Quote from turnforthenurseRN
Any tips on getting better at "moving the meat?" lol. I think I have a problem with that "floor nurse mindset" regarding patients being discharged even if they are still having pain, etc. I had a patient who came in c/o abdominal pain but had psoriatic plaques all over body. Patient received 1mg Dilaudid IV + 125mg Solumedrol IV, then started complaining of an upset stomach so the doc ordered a GI cocktail. About an hour later the doc wrote their discharge instructions and gave them two Rxs, Norco and Prednisone. Patient was requesting something else for pain, but the doc had already left. I spoke with the charge RN and she told me, "too bad, the patient is being discharged and the doc is already gone. Get them out of here!"
For the record, I'm a floor RN but I have been floating to the ER frequently as of late. The ER nurses appreciate my help and I get along with everyone I work with down there....the charge nurses have introduced me to the ER nurse manager. Overall, I love floating to the ER and I'm thinking about making the switch.
I also quickly learned that brain sheets do not go over well if you're working in the ER. My "brain" is a piece of computer paper or paper towel with notes written on them. Sometimes I use my hand or alcohol pads if I don't have anything!
Keep the tips coming, please
Well it sounds like you are already well on your way to being an ER nurse. I also am a former floor nurse and I kinda envy you your slower transition because for me it initially felt like hitting a brick wall.
In the situation you describe, the patient has been medically evaluated and is well enough for discharge. It is difficult to say no to a person in pain but you have provided an oral analgesia, it is now the patient's responsibility to fill that prescription and manage the pain at home. Further IV narcotics for this patient is not necessary or appropriate when discharging. Sounds like this patient had a good plan going forward and just needed some education.
As an ER nurse most of your patients will not be admitted, some will be suffering from "acopia" rather than an emergent complaint. You need to steel yourself and treat them as outpatients, meaning they are an adult, healthy enough not to require hospitalization, and they are going to be fine.
It is hard at first. For my first month or two I had anxiety every time I discharged a pt.... What if we missed something, the patient is angry and yelling at me, will I get in trouble? Now I'm more of your Charge nurse's opinion. Diagnosis: check, treatment plan: check, patient able to leave ER on own power: check, there's the door, feel better!
Like I said, this is a huge shift in thinking, it was hard for me, but you get there eventually an start to trust your instincts more. That being said, if with this patient your spidey sense was tingling for some reason you should trust that instinct too, the physician and more experienced nurses may disagree as in this case and that's part of learning, but it never hurts to ask for another opinion.