Thirty Minutes In The Day Of A Registered Nurse

I was working as the nursing supervisor of the Family Medicine Center on a busy Thursday afternoon. The center saw about two hundred patients a day. The center was a resident training program and also had medical students. It was brimming with people all the time. Because I am a registered nurse I routinely checked in patients for the doctors. Family medicine doctors see patients from infants to the very elderly and deliver babies. It was an exciting place to work where anything could happen. Fourteen nurses staffed the center with two supervisors. The center was divided into two sections and five or six doctors would be seeing patients on each side. That made for ten doctors seeing patients in the morning and ten or twelve in the afternoon. It was barely controlled chaos due to the sheer numbers of patients we saw.

On that Thursday afternoon I went out to the lobby and asked a young man in his twenties back into an exam room for a senior resident.  I saw immediately that he was incredibly ill. I put him in the first room available by the door. He should have gone to the emergency room but it was far too late for that discussion. It was not unusual for our patients to come in while having a heart attack instead of going to the emergency room. I quickly took the young man's blood pressure. It was low. His pulse was rapid. He had a high fever. He had a purple rash all over his arms. He was not fully alert. His neck was stiff. I started a large bore IV and opened the IV fluids to flow freely. Then I quickly went after the resident.

I told the resident about the patient's vital signs, that IV fluids were started, and that I suspected meningitis. I know nurses do not diagnosis patients but after you have seen an acute illness many times it is not difficult to at least presume in the absence of a spinal fluid specimen. The doctor immediately stopped what he was doing and quickly went to exam the young man. He thought it might be meningitis as well. But what kind? Hard to say without doing a spinal fluid tap. He had me start IV antibiotics. He quickly talked to his attending physician. The decision was made to send the patient to the emergency room. We placed the young man on a stretcher and rolled him the short distance to the emergency room. Our center was part of a large university teaching hospital and adjacent to its emergency room. All of this from the time I greeted the young patient to the time we took him to the emergency room took approximately thirty minutes. Maybe less.

 The family medicine staff and I, who had contact with the patient, had to take Cipro, an antibiotic, just in case the young man had a contagious form of meningitis. That was not the first time I had been exposed to a contagious illness nor would it be the last. I had taken Cipro three times while I was a hospital charge nurse for seventeen years. We later found out that the young man fully recovered. I was afraid he was going to die. He was acutely ill and in shock while in our center. He did have meningitis but it was not a contagious form.

My days at the center were, thankfully, not always that eventful but my education and nursing experience prepared me for those thirty minutes.

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