Saturday, March 22, 2008

4.25 shifts left

I have a hard time believing that my 436 hour internship at the small-town Emerg is almost complete. I have 52 hours left, and will be complete by the 2nd of April.

I must admit I've learned a lot about nursing and about myself in this rotation. Here is a small list:

1) I enjoy emergency nursing
2) I've learned about assessment, more then I ever thought I would
3) There are many ways to go about nursing, and many factors to consider before notifying the physician... and I still have not developed an instinct as to what is important and what isn't, although I am learning.
4) Most people who come to the emergency department do not have emergencies
5) I'm still having a hard time determining when to hook someone up to telemetry, and when I don't need to. ABC emergencies of course, but sometimes there are other reasons, and that's why it's confusing.
6) A lot of things I have applied to the emergency room I DID NOT learn in nursing school. I have learned most of my "emergency" component through the pre-hospital first responder and first aid courses.
7) I can size up a cervical collar and place it on a person better then some of the seasoned nurses.
8) I can get in most IV's that I have tried. There have been a few (that I can count on 1 hand) that I have tried twice and have not succeeded. It was when I learned how to do IVs that I felt like a real nurse.
9) I'm scared to be looking after a seriously ill patient by myself. I'm glad there is a team of nurses around, and I'm glad I'm going into a job where I have backup for at least the first couple months until I feel more comfortable.
10) Although non-rebreather masks are used a LOT in prehospital care, they are not used much in the ED.
11) There are some patients whom I will like, some whom I will dislike. Either way, I will treat them professionally and with respect for their person.
12) There will be sometimes where I will disagree with the treatment plan of the physician. For this I have advocated for my patient. Sometimes I will not win, that doesn't mean I don't try to get my point across.

This is a short list, and I'm sure I have forgotten something. I'm still not 100% sure of my place in nursing, and continue with my internal struggle learning to accept that this is my career path. However, I have found a way to provide help to people in need. That was a goal I endeavored to do with any profession I entered. For this, I am proud.

Thursday, March 20, 2008

Change of Shift!

Change of Shift is up at Emergiblog.

I promise to post more soon!


Tuesday, March 11, 2008

And the decision is...

With the advent of one of the largest snowstorms this area has seen in a very long time, I really took a look at what it would cost to work at the rural hospital. The 45 minute commute in a snowstorm takes 1.5 hours. I almost fell asleep at the wheel.

If I was living in the rural area, I would have chosen the rural hospital. But instead since I'm living in the city, and there are decent hospitals here, it was the most logical to stay in the city.

Hence my decision has been made. Big city hospital emergency department here I come!

Friday, March 7, 2008

Tired and wired.

Last night we were a nurse short for the shift. They couldn't fill the shift. In the rural hospital where I'm doing my final placement, we only have 3 nurses on at night. Well, now we were at 2. This means the ER nurses don't get a break. They have to work the full 12 hour shift straight.

I consider myself a half nurse. A psuedo nurse. An extra set of (somewhat skilled) hands during crunch time, but still slower then the regular RNs and still needing guidance. As a student I think I'm in the top percentile, but compared to RNs I'm low in the overall RN pool. I think I'm adapting well to the ER but I definitely have a long way to go.

Last night was a test of sorts. My preceptor really needed a break... she was having a hard time concentrating and didn't get much sleep before the night shift. She was practically falling asleep standing up, despite us being busy. The other nurse sent her to the back for a power nap and figured that between her and I we'd be fine, as there were only about 5-6 patients in the department and they were all very stable. The staff nurse would then be my supervisor. Well, all of a sudden there were 4-5 more people to triage, and as a student I cannot and should not be triaging. So that left me all alone looking after ALL the patients in the department. The staff nurse watched over me (popped her head out a lot and checked in) and the doc was there for questions if I had any, but basically, I was on my own.

I tried to prioritize, and managed to do quite well. I prepared Pantoprazole for one patient, hung some metronidazole for another, gave a little girl some trimethoprim/sulfamethoxazole, dispensed some medications for another, and then started an IV on the pantoprazole guy, started on the 2nd line (which i missed, twice, grr) and had to eventually call the other nurse in to start it ;ater (we only get 2 attempts if it's not an emergency). I was slow at what I was doing and the patients were getting.. ahem.. inpatient... (hee hee) but I managed to do ok.

Because I don't' know the medications sometimes, I have to look them up. That takes a bunch of time, and I wanted to make sure I didn't screw up. I kept chanting... 5 rights, 5 rights, 5 rights... to make sure that I didn't give improper medications to the wrong people!

Not only that, but there were crazy things happening on the other floors. Later on ICU needed someone to intubate, and the ER doc had to do it. Since I have yet to see an intubation (tragedy, i know!), I quickly ran up to the 2nd floor with her (my preceptor was working again so it wasn't a problem). I ended being the one who was bagging the lady (SpO2 hovered around 83 prior to intubation) until the RT on call came in and put her on a ventilator. The ICU nurses even stated that I could start tomorrow working for them! I'm not interested in ICU, but that was a nice compliment.

Overall synopsis: I must have done well. The staff nurse called me an "RN" today. Aww shucks (*blush*).

Thursday, March 6, 2008

Change of Shift

Is up at Emergiblog. I did not submit this time but I will enjoy reading it!.

And another thing...

I got offered a job today! WOO HOO! It's official... I , as of May, will be an Emergency Nurse! Not a student... A REAL WORKING PERSON! Scary, eh (the Americans in the crowd have officially snickered at the "eh", but you can't take the Canadian out of the girl). After all the work I have done the past 8 years, I am thisclose to being done.

I won't accept the job until I hear from the other hospital I applied to. In the meantime you can stew in your juices trying to guess which one I will choose!

Sigh, soon it will be time to start paying back those loans I've been ignoring....

a word on vaccinations...

As a student of Epidemiology, it has been ingrained into me that vaccinations are one of the most natural* ways of stopping infectious disease in its tracks... and the eradication of small pox is just one example.

However, if polio, mumps, measles, rubella, etc come back as a rampant infectious disease due to the lack of people being immunized, will we as health care workers know how to treat it?

I met a gentleman today who, at the age of 3 (some 75 years ago) contracted polio. Currently, his right leg was distinctly smaller then his left, and although he was lucky and it only affected his leg, he has spent his whole life with a limp, and wearing a brace.

He was in the ED today because his polio affected leg hasn't worked properly lately.

I overheard the docs talking to each other... these docs are seasoned, and in their late 40s early 50s. They, most likely, have NEVER seen a case of 1) actual polio, and 2) much related to polio 70+ years after the fact. They didn't really know polio that well, and what to do with this patient. They must have figured something out (with some research) because they ended up discharging the patient back home after some reassurance and treatment.

My question is this: If seasoned medical professionals are having a problem working with a problem related to a disease that hasn't effected a person in 75 years, then how the HELL are they going to work with an ACTIVE case?

Something to think about.

** being exposed to the environment and building antibodies towards foreign invaders is what the body's immune system does naturally. Without going into technical detail, vaccines are made of components similar to actual bugs (or a protein the bug makes) that provide the building block for antibodies to be created in the body. This means that if one who is vaccinated is exposed to the ACTUAL pathogen, there is a systemic response causing the body to "remember" this bug and kill it fairly easily. If there was no vaccine or prior exposure to something very similar, the body does not have an internal defense already in place . Instead, it has to create one, which takes time. This makes the body more susceptible to that pathogen. Essentially, if one is thus exposed to the pathogen, and is susceptible, the immune system may be overwhelmed and the person will begin to show symptoms of the disease. Once the illness is over, however, as long as the disease-causing pathogen does not evolve/change, the body would most likely be protected later. (think Chickenpox.. you don't get it twice!). Vaccinations essentially allow you to skip the "sickness" part, or at least mellow it down quite a bit. Not too shabby for a day of an arm hurting post-vaccine.

Tuesday, March 4, 2008


this is a first for me.

I have been notified by the manager that a patient I took care of is going to court. I have to give a statement. Good thing I wasn't the primary nurse!

Can't say any more about it, but it's definately a first for me, and probably the first for my class!

Monday, March 3, 2008

Job update

The interviews are finished, both at the rural 40min away hospital, and at the large teaching hospital.

I have been tossing and turning about which one I would choose if I get both opportunities. I'm starting to lean toward the larger center, not because I would necessarily get more experience (although I think I would), but because it's closer to home, and there are more teaching opportunities (for me as a student, and later me as a mentor!)

And although I was concerned about not getting any trauma experience, apparently they still get some trauma at the large non-trauma center hospital. Plus, since I was open about my wanting to see trauma, the coordinators were also encouraging about that, stating that a part time position at the large hospital and a part time at the trauma center was possible.

I have also been working non-stop as a first aid instructor, and a data enterer. That's why I haven't been able to post about patient related stuff. I will add some things soon.