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nurse2033 23,192 Views

Joined Jun 6, '07. Posts: 2,081 (46% Liked) Likes: 3,013

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  • Sep 16

    There needs to be an assessment of the patient's competence to make medical decisions in order to answer your question. These are sometimes referred to as the 3 "magic questions" required to make your own decisions: Does the patient understand what we believe to wrong them, do they understand the purpose of the medication/test/procedure in question, and do they understand the risks of refusing this medication/test/procedure. They can be totally kooky, but so long as they meet these three criteria then they can refuse. If they can't meet these criteria, then that must be documented, and questions about tests/treatments/procedures/medications must be directed to a surrogate decision maker or in emergent situations medical necessity may be used.

    I have seen situations where the solution is essentially 'lets wait until they can't refuse and then just do it', which is an illegal act.

  • Sep 3

    "Please don't ask me to shed the impenetrable cloak of mystery which shrouds me"

    How's that?

  • Sep 3

    Deep breaths. You can do this. Listen and learn.


  • Sep 3

    Just like you, I went from ICU to ER. The first 6 months is rough. The flow is different, the documentation style is different. What do you mean you give antibiotics without a pump? :0) In such a fast paced environment what I have learned is to acknowledge when I need help and ask another nurse to help me with starting the patient care tasks while I document. This is great when you get 2 ambulances one after another. Or get a STEMI, code etc. Another thing that helps me is memorizing what questions are needed for your initial documentation and asking the patient while you are performing initial patient care. This takes time! But once you get it down it makes the process faster.

    For example, I'll walk into my pt's room who just got here by ambulance for abdominal pain. I will get quick report from EMS then ask pt "What brought them to ER today"? As the pt is talking I will be listening and doing initial vital signs. Then setting up for IV, labs. Based on what the patient tells me will I then ask more detailed questions.

    "I've been having diarrhea and I have stomach pain".

    From what the pt states I will then ask how long this has been going on, color of diarrhea, frequency, last episode, description on pain. Sick contacts, recent travel, febrile, recent antibiotics etc. By now I'm doing IV, lab work. After time you memorize what you say and what patient says.

    When I was thinking like an ICU nurse working in ER I would ask nausea, vomiting, and more questions. Write every detail down or bring computer in room. But as time has went on, I focus on what brought the pt here and what they state the symptoms are and what questions are the most important to ask regarding their chief complaint. If a pt does not state they were nauseas or having vomiting I am not going to ask on my initial assessment.

    When I am doing line/ labs I am asking the patient the questions that are required for triaging per my institution ex. Have you thought about hurting yourself recently. How much alcohol do you consume per week. Smoking status etc.

    Once I am finished I can document -not at bedside! The only thing I document bedside is if I am going over medication list and the pt does not have an updated list. If a pt has a med list bring it with you to nurses station, document them when you get a chance and then give it back to pt.

    As a resource the best thing I could have done is on my badge make a badge of references. One important reference is range dosing for RSI, even though you come from ICU I found that the ER can use different RSI meds- some that I've never used on the unit. It's always good to have a quick reference badge.

    Recently the most helpful thing to me was the "Dirty Epi drip". I had that written on my badge.

    After 2 years in ER I will never go back to ICU, I love it and have found my calling. I wish you luck and hope you get past your orientation. Message me anytime.

  • Aug 29

    Not sure about the rest of the story but giving IVP hydralazine for a BP of 175/90 in an otherwise asymptomatic patient makes 0 sense.

  • Jul 29

    You need the MSN, because your BSN in effect doesn't count. There are dual MSN/MBA programs that may interest you. Just make sure the MSN has the correct accreditation.

  • Jul 29

    Stop perseverating on this. You'll be fine. Unless you clicked on something IN the chart you aren't tracked. I'm an Epic Superuser.

  • Jul 25

    It's all about being a patient advocate. Good job for standing up to the doctor when you knew your patient needed more treatment.

  • Jul 25

    He wasn't mad at you because you did anything wrong; he was mad at you because you made him do something. He was going to turf the patient and make him someone else's problem. That doctor would have been the one in the hot seat when the unstable patient coded and died on psych. So he owes you gratitude and an apology. Neither of which you are likely to get. You won't get any lifesaving awards for saving this patient's life; you'll have to make do with personal satisfaction.

    When you're a nurse, you don't have to do something wrong to get yelled at. You will get yelled at for doing the right thing, too. You'll get used to it. Meanwhile, please accept my kudos for being a conscientious and assertive nurse.

  • Jul 25

    I think they sound like a lot of things in nursing. Really vague, qualitative, and difficult to measure. The only concrete info is 'start a nationwide campaign to make nurses be healthier' and 'get revenue other than dues'. Awesome. They're going to use their resources to remind me that in addition to everything else I do, I also need to exercise and eat kale because I'm a role model for America.

  • Jul 9

    Nurses in California formed a powerful lobby back when Arnold Schwarzenegger ran for Governor. They helped him get elected and he in return signed a safe staffing bill into law. It was a big deal back when it happened. Still there are significant exclusions to the law and it only covers acute hospitals.


  • Jul 7

    Human trafficking is defined as, "the recruitment, transfer, harboring, or receipt of persons by threat or use of force, for induced commercial sex acts, and sexual servitude." This definition comes from a recent study published in the Journal of Emergency Nursing. The sex trafficking trade is here in the US. Atlanta is sometimes referred to as the "hub" of the US trade. Its a big city, with many conventions, events, things to do and it has a very busy airport where people can come and go often in a single day. CNN recently explored the sex trafficking industry in Atlanta.

    It is estimated by the Department of Justice that the profits from sex trafficking exceeds 32 billion dollars per year. The National Human Trafficking Hotline reports that they have received over 145,000 signals (including emails, calls, webform reports) since 2007 of potential sex trafficking cases. And, it occurs in every state. A lit review from the article in the Journal of Emergency Nursing provides this statistic: "87% of victimssought medical treatment during captivity without recognitionor rescue."

    How to recognize possible sex trafficking victims in YOUR ED? Its estimated that only 1% are identified when they seek emergency care as they are frequently on the move, knowledge deficit of the ED personnel, and the victim's inability to escape.

    The Emergency Nurses Association released a new study in the Journal of Emergency Nursing detailing an evidence-based project that puts a spotlight on the importance of formal education, screening, and treatment protocols for emergency department personnel to guide identification and rescue victims of human trafficking. The program tested in the study showed success with screening tools, awareness of medical red flags of human trafficking, and a silent visual notification to help victims safely ask for help.

    The Journal of Emergency Nursing study developed these guidelines for practice:

    • Screening began at the registration desk, where personnellooked for social signs of trafficking. Social signs oftrafficking include no insurance, offer to pay cash, nopersonal identification, no guardianship documentation,and a patient who is with a person who does all of thetalking.
    • If registration personnel identified a possible victimor if the patient answered yes to questions in our existingdomestic violence screening, the emergency nurse completedthe Department of Health and Human ServicesScreening Tool for Human Trafficking whichwas embedded in the electronic health record.
    • In recognition that victims may be fearful of thetrafficker overhearing a conversation, a silent visualnotification tool was implemented to notify staff of abuseor unsafe living situations.
    • Signage was located inbathrooms and instructed potential victims to place a bluedot on the specimen cup when giving a urine specimen. Ablue dot on the specimen cup triggered the use of thescreening tool by the emergency nurse.
    • To ensure patientsafety, all team members were also alerted of the blue dot,and the patient was taken to a designated safe area withinthe department for care.

    If there was a positive response to the screening, the following steps were implemented:

    • Theemergency charge nurse conducted a huddle with thephysician, security, social services, and nursing leadership.During the huddle, plans were made for further assessmentand rescue.
    • A room in the radiology department was used asa private place to interview the patient without the trafficker present because it is common practice for patients to bealone when radiographs are taken.
    • An emergency nurse andsocial worker escorted the patient to the radiology area for aprivate screening.
    • For victims younger than 18 years, areport was immediately filed with child protective services asrequired by law, and the victim received intervention.

    Safety of the victim, staff, other patients and security of the hospital campus are always paramount and protocol is followed:

    • When a potential victim was identified, securitypersonnel participated in our huddle and remained in thedepartment.
    • While health care providers ensured that thepatient received adequate medical and nursing care, securitymanaged any threats to safety and tried to detain the traffickeruntil local law enforcement arrived.
    • If the trafficker attemptedto flee the hospital, security was instructed to contact localpolice and maintain the safety of the hospital campus.

    By adding a sex trafficking screening tool to your already-existing domestic violence protocol, ED personnel can save lives.

    And...that's what we are about!

    Does your ED have a sex trafficking protocol?


    Farella C. Hidden in plain sight: identifying and responding to human trafficking in your ED. ENA Connect. 2016;40(4):4-22.

    Journal of Emergency Nursing. Implementation of Human Trafficking Education and Treatment Algorithm in the Emergency Department

    National Human Trafficking Hotline

    1 (888) 373-7888
    National Human Trafficking Resource Center

    SMS: 233733 (Text "HELP" or "INFO")
    Hours: 24 hours, 7 days a week

  • Jul 7

    You can commission into the Air Force once you complete your first enlistment. Your unit may release you before your contract ends. If you elect to receive any incentives (bonuses, kickers, etc.), you may have to repay them back for ending your contract early.

    There are some California schools that have a LVN to RN bridge program. The 68C course provides you with a transcript upon completion of the course; however, the transcript does not include grades.

    You will take the full 68C AIT even with a NREMT. NREMT is not part of the 68C curriculum.

    First, raise your GPA. I believe most CSUs BSN require a minimum of 3.0. I would try Army ROTC, direct commission then enlisting - in that order if your goal is to become an RN.

  • Jul 1

    Yes, other foreign grads have tried. I've never heard of one succeeding. My guess is that whatever 'OIC' told you that load of crap was probably some junior O-3 whose only accession/recruitment 'experience' was about 4 years of patient care on a med-surg floor. The enlisted recruiters with recruiting experience often have little knowledge of the medical world. Blind leading the blind...

    Are you a U.S. citizen? You can't commission as a nurse without that either.

    Who told you to enlist in the reserves in the first place? Even if you did have a BSN from a properly accredited school, it's not exactly easy to direct commission as an enlisted person to begin with. It's far easier to commission as a civilian RN than an enlisted member.

    As Pixie said, your only option to commission as a nurse is to get a nursing degree from a properly accredited U.S. nursing school: an MSN makes the most sense (many can be done online in as little as 32 credits). An MSN in informatics, education, or leadership/management would have no clinical hours aside from a capstone project.

  • Jun 25

    Look at the USAGPAN info: School of Nursing | US Army Graduate Program in Anesthesia Nursing | Nurse Anesthesia Programs | Army Nursing Program

    You can apply when you have the required critical care time. This is the best way to CRNA in the military. I know several people who came into the Army via direct commission as experienced civilian ICU nurses to attend the USAGPAN program.

    Pros: top notch education to a DNP without debt. Cons: you are owned by the Army, and CRNAs do deploy. If you truly want to serve, it's a great way to do so.

    There are lots of posts in this forum about USAGPAN, the search feature should provide you with lots of information. Good luck!