I'm a 3rd year Occupational Therapy student (which means that I have to
write in nursing notes whilst on placement...)
I have used various strategies depending on the placement environment (I
don't know about the nursing fitness standards, but for those of us under
the Health Professions Order, the HPC (governing body) has made it clear
that it is the outcome rather than the method which is important).
http://www.hpc-uk.org/publications/index.asp?id=111 and http://www.hpc-
uk.org/publications/index.asp?id=109 may prove useful as general reading
(although you'd need to find out whether nursing has similar views).
With regard to drug names, there should be no issue with the student
either referring to the BNF in paper format, or having the electronic form
on a PDA (I know of a medical student who uses the latter - then you are
more likely to get the spelling right due to being able to read what the
drug is for. If there are certain drugs commonly used on placement, the
student may find it helpful to compile a list on computer and print it).
Confidentiality is an interesting point. I have dictated notes/used a
scribe in open ward areas (not ideal - but the noise level is usually such
that if you speak quietly, you can't be heard anyway).
The other thing that I've done is type on my laptop whilst my PA scribes
into the nursing notes (which deals with the 'being overheard' issue.
This usually improves as the PA gets used to it as well. Your student may
be able to use a PDA or even a mobile phone(?) for this if they have good
Another low-tech method of getting round the confidentiality issues with
PAs that I've found is openly dictating parts that do not contain patient
identifiable data (e.g.) time, date, my designation/bleep/extension, 'OT
initial assessment plan carried out with...', and then when it comes to
confidential information finding (e.g.) the name/address/age/diagnosis of
the patient/relatives already written in the nursing notes, and pointing
at it (not my strong point as I have multiple disabilities, but your
student may be able to manage that).
PAs can be expected to sign a similar honorary contract with the Trust as
the student/whatever else the student has to do to agree confidentiality.
Independently shouldn't come into the equation - in that (at least insofar
as the HPC are concerned - don't know about the nursing governing body),
independently can mean with the assistance of a PA - I'd be unfit to
practice without one. Independently means without the supervision of a
qualified member of staff as far as I know.
Functioning in a timely manner may be more difficult for your student. I
have a full-time PA on placement because I have multiple needs (also have
vision issues and am a wheelchair user).
I know other students who've had a PA part time, and that has caused
timeliness issues (e.g. only writing up notes in the afternoon). However,
that also depends on the environment - if the student is somewhere such
that notes generally only need to be written at end of shift, then having
a designated time with a PA each day may be possible. It's much harder to
accomplish with a part-time PA on an acute ward (I am very glad that I
have completed my one acute placement).
I have become more bold about asking if I can use an appropriate place for
note-writing as I've progressed through the course - whilst making it
quite clear that I'm not trying to monopolise the space. For example, on
my current placement I note-write in the handover room like everyone
else. However, I shut the door when I'm dictating, so that the words
don't filter through the second door (if open) to the public area where
clients could here. I've disclosed to all nursing, pysch and OT staff
what I'm doing, why, and that the door is not closed to keep them out, but
to keep the sound in (as that can cause bad feelings).
It may be helpful for you to ask the Nursing School to quantify their
objections more, so that you can determine which parts of confidentiality
they're worried about etc.
PS Hope that's helpful - I seem to have rambled a little.
I wondered if anyone has experience of a nursing student successfully
using alternative means of written communication on placement other than
handwriting information. If anyone is aware of students who have continued
to use alternative methods once they have started working as a nurse, this
information would also be extremely useful.
A student is studying at present who has difficulty recording anything in
handwriting due to extremely slow (8 words per minute) handwriting. In
addition, placement staff are having difficulties with the legibility of
his notes. The student also struggles with spelling and this is causing
concerns about misspelling of drug names which are similar.
I met with members of the Nursing School to discuss use of a recording
device/transcription or the possibility/feasibility of an amanuensis being
present with the student during placement hours, and they have raised
concerns about confidentiality and the student being able to function
independently and in a timely fashion as a nurse.
I would be grateful for any replies either on or off list
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Many thanks for your time
Disability Support Office
University of Manchester
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