1) Don't be afraid to say No. To patients, visitors and doctors. Our right to refuse (unsafe treatment, poor behavior or to be manipulated) is one that we as nurses don't use frequently enough.
2) Always follow your gut instinct. If the little voice is telling you something isn't right, figure it out. Work the problem until you know you have things under control.
3) Always remember the other people. Social Work, environmental services, chaplains, EMS. They will bail your ass out when you need it the most... and it helps to know their names when you thank them.
4) Never, NEVER assume that you have seen it all. Something is out there that will shock the shit out of you.
I picked up the dancehall Thursday night. That used to be where we stored the drunks and undesirables. Now that our census is WAY up and our diversion is WAY down there are actual sick people out there. So this woman is a G10P1 with many many spontaneous abortions due to Rh incompatibility and incompetent cervix. She was pregnant and had a miscarriage the end of Thanksgiving, but returns with belly pain. She was clutching her bible and doing the "Dear Baby Jesus" rock back and forth. She wouldn't let go of the bible, even when we went to do her pelvic exam. I found out that when she had the last miscarriage she kept the POC (products of conception: she was only about 12 weeks, so it was more tissue than baby-looking stuff) in a ziploc bag. The bag was wrapped in a cloth tissue and was put in the bible. Yeah, thats where it was. Pieces of dead baby in the woman's bible. Fucking gross. I can't imagine the smell!
Once I get to triage it really becomes like reality TV auditions. Everyone wants the starring role in the back. They make things sound 100% worse than they really are. An ingrown toenail can become an unsteady gait with stroke symptoms and who the hell knows what the common cold can be inflated to... the Bubonic Plague, maybe? I am the Simon Cowell of triage. You really have to be sick to get a rise out of me. I'll put you in the waiting room at the drop of a hat. I had a 22 year old come in with a nosebleed. It had been bleeding for a couple of hours. She was a little upset, but very appropriate. I sat her down and was in the process of doing the "Hi, my name is.... and what seems to be the problem" while slipping her jacket off.... she looked up and blinked hard and then blood came out of her freaking eye. Like out of the tear duct and down her face. She continues to cry and blood poured from her eyes.
Ok, WHAT THE FUCK?!?!?
I popped her up, no vitals, put her in the wheelchair and took her straight back. The charge nurse started to give me shit until I explained that this was more than just a run-of-the-mill nosebleed. I don't freak out about much, but I must have had a WTF look on my face. She was whisked into a room and the attending was not far behind. I'm not sure what the blood in the eyes was really coming from, but she had no other medical problems and platelets of 8. Here's to good nursing assessments, huh?