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
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