Monday, January 17, 2011

Oh Emergency!

This past week I had my last clinical EVER for nursing school! I cannot even believe the end is so close. Although we have two simulation labs this week, last Wednesday was our last day at Placentia-Linda Hospital for our critical care rotation.

I originally was on the schedule for the ER. However, since my instructor hadn't been with me to pass meds during this term I knew she was going to ask Brooke and I to stay on telemetry for the day. That would make it my 3rd day on the tele unit and I would have been bummed to miss the ER since I knew I would never work there but at least experience it for a day. I've passed plenty of meds in my days of school. I could crush and administer through a G-tube with my eyes closed with one arm only. Of course I can always practice calculating and pushing IV meds or hanging a piggyback, but to be honest, I really didn't want to. While being team lead one day I helped classmates pull their meds from the Pyxis system and administer. They told me that when my instructor asked who hadn't passed meds to simply say I had "handled" medications. I couldn't do that though.

So, the morning of clinical I called my dad on the way as usual. We discussed the possibility of me either being placed in the ER or Tele for my final day. I believe I told my dad the ER would be too complicated so I should probably just do Tele because that felt safe to me. My dad of course encouraged me to challenge myself and plead for the ER. 

Our clinical group gathered in the cafeteria to meet before we broke off to our assigned units. Our instructor went around asking where we were each headed and told us to go our own ways. I blurted out that I was assigned to the ER and she said, " See ya. Have fun!" but I didn't budge. I couldn't because what if she asked who hadn't passed meds. Ah! I was wise to stay put because right after she asked who had not given meds with her yet. Brooke and I slowly raised our hands and we told to head to tele to spend the day.  I couldn't tell if I was bummed or relieved. Maybe a mix of both. I think she noticed our confused faces ( Brooke really wanted to go to ICU) so she threw out the option that we could choose where to spend our last clinical day since it's our experience and we could pass medications in any unit. A dilemma. Do I choose telemetry so I am guaranteed a patient info for my last careplan? Or do I choose Er which I am scared to death to be in and probably won't like it? I blurted out ER before I could think any more......and I am SO glad I did!

From the minute I walked into the ER I knew it was going to be a fabulous day. There were 3 male nurse and one female who took myself and my classmate, Gem, under their wing right away. They walked us through how the ER is run and what their expectations were from us. Now on most floors we are put to work doing daily patient care such as bed baths, oral care, feeding, dressing, toileting and so on. I don't mind that and I would prefer to do the complete care for my patients while providing them dignity, respect, and kindness than how some of the CNAs treat them. But, after 2 years of doing that, I am ready to add some excitement! In the ER they trusted the two of us to perform as an RN, all duties. We were starting IVs, passing meds, hooking patients up to 12 leads, giving straight catheters and regular foleys, setting up for specialty exams and collecting specimens all on our own, all day. I was in heaven. There is a thrill with putting an IV in. Granted, I have yet to not get it on the first try but I know when I get a tough vein or mess up I will probably be crushed and there will be no thrill to it! The first one I put in was this man that reminded me of my dad. He was in for chest pain and after hooking him up to a 12 lead to make sure he was not having an MI, I started his IV. We chatted away the whole time and he had no idea, but he was calming me while I was getting ready. When I saw the flashback (the blood that pools once you are in the vein) I wanted to squeal. After the IV was secure and he was taped up he patted my hand and said, " I didn't feel a thing! Thank you!' No sir, thank YOU for being a wonderful patient and having the same calming effect that my dad has!

To say I loved the ER is an understatement. I loved the staff I was with. Er has more male nurses than the floor and there is something about having a guy in the mix that changes things. Girls are catty and drama no matter where you are, but throw a guy in the loop and it eliminates part of that. The nurses we worked with  challenged us. They quizzed us all day. When a patient would come in, we were asked what 3 possible diagnosis could be for their presenting signs and symptoms, what labs would be ordered and why, and so forth. Before anything we did they would question us as to why this was needed. It really made me critically think through everything. I loved the hustle and bustle. I should have known I would work well under pressure since I usually save all of my homework till the last minute and somehow crank it out. Being under pressure in the ER I felt that I worked better as a nurse than before. I liked being barked orders to run to bed 3 for a 12 lead and than bed 4 for a foley with specimen. I loved that in some cases we had minutes to intervene in a situation. I know I need to be on a unit that will keep me busy because down time kills me

To say everything went perfect that day is false. I missed a straight cath on an elderly female, but I learned a great trick so next time I will be able to do it faster. I was so excited about collecting a specimen and rushing it to the lab I forgot to write how it was collected on the label. I will never forget that now! On one foley insert there was so much going on with her infection in the area, my eyes were burning and watering from the smell. I wanted to lean over my shoulder and hurl but I reminded myself that I was there to help this lady. And what I was about to do would be a step in her getting better. But I learned more in my short time there than I could have imagined. Everything from nursing school fell into place in the ER. It's one thing to take a test on the material that was taught. You learn to work the tests. To read the answers first and know exactly which one it the right one. But applying it to real life is an entirely different concept. I learned to critically think FAST in the ER. I learned how to take everything I have studied and put it into practice. I learned to face fears, to ignore smells without gagging, and push myself to be the best that I could be for each patient I encountered.

I know I want to work with pediatrics. I love kids and I can't imagine not working with them. For me, things are easier with kids. A child can throw up, poop, spit, pee, and who knows what all over and I won't flinch. Adults, I can't say the same. But a pediatric Er sounds pretty interesting to me and I truly think I would love it. I would miss having a relationship with families from prolonged hospital stays, but it would be fun to do for a little while and than maybe I can head into Peds Oncology. I may not land a job in Peds right away but I now know what my next goal is and the prayers are starting now. :-)

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