Personal Narrative: My Practicum Experience

For my practicum experience I was at the Sacred Heart Medical Center ICU (2S). The Sacred Heart ICU takes a variety of different patients – traumas, strokes, septic patients, etc. To guide my time on this unit I was assigned a nursing preceptor. Mackensie Rockstrom, who was with me for all but 28 of my total 136 hours, has been a nurse for five years. Two and a half of these years have been spent in the ICU, the other two on the 8th floor, a neurological floor, of Sacred Heart. Mackensie’s teaching style was that of modified independence. Skills that I was allowed to perform, and which I had proven my competency in, I was allowed to do on my own. However, some specific skills, like titrating or giving medications IV push, were not allowed by

During one of my early shifts, with the help of my preceptor, I recognized a neurological change in the status of my patient. He had increased confusion and a slowed pupillary reflex. This change caused us to call the intensivists and order a stat head CT to check for bleeding in the brain. While there was no new bleeds identified following this CT, this experience taught me just how important it is to have a solid baseline assessment of a patient and how important it is to re-preform specific assessments based on a patients condition. According to a study by Rothman, Solinger, Rothman, and Finlay (2012), nursing assessments can act as a longitudinal source for quickly identifying indicators of a clinical problem a patient may encounter. In being able to efficiently and effectively identify these changes, appropriate medical intervention can occur quicker which can help to reduce overall mortality and morbidity. This goal, and experience with identifying a change and initiating intervention quickly, taught me just how valuable the head-to-toe assessment really is. I know that when I finally practice as an RN on my own, I will assure that I always have this baseline assessment down

Without it, things can go awry. Even during the nights there is always a variety of different providers and family members present in the ICU, and being able to successfully communicate with this wide variety of people requires careful listening to what is being said. As I spent more time in the ICU I grew more comfortable in listening to what providers were expressing and communicating. I began to understand their reasoning for a certain action, even if it was one I disagreed with. With families I began to listen more carefully to their worries, concerns, and stories. These helped me to better understand my patients, and to know how to appropriately speak with both the patient and their family. This practicum experience also helped me to grow in several other servant leadership characteristics - empathy, awareness, and foresight. The ICU is a place of constant vigilance that requires me to constantly be aware of what can happen, and to pre-plan my actions appropriately. It is also a place of ethical dilemma. This requires the provider to be aware of their own feelings regarding these issues. Carrying this ability to listen to my patient, be aware of my feelings regarding certain