WOW, I just had the hardest week so far in my orientation to the ER. Worked my 3 days in a row. Now, up on the floors, I hated working 3 days in a row. Sometimes its cool to get your days done and have up to an entire week off before working again, but working 3 days in a row week after week got old real fast. In the ER it seemed to be not that bad working 3 in a row. Of course I'm talking about 12 hours shifts so it can get tiring mentally and physically depending on your patients. Now when I was on the floors I was working graveyards and that in itself could be taxing but the biggest problem is when working on the floors if you get stuck with shitty (figuratively and literally) patients. You're almost certainly stuck with them for the rest of your shifts that week when working them in a row. Of course you can complain about your patient group and get assigned another or give a patient up but thats just not how i roll. AND, if you do give up your patients, you'll almost certainly get an even shittier group. What can i say, i believe in karma.
So, about my week from hell. My first day for the week nothing stands out as really difficult or overwhelming, but I had just come back from about 6 days off or so. That is kinda hard to bounce back from as you're still in lazy mode. Now my second shift for the week was the shift from hell. I'd say i'm pretty good at handling stress. I've had hard shifts on the floor but at our hospital what makes our med-surg floors hard is that its a little more back breaking than other facilities would probably be. How do I know? Not because i've worked at other hospitals but because even our own hospital wasn't that demanding initially when i started working there. Say what you will about CNA's (nurses aids), I'm not the type that puts all my work on them, I like to consider myself as self sufficient. I was a CNA myself for a couple years. The thing is, having an aid there, even just to answer a call light and tell a patient i'll be there, or to take my vital signs, once during the shift makes such a difference to me as it helps me put more into the charting i'm supposed to be doing. Which is a big part of nursing as "if its not charted, it wasn't done". I agree but I think nurses begin to spend more time with the computer than the actual patient and thats a whole other blog on its own.
Lets talk about my second shift before i get sidetracked again. For the sake of privacy, I wont delve into specifics, and some people may not have the stomach for what goes on in the ER. Heres the thing, I had two patients, one came in completely altered and didn't even know their own birthday the other we'll just say, is losing a lot of blood. The first one, after doing a workup and getting her stabilized. She is so much better and supposed to go to a med-surg floor. No problem, when i sent patients up to the floor, I do what I can and try not to leave too much left over work for them to do upstairs but at the same time I'm not going to do EVERYTHING. If its something i feel is somewhat critical like fluid boluses, antibiotics, or especially stat orders. Then yeah, i'll most definitely do them, but i'm not gonna concern myself with stool softeners or even some home medications. If a patient comes in with a blood pressure through the roof with a systolic of almost 200's and its down to 140's. I'll let the floor give the scheduled home med for that. I mean, half the time we dont even have those meds in the ER. Now, what I am adamant about is the patients safety. If i feel a patient isn't appropriate for the floor i'm sending them too then i'll do my best to get them upgraded. Lets take my confused patient for example. Doing so much better, actually talking, alert and oriented to everything. Complete 180, had some complaints of pain but this was a normal chronic thing. This person is supposed to go to a regular med-surg floor. The problem is that the blood pressures originally hovering around 90's/50's is now starting to dip and stay well into the 80's/40's and periodically getting lower than that. Of course she's not symptomatic, but in my humble opinion this is a patient that should be on at least a telemetry floor. Long story short, and i do mean long story, I got her upgraded to a stepdown unit which is basically between ICU and a telemetry floor. ICU nurses usually take 1-2 patients and telemetry nurses take 4 patients. So in IMC which is our stepdown, the nurses take up to 3 patients. Much more monitoring going on there. From beginning to end, we were having trouble with starting that patients IV's. The Paramedic wasn't able to start one. We started one, went bad, started another, went bad. Of course the first one i tried I didn't even get so she was poked at least 4 times. Last IV went bad just before I had to send her to the floor. Damnit sending the patient up without an IV sounded good right about now. Well its not in me to do that to them so I tried another and it worked great at least for the time being. And during this time my other patient bleeding profusely was there needed attention too.
My bleeding patient, originally was supposed to get stabilized and sent home, which in my opinion wasn't the right decision. It really wasn't and in the end we got to admit him but not right away because that would have been too easy. This patient was supposed to be going to a med-surg floor and then in the end got upgraded all the way to an ICU floor. Yeah, pretty critical patient, as if all the bleeding wasnt enough, and all the tried and failed IV starts didn't top it off. To top it off we had 1-2 other patients at the same time who thankfully were not as critical.
Now at this point in my preceptorship, the anecdote should just be about MY patients and not OUR. For the most part they are only MY patients but on this particular day my preceptor had approached me at the end of the shift and said she just couldnt let me drown any longer. I definitely was drowning though. I mean I could probably manage on my own but the whole IV thing simply had me on my wits end. It was like at one point I was stuck doing nothing and couldn't move forward. I knew I had to buckle down and just try one but it was seriously like, "who should I start with, the patient with nonexistant veins, or the patient with veins has already blown 5-6 times?" and this was in the middle of all the shittiness going on. Well, like I said my preceptor approached me saying she couldn't let me drown any longer, and at the same time told me that those patients were definitely hard and that is a situation where she most certainly would have HAD to ask for help because that was just too much for one person.
