Ambulance after ambulance after ambulance after ambulance lined the ambulance bay in front of the ER I work in, about 2 weeks ago. Our two sister hospitals were on divert, and our ER kept accepting the calls. Every room was filled, and the halls lined with patients on stretchers, medics, and police officers, who watched me and the other nurses and medics busily run from patient to patient. One lady cried, “that lady got a room before me… why am I still in the hall when I was here first?”
It was my first ER shift by myself. My preceptor had moved on, and even out of the unit to the overflow area, where more patient’s anxiously waited. One of my patient’s, we’ll call him Mr. A, came in with chest pain and shortness of breath. He was a full work up. He needed an EKG, labs, O2, a Chest x-ray, an IV and antibiotics. Meanwhile Mr. B was wheeled into the room next door, via EMS. He was hypotensive, tachycardic, covered in wounds, and overweight. He moaned in pain, and he was tall. His big body barely fit our stretcher, as his feet hung over the end. He looked uncomfortable, and like a lot of work. The patients in the two rooms over, were waiting for ICU beds. Mrs. C, watched me run by her room, and cried out that she needed pain meds, and to use the restroom, while Mr. D who was pleasantly confused and came in with a fever, needed another body temperature measurement. His room was filled with family members who seeked an update from me. Fortunately, they were kind and patient because they saw me running. It was then that Mrs. E, who was complaining of abdominal pain in the hallway, threatened to leave against medical advice (AMA) because she was stuck in the hall, and “the other patient came in after me”. I escaped her complaint, when someone from radiology came to wheel her away for a CT scan of her abdomen. Then another EMS wheeled up, and transferred Mr. F into the hall bed right behind her bed. He was an amputee, and carried the biggest smile on his face. I approached him to introduce myself, and inform him that I would be with him as soon as possible. He was so warm and sweet and said, “whenever darling, I have all day”. That was a relief, because at that moment it felt like it may be all day before I could get back to him.
Mr. B’s blood pressure was not improving, and another bag of fluids was in order, along with antibiotics. He needed to be in ICU an hour ago. I ran from room to room, to hall to room, and hall bed to hall bed. I transferred two patients to ICU, gained another patient, and ran into Mr. A’s room when his wife came running out to inform me that he was bleeding out of his nose and mouth and his BP was now 70/40. Then ICU called for a report on him. I gave as much information as possible, and pleaded for the nurse to come STAT. Meanwhile Mr. F needed a full work up, along with labs, cultures from his open wounds that covered his stump, and meds. Mrs. E was ready to be discharged, Mrs. C, was covered in urine, and Mr. D’s family really wanted an update. Assessments, H&P’s, meds, IV’s EKG’s, labs, temperatures, urine collection and much more waited in the queue labeled, “things that need to be done STAT”. Where do I begin? What’s most important right now?
It was then that I almost broke down. I ran from task to task, barely staying afloat. I asked for help, and received help several times, but every other nurse and medic was in the same boat, or lack of boat because it was like we were all treading the open seas, trying to stay above water. At one point, my friend Tekila glanced over at me and said, “You’re not an octopus. You only have two hands. Do one thing at a time and focus. You’re only one person and can only do one thing at a time.”
With that new advice, I went back to work, tackling the most important things first. Then 7pm came, and I found the charge nurse and I sobbed. She grabbed me with a big hug and said “Welcome to the ER! I’m so proud of you! You did it.”
I suffered from moderate PTSD and anxiety for about 2 days after I left the hospital that night. Did I chart the IV on Mr.C? Did I hang the antibiotics fast enough for Mr. B? Did I notify the doctor soon enough, about Mr. A? I should have handled Mrs. E this way, and so on.
I love the ER, and since that shift I’ve grown. I’ve experienced similar shifts since that first crazy day on my own. I’ve given TPA, helped insert a chest tube, assisted in intubating a patient, pulled an overdose from a car and watched him go from 8% O2 sats to 99%, ran a code, ran a stroke alert, held the hand of a suicide attempter, dressed a fair share of wounds, transferred a patient to our sister hospital via ambulance for a STEMI alert, and calmly dealt with a load of psych patients including one who ran around a hotel nude and then tried setting his man parts on fire. There are many more stories in between. I’ve learned so much in such a short time. The variety of people that come through the ER is vast. I’m getting faster and faster, but I still have so much to learn, and a long way to go. I could leave every shift and arrive home to study new things, if I had the energy and stamina. And, plenty of work awaits for me on my desk at home, since I’ve started the BSN program this semester. I’m so fortunate to work with great nurses, medics and physician’s. They’ve warmly welcomed me, jump in to help when they see I’m drowning, and encourage me when I need it the most. I feel so blessed to work with such a great group of professionals. Someday, I’ll be the one encouraging the new ER nurse. Someday I’ll be in my element again, and I’ll rock the ER.