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OPINION

'To my mentors, from a service-using student nurse'

  • 6 Comments

This is a different kind of blog. It’s about students, but isn’t addressed to students – it’s addressed to the mentors, practice facilitators and healthcare staff everywhere.

I recently failed a placement at an inpatient psychiatric ward during my second year.

When I say second year, I mean umpteenth year, because of my frequent repeats following some pretty regular relapses into my mental state, which sounds bad, but are pretty much the norm for me in the last few years.

Being a service-user turned student nurse is a hard position to be put in, as you are putting yourself back into the position of inferiority at the hands of nurses once again. An experience that for me became a trauma in itself.

Failing a placement is pretty much every student’s nightmare. All that hard work gone up in smoke. All those early mornings, bothering nurses for signatures and putting the placement before everything else seems for nothing. But for those of us who have used services, it feels even worse.

“I would be faced with the possibility of being sectioned by some of the nurses who trained me”

We are like most students but with a few exceptions, such as: I had to travel one hour and 45 minutes to placement as I couldn’t train in any of my local trusts because I had been treated in all of them and were on Christmas-card terms with most of their regulars. I also have a less than flattering reputation from some of their teams. I couldn’t move because I finally had a CPN who knows me and a team that supports me well.

If I moved closer I would be faced with the possibility of being sectioned by some of the nurses who trained me, which is my ultimate dread.

I also do all the other student things: huge assignments, classes and university stress, with the added bonus of having to do all this on the amount of antipsychotics that would knock out a concrete elephant.

I am pretty used to set backs and have come to accept them but this time I am going to defend myself. Because I was not failed because I was a bad student, you failed me because I am a bad service user and you probably didn’t even realise.

There was a point during this placement, as there has been in placements before, that I stopped being a student to you and became a patient.

“I stopped being a student to you and became a patient”

I had a few chief criticisms from the manager, nurses, practice facilitators and matron, which included “you have to learn to cope better with your emotions” (this was in reference to me falling to pieces when pulled into meetings with this group) and I need to “get over being told off”, “listen to us as we have been doing this a lot longer than you” and ”you need to remember that you are now a professional”.

They would pull me inyo intimidating meetings and have a go at me one at a time. I remember being so petrified that I could only answer in one-word quiet answers and I’d be accused of having “attitude”.

I once swapped a shift to try to cope with my heavy-duty depot, explained that had been a condition of my return to practice and was struggling and got sent home. When speaking out against what I felt as a service-user was wrong, I was reminded promptly that I am “a professional now”. I would get upset at something and sighed at and made to feel as low as I’ve felt when I’ve been ill, and as worthless as I have been made to feel as a patient.

I have spent the last few years at the mercy of nurses like you, some kind, and some not-so-kind.

“I have spent the last few years at the mercy of nurses like you”

I think most mental health staff are familiar with the sense of camaraderie between inpatients (especially the ‘revolving door’ guys like myself) and the almost militant attitude of those of us who have spent parts of their lives behind locked doors. By becoming a student and a ‘professional’, you are asking me to walk away from the anger and resentment against you, built up from years of incarceration, forced medicating and poor care.

In terms of ‘you have to learn to cope better with your emotions’, one of the reasons I went to pieces when being surrounded by nurses in meetings on placement is because of the eerily familiar sense of vulnerability and the predictability of what is going to happen to a disturbed patient when a group of nurses converge on them in an inpatient environment. Which we all know is an oncoming restraint.

Unlike most people; I can detect exactly when my illness started. It started in the wake of rape when I was very young. Very few people will go through their lives and not know what breaks them, but I found out early on and the experience distorted into a psychotic illness that has led me to threaten myself and others.

For those of you who have witnessed a restraint and ‘IM-ing’, it probably hasn’t dawned on you the similarity between this situation and rape.

The mechanics are not that different. Some burley men grabbing you and tearing down parts of your clothes and sticking something into you. I relived that terrible moment every time this happened, in the presence of those who knew what had happened to me and did it anyway.

“There is no such thing as getting upset about nothing”

So these convergences of a silly amount of nurses in meetings provided me with the flash backs of truly horrific abuse, and if in response to this I get upset and “go to pieces” then I have every right to and how dare you, simply because you had a 12 digit pin on a piece of paper, tell me otherwise?

There is no such thing as getting upset about nothing, one person’s irritant is another’s agony and acknowledgement of this is what you should be teaching me – but funnily enough I have looked through my skills pad time and time again and there is no box for that.

Your excuse will probably be “I didn’t know”, and my response would be “you didn’t ask”.

As for ”getting over getting told off”, maybe you haven’t been “told off” like I have. My experiences in inpatient wards include being told ”if you don’t shut up, I am going to IM you and you’ll sleep for a week” or ”I will tell the doctor to put you on a section three if you don’t go to your room” or, a personal favourite, ”you don’t want to be here? You don’t want our help? Then we won’t help you when the male patients bother you”.

Your excuse will probably be “I didn’t know”, and my response would be “you didn’t ask”.

”Listen to us as we’ve been doing this a lot longer than you”; this comments hit a sore spot. The idea that I have survived this illness for 20 years, all day, every day; and you, who has spent 7.5 hours, five days a week for a few years, think you can compare.

“I knew most of those medications inside out because I’d taken half of them”

I would stand in medication rounds and try to sound interested in what I was being lectured about, as the nurse chatting to me was totally unaware that I knew most of those medications inside out because I’d taken half of them, often unwillingly, and watched you dish them out with no understanding of why you would have to not be in your right mind to want to take them. Because we love gaining weight on olanzapine, developing tremors on haloperidol, over-salivating on risperidone and feeling sick on citalopram. Even watching a restraint and fetching equipment makes me feel like a turn-coat.

Your excuse will probably be “I didn’t know”, and my response would be “you didn’t ask”.

This may not even necessarily be a reason to hate you. I think nurses and support workers are so often onlookers into suffering that they think they know what it is and therefore how best to treat it. Those of us who become ‘professional patients’ don’t have that luxury.

But the thing is, you will never know.

All your papers, research, portfolios and codes are totally useless unless you understand that you will never understand. And if you don’t understand, how can you possibly hope to know better?

As for being a ‘professional’; I think that concept may have different meanings to you and me. To me, professionals are people who have restrained me and nearly broken my arm. Professionals who refused to come to a rape clinic because ”she’s attention-seeking and probably just doing it for attention” despite needing my downstairs stitching up. Those who put a young girl on a mixed ward and didn’t protect her from the male patients, those who made me wait all weekend after I had poured boiling hot water from the kettle into my ears to drown out the voices and wanted to wait ”to ask the consultant on Monday” so I lost a lot of my hearing. Those who locked me in a seclusion room with the hallucinations that had driven me mad in the first place or those who think because I use NHS public services that I have no right to criticise them.

These are my experiencesof professionals.

So the most obvious next retort would be; if the mental health system has failed you, why are you training to be a mental health nurse?

Simply because I know the difference nurses can make.

I have met some who almost restored my faith in the profession. Sadly on this occasion, I met those who did not.

I hope this blog teaches something to you that face-to-face, I obviously could not.

If you think you have a service-user-student who is, like me, struggling or gets upset, ask them why. Don’t just fail them.

 

  • 6 Comments

Readers' comments (6)

  • This is such an important, sad, valuable piece of shared experience and powerful writing. It deserves a wide readership. I am also a previous patient (I hate the term service user, can't bring myself to use it in relation to my own situation -though I still find myself having to parrot it to avoid a frustrating conversation about exactly why I object to it every time..) now training as an MH nurse, and have experienced some similar dynamics and practical difficulties in practice. My reasons for wanting to train, despite everything, would echo what you end your piece with. Wishing you all the best for the future (personally and professionally).

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  • Thank you for your powerful post. I was also a service user whilst training a few years ago and attempted to take my own life towards the end of my second year. I was treated by the community team I had just spent my elective placement with; they were shocked but understanding. However I'll never forget the 'nurses' that I met when I voluntarily went into hospital.

    One nurse insisted on giving me oral PRN lorazepam despite me telling her it was only for a "when needed" basis. But I was so insecure at the time I thought "well she's qualified, she must know more than me" and I ended up taking it and then spending the whole of the following day sleeping it off. The manager took umbrage to me sitting calmly on the desk at the nurses station and got me restrained when I refused to move. Even the resident OT disclosed to another patient during a 'therapy' session that I was training to be a nurse, and almost seemed to find enjoyment at the fact that I was now on the other side as a patient.

    I also remember some of the hospital staff saying I should quit the course because it was too stressful for me. There was an implied hint that I couldn't possibly be a mental health nurse if I needed treatment for my own mental illness. I agreed with them at the time and very nearly quit. I'm so glad I didn't.

    I hope you realise that the unfortunate experiences you've had will make you an incredibly emphatic nurse. And I wish you the best of luck with the future.

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  • Hi
    Thank you so much for sharing this. I am a student nurse too, in my second year.
    Your article has given me some insight and helped me to reflect on my practice both note and for the future.
    I want to share this article with my student colleagues, so that they too can gain insight and learn from your experiences.

    I'm sorry that things have gone as they have for you but thank you so much for being able to share your story with us all.

    Best wishes
    K

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  • One really has to ask are you fit to be a nurse?
    I grew up in an asylum and went on to train as a nurse in days when it was unheard of. I suffered the same things you are suffering but at the end of the day, staff are paid to care for the sick, not care for you.

    Even as a service user becoming a nurse way back in time when stigma was really rife, I had to decide if I could cope what was expected of me. I knew the score, I knew I would have to travel and it was part of my recovery to lear to mange the situation.
    As a patient, i wouldn't want someone that appears to be as disturbed as you can be, caring for me, as sad as that may sound, at the end fo the day you are there to care for others.
    I do hope you complete your training and learn to manage your MH better than you are at the moment but please remember, stigma was born in, and nurtured by the NHS.

    Being unwell physically or mentally is one thing, making life impossible, it is just not really worth it!

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  • Jane G

    I'm in a very similar situation; bereaved Mum of a little boy whose complexities meant he accessed just about every service in our locality. I too am in my second year and have to train out of area, being mindful of the change in dynamics between myself and qualified staff.

    It is incredibly hard to get the balance - I really have to prepare myself every day because I am worried about doing something, anything, to jeopardise my patients, myself and all my hard work . I'm fortunate to have had amazing mentors who offered constructive feedback and advice, and its such a shame your haven't had the same.

    I'm just wondering if you are a union member and could access advice and advocacy? And/or speak to uni?

    Thank you for writing in - such a shame it is necessary though. You aren't alone though; will be thinking of, and cheering you on from here.

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  • Do you what you are?
    You are heroes.
    Yes that's exactly what you are.
    And do you know why?

    You are becoming nurses because you have been there yourselves and know all about being powerless and to turn this into empathy.

    You are becoming nurses because you face nastiness in your placements and stress - in the true meaning of the world - everyday and you still continue working.

    Why are you all being treated like this? So badly?
    If I met you I would want to hug and cuddle you and tell you how amazing and how lovely you are.

    LOVE
    PDaveAngel

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