Confidence in an Emergency
As of late, I have definitely been feeling more confident in my care. I do not know if it was the whole milestone "one year" idea that really helped it set in, but confidence was upon me.
This was truly solidified when I recently had an emergency situation with my patient. I was getting ready to discharge this patient when the patient had a new, acute, severe pain. After assessing the patient, having the patient walk (both the MD and I suspected gas pain initially) I obtained another set of vitals as the patient was looking increasingly pale. The patient had become hypotensive. I called the doctor again. He came immediately.
In the meantime I prepared IV fluids and informed my charge nurse of the situation. I also obtained labs on the patient as quickly as possible and knowing that I only had one arm to work with and that I am not the best at IVs, I tracked down a more senior nurse that I knew would obtain 18 gauge access, quickly.
I suppose what gave me confidence throughout this was that the MDs and I were on the same page as far as what was possible happening with the patient. I suspected this patient was bleeding internally based on the surgery the patient had had as well as the fact that the patient had been anticoagulated as recently as that day. It turned out after a CT scan that that was indeed what was occurring.
When you are hustling around for fluids, lab materials, IV materials, pain medicine etc., it is easy to overlook the fact, "hey does this patient have an active type and screen while I'm about to draw labs anyway?"
I am not sure that anyone ever feels totally confident when a patient is acutely ill and has the potential to crash, but it felt good to know the proper steps, remain organized and calm and ultimately get the patient to a higher level of care.