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.

World Mental Health Day 2017

World Mental Health Day, founded by the World Federation for Mental Health, takes place each year on 10th October and adopts a different theme each time. The aim is to raise awareness about mental health and encourage people to think about ways to support those who are experiencing mental health conditions. This year the focus is on mental health in the workplace.

imageThe World Health Organisation discussed how depression and anxiety disorders are common and can have an impact upon a person’s work life. Stress is a major factor that contributes towards the development of mental health conditions. With increased demand, funding cuts and staff shortages, there is no doubt that nurses and healthcare services in general are under immense stress. Nurses working in hospitals are said to be twice as likely as the general population to have depression.

For some mental health nursing students, having lived experience of depression and/or anxiety is a big part of what motivated us to choose to study for a degree in this field of nursing. Personally I chose this career because of the platform it can hopefully give me to help improve mental health services that I was involved with when I was an adolescent and to promote awareness of mental health using not just personal experience but professional knowledge too.

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Not many health professionals speak out about their experiences of living with mental health conditions through fear of having their capability to support other people doubted. Mental health conditions affect people in the workplace, and healthcare settings are no exception. To reduce the impacts of stress and workplace pressures on mental health it is important for people be aware of the support services available for employees. The NHS Services Directory is a useful tool for locating local places where psychological therapies can be accessed. Offering support can be as simple as asking a colleague how they’re feeling. If we start conversations, we’re closer to ending the stigma.

Sexual health healing: my elective placement in a GUM clinic

People coming to sexual health services experience a wide range of emotions; from embarrassment and fear to shame, guilt and anxiety. Sexual health carries with it some serious baggage and stigma that other areas of health don’t, but why is that? We wouldn’t think twice about going to the doctors for other health conditions, yet for some reason feel like we need to sneak in to sexual health clinics cloak and dagger, desperately hoping that we won’t be recognised. Sex is one of the most normal and natural things imaginable and anyone taking proactive steps to look after their sexual health should be celebrated…yet it is an area of health that many still find embarrassing or taboo.

This summer I completed a seven week placement in a sexual health clinic. I was excited to start as I’d always been interested in sexual health, but I must admit I was also a little nervous. Discussing sex openly and frankly can sometimes be just as intimidating for the healthcare professional as the patient – especially for an inexperienced student nurse still finding her feet! I’d be lying if I didn’t say I had the odd awkward moment over the placement – I struggle to hide my emotions and definitely felt my cheeks blush on the odd occasion during my first few solo interviews – but I soon realised that patients took their cues from me and the more relaxed I was, the more at ease they seemed. Before too long I was discussing STIs and sexual preferences as casually as the weather or what they had for tea last night. It was rewarding though, seeing people arrive at the clinic looking nervous, upset or worried and leave, free condoms in-hand, looking relieved and reassured. Along the way I also learnt a thing or two about the broad skills and expertise of sexual health nurses. Here is what I learned:

They can keep a secret

Confidentiality is one of the fundamental principles of sexual medicine. All staff working in sexual health, from consultants to student nurses, must sign a confidentiality agreement on entering the department. Of course this principle applies across all areas of healthcare, but it is particularly precious in sexual medicine where a patient’s right to privacy is central. Patients are not obliged to give their real name or date of birth when accessing sexual health services, nor will you hear a nurse calling people in the waiting room by their full name. Patient notes are also kept completely separate to other systems in the NHS and information will not be passed to services like GPs without consent or unless absolutely necessary. Explaining this to patients at the start of their appointment is often a good basis for gaining their trust and confidence.

They are expert communicators

Specialist sexual health and HIV nurses are incredibly skilled in taking detailed histories, asking the most personal questions imaginable, while remaining non-judgemental. Those questions can seem extremely intrusive and many people wonder why they need to share details of foreign partners, drug-taking or exactly what type of sex they had, so it takes a highly-skilled communicator to gather this information in a matter-of-fact, caring and non-judgmental way. As the interview unfolds, you can sometimes visibly see people recoil at the questions – in the cold light of day, sitting in a clinical room opposite someone in a uniform asking you about some of the most intimate parts of your life can be extremely difficult. Sexual health nurses completely understand that; they want to make the process as painless as possible, so will adopt many different communication strategies to put their patients at ease.

They know their stuff

The majority of sexual health and HIV nurses are specialists, with many years of experience and additional qualifications or training in sexual medicine. While in the past nurses in sexual health clinics would have assisted the doctors, they now work autonomously, often in nurse-led clinics. Nurses are the backbone of gentio-urinary medicine (GUM) clinics, working closely with consultants and experienced healthcare technicians. It’s a highly-skilled role that requires in-depth knowledge of sexual health conditions including their symptoms, methods of diagnosis and the latest evidence-based treatments, some of which they are now able to prescribe themselves under Patient Group Directives (PGDs). They work hand-in-hand with the doctors, undertaking the same assessments and doing the same tests and examinations. They also tend to be the clinicians delivering the treatments, from antibiotics or deep IM injections to wart freezing. They can do the whole lot.

They are un-shockable

Believe me, they have heard and seen it all. They are not there to judge your sexual behaviour and they don’t. They ask such personal questions because they want to make sure they carry out the most relevant tests, ensuring that they pick up any potential sexually transmitted infections (STI) someone could have been exposed to. Knowing whether someone has had foreign sexual parters or taken drugs, for example, can influence whether they decide to add in blood tests for hepatitis B and C. It pays to be as honest and frank as possible because it means that they do the full range of relevant tests.

They care about your physical AND mental health

WHO define sexual health as both absence of disease and healthy attitude towards sex. Sexual health nurses aren’t just concerned with detecting and treating STIs and giving out free condoms; they also play a therapeutic role, helping to ease anxieties and educate individuals about safe sex.  They can play a big part in helping someone overcome a bad sexual experience, often taking on a support and counselling role, especially nurses who choose to be sexual health advisors. Even for patinets who don’t specifically open up about their worries, you can see how a skilled sexual health nurse can make someone feel better just by being kind and matter-of-fact. Conditions like HIV of course sadly come with some of the greatest stigma and potential to impact mental health. HIV specialist nurses therefore are key in helping people come to terms with their diagnosis and cope with the wide range of emotions they may experience. They are often the first port of call for patients, sometimes being the only person that a patient has disclosed their HIV status to and feel comfortable phoning up to discuss worries and fears. As well as managing and monitoring their treatment HIV specialist nurses often become a trusted confidant, helping individuals to regain their confidence and self-worth or access local networks where they can access peer-support.

All-in-all, my placement in a sexual health clinic revealed the nursing role to be fascinating and rewarding. Sexual health nurses are a down-to-earth bunch who come into contact with people from all walks of life and use a broad range of advanced nursing skills to make a positive impact on physical and mental health. There’s a lot more to it than giving out free condoms, that’s for sure!

If you’re interested in sexual health, there are some brilliant websites out there. The British Association for Sexual Health and HIV (BASHH) guidelines for example share evidence-based clinical guidance for diagnosis and treatment of STIs. There are also some fantastic Manchester-based charities and organisations with a focus on improving sexual health such as Manchester Action on Street Health (MASH), a charity supporting women engaged with sex-work in Manchester; George House Trust, a charity supporting people living with HIV; LGBT Foundation, who offer sexual health testing for LGBT communities among many other services; and Sexpression Manchester a student-led organisation that offers informal sex and relationship training for young people.

Do you have an experience or reflection from placement that you would like to share with other student nurses and midwives? We think every student nurse or midwife has a unique and interesting perspective to offer so we are always keen to welcome new student bloggers to our team. If you have a story to share please do get in touch via our Facebook page @UoMPlacementProject or email studentnurseplacementproject@gmail.com. 

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

Nursing behind bars: Q&A with student nurse, Laura, who shares her prison placement experience

One of the incredible things about nursing is that it is one of the few professions that reaches people in every part of society. This includes prisons which could arguably be considered one of the most challenging environments in which to nurse. Earlier this year student nurse Laura Golightly (pictured) was among a handful of student nurses to be placed at a prison in Manchester. We are delighted to share this Q&A with Laura who describes her experience working alongside the prison nursing team, including the daily challenges but also the huge variety of nursing skills and confidence she gained from this rewarding placement.Laura pic

What originally drew you to applying for a placement in a prison?

I have always had a fascination with prisons since growing up and watching compelling documentaries made by influential documentary makers like Louis Theroux. For many people, and certainly for me, this sub-section of society living their life behind bars in massive secure institutions was really intriguing and something that I felt I could have no real concept of. The reality of life within prison is often something that’s kept very private from the general public, including the mental and physical health problems faced by inmates and the concept of institutionalisation, this threw up some really interesting and thought provoking societal questions about the effectiveness of the prison system as a whole which I really wanted to explore, not only as a health professional, but on a human level also. It had really been a desire of mine to work within a prison, safe guarding very vulnerable members of society, before the opportunity even arose so when I saw the email detailing the placement, I knew I would do everything in my power to secure it.

How did you feel when you arrived for your first day?

I was completely overwhelmed when I first stepped foot into the prison for my first day. Starting a new student placement can be intimidating at the best of times, I’m often left feeling anxious about meeting the staff, performing up to standard, not knowing enough and many of those little worries that seem to occupy your head before starting a new placement. There is certainly plenty to consider turning up on your first day so then to be turning up to a huge Victorian building which seems to dwarf even such vast city centre buildings surrounding it, complete with barbed wire running around the parameter and prison staff greeting you with a sharp eye and a pat-down, well it certainly puts things into perspective. The first day my mentor took me into the grounds and gave me the grand tour, we discussed what general day to day life is working within the prison and he soon made me feel at ease. I have to say though, it did come as a bit of a surprise when we discussed this over a coffee and he pointed out to me that the staff serving us in the café were actually inmates.

What was your daily routine like on placement? Describe an average day.

There was no real average day within the prison, this was one factors I particularly enjoyed about the placement! There are three main areas to work and these are on reception, on the health care unit and on inpatients. The role is vastly different on all three which was fantastic for bringing variety to the role as nurses were rotated throughout the week. On reception we would take care of the medications for all inmates leaving for court or being transferred out and we would medically ‘fit’ them for departure, we would then also take care of all inmates being transferred in, this was the really interesting part. We would conduct an assessment with the patient discussing their past medical history, recording observations, their general contact details, the reason they have come to prison, their mental health, health promotion advice and some screening tools, this was their first point of contact with the medical team so there is usually a fair amount to cover and they would have a follow up within the first 72 hours to once again check in on them and discuss anything they may need to add since their first assessment. A day on the health care unit would consist of giving the meds for a specified wing (which could often take hours with the cocktail of meds some inmates are on) and then reporting back to the health care unit to complete the clinics for the day. There was an afternoon clinic and a morning clinic within this prison and these would often be clinically very similar to a GP surgery clinic. There would be many different health professionals running specialist clinics also such as psychiatric, counselling, smoking cessation, sexual health, BBV, dentistry, optometry and more, just as you’d expect to see in the community. The inpatient unit was quite different all together as these were the extremely vulnerable patients, it mainly consisted of mental health nurses and prison officers who were specialised to deal with the kind of inmate that presented in the unit. It was nothing like what I could have imagined, with huge solid metal doors, no windows, rooms without anything at all inside, no real equipment and it seemed to be constantly deafening with lots of screams and shouts from inmates. On top of all this there was the emergency response radio one nurse would have responsibility for, this would be used to request emergency medical first response. While I was on placement I attended these calls for a range of incidents such as fights, overdoses, inmates high on illicit drugs, cardiac and respiratory disturbances and mental health crises.

What kind of clinical skills were you able to practice with the prison nursing team?

The clinics were fantastic for practicing clinical skills, with lots of hands on experience being available. ECGs, dressings, injections, wound closure, suture removal and observations were all common practice. Every morning and afternoon there was the opportunity to complete the medications round also and due to the vast opportunity for spokes within the prison I also managed to complete a mental health assessment, smoking cessation assessment and observe the work of the specialist drug and alcohol team.

What do you think are the most challenging aspects of prison nursing?

The most challenging aspect of nursing within the prison for me was the prison regime itself. Many individuals within the prison have very low wellbeing for obvious reasons. To prison staff they are inmates, however to medical staff they are patients, this creates a very tricky dynamic when it comes to dealing with their needs. Being unable to encourage patients with activities to promote wellbeing was very difficult, I struggled to encourage patients to be active when they are only entitled to one hour in the yard a day and they are kept locked up in their cell for such prolonged periods of time. I struggled to encourage patients to connect with loved ones when they are only allowed a certain amount of visitation and many of the relationships the prisoners keep are strained due to their absence from home. I struggled to encourage learning when often classes are full up with long waiting lists and staffing levels inappropriate for the level security needed. The problem with prisons is that they aren’t therapeutic environments and this creates a vicious cycle that many vulnerable people fall victim to.

What did you enjoy most about your placement in a prison?

I can honestly say I enjoyed everything about the placement. The staff were all fantastic, great fun, welcoming and always happy to teach, my student colleague on placement with me was lovely, the prisoners were generally very polite and interesting to talk to. Being exposed to all the different healthcare sectors and how they are applicable to the prison community, highlighting the different demands of this small sub-section of the outside population was fascinating and I learnt how to deal with a patient who’s needs were often vastly different than what I was exposed to in my general training so it was fantastic to gain this different and unique experience.

What I really want to get across to nurses that would potentially consider a career within the prison service is that it really is a fantastic and unique experience. Often patients have very complex needs and this can lead to a really exciting and challenging working environment which really allows you to make a difference for your patients. Many of my friends and family thought I was stupid for wanting a placement they perceived as so ‘dangerous’, I really want to communicate how safe I felt in there. The prison officers are very well trained and experienced and look after the safety of the medical staff absolutely superbly. Do not be discouraged by fears of safety as officers are always on hand to assist you and will never leave you alone with a prisoner. Security measures in there are top priority for prison management and you’d never be left to work in an unsafe environment. If you have a keen interest in working with challenging individuals and nursing in a holistic and non-judgmental manner with a particular interest in mental health then the prison environment could be just right for you.

Thank you, Laura! It is fascinating and valuable to hear from other student nurses and midwives working in all kinds of different placement areas. If you have an placement experience or reflection that you would like to share on our blog, please do get in touch! Find us on Facebook @UoMPlacementProject or email studentnurseplacementproject@gmail.com.