Wednesday, March 19, 2008

Terrible, Horrible, No-Good, Very Bad Day and Now - Im In Debt!

I've been turned loose on my ED. No more orientation, no more preceptor, no more hand holding. This is the real thing. Its been about two weeks and I have to be honest, its gone really well. Little did I know that during these past two weeks I have been lulled into a false sense of confidence. Little did I know that an ED nurse never really feels 100% confident, because he/she never knows what the next rig is going to bring in.

My reality check arrived last week, it was a Friday. The short and the sweet of it is, I "got my butt kicked." I knew it was going to be a "terrible, horrible no good very bad day" when my first encounter with an assigned pt was to find him lying on a stretcher with a 12cm 3inch deep lac on his upper arm that was in the process of being "explored" by a surgeon's gloved hand (NOT a sterile glove, by the way). The kid was young and trying to be tough (fists clenched and white knuckled) and I was ticked he hadn't been pre-medicated. In fact, in all reality he should have been taken to surgery for the repair. From that point it just got worse and worse as each new pt arrived. I was bitten in CT by a pt I had just given an amp of Narcan thanks to an OD of Kadian with a respiratory rate of 4. I was yelled at by a cardiologist, and belittled by a cocky neurologist younger than I. UGH!! By the end of the day I wanted to move to Australia.

All of that background to sing the praises of one of our float nurses. He's an ED vet, and he knew exactly what to say and what to do for me. He didn't take over, just took some of the tasks that were "muddy-ing" my waters. He didn't sugar coat it and caudal me. Instead he re-oriented me to my priorities, told me what I could ignore and what I needed to heed. His best advice thru it all was "take a minute to collect yourself, because that is when we make mistakes."

I recognize what he did for me, but its so frustrating to know that he will always know more, always be 10 steps ahead of me, so how will I ever be able to return the favor?
A debt I can't repay.

Sunday, March 09, 2008

"I Can See Clearly Now" A Plug For TNCC

Have you ever heard of TNCC? Its a certification offered by the ENA for ER nurses (any critical care nurse, actually). I took a two day course last week and it was SO helpful. As a newbie, I highly recommend taking the course. Its challenging, but if you read the book, study, and practice the assessment mnemonic ABCDE/FGHI, you should find success.

Aside from the learning experience it provides, it is also an excellent way to network with other ER nurses. I took my class at a hospital 2 hours from my own ED. I was nervous at first, not knowing anyone, but I was able to get to know how other EDs function and I had the chance to swap stories with other nurses. It offered great perspective on differences among various EDs.

In my class of 10 RNs, 2 were ICU nurses. They said it was hard, but worth it because they now have a much better understanding of what happens in the ED. They also reported feeling more confident in assuming care of an ED transfer under stressful circumstances where report was short and sweet.
(we never do that, do we??)