http://allnurses.com Here is where you can discuss issues and questions regarding the emergency department. en Fri, 20 Nov 2009 22:53:53 GMT vBulletin 60 http://img.an-file.info/misc/rss.jpg http://allnurses.com http://allnurses.com/emergency-nursing/how-should-new-440171-new.html Fri, 20 Nov 2009 20:28:57 GMT After graduating last December and spending the last eight months hustling in acute rehab, the call... After graduating last December and spending the last eight months hustling in acute rehab, the call I'd been waiting for finally came last night: I've got a job in a busy ED! I'll start in about six weeks, and I have at least three months of orientation ahead of me. I'd like to make the most of my free time between now and then getting ready. I would appreciate any suggestions, whether from new grad or seasoned veteran.

Among other things, can you recommend any books to read? Or a great CEN prep manual? I'd really love to find something with an interactive CD if possible, as I loved studying for NCLEX that way. I've got an armful of ACLS materials for some light reading!

Thanks in advance for your help. I'm still trying to pull myself off the ceiling. ]]> Emergency Nursing Freedom42 http://allnurses.com/emergency-nursing/how-should-new-440171.html http://allnurses.com/emergency-nursing/emergency-department-ambulatory-439595-new.html Tue, 17 Nov 2009 17:55:27 GMT I was wondering how many hospitals allow ambulatory patients & visitors to access the ER directly through the ambulance bay? I work in a hospital that for 35 years, has allowed the ambulance bay to be an open access point to the ER & the rest of the hospital. We are moving into a new facility and we want that practice eliminated in order to secure the work site for patient/staff safety and provide higher patient confidentiality. Does anyone know if there are any regulations that define or address this issue? I would appreciate any & all input. ]]> Emergency Nursing Rickbos http://allnurses.com/emergency-nursing/emergency-department-ambulatory-439595.html http://allnurses.com/emergency-nursing/forensic-unit-help-439582-new.html Tue, 17 Nov 2009 17:45:11 GMT I am currently completing my Leadership clinical at a hospital that is trying to develop a Forensic... I am currently completing my Leadership clinical at a hospital that is trying to develop a Forensic Unit into their Emergency Department in order to safely serve the incarcerated population that the Department of Corrections send us. I would love any advice on how your hospital was able to effectively design and implement a forensic unit. Here are some of the areas that we need information on but please feel free to share anything. Thank you so much for you time!

Interview Questions for Forensic Unit


1. ED Specifications:
1. Size of your ED
2. Number of beds/rooms
3. Self pay vs. insurance mix
4. Estimated number of patients seen per month
5. Teaching hospital/residency program
2. Why did your hospital decide that a forensic unit was needed
1. How long ago was the forensic unit established
2. How many beds does the forensic unit have
3. Type of patients seen on unit
4. Inclusive/exclusive criteria for patients on unit
3. Planning of unit:
1. Who
2. Cost
3. Outside agency support (ex: Sheriff Department)
4. Room needs related to safety
4. Staffing Model:
1. RN to Patient Ratio
2. PCA
3. HUC
4. Security (Staffed or 1:1 deputy)
5. Changes in Data:
1. Walk out rate before and after unit
2. Press Gainey scores before and after unit
3. Financial consideration (costs vs. gaines)
4. Safety data before and after unit (ex: security being called to ER)
6. Specific forensic unit policies
Additional Comments:_________________________________________ ________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ ____
]]> Emergency Nursing copek1 http://allnurses.com/emergency-nursing/forensic-unit-help-439582.html http://allnurses.com/emergency-nursing/want-flu-come-439400-new.html Mon, 16 Nov 2009 17:22:19 GMT So- We know the flu thing is likely to get worse, which means a lot more ER visits. As I... So-

We know the flu thing is likely to get worse, which means a lot more ER visits.

As I have seen so far, we are more a part of the problem than the solution. Even when people call to ask if they should come in, we can’t give them consistent accurate advice. Our docs are all over the place regarding who gets swabbed, and who gets Tamiflu. Most get at least fluid and Zofran, re-enforcing the belief that the ER is the place to go if you think you might have the flu.

Our ILI visits fall into 3 categories:

People who have the flu and might benefit from tammiflu. A small minority.
People who have the flu and won’t benefit from tamiflu.
People who are sick, but don’t have the flu.

This last category is probably the majority- people with compromised immune systems. They spend hours in a poorly ventilated waiting room and an ER. Every surface is coated with god knows what, people are coughing and hacking. Other than actually sucking on used flu swabs, I can’t think of a better way to get the flu than to come to the ER. We make half hearted attempts with gowns and masks on occasion, but ignore basic hygiene.

In addition, there is the general crowd of ER patients, many, (if not most) are not acutely ill, but tend to be unhealthy in general They are also being exposed.

We have no plan in place to deal with this. There has been no change in staffing models. There has been no change in flow. We will continue to use the same cumbersome system. I will still need to ask a bunch of questions that A- have no bearing on treatment, and B- people lie about. I will still need to do redundant charting etc…All the things I currently waste time doing. Except I will be doing it in the middle of an epidemic. Or pandemic. Or whatever might be on its way.

Assuming this continues to grow, both in reality and public perception, we are hosed. I wish I could say it is unbelievable how unprepared we re, but it is unfortunately completely believable.

Anybody doing a good job preparing and dealing with flu this year? ]]> Emergency Nursing hherrn http://allnurses.com/emergency-nursing/want-flu-come-439400.html http://allnurses.com/emergency-nursing/power-ports-439048-new.html Sat, 14 Nov 2009 16:03:18 GMT I had a patient who had a CT with contrast ordered. She had a port (round) she said she had had a... I had a patient who had a CT with contrast ordered. She had a port (round) she said she had had a CT a couple of weeks ago in another city and the ER nurse accessed the port with a power port huber needle and they used it with the power injector. I told her I believed her but that our protocol is that if a patient has a power port we have to have an ID card confirming it is a power port and it's safe for a power injector and x-ray confirmation of the triangular port. I wouldn't access the port and the patient refused a peripheral IV so she got the CT with oral contrast only. Do any of you use a traditional port with a power port huber needle? ]]> Emergency Nursing IlovenursingRN http://allnurses.com/emergency-nursing/power-ports-439048.html http://allnurses.com/emergency-nursing/today-my-er-438859-new.html Fri, 13 Nov 2009 15:37:51 GMT Please tell me what you would have seen or done in your ER today, I don't care if you think it's boring, or the same old thing. Heck, I'll even take your ER vents, if you hate it and can't wait to get out.... I just need a little motivation to keep me going while I do my make-up packet.


I was supposed to have my ED observation rotation today, for my Med/Surg clinical. My instructor is sick and canceled today's clinical. I have been waiting YEARS to get back into an ER. A 12 hour rotation experience as an EMT student in the ER is a major part of my going into nursing. I have very little hope that this instructor will allow me into the ER next week; if you miss it you miss it, others are scheduled for next week, it's a privilege, not a gaurantee, etc. And next week is our last clinical. I have been so excited about this rotation since before the semester began, and all semester when I got my calendar, counting the weeks. I don't think I see the ER again in the final two semesters. And, no, my getting a job as a tech or CNA in the ER is not realistic for my family right now. I wish.

I was hoping to see whether or not this area is really what I want, or if I've romanticized my experience into something better than what it was. I love nursing, I just want to know if the area that motivated me is what I thought it would be.

Thank you, Sarah ]]> Emergency Nursing SAHMStudent http://allnurses.com/emergency-nursing/today-my-er-438859.html http://allnurses.com/emergency-nursing/macho-men-ed-438779-new.html Fri, 13 Nov 2009 02:05:38 GMT I have worked in 5 ER's as an RN on both East and West Coast. And on both sides of the country you always run into a few Macho Men Nurses in the ED. These are the ones with poor impulse control and poor coping skills and they alway's seem to internalize anything that an angry patient says to them. Quite a few that I have worked with were Homophobic also.

In situatons when Patients are aggressive with me I always try and set limits for acceptable behavior and or defuse the situation butttttttttt............. The Macho men always prefer to do a take down. I avoid a Take Down if I can because someone usually gets injured and there is risk to life and limb and liability issues also. But if all else fails I will be in the mix for the Take down.

The Macho men enjoy pushing the buttons of the already agitated pt. a few notches higher till he escalates and attacks. For what? Is it worth it? Why push the guy's buttons? What if he has a knife or a gun or grabs and IV pole and bashes your brains in alittle or waits for a smaller more vulnerable prey to vent his anger on now that you egged him on? ]]> Emergency Nursing Mike SIE http://allnurses.com/emergency-nursing/macho-men-ed-438779.html http://allnurses.com/emergency-nursing/gagging-a-drunk-438778-new.html Fri, 13 Nov 2009 01:58:28 GMT While working in the ER I saw allot of illegal and dangerous behavior by many staff when it comes... While working in the ER I saw allot of illegal and dangerous behavior by many staff when it comes to management of agressive loud mouth drunks. At one hospital the staff was sick of the guys mouth so they restrained him and locked him out of sight and sound in the coffee room. Everything was fine untill he kicked over the large aluminum coffee container and it smashed against the floor then the security guards ran in and worked him over and the female nurse got a few wacks in to.

Another time I was attending to a pt. when my 2 male Nurse partners wheel in a male drunk restrained to the gurny with a pillow case balled up and taped into his mouth as a gag. And the Nurse was holding him down by his hair. The Pt. I ws taking care of asked me why that pt. was gaged. I mentioned to my partner to get the gag out of his mouth he might puke and aspirate his response to me mind your **&%^$## business!

I went to my Charge Nurse and mentioned it to her "I didn't see anything" she was hiding out in the Radio room to avoid involvement. Why people do stupid things like this I will never know? They risk injuring the pt. or killing the patient and also put anyone else who witnessed it at risk for not reporting it! they coulda just put a mask over his mouth and let him yell. ]]> Emergency Nursing Mike SIE http://allnurses.com/emergency-nursing/gagging-a-drunk-438778.html http://allnurses.com/emergency-nursing/dumping-syndrome-438596-new.html Thu, 12 Nov 2009 03:50:38 GMT I have worked as an EMT/Medic and ER RN. I have worked as RN on both east coast NYC as well as San... I have worked as an EMT/Medic and ER RN. I have worked as RN on both east coast NYC as well as San Diego. A problem known as "Dumping Syndrome" exists on both coasts. The syndrome would be characterized by an ED getting a really dirty drunken skell patient who never wanted to go to the hospital in the first place. The Medic may have had a bad experience in that ER earlier in the shift and wanted to pay back the staff with a gift and just picked up the filthiest derilict he could find on the Bowery and told him he would take him to the hospital for a free meal.


I am sure we have all experienced this more then once????? ]]> Emergency Nursing Mike SIE http://allnurses.com/emergency-nursing/dumping-syndrome-438596.html http://allnurses.com/emergency-nursing/am-i-missing-438570-new.html Thu, 12 Nov 2009 02:48:36 GMT Two recent incidents make me question some stuff. 1. A friend who is a new grad being oriented... Two recent incidents make me question some stuff.

1. A friend who is a new grad being oriented into the ICU of a cardiac center seems to be given bad information. She uses a 5 electrode system, and believes the the brown electrode is a ground, and can be put anywhere on the chest. I explained that the brown electrode is more likely a v lead, and can be placed in a number of positions, the most common being v1-v6. I explained a couple of reasons one might want to choose where to monitor. She seems a little skeptical, as she is being precepted by one of the more experienced nurses there, and what I explained to her seemed pretty basic.

I have seen this in the ICU, where most of the nurses I worked with, put the brown electrode in a random spot, and only monitored the inferior heart through lead II.

2. Had a pt last night who's primary complaint was respiratory- no chest pain, but multiple risk factors. EKG showed depression in leads v5-6. So- I set the monitor up to monitor lead v6 as the primary lead. Figured I might want to know if any treatment I gave resolved the ischemia. Also figured if there was going to be any elevation, that might be a good place catch it. While I wasn't watching, somebody mpved my brown electrode to the middle of the chest-somewhere between and below v1-v2. (right at shift change I got a positive troponin)

Am I missing something here? This can't be all that complicated, as I am not all that well educated or experienced. It seems rare that I encounter other nurses who know this stuff. Why is that?

Any thoughts? ]]> Emergency Nursing hherrn http://allnurses.com/emergency-nursing/am-i-missing-438570.html http://allnurses.com/emergency-nursing/kid-fell-off-437792-new.html Mon, 09 Nov 2009 01:35:28 GMT What do you think is the proper course of action for the following scenario: A 7 year old was on... What do you think is the proper course of action for the following scenario:

A 7 year old was on the bike with his brother and they both fell off. His older brother had abrasions to both legs. The 7 year old had an abrasion to the the hand and occipital area of the head. There was no bleeding and no hematoma. The kid ambulated into the ED. He was awake, alert and acting appropriately as per the father. There was no loss of consciousness. No nausea, no vomiting, his gait was steady and his pupils were PERRLA. What do you think the treatment should be?

1) Neuro exam, observation and discharge

2) Neuro exam and head x-ray

3) Neuro exam, IV and Head CT

4) Trauma Code ]]> Emergency Nursing MikeyBSN http://allnurses.com/emergency-nursing/kid-fell-off-437792.html http://allnurses.com/emergency-nursing/any-advice-help-437637-new.html Sun, 08 Nov 2009 06:47:19 GMT I got my RN in late 07. I worked 1 year in a very small ER, just 5 beds had to transfer most... I got my RN in late 07. I worked 1 year in a very small ER, just 5 beds had to transfer most everything out. Although we did not see alot of action what we did have was quite a variety. I have the basics down and what I believe to be a strong foundation to build on. I did order the Emergency Triage book and bought ER
facts and ECG made easy. The DON says although I don't have alot of experience, they usually don't hire anyone with less than 3 years ER experiece, he is willing to give me a chance since he has faith that I will work hard and succeed. I really know that this is the area I want for my career. There is a 5 week orientation period before I will have a patient of my own. I have my ACLS and TNCC certs and I plan to really hit the floor running, take notes and study hard. Is there any advice you can offer to help me succeed? ]]> Emergency Nursing chelynn http://allnurses.com/emergency-nursing/any-advice-help-437637.html http://allnurses.com/emergency-nursing/er-vs-med-437596-new.html Sun, 08 Nov 2009 00:43:15 GMT Hi guys. ER nurse of almost 2 years here. Never have worked anywhere else, thinking of picking up... Hi guys. ER nurse of almost 2 years here. Never have worked anywhere else, thinking of picking up some shifts in med-surg. Wondering if I can do it? Obviously it is different on the floor, but how much different? Can anyone enlighten me? Any ER nurses actually enjoy med-surg? Thanks! ]]> Emergency Nursing PAERRN20 http://allnurses.com/emergency-nursing/er-vs-med-437596.html http://allnurses.com/emergency-nursing/what-made-you-436885-new.html Thu, 05 Nov 2009 04:05:57 GMT I'm still going through nursing school, but I'd previously not had any preference for a specialty. Nothing had caught my interest - but I'd been able to rule out many areas! Until I got to do a rotation to the ER yesterday! I loved it!! Problem - I don't know if I'm "cut out" to be an ER nurse. How did you know you could handle it? What kind of person does it take to be an ER nurse? And what made you decide to work in the ER? From your experience - do Emergency Departments hire new grads? Would you recommend going right into ER or working Med/Surg for a year or so first?

Thanks for your help!! :loveya: ]]> Emergency Nursing MallysMama http://allnurses.com/emergency-nursing/what-made-you-436885.html http://allnurses.com/emergency-nursing/lippincott-04-out-436797-new.html Wed, 04 Nov 2009 20:46:23 GMT I'm getting ready to purchase my CEN review material, and was considering going with the ENA Core Curriculum (published in '07), and the Lippincott Q&A. I think the ENA will be okay at 2 years old, but what about the Lippincott from '04? Would it be too old? The other option is getting the new ENA review published in '09. I have a Sheehys manual, and would be using that and the Core as the reference books, then the other book as just sample questions. Thoughts? Looking to take the test in the spring sometime. ]]> Emergency Nursing F.E.R.N. http://allnurses.com/emergency-nursing/lippincott-04-out-436797.html