This reflection was prompted by a conversation a group of nurses were having on Twitter. We chatted about how much responsibility we had shouldered when we were students. I can remember taking charge of a ward as a third year student on nights; it wasn’t uncommon where I trained back in the 1980s. Although this wasn’t what made me scared I am glad that this no longer happens.
These conversations took me back to when I had first qualified. Essentially there is only one day’s difference between being a student, and wearing a staff nurse’s uniform; one day in white and the next day in blue. Perhaps if I had stayed at the hospital I had trained at it would have been easier; it was a small hospital so everyone knew me and would have known I was as green as grass, even though I was competent – I had, after all, just passed my finals.
But that isn’t what happened to me. I moved from a very small district hospital (we had 8 wards in total) to St James’s Hospital in Leeds. At the time it was the subject of the ‘Jimmy’s’ programme, one of the first hospital ‘fly on the wall’ documentary and was notorious as the largest hospital in Europe; I couldn’t have gone to a more different place. My first job was as a staff nurse on a 6 bedded coronary care unit, with 6 telemetry channels; I loved it. I love acute work but I liked the fact the patients were awake unlike in ITU. But of course it was a pressurised environment. The sister at the time was amazing but she left within a few weeks of my arrival and in what seemed like no time at all I was rostered to be ‘in charge’ on nights.
Just to put this in context, the nurses on the CCU only had the support of house officers at night. The house officers often looked to the nurses for guidance and advice – in my situation I really felt exposed and it was like the blind leading the blind. I really hope this would never happen now!
I can vividly remember driving down the motorway to go on my nightshift feeling really sick, gripping the steering wheel hard, and praying that nothing would happen. Life isn’t like that though is it?
It can’t have been my very first shift but not much later (I was still at the feeling sick stage) I turned up for work and took handover from another staff nurse, Pete (I wonder where he is now). I will never forget what happened next.
We took handover in the middle of the unit – we could see all the beds. While we were handing over Pete had given a gentleman a bottle, he couldn’t pass urine in bed and Pete had assessed that he was well enough to stand to try to pass urine into a bottle.
We completed the handover and Pete left the unit, leaving me with a (then) nursing auxiliary. He had just left, we were moving towards the curtained bed and there was this almighty crash. The man had arrested, face down on the floor, wrenching out his heparin pump in the process and of course this was bleeding. What followed taught me what I was capable of; not flapping and taking practical steps to do the best I could to save the man’s life. The crash team were prompt but we couldn’t save him.
The next part is why I remained scared for quite a long time. I had never told anyone that someone had died before.
This gentleman’s wife, not an hour before had been visiting her husband; apparently everyone thought he was doing very well. She must have left the hospital worried – he was on CCU after all – but reassured too, he was alive and well when she left him. When she got home the phone was ringing. It was me; please could she come back to the hospital?
We didn’t have a relative’s room; we used the sister’s office on the adjacent ward to break bad news. I can see the room now, blue carpet, brown furniture, big desk; not an ideal space to do what I had to do. I did the best I could carefully explaining that her husband had died.
I didn’t expect what happened next. The lady grabbed me by my uniform, around my neck and thrust me up against the wall. She screamed that she didn’t believe me and what had I done to him? I remember my surprise and being scared as I was on my own and she was really very upset.
I must have sorted it out somehow and I know I will have tried to do that as well as I could but those moments that happened around 26 years ago are still quite vivid. I know there has to be a first time for everything but I am honestly not sure I was ready or that I got the help I needed afterwards.
I learnt to cope, I know that I used to be able to be relied on in a crisis (I suspect it’s still true but untested of late) but I do feel I learnt the hard way. But why is it important and what did I learn? It taught me to make sure newly qualified nurses are given proper support and preceptorship. It taught me how resilient I am. I am not fazed by breaking bad news anymore and it no longer makes me feel so sick, although it’s always something I find challenging – but that’s normal.
But I remained scared for quite a long time – so scared I used to feel sick! Have you ever been so scared you feel sick?
Great blog Anne, triggered lots of memories as a newly qualified nurse in charge of the ward. On one particular occasion I was nursing a lady who’d just returned from theatre…..her husband lost his temper because he couldn’t see her straight away. He then had a cardiac arrest on the ward, luckily a positive outcome for both & a very steep learning curve for me. I remember being calm and collected at the time then the sheer shock of what had just happened hit me & I felt very very sick!
Thanks Jo. I think we should talk more about what we find hard as well as what we should do. I am sure you were fab!
Thank you for sharing this. I think many nurses have similar experiences (me included). Sometimes we are fearful because we care so much about what we do. You are right, it is so important to support and care for each other, but not just newly qualified nurses – all nurses. The realisation of the enormity of accountability and responsibility comes at different times for different people but certainly a good solid preceptorship programme is crucial for newly qualified nurses.
Thank you Wendy – I so agree. It did get easier though in the main but we should support each other. Clinical supervision seems rare these days too. Shame
Thanks Annie for confirming to me that those days (I trained in the 1980’s like you) were hard but bred confident resourceful and knowledgable practitioners. Looking back now those days were scary but we learned through experiential practice and good support from the ward sisters. I agree the house officers relied on us for support even though you hard worn your blue dress for maybe only a couple of days but were expected to know it all!
Thank goodness I was normal 😉 Thanks for your comments. and you are right – I’m fairly sure it was the making of me too!
Great blog! Brought tears my eyes similar situations. That’s why I enjoy being a mentor and appreciate students and newly qualified nurses. They need support, excellent role models and time to reflect. Well done!
Thank you Andrea and we need people like you. X
Also trained in the ’80’s and it was scary, remember being left in charge on nights in my third year! Not sure it was the right thing but it has made me really think about the support and experiences we should give to students.
Thank you Karen – I remember too. Feels like such an unsafe thing now but normal then! we think things are bad now but we must remember where we have come from – thanks for taking time to comment 🙂
I agree with the comments submitted, I qualified in 1980 and I remember being in charge of a surgical ward in my first year and was brave enough to refuse to insert a naso gastric tube which had been pulled out, the night sister was furious with me but I stood my ground.
I loved every moment of my training however, it was hands on with a blend of theory and I think our generation turned out alright. I dont think the expression “it was better in my day” is helpful as its all context driven and our political and healthcare system is very different now!
Thanks Lynn – great comments and so true. Its not the same now and we need to throw our rose tinted glasses away! x
Great blog, reminds me of being newly qualified, working in busy city centre A&E in Leeds. Often given responsibility of caring for critically ill & injured patients in the resus room & feeling sick with anxiety that somebody might ask me to do something I didn’t have the skills or knowledge to do. Like you I toughened up quickly but was often “flying by the seat of my pants” in those early days! Highlights to me the need to ensure we nurture & support our students & newly qualified. Leadership by example, providing excellent role models is the only way forwards.
Gosh this brings back memories of those days when students weren’t supernumerary. I was also in the era of students left it charge on nights with support from night sisters.
I remember not being able to relax or take breaks because I was apprehensive about what could happen and how I would manage. I did manage without too many issues. Scares me now thinking about what could have happened!!
Scary moment for me was as an experienced children’s nurse on nights when a parent tried to abscond with their child who was admitted following a non accidental injury.
Community nursing now has made me realise about how little safeguarding knowledge and training I had back then. Yes I was scared and feeling sick.
Thank you so much for your comment. Gosh left on a childrens ward. I think i would have been sick with anxiety. I suspect we turned out OK but we can make it better for students and new nurses now. Not so good old days!
Thank you so much for your comment! I nearly didnt blog this. I wasnt sure if i was being ‘odd’ but am reassured I wasnt 🙂 x
Thanks for sharing Annie, and for pointing out that it is often the psychological aspects (for patients, their relatives and for the staff) that are the most scary. I too remember the shock of receiving an angry response from relatives that I was not expecting, even though Kubler Ross was writing about it long before I experienced it. I guess, like me, you didn’t get any clinical supervision to work through it. I wonder if anything has changed?
You are right Elaine – clinical supervision just didnt happen then and Im not sure what would happen now :S
I have absolutely no experience in nursing (except as a patient), but I loved how you made me feel your anxiety of being a new lead! This is very well written & I thank you for sharing your very personal experience! I’m sharing it for all my nursing friends as well.
Thank you for commenting, and your understanding 🙂
This really is a brilliantly written blog and I feel that I am right there with you – interestingly it is the second blog that I have read this week about a nurses experience of resus and the aftermath …. you may want to read Laura Carters blog “22 and newly qualified” as it may give you hope that support is now out there > http://21-and-nearly-qualified.blogspot.co.uk/
Thanks so much for sharing this very personal story Anne – we sometimes forget how courageous we have to be in nursing 🙂
This is such a moving (& familiar) account of those days. The other posters are right of course … things are very different now (thankfully!) I’m another 80’s student-left-in-charge-on-nights. I remember taking handover on my first night & the staff nurse rushed through every patient & I was terrified I wouldn’t remember anything. Then at one bed a little old lady appeared grey-er than she should have been. I pulled the curtains as the patient in the next bed had said “oh she’s been asleep for well over an hour” … as I could see the staff nurse tripping off home down the corridor. I remember feeling sick & scared as I ran for the crash trolley & phone all at the same time. For some reason the crash call has since instigated that sick-to-the-tummy feeling (even now in simulated education scenarios!) and I worked in Crit Care/HDU!! You’re not alone Annie
Gosh – those ‘surely they are breathing I just cant see it moments’. Or those where you tell the doc ‘They are just not right’ and you get a sinking anxious feeling. I know I take responsibility ultra seriously (its from a childhood of being oldest child) but you don’t forget do you? I’m many years on too. It all come flooding back! Thank you XX
Hello from another 80’s trainee – I was left in charge of a thirty bedded surgical nightingale ward in my second year for 8 days on the trot. I think when I was newly qualified my saving grace was the superb well rounded training I had had. I wasn’t over confident but I did feel prepared. I remember being in charge on nights (again) and having two patients in adjacent beds simultaneously arrest – we just put the arrest trolley between them and resuscitated them both 🙂 15 years later when I was left in charge of a grossly understaffed postnatal ward I was much more frightened and I find in my life generally I am more of a worrier the older I get…….. Fantastic talk yesterday by the way Anne – hoping to persuade my manager to embrace social media
Oh thank you so much! Your story trumps mine my a mile 🙂 i also worry more now. But again thought I was just being silly :))
Thanks for comments re talk. It means a lot. I am always nervous but always mean what I say x
That came across loud and clear Anne. Had goosebumps and hair stood up on back of my neck as you were talking – you are just sooooo inspiring 🙂
Have you seen this? My hubby found it and shared with me http://www.nhsemployers.org/Aboutus/news-dean/commentry/Pages/Five_myths_preventing_social_media_use_in_the_NHS.aspx
Thank you. Humbled x
I’m still scared. I’m a nurse consultant now, and my patients put huge faith in me, and I’m terrified I will let them down.
Wonderful post, Anne. As ever.
Bless you. i am sure you never let them down through choice or neglect. (Secret im often scared still too, today I was thinking – i wonder if they really know its me they have employed) x
Anne it would appear we’re a product of the same era. Like others I can recount numerous learning vents similar to this. What has it thought me that coping is a life skill which you must use both at work and at home.
I do think things have rightly moved on. Reading this made me think, have we lost excellent nurses because they came into training very going unable to cope. I believe we did. We hopefully don’t inflict suck learning now. By using preceptorship, supervision and clinical learning we can support and prepare people.
This story is also about leadership. Recognising that tough decisions as tough days can physically make you feel sick. The leaders in us will want to check with staff colleagues that it is ok to talk about this because most of us will fell sick. Have I ever felt sick about week. Ill let you into a secret almost weekly! Thanks for sharing
I also qualified early 80s – went on duty as a student nurse and by 10am was in a staff nurse’s uniform! I can still remember worrying myself stupid about what might happen and wishing ‘they’ had taught me what to do in every possible situation. After a while I realised that my tutors had done their job well. They couldn’t teach me what to do in every situation but they did teach me to think on my feet and how to find out what was needed if I didn’t know. Now I try and help others to develop the same knowledge and skills.
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