The expectations of many students heading to an emergency department are not always that high.
That’s the view of Inmaculada Diaz-Alonso, clinical nurse lead at Medway Foundation Trust’s A&E department. “They hear things, they watch emergency departments on television, or see fictional programmes such as Holby City, and I recognise that because of that we can seem like a scary place,” she says.
But Ms Diaz-Alonso says she tries to ease their nerves about it before they arrive. “Through Canterbury Christchurch University, I ask them to contact me at least three to four weeks in advance of coming in so I can talk them through who will be their contact, their shift pattern and how we work.”
That friendly culture continues on their first day, with a scheduled tour of the facilities and being provided with a student guide, which is created by the team especially for the students.
This written induction gives information on how many patients Medway sees a year (it’s 100,000), what happens during shifts and the days they will be expected to work.
“It introduces them to who we are and the way we work,” says Ms Diaz-Alonso. “There are also some descriptions of common procedures we do in there, such as burns pressing and wound closure, and a list of common acronyms that we ask them to discover during their time with us, such as COPD and TIA. They remember it better if they’ve had to find it out for themselves,” she says.
The guide is rounded off with some space to write their learning objectives and information for when they graduate, such as working on the trust’s Flexibank.
But for all the good intentions of a structure at the outset, this is a busy emergency department in the south east, which is getting busier. This is an advantage, according to Ms Diaz-Alonso. “Even though our placement deals with the unexpected, the department does have a routine, and there are certain things, such as femur fractures, falls, abdominal pain and minor injuries that they will be bound to see. They spend a minimum of two weeks at Medway, and during that time they are moved around as their mentor moves around – so they spend a week in navigation, where they observe the assessment of patients; a week in resuscitation, where again they will shadow the nurses’ work on more critical patients; and a week in the trolley area, where they will deal with patients with a wide variety of conditions, although they are clinically stable.
One week a month, a nurse will spend in minor injuries, and so a student will be transferred to another mentor if needs be to gain insight into this area.
Such a busy A&E can mean that students will get exposed to everyday trips and falls and instances of shortness of breath.
But some of the patients’ visits may be more serious. “When there are cardiac arrests or cot deaths, for example, we encourage students to see this because it’s important that they know that this is nursing. But we will always build in time to talk to them about upsetting things I am proud of my mentors, and they are all very sensitive and know when students need some time. I trust every one of my team to have a student, there is no one I wouldn’t be able to put a student with.”
Outside of navigation and rescusitation, students are encouraged to assess patients in minors, for example, and make their own assessments, which are double checked by other clinical staff.
While most of the learning experience is about shadowing and coaching, the trust is about to start some band 5 development days for staff nurses. “This will teach them basic nursing skills, as I don’t think it hurts nurses to go over things they maybe last learnt 25 years ago,” she says. “And I am going to include students in that.”
She is also going to increase students’ time with the practice development educator to go over basic skills, such as observing ECGs. Instead- students have learning sessions with the practice facilitator in the trust throughout their placements.
With such a busy department, there are up to 25 students, 18 of which were nursing students last term. But Ms Diaz-Alonso says that having students and shaping their future generation of clinicians is one of the most rewarding parts of the job.
“All our reviews from students are always nice, which motivates us to do even better next time,” says Ms Diaz-Alonso. “We are assessing the people who will care for us in 20 to 30 years’ time, so we want to make sure that we have taught them correctly and they are safe.”
Tips for providing a great placement
- Introduce yourself and the place of work before the student starts work to soothe their nerves
- Create an induction pack for students of common procedures that they will see while they are with you, and give them some learning points and features, such as acronyms or jargon, to discover for themselves while they are with you
- Give them time to talk to you if they have seen something troubling or upsetting - recognise that while a death may be commonplace to you - it may be their first time
- Don’t shield them from traumatic experiences - they should be encouraged to see what nursing is all about
- Give students some autonomy if it is safe to do so and you can double check their assessment
- Don’t be afraid to move them to another mentor in another area so they see more procedures
- Ask them about their learning objectives and check them throughout the experience as well as at the end