patients from door to door
The first awkward moment was in the med room, with my preceptor needing her H1N1 shot and not wanting me to give it to her. ouch. Nothing personal, ya sure.
My goal for the first week in ER was to take care of one patient from start to finish. Today I managed four! No, not at once, one after the other, never more than one at a time. I was working the blue side, less critical patients, mostly things like abdominal pain, fever/ flu, alcohol intoxication, UTI and the like. I managed to get an IV in an intoxicated patient on the first try, even thought the guy had some pretty tough leathery skin from spending many a night sleeping under bridges. I learned how to mix a banana bag, saline with vitamins and minerals added that rehydrates and replenishes the nutrients a chronic alcoholic desperately needs. All the while our fabulous social worker was trying to find a place for him to go to detox, I was trying to convince him to stay long enough to get rehydrated and stable.
I greeted my 15 month old patient in the lobby and she was all smiles in her mom’s arms until we walked into the exam room then she grabbed her mama’s neck and screamed. No way was she going to let me listen to her lungs and take her temperature. I was actually glad to see her respond appropriately to a stranger, and thankful I didn’t have to give her an injection.
I stood by observing a patient brought in by ambulance having a seizure. The patient was having trouble breathing, swelling in her eyes and face, and her skin was quite red. The MD looked at me and started firing questions as if I were her med student
MD: what do these symptoms indicate?
Me: anaphylactic shock?
MD: good, how do we treat it?
Me: uh, give epinepherine
MD: perfect, how much and how do we give it?
Me: (in my head, aaaah I have NO idea how much, why is my mind blank?) um, 1mg I think? IV?
MD: no! that is for ACLS, the dose for anaphylaxis is 0.3 mg and we give it IM, where?
Me: in the thigh ( suddenly remembering EPIpens that you stab into the thigh)
MD: yes! go get it, you are an RN aren’t you?!
Me: I am! (rushing off to the med room feeling like, wow, I AM an RN, I CAN go get this med and help this patient ) I felt like I was really on the spot and really I was just observing why did the MD turn to me? I guess, I did okay. And the patient came out of the situation and in a couple of hours was sitting up and ready to be discharged with her very own EPIpen in case this ever happened again.
I was starting to gain some confidence, learning the routine, knowing where to find supplies I need, even helping another nurse put a foley in. Then came another awkward moment one of the MD’s made a comment that she could tell I was new to the unit because I had the chart ready in the slot for her to take in to see the patient to write her orders. And another nurse quipped “yea, and she doesn’t have a bad attitude yet.”
And I hope I don’t, it is not in my nature.