Colleen McFadden, R.N., has been a nurse at CHOP for 16 years, including 10 in the Emergency Department. This is a day in her life.
The alarm clock rings. With her hair still damp from last night’s shower, she blows it dry.
Makes lunch — turkey and cheese sandwiches — for herself and her two kids, ages 11 and 13
Embarks on the 30-minute drive to CHOP, stopping at Wawa for a 20-ounce coffee
Arrives on duty and pockets the adult emergency phone, which will ring if any adult in the Hospital (i.e., parents or staff members) has a medical emergency. Thankfully, today it is quiet.
Performs a “safety handoff” on three patients, with the outgoing nurse briefing her on each case and introducing her to the patients
Eats a protein bar
A 10-year-old boy with sickle cell disease, fever and chest pain is on his way to her empty room. McFadden begins the protocol for this type of patient, preparing to draw blood for lab tests.
Fills a syringe with liquid ibuprofen for a 7-year-old girl with a fever. The girl cries — she doesn’t like taking medication. McFadden sweetens the deal by giving her sips of chocolate milk in between sips of medicine.
Goes over discharge orders with the family of a girl who had come in with an asthma attack. “The biggest thing you have to do is wash your hands,” McFadden tells them. “Flu is out there!”
“Revitalizes” patients — nurse-speak for rechecking vital signs, something she does at least once an hour on every patient
Brings a laptop to a 16-year-old patient for the behavioral health screen, given to all teenagers in the ED to look for things like depression, drug use, suicidal thoughts or abuse. “Sometimes kids will come in for the equivalent of a stubbed toe, and we’ll find that they’re feeling suicidal,” says McFadden. This teenager’s results: “mildly depressed.” McFadden gives a printout to the doctor to follow up.
After handing off her patients to another nurse, McFadden arrives at the triage desk as the nurse in charge. Her job is to make the quick initial assessment of every patient, rating them on a priority scale from 1 (acute emergency) to 5 (no emergency), then assign the patients to available ED rooms. A line forms and McFadden goes from one family to the next, identifying the complaints: dental pain, rash, fever, cough, suspected appendicitis, split lip.
McFadden’s shift in triage is over. In two hours, she triaged 68 kids.
Emergency Department Shift
The charge nurse gets a call about a patient, recently arrived from Saudi Arabia, who is on her way to the ED with labored breathing. McFadden — now assigned to help wherever she is needed — raises the possibility of MERS, a serious virus found on the Arabian Peninsula. They phone to find out if the child has a fever, a hallmark of the virus that would require putting her in one of the ED’s negative pressure rooms. Thankfully, she doesn’t.
Eats an apple
A fellow nurse asks for McFadden’s help to get an IV line into a 13-month-old’s tiny veins. “Colleen is a master!” he says.
Paramedics wheel in a 10-year-old hit by a car as he crossed the street. McFadden and a doctor quickly assess the boy. They are able to remove his jacket safely but must cut off his clothes. (“Sorry, buddy,” they tell him.) As the doctor orders X-rays of the areas that hurt, McFadden documents everything in the computer. “You’re going to be all right,” she assures him.
Eight and a half hours into her shift, McFadden takes lunch.
Takes over responsibility for three patient rooms and focuses on a 2-year-old with metabolic disease who is vomiting.
Hands off three patients and clocks out
Arrives home and helps with homework
Joins her husband and two kids to watch TV, then takes a shower
— Julie Sloane