Student uses recent hospitalization to reflect on common learning practices
By Natasia Varieur
August 22, 2022
As a nursing student, it is natural to want to seize every opportunity to develop clinical skills during limited educational placements. Who wouldn’t want to attempt a new procedure for the first time under the watchful eye of a more experienced nurse? Due to the intensive nature of nursing school and the sheer number of skills to master during a relatively short period, many student nurses perform procedures for their first time on “real” patients. This approach is an excellent way to learn, and until recently, I didn’t give this common practice a second thought.
It wasn’t until I spent three weeks as a hospital patient that I realized there is a time and a place for learning and a time and a place to put the patient’s needs first.
Unexpectedly in hospital and severely ill
I was halfway through my third semester of nursing school when I unexpectedly became extremely ill. When I walked into the emergency department, it never crossed my mind that I would be admitted for weeks, bedridden.
During my hospital stay, I experienced numerous invasive examinations by nurses and physicians, urethral and suprapubic indwelling catheters, biopsies under anesthesia, countless tests, IV lines and many invasive procedures that I had only read about in my textbooks. Throughout the entire process, I was not only anxious but also in extreme physical pain. I experienced first-hand what it is like to be a severely ill patient, being cared for by both experienced and inexperienced providers, and this ordeal changed my perspective on the role of students interacting with challenging cases.
Clearly, there are many tasks that do not require practised skill and can be performed by any clinician on any patient. Most of the time, a student learner is appropriate and able to contribute positively to patient care. However, I now believe that when a patient is in extreme discomfort or has reached their self-described tolerance level, certain tasks should be left to those clinicians with solid experience.
During my recent admission, the hospital policy was to train their staff by partnering a novice bloodwork technician with a more experienced supervisor to give assistance when needed. I had my blood drawn by several of these teams during my hospitalization, and, despite my severe illness and high baseline pain level, the learner was always instructed to try to take blood first. Time after time, I could tell that the student was going to miss my vein, yet I felt powerless to do anything about it. I also experienced this challenge while having my IV line started, and the learning process slowed down the administration of my medication, resulting in increased distress.
Looking back, I feel that I was subjected to unnecessary suffering simply for the supposed benefit of the learners, when in fact the students became less confident in their skills as they witnessed my distress. It was clear to me that neither of us benefited from this experience, and it was occurring only because it was hospital policy. Owing to my acute illness and pain level, both the student and I would have appreciated having the more experienced nurse immediately complete the procedure to avoid an escalation of my discomfort and the delay of crucial fluids, medication and pain management.
I understand the difficult balance between patient comfort and the importance of learning by doing.
As a student myself, I can empathize with the learners and imagine how uncomfortable this situation would have made me feel had I been in their shoes. I believe that the method employed at the hospital works well in almost all situations but should be re-evaluated in the case of severely ill patients and those not able to advocate for themselves. Although students should generally be involved in patient care, I do not believe that every situation is an appropriate time for learning, and the patient’s level of distress must be assessed.
Each patient deserves the best care
I was unaware of how deeply and profoundly my hospitalization had affected my mindset until I performed care on a non-verbal patient for the first time during a clinical rotation. The patient had Down syndrome and required morning and personal care to help her get ready for the day. It was my first time working with her, and my buddy-student and I were slightly anxious about attempting such a challenge alone due to the patient’s lack of mobility and inability to communicate with us. Partway through our care, the patient began to shake and cry, and because we were unfamiliar with her non-verbal cues, we made the decision to get our instructor for assistance. The three of us were able to work together to get the patient ready for the day, and she seemed happy by the end of the procedure.
As I was holding her hand, I began to have intense flashbacks to my time in hospital, when I had experienced physical and mental trauma, and I felt profound empathy for this patient. I was so relieved that we had chosen to ask for help as my time as a hospital patient had taught me never to assume that you can know a person’s tolerance level.
Afterward, my instructor informed us that this patient often cries even when everything is done right. This was a relief, but the feelings I had during this experience will stick with me and serve as a reminder that each patient deserves the best care possible, and it is my duty to step aside if I am not capable of providing that. I feel that my time in hospital has made me more comfortable asking for assistance, and I hope that speaking about my experience will encourage others to do the same.
As a nursing student, I understand the difficult balance between patient comfort and the importance of learning by doing. I know how vital clinical experiences are when building competent, capable and empathetic nurses. Client-centred care is a hallmark of our profession, and developing this technique takes practice. For this reason, students may feel they must always perform care in clinical situations to build experience. This mindset is created and fostered by the pressure of our profession and the long-standing method of learning by doing, which works well in most situations.
However, nursing students may be put into the uncomfortable situation of attempting skills they are not comfortable with. None of these care providers want to cause distress for their patients, but they feel the pressures of a fast-paced environment and common practices in nursing. I now believe that this method of learning may be harmful in some cases, such as with very distressed patients. I further believe that students should work with clients who are able to tolerate the student’s inexperience and potential mistakes and speak up for themselves when necessary.
Before my experience as a patient, I would have said that there was a place for learners in every situation. My mindset has been altered by my illness and hospital experiences. I now feel that patients who are already experiencing severe distress do not need the further burden of inexperienced care providers adding to their discomfort. Nurses have a duty to put their patients’ needs first. This includes prioritizing the comfort and safety of patients over our own learning.
I am so grateful that I had such high-quality care during my hospital admission. Access to safe, free and evidence-based health care is a privilege that many people in the world desperately need but are unable to obtain. However, even though my nurses were excellent, there is always room for improvement.
I am choosing to speak up about my experience in hospital to advocate for patients in similar situations, as well as the providers who feel that they must perform procedures even when they are uncomfortable. My hope is that other nurses can understand the burden students and learners may place on an already fragile patient and modify their actions accordingly. Patients have the right to speak up when they have reached their own personal limit, and at that time, everything should be done to minimize pain and anxiety. When patients are unable to advocate for themselves, we must do everything we can to read their non-verbal cues and respond accordingly.
Students and nurses should feel comfortable asking for help when dealing with these very ill patients, who are in significant distress. It is not a failure to step aside and allow someone else to perform certain tasks or to ask for clarification on how to do something. Nursing practices are evolving as new information is discovered and new research is done. We are constantly striving to better ourselves so as to better support our patients.
After my time in hospital, I wish to share my experiences from the perspective of both a patient and a student. I have had the unique opportunity to experience both sides, and my views and opinions on common nursing practices have evolved. As nurses, we are in a position to prevent suffering simply by evaluating our own capabilities and deciding whether it is the time to learn or the time to step aside.
Natasia Varieur is a nursing student at the University of Calgary. She has now recovered and is happy to be back at school.