ER life

I am no longer an ER intern. I am now an ER nurse. Saying these words is exciting, yet terrifying at the same time. My first day on my own started off nicely, with most of my patients only having minor problems. I began building up my confidence- I can handle this whole nursing thing! Then a patient with DKA (diabetic ketoacidosis) was brought to my room. I dread DKA patients more than I dread any other type of patient. They require a large amount of work and monitoring from the moment they enter the room until they finally can go up to the floor. I am not sure why the charge nurse gave me this child my first day on my own, but it probably was not the wisest decision. The girl’s blood glucose was above 700 (should be around 100) and her blood pH was 7.14 (her blood was acidic). She was slurring her words, which is never a good sign. DKA puts patients at risk for cerebral edema (brain swelling), which can cause death. I took a deep breath and started working. I had a little cheat sheet I made for myself on how to handle DKA patients- what labs to draw, how to calculate the fluids, etc. I knew I needed two large IV’s, so I overhead paged my tech. No response. I overhead paged any available tech. No one was available. Crap. I tried twice to get an IV on her, but was unsuccessful. Not off to a good start! I finally got a small IV in and was able to get her blood sent to the lab. By the time I got everything organized, it was time to draw more labs. The IV would not draw back blood, a new resident had picked up her chart and was standing there reading through the protocol to see what to do next, and the mother kept demanding that we give her a meal ticket for the cafeteria. Didn’t she realize how sick her daughter was? I felt like the room was spinning and that I was going to hyperventilate. I still had two other patients! Right when I was about to lose it, the resident figured out what needed to be done, my tech arrived and was able to start an IV, and the pharmacist helped me hang all the necessary fluids and insulin. Another nurse agreed to check in on my other two patients, and even helped me get that first IV to work again. As I was charting everything going on in the room, it hit me. I am nowhere near being alone! The night nurse arrived and although it took half an hour to give report and try to explain everything that had gone on, I couldn’t help but smile as I walked back to my car. I had made it through my first day “on my own.”

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23 thoughts on “ER life

  1. Way to go in handling your first DKA "on your own".  My first night as a resident in the PICU, I got a girl in DKA.  I spent the entire night awake near her room, talking to the nurses (who were all thankfully much more experienced than I was) about what happens next, etc.  I was so freaked out about the possibility of her crashing while I was taking care of her, I just stayed awake watching her labs and such.  I was so happy the following morning when my attending showed up and confirmed that I did alright. 
    I agree, although DKA has kind of a set protocol of what to do, the possibility of a bad outcome is very scary.

  2. OMG! I have made myself so nervous about starting in the ED at the end of the month!!! I have just graduated and registered and will start the Graduate programme in the Emergency specialty.  How does your intership programme work? How long ago did you graduate? Sorry for all the questions, I am just amazed at how much you seem to know, my mind has gone blank and it feels like forever since I actually helped a patient. 
     
    Thanks for stopping by at my blog at unimum209@blogger.com I appreciate your comments.

  3. Just remember you\’re never really alone..all you have to do is hollar really loud, and another nurse will bust a gut getting in there! You did great..you\’ll look back at this time and laugh, someday…it\’ll all be old hat to you then. I remember that time..that\’s about when I looked around for a new challenge!!lol Even neonatal became old hat eventually… remember my mantra..if they\’re all alive when I leave, I did great.. Even if they\’re not, as long as it wasn\’t me, I still did great!! You will learn and get more comfortable, I promise. Just hang in there.
    Hugs,
    Jean

  4. I used to read your blog every day since the time it was a featured item, but havent been on in months.  Out of the blue I wanted to see what happened and I\’m really happy for you that everything worked out.  If I am ever hurt, I hope I\’m lucky enough to get a nurse that cares as much as you do!

  5. Congratulations on your "Nurse" status!  It\’s true, you are never truly alone and soon you will be an ol\’ pro!  I\’m sure that seems way off for you, but you\’ll get there.  Just think, the next time you get a DKA you will already be that much more experienced.  Never be afraid to ask for help!
     
    We are all pulling for you, Katie!!

  6. Dear Lord, Katie!  I\’ve never even heard the word "intubated" before, but that scared me like you wouldn\’t believe.  High fives to surviving the first day "on your own". *whew*
     

  7. Happy New Year Katie–
    Just wanted to stop in before I start hitting the books Monday. Gee that 30 days went fast…
    Barbara

  8. Wow Katie!!  Congrats first of all!!!  Second, what a story!!!  Sounds like you have a great team backing you up.  I liked you idea of having a cheat sheet with you…I will need to do that for myself, I just need to dedicate the time to complete it!   It seems as if time is on fast forward these days!  Too bad I can\’t fast forward to where you are!  Ha ha!  Today I practiced injections on weeinies and oranges….I actually felt sorry for these items.  But I got thumbs up and nods of approval…..so I did the happy dance.  Take care and keep up your fantastic work!
     

  9.  
    congrats on surviving your first day alone as the new ER nurse!!! No matter the lows that will happen….you are a wonderful person and I\’m sure an even more wonderful nurse…. try to remember that when it hurts…
     
    take it easy and don\’t work too hard… WAIT? YES work hard… LOL :o)

  10. Well congrats on your first day "on your own"!  You made it!  And I\’m sure after time that self-doubt will lessen.  Happy Monday!God bless 🙂

  11. It\’s horrible to be new!  I always feel like it takes me three months to get really good at a new job… And you have a "new job" every single night you work, I think.

  12. It\’s horrible to be new!  I always feel like it takes me three months to get really good at a new job… And you have a "new job" every single night you work, I think.

  13. I AM SO HAPPY FOR YOU!!  BRAVO!!!! I envy you more than you will ever know. I have even considered going back to school to bring my credits forward so that I could take my boards. I still think about it alot. Who knows..maybe one day I will get the wild hair up my butt to return to a nursing career!

  14. I enjoy reading your blog.  Can you tell me the process leading up to going to nursing school?  I am applying right now and would like to know what you went through, how hard it was to get in, what you wished you knew back then that you know now etc.   If you have time, please email me and I would thankfully appreciate any feedback!  Thank you so much!!
     
    Tasha
     
    tdc03@hotmail.com

  15. Hi..wow I really liked your story.  Brought back memories. Iam an icu nurse and I just wanted to say those ideas you expressed about "something done worng" doesn\’t usually go away,especially with kids.  I have been working in the icu for 8 years now and I still have days like that… But when you feel your getting overwhelmed call out for your charge nurse thats what she/he is there for. …  Don\’t be afraid to ask question, even if you feel they are stupid or you need reassurace that you are going down the right road.  You have peoples lives in your hands and healthy doae of fear is good.  It will make you cautious..and with time and repeated exposures you will gain more confidence.  Now the real training begins…….. April RN BSN CCRN

  16. Where\’s Katie????  Is the hospital keeping you 24-7??? LOL! Seriously, I miss reading your blogs!!!!  Hope all is well…Eve

  17. You are rapidly building your experiences in the ER.I like how you came to realize that you were"on your own". The team of nurses we work with are our greatest resource. Pt\’s with diabetes and esp DKA can be challenging to care for.Also in your case , the care of pediatric(juvenille DM)diabetics is esp complex.Sounds like you handled things well.Before you know it, YOU will be the experienced one……………….Nurse Bill

  18. I went to Emergency this morning with Scooter (he had croup we found out) and thought of you the WHOLE TIME, remembering your breathing babies blog…  I kept praying Scooter wouldn\’t have asthma… Still am, as both Jonathan and I have some asthmatic symptoms.  🙂 

  19. I\’m needing more stories.  🙂  I hope everything\’s okay.  You\’re one of two of my blog spots that has taken a wee break from the virtual world.  🙂  I hope it\’s rejeuvenating and hope to see you soon.  🙂

  20. Katie..ER NURSE..whoo whoo
    I had clinical rotations last week in ER…OMG  organized chaos!!  I enjoyed it because time flew by.  It made me nervous because because some doctors give you a look of "don\’t you know?".."what you\’re doing?"  Our ER had 18 rooms..one man was yelling and yelling so a nurse sent me into to see what he wanted in his room.  Well he was 92 years old and just wanted a drink of water.  I asked him what on earth was he in the ER for? (and told him that he did not look sick!!) he smiled and replied..welll, when I go outside I get cold….and when I come back inside I get too hot…..and I\’m sick of it. ( I thought okay…this man is l o n e l y..and old…and he has a right to be sick of it) I visited with him for 20 minutes and his daughter came in (and gave me this ..WHO are you and WHERE have you been?) I finished up by telling him to drink lots of water (the elderly don\’t realize how much they need to keep hydrated due to loss of sensory nerves) I enjoyed the visit and went to the next room where a German man thought we were going to cut him open and sell his organs…I was usless there except to inform him that I was a student and just wasn\’t smart enough to find an organ much less cut one out of him….while one man beyond the curtain was tossing up his toes…if he barfed one more time..I thought I\’d loose it…then I drew blood, began IV\’s, ran to the lab…delivered a patient up to her long awaited room.
    …….how I get a sinking feeling when I think that in 5 months that LPN titled will be in my lap…Katie keep writing…I am still reading and bloggin….NURSING II is so much easier to me than Nursing I…..my feet get so tired from 12 hour clinicals and I still feel so dumb.   I have had 7 knee replacement patients.  I cried when my patient had a tumor scrapped out of his baldder and I went home and via internet found out that 90 percent of them are malignant…this week I saw him come back to the hospital just a frail old man loosing weight, worried,….bonified bachelor for life at 76…..coming in for his illioscomy. 
     
    Katie keep on blogging….you are the nurse I inspire to be.
     
    bloggin joyceee….

  21. You go girl!!  I know I\’ve never met you but I\’m proud of you.  The work you do is so awsome.  Keep it up and don\’t freak out, you\’ll do great.
    Musica

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