As of today, I've been working in the ER as a tech for a year and four months. I've been in the hospital setting in general for two years. In the tech position, I feel as though I'm a professional part of a team. The ER is a tight-knit group, where one person can make a huge difference in the work atmosphere, patient flow, and overall dynamics. In this exclusive group, I'm the employee with the least required education. I have no license, or registered title, or even certification (unless registered nurse aide counts). Yet, I am responsible for making sure everything flows smoothly. I order and coordinate labs, radiography, and respiratory therapy. I clean and lay down fresh linens, and stock each of the nine rooms. I track down and page doctors for the ER doctor. I gather records, send records, and otherwise obtain information if a situation demands it. I perform all EKGs in the department, and all "Stat" EKGs in the hospital itself (and my EKG interpretation skills are better than some of the nurses). I help nurses as directed, and, if I'm finished with my current tasks, I check in patients and run vital signs. I perform compressions when a patient is in cardiac arrest, and run to calls to help subdue aggressive patients. I irrigate lacerations in preparation of suturing, and I dress wounds as required.
This paragraph wasn't to brag (well, maybe a little), but to illustrate the training and experience I get from this job alone. As I get more in depth in the medical field, I am drawn towards expanding my scope of practice. To that aim, I've begun the first few steps. I'll be starting prerequisite classes this winter for Physician Assistant school. The schools I'm looking at require a certain number of experience hours. By the time I finish the classes, I should be a fairly competitive applicant, assuming I keep my GPA up. It's good to have a goal again, and it's strange how quickly two years have passed.
Thursday, October 1, 2009
Thursday, July 16, 2009
On Behalf of the ER
I've decided that today would be a good day to hopefully explain some mysterious going-ons that patients and families of patients have asked about. It's meant to be a not-very-comprehensive but also-not-sarcastic little list.
1. The ambulance came to pick up my mother, but then sat in the road while they fiddled around in the back putting in an IV. Why weren't they rushing to the ER?
- A lot of times, the medics will perform interventions that they feel is needed immediately before transporting the patient. For many of these interventions, having an access point to the vascular system is important. This is especially true if a patient is unstable - it's best to put an IV in while it's still possible (i.e., there is still enough blood pressurizing the veins to allow a peripheral IV attempt) rather than having to resort to more invasive methods (needle that goes into bone marrow, needles that go into your jugular, etc). Keep in mind that IVs are the gateway through which fluids and many medications can be administered.
2. The nurses are all just milling around outside. Why am I just sitting in this room, what am I waiting for?
- Unfortunately, this question occurs due to a lack of communication. Once the initial barrage of assessments, x-rays, and blood draws is over, we have to wait to have the results back. Our lab can take around an hour or two to return the more common tests, while some uncommon ones may take longer. X-rays are usually available for the ER doc to see within a few minutes, while CT scans and ultrasounds have to be digitally sent to a radiologist off who-knows-where. The radiologist types up a report of his/her findings and then faxes it to us in about an hour and a half.
- The reason the nurses may be milling around is because he or she has done everything for the moment, and is now waiting for results or more doctor's orders. The ER personifies the "hurry up and wait" mindset. Also unfortunately, the nurse cannot always stay in a room with a patient while waiting - he/she needs to be available to take care of the other 1-4 patients he/she may be responsible for.
3. Why was that person brought back before me? I was here first.
- During registration, a nurse will triage each patient that checks in. The patient is marked 'non-urgent', 'urgent', or 'emergent'. These are based many variable such as why the patient is checking in, initial impression, past medical history, etc. That man sitting in the chair may be complaining of back pain after lifting heavy furniture, but if he is also pale as a sheet, has a blood pressure of 90/50, and has a history of an aortic aneurism, he is going to go ahead of someone with an abscessed tooth. The entire system is centered around priority. Nobody comes into the ER for fun, and it is understandable to be frustrated by the wait and the feeling of being bypassed by other patients, but critical patients always come first.
4. Why do I have to get all these procedures done again? I had all the same ones on my last recent visit.
- While the previous test results may be good to set a 'baseline' (what your lungs usually look like in x-ray, what your ekg usually shows, etc), we need to see why you feel or look the way you do now. We're trying to figure out what changed, and in doing that we need to look at all the potential causes. You may have had an ekg done last week, but today you're having chest pain, and another ekg may show that parts of your heart are dead. Things like that are very very important to catch.
I may or may not add more questions here as they arise. If anyone reading has any, go ahead and comment and I'll try my best to answer it!
1. The ambulance came to pick up my mother, but then sat in the road while they fiddled around in the back putting in an IV. Why weren't they rushing to the ER?
- A lot of times, the medics will perform interventions that they feel is needed immediately before transporting the patient. For many of these interventions, having an access point to the vascular system is important. This is especially true if a patient is unstable - it's best to put an IV in while it's still possible (i.e., there is still enough blood pressurizing the veins to allow a peripheral IV attempt) rather than having to resort to more invasive methods (needle that goes into bone marrow, needles that go into your jugular, etc). Keep in mind that IVs are the gateway through which fluids and many medications can be administered.
2. The nurses are all just milling around outside. Why am I just sitting in this room, what am I waiting for?
- Unfortunately, this question occurs due to a lack of communication. Once the initial barrage of assessments, x-rays, and blood draws is over, we have to wait to have the results back. Our lab can take around an hour or two to return the more common tests, while some uncommon ones may take longer. X-rays are usually available for the ER doc to see within a few minutes, while CT scans and ultrasounds have to be digitally sent to a radiologist off who-knows-where. The radiologist types up a report of his/her findings and then faxes it to us in about an hour and a half.
- The reason the nurses may be milling around is because he or she has done everything for the moment, and is now waiting for results or more doctor's orders. The ER personifies the "hurry up and wait" mindset. Also unfortunately, the nurse cannot always stay in a room with a patient while waiting - he/she needs to be available to take care of the other 1-4 patients he/she may be responsible for.
3. Why was that person brought back before me? I was here first.
- During registration, a nurse will triage each patient that checks in. The patient is marked 'non-urgent', 'urgent', or 'emergent'. These are based many variable such as why the patient is checking in, initial impression, past medical history, etc. That man sitting in the chair may be complaining of back pain after lifting heavy furniture, but if he is also pale as a sheet, has a blood pressure of 90/50, and has a history of an aortic aneurism, he is going to go ahead of someone with an abscessed tooth. The entire system is centered around priority. Nobody comes into the ER for fun, and it is understandable to be frustrated by the wait and the feeling of being bypassed by other patients, but critical patients always come first.
4. Why do I have to get all these procedures done again? I had all the same ones on my last recent visit.
- While the previous test results may be good to set a 'baseline' (what your lungs usually look like in x-ray, what your ekg usually shows, etc), we need to see why you feel or look the way you do now. We're trying to figure out what changed, and in doing that we need to look at all the potential causes. You may have had an ekg done last week, but today you're having chest pain, and another ekg may show that parts of your heart are dead. Things like that are very very important to catch.
I may or may not add more questions here as they arise. If anyone reading has any, go ahead and comment and I'll try my best to answer it!
Monday, June 8, 2009
I'm almost through with another week-long stretch at work, and I'm feeling pretty good. I'm slowly becoming accustomed to the odd sleep schedule, and I'm starting to understand exactly how much sleep I need as a minimum. Night shift is the fine art of arranging your lifestyle around sleep, which I admit makes one appreciate sleep quite a bit. Not too much noteworthy has happened recently in the sleepy little ER. A handful of true emergencies, a parcel of urgent issues, and a whole truckload of mostly unnecessary visits. I signed in a patient yesterday who had a chief complaint of "sunburned face". He had a little bit of reddening around his eyes and cheeks - he rated his pain as an 8 out of 10. This would sound completely ridiculous but for the fact that he's a known drug seeker, so I suppose any excuse would do. Because of the sunlight, we have had several patients check in with sunburns, which doesn't make much sense to me. I can understand how it can be painful, but I'm curious as to what mentality would make someone think of the ER as a place to go for it. I suppose I can blame popular culture and commercialism, where everything and everyone should be medicated (at least according to the pharmaceutical companies).
In other news, with the fiance applying for (and likely to be accepted to) a radiology technologist program, things are up in the air. The school is a three-hour commute from where we currently live, so we're going to have to figure out whether we need to move or if we're going to keep our home base here. There are many arguments for both, so crunch time will be later this week when we get word back on acceptance. I will either keep this job, or apply for another ER position at a hospital in that other town. Either way, I'll work while she gets edumacated, and then we'll switch off once she graduates.
In even other news, I recently attended an in-house tournament at my judo club and attained yonkyu rank (blue belt). Now I need to start really training my butt off so I can get to brown belt! With no schooling to distract me, I can focus on work, the kiddos, and physical training. It's pretty nice. When I'm not working I'm either playing with the kids (we made some cool little bonfires last weekend!), sleeping, or training. Five days a week of lifting/cardio/judo/jiu-jitsu is pretty good, it tends to balance out well with the rest of my schedule.
In other news, with the fiance applying for (and likely to be accepted to) a radiology technologist program, things are up in the air. The school is a three-hour commute from where we currently live, so we're going to have to figure out whether we need to move or if we're going to keep our home base here. There are many arguments for both, so crunch time will be later this week when we get word back on acceptance. I will either keep this job, or apply for another ER position at a hospital in that other town. Either way, I'll work while she gets edumacated, and then we'll switch off once she graduates.
In even other news, I recently attended an in-house tournament at my judo club and attained yonkyu rank (blue belt). Now I need to start really training my butt off so I can get to brown belt! With no schooling to distract me, I can focus on work, the kiddos, and physical training. It's pretty nice. When I'm not working I'm either playing with the kids (we made some cool little bonfires last weekend!), sleeping, or training. Five days a week of lifting/cardio/judo/jiu-jitsu is pretty good, it tends to balance out well with the rest of my schedule.
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