All of us have been to an emergency department at some time in our life. We're there for ourselves, our kids, our parents, or a family member. While the emergency department is designated for "emergencies" most ED visits, these days, are for things that could be handled in your local primary or urgent care settings. The sheer number of patients seeking care taxes the staff and resources especially at busy inner city hospitals. And these hospitals are truly the gatekeeper between life and death. Every. Single. Day.
I currently work at the Capital Health School of Nursing in Trenton, New Jersey. It's there where we teach prospective nursing students in both the classroom and hospital settings. I've had the privilege of being on the clinical side of their studies. My role takes me from working with freshman at a long term care facility to working with the seniors on medical/surgical units in the hospital. This semester I'm heading up a clinical rotation in Capital Health's Regional Medical Center's Emergency Department. Each week I take a small group of students there from before the sun rises to after it sets. It's a long day, but it's teaching and learning from start to finish.
Luckily, for us, we're a hospital based nursing school, which allows me, and us, access to just about everything that happens in a hospital. From the ED, to the med/surg floors, to the OR, and the specialized units, we can and do see it all. In the ED the "kids", as I call them, rotate through triage, fast track, mental health crisis, and the main ED, seeing everything from tooth aches, to cardiac, respiratory, and neurological emergencies, to the effects of drug and alcohol abuse, to trauma patients. Being a Level 2 trauma center in an inner city means patients come in on foot, by ambulance, or by helicopter. It's a great thing to watch as a student sits outside the tarmac waiting for the air ambulance to arrive.
And while I do my best scanning the sea of patients to introduce learning opportunities for my students, it's the staff that makes my job possible. On any given day upwards of 15 registered nurses man, or woman, the various posts in the emergency department. And they are always on point. As I have gone on to know and work with them I am amazed that most are mere tots themselves, having just a few years out of nursing school under their scrubs. The more experienced nurses hold the titles of charge or manager, and bring their knowledge and expertise to the unit.
It doesn't take long for young nurses to develop the skill of critical thinking, and more importantly critical action, when patients arrive in the ED. It's a sixth sense that only a nurse can have, as we see patients in a different light then the other healthcare providers who are beside with them in the trenches. It's a well oiled machine and a pleasure to sit back and watch. In the ED patient's can present or change in an instant and seeing those early cues in a patient's changing presentation is something I push for my students to see.
As an instructor it's fun to see wide-eyed students begin their rotations and grow with experience. Seeing them jump in during a cardiac arrest, hanging IV's, giving meds, dropping a Foley catheter, inserting a NGT, or just assisting patients at the bedside is very gratifying. But it's at the end of the day, during post conference, is where the gifts of teaching deliver its best. Hearing about their day, about their patients, what they did or should have done, and most importantly about the connections they made between the classroom and clinical, makes the 30,000 steps and having my head-on-a-swivel, that leaves me tired by days end, all worth it.
Some students are just there and putting in their time. This may not be their jam. They may be looking into nursing roles in obstetrics, mental health, or the OR. But then there are those who are hungry and can be seen moving, and thinking, non-stop, for the 12-hour shift. Many times I can sit back and see that light bulb moment go off in their heads, while they are busy putting what they learned into practice. Some will go on to graduate in a few months and begin their careers in settings like this. And while I'm old school, and believe that every new nurse should begin on a med/surg floor, I have seen the amazing things nurses, with ink on their licenses that isn't fully dry, do while saving lives.
It's been 30 years since I graduated from Essex County College and started my nursing career. Most of my students, and the nurses I encounter, aren't even that old. When I sit amongst them, during a break in the action, I realize how old I am, and how much nursing, like firefighting is a young person's game. What stumps a lot of us old farts in the mix of old school nursing and the computer based charting systems that are a huge part of healthcare today. I came from a time before computers when charts were thick and everything was hand written. Navigating though these computers, while trying to maintain a bedside presence, is challenging to say the least. I say we've moved from patient focused to computer focused care.
After my shift last night I stopped by the liquor store to pick up some beer. When I got home I said hello to the dog and sat down and had a few pints of Guinness. I was just an old man tired from the day sitting there having a beer. It's a Friday night and I could only think of the young nurses clocking and then heading out for the night. It's what you do when you're young. As I write this some of them are preparing for another day at work unsure of what is coming though the door at any given moment. I wish I was there, and had some students in tow. But I'll to wait till next week for more fun.
So I raised a glass last night to the nurses of Capital Health Regional Medical Center in Trenton. Any of whom I would feel safe, confident, and comfortable with if I were laying on a gurney in front of them. While some of these nurses may look like your kid or grandkid know their experience may be far older then the years they've been on this earth.