5 top tips in nursing…

I cannot quite believe the 30-day blog challenge for NHS Horizons ‘transforming the perceptions of nursing and midwifery‘ has come to an end. I have thoroughly enjoyed reflecting on my thoughts, writing them all down, and putting them out there into the ether. I cannot thank you enough for all your comments and engagement. It has been overwhelming.

As for the other wonderfully brave bloggers and vloggers who have joined in with the challenge, I have loved reading and watching your contributions each day, and feel as though I know you all a little better. When your opinions have aligned with mine, it is nice not to feel alone; and when they haven’t, it has expanded my thinking and offered me an alternative viewpoint.

This challenge has made a blogger of me, and I hope to continue for a long time; as long as people want to hear what I have to say. And maybe even when they don’t – I’m not scared to put my head above the parapet and challenge for what I believe in, backed up with evidence, of course.

So, the time has come for the last topic of this challenge: “5 top tips in nursing”. I am just at the start of my nursing journey, still in education, and have much to learn. I hope it is a long and fruitful career, and that my passion for nursing continues as I develop and progress as a nurse. Therefore, I feel a little ill-equipped to offer “top tips” to others in nursing. That is why I am choosing to offer tips for myself to follow as I progress throughout my nursing journey instead. I think they may apply to other student nurses, and perhaps even qualified nurses too.

Always remember why you chose to be a nurse:

There will be times when you are exhausted; times when you are pushed beyond what you think is possible; times when you want to break down and cry. That is okay. Hopefully, the safe staffing legislation that is getting rolled out by RCN Scotland and the Scottish Government will help, and you must always fight for this: to protect both patients and yourself. But there are times when you will question why you ever wanted to be a nurse.

I hope this doesn’t often happen, as you love what you do, and I don’t want your passion for the profession ever to be extinguished. But, when it does happen, and it will; remember why you chose to be a nurse. You wanted to make a positive difference to people’s lives; you know you can. You wanted to be that nurse that people always remembered fondly with a smile, who went the extra mile for them and their families. The nurse who cared, but who was also really good at their job; the nurse who always acted in their best interests. Be that nurse. That is who you are, and why you chose to be a nurse above anything else you could have been.

And Craig, remember that looking after your self is equally as important as looking after those you care for. Make time for yourself, your family and friends.

Use your voice to champion the nursing profession:

You know you will always do this. You have been doing it since you first started your nursing education. But remember how important your voice is: your one voice. Your one voice can make all the difference. Be that voice. Be a nursing advocate, a nursing champion.

Inspire and encourage others to use their voices. And if they feel they cannot speak up then advocate for them, remembering to channel their voices without a personal agenda. Welcome new voices into the fold; never exclude people or make them feel intimidated or unwelcome. Never become one of the people who shoot down those with different viewpoints.

Encourage discussion, debate and resolution, always with a questioning mind. Remember that you are not always right; allow yourself to be informed by those who know better, without being defensive. But, don’t be afraid to champion your cause when it is something you passionately believe in and can back up with evidence. Don’t bow down because it is the easy option or you feel scared that people won’t like you for saying something against the status quo. Just because it’s the way it’s always been done, does not mean it’s the way it always should be done.

Craig, remember that with all nursing voices together, we can create a revolution. We can make a difference: for patients, their families, and for nurses. Help lead the revolution.

The best leaders lead by example:

Being a leader does not mean being the boss or the person in charge. You are leading by example now in your advocacy and activism work while you are still in education.

When you become a staff nurse, you can lead by example by always being a critical-thinker, a problem-solver, and by following the best evidence to guide your practice. Lead by example by helping others. Try to be the nurse that others look up to. Not because you’re special – you’re not – but because you wouldn’t be happy in yourself if you weren’t pushing yourself to be the best nurse that you can be.

Craig, if you do ever enter a management role, remember that respect is earned, not given freely, and works both ways. That team cohesion and productivity is best achieved when everyone feels respected and valued. Lead by example then. Never ask someone to do something you either haven’t done or wouldn’t do yourself. Don’t breathe down people’s necks. Delegate and trust others. Offer support and guidance when needed. Know everyone’s strengths and weaknesses; celebrate their strengths, and help them develop their weaknesses. Don’t govern by fear and intimidation, be nurturing – remember what you heard at Congress: “I have your back, you’ve got my ear.”

Never stop pushing yourself to learn and develop:

You are ambitious, there is so much you want to achieve. Keep that fire burning. But, learn how to be a good staff nurse first. There is no point running before you can walk. Have goals; but, keep them manageable. And don’t feel like you’ve failed if you need to change or adapt them. That being said, never stop pushing yourself to learn and develop as a nurse.

Keep questioning; keep reading; keep going on additional training courses. Please promise me you will go back to university to push yourself academically and to develop professionally.

Craig, you can do it. Just do it. Believe in yourself. Yes, it may be hard, but it will be worth it in the end. And you can make a difference.

Inspire student nurses – they are the future:

Remember the tweet you read:

You love being a student nurse, and you have had some fantastic mentors. Take elements from all of them and add in a pinch of what is unique to you. Always, support and inspire students to be the best they can be. Find out their learning style, what works for them, and foster growth. Be proud of them.

Challenge them, but never, ever ridicule them or make them feel stupid or less than. Student nurses have given up so much in their pursuit of nursing, and we ask so much of them. Remember, nursing is not easy. University is not easy. Remember not to “eat your young” – you won’t, but you find that expression hilarious, though strangely apt for some nurses.

Lastly, Craig, remember student nurses will often have just as must to teach you as you them. They are the ones being taught the most up-to-date information. And nursing education will evolve; so, adapt with it. Things change for a reason. It’s usually for the better. Don’t look at your history with rose-tinted glasses. Look to the future of our nursing profession – our student nurses.

So that’s that. With this final post, the 30-day challenge is over. Thank you so much for reading. And I hope to be back blogging again soon. I will miss talking to you all every day.

Craig

@CraigDavidson85

5 words that describe a nurse…

There are a plethora of words that could be chosen to describe a nurse. In this current climate, undervalued, exhausted, overstretched and underpaid are a few that come to mind.

Nurses have faced years of hardship and have been beaten down during a period when services have been stretched to breaking point. First, there was the pay freeze, then the pitiful extended 1% pay cap. Workloads have increased, often to unsafe levels, and many nurses have left the profession, burnt out, disenchanted, and genuinely fearful for patient safety. Also, there’s been a decrease in student nursing applicants, threatening the very future of nursing. The removal of the NHS nursing bursary being the direct cause in certain parts of the UK.

This all adds up to a disaster: for our profession, for the NHS, and for the public – we all deserve better. Nurses deserve to be treated with respect and dignity, just as patients are too. Nurses deserve to be paid appropriately for the work they do. And student nurses deserve bespoke nursing funding to support them throughout their studies for what is not a conventional degree programme.

Nursing requires the essential values of compassion and empathy, amongst many others, but it is also so much more than that. It’s a degree-educated, graduate-entry profession, requiring constant critical thinking and the use of the best evidence-based practice to protect patient safety and deliver the best outcomes. Nurses are often the coordinators of care, and they’re also researchers, educators, pioneers.

However, the purpose of this 30-day blog challenge is to transform the perceptions of nursing. So, I would rather focus on the positives of nursing. I love our profession and being a student nurse, and despite all the negativity surrounding it, I cannot wait to be a nurse.

I think the 6Cs of nursing describe nursing well – care, compassion, competence, communication, courage, and commitment. However, perhaps they are a little basic. So, what can I add to these in my “5 words that describe a nurse“?

I have purposefully not chosen the word resilient. Though, I agree nurses are resilient and have to be so – for both themselves and patients. ‘Resilience’ is often used as a buzzword. I do not believe nurses or nursing students are offered enough mental health or emotional support in what is a very demanding, all-consuming profession. Nurses are expected to be able to deal with anything that is thrown at them. If they are struggling, they have to be more resilient. Do they? Is that the answer? Would it not be better and more healthy to have reflective conversations with peers or senior members of the team that could identify ways to help them cope; rather than tell them to toughen up? Resilience is, of course, important, and nurses could not be freely weeping on the wards all day. But they should be supported in this resilience, and I don’t believe resilience is a badge to be worn with pride and honour. It’s a bit ‘stiff upper lip’ for me. With regards emotional and mental health support, I am aware this is different for mental health nurses – so I speak for adult nursing, which is what I know.

In my choice of 5 words that describe a nurse, I have also not included the words kind, caring, empathetic and compassionate. Not because I do not consider these to be necessary skills or words that describe the nurse, quite the opposite. However, these words I feel are a given. All nurses should possess them. The purpose of my chosen words is to help transform public opinion of the nurse – to educate them on our role further. So, here they are.

ADVOCATE:

There is a reason nurses come out on top time and time again in polls regarding the most trusted professions. I believe advocacy is a significant reason behind this. As is laid out in the Nursing and Midwifery (NMC) Code (2015), nurses must advocate on behalf of their patients. When patients and their families are at their most vulnerable, they need someone to be championing their cause and making sure they fully understand everything that is going on with regards their diagnosis, treatment and continued care. When they do not, or if they do not have the capacity, then the nurse must act in their best interests at all times.

For nurses, advocacy goes beyond this. Or at least I believe it should. They should be advocating for their peers, for student nurses and championing the profession as a whole. Some nurses have often felt as though their voice cannot make a difference. But it can. I would always encourage nurses to make their voices heard. If they feel they can’t, then it is up to other nurses to advocate on their behalf. If we don’t make a noise and raise our concerns, then we can’t complain about our poor treatment.

COORDINATOR:

Nurses are more often than not the coordinators of care for patients. They liaise with other members of the multidisciplinary healthcare team and social care services to make sure that care runs as seamlessly as possible.

Nurses are the backbone of hospitals and care in the community; without them healthcare as we know it would cease to function, which is why the profession deserves to be respected and valued.

ADAPTABLE:

No two days are ever the same. This constant change is part of the reason I find nursing so exciting. But it is for that reason nurses must be adaptable. They have to be able to react in the moment and adapt.

Being adaptable helps protect patient safety and achieves optimal clinical outcomes. The need for constant adaptability is why I am against the “this is the way we’ve always done it” mentality and the rose-tinted nostalgia of nursing history. We can adapt because we are critical thinkers who rely on the best most up-to-date evidence to guide our practice. Another reason why it’s so essential that nursing remains a degree educated profession, fostering this level of academic thought.

NON-JUDGEMENTAL:

Nurses should treat all people equally, free from judgement, regardless of any personal views. I believe this to be such an integral quality of a nurse. In practice, when I have seen nurses and other members of the healthcare team exercise judgement, I have found it galling. There is no place for it in healthcare – or in the society, in my opinion.

REFLECTIVE:

Through reflective practice, we improve not only our practice, but we improve healthcare as a whole and the patient’s experience of their care. Of course, we will make mistakes – it is inevitable, we are human. However, it is how we reflect upon these instances and develop from them that speaks more about us as nurses and as a profession.

I look forward to your thoughts and to reading your words describing a nurse.

Craig

@CraigDavidson85

What are my nursing pet peeves…

Well, today is the day where I am going to sound extremely critical of our profession, but it is what the question entails. And we are encouraged to be critical thinkers to improve services. However, I am aware that I am still studying and only at the very beginning of my career with lots to learn. So, I in no way think that I have all the answers. Anyway, here goes. I have addressed several of my nursing pet peeves in previous blog posts:

  • Poor patient care due to understaffing or poor communication and interpersonal skills.
  • Patient choice being neglected in favour of ease for healthcare practitioners – particularly concerning end-of-life care.
  • Insufficient understanding and delivery of palliative care.
  • Lack of emotional and psychological support for nursing students and nurses.
  • The failure of the government to secure bespoke funding for nursing students. In Scotland, the bursary is not enough. Elsewhere in the country, the student loan system, where students are getting in massive amounts of debt to become nurses, certainly isn’t working.
  • Incorrectly measured and documented observations endangering patient safety and health outcomes.
  • Lack of respect for nursing as a degree educated profession, which applies to both fellow nurses and society in general.
  • A nursing workforce that is not representative of the communities we serve.
  • Nurses being resistant to or unwilling to adapt and change.
  • The varied roles of the modern nursing not being understood.
  • Nurses who are not politically active or using their voices to affect real change and champion the profession – you can’t complain if you aren’t doing anything about it.
  • Nursing history being viewed with rose-tinted glasses. It is time to look forward.
  • The lack of education around nursing history at universities. How can we improve the future without understanding and improving upon the past

However, there are a couple of nursing pet peeves that I haven’t previously discussed.

Firstly, the reticence of certain individuals and institutions to encourage and support younger, newly qualified and student nurses in leadership roles. Sometimes the best leaders are not those with the most experience. In fact, having a fresh pair of eyes, different perspective or new vision – whatever you call it – and being on the shop floor, working directly with patients day-in-day-out, can be what makes them the best people to advocate for patients and nurses and to champion the profession.

Lastly, as a student nurse, one of my biggest pet peeves is being called “the student”. Luckily, this doesn’t happen very often, and when it does, I jokingly say: “my name is Craig”. But it is just rude. Don’t do it. Respect is a two-way street, and students are people too. We are the future of the profession after all.

Sorry about the rant – I promise that tomorrow I’ll be back to my usual chipper self. Would love to hear if you agree or disagree with my nursing pet peeves and any additional ones you have.

Craig

@CraigDavidson85

5 things I do on every shift…

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.

Craig

@CraigDavidson85

My favourite thing about being a nurse…

I know it may seem cliché, but I am unapologetically so. My favourite thing about being a nurse is 100%, without a doubt, the patients. It is a privilege to be a nurse, to be there for someone when they are at their most vulnerable. I love getting to know people, to find out their stories. When I am able to comfort them or allay their worries, I feel as though I have done a good job. This is why I think excellent communication and interpersonal skills are essential.

We need to use these skills to develop and maintain strong therapeutic relationships built on mutual respect and trust. I genuinely enjoy doing this. Maybe it’s because I’m a chatterbox who loves a good chinwag. Maybe it’s because I was an actor for years and in companies we had to build trusting relationships quickly. Or maybe it’s because I find it fascinating to learn more about their lives, their hopes, their romantic pasts (those stories are always my favourite – I blame Disney). Whatever the reason, getting to know the patients I am looking after is my favourite part of the day.

Truly knowing our patients facilitates optimal care delivery. Because how can we properly identify deterioration if we don’t really know them? Yes, observations and algorithms may give us a medical indication, but what if they don’t? On paper things may appear fine, and if we don’t know them then we may just accept this. However, if we genuinely know “Anne”, then we know that something isn’t right. She isn’t just tired; she may be depressed, she may have hypoactive delirium. If we don’t know her and this goes unnoticed we are failing her. We are ineffective nurses who are compromising patient safety and outcomes.

It is for this very reason I am so troubled by the nursing staffing crisis in the NHS, and the failure to recruit and retain nurses. The real losers in this situation are our patients – the reason I love nursing. Nurses are so stretched that often they simply cannot spend the time they would like to getting to know their patients. And things get missed – I’ve seen it happen, as I’m sure most of you have.

As a student nurse, we are supposed to be supernumerary. However, this status often goes when wards are short staffed and we become an extra pair of hands. But, when we do get to retain it, I love the opportunity it gives me to get to know patients better. I don’t want to lose this ability when I become a staff nurse.

People have mentioned to me that they can see me progress into management or education roles in the future, which of course is extremely flattering, and a confidence boost. They certainly have more faith in me than I do. However, I worry that this would take me away from direct contact with patients. They are the reason I got into nursing and why I enjoy it so much. For this reason, I would much rather become a clinical nurse specialist or advanced nurse practitioner in time so that I still provide face-to-face patient care on a daily basis.

After all, without patients, there would be no need for nurses.

Craig

@CraigDavidson85