My second
mandated Saturday clinical was another blessing in disguise. Initially I balked
at having to do a clinical on a Saturday, for I only work two days a week, and
they are always Saturday and Sunday. So therefore, I effectively loose a
half-week’s worth of pay every time I pull a Saturday clinical. However, the
primary blessing of these Saturday clinicals was my clinical instructor, Mrs.
Cynthia Chaney. Mrs. Chaney, you truly radiated an inspirational charm that
inspired students towards enjoying their opportunities to learn under your
leadership. I for one feel blessed to have been afforded these two Saturday
clinicals with you, Mrs. Chaney, and I really appreciate every effort and
consideration you contributed towards ensuring that we were each placed into an
area and under the guidance of a nurse that best suited our individual learning
needs.
Now I will focus
on answering the objectives of this assignment. How does the role of the nurse
within the emergency department differ from that of other nurses? Emergency
department nurses are relentlessly challenged with an endless variety of
patients whose needs and conditions are unlimited, and the volume of the influx
of these patients is never predictable. As my primary nurse, Donica, so
eloquently explained, emergency department nurses are expected to be capable of
caring for anything and everything that may walk or be wheeled in at anytime.
Their patients are not confined within any age or specialty categories, and
other than the patients who are brought in by EMS,
have not been pre-sorted or pre-treated by any other medical specialists and
therefore require complete assessments, frequent re-assessments, and a myriad
of treatments. The average number of patients each emergency nurse must care
for far exceeds that of most hospital nurses and each new patient potentially
presents with problems that may be entirely different from those of the
previous patient’s. Emergency nurses are expected to remain current in a
variety of disciplines, and frequently seek to update their knowledge base of
ever-changing treatment modalities and medications as patients are often
presenting with reports of new therapies and varied histories.
Some nurses
may never have to deal with the patient’s family, but the emergency nurse often
does. These family members always broaden the care efforts that the nurse must
extend. Just as the nurse must make a quick assessment of the patient, the
nurse must also incorporate accurate judgments in determining how to
effectively converse with and communicate effectively with the patient’s family
member or visitor. How a nurse responds to the patient’s visitors will often
determine the patient’s response to the medical staff and to their care
efforts, especially when the patient is a pediatric or is mentally impaired. The
emergency nurse’s role should include taking into account the eventual
incorporation of the family into the patient’s care whenever appropriate.
Emergency
nurses are exposed to hazards far beyond those of the average nurse. Emergency
nurses are on the frontline in the war on terrorism and are always at risk of
exposure to infinite threats. As Donica reminded me, emergency nurses assume a
certain element of risk, for they face caring for patients who may have been
exposed to weapons of terrorism, and they quiet likely may unknowingly become
victims themselves. Donica reminded me of the report of the nurses and doctors
who had died as a result of treating the victims of the Tokyo
saran gas attacks. Another sobering reminder of the risks faced by emergency
and flight nurses and flight paramedics was observed outside the trauma
resuscitation rooms. I read the plaque honoring one of each of them, and was
chilled to remember the time that the flight paramedic Michael Elam assisted me
on an emergency ambulance call as a “good Samaritan” volunteering to assist at
a motocross accident in Crawford County, Georgia.
Maybe this is off-track from the objectives of this assignment, but I felt
compelled to acknowledge his contribution towards assisting me in my care of a 17-year-old
race participant who sustained an angulated thoracic spine, paralysis, and
critical internal injuries. That patient was the same age as my son was at the
time, and Michael’s supreme guidance and assistance during what was one of my
most memorable calls of my 30 years of EMS
experience will forever remain etched in my mind. Even though I did not get to
perform anything exceptional clinically speaking, the opportunity to view that
plaque was an occurrence that equated to applying icing on a cake. Therefore, I
view my emergency department clinical rotation within Phoebe
Putney Memorial Hospital’s
Emergency Department as one of the best clinical learning experiences of my
entire 33-plus years in the medical field.
In regards
to the actual clinical learning opportunities I experienced while in the
PPMH-ED, I have mixed emotions. I was assigned to a very serious and
knowledgeable seasoned nurse who apparently availed herself as much as
possible, but unfortunately seemed to be too busy to allow me many
opportunities for skill practicing. Nevertheless, she (Donica) did go out of
her way to instruct me, and once even researched a textbook on the subject of
disseminated intravascular coagulation (DIC) before furthering her instruction
to provide an in-depth answer to a question I had posed. She also allowed me to administer an
intravenous injection of an anti-emetic, oriented me to areas while instructing
me on equipment used within the emergency department, and explained some of the
processes common to the emergency department. She even complimented my quick
detection of missing items from the set-up arrangement in the trauma
resuscitation rooms. After demonstrating a calm and purposeful approach to
assessing a new arrival, she allowed me to accompany her in transferring and
attending the 8-year-old trauma victim to the CT scan. While attending within
the radiology room, she answered questions yet never seemed disturbed by my
barrage of questions. I accompanied her to the blood bank, and witnessed her
correctly verifying the receiving of two units of fresh-frozen plasma (FFP).
Later, in the ER, I observed as she again verified identity and the correctness
of the FFP with the charge nurse and with the
patient before administering the fluids at a wide-open rate of infusion. I
observed her diligence to following the rules of infusion of blood products,
and was reminded of the importance of staying with the patient during the first
15 minutes of transfusion, of the need to do assessments before, during, and
after the transfusions, and of the never-ending need to provide frequent and
thorough documentation on all of her patients.
Although I
do not feel like I gained much experience in actually performing clinical
procedures, I did stay mostly busy, and was able to observe nurses who were
steadily engaged in nursing activities. In the early after-lunch period, I was re-assigned
and was able to observe another nurse’s interactions with one patient. Although
I have nothing negative to say about that experience or about the nurse I was
temporarily assigned to (Ashley), I did gain a deeper appreciation of the attention
that Donica had committed towards ensuring my clinical experience was instructional.
When the opportunity seemed appropriate, I returned to observe Donica in
action, and was rewarded with more instructional opportunities. If it were
possible and practical, I would enjoy more time in clinical observation of
emergency nurses, and probably would request to attend more such activites on a
volunteer basis.
I have
enjoyed my clinical learning experience, and I would like to take this
opportunity to thank you for this wonderful blessing. I guess I am an
adrenaline junkie, and despite having already spent over 30 years in emergency
medicine, I just cannot seem to get enough of the action. This emergency room
was a busy place, but it certainly was not the most intense emergency
department I have ever worked in, for I was trained at the Air Force’s largest
medical facility, which is one of three trauma center in San
Antonio, Texas. However, I was
impressed with the level of the staff’s expertise, their professionalism and
teamwork, and with the layout and the set-up of the emergency department. I
felt honored to be a part of the team and again, I really appreciate the
opportunity you have provided for me. Most of all, I deeply respect, admire,
and appreciate you for your part in providing educational instruction for the
whole emergency department team and for your efforts to lead, motivate, and
inspire each of us as nursing students of the bridge program. You are an
exceptional leader, I admire your style, and I hope you know you are truly
appreciated by all of the students whom I have heard comments from.
Sincerely,
Eric M. Simpson (“EMS”)
