How to stay calm during traumas?

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Specializes in Northern Nursing.

Hi,

I'm a new grad and I really like my job in my northern nursing hospital job. I love the challenge, I love being able to prescribe meds, diagnose and caring for patients in a completely different, more complete and complex way than "down south".

However... Traumas with no doc are super scary. I'm never sure what meds I can give without telephone orders, or what really to do other than get a line, try and stabilize my ABCs then call the doc to figure out what to do next. Clearing C-spines is something I just kinda avoid if at all possible. I'm getting better at staying calm( I never freak out, but I get nervous and rushed...). It's getting better with practice. But it's really hard.

Does anyone else have a similar experience? What are your tricks for staying calm?

Thank you!

-New RN

PS:There are basically no training or resources here. And the last time the policy and procedure where updated was before I was born.

Oh my goodness, I don't even know where to start. Sounds like your job is a liability just waiting to happen.

No training, no resources, no P&P and you're a new grad working in trauma by yourself? Why did you even agree to working under such unsafe circumstances?

Since you say you prescribe and diagnose, you must be an NP, right??

I don't understand why you're not worried about losing your license working under such unacceptable conditions.

Specializes in NICU, PICU, PCVICU and peds oncology.

The OP indicated she works in a northern nursing station. Those sorts of conditions ARE the job. Most of the time there is ONE nurse on site at a time. New grads should not be hired into these positions because they lack the judgment and experience to perform independently and safely. No, she doesn't have to be an NP to dispense; the nursing station will have standing orders for many drugs, much in the same way that telehealth nurses have a script to follow when they advise people over the phone. Nursing station nurses are given some training before they venture north; suturing, taking and reading x-rays, setting and casting simple fractures, emergency deliveries, neonatal resuscitation and so on are expected interventions. There are many transferred functions extended to nursing station nurses. When you are the only health care provider in a community, you do what is necessary and are covered by something like a Good Samaritan principle.

Got to agree with Jan. These are the known working conditions in the high north.

When some of oldies try and explain these jobs aren't for new grads we get told we are quashing someones dreams.

The welfare of the patient/community always has to take precedence over the dream of the new grad.

It's sink or swim up there. So coping with the traumas will eventually become second nature.

Specializes in Northern Nursing.

Hi All,

I agree that coming up here is hard... However, there is no one else to come up. The only people that will come up are new grads that NEED experience. And with the job market being so poor... it makes sense to come up. I came up because I wanted to learn about northern culture, gain some skills and make some money. Almost everyone here is within there first 1-2 years of nursing. Experienced nurses don't want to come... I really wish they did.

I do really love it here. I love suturing, figuring out diagnosis and everything else :) It's just trauma that is difficult. I'm pretty good at it. It's just ruff sometimes... I'm looking for tips to help me learn and be better :)

-New RN

The OP indicated she works in a northern nursing station. Those sorts of conditions ARE the job. Most of the time there is ONE nurse on site at a time. New grads should not be hired into these positions because they lack the judgment and experience to perform independently and safely. No, she doesn't have to be an NP to dispense; the nursing station will have standing orders for many drugs, much in the same way that telehealth nurses have a script to follow when they advise people over the phone. Nursing station nurses are given some training before they venture north; suturing, taking and reading x-rays, setting and casting simple fractures, emergency deliveries, neonatal resuscitation and so on are expected interventions. There are many transferred functions extended to nursing station nurses. When you are the only health care provider in a community, you do what is necessary and are covered by something like a Good Samaritan principle.

Well what you describe isn't "prescribing" and "diagnosing" which are the terms the OP used.

An experienced nurse I can see rising to the challenge and surviving but a new grad? She already mentioned she got zero training and has zero support so is basically flying by the seat of her pants. Yikes. What might be scary to a seasoned nurse would be impossible for a new grad. I fail to see how this could possibly be safe. I suppose someone is better than no one but that Good Samtaritan principle can't possible cover everything that can go wrong, especially with a nurse so wet behind the ears. It just screams wrong on so many levels.

New RN

I am glad that you avoid clearing c-spines, who does clear suspected c-spine fractures? Can you send the x-ray images electronically to a radiologist for interpretation? The technology exists to do this, and the north definitely needs it, see report.

http://www.car.ca/uploads/crf/crf_report_mi_in_northern_canada_2009.pdf

As for the policies and procedures that need to be updated, have you discussed this with the administration? Maybe some of the hospitals in the south can send copies of their policy and procedures and the nurses can adapt them for the north? Or maybe some of the procedures on reliable websites can be adapted for the north, see University of Ottawa dept of emergency medicine procedures as an example http://www.med.uottawa.ca/procedures/index.htm

Another way to increase your knowledge and ability to deal with rural traumas is to take the rural acute nursing certificate program available through distance education, http://www.unbc.ca/calendar/certificates/nursing.html

I think your post is compelling and I encourage you to discuss your concerns with the administrator and outpost doctor.

warm regards

dishes

Specializes in ED, ICU, Education.

Most hospitals have trauma protocols to follow. Perhaps you could create a few of your own to follow, using a systematic approach. For example: Neurological

Orthopedic

Burn

MVC

Assault

I wish I could scan some of the forms we use! I hope this helps! Remember deep breaths, all bleeding stops eventually!

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