Preparing for the placement

Each university will have its own curriculum expectations with regards to achievement of learning outcomes and assignment requirements. However, every student, through whatever practice assessment documents and processes have been developed, has to achieve the NMC Standards and Competencies in theory and practice in order to become a registered nurse. These combined requirements lead to an academic award (in future, a degree will be the minimum academic award to enter the nursing profession) and a professional award and subsequent nurse registration.

Earlier in this section we introduced you to some of the theoretical knowledge which will help you understand how and why individuals are diagnosed with cancer. This is important in order for you to start to plan for your cancer/palliative care placement. It is also vital that you reflect on your previous clinical experiences and consolidate knowledge you have gained in other clinical areas as well as in the classroom, enabling you to plan your learning objectives.

Before starting your placement, you should read your competency outcomes and essential skills cluster documentation and make a note of what your leaning outcomes will be on this placement. This will help you to start thinking how you might be able to meet these learning outcomes. It is important to do this ahead of time so you are prepared when you commence placement. This will ensure you maximise your learning opportunities and achievements. It will also demonstrate to your mentor that you have considered your own learning needs and are motivated, and this will be a good start at your preliminary interview.

As well as identifying the competencies you need to achieve, you also need to consider what level of practice is expected of you on this placement. This is generally dependent on where you are in your progression through the programme. For instance, as a first year student nurse, you will not be expected to work with minimal supervision, but as a final year student, this will be expected.

Although all student nurses are required to meet the NMC standards for pre-registration nursing education (NMC 2010) before progressing to registration, each university has a different method of assessing the level of competency. Benner’s (1984)From Novice to Expert and Bondy’s (1983) ‘skills escalator’ are examples of commonly used assessment strategies. Other universities may have an ‘achieved’ or ‘not achieved’ system. The NMC stipulated that this is not a sufficiently robust method and all pre-registration nursing providers will be expected to introduce a rigorous clinical assessment strategy, in which to measure the NMC Competencies.

Bondy (1983) (Fig. 6.1) uses four levels of achievement, and as students progress through their placements, they have minimum levels to achieve from 1–4. They can, however, meet a higher level in some outcomes or competencies if their mentor assesses they are working at that level. In each placement, they must meet the minimum level or the outcome/competency is not achieved. The levels are indicated in the ongoing achievement record on the corresponding ‘assessment results’ sheet for that semester. The level achieved for each outcome/competency should be recorded rather than merely a tick in the box.

Fig 6.1 Bondy skills escalator

(adapted from Bondy (1983))

Starting to develop your portfolio from the beginning of the placement is essential to ensure you are prepared for when you meet with your mentor to review and demonstrate your learning and clinical achievements, relating to the NMC Competencies and Essential Skills you need to achieve.

Planning and preparation are competencies in their own rights and, as well as being essential to starting any new placement, learning these organisational and prioritising skills will be worthwhile throughout your training and in your professional role as a registered nurse. Levett-Jones and Bourgeois (2007) offer excellent advice and guidance for students prior to, during and after placements.

Roberts (2010) outlines key things you can do to prepare before starting a clinical placement. These include making sure you attend your planned clinical skills and simulated learning sessions and also, if an opportunity is planned into the timetable, undertaking some additional practice in the clinical skills classroom, either on your own or with a colleague (make sure your skills tutors are aware that you are doing so).

Practising skills prior to undertaking a placement can enhance your confidence when asked to undertake tasks that you have been shown how to do and may have practised a few times, but still possibly lack confidence in. Skills such as taking a blood pressure, for example, will be an essential skill to learn if undertaking a cancer/palliative care placement, given the importance of blood pressure as an indicator of infection in an immunocompromised patient, such as septic shock.

Some universities also have excellent resources for students to use on their student learning Websites, accessible via personal passwords. You can also find useful resources linked to publication of books which also make a valued addition to pre-placement preparation.

A good way to dispel your fears is to make contact with your placement area. Many universities have placement details on the internal Web pages and this can be a good starting point for finding out about the area. Phone or e-mail the placement and arrange to speak with your mentor. You may use the placement checklist in Figure 6.2 to remind you of things to find out or do before starting your placement.

Fig 6.2 Placement checklist

Before your placement commences, enquire whether the placement has an induction/orientation package which will highlight the specific learning opportunities that might be available. Some universities will have these available on the Intranet before you start. In other schools, you may be given a pack on your first day or as the placement progresses.

An induction may include the following:

What to expect in the first week

Once you have commenced your placement, there will be a number of key things you will need to know and achieve in your first day and your first week.

Mapping your own learning needs to NMC competencies

You will probably be undertaking either a programme of study where the course is clearly divided into a 1-year common foundation programme (CFP) and a 2-year branch programme, or one where there is no CFP and branch evident but still requires a programme of study which enables you to achieve outcomes (NMC 2010) which are field specific (adult, child, mental health and learning disability nursing).

Regardless of which NMC outcomes you are having to achieve on this placement, the principles remain the same. You must adhere to both the Guidance on Professional Conduct (NMC 2009) and The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (NMC 2008). It is very important that you read these and discuss them with your personal tutor before undertaking placement learning and also your mentor when you meet for the first time.

During your first week of placement you should sit down with your mentor and start to review your learning outcomes and identify learning opportunities in the clinical area.

Learning about the team

Establishing a relationship with your mentor or practice learning facilitator is important right from the first day. You should have been allocated a mentor and possibly a co-mentor and you should have your first day interview with one of them. Remember that the placement will have been informed when you are due to arrive and will have allocated you a mentor. Ward staff will be expecting you and will be keen to make you welcome.

As well as being supported by a named mentor, there will be a number of other qualified nurses (now known as registrants) and other healthcare workers and professionals who will help facilitate your learning and will contribute to assessing your knowledge and skills while on placement. It is important for you to consider the specific roles and responsibilities of these individuals. This is covered in Chapter 7.

Key roles linked to student learning in practice

The mentor

Every student who is allocated by their university to gain a clinical placement learning experience has to have a named mentor who will be their main facilitator of learning, supervisor and assessor of their practice (mandatory requirement of the NMC 2008). All mentors should be experienced nurses who will have completed a course of mentorship preparation or have an equivalent qualification in their own field which is recognised as being appropriate to supervise and assess student nurses in practice (this latter individual will only be able to undertake the mentor role in specific placements and not at the major progression points within the new NMC (2010) guidance for curriculum delivery). Your mentor will be responsible for assessing your learning and competence in practice and your practice assessment document, as well as completing and signing your ongoing record of achievement (ORA) (Box 6.1), sometimes known as ongoing achievement record (OAR) (NMC 2007).

Box 6.1 Roles and expectations of you as the student and your mentor in relation to the assessment (ongoing record of achievement (ORA))*

The assessment process

Week 1

1. Student MUST negotiate with their mentor a time for their initial interview to discuss learning needs and goals and agree an action plan for achievement.

2. Student MUST share with their mentors their ORA from any previous placements and any action plans resulting from their last assessment of learning in practice.

3. Student will ensure that mentors are aware of any non-practice assessments they need to complete which may require their support for achieving, such as a client-focused assessment or evidence-based practice on a placement-specific topic.

4. Student may also have additional practice-based assessments to achieve in the placement, such as medicine management, handwashing skills or (ward/patient care) management.

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