The ED is a completely different animal than any other place in the hospital. In more ways than one, it's just like the restaurant where I work - sit them down, ask what they want (what's wrong), get them what you can (push meds, get blood or urine), send in the manager (the MD, PA or NP) and send them on their way. Turn those tables (rooms)!
Instead of doing a head-to-toe assessment where I use my stethoscope, penlight and fingers, I get to have a 3-minute question and answer session, with minor follow up if there is a specific ailment (like listen to bowel sounds if the abdomen hurts, etc.). As the days in the ED went on, I think I became complacent in my assessment - one of the things that I wanted to get better at during my time in the ED.
We had one patient that came in complaining of flu-like symptoms. The Physician's Assistant thought it was probably the flu, but ordered a chest x-ray to cover her butt. When the results came back, we were both were shocked - Pneumonia. At least she had listened to his lungs and determined that his right lower lobe was diminished. I, on the other hand, only asked him how long his signs and symptoms had been going on, and if had been taking anything for them. Sigh.
Later on I started the same patient's IV. He didn't like needles, so I told him to look at the wall while I put in the IV. Good thing I did, because I didn't pull the tourniquet off his arm and couldn't get the saline lock on fast enough ... so he bled everywhere ... like to the point that I had to move my white pants and shoes out of the way so the blood could drip on the floor. I was seriously freaked out by this incident, but both my nurse preceptor and the PA told me not to worry, and that I was still learning. I still felt bad though. Thank God the patient didn't look over toward me! Sheesh.
Eventually I get better at all this...right?