YKY: August 2012

In comparison to processes within some areas of the hospital, the nursing process within the Emergency Department (ED) is dramatically different and dynamic. It is ever-changing, and lends itself to needing constant attention and reevaluating as the flux of patients and orders are relentless and seemingly never-ending. Our exposure to this process began quiet interestingly while observing the nurses as they began their shift “huddling” in the break room preparing for their onslaught against the challenges of the day ahead. As we began our clinical rotation in the area of the hospital that holds one of the most compelling and attractive nursing roles, we were privy to the final moments of this huddle. We listened as team members expressed their concerns and expectations concerning an item that holds the potential to dramatically improve the efficiency of their operations and keep them closely connected and accessible. They were concluding their pre-shift report huddle by discussing their new individually assigned radios, and some were expressing excitement at the possibility of “bedazzling” and personalizing their newest “weapons against ignorance”. With these radios, they apparently anticipated improving their abilities to stay abreast of events as they unfolded, and of each other’s whereabouts.

Seriously, my clinical experience within the ED was almost everything I had hoped it would be. It was not a day of unusual and extremely interesting case presentations and endless episodes of once-in-a-lifetime chances; however, it was a grand opportunity to “do anything they’ll let you do”. My day began in the best way it could, by being assigned to the ED. In the ED, I was assigned to shadow Leah, a relatively “new” nurse; a very effective and polite nurse who maintained a great attitude, demonstrated excellent care for her patients, and presented herself quite professionally at all times. She managed to offer frequent instruction and directions without being overbearing or insensitive while simultaneously attending to her responsibilities and making me feel appreciated and respected. Leah was one of many wonderful ED staff members who made us feel welcomed and appreciated.

I began the shift observing the layout of the unit, and noted some distinct similarities with the ED where I work part-time. I shared my limited knowledge and instructed my fellow clinical student in the utilization of the status boards, and how the “tracker” monitors are used to alert staff in regards to outstanding orders, procedures, and other information pertinent to the patients.

Throughout this day, I was awarded numerous opportunities to assist in direct patient care activities. I provided multiple blood-draws and made one IV attempt (which incidentally was successful on a “very difficult stick”). I assisted with and observed repeated external jugular cannulations made by the emergency room physician. I regulated and monitored intravenous fluid administration, provided a few intramuscular and Z-track injections, performed some physical assessments of initial and repeat vital signs, attended one patient transfer to the radiology department for a CT scan and one to the CCU for admission, and assisted with receptions and movements of EMS patients.

During the little downtime there was, I was allowed to interact independently with patients, and occasionally provided much-appreciated efforts directed towards positioning, cleansing, comforting, consoling, humoring, and even educating patients and family members. At times, I reported the patient’s or their family’s needs or desires as requested, and subsequently followed-up to determine if their requests had been met. In many of these “nursing process” instances, I acted as a nurse would, for I was assessing, intervening, and evaluating for the effectiveness of our treatments and efforts. I even made repeated efforts to help in the restocking of linen when the need presented itself, and frequently provided efforts to clean and prepare the rooms and stretchers for awaiting or upcoming patients.

I saw and learned a lot during my short clinical exposure in the ED. I observed and appreciated the effectiveness of three team leaders who each were partially responsible for a very successful day. Our clinical team leader, Cliff, availed himself to us often, and provided much welcomed, appreciated, and respected assistance to us many times during our day. It is no wonder he is a supervisor at his job, for he seems to possess a natural ability to provide comfort and strong leadership. The ED’s team leader, or charge nurse, Carolyn, was another person who inspired me during this clinical. She also seems to have the unique and rare quality of a leader who is there for all the right reasons. Moreover, of course, I must recognize our clinical instructor, Ms. Brown-Lucas; without her, our day would have been incomplete, and would have lacked the icing on the cake. Ms. Brown-Lucas has complimented our cadre of instructors, and brings a much-welcomed style of leadership that is truly respected and very much appreciated. I really appreciate Mrs. Miller’s including her in our team of clinical instructors, and by all reports, I am not the only one.