Tuesday, 19 November 2013

The Shortfall

Truth be told, I've struggled with third year since day one: it's not quite what I thought it would be, yet at the same time it is. It's not the workload, lack of social life, or even the new tangible weight of pressure and expectation that's the problem - OK, maybe it's some of that - but rather the issues I've already touched upon in an earlier post that are bothering me, which to make things worse, are coupled with seemingly unshakeable feelings of self doubt.

I recently completed my first placement of third year, and it was absolutely one of the toughest things I've experienced to date. For the first time ever since beginning my nursing education, I very nearly arrived at the decision to walk away from it all, and I'd be lying if I said the thought isn't still lingering somewhere in the back of my mind.

For the past four weeks I've been in a state of flux: wrestling with feelings of complete inadequacy and incompetence one minute, only to swing to feelings of accomplishment and gratification the next - though the latter has been considerably less frequent in occurrence.

I finished second year on a high, replete with a newly-found and much-needed confidence that I perhaps had what it took to be a nurse, and a good nurse at that. Yet, here I am at the beginning of my third year, questioning whether or not I am in fact cut out for all of this.

At first I thought it was simply me that was the problem: specifically my lack of confidence and self-belief. I reasoned that I was placing too much pressure on myself, and prematurely at that. Yes, I'm in my third year, but I'm at the start of it, not the end: I'm not a qualified nurse yet. However, with only ten short months until I do actually qualify, this form of logic is of little comfort to me at this particular juncture.

To further exacerbate things, the placement area itself was that of a 'heavy' acute ward, the kind of ward I had not experienced since the beginning of my first year, and it was absolutely a shock to the system. For those who work in different fields, the nurse-to-patient ratio can be anything from eight to ten patients per staff nurse, if not more. I should mention at this point that I've often been described as an unashamed idealist by some of my friends, and I suppose in many ways I am. I aspire to and enjoy the kind of nursing that addresses all patient needs: otherwise known in the trade as holistic, patient-centred care, and in my experience, acute adult wards are often not where this occurs. 

I want to make very clear that in my experience this is rarely due to the quality of nursing staff on these wards, but rather the number of staff and resources that are deemed 'sufficient' to provide 'safe' patient care in such settings. These wards are often filled with older people, requiring extensive medical and nursing input and interventions. 

An average morning on such wards usually consists of the following: a nursing handover, the serving of breakfast, the administration of medications, the facilitation of patient hygiene needs, and the participation of ward rounds; all of which is completed just in time (hopefully) for lunch to be served. 

Following lunch you have: regular 'turns' and 'checks' (which would have also been performed throughout the morning) to maintain, the first set of documentation to complete for each patient (which ideally would have been done earlier but there probably wasn’t time), IV antibiotics to prepare and administer, three medications rounds, dressings changes, the carrying out of physiological observations, any additional nursing interventions that are required, consultations with patients' loved ones, an MDT meeting to attend depending on what day of the week it is, a final set of documentation to complete, and nursing handover to give; all of which is to be completed before you finish your shift and go home, though most likely not on time.

What I’ve described is only a very basic and general rundown of an average shift: I’ve not even touched on the hypothetical three discharges that you somehow managed to squeeze in, nor the three new admissions that all arrived during your final medications round, precisely one hour before the night staff are due to arrive for handover.

This is the daily reality for most adult nurses on acute wards, and it is this that creates what the brilliant nurse-blogger @grumblingA insightfully articulates as ‘compassion hunger’ for many of these nurses - the post for which you can find here. It’s not a coincidence that as a student nurse with less but ever-increasing responsibilities, I seem able to build better rapport and relationships with patients than most staff nurses - at least in my opinion - which is another insight the aforementioned author highlights in the same post, but that I only recently began to really focus on and scrutinise - a fate that sadly I suspect awaits me.

So what now? Where does all of this leave me? Right now, I’m not sure. All I know is that I’m left with lots of questions and doubts, and feeling woefully short of answers.


  1. I make a point of asking the students I'm mentoring in their final year if they've considered simply giving it up and going off to do something else - frankly, I'd worry about any nursing student approaching registration without serious (but entirely appropriate) doubts, of the kind that you express.

    Idealism is a wonderful quality to have as a nurse, and will keep the fog of fatigue, stress and embattlement from obscuring all that is truly great about nursing. That idealism needs to be set against other considerations (and the surveys of nurses who leave within the first year of qualifying):

    Consider the sheer slog - not just on acute wards but on every under-staffed ward or clinical area. Consider the non-contact time and effort spent feeding the stats beast that ultimately returns nothing but management meetings. Consider the hourly rate, especially against other public services. Consider the empathetic load. Consider the juggling of shifts on family life, and the health impacts of swing/nightshifts. Consider the nurse-as-political football, booted around between players in a game with constantly shifting rules. Consider the NMC and what those annual fees do for you and the nursing 'profession'...

    Consider the nurse-patient relationship above all else, for that's what will sustain you against all the above.

  2. Andrew, firstly thank you for taking the time out to reply to my post - that in itself means a lot.

    Secondly, thank you for your understanding, support, and passion - it brought a much-needed smile to my face.

  3. I haven't even started the actual nurisng program and I already have doubts. Not that t I can't handle the job, or that I'm going to get burnt out or anything like that, just generally in doubt about what I am getting myself into. But I genuinely love helping people, and I love medicine. I know thats probably cliche and a million other nurses say the same thing, but I have known since I discovered what nursing was in junior high that I wanted to be a nurse. It saddens me that people think that you need to just leave all that behind to be a successful nurse.

  4. Sounds to me like you'll be a great nurse, and one who won't lose sight of what nursing actually is at that. If you want to talk at all you can reach me at florencenursingtales@gmail.com

  5. Being a student nurse is just the start of it, I admire your determination and being a nurse truly is a rewarding job. The nurses you see in those wards choose to stay because of it. Beyond all the stressful situations, one day you will get the hang of it and breeze through those wards as a confident nurse.

    If you continue on and will take the NCLEX exam, I can help you. I am a nurse educator and I have made useful test taking strategies, question trainers and free mobile application with review materials that you can use for our NCLEX review. Just visit www.nclexpreceptor.com to know more.