As a student nurse, we are constantly on placements in different settings. And things change significantly from one setting to the next: an acute ward, an outpatients department, a community setting. So, here are five things I always do on every shift regardless of setting.
- Introduce myself: You would think this was a given, but I have been genuinely surprised that some people do not do this. Patients deserve the common courtesy of knowing our names. We know theirs, and if we fail to introduce ourselves, it only serves to amplify the potential power imbalance in the relationship. Patients are already in a vulnerable place, why on earth would we not take the two extra seconds it takes for a proper introduction? There is no excuse. The work the late Kate Granger did in launching the #HelloMyNameIs campaign has helped address this issue on a national and global level.
- Gain consent: I always gain consent, either written, verbal or implied, for whatever task I am about to undertake. It is essential we do this. Patients should be treated with dignity and respect, and nursing must be person-centred and focussed on patient choice. Consent must be informed, and they must be given the option to refuse treatment, as is expressly stated in the Nursing and Midwifery Council (NMC) Code (2015), which all nurses must abide by. As a nursing student who happens to be a man (note – not a “male nursing student”), I feel as though I am hyper-vigilant about gaining consent, particularly when performing intimate tasks on female patients. There was a recent debate on social media in which some nurses believed patients should not be given a choice to refuse a nurse based on gender. I vehemently disagree. Of course they should. A patient has every right to refuse care, or ask for a different nurse of the same sex. It is ludicrous that a nurse should take offence at this. I would never for a minute consider carrying out an intimate procedure – or any procedure – on a patient without first asking if they minded, and then explaining exactly what I was going to be doing. This is why I truly believe we must recruit more men into nursing so that we can offer male patients the same choice as women. With 11% of nurses being men, and often none on a shift, this is often an impossibility.
- Ask questions: If I don’t know the answer or understand something properly, I will always ask questions; whether of my mentor or other members of the multidisciplinary team. I have never had someone shoot me down for this – and if they had then frankly, they are in the wrong job. There have been occasional times where they have not known the answer themselves, and this has then proved to be a learning opportunity for us both. It is, however, always important to ask questions at appropriate times, and this is where my trusty, surgically-attached notebook comes in handy. Asking questions encourages critical thinking, so this is something I will never lose as I progress through my studies and career.
- Accurately measure and document observations: It is so important that observations are measured and documented accurately. An altered respiration rate is the first indication of deterioration, and universities teach that it should be counted for a full minute. A medic friend of mine suggests that there is often not the time for this; that although a full minute is ideal 30 seconds should suffice unless the patient’s breathing is erratic. But still, how many people measure for even that long? Evidence suggests that respiration rate is the most commonly overlooked observation. Likewise, a pulse oximeter will tell you the pulse rate, but it will not measure rhythm or amplitude. It cannot replace an accurate manual pulse reading. These are only a couple of examples. Others include people failing to accurately assess skin condition when carrying out positional turns, or documenting fluid balance. We shouldn’t be taking shortcuts. Yes, a lot of this is due to understaffing and an increased workload. But in the end, it will only harm patients.
- Drink plenty of water: Dehydration not only affects us physically, but it also affects us cognitively, which is the last thing we as nurses need when administering medication and such the like. I always carry a water bottle and make sure I am keeping hydrated throughout the day. We are always prompting patients to drink plenty of fluids. So, we should practice what we preach. Also, if patients see their nurses keeping hydrated, perhaps it will encourage them to follow suit.
So that’s the five things I do on every shift, regardless of setting. None of them groundbreaking but all of them important.