I am a new ER tech in a small town hospital. I have recently finished orientation and am still far from comfortable, as it's clear I have a great deal to learn. I would never, ~ever~, second guess one of my nurses (I adore them) let alone a Dr. Though I'm new, I can already see we have a solid crew and I trust my nurses and Dr's.
But I think we did wrong by a patient on my last shift. It bothers me very much. I talked to my boss about it today in fact to get some feedback on how I could've handled this better. I'm posting to get some feedback from more nurses in the hopes of learning how in the world I should react to situations like last shift.
At 2200 a couple arrives. They had tried to relight their water heater pilot and the wife burned the back of her hand pretty badly. As I am new, I have only seen one comparable burn (kitchen fire grease burn). This particular case was a pretty good second degree burn that spread between her fingers. She is crying (of course) and the husband is terribly anxious as he can do nothing for her.
I get her vitals to triage, settle her in a room and immediately ask her nurse if I can apply sterile water via the fancy poke holes in the top and turn the bottle over trick. "Of course. I have the basin there already" she says, so I set to it.
It's crazy in the ER. It's a full house, another nurse is calling for my assistance in another bed, a baby is still screaming in triage, we've run out of IV start kits, you know how it can get. I need to get out of this particular room and help. So I instruct the husband to glove up. I tell him to be certain not to touch her hand, but keep the water running on it. She jokes that I ~must've~ put some sort of meds in the water, it took so much pain away. I prop her elbow up with a pillow. I set two more prepped bottles by the husband in case we (Dr, nurse or myself) can't get back to them soon. I leave the room feeling proud. The couple came in stressed and in pain. Now she is not in pain and the husband is not anxious as he is helping his wife. They are even joking with eachother, saying that he looks so handsome in gloves he should've been a nurse. All is well, and I move on to assist elsewhere.
It is 20 minutes before I can get back, roughly 10 minutes before I am off shift. I don't want to leave without making sure they are ok, so I stop in while the nurse is giving some pain meds. Husband is still applying water. All is still well. I am feeling good.
Dr. comes in. I have never worked with this Dr. before. He is a traveler (I don't think that means anything, just something I noted) and we haven't even introduced ourselves. He quickly assesses the room and says, "I don't know what's going on here. I didn't order this."
The oh-#*$# feeling comes on.
He stands there looking at the hand. He looks at me. "I want this wrapped in dry guaze. Medication will take her pain away more than water." Then he looks to the patient. "So tell me, how did you do this? ...." and so forth. He leaves shortly thereafter.
I'm left standing in the room thinking...? Dry gauze. No silvadene? Not even adaptic? I look at the nurse and she's already at work. She took the bottle from the husband and started drying the hand. The wife starts to cry again. It's 3 min before I'm off shift. I stand there a while, tell them they'll be ok, then turn to leave.
As I'm walking out of the ER a few minutes later I turn to look in their room. The last thing I saw before I left was the woman crying in the bed, her hand in a dry dressing, holding it over her head to stop the throbbing, the husband shifting back and forth back and forth in nervousness STILL GLOVED! Everything they need to take away the pain RIGHT IN FRONT OF THEM. Bottles of water, a basin, even a pillow for her elbow!
I haven't seen that much in my little ER. I'm new, like I said. I've seen a shooting, some stabbings, a couple of good MVA's. Lots of sick people, a miscarriage. Nothing has ever really ~bothered~ me about it. It's actually been a wonderful experience. But this...this felt like torture to me. Why did he stop us from helping her? Why? Why didn't the nurse stand up for her? Let the water take the pain until the meds kick in at least. I mean, helping her was at verrry little cost to the hospital. We don't pay her husband and water is cheap, you know?
I think just knowing why will help me with this. Why did he order that? Is he worried about contamination? Why didn't the nurse say anything? Are they not supposed to? What am I supposed to do? Nothing I suppose. I know my place.
It just bothers me. I went to my boss this morning to get some feedback. My boss is very maternal and protective of her staff, yet very authoritative. Just being in her office recounting the story of that poor woman I started to cry like an idiot. Now I'm embarrassed and don't want to talk about it anymore. She said that I shouldn't worry about what that Dr. said, that I did the right thing. Policy is to apply water and I asked my nurse before hand. She was surprised he didn't order silvadene and floored he stopped the water. She said she should talk to him. God I hope not. This isn't worth any drama. It was just a second degree burn. Nothing truly serious.
But it bothered me. I don't think we did the right thing. She says I will see lots of this kind of thing in the ER. Man, I hope not. So I'm left here just...confused....and waiting the day when I have more education and my RN to stand up for patients like that woman.
I don't know. Am I being too silly?
Washoften
5 Posts
Wow, that is a very good and insightful post Mcvaragon. Especially in this case as I was left very confused. I would still be very confused if not for these boards, quite honestly.
I know my role. I am merely the helper. I am that third set of hands that can help things run more smoothly. That's it. I get this.
But still...
Your post is so spot on with some vague feeling in the back of my mind that I catch myself rereading it. I have to sleep on it and consider it more in the morning, I think.
Before I leave I have to ask myself, WHY do I feel I should've "done something different?" This is incorrect and illogical. This is not my role. I am a tech, not the nurse, and I did my tech job like I should've. And yet I feel there was something wrong with this picture.
It may be because the RN did not give me any direct instructions, actually. I was the one that approached her about the water. I was the one that decided to have the husband to continually apply the water. I was, well, being the nurse. The nurse wasn't there but to give meds (it was slammed and she was very busy) nor did she say anything about/for the patient to the Dr. She didn't even look at the wound except to wrap it in dry gauze when all was said and done. I felt her role was unfulfilled in this case?
...
Well, if that's it then I need to get over it. First of all, a second degree burn is not a huge deal for heaven's sake. Second, my nurses will be slammed more often than not and I am not here to demand they hold my hand through the trivial. I want to help, which means I need to apply some critical thinking skills and pull my weight.
Having said all that, I think I would've appreciated my nurse to assume her role there very much. Just anything, really. "Bring me another set of vitals in 30." Or "Make sure that's kept sterile." I suppose that's just rookie nerves talking?
Wow I over-analyze.