A Night at Practicum
I cannot attest to what it was like to have practicum on an ICU floor in which you only have a max of two patients. However, to my knowledge, the majority of students were on a unit in which the nurse to patient ratio was 1 to 4. Since I only had the entire team of 4 patients for my last two shifts (if I remember correctly), I decided that I would talk about how a usual shift went where I had 3 patients and my preceptor had 1.
1830 – arrive on the unit, put my things away, and make sure I had everything I needed in my pockets or on my body some way (badge, stethoscope, scissors, hemostat, alcohol pads, NS flushes, tape, Band-Aids, and both sizes of alcohol impregnated green caps)
1845 – the unit would do a huddle and hand out patient assignments with the report sheets
1850 – start getting report from day shift and introduce myself to each patient. This would usually last until about 1930 to 2000 depending on the assignment and if the day shift nurse likes to give a lot of detail and/or gets distracted.
2000 (or whenever report is done) – check orders in the computer and make schedule for the night based off of care needed (medication administration, dressing changes, perfusion checks with the Doppler, etc.) I would use the printed out patient report sheets and on that back, I would write down a spot for every hour and write what has to happen at what time.
2015 – Determine the order in which to see each patient, and go. Perform a head to toe assessment for the most part. Determine which systems need more attentive assessments. Ex: I’d always assess heart, lungs, abdomen, skin, pulses, perfusion, surgical sites, drains, pain, and strength (to determine ability to ambulate - squeeze my hands as hard as you can, push your feet against my hands, pull your feet towards you to resist my pull).
2200 - After seeing each patient, it was usually time for the 10 o’clock meds – that was the usual time that most patient received their night time doses. On the floor I was on, we could give meds within an hour that they were due, whether it was early or late, so just depending on what I needed to get done, some patients got them right on time, others got them when I went to do their assessment, etc. You’’ figure out what had to be done, and your nurse is always there to guide you. It’s also okay to go in and do your assessment, think that you’re done with that patient for a couple hours so they can rest, leave the room, and then remember that you completely forgot to grab their medications. I did that multiple times at the beginning. It’s okay. You’re human. The patient might get annoyed because they were almost asleep, but most are understanding. The majority of the time, the patients knew exactly what medication they were to get and when, so they usually asked for their meds before they got ready for bed.
The rest of the shift from here on out just goes however it will. The rest of the night will be based off of each patient’s medications and when they are scheduled, who needs pain meds, who requires perfusion checks every 1 or 2 hours, who requires pain reassessment, who has a scheduled dressing change, how many times that one patient pushes the call button, etc. And all the while in between, you will be trying to steal time to sit and chart. Once I got the hang of things, I found more and more time to be able to sit, but some nights, you really don’t get the opportunity to sit unless you’ve somehow managed to find the time to empty your bladder.
Yes, some of that may have been a bit dramatized depending on the shift, but honestly, there will be some shifts that you really don’t get the opportunity to sit until the shift is almost over. I remember one of my first practicum shifts, I had a patient that kept forgetting where he was and what was going on and had continuous bladder irrigation going. My nurse and I were walking to the break room at about 0350 and I glanced in his room as we passed it, and I did not see his feet at the end of the bed. So, I bolted into the room and my nurse saw me go and followed. Sure enough, he was trying to get to the bathroom to go pee (for about the 3rd time). He managed to tangle his IV tubing around the door handle. His foley bag was still attached to the bed and was pulling (ouch), and blood was dripping on the floor. Definitely a crisis moment. We called for help, got the patient back in bed, and got a sitter to watch him. I finally sat down at about 0430 when I took my lunch break. I think I had only one other night that I took such a late break, because I got better at judging when I should take it, and I also took my break when I needed to as opposed to always taking it with my nurse. And yes, there were shifts in which the night was calm and I got to sit for most of the night, but you just have to always be prepared for whatever happens.
Not every floor is like the one I was on, I know some students were on busier floors than mine, and others were on slower ones. So just remember that every floor is unique to its own, and every shift is even more unique.
It never gets easier; you just get stronger.