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Challenges in 'the community'...

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As a student nurse you become used to moving around different areas of the hospital, from department to department and between specialities.

The wards may be different specialities and have different staff, but you become very comfortable with the same routine, handover, early starts and morning washes. And then you get put into ‘the community’ - completely out of your comfort zone. Sure, the shifts may not start as early but you are suddenly expected to travel around an unfamiliar area, in the car of someone you barely know. The familiar ward set-up is a distant memory and you are now faced with the scarily unfamiliar environment of a patient’s natural habitat.

I am currently completing my six-week community and district nursing placement as a third-year student nurse. I am used to that nervous feeling you get before starting a placement somewhere new. But this time around - as I knew I was in the community - the nerves really got to me, and I had no idea how to prepare for the experience. I felt like everything I had learnt on my ward-based placements was going to have to go completely out of the window and I would need to start fresh.

Thankfully, this was not the case. Essentially, the principles of nursing are exactly the same, as are the clinical skills. It is the adaption that is the tricky part, but once the daunting new environment is ‘old news’, the experience really starts to become enjoyable.

Something I have found as a student working in the community is a very high level of job satisfaction. In comparison with working on a busy ward, where I used to go home panicking that I hadn’t documented everything, or hadn’t had time to complete certain tasks for patients, the community allows for increased one-to-one patient care where you can spend the totality of the time with the patient in question, uninterrupted by other staff or other patients. I therefore find that going home at the end of a shift, I have a feeling of satisfaction as I have had time to complete everything for the patient - sufficient time to document and make sure that everything was up to date with the patient’s care.

In comparison to the wards, where the patients are in your domain so to speak, the tables turn and you become the one outside of your comfort zone. Adapting tasks and interventions you are used to completing in this unfamiliar setting can be daunting.

During my first week of placement I was given the opportunity to catheterise an elderly patient. I had only ever completed this task on a well-stocked, clean ward, and the thought of doing this in the patient’s bedroom, with limited supplies and serious infection control risks was very daunting. To make matters worse, my nerves got to me and I ended up dropping the catheter on the floor outside of a sterile field. Normally this would be embarrassing, and I would have to sheepishly ask for someone to fetch me another catheter from the clean utility to have another attempt. In the community, you can never rely on the patients having the correct equipment and this simple mistake - that I am sure many before me have made - resulted in a 45 minute round-trip back to base to collect another catheter.

Despite its challenges I have found ‘the community’ an interesting and rewarding place to complete a nursing placement. I feel like it has introduced me to a new dynamic of nursing care, developing my problem-solving and organisational skills, and in turn my professionalism as a student nurse - one day to be staff nurse.

Ellie Monsell third year student nurse on the University of Nottinghams MNursSci Course

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