2nd year blues

All through the first year of my course you will find hoards of people (by which I mean every-one) who are either newly qualified or third years who say a variation on the following:

"The second year's the hardest, you will cry and breakdown and want to drop out. the second year will be the ...

WORST YEAR OF YOUR LIFE!"

So - is it true?

Uhhhh ...

Ummm ... 

Well ... 

OK ... yes!

Where I am in my head!

 I give up - I can try and pretend that they're all liars, but they're not. These two months back at uni have been really bad, I've felt lost, scared, snowed under, like dropping out, like jacking it all in to work in a bar in Australia! People say that whatever your course the 'Second year blues' is fairly common, you've lost the energy of year 1, and the scary exciting almost finished feeling of year 3 is yet to come. So am I alone? 

I have friends who've thought about dropping out recently, because the work load suddenly goes from 0-60 in precisely no time, and for some reason everyone seems to be doing far better than you. The work load is insane, not because it's massively hard (although ...) but because nursing courses are full of little tiny bitty things that need filling out and completed, which is confusing and infuriating and crazy.

Oh and there's a three hour exam too .... yeah!

Three hours ... WTF!?

The makings of a good nurse: practical or theoretical!

Textbook good nurse:
Florence Nightingale 

What does make a good nurse? 

Answers on a postcard please. Because, really, truly, I don't know! You see the problem is, what is on paper as a good nurse  doesn't always translate into a good nurse in practice.

The nursing courses today are all degree courses, which is fantastic in empowering nurses and giving us a broad skill set that means we can work as skilled, well trained healthcare professionals. However, it also makes the occupation much more, exclusive. Suddenly people who would make awesome nurses, who could more than cope with the drugs calculations, the dressings, the comforting patients and the long hours, but can't write an essay to save their life, or reference an article for that matter. Does that make them a bad nurse? Or unsuitable for the occupation?

Not in my opinion, but then again I'm biased. I am terrible at essays, I love my lectures, love my placements and without sounding like a smug idiot - I think I'm a damn good nurse. Obviously I'm a second year nurse - I've got a long way to go, but I feel that I do do a good job when I'm on duty. I make sacrifices for the work and I love it (not making sacrifices, I mean the job!) but arguably I may never make it to being staff nurse because I really struggle with my written work.

Is it fair? Is it right? And is it the best way of selecting the best nurses in the country - especially when I for one know student nurses who are piss-poor at placement and awesome at exams and therefor are going along like super-stars ... when actually they might not make the best nurses.

Just to show that I'm not an embittered old harpy - I also have some lush friends who are brilliant on placement and brilliant at their assessments and will make brilliant nurses!

Back in the saddle!

So here we are - a brand new house, with a different set of house mates and a brand new year. Year 2 - which I promise you is totally terrifying! I am now 1/3 of the way through my course - 2 years away from being a qualified which is proper proper scary.

My scared level right now!

Obviously with each continuing year and semester, what the hospital and the uni expect from you becomes more and more, and so I find myself - a year in, and not entirely sure that I'm ready to be a second year. But hey - how do you know how something's going to go until you dive in!

So aside from being petrified about what the future holds what else is happening in Nurse P's life? Well I've discovered that a dangerous thing to say in my house is "Anyone fancy a brew?", a tolerance/love of Coronation street is vital in the house, and I'd forgotten that Cheerios are lush when your drunk!

Student nurse placement haul!

This is going to be my run down of all the stuff that in my opinion are "must haves" for the student nurse on placement and quite a few are things that I hadn't thought off before I started so hopefully this'll help you too!

• Your Uniform
  
  Might seem a little obvious, but you'd be surprised how long it takes for your uniform to arrive from your universities uniform supplier. It took me several months, and I actually had to use a non university-logoed tunic for my first placement because it was taking them so long to get the logoed ones sent out. So be prepared! You can also get a rebate on the cost of your uniform from the uni, but remember to get your application in before the deadline ... unlike me!
• ID + holder
  
  Depending on your university and depending on the trust you are training will affect the type of ID you
  
  need. For example my trust wanted us to use our normal uni ID for hospital ID, whereas other student nurses with other trusts needed them to get a special Trust ID for student nurses. Any induction days at your trust should tell you about this, but make sure you have what you need. And make sure you have a durable ID holder: some hospitals don't let you use lanyards, and some are fastened with clips kind of like a clothes peg which I don't like because I found it dragged my tunic pocket and annoyed me. There's a kind called a lever clip which I prefer because I found it kept my ID flat against my hip. Similarly if your ID is a hospital ID which opens doors to department and wards then you might want it kept on an extendible ID holder so you don't have to take it off your uniform to use it on doors.
• Pens!
  If you ever want to know how a smoker feels when trying to find a cigarette at 3am then try not having a pen for 5 minutes on the ward. There's a desperation that takes you over as you hunt and hunt and hunt and no-one else seems to be lurking about with a spare pen. So always have a pen in your tunic, and if you want my advice, then always keep a spare in your bag so that that morning when you over sleep and forget a pen - the it's not the end of the world!
• A good quality stain remover
  Your uniform WILL get grotty, and grubby and manky. From general dirt, medication spills or in my

  

  The night shift where my pen
  decided to explode!

  case biro ink! You kind of want to look as presentable as possible for most of the time, so I would recommend investing in some good stain remover. Especially since your uniform will most likely be white, bleach is also pretty good, but it's more or a high maintenance cleaning method as it's a kind of keep an eye on your washing kind of method!
• Lunch box and water bottleYou might be buying lunch at the hospital or you might be bringing a packed lunch, either way I'd recommend having a Tupperware box and a water bottle. Many housekeepers run very strict staff fridges, mine wasn't alowed to hold plastic carrier bags which is why even if I was buying a sandwich from the shop I would shove it in a tupperwear box, you may also find that your houskeeper on the ward requires you to put your name and todays date on your luch - and that's just easiser with tupperwear! Some people are a bit funny about drinking tap water so there are some really funky water bottles you can buy with a kind of built in water filter in the cap. I have never used one so I can't really recommend it, but I know loads
  
  of people in yoga use them and love them so ...
• Jewellery retainersThis one's quite a specific one! But for those of you with any piercings that are facial then you might want to invest in a piercing retainer. If you haven't seen them they're flesh coloured studs that make your piercing almost invisible and because they're flexible they're really safe.
  Depending on your hospital they might be totally cool with you having a facial piercing, or like mine they might not be cool at all! Mine isn't so I wear one in my nose piercing but it's up to you, although it's something worth looking into and considering buying.
• Hair and MakeupOne for the girls among us perhaps! General rule of thumb for nursing staff is that your hair should be above your collar, you'll see plenty of people disobaying this rule, but the only way to escape a bollocking is to follow it. Also - quite aside from any kind of infection control it makes me gag to think of my hair hanging into a wound or something! So I always wear my hair in a bun, a normal bun tends to fall out in my hair so I use a bun doughnut, it was about £2 from Tesco and I wear it every day - so I can't really recommend it highly enough!
  Also invest in a good quality moisturiser and foundation, I'm not one for high end brands or anything - but I haven't found a foundation that stays as well over a 12 hour shift as Bobbi Brown's Skin foundation SPF 15. And the combination of no air, hot wards and long hours with little sleep wreaks havoc on my skin - so make sure to invest in some kick ass moisturiser. I love Simple's light moisturiser but go for what you love!
  
  
  

So I hope that that list is all right for you all - it's not all encompassing and it's not total, and it's just my own personal list of what I felt is needed most on placement. So feel free to comment on what other things you think might be needed, and a massive good luck to anyone starting their nursing course this September!

Just jump in!

This was a piece of advice that I gave to a nurse starting her first placement, on my latest placement I was faced with so many opportunities to try out new skills that I had observed, like making up IV's, catheterising, dressings and passing NG (naso-gastric) tubes. But a lot of these things i.e. the NG tube, will happen occasionally and not on a lot of wards, so if you get the chance to do one - then do it!

A properly placed NG tube on an X-ray

Over my 10 week placement, but the time I reached my 9th week I had seen two NG's being passed, and while on a night shift one needed doing. So - putting on my best confident in this face I asked to do it. It was terrifying, it's easy to put an NG down the trachea instead of the oesophagus for example. (For the record - that is a bad idea!) And obviously, shoving a tube down someone's nose isn't much fun for them, and a lot of people have really strong gag reflexes, some people will try and hit you, scratch you and kick you, but after a point it becomes more important to get the tube down to their stomach to feed them than to avoid being maimed. With the 12 hour shifts and the missed breaks and the poor pay, half the fun of nursing is getting to be a martyr and striding into the house at 8am after a night shift to proclaim: "I got kicked in the stomach tonight but at least Mr Smith isn't going to go into a diabetic coma on my watch!"

Edith Cavell .
A WW1 British nurse, executed for helping Allied soldiers escape occupied Belgium. 

So my tip to the lovely student nurse I met on my (now former) ward, was to just jump in, if you see someone about to do something that you're interested in, then go on and ask if you can watch. I've watched:

• Chest drains, ( I actually became part of Dr Williams' Chest Drain Dream Team!)
• Lumbar punctures,
• PICO dressings,
• A Bronchoalveolar lavage,
• Seen some really funky wounds,
• Passed an NG tube,
• Removed cannulas 
• Watched a load of X-Rays

and many many more things besides. Speaking to the fellow student nurse, she was nervous and was a bit unsure about how to get to do stuff. I tried to reassure her and now I'm trying to reassure you guys too - the way to gain experience is to nag, wheedle and blag your way into watch procedures, because once you've watched once or twice, you can offer to lend a hand for the next few, and after that you can ask to do them yourselves.

Experience breeds Competence

I've now finished that particular 10 week placement, and it's now onwards and upwards, that pesky assignment that I was worried I had failed I passed so I'm clear to move onto the second year! I've moved out of halls (or the prison-cum-psychiatric hospital that my Mam christened it) and into my new shared house which is very exciting, it's going to be fun if a little difficult, we're all very different people with big personalities, different interests, different senses of humour and everything so I'm sure sparks will fly but we're all really close friends and we all love alcohol and bacon so I'm sure that things wont be too bad!

The idea that I'm now a second year student nurse is terrifying, 1/3 of the way through my course, my Mam pointed out that I left high school and started 6th form 3 years ago - and in 3 years time, I'll be a qualified in my blues, hopefully doing everything right (ish)

I'll speak to you all soon, and if any of you are particularly interested then my next post is going to be a "Student nurse haul" blog post, about what you will need for those of you starting your training in September.

Moving on and my addiction

"There is no standing still because time is moving forward."

Greg Lake

It's not something I've ever really considered, when you think of nursing you think how great it is to be helping someone, or how hard it is when there's someone you can't "fix" or the paperwork pisses you off, or the hours get you down. But I never really considered how we as nurses are expected to just move on.

Treat a patient for weeks, months or years - grow close to them and their family and then to lose them and within hours to be treating a totally new patient as if the previous were never there.

I lost a patient over the weekend, I worked Saturday - and Monday. At Monday handover we were told that we had lost her the night before, by the time drugs rounds had started the room was being fogged and by tea time we were admitting a replacement. And that's meant to be fine: we've lost A and in her place is B. You don't think that when you become a nurse - you don't imagine that you're going to be in a position where you just have to switch off and over so quickly, and it's hard - it's so hard, because it's not the kind of thing that we're programmed to do, we're meant to care, we're meant to care and yet we're meant to just move on without being emotional, and that's inhuman and hard.

So on I move, I smile and I welcome chat away - and then when I get home I think: think about how this works, I drink my tea I eat my pasta I watch my tele and I think.

"This is my life, I  can either think; there's one person who I did everything for to make their end more comfortable, I learnt from treating them, and here's a brand new person - who needs my help and who I can transfer all this new knowledge to. Or I can jump - go and leave and take myself  off and become a temp again."

And I've chosen - I'm staying. If you don't move on and fight it out and keep going then you're never going to get anywhere. Nothing worth having comes easily.

I am an addict.

I don't take drugs, I don't drink to excess, I'm not a sex addict - I'm a courgette addict. I mean I've always liked courgettes, but recently someone told me that courgette, prawns and tomatos make a lovely pasta sauce so: off I go and make some very nice pasta sauce with courgette in.
 And BOOM! I'm now on my 3rd week of eating courgette with everything - every single one of my tea's these 3 weeks have consisted of courgette with something - anything - as long as it's courgetty!
Agghh - it's so delicious! I'm going to assume that this is an OK addiction, I mean if you look at alcoholism, heroin addiction, smoking and hardcore courgette addiction and I'm pretty sure that mine'll come out the safest!

Nurse P's top 10 tips of being a nursing student!

So, it's occurred to me that the majority of you reading that will either be prospective student nurses or current nurses. So I thought I ought to do some kind of top 10 run down of tips since I'm almost at the end of my first year.

10 
There are no stupid questions.

This one's not just for nursing, pretty much anyone can benefit from this one. But in nursing, for that is what I know,  it is particularly important. Firstly in lectures, you're going to learn a lot of stuff ... or rather you're going to be told a lot of stuff that you're going to be expected to remember, and asking questions - helping you to understand the wider picture of the patient, the condition and the body. And when you're on placement ask questions, I don't mean be pestering and pulling on your mentors sleeves, but ask what condition a patient has then you can research it, ask the physio what it is they're doing, ask where things are because there will come the day when a doctor grabs you at the nurses station and says "Can you bring three blue cannulas to side room 8 please?" and you're going to have to fetch some and know where they are. Same goes for asking how something works, when your mentor asks you to set a litre of water to run through it helps if you're not staring at the machine like this!

9
It might feel like it's all hopeless - but it's better than you think.

Oh my God, it's not going in and, I'm going to be shit at this and OH MY GOD I DON'T UNDERSTAND! I'm prepared to put good money on every-one of you reading this will either have thought that at one point in the course or will do at one point or another. Yeah - we all have, I have, I will again, it's going to happen - live with it! Try not to feel as if it's all entirely hopeless, things, in my experience, tend to come together in time. Sometimes that thing that seemed like double Dutch to you in that lecture, suddenly makes sense once you attend the relevant seminar, or once you have another lecture a fortnight later that pieces the pieces together or even once you're on placement and you see that thing that makes no sense to you, in the flesh and suddenly you get it!
And there is no better feeling than something going wrong on the ward and going onto automatic pilot and knowing exactly what to do and sorting it. And I found that I knew exactly what to do once, just because the stuff that had been taught in lectures has seeped in and stuck without me even knowing and I was very proud of myself.

8. 
Buy a stethoscope. 

They are like gold dust, if you get asked to do the obs on your bay, and you can't find a stethoscope - you're screwed, so buy one and make it bright! Because when someone tries to steal it and spends the rest of your shift wandering around with it around their neck, it helps if you can spot it. I recommend Littmann stethoscopes - they are ace, genuinely the best ones you can buy, not cheap but like wine and shoes good things rarely are!

7.
Be positive.

Yeah a confused patient just tried to hit you as you were wiping their bum, yeah you're 10 hours into a 12 hour shift, yeah you're tired and hot and your feet hurt. But try to be positive, some days are going to be shit and some are going to be amazing, some will make you want to cry and some will make you want to sing with joy. But no-one, especially not the patients are going to benefit from you hating everything. Off load onto other student nurses when you get home, with a glass of wine and last nights Corrie, but the time when you're at work is the time to extenuate the positives. You might forget about that patients you looked after for 3 days 2 years ago, but chances are they wont forget you, and the aim of the game is for them to remember you as that cracking nurse who was really helpful and supportive, as opposed to that miserable bitch who walked around with a face like a slapped arse. Take your break alone, outside and let your armour fall with a cup of tea, a packet of crisps or a cigarette (whichever floats your boat - or all three!) and recover if needs be, but your patients need you to be strong, so try to be.

6.
You're not a normal student - so don't try to be.

You're at a uni - with many students attending it, and chances are you will bump into them, live with them, end up being filmed by them for course work, have sex with them or maybe even marry them! But the time will come when you realise that you're not like them,  they're different! Because all those stereotypes about binge drinking during the week, lie-ins and missing lectures are possible for them.

• Nurses have long years, a normal student will usually finish in or before June, and return late September or October. A nursing student will finish in the middle of August and start back at the beginning of September. And forget a 4-6 week Christmas and Easter, it's two weeks for us.

• Whereas a normal student will often have a 2 or 3 day week, a nursing student will have a 4-5 day working week in lectures, not to mention those pesky periods on placement with 5:30 starts.

• Due to some very specific training from the NMC guidelines, you can't really miss lectures, you'll have to sign a register and if you don't turn up then it's bye bye! 

I'm not saying that being a nurse is dull, or boring or anything even vaguely like that, I mean what other course means you spend your lunchtime laughing about catheters!? But if your flatmates are going out on the lash on a Tuesday night while you have 9am lectures the next morning, suck it up, swig some Horlicks and settle down to watch tele. You can still go out an have fun, trust me - I've drunk enough to feel a bull on occasion, but just remember that while you're both here to get degrees yours is a professional qualification and as a result you get to have a lot less mid-week fun. On the plus side you will quickly become the human equivalent of Eastenders Wiki page!

5.
Stop trying to look sexy - it's not going to work!

This isn't a vendetta against fake eyelashes or anything don't worry, I love my falsies for a night out! But in your uniform, when on placement,

don't think you're going to look like her, because you wont, I mean for a start the tunics make you look like a Moomin, the trousers make you like like your applying for a Simon Cowell look-a-like competition and those shoes ... well, if I say lesbian police-woman then you get the idea! But you know what, that ugly tunic and those trousers that come up weirdly high are actually really comfy, don't flash your arse when you bend over a patient and are loose enough so that you can bend and stretch. (The also have massive pockets that are great for stashing stuff in!) Those shoes are ugly as hell and as comfy and supportive as though you were standing on cherubs covered in silk wrapped feathers. It's the girls who come in with freshly curled hair, eyelashes that could knock out Joe Calzaghe they've got so much mascara on who start to slide down the warm sweaty slope first, you might not look sexy - but if you look no wors 12 hours after you started the shift than you did than when you started - then go and give yourself a pat on the back!

4.
Don't fall at the first hurdle.

What's this? You've failed an exam? Well - I'd give up now if I were you.

Yeah - not really - don't fall at the first hurdle, we all fail exams and think "OK, so this isn't for me, I'm off home." have a good cry, drink a lot of wine or eat a lot of cake, shout, rage, dance on your own with your ipod in but don't give up. Or at least not because you've failed an exam, if you come to realise that the course  and the occupation isn't for you then maybe you should re-think your options. But we all fail at least once and it's hard and soul crushing and we all wonder about dropping out. But remember why you started all this,   if you fail more than once and have to take a year out then that might be the time to consider your options, but until then - don't start to apply for the temp work just yet eh.
(For the record this also applies to placements, you might get a shit one where the nurses hate you, the patients hate you and you just want to curl up into a ball and weep, but for each shit one you're pretty much guaranteed 2 good placements. And while you're loving your next one - that annoying friend who loved their last one will be crying into the pillow because they hate this one!)

3.
Be appropriate.

I add this one with caution, because appropriate is a kind of a how long is a piece of string thing. What everyone thinks is appropriate is different, I mean I have no issue when doctors and nurses pop out for a fag break, but some other people do. However some things are probably universally thought of as inappropriate:
(these are all things that student nurses I know have done)

• Telling patients how shit faced you got last night/will get tonight.
• Telling lecturers how you used to be into drugs but you're "not in that scene any more"
• Telling people loudly in the staff room how much you hate Matron or Sister, hate them if you like but keep it schtum!

2.
It's poo - get over it! 

This one seems obvious for nurses, but you'd be surprised about how many people struggle with this, everyone has something that makes them retch and want to vomit, be it blood, poo, urine, fluid from a stoma bag, sputum, pressure sores ect. (For the record mine's sputum - cleaning out a trachy tube makes me want to do exorcist style vomiting.) But in the nicest possible way you need to deal with this and get on with it, it'll still disgust you and you'll still shudder but it needs doing, your patient needs you help them as best as you can - so you need to the job in hand. My top tips for getting through are:

• Grin, this helps stop the gag reflex - you'll look a bit manic and insane grinning wildly but hey, go for it it's worth it for not retching over a patient's face!
• NEVER NEVER NEVER inhale through your nose, I made this mistake once ... never never never again.

1.
Remember to laugh.

This is actually me - I'm really hairy when I don't shave.

You are on your way to having some of the best times of your life, some of the funniest incidents will happen to you when you're on the wards, you'll see the most bizarre things, have the oddest things said to you. And the best way of coping with all the bad stuff, the heartbreaking, the painful and the soul destroying is to look at the great, funny and bizarre stuff and to laugh, laugh on your own, laugh with the doctors, laugh with the nurses, laugh with fellow students and laugh with all your mates who are already concerned about your sanity, and will be even more so now!

So I hope that my 10 tops tips and advice for prospective and newly starting student nurses have been of some assistance, please do tell me in the comments section if there's anything you feel I've missed out!