Wednesday, 30 May 2012

The Basic Facts of Nursing:

Let’s talk about the ABCs of Nursing – for once I’m not talking about your Airway, Breathing and Circulation (of ABCDE assessment) but actually the basics about doing a Nursing course. Let’s assume you have read my suggested book by Sarah Snow “Get Into Nursing & Midwifery: A Guide to Application and Career Success” or have done an Access Course or have already the prerequisite Level 3 work. On top of that you get short-listed to an interview and pass the required Maths & Literacy tests prior to the interview. Having passed that, you go to the interview and you simply wow the panel and you get it! They offer you your desired place in the branch of your choice. Well done you!!

                You will have many days in placement where the other posts will make more sense. But this one is about the FAQs potential students ask all the time. Money. Time. Childcare. Weeks of study. Holidays.

                First things first: I’ve stated this before; it’s worth mentioning again. Nursing is very competitive – DO NOT APPLY LATE. The deadline for UCAS is the 15th January – don’t be late if you really, really want to be considered for a place. At present, most universities have two intakes – September and May (or this may be March) but two intakes nevertheless. It’s up to you which one you’d prefer but applying for September does not guarantee you a place in May should that be full as people will have applied for May and there are fewer places on the May cohort. To increase your chances, do not apply late. Just in case it hasn’t been said enough: don’t apply late!
                Time. You’re not going to have lots of it. Other students, such as the ones who do humanities subjects, go to university for 24 out of the 52 weeks of a year. They have 2 hours of lectures per week per module. I don’t know what they do with their time but nor will you, dear nursing student. You will have 45 weeks of studying and/or working in placement which is full-time hours of 37.5 hours a week. Work and placements are done in blocks of time so you will have up to 7 weeks of time at university, doing theories and/or assessments and then you will have 12 weeks out in placement, of which you may have to change placement areas every 2 weeks. In your management placement (your last placement before you qualify) you will do 16 weeks in the same place, but that is the exception.
University time spent in lectures is from Monday to Friday, 9 to 5 pm, including any group work or skills lab you may have. When you’re finally used to this routine, it’s time to go to hospital or community for your placement. This will vary enormously and the times may be Monday to Friday, 9 to 5pm or it may be the hospital rota of 37.5 hours per week of any day or night at the usual shift pattern of 12.5 hours per shift (with an hour’s break), over 3 days for 3 weeks and 4 days one week.
What about holidays, you ask? Students seem to have an abnormal amount of time on their hands. Every day is a holiday. My friend, this will not be your student experience. Student nurses have 7 weeks off a year and that’s it. “Great”, you may think, “I’ll take the 7 weeks in January when it’s filthy weather in England and go to Costa Rica for an extended surfing holiday. It’ll be surfing, casado and coconuts for me every day”. Not so, amigo. Holidays are set – those 7 weeks are set this way: 2 weeks at Christmas, 2 weeks at Easter and 3 weeks in August (which are also the times when air fares/holidays are the most expensive). As a student nurse you will get more holiday as a student then you will as a newly qualified Band 5 nurse (you only get 27 days) however compared to other student, it’s shameful. They get the 2 weeks in Christmas and Easter and break up in June and return in August. Oh the envy!
Time and attendance go hand in hand. A condition of your bursary is that you go to lectures and attend placement. If you don’t, you may be withdrawn from the course. The Nursing and Midwifery Council (NMC) set the hours you must have in order to go on the registrar: 2,300 hours in placement and 2,300 hours at university. Its simple maths: if you don’t have the hours, you can’t be a registered nurse (yes, it’s a strict course). Also, if your hours don’t add up, you may be able to redo them but it will be without any bursary or funding and who can afford to do that?
Let’s talk money then. In order to study nursing you must be eligible for a bursary. I won’t cover every single case here but suffice to say that if you’re an EEU national and have lived in the UK for 3 years, you should be okay (however you need to check this out as this is not an assessment of your circumstances). Anyway, it’s important that you are eligible for the bursary (even if you could pay your own way) because as there is no tuition fees for the nursing courses, the university get money per student eligible for bursary. This doesn’t affect your bursary or loan or amount that you would receive – it’s simply how the university gets paid and why it’s unlikely they will take anyone who doesn’t qualify for the bursary.
Nursing courses are offered at a graduate degree level now. For bursaries, this means a slight change. All eligible students are eligible for a £1,000 grant each year. This is yours to keep; you won’t have to pay back. Then you may be eligible for an additional means-tested bursary of up to £5,460 (as Uni of Greenwich is in London). Means-tested bursary will take into account your parents’, spouses’ and/or partners’ income as well as any other income you may have; however this bursary also doesn’t need to be paid back. You may also choose to apply for a loan from Student Finance England of up to £3,263 – this will need to be paid back. So that may be up to £9,723 for a year (if you were single, living in London, without children and not living with your parents). If you have children, you may also be eligible for Dependents Allowance or Parental Learning Allowance. (No tuition fees, bursary and a rewarding career, you’re starting to understand why there is so much competition).However you slice it though – expect difficult financial times ahead of you. One of the top reasons students leave this course is financial. Not only are you low on money but you also don’t have a lot of time to find work to boost your income. Students have been known to do bank shifts at hospitals and they have more money but are also more exhausted than your regular poor student nurse.
Childcare. If you have children, you will need to consider what you will do with your enchanting offspring. As mentioned above, you may be eligible for Dependents Allowance but you may also be required to use an approved child minder. Again, you will need to check this out. I guarantee you though at that some point in your interview and also at the start of the course it will be said that you need to make suitable arrangements for child care and that you cannot miss lectures or placements because of childcare. It’s very tricky. Of course there are days that you cannot go because you’re child is ill but if you consistently start missing classes or placement, this will be picked up.
Money. Time. Childcare. Weeks of Study. Holidays. I hope I’ve covered the basics but if you want more information, just ask. 

Saturday, 19 May 2012

Kozier’s ‘Fundamentals of Nursing: Concepts, Process and Practice’

You’re in your first year and you’re about to go out to your first practice. Regardless of your past experience, it’s going to be something new. Whether your only vision of healthcare has been through TV shows or reality TV, you have 2 years HCA experience or you've been seconded by your trust – you’re going to have a totally new experience when you step foot into the ward in your student nurse uniform. The only, and I mean only, difference is your level of confidence. It’s not that past experience isn't important (it is) or that your knowledge won’t be valued (it will) – it’s just that being a HCA is not the same thing as being a student nurse. Yes, there, I said it.

It is a different experience and no matter how good of an HCA you are or were, being a nurse means you’re accountable and as a student nurse, so are you. I did work some shifts and as a HCA you go in, do your work and go home. People want to complain, refer them to the nurse. Patients want their medication, refer them to the nurse. Patients want to know something about their care, refer them to the nurse. They don’t know if they should eat or drink, refer them to the nurse – I think you get the picture. That doesn’t mean that you’re rubbish as a HCA – it’s just a different role. As a student nurse, you’re going to need to know these things (but don’t worry, things start slowly).

I had no experience when I started – I had only done consultancy based work in offices or working from home. So when I stepped into a ward, it was like being in another planet. Of course, you have skills labs before placement and you have a lot of preparation but nothing quite prepared me for the fast-paced environment of a ward. Wow! It was baptism by fire, to borrow the old phrase. I very quickly decided that I needed extra support so I did some research and found a book that I could go to for help with the more practical aspects of nursing skills. Some people swear by the Royal Marsden – I found it too stuffy, oddly sectioned and didn’t like it much. I fell in love with another book – Kozier’s ‘Fundamentals of Nursing: Concepts, Process and Practice’ (I think Pearson publish it). In my years of nursing training, I have probably used every section it’s got. Nursing isn’t just doing what doctors want or knowing a few clinical skills. It isn’t an extension of the doctor’s role – it is a profession apart. If you’re nursing passively – i.e. merely following orders – eventually you will find yourself in a whole world of trouble which may end with you being struck off the NMC register. Knowing the nursing process and the frameworks we provide care from, knowing the legal and ethical dilemmas, the importance of advocacy, infection control and health promotion – this is vital information to know and operate from. There is also section after section about the clinical skills that you will need to know.

Take vital signs, for instance. This will probably be one of the first skills you’re going to learn (if doing adult nursing). If you’ve HCA experience, you’ll know how to strap on the BP cuff and the sats probe into a finger and you only need to see it once to have a fairly good idea about how to do it. However, as a student nurse you need to know about the correct positioning of it (same level as heart) and why, what the readings actually mean, what it is the sphygmomanometer is measuring and what the systolic and diastolic pressure actually mean. As a nurse, you will be accountable for all the decisions you make. So if you didn’t know (and got away with never knowing it during your 3 years training) that cardiac output is heart rate x stroke/volume and that there many factors that influence that and consequently the patient’s BP, and something happens to a patient and it just so happens that it was your observations that weren’t up to standard (or you failed to act), you will have a hard time justifying your actions. 

            You can get all stressed about the many things you will need to know or you can get a good book that you will always be able to refer to. For me that was ‘Fundamentals of Nursing: Concepts, Process and Practice’. I highly recommend it.

Monday, 14 May 2012

The NHS: Oh, the joys!

Picture yourself being a nurse – you are kind, you are caring, you are administering your care onto grateful patients who feed you lots of chocolate, fluffing their pillows along the way as your colleagues appreciate your humour and your delightful ways and you go home after every 12.5 hour shift knowing you’ve made a difference in someone’s life.

I’m not sure if I had quite that picture in my head BEFORE I started nursing but it wasn’t that different. The reality of nursing is quite different – hospital trusts are under extreme pressure to cut their budgets, getting less funding and having to admit more patients (in order to generate income) with less staff. In my last shift we were so short staffed that I was still trying to get people out of bed and washed well into the afternoon – in fact, I had to interrupt my washes and bed making to serve them lunch. Patients were getting grumpier by the hour and the nursing staff more and more stressed. And there you are as a sweet, innocent student nurse – smack in the middle of an explosion waiting to happen.

Why am I mentioning this? Well, because on top of solid interpersonal skills and having a caring nature, a potential student nurse really needs to be resilient (by resilience I mean being able to recover quickly from difficult situations). I can guarantee you that in your entry interview you will be asked some sort of questions regarding how you deal with stress, difficult situations or how you’ve dealt with past difficulties. The reason that is asked is that you are going to have more soul-destroying days than you care to think about at the moment. And how would you deal with that? You’re exhausted, you’re on your third shift in a row, you’ve barely slept or eaten well, you vaguely remember what your boyfriend/girlfriend/partner or friends look like, you’ve killed your goldfish, you’ve misplaced your children somewhere and there you have a patient’s relatives yelling at you because their mother hasn’t gone down for the scan yet and they’ve been waiting since the morning (it is 11:25am). You try and explain that the Imaging department doesn’t fall under nursing management and that they NEVER tell you when inpatients are going to be coming down because they have a long list of outpatients and have to deal with emergency imaging from A&E and ITU. It all falls on deaf ears – they are convinced you are personally keeping their poor Mama in the hospital for longer than is necessary. You try the old trick of saying you’re a student nurse and why don’t you just pop out of the bay (i.e. escape) and get the nurse who is in charge of the bay but this only makes them angrier. What do you do? How would you react?

a) You don’t take it personally, you promise them it will be done today and why don’t you just go give those nice, accommodating Imaging people a call to confirm it/hurry it along?

b) You listen empathetically but wonder what kind of day it’s going to be if this is happening already at 11:25am. When they’ve finished you patiently explain the same thing again which unfortunately comes down to there are no fixed appointments for inpatients and it gets done by prioritising cases. Which is the equivalent of saying: it’s out of my hands, it gets done when it gets done.

c) You look out the window as if there’s something really interesting and when they turn to look, you vanish into thin air (this doesn’t work if the relatives are in pairs – one never looks away).

d) This is a trick scenario. No way would this happen!!!!

If you’ve picked D, you’re probably right. On top of the screaming relatives, you’re going to have at least one patient per bay (1 in 6 at the very least) who no matter how busy you are, no matter what you are doing (even if you are giving someone CPR), is going to turn around to you, in the most inconvenient time, and say, “Love, when you have a minute, can you just go get me some ice? I must have ice for my water” (actually this did happen to me – someone had a cardiac arrest and we all rushed into the bay and an old dear did ask me to go get her some ice, just before I was to start doing CPR compressions). If you’ve picked A, I’m going to guess that you haven’t done a lot of work in hospital. My top tip: don’t promise irate people things you don’t know you can keep. If it’s another department, you don’t know what’s going on with them and what kind of day they’re having. And no one likes to be bugged about what they have to do in a hospital so unless you know the hospital, the staff and their ways of doing things, I’d steer clear of chasing things, especially as a scan can happen at 8am or 20:00. It’s not that you can’t, it’s that you should know how things are done before chasing things up.

But it is a trick scenario because you cannot know how you would react until you are confronted with this. And some days are going to be better than others. And you will learn how to diffuse situations. It’s not the situations themselves that are important but how you feel inside yourself when they are done. Do you share your frustration with a colleague and it’s done and you go back to work or are you still fuming over it when you are handing over your patients at 19:30? And though you may weather one day like this, what happens to your wellbeing when you have more demoralising days than you care to count? One word: resilience. Learn how to bounce like a tennis ball in Wimbledon and you’ll be fine.

Why do I come back? Well, just when I’m having the worst day possible, when I think I cannot possibly cope anymore, a patient comes up, squeezes my hand and thanks me for all I’ve done for them today. Or a relative will come and say how their father has really praised my work and how kind I’ve been. And then I think, “Well, maybe I’ll come back after all”. And maybe Scarlet O’Hara was right – after all, tomorrow is another day.

Thursday, 3 May 2012

My first blog!

I’m starting my first blog towards the end of my third and final year in Nursing. It may seem late to start now but the plus side of it is that I have survived three years of arduous training and now I have lots to blog about. I now look forward to finishing my management placement and starting my first Band 5 job in September – and I also look back to the three years (plus) it has taken me to get to where I am now. It hasn’t been easy but it’s also been incredibly fulfilling and I am really glad I finally did.

If you’re reading this blog because you’re thinking of doing Nursing, can I recommend a book? I recently reviewed a book, “Get into Nursing & Midwifery: A Guide to Application and Career Success” by Sarah Snow and I was really impressed with it. Sarah is optimistic throughout the book but also details the application process and how to get through it. This is very handy because as you may know, nursing education has been revised by the Nursing & Midwifery Council (NMC) and now a) nursing education will be to a degree level (no more diplomas) and b) universities have set number of students per branch. This translates to: entry requirements being raised (it is a degree course) and a lot more competition (due to limited places).

All Nursing and Midwifery students have to undergo an interview before they are offered a place. It is a good idea to have a think about why you want to do Nursing and being able to show some insight into what Nursing or Midwifery really is about. In the book, Sarah points out that a classic mistake would-be midwives make is to state that the reason they want to become midwives is because they would like to work with neonates and babies. Midwifery, Sarah clarifies, is about supporting the woman throughout the stages of her pregnancy. Children’s Nursing is where you get to work hands on with neonates and babies (I didn’t know that by the way) as I am an adult nurse. Enthusiasm will only take you so far. I was very enthusiastic about nursing but I remember clearly in the interviews I went to that they wanted to know how much I really understood about nursing and to justify my choice of Adult Nursing.

Lastly, consider this. It is very hard to imagine how exhausting the long shifts of 11.5 hours are – even more if they are at night. Difficult to imagine how stressful it is to work in what are now short staffed wards with patients who have high standards of care (ratio of medical wards can be 10 patients to 1 nurse – it’s very hard).   But it’s almost impossible to imagine what it feels like to make a lasting difference in someone’s life. What it means to hold a dying person’s hand and be present for the relatives. Or to establish an alliance with a patient and support them make better health decisions. Because nursing is more than an accumulation of clinical skills – it is essentially a caring profession that requires individuals who have commitment and interpersonal skills.