Whilst in the main the participants were allocated a contrived workload there were some complex visits to which the participants were allocated. For example they found visits to children and families with child protection or safeguarding concerns challenging as illustrated by Jesse:
“Well, it was a baby with suspected HIV, mum had HIV and she’d stopped taking her medicine whilst pregnant, so the baby was on some medication which we had to give twice a day for quite a while. And I went in and did the first visit, and mum had mental health issues, there was lots of concerns about mum and the family, grandpa was a drinker, and I went in and it was just all really quite daunting. I went to the hospital to meet them, and mum was really strange in the way she was. I was asked if I was alright to do it, and I was on the late shift, and I did feel a little bit obliged to say yeah, I’m fine, don’t worry. And I think it just all ... when I went in ... because I was worrying as well about the baby, was the other child okay ... we were told that there was possibly another child in the house that they weren’t aware of, so I was asking about that, and I think it was just a bit too much really for ..it was after about six or seven months, so it was quite a while, and I’d been going out ... But that was like the first referral I’d had that had that many concerns, there was quite a few, the main one being mum’s mental state really and possible drug use ... it was just all a bit daunting”.
Here Jesse had been asked to go on a first visit which was not usually the case for newly qualified nurses and the complexity of the visit and the safety concerns about this child and family led to the realisation that even though she was six to seven months into visiting on her own her knowledge and skill capability was being tested. She perceived that she was being placed in a situation beyond her current capability at this stage of her transition. She had reassured the nurse who had allocated her to the visit that she was able to cope with this and had felt obliged to do the visit which illustrated that her colleagues had confidence in
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her abilities. Whilst this increased her confidence it also intensified the pressure on her. Dearmun (1997) highlighted a similar finding, reporting that at nine months into the new post the participants in her study, whilst wanting to be stretched to develop their practice, were reluctant to volunteer to look after children who were critically ill questioning whether they had the capabilities and that those situations were daunting. Tyler explained that she had been supported by not being allocated patients with complex needs during the period of shadowing:
“and I have had a lot of support and I wasn’t given complex needs, so chronic patients until I did come out of my supernumerary period this year, so that did help, but it was a very daunting experience. I think just the thought and all the stories that you hear about in the newspaper as well, about the child protection issues and you think, “Oh I’m going to be out there on my own and if I don’t pick up on these”, it is very daunting, but that’s how it is.... And you can and do doubt yourself sometimes”.
She explained that had this had helped to ease her through to the next stage of working on her own. However now she was working alone she identified that she had apprehensions about her practice and being on her own and about missing areas of concern.
The added responsibility of child protection cases was particularly daunting for the participants when they were working on their own. For example Nasim told me during the fieldwork about a child who had been living with his father and his father had been abusing him. His mother did not want parental responsibility so he was now living with his aunty. Nasim had had to contact the social worker for information to do with this visit. She told me however that this issue was not her focus, her focus was the dressing. Although Nasim was aware that there were “parental responsibility issues” the focus of the interaction with him
was the care of his wound regardless of the other needs that he may have had. This approach was also observed during a visit with Yan who asked a child’s grandfather where his wife
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was and he told her she was in hospital having had a hip replacement. He tried to talk to Yan of his concerns about where she would sleep when she returned home and although Yan listened, she did not engage with this problem in any meaningful way, but focused solely on caring for the child.
This highlights that following the period of shadowing, during visits the participants sometimes found themselves in situations where they lacked experience. They expressed feelings of self doubt and lack of confidence in their ability and expressed that they had not had enough exposure and experience to be confident in these areas of practice. The two examples here illustrate the participants’ tendency to focus on the routine and what they know about the care of the child even in complex situations. They focused on the expected and known part of the visit and although they were beginning to view the child in the context of the family they maintained their focus on the task.
However whilst these situations tested their current stage of development they recognised the importance of being exposed to experiences that they would be faced with as a children’s community nurse as illustrated by Max:
“The emergency situations that you find yourself in, like finding that boy home alone that then allowed me to have exposure to social services and child protection. I did
refer on to social services and the child protection nurse knew all about it so that exposed me to kind of another whole group of professionals. Going to children’s houses and finding them poorly and having to phone 999 sharpens your skills it
makes you think on your feet and gives you its good exposure”.
Max had found the child at home alone which had been challenging but she valued the experience as this had provided her with the opportunity to develop her skills in working independently. Therefore, being allocated visits based on their previous experience and
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capability level was seen by the participants in this study as a facilitator and ideal as it assisted them to cope during their transition to becoming children’s community nurses.