All About My Senior Practicum

Fast Facts:

• Unit: Med/Surg (Primarily a Surgical Unit that had an occasional overflow of medical patients. There was also a section of the unit designated for Bariatric Surgery patients).
• Typical Assignment: 4-6 patients with 1 designated tech per nurse (on a good day).
• Shift length: 7 AM - 7:30 PM (Day shift) - although I always ended up leaving the majority of the days around 8:30 PM
• Unit Size: 35 beds
• Total hours required: 116
• Total hours completed: 124 in 5 weeks
• Hospital Shifts Completed: 10
• Daily commute: 35 Minutes in 1 direction
• Was this my desired specialty: No
• Scope of practice: Everything the nurse can do, I can do with her supervision.
• Greatest accomplishment: starting an IV on an elderly patient with fragile veins on the first attempt.
• Overall experience: 4.5/5

Deep Dive:

• What is it? Think of this as the equivalent of when your friends who are studying to be teachers do their student teaching. It's completed during your final semester. I know some of my friends refer to it as their Senior capstone, but it's all basically the same thing. 
• We were asked to rank our top specialties and then we would be matched based on our grades in those corresponding specialties. (ex. if you want women's services, you need to aim for having an "A" in Maternal Health. If you want ICU, you need to aim for scoring an "A" in Med Surg 2/High Acuity.)
• There's a common misconception that if you don't have practicum in _____ field you won't get a job in _____ field. This is false. I've secured a job in my desired specialty after having Med/Surg practicum:

• I had the opportunity to work one rapid response/code situation while I was there. I really just served as a runner and tried to stay out of the way while observing.
• ALWAYS double check + CYA (cover your ass) for any reported vitals/notes that seem suspicious, At the end of the day, nobody has your back the way you have your own back. "Chart as if one day it'll be read in a deposition."  (wise words once seen in a meme)

• In terms of placement, we were told that this year an unprecedented amount of hospitals declined students and positions in certain specialties. Apparently, in years past we've had "carte blanche" (noun: complete freedom to act as one wishes or thinks best) when it comes to practicum placement and most people in past cohorts received one of their top 3 choices. I expressed my desire to have an ICU placement at any hospital and was willing to drive any distance to have that. Unfortunately, it didn't line up that way. I didn't even get practicum placement on the unit/in the hospital where I had my nurse externship.

• Huddle began at 7 AM and typically lasted 10 minutes.
• The bedside shift report is what took the longest. Some days you were lucky if you only had to give a report to one nurse on all 4-6 patients. Other days you'd have to hunt someone down or give a report to 2-4 different nurses.
• Our school divides the cohort into 2 blocks, Block 1 and Block 2. Each "block" has 8 weeks to complete their 10-12 shifts. You are mandated to do 12 shifts if you have no plans to attend the annual National Student Nurses' Association (NSNA) Convention.
• The floor I was on had a very high turnover rate. Many patients came in for surgery and were discharged the next day or 2 days later. I saw many of the same surgeries and was able to do quite a bit of discharge teaching.
• Most days we'd be running around and wouldn't sit down for a break until around 4:30 PM.
• With 4-6 patients you don't have too much time to spend with each patient. You're spending most of the day running around and passing meds (or waiting for the pharmacy to send them up):

• My preceptor was great! She really encouraged me, always reassured me, and had helpful hints and tips for me. I'll admit that going into practicum I was nervous. Had I learned enough up until this point? Would I remember how to do any of the skills I was validated on in past semesters? On my first day of practicum, I just observed my preceptor and her "flow" to try and model how I planned to do things throughout my time on the unit. About halfway through the first day, I felt comfortable and wanted to jump in/help out with whatever she needed. 
• Although I wanted to help out the techs I was reminded that's not what I was there for. I've always said, "when I'm a nurse I'm not going to harass my techs or call them for everything unless absolutely necessary." With practicum I learned that delegation is KEY.
• I did experience some push back from a few techs who didn't understand my purpose or position. For some patients blood glucose readings would not be obtained, vital signs would not be taken, patients would not be ambulated to the restroom and subsequently soil the bed, etc. I was even asked by one tech, "so what are you here for?" in regards to me not obtaining vital signs due to having a new admission:

• I used to think being a tech required much more energy than being a nurse but it turns out I was WRONG. Now I'm not saying that there aren't some lazy nurses out there, but my preceptor and I do NOT fall into that category. Every day I left the hospital I was SPENT. After the first week, I ordered an 8 pack of compression socks to help with the swollen and throbbing feet. I'm usually a very high energy person but every day I felt like I used all my energy and had just enough to drive home. Nothing felt better at the end of each day than sitting down uninterrupted for 35 minutes on my commute home in silence, then taking a boiling hot shower upon arriving home, and laying down in bed.
• I know we preach "self-care" all the time in the health-care profession but the fact of the matter is that it's not always feasible. Most days I'd take a 15-minute lunch break, 20 minutes on a really good day, but never the full 30 minutes. The harsh reality is that you have so many things going on with your patients that you almost feel guilty stepping away for 30 minutes. We were told by our instructors that we needed to take breaks during our shift but I always felt like I was missing out on valuable learning opportunities.
• I now understand what it feels like to see the techs leave after giving shift reports and feeling sad because you still have anywhere from 30 minutes - 1 hour remaining due to charting or giving reports. 12-hour shifts, 3 days per week doesn't seem that bad but in reality, that's not how it works out. Shifts are more like 13-14 hours and when it's time to go, you're ready to GO:

 

• My main weak point going into practicum was therapeutic communication. Thankfully I had more than enough opportunities to practice speaking with patients and their families. Although every situation is different, it gave me a general idea of how to prepare for and handle comforting and educating patients. 
• Leading up to the last shift I was worried about the gap between completing my practicum and starting a new graduate residency. Would I lose my confidence? Would I lose all my skills? Basically a constant loop of worry. I know in past semesters with every new skill I acquired I would say " I finally feel like a real nurse." However, practicum was the icing on the red velvet cake. It was a wonderful experience and now I'm grateful to shift gears and focus on saving for NCLEX fees, having more time to study, catching up with friends, and finally sleeping:

That covers just about everything. If you have any questions feel free to leave them down below. As always, wishing you all the best and I'll talk to you soon!