ER assignment nursing school

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Daniel Steed
What was your analysis of the role of the RN (in detail). Look at the scope of
practice.
There were multiple RN roles in the ER. The triage nurse had to quickly obtain
crucial info about each patient, decide which area – depending on how emergent –
to bring the patient, and decide which nurse to give the assignment – depending on
patient load/nurse experience/etc. The floor nurse’s main role was stabilizing the
patient by using skills such as initiating IVs, obtaining specimen samples,
completing physician orders, administering meds and using a wide range of focused
assessment skills.
b. Did you observe or provide any evidence based practice on the clients you cared
for. You will need to list at least 2 items and explain.
One example would be a man admitted with several broken ribs along with alcohol
withdrawal. The patient was anxious and tense, greatly increasing the pain of his
condition. EBP was shown in administering Ativan in order to calm the patient which
caused a decrease in pain.
Example number 2 is a 2 year old boy admitted with a complete compound fracture
of his femur. EBP was show in the application of a hip spica cast and propofol
administration before manipulating the leg. Propofol has an amnesia affect that
would block the memory of the painful cast application. The MD also explained that
when casting a long bone, the pieces do not have to be perfectly aligned. He stated
that as long as you get them “in the same room” they’ll find each other and
eventually fuse.
c. When provided patient centered care in a critical care environment, did you find
yourself using the nursing process and critical thinking in your care? How did you
use it (you will need to reflect on patient scenarios and the ER process). How
confident in the role were you?
Yes, I spent most of my time with different floor nurses, so by the time I had my
hands on a patient they had already been assessed initially. Once the patient was in
the room I began with a quick focused assessment and assisted the RN in obtaining
vital signs/starting IVs/changing dressings. Once the initial contact was finished, the
RN would quickly create a plan of care using the assessment info and history of the
patient. We would then await MD orders and follow through with med administration
or whatever else was needed. Critical thinking was needed when analyzing
assessment data and orders because with the fasted paced nature of the ER, small
details can be easily overlooked. One must be mindful of any contraindications or
incorrect meds/dosages.
d. Safety is always a priority in any setting. In an emergency department, safety is
in more forms than just patient. What other forms of safety did you observe? Did
you ever feel unsafe or uncomfortable? If so, what scenario? If you did not, what
scenario could become unsafe for the clients and/or staff in the ER at any time?

I never felt unsafe, but a scenario could arise if someone intended to harm a patient
and security was not in place to stop the situation. Security seemed to be tight (I
believe you needed a badge to gain access to the unit) and although I did not see
an actual armed guard, there was plenty of staff that could react if a situation were
to arise. Something that could be improved was managing the volume of patients
received into the unit. Once rooms were filled, patients would be placed on
stretchers in the hallway and this could be a concern if a patient happened to have
a communicable disease unbeknownst to the staff. Another scenario: a patient
becomes combative during an IV stick and flings blood everywhere. I noticed
several unused rooms in different areas around the ER (toward the break room) that
could be utilized although they were not as close to the nurse’s station. There was
also a seclusion room in place if needed.
e. List three effective and three ineffective communication and/or
teamwork/collaboration you were involved with during planning and provided care.
Effective:
1. Communication of initial assessment data between triage and floor nurse
2. Physician communicating with the staff about the plan of care and orders
3. RN to RN communication when assistance, for example: with an IV start,
needing certain equipment to be fetched, transferring a patient to a new bed.
Each staff member seemed to respect one another and I never saw anyone
“talking down” to someone.
Ineffective:
1. One patient refused the drawing of blood because she was “being sticked too
many times”. The nurse tried to explain the importance of AGBs, but the
patient didn’t budge. After the second refusal, the nurse seemed to shut
down communication. The doctor had to be called and he eventually
convinced the patient to allow the draw.
2. I honestly cannot think of any other obvious ineffective communication
instances.
f. Name one type of informatics you utilized in the ER. Was the type of informatics
utilized a time saver of time waster for the RN? Explain.
We were able to chart a head to toe assessment using the computer system in
place. It was a great time saver because the usual assessment data was entered
into drop down boxes, so that allowed the nurse click boxes such as “R radial pule
+2” instead of manually typing or writing the info.
g. What do you feel was your most valuable lesson(s) learned during this clinical
rotation? Why?
I feel that completing skills was the best lesson for me during this rotation. I was
happy to finally get my hands on multiple IV starts and I learned some neat tricks
like pulling the flush back first before pushing to break the seal to prevent saline
from shooting across the room. I learned how to properly hook up and use the
portable EKG device. Also, I was able to do a few IV pushes, dressing changes,

IVPBs, and PO meds. I gained more confidence in all these areas. In addition, I was
able to work on my therapeutic communication when dealing with patients in
severe pain and anxiety.
3. Print an article related to ER Nursing...must be an ER nursing journal. List five
items you learned from the article that would increase your knowledge, skills, or
attitudes as a RN.
We were instructed to list 5 items that we learned during our disaster relief
discussion:
1. Nurses must prepare for disasters and it is recommended for a hospital to
drill 2-6 times per year (allowing each employee 1-2 times taking place in the
drill)
2. A huge issue in disasters is patient identification – measures need to be in
place like hot-lines or a website in order to reunite families
3. Nurses (in Louisiana) can either opt in or out of potentially being recruited for
disaster relief duty. Exceptions can be made such as pregnancies.
4. Sterility is nearly nonexistent during disaster relief in the field. Nurses must
use any means necessary to stay as clean as possible such as using
disinfectant gel on equipment if there is no power/running water.
5. Nurses with disaster relief experience need to be used in order to prepare for
future events. They understand what is needed and can identify weak links in
the plan. Surveys are a great tool to utilize this info.

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