Last Three Weeks of Critical Care

This is hard to write about it because the last three weeks were times of real discouragement for me in school. The whole time I was in school I felt uplifted in support by clinical faculty, care teams and friends. The last three weeks felt like a desert. I had a terrible midterm evaluation, a clinical instructor who made it obvious that she didn't care for me, and had a lot of sleepless nights worrying about everything; school, family, missed friendships, and second guessing whether I made the right decision to go into nursing school in the first place. There is this "myth" out there that nurses eat their young. For 3 weeks, the emotional toll this took on me made me rethink a lot of the optimism I had about becoming a nurse, how I could help people, working in a constantly changing environment and adapt to multiple personalities and temperaments.

Week three I went back to Tele (cardiac care) for two days and prepped on two patients. The first was a deaf patient with pneumonia and the other was a late Friday afternoon admit, whose records were still being assembled while I prepped on him. I made as many notes as I could gather assuming I would finish all my history gathering the following day as I assessed and care for him. Since things change so fast in tele...we always risked full preps on people who might be discharged the next day. This always happens with me, regardless of the acuity level of the patient, and as I arrived on the unit the next day, the care nurse told me that she was orienting a new nurse and to essentially stay out of the way. Nice.

My 2nd and 3rd patients were interesting. One needed an adenoscan. Went with him to see what that was all about and decided that if I ever needed one of those, I would not consent to one. Essentially, adenosine chemically induces the effects of running a marathon while you lie still. My patient freaked out. As I tried to reassure him, he looked at me like I pulled fast one on him. The first patient I was supposed to care for, but ended up deferring to the new orientee was just a little too active for the care nurse so she asked me to restrain him. As I zipped up his vest, he looked at me and said "no, SN not you!" Feeling like 'one of them', I cried in the shower that night. Seeking refuge with a little sweet old lady who need ortho HTN vitals done, I rounded out the day talking to her about books we both loved. After renal diet teaching and discussing the importance of medication compliance with my young dialysis patient, I went home to update all the care plans..four pounds of paper later...zzzzzz.

Week 4 was in ICU: My patient was in respiratory failure. My nurse was a tazmanian devil and really sharp. We had a loaded unit with two suicide attempts. My patient's family reminded me a lot of my own. They were there all the time. Dad was really struggling with breathing and as we tried SAT and SBT trials to wean him off his vent, I witnessed the most rapid respiratory failure I had only read about in books. Being Sunday, all I could do was pray hard that we could keep him calm while the RT fetched the BiPAP machine. Holding this guy's hand, it felt oddly familar. That weekend wiped me out.

Weekend 5 was full prep with two patients. One had a decub that wiped out his heel at a SNF. Seeing someone with DP pulses and missing his heel tissue was another one I thought I'd only see in the books, but SNF neglect still happens. Boatloads of meds. I enjoyed getting this guy up in a cardiac chair with PT and giving him my farewell speech. We both knew he was going to lose his lower leg two days later in surgery - I tried to equate this with the problems my own father had following his hospitalization and I demanded this patient keep his gym membership and never give up. Everything about recovery is in attitude. He had several rough months in a SNF - he could make it. Shaving away the last remnants of his beard, he laughed at the amount of cream I put on his face...we had to laugh. There was so much to cry about.

As I left that night. I was sad and tired. Spent and frustrated. Second guessing everything. This was the hardest part of school for me. The biggest learning curve and the most difficult to navigate. My CI gave me my final review and I passed. For some reason, I was numb. My clinical group all made it. But we all had that same worn torn look of fatigue.