Working in the Emergency Department, we see all sorts of everyday accidents. Through the years, I think this has given me a realistic set of fears. For example, after Hurricane Matthew I was helping my dad clean up shingles that had fallen, and we finally had to get on the roof. I was on the top of the ladder, one foot on the roof, and all I could think was, “This is how people die.” A few weeks before the hurricane, I can’t even count how many patients came to the ED due to injuries from falling off a ladder or roof – while they were putting up their hurricane shutters.
That being said – what is fear? That subconscious nudge to take a little extra caution. Fear has good and bad functions – it helps to sharpen our awareness at the moment but it can also hold us back. Starting a new job? Fear can be nervous excitement about a new chapter in your life, or it can be crippling and cause you to stay in a job you hate because you have accepted that as your “normal.”
This week I went to visit a friend in Colorado – I am a Florida girl and have only really been in snow once before. We decided to go snow skiing, which I have never done. The emergency room nurse in me is thinking of all the bones I could possibly break – but skiing is something I have wanted to try for years. We purchased a few items that we wouldn’t be able to rent (goggles, snow gloves) and drove to the lodge by the mountain- seems like no turning back! I think the real fear for me really set in when I was signing the waiver; it said something to the point of “you assume all risk of injury or death.” Being my first time ever on skis obviously we took a lesson. The instructor pointed out, “you don’t want to come down the mountain on that!” as people carrying a back board walked by us. I actually felt pretty confident until I was on a turn and couldn’t get my legs to work to properly slow down, I just threw myself down into the snow to stop — a bit comical in hindsight. But from then on I definitely had an aura of nervousness. I really, REALLY, enjoyed skiing, but I have to appreciate that I was able to push past the little voice of fear leading up to getting those boots and skis on.
So how can we use fear to push us out of our comfort zones but still feel some type of security/safety? I think it is important to try new things, step out of our comfort zones (boundaries?) to broaden our life and experiences. I wouldn’t say to ignore that little voice of fear but to keep in the back of your mind a sense of caution going forward.
I have two things I’d like to talk about today – EMS triage/assessment and sending EMS patients to the waiting room.
But first, a story:
I was assigned the critical rooms (my favorite). I heard the radio report of my patient en route, motorcyclist involved in a hit and run with possible alcohol on board. I prep my room, check on my other patients and wait. EMS rushes into the room with security; I literally can’t even see my patient because there are so many people around him. The paramedic kind of pulls me aside at the desk to give me report. I ask, “Can you give me report in there?” He smirks and replies – “Trust me, if I’m not worried – you don’t have to worry.” WOW we were off to a bad start there! What is going on in my mind: This is a trauma patient, does he have a cervical collar, is he bleeding, is he BREATHING?? I explained that I wanted to “lay eyes on my patient” which elicited a big sigh from Mr. Medic. I finally was actually able to check on my patient, who ended up being fine. However with all the hustle and bustle of getting into the room come on – I need to see this guy for myself and make sure at least the ABC’s are okay!
I think as you work certain places you learn which pre-hospital providers you trust regarding their handoff and clinical judgment. I had never seen or talked to his particular medic before so I wanted to see this particular patient ASAP. But sometimes what you are told and what the patients tells you end up being completely different! Also, sometimes what the patient EMS and what they tell the nurse (and what they later tell the doctor) are completely different – it is important to get the story for yourself!
On that note – different hospitals handle EMS triage differently. Some have a designated person who will triage or “check in” each EMS patient. Others send EMS directly to a room/area and the nurse who will be caring for that patient does bedside triage. What do you prefer? Personally, I prefer to triage my own patients so I can get the story from the paramedic or EMS’s point of view and ask questions. For a confused elderly person – I don’t just want their vital signs and BGL.. What did their house look like? Are they from a ALF/SNF? I want to have the opportunity to ask questions so I can better anticipate what my patient will need.
Next, different hospitals have different rules on whether a patient who comes in by ambulance can go to the lobby or must go straight to an ED bed. I personally love sending ambulance patients to the lobby – when appropriate of course. I don’t want someone to be rewarded for using EMS when their chief complaint is pink eye (yes – this has really happened) because they think they will get seen faster if they arrive by ambulance. That being said, whoever is receiving these patients and placing them needs to actually assess the patient so they go to an appropriate area. I was working in triage and had an EMS patient sent to me for a “thumb laceration.” It was busy so he did have to wait a while to be seen. Y’all – it was amputated!!!!
So the moral of the story is, from me, assess yo patients!!! You need to see what is going on for yourself for optimal patient outcomes. This goes back to patient safety and protecting yourself and your nursing license!
I have a newfound appreciation for people who take care of their family members at home. I mean the family where Grandma is living with them because she can’t live on her own anymore, and maybe can’t get around as well as she used to. Y’all – this is HARD work!!
My Grandmother has been living with my parents for the past few months. She was discharged from a rehab facility after a femur fracture and subsequent surgery and we just didn’t feel safe having her living home alone (she had previously lived independently prior to the fracture). I would visit my parents for a couple days in a row on my stretches of time off and help with transferring, toileting, etc. There was definitely a decline in my grandmother’s health and strength where she ended up needing truly total care. We didn’t want her stuck in bed all day so we would get her up to the sofa or recliner, to the table for meals and of course potty breaks. A bout of diarrhea would turn into nearly an hour in the bathroom because she was only able to stand for short intervals, even when it felt like I was holding her up all on my own. My parents did try various home health care agencies but there were days when they didn’t have an aide available or the aide didn’t show up. My parents have never worked in healthcare (and both have recently broken wrists!) so I was concerned about them injuring themselves lifting/transferring my Grandmother. Fortunately they were fast learners and we did find a couple excellent aides.
According to the Centers for Disease Control and Prevention, the number of patients who received home health care any time during the year (in 2013) was 4.9 MILLION – wow! Think about all the prevented hospital admissions (and ED holds) for patients who can get their wound care of IV antibiotics at home. Any how much that number has likely grown as we enter 2018!
Now when I have a patient and their family members offer to take them to the bathroom “because we do it all the time at home,” I just want to give them a big hug. And a break – let me take Grandma to the bathroom this time.
It’s that time.. bring on the New Year’s Resolutions! I don’t know about y’all, but in the big picture of things I am happy with myself. Sure – there are tons of things I would change or improve – but I don’t think I fit into the “New Year – New Me” announcements that we are about to be bombarded with. As I write this, I can’t help but laugh because I recently stopped my gym membership because I am working so much these next few months the schedule won’t really line up for me.. so I may potentially be one of those January gym crusaders!
My mantra as we enter 2018 will be: New year – BETTER me! I want to live my best life and become the best version of myself. There are all kinds of things that we say we are going to do “someday,” and while yes realistically they can’t all happen tomorrow I am starting to realize that we have to make that day happen! Want to travel more? Book a trip for later in the year. Just do it!
Professionally, I want to become the best emergency department nurse I can be. I hope that I can be a resource to my coworkers if they need help with something or are unsure about a procedure. One nursing skill I plan to work on this year is ultrasound guided IV insertion.
I have goals for improvement in various areas of my life. I would really love to cut some time off my mile run. I acknowledge that I need to put in the time, effort, and.. ugh.. running. I am currently trying to enjoy reading for pleasure again – I hope to continue this effort into this new year. I don’t know about you, but nursing school kind of squashed my love of reading. I am slowly getting it back – my goal is to read one new book each month. That seems realistic and achievable right?
Taking it back to those college days, when setting goals it is recommended to make SMART goals. That stands for Specific, Measurable, Attainable, Relevant, and Timely. These are all important aspects of a goal – dream big but be realistic, and set a timeframe to help motivate yourself and create some accountability!
What are your goals to become a better version of yourself this year?
Working holiday shifts is nothing new to nurses and our first responder families. There are different policies everywhere – alternating schedules, Holiday Team A and Holiday Team B, etc. After all, the hospital is open 24 hours!
Christmas Day is generally not that busy, but then again in the Emergency Department every day is different and you never know who or what is going to come through those sliding glass doors!
I would describe today as busy but steady. No waiting room pile ups, but certainly busier than I anticipated. You have to ask yourself, who WANTS to go to the hospital on Christmas Day? You have to consider the Christmas present injuries – falls from new hover boards and the kid that DID “shoot his eye out” with his new Official Red Ryder Air Rifle. It is easy to get a little cynical working the ED, but I try to take a step back and appreciate that from the patient’s perspective they are experiencing an emergency. I truly feel that for every patient we are ultimately treating their anxiety about whatever situation is going on. Our smile and comforting touch does wonders while we are simultaneously titrating their Cardizem drip, making sure their cardiac monitor is attached and drawing additional blood specimens for lab. It is just amazing to me the big picture of what we do – so many small tasks and so many people involved in the complete care of just one patient.
I don’t mind working on Christmas because it is a day I will make a difference in someone’s life.. whether it be by holding a hand, bandaging a wound, or maybe even saving a life. The camaraderie of the Emergency Department is unmatched, making the shift just a little more bearable. I hope you all had a good holiday!