“You have been amazing tonight.”
Last shift of placement tonight. Tonight, I will go through my final ANSAT (Australian nursing standards assessment tool) with my facilitator. I’m expecting it to be pretty straightforward – my interim ANSAT at the halfway point was solid, and I’ve only improved since then.
This placement has been incredible. I’ve found the thing I want to do – emergency nursing. Emergency nursing is fast and seems chaotic, but it’s highly logical and pattern recognition is important. During this placement I spotted a patient with early signs of sepsis because I saw the patterns forming in their vital signs, before they even met the criteria for sepsis. There’s a lot of if/then decision making, for example if my patient has come in because they’ve had a fall, I need to do vital signs and a Glasgow Coma Assessment like I would with everyone, but I also need to do neuro obs and pupil assessments to check neurological function. If they complain of chest pain I’ll order bloods including troponin levels, I’ll do a full respiratory assessment, do an ECG and put them on telemetry to monitor heart function. And so on. These are things I would have had to think about four weeks ago, now it’s almost automatic. And importantly, I understand why I would do those things.
Emergency nursing seems to be thinking all the time about what could happen next, and looking for information and interventions before we get there. It’s also super collaborative between nurses, doctors, and other allied health staff. Unlike wards where doctors swoop in, do their rounds, and leave, doctors and nurses work side by side and talk to each other to assess and plan. One doctor in paeds not only introduced himself to me (me? a nursing student?) when he would plan care for patients he would ask the nurses, ‘is that plan okay with you? Do you think that’s an appropriate plan?’ He would even check in with me and say ‘what about you Cat? What do you think, is that plan all right with you?’ As well as working so closely with doctors, nurses also have more autonomy in ED – we can order certain tests that are otherwise normally only ordered by doctors, such as blood tests and cultures, and can dispense stat doses of certain medications for specific presentations including a limited selection of analgesics, sedatives, and antipsychotics.
Last night I worked in an area I hadn’t worked in before. Its name is an acronym and I don’t remember exactly what the acronym stands for, but it’s an area to help manage the flow of patients from the ambulance ramp into acute. We take handover from paramedics and manage them until we can get them into acute, so we’re working in a small area with less fancy equipment than most of the rest of the ED (apart from the waiting room). Nurses have a high level of autonomy in this area, and everything moves fast. I discovered that being able to touch-type quickly is actually a prime requisite for ED nurses in this space, and ended up taking handover from several ambos just by virtue of being able to get all the info down quicker than anyone else. As I did that, I found myself becoming quite interactive with the paramedics, asking further clarifying questions that I likely wouldn’t have thought of a month ago. Then I’d hand the information over to my RN or the other RN concisely.
I feel like I’m going to hit the ground running on my next placement, and by the end of it I’m going to be ready to start working as a graduate nurse. I feel like I’m thinking like a nurse, my skills have developed out of sight this placement. I was already doing well with soft skills and theory but my hard skills are so far ahead of where they were four weeks ago. Although my regular student nurse job is going to feel pretty ordinary by comparison, I already know that I am going to approach it so differently after the experiences of this past four weeks.
Over my four weeks of placement I worked primarily with two nurse preceptors. Both were awesome teachers in very different ways. One of them was friendly and effusive and went out of her way to check what I knew and explain things I didn’t. We worked together collaboratively as team nurses – the flow was easy and we’d chat about all sorts in between tasks. My other preceptor though is very reserved in demeanour. He’s softly spoken and matter of fact. He offers very little in the way of non-verbal cues: he’s not closed off, he’s just understated. When he laughs, it’s a quiet chuckle and a slight upturn of the mouth. When he’s stressed, he just seems a little more focused on what he’s doing but his tone of voice doesn’t change. Kind of amazing really, but for someone like me, who is frequently anxious and often unsure I’m interpreting social cues accurately, this is incredibly difficult to work with. He would quiz me on aspects of patient care or pathophysiology and I mostly knew the answers, but I never felt like I quite measured up. When I could have done something better, he’d say, ‘okay, next time if that happens come to me first.’ I said to Dan at the time, it felt like he was saying to me, ‘I’m not mad, I’m just disappointed’.
I know, from experience, that when I don’t understand social cues I assume the worst. I always do. Conditioning is a hell of a thing. And all through this placement I’ve said to myself (and Dan), I know this is me talking, I am sure he doesn’t think poorly of me the way I feel like he does. I’ve been working hard mentally to stay in a place where I acknowledge I feel bad about our interactions, while still recognising that just because I feel dreadful doesn’t mean things are dire. It’s okay to just let the anxiety be and just keep doing what I’m doing because I’m sure he’d tell me straight out if I wasn’t performing.
Anyway last night toward the end of the shift, our last shift together, out of nowhere he said to me, “You have been amazing tonight. I mean, you’re always amazing. But tonight was exceptional.”
Friends, I think I said ‘thank you’ but honestly I’m not sure because I just about coughed and fell over. He just turned back to the computer and continued going through patient charts ready to handover to the next shift.
I’m looking forward to tonight’s shift. The pressure is off, because my assessment is done. I’m just going to get in there and be the best nurse I can be tonight. Maybe I’ll even be amazing. I guess we’ll see.