Placement problems

Hi, I hope someone can help before I have a breakdown.
iv just had my first week on my first placement (first year) I don't know if maybe my expectations were too high, but iv been really upset. The first day I had to go straight to the staff room for the handover and nobody said hello introduced themselves or introduced me to anyone. My mentor then came in and then after we went out to the ward, she said hello and then just sent me off to follow a HCA, which I did for the whole day. The following days all iv done is feed and change people. Whenever she has asked me to help with something I think "she's finally going to start teaching me" but she just carries out the task and doesn't explain anything to me. Whenever I ask questions she just give me a ****ty response. It's really getting me down. Is it reasonable to request that my uni allow me to move to another ward? This placement is 10 weeks and I don't think I can take it for that long as I'm worried I will fall behind. Or am I just being dramatic? I just didn't know people could be so rude especially when they are being paid extra to teach me, I assumed they became mentors because they WANTED to help and not just for the extra money. HELP PLEASE.

You need to have a chat with your mentor. Be casual about it at first, tell her you don't feel you are getting the best learning experience. Maybe discuss your goals and objectives with her. We have specific competences we have to achieve on each placement and I'm guessing you will have something similar. If she is not supporting you and isn't treating you as you feel you should be treated and talking to her doesn't resolve it, it's time to take it to the university. Does your university have link lecturers for the placement areas? If not then you need to speak to your personal tutor. Also, you should never be left working with a HCA, you should always be supervised by a qualified nurse. Mentors often don't want to be mentors, in my trust nurses are told they have to be mentors and are made to go on the course and don't get any extra pay or anything for having a student with them. It is worth remembering though that personal care is a fundamental part of nursing and skills you will always need, first year is the perfect time to develop these skills without too much pressure. Never underestimate the importance of personal care!


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It's pretty much common practice for students to work with HCAs for at least part of their first placement, technically they're still under the indirect supervision of an RN. I learnt loads of little tricks that make my life easier through working with the HCAs as a student.

HELP PLEASE.

I really hope that you were able to get this sorted, but for any other student nurses facing similar problems then there are a few things I would like to say that may clear a few things up. I am a qualified RN and have recently passed my mentorship course. I know as a first year on your first placement you are keen and enthusiastic and you want to learn everything you possibly can and this is not a bad thing, it's a very good thing but 1st year 1st placement student nurses tend to come to the wards with very high expectations. They want to be doing medications, IV's, CPR, gruesome dressings, ward rounds and running the ward but as a first year student nurse, even if you have healthcare experience you are just not at that level or have the skillset to do those things yet. It's important as a nurse to learn the basics, because they are so important. I know it may seem boring at times, but washing a patient is actually probably one of the most important tasks of the day assessment wise. As a nurse you aren't just washing that patient, you are constantly assessing them. It is the best time of the day to check your patients pressure areas to ensure that they have good skin integrity and that their skin is intact with no breaks. You can also see how well they are feeling for example, are they short of breath, do they seem hot and clammy, is their stomach distended, do they look in pain? etc. What is their mood like? Are they low in mood, are they anxious, are they worried? Patients tell you more in the 10-15 mins you are washing and dressing them than they will in the entire day! When you are repositioning a patient or changing a patient you are not just simply wiping their bum and changing their pad, you are checking to see if they have passed urine or had their bowels open. Also is it normal? You can tell a lot about a patient but just the look, colour, smell and consistency of poo and wee! Feeding a patient, you are having the ideal opportunity to assess nutritional intake, and to see if a patient has issues with chewing or swallowing. They may not be eating because they have raging thrush in their mouth because of the antibiotics they are on, or are struggling to swallow because they have dysphagia. Observations, you aren't just taking the blood pressure and vital signs, you are looking to see patterns and trends as well as ensuring they are stable. Just because someone has a blood pressure of 105/60 doesn't mean the patient is stable and well if their BP is normally 140/80. And likewise, some patients normal BP's will be 89/50, doesn't mean they need a STAT gelofusin if that is normal for them. It's so important to know these basic things because a lot of your care planning and how you look after your patients depends on these basic nursing tasks. We don't purposely make you clean up poo, wash patients and do the obs to make lives easier for ourselves and treat you like general dogs bodies, it's because you need to be able to identify things and understand what they mean so you can act accordingly. Even if you have previous HCA experience, you may know what something abnormal looks like, but what does it mean? What can I do as a nurse to solve this problem, do I need to escalate this to a doctor or relevant speciality? Some things are more obvious than others, obviously a patient that is blue with abnormal breathing is not right and it's obvious they need oxygen and immediate medical attention, but what about little Doris in the corner who has not passed urine at all in the morning? She could well be constipated causing her to be in urinary retention, she may not be constipated and still in urinary retention or she could be in kidney failure. Basic care allows you to make accurate assessments and actually makes your job 10x easier! Remember your APIE, assess, plan, implement, evaluate.


Obviously I do not expect the entirety of my students placement to just simply wash, feed and do the turns but they need to know the basics before I can allow them to perform more complex tasks like creating and writing in a care plan, because really, how can you write a care plan if you have no idea of the patients problems and symptoms and what to look out for and what you have done/or going to do to fix it. Once they understand the fundamentals of basic care then they can do dressings, insert catheters, admit patients, discharge patients etc. I would never in a million years take a first year, first placement student around with me to do the medication rounds because they just do not have the sufficient knowledge or competence to be able to do that yet! In fact, the universities attached to my hospital clearly state that 1st year students in the first half of their 1st year are not to do or go near drugs because they have to complete a competency at uni before they can undertake a drugs round, give injections, prepare IV's, enteral feeding etc. If an interesting learning opportunity comes up then of course I will always let my students participate and even if on my students first day I have to do something like a catheter or complex wound dressing then I will take them with me to show them, I will not just cast them aside.


It's important that you don't run before you can walk. I could let you do all these wonderful, fantastic things but one it would be irresponsible of me and I could be putting patients at risk and secondly it would not benefit you in the long run because you would probably struggle later on in your training. Yes there are many different specialities so how things are done on my ward would probably be vastly different to how another ward runs, but the basics will always remain the same so if you master the basics then you can master any speciality you are placed to work in.
I have the responsibility to make sure you are competent enough to progress in your course or qualify because if I pass you and something happens later along the line when you are qualified, I can be hauled in front of the NMC because I was the one that deemed you fit to pass and could risk losing my PIN number because of it (yes, these things are tracked and it does happen!). We as mentors also DO NOT get paid any extra to be mentors and is a requirement for all RN's to be mentors eventually so we do not get a say in whether we want to do it or not, which is why you will find you will get some mentors who are brilliant because they want to teach, and others who are not so great because teaching isn't their thing. We can also expect to mentor up to 3 students at any one time, so can you imagine how stressful that can be for one RN to have all that responsibility, to ensure that his/her students are practicing efficiently, ensuring they are meeting their outcomes and getting the best learning opportunities available and fitting in interviews AS WELL AS looking after a full ward of patients, dealing with drs., social workers, relatives, other disciplines. We are only human so yes we can sometimes not spend as much time as we would like explaining things, showing you things, yes we have a responsibility you are meeting your outcomes but we also have a responsibility to our patients and patient care will ALWAYS come first. When this happens, use a bit of initiative, ask your mentor or HCA you are working with if something needs doing or if there is not much going off on the ward but your mentor is tied up, why not go and do a bit of research on something you have learned about that day, or something you would like to learn about. We are not all monsters so if you have great ideas on some evidence that you want to write about, go and do it. I am not averse to letting students sit in the quiet room for an hour to work on some portfolio evidence during a lull on the ward. At the end of the day, yes, the university and mentors out in practice have a duty to ensure you are meeting your outcomes and having a good and insightful placement, but you are also responsible for your own learning just as much as we are. You get out of it what you put in and hard work really does pay off.


If you find that you are clashing with your mentor, ask if you can work some shifts with your associate mentor or ask the sister in charge of the ward or nurse in charge of students if you can swap mentors because it's not healthy for you or the mentor in question. We are all human and we are not going to get on with everyone we come across, that's life I'm afraid. If you are still having problems then you must speak to the practice learning team or your university ASAP. You don't want to be in the position of getting signed off at the end of your placement then being failed because of an issue or misunderstanding that could have been resolved on week 3 or 4. I know it's unacceptable for you to be completely blanked on your first day, it should not happen at all. It's not always intentional, we get so many students that we sometimes we forget who is where, who started when and we don't always feel too bright and breezy first thing in the morning after a stretch of 12.5 hour shifts. I'm not saying it's an excuse in the slightest, but like I have said before, we are only human. Generally, most wards are very welcoming and supportive, and if you do run into any problems then most mentors are approachable. I agree that some mentors are toxic and just shouldn't be mentors but we don't all possess the skill of being able to teach, or having the patience to teach. Being a mentor is not easy, neither is being a student but both have a responsibility to ensure that you are getting the best out of your placement. Remember, we are accountable for your practice so if you make a mistake because I let you do something that you are not yet skilled enough to do, it's my job and PIN number on the line.