Month: August 2019

This is the way WE do it…

During my time as a nurse, I find myself often asking “how do you do this here?”, a question often used; yet, the frequency of this question seemed to quadruple while I was working in the USA. I guess it is a typical question asked at many new jobs; however, getting a reply of “that’s the way we do it here” was unsettling.

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Healthcare is more than just fixing boo boos. And nursing is more than just “caring”. We are educated and should be using our brains with each assessment, intervention, or treatment we do. There should be evidence-based research that supports what or why we do things, and we must be cautious of not falling into the “that’s the way we do it here” attitude…

When we accept the “that’s the way it’s done here” attitude, we are not taking an evidence-based approach. Sure, potentially when the action was first introduced into the department, it was evidenced-based. And initially, nurses were taught the “why” related to the action; however, over time details become blurred and content becomes saturated with “I don’t knows” or “I don’t remember why we do it this way” until the telephone game is played for so long that we no longer remember the “why”.

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One of the things that struck me while working in the USA, was the lack of specialty training for emergency nursing. Yes, eventually one could study the NENA (National Emergency Nursing Association) book and write an exam to be ED certified, but as we know nursing is more than book work. The norm for training USA ED nurses, in my experience, was preceptorships. Now, this is a changing field of study, and in 2017 there were some more formal education processes being initiated and developed to help establish some standards of education. However, prior to this point, nurses were hired into the ED, received approx. 12 weeks of preceptorship, and then were “ED nurses”. I’d also like to say, that I have worked with some amazing nurses whose knowledge base is/was tremendous; however, it’s a long road for some and no one can deny the gaps in knowledge discovered along the way.

As an ED nursing specialty certified RN (BCIT) and a grad student (at the time), I saw an opportunity to look at this issue deeper and found that very few schools in the USA offered specialty training but awareness on the lack of specialty training was gaining ground and specialty training was emerging as a new norm. The research indicates that patient outcomes, length of stay, and patient satisfaction are all improved with advanced trained nurses on staff. The numbers are significant enough to support advanced training for nurses and encourage employers to set this as a new standard!

Through developing these programs, even in-house ones, the field of emergency nursing can only benefit. Through standardization, nurses will receive the same education with smaller variances in information delivery, thereby increasing the understanding of why we do something verses the “just because” answers. Although, the USA is slow to introduce this level of education (in BC it’s been established since 1985), it is refreshing to know that it is in progress!

I am happy to share my research on this topic and encourage nurses to advocate for advance training in specialty areas! Keep up the brilliant work!

Well done my USA friends!

Do you have a story or comment you’d like to share, please feel free to contact me or leave a comment!

fullsizeoutput_1e3c Trudi

(some images in this post are from unknown sources, no copyright infringement intended)

It’s all about teamwork…

The very essence of the ED is not knowing what will walk through the doors at any given time. We don’t know the background, the history, their story…

At times the unknowing is exhilarating, and other times it is anxiety provoking. Some nurses are always looking for the excitement of the ED and others will always feel the anxiety; I float between those emotions depending on many of life’s variables. Days at the end of a set, when you are tired and have already seen lots of action, are days I’m more anxious about the unknown. I supposed it’s because subconsciously I am aware of my mental fatigue and I worry that I won’t be at the top of my game.

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(As always, I will not disclose person, place, or time to protect the identity of the patient.)

I don’t recall the emotion of the day prior to receiving the gunshot victim…

When you look up from your desk, to see a security guard pushing a young man in a wheelchair through the EMS bay doors, the first thought is…”that’s weird, why are they coming in that door?” And then your brain starts to process the blood pooling on the floor as the wheelchair is pushed into the nearby trauma bay. By now, your body is moving, and your brain is engaged, and your eyes are assessing…Airway-check, breathing-check, circulation-oh no!

Up to this point, I had managed to go all of my nursing career without taking care of a gun violence victim. I’ve always prided myself on being the “white cloud” of good luck. But in these moments, having not experienced something, leaves you feeling vulnerable in your knowledge. As an ER trained RN, we are provided with education that supports us in these moments, ABC’s. And often instinct is what gets you through the rest.

As our patient came through the bay doors, we made quick work of getting pressure applied to the open areas of the bleeding leg, we continued pressure, lifted the patient onto the stretcher and began cutting the clothes off. We noted 2 holes, just above the knee and were careful not to label those holes as entry or exit. The holes could have been from 1 bullet or 2.

Many things happen simultaneously in the ED, and I’m usually proud of the teamwork that happens in these situations. Blood was being delivered from the lab, a search for a proper tourniquet was in progress, IV access was happening, cardiac monitoring initiated, support personal were notified and helicopter was on-route.

Many healthcare providers in these types of situations, describe time differently. Some say time speeds up and others describe things in a slow motion, but it’s interesting in the in between moments of what you take note of and where your attention wanders. Once I was able to securely wrap the leg, I observed how much blood there truly was. It was pooled in the wheelchair seat, puddles marking the route from the door to the trauma bay, shoe prints and smearing from nurses slipping in the blood on the floor. I remember thinking, with all this blood, were we fast enough, did we do a good job, will the patient make it, will he keep his leg?

After some intense moments, leg wrapping, blood products, and of course patient centered care, after all he was awake and talking to us through this whole ordeal (thank goodness!), the critical transport team arrived, and we waved good-bye to yet another experience in the ED. Thankful that our patient was on-route to a facility that can care for the trauma and thankful for the team we had beside us that day. No matter where you go to work, as a travelling nurse, trust and teamwork should be the number 1 goal. Knowing that your co-workers are skilled and knowledgeable is a huge advantage to being successful as a travel nurse!

We later found out there was no artery involved and they saved the leg!! We also learned, that the tourniquets needed to be kept under lock n’ key, they had seemed to walk away when we needed them the most. And we learned, what an amazing team and group of individuals we were lucky to work with! Well done ED team, you all rock!

DO YOU HAVE AN INTERESTING EXPERIENCE TRAVEL NURSING? I’D LOVE TO HEAR ABOUT IT IN THE COMMENTS!

fullsizeoutput_1e3c Trudi

(person, place, time are removed from this story to protect the identity, no violation of FIPPA/HIPPA intended)