ER Observational Experience

Aubrey Bennett
January 20, 2015

Upon arrival to the Emergency Department the atmosphere was very chaotic and not
uplifting. I immediately felt as if I was going to a cause of issues as I may slow down one of the
team members. Once taken to the locker room to stash my coat and backpack for the day I sat
around the tables with the other nurses to hear the change of shift report and to see who I would
be assigned with. During this time is when a nurse took the time to apologize to me for everyone
foul mood and vast amount of complaining due to the night before having been a nightmare
with every room full or double bedded, patients in the hall in chairs or beds; with 37 people in
the waiting room being told they had a 2-4 hour wait before they would be seen; emergencies
coming in from Lewistown had to be sent back, and at 2330 Life Flight was sent off to pick up
some of their staff to come in and help staff the ED. This also explained the eleven pizza boxes
in the room. Thankfully at this point the ED was much less chaotic with multiple beds open and
no one waiting to be put in a room.
I was blessed to be put with a nurse who was in the Navy for 15 years and currently has
23 years of nursing experience. Not only is he a phenomenal nurse but goes above and beyond
when it came to teaching me.
Based on my short experience in the ED I can safely say that much of the care that is
given was vary familiar to me with my experience on PCU, and now Hfam7 due to the vast
amount of cases were cardiac. However what differs the most is that when we get patients in the

ICU or PCU they are coming from a different department with medical information to review
and continue upon. In the ED my best way to describe it is thinking of it as each patient is a book
and when they seek help whether it be taking themselves to the ED or using EMS transport that
is where their medical story begins to be written. With that said it is also the responsibility of
the ED staff to see it the patient has previous encounters with medical services and to see how
the current state of the patient is similar of differs from the information, using it as a tool to
better understand the patients story.
The nurse I was with admitted that they see a lot of the drug seeking behaviors and in the
beginning you try to weed out these one and dismiss the case to the services that they truly need
and other times you give them the dose of meds they want (if medically advised of course) and
let them suffer from the rebound headaches they get and try and educate them on the need for
other services and use of Tylenol.
As far as the role of the RN in the ED you are a team first and foremost. There were
multiple situations during my brief time that were true examples of how everyone does what they
can to help each other out. This is a characteristic that I have unfortunately not often seen on
other units that have their cliques. I feel that the strong sense of team in the ED can only improve
the care the patient receives tremendously.
In relation to advanced technology skills in the ED nothing stuck out to me at first as
training that was above and beyond what I have already seen. Until I was shown the Trauma Bay
area. The amount of equipment that is similar to standard equipment but on steroids is incredible!
Pumps that can push immense amount of fluids on such a brief period of time, to radiant
warmers in the ceiling tiles that are based off the same idea or the warmers in a nursery. That
doesnt even begin to cover the carts full of sterilized kits organized and ready to go and boxes or

the Artic baths they may need to be given, or drills to relieve ICP. It is just proof of the advanced
skill, fast critical thinking, and team organization that is need to function in such a unit.
Two difficult situations that I encountered was dealing with the doctors and their med
students, which almost lead to a patient being transported to the cath lab before orders for his
heparin were out in let alone him being able to receive them. And the second difficult situation
was when a code was called and the nurse I was with immediately acted, grabbing the crash cart
closest to us but was able to assess the unit during this surge of adrenaline and take initiative that
he could not attend the code because the other nurses were already there or on their way leaving
only one other nurse to tend to the patients currently in the ED. Thankfully we had no family
issues besides trying to direct a wife to her husband who had the same last name as three other
patients without breaking HIPPA.
As mentioned earlier the unit has a very strong sense of team from the physicians,
paramedics, aides, nurses, lab techs, radiology, pharmacists, etch. Everyone worked together
with no matter what the job there was no hesitation.
As a side note I cannot say enough how much I loved this observation. As someone with
a lot of anxiety that often inhibits me and affects my performance this was an area that I didnt
have time to think about anxiety and after it was all over I was proud of myself for what all I had
accomplished. I really wish I could go back but it makes me excited for the second half of the
semester when I have my preceptorship in the ED at Williamsport. Can only hope what I
experience translates to there.