Friday, December 18, 2009

10 Things I have Learned/Learning in the ER: Some are easier than others!!

Things I have learned and or learning in the ER:

!. The definition of a fungating carcinoma (look it up and look at a picture)

2. That it is impossible to diagnose everyone with something…sometimes “of unknown etiology” is the best you can do…arrrrggghhh!!

3. If you can see a patient , get lab results and/or x-ray results, and get them discharged in under two hours…you have hit a home run!

4. That the patients WILL NOT stop coming in the door, therefore it is up to me to go get something to eat or go to the bathroom…because there will never be any downtime!

5. Just LISTENING to a patient apparently makes them feel better…I have had several patients and their families tell me I am a great listener and appear to care…of course all of the caring in the world is useless if I can’t figure out what is actually wrong with them!! (See number 2)

6. A seemingly harmless tooth abcess can actually turn into a major abcess that prompts the radiologist to call looking for the one (me) who ordered the CT of the head….lesson learned! If in doubt, order the darn test!! It’s never good when the radiologist calls to give the report over the phone instead of wait to dictate it!!

7. Just because someone doesn’t act like they are in much pain (even if a horse rolls over the top of them), they just might actually have their whole darn elbow broken off!! (Another lesson learned, don’t always trust a patient if they say they don’t really hurt)!

8. Apparently one can be too friendly to people (not patients)…and get themselves in trouble without even realizing what happened….(very hard lesson learned)

9. Do not EVER as a new NP pick up the chart that says room 1!! Room one if for the very sick and the trauma patients…embarrassing lesson learned!!

10. Having a background in women’s health has been what has made me feel confident on the days that I just want to go cry in the bathroom (and sometimes I do). My women’s health patients give me the incentive to carry on and hold my head up when I feel inadequate….

Thursday, December 3, 2009

Baptism by Fire...My FIRST day as a nurse practitioner in the ER!!

My FIRST Day as a Nurse Practitioner in the Emergency Room!

November 23, 2009 at 1:00 pm began the first day of my new career; a career that I had been preparing for almost non-stop the last 4 years. It was with great uncertainty that I walked into the emergency room with my backpack full of reference books, blank notebooks and Soy Joy bars for nutrition and the trusty lavender colored stethoscope I used all during my clinical rotations at Vanderbilt.

Baptism by Fire doesn’t even come close to the next 7 days or 84 + hours I spent in the ER praying for a simple otitis media, sore throat or sprained ankle to pop up on the patient screen. Injuries or disease processes that I felt confident I could assess, diagnose and treat as a newly graduated NP. I was hoping that I could at least be orientated for a day before being set loose to stumble my way through the maze of beds, rooms, and hallways that make up the ER at WBH. As luck would have it (and I am certain it isn’t because I seemed so competent), I observed 3 patients and was basically on my own. Words can’t describe the terror that shot through my body as a fellow NP handed me a chart and said “Ok Dani, go assess this patient and do the physical, then come back and dictate his chart”! WHAT??? I haven’t even learned how to use the phone for dictating yet?

Case 1: Patient #1!!

CC: Neck pain x 2 days

My first patient as a newly certified NP!! I will never forget him as long as I live. Neck pain and stiffness x 2 days. No known injury, woke up with stiffness across the shoulders and down the neck. Do you do a CT of the C-spine if no known injury is documented? Do you simply examine and make the diagnosis of “Acute cervical strain” and either prescribe a muscle relaxer or have the patient take OTC NSAID’s for pain? All questions that I was unsure of (a feeling I am becoming VERY familiar with)!

What would you do?

As I was leaving the room, he told me how nice I was and could tell I loved my job (a job that wasn’t even 2 hours old)! Certain I shouldn’t tell him he was my FIRST patient ever, I decided to tell him anyway. He told me he was going to tell anyone he knew that had to come to the ER to ask for the “red headed lady”…oh my….

And so, I began my new career with a satisfied patient (not often is an ER patient happy, I have discovered) and a totally botched up job on the dictation!

The learning curve is steep (Mt. Everest steep), the staff and doctors have been great, the hours are long and the patients don’t ever stop coming through the door (therefore there is NEVER a good time to eat or pee)……I love it!

Integrative Family Medicine