Growing from Novice to Expert
After twenty-one years in the ER, I’ve yet to meet anyone involved with emergency nursing brave enough to call themselves a true expert. Emergency nursing is constantly changing because emergency medicine is constantly changing.
The past twenty-one years have been a series of learning experiences for me. I’ve learned that sometimes you have to cry and sometimes, no mater how hard you try not to, you just have to laugh. And it’s okay to laugh. I certainly don’t advocate standing at my patient’s bedside to laugh. I’m just saying there is some humor to be found in this job. I don’t have to look for it because it usually finds me.
Several years ago, I was working at the front triage desk when a gentleman came in by wheelchair. So when I saw the man’s arm wrapped in a beach towel, I got up and walked over to him. He said, “I think I’ve cut my fingers off.” Since there was very little blood on the towel I had the same robotic reply that all ER nurses learn early in life. “Let me see.”
The man flipped the towel back and when he did three fingers flew across the waiting room in different directions. Now, nothing can create havoc in a waiting room any quicker then body parts on the floor. People were horrified. In fact, some were getting out of their seats to get away from the fingers. As I put my gloves on, I tried not to laugh, but I lost it when the patient chuckled, “Aw, hell, they’re mine. I’ll get ’em.” Before I could speak, he was out of the wheelchair and had retrieved all of his fingers. He came back to the wheelchair, sat down and cradled his fingers in the towel for safekeeping.
In all the years I’ve been in the ER, I’ve never seen a baby delivered in the special room designed to deliver babies. The very first one I ever delivered arrived on the coldest, rainiest night I’ve ever seen. A man came running into the ER asking for a wheelchair so he could get his wife out of the car. I didn’t know enough to ask what was wrong with her, and he didn’t know enough to tell me. I found the mother wedged up under the steering wheel of a tiny Volkswagen in the process of having her baby. Between God and me, we delivered that baby, wrapped him in my lab coat and had him in the ER in less time than it took to get the mother out of the car after delivery. I learned a lot that night and even today, I won’t go anywhere with a wheelchair without knowing were and why.
On most days, ER nurses work with many different doctors caring for many different patients. Sometimes anticipating what a doctor wants is a judgment call, and we all make mistakes. Such was the case fifteen years ago. The doctor was an intern. He is now on staff and knows who I am, where I work, and what I did, so let’s just call him Dr X. I went with Dr. X to do a pelvic exam. He sat on the stool to do the pelvic exam then stood up to do the bi-manual exam. I said, “Let me move this,” as I moved the stool out of the way. I had no way of knowing he intended to sit back down. Anyway, he was in the middle of the bi-manual exam when he decided to sit down on the stool that wasn’t there. Well, as the doctor fell on the floor, the patient was rising up off the table looking for him, and I was standing at the door contemplating my future in healthcare. A Kodak moment if there ever was one.
About twenty years ago, the EMS crew would call into the ER, identifying their patient with color codes to signify severity of illness or injury. Their color green was non-life-threatening, yellow was potentially life-threatening, and red was life-threatening. At the same time, my hospital decided they needed a fire code. So, they made code red for fire and code blue for cardiac arrest, which meant that the ambulance patient could be a code red until he hit the door, and then he became a code blue.
They say confession’s good for the soul. I called a code red for a cardiac arrest, and the switchboard operator called the city fire department. It was pretty impressive because the fire department responded with engines, ladder trucks, and all the fire fighters dressed in full gear. The patient was deceased on arrival, which left me facing the hospital administrators in the middle of the hall with what appeared to be the entire fire department. I thought about my very life passing before my eyes. I had to fill out an incident report but didn’t get fired.
I guess self-preservation is the one and only thing I’ve learned that I hope will never change. To me, it means knowing that it’s okay to walk away and cry when you need to, and it’s okay to walk way and laugh when you can. Self-preservation has allowed me to grow professionally as maybe I’ve grown from novice to expert – an expert novice, that is.
Sandi Reinholdt, RN
Emergency/Trauma Center, Riverside Regional Medical Center
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