Content That Anna Flaxis Likes

Content That Anna Flaxis Likes

Anna Flaxis, ASN 21,551 Views

Joined Oct 15, '10. Posts: 2,842 (67% Liked) Likes: 8,470

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  • Jul 21

    It's totally not for me to dictate what size bag someone brings to/from work ... but I'm having a hard time picturing "educational resources" that I would be responsible to lug back & forth with me every day.

    References on gtts & IV meds? Should be easily, quickly accessible in either binder or electronic form.
    Educational materials? If there are references that are considered the "gold standard" in line with your policies ... shouldn't they be accessible to all?
    Eye charts?? Is this ED not equipped with a Snellen chart?

    Leaving personal belongings in a group work environment is a recipe for a mishap.

  • Jul 21

    I'm confused. I work at an urban level 1 trauma center and don't feel the need to have a bag full of stuff. No one does. There is one guy on the pediatric side of things that has a fanny pack of useful things (stickers, etc) for the smaller kids, but he's the exception rather than the rule.

  • Jul 20

    Quote from Anna Flaxis
    And this is exactly why many of those suffering burnout/compassion fatigue don't feel safe coming forward. This saddens me.
    Just as we entreat the OP to see past the patient and their presentation, we too should see past theirs. We can guess but we don't know what brought her (him?) to that point, and while I don't have the same outlook and lack of compassion towards the specified populations, I understand why they developed.

    I'm with Anna Flaxis that she should feel free to express her ire. I just think it's unfortunate she feels that way (the OP, not Anna), and I'd love to see another perspective.

    I suppose it is fortunate that she is in a different role now, maybe it will chip away some of the jadedness and be replaced with positive motivation.

  • Jul 19

    LOL ... I just noticed that this thread turns 6 years old tomorrow. Happy birthday, Kryptonite thread!

  • Jul 19

    Go for it. She may turn you down for coffee in the cafe, because she doesn't have time for a break. Just ask her if she would like to get together sometime.
    Who CARES if other hospital personnel see you and start "rumors" This is work, not junior high.

    Good luck!

  • Jul 19

    Unless someone is holding a gun to your head, you are not being "forced" to work OB, you are being "required" to as a condition of your employment.

    Since the facility does not want to take your concerns into consideration, it seems your only other options are to get out of the float pool and land in a unit you feel comfortable in, or find another job.

  • Jul 19

    Eek. This sounds incredibly toxic.

    Some units/shifts are just like this. I second the advice to get out if you can- being stressed and miserable is not good for you OR your patients, and if they're actually leaving fellow nurses out to dry when their patients crump, that's just... don't work in that if you have any other choice.

    If you have no choice (contract, large debts, new lease, whatever), I think the advice about befriending new employees and being kind to people outside the in-group is wise. I once had a job in a deeply toxic ED, where the ugliness started with management and was maintained by a group of nurses who had worked there a long time and were all best frenemies. There were a lot of frustrating and a few scary moments, but by being nice to new nurses and people who weren't in the clique, after a while I found I had my own support system of people who didn't suck, and when the toxic manager and two of the worst queen bees were fired, suddenly my nightmare workplace wasn't so bad. Keep your head down, focus on your work, and don't let the nastiness of others turn you in to one of them, and you might find it improves with time.

  • Jul 19

    I've seen on numerous occasions where we give patient satisfaction IVF, Duonebs, etc. Heard a provider call it that one time, and the term has stuck and pervaded our ED for such treatments.

  • Jul 19

    Much of what we do in the ER is pretty pointless.

    IVF is just a small part of it. People who are "dehydrated" and tolerate po can just drink. It's what they should have been doing in the first place. And, if you think of all the actual abd pains that drink 1 liter of contrast, it is pretty damn obvious that these poor "dehydrated" souls can drink.

    And, if they are ACTUALLY vomiting (a small fraction of NVD complaints), SL Zofran has similar onset/efficacy as IV. So- you could give a SL Zofran and a liter of water. Every 5 minutes, 2 shot glasses of water, and they will be magically cured in an hour.

    Even even if they actually have diarrhea, they can still drink water. It's what the rest of the world does.

    But, when we start an IV, medicate, hydrate and send them home with a DX of dehydration we are basically telling them that they had a real problem, and it's a good thing they came in to the hospital where we can treat it with our special IV meds.

    And, plenty of the IV meds we give could be given PO. Steroids for routine exacerbation COPD for example. In fact, there is a question whether IV steroids are any better at all for certain issues.

    IV ABX are great for something that is rapidly progressing, or potentially dangerous. But, for any problem going on for days, reach therapeutic levels an hour or 2 later just doesn't matter.

    If you think about all the ER problems that could easily have been dealt with at the PCP, it becomes pretty clear that a lot of the more invasive, costly stuff we do is not needed. But it does reinforce using the ER for primary care. As much as we complain about that, it is a good business model.

    But, if all we did in the ER was treat emergencies in an evidence based fashion, many of us would be out of work. This ridiculous system of ours allows me to live working only Per Diem, taking breaks when I want so I really shouldn't complain or advocate change.

  • Jul 19

    Quote from offlabel
    Sounds like insurance fraud to me. Risky business for the docs and the hospital if complicit.
    Unfortunately providing services, medications, etc that are aren't well justified is pretty common, this is an area where nursing could do a better job of questioning these orders and determining if it's appropriate to initiate them. Because of bundled billing on the inpatient side, instances of fraudulent billing for unnecessary services is much more common in EDs and outpatient services where services are billed individually.

  • Jul 19

    There are certainly patients coming to the ED that need IV fluids, but a lot of it seems to come from the old ED wisdom that IV fluids and O2 can cure just about anything.

    I have worked with an ED physician who claimed they get pressured by the inpatient docs to order IV fluids since that helps justify them ordering IV fluids which is one way to bump a patient's status from observation to full inpatient (so long as the fluids are ordered to run at 100 ml/hr or greater). Basically, this means that the physician who has to do the same H&P either way, can significantly increase what they get reimbursed for that H&P by justifying inpatient status instead of observation.

  • Jul 19

    Are these fluids being ordered after labs have been resulted?

    The above responses have given a variety of reasons why fluids might be given during a work up, until we have lab evidence of a lack of anything actually clinically wrong with the patient. But if fluids are being ordered after lab results ... I'm inclined to think this is more about a customer-service driven desire to appear to have "done something". And apparently your management is ok with the resulting drag on throughput times.

  • Jul 19

    Today actually I hung a bag of saline on a young girl. The docs rational was because it is "just something to make her feel like we did something". Instead of just discharging her since she came to the ER.

  • Jun 22

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    Yeah, no. It is actually lose-lose.

    I didn't become a nurse - especially an ED nurse - for "job stability." In as much as I didn't become a nurse to treat "customers" instead of "patients."

    This is exactly the kind of hokum peddled by un-supportive management to ensure a continuation of ED abuse and over-crowding. A few years ago at my old ED job, management tried to convince ED nursing staff that an establishment of an "Observation Unit" (monitoring admitted, stable Observation patients - usually for chest pain/ r/o ACS) was in our best interests. More "hours posted" for nurses/techs to pick up, hence bigger paycheck etc.
    NONE of the nurses/techs 'assigned' the Obs Unit liked working it - for obvious reasons (not all that different from taking care of holds/boarders!)

    And let me remind everyone - ED overcrowding is as serious as a heart attack, and can be just as deadly! How many of you would like to bring your Father or Grandmother to the ED with complaint of chest pain and be told to wait in the waiting room? Or let us assume the initial EKG shows an acute MI but the ED is so full (with emergent and 'non-emergent' complaints), the staff has to "create a bed" to accommodate an obvious emergency - would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?

    Or let us even assume that the initial EKG at triage was normal or borderline - how many of you would want the triage nurse to send you back to the waiting room instead of a monitored bed? Be truthful!

    Quote from klone
    I saw a woman who had called the ambulance and went to the ED for "vaginal itching/yeast infection".
    I had one a few months ago.
    Very young, adult female. Came in by EMS. I triaged her out to the waiting room because I had no open beds. At 0830 in the am. She huffed and certainly appeared offended that she was going to the 'waiting room' even though "I came by ambulance."
    As the EMTs were wiping down their stretcher and getting ready to head out, I noticed that their radios were going off constantly. The EMTs looked upset. I leaned over and asked "Y'all ok?"
    "No. Not ok. That's the third call out requesting an ambulance to transport a critical patient but nobody in the township or county can respond because we're tied up with BS calls!"

    The very young, adult female that came by EMS? Her chief complaint?
    'Vaginal discharge'...
    Nope, not kidding.

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    * Have you EVER had to take a "chronic headache patient" and smile about it, when it is the patient's 240th visit in the ED in 2016? For the same "chief complaint"?
    The ones who are allergic to everything except Dilaudid and Benadryl/Phenergan? None of which are drugs recommended to treat chronic migraines or headaches?
    * The ones who refuse Imitrex (for example) because "it doesn't work. That drug what starts with the D... Dilauntin.... usually helps."
    * The ones who occupy a stretcher in the ED with their chronic, non-emergent complaint - while 80 year old gramma lies in withering pain in the waiting room!

    Not burned out - but I am certainly very frustrated!

    cheers,

  • Jun 21

    A headache is not an emergency, except for when it is


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