3 Preparation for placement learning
Introduction
You are now aware of what a medical ward is and how it works but what can you do in preparation for your medical ward placement? This chapter aims to give you some tips and preparation activities to ensure that you start your medical ward placement feeling confident and ready to learn. Remember that your practice learning opportunities make up 50% of your nurse training programme and you need to recognise the importance and value of this learning opportunity. You are an adult learner and there will be an expectation that you take personal responsibility for directing your own learning and making the best use of the learning opportunities available. You may worry that the medical ward may not be the right place for you to achieve the learning outcomes, however let us reassure you – care is always taken to place students in wards that allow them to meet their learning outcomes and placements are linked very closely to your curriculum.
Student reflection
The first day I started practice I had not much confidence at all. I thought ‘how can I do this and help a patient?’ I put myself in the mindset of a role as a nurse and this mindset helped me a lot throughout my time on practice, but I also talked to my mentor about my concerns and worries and they gave me some guidance and then, in time, my confidence grew and I was able to perform to the best of my abilities.
During your practice placement, your learning outcomes will be assessed by a registered nurse who is a qualified mentor who has undertaken a specific course that is recognised by the Nursing and Midwifery Council (NMC). Sometimes a team of mentors will support you and this may also include co-mentors or associate mentors who have not undertaken the recognised mentor course but are expected to contribute to your learning.
There are a number of aspects that you should consider when preparing for your placement:
Practicalities
First of all, when you find out the name of the ward and the location, the Website at your university will probably have placement profile information. This may contain information about the ward, who to contact, phone numbers, shift times and general advice. Do they advise any special preparation activities? It is important to contact the ward at least 2 weeks before your placement to ensure that you know when to start and, even better, if you can arrange to visit the ward before you start (Sharples 2009).
If you are a more senior student, you may need to work some night shifts or weekends to cover the expectations of your professional body for registration. Ward managers will need to know if you have any special off duty requests so that they can ensure you are allocated to an appropriate mentor who can work with you for the required amount of time to facilitate learning and assessment in practice. Even though you are supernumerary, nursing is fundamentally a practical job and you can only learn with hands-on practice and will need to be there for patient handover to ensure you are fully informed of the patient caseloads.
The university will probably have an identified lecturer who will link with your ward and it is important that you know how to contact this person and the times and dates that they visit the ward. It is also important to consider whether you have any learning needs that require discussion prior to your placement to enable the ward staff to support you appropriately. You will need to find out if there is a planned induction or welcome meeting that you need to attend and if there is a student notice board somewhere locally or centrally within the hospital. The ward will want to keep you safe while you are in your placement and you need to inform them of any adjustments or risk assessments that need to be carried out. For example, if you are pregnant you will be able to achieve your learning outcomes but will need a risk assessment outlining any adjustments required.
If this is your first placement, this is a good time to look through your learning outcomes and consider what your priorities might be and if you have any transferable skills that you can bring to the placement. If this is not your first placement, you should look at the feedback you received from your mentors in your last placement, focusing on areas of strength and areas for development, and consider what your learning objectives are for this ward.
Student reflection
My first placement was an experience that I will never forget, but before my first day of placement I prepared myself by watching the clinical skills DVD, reading the clinical skills book, reading the biology and anatomy books and also reading the lecture notes from previous lectures.
Box 3.1 What are the practicalities of this placement?
Look up the ward profile on the student Website:
1. Is there any information about your learning outcomes for this placement on the student Website?
2. Who can be your mentor? If you are a final placement student you will need a sign off mentor (NMC 2008b).
3. What shifts does the ward work?
4. What shifts do you need to work to meet the university’s expectations.
5. Do you have any special off duty requests?
6. How do you get to the placement – what are the transport links like?
7. Is there a lecturer from the university who links with the placement?
8. Is there an induction planned?
9. Do you have any learning needs that require discussion with the placement before you arrive?
10. What were the strengths and areas for development highlighted in your previous placement?
11. Do you have transferable skills?
12. What do you want to achieve in this placement?
13. What is the uniform policy?
14. Who do you inform at the university if you are sick or absent from placement?
15. Do you need to make arrangements to see your personal tutor while you are on placement?
16. Are there any university lectures, exams or assignments that you need to plan into your time?
17. Have you attended all the mandatory training at the university prior to your placement?
18. Are you pregnant? If so, have your read the university maternity policy and understand that you will require a risk assessment?
Professional standards and behaviour
As a student nurse you will not only be expected to develop clinical skills but also a certain level of professional attitude and behaviour (Parker 2009). These attributes will be assessed as part of your course and your mentors in the clinical environment will play a key part in your assessment in this area.
It is expected that, as a student nurse, you will act in a professional manner at all times. This means not just within the clinical area but in public places as well. It is essential that people feel they can trust nurses, and any behaviour which may damage the respect and credibility of the profession in the eyes of the general public could be detrimental to how safe patients feel when they are admitted to hospital (Levett-Jones & Bourgeois 2009). This may sound daunting but there is plenty of guidance and support available to help you. This chapter aims to help you understand what is expected of you and how to use the support of your mentors in the clinical area to help you develop your professional behaviour.
Good health, good character and fitness to practise
The NMC sets out what they expect from student nurses in their Guidance on Professional Conduct for Nursing and Midwifery Students (NMC 2009). At the end of your nursing course your university is required to inform the NMC that you have not only met the educational and clinical requirements of your course but also that you are in good health and are of good character. It is essential that you read this and adhere to it, and discuss it with your mentor at the start of your placement learning experience.
What does good character mean? It is based on your conduct, behaviour and attitude. It takes account of any convictions and cautions you may have that may bring the profession into disrepute.
Both of these elements are required for you to be deemed fit to practise and join the nursing register.
1. What do members of the public think when they see a nurse in uniform smoking a cigarette in a public place?
2. What do they think about a nurse doing their shopping in the local supermarket in their uniform?
3. What do they think when they overhear nurses giggling and laughing about their patients?
The areas of concern highlighted in Box 3.2 are also cited by the NMC as aspects of your personal life that may influence your ability to be judged as having good health and good character.
Box 3.2 Aspects of your personal life that may influence your ability to be judged as having good health and character
Aggressive, violent or threatening behaviour.
Criminal conviction or caution.
Dishonesty, e.g. misrepresentation of qualifications, fraudulent CV.
Health concerns, e.g. putting others at risk by not seeking help for medical problems or not recognising own limitations.
Persistent inappropriate attitude or behaviour.
Now that you have read about behaviour that is not acceptable for a nurse to display, list the positive attributes and behaviours you would expect to see in a nurse and consider how you can ensure that these are displayed in your personal and professional life.
The NMC Code (2008a) in the UK is a set of strict standards that registered nurses must adhere to. The sooner you become familiar with these, the easier it will be to ensure that your practice and behaviour are meeting the standards required for registration. Other countries will have similar guidance and standards, so ensure you are familiar with the requirements of the country you are registering in.
Accountability
Accountability is a word you may hear your mentor and other registered nurses use. It is integral to nursing practice and, although the level of accountability expected of you as a student differs from that which will be expected of you as a registered nurse, it is important that you understand what it means to you and to your practice.
Accountability can be described as (Thompson et al 2006, p. 84):
The ability to give account of one’s actions, in particular to give a coherent, rational and ethical justification for what one has done.
Registered nurses are accountable in four ways:
Professional accountability
The NMC Code (2008a) states that:
As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions.
Your mentors are accountable for passing or failing you – they need to be able to justify their decisions. At the heart of their decision will be patient safety. Patients have expectations of nurses – that we are registered, educated to a certain level, keep up to date and that we will not harm them. Patients do not expect us to know everything but they expect us to acknowledge when we cannot do something competently and to seek assistance and advice if we are ever unsure.
In our daily lives we have expectations of other registered practitioners. For example, if a gas fire is not working we would only employ someone who is a registered up-to-date gas fitter to come and fix it, as anyone else could harm us and our families.
So what should patients expect from a registered nurse? This is a good starting point:
• To know who is looking after them each shift.
• To know when the shift changes.
• To know what’s happening to them and when.
• That care is evidence-based.
• That nurses work to policies/guidelines.
• That nurses are not afraid to challenge poor practice.
• That nurses work in a team for their benefit.
• That nurses monitor the standards of care ensuring quality, safety and efficiency.
The roles and responsibilities of those who can support you doing your medical practice placement
The mentor
During your practice placement, your learning outcomes will be assessed by a registered nurse who is a qualified mentor who has undertaken a specific course that is recognised by the NMC (NMC 2008b). The mentor who assesses you must be registered within the same field of practice as you and have attended a mentor update within the last year. The placement holds registers of mentors and their updates and is expected to be able to produce this evidence for the NMC. Each mentor also has a triennial review to ensure that they are meeting the NMC Standards and a record of this is kept by each placement. Your curriculum documentation will often have a section that requires the mentor to print and sign their name, year of registered mentor course and the last update they attended to ensure the validity of your assessments.
You are expected to work with your mentor for 40% of your placement time and this must be evident through the duty roster (NMC 2008b, 2011). Your mentor may work weekends, nights, 7.5-hour or 12.5-hour shifts and your allocated duties should follow this. Mentors will also have annual leave and study days themselves, so sometimes this will be difficult to achieve and you may be allocated more than one mentor. Sometimes a team of mentors will support you and this may also include co-mentors or associate mentors who have not undertaken the recognised mentor course but are expected to contribute to your learning (NMC 2008a). Associate or co-mentors are registered nurses who you will often work with and learn from, and they will often provide feedback on your performance to your main mentor. They may do this verbally or by writing in your record of achievement, for example in a mentor comment page. However, they will not be able to assess you until they have undertaken the recognised mentor course.
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