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.

 

 

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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.

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. 

What can nursing give to me?

Becoming a student nurse can consume you. With placement and academic work mixed together, it can often feel like all you do is nursing! On top of that, we often focus on what you can do for nursing. But what about what nursing can offer for you?

Recently, I’ve opened my eyes and seen the reciprocity within nursing. It started with my Nursing Therapeutic module, where we’ve been learning about Muetzels model who says that a therapeutic relationship between a patient and their nurse requires three components. These include: partnership, intimacy and reciprocity. Since we explored how a therapeutic relationship could benefit both the patient and the nurse, I thought maybe nurses get more out of their career choice than I thought?

Confidence! Going into placement takes guts. You are literally throwing yourself into new situations with new people everyday, and that takes a certain amount of confidence. Speaking to the wider MDT use to fill me with dread, but now I basically chasing them around for questions. This has reflected into my personal confidence A LOT. I am more sure of myself, and what I want to get out of situations.

unknown-2Time management. I thought I was organised before I came to uni. I was wrong. I feel I’ve reached a higher-level, as uni has forced me to gain the ability to spread out my work so I’m not over-exerting myself. It’s a VERY good skill, as it’s very easy to become burnt out. Spreading out work helps you fit in the other important stuff that isn’t necessarily related to nursing/uni but is absolutely vital! Get yourself a fab diary and a calendar life will become easier.

Problem-solving. I recently attended an inter-professional workshop with our lovely midwives all about the health needs of refugees. Once we were put into teams, it was like somnurses and midwiveseone lit a spark! Suddenly, adult nurses + midwives + child nurses + mental health nurses were able to outline all these potential solutions to the fictional family we were ‘caring for’. We were more than able to use our combined knowledge to solve the situation with ease!

Honesty. Before uni, I would often be told to do something at work/school and just nod endlessly until they told me to go and do it. What would happen? I would have literally no idea what I was meant to be doing. You can’t really do that in nursing, so you end up asking more questions and understanding where you need support. This not only shows honesty, but it shows a lot of maturity as well.

This is not an exhaustive list by any means, but its great to reflect back on how you’ve grown. I would urge any of you to do the same! Not only is it a useful skill for interviews, but it really helps with realising why this degree is so worth it.

What has nursing given to you? Comment, tell us on facebook/twitter or send us an email!

The next chapter: Starting a new academic year

Last week I was going to post a blog about how I was feeling about starting third year but feeling terrified was my overriding feeling, and no one needs that kind of negativity, right?! I decided to wait until my first day back to write my feelings. So, here goes.

Firstly, I am exhausted! Woah, information overload! But not too exhausted to write to you lovely bunch so may be exaggerating a little! Today we were afforded an incredible opportunity to speak to trusts from all over the country and learn what they want from students applying for jobs. I felt anxious entering the room but left university feeling inspired. I feel like I can be anything I want to be! The trouble is, I don’t know exactly what I want to do yet. I know what my key interests are and know that I want to consolidate my learning in my first role as a qualified nurse but there isn’t currently a specialism screaming out at me. That’s okay though, isn’t it? Here I am referring to this as ‘trouble’. Pardon? This is a PRIVILEGE!

I received encouraging feedback today from representatives from different trusts, as well as from my colleagues. We’ve talked through the benefits of keeping a professional profile and throughout that discussion I flicked through some of my written feedback… Wow! I had forgotten about some of these kind and inspiring words.

I’ve complied a little list of pick-me-up reminders influenced by today’s activities and how I was feeling just last week. I thought I would share them and maybe you might take something from them too:

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  • Try to recognise whether I’m thinking rationally
  • Read over feedback and realise my potential
  • Focus on the positives. I have another year of study and a future of continued professional development – even my weaknesses can be positives!
  • Pat myself on the back. I have shown myself I can do so well already
  • Remind myself why I wanted to nurse and reignite those drivers
  • Get organised. Taking some time now for good planning will save a lot of time and worry in the long run. Time to get everything in that shiny new diary!
  • Take some time to digest ‘information overload’ – break it into more manageable pieces
  • Remember that it is okay to feel a bit overwhelmed – I’m not the only one feeling this way. I must remember to be good to myself and do something that is not nursing-related from time-to-time… Starting this weekend!

Now I approach this academic year feeling like I can achieve anything if I work hard enough. I’ve got this! And you have too!

Special thanks to today’s speakers, exhibitors and organisers for a motivating and informative day.

How to beat second year blues

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With second year around the corner, I’d be lying if I said I wasn’t a little apprehensive.

I’ve heard of the elusive ‘second year blues’ and worry that they might already be setting in. Despite having a year under our belt, the end goal somehow seems further away than at the beginning. We’re a year wiser, with a better idea of the challenges ahead…and let’s face it, we’re probably all a year poorer too. All things considered, its no wonder we might feel a bit down.

In the blissful ignorance of first year, I ignored second and third years warning us that we’d feel like this – turns out they were right! In a quest to ease my own anxieties, I’ve asked the for their tips for beating second year blues. Here’s what they said…

Get ahead

I know most of us have spend the last few weeks catching up on sleep, earning some pennies or reminding our friends that we still exist, but it’s worth having a look at what’s coming up. By second year, we’re expected to be independent learners, so its up to us to be proactive and find out what is in store for us over the next year. I’ve been putting it off, but it’s time to get organised, dig out the diary and log in to Blackboard…what’s my password again?

Set goals

Somehow I’ve managed to erase all memory of PAD submission day, which seems like ages ago now, but I remember that we were asked to set some goals for the year ahead. I’ve just had a look back at mine and they actually make some sense. Personal development plans can sometimes seem like a bit of a box-ticking exercise, but having a goal in mind for second year will give you something to focus on and makes the time fly by.

Avoid stress

When I started this course, I made a pact with myself not to leave everything to the last minute. In my last degree, I tactically worked out my words/per hour ratio (about 400), convincing myself that it was totally fine to leave a 3,000 word essay to 24 hours before the deadline. Yeah, I always got them in, but I was an absolute wreck. Believe me, its not worth the stress. This degree is full on enough as it is, so help yourself out by starting early.

Oh and this applies to overcommitting too – a lesson I’ve learnt the hard way. Figure out what is really important and realise that it’s ok to say ‘no’ sometimes. I still haven’t mastered it, but it’s a work in progress.

Talk it out

Chances are that most of us will feel down at some point over the year, but if ‘the blues’ hit, don’t bottle it up.  With hundreds of student nurses about, you’re bound to find a kind, listening ear and you might find that others are feeling the same way.

Also, don’t forget the PEFs are there to address any issues you might be having on placement – take a look at this blog to find out more about their role and how they can help.

Remember it’s not all about nursing

Maybe it’s just me, but does nursing have a way of taking over your life? While on placement, it feels like you think, breathe, dream nursing – sometimes you just need to switch off. Step away from the stethoscope and plan some totally non-nurse activities for the weekend. A break will do wonders.

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Keep calm and carry on nursing

Conquering second year and banishing those blues is about finding the right balance. This course can take over if we let it, but by staying organised and making time for the other things we love, we can actually be better nurses in the long run.

See you next week!

Out on Placement

Guest Blog written by Emma Wilkes


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

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

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

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