My clinical placement: Emily Beeks
Student midwife Emily Beeks talks to us about her experiences in clinical placements.
What and where have your clinical placements been? Could you explain a bit about them and your experiences?
I have had a range of placements. The majority have been midwifery; others have been nursing placements – this is only for direct-entry midwives, like myself. I will start from the beginning (2009)…
I started with an introduction, which was working as a community midwife. Here we did a range of antenatal clinics in local areas and postnatal home visits. I also got the chance to attend any home births that happened while I was on placement, however, no one who was due for a home birth went into labour! I had a great time on this placement, but was a little shy at the beginning, as it was all so new to me and I felt as though I couldn’t really talk to the women about their problems, as I had no idea. But it was really fascinating to work with my midwife, who is an absolute inspiration.
I then did a couple of weeks in an antenatal clinic in hospital, where it was really busy, and I couldn’t really understand why people were coming in, as there were so many reasons such as glucose tolerance tests, dating and anomaly scans, referral scans from community, blood testing, newly pregnant women who came in to be booked with their midwife. It was pretty manic and I was overwhelmed by it, as I was still very new and swamped with new information. But I gained so much confidence in speaking to women and their families.
Our hospital then set up ‘team midwifery’, which was a form of caseloading women, so for every week I spent with a team, I would spend two days a week in the community, then a day/night on labour ward, in the hope that some of the women you would see in community would then deliver when you were on shift, or you would see them postnatally. This was really good, as the majority of women got continuity of care from either just one midwife, or as the teams contained about five midwives, the women knew they would see at least one of these five. It was also a great opportunity to caseload some of the women myself, building my confidence, and seeing the progress of pregnancy. It was good for me, but also the women really value it, as they know they will see you for the majority of their appointments. I was on placement here until the end of the first year.
I then spent four weeks in the special care baby unit (SCBU), which was quite overwhelming, as I had spent a year with the normalities of birth and pregnancy and now I was seeing the other side to midwifery. Even though midwives worked in SCBU, I was working alongside nurses, who gave us a daily teaching session. In SCBU we had mainly premature neonates, a couple of babies with congenital abnormalities that were awaiting transfer to specialist hospitals and one social services case where the baby had to stay with us until the mother was cleared of drug abuse.
I then carried on with my nursing placements and was on a post-surgery ward for adults. This is where I got to develop my nursing skills further, for example blood pressure taking, care of the ill patient, referrals to the multi-disciplinary team. I enjoyed this placement, but was starting to miss my midwifery practice a lot – nursing and midwifery are completely different.
I was then on the day assessment unit (DAU), which was back into my midwifery placements. Here myself and a midwife would receive referrals, mainly from community and sometimes from labour ward where complications had risen, or triggers for complications were present, for example women with high blood pressure, with or without proteinuria – a trigger for preeclampsia, or pregnancy induced hypertension, reduced fetal movements, itching – a trigger for obstetric cholestasis, or women who were identified as high risk and had to come into DAU for weekly CTG monitoring. I thoroughly enjoyed this placement and by this point, I had great confidence in working with women and listening to their concerns, answering as best as I could and developing my understanding of the pathophysiology for certain conditions.
I was then in the intensive care unit (back on nursing placement) for a short period of time, as sometimes women who are pregnant or who have just delivered need further critical treatment here. However, I didn’t experience this, but I did experience many elderly patients who were mainly suffering who had mainly renal failure, and how this affects the body as a whole and leads to the failure of other organs. It was really interesting as it taught you physiology that can’t be learnt in textbooks.
I have also worked quite a lot on labour ward where I have gained so much experience in being in theatre – handover of care to doctors when complications arise and when doctors need to be more involved.
I also spent a couple of days in my first few months of being a student midwife in early pregnancy unit. This was fantastic and really interesting, run by nurses and gynae doctors, I felt I could ask questions, of which I had many, and really talk to women. It is an area, which I would love to go back to, as I now have more understanding. Also as midwives you tend to see women when they are around ten weeks for the booking appointment and then not again until 16/20+ weeks, so it was really interesting to be with women who had literally just found out they were pregnant.
What were/are your key concerns about your clinical placements?
It is hard to remember what my key concerns were, as two years have gone by now, and all of my worries have evaporated. I think for myself it was hard being involved in such a diverse population, as I had moved from South Wales and despite travelling I was completely unprepared for the massive culture shock of living in London. My concerns were not being able to communicate effectively with people who didn’t speak much English. But as time goes on, you do manage it, mainly in the form of sign language and prompts, but also with Language Line (translating and interpreting services) – also many of the midwives I work with come from the same areas as many of the women we work with.
I was concerned about the workload too. Nothing can really prepare you for getting up at the crack of dawn and coming back home late at night, I found it hard to balance my work and social life at first. I still get nervous about what to expect on my shift, as we all know every woman is different, and the complications that may arise cannot be predicted in some cases.
What difficulties/issues have you had? What things would you change?
I would make sure I had a mentor for all of my placements, as at the beginning, I was very new and didn’t realise the importance of learning from one midwife. I think in certain placements I could have had a better experience if I had the same mentor for that one placement.
Do you think your expectations of clinical placement are realistic? Do you think they differ from your mentor or are they the same?
I think it is important that there is a balance between yourself and the mentor. It is very hard being a mentor, midwifery is a hard enough job as it is, and to have a student with you could make it difficult. I like to feel I have helped out my mentors a lot, for example going to collect notes/ ringing and referring women. I have learnt not to try and plan what to expect from placements as you learn more if you go in with an open mind and just take things as they come, then go and read about them afterwards. It’s much easier to learn, if you see something in your placement first and then learn the theory behind it afterwards.
Do you think there is a big gap between theory and practice?
In certain areas there is – in theory there is always a discussion that starts with, ‘but in practice it happens like this…’ but I think it’s really hard to link the two all the time. Going into my third year, I am still pulling out my notes from some of my first ever lectures, as they now relate to certain aspects of my placement. My most recent theoretical module ‘Pre-existing medical conditions in pregnancy’ relates to pretty much everything we have learnt so far, as you need to know the norms and then pathophysiology of when things become abnormal. This module has related directly to my placement, as I have been in ITU, DAU and also with labour ward and community, as you do come across pre-existing medical conditions.
Are your clinical placements really learning environments or do you feel that you are simply just 'another pair of hands'?
On some of my placements I have learnt so much, as the mentors are really pro-active in teaching sessions, and if you ask a question they will sit you down and discuss it in great depth – this has mainly been in the nursing environment. In midwifery I have learnt so much, but not many midwives or mentors have given us teaching sessions, sometimes I do feel like I am another pair of hands, but you learn this way, by just getting stuck in and seeing aspects of maternity care first hand. Sometimes it is frustrating that when you want deeper understanding, midwives will tell you that you need to read up on it, but now as a senior student I know the midwives to go to if I need specific help or understanding. I think this is down to the shortage of midwives.
What tips do you have for improving the learning environment within your clinical placement?
I have noticed in nursing that student nurses have once-a-week teaching sessions when on placement. I think something like this would be beneficial. However, it is hard to arrange as student midwives don’t all work on the same days, for example many of us work nights/long days/early/late whereas most student nurses I have spoken to tend to just work in the day.
The senior midwifery students and I have been asked to carry out anatomy and physiology sessions for the junior midwifery students, even though I think this would be beneficial to both aspects of student midwives, I really don’t think I have time myself to teach others, when already I work 37.5 hours a week minimum as well as my university work.
How effective are the simulation rooms in preparing student midwives for practice? Can you explain your experience of a simulation room?
In university, we probably use the simulation room once a month/every two months, depending on what we are studying. I think they are fantastic. In the first year, we mainly used it to practise blood pressure readings, blood taking, hand-washing, injections and temperatures – just general observations. In the second year, we used the room for our objective structured clinical examination assessments, where we had model women who either had a postpartum haemorrhage, shoulder dystocia, breech delivery or neonatal resuscitation. This allowed students to be very hands on, be able to visualise clearly what was happening and feel as though we were in a clinical setting, and get us into the ‘zone’ rather than reading PowerPoint after PowerPoint!
What makes a good mentor?
Somebody who wants you to do well, who is dedicated to being a mentor and who has experience of being a midwife. I have also worked with midwives who only graduated last year, which was great, as they know exactly what you’re going through and what assignments you have for example. You have to work with your mentor and respect one another, if you don’t, it’s going to make your experience as a student midwife very stressful!
Have you had any issues with your training and your mentorship? Perhaps your mentor only works part time? Have you had an issue with your paperwork being completed if you've not been on all your shifts with her?
I quite enjoy working with a range of midwives. I tend to always have been allocated a full-time midwife, and if she isn’t, then I work with someone I have worked with before, even if it’s only for the day. Sometimes I find myself running all over the maternity ward looking for a midwife I have worked with to sign off some of my paperwork, but you just have to learn to be very organised and say at the beginning of the shift that you need to get this signed off by the end of the shift.
If you were honest, do you think that some students swap shifts and hence potentially mentors because of personal issues and hence aren't helping themselves in their training?
I haven’t personally been aware of this. I used to dread working with certain midwives, but you have to take it as a positive. You have to learn from them, how you do not want to practise, and you can pick up on things that perhaps weren’t that well understood by the woman, and rephrase the information for example. I think a lot of the other student midwives I have worked with all have the same mentality as I do, we just have to grit our teeth and get on with it, and at the end of the day you can just relax and say that it was a difficult day but that I have learnt lots about how not to be. I do know a couple of older students that have missed placements or even dropped out of the course because of their mentors or because they didn’t think certain placements were important, such as the nursing ones. I don’t agree with this, because when you actually qualify you can’t keep changing your shifts or refuse to work in a particular area, therefore I do not think some students help themselves. Every placement is given to you for a reason, and yes sometimes they are not related to midwifery, but you learn other aspects of care, such as communicating with a critically ill patient, which you can then bring back to your midwifery training. I really value all the placements I have been on, and all mentors I have had, reflecting now has made me realise how much I have learnt from so many different people whether positive or negative – it shapes your future as a midwife.