Same Skit, Different Placement

Negotiating the path as a student nurse is about as smooth-going as an inpatient hospital towel. As soon as you integrate yourself into and start to become part of a team, your time is over and you must move on. Let’s embrace the analogy of the sandpaper-esque towels we actually expect patients to rub themselves with, having never seen a drop of fabric softener in their lifespan. The more entrepreneurial of us nurses may even attempt to market these towels as “exfoliating”, much to the raised eyebrows of our patients who I’m sure are not enamoured with the experience of the National Health Spa.

In a similar sense, placements exfoliate us almost to the point of friction burn – over time they wear down all the dead skin and dirt leaving us polished and shiny-new by the time we get to qualification. At times it hurts, and maybe when those times come we simply need to lay off for a bit, stop rubbing and give ourselves time to heal. There’s an important lesson here about knowing yourself; knowing when the best thing for you to do is break out the Lenor and bathe in fluffy blankets for a while before going back to the land where you can file your fingernails on the hand towels.

Additionally, and I’m getting to the end of my towel-based-analysis, perhaps student placements are simply too small and/or numerous to be at the peak of efficiency.

Q: “How many hospital towels does it take to dry a patient?”

A: More than what it bloody should.

So here you are; Same Skit[sic], Different Placement.

Whilst you’re trying to suss out your new colleagues, they’re trying to suss out you..

Make sure you bank your answers to questions such as: “What made you go into nursing?”, “What did you do before?”,

and (above all): “Do you want to work a night shift?” [said to the tune, and with all the wide-eyed-innocence of Frozen's, Do You Want To Build a Snowman].

Even in the few years I've been qualified, student'ing has changed.

I’m not going to claim I understand all this e-pad business, my Health Board is not electronic – and I love pens and paper. Yet adapt we must, and I’ll 100% dive into decoding the e-pad with you. As a student you’re forced to do the most adaptation, evolution being slower and more in the background.

You’ve got through the nerves and outright fear of your first day on a new ward, the way they do things here is different to the way you’ve seen things done before, so you can’t even fall back on the building blocks you built up on your previous placement(s): too brief, too long ago, too much has happened since!

We’re starting from scratch, all ingredients and no recipe - a true GBBO Technical Challenge.

Or, it’s your first ever placement! Congrats and welcome to the scrub life.

You have no idea what to expect – sure you’ve had ten weeks of uni to try and prepare you but, naaaah, it doesn’t really. You’re like a dry sponge, just soaking in all the new sounds, sights, smells - some more fragrant than others - a dab of Vicks under the nose can help; and people, there are people.. e v e r y w h e r e.

You don’t yet know the routine, you’ve found yourself to the breakroom ahead of morning handover but that was a struggle (why do all the doors around here look the same?). You’re just going to follow the crowd, do what other people do and hope for the best. Someone’s given you a handover sheet, here are the names of the patients who you’ve not yet met but will soon become intimately familiar with. You don’t know what ails them, just lists of letters and abbreviations, or long mixtures of Latin and ‘it’s all Greek to me’!

I don’t miss those days, not one bit. It’s not just a baptism of fire, it’s many baptisms of many fires. You feel like you’re always in the way – you’re not. The only way you’re going to pick up what’s going on is by throwing yourself headfirst into it, get in the way! Build up an alliance of other students, you’re all going through the same thing. If there are other students on your placement, use them as a sounding board. Get a feel for who the newly qualifieds on the ward are - they're going through the exact same things as you, just in a different colour. Heck, drop me a message, just:

Don’t be alone.

One of the first things you need to pin down is the morning routine, it's like a well(ish) choreographed dance - music/internal screaming optional.

On a ward, it goes something like this:

• Safety Brief – this is where patient safety/plan for the day issues are highlighted, who’s in charge, patients who are a high risk of falls, not for resuscitation, NEWSing, pressure sores, this is the outline of what’s happening on the ward.

• Handover – this in an in-depth explanation of what brought each patient to hospital, details of their history, their treatment, their social situation, and any other business.

• Allocation – You will be allocated to a nurse to work with, and you'll both be allocated to a group of patients.

• Intentional Rounding – the team go around the ward, waking up the patients, sitting them up ready for meds and breakfast, detaching finished IVs, opening curtains, turning the lights on. Fetching commodes or walking people to the bathroom.

• Checks – Two nurses must go through and check the controlled drugs; arrest and sepsis trolleys are also checked to make sure they are in good working order and stock has not expired.

• Meds – The qualified does the morning meds round, you may or may not join them. Morning meds round tends to be the biggest and most time-consuming of the day, so I like my students to pitch in with the following while I’m dealing the drugs.. legally ofc.

• Beds – The linen trolley is brought round as patients are having breakfast and we change the bedsheets and tidy the beds of any patients sitting in their chairs.

• Washes – Some patients are independent with their hygiene needs, some may need bowls brought to them (and the towels, remember: exfoliating). Some need assistance of one person, and some need assistance of two or more. We re-group as a team to figure out how we’re going to get everyone looking their best.

• Breaks – because amongst all the rush, a good three hours have gone by. It depends on the setting but it’s general ward etiquette to make sure all the washes are done before we start talking breaks.

Here ends the morning routine. Some nurses will fit in a cheeky dressing change before their morning break, most tend to leave it until later in the day. It all depends, sometimes a patient will be going home in the morning with transport booked for 9am, so they tend to be the ones who are helped with a wash first so they can be dressed and ready to go.

Morning routines can be quite chaotic if you’re not yet familiar with them.

It’s between 8-10am that most teams do their doctor rounds, so you may see doctors fighting above the soapy bowls and bed-sheets to clap eyes on their patients.. you get used to it.

Do not be afraid to object to a five-strong doctor team parading through the privacy curtains to assess Mrs Jones whilst she’s half-nude and mid-wash – the doctors might not like having to re-shuffle their patient list but Mrs Jones will appreciate a nurse who defends her dignity.

**Opening towel paragraph was written post-night shift on 36-hours of no sleep, it shows!**