Dress code

Contact the placement prior to arriving for your first day. Do not assume that the care staff don't wear uniform because they are based in the community or do wear uniform because they are based in a hospital. There are exceptions to both these generalisations, and culture and philosophy in mental healthcare settings often change. For example, some recent changes back into uniform have been driven by the need to control the spread of infection more effectively, rather than as an attempt to clearly demarcate professional carers from service users. (The use of alcohol hand gels, implemented for exactly the same reason, has brought with it difficult consequences such as ingestion by mental health service users (Archer 2007, Bairy 2006, Batty et al 2011).)

Another issue to consider is the need to present a professional image. Exactly what this means can only be gleaned by looking at what your colleagues are wearing. Some areas will be happy for you to wear jeans, whereas others will consider this inappropriate. Your work area is not the place to be making fashion statements. Your job is to be as approachable as professionally possible. Your clothing should not be a barrier to your achievement of this. Wear clothing which is comfortable but also appropriately formal or informal.

The Nursing and Midwifery Council (NMC) Guidance on Professional Conduct for Nursing and Midwifery Students states that students need to ‘follow the dress code or uniform policy of your university and clinical placement provider’ (NMC 2009). The most useful way to interpret this guidance is, as mentioned above, to emulate the dress standards of your professional colleagues. Usually any misinterpretation on your part will be quickly pointed out by a colleague on the placement.

This guidance also applies to culturally sensitive issues in your work with service users. Be aware that, for example, tattoos, piercings and florid artificial hair colourings may serve to distance the very people that you are trying to engage with. Again, be welcoming of advice from your mentors about this if it seems to be an issue.

Some things to do before, and during, your placement

Making the most of time with your mentor

This does not mean being with your mentor all the time you are on duty. Some of your richest learning may come from the time that you are not with your mentor. Set the situation up to help both of you. Be an asset to your mentor rather than a part of their caseload. Be proactive as well as reactive. Work to create opportunities for yourself to enhance your learning in each placement. If the placement is not your ideal, then discuss this with your mentor. Try to make the best of each experience you have. Be memorable for the right reasons.

What to expect from your mentor

• A positive role model, in terms of behaviour, attitude and professionalism.

• Empathy with what it is to be a student.

• Empathy with what it is to be you.

• To be a resource and a sign-poster to resources.

• Honesty.

• Congruence.

• Welcoming – even though you will undoubtedly represent extra work for them.

• Up to date in terms of evidence-based practice.

• Open to innovative suggestions from you, regarding care practices.

Activity

1. In small groups, list the characteristics of an effective mentor.

2. Use the following link to look up the standards for supporting learning and assessment in practice which were published by the NMC in 2010:

http://www.nmc-uk.org/Publications/Standards (accessed June 2011)

3. How do these standards compare to your list of characteristics?

Lone-working policies

Community-based placements will have agreed and accessible policies to protect employees who need to see clients alone. If you are in the situation of being entrusted to see clients on your own, it is essential that you ask your supervisor to help you clarify any parts of the placement policy that are unclear to you.

Personal safety

Generally speaking, your supervisors will forewarn you about any client who may present a threat while you are on placement. In any mental health setting it is impossible to always accurately predict the behaviour of some clients, especially during the assessment stage of their care. If you are with any client and your instinct tells you something is wrong – you feel at some sort of risk – then listen and react to this. Sometimes intuition is proved to be inaccurate, but sometimes it is right. If your ‘gut feeling’ is telling you that there is danger, ignore any intellectual thoughts that argue things are alright. There are many simple things that you can do to minimise the risks that sometimes become present in mental health nursing:

Practice support from your university

If you feel you need additional support from your university tutors, do not hesitate to contact them. People come into the job of nursing from a wide diversity of cultures and experiences, and of course have a wide diversity of abilities. Most organisations that carry out nurse education have people within the organisation that can support this broad spectrum of need.

Many of your teachers and most of your mentors have come through a similar programme to the one that you are processing through. Additional support is not always directly linked to lesser ability. Given the diversity mentioned above, it is clear that every student nurse brings with them a history. For many, over the duration of the course, some aspect of their life will change. It is at these points that some students feel a need for extra support. It is probably best, as a generalisation, to ask for help sooner rather than later.

Switching off

Probably very difficult to do … at first. This is because in some clinical settings the emotional stimulation within the area can be very intense. Even in low-activity areas, the very slow pace and the need to be ‘doing something’ can be a stress in itself.

Obvious ways to detach from the work environment usually involve diversion, although even the drive home can sometimes be done on ‘automatic pilot’ while you worry about what you should have said to that rude consultant, or difficult relative.

Most people are able to develop their own way of ‘leaving work at work’. If this becomes difficult to manage then, informally, a trusted colleague may be able to help. A more organisationally formalised way is to contract to meet with a supportive supervisor, seen regularly or as and when required. This can be really helpful as a way of learning how to switch off, or disengage from work-related stress more effectively.

Making the most of insight visits

These should always be pre-arranged rather than impromptu. Try to be clear why it is that you want to carry out an insight visit. What specifically is it that you want to learn? Do some prereading about the speciality of the area first so that you are an informed visitor. Consolidate your visit with more reading or Internet searching. A very useful starting point for this, for example, is to search the Internet site for ‘NICE Guidelines’ appropriate for the area you wish to visit. This site is easy to access and will give you a good idea of some of the practicalities and dilemmas of care work in that type of placement.

It is often helpful to discuss the rationale for your visit to another placement area with your mentor. This can help to bring clarity to your objectives for the visit. In some instances these discussions lead to the creation of new placement opportunities as student visits can create or stimulate interest in the benefits that learners can bring to a clinical area. With this in mind, it is essential to be aware that when you undertake insight visits, you represent both your university and nursing students.

This concept of using your placement as a base, and ‘outreaching’ to other clinical settings, may become more predominant as a feature of future nurse training as the idea of the pathway placement model of organising placement sequencing is more widely adopted (see Ch. 4).

Finally, engage respectfully and sensitively with the people who work in your insight areas. You may want to revisit that area one day, as a prospective employee.