As the last stretch of my first placement as a student nurse approaches, I’ve learnt so much. The first day I met my new mentor and senior sisters in charge, they were honest about what I should expect, and what was expected of me. I believe ‘baptism of fire’ were the exact words. First-year student nurse, no hands-on experience, a depleted NHS and a cold winter to come… it could have all gone so wrong.
So, these are my tips for student nurses in their first year who have been allocated an emergency ward, and advice on how to survive it.
Take an active interest in your patients
It’s difficult to get into the swing of things when there’s just so much to learn and honestly, I had no idea about handovers and NEWS scores, end of life care and trigger response teams. But the only way you’ll learn is by getting involved, by paying attention and by asking questions from everyone.
During handover, make sure you ask any questions about mobility and previous medical history to get a picture of your patients. And while some nurses prefer to crack on with drug rounds, step aside for ten minutes to introduce yourself to them.
In emergency wards, patients won’t be around for long, perhaps just a few hours – heading off to other wards, being discharged home, or sadly passing away – so make the most of every minute you get.
If you have no care experience, then ask your mentor to allow you the chance to shadow HCAs (health care assistants) for the first few weeks. Trust me, you’ll soon be up to your elbows in pus, blood, and faecal matter. You’ll be turning patients who are bedbound. You’ll be changing sheets in a matter of seconds and using Tristel with bare hands. You’ll be a pro at observations and whipping out cannulas. You’ll be able to measure catheter output and food input.
Everything an HCA does, a nurse will do, so getting the basics down to a tee will be a real help when you start moving on to IVs, IMs, drug rounds and advanced obs.
Make sure you attend ward rounds and MDT (multi-disciplinary team) meetings
On your first placement this might one be a few occasions, but by the end of placement ask to sit in on ward rounds.
This is where the doctors and consultants will speak to the nurse in charge to discuss patients’ care and needs, who can be discharged and transferred, and concerns such as safeguarding and MCA (Mental Capacity Act).
The Occupational Therapists and Physiotherapists will talk through patients who need assessing, and other teams, such as community liaison and district nurses, will be able to assess patients who need to be seen regularly out of the hospital.
Once of my best spokes has been with the social care team, who ensure elderly patients get the care they need, whether that’s in their own homes, or in a specialist convalescence hospital. I wasn’t offered this, I pretty much demanded to follow the head of social service around, which brings me on to my next point…
Use your spokes wisely
First years especially are able to use their time in placement to shadow other teams and interrelated wards.
So pick a patient and follow their journey. Read their notes to see their PMH and how they came to the hospital. Read up on what OT/PT have said about their discharge home, and what tests the consultants have ordered for them. Are they heading over for scans? Does their package of care need to be increased?
Use every opportunity to follow experienced staff members around and gain insight into the wider MDT’s actions.
One patient won’t just see one nurse. They may have been BIBA (brought in by ambulance) or a family member might have been concerned and dropped them at A&E. Their GP may have been worried and suggested a trip to hospital… it never starts or ends in the ward, so use the chances you have to see as much as you can in and around the hospital.
Oh, and when it comes to spokes, you might need to be a bit direct. I told my mentor what I wanted to see and while some were viable, others (such as trigger response teams and coroner court) were a bit too advanced for my current skill levels. But we negotiated, and I approached the right people.
I’ve been commended on doing this, and being actively interested rather than just following them around. Interest in the job means good feedback to your mentor, not just that you were a lump following them around.
Do more than an HCA does
Ok, so while doing what an HCA does is great for getting a foundation in nursing care especially if you’re new to the scene, emergency wards give student nurses a great chance to learn a wide variety of skills.
Everything from overdoses and mental health management to frailty scores and NEWS escalation will be touched on. In my ward, we’ve seen suicide attempts and people in mental health crisis. We’ve seen dementia patients become aggressive and families been brought to the edge of despair. An HCA’s job is to assist, of course, but at the end of three years, you’re going to be leading treatment.
So get to grips with medicine management: learn analgesics, anticoagulants, hypertensives, beta blockers to start, moving on to steroidal drugs and IV/IM routes later. Learn what they are indicated for, and what a nurse’s responsibility is when dispensing. Should you give that tablet to someone who has a low blood pressure? It’s your job to know!
Care rounds and regular observations are the responsibility of the Registered Nurse, after all.
I walked on to the ward a bundle of nauseated nerves, scared and new. But I’ve really thrown myself in. I’ve made more mistakes than I care to remember, such as getting medication rounds totally wrong, and learnt just how difficult nursing a ward is during a cold winter.
Emergency medicine is quick and fast.
On more than one occasion I’ve left the ward at the end of my shift, returned in the morning and a stable-seeming patient has crashed. Every shift you’ll see patients being moved here and there, so the chance to learn quickly slips by. But confidence is the key. If you’re confident, then your patients won’t see you as ‘just a nursing student’ and will see you as a nurse. And you’ll start to believe in your ability, working in one of the busiest, most critical wards in the hospital.
My mentor and I have discussed my lack of confidence in great detail, and for me, I suppose it’s a way to keep myself realistic and not get complacent.
But I know that when I’m 100% focused on the task, I can admit a patient and speak to a doctor about getting a patient’s TTA ready for discharge. I can calculate a MUST and Waterlow score and escalate if needed, while on the phone to Medical Equipment for an air mattress and low-rise bed. Writing this now, I can’t believe how far I’ve come.
I’ve enjoyed my time in placement so much, and I’m genuinely so sad to be leaving. I’m so lucky to have been given a chance to experience accident and emergency, and know I’ll be taking my newly learnt skills onwards throughout my next few years!