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.

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Nursing behind bars: Q&A with student nurse, Laura, who shares her prison placement experience

One of the incredible things about nursing is that it is one of the few professions that reaches people in every part of society. This includes prisons which could arguably be considered one of the most challenging environments in which to nurse. Earlier this year student nurse Laura Golightly (pictured) was among a handful of student nurses to be placed at a prison in Manchester. We are delighted to share this Q&A with Laura who describes her experience working alongside the prison nursing team, including the daily challenges but also the huge variety of nursing skills and confidence she gained from this rewarding placement.Laura pic

What originally drew you to applying for a placement in a prison?

I have always had a fascination with prisons since growing up and watching compelling documentaries made by influential documentary makers like Louis Theroux. For many people, and certainly for me, this sub-section of society living their life behind bars in massive secure institutions was really intriguing and something that I felt I could have no real concept of. The reality of life within prison is often something that’s kept very private from the general public, including the mental and physical health problems faced by inmates and the concept of institutionalisation, this threw up some really interesting and thought provoking societal questions about the effectiveness of the prison system as a whole which I really wanted to explore, not only as a health professional, but on a human level also. It had really been a desire of mine to work within a prison, safe guarding very vulnerable members of society, before the opportunity even arose so when I saw the email detailing the placement, I knew I would do everything in my power to secure it.

How did you feel when you arrived for your first day?

I was completely overwhelmed when I first stepped foot into the prison for my first day. Starting a new student placement can be intimidating at the best of times, I’m often left feeling anxious about meeting the staff, performing up to standard, not knowing enough and many of those little worries that seem to occupy your head before starting a new placement. There is certainly plenty to consider turning up on your first day so then to be turning up to a huge Victorian building which seems to dwarf even such vast city centre buildings surrounding it, complete with barbed wire running around the parameter and prison staff greeting you with a sharp eye and a pat-down, well it certainly puts things into perspective. The first day my mentor took me into the grounds and gave me the grand tour, we discussed what general day to day life is working within the prison and he soon made me feel at ease. I have to say though, it did come as a bit of a surprise when we discussed this over a coffee and he pointed out to me that the staff serving us in the café were actually inmates.

What was your daily routine like on placement? Describe an average day.

There was no real average day within the prison, this was one factors I particularly enjoyed about the placement! There are three main areas to work and these are on reception, on the health care unit and on inpatients. The role is vastly different on all three which was fantastic for bringing variety to the role as nurses were rotated throughout the week. On reception we would take care of the medications for all inmates leaving for court or being transferred out and we would medically ‘fit’ them for departure, we would then also take care of all inmates being transferred in, this was the really interesting part. We would conduct an assessment with the patient discussing their past medical history, recording observations, their general contact details, the reason they have come to prison, their mental health, health promotion advice and some screening tools, this was their first point of contact with the medical team so there is usually a fair amount to cover and they would have a follow up within the first 72 hours to once again check in on them and discuss anything they may need to add since their first assessment. A day on the health care unit would consist of giving the meds for a specified wing (which could often take hours with the cocktail of meds some inmates are on) and then reporting back to the health care unit to complete the clinics for the day. There was an afternoon clinic and a morning clinic within this prison and these would often be clinically very similar to a GP surgery clinic. There would be many different health professionals running specialist clinics also such as psychiatric, counselling, smoking cessation, sexual health, BBV, dentistry, optometry and more, just as you’d expect to see in the community. The inpatient unit was quite different all together as these were the extremely vulnerable patients, it mainly consisted of mental health nurses and prison officers who were specialised to deal with the kind of inmate that presented in the unit. It was nothing like what I could have imagined, with huge solid metal doors, no windows, rooms without anything at all inside, no real equipment and it seemed to be constantly deafening with lots of screams and shouts from inmates. On top of all this there was the emergency response radio one nurse would have responsibility for, this would be used to request emergency medical first response. While I was on placement I attended these calls for a range of incidents such as fights, overdoses, inmates high on illicit drugs, cardiac and respiratory disturbances and mental health crises.

What kind of clinical skills were you able to practice with the prison nursing team?

The clinics were fantastic for practicing clinical skills, with lots of hands on experience being available. ECGs, dressings, injections, wound closure, suture removal and observations were all common practice. Every morning and afternoon there was the opportunity to complete the medications round also and due to the vast opportunity for spokes within the prison I also managed to complete a mental health assessment, smoking cessation assessment and observe the work of the specialist drug and alcohol team.

What do you think are the most challenging aspects of prison nursing?

The most challenging aspect of nursing within the prison for me was the prison regime itself. Many individuals within the prison have very low wellbeing for obvious reasons. To prison staff they are inmates, however to medical staff they are patients, this creates a very tricky dynamic when it comes to dealing with their needs. Being unable to encourage patients with activities to promote wellbeing was very difficult, I struggled to encourage patients to be active when they are only entitled to one hour in the yard a day and they are kept locked up in their cell for such prolonged periods of time. I struggled to encourage patients to connect with loved ones when they are only allowed a certain amount of visitation and many of the relationships the prisoners keep are strained due to their absence from home. I struggled to encourage learning when often classes are full up with long waiting lists and staffing levels inappropriate for the level security needed. The problem with prisons is that they aren’t therapeutic environments and this creates a vicious cycle that many vulnerable people fall victim to.

What did you enjoy most about your placement in a prison?

I can honestly say I enjoyed everything about the placement. The staff were all fantastic, great fun, welcoming and always happy to teach, my student colleague on placement with me was lovely, the prisoners were generally very polite and interesting to talk to. Being exposed to all the different healthcare sectors and how they are applicable to the prison community, highlighting the different demands of this small sub-section of the outside population was fascinating and I learnt how to deal with a patient who’s needs were often vastly different than what I was exposed to in my general training so it was fantastic to gain this different and unique experience.

What I really want to get across to nurses that would potentially consider a career within the prison service is that it really is a fantastic and unique experience. Often patients have very complex needs and this can lead to a really exciting and challenging working environment which really allows you to make a difference for your patients. Many of my friends and family thought I was stupid for wanting a placement they perceived as so ‘dangerous’, I really want to communicate how safe I felt in there. The prison officers are very well trained and experienced and look after the safety of the medical staff absolutely superbly. Do not be discouraged by fears of safety as officers are always on hand to assist you and will never leave you alone with a prisoner. Security measures in there are top priority for prison management and you’d never be left to work in an unsafe environment. If you have a keen interest in working with challenging individuals and nursing in a holistic and non-judgmental manner with a particular interest in mental health then the prison environment could be just right for you.

Thank you, Laura! It is fascinating and valuable to hear from other student nurses and midwives working in all kinds of different placement areas. If you have an placement experience or reflection that you would like to share on our blog, please do get in touch! Find us on Facebook @UoMPlacementProject or email studentnurseplacementproject@gmail.com.

You’re a Qualified Nurse!

Congratulations!! 

You have graduated! You are now a qualified nurse! 

Yes those three years that felt very long at times have flown by and you’ve passed your last multiple choice exam and written your last essay and possibly lost the will to live writing your dissertation out.

And if you’re fortunate enough you’ve got a new job starting very soon or maybe you’ve already started.

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Again, those differences with your peers stand out as some take to being an employed qualified nurse like a duck to water… others are petrified still. The thought of being responsible and held accountable for all your actions and everything that happens to your patients!?! We are all different remember and every trust and team are different and work in different ways

You should be on a preceptorship in your new role which allows you to settle in. You should build up at your own pace your confidence in the role you now have. Your workload should be lighter than your work peers and you should have a preceptor to support you through.

There should be contacts and time available in your shift/daily routine to allow you to reflect and give you time to learn all about your specific responsibilities and how the other teams around you work to support your patient on their journey.

As with being a student nurse – don’t be afraid to ask, no question is daft. Make sure your team know your strengths and your weaknesses so they can support you effectively. Use your preceptorship time as an opportunity to explore other departments, you should be allowed time to learn from them to – a bit like spokes still but with a more focused view and outcomes set.

Change can be good but sometimes things don’t always go to plan. You may find yourself not enjoying your new role as much as you’d thought or you may find something new you didn’t know existed out there. Be honest with yourself and seek support from your preceptor. People do move jobs in their first 12 months. It’s better for you and your patients if you a comfortable in your role.

Supervision should be part and parcel of your nursing role giving you a chance to discuss events or patients that you need support with or after. Some places will offer peer support sessions too where you can discuss thoughts and experiences with people in a similar position as yourself. Try and keep preceptorship time separate from this, preceptorship is about you and your learning not your caseload specifics. Every work place will have various tasks, limits and time frames on preceptorships, so don’t worry if others are getting signed off and you’re not. Take your time and make the most it… trust me!

Remember your portfolio? Certificates and reflections etc, keep it up. Use your skills to carry on and show your lifelong learning. It will make revalidation so much easier when your time come, one thing us new nurses have the advantage of now.

Being a newly qualified is far from easy but remember this is just the start of a new journey, keep your eyes and ears open, don’t forget to ask, question and don’t be afraid to suggest new ideas too – remember you are fresh from university with perhaps a more update focus, a new pair of eyes etc.

Continue to strive for the best for your patients and yourself!

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You’re a Qualified Nurse!

Congratulations!! 

You have graduated! You are now a qualified nurse! 

Yes those three years that felt very long at times have flown by and you’ve passed your last multiple choice exam and written your last essay and possibly lost the will to live writing your dissertation out.

And if you’re fortunate enough you’ve got a new job starting very soon or maybe you’ve already started.

Image result for omg

Again, those differences with your peers stand out as some take to being an employed qualified nurse like a duck to water… others are petrified still. The thought of being responsible and held accountable for all your actions and everything that happens to your patients!?! We are all different remember and every trust and team are different and work in different ways

You should be on a preceptorship in your new role which allows you to settle in. You should build up at your own pace your confidence in the role you now have. Your workload should be lighter than your work peers and you should have a preceptor to support you through.

There should be contacts and time available in your shift/daily routine to allow you to reflect and give you time to learn all about your specific responsibilities and how the other teams around you work to support your patient on their journey.

As with being a student nurse – don’t be afraid to ask, no question is daft. Make sure your team know your strengths and your weaknesses so they can support you effectively. Use your preceptorship time as an opportunity to explore other departments, you should be allowed time to learn from them to – a bit like spokes still but with a more focused view and outcomes set.

Change can be good but sometimes things don’t always go to plan. You may find yourself not enjoying your new role as much as you’d thought or you may find something new you didn’t know existed out there. Be honest with yourself and seek support from your preceptor. People do move jobs in their first 12 months. It’s better for you and your patients if you a comfortable in your role.

Supervision should be part and parcel of your nursing role giving you a chance to discuss events or patients that you need support with or after. Some places will offer peer support sessions too where you can discuss thoughts and experiences with people in a similar position as yourself. Try and keep preceptorship time separate from this, preceptorship is about you and your learning not your caseload specifics. Every work place will have various tasks, limits and time frames on preceptorships, so don’t worry if others are getting signed off and you’re not. Take your time and make the most it… trust me!

Remember your portfolio? Certificates and reflections etc, keep it up. Use your skills to carry on and show your lifelong learning. It will make revalidation so much easier when your time come, one thing us new nurses have the advantage of now.

Being a newly qualified is far from easy but remember this is just the start of a new journey, keep your eyes and ears open, don’t forget to ask, question and don’t be afraid to suggest new ideas too – remember you are fresh from university with perhaps a more update focus, a new pair of eyes etc.

Continue to strive for the best for your patients and yourself!

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Collaboration: the future of our NHS- #nurswivesunite

13151090_226356241076122_2131036156_nI write this not to highlight the negatives of our current NHS in crisis, but to address how we can collaboratively work together to save our glorious institution.

I don’t need to talk about our failing health service, I don’t need to talk about the millions of pounds needed from the money tree to keep our beloved institution a float. I don’t need to talk about what the NHS means to Britain and its people, I don’t need to talk about the pressures, the constraints we as healthcare professionals all face.

What we need to talk about is how we can change the future.  I don’t think I’m wrong in saying this is without question the hardest time ever to train to be a nurse or midwife.

We’ve lost our bursary, some of us have lost our passion, our dreams of delivering the care we want to.  Who do we thank for this? Is it a question of politics? Or has our health service just reached a tremendous plateau of increased life expectancy, a rise in population, increased complex care which have become a potent mix given the current economic climate.

How do we adapt?

Collaboration that’s how!

Collaboration– “A purposeful relationship in which all parties strategically choose to cooperate in order to achieve shared or overlapping objectives.”

I love this definition, it epitomises what I believe is at the heart of what we all signed up for; whether you are a student midwife or student nurse we all have overlapping goals, we all CARE.

 We all want to deliver the best care possible whereby it be to a baby on neonatal unit, an Alzheimer’s patient, a child, a patient on a high dependency unit, a labouring woman, they all deserve the same amount of care and compassion.

 We are governed by the code (NMC 2015), we all follow the code, are regulated by the code, we all follow the same overlapping objectives -care, compassion and empathy.

As a whole we are truely invincible.  We have the power to stand up and fight. We have the power to change OUR NHS !!!

Let’s get to know one another, the roles we represent, the care we provide and how we can support each other.  Once we are fully united then I believe we have the power to transform and adapt to the future of our glorious glorious service.

 

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!