The mentor that changed everything

0

This post does not by any means suggest that my other mentors haven’t been amazing, because they have. I have been extremely lucky that every mentor I have worked with up to now have taught me so much and have always been fantastic to work with. There is just one mentor who changed everything for me.

Rewind back to the end of year 1, to me receiving my first placement allocation for year 2 and seeing HDU/ITU. I hadn’t been on an acute ward in my training yet and I was starting my acute experiences in one of the scariest places, A&E being another one that fills me with dread.

I spent weeks panicking (a common occurrence with me as you will know if you’ve read my other blogs 😂) and worrying that I really did not know enough to be trusted with this kind of placement. I was going from year 1, in a placement that I was actually quite confident in due to previous experience to my first acute ward. I did not have chance to visit the unit before starting placement so I walked in ‘blind’. The first thing I saw was all the machines and I must have looked terrified because one of the NQNs said ‘It’s not that scary once you get started, don’t look so terrified you will be fine!’. I met my mentor and she took me into handover. From the first moment she was welcoming and kind, I instantly warmed to her and felt a little less nervous. I picked up the handover sheet and was convinced it was in another language, I didn’t understand half of the actual handover and worried that this would happen every morning.

I started my placement with 2 weeks on HDU, so the ratio of patients is 2:1. My mentor started by showing me the crash trolley and the airway trolley. We then moved onto the bedside checks and the observation charts. By lunchtime, I was feeling confident enough to record the observations myself and my mentor was happy for me to do so. The next week passed so quickly and my mentor knew so much, the knowledge she had blew me away and I remember thinking to myself that I would never know all the things that she knew. At the end of my second week, I had 2 weeks annual leave for Easter. When I returned, I was on ITU.

I asked over and over if I was doing ok, if I was where I should be and was doing everything I should be. I was doubting myself as I always do and thought I didn’t know anything. My mentor encouraged me all the time to complete skills that she knew I could do, she had faith in me and taught me things that have since come in very handy on my other placements. The day she told me I was having my own level 2 patient in ITU, I remember thinking no, no way I’m not good enough. This is not happening I will mess this up big time. And guess what? I didn’t! I felt confident in the bedside checks and the observations, she provided me with support and encouragement and actually made me believe that I can do this. The next few days passed and I became more confident with everything, using my own initiative to complete tasks that I could do. Then my mentor said I was taking care of a level 3 patient. WHAT?! No, no thank you I do not know what to do and the ventilator scares me to death 😂 Of course I wasn’t on my own I had her supervision but I was allowed to complete tasks by myself, keep track of medication times and assess changes to care based on ABGs. She pushed me to make decisions based on my own knowledge without ever making me feel ‘belittled’ if I didn’t know anything or needed to check something.

Before this placement, I had absolutely no faith in myself at all and thought I wouldn’t make it as a nurse. This mentor completely changed my way of thinking. She showed me so much support and encouragement that it was impossible to continue doubting myself. She taught me so much and I genuinely think that if I become even half the nurse she is, I will be very lucky. She constantly made sure that I was feeling comfortable and gave me every learning opportunity, involving me in ward rounds and procedures such as intubations and tracheostomy procedures. I felt welcomed from day 1 and completely fell in love with the place, which is partly due to my mentor and the faith she had in me. The feedback she gave me made me cry and I always look back on it if I’m doubting myself and feeling low. To reiterate, I can say that I’m very lucky and all my mentors have been fantastic and I’ve learnt so much from them all, but there was something different about this woman. In 6 weeks, she took me from a nervous second year student believing she would never be a nurse – to a semi-confident (only because I’ll never be fully confident!) second year knowing that she could do this and that there was a good chance that she would qualify! I now feel slightly jealous of anyone who receives that placement in the time we have left on the course 😂

Let me know any stories you have of mentors like this!

Love,

T x

Second year is the worst….or is it?

3

I’ve seen so many posts about how bad second year is and how difficult it can be, I am 6 months into second year now and thought I would share my top tips on how to make it a little more bearable!

  • Start work as soon as you get it. Gather references for the assignments before you start them as this helps when starting to write.
  • Remember how far you have already come. Think about your first day and how much you have learnt/changed since then. Write a list of achievements from year 1 that you can look back on.
  • Plan things throughout the year. I found this helps the time to pass a little quicker if you have things to look forward to.
  • For research modules – make sure you fully understand the terminology as this will help you when completing the assignment.
  • Take everything you hear from previous cohorts about assignments with a pinch of salt, you may really enjoy something that someone else didn’t.
  • Placement pre-reading. Placements will expect you to have a little more knowledge this year so pre-reading is a must.
  • Take on your own patients. Even if it’s only one patient for that day, take responsibility for their care (within the limits of what you can do with mentor supervision). This really helps to build confidence and third year responsibilities won’t seem as daunting if you have been doing them through year 2.
  • If you’re struggling, reach out to someone. Your personal tutor, another lecturer, someone on social media. It doesn’t really matter who it is just make sure you open up to someone, don’t try to manage through on your own if you feel you are struggling.
  • Get hold of a book on critical writing and thinking. The step up to level 5 writing can seem huge but it’s really about being able to say why something is done the way it is, wider reading and being critical in your thought process. I can recommend these two:
  • Take time for yourself. This is important in any year but do the things that make you happy. Self care can really help when you’re feeling fed up!
  • Chip away at assignments bit by bit. I start mine as soon as they are available and chip away, doing an hour or 2 a day if that’s the only time I have. Before you know it, the assignment is completed and it’s just the final checks you need to do.
  • Reference as you go! I say this all the time but with critical thinking comes more references, the last thing you want is to get to the end and have to find all 50+ of your references again to get them on your list.
  • Take on board previous feedback from year 1 and speak to lecturers about how to successfully write at level 5, they may have little hints and tips that will help you.
  • If you have to work around university, try to keep at least 1 full day off a week for assignments and yourself. You may even be able to join the bank at your hospital trust now, allowing more flexibility with shifts.
  • Try not to be disheartened if your first result is a drop compared to your first year grades. This can happen with the step up to level 5 writing, ask for guidance and really pay attention to your assignment feedback.
  • Try to save a little money each month, student finance drops in year 3 so saving a little bit during year 2 will help fill the gap.
  • Make sure your referencing is up to scratch, I have found this book really helpful for referencing (there is a website as well). Referencing tools are great but I prefer to create them myself then I can be confident that any errors are down to myself and you actually learn how to reference when you do them yourself.

img_3353

  • Keep up with your car maintenance, this may seem obvious but if you use your car a lot for uni and placement, wear and tear can occur faster than through doing normal mileage. The last thing you want is to be sat on the motorway waiting for the AA! (Other breakdown recovery companies are available 😂)
  • Email your assignments to yourself or save them on onedrive/google drive/a USB stick. Again, this may seem obvious but if your computer breaks or your work doesn’t save, you risk losing all the work you have done towards an assignment.
  • Keep in touch with your friends during placement, this kept me going through long shifts and weeks on placement.

Let me know if you have any other good tips for year 2 😘

Love,

T x

A day on ITU

0

The shift pattern on ITU is the same as the shift pattern on HDU (You can read my day on HDU post here) :

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

Just like on HDU, there is no ‘typical’ day on ITU as every day can be different from the next. Below is one day that I experienced on ITU.

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On ITU, the staff nurses’ have 1 patient each for the whole day (1:1).

07:45 – 10:00 – The nurse in charge checked the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses completed bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points were working and checking the infusions to ensure there is enough left to last a couple of hours. In ITU, there are also ventilator settings and alarms that need to be checked to ensure they are working correctly. After all these checks, the patient was assisted with personal hygiene needs and repositioned. Pressure areas are checked and patients on ITU are repositioned 4 hourly, with pressure areas checked on each reposition. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or a change in ventilator settings, depending on how the patient is responding to their current treatment plan. Sedation holds may begin around this time to allow the patient to have time to respond, sometimes the patient is not ready to fully break from sedation so the sedation may be restarted and a sedation hold attempted the next day.

12:00 – 18:00 – Again it’s hard to fully describe what happens in the afternoon as every day is different. Obs are usually completed hourly on ITU, they may be 2 hourly if the patient is self ventilating and being transferred to a ward. Obs on ITU include fluid input and output. Fluid input includes any medications given by IV or through a NG tube. Fluid output includes blood taken and NG tube aspirations as well as urine output. Every hour the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Patient observations are monitored closely and medications/oxygen can be adjusted accordingly. If a patient is responding well to ventilation, the ASB rate, PEEP or oxygen % may be adjusted to see how the patient manages. Extubation may occur if the patient is responding well to treatment but this will be planned in advance and discussed in the days leading up to the decision. ABG’s will be taken and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E, HDU or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Love,

T x

A day on HDU

1

My first placement of year 2 is 6 weeks on ITU/HDU. At Derby university in second year, we have two hub placements. One is for 6 weeks and the other is for 12 weeks. We also have a spoke placement where we spend 4 weeks.

The shift pattern at my placement is:

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

There are 1/2 days but I won’t be doing any of these during my placement block.

There is no ‘typical’ day on HDU as every day can be different from the next. Below is one day that I experienced on HDU. Other areas/trusts will vary and I would love to hear about your typical days on placement!

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On HDU, the staff nurses’ usually have 2 patients each for the whole day (2:1).

07:45 – 10:00 – The nurse in charge checks the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses also complete bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points are working and checking the infusions to ensure there is enough left to last a couple of hours. After all these checks, the patient is asked if they would like to have a wash and a fresh gown. If the patient declines, they are re-positioned and a skin check completed. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or transfer to a ward such as respiratory or stroke wards, depending on the patient.

12:00 – 18:00 – It’s hard to fully describe what happens in the afternoon as every day is different. Obs are done hourly or 2 hourly, depending on the patient. Obs on HDU include fluid input and output. Fluid input includes any medications given. Fluid output includes blood taken as well as urine output. NG tube aspirations are included in the fluid output also. Every hour/2 hours the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Personal care needs are met as needed and re-positioning is carried out regularly if the patient is unable to do so themselves. Patients observations are monitored closely and medications/oxygen can be adjusted accordingly. Equipment may also be changed if needed, such as changing a patient from a nasal cannula to an oxygen face mask. ABG’s may be taken in this time and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Look out for further blog posts in my HDU/ITU series!

Love,

T x

Receiving a new placement allocation

0

February 18th 2018 I was on a night shift on my year 1 hub placement. At midnight, my first placement allocation of year 2 was due to go live. I nervously logged on around 00:30 to find it said access denied! I was so disappointed to not be able to see my placement allocation, it said it was a medical ward but did not have the name of the placement area, at this time I thought it was just mine saying this. I kept refreshing the page throughout the night but it didn’t change. The next day, I realised that all my cohort had the same message. After some emails and phone calls to the placement team from other students, we were told it would go live the next day.

Later on that evening, I saw a Facebook status from someone in my cohort about their placement allocation. I was so nervous to log on again and check as there were a couple of areas I would have preferred not to have been allocated due to them being similar to my first year hub. I logged on to the placement allocation area and it was there.

I HAD BEEN ALLOCATED ITU/HDU FOR 6 WEEKS!!! 🎉🎉

17062ca8-7b9d-4d3a-8ecf-9be9793ee0da

I was so excited, this was an area I had hoped to receive as a placement but didn’t think I would. After the excitement, the usual doubts set in. I was worried that I would be at a disadvantage having been in a community hospital for first year. I didn’t think I would have the knowledge necessary to have a good placement on an acute ward, especially one as specialist as ITU/HDU. I had two weeks at university between being on placement as a first year and going back to placement as a second year. I wondered how much more knowledge I would be expected to have being a second year on placement.

I walked in on my first day and I was terrified. I felt so overwhelmed, I had no idea what any of the machines were for or how the paperwork was filled in. I was worried I didn’t know an acute ward routine and that I would have a bad placement. My mentor was lovely and put all my worries to rest straight away. They do not expect you to know the machines or the routine as you’ve never been there before. She talked me through the daily checks and morning routine. There was a NQN on my first day as well and she was great at making me realise there’s nothing to be worried about and that even if you’re qualified and choose to work on ITU/HDU, you won’t know everything and it is all a learning curve. During my first shift, comments were made to me about applying to work there once I qualify and these have since been mentioned on my following shifts as well, so I must be doing something right! The feedback from my mentor has been positive and I feel like I know the routine a little more now. I am a quick learner so I seemed to pick up the paperwork side of things quickly and by lunchtime on the first day, I was completing the hourly obs on my own meaning my mentor could concentrate on other areas of patient care.

On my first night shift, I was drawing up a vial of Pabrinex and managed to get it all over the floor and myself! Luckily, my mentor and another staff nurse had a good laugh about it and that put me at ease. They said everyone manages to get it on them once during training, which was a relief to know I wasn’t the only clumsy one! I had 2 weeks on HDU and I am now doing 4 weeks on ITU, I have followed my mentors rotation. At my trust, the staff nurses employed on ITU/HDU do a rotation, they spend 8 weeks on HDU and 16 weeks on ITU.

I seem to have fitted into the team really well and can definitely see myself applying to work there, I just need the job to appear on NHS jobs now 😊

Do you know where you would like to work yet? Let me know!

Love,

T x

Celebrating milestones

2

Year 1 contained so many milestones in my student nurse training and I can only hope that year 2 will be just as productive. I can still remember the first time I completed a drug round or the first time I injected a patient.

Enjoy the times that you get on placement doing a skill for the first time, knowing that you understand the rationale behind it and can carry out the procedure effectively. Make a note of when you do them for the first time as they are things you can look back on throughout your training and career. Milestones feel like big achievements at the time because they are individual to you and allow you to build your confidence in the skills that you are learning. Plus in a way they make you feel like a ‘real’ student nurse because you are practicing what you may have learnt in clinical skills lessons. Don’t worry if people in your cohort seem to be learning lots of new skills and you have only learnt a few on your placement, this is not a competition and we all have times where we are able to learn lots of new skills and times where it’s ‘quieter’ and you are just practicing skills that you have already learnt.

If you would like to remember your milestones throughout your training, there are many ways to do so! The Happy Planner Company sell milestone cards which are postcard sized and allow you to write the date on them, plus a few thoughts about the milestone. CA6FB4AB-C05E-4A9C-A0EC-87FA87267230

You can write the date in your diary or create a scrapbook of important days. You could even follow @PUNCadp lead and create a Year 1 highlights poster (pop onto her twitter to see for yourself!). You may want to begin a journal or follow my lead and create a blog. Find the way that works for you!

If you like to share your milestones on social media, go for it! If you’re a private person and prefer to keep them to yourself, that is also great. Don’t feel pressured into having to share your milestones just because others are doing so.

These milestones are what help us to see how far we have come as student nurses throughout our training and I feel we should be talking about them more, enabling us to show the positive sides of nursing and placement days.

Let me know the milestones that you are particularly proud of!

Love,

T x

Changing years: Expectation vs reality

0

Being a student nurse is often about change and particularly transition, time seems to fly and when you’re told in the very beginning that time will fly, you may not believe it. But the longer you study, the more you realise that this is exactly the case. And now in the face of dissertation and nearing the end of my training, first year seems so far away, but it has passed in the blink of an eye.

Through this process, I’ve had a lot of questions. Some of those times, I’ve been fortunate to be able to catch another student nurse on placement about what I can expect from my future in nursing, but part of the time — I haven’t known what to expect and it has felt like entering into the unknown.

Sitting down with Toni, a second year student nurse, we decided together to do a mini Q&A on what to expect, from the eyes of someone who has been in her position.

Q. I have achieved good grades in year 1 and I’m worried about keeping up the same standard in year 2 now that they count towards the final degree classification. Is there a big jump from level 4 to level 5 academic writing?

The expectations shift a little, level 4 is often a descriptive form of writing and this year you will be expected to analyse your description more, to understand why you are saying that, from what the evidence base is telling you and to consider why pieces of information can contradict each other. In second year, I learned more about how to effectively appraise my evidence, before I reference it within a piece of academic work.

It isn’t a huge leap, the word level probably makes it sound more scary than it is. You will be guided by your lecturers, the library staff are always available for support. Your writing won’t necessarily change, rather you’re developing on the foundations that you’ve laid in your first year.

Q. I had a brilliant community hub placement in year 1 that was mainly elderly patients and I wonder if this had put me at a disadvantage coming into the acute hospital for my next placements. Will I be expected to know so much more in year 2 placements than I did in year 1?

I had a similar experience of moving from a year in the community in second year, to a placement in ITU in third year. I felt like a fish out of water! I found it was important to communicate these feelings with my mentor, to explain that my memory needed jogging about working in a hospital as I’d lost track of routines and schedules.

Placement in the community does not put you at an disadvantage, instead you learn a separate group of skills to what you may now develop going into a hospital. These skills are highly applicable, they are still nursing skills that you can utilise in any placement. For me it really just boiled down to grasping the new routine.

You will be expected to develop from first year, but that isn’t a bad thing. It’s a gradual thing. Your mentors will guide you, you will evaluate yourself as you learn more throughout the year.

Q. Almost every time I see a post on social media about year 2 it is negative, are year 2 blues really a ‘thing’?

I think this is something that we often end up a bit blasé about. Being a student nurse is a journey of highs and lows. There have been times when I’ve felt frazzled by my course, others where I’ve just known it’s perfect for me. I think the blues comes from the idea that you’re quite a distance from the beginning, but also a distance from finishing, so sometimes it feels like you still have so much to do.

My advice for this is to talk to your peers, your mentors, your lecturers. Look after yourself, practice good self-care. I always found it helped me to reflect on why I wanted to nurse in the very beginning, always go back to the start. Second year is hard, particularly emotionally, but a cup of tea and a chat can go a long way.

Q. The workload in year 1 appeared to be manageable with assignments launched early on in the year with 5-6 months to complete them. Is the workload more than year 1?

On reflection as a third year, where I have had OSCEs and I’m working on my dissertation, I do feel now that my second year workload was more manageable than this year. However, the pressures do increase and you will be balancing assignments while on placement, but this helps you to learn time management skills that are ultimately essential to life as a registered nurse.

This was a really tough part for me! Balancing moving up a level, placements, reading further, they all took more time. I cannot stress how important time management is to a successful nurse education. It’s hard work, but with good management it is manageable. Lecturers will not set assignments to be cruel, they set them to meet competencies and they set them with due dates that are manageable. It’s about taking control of your time, your education and what you want from it.

I found that in second year that I was able to explore my own interests a little more in my assignments, being able to choose an assignment focus from several case studies and following one. This is a good opportunity for you to identify the gaps in your knowledge and fill them, often also helping you to discover what areas of nursing you have a passion for.

Second year is a journey, I thoroughly enjoyed it. Enjoy the time you have, manage the time you have, remember why you started and remember that you’ve come so far. First year is completed and you are entering the next stage of your education.

Good luck for this year!

Love,

T & A x