One Down!

So that’s it, placement is finished!

I’ve really loved it. Over the last few weeks honestly it feels like I’ve properly thrown myself into it, and really enjoyed everything that I've been doing. It’s gone so quickly, and I won't pretend it’s been easy- trying to juggle a family life and placement as well as writing an essay and making sure that was in on time- but it’s definitely been worth it. It’s 100% made me realise I've chosen the right career path. 

I’ve done so many different things and met some really interesting and lovely people. My mentor has been absolutely fantastic, and the other nurses that I was working with were lovely as well. I feel so lucky that they were such a lovely bunch of people, and they made me feel completely comfortable and able to be myself around them. I was quite pleased as well that my mentor said my communication skills with patients was really good as well, but I honestly think that comes from years of working in a bar and talking to every kind of person! We’ve had some really interesting and varied patients, which has been really good as I’ve been able to experience a lot within quite a short placement. I think I've grown in confidence as well, I feel like I’m able to talk comfortably to patients now and I don’t feel so awkward and nervous about it. I like community nursing a lot more than I thought I would. 

I’ve found out I’m not as squeamish as I thought I would be as well. 

There’s been so many interesting patients. We had one wound which had to be packed daily. Originally it was thought it was an abscess which the patient had had lanced, but it turned out to be a fungating tumour. We had asked plastics to reassess them and they had taken biopsies, and the medical diagnosis was non-Hodgkin’s lymphoma. The patient had deteriorated over the 3 weeks we were seeing them, and we had to phone an ambulance on our last call to have them taken to hospital. So it was good to see why accurate nursing notes are important to keep as it means that when different nurses visit patients, then they can see if there’s anything unusual going on. 

I’ve been able to give some injections as well which was good as I was quite nervous about that for some reason! They were mainly tinzaparin ones as I had built a relationship with that patient, so she was comfortable with me giving them. I’ve learnt a lot about wound-care as well and the different types of dressings/packing, and why it’s used, which I know is going to come in useful over the next few years. I also got to see male, female, and suprapubic catheters being changed, and did a number of palliative support visits as well as helping set up syringe drivers. We also did one bereavement visit after a palliative patient had passed away. I was a bit nervous about that call because I didn’t really know what to expect, but I think the family were prepared for it, and they were happy that he was comfortable in his last few days more than anything. 

Over the last few weeks I’ve really familiarised myself with all of the paperwork required for community nursing, which has involved a lot of different care plans, initial patient assessments, patient notes, skin bundles, nutrition pathway documents, syringe driver documents, and risk assessments. It’s been good because I’ve been quite confident in filling these out as well, and even got together a few new patient notes folders myself. My mentor was really helpful in showing me how to fill them all out correctly and got me to do it for a number of patients as well, which I definitely think boosted my confidence. She also showed me how they order patients equipment as well, like the EHOB cushions and other pressure relieving equipment. It’s a little bit like online shopping ha!

I think what has surprised me most is that my mentor trusted me with a lot. I’m really grateful for this and it gave me confidence in my own ability. She would ask my opinion on things (I’m sure she already knew but I feel like it was to build me up) and trusted me to prepare dressing packs for patients we were visiting the next day, as well as doing a lot of complicated dressings myself. She also got me to phone GP surgeries and patients about prescriptions and things. It might not seem like a big deal, but it feels like it to me. We had quite a complicated patient about half way through the placement as well, they had Huntington’s disease and really struggled to communicate, and his condition had recently deteriorated quite a lot. A family member of his had LPA, and he was being referred for a capacity assessment and CHC, as he was not engaging with care and it was becoming detrimental to his health. It was really interesting to see the entire process of this, and it was good to develop a relationship with the patient, as his communication needs we’re a lot different to other patients I had met, so I feel like I definitely learnt something. I got to sit in on the CHC meeting with my mentor as well, as they were trying to move the patient into a suitable placement instead of having him live alone. This was along with family members, a social worker, and a Huntington’s specialist nurse. It was a really good experience and seeing how different teams come together for the good of one patient was really eye opening. 

I’ve managed to get quite a lot of my competencies signed off, which has been great as we don’t find out what our next placement is until mid-August, but it takes a lot of the pressure off as well. I managed to get my dignity essay finished as well, which is great, I just did a bit every evening and managed to finish it the week before the deadline. 

So, all in all it’s been really good. 

I got my mentor and the other nurses a card and some chocolate when I left because they genuinely were really lovely to me. 

Community Placement and New Experiences

Well, the first two weeks of placement have been absolutely packed full of new experiences. 

I took a notebook with me, so I could write down the main things that I’ve done, and I tried my best to keep a diary but honestly keeping on top of it was impossible! Working with the community nurses has certainly been eye opening, I don’t think you realise how many different things they do until you’re out there doing it. My mentor was off for the first week on annual leave, so I was with a few different nurses until she returned, but it was actually really good to see how a lot of different people worked. Everyone has their own way of doing things, but the outcome is the same which is good. Every patient is so different as well, so I got the opportunity to see and do loads of different things. 

Over the past two weeks I have done a lot of wound care, mainly venous leg ulcers, lymphoedema patients, wound packing, I got to take clips out of a few hip and knee replacements, and stitches out of wounds- which I really enjoyed. I’ve also seen quite a lot of palliative care patients, which has involved syringe drivers, PICC flushes, and PEG water changes. It was really interesting to learn about the different medications used in end of life care. 

I tried to get stuck in straight away.

Mainly because I was really quite nervous about it, so I thought that would be the best way to overcome any fears. If I’m honest I’m not really that confident about my abilities, and I really struggled the first few days. It was difficult feeling comfortable walking in to patient’s houses and introducing myself, and I felt really out of my depth. I got into my own head about it quite a bit and thought that the nurses would think I was stupid because I didn’t know anything, it did make me quite upset for the first few days. I’m not sure why, I think it’s just because it’s all so different from anything I’m used to, and I was really aware that people might be judging me on my knowledge (or lack of it). 

After a few days that passed though, and I got really involved with the wound care, and we saw some really interesting patients. By the end of the week I was able to give the nurse the dressings she needed for particular patients who were in compression, and I was able to remember what we used for them on previous calls without having to ask. So that boosted my confidence a bit. I've seen a few palliative care patients as well which has been really interesting. I was quite pleased that I actually managed to do the medication calculations correctly- the nurse let me figure it out (before she checked it) as we were drawing it up- which was good as it gave me a bit of a confidence boost with that. It was really interesting as well to see all the different paperwork that comes with having controlled drugs in a patient’s home. It was strange though, meeting patients who knew that their disease was terminal. I guess I found it a little awkward because I've not really dealt with death before, so seeing these patients who have seemingly accepted the illness was different. 

I am finding it easier to talk to people now though. That start was really hard but honestly over the last few weeks it has gotten a lot easier. I think it’s helped as well that I’ve seen a few of the same patients so have managed to build up a relationship with them, mainly through having conversations about seemingly random things like their dogs, or kids, or the weather ha! 

But so far it’s been enjoyable, even if it did take some getting used to at first. Just got another 3 weeks to go now, it’s going really quickly. It has been difficult though, trying to juggle family life and being at placement 5 days a week. I mean, I appreciate it's a normal working week, but with Cal looking after the baby all the time and working nights as well it's just seemed like we have no other time in the days! But we both know it's only temporary, and we're working quite well around it as well. 

End Goals and the Basics

Basic Life Support, Manual Handling, Clinical Observations, and Bone.

That’s what we’ve done the past week or so. It’s been a short week, which is- I am led to believe- a rarity when it comes to this course. I’ve been quite glad of this to be honest, it’s been nice to have some down time with the baby: I feel like I’ve been missing out on quite a bit with her. She’s started walking this week, and I’m so glad I didn’t miss it. 

But let’s not get into the whole mum-guilt aspect of what I’m doing. I refuse to open that can of worms until I’m at least a few glasses of wine in. 

So- CPR. That’s basically what BLS is- for the first year at least. It was quite interesting actually, the practice suite we were in had these fancy CPR dummies where they tell you if you’re doing it right. It’s a far cry from the ‘annie’ dummies I trained on as a lifeguard when I was sixteen! 

It’s really tiring! I can see why you need a whole team of people to continue longer than two minutes. The average cardiac arrest lasts about 30 minutes, or until a doctor calls time, and we replicated this in teams of four- ten minutes in we were all sweating. My hands were actually bruised from it! It’s quite daunting really, thinking that now- even as a student- if something happened in the street we have a duty of care to act as we have the training. We have our first MCQ exam in May and there are elements of BLS within it, so I think I’m definitely going to have to revise the whole ‘DRSABCD’ process so I know it properly. 

Manual handling was something I haven’t done before. To be honest, there’s no real way to make it exciting- but the training has to be done before we are allowed out into clinical practice. Anyone working in the NHS in Wales- student or not- has to have their Manual Handling Passport signed off before they can start work. It’s good really, because, in theory it means that everyone is trained to the same standards. Although I am sure out in practice there are instances where ‘shortcuts’ are taken, as is usually the case with things like this. Fingers crossed it doesn’t happen, mainly because I’m imagining it would be daunting to say, ‘this isn’t the right way to do something’ to people who are actually qualified whilst I’m only a student. 

What is interesting though are the ingenious ways there are to move people who can’t move themselves! All sorts of hoists and machinery!

I learnt how to manually take blood pressure.

Honestly it is about as faffy as it looks when someone else does it for you. The concept, when explained, is actually fairly simple. The reality is not- especially when your patient has an awkwardly placed brachial pulse! It’s definitely something I’m really going to have to get used to, I’m ordering a sphygmomanometer online so at least then I can practise at home. We have an exam on that in the second week of May. It’s only a formative exam so if you do get something wrong you can do it again until you get it right, which is a bit reassuring I guess. They just want you to know how to do it, even though mostly in the hospital it’s all automatic machines. 

What I have really enjoyed so far is the nitty-gritty learning about the human body. It’s so fascinating, all the microbiology and anatomy. I understood a little bit before from the access course- but we’ve looked at viruses and different types of bacteria that live in different areas of your body, and what it can do if it gets into the wrong areas of your body. We did a class in the anatomy lab, which was about the skeleton and the structure of bone- we actually got to hold and feel real human bones, which had come from people who had donated their bodies to science after they died. It was kind of weird to be honest, thinking that these were actually inside of someone. Three of the skulls that we got to examine were from children- a one year old, a stillborn baby at full term, and a foetus. That was bizarre. We were told usually these smaller skeletons were usually donated by families who worked in science and medicine, as they help towards research. It’s quite sad really, but it’s also such a nice thing that these families donated them, as it enables people to learn about them. 

I’ve been thinking about our first placement as well. I’m quite nervous, I’ve never done anything like it before and it’s daunting. For my first placement, I’m actually hoping to get a community placement or something like that. The end goal is to work with women before and after childbirth- not as a midwife as I don't want to deliver babies, but after everything I went through with Alys I feel really strongly about honest communication about the mental effects of having a baby and everything else that comes with it. I think it would be a nice ease into clinical placement and what’s required. The main reason I did adult nursing first is because my health visitor and midwife both told me to, they said it’s better to go through and do adult first, and then do a short course after in paediatrics. 

I know there’s going to be placements I don’t enjoy as much as I should, and things I’m going to have to do that aren’t nice, I just have to think about the end goal.