Back in my home training hospital I started worked through the final leg of my three year training in 1986. Unlike many of today’s nursing students, we each had the same number of placements in the same types of areas (Theatres, ITU, surgery, paediatrics, medicine, gynaecology, accident and emergency...). It is very different for the modern day student; although they must complete the requisite number of practice hours, where that experience might take place can vary tremendously. This is primarily due to the stiff competition between universities trying to get their students into limited numbers of placement areas, or rather limited placement areas that have the necessary staff to ensure a viable and safe learning environment for students. Of course, the location does make a difference too. In the south-east, despite the many densely populated areas, there are fewer hospitals than in the past and far more primary care (community) services. This is no surprise given this is where successive Governments have focused their energies in providing care as population numbers have risen and longevity increased. Now there are simply too many people with long term illnesses (conditions) to have them all in hospital. So today’s nursing student can work in a wide variety of clinical areas, any number of which may be in primary care with school nurses, health visitors, sexual health nurses, practice nurses, district nurses and so on. However, despite the fact that a community placement emphasises the complex and skillful preventative and long-term aspects of nursing care, the variation in placement experience can be a source of frustration for student nurses with placements in acute settings often being highly prized.
How things have changed. In my training, the majority of our clinical experience was gained in our home hospital with just one relatively short community placement with the district nurse. For mine, I worked with in the towns of Radlett and Park Street accompanying the District Nursing Sister on her daily rounds and helping with insulin injections, washes, suture removal and dressings. All good experience and much more hands on than it is now (since the division of nursing care and social care, when washing people became nobody’s responsibility). Once we visited an elderly man with bilateral venous leg ulcers. His dressings need removal, his legs cleaning and new bandages applying. The house was dirty, his legs smelt terrible and there were several cats adding there hairs to the general mess and disorder. However, 'on the district' you were always reminded that you were a guest in somebody’s home and could be asked to leave any time. So you worked with the patient in their bedroom, their kitchen or living-room and that might well include working around the dried up pet food, the over-flowing bins and the animal faeces. In the area we were covering, we served a mix of people from the very rich (far more of these) to the less privileged. It was quite an eye-opener for me. Coming from an average 'three bed semi' family, it was my first ever glimpse into how people beyond my own circle of family and friends lived.
Community nursing is quite a different power differential to the one that patients experience in hospital, where the minute they put their pyjamas on, they surrender their (despite our best efforts) dignity and privacy and hand over control to the so-called authority of the nursing staff. It is important that students have a chance to experience these different settings and to recognise the underlying factors that play into how nursing care is provided and received in each of them.
