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Graduate Nurse Residency Program: Clinical Narratives

Clinical Narrative #1

A year ago I had just moved to Colorado and was beginning my career as an RN. I was feeling excited and terrified I’m not sure which emotion was stronger at the time. I was excited to begin the career that I had been working towards and thinking of for years and terrified that I wouldn’t be good enough. A year later I’m still excited and still a little terrified at times but less often. I am no longer as stressed about the clinical tasks like starting iv’s and more concerned about improving my assessment skills and critical thinking. I’m noticing changes in patients that I hadn’t before and I am building friendships with co-workers and patients.

I decided on oncology because I wanted to get to know my patients and their families. At times it is difficult to find enough time to sit and talk with a patient but it is at those times when I truly feel like a nurse. Over the past year I have taken care of many patients but there is one who I really felt close to. He has been on the oncology unit on/off for chemo treatments since I started. Always friendly and kind he has called us (his nurses) his Colorado family. At Christmas one of our nurses helped him find an apartment, he had been homeless, and our staff provided him with furniture, grocery money, clothes and his favorite coffee. I saw him a week after he received all the gifts and he hugged me and cried saying that he was so blessed to have us in his life. I worked New Years Eve and he came running out of his room to wish all of us a Happy New Years, and said that there was no other place that he would rather spend the holiday than with us. I couldn’t imagine being happy to be in the hospital at all but especially on a holiday. He had a way of always being positive.

A couple of months later he was found on a park bench septic and was taken to the ICU where he was in critical condition. I found out that they were planning on withdrawing care in the morning. I visited him in the ICU and held his hand and told him that we all cared about him. It was so hard, he didn’t look like himself and I wasn’t used to being the one that the nurse had to comfort. I left that day feeling distraught. Why couldn’t we save him? He had just gotten into remission and his life was turning around.

I found out the next day that he had shown some signs of improvement and the physicians were going to wait to see if he could recover. For the next several days all of us visited him day/night and he pulled through. I got the email that he was awake and responding to treatment and that he was demanding to be back on our floor. I cried and realized that this is what nursing is about. We can’t always find the ways to medically save someone but we can give them our support, kindness and attention and maybe we’ll get a miracle every now and again.

Clinical Narrative #2

The past year has been so much more than I ever thought it would be! I feel I have learned so many applicable aspects of being a nurse. While a college education is obviously vital, this past year was equally as important, not so much in learning (although I learned a lot as well), but applying. Anyone can learn from a text book and earn the degree, however if you can’t apply that knowledge, what use is it?  That is what this past year has been—learning to apply the knowledge I learned in school, and of course adding to that knowledge which occurs every day.  There are so many things that a text book can not teach; how to grieve with the family who just lost a loved one, how to comfort a patient who recently received a poor prognosis, how to read that patient’s facial expressions and know they are worried, scared or simply lonely and in need of a smile and encouraging word.

There is one patient I hope I never forget because it is such a reminder of how precious life is—He was in his mid 90’s, his son and daughter-in-law visited him every day in the nursing home, he didn’t know who they were anymore, he probably didn’t even realize they were there with him every day. In his younger years he was a musician, he taught music to hundreds of people and played in a popular orchestra- he was very talented. Now, however, he never opened his eyes, he moved his arms and legs very little and the only way he enjoyed his one passion in life was to listen to classical music on the CD player next to his bed. When he was brought to the hospital, he was diagnosed with a pneumonia, the doctors had planned on giving him 24 hours of antibiotics and sending him back to the nursing home. Throughout the day, he became progressively unresponsive, although did not worsen any other way. The next day his prognosis worsened, and the doctors told the family that they did not think he would live much longer, the infection was simply too much for his body to handle. The family left in good spirits, saying they would come back first thing in the morning to take their father back to the nursing home and allow him to pass away where he was comfortable and in familiar settings. That evening with only a couple hours left of my shift, the patient worsened. I called the family, and could not get a hold of anyone, leaving messages for them to call the hospital as soon as they could- but it would be too late. A C NA and I held this patient’s hand while he took his final breaths, all the while listening to his favorite rendition of Cannon in D. Not even five minutes after this sweet man passed away, his son arrived on the floor- bringing more of his father’s favorite music. After I told him his father had passed away, he gave me a hug and thanked me profusely for not letting his father die alone. I spent the next hour listening my patient’s son tell me all about the life of this musician, of his love a passion for music and the life he had.  I drove home that night with a new insight to how even seemingly insignificant actions on the part of any health care provider can make a lasting impact on numerous lives- something only experience can teach.

Clinical Narrative #3

In nursing school we were asked what characteristics we would like to portray as a nurse.  I remember answering “fruit of the spirit”.  The fruit of the spirit being: love, joy, peace, patience, kindness, goodness, faithfulness, meekness and self-control. I did not truly understand how often my ability to portray these characteristics would be tested. My journal entry after my first week on Labor and Delivery was “Oh my GOD!!!”

The first time I experienced fetal heart tones dropping, the panic I felt, my preceptor patiently asking “have you turned off the pitocin, oxygen applied, position change?” Now these interventions are automatic and I am able to explain to the patient, enlist her cooperation.

The first birth I participated in, pushing with the mother for hours and then her tears of elation as she delivered her son. My first precipitous birth, my preceptor described my facial expression as “a deer in the headlights!”  I remember the mother’s scream as her baby presented herself to the world without warning.  Her scream is what brought other staff into the room, I was unable to move! The dad laughed and thanked me for being in the room and reminded me my services had not been needed. My second precipitous delivery, I was calm, called for help (emergency call light), put on a glove and gently held baby’s head as he entered the world.  The mid wife was complimented me on my actions.

I have learned, rather quickly, births do not always bring joy or life.   The shock of seeing a 28 week old infant who has died, then, acquiring the ability provide comfort and support to the mother and  family, dress the infant, take pictures, hand and footprints, and prepare its tiny body for the morgue. You question GOD and yourself when you develop a relationship and provide support to a mother who wants a baby desperately but know she is unable to maintain the pregnancy and her child is not viable, or the child is viable but does not live. Recently I found myself assisting a peer by holding and rocking an infant until he passed away. His mother was unable to hold or look at him. Although not at the age of viability, I was amazed he lived two hours.  No one should have to die alone.

This year was been one of successes and challenges. In a previous career I was a Patient Advocate, I had to learn how to advocate for my patients differently and communicate with physicians in a different manner. My preceptors, peers and unit leadership have been a wealth of knowledge of which, I am able to draw from, and without them I am sure I would not have succeeded.

Nursing is not stagnate profession, I must continue to grow through education, the knowledge peers younger and older can provide, my own experiences and challenge myself to display the fruit of the spirit. I am grateful for the opportunity to increase my clinical skills through the Nurse Residency program and unit based educational opportunities. I look forward to see what the future holds.