Admitted patients....

I have been working with a lot of admitted patients recently. I feel like I'm doing floor nursing, with half the supplies, lack of comfortable beds for my patients, and of course about 2 pages of admission orders. It was not what I signed up for when I started working in Emerg, but apparently this is the trend at most hospitals... admitted patients will stay in the ED for sometimes up to 48 hours before getting a bed on the floor.

What's causing this delay? There are many causes:

1. Lack of staff on the floors- beds closed because no staff are available to man them.
2. Lack of long-term care placement beds. Many acute-care patients are awaiting placement in a long-term care facility, and stay sometimes 6-months if not longer.
3. People are sicker. We are keeping people alive longer, with complicated comorbidities which require intense medical care.

The other day we were so swamped that we had to hold patients in the RESUS room. There were absolutely no beds in the ED for admitted patients, and no monitored beds in the hospital. This is getting ridiculous.

And yet, all we hear is about the wait-times for the emergency department. The problem is not the ED, the problem is the lack of floor beds, and lack of long-term beds.

Life of a student in a small town ED

I've started to feel more comfortable in the small-town ED. Now that the nurses are getting used to me, they have been making sure I get "learning opportunities" all the time....

"Student!... want to do another glucose?"

"Student!... want to take out some stitches?"

"Student!... how about you do the interview for room 3, both kids have a rash."

"Student! ... go and pack that abscess wound"

I know that I'm the runt of the pack right now, and I take it in stride. Honestly, this department has been really welcoming, a change from other floors I have worked on as a student.

Although I still feel I don't know very much, I'm starting to feel more comfortable doing assessments, and doing basic treatments without the aid of my preceptor. I still check in with her and we do a lot of stuff together (I'm surprised she's not sick of me yet!), but I'm feeling more independent.