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!
Looking back – what advice would you give your first year self… hear are some of the things I would have liked to have known more about!
The contribution that our pockets make to the nursing profession is under-recognised! Nurses are adept at filling them – inside and out… Have you ever wondered what is inside a nurse’s pocket? Recently, some new nursing students, asked me what they would need for going on prac… and so, I turned out my pockets… this is what I found…
- Smart phone – and before that mobile phones… and before that fax machine print outs!
- Scissors: 29 years ago my enrolled nursing tutor said ‘a good nurse always carries scissors’, and since then, I have never been able to shake the habit, despite the fact that there is no evidence to support the notion! I just wanted to be good! We used a short length of O2 tubing to stick on the pointy ends to avoid getting poked in the pocket!
- Pocket clip An important accessory at one point was the metal pocket clip that had 3 or 4 stretchy pen holders – you could clip it on your pocket, then fill it with pens, scissors, artery forceps – and you looked the part!
- Notebook with hand over notes. I used to have a very cute little pocket size ring binder… so stylish! It was my favourite.
- Black pen or two… someone will borrow one pen and forget to give it back! So carry two! Actually, when I started we had a blue pen for most things, green pen for recording respiration rate on charts, and red pen for noting allergies and heart rate… it was a complicated business… – and then we made pen holder contraptions our of O2 tubing and micropore tape to attach to our pockets. It was the fashion in my hospital anyway! Then we moved on the four-colour clicking bic pen… they were all the rage! Now-a-days – black pen should do the job…
- Stethoscope… Well … nearly, more likely swinging around your neck– but sometimes they will be stuffed in a pocket. Tip: Get your own… nobody want to share earwax!
- Name tag… actually it is displayed on the outside of your uniform! But – there was a time when the most fashionable place to wear your nametag, was clipped to your pocket, and embellished with stickers! Then came the horribly unhygienic lanyard… and now we prefer the plastic magnetic nametag to wear on your top shirt pocket. But whatever the style of the era… Remember to stick it inside your pocket when you go off duty, otherwise people will look at you funny in the real world outside of the hospital!
- Neuro torch there are the disposable ones… but my favourite was a very groovy little red aluminium torch that double as my night shift torch as well. It had a key ring on the end of it, so I could attach it to my scissors to keep them together.
- Chewing gum or mint tin or a box of jols help to ward of the experience of bad smells… say no more! Just chew.
- Tube of paw paw cream… or lanolin. Ever so useful in so many situations… a blog could be dedicated to the wonders of paw paw cream alone!
- Roll of micropore tape. The nurses answer to gaffer tape!
- Sachets of alcowipes. If the problem cant be solved with paw paw cream of micropore…then the alcowipe will do the job!
- $4 for a coffee just in case someone does a coffee run. Café Latte : Skim milk and no sugar thanks. But anything caffeine laden coffee style will do!
- Bungs Nothing worse than being caught bungless and with not enough hands to fix it!
- Pair of gloves…
- Torn off piece of paper hand towel probably with U/A results scribbled on it… or vital signs… of coffee order.
- Artery forceps – no cannula too tricky!
- Prompt cards for physical assessment, mental health assessment and pathology normal range values. These helped me heaps with my report writing – especially when I was starting out!
Now as an academic nurse these days, my pocket contents has been modified slightly…
- My iphone with my facebook, twitter, instragram and linkedin apps all fired up.
- Thumb drive with the lecture of the day.
- Coloured white board markers people complain about the orange and green ones… but I like them!
- Postit notes… multi-colours preferred.
- Class roll
- Groovy coloured pen – because I get sick of black… and I like nice stationary!
- A riveting journal article to read if students are late… scribbled on with a groovy pen.
- And …still have $4 for a coffee!
I asked around and here is what other nurses said on Rural Mental Health facebook page that they put in their pockets…
Dymphia said: Alcohol wipes, IV cap, scissors, clamp, 2 x black pens, whiteboard marker, neuro torch, roll of tape.
Crystal said: Alcohol wipes, IV Bungs, scissors, clamps, numerous black pens, sharper pen, white board marker , neuro torch, tape, notebook, candy or biscuits, phone, unsolve wipes, handover paper, lip gloss (LIP GLOSS!! Nice touch)
Josie said: Duress alarm
Cassie said: Stickers and bubbles….Oh… And a few nursing bits and pieces too. Lol. But mainly bubbles and stickers. #paedsnurse
Angela said: Pens, scissors, forceps, patient list, T-bag & gloves in my right pocket. 1 vial each of Suxamethonium, midazolam, a 1+3+5ml syringes & alcohol wipes in my left pocket #aneastheticnurse
SO – there you have – nurses pockets turned out… and the contents are revealed!
This year is my 29th anniversary of commencing nursing… I have nursed in a lot of different places… and I have seen a lot of human pain, and I have been privileged enough to be in a position as a nurse to alleviate some of that pain.
I love nursing – always have! There is always something happening… it is rarely dull, not if you are playing it right!
If I had to choose the one thing that is most important for a nurses pocket – here it is: the smart phone.
One of the survival strategies for striving in a nursing career is to Be Prepared! And…one way to do that is by filling our pockets with the stuff we need, or easy and convenient access! My pocket contents have changed a bit over the time… and there is one item that I prize most and I think should be in every nurses pocket all the time… that item is your Smart Phone! Times have changed… it is a tool that we will see used more and more over the coming years with more advances in smart technologies and E health.
My tip: If you don’t have a smartphone– get one! Get involved in the social media conversion amongst nurses around the globe! And, be prepared to adapt to the changes that are upon us all. Health care promotion and intervention is increasingly happening in the virtual world… for real people!