DiversityNursing Blog

10 Things I Wish I Knew Before I Became an Emergency Room Nurse

Posted by Pat Magrath

Wed, Dec 14, 2016 @ 12:37 PM

nurse-male.jpgIf you’re an Emergency Room Nurse, you may have some things to add to this list. If you’re in Nursing school or considering changing your specialty to ER, this information may be helpful to you. 

As a recent patient in the ER, I was amazed at the composure of the ER Nurses and the way they handled the chaos around them. While in the ER, there was an individual constantly complaining about how long he had to wait to be seen. Every Nurse was kind to him even though he was annoying everyone else waiting to be seen. With everything going on around them, I saw that every Nurse was professional and focused. Emergency rooms couldn’t exist without the expertise, professionalism, attention to detail, and compassion of the Nurses in the ER department.

1. Unlike most specialists, you need to know how to treat people of all ages and needs. Emergency nursing is considered a nursing specialty, but we’re also generalists. We take care of children and the elderly, pregnant patients and psychiatric patients, patients with special needs — you name it, we do it. It’s essential to regularly brush up on medical information and keep current in your continuing education, because you have to be prepared for any kind of patient to walk through the door.

2. Deciding who to treat first is really, really hard. We do get the stereotypical “emergency” cases — heart attacks or trauma victims — but we also see patients who are not able to get care from a primary care physician. A triage nurse will do an “across-the-room survey” to see who needs to be seen immediately and who can wait a little longer. In most emergency departments, only experienced nurses [with] advances certifications perform triage.

3. Multitasking is essential. You need to think fast on your feet, because you never know what’s you’re going to be asked to do next. One minute, you might be drawing blood or starting IVs; next, you’ll be checking on someone’s vital signs; then you might have to perform CPR on someone. Fortunately, there are many safety mechanisms in place to catch potential errors. For example, before we give a patient medication, we scan both the patient's ID band and the medications to make sure it’s the correct one, [and] we’ll do a targeted medical history, and review current medications and allergies to make sure there are no problems.

4. It’s way more work than it looks like on paper. Traditionally, nurses work 12-hour shifts, three shifts a week. It’s less than a 40-hour workweek, but it’s still exhausting: There’s virtually no downtime and you’re physically on your feet, running around during the entire shift. I wear a FitBit and I can easily put on 5 miles in a single day. In my institution, we also have on-call times, so you have to sign up for so many hours of on-call every six weeks — beyond your regular shifts — and be prepared to go into work at a moment’s notice.

5. You’re a nurse no matter where you are, even when you’re off the clock.When people know you’re a nurse, everyone wants to know if you can take a look at their rash or help them heal a cut or tell them how to get over a cold. A couple weeks ago, I was on an airplane and wound up taking care of a passenger who was having difficulty breathing after the flight attendants asked if there was a medical professional on board.

6. You will become fanatical about your loved ones' safety. I’ve seen a lot of things come through the ER doors, and a lot of injuries could’ve been prevented. For instance, we treat people who were in car crashes but didn’t have their seatbelts on, or children who were not in their car seats, or bicyclists and motorcyclists who weren’t wearing helmets. All of those injuries can be prevented.

7. Emergency departments don’t always hire nurses straight out of school. The reason is that new nurses take upward of six months to get oriented, so that basically means six months of training before a brand new nurse can start working. Some ER nurses start off in intensive care, telemetry, or maternal child health to gain experience before applying to work in the emergency department. Another way to get a foot in the door is to start as an ER department tech, which offers on-the-job training and can give you the experience you need to be an ER nurse. Some nursing students also do a preceptorship, where you can shadow a nurse for a few months while you’re still in school. I’ve taken on students for preceptorships and several of them have been hired in the end, so it’s a good way to make connections and prove you can do the job.

8. Sometimes, patients will treat you like a punching bag. There’s a lot of what we call “violent verbal abuse” in our department. Patients might call you names, or take out their frustrations by yelling at you. I think everybody just has to put on their armor before coming to work but it does affect you. It helps to be part of a professional association where you can vent to other nurses at the end of the day, or just talk it out with somebody who understands the environment.

9. You will have to learn how to deal with death. These days, especially with medical technology, we’re saving more and more people due to the advances in healthcare. But you will also see the cardiac arrest who can’t be saved, or the person who has such bad trauma that they bleed out. Death is part of the territory but nothing can really prepare you to watch one of your patients die. The hardest cases are when the patient is young. When you see something really upsetting, that’s where you lean on your network of other nurses. It’s so helpful to talk about what happened with someone else who understands.

10. Just being there with a patient, or patient’s family, can be healing. Most people, when they come to the emergency department, it’s not a planned visit. Patients and their families are dealing with a lot of anxiety and stress, and we have the opportunity to be there when people are most vulnerable. Just being there, holding their hand — that can go a long way.

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Topics: emergency room, emergency room nurse

After 2 Liver Transplants Woman Becomes Transplant Nurse

Posted by Erica Bettencourt

Wed, Jun 17, 2015 @ 12:31 PM

By Erica Bettencourt

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When did you first know you wanted to be a Nurse?

This story is very touching about a patient’s perspective of Nurses at a very young age. Her experience with the Nurses who cared for her over the years, made Nursing an obvious choice for her.

Laurie Lukianov, 26, is a woman from Massachusetts who received two liver transplants as a child and is now working to become a transplant nurse. She told Boston Children's Hospital's blog “There is no question in my mind. Since I was 3 years old, I wanted to be a nurse.”

Laurie was born with biliary atresia and she needed liver transplants to save her life. At 3 years old she made headlines when she became one of the first patients in the country to receive a liver transplant from a living donor -- her father, Alex Lukianov.

When she was 13, Laurie Lukianov needed a second liver transplant. It came from an organ donor, and she had to fight for her life.

"I had 13 emergency surgeries from the two-week span from the initial transplant," Laurie Lukianov said.

But she won the fight and continued on to good health with the help of her family, a great surgeon and nurses.

Now the mother to a 6-year-old boy, already works in a local emergency room and is finishing her first year of nursing school.

Laurie Lukianov is also an advocate for organ donation. She tries to let potential donors know that the medical staff will do everything to save a life. Sometimes modern medicine falls short but, the gift of life is never lost on the recipient. 

Topics: emergency room, nursing school, nurse, transplant nurse, liver transplant, biliary atresia, organ donation

51 Years After Accident, 7-Inch Car Part Found in Arm

Posted by Erica Bettencourt

Fri, Jan 02, 2015 @ 11:30 AM

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Fifty-one years ago, Arthur Lampitt of Granite City, Illinois, smashed his 1963 Thunderbird into a truck. This week during surgery in suburban St. Louis, a 7-inch turn signal lever from that T-Bird was removed from his left arm.

Dr. Timothy Lang removed the lever Wednesday during a 45-minute operation. Lampitt, now 75, is recovering at home.

The St. Louis Post-Dispatch ( http://bit.ly/1EOtGa6 ) reports that the accident broke Lampitt's hip, drawing attention away from the arm, which healed.

A decade or so ago, his arm set off a metal detector at a courthouse. An X-ray showed a slender object the length of a pencil, but since it caused no pain or hardship, Lampitt was told to let it be.

He was moving concrete blocks a few weeks ago when the arm began to hurt for the first time.

"Everything was fine until it started to get bigger," Lampitt's wife, Betty, said. "The arm started bulging."

Lampitt decided to have surgery. He initially wasn't sure what was in the arm. He wondered if perhaps a medical instrument had been left during the emergency room visit in 1963.

He unearthed a collection of old photos of the mangled Thunderbird taken by a friend at the scene. He noticed the metal blinker lever was missing from the left side of the steering column. He figured that was it, and surgery at City Place Surgery Center in Creve Coeur, Missouri, confirmed it.

"Seven inches long," Lang told Betty.

"Oh, my God," Betty said.

Lang said a protective pocket grew around the lever.

"We see all kinds of foreign objects like nails or pellets, but usually not this large, usually not a turn signal from a 1963 T-Bird," Lang said. "Something this large often gets infected."

Lampitt wasn't sure what he'd do with the lever ? maybe make a key chain out of it.

"We'll figure out something, I am sure," he said.

Source: http://abcnews.go.com

Topics: surgery, emergency room, accident, car part, arm, health, healthcare, medical, hospital, infection

ER Visits on the Rise, Study Reports

Posted by Erica Bettencourt

Wed, Nov 26, 2014 @ 11:49 AM

By Robert Preidt

ERsign 18172 resized 600

The number of emergency department visits in the United States rose from about 130 million in 2010 to a record 136 million in 2011, according to the U.S. Centers for Disease Control and Prevention.

The findings also showed that fewer people were going to ERs with non-urgent medical needs: 96 percent of patients were identified as needing medical care within two hours of arriving at the ER. In 2010, that number was 92 percent, according to the research.

Sixty percent of patients arrived at the ER after normal business hours (after 5 p.m. on weekdays). One-third of visits were for patients on either end of the age spectrum -- younger than 15 or older than 65, the researchers found.

Almost 30 percent of visits were for injuries. The highest injury rates were among patients 75 and older, the study noted.

"The report also finds that there are large numbers of admitted patients who wait long times for inpatient beds," Dr. Michael Gerardi, president of the American College of Emergency Physicians (ACEP), said in an ACEP news release.

"Nearly two-thirds of patients waited two or more hours for beds in 2011, and nearly three-quarters of hospitals continued to board patients, even when the emergency department was critically overloaded. Hospitals must move admitted patients out of the emergency department faster to make room for the increasing number of people coming," he said.

It's believed that there will be about 140 million ER visits in 2014, according to the ACEP.

"The growth in patient demand aligns with what emergency physicians have been seeing and predicting: demand is going to increase," Gerardi said.

"Given that our nation's population is aging, and emergency departments have a critical role as the front line of responding to disasters and infectious disease outbreaks in America, such as what we saw with Ebola, we need to prepare for increased numbers of patients," he added.

Despite increasing use of ERs, most hospitals had not expanded their ERs as of 2011 and had no plans to expand them in the following two years, according to Gerardi.

"Emergency departments are essential to every community and must have adequate resources," he said. "They continue to be under severe stress and face soaring demands, despite the efficiency of caring for more than 136 million of the sickest patients each year using only 4 percent of the nation's health care dollar. This report is more evidence that we are going to need more resources, not less, in the future."

Source: www.nlm.nih.gov

Topics: ER, emergency room, studies, health, healthcare, nurses, health care, medical, physicians, hospitals

Study pinpoints issues that leave ED nurses vulnerable

Posted by Alycia Sullivan

Wed, Feb 12, 2014 @ 01:11 PM

By Nurse.com News

A qualitative study on assaults on emergency nurses, sponsored by the Emergency Nurses Association, found a need to change the culture of acceptance that is prevalent among hospital administrators and law enforcement.

Better training to help nurses recognize signs of potential trouble also is key, according to researchers, whose study was published Jan. 17 on the website of the Journal of Emergency Nursing.

“Assaults on emergency nurses have lasting impacts on the nurses and the ability of emergency care facilities to provide quality care,” 2014 ENA President Deena Brecher, RN, MSN, APN, ACNS-BC, CEN, CPEN, said in a news release. 

“More than 70% of emergency nurses reported physical or verbal assaults by patients or visitors while they were providing care. As a result, we lose experienced and dedicated nurses to physical or psychological trauma for days or sometimes permanently. Healthcare organizations have a responsibility to nurses and the public to provide a safe and secure environment.”

According to Bureau of Labor statistics, an assault on a healthcare worker is the most common source of nonfatal injury or illness requiring days off from work in the healthcare and social assistance industry. 

Despite that statistic, the qualitative research study discovered a culture of acceptance among hospital administrators, prosecutors and judges. One emergency nurse assault victim told the researchers the “administration will only take action when some lethal event happens.”

Perhaps in correlation with the culture of acceptance, the study also concluded that emergency nurses and hospital personnel in general are not trained to recognize cues for violent behavior. 

“It is imperative that hospitals and emergency care workers address the issue preemptively through adoption of violence prevention education, zero-tolerance policies, safety measures and procedures for reporting and responding to incidents of workplace violence when they do occur,” the researchers noted. “Such actions are necessary to help nurses recognize incipient violence.”

The ENA long has taken the position that healthcare organizations must take preventive measures to circumvent workplace violence and ensure the safety of all healthcare workers, their patients and visitors.

“There will always be the potential for violence against emergency nurses,” Brecher said. “But we must not accept it as the price of helping the sick and injured. With training and a change of culture, we can significantly decrease the occurrence of assaults against emergency nurses.”

The study was conducted using a qualitative descriptive exploratory design. In the fall of 2012, a sample of ED nurses was recruited by email from the roster of ENA nurses and through an announcement on the ENA website. Eight men, 37 women and one person of unknown gender responded to the question, “Tell me about your experience of violence in the emergency setting.” Answers were emailed to and analyzed by the Institute for Emergency Nursing Research. 

Only one other previous qualitative study is known to have been conducted to address workplace violence against emergency nurses in the United States since at least 2004, according to the news release.

Study abstract: http://bit.ly/1iwMuM8 

Source: Nurse.com

Topics: study, emergency room, prevention, nurses, ENA

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