Archive for February 2010
I just finished working 5 shifts in a row and am beginning to feel like a real ER nurse now. I still think I need a sign that says “new nurse” on my forehead though. Now that I have been in the department for all these months, and because I am older, the docs forget and think I am one of the nurses with 30yrs experience! They expect me to be familiar with many more diagnoses and more efficient in getting things done for my patients. It is nice however, that they now come to me about the patients instead of my preceptor. I am starting to develop relationships with them and gain their trust to be their eyes and ears with the patients. I am beginning to trust my own instincts a little more too. I had a 1 yr old patient this week that was pretty sick, he just LOOKED sick from the moment I laid eyes on him and it turned out to be true, his WBC count was way elevated and he was dehydrated. He wouldn’t drink anything and he just had this glassy eyed look about him. We ended up transferring him to Children’s Hospital.
There was another patient I had last week that was confused and altered from alcohol encephalopathy. She was completely disassociated from reality and fearful. Her skin had a yellow cast to it, her sclera were definitely yellow. She was tremulous too and at one point seemed like she was having a seizure but did not lose bladder or bowel control and kept talking through it. The doctor wanted to just pump her up with ativan, he thought she was going through alcohol withdrawal. I talked to her sister who had been caring for her, and was convinced that she was not drinking. She didn’t smell like it ( I can recognize that smell now) or act like it. Her blood alcohol level came back undetectable and her ammonia level was elevated. What she really needed was thiamine and lactulose. We gave her a banana bag without the thiamine, but pushed the thiamine first to get it into her system quickly. We gave her a lactulose enema because she had been vomiting and could not take oral meds. Then I had to drop and NG tube to suction out her stomach because she started to vomit blood. Because of her confusion, everything scared her, and she kept trying to pull her IV out and get out of the bed. We ended up having to use soft restraints to keep her tubes in and eventually admitted her to ICU.
I rarely get to know how my patients do after they are admitted to the floor from the ED. I often wonder what happens to them and how many of them make it home. I think at the end of everyone’s medical record there should be a “what happened later” section like in the movies when they tell you “so and so grew up to be a teacher and someone else ended up being a cop and tracking down drug dealers because of his experience from being one. I wonder if my patients go home and back to their old habits after their health scare or do they make even just a few changes like eating less salt or becoming sober, or becoming consistent with always using a barrier birth control method if they are going to have many partners. But, alas, I don’t get to know, I can only hope and have faith.
It has been a long time coming. Way back in January of 2007 when I took my first prerequisite classes to start my nursing career, it seemed like I would never get to this point. Ever since then it has been an intense ride through nursing school, and then through the new grad program. Finally after 16 weeks of working in the ER with another nurse watching my every move, I am being turned loose. I’ll be working my first solo shift next Wednesday, so try to stay safe and out of the ER.
I am excited and nervous at the same time. For the most part I feel confident. I know I am a good nurse even though I am still pretty green. I am thorough with assessments, clear in my charting, and getting more efficient at getting everything done for my patients. I have figured out how to get the attention of the lab, radiology, CT and ultrasound. I have learned a bit more about the docs so I can predict what I can get started for my patients before they ask. I listen well to my patients, and they are always grateful that I am nice to them. They comment so much on my being kind and compassionate that it makes me suspicious that this is not the norm. I think however that the truth is that I have not worked long enough to build that protective shell around my heart, I am still wearing it on my sleeve. The nervous part comes when I get a patient that is really sick and I know the timing of my care is critical. I am not so fast yet, I still look up lots of meds before I give them, I double check dilutions and infusion rates and compatabilities just to be sure that what is in my head is actually right. I worry about getting IV access started quickly enough and those sickest patients have the worst veins! I worry about not recognizing just how sick a patient is, especially a kid because I haven’t seen enough of them. And my biggest worry is that I will make a medication error that will cause a patient harm, I guess no amount of experience will ease that worry.
So far I have surprised myself at what doesn’t gross me out. Patients puke, poop, and scream. Bleed, smell bad, and curse. So far none of it has made me want to run. Usually there is a glimmer of a scared individual that melts my heart and makes me want to help them feel better. Each case is a challenge to try to figure out what is making them sick and how can we help. And there is endless opportunity to educate people about their health. Many have heard it all before, and really need encouragement to take steps towards health. Call me crazy, but I get off on encouraging people and giving them hope.
So if you come into my ER you can expect to be listened to, cared for with kindness, have your stuff explained to you and be encouraged to live a healthier lifestyle. Watch out, new ER nurse turned loose.