So last night was super busy, again, only it was more busy than I've ever seen it, and with actually sick people. So as a UNE, my big helper job is to reassess patients in the waiting room as their names come up on the triage screen.

Being at the window facing the waiting room, of course, means that I am that I am the prime target for those asking how long the wait was going to be. I'm still trying to find a way to say "a long time" or "hopefully soon" without actually telling them a TIME because that's when they will be coming up to the window thinking they are going back. And unfortunately the back was full of really sick people who weren't going anywhere.

I call up one girl to the desk for reassessment and she is doubled over in pain, dragging her feet, arms over her tummy. She sits down and I reassess her vitals. Abdo pain is increased since arrival. Feels nauseous. Has not vomited. She had to wait quite a while to get to the back, because of the dearth of beds.

So a while later, I am zipping around cleaning rooms and I walk by hers.....gown on the bed.

"Wha?" I said, possibly out loud. I don't remember her being discharged. I go to the computer and she is still showing as admitted.

Mystified, I go back to the room to make sure she hadn't gone to x-ray or something. Nope, gown on the bed, and hey, is that her IV ripped out? Yes, yes it is.

Has the rapture come and stolen her away? She seemed to be really in pain. I asked a nurse who said she'd gotten a morphine shot and her kids were fighting so she decided to go home. Without being discharged? Okay...

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In other news, last night was the night staff started calling me out on mistakes. Which is good, and all, but I felt a little blindsided because they were things no one had previously told me about.

For instance I was asked to bring some people back and I wrote them up for the chart. But I didn't start nursing notes on them because I thought that was done by the nurse on that team. So picture my surprise when I am in the middle of a dressing change and a (fairly intimidating) nurse comes up to me and asks where so-and-so's nursing notes were, because he'd been back for a couple hours and they needed to chart his vitals. Then when she learned I hadn't started them, she walked away saying "bad nurse, bad nurse". Unfortunately there was a little kid also sitting there who then asked her mom what "bad nurse" meant. Umm..

Then the charge saw me and told me I needed to start nursing notes on all the patients I brought back, because so-and-so was a Triage 3 and he was being transferred out, and he hadn't had vitals done in however-long. I think my cheeks were a new shade of red.

Later, I was sitting at the reassessment window and a guy comes in with a kid. I see the kid and he looks pale but alive. Dad says "hey, my kid's having an asthma attack". I pause, at a loss for what to do. No one has told me what to do or who to call if this happens. The triage nurse is busy with another person and the last time I interrupted the triage nurse (a different one) with someone who was worried, she told them to sit down and wait for triage. So I told this dad the same thing - just wait in the chairs and the triage nurse will assess you. The dad kind of glowered at me but they went and sat down. Then the kid got triaged a few minutes later satting at 88% with decreased air entry, tripodding, and in-drawing. Oh my gosh I felt so bad. I talked with some of the nurses about it later and they said that there was a sign for SOB/chest pain to report immediately at the window. The kid was admitted quickly and stayed back for pretty much the rest of my shift. I was also quite humbled because when I looked at the kid briefly, he looked fine to me. I obviously have a lot to see and learn about kids and SOB in general.

Then I was asked to bring another person back who was a ?cardiac patient with history of stroke. I did her ECG, brought her back, put her in the room they told me to, put her on the monitor, wrote up her chart, AND yes I wrote up her nursing notes. Then, a few hours later, a different fairly-intimidating nurse comes up to me and says hey, you need to report off to one of the team members when you bring someone back. What if she crashed and we didn't know what was going on?

So again, I felt like I screwed up without knowing that I was screwing up because this wasn't something that they really emphasized in my buddy shifts.

So I learned last night that it is better to communicate TOO MUCH than NOT ENOUGH. Tell at least 3 people what you're doing, and possibly also the charge nurse. Don't feel bad about interrupting, when necessary, because the alternative is not good.

Lessons learned in the ER.