Who Really Understands?

Reflecting back on the excitement I felt when I began my nursing journey. How proud I was being accepted into Queen’s University in Belfast. My family were so proud and supportive of me. Fast forward three years on and although they are still extremely proud of me, I question whether they really understand what my working day involves and how stressful the working day can get? Not just what the working day involves as a Newly Qualified Nurse (two weeks and counting since registration) but the continued learning process that this vocation/profession involves.

I do believe that people around me think that once you’re out in that working world you’re finished, and you can just go in do your work and come home on time. We as NQNs or even experienced nurses know, that just does not happen.

I’m two weeks in and I have a list as long as the handover of training I need to complete. Where in the world will I get the time to do it. Alot of the training is done online, chances are, some of it will have to be done at home. I will need to continue reading up on some of the skills and procedures/diseases that we come across while working. And all this is while running a household and having a social life. Let’s not consider if we have an emergency situation. It can be so mentally exhausting once that adrenaline wears off.

My family and friends will ask “have you had a good day?” I’ll smile and say, “yes it was good”. Who really understands that situation better than your nursing friends?

The moral of the story, have a good support network of nursing friends around you, either in or outside of work. They will understand you like no one else.

Lynsey https://twitter.com/lynseyf11

The Power of Words

I love words. I love how they have unique sounds, how together they can give anyone power and strength, that they can convey meaning, emotion and passion. Words in song, in poetry or on literature allow you to escape and discover new worlds and different people. Words in law or reporting or policy give us structure and clarity. I have found a new love of words in writing, watching the letters form as the ink from my fountain pen skates with twists and turns across the page and brings me a sense of calm and clarity.

But words can be dangerous, they can cut and bruise, and those wounds can take a lifetime to heal. We can hear words ringing in our heads of times that we have been told negative things about ourselves or others. Words can segregate, incite hatred and condemn people. Words can cause us torment, angst and long term mental health issues.

In this world where we write less and less on paper, but increasingly tell people how we feel or think instantly through a variety of social media and messenger apps, the power and pain of words is evident. Now, we often send messages without reflecting on the impact of those words or considering if we’d be happy having them published or attributed to us as a reflection of our character.

So, why, as a nurse, do I write this? Well, I write it as a nurse, a human and a person who has been hurt and damaged by the words someone has used about me, and who has seen that hurt in others. I write this blog as a word of caution, but hopefully also as a source of comfort.

If we value words and the meaning and thought that goes alongside them, choosing to match our emotion and effort to these words, they become all the more powerful. As nurses, the words we choose about ourselves, our colleagues, our patients and their carers are powerful, strong and are listened to and reflected upon.  

Words allow us to advocate for others, to stand up for those whose voice is not yet strong or loud enough to be heard or has been silenced by oppression. If you have a platform and voice – use it for good, use it to empower, but also use it to listen and to question.

If you are a newly registered nurse – use your voice. Use it to ask questions, don’t stand idly by. Use your voice and your words to show how you value others, to gain feedback, to advocate and to inspire. Use it to say sorry for mistakes and to forgive others for theirs.

Use words to learn and to teach. Just match those words with thought and emotion and use them wisely and with consideration, for when we do that and engage on that level – wow, what a difference we as nurses can make to the world.

Clare https://twitter.com/mannersofmarple

A Very Different Newly Registered Nurse Year

Last week I duly paid my £120 fee to the NMC, marking a year since I first joined the register as a Registered Children’s Nurse. I had put it off for a while because the thought of having been qualified for an entire year was beyond belief to me.

Last winter, I started my position as a Staff Nurse in a busy acute medical ward in a children’s hospital. It was a baptism of fire, thrown into an environment totally different from the one I had trained in. And I had a huge amount to learn. I’m not one to sugar coat and will freely admit it was at times overwhelming and exhausting to start in such an intense environment – but I embraced every opportunity to increase my skills, knowledge and competencies as a Registered Nurse. I was also lucky to start my position at a similar time to a group of other NQ nurses on the ward. We were able to rely on each other, figuring out this strange new world of learning together. By the spring, I started to feel as if I had found my feet on the ward, I was trusted (and trusting myself) with more responsibility, and my confidence was growing.

By the end of February, we were starting to hear more and more about what we now know as Covid-19. The talks of PPE, social distancing and self-isolation sounded alien to us all – particularly in paediatrics where we were perhaps less exposed to the realities. At this point, it was not something I was worried specifically about in respect to myself. We knew so little about what the virus entailed and how it may affect the children we care for, and that was my main concern.

Every question was answered with an, “I don’t know”. But spirits were generally good, and we got on with the job in hand.

As we went through March, we were still relatively ‘untouched’ in paediatrics except for an eerie sense of calm and anticipation – with far fewer A&E attendances and subsequent admissions. When Boris Johnson announced that the country was going into lockdown, that was the first time I sat and thought about my own vulnerability.

NHS workers were being hospitalised after contracting the virus, and many sadly passed away. I knew that my track record with respiratory viruses wasn’t good – I had developed asthma aged 17 after a chest infection. And over the next five years, I had two more bouts of pneumonia, and my asthma symptoms considerably worsened, getting to the point where I couldn’t get through a simple cold without high dose oral steroids.

I suspected I would probably become very sick if I did contract Covid-19. That worry sat in the back of my mind quietly for a few more weeks, until one day I got the letter through the door. I was officially ‘clinically extremely vulnerable’ and required to shield from Covid-19. While this was a huge relief in some respects, it was also mentally very challenging.

I had only been working for four and a half months; I was still an NQN with a considerable amount to learn and so much to give. I hated the fact I was sat at home whilst my colleagues worked through it, the public clapping for the NHS I too should have been working for. I felt guilty for not ‘pulling my weight’, and worried about deskilling as I was stuck indoors.

My confidence as a practitioner plummeted. In total, I spent 17 weeks at home before shielding was paused. Returning to work at the end of July created a mixture of emotions. Mostly, I was over the moon, but also I worried about managing the hours after shielding caused physical deconditioning, the toll of over four months at home caused me mental health struggles. The underlying threat of Covid-19, of course, remained, and I was worried about remembering how to be a nurse!

Like many people in the ‘shielding’ category, I had never considered myself vulnerable in my life before. My chronic cough was a running joke amongst my friends, but severe asthma had never stopped me doing anything I wanted. It certainly had not affected my work as a student and then NQ nurse. I never worried about ‘catching’ anything from my patients, I’d never thought twice about the impact nursing might have on my health. Then I was back at work and finding myself second-guessing everything I was doing, anxious about going near patients with a queried Covid-19 diagnosis, trying to maintain social distancing, and being careful without appearing over-cautious.

Honestly, my confidence was shot to pieces, which seemed to get worse instead of better as time went on. This lack of confidence resulted in me having to take more time away from work to sort out, but I’m starting to feel better now. Unfortunately, the uncertainty of Covid-19 remains, and the threat has continued to rise by the day. It may be that I must shield again in the near future. But I hope if this is the case, things will be different. I hope that NHS staff who have to shield are remembered and supported to maintain our skills and confidence. I hope in general that ‘clinically extremely vulnerable’ people are looked after by the government and their communities so that their mental health doesn’t suffer.

In hindsight, although it’s been a strange old first year as a nurse for me, spending more time within my own four walls than at work, I do think it’s also been a valuable personal learning experience. It will make me a better practitioner. I will greater appreciate the isolation that families I care for may face. I will even more so embrace the opportunities I am given within the NHS, and how lucky I am to be able to call myself a nurse.

Beth www.twitter.com/paedsnursebeth

Student nurse reflections on placement teamwork during Covid-19

I am an adult nursing student, and I am in the later stages of my third year. I am also a mature student, and I have found the pandemic challenging, to say the least. In previous placements, I have always found that teamwork allows me to enjoy the environment I am in because I am a very social person who likes to share what I have learned and wants to learn from others. A strong team has proven invaluable in facilitating this in the past, so it is something I always watch out for wherever my placements may be. So, it wasn’t a surprise that the effects of the pandemic on teamwork were a concern when heading off to placement, especially this time.

Before the pandemic, my placement was going to be in the Accident and Emergency Department, and I was so excited. Critical care and ED were my top desired management placements. But when Covid-19 hit all plans were cancelled, and everyone was so unsure of what next, myself included.

Either way, I was going to complete my course, come what may. So, like many others across the country, I opted in, not knowing what would happen next. At a hurried pace, we were all assigned new placements, and for me, I was allocated one in an area that I did not necessarily have a great deal of interest in. But I took to the challenge and decided I would make the most of it. Now, if you have ever been a student and you are reading this, you may be able to relate.

 As I stood there being introduced to the team where I was going to be undertaking my next placement, I couldn’t help but feel very odd that I could not see their faces because of the masks covering them. My usual reassuring smile could not be seen, leaving me feeling anxious because I could not tell if my new teammates were smiling back under their masks.

As happy and frightened as I was to be there, this gave me a feeling of insecurity and a lack of confidence. I had not experienced these feelings since my very first placement in year one, and this took me back. Since that first placement, I would call ahead, visit the placement area, introduce myself and check who I would be working with. This time around, I had almost not been able to attend placement and just being there felt like a stroke of luck, all because of Covid-19 and the challenges it brought with it.

Being a part of the team has always been important to me because of the changing nature of our placements, and it did cross my mind how difficult it would be to get to know everybody and vice versa. Not being able to see my colleagues’ faces under their masks felt like a real bridge placed between us and the social distancing certainly was not going to help. Mainly because I would have to reintroduce myself on each shift and the connection just wasn’t forming like before.

Not only did I get so many people’s names wrong, when they were out of uniform, but I also couldn’t recognise them at all. All this led to a few apologies as people would pass me by on the corridor and when I said hello, they could not place where we had met as I had resorted to saying hello to everyone.

So fitting into a new team is not always straight forward and the challenges that we were all facing were alien on every side of the fence you looked from. Activities such as hoisting had to be well thought out with excellent communication to enable adequate safety while still maintaining social distancing. The uncertainty of how to conduct myself and decide if the other person was comfortable around me took a lot of body language reading and asking questions to clarify their position. Whether to keep my mask on in break areas or not?

Fortunately, this was taken well and reciprocated.

 The guidelines changed almost daily, and sometimes it felt like a catching up game. What did help though was that the nurse leaders on duty daily updated us on any new working practices during handover safety huddles and chipped in when we were short of staff.

I especially witnessed this when a colleague came in not feeling so well, but the fact that we had a strong team meant that they could let us know how they felt and the rest of us having an okay day would help out where we could to get things done. Seeing everyone come together like this for the sake of a colleague, and ultimately our patients has really made me think of the kind of environment I want to work in. Such human behaviour is so admirable that after a few weeks, it didn’t seem so hard to get to know people. Largely, this was because we had gained mutual trust, and I knew that I would be well supported if I needed the help.

 In hindsight, although it took longer than expected, I eventually felt a part of the team, and some of the strategies were as simple as communicating effectively what my needs were and being flexible. There are times I needed to weigh when to go on shadows and when not to, so I would not leave the ward short.

I felt that this was one of the disadvantages of being counted in the numbers. It carried some level of guilt and satisfaction to get to know what other teams were doing in dealing with the pandemic. This felt like an opportunity to come back onto the ward and replicate good teamwork practices among staff and patients.

A few other strategies were taking a few minute breaks to have a drink, which was a challenge due to the masks and an infection control issue (not to take masks off on the bays). Staff would have a drink and remind their partner to do the same, almost like a game of tag. The patients often commented about how harmonious the staff were, laughing and making the atmosphere of the ward light in what were trying times at best. This helped a lot, especially on days when we had a few people on shift. And whenever I would get a bay that was lighter, I would go and see if the others were okay and needed help. This rubbed off because others started doing the same. The main reason I felt confident enough to handle a patient who was not assigned to me was the comprehensive handover of all the patients on the ward.

Allocation of patients would come after handover, which meant we would all listen keenly. I had experienced different wards where only the bay you were assigned was handed over. I was not too fond of this system, and I finally understood why I did not feel confident enough to venture onto other bays, as I had no clue what to do with the other person’s patients.

Another area I found great teamwork, was with patients because we would encourage patients to remind us if we missed anything or they felt like they missed their families. This was because of visiting restrictions. Therefore, we were provided with mobile phones that could support video calling, and together we taught so many of our older patients to use smartphones. Something that I am so proud of, because this made them feel more independent, and that we were working with them towards their complete well-being.

As a final word, I would hope that the pandemic has managed to bring people together to find ways of “working well together”. I certainly have seen people come together in a way I did not expect, and this experience gives me a good standing in choosing where I work next and the clues that people give out showing the quality of their team-working behaviours. The pandemic may change our ways of working. Yet, we have also had an opportunity to support each other more, which shows the essence of nursing — compassion, not only to our patients, but also amongst ourselves as a collective.

Gloria www.twitter.com/Gloria_Sikapite

Don’t forget this cohort

I write this the day before I start my first nursing post, it has been a long time coming – five years in fact. Gaining a Bachelor of Nursing in Adult and Mental Health Nursing took four years and before that I completed an Access to Higher Education Diploma in a year while working part time. Five years.

It’s been a while since I blogged, I love doing it but it takes me some time to get going and when I do I have a million different blogs I want to write. There are many different versions of the blog I wanted to write for RCNNQN, focussing on many different aspects of this transition from expert student to novice nurse. But the focus for this one is the cohorts who completed their nurse education in a pandemic. Please don’t forget these cohorts.

This blog isn’t dedicated solely to the September finishers, but to all recent newly registered nurses. There are thousands of us. From those who started their first posts before COVID-19 reached our shores, who have had to cut short their preceptorship programmes due to the need for as many on the frontline as possible. And those who completed their courses slap bang in the middle of the UK’s first wave, who had to learn quicker than ever before how to function as a new nurse. To those who were presented with ‘opt in’ or ‘theory only’ as options on routes for course completion by our nursing leaders. Yes, there was an element of choice, but neither option was how we ever imagined our nurse education to come to an end.

As a workforce, we will all need good support, supervision, and chances to offload when this is all over. Scrap that, we should be getting that now but I acknowledge that it is not always possible. But in addition to the needs of the entire nursing workforce, I strongly believe that there needs to be a planned programme of support for these cohorts who have completed their nurse education in or around the time of a global pandemic. There will be loss, there will be grief, there will be guilt, but there will also be pride, innovation, and passion. As well as support us, please listen to us, guide us, and encourage us.

There is no denying that at the core of nursing is our patients. However, we also need to place our workforce there too. With the focus of this particular blog being on our new registrants there is a particular need to nurture them yet simultaneously we must allow them to be innovative and collaborate across hierarchies. These cohorts need to know that their opinion, their voice, matters.

While I personally navigate my change in status from expert student to novice nurse, I will continue to advocate for my peers and colleagues. The voice of newly registered staff is not heard enough at a Trust level, System level, or national level. My wish for this to change is not a lone one, and I’m grateful to be working alongside such incredible newly registered practitioners within RCNNQN.

Jess www.twitter.com/JessLSainsbury www.instagram.com/NHSJess)

Changing roles as a newly registered nurse…

My name is Dawn Marr and I am a Newly Qualified Mental Health Nurse, I qualified in September 2019.

I started my Nursing career within a low-secure forensic ward. I had spent time within this environment as a student and it really intrigued me, the amount of time that staff had available to spent time with patients was something that really drew me in. Patients within these settings often have complex needs which intertwine mental health, social and economic needs, I was excited to start my career here and make a difference.

Due to having to make up hours my transition from student nurse to newly qualified nurse was a very fast one, I was a Student Nurse one week and a Registered Nurse the next. I remember feeling at this point I was ready to become a Registered Nurse, I had spent 3 years on placements and studying the theory behind the practice and was confident in my abilities however, I soon realised that nothing could have prepared me for the moment my training wheels came off.

I no longer had the security of “I’m a student nurse”, I walked into a world where the full responsibility of being a registered nurse hit me hard and I went from “I’m ready for this” to “do I even know what I am doing?”. I struggled with imposter syndrome, the first time I introduced myself as a Staff Nurse I had this feeling that people were going to “find me out”, on the outside I was a nurse however on the inside I still felt like a terrified nursing student.

This feeling of being an imposter was a common theme within my first 6 months, it came in waves and appeared to be directly correlated to my confidence levels. I was soon in a position where I was helping nursing students who were in placement within my ward, this allowed me to support and pass on knowledge to these students, these experiences helped increase my confidence in my abilities.

During this time, I became involved with the RCN Newly Qualified Network. I soon found out my experiences were commonplace, speaking with other Newly Qualified Nurses gave me a space to voice my experiences and worries and gave me a sense that I was not in this alone. Feeling part of a community helped me to process this transition from student nurse to newly qualified nurse and it has been invaluable.

After 6 months in my first post I was beginning to settle into this new world of being a Registered Nurse. I however began to notice my mental health was becoming poor, I felt unable to switch off from work when I was at home, I struggled to sleep, my mood was low, and I could feel myself becoming withdrawn. This led to me to experience an identity crisis, I had spent 3 years juggling academic work, placements and part time work to finally fulfil my dream of being a Registered Nurse only to run into the stark reality that I was not enjoying it.

I engaged in reflective practice, clinical supervision and spoke with my colleagues and peers, this helped me identify that it was not being a nurse that I was not enjoying, it was the setting I was nursing in that I did not enjoy. This realisation came with lots of conflicting emotions and I eventually came to the conclusion that I needed to change work environments.

After I came to this realisation I began to search for a new job, this came with feelings of guilt and failure, guilt for leaving a fantastic nursing team who needed staff and failure for not being able to “stick it out” in my first post.

I applied for a job within an acute admission ward, was invited to interview and ultimately was offered the job.

I was nervous to start this new chapter in my career, I would be working with up to 25 patients in my new job when I had previously been working with 8, my new environment would be very fast paced, and I knew could be chaotic at times. I joined my new ward and realised I had a lot of learning to do however felt I had a strong foundation to build on from my previous experiences.

I am now 3 months into my new job role, it has reignited my passion and my “fire” for the profession. My mental health has also improved, and I am able to switch off from work when at home and my mood is better.

The lesson I have learned through this experience is to be true to yourself and don’t ignore warning signs of your own mental health. Each one of us are individuals and finding a space within the nursing profession that “fits” with you will benefit you as a nurse and ultimately your patients.

Dawn (www.twitter.com/DawnMarr20)

Taking the ‘theory route’ during the pandemic.

Start of placement and pandemic…

There I was finally on my management placement reminiscing about the last three years of my training and how I got there. Wondering how ready I’ll be after my 450 practice hours. Will that be enough time for me to be an expert on all subject’s general paediatrics? I have been told by nurses before that these feelings are normal and that everyone goes through these notions.

Of course, the plot twist to this story is that it’s the year 2020 and we know by now that nothing really goes as planned. So, in true 2020 fashion, I was faced with a few dilemmas. I was placed in general paediatrics, and the pandemic was becoming more and more real. Guidelines and laws were changing in what felt like every half an hour, the Covid19 virus was taking over the planet.

Very little was known at the beginning of March, and things seemed a bit strange because of the unknown. There we were treating the bread and butter of general paediatrics during the spring months; difficulty in breathing, wheezing, coughing, asthma and allergy rhinitis. Next thing we know new guidelines were being released two weeks in with possible symptoms of the famous virus. Anyone that comes in with any of the following listed symptoms has to be tested for Covid19;

  • Coryzal
  • Coughing
  • Fever
  • Difficulty in breathing

Wait HOW? This is general paediatrics in Spring, how will you be able to test every child that comes in with these symptoms? That will be every patient that I’ve had before these guidelines? This will mean that literally, every child will need to be tested.

Of course, the obvious was happening after that, every child that came into the ward was COVID positive or suspected COVID. I should also add that at the time PPE was scarce.

I remember being asked to go and collect my patients from ‘dirty’ accident and emergency that was dedicated to anything respiratory. My two patients were suspected of COVID. I remember asking the manager at the time to give me a mask before entering as every other professional inside had one. Her response was that I was only going to be here for 15 minutes maximum, so I will not need one. I had to take handovers for both patients at the ‘dirty’ A&E without any personal protective equipment. Did I feel safe doing so? Absolutely not, but I stayed professional and carried on with providing my patients and worried families with the best care I could.

So, we’re nearing the end of March and numbers of infections were rising, and PPE was not getting any better. The government decided to shut down the schools, and my two DDs had to now stay at home. More updates were coming out, some students that I knew were now moving into hotels to avoid contact with their children. I knew that I had to start making some difficult decisions, I had worked so hard to get here, yet I did not want to put my daughter with underlying conditions at risk. After some pondering, I made the decision to take the theory route and shield with my daughters and put a pause on my placement.

Anxiety Galore…

I knew I had made the right decision for my family, but I started to suffer from a lot of anxiety, wondering if I did. It was always worse at night, and a friend suggested that I use apps such as Calm and Headspace. I gave them a go, and they were great for helping me sleep. I then realised that my anxiety was not only caused by the fact that I was no longer at work but also because I had stopped exercising as the gyms had closed too.

So, I started to exercise at home and began doing challenges such as planks and tummy exercises. Sixty days into the challenge, I saw a change in my body and soul. I know that sounds a bit like a mindfulness magazine, but it really did wonders. The results motivated to do more, so I stayed consistent.

The children being around and home-schooling was a blessing in disguise. Getting to know how each of them learnt and their style of learning was a valuable experience. I loved learning with them and trying to read my research articles for my assignments once they had gone to bed. So, the sort of new routine was enough to relieve my anxiety.

My new found love for indoor gardening was also a very relaxing hobby. I had owned plants before but never managed to keep them alive longer than a month if not weeks. This time I was determined to be more intentional. I was ready to know each plant and their specific needs so I can cater to each of their needs. Maybe this was a way of getting my need to care and give met? Maybe but whatever it was or is it helps me focus on something more significant than overthinking.

Returning to work and anticipation…

So, four months into this new routine with lockdown, I now have a start date to return to placement. I have received my off duty and anticipating what it will be like to be back. I am looking forward to getting back to work but also worried about possible lost clinical skills.

I also have so many questions about what the ward would be like. What will it be like post the four months of the pandemic? Will there be a second spike? Will I have to shield again? Will schools remain open, or will they have to close again? Is there adequate PPE?

I guess I will never know the answers to these questions until the time comes. Meanwhile, I am mostly positive about getting back into placement and coming out the other end as a ‘Newly Registered Paediatric Nurse’. It feels bizarre to even write that. But yes, after working hard on all my final assignments and passing two of them with 1st class grades and one with a 2:1. I am now only 10 weeks of placement away from becoming a paediatric nurse. I am nervous and most excited.  

Lily (www.twitter.com/MissWolday)

Considering the Potential Resurgence of Eugenics

Recent world events have quite rightly caused me, and much of the rest of society, to consider our relative privileged status. And reflect on the fact that minorities within society face significant challenges in their lives that many people may not even have realised existed.

 Pleasingly this seems to have led to an increase in people’s interest in campaigning for positive change in things like legislation and more people looking to be allies to minority groups.

Eugenics developed as a sub-branch of the study of genetics. Large industries have developed out of the careful breeding of plants, to improve crop yields, make more interesting flowers or increase disease resistance. During the 19th Century, people started to consider whether the same ideas might be applied to people. In simple terms, the answer to this question is yes; if particular people have a child, they are more likely to pass on positive genetic attributes such as the probability that the parents of an Olympic athlete passed on athletic prowess. In a consensual relationship, this creates few issues. However, as the field developed, people started to talk about enforced control over breeding, which creates a vast range of ethical issues. There is not enough room to fully explore these here. But it includes the discussion on what are desirable characteristics, which inevitably excludes and devalues the people who don’t have those characteristics. The most famous example of this is probably the mass killing and sterilisation of a broad range of people under the Nazis, including people with a learning disability under the T4 programme. I was lucky enough to attend a fascinating talk on this at the Positive Choices 2019 conference by Helen Atherton and Florian Schwanninger, which really improved my knowledge in this area. I was surprised to learn that people from around the world, including the UK, found themselves victims of this program.

I must admit that before I began my studies, I probably considered eugenics to be a thing of the past, consigned to a similar part of history as Nazism.  I was aware that discrimination remained an issue. Still, I probably felt both that it was significantly reduced compared to the past and that it was limited to people’s personal opinions rather than being the state-supported general consensus.

 I am increasingly aware that my privilege significantly impacted that opinion.

I recently watched the Eugenics Science’s Greatest Scandal documentary on the BBC, which highlighted that for people with a disability, eugenics, though not called that, is potentially very much part of their life and the complicated ethical issues that go along with that. For example, does being able to genetically screen to avoid having a child with a particular disability devalue the life of a person with that condition?  Will advances in genetic selection revive the idea of creating the ideal human, and if so, who decides what that is? 

The recent Covid-19 crisis has brought sharply into focus the challenges faced by people with a learning disability and highlighted that eugenic thinking is still prevalent. I have every reason to think that life is as good as it has ever been in general for people with a learning disability. People are often able to live fulfilled lives in the community away from historical institutions. And increases in medical knowledge and technique mean that people are living longer than ever before. However, the Office for National Statistics has recently advised that two out of three people who died of Covid-19 had some sort of disability. And the CQC suggest that just between April and May the death rate for people with a learning disability, which was already above the national average, rose by 134%. There have also been reports of record numbers of requests for unlawful DNR orders for autistic patients and patients with a learning disability during the crisis. All of this leads me to think that for many people, the lives of people with a learning disability are somehow seen as less valuable than those of non-disabled people.

Why might this be?  As I began to study more about people with a learning disability, I began to appreciate the challenges that they face. At around 1.5 million people, even collectively, they represent a relatively small part of society, getting their opinions across is further exacerbated by a high prevalence of communication difficulties.  From a healthcare point of view, virtually all available evidence from government policy and research shows that people with a learning disability experience significant health inequalities. These inequalities are caused by general factors, such as social inequality. However, there are also discriminatory practices, such as diagnostic overshadowing, whereby symptoms are automatically attributed to the learning disability rather than the specific health complaint that the patient is presenting with at that particular time.

So what relevance does this have for us as student and newly qualified nurses?  As a student and soon to be newly qualified nurse, I am passionate about trying to reduce these health inequalities and help people with a learning disability access the best possible care for the problems that they have. But I can’t be everywhere and do it all by myself. Whatever your field of nursing, it is highly likely that you will have a patient at some point who has some of these additional needs. It might feel scary and challenging to deal with, you might not know what do to, and that is okay. But I would urge you to take the time to give them the best possible experience. Have they brought a hospital passport detailing how to help them best? Do they have a parent or carer who could provide you with advice? Do you know a specialist nurse or doctor who you could consult with in the same way you might for a complex physical health issue? By working and learning together as newly qualified nurses, we can make healthcare a safe and helpful environment that is accessible for everyone.  

Daniel (@MAGEOFJUSTICE)

Starting as an NQN in the Community

“You should go to the ward first? Shouldn’t you get some experience before you go into the community? Oooh, are you sure about doing that?”

These are some of the common statements I heard from fellow students, nurses, and lecturers when telling them my Newly Qualified Nurse (NQN) role was a Mental Health Nurse, also known as a Care Coordinator, in the community. Why are we still questioning and doubting our student nurses’ decision to go to the community or a slightly different path to the ward as an NQN?

Nursing is varied. That’s why we have numerous placements. So that we learn how to nurse in a variety of settings. I’m now a year into working in community mental health, 10 months of that as a Registered Mental Health Nurse. Of course, being a community nurse is different from being a ward nurse. Like being a ward nurse is different from being an A&E nurse. And being an A&E nurse is different from being a research nurse, which is different from being a nursing home nurse. None of these roles requires fewer skills. But all these roles require different skills, which as an NQN, you can learn and develop.

Over the past 10 months as a newly qualified Mental Health Nurse in the community, I’ve learnt so much. Some of which, I would like to share. So, whether you’re thinking about heading out into the community, have a job in the community lined up, are currently working in the community, or are just interested, I hope these help.

1) Supervision is not all about your patients, but it’s also about how you are emotionally, academically and personally doing. You need to be open to receive constructive criticism. Open to receive support. And honestly admit when you are struggling or if you don’t know something. For me, supervision has been so helpful and a vital part of my first year as a Registered Mental Health Nurse.

2)The to-do list never ends. But that’s okay. In the wards, you hand things over to the next nurse. In the community, this is a little harder. My to-do list seems to go “one thing done; three things added”. You have to learn to accept that you can only do as much as you can that day and prioritise. I personally like to highlight my to-do list in different colours, so I can visually see what need to be done when. 

3) Teamwork. Although you’re care-coordinator for your patients, it’s mega important to work as part of a multidisciplinary team. Seek advice from Occupational Therapists, Support Workers, Social Workers, everyone, as they will all give you a different perspective. Before my role in the community, I had no idea how to apply for social care funding (we don’t learn that as a nurse in my area). But thank goodness the Social Workers in my team who were there to talk me through it!

4) Team dynamics can be challenging. Some people don’t get along with others, some people may not get along with you, some people may gossip & try to draw you in. Be professional at all times.

5) Every day is so different. But that’s why I love it. One day I’m in depot clinic, the next I’m having a meeting with a cleaning company, the next I’m doing risk assessments and care plans. Embrace the difference.

6) Not all patients will take your advice. And because they are in the community, you have to respect that, even if it means that the patient’s mental state may deteriorate. This can be frustrating, sad and difficult to manage. Use your colleagues to discuss cases and gain emotional support yourself.

7) Positive risk-taking is necessary but can be scary as NQN in the community when you don’t have the protection of a ward environment. Gain support and advice from colleagues and remember to document and risk assess.

8) You get to know your caseload of patients and their families over time as you build that therapeutic relationship and also get to know yourself. I’ve learnt so much about myself these past 10 months.

9) Switch off. As I explained above – that to-do list can be never-ending. But it’s so important to switch your phone, laptop & mind off at 5 p.m. Because you can’t pour from an empty glass!

10) Paperwork. Tribunal reports take half a day at least. Social care funding forms take another day or so. Case notes are a must. Then there are plans, risk assessments, letters, housing forms, emails, etc. etc. Being good at organisation and timekeeping is very important in the community, so find a routine to your day and week that suits you and the team you work with.

I loved the past 10 months in the community. Sure, at times, there are some not so great days, but we all have those. Working in the community as an NQN, for me, has been amazing. It’s taught me so many skills, strengthened me both as a professional and person, given me many opportunities to develop. And I feel so privileged to have started my registered nurse journey there. If community nursing is something that you have a passion for then go for it and embrace that passion.

Abby (www.twitter.com/MHnurseabby)

First day in the numbers in critical care.

Yesterday I worked my first shift in the numbers in intensive care as a newly qualified nurse. After a slightly unorthodox supernumerary period including a seven-week long absence due to sickness, as well as starting in the midst of a global pandemic, I had, in total, around six or seven weeks clinical practice before being assessed by a very supportive senior nurse who deemed me capable of looking after critically unwell patients without supervision, which seems to be about average for a lot of ICUs.

Prior to going into the numbers, I had a lot of anxiety about all the things I just didn’t know. I know I can (and I do) ask a LOT of questions, but what about the bits I don’t know that I don’t know?! Will I miss something serious? What if my patient rapidly deteriorates and I freeze up? All of these questions were constantly whirring around my head. Nonetheless, I had to bite the bullet eventually, and I went into work for my first shift working ‘alone’.

Thankfully, I’m not really alone, the education team and senior nurses are incredibly supportive of new nurses into ICU where I work. I was placed working near to very experienced nurses who would be able to help me if I needed it. The patient I was allocated to was a bit of a mixed bag in terms of their nursing requirements with some elements I had previous experience of, and some not.

I set out planning my day which was easier said than done; this patient had a LOT of medications (all IV) and not many free lines, as well as various pumps and drains which needed regular maintenance, and not to mention a very pressing need for regular physical rehabilitation to help clear chest secretions. All in all, my time management was definitely going to be put to the test as I tried to scribble out some kind of rough plan that I was sceptical I would be able to keep anywhere near to.

The day went very fast, and lots of curveballs were thrown my way; a radiographer turned up for an ultrasound I wasn’t expecting, morning physio took much longer than I had anticipated (but was extremely beneficial), stitches popped on the patient’s central line which needed re-suturing. All of these meant I was continually reassessing the tasks that needed doing and rescheduling according to priority. Additionally, due to happenings in the areas surrounding me, I had a much-reduced level of support from colleagues for a lot of the afternoon (through no fault of their own) Needless to say, it felt a bit relentless all day.

At last, the end of the shift came, and I handed over to the nurse for the night shift. I looked back at my shift and weighed up how my first shift had gone. Had I managed to perform every task I had wanted to? No. But I had carried out the essential tasks and any non-essential ones I could manage and handed over the ones I hadn’t been able to do and, I might add, there was no judgement from the night nurse for handing over a couple of jobs.

So, did I manage to do a good job? At the time, it certainly felt like I wasn’t keeping it together, but I talked briefly with the nurse in charge at the end of the shift, and I expressed that I hadn’t done as well as I’d have wanted. However, she highlighted to me that I had managed to deliver all the patient’s essential medical care (including all those pesky IVs!); managed to help them get out of the bed for their longest stint yet with help from the physios; managed to wean down on their O2 support; managed to sort out getting the patient to speak with their family; managed to autonomously deal with issues as they popped up, and managed to ask for help when I wasn’t sure. I realise I said ‘manage’ quite a lot there, and that’s because the penny dropped for me, I had actually managed, not merely scraped through my first shift in the numbers.

Sure, I didn’t do things perfectly, but I left work leaving behind a patient who was a little better physically, mentally and socially at the end of my shift than when I went in at the start. All in all, I’d say that was a success. Bring on day two.

Michael (www.twitter.com/MLJCarter)