A night in the life of this ER Nurse
This is a REALLY LONG account of one of my EASY nights…but then 12-hour shifts get REALLY LONG too sometimes!
When I started working in the ER, I would hear staff ask each other how they were doing, and I frequently heard the response “Livin’ the dream”, which always makes me smile. I have to remember that ER Nursing had always been a dream of mine in some sick former life, and on my busiest nights when I don’t think I’m going to live through it, it sometimes helps to hear that…to say that…and be reminded that however difficult at times, I’m still doing something I’ve always wanted to do (what was I thinking?!!), and that’s something that not everyone in this world can say. I bet there are a few mothers out there that could relate to those feelings…
So many people ask me, “Is working in the ER like the TV show?” I don’t always know how to answer. It is different from the other areas of nursing I’ve done in that it is not as structured, the “rules” don’t always apply, and we often “fly by the seat of our pants”. I guess it’s because we can’t control what happens in the community (often we can’t even control what happens in the ER), and we have to be prepared to deal with anything at any given time. We often do just that… anything and everything… sometimes in the same night. It’s hard to picture what that actually looks like in a 12-hour period, though. This is going to be my attempt at telling the story of one night I’ve worked. It was a fun night overall (for me), and was actually on the easy side, and I felt like I was slackin’ the entire night. I worked with a total of 12 patients during the night (13 if you count the one that came back). Obviously I’ve changed any names and defining aspects of stories to protect the innocent… (me)!
6:45 p.m. I got to work a little early as usual, and by 7 pm had picked up 4 patients from 2 different nurses that were going home. I got report on each of them, and then decided to do rounds and just look at each of the patients, and see if they needed anything. My first pt had come in with breathing problems which had resolved, and I only had to call the Respiratory Therapist (RT) for one more treatment before I discharged her. The 2nd one had also come in with breathing problems and chest pain, and was waiting for test results before we decided a course of action. The 3rd patient was a really sweet and beautiful lady (65ish) who had recently been diagnosed with kidney cancer, and was having some internal bleeding that she needed to be admitted for. We were currently running blood products into her (which meant I needed to check on her every 15 minutes or so to make sure she was not having a reaction). Of course she was in the furthest room, so I had to pass all my other pts to get to her. When I finally got back there to see her the first time, she needed pain meds. I left to get those, got stopped in the hall by the doctor inquiring if my 1st pt had been seen by RT, because she could go home as soon as she had. I had to page RT. Then off to the Med Room to get meds for my Cancer pt. On my way back, RT was on the phone, and had done the treatment. I stopped to report this to the doc, then headed down to the end of the hall to push the meds. We talked briefly while I pushed pain meds into her IV, and checked her vital signs again, and got my paperwork caught up. Then back down the hall to discharge my 1st patient. Of course I had to call the interpreter to come help while I sent them home, but that was quick.
I finally get in to see my 3rd patient, who was still waiting for test results, but doing fine in the interim. I can see that my 4th patient, a crisis patient (let’s call her Brandy), was laying down on her hall bed sleeping (and still breathing). Clearly she’s fine…I learned a long time ago to always “let sleeping babies lie”. By now I notice that the Resident was in talking with my 3rd patient, probably giving her test results.
I also know that they want to admit my Cancer patient, so I started by checking to see if the appropriate paperwork had been turned in to get her a bed. It hadn’t. I start chasing down docs to get someone to fill out the paperwork so she can get a bed. Time to check her vitals again. On my way in, my 3rd patient informs me (as I walk by her room), that she can go home, and in fact needs to leave right now. I took vitals, and pulled both of her IV’s out, and told her she could get dressed while I do the paperwork. I printed up her discharge instructions (after filling the printer with paper from the other side of the unit), and got her out of there.
8:00 p.m. Finally down to check on my Cancer patient, who is doing fine. I met her husband this time, who was a pleasant man. Brandy is still sleeping, and I realize that I am down to 2 patients, and need to pick up some more. The Waiting Room only has 3-4 patients in it, and we have enough beds.
I pick up another Crisis patient (my theme for the night), who had gotten upset, started hitting his head against the wall, and developed an impressive hematoma over his forehead, about the size of a baseball cut in half. His family had brought him in. He wouldn’t talk to me, but his family explained the situation. I went back and documented my part, and got him an ice-pack for his head.
I also finally got a bed assignment for my Cancer patient, so I attempt to call report. The unit receiving the pt didn’t know about her yet, so they wouldn’t take report. I check on her again, and got her a box lunch this time, as she hadn’t eaten all day.
At this point, I notice that Brandy is sitting up looking around. I’m sitting at the desk looking things up on the computer (labs, etc), and am still looking to pick up more patients, but none were available. Next thing I know, the Security Guards are running out the door, apparently after Brandy, who had been deemed a “danger to self” and was placed on an involuntary hold until they could find placement for her in a psych unit. They caught her and brought her back, and I decide it’s time to learn a bit more about her. Apparently, she suffers from a list of psychiatric problems, including Schizophrenia. She’d tried to cut herself after a fight with a family member, and wanted to die. She had a “hit” out on her, and her “time was coming short”. She knew “they” had to find her soon because she’s too smart for them to just let her go. She had a high-ranking political officer (won’t say who), buried in her front yard, and buildings were going to start blowing up when someone learned that. Okay…now that I have the background, I go over and meet her, and ask her if she’s doing okay, or if she needs water, juice, etc. She doesn’t want anything, except to go home. I find the Social Worker (SW) involved in her care, and learn that they’ve deemed her “safe” and are going to let her go home. Whatever…I don’t make the decisions.
I finally got report called for my Cancer patient, and disconnect her from things so she’s ready to go to her new bed when Messengers get there to take her. I told her to call me and I’d wrap her up in blankets to go in the wheelchair, when he was here to pick her up.
9:15 p.m. I work with SW to get Brandy discharged, and she runs before she can get the paperwork. Oh well…
Messengers arrive to take my Cancer patient, and I got 3 warm blankets and completely wrap her up in them as I help her to the wheelchair. She was such a lovely lady, and a pleasure to care for. I wish her and her husband the best and they wheel away.
Now I’m down to one patient. The Charge Nurse (CN) wants me to take an ambulance coming from a city in middle Utah, with a 15-minute ETA (estimated time of arrival). So now I look like a real slacker, with one Crisis patient, and not picking up new ones. Oh well…I don’t often sit. I offer to help co-workers, and I think I did a couple of minor tasks.
9:50 p.m. Finally my ambulance arrives, and I take the new patient, who rolled in with the biggest smile on his face. He was a very nice, young man who had Multiple Sclerosis with lots of muscle spasms and tremors, and was having complications from a recent surgery, causing him severe headaches. His wife was on the way in, but wasn’t there yet. We talked and laughed a bit, as I got his information. I put it into the computer, and was getting some treatments started when I learn that Brandy is coming back in by EMS again, and escorted by Police this time. Apparently she didn’t make it to that nice, safe place she was supposed to go home to, but was running in a busy intersection without shoes trying to get hit and killed by a car. When the police arrived, she tried to get them to shoot her. They brought her to us.
10:45 p.m. Brandy’s back. Looks a little shaken up, but didn’t look like she’d gone out and used drugs again yet. I took her back, and got ahold of our SW, who was getting ready to go home, but passed it off to the on-coming shift. I also picked up a patient with nasal congestion, and discharged my crisis with the forehead hematoma. I saw both new patients and did the paper work, and by now it’s just after 11 pm. I haven’t had a chance to see my MS patient in quite a while, so I check on him, and meet his wife. She was a lovely lady as well, and both were so young, and so nice. It was fun to talk with them for a minute, and attempt to get things for them to make them both more comfortable while we waited.
11:45 p.m. I take another Crisis patient who came in by ambulance. She’d been hearing voices that told her to flush her meds, then to cut herself, and try to kill herself. Why do people always listen to their voices? She was very sweet, and if I just smiled and talked with her nicely and calmly, she did anything I asked her to do. That’s the benefit of someone who is easily directed by voices. Her sister arrived, and I explained why they had to be in a room with 4 walls and a sink, and no TV. I explained all of our “crisis” patients have these stripped-down rooms, or a hall bed, because a regular room has too many things that can hurt them. I told the family member that while I like her sister, I don’t trust the voices, and there’s too many cords, heavy equipment, needles, etc, that she could hurt herself with in a room with a TV. I had to explain this all again about 30 minutes later, when they were sick of their room again, and while they were still waiting to be evaluated.
I’m in a holding pattern at this point, so I take a few minutes and walk outside to cool off. Our ambulance bay is full of ambulances and paramedics, with more coming in. Apparently it’s too cold to drive yourself into the ER tonight. It’s stopped snowing and was almost a little warm. Then I go to Starbucks (just across the hall from the ER…my favorite part of this hospital), and buy myself a hot cocoa and the CN a mocha since I had a 2-for-1 coupon. It was a nice break.
12:40 a.m. I check on my MS patient and got him pain medicine for his headache, and it helps. He was such a great guy, dealing with everything so well. He is waiting to be admitted to the hospital.
12:50 a.m. I have a bed assignment for my MS patient, and call report, and messengers to take him upstairs. I also discharge my guy with nasal congestion, and pick up another new patient who also has a head cold with runny eyes. Like I said, my theme was Crisis patients and Head-Colds…I was a slacker! I was also helping other coworkers with things, drawing blood, ordering xrays, etc…
Both of my crisis patients are going to be admitted to a psych hospital really close to us, but which still requires an ambulance ride to get there. I call report on both of them at the same time. The SW does the rest of the arrangements and all I have to do is be ready to give report to the ambulance people when they arrive.
1:35 a.m. Messengers still have not come to take my MS patient upstairs, and I have a few minutes, so I run him up there myself, and help him walk from the stretcher in the hall to his bed in the room.
As I’m walking the stretcher back downstairs, I reflect upon my two patients I’d had that night with debilitating diseases (Cancer and MS), and how both of them were the nicest patients I’d worked with in a while. I was saddened to think that these bad things always seem to happen to the nicest people. Then I thought of a few other patients I’d had in the past who had bad things happen and were not very nice about it all. I think the way we deal with our “bad things” in life shape us, our very countenances, and make us the people we are in the end. I have to wonder if we wouldn’t become as loving and patient along the road of life without some of the very difficult struggles we face at times. They had both dealt with their challenges admirably…maybe not every day, or every moment, but overall, they had love and patience in their hearts, and it was my honor and privilege to serve them both.
02:20 a.m. I discharge my last head cold. Now I’m just waiting for the ambulances to come for my crisis patients. Brandy is awake again, and I talk with her for a moment. Security is stationed all around her bed…I guess they didn’t want to chase her again if she bolted. She was mad at me because I would not kill her, and as she stared straight into my eyes, I got the feeling that all she really wanted to do was choke me with my stethoscope that was around my neck. I never wear it around my neck when I walk into crisis rooms, but she was in the hall, and I hadn’t taken it off. I stood back a ways, and was ready to move if she did, but that look is unsettling. I can’t even imagine the craziness going on in her head at any given time. I gave her two choices, settle down and rest while waiting for the ambulance, or try to run and we tie you down to the bed while you wait for the ambulance. Then I walked away. I was actually surprised that we never had to restrain her the entire night.
2:55 a.m. Brandy’s ambulance is here to take her upstairs. I am just about to give report when I am told by the CN that he needs me to go with him to the parking lot
immediately. I excused myself and went. Apparently someone just drove up that was having a baby, and I’ve done babies before, so he needed ME there. As we walked quickly, I told him I don’t go out there without gloves and blankets, so he ran for the blankets while I got myself some gloves. As I got out there, another nurse had helped wipe off the baby, who was delivered in the front seat of the SUV, and was just holding him with a sheet around him steady between mom’s legs so he wouldn’t fall on the ground. I tried to make him cry, and got one good cry out of him before he fell silent again. I opened the Delivery Bucket, found a cord clamp, and clamped the cord off, then tried again to make him cry. He wasn’t really wanting to. At that point, the 2nd nurse there clamped the other side, and cut the cord. I had to remind her that it was a boy, and not to cut anything important, as it was pretty dark. I placed him in a new warm blanket. Then I heard the doc behind us say, “Well, they don’t need me…the nurses just did it all!” I didn’t even know she was there. I wasn’t willing to move because I know I have baby experience, and the other nurse wasn’t moving, probably because she was there first. I picked up the baby and headed inside, where I set him down just inside the door on a stretcher, and the doc and I made him cry and checked his color, and I checked heart rate, which were both good. Then she carried him and I accompanied her while we went upstairs with him to Labor & Delivery. The other ER Nurses & EMT’s got mom out of the car onto a stretcher, and followed us up, arriving very shortly after we did. When we got up there, I was able to stimulate baby and get a couple more good cries out of him before we had a nurse ready to assume care. As I walked back down, I remembered how much I love doing the babies, and how I miss that sometimes! The other thing I realized is that while I’ve helped with a LOT of babies (200+) in my career, that’s likely the first time I’ve ever put the FIRST clamp on the cord. It was cool!
I got back down and remembered that the ambulance crew was still waiting to get report from me before they could take the patient. I walked up and said, “Sorry, had to deliver a baby,” and then I gave them report so they could take Brandy. The 2nd ambulance crew had just arrived for my girl with the voices, so I gave them report as well, and they left. She was hitting on one of our security guards as she left, telling him (very sincerely) how gorgeous he was, and how she would marry him if he wasn’t already married (which he wasn’t). We teased him about that pretty hard after they left!
3:20 a.m. I was down to zero patients, but we had a trauma coming in, so I took that. He was due to arrive any minute. It was a young male in a car accident, coming by ground from a city in southern Utah…clearly not THAT life-threatening, or they would have flown him!
3:42 a.m. The trauma pt arrived, and we got busy with that for a while. He had broken a few bones, and had a dislocated hip, but was alert and oriented, and very nice. On traumas, one nurse always stays with the patient at all times until it’s determined where they will go (floor vs. ICU vs. Obs. Dept vs. home). I had a little fanny-pack around my waist with typical drugs (pain, nausea, etc) that I might need to give him during the process, along with needles and syringes. We went to CT scan, then x-ray (where I medicated him for pain because they always want to move them around), and back to the ER, arriving back around 5:15 or so. Then I got a TON of things together, because the Ortho team had reviewed the x-rays and were ready to put his hip back into place. I medicated him HEAVILY and monitored him through the process, with the doctor that was there directing the meds. He slept, wincing off and on (I pushed more meds every time he winced), but he was relaxed and sleeping through most of the procedure while they relocated his hip, and then drilled a pin through his femur bone, hooking that up to traction (ropes that hold the dangling weights) which hold it in place so it won’t fall out again until he can go to surgery. We finished all of that at 6:15, and I was left with the patient to “recover” him…make sure he wakes up okay. He did fine, and I was ready to give report and send him upstairs by 6:30 or so.
I took my final patient of the morning at 6:40, while I still had my trauma dude in the trauma bay waiting for transport upstairs. I took a young girl who’d been out drinking and had had a little too much, and came to us with nausea/vomiting. Go figure. It’s the price you pay to play, right? What part of this is an EMERGENCY? This is where I get calloused…I actually did start IV fluids on her (only because someone had put an IV in her already), and was going to get her anti-nausea meds, but the next nurse coming on took report from me, and she got her the meds. I was able to leave at 7:01. Thank goodness, because my patience for crap was gone!
So that’s an easy night in the ER…I laughed and joked a lot with some of my patients, and with many of the other staff, and doctors. Overall, it was a fun night and unusually slow (for me) even though the ER was still pretty full the next morning. Most days, I still enjoy what I do as an ER Nurse, although I did have a break-down a couple of weeks ago, when I couldn’t remember why I do this at all. I have since recovered, but recognize that we really need to take care of ourselves first, no matter what we do in life, so we are available to bless the lives of others. Most people I work with just remind me how lucky I am to be ME, with my own problems. :-)
