Time for placement!

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Here are my collection of top tips for your first placement, based on my own experience:

  • Visit your placement before starting if possible, it gives you a chance to check how long it will take you to get there and what the parking options are if needed. You can also meet some members of the team and be shown around the ward. I find a quick pre-placement visit helps to stop first day nerves.
  • Contact your placement and ask if there is anything specific that you need to research before starting.
  • Don’t be afraid to ask questions. If you want to know how to do something or why your mentor is doing something, ask! That is what they are there for and should be happy to answer any questions you have.
  • Organise time with your mentor to go through your placement paperwork and remember to get your hours signed after every shift.
  • Make a note of any terms on the handover sheet or in the care plans that you do not understand and check them with your mentor when you get chance. There are often abbreviations on a handover sheet, the first time I looked at one I thought half of it was in a different language!
  • Spend time with the HCAs, they know so much about the ward routine and the patients.
  • Organise insight visits throughout your time there. I am on a rehab ward in a community hospital so I have spent time with the OTs and physios. I plan to spend time with the district nurses and ANP as well. You can arrange insight visits that are relevant to your placement and these help you to understand the roles within the MDT.
  • Ask to sit in MDT meetings, care planning meetings or other meetings on the ward. Accompany the doctor on their rounds. All these things give you an insight into how the whole ward team work together to provide care for the patients.
  • Take a packed lunch. You may be in a busy area or may not know what the catering options are at your placement, having your lunch with you takes away the stress of spending your break finding something to eat.
  • Your uniform is a reflection on you and the university so always wear a clean, ironed uniform and adhere to your university’s uniform policy regarding hair, shoes, nails etc.
  • Try not to go into placement with high expectations, you may spend a few days with the HCAs or observing your mentor for weeks before you start practicing new skills.
  • If a patient asks you a question you do not know the answer to, it is ok to say that you do not know but that you will find someone who does know the answer. Patients respect the fact you are honest enough to admit you do not know and will appreciate it when you return with the correct answer for them. This also helps to build your own knowledge.
  • Remember to stay hydrated! It is easy to forget to look after your own fluid intake when you are monitoring patients or busy with your mentor but try to keep drinking throughout the day whenever there is an opportunity.
  • Turn up on time and if you will be late, give your placement a quick ring to let them know. Also adhere to any absence policies at your university if you need time off.
  • There will be common medications that are used on your placement, try to make a note of these or ask your mentor if there is a list they can provide. It is handy to research these and to know what they are used for/a few common side effects.
  • Have a little notepad in your pocket to note down anything you will need to research later or terms you don’t understand to ask your mentor.
  • It is ok to feel out of place or overwhelmed. Speak to your mentor or your personal tutor if you are feeling this, they will help in any way they can.
  • Spend any time you can interacting with patients, they will often be experts in their own condition and you can learn so much by spending a few minutes with a patient. This also helps to build your confidence and develop your communication skills.
  • Reflect often. Every experience is a learning opportunity and by reflecting on situations you can see what could be improved upon for the next time or what was done correctly the first time.
  • Do not worry if you don’t have any previous care experience, you will develop the skills over time and it can often be beneficial to go in with no experience as you have no preconceived ideas of how things are/should be done.
  • If you do have care experience, discuss this with your mentor and utilise your existing skills whilst on the placement. However, be aware that some of the practices used within the hospital may differ to those used in care homes or community care if this is where you have gained your experience. Basic care skills are very transferable though.
  • Try not to compare your experiences with those of your cohort, I had days where it hadn’t been a good day and seeing other people really enjoying their placements made me very jealous. Other times, it was me having a brilliant day and others feeling down. It’s good to have their support but remember everyone has their own experiences and good/bad days.
  • Check with your university what you are allowed to do, for example some universities do not allow students to test blood sugar levels even if you have had the training in your employment/previous experience.
  • Remember you are allowed to say no if you do not feel comfortable trying a new skill. It is perfectly fine to observe your mentor until you do feel comfortable to give it a go!
  • Enjoy your days off, even if it means staying in your pyjamas and binge watching tv you have missed!
  • Remember that it is your first placement. Your mentor will not expect you to know or be able to do everything. Take every opportunity to learn and get involved wherever possible. Show a willingness to learn, enthusiasm and respect for the ward and you cannot go wrong 🙂

Let me know if you have any more and where your first placements are!

Love,

T x

A typical day on an elderly rehab ward

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My first year hub placement is on an elderly rehab ward in a community hospital. At Derby university in first year, we have one hub placement where we spend around 16 weeks throughout the year and a spoke placement where we spend 2 weeks.

The shift pattern at my placement is:

Early – 7am-3pm

Late – 1pm-9pm

Nights – 8:30pm – 7:30am

Long days are 7am – 9pm.

Below is a timeline of a typical day on this ward. Other placements will vary and I would love to hear about your typical days on placement!

7-7:30

The night shift nurses handover how the patients have been throughout the night and the patient early warning scores from the previous day. They also relay any information relevant to a patient for the day and if there are any care plan reviews outstanding. Before leaving the handover, we check the discharge board to see if there are any discharges planned for the day, these are often mentioned in the handover as well. HCAs are allocated patients that they will be responsible for assisting throughout the morning and students will often be allocated 1/2 patients as well. The nurses on the day shift decide which side of the ward they will be in charge of for that shift.

7:30 – 9

During this time, the nurses and HCAs are assisting patients to wash and dress. We encourage patients to wear their own clothes and to get out of bed. Information about how a patient mobilises/transfers is included on the handover shift and is also on the board above the patients bed. A number of patients come into the dining area for breakfast but the majority like to have breakfast in their own space. Around 8am, the nurses begin the medication rounds. As a student, there has been times when I have assisted with the morning medications and other times when I have been helping the HCAs to assist with patient personal care needs.

9 – 11:30

During this time, patient observations are completed and documented on the NEWS (National Early Warning Score) chart. Any patient scoring is reported to the nurse in charge and documented. We also document the reason as to why they were scoring and these patients will have their NEWS checked again later on in the day. Any dressings that need changing and UCAM (urinary catheter assessment and monitoring form) charts will be completed in this time. Daily evaluations are completed for each patient, as well as fluid/diet charts for those patients on them. Once my mentor has completed all her duties in this time, I chat to patients and get to know them a little better. The physio team will often be on the ward at this time, completing assessments on patients and helping them to gain confidence with their mobility. The tea trolley goes around the ward around 10:30 for the patients to have a cup of tea and a snack.

11:30 – 12:30

We use this time to assist with toileting any patients who need assistance and patients come into the dining area ready for lunch at 12:30. Patients are welcome to remain in their own rooms but they are encouraged to come to the dining area and socialise with other patients.

12:30 – 14:00

Lunch arrives at 12:30 and all the staff on the ward help to give meals out. HCAs and available students help any patients who need assistance with eating and drinking. At 13:00, the nurses and students go into the handover to provide information to the staff beginning their late shift. Any outstanding duties are handed over to the afternoon nurses to be completed on their shift. After the handover, the nurses on the morning shift complete the lunchtime medication round. The late shift nurses walk around the ward and check on the patients they will be responsible for that afternoon.

14:00 – 17:00

These hours are visiting hours so there are often lots of family members on the ward. I have often completed care plan reviews or personalised care plans within this time, chatting to patients and their families about their preferences. During this time, the nurses will complete any paperwork that needs updating. Morning staff leave at 3pm leaving the late shift on duty.  Patients have a cup of tea and a snack around 3:30pm. Any patients scoring on their NEWS in the morning will have their obs taken and documented. Changes in scoring is reported to the nurses on duty.

17:00 – 18:30

Teatime. Patients often remain in their own rooms for tea, some patients may sit in the day room watching television whilst they have their tea. Patients are offered a hot and cold option and there are different choices each day.

18:30-19:30

Visiting time again, some patients who have had visitors earlier on in the day ask to be assisted into their nightwear at this time as they like to relax late evening reading a book or listening to music in their own space.

19:30 – 21:00

Patients have a hot drink around 8pm and some patients will ask to be assisted into bed around this time. At 8:30, the nurses’ go into the handover to relay any information onto the staff on night duty. At 9pm, the late shift finish leaving the night staff for their shift.

Let me know where your first placement is/was and if your day is different to mine 🙂

Love,

T x

You can find out more information about NEWS here: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

Missing placement

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Hi guys!

So this week I’m having to miss a week of placement attendance. On the way home from a night shift last week my car gave up on the motorway and I had to ring the AA! After a few hours in the garage to determine the problem, I was informed I would be without my car for at least a week. Not the best news considering it would only be my second week back on placement. The worry set in and I considered that I may lose my place on the course due to this. Silly now I look back but it was on my mind at the time.

I rang the programme lead at university and I cannot fault how supportive she was! She really put my mind at ease and assured me that I wouldn’t have to leave the programme at all. With my placement being 45 miles away from my house, public transport really wasn’t a feasible option as it would take me nearly 3 hours each way so the advice was to be absent for the week as I have plenty of time to make my hours up. I stopped worrying a little bit then about university but was anxious around phoning placement.

I rang placement shortly after and they were absolutely fine! They put my mind at ease again and I assured them that I would work with my mentor when I returned to make my hours back up through my remaining placement time.

If you ever have a situation where you may need to miss placement hours for whatever reason, do not panic! Be honest and open with your university and they will support you in any way that they can. I can only speak for my placement area as they have been fantastic but I’m sure that many others would be just as supportive and will help you if you show that you will work to make the hours back up as and when you can!

I’m hoping to have my car back this weekend so placement can resume next week.

Let me know of any experiences you’ve had missing placement for whatever reasons!

Love,

T x

First placement begins!

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Rewind back to May 21st. I woke up to loads of messages telling me to check placement allocations as they had been uploaded. I went on to find I had been allocated a ward in a community hospital as my hub placement for year one. This means I will return here three times throughout the year around spoke placements and university. I did a google search of the ward and found out it was an elderly rehab ward. My first feeling was disappointment. I bank in a residential care home and thought it was going to be exactly like work, I had wanted something really different and interesting.

Everyone was excited for their placements and I was feeling deflated. I had already formed an idea in my mind that it would be boring and that I wouldn’t be able to learn much. The week before I was due to start, nerves were building and I was worrying that I wouldn’t know anything and that I would just be in the way all the time. I visited the ward and a third year student nurse showed me round. She was lovely and answered all my questions. She really put me at ease about starting the following Monday. I felt more excited about starting after I’d been so I would definitely recommend visiting your placement area before starting. Already knowing the drive and where I would park took some of the worries away as well.

I arrived on the Monday morning and went into handover. The handover sheets have everything about the patient on, including past medical history which I found really useful. The sheets have lots of abbreviations on so I wrote them all down and went through them with my mentor so I knew what they meant ready for the next days handover. I was introduced to everyone and all the staff seemed friendly. I was on shift with one of my mentors and the third year student who had shown me round the week before. She was on her management placement and she really helped me get settled into the routine of the ward in my first week. She was always willing to answer questions and allowed me to ‘get stuck in’ pretty much straight away. I spent the first day getting to know the ward routine and spending time with the patients.

Over the first week, I completed my initial interview with my mentor and we discussed what I would like to learn whilst I was there. I decided that I would like to improve my manual blood pressure taking, my placement area is perfect for that as they only take manual blood pressures. My confidence in taking manual blood pressures has increased already. At first I was worried the patients wouldn’t want a student doing it but they have all been more than willing to let me.

I am in my second week and I have already learnt so much! I have learnt how to fill out admittance and discharge paperwork, completed care plans, taken bm’s, administered enoxaparin sodium injections (these are subcutaneous injections), redressed wounds, applied leg bandages, completed district nurse referrals, continence assessments and removed a female catheter. I think it’s been a big advantage already having care experience as it meant I could go straight into shadowing my mentor, instead of spending a few weeks learning personal care skills. I have still helped the HCA’s with personal care when needed but it wasn’t something I had to learn. The HCA’s on my ward are fantastic, they know so much about the patients and are really helpful. I was conscious that I was going into their working area and didn’t want to be an inconvenience to them but they have all made me feel so welcome. Don’t be scared to ask your mentor anything at all, I am constantly asking mine questions about patients and medication.

I can honestly say that my first thoughts about the ward were completely wrong. Sometimes it is slow, especially in the afternoons but if there hasn’t been anything to do with my mentor I have spent this time talking to the patients. They love telling you their stories and it’s great to see them excited when they know they are going to be discharged. It is hard to step out of the carer role from work and into the student nurse role but I think I’m getting to grips with it now. I haven’t found it boring at all and I feel like I’ve learnt lots already! Being on a quieter ward allows you more time with your mentor, more time to ask questions and longer patient interactions. I’m already looking forward to returning in October and I haven’t finished this placement block yet!

Let me know any good or bad placement experiences you have had 🙂

Love,
T x