mamatrauma

ER nurse and resident knitwit

Goals

with 2 comments

Each week of orientation we are supposed to work towards some goals.  They start out pretty basic such as find various supplies in the unit, identify where the medication resources are, care for one patient from arrival to discharge.  I have two preceptors that I am working with, both wonderful nurses but with very different styles.  This is a good thing for me as it gives me the perspective that there is more than one way to do things.  One of my preceptors is also a nursing instructor at one of the local colleges so she is very much into writing out my goals and how well I accomplish them each shift.  At the end of the shifts though, the last thing I want to do is organize what happened into a list of goals fulfilled!  But I try.  I am getting to the end of week four in my training and my goals are a little harder to reach. This week I am supposed to care for respiratory and cardiac patients, take two patients with increasing complexity, and improve my assessment skills.  I did get a baby with croup this week and if you have never heard the cough that these little one produce when they have croup it will scare you to death! It is a loud dry bark, and it sounds like they are not going to be able to get their next breath in.  I settled mom and dad in the room with this baby and tried to listen to his lungs and he started screaming.  A good sign that plenty of air was getting in, he was pink and warm too. So I rushed off to get some Albuterol and set up a blow by nebulizer, and pretty soon he was sounding better and playing with his dad.  Then I had to get some IV Decadron in him by mouth. This stuff tastes terrible, I am told, but I did manage to get it in (kind of like getting a cat to swallow a pill) and rewarded him with some nice cold apple juice.  We treated him with some humidified air for an hour or so and sent him home with instructions for his parents to use a humidifier or a shower to help him breathe.

I never got a cardiac patient, but I did get quite a bit of experience tracking down the responsible MD for my two admitted patients that were staying with us while we waited for beds to open up. They ended up staying the entire shift and I spent a lot of time paging MD’s to come see them and write some orders so I alleviate their pain while they waited. I learned about tracking down surgeons and advocating for my patients.

Then last night I had a dream that I totally screwed up the computer charting by departing my patients in the computer while they were still here! I was getting yelled at by the clerk and the MD’s to not ever depart patients and  I woke up woke up trying to figure out how I was supposed to get them off the tracking board without departing them?  And feeling frustrated that I don’t have a good grip on all the logistics of using the patient tracker.  Ahhh!  Just got a call from the nurse educator that is running our orientation and we are being pulled from the floor to do some more training on the computer tomorrow.  I hope to get a better grip by the end of tomorrow.  Whew!

Written by knitwitmama

November 19, 2009 at 3:21 pm

2 Responses

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  1. Sounds like your orientation is coming along well! I agree two preceptors is a good way to get a broader perspective.

    Re: croup – please tell me that the child got an epi mask, not an albuterol mask for that? Croup is upper airway, albuterol works on lower airway…..

    Good luck with the rest of your orientation – emerg is an awesome place and I think you will love working there!

    Mama Mia

    November 21, 2009 at 7:20 am

    • thanks for your comment, you are right racemic epi would be the drug of choice, though albuterol was the drug ordered. I appreciate you pointing that out.
      I love working in the ER, everyday is something different and it keeps me on my toes.

      jennie

      November 21, 2009 at 7:39 pm


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