***Please do not move to student nurse forum. I want advice from nurses*****
I chose to have my leadership (capstone, senior practicum) clinical in the emergency room. I have a strong interest in psychiatry, and I was aware that many psych patients wind up in the emergency room. This is where I would like to make a difference.
I felt the ED was a good place for me because I enjoy a fast pace, I like to see many different people, I am okay with trauma and emotionally charged situations, I keep a cool head under pressure.
For the most part, I enjoyed it. I handled two codes and one death very well. I also really admired the charge nurse and I think the hospital is a good one.
However, I became very frustrated with a few things. I would like your opinion on whether these things happened because I was sometimes paired with a bad nurse (and I think I was) or whether my difficulty means I am not right for the ED, or whether it is something else. Your insight, whatever it may be.
In short, these are the things that happened that I struggle with:
1. A general and open disdain for psych patients.
2. A nurse told me to discharge a patient AMA even though the patient told me she had changed her mind and would like to stay. I refused to discharge her, by the way. That did not go well, but I survived. (this I attribute to the bad nurse). In addition to this, there was a general rush to clear the beds, especially during busy times.
3. I was told that we do not address problems that weren't "what the patient came in for." I also attribute this to the bad nurse, because the charts suggest that we do in fact do that, or we are supposed to.
4. A disregard for all things not immediately life threatening. For example, a physician removed an unconscious patient's leg dressings, then just threw the bandages back on without tape saying, "Ok, that's done." When I addressed this problem with the nurse and asked if I could redress the wounds she said "No, we don't do that. The ICU will take care of it." But the ICU did not have a bed for the patient for the rest of the 12 hour shift.
***On a side note, I am noticing most of my issues have to do with one nurse whom I feel gave poor care. ***
5. In general, I heard a lot of "we don't do that." in response to my questions about interventions.
One thing that I feel may make me ill suited to the ED in general is that I prefer to address all the issues with the patient., rather than just the emergent ones.
I would like to think about the future for the patient and not just their present needs. If a psych patient keeps bouncing to the ED, for example, I would like to help address this problem rather than send him out without referrals knowing he'll be back tomorrow. Is there any ED that works this way? Does this mean I should go to psych inpatient instead?
The social worker in charge of admitting or releasing crisis patients had so much disdain for the psych patients too. It was disheartening. The other social worker, the one not in charge of that, was wonderful.
