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'Admire students who adapt to the specialist club that is A&E'

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The redoubtable 82-year-old lady next door had a fall last week.

It happened in a DIY shop where she may have been going to renew some power tools. She is a remarkable woman - when not singing Gilbert and Sullivan, she is planning hiking holidays in Cambodia. The slightly patronising neighbour in me occasionally wonders if she needs help with her shopping. My more reasoned self suspects she has a sniper’s rifle and a pet tiger in the garden.

Anyway, she fell over and had to go to accident and emergency. What I found interesting when she recounted her experience was that her treatment sounded thorough and appropriate but the way she was treated sounded, well, a bit chaotic and for her quite confusing. Inevitably, she brought the sense of confusion home, not the clinical pathway.

After a scan, she was asked by a young man to wait for the results. Two hours later, a young woman came and told her she could go. On her way out, the young man returned and asked here where she was going.

“I was told I could go,” she said.

“No you weren’t,” he said.

“I was.”

“You weren’t.”

“Is it the case that you need me to stay?” she asked.

“Yes,” he said before marching off to deny someone else’s reality.

Thirty minutes later the young woman who had told her she could go came back to ask here why she was still there.

“I was told to stay.”

“No you weren’t,” said the woman.

And so it continued.

In the end my neighbour left, commenting later: “I got the impression that everyone in that place knows what they are doing. They just have no idea what anyone else is doing.”

I am not relaying this as second-hand criticism of people doing difficult work. It is all too easy to pretend anecdote constitutes analysis, and this can leave clinicians having to defend themselves against perceptions rather than events.

That day, I had been teaching some second-year students, some of whom were on placements in casualty. I was struck by how difficult it may be for new nurses to learn how to nurse but also to acclimatise to the pervasive working culture.

In many clinical environments, the culture becomes so deeply ingrained and then so familiar to staff that, from the outside, it can look like a specialist club.

Students sometimes talk about going into environments and feeling inadequate, unskilled or overwhelmed before emerging some months later feeling like “a proper nurse”, not necessarily because they have honed their skills but because they have managed to “fit in”. Then they move somewhere else and have to fit in again.

I don’t know if that is always a good thing. Is fitting into whatever the working culture is demands the best thing for patients, staff or students? However, I think students’ willingness to adapt says a great deal about their continued commitment - a willingness to be useful still tends to transcend the need to be educated in many of them.

Students are an easy target at the moment. In difficult times, it is usually the ones with the least power who are attacked. Yet still they come, desperate to nurse well, to do some good and to try to fit in, sometimes into environments that do not always make sense. You can’t help but admire them for that and welcome them to the struggle.

Students can find advice on handling their placements at

Mark Radcliffe is senior lecturer and author of Gabriel’s Angel.

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