I’m currently three weeks into my supervised practice placement, which is the final twelve weeks of clinical practice before qualifying as a Registered Nurse. As you progress through your journey as a student nurse, you take on added layers of responsibility when you are out in practice. I think some of this is expected of us by others, laid out by our clinical grading tools and part of our development, and some of it is self-inflicted. It’s not a secret that the vast majority of student nurses put way too much pressure on themselves to ‘perform’, to both feel and appear competent, and there are, fortunately, many times that we manage to live up to our own expectations. However, there are also many times that external factors within clinical practice area make this feel very challenging. So how do you cope when this happens? What can you do to manage the situation and make it feel easier?
I had one particular shift recently in which I would not be exaggerating by saying tested me to my absolute limits. I had my own patient load, as is typical once you get to supervised practice – that particular day it was six patients – and there were a variety of factors at play which made the experience more challenging than usual. It was also a weekend day, and over thirty degrees outside, which basically meant I was on placement on the surface of the Sun. Everybody was grumpy, because nobody wants to be stuck in hospital in the middle of summer, and the children were struggling with feeling uncomfortable from the heat which added to their parents’ anxieties. It was important for me, as overwhelmed and stressed as I felt, to take a minute to remember that the families under my care were feeling a thousand times more stressed. It can be difficult to do that – nobody is a saint, and it can be easy to brush off an agitated parent as being unreasonable. Therefore I find it helps to take a minute out every so often, to constantly be reflecting, and remember the importance of holism and family-centred care. How you respond emotionally and practically to a parent ultimately impacts their child’s care, and if it’s a particularly challenging shift, making sure that this experience is as positive as possible for them can really help to manage the stresses.
So reflection obviously helped during, and after, that shift – but what else did I do to manage a highly-pressured situation?
Delegation and Team-work
I think the best resource you have as a student nurse out in practice is in fact other student nurses. There are a lot of other students in my current placement area – some are Y3 like me, and we also have some Y1 students.
On this particular shift, a Y1 student nurse who was on her second ever shift on a hospital ward (!) was allocated to work alongside me. I absolutely love teaching and peer support – it’s why I started this blog in the first place – so I was more than happy to be working with this lovely student. However, I totally underestimated just how valuable she was going to be during that shift. Being so brand new she shadowed me pretty closely, but by the end of the day her confidence had grown enormously and it was so useful to have somebody else ‘on my team’. We doubled up on taking observations, making beds up and even doing bits of paperwork, and so our jobs were done quickly and effectively. I was able to delegate some tasks within her capabilities to her which meant I could concentrate on the more complex jobs.
There was also a Y3 student on the same shift, and she basically sorted me out when I had a wobbly overwhelmed moment. It really helped to be able to talk through my list of jobs and priorities with her – and she helped me to rationalise that actually I was doing fine and everything was well under control! We do a lot of informal reflecting and debriefing amongst ourselves as a group of Y3s on this current placement. After all, nobody understands what it’s like being a student nurse better than other student nurses, and I think we are really lucky to have each-other.
Confidence and Initiative
Fake it til’ you make it, I think is the name of the game when you are in the midst of a chaotic or challenging shift. These shifts can be the greatest confidence boosters because they force you to be confident. You have to make the decisions, make the phone-calls, liaise with the various multi-disciplinary teams, escalate concerns, chase up pharmacy for the hundredth time in two hours – because you do not have a choice. Remembering that you are more than capable, your training and experience has prepared you and that your gut instinct is normally absolutely right all helps enormously.
During my first ever placement as a student nurse, my mentor taught me to draw up a grid on the back of my handover sheet with an hour by hour breakdown of what needed to be done during the day. I’ve stuck with this method for the entire three years of my training and it has never failed me. It is like the queen of to-do lists – as you tick off the hours and mark off your completed jobs, it allows you to plan your time and prioritise. Obviously, shifts are never predictable particularly in a setting where patient turnover is very high. But having it all written down makes sure things are not forgotten.
Furthermore, when it’s a difficult one where there just feels like there are not enough hours in the day, having your list of jobs written down allows you to work out what is vital and what can wait a little bit. That bed which needs making can definitely wait for a while – but that patient has IV antibiotics due soon, I need to find an RN to give those for me.
Talking about difficult shifts is absolutely invaluable. Experiences like these are a brilliant learning opportunity, but I think that learning is enhanced tenfold if you get the chance to chat about what went well and what didn’t go so well. This particular shift had possibly the best nurse-in-charge ever at the helm, who properly debriefed with us. It doesn’t have to be anything fancy – just a quick chat can make a difference. Remember – it’s more than okay to admit that you found a day difficult. We also have some pretty fab Practice Liaison Tutors to talk to if you need to.
I hope that this post was at all helpful for if you find yourself on ‘one of those’ shifts. If you’re a 1st or 3rd year student and currently out in clinical practice, keep going! We are nearly there, and you’re doing an amazing job.
Author: Beth Phillips, Year 3 Student
Disclaimer: This blog contains personal opinions of students only and does not necessarily represent the views of the Children’s Nursing team, School of Health Sciences or the University of Surrey.
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