First year of mental health nursing...

... what have we learnt? Have we learnt things? Let's find out!

Mr Peanutbutter from Netflix series BoJack Horseman, the best series in the world. I'll be using this meme more times than I should.

It was August 2018 when I knew I was going to start my nursing journey. I had applied to my Bachelor of Nursing (Mental Health) just a few months before, through clearing, a process which allows students who either didn't get a place in their desired courses, or applied too late, to apply again for any places that are still left. I had very low hopes and expectations and was starting to plan my life around not being accepted. But I was accepted and in a month I'd be starting on a very different journey. In me, there was a desire to explore the realm of mental health - which had always been a dream of mine - and to work with people in a truly meaningful way. And at that stage, that was all I knew.

No one is expecting you to be a nurse, but they expect you to begin to understand how to behave like one.

The course

Nursing degrees in the UK are 50% theory and 50% practice across the three years, which means that two months into the course, I was already starting my first ever placement. But before jumping onto placement, let's cover theory.

Theory

You start nice and slow in the first year. I personally believe there is great academic support from my university and they make sure to show you around everything you need to do before sending you to the lions. There are more contact hours in the first year, which means you'll spend more time at the campus, in lectures and practical classes. The topics cover nursing theory, methods, and practical skills. In first year, there was a great deal of energy spent on dissecting the Nursing and Midwifery Council (NMC) Code, the values of nursing, such as compassion and professional behaviours. Besides theory, there are certain skills and training that students need to have before going into placements. I was trained on violence & aggression, basic life support and manual handling, as well as some very basic nursing skills, such as BP, temperatures, respiratory and oxygen rates and medicine administration, just as examples.

"Life as a student nurse", an accurate representation of my life.

Placements

I don't think any amount of theory can prepare you for putting on your uniform and being considered a member of staff. At first, it will be hard to feel confident about what you're doing. Especially for me, having zero experience in the area, I only had my communication skills and my instincts to go with. And fortunately, in the first year, your instincts and your interpersonal skills are all you need. No one is expecting you to be a nurse, but they expect you to begin to understand how to behave like one.

I had two placements. One in a ward for older adults (with neurodegenerative diseases such as varying types of dementia and presenting challenging behaviour) and the second one in a day centre for people with mental health problems. They were very different from one another and neither of them was exactly what I wanted. But both taught me something and more importantly, both provided me with different mental health contexts, where different kinds of skills were required.

Placements aren't perfect. Ever. I'm going to say this very bluntly and with deep honesty: being a student nurse is very difficult. It is a learning experience, sure, but you're dealing with real people, real patients, and you feel more responsible for them than for the mannequins you practise with in your clinical skills classes (or at least, you should!)

Some positives of being a student nurse on placement:

• You're learning. And learning stuff is very exciting. A lot of nursing involves doing things for yourself and the more you do them, the more confident you feel about your learning. You'll also get to experience different environments, from acute wards to community settings and as a student, you can phone everyone and they'll accept you to come for a visit or a shift. This will give you the opportunity to see what you enjoy and what you don't enjoy and to start visualising yourself in your ideal job.
• Everyone knows you're learning. Both patients and staff know you're a student, they see your grey uniform and they know and accept that you don't know everything. Most places will have at least a few very decent members of staff who really want to help you. Grab onto them with your life! And bring them chocolates so they'll love you! When it comes to patients and families, they also understand you're a student and they appreciate your authenticity and your desire to change the world. That's a pretty good feeling :)
• Patients come to you because you have time and you listen more than other staff can. Sometimes, they see you as an ally to their cause, especially when they feel like the actual staff are being unfair or don't have enough time for them. When you're a staff nurse, you'll be responsible for a million things, so being a student gives you a chance to properly connect to people. I've had days when the only thing I've done was to sit and listen to people, talk to them, motivate them. I'll never forget I had one person come to me in a very vulnerable moment to tell me something deeply personal, that had caused deep trauma to them and I could see that that came from a place of trust and feeling heard and seen and understood. There will be times when having these relationships and these moments will make everything worthwhile.

Some negatives:

• You're learning. And damn, learning can be so hard and so frustrating and it can make you feel very uncomfortable. Sometimes, you'll lose your confidence. No one prepares you for when you fuck up, and you probably will many times. You'll probably say the wrong thing at the wrong time. You'll probably forget something that's already been explained to you multiple times. You'll probably be scared of asking questions because they say you can and should always ask, but then you feel stupid for asking when you feel like you should already know. Learning isn't a linear process and in the most difficult times, I try to remember the words of an anonymous mental health nurse to The Guardian: "there are no good decisions, only least bad ones". Sometimes, you need to make mistakes to understand which decisions are the least bad ones. Let me just say, although I sound super confident writing this from the top of my second year expertise, I am very much trying to learn from these same words. We're all learning. It's hard. We're gonna be okay.
• Everyone knows you're learning. And that can be bad. Expect that people will be condescending, expect that they won't trust you when you feel like you want a certain learning opportunity and they won't give you the chance. You constantly need to prove yourself and show that your skills are developing. Some people may try and put you in uncomfortable positions and you'll need to be strong enough to stand your ground. Remember there will be support from other staff, other student nurses, from the university even if it comes to that. You're not alone and you're gonna be okay.
• Patients come to you. And sometimes, you'll have no idea what to do with what they give you. They'll tell you traumatic things that have happened, they'll ask you questions about how to deal with certain situations, occasionally they may get upset at you. Very often I feel like a child trying to navigate a foreign adult world I don't understand. You won't have the answers to a lot of these problems, even when you might think you do. Mental health is complicated and there's more to it than giving someone antidepressants. You have to trust that both professional and personal life experience will one day give you the answers to the questions you can't yet answer. For now, as a student nurse, my best advice is, again, to accept you'll fuck up and to forgive yourself when you do. You're gonna be okay in the end.

So these are some thoughts and reflections from a year and a half of being a student nurse. If you're reading this, tell me what motivates you when you're down and share your advice about being a student for first-year colleagues or prospective students. Let's start the conversation and help each other for...