Last night was one of those nights....Yes, one of those nights where this new nurse felt like a complete idiot. I started the night thinking that a certain group of rooms just fell into my scope but I most definitely think I am being challenged.
The night started with an automatic ICU patient, meaning I came onto shift and someone else had this patient for the majority of the day. I usually would prefer to get someone from the start, in that way you know the patient. Luckily the majority of stuff was done and I was just waiting for a room.....Thank goodness because Mr. Altered was screaming out of the next room. I was in and out of his room every 5 minutes because he wanted to get out and walk around....He did not know why he was in the ER, or what was going on and my biggest fear was that he could possibly fall down.
I actually really enjoy it when my patients get beds in the hospital because I can get them wrapped up and sent off. Last night one of them decided to have a bowel movement while transporting, therefore, making me look like an incompetent and inconsiderate ER nurse, as they already think of ER....ICU nurses are a different breed, just as ER. Needless to say I hope I do not have to go to "that" ICU for a week. On my way down...I use my walk to gather my thought because I just have that feeling about how the night was going to go. I turn the corner back into the ER and I hear yelling. Lucky me! I have a new patient who is being intubated....ahhh. I actually do not have that much experience with intubated patients, so I was feeling okay about it but very scared. I know how time consuming ICU patients are, on top of that you are on the phone a lot with their consults (other docs) and getting more orders just to increase your load of work. I pulled myself together and went into the room. Unresponsive, agonal respirations, high BP and HR...look who just bought themself a tube. Intubations are similar to codes...sometimes they are organized and sometimes controlled chaos. Last night was a little of both. This patient did not have IV access and lucky us, no one could find anything to poke....therefore, buying herself a central line as well. High risk drips still scare me because the patient can go bad very quickly, as well as spinal taps on ventilated patients. This patient had a very high fever with really no evident signs of where the infection was coming from...Poor, poor ER nurses get exposed to everything. I would like to think the ER is helping me build a super immune system. I did indeed receive a significant amount of experience. Thankfully, I had a great experienced RN to help me most of the night. Finally, I get this patient settled only to get 2 other patients who are very sick. I thought I was going to collapse but I just kept on.
The EMS phone was ringing off the hook for a Saturday night and I knew there was even more patients being transported in.
I received another wake up call when I lost my compassion for about 0.5 seconds. I had a patient constantly on the call bell due to pain. The ER is always busy but I always find time to answer the call bells and see what my patients need. My patient wanted more pain medicine but the scary thing was her pressure was very, very low...come to find out she had a GI bleed. GI bleeds can catch up to a patient very quick and are often deceiving. I knew she was going to need a transfusion. Eventually, I was able to calm her pain, which was actually from battling cancer with Dilaudid. I mentioned to another nurse that "she was needy". Whoa, did I get a wake up call! "She is dying of cancer, do not lose your compassion. It is way to easy in the ER!". I instantly felt like an ass and felt horrible because that for one is not my attitude. Wake up call.
It is important to know others have no idea what you are dealing with outside of their room. The ER will not take that toll on me. One of the other patients family was getting angry at me last night because I was not in their room very often. I agree their family member was very sick but the patient next door was dying...ventilated, tapped, and drips galore. It is very difficult to get others to understand that Yes, you are sick and in the ER but sometimes there are others who are still "sicker". I wish there was more staff so that the patients could get more thorough care. I often go home feeling inadequate when I feel like the bare minimum was done. I always want to do more. I get so frustrated when patients come in by EMS or as a walk in and expect a ER mini mart. We are trying to save lives here people and if you are that sick...you will be NPO! It is so sad how the ER is abused and unfortunately will not improve anytime soon. We sure deal with a lot of bullshit, so I guess I can appreciate a night with real emergencies.
I am Thankful that I work with experienced nurses who are willing to help but I am so scared to one day not have that help. I have now been on the floor taking care of patients for 5 months....supposedly in 7 more months I will be competent. I feel like a wild animal who only eats when time allows, meaning it just might be my last meal...that came at 4am! 10 hours after I had already been running around the ER with my head "almost" falling off. I had to admit to my coworkers before shift change that I lack a poker face, which was evident all night long. "You got your ass handed to you last night" and "you were running all night" were some of the comments. Well....at least I was not the only one thinking that. Last night was my grand royal dose of ER. OUCH
Found this pic amusing...
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