Emergency RN, BSN, RN, EMT-B 9,283 Views
Joined: May 24, '06;
Posts: 570 (65% Liked)
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To make a long story short:
ED = confusion, down and dirty, stabilize and get 'em up alive, move on to the next victim.
ICU = figure out what's REALLY going on, fine tune, start the road to recovery
MED-SURG = heal, educate, rehabilitate, release.
It's a nursing continuum and one needs to remember that. After 30 years of hospital service in both Emergency and Intensive Care arenas, I won't belabor the point. But IMHO, I think that all ICU nurses should have an annual mandatory rotation in the ED and vice versa. The lack of appreciation for the clinical needs and differences of each setting is what drives this perpetual misunderstanding and my personal belief is that management seriously needs to look into providing a solution. However, one final note. If the confusion in the ED rises to the point that patient contacts are so haphazard that it OVERLY impacts patient care, then staffing is generally at issue.
Don't waste your money. After having put in in excess of 100,000 IV's, I can readily tell you that those vein "illuminators" are just get rich quick schemes for a variety of medically knowledgeable people. The bottom line fact I've discovered over the course of a 30 year career is, none of them really work any better than a good old fashion flashlight held up tight against the skin. When one transilluminates through the skin, the vein generally stands out as a dark line because the fascia will reflect light while the vein does not. Just aim for the dark line and you're usually in.
At MunoRN, IIRC, if said property owner told you to stop taking pictures (or signs advising that photography is not allowed) while you're on his property, and one disregards him and continues to do so, then its considered trespassed because one violated the conditional property access.
Having said that, most hospitals have general rules that disallow recording devices without written permission from the hospital. I think this stems from the obvious potential for liability, so it then becomes a blanket rule with exceptions only granted on a case by case basis. In my institution, if we see someone taking photographs or video, we're instructed to tell them to stop and ask them to delete the files. If they fail to do so, our standing policy is to have security ask them to delete the recorded files and then escort them off the premises. If they refuse to leave then security will call the police and have them charged with trespass.
From my experience, most people generally cooperate and stop when you ask them to. I've only had to call security once when a guy kept doing it repeatedly when he thought that no one was looking.
Having worked for years on an IV Team, I'm reluctant to favor one particular site repeatedly over many venipunctures. In drug abusers' parlance, we refer to this as creating tracks, as such veins become useless over time from scarring. The vein doesn't care that it's being used for a clinically legitimate purpose; all it sees is the constant cutting and it will scar accordingly. That is why site rotation is so important, especially for someone with known access issues. I also agree with the other respondents vis a vis the use of an in-dwelling venous catheter over the butterfly injection technique. An IV catheter is much more stable (isn't prone to shifting or continued unintended venous injury) and more importantly, can provide immediate secure access if the patient has an untoward response during any procedure. This isn't only because of allergic reaction as I've seen patients vagal for even the simplest of things. Additionally, having a running IV line attenuates the irritation of the infusion because it dilutes whatever solute one needs to give.
But, given that this is occurring in a office practice situation, I certainly understand the monetary constraints; IV lines, catheters, and fluids all cost money. Some doctors may not want the expense and prefer to do it on the cheap. Additionally I would decline to participate in an IO insertion for this patient; IO's should be strictly reserved for lift saving emergencies where immediate access is critical to the survival of a patient. To puncture someone's bone marrow just because we can, for the purpose of delivery of a non clinically proven substance, IMHO, would dangerously flirt with malpractice.
In difficult access cases, I've always found that either transcutaneous illumination, or if available, ultrasound, to be the most helpful non-invasive adjuncts in obtaining reliable venous access. Obviously, given the known condition of the OP's patient's veins, it may be worthwhile to reconsider the overall risks versus benefits of IV versus the PO route.
Photography for personal and or commercial purpose, and property rights, can often overlap, however their legalities are different. This is aside from any patient privacy issues, which is another ball of wax. Simply put, in general, no one has the right to take or make any recordings of any kind while they are on your property without your permission. Thus, if we applied this same property rights rule in a hospital, no patient or visitor has the right to record anything without the permission of the property owner (ie the hospital). It doesn't matter that the patient is taking only a picture of himself in the privacy of his or her own room. If he's within the confines of property that belongs to another, he needs permission from that other person (or legal entity, in this case, the hospital). This has nothing to do with HIPAA.
Oh, and a note to imintrouble; your post made me recall an incident I encountered while touring through Guilin, China, way back in the early 1990's. I was riding by boat on the picturesque Li River, about to dock at Guilin, when I took a picture of the dock as we neared. I saw that one particular man had taken immediate notice of me, as he suddenly got up from his sidewalk squat and began moving quickly to our anticipated point of disembarkation. As he arrived there first, there he stood, waiting for me as I got off the boat. He approached me and quite boldly stated (through our tour guide interpreter) that he saw me take a picture of him, and for that I needed to pay him compensation. I listen attentively as the tour guide carefully and politely explained what the man wanted. I then locked eyes with him and all the while told the guide to translate word for word; I explained that I had saved for years for the air ticket to come from America especially to take a picture of this beautiful dock in Guilin, and just as the boat approached with the lighting perfect for my prize winning photograph... 'HE' BUTTED IN HIS UGLY ASS FACE INTO THE PICTURE AND RUINED EVERYTHING!!! Therefore, I needed him to repay me, the price of my air ticket, my film AND for the monumental loss of this once in a lifetime opportunity. He stared slack jawed at the tour guide for a moment, and then back at me; then shook his head and wagged a finger, but quickly retreated back into the crowd as the other listening natives roared in laughter at his expense.
One has to realize that if egregious behavior is so egregious that it defies the imagination as to why it is being overlooked, there exists the distinct possibility that the parties tasked with oversight are actually co-conspirators. In other words, don't be surprised if it turns out that the administrator is being given a nice portion of that 150K payoff. You may be dealing with multiple levels of fraud here.
I have the original Galaxy Note, Android v.4.04. The best apps out there are free, from Skyscape and Medscape. Look them up on Google's App store.
Just learned that NYPNU and NS-LIJ may have reached a tentative agreement; it looks like the strike may have been averted. Regardless, it shows how important it is for nursing to stand strong and stand together in order to preserve not only employment rights but to safeguard the care of our patients.
Support Your Nursing Unions!
I work in one of those hospitals that took in many of those emergency transfers from NYU Langone; let me tell you, that if people think those nurses deserve praise for transporting those patient out, many may be surprised to realize that it didn't just stop there. Upon arrival with those patients into the new hospitals, many of these RNs resumed their care despite being in completely new surroundings. The hospital took their names and was able to ascertain licensure status from the state, and allowed them to continue working as full RNs.
It seems to me that the more one digs into this story about dedication to duty, the more one finds that is worthy of laudatory adjectives. IMHO, that's just the nature of the nurse, humbly and quietly going about their business while conducting themselves with the best of human character; it's a shame that it takes a disaster for the public to notice.
Kudos to those in NYU Langone for showing the world what nurses really are.
Live in Queens, NYC; apartment is at least 3 blocks outside from zones B and C. Zone A was the mandatory evac. Had prepped extra supplies, water and food at home to last 2 weeks. One month MRE's in reserve in the closet. Car fully fueled in the indoor garage; go bag also in the closet for "just in case" purposes. Kissed the wife and kids and went to work, just getting into the city before the MTA wide shutdown. Stayed at work for the next 48 hours whilst the family hunkered down. Kept in close contact throughout by phone. Luckily, no power loss at home or work (several other area hospitals weren't so lucky). Left from work as soon as the bridges reopened and they released us.
I think it bears mention that there were some that criticized both Mayor Bloomberg and Governor A. Cuomo for closing down mass transit so far in advance of the storm. IMHO, it was an excellent idea, as nearly all of New York City is reliant on mass transit to get around the city. By closing it down completely, the authorities basically forced everyone to go home and stay there, well before the storm hit, where they could be safe, secured and not run the risk of having thousands out in the streets trying to get home just before the worst storm in a century hit. My personal kudos to both Bloomberg and Cuomo for an excellent command decision.
Oh, and BTW if anyone wants to see a good photography book about nurses: The American Nurse
As I read through this thread, one of the more hilarious observations that I've made over the years (having worked both union and non union sites) is that there is a general misconception that unions will somehow protect the lazy from being fired. So, let's turn the equation around and ask, has anyone ever seen lazy nurses or aides working in NON union jobs? I have; and plenty. IMHO, non union jobs probably have an equal number of non productive personnel; being in a union or not has nothing to do with their survival skills. The bottom line is, the ne'er do wells often know how to kiss the right booty and that's really why they stay in their positions. The fact is, that unions cannot ever protect or save a job for someone who violated company rules, that is, unless management allows it.
Frankly, having a union is rather like being Mirandized, or getting due process. Or lets put it this way, just because someone has a defense attorney doesn't mean he'll get off scott free. It just means that he will have all of his legal rights observed. Thus, having a union participate in your employment is the best way to ensure that you get all the benefits and protections as afforded by labor law.
Of course, there are corrupt organization and unions are no exception; even entire police departments have been put under federal oversight after compelling evidence that emerges of criminal wrongdoing. However, such should not be used to broad brush all police departments. Likewise, not every union is corrupt and the bulk of them are actually quite useful and helpful to their members.
Me too, lol. Although his technique is a little unconventional . . .
Considering that Texas has long been a state that is not politically friendly to unions, this was a tremendous win. Kudos to those RN's sticking up for themselves and their professionalism
Support Your Nursing Unions!
Lenox Hill Hospital, an institution with more than a century of history, is staffed by the great nurses of the New York Professional Nurses Union (NYPNU). After Lenox Hill was taken over by North Shore - Long Island Jewish Health System NYPNU has fought to keep nursing at the stellar standard which its community deserves. As the old nursing contract is nearly up, NS-LIJ has now threatened to undo years of hard won clinical excellence simply for the sake of boosting their already profitable bottom line.
NYPNU nurses have decided to confront the "Money Uber Alles" bosses of NS-LIJ, and will strike if they have to in order to protect their patients and their own nursing professionalism.
Please support these valiant nurses in their struggle to maintain nursing excellence!
Please take two minutes and listen to these fine passionate nurses speak for themselves of why they love what they do:
This whole thread sort of reminds me of how audiophiles choose stereo systems. Some only want to have "the best" that money can buy because only then, would they be able to distinguish the high quality of the music that they listen to. Frankly, I'm of the portable AM radio crowd; as long as I hear something, I'm happy.
In the busy ED that I work, the environment is often so noisy that I would be hard pressed to tell the subtle nuances which very high quality scopes are known for. So using a "master" cardiology, while filled with panache, is probably overkill unless one is really within an arena that not only needs it, but where one can fully utilize and clinically appreciate those subtle differences. Thus aside from the invitation for theft (that all high priced scopes bring), the cost of one spectacular scope can likely pay for several 'average' ones; one for the locker, one for the backpack, one for the car, or whatever; all extra back ups in case you really need a scope or for when you eventually lose one.
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