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'How can you learn to nurse without any patients?'


What happens when the location of your placement is right, but the timing is all wrong?

Claire Harries_SNT

Claire Harries is Student Nursing Times’ Learning Disabilities student editor

I’d been somewhat excited in the weeks leading up to my most recent placement. I was scheduled to work alongside nursing staff at an Assessment and Treatment Unit for adults with learning disabilities.

The unit is purpose built for those with complex mental health needs and/or challenging behaviours that can’t be managed in the community. This was to be my first and only placement of this kind and I found myself looking forward to the challenge and to finding out how I would manage when faced with the stresses and strains I’d heard about.

The idea behind this type of unit is for individuals to be cared for by staff while an assessment of their mental health, capacity, autism spectrum disorder, epilepsy etc, is carried out. This gives the team time to put together the most appropriate treatment plan before the individual is discharged back into the community.

When I first arrived, I was shocked to find only three patients on the unit.

What’s shocking about that?

Well, in addition to myself there were another three students on placement at the same time. So with the four students, plus the regular staff team, at times there were 10 of us present. 

Then, three weeks into the placement, one of the patients left, leaving us with just two. Of course, the nature of this facility means that there could be an influx of patients at any given time, but it looks like I’ve missed it. 

This means that although the nurses have taken me through the admission process and all of the necessary paperwork, I haven’t actually had the opportunity to do it for real. There’s not enough for one student nurse to do, let alone four of us.

I can’t even blame anyone: the placement can’t help that they have so few patients and with so few placement opportunities for learning disabilities students, the university are doing everything they can to give us a broad range of experiences.

Of course, the really positive thing about there being so few patients is that those who could be admitted are out there living well thriving in the community.

Community nurses do everything they can to ensure people with learning disabilities remain in their own homes wherever possible. This involves arranging and delivering training to teams of social care staff and families, as well as working closely with learning disabilities psychiatrist and other professionals.

With so few patients at the unit, I had plenty of opportunity to talk with my mentor and other staff. I really appreciated and valued the time they took to teach me and to share their stories but, all the same, it would have been nice to have these experiences myself during the placement. The staff team at the unit was great and made us feel welcome. They worked well together to deliver a range of evidence based therapies, followed Positive Behavioural Support plans and created an environment that encouraged meaningful activity.

With the end of my second year rapidly approaching, people have suddenly started asking me where I see myself working after qualifying.

Even though I realise I haven’t gained as much experience from this placement as I had hoped, I still don’t think it’s for me. I can’t quite explain why because a lot of other students loved it so much they have already decided that they want to work in assessment and treatment. 

I’m just glad I have another year to weigh up my options, because I have no idea where I want to be yet…

Does anyone else feel the same?


Claire Harries is Student Nursing Times’ Learning Disabilities student editor





Readers' comments (4)

  • It's a shame when the work to do isn't there, like you said it's nice to know the patients don't currently need an admission but I found it can leave you feeling a bit unprepared for actual practice.
    I have had placements where the work seems a little scarce, I usually spend the time doing research into whichever area I am working in, but after a while you do really long for a patient to apply your acquired skills to.
    As a student who is about to qualify, I've been looking at where I want to work and although I'm fairly settled on inpatient as it suits my style of work better and I prefer shifts to 9-5, for my first job I will just take whatever is available and apply myself to wherever I end up. I'll get pickier about it once I have some real post-qualification experience.

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  • Gerry Jones

    Yes it is quite dissapointing that you didn't have the patient throughput to allow you more hands on experience, but as the previous poster said it's also great news that more people with difficulties are being enabled to be in the general community.

    However I also believe that you have hit on another very important issue. With the current funding crisis in all of the NHS don't you believe that this level of obvious overmanning needs to be dealt with more efficiently ?

    Surely there should be contingency plans in place to more flexibly utilise these staff in other areas ?

    I work as a Manager for a medical supply company, and in all honesty this type of overmanning couldn't be tolerated in any "for profit" organisation.

    A very well presented and informative article once again Claire, apologies for playing devil's advocate, but I believe you have highlighted a very important issue.

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  • I agree Richard, I'm happy to take any job at first but I bet nobody will want to employ me after writing these blogs haha.
    Gerry- the unit is not over staffed at present, and where possible have been redeployed appropriately. However, to ensure the patient are able to engage in trips out and to appointments, use prescribed pbm interventions etc, higher levels off staff are required when compared with more traditional nursing environments. It simply seems as though there are more staff die to having four students at this time.

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  • This is actually about placing too many students in one placement at once. My team can only accommodate one student at a time, this is what our educational audit says to ensure a quality learning environment [no we are not overstaffed by any means]. I am constantly being pressed to take two or three students which means we have more students than staff and its not satisfactory for anyone. To my mind placements are in crisis and there needs to be some serious thought put into addressing this. Too often students are squeezed into placements and have to make the best of it no matter how inappropriate.

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