My Locker

I have a small locker to keep my stuff secure while I'm at work. Here's a peek into my locker:

Originally uploaded by jeku arce

Coffee + mug
This goes without saying. A must for pulling night shifts and long days. Also good for keeping morale up by making a fresh brew during the shift.

Crystal light
Because the taste of water is without flavor.

Various medications
Omnicell access is for patient meds only. I bring my own just in case.

Gum
For building rapport with patients and staff.

Various snacks
Keeping the hunger down when not able to get lunch or just out of energy.

Toothbrush + toothpaste
For those long overtime shifts or those times I don't have Orbit to keep my teeth minty fresh.

Things I want to add:
Photos of friends and family

*Note: I have no vested interest in any of these products.

Eat with me please?

One night one of my patients had come back from a procedure and was NPO for a long time. I offered her a box lunch (sandwich) because our dining facility was closed. She refused and wanted something else. My patient asked for a phone book to order food. I checked her diet orders and she was clear for a regular diet. She was given a phone book and she had money with her and made her order. My patient asked me if I wanted any thing to order, but I politely refused.

When her pizza came the CNA working with me told me that my patient who ordered pizza wanted me to have some pizza. My CNA told me that my patient insisted that I go in.

At this point I'm at an ethical dilemma: politely refuse again a free gift harming rapport or accept this free gift to increase rapport with my patient. I know I'm to maintain a professional nurse-patient relationship, but my patient keeps insisting I take this gift.

I made sure all my other patients were fine and went to see my patient. She had plates, soda, and the pizza she ordered on her bedside table. Seeing her face I knew I would do more harm by refusing again. I pulled up a chair next to the bed and took a slice she offered to me. We began to converse about her life as a military wife prior to when her husband retired. She had quite the travel record. She told me about her favorite places and the amazing things she saw. After about 15 mins I thanked her for the food and told her I needed to go back to work.

I realized that my patient just wanted someone to talk to. She did not have any visitors that day and her husband has passed away. I feel that ordering food was a way to entice me to spend some time with her making me feel guilty for trying to refuse her offer. It worked.

Was my decision the right thing to do? This was not a monetary gift, however it was not shared with the rest of the staff who was working that night. However, my patient kept insisting I eat with her. At the time I didn't really know the answer, but spending time with my patient made her feel better.

Emergency Department Rotation

WAMC ED
Originally uploaded by jeku arce

Chaos. Mayhem. Fury.

Those are some of the words some people call the ED. Being that my home unit is a medical/telemetry floor where most things are scheduled out for my shift, I agree with some of those descriptive words. During my rotation I found 3 characteristics one must have when working in the ED: good communication skills, critical thinking skills, and endurance.

Communication -
Asking the right questions related to the patient's chief complaint is important in determining the plan of care. Obtaining information can be difficult when a patient is unable to answer questions due to development level, with decreased level of consciousness, or refuses to respond. Getting information from parents, friends, or EMS becomes crucial in obtaining patients medical history: surgeries, medications, allergies, etc.

Communicating with staff and ancillary staff is important in implementing care. The doctors are in close proximity looking at x-rays, labs, and writ ting orders. This makes bringing up concerns easier to bring to attention. I've had several pediatric patients with problems I had no solutions to. Calling up to pediatrics and getting consults over the phone from other nurses helped me implement care for my patient. Knowing who to contact for help made giving care easier.

Critical thinking -
This skill is needed when acting as triage nurse. My experience with the triage nurse showed me how low my expectations were. I feel acting as triage nurse is the 2nd hardest job next to being charge nurse in the ED. The triage nurse asks the chief complaint of the patient and follows and the algorithm related to the chief complaint. The thinking process is "at this moment, what will kill my patient?" With each patient response the triage nurse can rule out possible causes. This may seem like diagnosing the patient, but it the goal is to get as much information needed for the nurse and doctor that will see the patient next.

Situational awareness is necessary when acting as triage nurse. The ability to gauge the waiting room wait time and to see what patients need to be re-prioritized will provide a smoother shift. The waiting room is full of people with many different chief complaints. Some may be non-emergent like a cold or some may be emergent like chest pain. Being able to re-prioritize who needs to be seen next can save a life. My preceptor told me that people can die in the waiting room.

It's vital to keep assessing your patient from the time you see your patient walk through the door until when the patient leaves the building. The patient's condition can change at any moment and being quick to catch the change to respond to it can safe your patient's life. With every vital sign check to just talking freely keep assessing your patient for changes.

Endurance -
This can be defined as the "ability to sustain a specific activity for a long period of time." Nursing care can take a toll on the body. Being in the ED the only time I had time to sit in a chair was when I was typing up discharge orders. It can get very busy during the day it is important to keep your energy and attitude in high gear. Having snacks in my pockets and drinks readily available kept my energy up. I learned that having a weird sense of humor is necessary to get through the day. Laughing at a silly joke or talking about the time where a staff member expeled their emesis on a patient after not being able to tolerate the smell of feces when cleaning up the same patient lightens up the mood from a rough day.

I enjoyed my week rotation in the ED. I the skills I learned can be applied to my medcial/telemetry ward. Now I know what's going on before my patient gets admitted to my floor. Boy do they have it rough down there.