I can’t fix everybody
My two preceptors happened to both be on the same day and I got to hear them discuss with each other how they think I am doing in my orientation. I am slowly catching on to the flow of the department. I can take care of two to three patients at a time by myself as long as there is nothing to unusual going on. I can usually get an IV in on the first try but not always, I know the codes to get in the med room and the psych unit. When someone needs me to get something for them not only do I know what the thing is and what it looks like, I can usually find it. I am still rather slow and methodical, I still take longer to chart as I ponder the wording of my nurses notes. But for the most part they think I am doing fine. One preceptor said to the other, “you know she is going to be fine because she has the maturity to not freak out about what happens, and she is a mom so you know she can multitask!” The one thing they both remind me about is the fact that in the ER we can’t fix all of peoples problems. Many of our patients have chronic issues and psych social problems that are not solved quickly if at all. I had a patient in for back pain needing a refill of her RX however she had several other issues that we could have helped her with but didn’t. She was a diabetic and her finger stick glucose machine was not working properly, she needed a new one, she had a nasty contact dermatitis on her abdomen that could have used some barrier cream and perhaps steroid cream, and she had a decubitus ulcer developing on her hand where it was contracted due to a stroke 3 years earlier. She was feeling overwhelmed and frustrated with staying on top of her own care, and I felt like we could have taken an extra 15-30 min to just help her out and get her back on track. However the ER doc insisted that she follow up with her primary care doc for those things and just refilled her pain med RX, even when I asked him about it. We had a homeless guy found under the overpass in a drunken stupor, we rehydrated him, got him a spot in a detox center because he said he wanted to go and heard that the next day he was thrown out. Then there was the mom and her two kids, she told triage that she was having asthma problems, but when I interviewed her she told me she needed a document from our ER for her employer excusing her from work for a car accident that happened 4 months ago! oh, and also her daughter had a cough and a slight fever. She was going to lose her job if she didn’t produce this note, but we couldn’t help her, it was 4 months ago and she didn’t seek treatment! Lots and lots of smokers and alcoholics who are coming in with health issues that are either due to the habits or made worse by those habits. I can’t fix them, I can just help them with their problem of the moment. I can be compassionate, and listen to them, and try not to make them feel like they are just another chart to be checked off and pushed through. The motto for the ER is “treat ’em and street ’em” and sometimes “admit ’em”. I just need to learn how far to go with each of them, where does the ER care end and another resource pick up and can I make sure they get connected with that other resource to help them with those chronic issues that take longer to remedy. It is a fine line, and I seem to run right over it resulting in my precepter stepping in to say “you need to ask the doc what the plan is for your pt, we have done what we can” That line always comes sooner than I want it. I have so much to learn.