Mythbuster- an NQN in community?

Many of us students will have been lucky enough to experience a placement where we felt we belonged. Ever since my first summer block placement in community, I knew it would be my dream job. I was then lucky enough to spend my 2nd year elective and my sign off in community too! 

Even though I was really passionate and excited about wanting to work in community, I didn’t always see it as a possibility. Every time someone asked me where I wanted to work, and I said community, I was met with disagreement.

“You can’t go straight into community”

“You need a few years of ward experience first”

When you hear this all the time, from qualified nurses, it’s normal to feel a bit perplexed. I thought we could work anywhere…?

Well I’m hear to let you into a not-so-secret secret, you CAN work in community as an NQN!

Once I entered 3rd year, I decided to ignore all the advice I was given, and applied for community posts anyway, without a driving license. I got the job! In fact, I was offered two posts in different areas. So I thought I’d debunk some myths around community Nursing….

It’s only for older nurses who want to retire soon as it’s boring!

Hahahahhha! You may not be on your feet for 12 hours straight but you are forever bending into odd shapes in order to do wound care/catheterising/injections in order to fit into the home environment, as well as other challenges. You still have your patients, on your list, and possible added extras too. It’s not a job for someone who wants an easy life that’s for sure! But is any nursing job an easy life? I’ll let you decide…

You have to go to uni again to work in community

Wrong! You can join as a band 5 staff nurse! If you want to be a registered district nurse, you need to complete a year full time/ part time masters, which will make you a band 6. You need community experience (at least 2 years) before undertaking this. It’s massively helpful, and aids career progression, but by no means essential. If this is your aim, mention it to potential employers and ask about secondment.

You need ward experience before you go into community

Nope! This used to be the norm, but not anymore! Newly qualified nurses should have the skills to be able to work in a ward or in community. I personally feel more prepared to work in community once qualified, just as someone else might feel at home in ICU. It’s personal choice!

You de-skill yourself working in community

Incorrect!! And one of my biggest pet peeves. Every nursing role is different, and will require both general and specialised skills. Community nurses need to be able to: work independently, feel confident giving medication such as diamorphine or insulin by themselves (these usually have to be countersigned in the hospital!), provide wound care, support patients at the end of life and their family and many many more skills. This isn’t deskilling! It’s just a different set of skills.  

If you want to work in community, do not lose hope if you are being told otherwise. Attend recruitment events, speak to your preferred trusts and apply for jobs! 

Keep an eye out for more Mythbuster: NQN jobs blogs…

Advertisements

The 3rd Year Survival Guide

After 3 long years, the September 2015 cohort is finally done! Portfolios have been verified, dissertations are completed and PARE is locked. It’s unbelievable that just 3 years ago, we were starting our student nursing journey. Time has flown! Many of us began this journey with little to no care experience, either coming from school or college, or previous degrees or access courses. It just shows that Nursing is not a career where you need experience, or very strict qualifications. It can be for anyone!

As a goodbye present to the younger years, I asked the ‘15 cohort to impart some wisdom about surviving 3rd year…

Dissertation/deadlines

You’ll be given a little suggested timeline for your dissertation. Try to keep to it as it really helps with structuring everything.

Plan ahead, and try not to leave things till the last minute (unless that is what works for you!)

Remember that your dissertation is YOURS, it should be enjoyable too!

I found keeping a dissertation diary (noting down time/date of session and what you did) is hugely helpful, as it can be easy to forget what you did when there’s so much to do!

Make sure you act on the constructive feedback from your supervisor. If you aren’t getting it- ask for it! 

Placement

You will have to complete your medicines management mini exam at some point in 3rd year. The earlier you do it, the better! It’s a weight off your shoulders, and task ticked off!

Be honest about your academic workload and life commitments to mentors. They should be sympathetic and ensure your off duty works with life.

You will feel like a lot is expected of you as a 3rd year, and that might make you a it terrified. It’s okay! Keep going. Make your own goals, talk to your mentor about it and set your own pace!

Trust me, you will feel SO ready to qualify in your last few weeks!!

Portfolio

Plan how you will meet your exposure to other fields as early as possible, otherwise you’ll have a mad rush at the end of the year!

Don’t leave it till the end of the year. Make you life easy, even if it means spending a weekend or doing it in bits over the year. It will allow you to enjoy your last moments of being a student nurse. 

Advice for student parents

Keep to your deadlines, and try and submit early if possible. Including your portfolio!  Leaves less room for unfortunate occurrences like a sick child.

Make sure your mentor knows that you are a parent,hopefully they will be sympathetic and flexible.

The most important pieces of advice

Talk to your family, family, anyone you trust if you feel you are struggling. You will feel better. Share the burden!!!

Peer support is what will get you through the madness that is 3rd year.  Ensuring that you attend seminars and lectures is a great way of doing this. Don’t lose motivation! 

Having a twitter account (personal, just nursing or both!) is an excellent way of getting advice, learning and networking. You can start by following us

Practice self-care in your own way everyday. Whether its a relaxing bath, a run, playing computer games or walking the dog, you are the most important person to look after. No matter how busy you feel, it can’t come before you!!

So there you have it! The baton has been handed to September 16, and will be yours before you know it September 17!!

If you want to blog for us, or want to request a topic, drop us an email or message on Facebook/twitter/Instagram

The not-so-clinical skills

Placement allocation. A daunting prospect for all! There are, as always, disappointments. Many of these are for valid reasons, such as very similar/the same as another placement, too far away or you’ve experienced it as a service user/you worked there.

But I’ve noticed that many people (including myself previously!!!) get disappointed with placements if they aren’t “hands on” enough. But why?

We all enter into nursing for different reasons, and many of us will prefer “more clinical environments” than others. But does this mean that we should expect these placements throughout our studies? No! Because that wouldn’t reflect what nursing is!

Even with the nursing role changing, the non-clinical skills such as communication, leadership, delegation and teamwork will always be at the forefront of nursing. These skills may seem “soft”, but they are the bread and butter of our practice and are transferable across all jobs!

I’ll use an example of my own.  My first ever placement was on outpatients, and I was gutted! Most of my nursing friends were off living the dream on wards, whilst I was falling asleep in doctor’s consultations. The staff were lovely, but I wanted more! I was convinced that my time in outpatients was a write off, completely pointless to my nursing education. Surprise surprise, I was wrong! My listening skills improved greatly, and, since I spent so much time noting down words I did not understand, I learnt a lot about pathology. Whilst at the same trust later on in my degree, I was able to reassure patients and relatives about the outpatient clinic process. When I held someone’s hand during a painful procedure, I learnt how even the smallest of actions can make a difference. And I still fondly remember when I was present whilst someone was being told they were cancer free, and I cried with the patient and their mother. These experiences and lessons have stayed with me throughout my training, and I am so grateful for that!

Clinical skills can be taught at any time in your career, whether you are in your first year of training or you have been practising for 30 years. But the non-clinical skills, those are harder to teach. They require time, experience and reflection. And remember; your degree is the start of your learning, not the end!! 

“The Student”

Being addressed as “the student” is not my favourite thing in the world. I’ve never spoken up about it, but I feel it makes you into a commodity as opposed to a human being who is there to learn. My usual response is to introduce myself, and keep introducing myself until people understand that I have a name. It sounds daft I know, but it tends to work.

But sometimes introductions are not enough.. I was working a Saturday shift, in order to see my mentor, and it was my 3rd day of placement that week. During handover, I noticed that my mentor wasn’t there and none of the nurses were regular members of staff; but agency staff who I had seen once or twice. I was really disheartened that my mentor didn’t turn up. And then, after handover, they allocated the Trainee Nursing Associate with a nurse, and left me standing there like a proper lemon.

I was hurt. I’d spent the past 2 days working really hard on placement, during the snow and short-staffing. I thought I was finally somewhat integrated in the team.  The tiredness, shock and hurt built up, and I had to retreat to the staff room to try and calm myself down. I just kept thinking, I’m third year! I shouldn’t be doing this! Why am I upset!

I knew why. I’m a confident person, happy to talk to anyone and everyone. But when you’re in a room of people and nobody acknowledges your existence, confidence can be hard to come by.  After some kind and supportive words from my boyfriend (an endlessly calming presence even via text), I knew it was my responsibility to make something of this situation. So I spoke to the nurse in charge and (after being passed between 3 different nurses), one finally agreed to take me.

I ended up having an okay day, and the nurse I was working with let me be mostly autonomous, and still made time to teach me about NG tubes and giving medication down them. At the end of the shift, she apologised for not wanting to take me on initially. She felt that, with the time pressures and being an agency nurse, it wouldn’t be fair to me. I explained that as a third year, and having been on the ward for a few weeks now, I was quite happy being somewhat autonomous and would ask if I needed anything/wanted to learn about something.

This experience threw me, and I need to raise it with someone so it doesn’t happen again. But it did teach me how important it is to communicate your needs to whoever you’re working with, and make yourself known. It’s not easy, and it can be daunting, but it needs to be done!

If you’ve had a similar experience, feel free to comment and share your story.

If you’re interested in writing a blog for us, about anything student nursing related, please find us on Facebook, Twitter or email us.

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!

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

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

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

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

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

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

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

 

 

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

image001 (1)

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?

download

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.