Tiffany Quach

Nursing Exemplar for March 2020

In the Emergency Department, professional nursing focuses on the care of patients who

require prompt medical attention to avoid long-term disability or even death. In a single shift, an

ED nurse may care for an elderly woman who suffered a stroke, a young man with a gunshot

wound, or even a child with severe burns. Due to the vast array of patients entering the ED, it is

essential for nurses to be flexible, have excellent interpersonal skills, and to remain focused

despite experiencing turmoil in a crisis situation. This exemplar tells a story on how important it

is for an ED nurse to have and utilize these skills.

It was my very first shift in the ED as a nursing student and I was amazed at how big the

department was. My nurse gave me a quick tour of the place, introducing the trauma bay and the

psych department. It’s interesting how as an ED nurse, you won’t know where you’ll be placed

within the ED for each shift. The unpredictability excited me. My nurse & I were assigned to ED

1, but she encouraged me to assist other nurses wherever needed. We received an incoming call

for a 36-year-old male who was found pulseless and unresponsive on the side of the highway.

Paramedics would be arriving within 10 minutes. I waited in the trauma bay while another nurse

explained the dynamic of an emergency situation, such as this incoming one. There were so

many people in the room, I felt overwhelmed at first. As the patient rolled in and was transferred

onto our bed, the trauma technician immediately resumed chest compressions while the other

team members fulfilled their roles. I was on stand-by to assist wherever I saw fit. I scanned the

room to see so many people each doing their necessary part for this critical situation. One nurse

was documenting, one nurse was inserting an IV, one resident was examining the head and
airway of the patient, one attending was supervising and giving orders, and so many others. My

initial overwhelmed feeling dissipated as I realized the ED is an ​organized​ chaos.

I noticed that the nurse inserting an IV had blown the vein and needed to start over. I

didn’t hesitate to grab another needle & alcohol to give to this nurse. I then noticed that the

trauma technician doing compressions was looking tired, so I stepped over and offered to switch

out. He had a sigh of relief, patted my back, and said, “You got this!”. I was so nervous that my

compressions wouldn’t be sufficient and that one of the nurses might criticize my technique.

Immediately I noticed that the patient and bed were too high for me to do proper compressions,

so I looked at the technician beside me and asked her to lower the bed a little. She quickly

adjusted the bed and I felt much more comfortable with my position for compressions.

Thankfully one more round was enough for the patient’s pulse to stabilize. Unfortunately this

patient had no intact brainstem reflexes and was now being prepped to go to the catheterization

lab. My nurse came to me and congratulated me for not being intimidated and initiating

assistance with the team. It was my first time ever truly feeling as if I was an equal part of the

healthcare team, and not just an assistant following orders.

My nurse handed me the foley catheter kit and exclaimed, “Show us how it’s done!”. I

eagerly opened the kit and inserted the catheter while maintaining sterile technique despite the

mess around me. The nurses around me praised me for a job well done, and for the first time, I

felt like I found where I belonged. I chose to be a nurse because I wanted to help save lives and

make a positive impact on others, but I wanted to be in a unit where I can excel in. Flexibility,

assertiveness, observation, and focus are essential skills that I would like to further develop with

time in the ED.