How to survive a placement in a residential care h...

How to survive a placement in a residential care home

I’ll be honest, when I realised my second placement of year one was going to be in a care home I was disappointed. I’m one of those students who KNOWS that my future career will be in some kind of intensive environment. Something surgical perhaps, where I can wear pyjamas scrubs for my day job. Where there are MYSTERIES and PUZZLING SYMPTOMS. Where things must be diagnosed, and journeys planned for each patient. Where it’s someone new every day, and you’re left wondering what will happen to them next.

Think a mix of House, with Grey’s Anatomy thrown in, a generous spoonful of Green Wing and a touch of 999 What’s Your Emergency.

My future career plans have never been to work in a care home. Never. Care of the elderly drains me. Not because I don’t like working with older folk, or because I don’t think they ‘fun.’ I love talking to the older generation. One of the most incredible conversations I had in my first ever placement was with a 101-soon-to-be-102-year-old woman who used to drive ambulances during WWII. Her life was amazing. Her husband had died decades before I met her, and the warmth and love she had in her eyes when she spoke his name was so endearing.

It’s just, well, working in a residential home is monotonous. It’s the same residents day in day out. The same morning routine. The same medications in the same pre-prepared packs being popped out into pots and swallowed with a liquid thickener. The same medical concerns, with the same medical outcomes.

The residents were lovely. The care support staff work so hard to ensure the home stays as their home, not as a community-based hospital wing. The nurses plan with meticulous detail each Best Interest form and each Specialist Report. But I dreaded every day coming in, because I knew for me there was no excitement.

For learning the management side of taking complete care of a patient, it was fascinating. But as awful as it sounds, I felt like I lost my practical skills. Like taking a manual blood pressure, or remembering the upper and lower limits for blood pressure. NEWS wasn’t really used as patients all had DNARs in place, therefore escalation wasn’t needed. I felt as if it was a deflating end to first year, and I had serious nerves when I saw my next placement was in surgical.

What did I learn in my eight-week placement? Well, not a lot really.

There is A LOT of personal care

Every morning started off with getting the residents washed and dressed. As many were in the late stages of dementia and had learning disabilities, most required total personal care. There was a rota of shower days and wash days. On a shower, the resident would be hoisted into their shower chair, washed and dressed. On a wash day, it would take two of us to ensure they were washed in bed safely. Hair, oral care and skin management were all completed and documented.

It was great to get good personal care routines nailed down. But after a few weeks, I felt like I was being used more as an additional HCA than a student nurse. Mainly as the nurse on shift didn’t assist with personal care.

There is A LOT of paperwork

As patients very often lack capacity, it was great to see the paperwork side. Everything must be documented, including any financial assistance residence received such as pension payments and the like. However aside from doing a bit of transcription, there wasn’t much I as a student could help with as legally it all fell beyond my competencies.

It gets very lonely

The care home I was placed in was for adults with learning disabilities. As that was the case, it wasn’t possible to have a chat with them about their lives. While experiential activities were planned, like music therapies and arts and crafts, I felt incredibly lonely at times. The team was wonderful but I often left placement feeling a little deflated.

The routine

The routine didn’t change at all from the first day arrived to the last. Morning was personal care, then breakfast with morning medications. Then the residents had rest time for a snooze. Then there were afternoon activities, lunches and another rest time. On certain days a hairdresser or therapist would come in and residents could pay to have a blow dry or manicure. Then it was dinner and evening medicines before getting everyone ready for bed. Lather, rinse, repeat.

No, care homes, nursing homes, even residential homes, aren’t the type of work I want to do when I graduate. They’re an increasingly important part of the NHS, though. Run well, like my care home, they keep residents out of hospital and out of danger. Hospitals are being pulled apart with unsafe staffing levels, unsafe budget cuts, and unsafe closures. Care homes, good ones, ensure they know their resident’s daily needs and functions for the years, decades, they live there.

For me, though, it’s just not what I want. And there’s no shame in that.

Tips for a care home placement

Spoke visits will be your life. Ensure you take time to get out and about and see all the allied health professionals that interact with the residents.

Ensure you read up on each resident's personal file. This will document likes and dislikes of each patient. And if things change ask if you can update them for the next student.

Is there a student guide? If so, check it's relevant and up to date. If not, create one for the next student.

Keep busy. There will be times when there's nothing you can do. Take your books in just in case you're able to catch up on revision.