Each time I am in the emergency department (ED) as a medical student, I meet new members of the health care team that make superior patient care possible. I have quickly developed a greater appreciation for the fact that no medical professional works in an isolated bubble. The strengths that each other bring to the table are paramount to the flow of patient progress. Before my time as a medical student in the ED, I did not know exactly what the jobs of each type of provider in the ED entailed. However, understanding the scopes of practice of each profession is integral to thoroughly understanding the patient care setting, and on one day in the ED, I stepped outside of the typical role of the second-year medical student to work closely with a nurse to better understand the vital role of nurses not only in the ED, but across all specialties. While shadowing one of my attending physician mentors in the ED, emergency medical services arrived with a patient who was awake and talking with altered mental status. Ready for action, the resident physician began a physical exam, and a newer nurse attempted to insert an IV in the antecubital region of the patient’s left arm. Her veins were incredibly small, and even with the smallest of needles, it was proving to be a challenge. An experienced nurse, one who I had met on one prior occasion, came over and offered her assistance. Making it appear effortless, she inserted the IV into a vein in the dorsum of the patient’s hand. She collected blood into vials with tops of various colors as well as cultures (which were ordered to see if the patient had an infection causing her altered mental status). Nurses collected other needed supplies, and a physician prescribed medication for light sedation as the patient was moving around harshly almost removing her IV on one occasion. Asking the more senior nurse if there was anything I could do to help, she answered that getting another clean gown for the patient would be of great help. The patient had since started vomiting, so the one she was wearing was dirtied. I quickly returned with the gown and a vomit bag; we changed the patient and removed her jewelry for imaging. All the while, both the newer and more senior nurse danced around the room in what seemed almost like a choreographed routine to perform countless tasks to make sure that the patient was stable and settled before she was transported anywhere. Once the patient was cleaned up, her labs were drawn, and radiology captured needed X-rays, the patient needed a CT scan to see if there was internal damage that caused the shift in her mental status. The more senior nurse was going to bring the patient to CT, and after I spoke with my attending, I continued to follow the nurse through with this patient’s care. I tried to maneuver the patient’s stretcher to CT, but it was difficult! It was hard to turn and move through the hallways that at one point even had an incline. Stepping in to help, the nurse showed me a trick she uses to move the stretcher most efficiently — though not without remarkable strength that was truly impressive. As we assisted the patient to the CT machine from the ED stretcher, we had to make sure that the portable monitor that cycled to assess the patient’s vital signs did not fall. On one occasion when it almost fell at the patient’s feet, I watched as the nurse — who was placing the breaks on the ED stretcher further toward the head — swooped in and stabilize it, after which I held it through the rest of the patient’s transport through CT and back into her hospital room. After the scan, we brought the patient back to the ED. While in CT, the patient’s status worsened, and she started to move around and almost remove her IV. Ultimately, the attending placed orders for soft restraints. We applied the restraints as we got her settled into the room she was assigned in the ED, before nursing care was turned over to the permanent nurse that would be taking care of the patient. Of course, it is impossible to document every action that the nurses played in this case because the list would be endless. I am grateful for the opportunity to take part in this patient’s care from the side of a nurse, furthering my education from an interprofessional standpoint. In achieving the common goal of what is best for the patient, it is crucial that each player on the health care team is appreciated for what they bring to the table. As I continue to learn both in the rest of medical school and beyond no matter what specialty I pursue, I want to continue to make a conscious effort to learn about the other players of the health care team so that together we can provide the best possible patient-centered care. While I can say for sure that I respected nurses before this experience, focusing specifically on the way that they perform so many tasks to take care of the patient, seemingly all at the same time, while also smiling and holding their patients’ hand in often the scariest time of the patient’s life has revealed care that is truly admirable. It is a true display of keeping the patient at the center of all medical care. And that is something I seek to emulate as a physician. Jennifer Geller is a medical student. Source
