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Emergency Nursing- An ER's Nurse's Day...

Winter Season in a level 2 emergency room. Busy, stressful, and always entertaining to both the staff and patients. I am a charge nurse in the ER. My job is to help flow, facilitate care, troubleshoot problems and just get us all through 12 hours. One recent night we arrived to 4 ambulances already in the bay. The ER and its waiting room was packed. I often compare the
nurses station to the deck of a ship. We were on choppy waters right away. Some of the other hospitals in the area were already on bypass. Bypass is when an ER diverts ambulances (except truly critical patients) to other hospitals due to certain criteria. Some of the reasons could be an ER so busy, it hasn't the capacity to see the patients (in a timely manner anyway) that are already there, and it needs some time to "catch up" so to speak. Other reasons for bypass are internal or external disasters. An internal disaster could be problems with the oxygen system, water main breaking etc....An external disaster could be a plane wreck where the hospitals are tending to all the victims.

Well, when other hospitals in your area are already on bypass, it doesn't take long for your ER to become overloaded as well. Two hours into the shift we were on bypass. We had many admits waiting for beds in the hospital..trouble was, patients weren't being discharged from the main hospital so the ER patients weren't going to be admitted any time soon. With ER beds tied up now, all the people waiting to be seen (by ambulance and in the waiting room) will be waiting even longer to be seen.

Not long after we went on bypass the first code green was called in. A code green is an incoming code in progress. OK, we can do this. We are on bypass, but critical patients are why we choose to work in the ER in the first place. The adrenaline is pumping in the staff's veins. An elderly man arrives in cardiopulmonary arrest-one doctor, 3 nurses and an ER tech help with the code. One half hour into that code, a second code green is announced as coming our way in less than 5 minutes. Another ER doctor, 2 more nurses and an ER tech greet the other patient arriving in cardiac arrest. The first code patient is still fighting for his life. The other patients and their families watch and hear real lifesaving efforts are going on. The families of the two patients in critical condition are in the waiting room. Paramedics and EMT's from the ambulance and fire crews are pitching in. Remember when I compared the nurses station to a ship?

Well, the Tsunami is here. I have never worked when two codes came in. In fact in a poll of the staff later, no one else had either. Both patients expired. The families were told; it is an unfortunate but expected part of the business. We are humans trying to save human lives. Another expected part of the emergency room business is another non-critical patient who came to the ER at 2 a.m. for a cough he or she has had for weeks, and becomes upset that they have to wait 2 to 4 (or more) hours to be seen. People become verbally abusive, throw things and have fits because they weren't seen "before the dying ones." I have been "working" a code when a patient in the next room complains because they haven't received their Tylenol yet. Well, the rest of that night went smoother, and we made it through the 12 hours. We went home, slept and came back for more. There's always more.

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