Learning to Prioritize

First I have one correction to make on a previous post. The boy told me there was a Starbucks at the airport, and oh no, that is not the case. I believe I was actually laughed at for inquiring about it. So should you decide to fly to Sioux Lookout you will not be greeted by a pumpkin spice latte on this end, the closed coffee shop with the espresso machines is one of the local Roy Lane Coffee. Too good to be true 😦 I will have to venture to one of their local coffee houses more often.

Yesterday, I attended a cultural sensitivity training for eight hours. This training is available to all staff, despite your position and students. I am including a link to a 30 minute video to anyone interested in learning more about the challenges to providing quality healthcare to First Nations Peoples. Sharing Tebwewin was filmed in Northwestern Ontario in 2007.

Then I snoozed and went back to the hospital for an eight hour night shift. Let me set the scene for you a bit. You may recall I mentioned that this ER dept is staffed with only two RN.  Some days this department sees 60 patients in a 24 hour day. When I left WLMH a couple of years ago they were averaging 100 patients in a 24 hour day and when staffed to budget of 5 RN on days and some days it was still a circus with people waiting hours to be moved into the department and seen (I’m sure you guys are just as busy if not busier now).

So I walked in and saw the department was full and there was a nurse I did not recognize moving through the department. This is a summary of who was being treated. (Please note I’m really taking my time to word all this correctly so not to breech anyones’ confidentiality.)

1. Small child 4 doctors and my preceptor wearing a mask. Child is on the cardiac monitor and has a nasal canula taped to his face. 2 IV lines infusing.

2. Mom and tween. Tween’s face, hands and clothes are stained with charcoal. This patient is also very drowsey and has an IV infusing.

3. Adult patient newly arrived with (to my novice eyes) an anxious shortness of breath exacerbation. Family is a the bedside speaking in their language, appears to be trying to soothe patient.

4.  Young adult woman with blood infusing. I was immediately told her hemoglobin was 45. She too has family at the bedside.

5. OPP officer standing outside of a door and I recognize the patient as someone I traiged on my previous shift. On that date he came to the department unaccompanied.

6. Older patient seated in a chair that was used for patients who receive their IV antibiotics, she is wearing a wristband but sitting patiently. No IV meds, no apparent dressings that may need to be tended to, just sitting.

So, woah. I’m sure any of the nurses’ reading this will think.. umm.. that sounds like a lot and a few pretty acute things going on. And yes, you would be corect. Nutso! What a different scene opposed to the previous night shift I worked. I suppose like anywhere else, it’s feast or famine.

First I wanna just give kudos to the 2 nurses who came from the med/surg unit to help out. They ran and jumped in, and to the nurses who stayed behind and looked after the ward patients!! I think I can honestly say that in the multiple hospitals I have worked at, I have never seen anything like that before! One of the med/surg nurses figured she spend 5 of her 12 hour shift helping in the ER!

giphy

GIPHY

I spent the first 4 hours of that shift with the youngest and most critical patient. This little one came in from the North with an elder (not a parent) and the inital triage story sounds like the flu. Over the course of the day it began to sound more and more like meningitis, hence the isolation precautions. His status deterioritated to the point of having to wear defib pads. And after a CT scan it was found that his poor state was related to a mass in his head. I supported the physicians in stabilizing, intubating and then packing him up for air travel to a larger center that had a paeds neurosurgery ICU.

This case had so many complex elements to consider, I mentioned how difficult it is to access services. It took hours to get him to us, only to have to get back on a plane because we could not provide the care he required. Today the physician has to fill out (essentially) an insurance claim form so that the parents of this child can fly to meet them, they’re life will be forever changed. Does this elder, with limited english really understand what is happening? Or how about the child?

For me, this was my first critical paeds case. In the true sense of being a “Nursing Student” I have alot of learning to do.

Oh yeah PS – Remember when I was worried about perhaps going into the past with equipment (remember the training myself to use a straight needle for bloodwork) Well these guys have IV catheters that when inserted into a vein, have a valve that doesn’t bleed out while you’re trying to connect the saline lock! Apparently they’ve had them for years — wtf! However you should see these IV pumps, ancient!

So this is TTFN – as I plan my travel day tomorrow, back to the south for the weekend.

Make sure you’re all caught up on my posts Click HERE

 

 

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