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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Pearls of wisdom from the 2016 graduates!

It was great to meet so many of the third years at today’s employability conference and to the new cohort of first years a very warm welcome! We’ve been asking some of the BNurs 2016 graduates what they’ve been up to since graduation to help give you some inspiration, careers & studying advice and some reassurance that there is light at the end of the tunnel!


 

Gina, Chemotherapy Nurse.

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I work on a nurse led chemotherapy unit, one of the most interesting things about my job is being able to assess patients and use my own clinical judgement in providing holistic care. Rather than task oriented nursing, you’re able to work more autonomously but there’s still a lot of support available from the rest of the team. We see patients from a variety of different disease groups with different chemotherapy and immunotherapy regimes so there’s been a lot to learn over this first year! There’s also exposure to higher acuity patients and oncological emergencies so there’s a variety of clinical skills.

I’d advise current final year students not to underestimate the benefits of a good preceptorship programme! Ask about what support and training trusts can offer you as a newly qualified member of staff and it’s also worth looking at how they score on recent CQC reports. Always have a few questions prepared to ask at the end of an interview to show your interest in the role and it’s well worth organising an informal visit or arranging a phone call with the ward manager to find out more information. They’ll remember you and if offered an interview you’ll have an advantage over other candidates who didn’t show the initiative!

For first years at the start of their nursing journey, make the most of what your placements have to offer and get involved with sports and societies while you’re at uni, sometime it can feel like a struggle to balance everything but it’s important to have variety and these things will help you unwind after a hectic shift! Always show interest on placements and ask lots of questions, make sure to go to your PEF or AA with any issues and they can support you through it and improve the placement for other students in the future.21952670_10155829453445820_863942415_o

One of my proudest achievements so far was presenting a piece of research I did at the RCN Centenary conference, it was quite daunting being a student at an international research conference but I’d definitely recommend applying for things like this, there’s so many amazing opportunities out there! I’m definitely interested in research career options for the future but I also enjoy the clinical side of nursing, I don’t have any set goals for the future as there’s so many fantastic career paths out there but I’m quite interested in becoming a nurse prescriber, I’ll just have to wait and see what pans out!

Chris, Cardiology Nurse.

The most interesting thing about my job is the procedures and interventions carried out on patients. I’m currently working towards mentorship and a link nurse role and in the long term a specialist nurse role. For current third years job hunting; choose an area you find interesting to work in (for myself it was cardiology). Ensure when you prepare to interview you show your passion or interest for that speciality or area. Demonstrate your knowledge!

Some advice for first year students would be, don’t be shy. Ask lots of questions and get stuck in as much as possible when on placement. I wish I had known more abbreviations of medical terms. Advice for final year students, get on top of your dissertation early. I can’t stress this enough!

Emily, RMN on a Psychiatric Intensive Care Unit.

I chose this job because I wanted a fast paced ward and it’s certainly that! It’s really interesting to see people come in very poorly but go back to acute wards much better. I see myself staying on this ward for the next 2 years or so, then hopefully moving into forensic services.

Some advice for third years’ looking for jobs is to go for something you know interests you, you’ll enjoy going to work then. Research the ward and trust before the interview, they’ll most likely ask you for evidence/scenarios to back up your answers.

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Also, take time for yourself!! Although the course is full on you need to make sure you look after yourself, take the time to do it now because you won’t get it when you start work! Take it as it comes, get ahead with your dissertation, DON’T leave it until last minute. You will have enough stress in your final few months. And finally, enjoy your training, don’t let it get on top of you. It will go by quickly!

Liz, Staff Nurse on a General Surgical ward.

Something I wish I’d known when you started the course? I remember everyone complaining (including myself) how we felt like we only did obs for the first placement. This is an important skill the more you do the more efficient you become and the better you get at recognising deteriorating patients early!

Advice for current third years deciding where to work: Go to every interview you get offered they are good practice! And then if you get offered lots of jobs you have more choice.If you feel like it’s impossible or you don’t feel ready. You are ready and you can do this! There will come a time on your final placement when you wish you didn’t have to check the drug round e.t.c with someone every time. That’s when I realised I couldn’t wait to qualify!

I’m enjoying my new role, it’s very diverse and I get to use and perfect every clinical skill I could wish for, in a first job. In the future, I see myself working in the merchant navy and also on the bank in an NHS hospital. Moving from student to staff nurse is the most challenging and fun time. Enjoy it and remember to be nice to the students who, before you know it, will be your mentees!

Natalie, Surgical Triage Nurse.

I chose this area as I love Surgery and wanted to gain experience in Acute illness, emergency surgery and different surgical conditions not just one speciality.

Enjoy student life whilst you can as 2nd and 3rd year are intense. Spoke out as much as you can and make the most of the supernumerary status to learn. Make sure your work/placement/study/social life is well balanced. Seek advice where necessary.

Some interview tips for third years is to learn about policies in your chosen field, memorise the 6C’s,  and look at recent CQC reports to draw on points for why you chose their hospital/department.

Alyssa, Community Staff Nurse.

whitworth hallI am a community staff nurse, nursing patients with long term health conditions. The patients whom I care for can be under my care for years. The care that I deliver enables you to build a very strong therapeutic relationship with patients that you wouldn’t necessarily get in a hospital environment. In the future I see myself working in the community, hopefully as a district nurse.

Some tips for first years would be to follow your passion. Find something that you love and run with It! For me, that was community nursing. If you do what you love, this will show in the excellent care you give to your wonderful patients!

And for third years preparing for interviews; do lots of research about the trust you want to work at e.g. core values of the trust and the person specification for the role which you’re applying for. Phone your prospective ward prior to the interview and ask for an informal visit to get a feel for the ward/department.

Third year is tough. There will be a lot of blood sweat and tears during your final 12 months, but there is a light at the end of the tunnel and if you work hard you’ll soon be wondering where your final year went! Your hard work and pure determination will pay off. Your patients will make you feel so blessed every day and I promise all your stress and worry is 1000% worth It!

Donna, ICU Nurse.

What made you choose this speciality to work in? What’s the most interesting thing about your role? I wanted to work in a dynamic and interesting area, seeing lots of different ailments and issues that people come into hospital with. I love being 1 to 1 with my patients and able to give all patient cares, being 100% involved. I get to be very involved in the patient journey and plans for their care and my opinions are respected and listened too.

Some tips for 1st year students, don’t leave everything til the last minute! 3 years might seem like a long time, but it flies by! In placement, there is something to be learnt in every situation that will develop you as a nurse and make you a safe but above all, caring practitioner.

Final year students, don’t get too wrapped up on knowing everything, no one expects you to know what you are doing when you qualify! You will get training and helped along the way by your peers! Enjoy your last few moments of student life, it’ll be over before you know it! Be proud of yourselves!

Placements aren’t the be all and end all. I did not have a placement in critical care, but still managed to get my dream job. Never let someone tell you that you can’t do it! If I can, anyone can. Whether you’re in the final phase or are just at the beginning of this journey, you have achieved something wonderful to come into this profession, especially at such an unstable time. I wish you all the best with your future endeavours, whatever they may be.

My proudest achievement so far is being able to actively be involved with my patients journey and care plan! When you start out as a fresh eyed newly qualified nurse you feel like a fish out of water, especially in such a highly specialist area as critical care! To be able to see yourself develop and be able to suggest or question a care plan with enough knowledge to back it up is a huge achievement. In the future, I’d like to progress in my role, maybe into a band 6? Who knows. But for now i’m happy to learn my specialisation and will start a level 7 course in critical care next year and begin my mentorship course!

Victoria, Critical Care Nurse in ICU & HDU.

The fast pace and quick thinking, variety of conditions I come across and complexity in illness, continuation of learning and developing new and old skills and knowledge, problem solving and the use of all my nursing skills attracted me to working in this speciality.

Some tips tips for 1st year students are to always ask and never be afraid to ask for help at any time..nurses are more willing yo help than you think, always reflect on your day it will help you throughout your career. If things get a bit too overwhelming stop, make sure you patient is safe and remove yourself from the situation and take a breather.
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I’d advise third years to do what you enjoy because you’ll be passionate in providing great care to your patient. Relax and be yourself…yes, you are being interviewed, but so are your possible employers, so always go armed with questions yourself. Be organised and try to stay on to of your work. Time management is very important.

My proudest achievement so far is getting awarded a first class degree and getting the opportunities to carry on my learning to help others. In the future I’d see myself being an experienced critical care nurse and mentoring and supporting other newly qualified staff in the area to be fantastic nurses.

Enjoy every moment of your university time and career, the hard work will pay off and if you enjoy what you do it will translate in your work and the care you give your patients. Always smile, a smile goes along way and is noticed by all, patients included!

Holly, Staff Nurse in A&E.

Initially I wasn’t sure where to work and A&E provides such a variety of conditions. The most interesting part of my job is providing life saving care in resus. I want to work in A&E for a couple of years to build on my skills and confidence, but I’ve not thought past that yet!

For job hunting in third year, don’t stress about it! If you are a last minute kind of person, like myself, and your friends have all got a job lined up by December of 3rd year don’t let it panic you, I didn’t apply for jobs until the end of summer of 3rd year and still got a job well before graduation! Start the dissertation early, don’t leave it all till the last minute like I did, trust me it’s not worth the stress!

My proudest achievement so far is getting a first class degree, never thought it would happen but hard work definitely pays off. I was a mature student and found the financial side of being a student very difficult, going from working with a full time wage to do 4 years of study (I did the access course & degree) was a difficult decision and I can only imagine how hard it was for my colleagues with children, but it is so worth it. If you’re having a rough time at uni and really struggling, I used to think about my first months wages and think about what I’d treat myself to…only afforded something little after bills were paid but that felt amazing. Keep at it, 3 years seems like a long time but it goes so fast then you have a fulfilling career ahead of you.

Ellie, Mental Health Nurse in Acute CAMHS.

I chose this speciality as I really enjoy working with young people, it’s challenging at times working in an acute environment but really rewarding and enjoyable too.

I’m currently working towards becoming a student mentor as I’m still at a point where I remember how it felt to be a student, and also what it was like to have a bad mentor. I love working with students now. In the future I can see myself training to be a nurse therapist.whitworth hall (2)

Some advice for first years would be that confidence will come in time. Every skill the nurses have they learned somewhere, you can be a great nurse if you stick with it.
For current third years deciding where to work, don’t be disheartened by everyone else saying they have jobs (there’s lots of quiet people who don’t)! I felt like I was one of the last ones to get a job and I ended up getting one in my ideal speciality – it made me glad I got rejected for the ones I wasn’t actually too fussed about!

Do I have any advice for current students on managing their final year? It ends! Joking aside, it really does. You’ve got this guys. Honestly, finishing a nursing course at University of Manchester is one of my proudest achievements so far. It is genuinely one of the most academically rigorous courses out there.

Nina, Paediatric A&E Nurse.

I loved A&E since my third year placement.  The most interesting thing about my job is that I work in a major trauma centre in London and get to see a wide range for illnesses and injuries. In the future I can see myself doing a management role or being an Advanced Nurse Practitioner.

Some advice for new students would be to get stuck in with placement! Take opportunities and involve yourself. For current third years deciding where to work; pick somewhere you have a passion for or want to learn more about!

Julia, Community Dementia Nurse.

grad bannerPersonal experiences made me want to work in elderly and dementia care, I felt I had a basic understanding of what a patients family are going through and help me to support them better.

I’d advise current students to speak up on placement and be questioning… ask why was this or that done a certain way whilst on placement. For third years job hunting, go with something you feel slightly confident with. For managing your final year, stay organised till dissertation is done! Don’t be afraid to start from scratch again if needed.

My proudest achievement so far is making patients smile and getting thank you cards from families I’ve helped. In the future I see myself doing exactly what I’m doing now! Just more knowledgeable at it!

You never stop learning, transition isn’t that bad, but remember you are accountable which is scary but don’t let that stop you from holding hands up if something goes wrong. Support is out there. You learn from your mistakes.


If you graduated from the UoM BNurs cohort in 2016 and want to contribute your experiences of your first year since qualifying to this article please use the contact form below.

Likewise if you’re a current student and want to get involved with the placement peer support project or write a guest post on a particular placement or topic that interests you, please drop us a line! We’d love to hear from you!

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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.

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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.

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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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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!

The next chapter: Starting a new academic year

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

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

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

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

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

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

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