Emergency Department Thoughts

My clinicals in the ED for CCI have been AWESOME. So far I’ve completed 5, and will have the other five completed before November 1st. Whoop! That’ll open up even more time for me to work on projects and prepare myself for finishing up this last semester of nursing school.

My preceptor in the ED is a former TWU grad herself and she has been so amazing with me. She has a lot of patience but she tells me exactly as it is and I so I don’t have to wonder what she’s thinking or if I’m doing something that will ultimately hurt my patient. She allows me to be independent but she’s right there if I need her. Even when she’s super busy (as happens often in the ED) if I have a question or am nervous about doing something then she will patiently guide me through it.

I’m to the point now that I’m taking one patient completely on my own (well as much as I’m able to…I can’t get into the pyxis so she still has to get the meds for me) and then helping her out wherever I can with her patients. This means that I’m doing the initial assessment on the patient, getting them hooked up to monitors to take vitals, documenting in their medical record, and then carrying out the doctor’s orders on my patient while they are in the ED. It’s SO fun but it’s also quite exhausting. The ED moves at a weird pace…you’ll have moments where you are not busy at all and sometimes that can last for a couple of hours. For example, we have patients in each one of our beds, we’ve done all orders, and now we’re just waiting on what the doctor wants to do – are the patients going to be admitted or discharged from the ED? And then we’ll have hours that are SWAMPED. We’ll receive one patient just as we discharge another, and then receive another in his place…and you feel like you’ll never get caught up with the initial assessment & documentation as well as carrying out orders for each of your patients. I’ve never had 12 hours go by in such a manner…it’s a long 12 hours but at least I’m having fun while I’m there!

I’m really glad I’ve had the opportunity to be in the ED while in nursing school, for several reasons. First, it’s been great to know exactly how emergency departments work and the flow of how they run. I have the perspective of nursing from an emergency nurse’s eyes now. Second, I’m glad to have had this experience so that I can rule out ever wanting to work in the ED in my nursing career. I thought that it’d be a great place to work as a nurse but I’m discovering that it’s REALLY not for me. Not in a bad way – I think that all nurses have a “niche” and the ED just isn’t mine. Why don’t I like it? Well there’s a much more limited contact with the patients in ED. Even if they are with you for hours, they are generally NOT in a mood to be talked to. Most of them try to sleep their day away, in actuality. But most patients aren’t even with you that long. Either they get admitted up to the floor pretty quickly or they are released back to the street pretty quickly. There’s just no satisfaction of seeing a patient coming in really sick and then watching them get better over time, because once they are admitted you never get to know how they’re doing later. And then, and I’m sure I’m NOT correct in my assumptions, I feel like when we “treat” a patient in the ED they really aren’t getting better. We have  patients come in for a pain in their back, and we can’t find anything wrong with them, so we give them pain meds and street them and I’m left to wonder “well what happens when their pain comes back??” (And no I don’t think they’re just drug seekers.) And so on and so forth. A lot of patients that we see are “treated” and then sent right back out but I’m wondering if they were really helped at all. And so with that I get very little satisfaction.

That’s not to say that all the patients we see are that way. We have had some truly emergent cases come through our doors that have been admitted to ICU, all the while we were crossing our fingers that they wouldn’t crash and burn right there in the ED. Those types of patients are definitely rare though.

But I have had a great experience in the fact that I’ve had the opportunity to practice a TON of skills and see some really cool things as well. I’ve:

  • Inserted more IVs than I can count
  • Inserted two male foley catheters and one female foley catheter
  • Inserted an NG tube
  • Drawn blood cultures (my least favorite skill, I think; it’s extremely tedious)
  • Done several butterfly sticks into the veins to draw blood
  • Hung IV meds, IV fluids, given IVP meds, PO meds, IM tetanus vaccine
  • Drawn, labeled, and sent blood to the lab
  • Performed EKGs
  • Seen a STEMI on an EKG of a patient going through a heart attack at that moment
  • Watched a urologist irrigate a foley catheter for almost an hour to pull out clots so that the urine could drain
  • Watched a plastic surgeon sew up a DEEP hand laceration
  • Listed as a mentally altered patient screamed obscenities for about an hour before his meds kicked in and he fell asleep
  • Seen a BAD case of ascites
  • Had a patient that we nearly had to intubate due to a COPD exacerbation and resulting respiratory acidosis
  • Seen a hypochondriac throw themselves on the ground in an attempt to get someone to pay attention before they stormed out of the ED and were brought back in by police
  • Watched as the VA had a medical disaster drill and taught their staff how to respond in that type of situation (they had tents set up and were wearing HAZMAT suits and everything!)

Another awesome thing about being there for clinicals is the fact that there’s one doctor in the ED who LOVES to teach. Whenever he has the opportunity, he will teach you about what’s going on with his patient even if it’s not your patient. I’ve learned a lot just from listening to him!

All in all I’m SUPER SUPER thankful that I have had this opportunity. I can’t believe I’m already half-way done though! Clinicals go by SOOOO fast when you’re in charge of scheduling them when you want!