The Nursing and Midwifery Council (NMC) require pre-registration nurse training programmes to be 50% theory and 50% practice.
Clinical placements provide and fulfill a number of functions, depending on the role that you have.
From a student perspective, it is a chance to experience real, clinical situations, reflect on practice and begin to comprehend the relationship of theory to practice. Alongside this, it is an opportunity to incrementally gain further skills, knowledge and competence on a journey from novice to expert in meeting with the requirements set by the NMC for registration standards.
From a mentor’s perspective it is an opportunity to act as a positive, supportive role model by teaching, assessing and offering constructive feedback on a student’s performance in the clinical setting. Further, mentoring students is a real opportunity to gain valuable feedback on one’s performance as a mentor, and identify both strengths and areas for improvement.
At an organisational level, hosting clinical placements is a good opportunity to gain alternative perspectives and constructive feedback on the care delivered to patients. As students will often be working in a particular setting for the very first time, they will come to an unknown clinical area with fresh eyes, whereas forpermanent staff, a well-known environment may make it harder to retain a level of objectivity.
It is evidential that clinical placements offer a wealth of opportunity and - depending on which perspective you take - a little overwhelming or anxiety provoking. However, it is important to remember that these thoughts and emotions are ones that many nurses will identify with from their own experience of training, so they will understand your concerns. Accordingly, there are a number of steps that students can take to prepare themselves for placements and a number of practices that they may engage in in order to get the best possible experience.
The following P`s framework may act as a memory aid:
Plan (and procrastinate not)
As with all projects, failing to plan may ultimately equate to planning to fail. Similarly, procrastination may also prevent you from being proactive in your approach. Although thinking is important in the planning stage, sometimes it may be necessary to think less and do more. Planning activities will involve making an appointment to visit the clinical area so that you are able to introduce yourself to the team and ascertain practical aspects of the environment. Such aspects include shift patterns, uniform or dress code and health and safety. Do ensure you make an appointment - otherwise, staff may not be able to accommodate your visit.
Ponder and prepare for your visit
Whilst your initial visit will be an opportunity to ascertain the issues mentioned above, it is also a time when you can start to think and formulate your own individual goals for this placement. In addition to the competencies that are set for you to achieve, clinical areas are also a golden opportunity for you to clarify issues that may have been introduced in university but are difficult to envisage or comprehend. Examples may include attending ward rounds, case conferences or other practices and procedures that are frequently mentioned.
Punctuality is more than being there and starting a shift on time. Punctuality is closely linked with professionalism and reliability. It is important to demonstrate that you can be relied upon and are dependable. Therefore, you may want to consider planning to be at placement 15 minutes before you are due to commence. Arriving early will be a contingency for any unforeseen delays - or simply provide enough time to change into your uniform.
Present yourself professionally
First impressions do count and it is a requirement of the profession that you adhere to the NMC code of conduct. In view of this, you may want to consider how you present yourself and if it reflects the NMC code. How you present and communicate with others will have an impact on developing and building the patient-nurse relationship. Remember, patients are often at their most vulnerable when they are ill and need practitioners who offer hope, sincerity, understanding and someone who they consider to be professional.
Put ‘policy’, ‘patient’, ‘practice’ and ‘professional’ into your philosophy
Modern healthcare requires us to be guided by the incorporation of the above into our work. By linking together these aspects, not only will you begin to get a greater understanding of how various systems compliment one another and how theory links with practice, you will be aided in your understanding of when tensions between them might arise. To do this, it is necessary to reflect on your practice and identify whether it meets with current policy, best practice guidelines, the needs and wishes of the patient and your professional body. Your mentor will prove invaluable in this. Do ask questions about the rationale for particular practices, keep an open mind and be willing to challenge your subjectivity. For example, why is a certain patient not being offered food or drink? It may appear that they are being overlooked, but they may be fasting for a particular reason e.g. they are due to have an operation.
As an aid to understanding the process and outcome of care, it is imperative that you understand all of the facets that aid recovery. For example, there is little point in thinking that a patient’s chest infection was treated purely with antibiotics and that solely the medication led to a successful outcome. Other interventions - carrying out a culture and sensitivity test, ensuring that sufficient or additional fluids were provided and that patients were encouraged to sit upright for periods - are all very important contributors to recovery. Therefore, process mapping may prove to be an invaluable tool in understanding the care and recovery process.
Progressively perpetuate proficiency
Following the above, it is important to learn from your reflection and take the necessary steps that will lead to improvements in care. Remember that as healthcare evolves, it is necessary to continuously update skills and knowledge in order to maintain proficiency for registration and beyond.
Proactively partner with patients and peers
Patient centredness is vital in nursing. Remember that though healthcare professionals bring expertise into the field, the patient is an expert in their experience. Do not be so naive as to think that you understand the patients’ needs without collaboratively working with them. Similarly, be proactive in developing peer relationships. Teamwork is another vital component of any practice area and all personnel have equally important and valuable roles to play. Do not undervalue your position. Remember, you have a lot to offer now and in the future. As mentioned above, you come to the area with fresh eyes and are in one of the best positions to offer feedback to your mentor about their performance.
Put yourself forward
Ask to be involved with a variety of experiences. Apart from showing enthusiasm, it also enables you gain the necessary skills required for qualified status. Though there may be other students in your placement area who will want the opportunities presented, there is no reason why you cannot demonstrate leadership skills by taking the initiative to write a schedule so that you get the chance to be involved in particular procedures. Remember - placements are busy environments and staff may not always have the opportunity to seek you out when particular nursing skills are being performed.
Nursing is a demanding job and at can, at times, be very stressful. It is important that you take care of yourself. Although you are leading a busy life and juggling many competing demands, don’t forget to schedule some time for your own wellbeing. Student Nursing Times offer some really valuable and sound advice that you may wish to read up on.
There will be times when you are faced with difficulties that you have not previously experienced. This is an ideal time to hone in and improve your problem-solving skills. A simple framework to help with this process may be: (a) define the problem; (b) think up as many possible solutions to the problem; (c) weigh up the advantages and disadvantages of each; (d) as objectively as possible, choose one solution; (e) try out the solution; (f) review and reflect on the strengths and weaknesses of the approach; and finally, (g) if the problem is not being dealt with, try out another until you find something that is effective.
Pursue your studies
Don’t forget your studies. Although placements can be quite time-consuming, it is important to factor in time for further reading and preparation for assessments that await you on your return to university.
Thomas Currid is a Senior Lecturer/Programme Director in the Faculty of Health and Social Care at London South Bank University.