April 3, 2024

Days in the Life of a Rural Student Nurse

I didn't know what to expect. It was the summer before my last year of nursing school, and I started an employed nursing student (ESN) posting in a tiny town I'd never been to before. The hospital had a dozen beds between the inpatient unit and the ER. There was an on-site x-ray and lab, and we had some outpatient appointments throughout the week. The hospital's Labour and Delivery room was used as a nap room by night shift staff, and the procedure room wasn't fully stocked - neither were used by patients due to the town not having an anesthesiologist. We had community health and home health nurses, a clinic based in our community health wing, and a long-term care home in the building.

With all of our hospital's services, I expected us to be a bit busier than we ended up being. Often, we would have two or three inpatients and just minor complaints in the ER. I was able to settle into the routine fairly quickly, and before long, staff were letting me take charge of the inpatient area, with me doing all the tasks and them being around if I needed an independent double check or an additional set of hands.

This all changed one Sunday. I was working a day shift, taking care of our two inpatients. Since it was a weekend, it had been a fairly calm day from what I could tell. After dinner came and went, I realized I hadn't seen the nurse assigned to the inpatients with me for a while. Heading over to the ER, I checked in on the folks waiting in the hallway to see the doctor, and they commented on how busy the ER was that evening. When I entered the ER, I saw our two baseline nurses in a bit of a frenzy, as there was one patient who wasn't doing well; let's name him Joe. The on-call doc had been called in, Joe's oxygen sats kept dropping, he was maxed out on wall O2, and the nurses were working on getting our one Optiflow machine set up. I watched for a bit (being a student, I wasn't allowed to do anything), then went to catch the incoming night shift staff to let them know that the ER needed hands. We ended up with one doc, five staff RNs, and two students in the ER working on Joe - day shift, night shift, it didn't matter. While the doctor and the RNs were focused on Joe, the other student and I monitored those waiting for the ER, checked on the inpatients, and answered the phone calls from the lab. We were able to get Joe intubated and stabilized, and right when we were starting to take a step back, the HART team arrived. For those who don't know, our region's High Acuity Response Team (HART) is based out of a city a few hours' drive away. Their staff are on call for any stat questions we have and can be dispatched to transport patients who need higher care than EMS can provide.

So when HART arrived, we were able to breathe. I remember thinking, "We did our job. We kept him alive till we were able to transport him out." At this point, day shift had been on for an extra two hours, so with the reinforcements present and them getting ready to transport Joe, day shift was able to go home.

I thought that would be the end of the story. We were able to keep him alive, HART was there to transport him to higher care and better resources. We did our job.

I wish that was the end of the story. The next morning, I was in the nurses' residence kitchen when one of the night shift nurses came home. "The guy from last night - he didn't make it out." I brushed it off. I knew what she meant - he didn't survive, HART wasn't able to do anything more for him. But Joe wasn't "my" patient, I wasn't "involved" in his care, and I'm not allowed to feel his death. That day, I was able to push down the feelings that were threatening to well up inside me. I was switching from days to nights, so I went through my routine - go for a run around town in the morning, do some crafting, take a nap, and eat a good dinner before walking across the parking lot to the hospital. I start my night shift, and most of the staff from the previous day are on shift with me. We end up spending most of the night talking about Joe. How his lungs were failing even before he came to the hospital, how he must have thrown a clot when being moved to the HART stretcher for transport, how we did everything we could. How we'll never know what really happened. I think that was the hardest part - here we had a patient who had died and we had so many unanswered questions.

As I finished my contract, I tried to rationalize it. In my head, I was able to convince myself that it was a clot. "He threw a clot, it was a PE, there was nothing we could've done." I would chat with the other nurses at the hospital, an informal debrief of sorts, and they seemed to be in the same place as me.

In the months since I left that small town, I have thought about Joe many times. At first, it was whenever someone asked, "Oh, how was your summer?" and it would hurt to give the cheery answer without the details of what I was really feeling. Nowadays, I'm moving a bit closer to accepting what happened to Joe. He's still the only traumatic death I've been a part of, and weirdly, I thank him for waiting until after I left to die.

Overall, I loved my time as a student nurse in a small town. I learned independence, autonomy, and flexibility at work, as well as how to occupy myself on my days off when I knew no one in town and didn't have a car. Most importantly, I learned that it's okay to be affected by bad situations. That it's not just students who feel the turmoil after a death, but also veteran nurses. That it's better to talk about these situations than to push them down. I also learned that I have more work to do - I have to find people to talk to who don't need me to explain all the healthcare stuff, people who I relate to and who relate to me, people who have been through some of the same situations.

I know I will never forget my time in rural nursing, and I will never forget Joe. And I will never forget what Joe taught me.

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Nursing The Future™ acknowledges that nurses across this country live, work and play on the lands of our Indigenous Ancestors and we join our members in expressing respectful gratitude for this privilege.
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