Clinical placements

Why we’re glad we opted-in to paid clinical placements to help the NHS during COVID-19

Reflections on the unforgettable experience of front-line practice during the pandemic

Nursing students reflect on what they learned volunteering for front-line practice at its most challenging – all while juggling a critical stage in their studies

I felt daunted, but support from the multidisciplinary team soon fixed that

In January, the Nursing and Midwifery Council (NMC) introduced paid clinical placements for nursing students for the second time during COVID-19, with final-year students asked to step in to plug staffing gaps during the ongoing pandemic.

Due to the demands of the final year, our university lecturers had warned us about taking on extra work. But with colleagues struggling and the NHS under immense pressure, it was hard not to step in to help.

Anxieties about caring for high-acuity patients

Nursing students reflect on what they learned volunteering for front-line practice at its most challenging – all while juggling a critical stage in their studies

Picture: Alamy

I felt daunted, but support from the multidisciplinary team soon fixed that

In January, the Nursing and Midwifery Council (NMC) introduced paid clinical placements for nursing students for the second time during COVID-19, with final-year students asked to step in to plug staffing gaps during the ongoing pandemic.

Due to the demands of the final year, our university lecturers had warned us about taking on extra work. But with colleagues struggling and the NHS under immense pressure, it was hard not to step in to help.

Anxieties about caring for high-acuity patients

Students who opted in were not given a choice where to work but were sent where the clinical need was greatest. I was asked to support a COVID red ward – formerly an emergency admissions ward – that accepted step-down patients from the intensive care unit (ICU), and those who were acutely unwell but did not meet the criteria for ICU admission.

‘I was worried I would be “on my own” and might miss something because of my lack of experience, but this was never the case’

Before starting my eight-week placement in early February, I contacted the ward and was reassured that I would be welcome and well supported. As I hadn’t worked in many high-acuity areas before, this made a huge difference to the anxieties I felt.

When I voiced my fears about caring for patients in this setting, I was reassured by the other nurses that it is natural to feel this way. Patient numbers had fallen on the ward by the time my placement started, so I was able to combine my nursing duties with developing my learning as a student.

Multidisciplinary teamwork is essential

One of the most important things I learned during my placement is that caring for high-acuity patients is always going to be challenging, but good teamwork is crucial. I was worried I would be ‘on my own’ and might miss something because of my lack of experience, but this was never the case, and I was able to practise safely with lots of support from the multidisciplinary team.

‘Seeing a patient improve was highly rewarding, but watching them deteriorate was a huge emotional strain’

Feeling part of a team, where everyone’s contribution is important and valued, was the best thing about ‘opting-in’. As a student, I felt listened to and respected, and when I had concerns about a patient, I felt confident in raising these.

My practice supervisors and assessor challenged me on all aspects of nursing care, particularly drug administration, which was an area I needed to develop, and I learned so much about caring for patients requiring intensive care, such as the ceiling of care and the effect the different types of non-invasive ventilation can have on patients.

The competing demands of practice learning and academic study

Seeing a patient improve and titrated off ventilation was highly rewarding, but watching patients deteriorate was a huge emotional strain. Continually learning about complex patient care was mentally exhausting, and I sometimes felt frustrated when I could not concentrate on my academic work.

But my university lecturers understood the issues and were very supportive. Lectures were recorded so we could catch up on anything we had missed, and deadlines for academic assignments were extended.

We were also able to participate in properly researched and referenced discussions rather than written assignments, and getting some of my competencies signed off while opting-in relieved some of the pressure before starting my final placement.

A chance to learn about practising independently

I am grateful to have been given the opportunity to opt-in during COVID-19. As well as supporting the NHS in a time of great need, helping to care for high-acuity patients has really increased my confidence; I have been able to practise more independently, managing my own patient caseload, and improve my handover skills.

Much to my surprise, I have enjoyed working in a high-acuity area, and am delighted to have been offered a position on the emergency surgical ward when I qualify in September.

Fiona Fitch is a third-year adult nursing student at the University of Suffolk and was a finalist in the student category of the 2020 RCNi Awards


Opting-in to this placement was the best decision I’ve made

As a final-year nursing student, choosing to opt-in for a second time during COVID-19 was not an easy decision.

When we were first given the opportunity to opt-in to an extended clinical placement in April last year, I jumped at the chance; I was nearing the end of my second year so was due on placement anyway, and I had completed all of my academic work.

But this time it felt different. I knew that undertaking an additional clinical placement during the final six months of my nursing degree would not be easy, but with the announcement made in January and placements starting in February, I had to decide quickly.

‘Arriving on the ward on my first day was overwhelming and I felt like I was back in year one’

After weighing up my options, I chose to opt-in again to support colleagues in the NHS and was allocated a 12-week placement on a cardiology ward – the same ward I had requested for my final clinical placement.

While I had no choice about where I would be working, I felt very fortunate; being allocated to this ward meant I could build my knowledge and confidence in this area before my final placement officially started.

The extra workload was understandably a concern for me and a lot of final-year students. Our dissertation deadline was slowly creeping up, alongside all of the other academic work we had to complete. A lot of students were also coping with the extra demands caused by the pandemic, such as home schooling and other caring responsibilities.

Infection-control practices made the clinical environment seem unfamiliar

Although I was eager to get back into clinical practice, arriving on the ward on my first day was overwhelming and I felt like I was back in year one. The hospital felt like a different place, with infection control practices ruling how we operated day-to-day.

As two of the four bays on the ward had been closed due to confirmed COVID-19 cases, the main challenge was getting the bays re-opened so we could accept suitable patients and provide the specialist care they required.

‘Despite all the challenges of COVID-19, opting-in towards the end of my degree has enabled me to improve my clinical skills and develop my confidence’

The reduction in placement hours caused by the pandemic had dented my confidence in my practical skills, but after spending a couple of shifts getting to know the ward and familiarising myself with the specialist cardiac monitoring equipment, I soon started to feel more confident.

Support from the ward staff has been invaluable, and I felt like a member of the nursing team from day one. As a final-year student, I feel like I am being coached rather than mentored; I am managing my own patient caseload, with my practice supervisor there in case I need any guidance or supervision, such as during drug rounds.

I didn’t feel ready to qualify, but I do now

University staff have also been a great support. As well as keeping us updated on any developments, they have been very understanding about deadline extensions or additional support with academic work, enabling me to focus on my placement with few concerns.

Despite all the challenges brought about by COVID-19, opting-in towards the end of my degree has enabled me to improve my clinical skills and develop my confidence in patient care and management. It has also given me and many other students the opportunity to support our colleagues and the NHS through an extremely challenging period.

It is the best decision I have made during my training. Going into this placement, I didn’t feel ready to qualify, but I now feel more competent and confident, and am ready to become a registered nurse.

Ben Toye is a third-year adult nursing student at the University of Suffolk


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