Day In The life

Now that you’ve met Travis, see what a day looks like for him as an ER nurse. He breaks it down in a log he kept especially for Healthy Living Magazine on a Monday in April, from 7am to 7pm. Here it is, in his own words.

humor and often greets his patients with an unexpected joke.

“You can laugh or cry,” he says. “I

Before he begins each shift, Travis mentally prepares himself for it by listening to the radio or meditating to clear

“I kind of go to my happy place,” he says. Each day in the ER is different, and no two shifts are ever the same. Although Travis is known for his ability to stay calm and collected no matter what happens that day, he also maintains a sense of urgency to avoid ever becoming complacent. And on a Monday this past April, both of those traits came into play.

In the middle of working with a team to put a patient’s hip back into place, Travis heard: “We have a hot one coming in.” Within 30 seconds, the hip was in place and the team members had assigned each other roles to take on the cardiac arrest patient that had just arrived. Afterward, they discussed what went well and what could be done better, if anything, in a “post-code” meeting—it’s one way the team supports and helps each other cope with the results from emergency situations.

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As an emergency room nurse, I start another 12- hour shift in the emergency department. I like to collect myself mentally and try to prepare for the upcoming shift. Every shift is di erent, but you tend to see the same processes and treatment paths. Although all types of conditions come through the doors of the ER, the top reasons people visit the emergency room are abdominal pain, chest pain and falls.

7am

“You can do everything by the book, and they still pass,” Travis says. “You’re family in all aspects of it.”

Although it’s difficult when anyone dies, Travis’ personal beliefs help him keep a good perspective. He still remembers performing CPR on an 8 month old and how tough that was for the family left behind. Situations when young patients go too soon are by far the hardest ones for Travis and others who work in an ER to deal with.

“You’re grateful for what you have,” he says.

Travis didn’t always want to be a nurse. He worked in construction in Utah before he became interested in nursing. He blames it on a few nurse recruiters he met, but after doing his own research, he liked the flexibility of the field.

“You can do anything,” he says. “The demand is everywhere.”

So, he went for it and earned his associate’s degree in nursing. Then in 2007, he and his wife, Tracy, moved to Florida to be near family. But just before moving, he took a trip to Florida to job-hunt. He planned for a week but racked up 18 job offers on the very first day. Once they moved, he worked the night shift, floating between West Marion and

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I make sure that my rooms are stocked. Interestingly, more time is taken prepping for procedures than the actual time the procedures take. This e ciency is crucial to a successful procedure, and many nurses keep up with the latest practices and techniques by taking continuing education classes and attending yearly skills fairs.

I receive the bedside shift report from the o -going shift. The nursing report in the ER is short and sweet, but a few words speak volumes. Over the years, I have learned the emergency treatment plan by heart and can understand a lot with little communication.

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I continue to care for my patients and make sure the doctor has what he needs in order to make a disposition of the patient. (Do they stay in the hospital or do they go?) Even when patients are discharged, the relief is only temporary since another patient immediately fills their vacant room.

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I receive a new patient by ambulance complaining of joint pain with possible dislocation. I place them in a room, start an IV and draw blood. Although an ER nurse’s responsibilities range from inserting IVs and taking blood work to comforting loved ones, they also take on more typical tasks as well. For example, an ER nurse will stabilize patients experiencing injury, minimize a patient’s pain, quickly uncover medical conditions, start on a treatment path and teach patients about injury prevention.

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Room X has a dislocated extremity and needs sedation to put it back into place. I make sure that I get the proper information from the patient and family and ensure the proper paperwork is completed. It is important to pay attention to detail to ensure the right procedure is done on the right patient.

0830

Worked a cardiac arrest with the ER team. Giving medications and rotating chest compressions. The teamwork is amazing. We have one who records, making sure that we keep on track with our life support care. We have one who is in charge of medication administration. We have nurses and paramedics starting IVs and performing chest compressions. We have respiratory therapists and doctors ensuring that the patient is receiving oxygen and the airway is maintained. [Editor’s Note: Sadly, this particular patient did not survive.]

Patient returns from X-ray with a confirmed dislocation. As an ER nurse, we are driven by times, because we understand that the faster we know what is ailing the individual, the faster we are able to treat them properly.

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Notified that we have a patient coming in that will need lifesaving interventions, like CPR, intubation and emergent medications. When paramedics pick patients up in the community, they use a radio and call the ER to tell us a brief description of what they are bringing in. This helps us prepare for the patient’s arrival. For example, if we have a stroke coming in, there are things that need to be done within the first hour of arrival. They need a CT scan and lab work.

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Ocala Regional Medical Center, while he went to school for his bachelor’s degree.

He graduated in 2014 and was able to give up nights and assume his current position at West Marion, where he’s a point person, scheduler, auditor and caregiver. Something he remembers about nursing school is how tough it was to learn the ‘why.’ He advises future nurses to just hold on.

“The more you do it, the more it becomes comfortable,” he says. “Treat everybody as if they are your family. That’s when you will find true happiness in your job.”

In fact, his advice to all nursing students would be to establish excellent care and trust within the first three minutes of a patient’s hospital stay. Those first few minutes will make or break their stay, and he refers to this technique as building a relationship of trust, or BRT. The first hour in the ER is the most stressful for patients because they aren’t feeling well, so building that trust from the beginning will make all the difference. To get to that point, though, nurses sometimes bear the brunt of patients’ situational anger and frustration. Travis says it’s the only job

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We had a post cardiac arrest meeting with our ER team. I find this important because it gives us time to process what just happened, focusing on things that went well and what we could do better to improve patient outcomes. Talking with co-workers is probably the most helpful coping strategy in getting through a di cult death.

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Continue to round on my other patients and their various needs.

1100 where people can curse you out, but you still put on a smile and care for them.

Travis struggles at times to find a balance between laughing and crying when dealing with patients and their families, and he often has to shut out his feelings to do what’s best for them. While doctors focus on treating the disease, it’s the nurse’s job to treat the whole person mentally, spiritually and physically— and that involves putting your emotions on the back burner. Travis mentions that when a patient comes in from a massive stroke or heart attack and the doctors and nurses are able to take care of them and see them start to come back, that’s what it’s all about.

“Helping people is what makes it all worth it,” Travis says.

At the end of the day, when his feet hurt and he’s mentally worn down, Travis will take the long way home to decompress. His favorite way to unwind on his days off is spending time with Tracy and their two sons, ages 12 and 10. They love the outdoors, going camping and taking beach trips when they can, but overall, just being home together is special.

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Transported patients to the floor. I enjoy this time. The patients are excited to get a room upstairs and to get o the ER stretcher. It is a great time to talk to them about their ER visit and see if we can improve the ER process.

Comforted a deceased patient’s family member, which is one of the hardest parts of the job. When comforting family members, it is important to try to make sure that they have a support system and we help facilitate contact. Many times in nursing, you hear holistic care. This is the art and science of caring for the whole person. It is based on the belief that dynamic mind-body-spirit interactions are ongoing and impact a person’s ability to grow and heal. Holistic nurses aim to promote health and wellness as they facilitate their client’s growth and healing.

0930

The day just blew by, and the cafeteria was closing in 10 minutes. I gave my report to the charge nurse and hurried to get food. I had a bacon cheeseburger with fries.

Rounded on patients in the ED. As a nurse leader, we have the opportunity to round and talk to patients and families and ask them how their stay is. We really value the opinions of the patients and families. Not everyone is comfortable during their ER stay, so this gives us the chance to help patients and families feel more at ease.

1215

I feel sometimes that I Inhale my food as fast as I can. I really need to try and take my time eating so I don’t pay for it later. Too late.

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1430

Heading to my locker to take a Tums.

1530

Responded to in-house emergency situation.

(Facilitating care and transferring patient to the intensive care unit). As an ER nurse, we respond to in-house emergent situations.

Went to a daily bed management meeting and reported the current status of the ER, focusing on anticipated admissions, discharges and sta ng.

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1700

Working with case management to facilitate the transfer of my patient to an outside facility. Many times, we have patients who can no longer care for themselves or need to go to another facility for continuation of care. We work with the community and case management to try to facilitate the transfer safely and in a timely manner.

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Gave my report and heading home. My ending is a beginning for another ER nurse.

7pm

Realized I have not used the restroom all day. Took a fiveminute break.

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Working to ensure the patients have what they need and the other sta members are caught up in preparation for shift report. We like to say that nursing in a hospital setting is a 24/7 job— sometimes I have not been able to finish all that is assigned. The beautiful thing is that the nurse coming on is prepared for the challenge.

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