Welcome to the exciting world of Air Ambulance and the Royal Flying Doctor Service (RFDS). Aviation nursing involves the preparation, stabilisation and transport of patients within an aeromedical environment. This position involves flying in small aircraft to areas all over Australia, with a nurse and, of course, a pilot. Much of the work is routine, which includes transferring patients to and from major hospitals for care. The other aspect of this role is retrieval work, which involves flying with a doctor to transfer acutely unwell or injured patients to the appropriate facilities.

Aviation nursing is an unpredictable, but challenging area in which to work. It involves the use of completely different skills to those used in other fields of nursing and allows you to visit a multitude of places and health services. It is a wonderful experience that will broaden your view on the world of nursing and patient care.

A basic understanding of aviation physiology prior to flying is important, as the environment is heavily influenced by the physiological phenomena of altitude, confined space and the extremes of weather and terrain. Within the aviation environment, these factors may impact on the transportation of patients and those on board. The physical environment often dehydrates individuals, which can result in a fatigue often referred to as jet-lag. The shifts can be long, particularly with retrieval work where times are only roughly estimated. To counteract these effects, it is strongly advised that you are well rested prior to flying and drink adequate amounts of fluids. The use of alcohol is prohibited for 24 hours prior to a flight.

As space is restricted on flights, there may be occasions where you may be offloaded from a flight and unable to fly. This is referred to as being ‘bumped’, and is simply a matter of weight and space limitations.

Community nursing is a specialised clinical practice area in which nurses are involved in the provision of healthcare to community-based clients outside the acute hospital facilities. Services may be provided in the clients’ homes, clinics, neighbourhood centres and schools/preschools. Usually, nurses are based in community health centres and are part of a larger multidisciplinary team that covers a specific geographical area.

Placement in the community setting gives you a unique opportunity to observe and participate in nursing services provided for clients in their own environment, either at home, in clinics or in schools/preschools. In some communities the nurse works with clients across the lifespan, for example remote-area nursing, while in other communities the nurse will work in a team, focusing on a particular population group, such as the aged, those with a chronic illness, or children and families.

For the placement to have the greatest value, you need to have a good knowledge and understanding of the core principles of nursing practice. These include codes of conduct, ethics and accountability, legal aspects of care (including consent for service), advocacy, infection control, documentation and confidentiality (client and staff). It is important that you recognise that these principles remain constant in all aspects of nursing practice, even though the work environment changes. Safety, security and manual handling have significant relevance in the community setting.

While day surgery is usually considered a development of the 20th century its origins began in the late 1800s. Today, day-surgery units (DSUs) around the world are found in integrated centres in healthcare facilities, large or small, and as free-standing centres. Many focus attention on a wide range of surgical specialties, while others select a single specialty as their primary treatment focus. Day procedure units may deal with surgical procedures and/or medical and diagnostic procedures such as endoscopy or haematology.

Students’ experiences vary widely dependent on the number and types of patients in the facility. You should find out what cases are performed, what the facility offers patients and then focus on one or two areas of interest.

Developmental disability services provide care to people with a disability of any age, in both large residential facilities and community settings. Both government and non-government disability services focus on supporting clients to lead valued, independent lives with the opportunity to participate fully in the community.

Disability services provide a microcosm of a whole range of learning opportunities. For example, students will have the opportunity to care for clients with disabilities and conditions that are rarely seen in the general public health system. These include syndromes such as Rett, congenital rubella syndrome, Dandy–Walker, cri-du-chat and cytomegalovirus.

The challenge for students is to understand the complexity of the health needs of people with a disability. Feeding, hydration and maintaining adequate nutrition are very important as many disabled clients have dysphagia (difficulty swallowing). Meeting the client’s mobility needs will often involve you using a range of equipment. Communication may be a challenge for you as many of the clients have limited or no verbal communication skills and rely on non-verbal communication, such as gestures, sign language and augmentative communication devices. Their verbal communication can also be limited to vocal sounds and/or limited vocabulary.

Substance use is widespread within the community. Among your own family, friends and fellow students you may have noticed that different people will choose to use different substances; from caffeine, alcohol, nicotine and marijuana to amphetamines, opiates and hallucinogens. Most people who use substances are able to do so in a way that causes little or no noticeable harm to themselves or others. However, you will be aware that for some people substance use may lead to differing degrees of psychological, social, legal, financial and physical problems. Many people who experience problems with substances manage the situation themselves, while others seek assistance from drug and alcohol services.

A clinical placement in the alcohol and other drugs sector provides a truly unique opportunity for students to learn first-hand about a range of interventions used in substance-use treatment, including counselling strategies such as cognitive behavioural approaches and motivational interviewing, as well as pharmacotherapies.

Some of the ethical dilemmas that you will encounter on clinical placement in this area may challenge your values and decision-making processes. These dilemmas will also provide you with valuable practical experiences in managing ethical issues that you will face throughout your future career. Motivation to change varies considerably between individuals who present for treatment. One of the challenges you will face in this placement will be the issue of seeing many clients who may be intelligent individuals, but who repeatedly use substances despite a range of negative consequences. Another challenge you will face will relate to your own views about your own substance use and that of your friends.

General practice nursing is a well-developed specialty area in the United Kingdom and New Zealand, and an emerging specialty in Australia. Although nurses have worked in Australian general practice for many years, in recent years the number of practice nurses has increased and their roles have developed (Halcomb et al. 2005). This has largely been the result of Federal Government initiatives that have provided additional funding for the employment of practice nurses and allowed practice nurses to claim Medicare items for certain procedures (Halcomb et al. 2008).

In Australia it is expected that you will work with a registered or enrolled nurse for the duration of your placement in general practice. In the New Zealand context only registered nurses fulfil the role of practice nurses. Although you may have a strong desire to gain hands-on experience, the specialised nature of the nursing role in general practice and the short consultation duration means that you may undertake significant periods of observation. It is important for both patient safety and your own professional status that you do not feel pressured to undertake duties unsupervised by a registered nurse or beyond your scope of practice (Australian Nurses Federation 2008; Nursing Council New Zealand 2008). General practice is an important learning environment for undergraduates as it provides an opportunity to participate actively in the frontline delivery of primary care. As such, it allows students to develop an appreciation of the complexity of health issues that face the community and the health services available in the general practice setting. This will assist in broadening the outlook not only of those students who wish to pursue a career in community or practice nursing, but also of those who seek employment in the acute sector. Given the increasing emphasis on primary care, now is an exciting time to be introduced to the specialty of practice nursing as there are significant opportunities to contribute to the health of the community, as well as to develop a career pathway and to participate in the advancement of the specialty.

In preparation for a placement in general practice, you would benefit from developing an understanding of the way in which general practice services fit within the broader context of the health system. This understanding will allow you to better appreciate the role that general practice nurses play across the spectrum of health and illness. Given the unique environment and models of service delivery seen in general practice, preparation for the placement should also promote your knowledge of the competency standards of registered and enrolled nurses in general practice and the legal requirements within which nurses’ practice (Australian Nurses Federation 2008; Nursing Council New Zealand 2007).

A major challenge that you may encounter is the difference in the environment of general practice compared to that of acute-care settings. In general practice, teams are often small and rely on each other to provide support and advice. This requires team members to work closely together and communicate with each other to optimise service delivery. While such an environment may foster the autonomy of the nurse in their practice, it may also create a degree of professional isolation (Halcomb et al. 2005). For students, it may be challenging to work in the general practice environment with a small group of nurse mentors for support. Before commencing a placement in general practice, you should be aware of key contacts, both internal and external to the practice, that can provide you with support should it be required.

There have been many reports, publications, texts and media stories about the poor status of Aboriginal and Torres Strait Islander Health. The opportunity to undertake a placement in an Aboriginal or Torres Strait Islander Community Controlled Health organisation and/or in a clinical area that provides health services to Aboriginal and/or Torres Strait Islander peoples is valuable learning opportunity that will help you to better understand the culture, history and health of Aboriginal and Torres Strait Islander people. This will help you in your journey towards becoming culturally safe.

As a student the aim is to learn as much as you can from the local Aboriginal or Torres Strait Islander community and those that provide services to the community. It is important to research the services and community prior to commencing the placement to ensure that you have an understanding of the protocols for the local Aboriginal and Torres Strait Islander Community. You might like to consider seeking advice from Aboriginal health workers, Aboriginal nurses, Indigenous advisors at the university or other members of the community or talk to other students that have completed clinical placements in that or a similar organisation. This will give you an understanding of the community and/or organisation you will be working in.

It is important to approach clinical placement in an Indigenous nursing context with an open mind. You may well find your concept of health and healthcare challenged by your experiences.

The type of placement will vary depending on the services offered by your host. You may have an opportunity to work in clinics at the AMS, attend outreach clinics, accompany an Aboriginal health worker or community nurse on home visits or attend community education programs. Occasionally, during these placements there will be no registered nurses to work with you and you may be asked to work with other health-service providers, such as Aboriginal health workers who have a wealth of knowledge about both Aboriginal health and the community.

The intensive care unit (ICU) is an environment that cares for critically ill or injured patients as well as the patient’s family and/or significant others. Patients in ICU have at least one organ system failure if not multiple organ failure. These life threatening conditions warrant close monitoring (for example: invasive monitoring of the cardiovascular, respiratory and neurological systems). Most ICU patients require life support devices such as ventilation, inotropic therapy, renal replacement therapy (RRT) to name a few. Because of the serious nature of the patient’s illness, they are nursed on a 1 : 1 nurse-patient ratio.

The ICU environment provides nursing students with excellent opportunities to learn and develop their nursing practice. As patients in the ICU are often totally dependent on others for holistic care, this provides a perfect opportunity to fine tune fundamental skills, including patient hygiene, range of motion exercises, positioning of patients, assisted mobilisation and, of course, meeting the psychosocial needs of the patient and family. Astute physical assessment skills are a must in the critical care environment. It is imperative that the nurse identifies subtle changes in the patient’s vital signs, pathology, etc., in order to develop critical thinking skills, engage in problem-solving and make accurate clinical judgements. The ICU setting is also diverse in that it caters to patients across the age continuum and provides opportunies for working collaboratively with multidisciplinary teams. It is an area at the cutting edge of biomedical technology and research. Therefore it provides a haven of opportunities to expand your nursing repertoire.