Acute care tested my clinical skills, but even more so, it tested my ability to stay grounded in the face of suffering, urgency, and vulnerability.
I look over at one of my fellow students from my cohort. Her eyes are watering, and she avoids my gaze, glancing downward as she blows on her noodles, still too hot to eat. Her primary nurse has been giving her a hard time this morning.
It’s already been a long day, and we’re only two-thirds of the way through a 12-hour shift. Her voice cracks as she talks, and her face goes red. I curl my toes in my shoes, hold my breath, and dig my fingernails into my palms to stop myself from crying. This will happen three times today before I eventually bend over, hands on my knees, and finally break down at hour 13.
We’ve prepared for this rotation by practicing simulation scenarios on manikins, and on each other. I’ve met Sonny, Marcy, Natalia, and many others more times than I can count — recurring figures from case studies practiced again and again. Day two at the hospital, I met a former student who asked me who my Integration case was. “Sonny,” I said. “I remember him,” he replied. “I remember all of them.”
Transitioning from care aide to nurse
We’ve been told for the past year that we have to switch our mindset from care aide to nurse. On the unit, I’ve made beds and changed pads. I’ve turned patients, washed faces, and brought blankets and ice. I’ve given a full-bed bath and changed an occupied bed covered in poop.
Every clinical rotation that I have, I think about the generic practical nurse students. I’m so glad that I can bathe, dress, and change a patient without batting an eye. It’s second nature. It’s a reminder that my hard work and attention to detail will bring me the confidence and tenacity that I am longing for as a nurse.
I asked one of the other students how long this will take. “Two years working as a nurse,” they said. I’m still not deterred. I want it. I have big plans. Life plans. Ideas swirling around in my head about what care means and how to help people. I think about practice, about policy. I think about shared humanity and storytelling. I think about art, but in a social context.
But first, how to be an LPN.
Learning to think like a nurse and survive the shift
I look at wounds and light switches go on: redness, edema, ecchymosis, drainage, approximation. I watch my patients breathe and listen to their lungs and understand why. I do a secret, internal happy dance when my pre- and post-assessments connect literal dots. There is an odd satisfaction that I keep to myself.
Compartmentalize. Prioritize. Shake it off. How do you process it all? There are many layers of distractions. I think my spine is compressed one millimeter per shift. I’m getting shorter by the day. The other students are with me on this journey, making me cry, laugh, roll my eyes, frustrated, or even confused.
Nursing school and the work culture that comes with it are grueling. I don’t subscribe to the hierarchy, yet I still find myself jumping through endless hoops. It’s exhausting, disorienting, and honestly a little surreal.
Reflections on working in acute care
How strange it is to walk around in this body. That’s not a statement of gratitude. You’d think that would be the case among patients who are bedbound or recovering from procedures that may send them home with permanent disabilities. Some of these folks are gravely ill and will transfer to the ICU. It’s probably more of a sentiment teetering on existential crisis. I hate this. I honestly hate this.
But I also love parts of it. I love collecting data, interacting with patients, connecting with their families, performing wound care, and every procedure I can get my hands on. Those moments ground me.
I don’t like the constant feeling of failure, being berated, falling behind, not meeting my own expectations, and the endless waiting — waiting for report, waiting for the equipment, waiting for my clinical instructor. Any kind of waiting when I just want to get things done.
And what I’ve learned in my role and what I know will continue to be a challenge for me as an LPN is this: when I see myself in someone else, I start to break. That’s why my cohort makes me cry. That’s why, when one of them started to tear up, I did too.
The pain we let go of and hold onto
I’ve had two experiences where I needed to do some work to resolve the residual pain. Why? Because observing the acuity of grief in other people reminds me of my own trauma and tragedy. People die, their family members suffer, and we bear witness as healthcare workers. I know this will happen again and again. And something tells me that this will serve a purpose, but it also needs to be continually monitored.
Does it bother me that my dementia patient is screaming and crying while we insert the Foley? Yes.
That older lady backhanded me across the face. Do I take it home with me? No.
Does it bother me that my patient is furious and yelling at me because he is in pain early in the morning? Yes.
Will I take it home with me? No.
Does it bother me that my patient is possibly dying because of respiratory failure? Yes.
Will I take it home with me? A little bit.
Will it stay with me? No.
During our post-conference, my clinical instructor told us about driving home from clinical when she was a student and how she cried in the car. “I’m welling up now as I talk about it,” she said.
I well up too and look away so no one sees my red face. I wanted to hear more about these things. The acute setting is rigid, and the more care and compassion that I give my patients, the more I fall behind.
Navigating a culture of critique
I use my agency when I can, but sometimes I feel publicly shamed, dignity in the trash, often for the smallest of things. Who is this for, the scolding? It’s not for me. It’s a symptom of a tired culture. There have been instances during my clinical rotation that feel averse to learning.
Do I take these feelings home with me? Yes.
Will it stick with me? Probably.
Do I think I am smart, capable, safe — all the things? Yes.
Do I hang on to the positives? I try.
A small success and a lasting impression
Two students struggled with a patient. He refused meds and wouldn’t engage. My clinical instructor warned me: Start with the essential ones, expect refusal.
But that morning, this patient was happy but pleasantly confused. He had taken all his meds. I held his hand as he swallowed slowly. His face and hands were already clean, warm from the washcloth. I smiled, and he smiled with me. I brought him heated blankets throughout the shift. He was always cold.
As a student, preparing and administering 10 to 15 meds to a dysphagic, cognitively impaired patient took me 30 minutes. That is far too long in acute care. Unacceptable. I beat myself up.
Unsafe care or imperfect learning?
I stay diligent with his vitals. When I ask if he’s short of breath, he says “yes.” This is the only time I ever heard him say a real word.
I auscultated: clear lungs, no adventitious sounds. His chest rises evenly. SpO₂ is 100%. I rarely see this. I double-checked. It’s amazing. His skin color was appropriate for his ethnicity. I patted my hands along his upper extremities. Then the lower: his legs and feet were warm. Equal bilaterally. I told myself his circulation is good. But I never checked his pedal pulses.
He passed gas, no nausea, and he had a bowel movement. Another student and I rolled him to change his pad. But I didn’t auscultate his abdomen.
After, my clinical instructor said I gave unsafe care.
Thirteen hours. Two rushed breaks. I cried on the way home.
