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Emergency RN, BSN, RN, EMT-B 8,350 Views

Joined May 24, '06. Posts: 570 (65% Liked) Likes: 1,899

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  • Dec 17 '17

    Like JoPACURN stated, the differences is in not knowing what the other side does. This is why it's always best to give report to someone who has worked the other side, because they inherently understand the differences in arena focus. Not that one is more important than the other, but rather, that the patient's needs evolves from emergent medical diagnosis, rapid treatment, selection of nursing priorities, and immediate stabilization in the ED; to the fine tuning of differential medical diagnoses, continued treatment, and consolidation and refinement of nursing care in the ICU.

    IMHO, I believe that ALL emergency and intensive care RN's should routinely work the other areas because in the long run, it actually makes you a much better RN. One begins to see and understand that one's own iron clad rules, are perhaps not so iron clad after all.

  • Sep 28 '17

    Sometimes, you just need to resort to brass tacks. Try something along these lines:

    "I'm sorry that you need to come back so often for something as ridiculous as an asymptomatic rapid AF, but unfortunately, the protocol here requires that I notify you for the change in rhythm. Further, if you don't respond, then I'm forced to call your senior (the higher resident, or the first's doctor's boss); if your senior also fails to respond, then I'll have to call the attending cardiologist at home. If you don't like that, then I would suggest when you're promoted to director of clinical medicine, please keep those dislikes in mind, and change the god damn policy so that us poor nurses don't have to bother the poor residents with such 'meaningless' things. I mean, it's really a waste of our time too, you know. But until then, when I call, I expect you to be here. Oh, and btw, if you don't show up; don't worry, you can read all about it in the chart; ie. who I called, how many times I called, how many minutes elapsed, what was ordered, et cetera; and have a nice day."

    Advice to the OP. Don't worry about it. Stick to your guns. You already have a license, so you need to protect it. A medical resident doesn't have a license yet, and is still in training. Whether he or she passes their training in large part, depends on how they conduct themselves on the floor during their residency. Your job is to protect the patient, not the medical resident. Frankly, their convenience or work load isn't even on my radar. Sometimes, these "doctors" forget that we don't work for them. Sure, we will follow their medical orders, but we work for the hospital in delivery of care to the hospital's patients. Ultimately, my employer makes the rules. If the rules are to call the MD for a rhythm change, then that's what I will do; the resident's likes or dislikes are not my concern. We are not there to make friends; just do your jobs. Period.

    Further, from your follow up post, the patient sounds like a train wreck to being with. Someone with such an extensive history, in new onset Rapid AF, really belongs back in a telemetry setting, regardless if they were asymptomatic or not, IMHO.

  • Jul 12 '17

    not responding in particular to this op's question, but wanted everyone to note this other case, in which a psychiatric patient was sentenced to five years for assaulting a nurse and giving her serious injury:

    typically, if it would have been a police officer, the patient would have been arrested for attempted murder (as had happened in other cases in the past), as he bit and his saliva could have potentially carried the aids virus.

    nurses have traditionally been used as various forms of punching bags, and the usual reaction from employers is to shrug and say "so what?" nurses and nursing needs to get together to help defend ourselves, both legally and physically, even as we're doing our jobs. hospital systems have to wake up to their legal responsibility to employee safety under osha.

    imho, once a patient attacks someone, then continue to treat them, but change their status to "prisoner" with police in attendance. then, once they're medically stable for discharge, they should be transported into and processed by the criminal justice system.

    large hospitals deal with police prisoners all the time. having a patient become one in the midst of his admission isn't so strange. in large cities like new york city, there are what are known as "prisoner wards" which are locked facilities like a psych unit, with corrections officers always in attendance.

    we as a society have to realize that crime and criminality does not stop when the criminal gets a cold. to ignore that facet of their life begets danger not just to nurses, but to society in general.

    support your nursing unions!