Placement is one of the highlights of student nursing. The chance to experience a setting you may never otherwise have been exposed to, have a designated supervisor to ask your millions of questions to (along with other fabulous members of staff, of course!), witness great practice and learn loads of skills and life lessons you never realise you needed to learn.
However, this may not always be the case. Healthcare professionals do a wonderful job, though they’re also human. You may be working with someone on a bad day, with someone who needs further training, or someone who for whatever reason, their style of working is different to what you have discussed in University or experienced on other placement areas.
As student nurses, we have the privilege to work alongside staff and ask them why they’re working in that way so a deeper understanding can develop. “Why” is an essential aspect to student nurse training as University continuously support deeper learning, criticality and analysis of practice and theory of which is linked to the best available evidence. You may have been taught something differently in clinical skills, so you may wonder why staff are doing something a certain way. It may or may not make sense to you at the time or following reflection. At this point discussion with experienced supervisors or assessors can help identify differences in practice and potentially identify areas for further development. You may feel anxious about asking them about it, but please rest assured most practice assessors and supervisors enjoy being asked questions.
As student nurses, we’re bound by the NMC Code, trust policy and university policy and regulations. This is to benefit both students, other staff, our clients and patients and their families. If we see something, we have a responsibility and a duty to say something. This is where your personal supervisor will be able to provide a sound board and support an informed decision.
Identifying areas for development or unsafe practice can be incredibly daunting for a student nurse. We do not want to cause any upset, we may not feel we have the experience or knowledge to question someone’s practice, or we may be afraid of the effects this may have on our future career, for very understandable reasons! However, those receiving a service often do not have the privilege of being able to walk away from that at the end of their shift.
You’ve been accepted onto your course, and as a future nurse, because of your excellent communication skills (along with many other fantastic qualities, we have no doubt!). This is a time when they really come in handy!
If something ‘doesn’t feel right’, or you see something and think that is not how you would want your nearest and dearest to be treated, then chances are, it’s not right. You can have had years of experience in healthcare, or have come into nursing without any experience, you still know when something isn’t right.
So, you’ve seen something that you’ve established wasn’t right, now what?
If you have the confidence, say something at the time this is the most preferred method and demonstrates leadership qualities. Ask the healthcare professional why they’re practising in that way. We are taught to use evidence-based practice in everything we do. We don’t just perform an activity how it should be done, we follow best practice such as clinicalskills.net, we look at the latest NICE guidelines. We are always encouraged to justify what we do and how we do it.
If your feeling of it ‘not being right’ has been explained and reassured, and the healthcare professional is acting in accordance with the best available evidence and up to date policies and procedures, fantastic. You just learned something! You may also have reminded the healthcare professional of the professional curiosity that they may not have the opportunity to utilise as a member of staff, and they may try to bring that into their practice more.
If you are still unsure or feel their explanation may be justifying poor practice for whatever reason, speak to someone else about it, ideally someone in a more senior position. Follow the information on your university placement handbooks which identify key person’s that you can talk with. Say exactly what you saw. They will have the clinical knowledge and judgement to know if this needs to be escalated, or if not, they will be able to explain and discuss the methods and next steps.
Escalation is a scary word. It provokes all kinds of emotions. As student nurses, we are kind, sensitive and compassionate people who often just want everyone to be happy. However, there may be a reason behind why the healthcare professional is practising in that way. They may need further training and support. They may have something going on at home that is affecting their practice and may not be aware that it is affecting them so much. They may have a very stressful workload and not feel they have the time to complete tasks in ways that adhere to policies and procedures.
If any of these reasons are the case, they are all able to be solved or the impact mitigated. For example, if a healthcare professional does not have time to complete tasks in the correct way, the employer has a duty towards their staff and their clients and patients. It may be that this is commonly talked about amongst staff but has not been escalated to higher management who have the power to support staff further.
The individual may have something going on at home or in their personal life. The healthcare professional may need time off work or reduced working hours. This is okay, and we can help to reduce shame and stigma of doing this. If an individual needs further training, staff across a workplace may not have received up to date training, so you may impact an entire workplace’s practice in a positive way.
Everyone might deal with this situation slightly differently, but the most important thing is to be aware it might happen and prepare yourself for what you might do if it happens.
Key things to remember are:
- The importance of documentation
- Know the policies and procedures of the trust and workplace
- Know who the Practice Learning Facilitators (PLF) is and their role
- Maintain good contact with your personal supervisor and link lecturer during placement
It’s important to remember that while we are bound by guidelines to confidentiality so we cannot talk about what took place, where, when or with who, but we can talk about how it makes us feel. We can reflect through journaling, talking things through with our friends and our Nursing Society family, or reach out to professional services such as our unions, who can offer counselling support.
If we are to witness practice that in our opinion ‘does not feel right’, the worst thing we can do is nothing. “Every day is a school day”
Recommended websites to get familiar with:
- NMC Code: https://www.nmc.org.uk/standards/code/
- Clinical Skills: https://www.clinicalskills.net/
- NICE Guidelines: https://www.nice.org.uk/guidance
There is a lot more that could be said on this topic. If you have something to say about it, and for example may want to write a blog about it, please email firstname.lastname@example.org.
Written by Sam Kitchen, Year 2 Learning Disability Nursing Student, with thanks to Heather Pepper for providing additional comments.
This blog was written by a student nurse, as an opinion piece. Hull University Nursing Society hold no responsibility for the content or how fellow student nurses may use it.