The joy of community nursing

Community is often painted as marmite- you either love it or you hate it. But is that strictly true? Surely there is something about every placement that can be enjoyable, and not so enjoyable!  I will first admit that my heart lies in community. I knew within the first few days of my placement in first year that I wanted to work in the community. So I thought I’d make a little list about why it’s just so amazing. 

You have to expect the unexpected! You aren’t in the relatively controlled environment of the hospital, you’re in a patient’s home/room. Anything can happen, even trying to stop the pet dog from jumping on the bed during catheterisation!

It really is community based nursing. No matter what area you work in, you’ll know the people, their attitudes and the roads like the back of your hand. It’s really refreshing to be moving around constantly instead of endlessly walking around a ward or clinic.

Improvisation is key! Can’t find the correct wound dressing? Come across a new skin tear? Can’t access the patient’s house? Better make it up! I’ve seen some amazingly ingenious solutions which I’ve then stored in case I ever come across it again. It’s one of the best ways of learning!

Community nurses can be a lifeline. Many patients you will visit in the community are elderly, some of which are very isolated from society due to mobility issues, lack of family or the fact that they live in rural locations. Often, community nurses are the only people they interact with in the day, and they appreciate their presence immensely!

The patient-nurse relationship is very different! As soon as you enter someone’s home, you are entering their territory and you follow their rules. I feel that this allows patients to have a larger role in care decision-making. It is what holistic nursing is all about.

Community nursing is not for everyone, but never underestimate it’s ability to build up your skills!

If you’ve had a community placement, and you’re feeling creative, why not write us a blog post? Simply send us an email at enhancingplacement@gmail.com. We always welcome new content!

Top Tips for Your First Placement

 

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

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

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

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

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

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

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

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

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

ATTENTION FIRST YEAR STUDENT MIDWIVES… Your PAD, White book and signatures!

I APOLOGISE AS THIS IS LONG…STICK WITH IT….. IT’S IMPORTANT INFORMATION;-)

Ok…you first years are all starting to think about placement right? It’s about a month away for the student midwives so your uniforms will be arriving shortly if you don’t already have them and you will have your documentation staring out of wherever you have hidden it because, if you’re anything like me, the thought of even starting to read that huge PAD document thing on top of all the studying you have to do is so out of the question it’s unbelievable!

Well I am here to hopefully hold your virtual hand through the whole documentation experience and share my many mistakes so you don’t make them!

First of all let’s clarify the difference between your

pad

 

PAD (Practice Assessment Document)……

 

 

 

 

white-book

 

 

……..and your white book (Record of Statutory Clinical Midwifery Experience).

 

 

 

 

 

You may not believe this but it took me a good couple of months to work out who can sign what and how equally important but different these two documents are!

 

So I’ll start with what I think is the easier one-the White Book. This will be held by you for the full 3 years then handed in at the end of your degree. Your AA will look through this during your individual meetings just to make sure you are ‘on track’.

The White book is where you record your statutory skills which every student midwife at every university will have to get signed off before they can qualify. You have the space in here to log your 40 births which seems to be the area of focus for a lot of students but there are A LOT more skills you need to achieve as well as delivering babies. For example, you need to record evidence of  antenatal examinations & care of 100 pregnant women and examinations & care of 100 postnatal women and their newborn babies.

In these midwifery areas any qualified midwife can sign off your evidence. They DO NOT need to be a mentor/sign off mentor. This is important because you will work with a lot of midwives when on placement and you may carry out a beautiful abdominal palpation and listen to the fetal heartbeat with a pinard whilst your mentor is on a break and you are working with another midwife…..WRITE IT IN YOUR WHITE BOOK AND GET IT SIGNED OFF! The white book just needs the woman’s hospital number, the date, what you did and the midwife’s signature. It can be written up in a couple of minutes and signed there and then! Otherwise you will get home, not written down half the hospital numbers for the women you have worked with that day, for the ones you have written down you’ll have forgotten what parity the woman was or the pregnancy gestation and for the ones you can remember you will realize the midwife who you worked with is now on maternity leave and so won’t be around to sign that evidence off (YES…ALL these have happened to me!!!-it’s gutting!).

There’s areas of the white book which can be signed off by qualified Healthcare professionals who work in other areas i.e. neonatal staff  or breastfeeding support  workers but the important thing to get into your heads about the white book is…

ANY QUALIFIED HEALTHCARE PROFESSIONAL CAN SIGN YOUR EVIDENCE FOR THE RELEVANT AREA YOU WERE IN WHEN YOU COMPLETED THE SKILL

AND

GET IT SIGNED THERE & THEN!

 

OKAY…..big, deep, breath…..THE PAD! Unlike the white book your PAD skills and interviews get handed in at the end of each academic year but you keep the folder (mine is already wrecked!). Your PAD skills are handed in through an official process where you are given a deadline (date & time) and you complete a front sheet for each set of skills and hand them into an exams officer (I point this out because this process was much more official than I expected it to be and it unnerved me a bit!). Your AA will probably take your interviews but this does depend  on the AA; I still have my complete set of first year interviews but I know a lot of my cohort have handed theirs in.

Signing stuff- this is a bit trickier than the white book as the people who can sign your skills off are limited. Let’s just talk about the actual documentation as an opener……..

Interviews

Ideally, at the start, mid point and end of each placement you and your mentor need to sit down and do your interviews. These will be read and checked at your AA meetings and are important for all parties involved as they help you assess where you are up to and also help you gather your thoughts on whether you are getting what you need out of the placement and if not how you can be proactive in accessing more opportunities.

During your mid placement interview do not forget to get your mentor to sign the actual interview AND the mid placement interview section on the front sheet of the set of skills you are working on (i.e. in the community this may be ‘Midwifery Care Pregnancy & birth antenatal skills’ section of your PAD. If your mentor has students from different universities they may not be familiar with UoM paperwork as every uni is different so its your responsibility to ensure every thing is completed.

As an aside, I did not realize our skills directly related to the academic units we were doing until about 6 months in…..don’t judge me I was overwhelmed!!!

Also you will have your progression points at week 19 & week 52….these tend to coincide with final placement interviews but not always so stay on top of these dates….get them in your diaries as both your mentor and AA need to write comments and sign these.

Skills

The skills section of your PAD is divided into 4 sections. Familiarise yourself with the sections, notice which sections coincide with your academic units so you can use what you are learning in university to inform your practice and vice versa, then write them up! Sounds obvious but it isn’t always! For example, if you have been learning about abdominal palpation in university and you are out on practice in the community, tell your mentor you have had a session on abdominal palpation and the use of pinards. Let your mentor know that you would really like to practice this in clinical placement. Your mentor will support you in this (if the opportunity arises) then you can write this skill up using all the theoretical knowledge and the practical skills you gained then get your mentor to sign this skill off! This, I recognise, is an ideal world scenario but this is YOUR clinical placement….make it work for you. This is your opportunity to apply what you are learning in theory to your practice; it is NOT your mentors responsibility to work out which skills you need to practice and get signed off!

Mentor/sign off mentor/SIGNATURES

You will be assigned a mentor when you go on placement for every clinical area you will be working in. You need to find out if they are a sign off mentor (they are usually quite forthcoming with this information!). Only sign off mentors can sign your paperwork and assign you a grade. If your mentor is not a sign off mentor ensure you know who the sign off mentors are in that clinical area and try and work at least a couple of shifts with them. Your mentor can sign your skills but the sign off  mentor needs to countersign them. THIS IS NOT THE SAME AS YOUR WHITE BOOK ! So if your mentor signs off that you are amazing at communicating with women the sign off mentor needs to countersign and date this skill as well.

I am going to **star** and bold and italic this next sentence because this caught me out on my placement and meant I spent most of my last shift at my first year trust running around trying to find one member of staff and ringing my AA almost in tears……..

******AS SOON AS ANYONE SIGNS YOUR SKILLS IN YOUR PAD MAKE SURE THEY SIGN THE SAMPLE SIGNATURE SHEET FOR EACH SET OF SKILLS THEY HAVE SIGNED AND WRITES DOWN WHEN THEY LAST HAD A MENTOR UPDATE******

(i.e. if a sign off mentor countersigns a skill in the ‘intrapartum care’ section of your PAD and the ‘tackling health inequalities’ section of your PAD, THEY NEED TO SIGN THE SAMPLE SIGNATURE FOR EACH SET OF SKILLS.

Imagine the scenario….you are finishing a night shift on the midwifery-led birth centre and the midwife you worked with observed you support a couple during a lovely labour & delivery. You had the opportunity to write up the skills you demonstrated during this shift and you got your midwife mentor to sign these skills off and she quickly got the sign off mentor, who’d just come on an early shift to countersign them before both you and your mentor floated off home to sleep…… WITHOUT GETTING THE SAMPLE SIGNATURE SHEET SIGNED BY THE SIGN OFF MENTOR!!! YOU NEED TO GET THE SAMPLE SIGNATURE SHEET SIGNED (yes this is what happened to me!!!) If you don’t, as a first year your PAD will be referred and you will have to return to your old trust to track down the sign off mentor to sign the sample signature sheet and then resubmit the whole skill set. If you do not have all the signatures completed on the sample signature sheet in second and third year YOU WILL FAIL (this makes me feel sick!).

Another starred, bold, italic section coming up……………………….

****YOU NEED TO DATE EVERYTHING YOU SIGN****

A LOT of my cohort got our PAD skills returned to us because we hadn’t dated our signatures on our skills documents! We had ensured our mentors had dated everything but we actually hadn’t! There is no ‘date’ prompt next to the student signature section but you do need to date it! I cannot begin to tell you what a complete pain in the rear it is when you have finally tracked down the sign off mentor to sign your sample signature sheet, hobbled, exhausted and emotional to hand in the PAD documentation hoping you never have to see it again, only to get it ALL handed back as ALL my signatures needed dating! Literally, every single one of the 60 or so skills I needed to go through and date! DATE THEM!!! Believe me you will not want that PAD handed back to you! If you aren’t sure if something needs dating and signing do it anyway! I am very much ‘better to be safe than sorry’ …once bitten and all that!!!

Think that’s all the terrible tales I need to pass on about documentation!! I do wonder how I managed to even get on this degree as reading back over this makes me look a bit lacking but I blame sleep deprivation!

You will be getting your uniforms soon-empty all pockets before you take it off and buy a tub of vanish….white is a TERRIBLE colour! What were they thinking giving nervous, tired students white?!! One night shift my pen had leaked in my pocket and because I was on an antenatal ward and the women were sleeping, all the lights were dimmed ….by the time I realised my pen had leaked I had fingerprints on my uniform, on some lovely white sheets, on a couple of CTG monitors and on my face!

uniform I was very glad I had purchased a tub of vanish big enough to bath a baby in!

Good luck and DATE EVERYTHING!!!!

 

`

 

 

 

Tips for first year Student Midwives….

CONGRATULATIONS! YOU MADE IT!!! YOU ARE STUDENT MIDWIVES!

How are you all finding semester 1? Terrifying? Is life sciences sucking the life out of you? Have some lectures left you running for the hills crying into your pints at the SU? Have you actually got over the shock of being a student midwife yet and now the reality of being a student midwife is kicking in?

cell-pic

Ok…so as a second year the horrors of that first semester are still fresh enough in my mind that I get goosebumps at the thought of how I felt this time last year but I am also sat here having survived so feel it may be a good idea to share how I got through it! I will add that maybe not everyone finds this first semester as a student midwife hard but I did and a lot of my cohort did so here are some tips that got me through to semester 2 in one piece and nearly sane!

  1. Don’t look too far aheadby this I do not mean do not plan…planning is GOOD (see point 2!) but do not look at your timetable for 4 weeks time and think ‘how can I possibly manage to do ALL THAT WORK?” . Think about what you need to do today and what you need ready for tomorrow. Have an awareness of assignments whilst you are reading stuff but don’t be consumed by it! One day at a time…your knowledge is building up one brick at a time so if you look too far ahead you will overwhelm yourself and you cannot possibly know what you do not know so just be with what you need to do now, today.
  2. PLAN –  you need to be organised! USE the time allocated to you for Guided independent study and independent study. If the timetable says 3 hours do 3 hours! It sounds silly but this will help you ensure you are doing the right level of work. I have a list of studying to do which I add to and cross things off as necessary! It helps me sleep at night not worrying I may be missing something i need to be doing!images-1
  3. Do not over think it (at this stage!)  At the moment you are bombarded with information and, lets face it, you’ve been accepted onto a highly competitive midwifery degree because you LOVE it and want to read and research EVERYTHING around it but you WON’T HAVE TIME! This was a downfall for me! More than once drafts would be returned to me as ‘too complicated’, ‘too complex’ etc because I didn’t want to just read and write about a nice straightforward pregnancy I wanted to research why a perfectly straightforward pregnancy and labour could result in a retained placenta WHY??? Goddamn it!!!! This is not the time for that level of ‘reading around the subject’-read what you have been told to read at this stage as you will have little time to read around the subjects if you want to get through the massive amount of material you need to get through and your FIRST YEAR is focusing on normality do not confuse yourselves by needing to know about the complex stuff….yet! Imagine your knowledge is being built and you need to embed the foundations nice and solidly before branching out further into the more complex stuff!
  4. Use everybody who offers support we are not just being nice we want to help you! Your AA, your PASS leaders, your mentors, midwives on your placement, your lecturers, your PEFs, your ward managers, your PEERS! They are all there as support – support each other! Knowing you are not alone in the struggle is such a bonding experience! Tell people if you are finding something so hard you are questioning your decision to train as a midwife! Take time to check out within yourself how you are feeling and reach out when you are struggling-learning to reflect on your experiences is important on  a lot of levels so the sooner you start the better!
  5. Be kind….to yourselves and others– please be kind to yourselves! Give yourself time off; spend time with your family and friends! Do non-midwifery related stuff! It is EASY to be consumed by this degree but self care is fundamental to resilience and good health so start as you mean to go on! Sleep well, eat well and invest in ‘you’ time it will benefit everybody around you especially you! Look at your cohort-are some people struggling? Reach out to them-this is not a competition we really can ALL succeed but its much nicer if we all help each other along rather than revel when people fall! We are training in a compassionate profession this starts with how we treat each other!
  6. Attend revision lectures – that is it really! Attend them-they are important!
  7. Use social media sparingly– so you did well and got 110% on your first assignment….AMAZING!!! Well done! Please consider why you would put this on Facebook! It’s super you’ve done well and you should be proud of yourself but tell your folks, tell your friends, shout it from the rooftop but jusocial-medast ask yourself why you are sharing that somewhere so publicly when you know others in your cohort are going to read it and maybe might not have managed to get such a great result! We all have areas we are strong in and areas we are not so strong in-support each other and celebrate successes but be mindful of how your fabulous result may make somebody feel who only managed 35% this time.
  8. Enjoy it! You will be frantic at times and wonder how you are ever going to get through your life sciences exam as well as hand in your poster assignment draft, get that presentation ready, complete your placement documentation plus have any kind of extra curricular life! But enjoy being a first year student midwife! Take time to stand on the 4th floor of uni place looking down Oxford Road at the buildings and the hustle & bustle and remind yourself you are a student at MANCHESTER a highly prestigious university! Go to the library and breathe in the smell of ALL THOSE BOOKS embracing how far you have already come and that YOU GOT CHOSEN! Do not be so consumed by panic that you lose sight of why you want to be a midwife. Oh….and learn to scan read! An essential skill!!!

 

So What Kind of Nurse Are you?

As I started my first year at university to undertake my nursing degree in mental health nursing I looked around and thought – I don’t fit in!

What am I doing here – a 37 year old with a background in the travel industry?

bird odd image

Surrounded by a majority of people in their twenties who all seemed so knowledgeable on nursing I felt so behind and out of my depth! As the year passed and I overheard people talk about things they had done on placement or listened to them talk so informed in lectures etc. In honesty? –  I still felt I knew nothing compared to them.

penguin-153660_1280By second year however I had passed all my exams and placements and started to feel hang on I can do this I do know stuff – different stuff! Just because I can never remember which way round the sections are or if a medication is an anti-depressant or anti-psychotic straight off doesn’t not mean I wont make a good nurse. One staff nurse on placement gave me sound advice, she said you will learn what you need to learn for your job in your job as you will be seeing it every day. As a student we are bombarded with a constant changing supply of medications and illnesses and practices to learn, we cant remember it all!

Eventually I got the hang of the sections and most of the medications (although sometimes I still have to use the BNF.)The main thing I learned however from colleagues and other nurses on placement, but mainly through my own observations of these groups, was that it takes all sorts of nurses to make up good nursing care.

There are so many different branches of nursing, for example in mental health you have acute wards, recovery or assessment units, community teams such home treatment and crisis. There’s elderly care, CAMHS, eating disorders, early intervention… the list goes on. Each of these departments needs special skills and a special kind of person to do it. Then within that team each patient they see is an individual and will require or connect with a certain type of nurse.

We all have a role to play.star trek team

So no matter who you are or what your skills are you will find your niche in time. The beauty of the degree course these days is the mix of placements you get. I was luck as one placement just hit me and I knew where I wanted to work for sure, I’d had an idea I wanted to work with the elderly but my placements confirmed which area for me as some I loved and some I hated. I am pleased to say I am due to start my career with a Dementia Team this year and I’ve never been more excited as I know this is where I belong and I feel confident in my knowledge and skills to really make a go of this and look after the patients in my care with confidence.

You will learn what you need to learn in your time and in your own way throughout the three years of your training. What you will learn and experience in  this time will be unique to you  – but that’s what will make you the kind of nurse you want to be!

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My day with the Health Visitors

As an adult student nurse, I don’t encounter many babies/children, so I was keen to try something a bit different. So when I found out that the Health Visitors were just down the corridor of my placement’s main office base, I soon popped my head in to organise a spoke! I had an absolutely wonderful day with the team! Not only did it help me understand the workings of the Community Multi-Disciplinary Team, but its exposure to another field of nursing! Plus, my current district nursing placement is largely based around treating patients, so observing some preventative public health care was great. Oh, and I got to play with some adorable children- I love being a student nurse!

Each Health Visitor is a qualified nurse (adult, child, mental health or learning disability!) or midwife, and their role is based around family care. By leading the delivery of the Healthy Child Programme, they ensure that expectant mothers and new babies up to the age of 5 get the best start in life! They visit families in their homes, GP clinics, Nurseries and Sure Start Centres. It’s an incredibly varied job.

pincer grasp

A tiny grasp for baby, a huge step for development!

My day with the Health Visitors started with a visit to a local SureStart centre, where the local ‘Baby Clinic’ is held. This is where one year old’s attend and the health visitors evaluate their progress. Its not as scary as it sounds, I promise!! They look for certain markers in a baby’s development and then, if needed, can give the parents pointers on how to help their child. For example, by the age of one they should be ‘babbling’ (repeating words they’ve learnt, usually nonsense), pulling themselves to stand and using furniture to wobble around on two feet, and using a pincer hand gesture. We had two lovely little babies visit us, both of which showed these developmental markers but at different stages. Each child, of course, is different and they have started to develop their personalities at this point. Our first baby was very outgoing and had his older sister to make him confident enough to play around and show us how well he was doing. The second child was a bit more shy, and preferred the company of her mum. However, after I showed her the wonder of some bells on a stick, she did everything we asked of her.

Alongside looking for the developmental markers, Health Visitors are also looking at the bigger picture. Their aim is to ensure that the family is happy, healthy and safe. How do you do this? Use a good old pyramid of course!

health visitor bible

Who doesn’t like a pyramid?

The Safeguarding and promoting welfare pyramid is designed to help pinpoint the areas which children should have. So, for example, if the Health Visitor detects that the child doesn’t seem like they have enough stimulation for the child to grow and enjoy themselves, that would question the parenting capacity. It’s useful for identifying a variety of factors that may be affecting a child’s development, as it’s never usually just one thing. Anything that is identified as missing can be worked on, via the Health Visitors, Social Workers or Family Support Workers.

If you want to learn more about Health Visitors, NHS England has a load of information about their role and how to become one! Or, if the chance arises, go and spend time with some!

Putting the Super in Supernumerary 

When I started my nursing degree, I was prepared to be a quiet observer. During my first placement, I did exactly that. I listened, learned, and did what was asked of me. I wasn’t exactly useful to the team, but they liked having me around. Now on my second placement with district nurses, this has changed drastically. I feel useful. There is a slight superstitious joke that I have healing powers, since a lot of patients that I visit (with different nurses) have lovely healed wounds. But maybe it’s that whoever takes me gets an extra of mileage to claim back whilst I’m in the car…
Anyway, because of this popularity, I’m starting to see how valuable students are to placements. This week I’ve been helping recreate the caseload map. Due to my computer skills (always knew that ICT GCSE would come in handy), I was being HELPFUL.

my amazing map

Caseload map, still needs work doing. It’s bigger than me.

Students are also useful for those more time-consuming patients. We have a lot of patients who need a two layer bandage on each leg, often due to oedema and ulcers. Now since a two-layer bandage requires a reasonable amount of time and effort, it’s always handy to have a second person. I recently visited a man who required two-layer bandaging on both legs, and had a suspected gangrenous toe! It was good that I was there as the nurse I was helping could take time to phone the relevant people, whilst I finished the bandaging and took notes. It makes the visits more efficient!

I’ve also noticed that I am often the eyes and ears, both in the office and with patients. So I will pick up something which one nurse might not have remembered, or wasn’t there during that visit. So I’ll often pipe up during handover saying “oh that patient needs a new sharps bin!”. It’s not groundbreaking or life saving stuff but it helps.

Although sometimes it can be frustrating because you are ‘just a student’, remember that this is such a valuable time. Not only are we learning hands on, but our education comes from how much you are willing to get stuck in with! Be brave, bring your skills to the table and you’ll get more out of every placement you go to.