Placements: 1st year Vs 2nd year

Written by Mandi

For me, my experiences on placement for both first year and start of second year have been positive. However, that is not to say that there were not days that I had wobbles, or that staffing levels were low, or that I felt like I knew nothing and felt more of a nuisance because I did, I felt all that. However, overall, I have had pleasant experiences. Therefore, I want to give you some insight into what these placements entailed as I know from first-hand, how daunting it is as a first- year student to go into an unknown place for the very first time.

My first placement was within the acute setting and the ward I went to, was an area of interest so I was very fortunate. I did, however, have some general concerns about how I would cope with the long placement hours, not knowing anyone, and what to expect from somewhere that was completely different to the environment that I was used to. However, as soon as I arrived those feelings started to fade. The staff who greeted me where lovely and I soon realised that all my worries and thoughts were just that ‘thoughts’.

Now as a first year, I was not expected to know everything, or anything in fact. Some people at this stage have no care experience, and that is ok. Having come from a care background, I felt it did not give me any advantage to those without because the hospital environment was completely different. I was there as a new student just like anyone else on the course. As long as you are caring, compassionate and willing to learn that is all that matters.  My first week consisted of getting to know the ward routine and working with the health care assistants (HCA’S), who by the way, have a wealth of knowledge and are people who I look up to.  This was important as it allowed me to find my feet, get to know the staff, the patients and how things were done.

The morning routine started with attending the handover – this is where staff from the night team hand over important information about patients currently on the ward and anything that needed to be done during the day. I remember sitting in the first handover and not having a clue what was being said. However, do not worry so much about this, this is normal and by the end of your placement you will actually start to understand a lot of the handover terminology. Remember it is your first placement and first week! be kind to yourself!

Once the handover was finished, I was then assigned to an area with another member of staff, where we would assist patients with personal cares, At this point some of you may be feeling nervous, you may not have done it before, and that is ok. Let the person you are working with know and ask if they can show you first or talk you through it. Again, personal care for me was very important as not only do you get to talk to your patient, but you get to check their skin for any signs of damage, which is important as patients are more susceptible to pressure damage during hospital visits, due to prolong exposure to lying in bed or sitting in the chair.

After personal cares, comes breakfast. Now when I first started I assumed, yes I said it assumed, that the catering staff did this, however, I quickly realised that whilst on this particular ward the HCA’s and students also helped, and actually it was a good way to get to know my patients and their preferences. Now this can be a little confusing at first, because during the hand over you may have heard that a patient is Nil by Mouth (NBM) this means that the patient is either down for surgery that day or may have an NG tube, PEG. NJ or RIG (feeding tube) so when you are helping with breakfast, make sure you are aware of those who cannot eat. Also look out for those that need assistance, they usually have a red tray. However, this will become clearer once on placement, just ask a member of staff to explain it.

following on from breakfast, the rest of my morning would see me assisting the HCA’s with patient turns, answering the patient buzzers and in between I would also complete patient observations and document them on the system (I would suggest you familiarise yourself with the NEWs scoring system) and liaise with the nurse if there were any immediate concerns. Another important but overlooked task is mouth care. You may find the majority of patients are unable to carry out this morning routine whilst in hospital, so It is very important to ensure mouthcare has been offered and assistance given where needed.

The afternoon routine was similar to the morning, in such a way that I would assist with lunch then myself and the HCA’s carried out our patient turns, answered patient buzzers, and then I would again carry out patients’ vital observations and then 5pm was teatime and so on.

During the rest of the placement however, I was able to spend time with the nurses and carry out some medication rounds. This was daunting at first because it was a real-life patient and I was handling medication all while thinking to myself of all the possible worse case scenarios, however, I double, triple and quadruple checked every single one I did, plus my assessor was watching me every step of the way (always remember the 6 rights to medication). Please do not feel at this point that you have to carry out any part of medication rounds. It is important to work within your competencies and if you do not feel confident, have the courage to say no. It is better to be safe and do it when you feel ready. I would suggest learning about the common medications for that particular ward / placement and build from there.

Now as a newbie you may be feeling like fish out of water, not knowing who or if you can approach different members of the multidisciplinary team such as doctors, physios, OT’s, however, my advice is go for it. If you hear that a doctor is doing a procedure ask to be present, if you notice a patient is going for a CT scan, ask if you can go and watch.  Although you will not be doing the procedures yourself it will give you a good understanding when you are in the handover or when having your own patients what the procedures entail.  Anything that came up I was there, it fascinated me, so I did not want to miss out on anything and at the end of the day, you are there to learn and are ‘supernumerary’.

I was fortunate and was able to watch the doctors carry out minor procedures on the ward such as lumbar punctures / suture removals / canula insertion,. I also watched the nurses dress wounds which required the need for the aseptic technique and even went with a patient and watched a PEG (percutaneous endoscopic gastrostomy) being fitted. I spent time with physios, SALT, dieticians, discharge liaison team, and I even got to spend time within the A & E department when specific urgent cases came in that related to the ward I was on. Currently with COVID – 19 it is little harder as we are not allowed to spoke out to other areas, however, make the most of your placement area as I am sure they will be plenty of learning opportunities depending on the speciality.

By the end of this six-week placement, I felt so much more confident and really enjoyed my time. I was sad to leave the patients and the staff as they all made me feel a part of their team.

Fast forward to 2nd Year. This placement took place during COVID-19 and was within the community. Another area I was interested in and again was fortunate to get.  The hours were Monday – Friday and I would be out visiting patients and attending care home visits with a registered nurse. The first week, I admit was slow for me. I am someone who likes to just get stuck in especially as our second placement of first year had previously been cancelled, so by this point I was super eager to just learn and do everything. However, this first week again was about getting to know the routine (which in hindsight, was not a bad thing).

This placement was very different from the previous acute placement, in that I was on placement every day, it was more of one-to-one learning and our days varied in terms of what we were required to do and who we were to see.

A typical day would consist of attending the insulin visits in the morning, this allowed me to really understand diabetes and the management of the patient’s condition. After the insulin visits, we could then attend anything, every day was different. The type of visits I attended when on placement ranged from wound care, catheter care, injections, syringe drivers, end of life visits, dopplers, suture removal, bowel care, all which I learnt a great deal from. As I had that one-to-one supervision, I was able to be involved in so much and ask endless questions. Then lastly we attended the evening insulins which usually started about 3:30 – 4pm. Now some people may not find community interesting, but I loved it. I was able to build a rapport with patients and get to see them on a regular basis and what was really lovely was seeing patients improve over time and even being discharged from the community care team.

Now do not get me wrong. I had my wobbles and my off days, more so since COVID-19 hit hard whilst on placement. This meant that any spoke days that I had arranged with other specialities had to be cancelled. I was angry and upset because as a student it is our time to be able to learn and I felt like I was missing out, however I understood the rationale for this decision which was we needed to ensure the safety of our colleagues and our patients. I reached out to my assessor and supervisor and they made sure that my learning did not suffer. I enjoyed it so much that this so far is where I would like to work when I qualify.

Below are some tips from me regarding placement which I feel is important to mention.

Tips when on placement

  • be willing to learn.
  • Ask questions
  • do not be afraid to ask for help.
  • do not be afraid to say no to something you do not feel comfortable doing.
  • be polite and courteous to everyone you meet.
  • be professional.
  • be on time.
  • Speak out if you see bad practice (through correct channels of course)
  • Spend time with your patients, you are supernumerary, you can do this!
  • If you see or hear that a doctor or another nurse is about to do a procedure or something you have not seen before ask to tag along, they usually do not mind!
  • and lastly, have fun, it may be your first placement, but before you know it you will soon be on your last, enjoy this time as a student.

If you take anything from this today, let it be that it is ok to be nervous, it is ok not to know anything, just go with the willingness to learn and you will be fine. Although I have had wobbles, I would not change it for the world.

Mandi

xx

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