Our Nurse of the Week is Lauren Wirwille, bride-to-be, who was driving to her own bridal shower with her mom in the front seat when she noticed a minivan stopped in front of her. She decided to honk, prompting the car to start moving again, but after Wirwille turned at the intersection her mom saw the van veer off the road. Realizing that the man had looked slumped over, Wirwille pulled over and ran toward the man’s car where she found him unconscious.
As an emergency room nurse for St. Joseph Mercy Hospital in Green Oak Township, MI, Wirwille knew exactly what to do to help the man who had gone blue in the face. She was already running late to her bridal shower but couldn’t help pulling over to help a stranger, and she quickly realized it was a good thing she had followed her instincts.
After instructing her mother to call 911, Wirwille began trying to find the man’s pulse. At the same time, another driver pulled over and offered to help get the man out of his vehicle. Then Wirwille immediately started CPR. She recalled the event to ABCNews.go.com, explaining that, “Not a lot of people know how to do chest compressions. After a little while, you do get tired, and you need to not be tired, so I had my mom start chest compressions. She did great. I was so proud of her.”
Shortly after starting CPR, Fire Chief Kevin Gentry arrived on the scene and assisted in performing chest compressions. The EMS crew was able to revive the man and transport him to Providence Hospital where they believe the man was recovering but weren’t able to retrieve any details.
Wirwille ended up being an hour late to her bridal shower, but she was welcomed with open arms and applauded for her heroic actions. She didn’t regret being late to her shower; she was simply humbled by the experience and happy she was able to help somebody through an emergency situation.
Earlier this month, the Texas A&M Health and Science Center held an event called Disaster Day, a mass casualty simulation to help prepare nursing students and other health science students for their future careers. The simulation was held in a gymnasium filled with approximately 400 volunteer victims affected by a tornado that touched down near Houston.
Matt Ward, a student leader for Disaster Day, tells TheBatt.com, “We have the largest simulation in the nation for running a disaster day. We have college of nursing, medicine, pharmacy, veterinary staff and biomedical sciences all here today. It’s important to get all of those communities together, because we have over 300 students on staff to help the patients that are here.”
As approximately 300 students entered the gymnasium, they were instructed to mark victims with green (not critical), yellow (need care), red (critical), or black (deceased) triage tags to determine their necessary level of care. The students were faced with a number of simulated emergencies from birthing mothers and mentally ill victims to lacerations, broken bones, and tree branches lodged in bodies. Simulation conditions included that all nearby hospitals were at full capacity so all medical work had to be completed on site.
College of Nursing Assistant Professor Alison Pittman tells TheBatt.com, “There are two nurses assigned to each row in the disaster and there is one provider assigned to each row. So they gave to triage their patients and decide who needs to be treated first, second, third.” The simulation provided an opportunity for students to experience a fast-paced emergency situation to prepare for potential catastrophes they might experience in their medical career.
To learn more about Texas A&M’s Disaster Day mass casualty simulation training, visit here.
Below, I interview Erin Sullivan, BSN, RN, CEN, about her experiences in critical care. She recently switched her specialty from the emergency nursing to intensive care, and shares her reflections, challenges, and some advice.
What is your background in nursing?
I graduated as a second degree nursing student from George Washington University in 2014. I was a new graduate nurse in the emergency department (ED) for about two years before I switched to the MICU (medical intensive care unit) in March 2016.
When did you decide to change specialty, and why?
I decided to switch to the ICU about 18 months into working in the ED. At the time, I was considering applying to some graduate school programs that required ICU experience as a prerequisite, so I made the switch to broaden my experience and learn a new skill set.
What do you do now and what is your job/where?
I’m working in the MICU at Northwestern Memorial Hospital in Chicago. I also still work per diem in an ED.
What was challenging about the transition to the ICU?
The biggest challenge I had in transitioning from emergency nursing to the ICU was learning how to think like an ICU nurse. There are jokes in nursing that the two types of nurses are “wired differently.” In the ED, the goal is to quickly assess, diagnose, and stabilize patients, and then to move them out to an appropriate level of care as soon as possible. In the ICU, the goals for the patient are more long term, and you have to consider a bigger picture and a larger scope than I would in the ED. It’s a completely different way of thinking, organizing, and prioritizing patient care.
What do you miss most from ER nursing?
The thing I miss most about the ED is the teamwork. I don’t know that I can quite explain the team aspect of ER nursing to someone who’s never experienced it, but there is a special camaraderie that forms between all of your coworkers. Whether it’s one of the best shifts or the worst shift ever, your fellow coworkers join together to make sure we all come out on the other side. I also miss the organized chaos that is the ED, and the anticipation of never knowing what is coming through the door next.
What do you enjoy most about the ICU?
Being in the ICU, I really enjoy being able to watch a patient progress from being critically ill to becoming well enough to leave the unit. Unlike the ED, many times you have a patient three or four shifts in a row, so you can get to know the patients in a way I never got to in the ED.
What do you want to do with your nursing career moving forward?
I’m not sure what the next step is in my career. One of the reasons I chose nursing was because there are so many different options in what you can do. For now, I’m enjoying working in the MICU and picking up in the ED every now and again to get my adrenaline fix. I’m fairly certain though that I’ll find myself back in school pursuing a graduate degree in nursing at some point.
What tips or advice do you have for someone who wants to change their specialty?
My biggest advice for anyone considering switching their specialty is just to do it. As nurses we learn new things everyday, and we shouldn’t be intimidated or scared of the challenges that come with switching specialties!
That said, do your research. Can you handle the stress of a new job right now? Are you adaptable and a quick learner? Do you get along well with new people? These are all considerations before jumping into a new specialty. For me, I was still within the broader scope of critical care. If you’re completely changing specialties, from adults to pediatrics, or from med-surg to labor and delivery, make sure you talk to people who are in that field and that it seems like the right fit for you. But remember, you can always go back!
“Are you crazy?” This was the response—replete with an equally stunned face—I got when telling people that I was thinking of taking a new graduate emergency department nurse residency. “Um, I guess so,” was my pathetic shy response. Inevitably, second guessing ensued.
Nothing about the ER is easy. Now, I would venture to say nothing about any kind of department or nursing is easy. I remember watching the TV show ER as a kid. I always kind of imagined the TV show…“ER.” Cue theme music. Cue fast screens of each actor looking serious, looking concerned, looking medical-ly. Wait. Where is sexy George Clooney with medication on hand, and that stethoscope placed precariously, but oh so perfectly around his neck? Nope. Not here. I’ve looked. No Clooney, no Noah Wyle.
I can remember it vividly. The moment I decided to tackle nursing. I had been sitting next to an elderly blind woman. I was a volunteer in the ED, the lowest on the food chain, and unbearably shy and awkward. I was asked to help feed this woman her meal. I approached the curtain, and with a feeble, “hello?” I walked in with trepidation. The woman was as sweet as she could be, with a southern accent and manners to match. She asked, “Well, hello there…Do ya have my Jello?” With this I felt at ease, and with a smile I sat down next to her and proceeded to have a long conversation about Jello, Southern food, and the smooth moves of James Brown.
I would not change my choice for the world, and working in the emergency department has been the most rewarding, challenging, and enlightening experience of my life. And, without a doubt, I have learned some of the most about nursing and myself during trying times and harrowing situations.
This brings me to Room 20.
We have all heard it. The stories, those patients that stay with you the rest of your career. The ones you never forget…you can be anywhere, doing anything, and BAM! An immediate recollection of the event. It is like a memory frozen in time that is destined to stay with you the rest of your life. I must admit I had not had mine yet. As a busy, task-oriented new graduate nurse with spankin’ new scrubs on (and a shiny pen light to boot) I was unaware of the fateful day I would encounter my moment. But then again, who is really ready when that moment strikes?
I was on top of things this day, I had my rooms prepped, my monitors ready for whatever may befall me. I looked over to the charge nurse desk, and saw a patient on a stretcher. Oh lord, I thought to myself, this one looks like a challenge. He was talking, more mumbling, and at first glance anyone could have mistaken him for just another guy who had had too good a time out on the town. Boy, was I wrong. “Put him in that room, room 20.” They were pointing to my assigned room. My breath quickened, I picked up my pace, and I steadied myself for my new patient.
“He’s responding, but just barely.” I looked at him; he looked like someone in crisis, not at all as he first appeared by the charge nurse desk. And I knew then we had to work quickly before he deteriorated even more. “I’m starting IV access.” My hands fumbling, shaking, I tried to keep his hand steady. I missed. The other nurse missed. Another nurse and a nursing assistant were getting the patient on the monitor and performing all other duties. I called for the code cart. “We need IV access…And quick.”
“I know,” I exclaimed, attempting to keep my calm despite a steady surge of butterflies and terror creeping up on me.
“Hey,” the other nurse looked me squarely in the eye and said one of the most haunting things I have ever heard. It was not so much what he said, but the way in which he said it that really struck home. “This guy is going to die.” I swallowed hard. This stirred in me more fight than anything. The attending physician and respiratory therapy were at bedside as we furiously wheeled him into the trauma bay. Multiple rounds of epinephrine, a failed pericardiocentesis, a chest tube, you name it. We couldn’t save him. In the end, we all settled on a brain bleed. The ultimate diagnosis: fatal and sudden bursting bilateral cerebral aneurysms.
Despite knowing we did everything we could—we worked as a team, we poured sweat and tears into this case—it was not enough. Perhaps his fate was sealed before he entered our ER. But, I still recall staring at his lifeless hands, hands that one time held coffee, high-fived a friend. He was in his 20s. I cried all the way home. Like a baby. The stress of the whole day just releasing into my steering wheel.
As a new graduate nurse in such a demanding environment, with equally demanding patients and tasks, I learned I can never get used to seeing a dead body. But I also learned I never want to get used to it. I try and treat every patient with as much respect and dignity as possible, and more often than not I choose to not know the backstory unless necessary. Death in an emergent setting can be harrowing, but there can also be moments of calm sadness, if not even serenity.
What Can a New Grad Do?
1. Breathe. My biggest advice: BREATHE. Really, you would be amazed at what an inhale and exhale can do for one’s nerves and clarity of thought. In retrospect, I know that as a new graduate nurse just the simple task of breathing in such stressful situations is immeasurably beneficial.
2. Decompress. Does nursing school prepare you for all of this? No. I say a silent prayer for each zipping of a body bag. It is hard to tell others of such morbidity, and to this end, self-care and decompression at the end of the day is both healthy and necessary.
3. Reflect. I think back to that situation often, and realize, more than anything, the worth of reflection in clinical practice—for improvement, for your own sanity. I personally like fitness or long walks, but it should be something fulfilling for both your body and soul.
4. Forgive Yourself. Fast, critical thinking is needed, split-second task performance, and impeccable teamwork. Will this always happen? Hopefully so, but honestly and unfortunately, it isn’t always possible. If this is the case, then learn to forgive yourself, and know that all your heart, effort, and knowledge were put into the case. After all, nursing is both an art and a science. And taking care of others is one of the most beautiful of arts.
And still, at the end of the day, I make sure to always try and reflect on two pivotal questions: Am I happy? Am I a good person? What are your answers? I know that as a nurse I am happy, and I know that I strive every day to be the best person I can be—for my patients, for their families, for my coworkers. As for the art that keeps on giving? Maybe it can be said that nurses are medicine’s Monets.
Below, I interview Lt. Meg Whelpley, a nurse practitioner (NP) with the National Heart, Lung, and Blood Institute (NHLBI) on the Cardiology Consult Service at the National Institutes of Health (NIH). She tells us about her career as a bedside nurse, a travel nurse, an NP, and now as an officer in the Commissioned Corps of the US Public Health Service.
Tell me about your background.
I got my bachelor of science in nursing in 2005 from Johns Hopkins University. My first degree, however, was in information technology, and I worked for the federal government before deciding that I needed to go into nursing. I have worked in both adult and pediatric emergency departments (ED), the intensive care unit (ICU), and I now work in cardiology.
What was your first nursing job?
My first job as a nurse was in the ED at Inova Fairfax Hospital, a level-one trauma center in Fairfax, Virginia. It was wild and fun, and the teamwork was outstanding. It was an amazing introduction to nursing and medicine, and I am grateful each day that I started my career there. The challenges of that environment were innumerable, and the lessons I learned continue to impact my daily life, both personally and professionally.
What did you do next?
As can frequently happen in an ED, there was a mass staff exodus when I had been at Inova Fairfax for almost two years. Travel nurses were hired to fill open nursing positions. The new travelers told me about the glory of the travel nurse life, and I was single and ready for a change.
Where was your first travel assignment?
My first stop was a tiny rural hospital on the Eastern Shore of Maryland. They had fewer beds in their entire hospital than we had in the ED at Fairfax! It was a huge eye opener. In only my second week there, I was made charge nurse of the ED four nights a week. The manager told me I had more experience than any of her night nurses despite having less time actually at the bedside.
Being a charge nurse must have been a great leadership experience for you. Where did you go for your next assignments?
My next adventure was to was Denver, in a pediatric ED. I was nervous about taking care of kids, but I had a great time and loved the work. I was there for nine months before heading to Chicago. There, I was in the ED of a level-one trauma center, and again was part of a great team, but the work was tough. Inner city Chicago was very different from suburban northern Virginia. I was there for the last six months of 2008 when the financial markets crashed. The effect was definitely felt in travel nursing. I was thrilled to be asked to come back to Denver and returned there for a three-month contract in January of 2009. I was then offered a position there as a staff nurse, and I took it while I worked on taking the next steps to pursue my master’s degree.
What led you back to school for your advanced practice degree?
I really liked the idea of participating in patient care at a higher level. As a bedside nurse in the ED, most of the physicians I worked with appreciated my assessments, and they challenged me to think further about possible differential diagnoses. They were wonderful teachers. I wanted to focus more on diagnosing and treating patients, and I really believe in both the art and science of nursing, so becoming an NP was the clear choice for me.
Where did you start working after you were a CRNP (certified registered nurse practitioner)?
My first job was in the ICU at Inova Fairfax. I loved the work, but the schedule was really challenging. We rotated days and nights, and I even worked a few 24-hour shifts as needed. It was harder than any schedule I had as a nurse in the previous seven years! I quickly found a new position with the cardiology service at MedStar Washington Hospital Center in the District of Columbia, and I stayed there for two years. It was a great place to learn, and we had a great team of NPs. It was a very autonomous NP service, which was professionally satisfying. I had the opportunity to return to federal service with a position at NIH in 2013, and I jumped at the chance!
Do you remember when you first heard about the United States Public Health Service (PHS)? What drew you to this organization?
My first encounter with the PHS Commissioned Corps was at a job fair at Hopkins during my nursing undergrad. I was reintroduced to the service when I took my position at NIH—many of the people that work here are Commissioned Corps officers. I had always been interested in serving. You could say it’s in my blood: My brother was in the Marine Corps, my father spent his entire career as a civil servant, and my mother worked as a priest and social worker. Of course, my husband’s service in the fire department was also a big influence on my decision to serve. We hope to instill the value of service in our son, as well.
The idea of being a part of a group dedicated to “protecting, promoting and advancing the health and safety of the nation” was very appealing to me. I had looked at other branches of service a few times through my years of education, but the fit with the PHS was definitely right for me.
What did it take for you to become a lieutenant in the PHS?
There is a multi-step application process (detailed at www.usphs.gov) that requires that you obtain employment in a federally qualified position prior to commissioning. My position with the NIH qualified, but many other positions are available throughout the federal government, and you can begin the PHS application process before securing a qualified position. We work in the Bureau of Prisons, the Indian Health Service, the Centers for Disease Control, and the Federal Drug Administration, to name a few agencies. Once you receive your call to active duty, there is a required two-week Officer Basic Course as a part of the commissioning process, and then it’s time to get to work.
Where do you work? What is your role? What is a “day in the life” like for you in your current position?
I am currently an NP with the National Heart, Lung, and Blood Institute on the Cardiology Consult Service at NIH. I work with a team to evaluate patients enrolled in any number of research protocols there. We see patients before, during, and after their participation in research, depending on their cardiac history and needs. I get to spend a lot of time educating and learning, with both my patients and the students that round with us. It is a very rewarding job. I wear my uniform every day with pride.
What responsibilities do you have with the PHS?
As an officer in the Commissioned Corps, I have added responsibilities with the PHS, which include working with the Capital Area Provider (CAP) team in support of the Office of the Attending. My CAP team duties also include local deployments to act as medical support for mass gatherings throughout the District of Columbia. Additionally, I volunteer with the MobileMed-NIH Heart Clinic, which is an organization that provides cardiac evaluations for underserved citizens of Montgomery County, Maryland.
What is most challenging about your job?
Understanding the complex diagnoses of my patients in addition to the proposed treatments and their cardiac implications is a challenge every day! We see some amazing things at NIH, and almost none of it is straightforward. I have been here three years and not a day has gone by that I haven’t learned something new.
What type of person would be good in this role?
I think that my success in this job has come from my strong foundation and training in the art and science of nursing. Caring is an art form, and it is essential in developing relationships with patients and the teams with which we consult. Science requires focusing on details and critical thinking about patients to ensure the best outcomes possible. The type of nurse that would be good in this role needs to be a caring, detail-oriented, critical thinker—oh, and I write patient reports constantly, so good written communication is a must!
What is most rewarding about your work?
Patients here are very appreciative of their care. Because they are participating in research, there is no charge for the care they receive, which makes people really grateful. Grateful patients are refreshing for me, as that was not always the case in the other places I have worked. I also get to take my time with patients. I can really help them better understand their own hearts and how to best care for themselves. Education is an amazing gift to give to patients, and empowering them in their own care is very rewarding.
Ever wondered what it’s like to work in an emergency room? Read below as I make a diary of what it’s like to work a day in the life of an ER nurse.
5:20: Up and at ’em. I get coffee before the shower, because I stayed up too late watching a certain show’s season finale.
6:55: Clock in. I walk over to get report from the night shift nurse. She is in a patient’s room, so I spend some time reviewing the charts of the patients who are already in the zone I’m assigned. I have four rooms today, ER 5-8.
7:15: I’ve done a quick assessment of my rooms and what shape they’re in—I’ll need to stock linens and supplies before the day gets too crazy. It’s a Monday in the emergency room (ER), a day notorious for its patient volume. Mondays are the busiest—whether it’s because no one wants to come in on the weekend or because people generally are sicker, we’ll never know.
8:04: It’s after 8:00 a.m. and this is the first time I’ve sat down again at my computer to chart. I’ve assessed my two patients, started intravenous (IV) lines and drawn bloodwork, administered medications, and restocked my rooms as much as possible. I’m charting the work I’ve done so far and documenting medical histories and medication information.
8:22: Received my first discharge of the morning. Discharging a patient involves removing any IV, taking a last set of vital signs, and perhaps most importantly, thorough patient education. I will be providing instructions to this patient about her follow up for chest pain, any warning signs warranting return to the ER, and how to take her prescription medication at home.
8:45: It’s the calm before the storm. I’ve had time to refill my coffee mug, clean my rooms up a bit, and now I just sit and wait for my zone to fill up. I currently have just one patient with abdominal pain. I gave her contrast dye to drink, and when she returns from her CT scan (computerized tomography) I will give her some additional medications for pain, nausea, and rehydration.
9:10: I receive a new patient with leg pain from ambulance arrival, quick differential diagnosis after my assessment is to rule out a deep vein thrombosis (or blood clot) in his leg. He’s presenting with leg pain and has a history of blood clots, and takes blood thinners. His leg isn’t red or swollen, so we’ll see.
9:13: I look over the imaging results for my patient with abdominal pain. The CT scan is completely normal. I prepare for her discharge.
9:50: Ultrasound shows no blood clot, leg pain patient will go home.
10:07: I’ve turned over two of my rooms to two new patient arrivals. One arrived by ambulance, a 91-year-old female with shortness of breath and respiratory distress, whose oxygen saturation (normally 100%) is only 84%. I immediately place nasal cannula on her nose and position her for better oxygenation. She may have a possible congestive heart failure (CHF) exacerbation or pneumonia (PNA), so I am starting an IV, drawing the lab work, and preparing her for a chest x-ray (CXR). My other new patient is a 28-year-old male with fevers and facial swelling down into his face and neck. He looks like the characteristic photograph of a mumps illness, and he’s spent time in Disney World recently, so perhaps he was around a sick or unvaccinated child. I start IV fluids and bloodwork on him as well, and do a screen for strep throat and mono.
10:21: I’ve drawn additional lab work and given medication to my patients. I’m about to get a new patient into my other room, someone whose chief complaint is a headache.
10:25: I’m looking over the lab results for my CHF vs. PNA case. Fortunately, she only has a heart failure exacerbation: The CXR shows no pulmonary infiltrates, and her BNP (B-type natriuretic peptide, a cardiac enzyme that indicates heart stretching in response to fluid overload) is extremely elevated. We’ve given her a diuretic called lasix to pull some fluids off her lungs and try to improve her oxygenation, so now I’m waiting for her to start urinating every 15 minutes. Her call bell is in reach, but she’s 91 and not ambulatory, so the next hour will be interesting.
10:35: The morning rush is here! We are slammed. I got an “ETOH”—alcohol intoxication—who we place in the hallway. He’s a frequent flyer, so after checking his vitals and a blood sugar, I place a sandwich and urinal within reach. I’m helping out some of my coworkers as our zones fill up and the waiting room starts to build. We get four new nurses at 11:00 (who work swing-shift, 11:00-23:00), so on Mondays all we have to do is hold out til our reinforcements arrive!
10:39: My possible mumps patient is off to imaging for a CT of his neck to check for any masses or soft tissue neck swelling. My headache patient will be getting some lab work, fluids, and medications for his pain. It’s also time to help the 91-year-old to the bathroom and recheck her vital signs now that she’s diuresing. I’m on it.
10:50: Rut ro, apparently we are considering a lumbar puncture (LP) to rule out meningitis on the headache patient, because he now reports he’s also been having some neck stiffness, low-grade fevers, and fatigue. It’s funny that sometimes patients tell the nurse a completely different story than they tell the physician.
11:20: In the last 30 minutes I’ve provided an extensive education session on lumbar punctures, as my headache/neck pain patient is understandably anxious about the prospect. I’ve assessed a new elderly patient here for weakness and hypotension (rule-out dehydration, urine infection, or some other infectious or septic process); I’ve drawn her labs, collected a urine sample, and checked her orthostatic vital signs and an EKG. We are giving her fluids, since her pressure a little soft in the 80s/50s. I’ve applied a complex wound dressing to a patient who just got a laceration repair on his elbow, rounded on my possible mumps patient, and assisted my (now admitted) CHF patient to the restroom and rechecked her vital signs. She’s actually doing much better now, 96% oxygen saturation on a lower level of O2. She’s perkier now, too!
11:35: My patient definitely has mumps, as confirmed with an amylase level. I will discharge him, check on my head-neckache patient, and go grab a quick snack before I faint from hunger!
12:15: I’ve discharged the mumps patient and gotten a new patient, a female in her 60s who recently had an ablation surgery for a cardiac arrhythmia who now presents with chest tightness and shortness of breath, especially on exertion. I’ve done an EKG, drawn her labs, assessed her, and now we will wait for a chest XR and echocardiogram to rule out atrial fibrillation versus asthma. She is stable, but I have her on the monitors for now. My patient with the neckache has decided against medical advice to forego the LP, so we are waiting to finalize the plan of care. My hypotensive patient is stable, and I’m waiting for a bed assignment upstairs so I can call report on my admitted CHF patient.
12:40: Time for a diet soda and some pretzels. My admitted CHF exacerbation is getting rather impatient waiting for her bed upstairs. My new patient just got back from imaging.
13:50: Another hour as flown by without much time at my computer station. I transported the CHF patient up to our telemetry unit on a cardiac monitor, and I gave bedside report to her nurse upstairs. I also discharged my patient who declined his LP (but made sure to give extensive information about warning signs and symptoms dictating his return to the ER, should he actually have meningitis). I gave additional fluids to my hypotensive patient, and administered a breathing treatment to my lady with asthma vs. A-fib. I also received a new patient who had a syncopal episode (fainting) this morning—I drew his labs, got an EKG, and placed him on the monitor.
14:10: I’ve discharged my hypotensive patient. She responded well to fluids, she must have been low on volume. I rechecked her blood pressures and she was stable to discharge home with follow up. Now, since I’m down to two patients, I’m running to the back to eat my sandwich. A rare “lunch break”—I’ll take it!
14:30: I came back from lunch with a full zone—gotta catch up! Two new patients and several new orders on my other ones. I also have a psych patient, who reports having thoughts of suicide. We place her in one-to-one observation with a sitter, remove her belongings, and call the social worker for consult.
14:50: I now have a cancer patient with shortness of breath, fevers, and a cough, as well as a woman in her thirties with chest discomfort. I’m about to discharge my A-fib vs. asthma patient—turns out it was asthma!
15:41: My rooms have turned over again. My newest patient is a 41-year-old female with right lower quadrant abdominal pain that is tender to palpation, with nausea, vomiting, fevers, chills, and loss of appetite. Sounds like a classic appendicitis to me, so we will work her up to rule that out or in. I’ve discharged my syncopal episode, and I’m waiting to hear more about the plan of care for my others. Lab results are back, so we just need dispositions to get these patients on the road.
16:35: I’ve turned over some of my rooms again. My psych patient has been determined stable for discharge with resources for follow up and some medication prescriptions. My possible appy is waiting to drink contrast and head over to CT, and I’ve given a breathing treatment to my patient with bronchitis. I just had an impromptu education session with a diabetic patient who didn’t take any insulin today “because I didn’t really eat anything.” Her blood sugar was 500, so we can’t discharge her now (even though her headache is gone) until we get her sugar under control. Up go the fluids, in goes the insulin!
16:55: I got pulled over to our ambulatory care area to help a colleague with a backlog of wound care, crutches teaching, and medication administration on that side. Mondays are also a big day for the fast-track area, lots of people who have minor injuries. Summer is also “laceration season,” along with bug bites, sunburns, and minor accidents.
17:10: The post-work rush is here, the waiting room is filling up. I help a colleague grab a stat EKG and blood work on a patient with diaphoresis, shortness of breath, and chest pain.
18:15: A few more patient discharges, medications, assessments ensue. The possible appendectomy will be transported to the operating room for surgery, so I have to draw a few additional pre-procedure labs and hang some IV antibiotics. Almost done, just keep swimming!
18:36: I rush down the hall because my patient-care cell phone is alarming that there is a Code Stroke in room 1. I hurry into the room and my fellow nurses and I quickly grab a blood sugar, attach the patient to the monitor, perform an EKG, and assess the patient according to the NIH Stroke Scale. The patient has slurred speech and right-sided weakness, and the primary nurse shuttles her off to CT for imaging. If the patient is a candidate for the clot-blocking medication called TPA, it needs to be administered within 60 minutes to meet the core measure standard for strokes. I know the patient is in good hands with my colleagues!
18:55: Made it through the day without a code. Time to give report to the incoming night-shift nurse. I round on my patients one last time, recheck vital signs, and tell them I am leaving but they are in great hands with the night nurse.
19:19: Clock out. Walk to my car. Phew!
19:24: As I drive by the main ER entrance I see the headache patient I had earlier walking back in. I consider stopping for a moment, but figure his symptoms didn’t go away and that he wanted the LP now. I say a quick prayer he doesn’t have meningitis and drive off-campus. Another day on the books, and I’m back tomorrow for more.