whirlwind med surg training
I have one more shift to go on my med/surg portion of training before I FINALLY get to the ER. The floor I have been on has a wide variety of patients, mostly medical with diagnoses of alzheimers with extreme dehydration, to CVA, cancer, wound abcess, brain mass, cellulitis and more. My goal working in this unit was to understand the criteria for admission, learn the equipment in less chaos than the ER, and get a perspective of what it is like for the RNs receiving the patients we will be sending from the ER for admission. This is a new approach for our ER training, I am gathering based on the questions I have been getting from the nurses. They all want to know why we are being oriented in their unit if we are going to work in the ER, then they chuckle that we will soon forget their perspective once we have been in ER for a little while. I have to say the main question I get is, “how did you get hired as a new grad?” It seems that this new grad program I managed to get into was not only a well kept secret on the job boards, it was not on the radar within the hospital either. I really am fortunate to have found out about it and gotten hired.
I have been working mainly with one nurse but tagging along with any nurse that is doing an admission from the ER so I see the process once the patient comes to the floor.
It took me a day to figure out where things are, and get a feel for the routine of the shift, most of the nurses have been very friendly and eager to welcome me to the hospital. It is the patients however that confirm for me that I am on the right path. I love working with them, even the cantankerous ones. This is one place where my age is to my advantage, they assume I have been a nurse for years and don’t seem to notice my clumsiness with equipment or nervousness inserting an IV. I have had several successes now so that nervousness is lessening.
On my second day we had a patient die at shift change. She had just come to the floor from ER a few hours earlier and her friends had just left to arrange hospice care for her. We were getting report when the nurse taking over this patient’s care went to meet her and discovered that she had died. I helped carry out the death protocol which involved notifying the appropriate people, getting the MD to fill out the forms, calling the organ donation network, and preparing the body. The thing that always catches me by surprise is the change in skin color that happens, the skin takes on a definite yellow tone. We washed her, changed her gown and linens, and tucked her in the bed for when her friends returned. It turned out that she was not approved for organ donation due to her liver disease. We moved her roommate to another room without revealing the death had occurred so as not to freak her out, and talked with and comforted the two friends as they said their goodbyes. Then we wheeled her body down to the morgue. Wow, I felt a mixture of emotions through the evening from sadness that she died alone to the profoundness of the end of life, to the the confidence that came from the self discovery that I can handle the process in a professional way and be there for the patient and family. I know I will be dealing with patients dying while working in the ER and I was glad to have gone through this experience.
Another patient that moved me was a gentleman with end stage colon cancer who has not been able to control his pain. He was extremely dehydrated and constipated, had gotten a few doses of morphine in ER but came to the floor with an infiltrated IV, pain level of 10/10 and respirations of 36. I tried unsuccessfully to place a new IV, but another nurse was able to get one in and we gave him some more pain medication. In spite of the excrutiating pain he was in, this patient was pleasant and patient as we tried to make him more comfortable. In contrast another patient I had that same day, a demanding former meth user with neuropathy in her feet and legs and suffering from panic attacks, yelled for her pain meds constantly, became combative on several occasions, and left the floor against advice to smoke. If one nurse didn’t give her what she wanted she yelled for another nurse or MD.
I could go on about each patient, they each presented situations that I learned a great deal from. (I know, my learning curve is steep at this point in my career, I have so much to learn) I am grateful for the chance to work in this unit for a couple of weeks, it has confirmed that I have made the right career choice and makes me even more excited to get into the ER. Next week!