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.
Showing posts with label Emergency Department. Show all posts
Showing posts with label Emergency Department. Show all posts
Saturday, March 22, 2008
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*).
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, January 31, 2008
Accidental death....
I heard about this one case from one of my classmates, who also works in an ED. This is an incredibly sad story. For privacy purposes some of these elements have changed.
A family of a 2 year old were in the living room. Mom was on an elliptical machine, Dad was nearby on the computer, and their 2 year old was on the couch. Child manages to get off the couch, but in the process falls into the elliptical, which was still being used by Mom, and gets crushed. Mom immediately stops, gets off, and then calls 9-1-1.
Child ends up dying.
I cannot imagine what it must be like to lose a child. I can't even fathom how someone must feel who had unintentionally caused their child's death. My sincerest condolences to this family.
This is a fear I have, working in the ED. I have fully admitted I"m not a fan of paediatric nursing, however I am coming around and learning to step up to the challenge. The idea of having to work on a child who was severely injured makes me sick to my stomach. I can't imagine how the staff felt that day, and how they could go back to working on the sore throats, injured hands, etc that we generally get in Emerg.
Blows my mind.
A family of a 2 year old were in the living room. Mom was on an elliptical machine, Dad was nearby on the computer, and their 2 year old was on the couch. Child manages to get off the couch, but in the process falls into the elliptical, which was still being used by Mom, and gets crushed. Mom immediately stops, gets off, and then calls 9-1-1.
Child ends up dying.
I cannot imagine what it must be like to lose a child. I can't even fathom how someone must feel who had unintentionally caused their child's death. My sincerest condolences to this family.
This is a fear I have, working in the ED. I have fully admitted I"m not a fan of paediatric nursing, however I am coming around and learning to step up to the challenge. The idea of having to work on a child who was severely injured makes me sick to my stomach. I can't imagine how the staff felt that day, and how they could go back to working on the sore throats, injured hands, etc that we generally get in Emerg.
Blows my mind.
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