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Sharing the daily nursing miracles

Rather than resenting having to teach students nurses should embrace it, writes Leonard Cox.

I  am hospital trained and have accrued letters and pieces of paper on the way through. I was taught by rote and had to work out the reasons for what I was taught to do much, much later. I saw to my own education. I found better ways of doing things.

I once was interviewed for a CNE position and was asked the test question, "In three words tell us what you want from this job?" I argued for four words and they were, "Someone to replace me." I got the job.

But I got nothing from the CNE position. Management expectations demanded a show of outward performance within the position - all those hoops you must jump through, like demonstrating this, involvement in that, sitting on this or that committee (or both) - rather than actual educational outcomes with real nurses in the clinical setting. So now I remain a CNS, and am often assigned a nursing student. I love having them and am able to deliver more clinical education by not being an educator.

Having a student at your heels hones your nursing wits. You must have an answer for each question they ask, a reason for each technique you demonstrate and empathy for the predicament of the student or graduate nurse rotating into your specialty for their experience. You were there once.

It's scary for both of you: they know little and can't quite reconcile lectures with the ward, and you have forgotten the reasons behind your practice because you do it every day. You're in it together.
When I introduce myself to my patients as their nurse I include my student. I explain that the student is just that, but "there will be two of us looking after you today." Sell the concept of two-level care and you won't be bothered by ill-fitting slippers or extra towels that shift. The student, who knows their restrictions on scope of practice only too well, will want to be involved, use their training - this is the reason they have spent one, two, three years at university - to get in there and nurse.

Complementing this, you will have a greater window of time with each patient as you dispense their medications, note your visual assessment of them and engage in a care plan with them. Alright, you have to keep an eye on your student at the same time but who can't do that? (I am a man. If I can do it, you women can.) Having a student in the room with you instructs the student - they're watching you, too - and it comforts the patient that they are being looked after on two levels. Tell the patients that you are going to tea, but the student will remain, and vice versa, and I'll bet you money, real money, that your patients will not use their buzzers. They'll wait until one or either of you return.

Yes, things take longer to achieve but I ask the student at the beginning of the shift what it is that their paperwork is asking of them this clinical placement, they show me. That way I tailor the shift to their needs, break down the tasks, allocate responsibility for this or that, give them a little autonomy and they report back. That gives me little packets of time to fulfil my nursing tasks, plan care and deal with those annoying little problems that crop up during a shift. Job done.

As for the paperwork, you've done it. You planned that right from the beginning of the shift, did you not? Having kept in mind the students' objectives and meeting those with practical tasks and a reason for/when/how, all that is required is your signature and a date at the end of the shift. Any issues are passed on to the students' clinical supervisor.

Having a student assigned to you means you are workplace instructor, not a "qualified teacher". It is your responsibility to provide the translation from learning to practice, from university timetables to the hospital free-for-all, from pages to pus. You, to the student, are the real nurse, not a lecturer. If you think that you must be a quasi-lecturer, you've got the wrong end of the stick. I make nursing look easy and wondrous, almost magical, through my experience. I take my student aside before performing the daily nursing miracles we all perform and say, "One day you'll be doing this, so watch." You still get your work done, you have a runner for anything you've forgotten to place on your trolley and you have access to an extra pair of hands. You also inform both the patient and the student as you explain what you are doing; your practice subsequently is open, transparent, informed, instructional and validated.

The patient trusts you (just listen to them comment to other patients as you wash your hands at the sink just outside the room), the student gains an insight into what must be considered while attending the task and gives them a starting point for new inquiry. Conversely, if you've found a deficit in your own knowledge, it gives you a starting point - and that ties in to our continuing education obligations. Students give you a practice audience for your next presentation, your next lecture. (And they won't be as critical, but they will spot the chinks in your argument.)

Let me be selfish for a moment, as after 29 years I've earned it (and pretend you're reading this with a hand across one eye). As a Clinical Nurse Specialist, an expert in my field and forty-eight with a back injury, I use students as cheap labour. I have my eight or so patients of varying complexity as my "full workload" which I'd have to complete in any case, student or not. So, by explaining the reason for fluid balance monitoring, my students happily empty catheter bags and keep the fluid balance charts up to date. By explaining the correlation between vital signs and haemo-dynamics, they do the observations for me. I announce to my patients that I'm not going to disturb them, but when they get out of bed their bed will be made (but not by me - I'm doing the medications). I have a pair of eyes still in the ward when I go on a now-guaranteed tea break.

There is the non-financial exchange: the student will be guided through a day of nursing in exchange for lower-order tasks.

And they'll thank you for it, and want to be assigned to you again tomorrow. Or not.

Leonard Cox is a registered nurse at the Medical Foundation Transplantation Unit, Royal Prince Alfred Hospital. Cox writes in response to the comment piece 'Student nurse practical education', which appeared in last month's issue of Nursing Review.

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