NicoleRN07 1,716 Views
Joined: Jan 27, '07;
Posts: 136 (4% Liked)
; Likes: 9
It is in our protocol that we can administer Vit K IV, however, I generally request from the ordering doc that we give SQ. That big DEATH written under the complication section in the drug book is just too scary for me.
I work in a busy ED, but when we initiate behavioral restraints, that is an automatic 1:1. We never have a patient in behavioral restraints that doesn't have a sitter at the bedside at all times.
You, as the nurse are an advocate for the patient, so if you feel that your patient should have limited visitors or visiting hours, it is your or your charge nurses duty to enforce this. I do not work on a floor, but in a very busy ER, but having visitors with the patient is in a way to our advantage. We have several patients that we are taking care of, and on most occassions only get around to looking in on each patient briefly, but when you have a visitor in the room, they can help to clue us in on a change in patient condition. So, despite the fact that family and friends can be very annoying at times, consider them an asset to you and the care that you provide to your patient.
We do the Pod thingie...didn't like the idea at first, but it's better than the team approach where our dept was divided. I don't feel so overwhelmed in my POD, because I am only concerned with my patients, and when my Pod partner is overwhelmed, I help pick up slack, and vice versa.
The best I've got this week is....."I can't tell you"......and "God said NO!"
CYA.....I can't tell you how important your documentation is in situations such as this. I work with a MD who is the same way, but I chart, chart, chart! Keep copies of your documentation for the supervisor/medical director, that way, when a problem presents itself, you have it there in front of you as your proof. The particular MD that I work with is aware that I have a problem with him, because i have addressed the issue with him multiple times, and he knows that I'm watching him, and has even seemed to have improved in the last few months. GOOD LUCK!!! Remember: DOCUMENTATION IS YOUR KEY!!
We do conscious sedation frequently in our ER as well. On adults, we always use Etomidate, because it has a short half life, and there is usually no recovery time. Usually, the patient is completely alert within 5-10 minutes after administration. With children, we use Ketamine. Ketamine scares me to death! Some of our docs prefer IM to IV, however, I refuse to administer Ketamine without an IV access. These kids become tachycardic, and in some instances hypertensive, and I've even had 1 or 2 drop their sats. Waking up from it is just as bad...these kids have drug induced nightmares, excessive crying, and agitation. It's not fun!!
You should not be working alone as the only nurse in the dept under no circumstances. That is setting you up for major problems. What happens when there is more than one code at a time, or more than one critical patient at a time? I don't know how many beds your ED has, but regardless, it can still be a sticky situation. Protect your license....you earned them. No one, not even the MD will stand behind you when something goes wrong and you're the only nurse in the dept.
I've never had that problem, and I've sent out some pretty unstable patients. Just last week, I sent a lady out who came in V-tach, had been shocked like 12 or 13 times, had a lidocaine drip, amiodarone drip, dopamine, and heparin drips and kept going into v-tach. I shocked her 4 times while the medics were loading her on the stretcher for transport, but they would have NEVER refused to transport her because she was too unstable......that's their job, they are trained for such.
I think that once you get started, you will see that you will have no problem finding an extra shift if you want or need it. Be careful not to over do it though. You will burn out quickly. I usually try to work one extra 12 hour shift every two weeks, that way, I get the extra money, uncle sam doesn't take too much, and I don't burn out. You will quickly learn your limits. Listen to yourself, and your body.
Give me a break...literally. And you've been a nurse for all of how long?
Have you ever had another fulltime job before you became a nurse?
No offense, but "workaholic" are ALWAYS the first to burn out. Pace yourself and stop being so naive. You're not a hero responsible for the welfare of all who have to wait in the waiting room.
Its a gravity thing. If that happens, (rarely, b/c I don't allow my fluids to run completely empty), I just d/c the IVFs, flush the heplock, and hang another bag of fluid in it's place.
The reason I entered nursing is because I care about others, and I enjoy taking care of people during a time when they need someone to care. I care enough about others not to complain about missing my break. I have based my whole life on taking care of someone else, whether it is my family or a complete stranger, and that is what I am happy doing. I'm not asking for anything in return. I am a wife and a mother first and foremost, and when I am home (4 days a week), I focus on my family, but when I am at work, I am a nurse and I strive to take care of my patients to the best of my ability, and if that means missing a break, then I am ok with that. I, when in charge, ALWAYS make sure that my co-workers have their break, even if I don't, it is no big deal to me.....if I don't get a break, I get paid for it. I am not asking anyone to agree with me, and quite frankly, I don't care what anyone thinks. It's my personal feelings and I do not believe in trying to force your opinions on another.
The facility I am currently employed put an end to the vented crocs when they first became popular for the same reasons as discussed above. We can however wear the solid crocs. We are not even supposed to wear tennis shoes with mesh to work. Our shoes are supposed to be "spill resistant", meaning that nothing should be able to soak through. Should we wear all wear vinyl scrubs too? After all, our scrubs are usually the first thing that gets messy.
If I didn't do the assessment, then I don't chart it.
We make sure the patient has someone to drive them home before administering narcs/benzos, and after giving IV/IM meds, we observe the patient for 30 minutes and then d/c. The observation time is on all meds, not just narcs.
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