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!! 

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“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.

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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!

Behind closed doors: a student nurse in general practice

When I first considered nursing as a career, it wasn’t the adrenaline-filled excitement of A&E or intensive care that attracted me; neither was it intricate technical knowledge of theatre nursing or the busy variety of working on a ward. From the outset, community-based or practice nursing had always been my ambition. Maybe I’m slightly odd, but I love chronic conditions and the idea of helping people to manage those has always been appealing. I was also attracted by the autonomy of practice nursing and opportunity to work towards advanced nursing skills like prescribing…and I can’t lie, the lack of nights or weekends didn’t seem too bad either.

Research online suggested that I would need at least two years experience, preferably in A&E, or even a masters degree before moving into general practice. I wasn’t put off, but as a mature student it felt like there were a lot of hurdles to overcome before I could realise my ambition of becoming a practice nurse. I didn’t think for a moment that I’d spend time as a student nurse in general practice – so when I tentatively checked our placement allocations earlier this year, I was over the moon to find out that I’d been placed in a GP surgery nearby.

My mentor and the whole nursing team at the surgery couldn’t have been more welcoming. I discovered that I was their first nursing student and that the surgery is leading a project locally to encourage more GP surgeries to offer placements to student nurses. Like other areas of nursing, there have been difficulties recruiting practice nurses for a number of years, partly down to current practice nurses reaching retirement age, alongside fewer newly-qualified or experienced nurses choosing practice nursing as a career. As such, surgeries like the one I was placed at want to promote general practice as an attractive place to work; they see placements for student nurses during their training as a key part of that strategy.

Over the 12 week placement I got a real insight in the role of the practice nurse. My mentor, who was also a prescriber, led on the management of chronic conditions like hypertension, asthma and COPD, which encompasses advanced assessment skills, prescribing and lifestyle advice. This was on top of bloods, smear tests, contraception advice and of course, lots of injections; a workload shared with another skilled nurse who also took care of all child immunisations and travel vaccinations. They both worked closely with an experienced care support worker who took care of ECGs and spirometry, among many other things. Meanwhile, an Advanced Nurse Practitioner also based at the surgery leads on emergency consultations, seeing everything from chest infections to mental health crises. It was fantastic to see the varied role of the nurse in general practice and just how valued they were by patients.

The first few weeks of my placement were spent observing however as the placement progressed I was encouraged by my mentor to start leading consultations under her supervision. This was nerve wracking at first, but my confidence soon grew. I was eventually given my own clinics to run, taking on straight-forward asthma reviews and blood-pressure checks. It was fantastic having my own room and calling patients in from the waiting room. I loved talking to people about their health, explaining how their medication works and making a plan together that we hoped would help them better manage their condition. The most rewarding part was seeing patients return. One man said his life had been transformed by a steroid inhaler I had encouraged him to start using, saying that he no longer felt breathless or worried about his asthma. The opportunity to get to know your patients and equip them with the tools and knowledge to improve their health and quality of life, has to be one of the best parts of practice nursing.

The pressures on GP surgeries were clear to see, as they are in many other parts of the NHS, however my time in general practice revealed just how crucial practice nurses are in supporting the everyday health needs of individuals. Practice nurses are highly-skilled practitioners in their own right who make a valuable contribution alongside GPs and the rest of the team in a surgery. Hopefully more GP surgeries will start taking on student nurses during their training so that more can gain experience in this often-overlooked area of nursing. Of course it’s not everyone’s cup of tea, but I loved my time in general practice and feel that student and newly-qualified nurses have so much to offer to this area.

We would love to hear your views on nursing in general practice – is it a career path you would consider as a newly-qualified nurse? Share your thoughts below!

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!