Completely Unfinished

(This is a heart-felt post; but I chose to include some humor at the end for amusement.)


     Nursing school prepares you to pass boards. Nursing school does not prepare you for specialty areas in nursing. So, although I'm finished with school; my learning will continue. I've spoke with 40 year-seasoned nurses that STILL learn things every day. 


     I've been working in the ER since September 2010. 6 months. The ER is a different world... as you could imagine. I'm working alongside some of the BEST nurses ever. I'd trust them with MY life... yes, they're THAT good. I came into the ER with base knowledge, with the eagerness and willingness to 'learn the ropes'. 


     Some days I have doubts; not about my skills or competency; but my personality. I wonder if I'm 'laid-back' enough for the chaotic-ER-atmosphere. I tend to be a bit of a perfectionist, I like organization and routines. The ER pulls me out of my comfort zone. 


     On our busiest days, I get a bit 'high-strung'; while I'm in a room for an hour with a critical patient; I've got 3 more patients waiting on me (for their discharge papers, pain medicine, to draw their bloodwork or lying in pee-filled sheets). Doctors are barking orders, another nurse asking me to help her hold a pediatric patient so she can start an IV, a HUC asking, 'what's this order say?', EMS lining the halls with their stretchers...and the list goes on. Can you see how this may cause a Type-A personality like myself to go into full-on anxiety mode?  I had an experienced nurse tell me once, 'If no one dies on your shift; it's a GOOD day in the ER." I'm adjusting and learning my own 'way' to manage my patients 


     I have, what I consider, a flaw. I'm prone to see the GOOD in all people. OK, maybe it's not a flaw...but more like...a double-edged sword. ER nurses get burnt out; I see it. I work with some. They have this 'hardness' about them and they have no tolerance for stupid or 'faking' patients. I'm not even sure they ENJOY what they do anymore. I never want to become that type of nurse...


     The patient encounters I've had over the last 6 months are unforgettable. I have laughed, prayed, comforted, yelled, cried (3 times) and counseled. Here's a few that stand out as I'm reflecting... 


-Shift change; 7A, I helped pull a dead elderly man out of his frantic wife's van onto a stretcher. 45 minutes into our code; he had a pulse, a blood pressure and was intubated. He was alive. (For those of you in the medical field; our doctor went against AHA standards---just a reference note. Atropine.) They let me go tell his wife. 
     
-Triage aka. 'the sorting booth'. 
Me: "Sir, do you have any health history?... Such as high blood pressure, heart problems, surgeries, mental health issues, breathing problems?"
Patient: "No."
Me: "Are you allergic to any medications?"
Patient: "Haldol and Abilify."
Me: "Are you currently taking any medications on a daily basis?"
Patient: "No."
...that moment when you realize you're in an 8x8 room with a schizophrenic patient not on his meds.


-One of my FIRST sick patients. Patient presents with tachycardia (high heart rate). Labs show elevated potassium 7.2 and I'm given verbal orders for a large dose of Kayexalate while we're waiting on a room assignment. I eagerly pull the medication; pour it in an 8 oz cup and instruct the patient to drink it. I casually ask another nurse, "so how is that going to lower her potassium?" The nurse gets that 'bulging-eye look' and says, "Get her upstairs now." ...breakdown: the excess potassium is then excreted in the form of "poop". Lesson learned. Code Brown (Poop) is never good in the ER. 
     Dear Floor Nurses, ER nurses chart that we gave Kayexalate 20 mins ago. In reality, it goes in our pockets and we let our patients drink it in the elevator on their way to you. We truly apologize.
Haha, JK... maybe. 


(Side note: EMS is not trained in Code Brown. I do not know this for a fact; but it's become my observation that EMS does nothing for their code browns. Thanks EMS! It's so nice that you slide poop from your stretcher to mine. Much love.) 



And I have to end this blog posts with quotes from my FAVORITE ER patients...(fellow nurses: I'd love to hear yours...post them in the comments below!)


"Well last time I was here, that gave me some pain medicine...it started with a D- I think; it really worked good."


During triage time, "Honey, do you think I could get a box lunch, I'm a diabetic and haven't had anything to eat today."


Child with a 102.8 fever, I ask the parents, "Have you give him/her any tylenol or motrin?" ---"No." (As I remove the child from a buddled blanket and fleece sleeper with footies)


I ask, "Have you followed up with the _________ (insert: neurogologist, pain managament, orthopedic specialist) since your last visit here?" --- "No."


I ask, "So what were you doing when your chest pain started." ---"Well, I just ate Taco Bell about 20 mins before." OR ---"I was smoking meth."


A 30-something patient brings her 4 misbehaving kids into triage (the 8x8 box). All of them munching or sipping on Doritos, Funions, Coke and Mountain Dew from the vending machines. I ask, "So what brings everyone to the ER today?" ---"We all need to see a doctor because we've got stomach pains and have been throwing up all morning."


I ask, "So why did you call 911?" ---"I didn't have a ride."


And finally....P.S. No worries; even if it's viral...we'll make sure you get amoxicillin or a Z-Pak!

-W. Scott, RN

Saving the World from Seeing Their Primary Care Doctor

Our Mini Spring Break

     After last week's work-week almost killed me...I had 5 days off in a row to spend with the best little man around! Here are some highlights...

     Friday we hit the Strawberry Festival with Aunt Leslie, Reli and Adi. It surprised me how 'selective' Ryan was about the rides. He rode 2; multiple times. First pick was the train- anyone that knows Ryan knows he loves trains! I wasn't sure if he was tall enough to ride alone, so I pulled out some tickets for the both of us...and he ran ahead of me. He picked a seat next to a small, blonde-headed girl. My heart sank; he didn't want to sit by Mama. It was bittersweet. My angel cakes is growing up. I took a seat behind him and caught this picture...

The next ride choice was...

'TRUCKS!" as Ryan would say. Trains and Trucks. That was it. No school bus, no ferris wheel, no cute spinning strawberries... he was very clear on what he wanted to ride! After the rides, it started to sprinkle so we headed towards the strawberry shortcake tent. (Ryan's been eating strawberry shortcake with Papa [my dad] recently. Dad pours milk over the strawberries and cake; it's a northern thing I believe...and Ryan tears it up!) But Friday, Ryan didn't want strawberries, or whipped cream, or cake. He picked 'corn'...popcorn!
     Today, we went to Holmes Beach at Anna Maria. Traffic was terrible; and finding a parking space was a nightmare. Once in Brandenton, we rolled the windows down and talked about everything we saw! Ryan can say "beach" (beesh) and it brings a smile to his face when he says it! He also learned that "sand" went in his bucket, not "dirt". It's tough to catch his smiling face; especially when he feels like he's "doing something" so my pictures are just him in action! (Mr. Photogenic will say "cheese" but never look up at the camera!) He loved the water; (the puddled spots were his favorite) and the sand! We grabbed lunch at Publix and he had a nice nap on the way home!

The Start

     I graduated nursing school in the May of 2009; passed my boards in the Fall of 2009 (6 months pregnant); had Ryan in January 2010. Then, started my first job in the summer of 2010. 
     
     (I couldn't have planned my pregnancy any better. I was able to enjoy my growing belly; be extra involved in Jaden's Kindergarten year; and spend the first 6 months home with my little prince. Financially...well...we made it!)
     
     I have Jan Croley to thank for my first nursing job. In school, they pound it in your head, "You really need med surg experience." aka, FLOOR NURSING. Not my cup of tea. So I was determined, to find something more compatiable with me. Jan was the Director of Labor & Delivery, Mother/Baby and Surgical Services at Florida Hospital. I applied for a mother/baby position and an RN-positions at Cooper, Branch and Lesasburg's office (OB/GYN). 
     
     First job interview; like in the REAL WORLD...not Foodway, or Central Florida Health Care- I was a nervous wreck. Jan spoke with me about the mother/baby position (only part time) and the lack of pay RNs received working in an office. I wasn't quite sure where she was heading...until she said, I've got another position... it's in Endoscopy, part of our Surgical Department. I want you to meet Deanna, the Director of Surgical Services. (cue Deanna). 
     
     Somehow, my desire to work with babies had become an endoscopy interview.  (What did nursing school teach me about endoscopy? Um...nothing? Endoscopy meant what to me? Scopes? Cameras? Oh God, I wasn't even sure. Note to self: go home and research endoscopy nursing.) Deanna was nice. (Thought to self: I could work for her.) Hospital nursing generally consists of 12-hour shifts. Endoscopy was a M-F, 7:00A-3:30P job...and I had a 6-month old baby at home. Ended the interview, torn, with Jan saying, "You go home and think about it; call me in 4 days. It's something you really need to consider." 
     
      End result: I became the next Endoscopy nurse at Florida Hospital in Sebring. I worked with the best 2-person crew; Tony & Carol. Best co-workers you could imagine. (I will later discover the importance of those you work with.) Tony & Carol taught me the ropes; quick, fast-paced, doctor/patient-pleasing. I've seen the inside of mouth, esophagus, stomach, duodenum, common bile ducts, colon; GI bleeds, ulcers, strictures, cancer masses, polyps, hemorrhoids. I was eager to learn. Deanna gave me the opportunity to learn outpatient sugery, pre-op and PACU (recovery room). Every free moment I got; I'd be back in the OR. I worked alongside the best nurses, techs and anesthesiologists around. I've laughed, cried and prayed with my patients. I loved my job. 
    
      Anyone considering nursing...I'd highly suggest it. It's such a broad-field with so many opportunities. But remember- nursing takes heart & compassion; it's a career (in my opinion), you've either got  it or you don't. There's qualities that a text book can't teach you... you never know where you're nursing career may lead you...


...next job, ER (more to come)