the view from the deep end

I am now 2 months and 5 days in to my first year of nursing- my first day on the floor was July 28th. I’ve already moved from the intermediate area into acute. Maybe I should explain first…

Our ED is divided into a few different areas. Intermediate, or EDI, is for minor injury and uncomplicated acute illness (something needs sutures, abdominal pain, etc). It’s affectionately referred to as “The Pelvic Palace,” in reference to most of our pelvic exams coming here.

The main area of the ED, EDM, is for more acutely ill patients. My first day here kicked my ass- my patients were SICK, and with many co-morbidities. This area receives a lot more ambulances and “straight backs-” patients who are assessed at triage and immediately brought back to a room based on the severity of their symptoms. Anything can and does roll through this area… chest pain, respiratory problems, sepsis, abdominal pain, psych complaints, trauma, etc. Our sickest patients go to the critical rooms in EDM- 5 rooms in one hall where we stabilize trauma patients, run codes, and manage stroke and heart attack patients. The rooms are larger (they frequently accomodate 5-10 people during the stabilization of patients) and come equipped with most of the materials, machines and meds needed for any patient or clinical presentation. I’m still a little scared of these rooms.

Next we have EDE, the extended area of the ED. I haven’t rotated here yet, but it always seems calmer and less populated than main. The Pyxsis (medication distribution machine) is out in the open and easy to access, there aren’t so many people running around, and there’s a lot more space. This area is used as overflow for critical patients if EDM is full as well.

Lastly we have our specialty areas, Kids Place for our pediatric patients (EDP) and our behavioral health unit, which is locked and staffed 24/7 with a guard. I have no interest in either of these areas but all staff rotate through the entire department (although there are certain RN’s who prefer these areas and work there almost exclusively).

I can’t believe how much I have learned and progressed over the past two months. I’ve noticed that as soon as we (the interns) start to get comfortable, our preceptors / clinical educator is behind us to push us a bit farther. I’ve reached this point in Main… I’m starting to feel like I can handle a full patient load on my own, with assistance and advice here and there from my preceptor. The feeling of accomplishment that comes from not feeling like a total spaz is quickly being replaced by some resistance / annoyance / anxiety as my preceptors are helping me less and less, and pushing me to operate on my own more and more. I recognize that it’s a good thing, but it doesn’t make it any easier, that’s for sure. It’s always nice to have a second person helping you while you have to mini-cath a demented old lady who insists she needs to get up and use the toilet now because she can’t hold it, but you know you have to get this cath done first because you need a clean sample in order to rule out UTI as the cause for her decreased LOC, and waiting for more urine will only delay care and hold up the flow of patients through the department. It would be nice… but we don’t have that luxury. So I grudgingly went in there on my own… and it was fine. My preceptors are there to dole out tough love just as much as guidance and information.

I’ll try to update more often. I’d like to keep track of my first year in the ED, and I think it would help me to process the events of the day to write about them. Too often lately I have spent the entire night dreaming that I’m at work, running around admitting and managing patients (or even worse, standing back and watching everyone else work, because I realize that I’m dreaming and I’m not actually at work, but I can’t seem to get out of the dream).

Off to bed early now, gotta rest up for a full day of evacuation and code grey training tomorrow. ‘Night from the NW.

View from one of the towers at work.