My first clinical assignment as a sophomore nursing student was "complete morning care" for an elderly patient suffering from cancer. He was sleeping soundly when I entered his room. I asked my instructor whether I should wait or wake him. She instructed me to gently proceed and cautioned that he would probably sleep through the bath. About halfway through the bath, the patient hemorrhaged onto the bed. I pressed the emergency button and was ushered out of the room as the staff worked on the patient. My instructor comforted me and insisted that I had done nothing wrong, "The patient is terminally ill, so I am not surprised. This was probably not the best choice for your first clinical assignment, and I do apologize." The next morning, at shift report, I learned of the patient's death.
I ruminated for weeks on my suitability for a nursing career and finally appealed to my instructor for help. I was able to work through my fears, self-blame, and feelings about becoming a nurse and continued to seek help and guidance throughout my student years. I was fortunate to have an instructor who salvaged this situation and pointed me in the direction of self-care. I suspect that I was the exception, not the rule, as I watched student colleagues leave the program after their own career crises.
Core competency, #10.1, a through d, of the 2021 edition of The Essentials, American Association of Colleges of Nursing,1 requires nursing curricula to include strategies to promote the health, well-being, and resilience of the student and healthy work environments. This formalization of self-care in the nursing curriculum is challenging faculty to move from "nursing as exclusively other oriented" to "nursing with a self-care focus that enhances clinical intervention."
I was lucky, decades ago, as I experienced my own career crisis. I had an instructor who was supportive and who directed me to resources that were not widely known at the time to be available to students. The expert counseling that I received, no doubt, influenced my leaning to psychiatric nursing and psychology as career foci.
The recent pandemic has highlighted the demanding nature of nursing practice and the struggles of institutions to address conditions leading so many nurses to resign. Nurses need to learn the skills of self-care and building resilience throughout their education and beyond. I look forward to the creative strategies that faculty will design to ensure the health and well-being of the next generations of nurses.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
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