Tuesday, January 27, 2009

Bad bad RN!

I admit it, for the past 1.5 years I have been a bad blogger. I have been using images online from other people's websites.

Today I rectified the situation, and went through over 185 posts and eliminated all pictures that didn't have credit on them or that I didn't take myself.

Thank you to those people who have lent me their pictures with permission.

Monday, January 26, 2009

When being a nurse counts.

I take pride in my work. Although being a nurse wasn’t originally my plan post-high school, I have found an area I like and I enjoy learning everything there is to know about emergency nursing.

The other day was a poignant experience for me- one that truly brought home how important advocacy and education is, and why nursing is a profession to be proud of.

I met a patient who had unfortunately fallen through the cracks of prenatal care. She didn’t have a family doctor, had gone to some prenatal ultrasounds through a walk-in clinic, but did not know how to access the results. Unfortunately, she was to be set up with a women’s health clinic, but in the hustle of a busy walk-in, nothing was set up and the patient was forgotten.

The patient was a young, first time mother, who didn’t know how to get access to prenatal care in the city. She came to emerg with abdominal pain. She was not bleeding, the baby was moving fine and the fetal heart rate was perfect. She was, however, terrified that she would lose the baby. With no family in the area and a laissez-faire boyfriend, she didn’t have much social support either.

I received her into my care at the beginning of my shift. The previous nurse pulled me aside and expressed her concern for this patient- not because the baby was in distress or because the mother was in trouble medically, but because of her concern over the lack of prenatal care and the lack of support this patient had received thus far.

The care and concern that this nurse had for my new patient blew my mind. Most of the Emergency nurses in my department aren’t known for wiping brows and hovering just in case the patient needed another glass of water or their pillow fluffed. They are known for being intelligent professionals, with a dedication for medical needs and providing specific nursing care. Our emerg nurses are at their best in a crisis- when a patient is coding, when the patient is obtunded and needing RSI*, or during STEMI’s*, CVA’s*, trauma, DKA*, etc. Although they do provide the pillow fluffing and water bearing for the patient when they can, most emerg nurses I know are fairly tough and aren’t the pillow fluffing type. ABC’s – that’s the motto.

This particular nurse is one of those tough nurses. She would tell you things as they were. However, now I can say she is also one of the best patient advocates I’ve ever seen.

Not only did she express her concern and have everything set up for the patient’s discharge, she also made sure I understood her concern, introduced me to her patient, and stayed later to follow up with things she had initiated. She wasn’t doing it because she thought that I wouldn’t do well for the patient (in fact she told patient that she would be in good hands) but because the nurse CARED. The emerg doctor who was seeing the patient also understood the gravity of the situation, but unfortunately did not have the time to manage the non-medical side of the patient.

Although this nurse didn’t have a lot of time either, she made it important to go back and reassure the patient, to provide her further instructions for prenatal care, to provide phone numbers for physicians accepting patients, and much more. The patient left the hospital less scared, and more hopeful for the care of the baby then when she came to emerg. She also had an ultrasound appointment, a women’s health appointment, and understood the importance of advocating for herself and knowing who to go to in the sometimes confusing healthcare environment. All because of this hard-edged, but amazing advocating nurse.

That is why I’m proud of this profession. This is why nurses are an important part of the health care system. This is whom I will strive to be.

*RSI- rapid sequence intubation
*STEMI- S-T Elevated Myocardial Infarction (heart attack… a bad one)
*CVA- Cerebral vascular accident (stroke)
*DKA (Diabetic ketoacidosis)

Friday, January 23, 2009

Happy RN

No rants today, or lately, which is why I haven't posted in a while.

I have been actually happy with my shifts. They have been both medically interesting, as well as challenging enough that I have to think a lot of my plan for the patients.

I can even say that my organization skills are improving. My patients are getting the care they need, when they need it. Before I was on my own, I was still struggling with that. However, mostly I think I was frustrated because I wanted to test myself and there would typically be a 'mentor' who wouldn't back off and let me try.

I know I'm new: I'm new to nursing, and I only have 1 year of experience with Emerg. However, the stuff I DO know, I know well. I try to be a sponge. I ask questions if I don't know something. I get senior nurses to show me equipment that I'm not comfortable with.

I don't have as many questions as I used to, and I'm proud of that. I see repetitive patterns. I also learn from my mistakes.

Last night for example, one of my patients was nauseated and was in a collar from a fall. The patient would need log rolling if she vomited. I was on guard. However, this patient stated she was nauseated just before she went to CT. Our CT is not in the department, they have to go with porter to second floor. I made the right decision to go with the patient to protect her airway, but I didn't think to grab some Gravol first. Next time, I would definitely grab some and administer it before we go! Everything ended up fine (aka no vomiting) but it was a definite lesson learned!

Friday, January 9, 2009

On my own

I am officially on my own as an ED nurse. No preceptors, no mentors... just me. And thank goodness there are lots of supportive nursing staff that are there willing to help out.

And boy did I need it tonight. I had one lady on bipap and another working his way towards the ICU, as well as a confused aggressive patient and a medicine patient.

By the way, in the hospital where I work there is no support staff to do your vitals for you, or to help people to the commode or do the bedpan stuff. It's all on the nurses. So not only was I prepping for an adenosine cardioversion, I was also wiping people's asses, getting vitals, prepping beds, reassuring confused people, etc.

It was a great experience to learn to organize, but still I have my doubts about my shift.

Questions run in my mind: Did I miss something that we could have noted earlier about the patient going to ICU now? Is there something subtle that I missed? How can I improve for next time? What would I have changed?

Am I ready to be an ED nurse? I think I am.. I have a lot of knowledge now that I'll carry with me to inform my decisions. Do I still need to learn? Absolutely. I have spent a year in Emerg nursing, and there is still more to learn.

I have absolutely no idea how some nurses can carry a patient load of 12:1. No idea. Kudos to them.

Saturday, January 3, 2009

I applied

Well I did it- I applied to teach a course at a local university.

I wasn't sure if I was actually going to apply. Summers are great for overtime in my emerg department, and I also want to spend some time enjoying the outdoors, which I didn't do much of last summer because of my broken knee.

But I figure even if I did teach the commitment would be approximately 10 hours a week, and the money I'd make would go straight to my student loans. No one really WANTS to pay off their student loans, but the sooner I do, the better I'd feel about money.

In case you are wondering, I would also continue to work full time at my regular job.

Speaking of which, I may have finished my last mentored shift today. Although I'm not sure as things are wonky in the scheduling department, technically my new contract starts on January 5th. I don't work again until the 6th, so I'll let you know whether I will be on my own or not.

Hope you had a happy New Year!