Anna Flaxis, ASN 21,551 Views
Joined Oct 15, '10.
Posts: 2,842 (67% Liked)
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.
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.
And this is exactly why many of those suffering burnout/compassion fatigue don't feel safe coming forward. This saddens me.
LOL ... I just noticed that this thread turns 6 years old tomorrow. Happy birthday, Kryptonite thread!
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.
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.
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.
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.
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.
Sounds like insurance fraud to me. Risky business for the docs and the hospital if complicit.
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.
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.
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.
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
I saw a woman who had called the ambulance and went to the ED for "vaginal itching/yeast infection".
A headache is not an emergency, except for when it is
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