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Nichole Paulson

Capstone Practicum 2019


My capstone experience...

... was at the Intensive Care Unit (ICU) at the Cheyenne VA Medical Center. Here I have had the opportunity to get my feet wet working with acute care patients...I have had the opportunity to learn and grow as a nurse and develop some independence while still having the structure and guidance from a very experienced ICU nurse...

Opportunity to see a wide spectrum of patients

The ICU has given me the opportunity to see a wide spectrum of patients from malignant hyperthermia to cardioversions and everything in between. The VA ICU is also used as a step-down unit as well as houses psych patients until they can be transferred to a more appropriate facility since the VA does not have inpatient psych. I have had the opportunity to really focus on studying EKG’s and becoming proficient at reading telemetry strips because the ICU is where all the EKG monitors are located. I have performed as a first responder to code blues and rapid responses throughout the hospital as well.

Growth accompanied by Encouragement

The VA staff has encouraged me and cheered me on as I have grown more confident in my ability to complete assessments, communicate effectively with other members of the healthcare team, and make decisions using critical thinking based on patient symptoms to develop an integrated and holistic plan of care in alignment with patient and family needs.

Team benefits

What excites me about the VA is how well the staff functions as a team. Often the physicians rely on nursing assessments and the nurses to be their eyes and ears when they cannot be there. The collaboration that the health care team has in this facility is like none other. It also excites me that because it is a smaller hospital, I can really focus on 1-2 ICU patients at a time and not feel overwhelmed.

What was surprising to me is how often the ICU must hold SI patients because they do not have a unit for this. The ICU has 6 beds, but one is a crash bed that is only used for codes, and when there are multiple SI patients the ICU sometimes must divert because there are not enough beds. I believe that having an inpatient psych unit would really benefit the VA.


Overall going into this experience, I wasn’t sure if I felt prepared, but after applying what I had learned in my classes I felt like I had a good grasp on many of the things that I was encountering. I feel that our professors prepared us with the fundamentals and applying what we have learned makes this experience so unbelievably incredible. It puts everything together. I feel more prepared to graduate and go out into the field after having this opportunity.


Story placed: 4/9/2019

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