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!


  1. Sooo.. What did you do? Order the CT or do the muscle relaxer? In the office setting, I do everything I can to determine the cause and most times it's muscle spasm.

  2. I actually ordered a C-Spine x-ray, no acute injuries shown. Gave him a muscle relaxer, told him to take OTC NSAIDS and sent him on his way! 99% of my back pain etc, have been muscle spasms. What a learning curve this job is!! We need a support group for NEW NP's in the ED!!

  3. It usually is muscle spasms but sometimes people just can't understand that it is possible to have pain without it being a critical matter. Pop over to my site for a post on ER nurse practitioners and ED wait times. I think you will like it!

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