First placement (surgical ward) TNA trainee nursing associate

The training I had was split into 4, 6 month placements this varies depending on trust. Within the trust I work for TNAs now have 6, 4 month placements.

My first placement was within the same hospital that I was employed as a healthcare support worker (HCA). I moved from the outpatients department to an inpatient surgical ward. This ward is now my area of work as a qualified NA and I love it!

I spent the first six months focusing on documentation and accountability. I was doing admissions over seen by an RN. I was following patients through the whole process of admission I found myself attending training like cathertrisation and catheter care, venepuncture, dementia champion course and any mandatory training were updated.

I found nursing staff very supportive and the teams around me would offer education and opportunities to learn. If I can give any advice learn about our bodies homeostasis and how to maintain it. Learn about interpretation of blood results not the nity gritty information but understand about the need for potassium, calcium etc. Try to find where our bodies source for these substances/vitamins are, how do we get them if our body is low. Learn who to escalate issues appropriately, learn about the resus trolley and the ward structure. See how the NA role could fit or is currently working in these areas. Try to understand the reason for observations, what are they reading? Moving from auto pilot to pilot is a big transition. Youll begin to understand why we do things in practice, not just know how to do it.

My first few weeks felt difficult but I just had to battle through. I was adapting to a higher level of education then I had previously studied. With the nursing associate (NA) being a new role everyone was questioning me and at that point i wasn’t even 100% sure myself. I was also wearing my old HCA uniform just to confuse everything a little bit more. This was due to organisation, speed of the role being created, uncertainty on colour etc.

This was my surgical placement so I wanted to learn about post op and pre op care. What signs should you look out for ? So a big one is urine retention caused by medication given when aneathatising patients (WJA 2019). Regular physical observation is a must and is part of our trust policy you’ll be looking for variation from pre op if available. Generally saturation can be lower in first instence especially if the patient is relaxed or is unable to sit up after surgery, this should pick up if all is well. Sato C, et al. (2004) this study explores risk post op of desaturation. I’ve learnt with experience that BP is commonly higher then usual prior to surgery. I believe this is due to nerves and uncertainty, but its important to inform the team that the patient has high BP, reassure the patient and excalate to nurse incharge if you have concerns with your outcome of your observations.

Patients if given a general anesthetics should be starved prior to surgery this prevents regurgatation. Patient who are diabetic blood glucose should be monitored as per policy and nurses judgement, this can be very irritating to the patient but is essential. Depending on glucose levels you’ll want a cannula insitu. Patients with diabetes especially if not controlled well a sliding scale (mix of glucose and insulin IV infusion) is likely to be perscribed. This is an attempt to control patients who are nil by mouth (NBM), sugar levels. NHS diabetes made a great information PDF (NHS diabetes, 2011).

I believe how much you put into a placement impacts what you get out of it. I was welcomed by the staff within my first placement, I took every opportunity I had to learn.

I did mountains of research around the wards procedures.I attempted to prepare myself mentally for the change into a general ward from a surgical ward, lots of time spent reading article and online training. You’ll spend hours finding topics that back up your current assignment or ways of practising. Exploring policies and procedures is a must and something that I feel is continuous and that I still do now as a registrant. Practice is always changing and it’s our responsibility to maintain awareness.

By the end of this 6 months I had found my feet and could imagine what I would be capable of doing as a NA. At this point I had not long got my uniform (brown with a white strip) and I was ready to move, learn, meet new people and gain new skills.

(WJA) World J Anesthesiol. Jan 15, 2019; 8(1): 1-12 https://www.wjgnet.com/2218-6182/full/v8/i1/1.htm

Masui. 2004 Jun;53(6):659-63. https://www.ncbi.nlm.nih.gov/m/pubmed/15242039/

NHS diabetes (2011) https://www.google.com/search?client=ms-android-ee-uk-revc&sxsrf=ACYBGNTaFV99lMVgtNQiEm5OO59ZWtUC_g%3A1580195405992&ei=Td4vXqyUPNjhgAaY_Kww&q=insulin+sliding+scale+preoperative&oq=sliding+scale+preop&gs_l=mobile-gws-wiz-serp.1.1.0i13i30j0i22i30l2j0i13i5i30j33i160l2.3221.8169..10227…0.1..0.140.1282.5j7……0….1………0i71j35i39j0i67j0j0i333.TYLkEdT4yhk

What is a Nursing Associate ?

Well if this is a question you’ve thought about or asked, this piece of work will help you to understand.

We are a new role developed across England to fill the gap in services. The role has been made due to evidence showing that care could be better if we had this type of training route and skill mix amoung staff. The shape of caring review (2015) explains this in a more detailed and factual way.

I talk from my own experience and knowledge as a nursing associate(NA). I was one of the first trainee nursing associates (TNAs) across England starting in 2017. We gained our foundation degrees around January 2019. In training we were placed in different areas that ensured we had exposure to children, adults, mental health and learning disabilities nursing. We were also educated in university ensuring we knew how to care for these groups of patients using the most current and evidence based practice in line with our local policy.

The Nursing Associate role is not specific to one area of the populations people and should when qualified be confident to work with all types of people. This would obviously be dependant on the training and amount of support provided when entering a new area of work. A general knowledge on approaches, risk factors and knowing how to adapt to the specific group of patients should generally be embedded as individually and person centred care has in our academic and practice work.

We are trained to a level 5 criteria when qualified this is a level below a nurse, nurses exit study with a level 6 meaning they complete 1 more year of training. The training provided to nursing associates is very hands on learning

We are employed by the trust meaning our skills previously if gained in the same trust are kept. This is taking into consideration patient group. These skills such as blood glucose monitoring and venepuncture skills, are valued in nursing care and can be undertaken provided we are competent and have evidence of training. We are able to do these skills without supervision, freeing up registered nurses time. We are employees of trust’s meaning we have access to systems like patient track, ICE and other online documentation systems.

As we were able to transfer skills, this allowed me to basically try to learn more advance skills that me and the people in the community I was working in befitted from. I found the course very interesting academically. Our first year i felt i was learning how to understand research, and learning about reliable statistics, quality of studies, best practice, holistic care, determinants of health, social impact, physical impact, anatomy and physiology the list goes on. I felt empowered in my role I gained the ability to speak and be heard. The impact I have on a patients wellbeing was at first a daunting feeling, but I was never forced into tasks I hadn’t been physically trained to do and felt competent completing. Now I use my ability to improve patient care in my area of work.

Each and every placement or spoke I attended I met masters of the trade each with there own story and knowledge to pass on. I had experience working in surgical, medical environments, community services and a specialist medicine.

My speciality was Renal inpatients, linked to a dialysis unit. The idea now is to have experience in hospital , close to home and at the homes of our patients. Having experience in all areas is essential for wealth of knowledge. This helps to understand services and know what’s available, allowing referrals to be made appropriately when qualified.

I am now able to take my own group of patients seeing people through admission to discharge, making appropriate referrals and involving any professionals I feel could be beneficial to the patient. I usually take a smaller amount of patients then Registered Nurses (RNs) or complexity is taken into consideration and patient groups and split fairly. I am usually being lead by a band 6 sister or charge nurse.

I’m capable of administering medication I have been assessed and deemed competent to do, this was assessed via route, IV is not amoung the routes we are able to administer but this is trust dependent as the NMC state we are able to further our skills with extra study and I know of some NAs are undertaking the IV course. I am unsure if this will be a skill I will gain in the future.

I can second check some IVs and CD from the cupboard. I’m able to administer those not kept within the cupboard. I am unable to administer the high risk medication groups with in my local trust. I personally tend to see oral, topical, inhaled, subcutaneous and occasionally IM in my area of work. When I am administering I am using the 5 Rs and my knowledge around medication if I am ever unsure I ask a more experienced member of staff for help.

We can progress to the role of RNs but we are also a stand alone role in our own right with a PIN like nurses and other professionals. Progression at this point would mean a self funded 18 month course. I hope that in the future we can do this as employees and not have to leave the trust, as for many people this is a big step to leave employment and become a student especially those who have families, bills and are dependent on there income.

Forgive any grammer or/and spelling mistakes. I plan on starting a blog talking about my experience through training and what I felt my challenges were. I also want to talk about how I have embraced becoming a registrant and how my trust have supported me and helped to embed the role. So if your interested follow my page on twitter @kerrycrookston4 and thank you for taking the time to read my vision of the new role.