Anna Flaxis, ASN 28,277 Views
Joined Oct 15, '10.
Posts: 2,886 (67% Liked)
Let me first preface by stating that I do not work corrections, but I do receive inmates on occasion in the Emergency Department.
I would think about the harm that could come from making the wrong assumption. If you determine that the patient is lying, and it turns out they really *are* having an MI, they could die.
If you determine that the patient is being truthful, you follow protocol, send them to the ED to r/o MI, and the workup turns out negative, what is the harm that can come from this? None, that I can see.
My advice is to follow your facility's protocol to the letter, and leave the question of whether the person is lying or not out of it.
Health doesn't have to be that impaired for a prescription. My Dr told me if it were legal in our state she'd rx it for me due to my stress induced anorexia as well as dull but constant back pain.... there are many other cases where it could be helpful that are not a contraindication to working.
It's called "Hospital Induced Paralysis". Onset is sudden, and coincides with crossing the hospital threshold. It's not limited to the patient, either. Often, any family members within the vicinity also contract this condition.
I am per diem, but I have only one job. I get plenty of shifts at my one job, so I haven't felt the need to take another one.
Different employers have different per diem policies. I am not required to work any holidays. The scheduled staff is responsible for covering holidays.
Also, I am tied to a home unit, the ED, and I am actively involved in the unit.
But yes, there are a couple of other per diems where I work that have other jobs, and they make it work.
As to #4 above, I think this must be true, as I am treated really well- it's like they actually care whether I leave or not. It's nice to be valued.
How much Ativan? How much Dilaudid? How much does the patient weigh? How well are their kidneys functioning? Are they elderly or frail? Are they opioid naive or have they been taking these medications regularly for a significant period of time? What health problems are they currently experiencing?
There is no yes or no answer. Every situation is different.
Okay, I'm going to chime in here.
Honestly, I don't think cutting a pill with scissors, nor discharging a patient with an IV catheter in place, are fireable offenses. I don't think those are the issues.
I think the real issue is your overconfidence and how that was perceived by your co-workers.
I think it's okay to be confident in your critical thinking abilities and to trust your own nursing judgment, but coming off as a cocky know it all when you are a brand new nurse will make for a very rough row for you to hoe, as you have learned.
Catching a med error before it happened? That's our job. It's an expectation. It doesn't make you super nurse or the savior of that hospital's bottom line. You just did what you were supposed to do. Don't let it go to your head.
You and yours are an exception to the bunch. The general public come to the ED for things that are non-emergent, we all know that.
No, I don't think this is a case of under-medicating. It is reasonable to start at the low end of the dosing range, and it's true that he should be thinking ahead to his post-operative pain management situation.
Also be aware that opioid-tolerant folks are much more difficult to deal with because their therapeutic thresholds are very near the toxic thresholds and it's easy to push these folks over the edge and kill 'em. It's happened more than once in our neck of the woods where chronic pain folks with other narcs at home have gone home and woke up dead d/t the synergistic effects of the various narcs and the required levels to attain pain control.
I have never heard of this practice.
Depends on the clinical picture.
Is this a new medication for the patient, or have they been taking it for a while?
If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses.
If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.
I find that often, especially for new grads, it's not a "safety" issue so much as a confidence issue. You just don't THINK you can handle what you really CAN handle.
At the same time, new grads do need a lot of hand-holding that a lot of departments can't afford, because they need bodies out on the floor NOW.
As a result, these "sink or swim" situations are exceedingly common.
Personally, I do well with sink or swim. But I recognize that one size does not fit all.
My personal opinion, based on what you have posted, is that you should try to find a more supportive environment to first learn how to be a nurse- then, once you have your feet on the ground, transfer to something more specialized. I hate to tell new grads to cut their nursing teeth in Med/Surg, because IMO, Med/Surg *IS* a specialty- and it's not fair to that specialty to use them as a stepping stone or training ground for people that don't really want to be there.
And yet, at the same time, Med/Surg units are really fertile learning grounds from which to step off into something more specialized once you've learned the basics of nursing, such as head to toe assessment, pathophysiology and pharmacology, the "soft" skills of therapeutic communication, and of course, prioritization and time management.
There is absolutely no shame in admitting that you need more nursing experience before starting in the ED, and while I respect M/S nursing for its role as a specialty, there is no better learning ground for those who want a solid foundation before they make the leap into an area such a ED or ICU.
A K+ of 3.4 is NOT a critical lab value.
Advertise With Us