Anna Flaxis, ASN 21,534 Views
Joined Oct 15, '10.
Posts: 2,842 (67% Liked)
If you push D50 through a peripheral line, the rationale for going slow is that D50 is a vesicant, so it should be pushed through a running line, and checked for patency periodically by aspirating for blood return. Since you were pushing it through a central line, this is not a concern.
First, think about the reason that it is recommended to dilute Phenergan for IV administration.
It is because this medication is a vesicant.
This means that this medication can cause tissue damage and necrosis.
If you dilute it in a 1L bag of NS, are you going to sit there and monitor the entire infusion? Or are you more likely going to start the infusion and then leave the room to go tend to other tasks?
More important than the amount of diluent you use is that you monitor the infusion as it is going in, and be prepared to stop it if the patient complains of any adverse symptoms.
Given this, this is why diluting promethazine 25mg/mL in 10mL NS and pushing it into a running IV line over at least one minute is the preferred method.
Either that, or stop giving it IV and only give it IM- which is what most EDs are doing these days.
I've never been in your position, but I have other leadership experience.
First, listen. Just listen. Meet with each individual, like you plan, and just hear them out. Don't offer solutions or opinions. Ask them "What would you like to see happen?". Take notes.
Look beyond specific issues to see what the over-arching theme is.
Develop a plan to address the over-arching theme.
Identify your informal leaders and try to get their buy-in to your plan by making it seem like their idea.
Just my uneducated humble opinion. Good luck!
I have since found out that most of the MD's that are attached to the facility where I work get upset whenever you contact them about their patients, leading them to be rude in the way they address nurses.
Yeah, no. Of all the potential precipitating events, the fentanyl is the least likely.
Let her vent without offering your opinion. And foot rubs. Lots of foot rubs.
...as little as possible.
I'm afraid I'm going to side with your unit educator on this one. Heart rate variability can be a strong predictor of mortality. Setting more narrow alarm limits can result in earlier recognition of deterioration, and thus earlier intervention, before the patient deteriorates into a code blue situation.
I feel your pain. I work with some folks who will spend 30 minutes fluffing and puffing a level 3 acuity patient while I carry the rest of the ER by myself, and then they look like deer in the headlights when three people show up to triage at the same time, and complain that they're not getting their breaks when I've told them, for the love of all that is holy, just go!!!
I don't have any words of wisdom to share, just know that I can empathize.
I think that, if the OP had posted something about being concerned that s/he was starting to experience burnout/compassion fatigue, s/he would have gotten different responses. Instead, s/he posted a rather grandiose rant full of condescension, hostility, and condemnation toward her client population, stating that s/he now understands (unlike any of the rest of us) what is wrong with the healthcare system (and, in the process, implying a resemblance to Martin Luther!), and then suggested that the reason people aren't all agreeing with her/him is because we are too stoopid to realize that s/he is right. I think that's the problem, not that it's not "safe" for people to come here and talk about burnout.
I understand that you are probably compassionate, good people in heart. But I am also certain that you all are not dumb either
The hospital staff is reduced to nothing more than a glorified, educated garcon whose primary purpose is to keep people comfortable, happy, satisfied in order to receive "EVERY TIME" in EVERYTHING to scramble as much reimbursement as possible, while in actuality, we are to serve and protect the public from the harm, preventable death, and in every event, do no harm but uplift dignity and preserve humanity.
I definitely feel that I get hung up on "phrasing" - for instance instead of saying "patient walked to their bed" my preceptor tells me I should say "pt is ambulatory"
Because it's oozing with misanthropy, hyperbole, superiority, judgment, bitterness, overgeneralizing, indifference to suffering, and victim mentality.
So you have to be an ER nurse to "get it"?
I think that what you bring to the table from the get-go when it comes to how you view your fellow man, has a bearing on the development of feelings of disdain and callousness towards some categories of patients. I do think that stress and burnout exacerbates this mindset, but as I said, it's hardly the only reason behind it.
Surely you don't think that feeling that "to me they can do die on their own accord either through OD or chronic illness they brought on themselves" and "the patheticness of people" is an unavoidable consequence of working in an ER?
Why isn't this post more popular?
Quoted on accident thanks buhbye
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