Four Weeks on Placement
This mini series is based around my first placement of my final year of my Bachelor of Nursing degree. The placement will be carried out a large metropolitan hospital in Melbourne, on a general medical ward, focusing firstly on older persons, then on chronic illness.
I aim to post at least weekly about my experiences, feelings and what I have learnt, or as they say - the good, the bad and the ugly.
I aim to post at least weekly about my experiences, feelings and what I have learnt, or as they say - the good, the bad and the ugly.
Part one - Pre-Placement
Before placement there is a LOT to organise.
First of all there are the logistics of basically working full time without being paid. This makes it almost impossible to work (in your normal job) so if you live out of home (like I do), finances are beyond stressful at this point so you need to prepare with some savings or work out how you can save money during placement. Here are some of my best tips that I have learnt from experience.
Once you’ve worked out the ‘life’ side of things, the next thing is to figure out the nursing side of your placement. Look at what ward you’re on and find out what they specialize in. Then, sorry to say it, do some homework! If it’s a respiratory ward, look up some common respiratory illness’, refresh your memory on respiratory assessments and maybe even look up a few common medications.
You have to remember that the impressions you make on placement will affect you when it comes to looking at grad years. Try your best to stand out (for the good reasons) and people will be able to tell you have put in some extra effort.
For now that’s all, I have my own study I need to be doing in prep for my own placement starting in two days.
Wish me luck!
First of all there are the logistics of basically working full time without being paid. This makes it almost impossible to work (in your normal job) so if you live out of home (like I do), finances are beyond stressful at this point so you need to prepare with some savings or work out how you can save money during placement. Here are some of my best tips that I have learnt from experience.
- Work out how to get there the cheapest way - parking at hospitals is never cheap/affordable for students so think public transport or car pooling. If you are going to drive and park, do a drive by before placement to work out where to park and how much it will be - there is nothing worse than being late on your first day or having your car towed because you misread the time limit on the parking sign...
- Don't rely on buying food every day so be prepared with lunches/dinners and snacks.
- As soon as you get your roster (which sometimes isn’t until the first day unfortunately), try and work out if there is a day or two you can work so you don’t end up behind. BUT! Don’t work every day that you have off! You will burn out from exhaustion which is not what you want when you’re trying to learn and care for people every other day you’re not working
Once you’ve worked out the ‘life’ side of things, the next thing is to figure out the nursing side of your placement. Look at what ward you’re on and find out what they specialize in. Then, sorry to say it, do some homework! If it’s a respiratory ward, look up some common respiratory illness’, refresh your memory on respiratory assessments and maybe even look up a few common medications.
You have to remember that the impressions you make on placement will affect you when it comes to looking at grad years. Try your best to stand out (for the good reasons) and people will be able to tell you have put in some extra effort.
For now that’s all, I have my own study I need to be doing in prep for my own placement starting in two days.
Wish me luck!
Week One
Day One
Day one is over and I'm sorry to disappoint, but today was all orientation so it was all paperwork, formalities and well, orientation. Unfortunately for me, I have sat through this exact orientation session on a previous placement so it was less than exciting. However! I got to visit the ward I will be working on for the next two weeks!
I am placed on a general medical ward and spent about an hour there today, knowing my way around. For each placement, we are given a bit of a scavenger hunt activity to do so that we can get our bearings on the ward. Think along the lines of locating resus trolleys, finding out where the nurse unit manager's (NUM's) office is and learning most importantly, where the staff toilet is so you can use it when you get two minutes to yourself, in between running around like a crazy person.
We also listened to a handover of the entire ward so I got a feel for the type of patients I'll be looking after. This may be a given, since it is a general medical ward, but there is SO MUCH variety I couldn't believe it! To be honest it kind of freaked me out a bit since there will be so many illness', medications, contraindications, social aspects and everything else that will come into play that I will need to learn. But then it made me so excited - I get to come across new things every day that I may not have the chance to do in a specialised ward which will give me the opportunity to learn so much more about conditions I may never have thought about...
Tomorrow is a public holiday so I won't be on placement then. But later this week, I'll have a new update about my first 'real day's' on placement.
Stay tuned xx
Day Two
And just like that I’m back in the action!
Day two started with an educational workshop that staff on my ward were involved in, related to dealing with patients with BOC (behaviors of concern – for example aggression and abuse) which I found out is EXTREMELY common on the ward I am working on the next two weeks. Great.
After this workshop was handover. If you’ve never been involved in a handover, here’s how it works:
Generally, there will be a group hand over involved with all staff (including NUM’s, ANUM’s, RN’s and any EN’s) at the beginning of a shift which briefly goes over each patient on the ward and anything that staff need to be aware of. For example, if there is a patient who frequently gets out of bed but is a high falls risk so all staff she be on alert for the falls mat alarm.
From there, staff go to their allocated group of patients – typically two nurses to eight patients – and another, more in depth hand over is done from the nurse on the previous shift. This gives more detail into the patient’s history, current situation and what the plan is for that patient. Majority of hospitals use a handover tool called ISBAR which you can find online and is great for getting all the relevant information out in a logical and consistent way.
If I were to write about each of my four patients, I would be writing for days, so I will just focus in on one ‘interesting’ patient (interesting from a student nursing perspective, not in any sort of derogatory way!). Plus, all patients who are on my ward have so many comorbidities which is why they are on a general medical ward so there are so many intertwined illness’ and factors contributing to their health, which would again leave me writing for days!
Please note: for all examples of patients, some information written is somewhat vague due to confidentiality reasons.
This patient is an older gentleman whose main reason for admission is related to his poorly managed diabetes with severe consequences. When I was involved with this patient, I was assisting with a wound dressing of (and I’m going to be honest here) probably the worst pressure injury I have ever seen… Think, deep, wide and necrotic. The wound was washed with normal saline using a sterile dressing technique and then packed with betadine soaked gauze.
Later that day I was asked to do a set of obs on this patient – blood pressure, pulse, oxygen saturations (sats), respiratory rate and temperature. As I entered this patients room, he said something about a funny feeling with his breathing so the first thing I did was put the sats probe on…. 78. His sats were 78!!!
Now if I were in first year, I probably would have run to my nurse to tell her his sats were extremely low and hope she could fix it. But being in third year I had to get my critical thinking involved and unfortunately in this instance, I was faced with a bit of a dilemma.
He was in MET call criteria, BUT I could see from his charts that he had been on oxygen throughout the day and I could see that his oxygen wasn’t on. You’re probably already thinking ‘well put the oxygen back on’, but (annoyingly for me in this situation) that is wrong. As a student, I cannot administer oxygen without being under supervision as it is technically classed as a drug.
So, this was my dilemma: he is in MET call criteria but he isn’t really because if the oxygen was on, his sats would increase which would get him out of MET call criteria; I can’t put the oxygen back on myself because I’m not supervised but technically I shouldn’t leave my patient; I could call the emergency buzzer but once again, I am quite confident this is not an emergency. So, what did I do?
I asked my patient how he was feeling. How his breathing felt and if he still felt funny. I explained to him that he probably needs his oxygen back on so I will grab my nurse to help me with that. He assured me he felt fine and promised he would take a few deep breaths while I calmly, but with lightning speed, grabbed my nurse (who was barely thirty seconds away) and explained the situation. She came in and put the oxygen on and wouldn’t you know it, his sats came back up and he was fine.
I’m not going to lie, this situation was not slowly thought about as it seems here, and although this situation was somewhat scary, I was pleased with my critical thinking and of course with the outcome. My heart felt so relieved when afterward my nurse said to me ‘what you did was the right thing’.
As you can probably gauge already, being a student can be frustrating by not being allowed to do things without supervision, ESPECIALLY in situations like this. But, I have already learnt so much from this one experience and I now value the idea of stopping and thinking before freaking out.
I am now getting ready for my second shift. Once again, wish me luck!
Day Three, Four and Five
The joy of shift work has already taken a toll on me. In all honesty I didn't have the energy after each of these shifts (day three, four and five) to write about my days as I was so exhausted. I've also just had three days off where I went camping to relax so I haven't had access to the internet to update you all, so I thought I would summarise these three days the best I can.
The AM shifts - 7am to 3:30pm - are much busier than the PM shifts - 1pm to 9:30pm. Day three was a PM shift and the other two were AMs. Throughout all shifts I do my best to do as much as I can independently, unless of course it's something like giving medications as this needs to be supervised. So my shifts (kind of) work out as follows:
Start of the shift is handover and then planning the shift. The ward I am working on does team nursing so it's two nurses between eight patients and they share the workload evenly (instead of one nurse to four patients exclusively). My nurses have been great at treating me as another nurse, not as a student, so between the three of us we plan and work through our patients needs as best we can.
Things I have been able to do on these three shifts include venepuncture (taking blood), medication administration, reconstitution of and administration of IVAB (intravenous antibiotics), hygiene care, obs and of course, paperwork. Soooo much paper work! I swear there is a form for everything - drugs, wounds, risk assessments, even poo!
I have also been writing notes at the end of each shift (which I have done on previous placements as well) so I'm getting used to writing these again since they can be so specific need to be accurate. I find the easiest way for me to write my notes is in a systems approach - CNS, CVS, RESP, GIT, RENAL, INTEG, MOBILITY, SOCIAL, PLAN - as this is how the head-to-toe assessments are done so it is logical and easy to follow.
I'll keep this update short and sweet since I need to meal prep for my next four shifts. Stay tuned for how the next few days go!
Week Two
Day Six and Seven
My shifts are blurring together in amongst trying to learn as much as I can on placement, then coming home to assignments and general living needs like, you know, eating and showering and stuff. These last two shifts have been good but exhausting. I find that while I'm on the ward working away I'm fine, then as soon as I get home I'm so tired I just want to go straight to sleep... at 5pm.
An interesting patient who I have been caring for is an elderly gentleman who has a few things going on, but his main issue is the excruciating pain a fracture in his spine is causing him. He requires full nurse care as he has dysphagia so cannot eat or drink on his own and is immobile due to the pain caused by his spinal fracture. Pressure area care for this patient is extremely hard to attend to as moving him causes him so much pain.
The thing that has really got to me with this patient is the pain management regime for him is not effective, which he has voiced many times, and it seems to me that when it comes to 'difficult patients' like this, people seem to just push the blame on to someone else. So for example, I will let my nurse know that he needs more/different analgesia and they will say that the doctors already know this (as if it's not them personally who is or isn't doing something), then the doctors will say they've already given him something extra but by the time this has happened we've already worked out that the new drug/increased dose isn't working so it's back to square one of trying to help the patient be somewhat comfortable.
I know I've already talked about being frustrated as a student so I'm sorry to sound like a negative Nancy, but this is another situation where it is frustrating because as a student you don't want to come across as annoying by giving people more work to do BUT being an advocate for your patient you need to find your voice and get something done. It's a super hard situation to be in, especially when you are the one who the patients ask 'what did I do to deserve this', not the doctors who the patient see's for all of three minutes a day (no disrespect to doctors intended I promise!).
On the flip side of this, being a student caring for this person has been so amazing because I have more time to assist him with eating and just generally be there to support him and have a chat. Since the registered nurses are off doing a million other things, I have time to actually take my time helping him eat which is massive when the patient feels bad for taking up nurses times - which they never should and DEFINITELY should ever be made to feel that way.
It was really nice to hear when this patient said to me: thank you. You are so patient. It's so nice to actually be cared for by someone, not just treated like a nuisance.
Moral of the story from my last two shifts - if you are not being a nurse to genuinely care for people, don't do it. No one ever wants to be in hospital and you as a nurse are there to help them so no cutting corners or trying to get out of the tough jobs. Compassion people, compassion.
My shifts are blurring together in amongst trying to learn as much as I can on placement, then coming home to assignments and general living needs like, you know, eating and showering and stuff. These last two shifts have been good but exhausting. I find that while I'm on the ward working away I'm fine, then as soon as I get home I'm so tired I just want to go straight to sleep... at 5pm.
An interesting patient who I have been caring for is an elderly gentleman who has a few things going on, but his main issue is the excruciating pain a fracture in his spine is causing him. He requires full nurse care as he has dysphagia so cannot eat or drink on his own and is immobile due to the pain caused by his spinal fracture. Pressure area care for this patient is extremely hard to attend to as moving him causes him so much pain.
The thing that has really got to me with this patient is the pain management regime for him is not effective, which he has voiced many times, and it seems to me that when it comes to 'difficult patients' like this, people seem to just push the blame on to someone else. So for example, I will let my nurse know that he needs more/different analgesia and they will say that the doctors already know this (as if it's not them personally who is or isn't doing something), then the doctors will say they've already given him something extra but by the time this has happened we've already worked out that the new drug/increased dose isn't working so it's back to square one of trying to help the patient be somewhat comfortable.
I know I've already talked about being frustrated as a student so I'm sorry to sound like a negative Nancy, but this is another situation where it is frustrating because as a student you don't want to come across as annoying by giving people more work to do BUT being an advocate for your patient you need to find your voice and get something done. It's a super hard situation to be in, especially when you are the one who the patients ask 'what did I do to deserve this', not the doctors who the patient see's for all of three minutes a day (no disrespect to doctors intended I promise!).
On the flip side of this, being a student caring for this person has been so amazing because I have more time to assist him with eating and just generally be there to support him and have a chat. Since the registered nurses are off doing a million other things, I have time to actually take my time helping him eat which is massive when the patient feels bad for taking up nurses times - which they never should and DEFINITELY should ever be made to feel that way.
It was really nice to hear when this patient said to me: thank you. You are so patient. It's so nice to actually be cared for by someone, not just treated like a nuisance.
Moral of the story from my last two shifts - if you are not being a nurse to genuinely care for people, don't do it. No one ever wants to be in hospital and you as a nurse are there to help them so no cutting corners or trying to get out of the tough jobs. Compassion people, compassion.
Week Three
This week is technically the start of a new placement, however, I requested to be on the same ward so it's not so new to me, but in all honesty this beginning is tinged with sadness...
Today I took new students to my ward and gave them an orientation since I was already familiar with how the ward worked and where certain things were. While I was on the ward I noticed the name of one of my patients was missing off the patient board... I didn't want to acknowledge this at first but I knew exactly what it meant.
On Saturday I MET called John* for 02 sats in the high 60's - low 70's. It was shortly after this I was involved in another, 2 hour long MET call and later discovered that doctors had decided that palliation was not far away from my patient John.
John was a lovely man. He was so kind to me and I know he appreciated the care I gave him, even though he was considered a high level care patient, or what some nurses would call a 'difficult patient'. I will never forget the day he had the strength to tell me about his cat, Tuppence, who had been living in a luxury cat home for the past year due to John's ill health. That same day he said to me 'Georgia, you are so patient. It is so nice to be actually cared for by someone'.
After I MET called him I checked on him later and he seemed comfortable but exhausted.
To discover today that he passed away on my only day off, after caring for him for so many days was a feeling I didn't think I would encounter until later in my career.
The hardest part for me was that the only thing that worried him was where Tuppence would end up.
Rest in peace.
Today I took new students to my ward and gave them an orientation since I was already familiar with how the ward worked and where certain things were. While I was on the ward I noticed the name of one of my patients was missing off the patient board... I didn't want to acknowledge this at first but I knew exactly what it meant.
On Saturday I MET called John* for 02 sats in the high 60's - low 70's. It was shortly after this I was involved in another, 2 hour long MET call and later discovered that doctors had decided that palliation was not far away from my patient John.
John was a lovely man. He was so kind to me and I know he appreciated the care I gave him, even though he was considered a high level care patient, or what some nurses would call a 'difficult patient'. I will never forget the day he had the strength to tell me about his cat, Tuppence, who had been living in a luxury cat home for the past year due to John's ill health. That same day he said to me 'Georgia, you are so patient. It is so nice to be actually cared for by someone'.
After I MET called him I checked on him later and he seemed comfortable but exhausted.
To discover today that he passed away on my only day off, after caring for him for so many days was a feeling I didn't think I would encounter until later in my career.
The hardest part for me was that the only thing that worried him was where Tuppence would end up.
Rest in peace.
Week Four
My final week on placement was busy as usual. I've come to learn that the ward I worked on has patients on each end of the spectrum - in for something minor or really, really sick.
This week I took a full patient load (4 patients) and didn't find it as difficult as I thought I would. I remember in first and second year only taking one or two patients and thinking 'how will I EVER be able to manage 4 patients?!' But I did it which I am super proud of.
In this last week I also witnessed my first code blue in which a patient had gone into cardiac arrest and needed CPR. Seeing CPR for my first time was intense.... It was so different to seeing a MET call where the person is still conscious and able to answer questions about how they're feeling, if they have pain etc. This was completely different.
There was a line of people taking turns in doing compression's and one after the other would do their round of 30 then get off the bed and the next person would get on the bed and start again. All the while, doctors, ICU nurses, anesthetists (basically everyone you could think of) were trying to work out what had happened and why. There were also really hard decisions being made like if they would intubate the patient and when they would stop doing CPR. It was full on to say the least.
The person ended up 'coming back to life' and two days later he was back from ICU talking to the nurses who did CPR on him. He was so thankful, even though he didn't remember any of the experience.
I had quite a few emergency experiences this week actually, and without sounding weird because someone was deteriorating, I LOVED them! I love how when it comes down to those situations everyone does exactly what needs to be done, as quickly as possible while still being calm.
So before I sign off on this Mini Series I wanted to say some take home messages I want other people to take away from these four weeks.
For the nursing students or anyone thinking about doing nursing the main things I want you to know is that even though you are a 'student' you are still an asset to the team and to patients so don't talk yourself down or think less of yourself because you're not as qualified as other people you will work with on placement. Following on from this is a cliche phrase that is SO relevant to placement - confidence is key. If you are about to do something for the first time (on a real person) and you look like you have no idea what you're doing, you look scared and nervous as hell, everyone around you (patients included) will pick up on those vibes and make you feel worse. Just own it. This goes for when you speak to educators as well! They will drill you about what you know if you look like you have no idea what you're doing/talking about.
To people who aren't 'nursing minded' can I just say one thing - placement is not easy. We are expected to work full time hours for weeks at a time without being paid, PLUS our employers from casual jobs also want us to work on our 'days off' so we can end up working upwards of ten days in a row. This on top of regular uni work like assignments and exam prep takes a massive toll on every student. It is exhausting.
I am passionate about nursing and I hope this series has given you some insight into the life of a student nurse. As always I am always happy to answer questions or help out anyone that wants to know more about studying nursing so feel free to contact me here.
On that note, it's time to end this series.
Thank you for coming along this roller-coaster of a journey with me.
Georgia x
This week I took a full patient load (4 patients) and didn't find it as difficult as I thought I would. I remember in first and second year only taking one or two patients and thinking 'how will I EVER be able to manage 4 patients?!' But I did it which I am super proud of.
In this last week I also witnessed my first code blue in which a patient had gone into cardiac arrest and needed CPR. Seeing CPR for my first time was intense.... It was so different to seeing a MET call where the person is still conscious and able to answer questions about how they're feeling, if they have pain etc. This was completely different.
There was a line of people taking turns in doing compression's and one after the other would do their round of 30 then get off the bed and the next person would get on the bed and start again. All the while, doctors, ICU nurses, anesthetists (basically everyone you could think of) were trying to work out what had happened and why. There were also really hard decisions being made like if they would intubate the patient and when they would stop doing CPR. It was full on to say the least.
The person ended up 'coming back to life' and two days later he was back from ICU talking to the nurses who did CPR on him. He was so thankful, even though he didn't remember any of the experience.
I had quite a few emergency experiences this week actually, and without sounding weird because someone was deteriorating, I LOVED them! I love how when it comes down to those situations everyone does exactly what needs to be done, as quickly as possible while still being calm.
So before I sign off on this Mini Series I wanted to say some take home messages I want other people to take away from these four weeks.
For the nursing students or anyone thinking about doing nursing the main things I want you to know is that even though you are a 'student' you are still an asset to the team and to patients so don't talk yourself down or think less of yourself because you're not as qualified as other people you will work with on placement. Following on from this is a cliche phrase that is SO relevant to placement - confidence is key. If you are about to do something for the first time (on a real person) and you look like you have no idea what you're doing, you look scared and nervous as hell, everyone around you (patients included) will pick up on those vibes and make you feel worse. Just own it. This goes for when you speak to educators as well! They will drill you about what you know if you look like you have no idea what you're doing/talking about.
To people who aren't 'nursing minded' can I just say one thing - placement is not easy. We are expected to work full time hours for weeks at a time without being paid, PLUS our employers from casual jobs also want us to work on our 'days off' so we can end up working upwards of ten days in a row. This on top of regular uni work like assignments and exam prep takes a massive toll on every student. It is exhausting.
I am passionate about nursing and I hope this series has given you some insight into the life of a student nurse. As always I am always happy to answer questions or help out anyone that wants to know more about studying nursing so feel free to contact me here.
On that note, it's time to end this series.
Thank you for coming along this roller-coaster of a journey with me.
Georgia x
