The morning of the first day of my clinical preceptorship I had such a mix of emotions. I had been lying in bed awake for hours because I felt too much excitement to sleep. My alarm went off and the nerves set in sending one question after another swirling through my head. Would my preceptor be nice? Would I disappoint her? Would I remember my lab values? Would I remember my skills? What if someone crashes will I know what to do? If everything is okay will I know what to do? A year of nursing school was coming to an end and suddenly I felt like I had forgotten everything.
I arrived at the hospital much earlier then I needed to and tried to relax. I took a deep breath and headed in to the ICU trying to pretend that I wasn’t terrified. I obviously wasn’t doing a good job. “Don’t be scared” was the first thing my preceptor Joslyn said as she greeted me and then assured she was here to help. That was a relief; she wasn’t going to eat me. With that I knew was going to learn a lot over the next few weeks and I was ready to get started. I remember hearing at some point in fundamentals, which seems so long ago, that as a nurse you not only be treating the patient but their family as well.
The first patient I had that day rang true with this sentiment. He was a man in his early fifties, intubated and heavily sedated lying in the bed with eight different drips running simultaneously one of which was locked in its own special box. I had just gotten comfortable with running one IV drip maybe a piggyback but eight! Jocelyn reminded me that she was here to help me learn and I’m not alone, thank god. Entering through the big sliding glass doors we walk in the room to do our assessment and I think “okay head to toe assessment | got this! ” I take a deep breath and then realize we are not alone.
There is young man lying in the chair in the far corner of the room just waking up. Once he is aware of our presents he is fully awake and walking over to the bed. “So how is he? ” Now I am even more nervous I did not expect to be doing this under the watchful eye of a family member that surely would not be happy with any mistakes I might make practicing to be a nurse. How do I respond to his simple question? Then I remember I’m not doing this alone as Jocelyn begins to speak with him. I complete my head to toe assessment and we begin evaluating all the drips and looking up our morning meds.
All while answering questions and listening to the concerns of the young man who identifies himself with tears in his eyes as our patient’s oldest son. He squeezes my hand and asks me to do everything I can he just want to talk to his dad again. I think to myself “what can I do I’m just a student nurse? ” I remember reading that the sense of hearing is the last to go, so I smile at him and tell him his dad can still hear him and he can talk to him now. He shakes his head yes squeezing my hand one more time and then sits in the chair near the bed.
We tried to make the environment and all the tubes and drains less scary after finding out our patient had a 13year old daughter coming in that day to visit him. Throughout the day, while providing care for our patient, he had six family members in and out of the room all day each with their own questions and concerns justifiably so. Just the day before one of his four doctors told them he might not make it. This was devastating to them. Three of his children had not spoken to him in almost three years and want a second chance with their father.
It made for a very interesting family dynamic that could not be ignored. It took much more time going in to provide patient care for him with so many people but the family needed comfort too. Explaining every move before you made it and why, this was actually beneficial for me as I am still learning so if was good reinforcement. The best news was our patient was getting better and weaning off the ventilator. This brought on more conversation and questions from the family with tears of hope and sadness. Would he be able to talk? How long before sedation wears off? What id extubating?
How long before we know? When is the doctor coming? Sometimes they just needed a smile while they shared a memory of happier times. At other times they were jumping up out of there seat calling for you because an IV was beeping and they don’t know if that’s good or bad so they needed you there now. All of this and we had another patient that we were taking care of as well. It was exhausting and at times very frustrating but I kept reminding myself they must be exhausted too and frustrated that they can’t do anything. So I listen to each story and answer every question I can.
It was the last hour or so of my twelve hour shift. Our patient had been fighting and had made a bit turn around, his eyes were open and he could respond to some simple commands. He couldn’t speak but you could see the joy and excitement on his face when he saw his family especially his estranged sons. Respiratory was here in to extubate him and this was the first time all of the family members were out of the room and we were there alone with our patient. I could still feel them, I knew each minute outside that room felt like an eternity to them.
After the tube came out I brought over a warm wash cloth and wiped his mouth and face put on his oxygen and began to coach him on how to breathe. This was the first time in 3 days that he was breathing on his own. He looked up at me and mouth the words thank you. After about thirty minutes the family came back in and I can’t even begin to describe the emotion that unfolded in that room. Thirteen hours later we were giving shift report to the oncoming nurse. Before we could leave we were requested back in the room yet again by the family. Our patient wanted to hug us and thank us for taking care of him and his family.
His family wanted to thank us for bringing him back and putting up with all of them. They kept trying to apologize for being over baring and always asking questions. At first I didn’t feel like I deserved a thank you, I didn’t do that much or so I thought. I got a hug and a thank you from each family member with tears in their eyes. I would be lying if || said I also didn’t have some moisture in mine. Watching them all together after the arch of the day was captivating. I experienced a different side of nursing that day one they can’t really teach you fully in the class room an emotional side.
Things could have gone in a very different direction that day but either way his family would have need us. Not just to take care of their loved one but to help them understand what was happening and allow their feeling to be heard. I was so scared that day about being perfect at all of my skills, remembering my labs and drug side effects and not screwing up I didn’t realize the strongest tool I already had. I learned the compassion I possess for my patients and their family has me on the road to becoming a great nurse