It Was The Best Of Times, It Was The Worst Of Times

With just under two weeks left of my programme, it seems only fitting that this post, which is likely to be my last as a student nurse, should provide a sort of overview of my imminently-departing nursing preparation. As the title suggests, the last three years have provided previously unchartered highs, and at times, seemingly unreturnable lows. They feel as though they have endured for an eternity, yet also elapsed in the blink of an eye. They have proffered a wholly unique and life-changing experience, but have somehow felt natural and familiar: forever changing who I am as a person, whilst also cementing aspects of me that have always existed.

In many ways I am glad to be at the end of my student-nurse career: three years of never-ending study and assessments combined with numerous transitory placement experiences, all of which are facilitated by accepting and maintaining a barren social landscape and penny-pinching lifestyle, is not something I'm eager to prolong in all honesty. Conversely, there are things that I’m not so keen to see expire, including the contentious yet much-loved-by-student-nurses supernumerary status (in light of the recent debates regarding CPD, why shouldn’t qualified nurses be allowed to arrange relevant and beneficial spoke placements?!), and the inherent protection in relation to what for the most part are, proportionate expectations and responsibilities, which in turn has often rewarded me with increased disposable time to spend with patients, often in contrast to the registered members of staff.

Looking back on the collection of posts on this site, it's clear to see how each academic year has informed my development. First year seems so long ago now that it almost feels irrelevant, which of course it wasn't. For the most part it was a gentle ride (excluding a particularly grim student flat that I inhabited for six months, and one placement that due to location involved 18-hour long days), above anything though, it's the excitement and enthusiasm that endured throughout, which for me is truly symbolic of my debut to the world of healthcare and nursing. I wanted to know everything, and was never satisfied with what I did l know, although not much has changed in that department.

The aforementioned enthusiasm and excitement extended into the first few of weeks of second year, however it wasn't long before those infamous 'second-year blues' kicked in. I can't explain what changed, although I do remember some of the modules being pretty hit and miss, and the reality of juggling assignments and exams alongside placements being rather a shock to the system. Second year was without doubt the best part of my nursing journey though, thanks to a truly spectacular placement on ICU, an awesome and awe-inspiring mentor who I am lucky to now call a close friend and career-long role model, as well as the awakening of what still is my infant nursing brain.

I began my third year feeling confident (but not too confident) and eager. I knew it would be a rough ride, but I hadn't anticipated quite how rough it would turn out to be. Things didn't go well from the start: both university and practice were unrelentingly stressful, which combined with my hard-to-let-go high standards, resulted in even greater pressure and stress. There were also serious health issues concerning multiple members of my close family, which obviously exacerbated matters. The stress of all these factors continued into my second semester, and by the time I had handed in my dissertation, it was clear to myself and those around me that the past seven months had taken their toll both physically and emotionally. I suspect I have always suffered with some form of low-grade anxiety, however sometime around April I found myself struggling with severe constant anxiety, along with an accompanying bout of depression. I don't want to focus too much on these issues for numerous reasons, but I do want to highlight my gratitude to my amazing friends, family, and GP for getting me through what was a particularly dark period, because I would not be coming to the end of my student-nurse journey without the care, compassion, and commitment that each of you afforded me, and I am forever grateful for that.

As the old adage goes, ‘time is a great healer’, and thankfully things were beginning to get a bit easier by the time my final placement rolled around. As with most placements, the first couple of weeks proved difficult - although more so due to the reasons identified above - but I steadily began to settle in and as a consequence my nerves began to settle down. As you might expect, core competencies for this placement focused on caseload management as well as leadership skills, and whilst I still make plenty of mistakes and forget things (am I the only one who never remembers when it’s time for meds rounds?!), there are definite tell-tale signs of just how much progress I've made during these past fourteen weeks. With said progress in mind, and the end of this my final placement now only days away, I am filled with relief: relief for finally reaching the finishing line against all odds; relief for the development of my knowledge and skills, which I was worried and convinced would never materialise; relief for my student-nurse peers who have completed their own nursing campaigns with both courage and determination; and relief for having had the courage to start on what has been a truly amazing and rewarding journey, allowing me to become the nurse that I have for so long desperately wanted to be.

The Final Stretch

Well, it’s finally happened. I'm on the final stretch. In just under five months time, I should be qualified. Put another way, I have one semester, one assignment, and one placement before ditching the lacklustre white for those symbolic ‘blues’. Those of you who follow me on Twitter or are regular readers of this blog will know that third year has been a tough year for me, so it will likely come as no surprise to hear that things have been rather touch and go of late. In the two months since I last blogged, I’ve finished and submitted my dissertation, completed my penultimate placement, and had my first job interview. Needless to say that from an academic and professional perspective it’s been a busy and stressful time, factor in a few personal issues for good measure - life doesn't stop just because you're undertaking a nursing degree - and you may be able to appreciate how much of a struggle this year has been without my detailing the specifics.

I’m still here however, and as professional registration draws closer, I find myself experiencing evermore mixed emotions. Part of me cannot wait to finish: mainly the part that is pretty worn out and fed up of assignments and myriad other assessments, yet another (bigger) part of me is scared to death and doesn't feel anywhere near ready. I'm reliably told however that the latter is entirely normal, and that 'being a nurse is like learning to drive: you don't really learn how to do it until you're actually in the job' - which is a topic for another post perhaps. Fortunately, I still have my management placement to go, and despite my reluctance to leave the safety and comfort of studentnurseville behind, I'm pretty eager to get started. The placement itself is epic: spanning fourteen weeks in total, and is in the field of neurology. As you might expect there’s lots of paperwork to complete, and copious competencies to achieve, not to mention the small stack of SMART goals I've set myself the challenge of meeting - suddenly fourteen weeks seems like it might not be long enough! Overall though I'm feeling fairly positive, and irrespective of the nervousness that is slowly building as 'the big one' (I really must stop calling it that) rapidly approaches, I’m also strangely calm about it all.

Beyond said placement and the other remaining final pre-registration hurdles lies the small matter of finding employment. The aforementioned job interview took place last week, and whilst I wasn't successful in being offered a post for the advertised position, I was offered an alternative. After some careful consideration and discussions with my nearest and dearest, I made the decision not to accept, as I felt the role wasn't quite right for me. The entire process was hugely valuable and positive, and even though it didn't lead to landing my first post, I do feel that it's given me the experience and confidence to help ease the pressure with regards to future applications, and ultimately left me feeling a little more secure about my future. In the meantime however, it's back to the books. Taking two weeks off to have some much-needed downtime has also meant that I’m now two weeks closer to my final academic deadlines, beyond which lies the finishing line, which is now beginning to creep ever so slowly into sight.

Letting Go

So as you're all too aware, third year has proven to be somewhat of a rough ride thus far, and not just for me it seems. On the whole it's been pretty unrelenting, and with the start of semester two and our final module having now arrived, there's no sign of things easing up. This is a positive post however (remember those?), and within the last week or so I feel that I’ve finally started to gain some sort of clarity and perspective on things.

Since Christmas, all talk at university has centred around three topics: dissertation woes, post-qualifying' uncertainties, and jobs. It’ll come as no surprise that I've been a contributor of such concerns during most of these discussions, however a subtle shift has begun to occur of late, and increasingly I'm finding myself becoming less the voice of doom, and more the voice of reason: proffering advice and a more-balanced view, or attempting to at least.

So what’s brought about this dramatic change? In a word, acceptance. I began this programme with the unwavering desire to be the best (student) nurse that I could be, and whilst that still remains the case, I’m realising that this doesn’t equate to the ultimate in unachievable goals: being perfect. Whilst I know there's no such thing as perfection, I see now that from the very beginning I set myself up to fail. My too-high expectations of myself combined with my self-deprecating and unforgiving nature have left me a little battered and bruised - proof of which can be found in the posts preceding this.

There have been copious sleepless nights, as well as a few tears along the way, because as I've said before, being a student nurse is no walk in the park, and this gig is tough enough without beating yourself up in the process. As fellow student-nurse blogger, @strongest_smile rather brilliantly writes here, the importance for having compassion for ourselves as people and professionals is as important as the compassion we show to our patients, something that is all too easily forgotten.

I've written this post for all the student nurses who are wrestling with similar feelings and issues. I've written it for those whose concerns we dismiss as disingenuous due to their favourable academic and/or practice achievements, as if by default they've no right to legitimate worries of their own. Above all perhaps, I’ve written it for myself: to serve as a reminder of the need to be kinder to myself, especially when things get tougher as they undoubtedly will. Because at the risk of sounding like a bad 80s love song, sometimes you have to learn to let go.*

*No offence intended to those who enjoy bad 80s love songs.

Personal Demons

Last night, following the third or fourth dissertation-induced stress fest of the week, I found myself nursing (pun intended) my largely self-inflicted wounds over a much-needed beer with a close friend. 

What started off as a productive discussion about where I was going wrong and how best to address my dissertation woes, ended up being more like self confession. Effortlessly I identified the causes of most if not all of my issues, and proceeded to position them as insurmountable obstacles to my qualifying or practicing as a competent registered nurse.
My friend, who isn't in the health-care industry, tried to comfort and appease me by declaring his unshakeable belief that I have what it takes to be 'a great nurse'. Due to a combination of his general loveliness and my unshakeable feelings of self doubt, it's not the first time he has said such things, and whilst I sensed his genuineness, it failed to resonate.

There's a simple reason for why his compassionate declaration was frustratingly ineffective, and that is that ultimately, I don't believe I can or will be that nurse. I've had all-too brief periods of feeling that perhaps I am capable of such things, but for the most part, I've never truly believed it. And therein lies the problem, because to a degree it doesn't really matter whether or not other people believe I can do it, I have to believe it myself. 

To further exacerbate the issue, I have a self-sabotaging tendency to overthink things: generally what that means in regards to my becoming a nurse, is that every identified flaw or undesirable trait, small as it may be, causes me to question my suitability to such a demanding profession - dramatic, but true. This coupled with constant academic and practice assessments, results in a level of self scrutiny that is simply physically and mentally exhausting. 

Eight months to go and I'm both eager and reticent to cross the finish line. I can only hope that the future's bright.

Don't Take It Personally

Last week I found myself engaged in a conversation with someone in which it emerged for the first time that I was a student nurse. I noticed immediately a look of surprise upon the person's face, and before I had chance to ponder the reasoning behind such a reaction, was met with a detailed account of numerous experiences of poor nursing care that she and various members of her family had encountered. I apologised (on behalf of the nursing profession!) for their collective experiences, and offered my sympathies in relation to the numerous emotive events that were effortlessly reeled off. I was genuinely remorseful for what had happened.

Most of you, I suspect, would have reacted in much the same way and left it at that. I however (rightly or wrongly) felt the need to go one step further and try and offer explanations to some of the events that I felt could perhaps be attributed to wider, less personal drivers. 'Staffing is a major issue' I found myself saying, 'I know from placements that quite often there just aren't enough staff'. I have no idea what if any comfort I was hoping to provide by offering this information, but thankfully she seemed not to be offended, and at least acknowledged my point regardless of its agenda.

A few days prior to this, I found myself in the midst of yet another debate regarding the perceived inadequacies of current nursing education on Twitter - a topic that you may be aware I am particularly passionate and vocal about! It had stemmed from a positive exchange between myself and another tweeter in which we highlighted the seemingly high calibre of our future nursing workforce, before being hijacked by a third party whose primary motivation appeared to be the blanket belittling of university-educated student nurses (see, vocal!).

I’ve encountered this argument so many times now that I’m literally bored by it - in fact it incurs an instantaneous eye roll pretty much without fail these days. Don’t get me wrong, I quite obviously like a good debate - it’s good to challenge and be challenged, but on this occasion I decided the safest option would be not to engage, and that’s what I did... for a whole twelve hours or so.

Preceding all of these incidents however, was yet another recent dispute that (for one reason or another) in this instance I did manage to avoid, again involving student nurses. This time though the focus was on those amongst us deemed to be ‘academic achievers’, and claims regarding their supposed attributable practical and compassionate downfalls. Reportedly and not surprisingly, it proved rather a contentious issue.

As with the ‘old-style-of-training-is-better-than-the-new’ argument, I’ve personally encountered this mindset out in practice - albeit only the once. Now on the whole I’m pretty happy with my general performance at university, but I consider myself to be neither superior, nor a showboater. As with most, if not all students at this particular juncture, I still have a lot to learn both in and out of practice. In addition, the issue of my compassion has never been brought into question, and has always been something that has been highlighted in an entirely positive manner.

Overall, it was a pretty disheartening experience, but ultimately I was able to disprove any preconceived ideas regarding my motivations and practice, although I felt the whole situation put me an automatic disadvantage right from the start. Thankfully the process of convincing them that I wasn't simply a textbook-quoting robot was a quick one, but I know that neither myself nor some members of the staff involved were ever completely comfortable with my perceived academic prowess.

These accounts illustrate just some of the persistent attitudes and obstacles that we as student nurses are up against before we even qualify. Add to this the hopeful expectations some hold for our ‘new generation’ in light of the prolific and often epic failings of our much-beloved healthcare system and profession (admittedly this is undoubtedly the exception as opposed to the rule), and it seems we have rather a lot to prove. Perhaps it’s good that we encounter such adversities now, before we register, and officially inherit all of this collective baggage. Perhaps it’s good training. Perhaps it will even stand us us in good stead. Who knows. I for one though plan on taking it one step at a time, perhaps I should start with learning not to take it all so personally first.

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.