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Summer Exemplar

Nursing graduates share significant clinical experiences

"The following exemplars offer a peek into the moments of life as a nursing student that shape and help inform who they become as professional nurses. The exemplar writing assignment is to "describe a significant moment in practice where the student had an impact on the patient or the patient had an impact on the student." One of the prompts is to "write about a time when you knew you had become a nurse". These stories from practice describe pain and pain relief, fear and courage, despair and hope and the search for health that defines the journey of all nurses and patients. The faculty of the Cedar Crest College Nursing Department are so proud of our students and all that they do in the name of healing. We hope you enjoy their stories."
~Professor Amy Edgar

These are the stories written by the July 2013 nursing graduates.
*please note that the names of all patients have been changed for confidentiality.

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Jan Costa

It was just before 0700, the medical-surgical unit was still very quiet. As I began gathering information on my patient assignments, one in particular caught my eye. Joe recently had his left great toe amputated and was currently on a patient controlled analgesic (PCA) pump. Having no prior experience with amputees, I expected this to be a great opportunity to broaden my nursing abilities. Upon entering Joes' room I spotted a distressed women sitting at his bedside. Quickly she began to inform me that her husband is in profuse pain and someone must call the doctor. I assured her I would address her concerns with the primary nurse after I complete my assessment.

According to Joe, the “burning” pain extends from his toes, up his left leg to his groin. Joe rates his pain at “1000” on a numbered scale from one (mild) to ten (most severe). During the assessment I noticed Joe press the PCA control incessantly to no avail. Following the lines, I located the clamps and noted they are released. I looked at the medication bag closely and it was full and intact. The machine settings appeared normal and the remaining amount to be delivered reads 30 milliliters (ml).

With three pillows propped under his leg, Joe grips his knee, grimacing and moaning from the pain. Empathically I asked Joe what pain relief methods he uses at home. He responded, “I’ve never had pain like this. I don’t know what to do”. His wife, Sue, suggested a cup of tea; Joe nodded in approval. I excused myself to get Joe a cup of tea and to notify the primary nurse, of my recent assessment. The primary nurse, Lee, was already busy reviewing her patient assignments for the day while simultaneously getting report from the night shift nurse. I informed Lee of Joe’s assessment. The night shift nurse interjected, “I already called the doc early this morning and he ordered Morphine. I gave it to him at 0500”. The night nurse added, Sue had come out into the hallway several times requesting the doctor increase Joe’s pain medications, as he was experiencing severe pain even after the dose of Morphine at 0500.

It was now close to 0900, Sue was in the hallway tearful next to her husband’s door; she sobbed, “I can’t watch him suffer like this, please, call the doctor or I will”. Lee called the doctor and this time the PCA medication was increased. While Lee entered the new rate I noticed the machine still read 30 ml to be delivered. I observed the bag of medication was still full; subsequently I questioned Lee why the volume on the pump and in the bag had not changed. She stated the pumps are new and she was not certain of the answer. After Lee exited the room I noticed Joe was agitated as he said, “What the hell is wrong with the machine? Call the company if you don’t know how to work it”. I tried to calm him down, while reassuring him I was working diligently to help decrease his pain. I could not shake the urge and again my eyes were drawn to the medication bag and PCA pump; I realized something was definitely wrong. I approached Lee in the hallway. I told her “Joe is in severe pain and I believe something is wrong with the pump.” At 0945 Lee requested another nurse come and take a look at the pump. Eventually the two discovered the pump was not set properly and no medication had been delivered via the PCA pump. Fortunately, after the discovery Joe began to receive the medication and almost instantly felt relief. Joe thanked me saying, “You are a great nurse”.

This situation validates that patient advocacy and inquisition are essential elements in nursing practice. As a nurse it is my obligation to be the patient advocate, or that persistent voice when theirs go unheard. Examining and advocating on behalf of my patient, along with a holistic approach to care, I was able to establish myself in the helping role (Benner, 1984). Furthermore, according to Benner’s (1984) domains of nursing practice, monitoring therapeutic response to medication is vitally important to proficient nursing care thus, administering and monitoring the effectiveness of Joe’s therapeutic interventions solidified my transition from novice nursing student to confident near graduate nurse.