“It’s not that we want something bad to happen; we just want to be there when it does.”
One of my colleagues recently saw that phrase on a T-shirt, and it perfectly echoes the sentiment of the ICU nurses I work with. We’re prepared for crises, primed for instability—and the lower acuity patients who have been populating the ICU lately leave many of us restless and discontented. We start to miss the dramatic cases, the incredible saves and miracles; we miss using our skills. We do see the irony of being in the awkward position of wishing for trauma patients, yet not actually wishing ill on anyone.
I haven’t always embraced unstable patients. When I was a new nurse I simultaneously dreaded yet was drawn to the instability of the ICU. I remember the early morning drives into work, a time of quiet anticipation filled with a gnawing fear that I’d make a mistake or be inexcusably inadequate at a crucial time. I’d pray to gods above to be good enough, to be up to the tasks of the day; I clearly recall, more than once, taking report on an unstable patient and getting physically sick. Dramatic, I know, but born of deep reverence for both life and nursing. And while I’m confident now, I’m still affected—the fear is gone but the passion remains.
This past weekend I recognized that same passion in a new nurse I’ve been precepting. It’s my duty as her preceptor to seek out the most challenging cases available, so we switched assignments mid-shift to care for a newly admitted and unstable trauma patient. He was our most critically ill patient to date, and although I thought she’d grasped the complexities of his care, she perceived the day differently.
“I shouldn’t even be in the ICU,” she said. She went on to say she’d been overwhelmed and felt subpar. I reassured her; her assessments had been spot-on, she’d been vigilant and always safe. But she insisted that she’d “dropped the ball.” She said she’d felt entirely task oriented, hadn’t been able to see the proverbial forest for the trees, had fallen far behind in her charting. She didn’t feel capable—a terrible feeling to have. But she came back the next day, anyway, full of passion and fear.
I always enjoy precepting. I love to teach, love seeing things “click.” I find it enormously satisfying to break down assessments and processes that feel instinctual into their respective components. I like discussing pathophysiology and pharmacology. This time, though, I especially loved the pleasant surprise of catching sight of a kindred spirit in a new nurse, and realizing that her trepidation and reverence are the things that most garner my trust in the nurse she’ll become.