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.

My ‘lollipop moment’

Have you ever had your life changed, even just a little bit, by a total stranger?

Several months ago, my boyfriend showed me a TED Talk called Everyday Leadership. The premise of this talk is about ‘lollipop moments’, when a stranger makes a difference to your life. The speaker, Drew Dudley, was lucky enough to be told by the person he helped, and how much of a difference he made to her life. The really interesting point that Drew also makes is how we often don’t realize that we make these differences to people!

I had my ‘lollipop moment’ today, at the Freshers fair whilst I was working at a stall. A woman approached the stall with her friend, and recognized me immediately. She told me that I had talked to her before her nursing interview this year, and helped her feel a little bit less nervous. I didn’t remember this moment until she reminded me!

I think the concept of ‘lollipop moments’ applies to nursing really well. Although it may sometimes feel as though we are endlessly doing paperwork and working in areas horrendously understaffed, we are making a difference. Somewhere in the world, you have changed somebody’s life for the better, just by doing what you love!

Have you ever had a lollipop moment, or did someone change your life for the better? Let us know by commenting, tweeting us or write your own blog post and submit it to enhancingplacement@gmail.com

Handling complaints: what I never learnt as a waitress

I have never been good at receiving complaints. Before I started my nursing degree, I worked as a waitress for 5 years. It was not uncommon to deal with customer complaints on a daily basis, and I would always just say “I’m really sorry about that. I’ll speak to my manager” which was always a fail safe. 98% of the time, the customer didn’t want to speak to me anyway!

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Accurate picture of me listening to customer complaints

But that changed when I started my nursing. Suddenly, whilst trying to make small talk with patients, I was being confronted with complaints about care they had received in the past or at that very moment. I couldn’t get away with my usual spiel because care complaints are more specific, more personal. You have to say something, and sorry doesn’t quite cut it.

I remember, very vividly, the first time I saw a nurse deal with a complaint efficiently. The patient in question was raising her concerns about the referral system for district nurse visits after a stay in hospital. Her care had been delayed due to this. The nurse I was working with listened to her very carefully, occasionally (when appropriate) asked for more detail and did not seem flustered at all. She then thanked the patient, said she would follow this up but urged her to voice her complaint at PALS.

PALS stands for Patient Advice and Liaison Service. It is confidential, and designed to provide support for patients, relatives and carers.

I was amazed at how calmly the whole situation went. Although the patient was upset initially, she was clearly at ease by the end of the visit, and I felt it was due to her being able to voice her opinion. And she was actively encouraged to talk about her concerns as Image result for complaintsit helps the NHS grow as an organisation! And it inspired me!

Since this event, I feel as though I have been inundated with patient complaints. Sometimes I feel as if there is a secret sign on my head that says please voice your thoughts at me!. I have now had endless practice at being calm and friendly, with some situations leading to me having to be a little firm (I will not be shouted at). I find that listening a lot, speaking barely at all, seems to work. Asking them to expand, answering questions when needed, and most importantly not denying their claims. It is extremely important, I think, to acknowledge that not every care interaction is perfect or goes to plan. We must embrace feedback, negative or not! Whether it comes from a staff member, a patient or a relative; complaints should be listened to!

Always speak to your mentor or a staff member about a patient’s complaints. 

Be Resilient, Stay Brilliant

Student nursing takes many different skills: patience, compassion, dedication, the ability to plaster a smile on your face for 12 hours even when you’re exhausted, and more. But there is one skill I never thought would be so useful; resilience!

Resilience is when you’ve made a simple mistake and you can feel the embarrassment creeping up, but you carry on caring and learning. It’s what makes you keep going when someone doubts your ability. It is what you use to take in constructive (but sometimes not!) criticism on an essay, a presentation or an act of care. Resilience is the ability to bounce back!

I didn’t realize how important resilience was until I was having an incredibly busy day on my last placement on an acute medical ward. Myself and my mentor had ended up with a few very poorly patients, an astonishing amount of paperwork, delayed transport for a patient and some awkward available beds mix ups. To help out, I offered to call a unit an explain that patient they were transferring to us needed to be delayed slightly, due to late transport. I was greeted with what I describe as understandable anger and frustration. I spoke as calmly as possible, explaining that we were sorting the situation and that the patient would not be delayed much longer. The nurse I spoke to continued to berate me on the phone, and eventually hung up.

Luckily, within 10 minutes, we had managed to sort the entire situation out. No more angry phone calls for the day! I spoke to my mentor about what had happened, and she reassured me that it was just a tough situation and not to take it to heart. I still get slightly annoyed when I think back, but I have to remind myself that we are all just looking out for our patients. Sometimes that comes across in different ways! I think if I was a qualified nurse, I would have had a better understanding of how to deal with the situation. But I know for sure that I will not forget this phone call.

Remember; if you have experienced a situation like mine, please talk to someone about it! Whether it is your mentor, a fellow student, the PEF, your AA, friend, family dog etc. Difficult situations should be discussed, and you are allowed to vent. I can highly recommend writing a reflection about it!

Have you had any moments of resilience? Let us know in the comments, or on Facebook/Twitter. Or, if you’re feeling creative, write us a blog post!

 

 

 

 

 

 

 

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 doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.