Preparing for going out on Clinical Placement or Practicum (Prac) takes personal courage… every Registered Nurse has been there… Personally, I think I loved all my pracs. I was able to choose a major theme for mine… no surprises… I chose mental health. Acute care and community… and loved every second. I am still in contact (and even have enduring treasured personal friendships) with some of my student-days lecturers and clinical facilitators/ mentors… some very special nurses! I remember I felt challenged with each new practicum…
IN real life…. a story for my student practicum days: I recall one experience on prac on an orthopaedic ward, where we had admitted a patient as ‘overflow’ from another ward… he had no orthopaedic problems… but he did have a tracheotomy tube in place (a consequence of smoking that he was quick to point out and recommend that smoking was a bad health choice to others)… he was a lovely fellow, and I was asked to look after him (under the supervision of a Registered Nurse). He was to be my patient load for the day… and I was determined that he would get the best nursing care known to humankind!
There was one problem though… there were no emergency dilators on the ward, should his tracheotomy tube dislodge. I was quick to note that these should be at the bedside in case of an emergency… staff around me were not too concerned about the missing equipment, after all, they wouldn’t have sent a high risk patient to the ortho ward! And… the Clinical Nurse Specialist was booked to do a round to see him each day… it should be fine!
I wasn’t satisfied with the responses I had from my ward nursing team… so I decided to discuss it further with my Clinical Facilitator when she came around to check on me later in the morning…. See, we had practised the care of a patient with tracheotomy in the simulation labs back at university the week before – something just wasn’t right. My Clinical Facilitator and I went and checked the hospital policies and procedures together… it was a book in those days, (but you would check the intranet now)! We discovered the policy concurred with my hunch that dilators should be present at the bedside at all times… so with my Clinical Facilitator, we tracked down a pair of the dilators required at the Central Sterilising department… and took them back to tape to the the bed unit wall… I reported in the handover that the safety equipment was now located at the bed unit (the Nursing Unit Manager thanked me for my diligence) I went home from that shift feeling very happy that even if they were not ever required (and it was not clinically likely in this case), I had made sure that my patient was safe!
The next morning… off my patient went for his shower… and while he was in the shower I made up his bed beautifully, refreshed his water jug, and tided-up his bed unit. I checked that the oxygen tubing was intact and the suction was working…. and the dilators were still safely taped to the wall. I was very eager to be a fine nurse… All was sparkling clean, fresh and ready for his return. As he sat on the edge of his bed… he coughed – and enormous cough…. his tracheotomy tube dislodged… fell out completely…. I could not believe my eyes… we were located in an alcove at the end of the ward… I buzzed three times for others to come and take over … (my plan in the event of an emergency was to assume a notetaker role… and being so eager to learn all I could… I would take very good notes!). Nurses came from everywhere… arriving in the room and know one knew what to do… so, I found myself applying the dilators to the patients tracheotomy to maintain his airway, while a code was called. The Junior Medical Officer appeared… and had never inserted a tracheotomy tube before…. so there I was, after practising the procedure over and over again in the simulation lab at university… guiding a bunch of senior health professionals in the procedure! My flashbulb memory persists years later… The NUM wrote a lovely commendation, and offered me a graduate position for the following year (you could do that then!). (I didn’t take her up on that offer… as it turned out… the cardiac intensive care unit offered me a spot and I took that instead). But, that was my first lesson in speaking up respectfully, being brave, being prepared and being safe.… with real life and death consequences in the balance. So… some tips from my prac to yours…
- Be brave! Yes, you will see and do things you never imagined – even on student prac! Each day will make you stronger.
- Be prepared… be ready to try new things… have a go (under appropriate supervision).
- Say yes! And, respect no!
- Mind your manners! Be quick to introduce yourself, don’t stand back and wait for introductions. Hello – my name is… I am from… I am here to help you with… Thank your patients and nursing teachers for guiding you and supporting you as you learn.
- Talk it thorough… what you’re doing, why you’re doing, how you’re doing, where you have been, and where you’re going, and … who you are doing with, and to… talk about your feelings, your thoughts and your actions as they relate to your developing practice with a trusted and confidential nursing mentor.
- Be kind to your student peers, mentors, teachers and of course – patients and their families.
- Be safe… do safety checks where and when ever you can – check the safety of equipment, processes, bed unit and environment. Every time you do a safety check you reinforce your learning and you train yourself to deliver quality care while keeping your patients and colleagues safe.
- Read all the policies and procedures you can… knowing the organizational structure helps you to navigate your way through the health care maze… and helps you to guide others towards the assistance they need too.
- Ask questions… don’t be put off by the unofficial-student-code-of-conduct that says ‘don’t ask questions so we can get out of here quicker’! Rather engage, immerse, ask, read, and listen.
- Turn-up, show-up, put-in… make yourself useful. Be ready to play an active role in the health care team, be prepared to help-out and chip-in. Onlookers need not apply.
To prepare for you own nursing practicum… you can learn more if you read Chapter One (by me and some of my past nursing students) The Australian healthcare context, Clinical Nursing Skills: An Australian Perspective. Cambridge University Press, Pages 11-19… here’s the link:
Or – ask your nursing school library for a copy.
If this has been useful to you – remember to share it with others too!