RAE'S CLINICAL PLACEMENTS
Clinical Placements
My Clinical Placements So Far...
As a student nurse on my course, the clinical placement experience you get really varies between students. Especially for the first few placements, it really does seem to be just luck of the draw. For example, I was over half way through my training before I had been on a medical ward. (Although I had nursed medical patients on other wards). Even though I now know I prefer medicine and would like to work in this area, I have actually had more experience of surgical nursing! These are the placements I've had so far (in reverse chronological order):
ADULT BRANCH PLACEMENTS
Community Placement - District Nurse Team, Rosebank Medical Practice, Lancaster I'm just coming upto the end of a seven week block with the district nurses. It's been very different to the hospital nursing that I've become so used to. Nursing people in their own homes is a very different experience. The nurse is a guest in that person's home and approaches the care of that person very much on their terms - rightly or wrongly, it is rarely like that on a hospital ward. This has a huge influence on patient compliance - a subject of debate for which there is no time or space to go into right now. This has been the first clinical area where computers have been in place for record keeping, and it has been a good experience to use this system and discover staff attitudes towards it. It appears to work quite well, and I would happily use computerised records on a ward setting. However, there are still a lot of paper records being kept which are then duplicated by the computer entries. This to me seems to be unecessary and a symptom of the state of transition between the old documentation and the new. I have also learned much about record keeping in general through assisting the team leader in her audit of records of the current caseloads. I feel I am finally able to discern what is useful and what is irrelevant patient information and I hope that my care-planning and documentation skills will have improved significantly from this exercise.
Continuing Care - ward 23 (RLI)
Ward 23 is a combined elderly rehab and rheumatology ward. The merger of two formerly independent units has resulted in some tensions and unsettling within the staff, but overall the ward is coping well with what must have been a difficult transition phase. I really enjoyed this ward. The philosophy of care is built on maximising independence (along the lines of Orem's model) and promoting dignity and self worth to the (mainly) elderly client group. Although one cannot get away from the fact that it is a hospital ward, the aim is to make the environment as 'normal' as possible. Patients' own clothes are worn throughout the day, as opposed to nightwear, and meals are taken in a dining room (unless the patient particularly wants to eat at the bedside). A self-medication system operates at varying levels where appropriate in order to educate patients regarding their medication and prepare them for self-medicating following discharge. The discharge planning is the best I have seen, with strong liaison with other multi-disciplinary team members and community staff. One of the most difficult things to learn, coming from hectic acute wards to ward 23, was to stand back and allow patients to do things for themselves instead of rushing round doing everything for them - and one of the most satisfying things was to see the confidence and independence of these individuals growing through the patient support of the nursing staff.
Finally, with regards to this placement, I must mention my most satisfying experience of my nursing career so far. It was in fact giving someone a bath. Seemingly not the most remarkable of events for most of us, but this lady, who suffered from chronic rheumatoid arthritis, had not been able to have a bath for the past three years. In assisting her to do this I recieved the warmest gratitude - and it really made me feel so good! Just shows how the simplest things we take for granted can make a huge difference when they are no longer available to us...
Acute Medical - ward 2(RLI) This was my first medical ward and lasted for ten weeks from November 1998 right through Christmas. I loved this ward! It was exceptionally busy mainly due to the 'flu epidemic which swept the country in December and January - affecting both staff and patients. Perhaps because of the hectic pace and the staff shortages I was given more responsibility than ever before and in taking this on I gained so much confidence. Despite being so busy, the nursing style was still far more holistic than on my surgical placements and the involvement of the multi-disciplinary team was far more evident. Overall a very good experience indeed.
General Surgery - Ward 33 (RLI) I have just finished my ten week placement here, and I'm so glad it's over! It has been my least enjoyable placement so far. The pace was so fast and the ward was very understaffed - which means of course that students get treated as dogsbodies for much of the time rather than having the time and space to really learn. Added to this was the fact that we had an important exam to study for in the midst of all this. It made for a very stressful time and I often wondered what am I doing this for. Ward 33 is a mixed gender 28 bedded ward which is always full. As soon as someone is discharged there is another patient waiting to come in. It takes both elective and emergency cases mainly for vascular surgery and bowel surgery. There was such a lot to learn, so much interesting stuff going on, but all in all the whole experience was just too stressful by far. The staff were a mixed bunch with some very highly skilled and knowledgable nurses, but some which made us feel so stupid and worthless and treated us really badly. It was as if they couldn't remember what it felt like to be a student nurse. Having said that there were also a few really lovely nurses who worked there, but all in all the atmosphere was not good.
Accident and Emergency (RLI) I spent 2 weeks in the A&E department, which I feel was no where near long enough. I learnt loads in that short time and had a fantastic mentor who was committed to my learning even though I wasn't there for very long. I enjoyed my two weeks there, but it was not long enough to tell whether Emergency Care is for me. I doubt I will persue this area of nursing, but it has been valuble to have that insight into what goes on in the A&E department.
Orthopaedic Ward 35 Royal Lancaster Infirmary I thouroughly enjoyed my eight week placement on this ward. Ward 35 is a mixed gender 28 bedded ward which takes mainly emergency trauma orthopaedic cases. The staff on this ward were fantastic - made me feel really welcome - and the atmosphere was wonderfully light and friendly. The ward uses a team nursing approach and it is the only place I've been where I've seen team nursing really working and working well. I enjoyed nursing these patients because, on the whole, they didn't particularly feel ill, just immobilised or incapacitated, which meant that most of them were quite bored and in the mood for chatting and talking about themselves and their lives. I had never really enjoyed doing bed-baths until I worked on this ward, where when helping someone with their daily hygiene needs, you can learn some interesting life-history! The other lovely thing about the orthopaedic ward is that, more often than not, you send your patients home well. You get to see progress as patients gradually mobilise day by day, getting better all the time. That gives great satisfaction.
MINI-BRANCH PLACEMENTS
with Project 2000 you have to do short (5 week) placements in all four areas of nursing before you progress to your chosen branch (mine is adult).
Children's nursing I very much disliked this branch, not especially because I didn't want to work with children, but I felt the placements were badly organised and I didn't learn very much from them. They consisted of less than two weeks on the Children's Ward at the Royal Lancaster Infirmary (RLI); three days with a health visitor; three days in the reception class of a primary school; and three days in a nursery. The idea was that you saw healthy children as well as sick children, but personally I didn't learn much from the school and nursery placements, and two weeks is not long enough on any ward let alone on a ward where you know very little about the nursing specialty. I did enjoy the days with the health visitor however - I'd have liked more time with her.
Learning Disabilities The care of learning disabilities clients is mainly carried out in the community. I worked in a house in Lancaster - home to three mature gentlemen with LD problems. 24 hour care was provided for them from a team of nurses and nursing assistants who worked across a network of similar houses in the area. I loved this placement! But it wasn't like work at all and there wasn't an awful lot of nursing involved. I got on so well with the gentlemen who lived there and most of the staff too. I just had a great time doing everyday stuff and fun stuff too with these people who were more like friends than clients.
Adult Nursing This was a crucial one for me, since it was my intended branch. My placement was on the Gynaecology Ward at the RLI. It was hard work - long, busy shifts with only quarter hour breaks and I'd come home shatered most days, but I learned such a lot, and the staff were very supportive. I think my skills and my confidence just came on in leaps and bounds during that placement. It was a great experience.
Mental Health The Thurnham Unit, Ridge Lea Hospital, Lancaster - I have loads to say about this - I think I'll come back to it later...
FOUNDATION PLACEMENTS
Laurel Bank Nursing Home (6 weeks) I think my second placement would have been better as my first, for a more gentle start. For the most part, Care of the Elderly in Britain is in the community in places like Laurel Bank rather than in hospital geriatric wards. I was apprehensive about going here as you tend to hear such horror stories about nursing homes, but Laurel Bank was a fine place, and I found most of the residents were very happy and enjoyed their life there. The home consisted of two floors staffed by two teams of nurses and auxilliary nursing assistants each with 28 beds. I worked on "Willow" floor which was home to the less able of the residents. It was hard work and entailed a lot of very basic nursing care, but I really enjoyed it and both the residents and nursing staff were great. Besides, as one of our tutors always tells us, you can never have too much practise at those basic shitty tasks we all hate.
Lancaster and Lakeland Nuffield Hospital (6 week placement,6 weeks after starting the course)This is a small private hospital in the centre of Lancaster. Most health care in the UK is free to the public through the National Health Service(NHS), so I was suprised that my very first placement was in the private sector. The hospital dealt with a wide variety of medical and surgical cases, although the majority of patients were in for elective surgery. It was a great experience to see such a wide variety of cases, and I learned so much, but I did feel thrown in at the deep end, and feel that I'd get more out of it now, 18 months on.
BACK TO RAE'S STUDENT NURSING HOMEPAGE