Er Rotation

Daniel Macinga
ER Clinical Date: 10/1/20

Objectives for Emergency Room Experience
1. Briefly describe the type of patients observed in the ER.

During my time in the ER, I saw two patients with falls, one with a high potassium,
another with narcosis related to obesity and heart failure, and one in critical condition
after a car crash. The fall patients both had diabetes with some form of neuropathy and
a heart complication. One fall patient had a subdural hematoma and two broken ribs,
while the other was a heavy-set gentleman with 5 broken ribs. The patient with narcosis
was the most interesting to me, as I was able to see the effects of CO2 retention
(respiratory acidosis) amplified by obesity and a heart condition. The patient with high
potassium was an elderly woman in the nursing home who saw a sudden change in
mental status.
2. Identify the members of the ER team and their role.
I was able to observe a triage team in action during my day in the ER. The members of
the ER team consisted of a lead (ER physician), second physician who was an
intensivist and intubated the patient, two nurses (one assisting in care while the other
took the role as a scribe), a physician assistant who served under the physician, an x-
ray technician, and a “runner” who gathered extra supplies when necessary. The room
was very congested but seemed to move in a well-organized manner. Each role was
clearly defined beforehand to the participating individuals and the handoff from EMS
was smooth.
3. Discuss the activities and importance of the triage area.
The importance of the triage area is to sort through the various patients and determine
which patients care is a necessity for and then placing them within a category based on
their condition. This ensures adequate and high quality care is provided within an
appropriate amount of time.
4. Describe the method/rationale for bed assignment in the ER.
Jerome had been given rooms 8-11 on my day in the ER. The rational behind this is that
with no doors present, access to rooms is increased and by grouping the patient
assignments within a close proximity, response time and time spent providing care can
be at an all-time high.
5. Discuss the ER nurse’s role with patients discharged to home.
The nurse’s role in discharge would be to explain to the patient their current health
status, review any medications that may have been prescribed, address any concerns
the patient may have, and possibly patient teaching to either the individual or present
family member/friend for at home.
6. Discuss the ER nurse’s role with admission to acute care.
The nurse has a big role with the admissions aspect to the emergency department.
Helping patients that come in as quickly as possible with acute problems while
preventing exacerbation is vital. A baseline assessment is created which includes vitals,
labs, pertinent health/family history, and medications, so as treatment progresses trends
can be established. With the nurse being a primary provider of care throughout a
patient’s stay in the hospital, accuracy and efficiency are at an all-time high.
7. Identify one potential ethical concern related to emergency care
A potential dilemma I see with emergency medicine specifically related to nursing is on
the basis of providing quality of life care. While the word emergent has a specific
definition and range of qualifying ailments, the patients that come into an ER can be
both within that spectrum but also outside of it on the furthest ends. I saw two patients
with falls, one with a high potassium, another with narcosis related to obesity and heart
failure, and one in critical condition after a car crash. While we are educated on
establishing a hierarchy of care necessity with our patient assignments, we may be
more likely to spend less time with the elevated potassium patient who is now on fluids
and only needs to be monitored as time passes until the levels return to normal while
we care for the other patients. A second ethical issue I noticed was the lack of phone
call response by family and friends of the patients. Many of them were there for
accidents and the hospital staff had to try numerous times with sometimes no avail to
reach these individuals. Care decisions must be made in the acute care setting and with
no one there to decide, the decision is turned over to the medical staff.
8. How was your experience overall? Would you recommend this experience
for future students?
I’d say my experience in the ER was truly amazing and educational. In addition to being
welcomed by the staff, I felt extremely comfortable being in the ER setting. I wish I could
go back down again before the semester is over. I’ve known that I wanted to be in some
field that involves critical thinking and high-paced work for a while, with this experience
just reaffirming that for me. I wouldn’t say that it’s my number one option, but it and ICU
are right next to each other as my top preferences. My encounter with the ER involved
being able to shadow Jerome Lynch, who in addition to working is also a preceptor and
clinical faculty member for Mercy’s nursing program. He, being someone who frequently
observes and teaches, was able to relay information to me in a digestible manner while
also allowing me to take control when I wanted to. He instilled confidence in me that I
didn’t know I had and further confirmed my knowledge base of basic concepts such as
IV’s, navigating the Alaris pumps, and providing patient care. I absolutely recommend
this experience to every nursing student, whether they are interested or not, because of
what it allows one to measure. Regardless of what niche one works in within the realm
of nursing, basic patient care is being provided and a general knowledge base is
required. All the nurses in the ER had 3-5 patients and had to have a general
knowledge base of each plus an ability to think critically.

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Daniel Macinga

ER Clinical Date: 10/1/20

1. Briefly describe the type of patients observed in the ER.

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