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Supernumerary? I beg to differ!

28 March 2014

When you start your first placement, mentors and lecturers stress over and over again that you are not to be counted in the staff numbers on your placement and that you must not be sucked in to becoming an extra body on days of staff shortage. You should of course help out and patient safety always overrides your learning but you should never be denied a learning opportunity just because the ward is busy and cannot do without your help.

Simple, right?

Not so. Most nursing students want to be helpful. We want to be liked and seen as hard working. Wards are almost always chronically understaffed. And who could say No when a health care assistant asks you to wash a few patients in the morning whilst your mentor is writing notes or preparing paperwork for a discharge. After all, you would only be sitting next to your mentor when you could be on the ward helping out with what most people think of as 'real nursing work'. And so, all too often, students say yes to such requests. Or we offer to help out before we are asked, thus creating a rod for our own backs. And we miss out on learning how to do discharge paperwork. But surely a patient is more important than paperwork?

Yesterday I was called to A&E by a trauma nurse who wanted to show me a particular injury on a patient who had just come in. He would be transferred to our ward after assessment so the nurse thought it would be good for me to see the entire patient journey from A&E admission to surgery to ward and eventual discharge. I left the ward to go to A&E and see the patient. When I returned 15 minutes later, I mentioned to one of the HCAs that I was hoping to go to theatre later on to see the patient's wounds being sutured and then bring him back to the ward. Her response: "Not today, you won't. We are too busy as we are an HCA short." I laughed it off and said in a jokey tone of voice: "I shall be reporting this to the university as you know we are not supposed to be denied learning opportunities just because the ward is under-staffed." The HCA laughed and encouraged me to do so in the hope it would demonstrate once again how understaffed the ward was. I was taken aback and did not know what to say to that. What should I do? Should I go anyway, knowing she said they really could not miss my pair of hands? I knew that leaving would mean a patient might have to wait a long time before having their soiled sheets changed. Or they might not get their afternoon cup of tea. Was my learning opportunity worth that? Of course you should help the patient if this is a one-off. But what if this pressure is structural?

How can they ask a nursing student, who gets compassion drilled in to her from day one, to be selfish and say: sorry but I need to put my learning needs first, I am here to train to be a nurse, not to be used as an HCA? Not every student is lucky enough to work closely with their mentor every hour of their placement and thus being protected somewhat from this pressure. I mentioned the comment to my mentor later on and she was not happy about it, saying she would rather send a student off to study in the hospital library than have them used as an extra body to make up for staffing shortages. So I felt better about it, thinking my mentor would fight my battle for me and tell the HCAs not to pressure me in to missing out on learning opportunities. Because I am simply not strong enough to do it. I simply cannot watch a patient in a soiled bed, knowing I could help if only I did not insist on learning how to write up discharge notes. On the other hand, I know that if I do that every time, I will end my degree as an excellent HCA but a rubbish nurse.

In the end, the patient did not go to surgery as it was too late in the day. He arrived on the ward straight from A&E and would have surgery the next day, when I was not on shift. I felt relieved because it meant I did not have to make myself unpopular with the HCAs by leaving the ward. However, it still made me feel uneasy. This issue has bothered me from day 1 on my first placement. How can we guarantee nursing students get a full learning opportunity when the pressure on them to help out on the ward is so great that it interferes with their learning? Especially at a time when more and more experienced nurses are leaving the profession, leaving relatively newly qualified nurses to fill the gaps, how can we ensure these newly qualified nurses have had enough suitable placement experience? I don't know the answer to this and I would love to hear from other students how they handle this pressure without feeling the burden of guilt when they walk past a soiled patient in order to learn to write discharge notes…

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This blog first appeared, in a slightly different version, as a guest blog on Britain's Nurses.

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