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Perfect Placement Week - Cornwall Coronary Care Unit

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The student who nominated Cornwall’s Coronary Care Unit for this award told the judges: “I am approaching my last placement as a student and rarely have I experienced this level of tuition and mentorship. It is truly a learning experience.”

The CCU is a 10-bed critical care unit delivering many aspects of cardiac care in a well-constructed learning pathway in a busy and critical environment. It is the only coronary care unit for the county of Cornwall and therefore experiences a high demand for bed spaces and specialised nursing care. The unit cares for patients with a range of critical cardiac conditions and events including myocardial infarction, arrhythmias, acute heart failure and cardiogenic shock. The unit benefits from being joined to a cardiac catheter lab offering many procedures including angiogram and angioplasty.

This helps expose students to a range of different procedures and teaching experiences, for example there is an ECG simulator and students are offered sessions with a nurse, learning to recognise rhythms and their physiology. Each student is scheduled for a week’s experience in the cardiac catheter lab and allocated another mentor to coach and support them during that time.

Offering constant support is paramount to the CCU. The unit is staffed well with up to four nurses at any time and is managed by an experienced sister, and accept up to three second or third year students at a time, as well as paramedic students.
This ratio is essential to making students feel welcome. The ward has written its own welcome pack and manual to outline expectations, as well as lists of what they will learn and checklists to help them manage their progress.

“From the outset, we go through the routine but emphasise that they are supernumerary,” says Fiona Brittle, ward manager at CCU. “We give them a background of what to expect while they are with us and the treatments they will see while on placement here.”

The unit actually considers its teaching role as part of the working remit and therefore sets aside time and resources to prepare and deliver structured teaching experiences as part of their day to day working.

Adequate time to attend extra teaching sessions, work with other professionals and complete paperwork is offered.

CCU offers actual teaching experiences as well as the mentorship required to achieve the necessary learning outcomes. This can include ECG recognition, watching procedures in the lab, regular ABCDE assessments on patients, discussions with doctors and pharmacists, time with cardiac rehab nurses and and even attending the Friday presentations that the doctors and consultants provide for each other. There are workbooks and textbooks available as well as ECG simulators, heart models, and extremely knowledgeable staff.

There is also time for reflection and discussion of an event. As each nurse cares for a smaller number of patients in a critical environment, there is ample opportunity to work through their care holistically and systematically.

Due to the critical and emergency care offered, there are often emotionally challenging experiences to share with patients or family and students who have been with patients at their time of death, feel supported and cared for.

“We can prepare them for seeing different things, such as a sudden cardiac arrest and then reflect on that with them afterwards,” says Ms Brittle. “Students write about it afterwards and that gets into their way of thinking.”

The structure of the team, the student works closely with their mentor and is therefore able to have a personalised learning experience – often building a close relationship with their mentor.

“But we recognise this can be quite intensive for mentors,” says Ms Brittle. “So we rotate them and we allocate everyone a mentor and a co-mentor to provide them with continuity.”

CCU is a clinical environment that allows for one to one mentorship at most times. It is therefore natural that each learning experience is personalised to the needs of the student. There is time to discuss progress and work on specific tasks and students are encouraged to ask for particular experiences.

 But this does not exclude them from learning from the rest of the team. Staff members who excel at a certain skill will demonstrate this to the students, and even if a student’s allocated mentor is unavailable, they will always work with someone. The ward manager is present on the ward and also spends time with the student and learning experiences.
The team on CCU is smaller than others and due to the nature of the care delivered, team work is essential. There is excellent rapport at all levels. Students are able to learn alongside the nurses, doctors, consultants, pharmacists and housekeepers. They will work with the chest pain team or community cardiac rehab and go to local gyms to work on rehabilitation to understand the patient journey and how it affects the patients and how they cope.

The unit says it is rare that they fail a student because they can provide such one to one coaching and can really get to know a student’s strengths and weaknesses, but that they will fail if the student can not meet their high standards.

“But on the whole, we try to provide a supportive and non-judgemental atmosphere,” says Ms Brittle. “And we give praise when students do well.”

The student who nominated this placement provider believes they have achieved that. “As a student nurse on this unit I can say that this truly has been a personal as well as professional journey. I have developed in many ways during my time on CCU and will carry the skills I have learned here throughout my career.

 “I have been made so very welcome on this ward and other students remark on the same experience. We never want to leave.”

Tips for providing great placement

  • Give praise when it is due to students, try and encourage them
  • Ensure they go out in the community and see the whole patient journey, even after they have left the ward
  • Offer a co-mentorship programme
  • Build in time for reflection, especially after a traumatic event
  • Schedule in teaching experiences into every day
  • Move the student around to expose the student to new procedures and environments, but make sure they always have a mentor
  • Give the student a co-mentor so they always have someone they can talk to about their experiences
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