Reflective Essay on 14 Years of Emergency Nursing: Challenges, Coping and More

Over my 14 years of an emergency nursing career, I have cared for a range of patients of different cultural and sociogenic backgrounds with varying issues. Although this makes nursing challenges, I have the great ability to remain clear-headed, non-judgmental, and be able to cope with whatever happens or is happening with patients. It was a busy winter day in the Emergency Department (ED). Staff receives Shift report. In the story the census in the ED: We are holding two medical/surgical patients, eight telemetry patient, four ICU; code 3 in room 16 and 10; a Limited Trauma just rolled in and15 Behavioral Health holds; my assignment to care for four Behavioral Health holds. I have ambulation of memories how I help save lives with stroke, STEMI, PE, trauma, but I like to talk about mental health which turned into a medical patient that fundamental nursing help saved her life. I received a report from the PM nurse; there are no Behavioral Health beds in the area; no one has been presented to the mental health facility and everyone been sleeping.

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Hall patient number 1: 45-year-old male. Arrived at the ED via ambulance from outside of parking lot from a store. The patient has a history suicidal ideation; the plan is to jump in front of traffic. History of drinking vodka every day for six months since his divorce. He has recently been fired from his job for alcohol intoxication. It has been 24 hours since his last drink.

Hall patient number 2: 41-year-old male has arrived at the ED via police 5150; the history of methamphetamine abuse. The plan is for him metabolized to safety and social work to and Behavioral health team to evaluate in the morning. Hall patient number 3: 68-year-old male. Arrived at the ED via ambulance with a history of suicidal ideation, depression, HTN, DM, alcohol, and drug tax adverse. Room 6 patient number 4: 32-year-old Spanish speaking female came into the ED; plan to shoot herself; she been calm and cooperative. Per pm nurse, "easiest of the three patients. My other patients kept me busy, the only thing I have done so far for the patient in Room 6 are vital signs, room safety check, meal tray, and offer toileting. After almost 3 hours of helping my other 3 patients, I was able to do a complete assessment of the patient in room 6. I first reviewed her chart and notice she came in as a trauma patient with a Gun Shot Wound (GSW to her right thigh) this was not told to me during nursing handoff. I performed a head to toe assessment then assess her wound. My patient was reticent did not ask for anything but cooperative with instructions. She understood my basic Spanish, but for complex information, I used an interpreter. I explained what a 1799 and 5150 is and our process for mental health holds. Even though the patient did not want to go to a 5250 facility, she was appreciated for the information. Then I proceed to ask questions and assess her wounds.

The patient has been here for three days waiting for placement without any wound assessments. To my surprise, the patient still had her original pressure dressing on that should have been checked and removed by Trauma services after the first 24 hours. I removed the bandage and also found an imbedded metal x-ray tag next to her GSW wound left by radiology. Her wound was complicated to clean d/t her green paper gown stuck to the sticky substance from the pressure dressing and digging out the metal x-ray tag. She was quiet throughout. Although the patient's vital signs were within normal limits patient has physical symptoms of infections and cellulitis spreading from her wound. I notified the Emergency Department MD and called Trauma services. I was given orders to start and IV and give IV antibiotics. She was admitted to the hospital. Trauma MD thank me and states that they had drop the ball d/t she was given an outpatient follow up a referral for a wound check not realizing that she was being admitted to Behavioral Health for suicidal ideations. My so-called "easies" patient turn out to be close call.