one word.... FLEXIBILTY..
got to have it cause if you are in a 15 bed er, all rooms are filled, 3 are critical, 3 can get there really fast, 3 are psych pt that have no evaluations done, 1 room is on hold for EMS, 2 rooms are trauma beds, prepped and ready to go. oh and the waiting room is full of headaches and flu symptoms.
of course... of the 3 criticals, one is waiting for flight team, one is waiting for ambulance team, and as you are getting started, one comes stumbling into the waiting area with severe shortness of breath. ie: sats are 78 and dropping and he is clutching his throat. yeah the last bed is the EMS bed. so now you have no room for ems.. ha ha.. and of course between this new one and one of the other critical pts., no one can get the iv's , one of those is a cardiac pt the other is the guy that cant breathe. in the middle of starting the very difficult iv on the cardiac patient, you get the phone call from H....L GSW to the head code 3 be there now. So you run to the trauma room, call the crew, did i mention you are not in a teaching hospital. so your crew is the doc another nurse the rt and the xray. and most of the time the crew bringing the nightmare with them.
so much fun.. of course he ends up on the ventilator so that takes one nurse off the floor cause he is unstable and is awaiting transport. oh yeah the flight crew is stranded in another city and there are no other teams available. this guy is not stable enough to go ground. so.. 2 nurses handle the rest which now consists of a guy that has done a great amount of cocaine and is having an MI. a gal with a bp of 225/118, and you still have the other critical pts one of which is waiting for his ambulance still. they arrive and starts to crash. yeah..
so you finally get the trauma pt out and you immediatly go back to the front and you take 4 pts asap. one has to have a "fast" pelvic, one is a small kid with an earache that needs meds, one is the MI that needs Retevase plus a few thousand other things and one is a psych pt still in your unit. oh and it is finally 5 am. 7am is getting close. ha ha the tone out goes for difficulty breathing and another call you dont even hear. finally the day shift shows up and so does the ambulance for the MI.. No flights available. you had 3 pts shipped out and 4 0r 5 admissions, you cant even remember anymore. finally at 7:30 you rush out the back door to your car and LEAVE..... but hey.. only one pt left AMA in the 12 hours and he was one of the psych pts that "escaped" during the trauma.
oh.. the other pts have to wait cause there is ONLY 1 doctor in the ER..
but i love it......
that is what we like to call things changing rapidly.