Behind the Curtain: The Emergency Room through the eyes of a nurse

At one point or another, most people will go to a hospital emergency ward. They might come with a friend or family member, they might just be passing through to get to another ward, or they might be the person sitting in the chairs waiting to be seen. However, you do not have to go to hospital to know about the infamous ‘waiting period’ of the emergency ward. Even I have fallen prey to the dreaded wait. A friend went to the emergency room in Toowoomba and I accompanied them, we arrived at 1900hrs roughly (7:00pm) and didn’t get seen by a doctor until 2200hrs (10:00pm). Three, long, mind bogglingly boring hours we sat there.

It made me wonder, ‘what on earth could they possibly be doing back there?’.

I wouldn’t get the answer to my question for another two months, when I looked at my allocation for my final clinical placement.
“Emergency Ward – Princess Alexandra Hospital”

I was over the moon. Who could ask for a better placement? High acuity patients means lots of tasks that need doing, which means as a student I get to do more and see more. It’s bad for the people in hospital, but great for me and the other nursing students.

When it was time for clinical, I drove to Brisbane and greeted my grandmother who kindly allowed me to stay at her house for the four weeks. Then the next day, clinical began. As far as placements go, it was fantastic. In my opinion, the people in charge of allocations for nursing practicals should put everyone in an emergency ward all the time because you see some many different things and get to do more than you might in a normal ward.

Due to privacy laws, I didn’t take any pictures so I don’t have any show readers of my time there. However, I did hear some good stories.

One particular day, we had a man present to emergency with a nail in his knee – he had been building in his backyard with a friend when the nail in the nail gun ricocheted and landed very snuggly in his knee causing pain, agony and a little embarrassment. It caused great excitement among the nurses, because one interesting patient always makes everyone talk about other interesting patients they’ve had. This man, unbeknownst to him, started the story train.

Two particular stories stood out for me. There was a man who came into the emergency room once with a nail in his eye. How on earth he got it there, nobody knew – as he wasn’t very forthcoming on details.

The second story, having moved from the topic of nails to eyes was about a man who came in with his eye hanging out of its socket. Every time he moved his head from side to side, it would almost ‘flap in the breeze’ the buddy nurse described but, luckily for the man, he went into theatre, they popped it back in and he could see fine. (I suspect there may have been more involved that just putting the eye back in its socket but I’m not down pat with those sorts of details).

But that doesn’t answer the question. The elusive question of “What the hell is taking so long?”

If I may be so bold, allow me to answer on behalf of all nurses.

The Doctors.

We (nurses) are usually fairly fast, once all the initial paperwork is done. That’s because we’ve only got about four patients – and that’s on a busy day, unless we’re covering someone else’s break in which case then it can be about six. That, however, is our limit. It means we’ve got time to do all the tasks that the patients need.

Sometimes we have patients that take a little more time. For example, while you may be lying in a bed after having finally been taken behind the triage desk, wondering why the nurses leave you alone for ages, we may very well be dealing with a septic patient, whose bowels aren’t working thereby causing gas build-ups and I could natter on about how bad their prognosis is but you get the idea. If you’re not too bad and there is someone who is worse, the nurses are going to be with the other guy. However, we do still have some time for you.

The doctors on the other hand might have about 11 or 12 patients. They might not directly see the patient, but they need to know what is happening, what treatments they might need and so forth. Basically – if we’re busy, you can be sure the doctors are even busier, which causes the delays. Then there are problems like beds not being ready on wards and waiting for test results, all of which takes time.

I think I’ll end this entry with a couple more patient stories and a non-specific funny picture.

We had a lady (not a child) present to the Emergency Room because she couldn’t remove a band-aid from her finger. (No, I’m not kidding.) Apparently it hurt too much to take off. The nurse, being the kind caring lady you expect all nurses to be – ripped it off and told her to go home. The nurse then told me that people have come to hospital for dandruff related issues. Again, not kidding.

We also had our fair share of drug seekers. A lady was sitting in bed reading a magazine, and when I walked past she waved me over and used these words…

 “Can you get me a glass of water, a band-aid for my foot and some Endone please?”
If I’d been drinking something I might have sprayed it over her face in surprise.
“Oh yes… some Endone,” I said hesitantly, “What would you say your pain score is?”
The lady leaned across the bed to rummage around in her bag for her phone.
“Oh…” she seemed to think about it for a moment, “I guess it’s about a seven…”

Please note, anyone who has a pain score of 7/10 is usually lying on the bed clutching something or sweating a little or groaning or all of the above. None of which she was doing.

It’s a shame there are people like that abusing the system, but you have to take the bad with the good – and as promised, the non-specific funny picture.

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Bye for now,
Laura

Group Assignments

 You know them.
You love to hate them,
And no university blog is complete without them.

They creep from the shadows into courses you’d least expect, and force you to do things you wouldn’t normally do, associate with people you would normally have never spoken too. They destroy friendships and make our hair go grey.

Group Assignments…
Group assignment

For some unknown reason, teachers think it’s a good idea to group people who have never met and give them a task that involves working together and give them all marks based on the overall presentation…

The only positive about that scenario is that you don’t know anyone so you’re free to love or hate him or her as you desire. If you’re already friends with someone in the group, then things tend to get awkward when they don’t do any work and you have to whip them into shape.

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However, there are methods to make sure people do what they are supposed to. The particular method that I favour is called a ‘Team Contract’. Basically, everyone writes their name and their allotted task then they sign underneath a couple of sentences that state that “if you don’t do your task then you don’t get any marks” – or something to that effect. A copy is posted on the forum so that everyone, including the teacher can see what you’re meant to be doing and if you’re actually doing it. It doesn’t guarantee that the work people do will be in any way good, but at least they do something.

I heartedly recommend Team Contract’s to anyone about to go into a group assignment. It makes the whole thing a bit more business-like. Plus then you can threaten to stick a lawyer on anyone who doesn’t pull his or her weight.

While not all nursing courses have big group assignments, most do have teamwork. For anyone who has done, or will do, an OSCE (which is the term used to refer to our exam where we dress up and give dummies medications, wound dressings, respiratory assessments or something along those lines) is probably the most hated thing in nursing.

Doesn’t matter if you’ve done the stuff a thousand times. When you’re asked to do a certain number of things in 20, 30 or 50minutes, with someone staring over your shoulder and coughing when you might not be doing something wrong – your brain shuts down and starts wailing like a three-year-old.

The first few OSCE’s that I had to do were done alone, and I confess that after my second one I had a bit of a cry because I couldn’t remember a single thing I was meant to do. But that has nothing to do with teamwork. In later OSCE’s, one requires a partner. This can be both a blessing and a curse – depending on the person. If you get a partner who is fairly confident and doesn’t let their nerves get to them, then the experience isn’t too bad. If you get one who is a nervous wreck then you become a nervous wreck and both of you do terribly. Not fun – let me tell you.

My motto with teamwork and group assignments is to expect the best and prepare for the worst. In OSCE’s for example, if you have to fake a bit of confidence then your partner thinks that you’re confident and that may calm them which will in turn calm you.

In group assignments, if you’re like me and worry that a certain person won’t do their part and be ready on the day then have a fail-safe in place. Don’t do their work for them though, because then that teaches someone they can get away with doing nothing. Before the talk, tell the teacher that so-and-so hasn’t fulfilled their requirements – show the team contract, and let the teacher mark the team based on who pulled their weight. Don’t be afraid to delegate tasks, usually not everyone in the team is terrible.

That’s about all I have to say for now.

Here’s a funny picture for your enjoyment.
hokey pokey
Bye for now, Laura.

#success

At present, I am just about to start a clinical for uni at the Royal Children’s Hospital – the main focus being mental health.

This is getting me thinking about mental health in general, and how our western culture, with our constant exposure to technology and media affects our mental health.

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To my mind, it seems as though many young people – some of whom I’m friends with, are on anti-depressant medication, along with scores of other pills aimed at making one happy. To me, it seems to be a loosing battle because our society has very specific guidelines, if you are to take subliminal messages at face value.

“Girls should weight this much, have their hair in this manor, wear these clothes and have this many friends. Then they will be beautiful”

It might not be something we’re conscious of, but its most definitely there. The other thing that I have noticed is that everywhere we look; there are subliminal messages that we need to be ‘successful’ in order to have a good life and be a good person.

This week, I wanted to look at success; how I view it and how others advise we obtain the increasingly desirable, and yet ever elusive ‘success’.

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I’ve read books and articles on the theory of success. All say the same thing, which is very aptly summarized in the above picture.

Success is not necessarily determined by how much money one has. In order to say that one has been ‘successful’ in life, one must first have a goal to reach, without a goal, there can be no success. An example of this could be that the boy sitting next to you in class wants to be a business tycoon when he gets older. Everything that I have read states that if he writes what he wants to be when he is older and the steps he must follow to attain that goal then he greatly increases his chances of becoming the person he wants to be. Simply thinking them, saying them out loud, or even writing them on a computer is not enough. Writing your goals on paper, gives them life that is not the same as simply speaking the words aloud.

 He might write – ‘I want to be a business tycoon when I’m older. This means that I have to do accounting in high school, and then a business course at uni or tafe, I have to read business magazines once a week, and pay attention to the things that other people do and say so that I know what they want and can make good business decisions.

This is pretty fair afield from my goals. I didn’t write a long-term goal quite like the one above, I wrote an ‘In 5 Years goal, which basically said,

“In five years, I want to have graduated Uni and be travelling the world and helping people,”

easy to achieve and what I want to do.

If someone were to ask me what I though success was, I’d say something along the lines of,

“We were all born on this planet for a reason, and that reason is to make the planet better for those who follow, and to be successful we have to make the planet a better place”

I’m sure there are people who would say that we were born to give birth or that there are far more complicated reasons, but that about sums it up for me.

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But how is any of this relevant to university? My advise to those just starting is to set goals and strive to achieve them. But don’t set goals you know you’ll just ignore. Perhaps set a goal for one semester that states,

“ I’ll pass all of my courses this semester. If I get better – fantastic, if I just pass, then I have succeeded.”

But make sure to leave time for friends, family and relaxation because without downtime it is easy to give up on one’s goals.

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 I hope I’ve given you something to think about,

Cheers all,

Laura