Sunday, 15 September 2013

My First Nursing Placement

I'm currently in the 3rd week of my 2nd block of placement on a general acute medical ward. The ward itself has 27 beds that are rarely empty and quite a high turnover of patients. There are 5 cardiac monitoring beds for patients who are most at risk. It is a very interesting ward to work on as patients come on with such varying conditions and I have learnt an incredible amount already, even after just 6 weeks. My mentor is a Sister on the ward and is obviously very busy but makes sure to give me excellent learning opportunities. I also have 2 co-mentors (staff nurses) who are brilliant and explain everything so thoroughly. I really think I have landed on my feet with this placement even if it is a fair distance for me to travel every day. The structure of placements at my university has changed recently and means that we have 1 Hub placement that we revisit over the course of the year and 2 Spoke placements in between. The placement I'm on at the moment is my Hub placement. I'm there for another 2 weeks and then back for 6 weeks in January. I have my Spoke placements after this placement where I will spend 2 weeks in a mental health environment and 2 weeks with a Health Visitor. These are basically to give us a broader outlook of the nursing career.

So when I first started reading blogs I was itching to know what student nurses do whilst on placement and at first I expected that people would be doing all of the nursey things straight away. Wrong. It makes A LOT of sense really as when you set foot onto a ward (which I had never done in a work capacity) it can be very daunting - alarms here, wires there, patients with life threatening problems, family who are anxious, staff running around, patients coming on the ward, other patients leaving, buzzers going...you get the picture - it's stressful! There is so much to learn that starting with the basic stuff, the fundamentals, is vital. So for the first 4 weeks of my placement (all of July basically) I spent in the role of a HCA (Health Care Assistant), learning from the resident HCAs, working with my mentor to understand the role better, getting used to the ward routine, learning how to take vital obs (BP, pulse, temperature, respirations, oxygen saturation, AVPU (alert, vocal, pain, unresponsive - basically that the patient responds and to what), blood sugar, passing urine and pain level (if any), reporting this back to a staff nurse if the patient had anything out of the ordinary, assisting with meal times, helping patients with daily living tasks (getting out of bed, toilet, shower, bed bath, dressing, etc.), bed making, restocking supplies, taking patients to different departments... the list is endless really. HCAs do a lot on the ward and basically keep it going. They have the most contact with patients and some of them can teach you anything you want to know. There are a few I have clung to on several occasions and they have taught me a tonne. Moral of the tale - stick with the HCAs ;)

Since I returned to placement after the Summer, my Mentor has given me more opportunities to broaden my experiences and is allowing me to partake in drugs rounds and slowly increasing my responsibilities, which I am thoroughly enjoying. I think the easiest thing here is to list the things I've been doing:

  • Bed baths
  • Showering patients
  • Making beds
  • Taking vital obs - completing NEWS charts (early warning system)
  • Admitting patients onto the ward
  • Completing documentation
  • Dressings
  • Watching procedures - Lumbar Puncture, Ascitic drain, Xrays, Endoscopy
  • Assisting a Dr with an Ascitic drain - I put a sharp in a normal bin as I was so nervous...oops! I'll never make that mistake again!
  • ECGs (heart trace)
  • Serving food and assisting some patients with their nutritional needs
  • Speaking to family/friends of patients
  • Re-stocking supplies
  • Tidying the patient's rooms/ward
  • Taking BMs (blood sugar)
  • Laying out a dead patient
  • Drugs rounds
  • Checking skin integrity
  • Calling family regarding patients' needs
  • Arranging transport for discharged patients
  • Preparing IV solutions (e.g. 450g Tazocin with 20ml water, mixing then adding to 1000ml Sodium Chloride) and setting up the machine...under supervision obviously.
  • Simple drug calculations
  • Injections (4 and counting!)
  • Observing Aseptic technique - Catheterisation and an aseptic leg dressing
  • Observing an Occupational Therapist assess a patient and attending a home visit
  • Assist in a cardiac arrest (SCARY!)
  • Swab to test for MRSA
  • Dip urine and sent samples to the lab
  • Accompany patients to other departments (Xray, Ultrasound and Endoscopy so far) and observed the procedures
  • Attend Medical Gas Safety and Syringe Driver Training
  • Removing venflons
  •  ...the most important one I've found - talking to patients.
I have come across a variety of patients on the ward, mostly elderly but some quite young. One girl was younger than me (around 20) and unfortunately admitted due to taking an overdose. That one was difficult. I love caring for elderly patients and to be honest before I started I was dreading working with elderly people. I think because of my previous work experience I expected it to be the same but the environment in a hospital is vastly different to that of a care home. I realise now how poor the care actually was in the home I worked in for a few shifts. This whole nursey thing doesn't half make you reflective!

I feel like I've dealt with all that has been thrown at me quite well and am adapting all of the time. I can feel myself learning and developing constantly, dealing with situations and people I never thought I'd have to contend with. All in all the best advice I can give to any student nurse is to just take things as they come and not expect too much. Every one learns at different rates and every hospital/ward/mentor is different in how they teach students. I have some friends on the course who did all I've done in the first month and at first I was jealous but after realised that taking things in my own pace leads to a better learning experience personally. Apologies if I've skimmed over things a bit. I've been trying to finish this post for ages and been a busy bee. If anyone reading this has any questions or would like any advice please don't hesitate to comment.

Overall placement came as a bit of a shock for me as well as my nails. They're usually coated in something sparkly but now look absolutely pants, short and plain. My toe nails remain overtly sparkly to compensate. Moral of the tale - make the most of holidays and paint your finger nails, ha!

P.S. I'm not sure if I mentioned this previously, but I applied for a Bank HCA job at a private hospital and heard last week that I got it! I'm very excited to get going.

Hope you're all well :)

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