mamatrauma

ER nurse and resident knitwit

ER at last

with 3 comments

After what seemed like an eternity of preparatory training I am finally in the ER. This has been my dream since I started nursing school and here I am on the job in a busy county ER. I am  working with a preceptor that is very experienced but not that happy about having someone to train.  Luckily I don’t need much hand holding and I don’t take her reluctance personally, she is just overworked.   We worked on the “blue” side which is the less acute side, seeing patients that are triaged as level 3 or 4.   Two patients stood out for me because we weren’t really able to help them.  One was a woman with chronic back pain who had suffered a fall, she had used up all her pain meds and was not able to refill her scripts  before the first of the month. She got some new RX’s but could not fill them due to lack of money.  She came in looking for some pain relief.  We were able to give her some pain relief, and take an x-ray,  but could not give her medication samples to carry her over till the first of November when her scripts would be available through her basic medical insurance. We provided her with a new cane and a cab ride home, she was not happy.  The other patient broke my heart.  A young woman doubled over in pain came in with her husband.  The history looked like this could be a chronic bowel issue, or a kidney stone. She was nearly hysterical in fear of what was wrong with her and not being find relief from this pain.  The MD immediately pegged her for a meth user and ordered a urine tox screen and pregnancy test which came back negative for everything. We gave her Ativan to calm her and some dilaudid to ease the pain and 3 liters of fluids. She went for an abdominal CT which was negative and she was discharged with a script for go-lytely and donnatal and instructions to come back if she did not get relief.  She was not a happy camper, she felt we were ignoring her needs and not listening.  She wanted to get to the bottom of what was causing her pain and I have to say I agree with her. In the end she left without signing the discharge papers, without taking her prescriptions or instructions, and telling us she was going to go to another hospital for help.  I felt like we didn’t listen well, I don’t know if the MDs and other nurses misjudged her, I am too wet behind the ears to see what they see. but my gut feeling is that we missed something, and it broke my heart that she left feeling frustrated with her care.  Both the charge nurse and my preceptor talked about how you have to be firm with these kinds of patients and not be caught up in their drama, I just don’t see the category of “these kinds of patients” yet and I am not sure I want to.

Written by knitwitmama

October 28, 2009 at 1:46 pm

Posted in nursing, the first year

Tagged with ,

3 Responses

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  1. Great blog! Sounds like a very intense experience. Do you find it hard to transition back home after a shift?

    Kristi

    October 28, 2009 at 8:53 pm

    • sometimes, I usually soak in a warm bath to relax and get to sleep.

      jennie

      October 28, 2009 at 9:01 pm

  2. Jennie-
    I don’t want to say get used to it, but get used to it. However it’s all in the way that you handle situations like these that’ll determine your satisfaction level. Two thoughts, #1 our health care system isn’t equipped to handle chronic issues, least of all pain. Our insurance is reactionary rather than proactive. I’ve often recommended massage therapy, acupuncture or chiropractic to my patients, which is a stretch because each of these therapies are out of pocket and, well, who has extra cash these days? And besides, most patients prefer taking a pill to any other type of therapy.

    Second, the physician and your preceptor are partly right, you can’t be thrown by the level of a patient’s hysterics. It’s something that you as the provider have to be able to tune out, in a sense, in order to find out the underlying issue. Sometimes patients think the louder, more hysterical they are, the more likely you’ll give them what they want. This patient leaving without signing papers is a clue that maybe she was drug seeking. I have no doubt that she was in pain and something was going on, but you also have to play the role of a skeptic, sometimes. But always trust your instincts, they will serve you well. You’ve just finished nursing school, now your real education begins.

    NurseMe

    October 30, 2009 at 11:21 am


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