My last placement block for my double degree was at Sale hospital in the Critical Care Unit (CCU), a ward that I requested due to multiple good experiences from fellow students. I had the options of emergency, CCU, paediatrics or operating theatres, all areas that interest me due to their diversity and high acuity skills. I was pleased to learn that I would be spending four weeks in CCU as I was looking forward to gaining some experience and witnessing cases that I had yet to see. All of my nursing placements had so far been low acuity and/or community experience and I felt that I was lacking the hospital experience necessary for a 4th year student nearing the end of her education.
The first week of my placement was all over the place as CCU was getting a refurbishment. I was annoyed that my first week would not run like a typical CCU but I understood that everyone was doing their best under the circumstances. Day 1 was just transferring equipment from one ward to another and helping set up and settle in a couple of patients. The week we were in our temporary ward did not see many interesting cases. Most patients were just flagged anaesthetic risk or cardiac monitoring. Although one patient did have necrotising fasciitis which was interesting to look at. I was excited for week 2 as CCU would return to its usual location and routine would be restored along with feeling like I had settled into the ward. Week 2 was also very quiet. I was becoming disappointed that my skills were not being practised apart from regular observation, medication rounds and IV antibiotics. I was eager to see MET calls and critically ill patients and witness how a team came together to stabilise these patients. The staff continuously apologised for how quiet it was and were trying their best to accommodate me with education sessions, activities or books to read when it was quiet.
On numerous quiet periods I was floated down to the Emergency Department (ED). Although ED is a high area of interest for me, I didn’t enjoy my experience there. This had nothing to do with the department, staff or patients but with my own personal insecurities. I felt like I was an intruder and like I was stepping on the other student’s toes. I didn’t know how the department ran, the paperwork or who I could turn to for help. I was in over my head and could feel the confidence I was building in the CCU, slowly disappearing in the ED. Even though on the inside I was terrified and felt lost I still managed to take the experience and participate in a serious methamphetamine overdose, a stroke MET and gain some insight on how the ED runs.
Week 3 I got to witness an intubation, participate in the care of the intubated patient and then watch the extubation. It was great to be there for the whole process as it gave me an opportunity to learn the whole process, get to know the family and their wishes and consolidate some of the skills I had practiced in the lab. At times the one on one care for an intubated patient became repetitive especially as this care was further divided between the nurse and myself. I did learn how to give medication to the intubated patient given they can’t swallow, how to use their inhalers, clearing the intubation tubes and gained a clearer understanding of how the respirator worked. It was nice to see the patient wake up, recover and go home with their family all within the week.
Week 4 was another quiet week. I was floated down to ED again and spent a lot of time refreshing knowledge through reading and education on interpreting ECG’s. The most interesting thing in week 4 was watching a cardioversion for atrial fibrillation. The staff were really great at explaining the ECG and the importance of timing when it came to administering the shock. I was surprised at how quickly the patient recovered and how he instantly felt better.
Overall my experience in CCU was not as highly paced as I was expecting with a lot of down time and slow periods. This may just be the timing of my placement and a little bit of bad luck. There were times that I felt I was in the way and not experienced enough to participate. This experience and knowledge obviously comes with post graduate studies but I certainly felt the huge knowledge gap. I did however still gain valuable skills and experience that I will utilise in the graduate year such a broader understanding of medications, interpreting ECG’s, confidence in using IV pumps and drug calculations, routine and a better grasp on CGHS’s policies and procedures.