What can a nursing student do on placement in the first week?

Stop. "Go ahead" isn't supervision. Ask, "Could you watch me?" or wait for your supervisor.

Got it? Nice. Kip's proud of you.

It's Alex's second day of placement on a busy surgical ward. She's a student enrolled nurse, and she really wants to be useful. Jo, one of the ward nurses, hurries past with a little medicine cup.

Could you give bed eleven his tablets? I'm flat out. If you were Alex, what would you do? Hold that thought. Alex doesn't want to look slow, so out it comes.

Sure, no worries! She carries the cup to bed eleven, where Mr Brown is sitting up. He peers into it and asks, what are these ones for, love?

Um, they're your tablets? Just then, Sam, Alex's supervising nurse, walks over. Pause here, and count the problems. There are four. One, students give medicines only with a nurse supervising them, and no one is.

Two, Alex didn't prepare that cup, so she can't check what's in it against his medication chart. Three, bed eleven isn't a name. Patients move beds, so a bed number doesn't identify anyone.

Four, when Mr Brown asked a question, Alex guessed instead of saying, I'm not sure. Sam gently takes the cup and says, you wanted to help.

That's a good instinct. Jo shouldn't have asked. But on a busy ward, someone will, so you need your own check before you say yes.

And Alex isn't alone. In one Australian study, first-year students often said they felt nervous before placement. So what are students allowed to do?

Australia's nursing board has a decision-making framework, and it says students can do the full range of nursing care, under supervision. Sam boils its checks down to three questions, on Alex's lanyard card.

In New Zealand, check your school's and the ward's rules. The same three questions still keep you safe. Question one. Have I been taught this, and do I feel confident to do it?

The framework asks about confidence, not just skill. So, I haven't done that yet, can you show me? is a safe answer, not a weak one. Question two.

Is this task allowed for students, here? That depends on your uni and on the hospital's policy. And medicines are the big one, because they have their own written rules.

Those rules come from your state, your hospital and your uni. In New South Wales policy, Queensland law, and WA Country Health hospitals, students give medicines only under direct supervision.

That means the supervising nurse takes direct responsibility for the care you give. In New Zealand, the nurses' organisation's guidelines say the same. Everywhere else, check your hospital's and uni's policy, and ask your supervisor on day one.

Question three. Is a registered nurse supervising me, right now? If the nurse who asked is too busy to watch, today the answer is no.

And here's the rule. If any answer is no, or not sure, stop, say so, and ask. Sam adds two more things for the first week.

First, introduce yourself by name, as a student, each time you meet a patient. Patients can say no to a student, and in Queensland's public hospitals, saying no won't count against them.

Second, if you're worried about a patient, even when the numbers look fine, tell your supervisor straight away. So how would day two go with the three questions?

Let's rewind. Jo hurries past with the cup. Could you give bed eleven his tablets? Alex runs through her card. Taught?

Not sure. Allowed? Not sure. Supervised? No one is.

I'm a student, so I can only give medicines with a nurse supervising me. Could I come with you and watch? Jo stops, and smiles. Good call.

Come with me. At bed eleven, Alex starts with a hello. Hi Mr Brown, I'm Alex, a student nurse. Is it okay if I help Jo today? He nods.

Jo checks his name, date of birth and hospital number against his ID band and his chart. Next, she checks whether he has any allergies. Then he asks again, what are these ones for?

Good question. I'm not sure yet, so let's ask Jo. Jo explains each one, Mr Brown takes them, and Alex learns how it's done.

Now it's your turn. For each one, go, or stop? Pause if you need more time. A nurse asks you to take a patient's blood pressure.

You've practised it at uni, it's on your placement skills list, and your supervisor is right there. Three. Two.

One. Go. Taught, allowed, supervised. Next. A nurse asks you to take out a patient's IV cannula, the small tube in the vein.

You've only watched it once. Three. Two. One. Stop.

You haven't been taught it. Say, I haven't done that yet. Can you show me? Last one. You've given medicines with Sam before.

Sam's on a break, and another nurse says, go ahead, you know what to do. Three. Two.

One. Stop. Go ahead isn't supervision. Ask, could you watch me? Or wait for Sam.

So remember. Before any task, ask three questions. Have I been taught it? Is it allowed for students here? Is a registered nurse supervising me?

If any answer is no, stop, say so, and ask. Think back to that little medicine cup. Would you still say, sure, no worries? Alex still wants to be useful.

Now she knows that asking is part of being useful. Alex, Sam, Jo and Mr Brown are fictional. This is general education only, so always follow your uni's and your hospital's policies.

What's your best first-week placement tip? Share it in the comments. Subscribe for next time: patient ID, and why a bed number isn't enough.