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A day in the life of...A student support services

Jan Farrar

When I was appointed, it was with the brief to set up a GP branch surgery on site to improve the health provision for students at the then higher education college. At that time we had 465 registered patients in our first year; 13 years later, through polytechnic and now university status, we have just over 3,700 students and staff registered.

Although I am employed by the university, and the full-time receptionist and part-time practice nurse are supplied by the practice, we work (and socialise) as a small, close-knit team.

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Technology has also advanced with the growth of the university, and my first task each day when I arrive at 8.30am is to check the incoming results sent from the labs at the local hospital and action any treatments or follow-ups. Dealing with emails and post are daily duties that keep me up to date with what's going on, both in the university and at the practice.

Doors open at 9.00am; the duty doctor arrives from the main surgery in time for the first patients booked in at 9.30am - still fairly early for some of our students! Surgeries are held every morning by the GP, practice nurse and myself, and most afternoons by me. On average I will see about 32 patients per day, four days a week. One morning and one afternoon are allocated to administration.

My daily surgeries are usually a mixed bag of the usual - sore throats, colds and coughs, ingrowing toenails, sports injuries, spots and rashes, and asthma checks. On occasion I see a case of appendicitis, and recently a large ovarian cyst. Some students have chronic and debilitating conditions such as Crohn's disease, epilepsy and diabetes and require regular monitoring and support.

Student health problems can be linked to their lifestyle. Many students have financial worries. Accommodation in Cambridge is expensive, so lots of students have part-time jobs to supplement their grants and loans, which can be delayed. Diets are not always of the healthy variety - the university is surrounded by fast-food outlets. Away from home, smoking and alcohol intake is often increased and, while the university has a strict policy on drug taking, there is no doubt that recreational substances are used.

However, with the vast majority of patients aged between 18 and 25, I spend a lot of time on sexual health matters. Contraceptive advice and provision; requests for emergency contraception; and treating and advising on genital infections make up a large part of my work. Routine screening for chlamydia is carried out at the time of the first smear; owing to the high rates of infection among this age group, screening at this time has been found to be cost-effective. It is also an ideal opportunity to provide health education about sexually transmitted infections. In fact, in most consultations the opportunity for health education and promotion is rarely missed!

The first smear can be a daunting prospect for young women; very occasionally a patient will seem unduly distressed and gentle questioning will reveal that she has experienced a rape or sexual abuse in the past. The university provides an excellent counselling service, with which I have very close links, often cross-referring.

The counsellors are invaluable, as many students experience problems with mental health while at university. Acute psychotic episodes have been known, while stress, ­anxiety and depression are commonplace. I will see at least one student per day with these symptoms. Patients with eating disorders, intentional self-harm and attempted overdoses are followed up regularly. A recent course in mental health training has given me greater knowledge and insight for dealing with these, at times, very distressed patients. Due to the ever-increasing numbers of students with these difficulties, the university has set up a "Student Wellbeing Group", of which I am a member. We look into ways of supporting students with mental health problems.
 
After morning surgery I have a welcome break for lunch between 1pm and 2pm. I am "on call" for emergencies during this time and carry a mobile phone so that I can be contacted. Occasionally meetings are scheduled at lunchtime with, for example, the local primary care trust (PCT) nurse group, the student counsellors or other Student Support Services staff. Every six weeks I have a meeting at the main surgery with all the nurses and practice manager. Liaising with the practice is very important to me, and I enjoy having their input and encouragement.

My university responsibilities include being a member of the health and safety panel and recruiting and arranging first-aid training for employees. I am also available for staff with health problems, and in October every year I provide flu vaccinations for those who want them.

The student union has a very active role within the university, and I maintain close links with the welfare officer in planning health campaigns. I have even been known to write the occasional article for the student newspaper.

After lunch, more patients. Most afternoons I work on my own. My training as a nurse practitioner has enabled me to diagnose and treat a wide variety of minor illnesses using skills in history taking, clinical examination and pharmacology. With nurse prescribing (albeit from a limited formulary), I hope to be able to provide the full range of services to my patients. My GP colleagues are fully supportive in this as with all my work.

The last half-hour of the day is often spent on paperwork - dictating referral letters and letters in support of mitigating circumstances for students, or, at this time of year, preparing for the intake of new students in September. Induction week sees the registration of over 1,000 new students, some 750 of whom will have a "new patient health check" in the first week! Extra hands are drafted in for this marathon, and it is an ideal opportunity for us to meet students with ongoing health problems and reassure all that we are here for confidential help and advice during this (for some) daunting time.
 
Anglia Polytechnic University has a large intake of international students; apart from being far away from home, they have to cope with new cultures and languages, not to mention the vagaries of the NHS! So the first weeks at university can be strange and unsettling - being a surrogate "Mum" and providing free hugs (if required) is sometimes all that is needed.

Also at this time of year, when most of our students have finished their exams, I will fulfil another role - that of external examiner for the RCN. Examining the clinical skills of student nurse practitioners for two or three days each year certainly keeps me on my toes!

Fortunately, for most students university is an exciting and fulfiling time, a time for personal growth and achievement. For those students who do have health problems, the medical centre team aims to provide help and support to enable them to complete their studies effectively and gain their degree. As part of Student Support Services, my role as an autonomous nurse practitioner is satisfying, challenging and rewarding.

If you would like to write a 'Day in the Life' piece for Nursing in Practice, please email elainelinnane@campden.com