The Newly Qualified Nurse's Survival Guide

Jackie Hole

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781846192753
• eBook ISBN: 9781315357904
• Topic: Medicine
• Subtopic: Health Care Delivery

Even after years of training and hard work, finding yourself on the threshold of your nursing career is often a daunting prospect. In this revised and updated second edition, Jackie Hole provides clear, practical advice on both managing the transition from student to qualified nurse - including getting the most from your final placement and making applications - and practical advice on key areas encountered in the first weeks and months after qualification. Drug safety, dealing with common clinical problems, and how and when to seek expert advice are all covered, while a newly written chapter addresses the key area of infection control. Management aspects such as delegation, objective setting, budgeting, prioritisation of care and time management are outlined clearly and engagingly, along with questions of professional development and career futures. This book will be invaluable to newly-qualified nurses, as well as to student nurses, nurse tutors, and experienced nurses wishing to gain an insight into their own practice and changes in the profession.

1

Pre-qualification

Use the time during your management/supervised practice placement to really look at the areas in which you are lacking practical knowledge. For some, it may be as simple as not having inserted very many catheters. For others, it may be the whole management experience that is daunting. Try to work with the person in charge of the ward as much as possible to gain experience in how others manage a group or a ward of patients. Request that you actually take charge under their guidance, so that you experience what it is like to really manage the ward. It is a good idea to work with more than one person in order to see different leadership styles in action. You can then pick out the approaches that suit you.

This may be the point at which you decide which speciality you want to start work in, or you may still have no idea about this. If that is the case, perhaps a rotational contract would be best for you so that you can find out where your area of interest lies. You will find that most NHS Trusts offer rotational posts for newly qualified nurses. They will run over varying lengths of time, but two years is an ideal period. This will give you the chance to experience medicine, surgery and high dependency care. Each Trust will manage this differently – the placements may be set from the beginning or flexible to allow the programme to fit individual needs. This is a really good way of finding out what suits you and what you enjoy the most, and it will also provide excellent experience. Many nurses find that they are ready for a more senior position following the completion of a rotation programme.

Use the following to guide you through your last placement to ensure that you get the maximum benefit from the experience.

MANAGEMENT/SUPERVISED PRACTICE PLACEMENT OBJECTIVES

The following are designed to enhance the objectives set for you by your university. They include both the theoretical and practical aspects of the last placement.

This is one of the most important placements of your training. It is during this placement that you will have the opportunity to consolidate the skills and knowledge you have acquired during your training. Make the most of the opportunity and remember that this is your last chance to ‘practise’ your skills before you become a staff nurse. If you feel that there are still certain skills or gaps in your knowledge that you have missed out on throughout your training, now is the time to make sure you address those issues. As well as ensuring that you have accrued all of the necessary skills, the following will help to guide you through the management process.

These are the skills that you will be using once you are qualified, so use this time to practise them as much as possible. This will make the transition from student to staff nurse much easier.

Allocation and delegating skills

Practise allocating staff to patients. This will be much less difficult while you are a student. Once you are qualified you will be expected to do this, and it is important to practise how to get it right. For example, you will need to find out who has been on duty the shift before, as you will want to provide continuity for your patients. You may need to find out which staff are in which team, if that is the way the ward is organised. You may also need to enquire as to how long the staff are on duty. Whether they are on a long or short shift may influence where you allocate them. If you need to allocate a registered nurse and an unqualified nurse to each group of patients, you will want to ensure that one of them at least is working a long shift so that someone knows about those patients throughout the day. This will ensure that even fairly simple matters, such as what a particular patient has eaten that day, are not neglected.

It is also important to remember that, when allocating staff, you may encounter negative comments such as ‘Oh no! Not that patient again today!’ These kind of comments are difficult to deal with, so the more practice you have in doing so the better. It is essential that this type of judgemental attitude is challenged and not allowed to continue unchecked. This type of communication is very damaging, as is well documented by Stockwell (1972), and it can cause negative feelings towards the patient before the nurse has even met them. Ways of challenging this behaviour include pointing out what you like about the patient or pointing out why you think they may behave in a certain way. Otherwise, the more this negative type of attitude is allowed to continue unchallenged, the more negative the team becomes.

‘It’s not what you say, it’s the way that you say it’

Delegation is another area where newly qualified staff experience huge difficulties. Often they do not feel confident enough to ask someone else to do something for them. Consequently, they try to do all of the work themselves and end up leaving late or providing less than adequate standards of care. Other members of staff will not mind if you delegate tasks to them, so long as you apply these basic rules:

➤ Is it something they are competent to do? When delegating, you remain responsible for that care if you do not delegate appropriately as stated in the Standards of Conduct, Performance and Ethics for Nurses and Midwives (Nursing and Midwifery Council 2008).

➤ Have you explained clearly what it is you want them to do and why?

➤ Are you genuinely busy yourself, or is it just something that you do not want to do?

As long as you ask the other member of staff in a courteous manner and stick to these rules, there will be few problems. That said, there may always be someone who has the potential to react in a negative way to your request. These people are often known for this type of behaviour and it should be dealt with swiftly by their manager. If you experience this type of reaction, try discussing the matter with the member of staff, or if you do not feel confident enough to do this, talk to your manager.

Management of a group of patients

This is something that can be practised well during your supervised practice placement. It is important to know about each of your patients, including their care needs, social situation, relatives and medical plan. You must find out this information quickly once you are on duty. Some of it may become apparent during the handover, but the rest can be found out by reading the nursing and medical notes and talking to your patients. Start the shift by making a list of things that need to be done. This list may well start during handover. This way you will ensure that you do not forget to do something important, and it also is very satisfying to be able to cross the items off your list as you go along. If you do have unfinished tasks on your list at the end of your shift, you can then hand them over to the next shift of nurses. Remember that nursing is a 24-hour profession – you don’t need to get everything completed during your shift. However, you do need to ensure that you have prioritised your list and that the essential jobs have been completed.

If you are responsible for a side room as well as a bay of patients, try to go and say hello to them first. It is important that you greet your patients and introduce yourself to them before you do anything else. If you get stuck on the drug round or with doctors, you may not see the patients in side rooms until well into the shift. Patients, especially those in side rooms, may feel neglected or uncertain who is looking after them that day if they have not seen you.

You must ensure that you work as part of a team. You will need to know about the care needs of all of your patients so that you can discuss with the nurse you are working with which of you will do what. You cannot expect the unqualified nurse to perform all of the essential care for your patients. Not only is this unfair, but it also means that you will not be seeing pressure areas, communicating with your patients, assessing their nutritional needs or teaching and being a role model for the untrained staff. It is all too easy to get caught up in paperwork, telephone conversations and referrals. Do they all need to be done as a priority, or can some of these things wait until the patient care has been done?

It is important to realise what is going on in the rest of the ward. It is very easy to become isolated in your bay. Make sure that you are aware of potential problems in other bays, and don’t forget to offer help if it is required. You would not be expected to know everything about all of the patients on the ward, but you need to know about acutely ill patients, violent patients, etc., in case your assistance is required. If a colleague is caring for such a patient, remember to make sure that they are coping with the situation, and offer your help. They may well have more experience and knowledge than you with regard to this type of situation, but your support will be much appreciated. Think how you would feel in the same situation. You may also learn the best way to deal with these issues.

Doctors’ rounds and case conferences

Doctors’ rounds, especially when the consultant is present, can be very daunting when you are newly qualified. While you are on your final placement attend as many of these rounds as you can. Watch what your mentor does – how he/she interacts with the doctors, the sort of questions that are asked and how he/she fields questions that he/she does not know the answer to. Once you feel confident enough, you may be able to attend these rounds without your mentor. As long as you know what has happened to that patient over the past 24–48 hours, what their social situation is like and what nursing care they are currently requiring, you should be able to answer most of their questions. It is very important that a nurse is present on these rounds. The reason for this is not to fuel the doctors’ egos or just because they want a nurse there. It is because you can provide valuable information about your patients. You are the one who knows them best. The doctors will only see their patients for a few minutes each day. You are there as their advocate and ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword to second edition
• Foreword to first edition
• Preface to second edition
• Preface to first edition
• About the author
• Introduction
• 1 Pre-qualification
• 2 Post-qualification: the first few weeks
• 3 Drug safety
• 4 Infection control
• 5 The next two to six weeks
• 6 ‘The six-month tears’
• 7 Your first year
• 8 The future
• 9 Common clinical problems
• Checklist
• References
• Index