Four Weeks on Placement – Week 1

Four Weeks on Placement

This mini series is based around my first placement of my final year of my Bachelor of Nursing degree. The placement will be carried out a large metropolitan hospital in Melbourne, on a general medical ward, focusing firstly on older persons, then on chronic illness.
I aim to post at least weekly about my experiences, feelings and what I have learnt, or as they say – the good, the bad and the ugly.

Part one – Pre-Placement

Before placement there is a LOT to organise.

First of all there are the logistics of basically working full time without being paid. This makes it almost impossible to work (in your normal job) so if you live out of home (like I do), finances are beyond stressful at this point so you need to prepare with some savings or work out how you can save money during placement. Here are some of my best tips that I have learnt from experience.

  1. Work out how to get there the cheapest way – parking at hospitals is never cheap/affordable for students so think public transport or car pooling. If you are going to drive and park, do a drive by before placement to work out where to park and how much it will be – there is nothing worse than being late on your first day or having your car towed because you misread the time limit on the parking sign…
  2. Don’t rely on buying food every day so be prepared with lunches/dinners and snacks.
  3. As soon as you get your roster (which sometimes isn’t until the first day unfortunately), try and work out if there is a day or two you can work so you don’t end up behind. BUT! Don’t work every day that you have off! You will burn out from exhaustion which is not what you want when you’re trying to learn and care for people every other day you’re not working

Once you’ve worked out the ‘life’ side of things, the next thing is to figure out the nursing side of your placement. Look at what ward you’re on and find out what they specialize in. Then, sorry to say it, do some homework! If it’s a respiratory ward, look up some common respiratory illness’, refresh your memory on respiratory assessments and maybe even look up a few common medications.

You have to remember that the impressions you make on placement will affect you when it comes to looking at grad years. Try your best to stand out (for the good reasons) and people will be able to tell you have put in some extra effort.
For now that’s all, I have my own study I need to be doing in prep for my own placement starting in two days.

Wish me luck!

3rd year nursing placement melbourne hospital

Week One

Day One
Day one is over and I’m sorry to disappoint, but today was all orientation so it was all paperwork, formalities and well, orientation. Unfortunately for me, I have sat through this exact orientation session on a previous placement so it was less than exciting. However! I got to visit the ward I will be working on for the next two weeks!I am placed on a general medical ward and spent about an hour there today, knowing my way around. For each placement, we are given a bit of a scavenger hunt activity to do so that we can get our bearings on the ward. Think along the lines of locating resus trolleys, finding out where the nurse unit manager’s (NUM’s) office is and learning most importantly, where the staff toilet is so you can use it when you get two minutes to yourself, in between running around like a crazy person.

We also listened to a handover of the entire ward so I got a feel for the type of patients I’ll be looking after. This may be a given, since it is a general medical ward, but there is SO MUCH variety I couldn’t believe it! To be honest it kind of freaked me out a bit since there will be so many illness’, medications, contraindications, social aspects and everything else that will come into play that I will need to learn. But then it made me so excited – I get to come across new things every day that I may not have the chance to do in a specialised ward which will give me the opportunity to learn so much more about conditions I may never have thought about…

Tomorrow is a public holiday so I won’t be on placement then. But later this week, I’ll have a new update about my first ‘real day’s’ on placement.
Stay tuned xx

Day Two
And just like that I’m back in the action!

Day two started with an educational workshop that staff on my ward were involved in, related to dealing with patients with BOC (behaviors of concern – for example aggression and abuse) which I found out is EXTREMELY common on the ward I am working on the next two weeks. Great.

After this workshop was handover. If you’ve never been involved in a handover, here’s how it works:

Generally, there will be a group hand over involved with all staff (including NUM’s, ANUM’s, RN’s and any EN’s) at the beginning of a shift which briefly goes over each patient on the ward and anything that staff need to be aware of. For example, if there is a patient who frequently gets out of bed but is a high falls risk so all staff she be on alert for the falls mat alarm.

From there, staff go to their allocated group of patients – typically two nurses to eight patients – and another, more in depth hand over is done from the nurse on the previous shift. This gives more detail into the patient’s history, current situation and what the plan is for that patient. Majority of hospitals use a handover tool called ISBAR which you can find online and is great for getting all the relevant information out in a logical and consistent way.

If I were to write about each of my four patients, I would be writing for days, so I will just focus in on one ‘interesting’ patient (interesting from a student nursing perspective, not in any sort of derogatory way!). Plus, all patients who are on my ward have so many comorbidities which is why they are on a general medical ward so there are so many intertwined illness’ and factors contributing to their health, which would again leave me writing for days!

Please note: for all examples of patients, some information written is somewhat vague due to confidentiality reasons.

This patient is an older gentleman whose main reason for admission is related to his poorly managed diabetes with severe consequences. When I was involved with this patient, I was assisting with a wound dressing of (and I’m going to be honest here) probably the worst pressure injury I have ever seen… Think, deep, wide and necrotic. The wound was washed with normal saline using a sterile dressing technique and then packed with betadine soaked gauze.

3rd year nursing placement melbourne hospital

Later that day I was asked to do a set of obs on this patient – blood pressure, pulse, oxygen saturations (sats), respiratory rate and temperature. As I entered this patient’s room, he said something about a funny feeling with his breathing so the first thing I did was put the sats probe on…. 78. His sats were 78!!!

Now if I were in first year, I probably would have run to my nurse to tell her his sats were extremely low and hope she could fix it. But being in third year I had to get my critical thinking involved and unfortunately in this instance, I was faced with a bit of a dilemma.

He was in MET call criteria, BUT I could see from his charts that he had been on oxygen throughout the day and I could see that his oxygen wasn’t on. You’re probably already thinking ‘well put the oxygen back on’, but (annoyingly for me in this situation) that is wrong. As a student, I cannot administer oxygen without being under supervision as it is technically classed as a drug.

So, this was my dilemma: he is in MET call criteria but he isn’t really because if the oxygen was on, his sats would increase which would get him out of MET call criteria; I can’t put the oxygen back on myself because I’m not supervised but technically I shouldn’t leave my patient; I could call the emergency buzzer but once again, I am quite confident this is not an emergency. So, what did I do?

I asked my patient how he was feeling. How his breathing felt and if he still felt funny. I explained to him that he probably needs his oxygen back on so I will grab my nurse to help me with that. He assured me he felt fine and promised he would take a few deep breaths while I calmly, but with lightning speed, grabbed my nurse (who was barely thirty seconds away) and explained the situation. She came in and put the oxygen on and wouldn’t you know it, his sats came back up and he was fine.

I’m not going to lie, this situation was not slowly thought about as it seems here, and although this situation was somewhat scary, I was pleased with my critical thinking and of course with the outcome. My heart felt so relieved when afterward my nurse said to me ‘what you did was the right thing’.

As you can probably gauge already, being a student can be frustrating by not being allowed to do things without supervision, ESPECIALLY in situations like this. But, I have already learnt so much from this one experience and I now value the idea of stopping and thinking before freaking out.

I am now getting ready for my second shift. Once again, wish me luck!

foodmann insiders collection

Day Three, Four and Five

The joy of shift work has already taken a toll on me. In all honesty I didn’t have the energy after each of these shifts (day three, four and five) to write about my days as I was so exhausted. I’ve also just had three days off where I went camping to relax so I haven’t had access to the internet to update you all, so I thought I would summarise these three days the best I can.

The AM shifts – 7am to 3:30pm – are much busier than the PM shifts – 1pm to 9:30pm. Day three was a PM shift and the other two were AMs. Throughout all shifts I do my best to do as much as I can independently, unless of course it’s something like giving medications as this needs to be supervised. So my shifts (kind of) work out as follows:

Start of the shift is handover and then planning the shift. The ward I am working on does team nursing so it’s two nurses between eight patients and they share the workload evenly (instead of one nurse to four patients exclusively). My nurses have been great at treating me as another nurse, not as a student, so between the three of us we plan and work through our patients needs as best we can.

Things I have been able to do on these three shifts include venepuncture (taking blood), medication administration, reconstitution of and administration of IVAB (intravenous antibiotics), hygiene care, obs and of course, paperwork. Soooo much paper work! I swear there is a form for everything – drugs, wounds, risk assessments, even poo!

I have also been writing notes at the end of each shift (which I have done on previous placements as well) so I’m getting used to writing these again since they can be so specific need to be accurate. I find the easiest way for me to write my notes is in a systems approach – CNS, CVS, RESP, GIT, RENAL, INTEG, MOBILITY, SOCIAL, PLAN – as this is how the head-to-toe assessments are done so it is logical and easy to follow.

I’ll keep this update short and sweet since I need to meal prep for my next four shifts. Stay tuned for how the next few days go!

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