Reflections from Two Years in the Emergency Department

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I recently had my two-year anniversary of working in the ED. Crazy! When I transferred from Med/Surg to the Emergency Department, I was terrified to say the least. I had zero critical care experience and was coming from previous jobs at two pretty small hospitals to a huge one. For a month I had to do education and get ready for the task ahead – learning how to be a safe and competent ED nurse. It wasn’t going to be easy!

June 12th, 2016

The morning of my first day precepting in the ED I woke up, of course late, and hurried to get ready. I was so nervous! I got on the road and remember thinking how empty an early Sunday morning on I-4 is. Suddenly, when I was almost to work, a police officer came flying up behind me. I thought, “Oh shit. This is it. I’m going to get a ticket for speeding and have to tell my preceptor what a loser I am on my first day.” Ha. Turns out, he was speeding toward what was at the time, the worst mass shooting in American History – the Pulse Nightclub Shooting, that would end the lives of 49 beautiful people and directly injure 53. I walked in through the EMS bay with my new badge access, still oblivious, and gave a big friendly smile to security and police officers guarding the door. I had no idea what happened yet. I remember thinking, “Boy the people here are grumpy in the morning!” When I walked in for pre-shift huddle, I got the news. We were all devastated and didn’t know what the day was going to look like.

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My first patient in the ED was a young person who had been shot twice. I remember we were getting ready to move to surgery and as I was assisting them out of some of their personal items, I noticed there was still a lot of blood around the back of their head in their hair. I asked if they knew if they hit their head also or had been hurt there and they replied blankly, “I think that’s my friend’s blood.” The trauma of everything they had been through in those early morning hours had shocked them to their core and they didn’t know if their loved ones were dead or alive. It shook me. I went through the day meeting new people and putting on a nice face. We took calls all day from people looking for their loved ones. Some that we would later hear the names of on the news as passed away from this horrific act of violence. I got in my car that night and sobbed the whole way home, thinking what a huge mistake I had made and how I should just quit while I was ahead.

One Foot in Front of the Other

In the days after my first day, I decided to come back every day and put the work in to see if I really did make a mistake or not. With lots of encouragement from my mom, another ER nurse, and my now fiancé, I put one foot in front of the other and continued to learn and change my floor nurse ways into those of an ED nurse. It was a big source of humor with some of my colleagues and I think I even helped them learn a thing or two. I ended up changing preceptors after 4 weeks (if you and your preceptor aren’t jiving, DON’T IGNORE IT!! You aren’t helping them or yourself! Some people just don’t do well together, and that’s okay.). I got some really critical patients and learned so much about what it takes to take care of these super sick people. I laughed, cried, and was worn the heck out some days.

I am thankful I precepted in the summer with its lighter patient flow and acuity. In Florida, the Summer is a lot like a Game of Thrones’ Summer (“Ohhhh, my Sweet Summer Child!”). Things are quieter for the most part (yeah, I said the “Q” word”) and the acuity of patients is somewhat lower. I felt like I had more time to ask questions and really learn. In the Florida Winter, some phenomenon happens and things get crazy, to say the least. I survived the following Winter on my own – even if I had to go cry in my car at the end of the day a few more times than I care to admit.

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Onward Bound

In the last 2 years and some change, I have grown, learned a lot about myself and my chosen area of nursing, and have really realized that ER is the best damn place to work in nursing (okay, maybe I’m biased…but still). So here are some lessons I’ll share for you:

  • You will take $h!t for missing IVs. Doesn’t matter how many amazing IVs you get that nobody else could get. Doesn’t matter if it’s 1 missed attempt a month. Someone, somewhere, will give you hell about it. And you will laugh.
  • You will find some crazy and ridiculous coping mechanisms.
  • Your sense of humor will twist into something unrecognizable and completely wonderful.
  • You’ll learn how to adapt to your circumstances and think on the fly, even when you may not have everything or all the people around that you need. You’ll do whatever you have to for your patients.
  • Every other nurse in the hospital hates you and a lot of the doctors will think you’re stupid/the worst. Okay maybe not that dramatic, but nurses will act like they hate you when you give report and some doctors will get so irritated when you’re holding their patients and can’t do everything for them there that the floor nurse can (and they do a heck of a lot we just can’t!).
  • You might get assaulted. You will encounter physically and verbally abusive situations and need to know how to handle them. Another post on this for another time.
  • You will find the most amazing, closely knit family in your ER co-workers and you will need them and lean on them more than you think.
  • You will sometimes hate your job, but you will always love it.

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Much love and luck,

Just Ask the Nurse

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