Part time nursing

It’s 6 30 am on a rainy Sunday morning in November. I should be in bed fast asleep, having rolled in just a few hours earlier from a Saturday night out in the student union. So why am I on a bus preparing myself for an eight hour shift in the orthopaedic wards at Ninewells Hospital, Dundee? I’m not on an orthopaedic placement; in fact this trip to the hospital has nothing to do with my medical course.

Like many students I have discovered that to afford shopping trips and nights out I need a job to supplement my income. I work as a nursing auxiliary. An auxiliary is a grade A nurse, at the bottom of the ward hierarchy. We help nursing staff to care for patients, and we can gain further qualifications to become healthcare assistants, who are trained for basic nursing duties, such as measurement of blood sugar.

As an auxiliary nurse you can choose to fit work around coursework and placements. At first this was just a convenient way of earning money. But after a few weeks of regular shifts I discovered that it is a great way to learn, practise, and perfect the so called soft skills that form the foundation of clinical practice once you graduate (box).

The term “soft skills” has no agreed definition, but, simply, they are the personal qualities that influence the way that we interact with others and deal with dilemmas in life. In the context of medicine soft skills refer broadly to communication skills; the ability to deal with difficult individuals and circumstances; ethics and professionalism; and working in the healthcare team.¹

Acquiring communication skills

The medical curriculum aims to strike a balance between giving us a solid knowledge of medicine and teaching us the communication skills that will allow us to put that knowledge into practice.

I have attended many teaching sessions to improve my communication skills. We are also encouraged to develop these skills in the wards. Although this allows us to interact with patients more often, which helps to improve the way we communicate, the underlying emphasis is on getting a good medical history or giving sound advice for health promotion.

Working as a nursing auxiliary enables me to interact with patients without the underlying agenda of medicine. In an average shift I spend time one to one with about six patients, helping them with personal care and meals. Not having to focus on taking a history gives me the opportunity to listen to what the patient has to say, which improves my active listening skills and helps me to build rapport. This has also made me more adept at empathising with a patient’s situation, and as a consequence patients are more comfortable around me when I am a student.

In addition, interacting with patients in a less formal relationship than patient-medical student has helped me to develop the way that I introduce myself and my ability to ask questions in an unobtrusive manner in terminology that patients understand. As a consequence patients find me more approachable, and this helps me to take an accurate history. This ability to listen to a patient and gain their trust is fundamental in the development of the patient-doctor relationship. This essential bond enables optimal treatment of a patient, and the development of these skills as a student is vital. Taking an accurate history is essential, so a balance must be found between being empathetic and gathering vital diagnostic information.

Facing difficult scenarios

As medical students we are often shielded from difficult patients or situations. Medical staff steer us towards patients who can give a good history, and we are reluctant to confront difficult patients. When we first face a patient with dementia or who is aggressive or unwilling to talk, it is often as a junior doctor, when we are also responsible for their care.

The teaching of communication skills in Dundee invites simulated patients to act difficult, but the reality is different. As a member of staff in a ward, I have seen many patients that might be perceived as difficult—for example, intoxicated and aggressive patients in the emergency department. As a consequence I am confident in the way that I approach and speak to such patients.

The only way to have confidence with older patients with dementia or confusion is to interact with them as often as possible. This allows you to gain experience in the best way to reassure patients who are confused or calm patients with dementia who are agitated.

Auxiliary nursing involves close contact with these patients, particularly as they are the ones who need most help with their personal care in the wards. As a consequence I have more confidence when dealing with them than other students in my year, and I actively seek out such patients in ward sessions to further improve my skills. This will benefit me when I am a doctor.

Ethics in real life

Exposure to situations with ethical considerations has also improved my thinking about the best way to approach these problems. Real life problems have much more learning potential than those invented for teaching.

Before working as a nursing auxiliary I was unaware about the difficulty that some patients have in making autonomous decisions. It is essential to properly inform a patient of their options and the implications of their choice.

My experience influences the way that I obtain consent for procedures that I can perform, such as cannulation and venepuncture. I ensure that I explain exactly what the procedure involves. Before I may have presumed that the patient understood what venepuncture entailed. I also make sure that the patient understands that they have the right to say no should they wish to because I am a student.

Working as a team

The multidisciplinary approach is a theme in the medical curriculum. In the wards as students we mostly interact with other doctors or consultants and do not necessarily appreciate the roles of other staff. I used not to know their exact role in the care of a patient.

At Dundee University we do not have placements in wards until our fourth year, by which time I had worked as an auxiliary nurse for two years. Knowledge of how the ward worked and the role of nursing staff helped me to integrate fully when I began my first placement, improving the experience in relation to enjoyment and learning.

Some medical staff seem not to understand the part that nursing staff play in the day to day care of patients. And on rare occasions I have been surprised by the lack of respect that medical staff give nursing auxiliaries. Seeing the ward from both sides has had a positive effect on the way I see other members of the multidisciplinary team and how I interact with them. I value the knowledge that nursing staff have and take time to discuss a patient with his or her nurse to get a better understanding of the disease and its management.

In summary

Working as a nursing auxiliary has helped me to develop my bedside manner, which will have a constructive effect on my learning and will make me a better doctor.

Medical schools should incorporate time in the curriculum for students to have the opportunity to take part in a placement with similar work to that of an auxiliary nurse. Students should pay attention to the development of their soft skills. Try to take the time to talk to patients, not just about their illness, and take opportunities to interact with elderly or confused patients. And pay attention to the role of nursing staff. They can provide helpful information about a patient and their care, but their knowledge is often undervalued.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

1. Bergh AM, Van Staden CW, Joubert PM, Krüger C, Pickworth GE, Roos JL, et al. Medical students’ perceptions of their development of “soft skills”. Part II: The development of “soft skills” through “guiding and growing”. S A Fam Pract 2006;48:15.
2. General Medical Council. Good medical practice. London: GMC, 2001. www.gmc-uk.org/guidance/archive/gmp_2001.pdf.

       

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