Holding On / D’Arcy Norman, via Flickr
By Martina Harris, EdD, RN, a UC Foundation assistant professor at the University of Tennessee at Chattanooga School of Nursing
It was 6 am and I was on my way to make patient assignments for my first semester nursing students. Inside the long term-care facility, the hallways were quiet, the majority of patients still in bed. I made my way to the second floor to begin identifying and assigning patients for my fundamental nursing students. Standing at the nurse’s station, my focus was on finding patients who would provide students varied opportunities to reinforce the basic skills they’d been learning at campus lab.
The charge nurse approached me and asked if I would be willing to assign a student to Mr. Hugh, an 84-year-old who was proving to be very “complicated.” Assuming that “complicated” meant that his care required lots of psychomotor tasks, I agreed to her request. She then explained that this patient had been using his call light frequently, but that each time the staff responded, he only wanted someone to sit and visit with him. Though this didn’t seem an ideal opportunity for a student to practice basic nursing skills, I felt the gracious thing to do was to take the assignment.
In the hallway, my group of fundamental nursing students huddled together, dressed in their white uniforms and nervously awaiting the start of their first clinical day. One by one, I went down the list, assigning individual students to particular patients and explaining to each what additional tasks needed to be done for their patient on top of taking vital signs and changing linen.
I decided to assign Mr. Hugh to James, the only male student in this rotation. I told him that there were not a lot of “interesting” skills to practice on this assignment, so he could basically just “hang out” with the patient.
After assignments had been made, I began working with individual students as they administered oral medications, performed subcutaneous injections, and assisted with dressing changes. After a couple of hours, I poked my head in the door to check on Mr. Hugh and James. They were engaged in conversation. “Are you doing okay?” I asked James, to which he emphatically replied that they were “fine.”
I was amazed that James had been in the room for two hours and not complained. When it was time for follow-up conferencing, I began with James, apologizing to him that he had to be stuck in that patient’s room the entire time, without a chance to practice any of the psychomotor skills learned in campus lab.
“No need to apologize,” said James. “I should thank you for this assignment. This was an amazing clinical experience.” He began to describe how the patient had told him all about his life, his world travels, and his time in the military. He’d heard stories about the patient’s beautiful wife of 50 years, who had recently died, and how much Mr. Hugh missed her. He said the patient told him he reminded him of his own son, the one he didn’t get to see as often as he would like. James told me that having a chance to listen to and “swap stories” with this patient had been very rewarding, far exceeding his expectations.
It was at this moment that I realized James was well on his way to becoming a nurse in the truest sense. He’d been able to see the patient holistically, while I’d focused on ensuring the student could perform tasks.
I felt humbled by this experience and determined I’d learn from it. The following week, I returned to the same long-term care facility, expecting to assign that same patient to a different student. This time, I eagerly approached the charge nurse to request a list of potential patients and to let her know I’d love to have a student work with Mr. Hugh. She looked at me with pained eyes and said, “I thought you knew. He died later that evening after your student left.”
I’ve never forgotten that clinical day with Mr. Hugh and James. I often wonder what Mr. Hugh was thinking when he was sitting and talking with James, and if Mr. Hugh in fact knew that he, too, was “well on his way.”
There are many lessons in this story and the comments that followed. Often faculty use the nursing home experience mainly to provide an experience with nursing care “tasks” for novice students. But these patients are the most complex of all. Most have several chronic illnesses and are experiencing transitions, many of which involve multiple losses – of home, independence, spouse and more… The NLN has a program called ACES – Advancing Care Excellence for Seniors. I invite you to check out the website (http://www.nln.org/ACES) to learn about the Essential Knowledge Domains and Nursing Actions contained in the ACES Framework. Nurse educators will be interested in the Unfolding Cases, each of which includes 3 simulation scenarios. All are available free of charge and can be modified to meet the needs of your own curriculum. As the “silver tsunami” grows larger, let’s find ways to provide excellent care to our older adults.
Mary Anne Rizzolo, EdD, RN, FAAN, ANEF
Thank you for sharing this story. As a nursing student I am constantly running around trying to complete tasks I can get signed off by my instructor. This story reminds me that although I am a student and need to practice my clinical skills…. Listening is one of the most critical skills
i want to talk you for posting this we sometimes forget then we have patients that seem extra needy or a pain is that they may just be truly lonely and just want someone to talk to. I am currently attending UTC to obtain my BSN and i look forward to having an experience like this I was able to set and talk with several patients when in Practical Nursing school. Now that I am out working and i have a patient that is non-verbal you dont realize how much you miss it when your patient can talk to you and are able to express their feelings.
Sometimes in nursing education there is so much focus on task completion that human interaction becomes secondary. I never assign a “task” to a student, I assign a patient who may need a task performed. The student must know the patient, the purpose of the task, and have the patient’s assent before performing the task.
In many inpatient situations there are few procedures to do with a patient but much need for exploration of feelings, the patient’s desires for the medical treatment, and planning for self-care after discharge. These are as vital as any tube insertion or pill to be dispensed. They are also where real nursing care lies. The procedural things are what we do in our role of supporting the medical plan. The human interaction is where the nursing science enters care.
I am sitting here with chills from this story. As a hospice nurse I can tell you that this man just needed someone to share his story so he could die peacefully. Having just supported a friend and colleague in the loss of her brother who though dying was also able to visit with his family for a short time before he died. This is not an uncommon experience and needs to be listened to. Mr. Hugh gave a gift to James and James gave a gift to Mr. Hugh. The nurses on the floor missed out on this but maybe they will listen to what the patient is not saying when they talk.
wow amazing! i’m also first year student, i’ll be going for my first clinicals next week.
i hope i’ll be able to listen as ‘james’
I am a recent nursing graduate and this story truly touched my heart. I learned very early on that my most rewarding patients were not the ones where I had performed a “beautiful dressing change” or had used perfect technique when giving an injection. My most satisfying experiences were always with the patients I was able to make an authentic human connection with. The ones I had the opportunity to talk to and learn about them aside from their illness. Don’t get me wrong, receiving compliments from an instructor related to skill performance is worth a million bucks, but having a patient hold your hand at the end of the day and say, “Thank you for taking care of me, I had a really good day today!” Well….that is priceless.
Thank you for this very touching moment. I have been a nurse a little over 2 years. I truly love every moment of my chaotic and hectic assignment but I always take a few minutes to hold hands and “listen.” I do not mind going home “late.” We need to have some bedside nursing back in our busy work life. Those few minutes coiuld mean the world to the resident. We just never know when we are moving on to the next part of life. I thank that charge nurse also along with the instructor and student. “James” you will be if not already a “great” nurse!
nursing is wonderful it is a therapy….mr hugh found rest because he found a ‘nurse’. oh that we could have more nurses and not just health workers,
Thankyou for this post. It made me a bit teary as it brought back similar memories. I totally agree that your student was “well on his way!” Sitting with a patient and listening is one of the best nursing skills you can and should perform. It is important to learn this early, as later you will be hurried and hassled and these opportunities will present themselves to your heart. Your head will want to ignore the need in front of you as you think of all you must get done. Listen to your heart, sit, and hear your patient- even if they aren’t speaking out loud.