone number of your placement, just in case you are delayed for any reason and need to let them know. Our Student Nurse Survival Pack has some helpful advice on planning your journey.

Pens, LOADS of pens! 

pexels-photo-261591.jpegAs you soon discover, pens are like precious gold-dust in the NHS. Everyone from nurses to patients will ask to borrow your pens and it’ll be a miracle if you ever see them again. Definitely don’t take your favourite fountain pen or any expensive stationary because it won’t hang around for long. My suggestion is to buy a big stash of cheap pens with the clicky tops that you can keep in your bag, so even if all yours go walkies, you’ll have a back-up. Alternatively, as every student or registered nurse knows, if you ever see free pens on offer TAKE AS MANY AS YOU CAN! They should always be black ink though, as it’s the only colour we can use to document in patient notes. I also chuck a highlighter or two into my pocket as I find this handy for highlighting key details on the handover sheet.

A pocket-sized notebook

A lovely friend who is already a registered nurse gave me this tip before my first placement: “make sure you take a notebook”. It is one of the best practical tips I’ve had as a student and I follow it to this day. So many things will crop up during a shift that you might want to look-up when you get home or remember, so it’s really handy having a notebook there to quickly jot down your thoughts to remind you later. I’ve also used mine to write reflections on the bus home or simply note down a set of observations or phone message if my handover sheet is covered in writing. I bought pack of small notepads and take a fresh one for each placement and they have been a godsend.

Fob watchfob watch

I’m sure you’re all sorted with this one already – the fob watch is one of the iconic pieces of nursing uniform – you’ll feel like a proper nurse when you pin it on for the first time! As well as making you look like a nurse, it is also an invaluable piece of nursing equipment that helps you measure vital signs like pulse and respiration rate as well as keep track of the time, a very important skill to master as you progress through your training. Whether you have an expensive fob watch given to you by friends and family or a freebie from the nursing fair, it doesn’t matter too much – you will use this every single shift and feel lost without it on days you might forget it. You’ll know you’ve starting to assimilate to the nursing life when you go to check your fob watch instead of wrist to tell the time outside of placement!

A diary

pexels-photo-733857.jpegA piece of advice from a chronically disorganised person approaching her thirtieth year on this planet: invest in a diary. Preferably in January.  As you may have already learnt, there is so much to juggle on a nursing degree – uni, assignment deadlines, exams, placement, family commitments, paid work, a social life (god forbid!) – meaning that things can come unstuck pretty fast without a bit of organisation. In first year it soon became clear that my usual ‘keep-things-in-my-head-and-pray-nothing-clashes’ approach was not going to work. A simple diary saved my sanity and probably a few friends who were sick of me double booking. The more tech-savvy among you will have this covered with phone calendars etc but I find a good old-fashioned hardback diary works best – I always take this with me to placement so I can plan my ‘off-duty‘ (nursing word for rota) with my mentor and spokes in advance, making sure this fits around uni and other commitments.

FOODpacked lunch

As someone who thinks about food almost all day, I can not emphasise this enough – take a packed lunch with you to placement! Breaks are often short (typically 30 minutes) and the last thing you want to do is run across a large hospital or find a nearby shop to buy an overpriced lunch which you have to wolf down on the way back. You’ll want to spend as much as your break as possible relaxing (ideally sitting down) and recharging for the next part of your shift, so it’s a good idea to bring something with you like a sandwich, last night’s leftovers or even a can of soup so that it’s one less thing to worry about. Most placement areas will have access to a microwave so you’ll be able to heat up something up, though this may be trickier for anyone on district/community placements where you might be out and about. It took me a good few months to get into the habit of packing my lunch, but it has saved me loads of money and hassle meaning I can now fully enjoy my breaks. Invest in a sturdy lunch box and large re-usable water bottle – it’s so easy to get dehydrated when you’re running around on a hot ward, but having a bottle there reminds you to drink. Our blog on healthy eating also has some good tips.

Identification and clinical skills training certificates

Some placements require you to bring along some kind of identification, like your student card, for your first shift. I had a placement in sexual health, for example, that needed to see my student ID on my first day as part of their confidentiality policy – while you might need it for other placements in order to be given a Trust ID badge. Your university name badge is also essential and will help staff and patients get to know you and remember your name – they’ll have no excuse for calling you ‘the student’! Our induction checks on PARE also require our mentor to see evidence of mandatory training like basic life support that you will have done in clinical skills, so it is a good idea to either bring these along or take pictures of them to show your mentor so that they can sign this off.

What NOT to take

As well as thinking about what to take on your first day, it’s also helpful to know what not to bring. The main thing here is any valuables like a purse or laptop. Some placement areas might be able to offer you a spare locker but many won’t and I’ve sadly heard of student nurses whose valuables have been stolen from communal changing/break rooms which can sometimes be left unlocked. While this is really rare, I wouldn’t take the risk – I leave my purse or any other valuables at home and just bring my bank card and a small amount of cash, which I keep with me in the top pocket of my uniform – just remember to take it out when you get home, so it doesn’t go in the wash! If you need to bring a tablet with you for completing your OnlinePARE for example, just let your mentor know and I’m sure they’ll be able to find a secure place to lock it away.

So there’s a run down of my top items to take on your first day of placement. Of course, as you progress through your training you’ll find that other items become handy in different placement areas – like alcohol gel in the community, a pen torch in A&E, a pair of blunt-ended scissors on wards or a stethoscope for wards that measure manual blood pressure – but these key items will help you start off on the right foot. With a little bit of pre-planning you can arrive at placement feeling totally prepared and ready to nurse – good luck!

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Never ‘just’ a student

“I’m sorry, I’m just a student.”

Sound familiar? How many times have you said this while out on placement? Maybe it’s just me, but I’m ashamed to say it’s more often than I can count, especially in the first two years of my training. It possibly stems from a lack of confidence or uncertainty, perhaps a fear that I’d do or say something wrong – something we’re all bound to experience at some point during our training.

But is this lack of confidence a wider issue among qualified nurses, as well as students? Do we sometimes have a tendency, as a profession, to devalue our work and contribution? Do we see ourselves as less important or influential than other health professionals?

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Conference programme

I recently attended the 2017 Nursing and Midwifery Conference held by the newly formed Manchester Foundation Trust at Manchester Royal Infirmary. The keynote speech was given by Dr Eden Charles, a leadership coach and consultant who has been successfully supporting individuals to create cultural change in their organisations, including the NHS, for more than 30 years. He recognised that as nurses and midwives it is in our nature to give, to put others first and to sometimes put our own needs on the back burner. But, he said, with that sometimes comes a tendency to lack confidence in our huge strength and contribution as a profession. He said he often hears nurses refer to themselves as ‘just’ the nurse and is always baffled because of how important the role really is from the perspective of patients.

As student nurses or midwives, we are on the cusp of joining the largest professional body in the health service who are in a unique and privileged role as both care givers and advocates for patients. Although not yet registered, we are still an integral part of the nursing profession and make a difference in many ways to care in the NHS. The more confidently we value our contribution, the better we can speak out for our patients and give a voice to those who otherwise might not be heard.

In his speech, Dr Charles said: “Never say ‘I am just a nurse’. Change that story to ‘I am a professional nurse’. Put yourself into the world boldly and confidently as people who deserve to have a voice.” He challenged us to be ‘nursing rebels’ or ‘rebels for compassion’; to acknowledge our strength and abilities in order to gain greater influence and make changes to practice that really matter. He reminded us that leadership can be found at all levels, not just at the top; we all have a responsibility to bring about the changes we want to see. It’s not always easy or straightforward, but as students we can make positive changes by living the values that brought us to nursing or midwifery in the first place.

So I’m making a promise to myself and I hope you will too; I will never be ‘just the student’ or ‘just a nurse’ ever again.

Thriving, not just surviving: award-winning toolkit supports the mental health of student nurses and midwives in Manchester

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Tracy Claydon, PEF

As we highlighted earlier this week, Tuesday 10 October marked World Mental Health Day, an annual, global event recognising the impact of mental health on the lives of many and the importance of showing compassion to those struggling with mental ill heath, as well as looking after our own mental wellbeing. As student nurses and midwives, we may experience a broad range of mental health issues throughout our training as we adjust to our role; juggle placement, academic work and our personal lives; and because of the distressing experiences we may be exposed to on placement. Thankfully, the wonderful team of practice education facilitators (PEFs) at the newly formed Manchester Foundation Trust  (formerly CMFT) have our backs, creating an award-winning toolkit for mentors to enable them to better look out for and support our mental health in practice. We are delighted to share this Q&A with Tracy Claydon (pictured above), PEF for the Division of Specialist Medicine and the Corporate Division at Manchester Foundation Trust and project co-founder. She gives us an overview of the Mental Health and Wellbeing Toolkit and how it aims to support students and mentors in practice.

Firstly, what is the Mental Health and Wellbeing Toolkit?

We identified that there was no specific practical guidance to help mentors in supporting students who may be in emotional distress and/or be experiencing issues relating to their mental health when on placement; the Royal College of Psychiatrists’ (2011) indicated that as many as 29% of students may experience mental health difficulties at some point during their studies, while the National Union of Students (2015) have this figure as high as 78%. The toolkit was developed to support not only current nurses and mentors but also of course to support students to better manage the emotional demands of the role and feel supported to carry out their job confidently.

It is possible and also likely that a significant proportion of the students presenting in distress will not have a diagnosable mental illness but will be experiencing distress related to ‘life stresses’ and will need support to allow them to cope effectively with these rather than seeking to be prescribed an antidepressant or similar medication (NHS Choices, 2016). The provision of a toolkit that would provide a structure and framework for mentors to better support their students was clearly needed. The toolkit includes:

  • Tips for mentors including advice on how to discuss and identify concerns
  • Algorithms for accessing support
  • ‘Having the Initial Conversation’ guidance for mentors
  • Top Ten Tips for students to look after their own mental wellbeing
  • Agency Directory

The toolkit was launched in November 2016 and re-launched in May 2017 to coincide with World Mental Health Awareness Week which had a theme of ‘thriving or surviving’ which reinforced our message… we don’t just want our students to survive, we want them to thrive!

Where did the idea for the toolkit come from?

Students will often experience quite harrowing situations during one single placement that possibly other members of the public will go through their entire lives without seeing.

We talk often about resilience, but how do we build this? And crucially, what can we do when anxiety becomes more than a transient emotion? From a practical guidance we recognised that there were gaps in our support mechanisms within the organisation and also that we had the underpinning literature to evidence this.

The Nursing & Midwifery Council and the Royal College of Nursing recognise the potential for students to experience difficulties in their mental health and yet surprisingly neither agency has/had provided any guidance for nurses or mentors to support them.

At Manchester Foundation Trust (MFT) we wanted to fill this gap and the toolkit was developed as a resource to address this. Equally, it was also incumbent upon us to acknowledge how anxiety or a sense of isolation when not managed in the early stages can then escalate into something more concerning.

The goal was to support our students at the beginning, end and at all points in between on their placement and learning journey, so that they will recognise and regard MFT as a caring and compassionate organisation that enables students to thrive and not just survive and that they would wish to return as qualified staff.

How did you go about developing the toolkit?

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Ant Southin, Specialist Mental Health Liason Nurse

It came as a result of a real life situation where I as a PEF was supporting a compassionate and kind mentor who was struggling to support a student on placement struggling with mental health issues. Myself and my PEF colleague Sharon Green, began working on the toolkit as a resource however, the toolkit only truly started to develop when we were able to access the knowledge and skills of Specialist Mental Health Liaison Nurse, Ant Southin (based at MRI, pictured right) who was able to provide the expertise that we as registered adult nurses by background lacked. This enabled it to have a real MDT approach and became a wonderful collaboration!

How has the toolkit been used in practice so far?

For some students the situations they observe or are involved in will be the most distressing thing they have experienced. It is important that they have a means of communicating and understanding these feelings and recognising that there is help available. The Toolkit has been used in a number of situations where students were struggling to cope emotionally: including supporting students who were affected by this year’s Manchester Bombing.

What are your plans for the future of the project?

Despite having been awarded the MRI Fellowship Award at the recent Nursing and Midwifery Conference and also having been acknowledged as an example of Best practice by Health Education North West (available as an E-Win) we feel this work is still in its infancy; while it is currently aimed at students, we recognise that the messages are important for all of our staff. We hope that we can develop it to be used to support any member of staff experiencing distress. The Human Resources department have requested a meeting to begin discussions around achieving this within the wider organisation. We will be presenting at the upcoming Midwifery Forum at St. Mary’s Hospital and we have also had heard nationally from other NHS Trusts interested in adopting the toolkit within their own organisations.

The MRI Fellowship Award 2017 included a £1000 monetary prize which will be used to support ward areas to develop their own ‘buddy box / soothe box’ resource which they can then continue to develop to meet the needs of their students and staff.

…and finally, what advice would you give to student nurses and midwives to take care of our mental health while on placement?

Student nurses and midwives need to feel prepared and supported for the career they are about to embark upon. The profession is challenging and demanding but with huge personal and professional rewards. Mental health issues can affect any of us at any time in our careers and should be considered a priority for all of us whatever stage of our career we are at. By making them a priority for students it is hoped that they will continue to see this as a priority as they progress through what we hope will be successful nursing/midwifery careers. Using our dedicated #icareforme approach we will continue to maintain the profile of the huge importance of self-compassion for staff working within such challenging and complex environments. It is vital that mental health has the same parity with physical health and we can only achieve this by making it the priority it deserves and needs to be.

Thank you Tracy!! If you’re interested in learning more about the toolkit, you can find it here – in particular, take a look at the ‘Top Ten Tips for Good Mental Health’ on pages 8-9 for simple ideas that we can all use to look after our mental health.

Remember that if you are struggling with your mental health or feeling anxious, worried or depressed then don’t try and suffer on in silence. If you feel confident to do so, speak to your mentor, PEF or academic advisor (AA) or the University of Manchester has a fantastic confidential Counselling Service. Often speaking with your peers can ease the burden – you may find that others are feeling the same – or if you simply want a kind, listening ear then Nightline is another brilliant option, you can find the contact number on the back of your student card.

Welcome all first year student nurses and midwives – you made it!!

So here you are – not only have you made it to the University of Manchester, you have nailed your first week as a student nurse or midwife!! All of your hard work has paid off and you are well on your way towards those coveted blue uniforms. I’m sure you’ve heard it a hundred times already, but the three years truly do fly by. handshake

Your head is probably swirling with a whole range of thoughts and emotions, from excitement and determination to nerves and apprehension for the challenge ahead. Well rest assured, although you will have some difficult times over the next three years (we’ve all had our fair share of teary moments!) you will also meet some absolutely incredible people, see things you couldn’t imagine and come out the other side a stronger, more resilient person – and ultimately a brilliant nurse or midwife!

For now, your main focus is making new friends, getting to know Manchester and getting to grips with the academic side of nursing – all very important! For student nurses in particular, placement isn’t yet on your radar – though I’m sure you are raring to get out there are start the real-life business of nursing and midwifery. Naturally you may have some anxieties or fears…and questions…lots of questions. That’s where we come in. We are a group of student (and some now qualified!) nurses and midwives who want to help you make the most out of your placements. Having been in your shoes ourselves we know how nerve-racking (and often overwhelming) the prospect of going out into practice for the first time can be, so we started this project to give fellow student nurses and midwives informal support, information and advice based on our personal experiences.

If you’re wondering what to expect on placement and the types of experiences you may encounter, I encourage you to take a look at our dedicated blog – written by students, for students. On there you will find over 150 blogs covering everything from practical advice on how to survive your first night shift or which shoes to buy (I say Clark’s Unloops…they’re the ugliest shoes you’ve ever seen, but my god are they comfy!) to personal reflections on topics including mental healthend of life care, miscarriage and nursing in challenging conditions overseas. You will also find our ‘Placement Survival Pack’ filled with a wealth of information to help you prepare for placement. DISCLAIMER: We are busily updating the ‘Survival Pack’ for 2017/18, so watch this space – we be sharing the latest edition with you before you go out on placement so you are fully prepared.

For those of you keen to share your own experiences as a student nurse or midwife, we would love to hear from you! We think every student nurse or midwife has a unique and interesting perspective to offer and would love to find new bloggers to join our team. To get involved, simply email studentnurseplacementproject@gmail.com or send us a message on Facebook, just find us by searching ‘Student Nurse & Midwife Placement Project’.

You will be hearing from us throughout the year – but in the meantime we wish you all the very best of luck at the start of your nursing and midwifery journey! xx

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!