Latest Comments by Anna Flaxis

Latest Comments by Anna Flaxis

Anna Flaxis, ASN 20,859 Views

Joined Oct 15, '10. Posts: 2,822 (67% Liked) Likes: 8,443

Sorted By Last Comment (Past 5 Years)
  • 4

    CSnyder823, a ruptured eardrum isn't an emergency. But, I can understand how a person might not know that, and think something seriously wrong is happening, and be scared, and go to the ED. I'm guessing the doctor was being kind to you and didn't want to make you feel badly or stupid. Regardless of whether a person comes to the ED for something that can wait to be handled by their PCP, there is no reason to be unkind. :-)

    Having said this, ED overcrowding is a serious issue. There are all kinds of ramifications from putting a strain on resources, increasing costs, and the safety of those truly emergently ill who are stuck waiting for a bed that is being occupied by someone who is not emergently ill. The reason so many EDs have "Fast Track" areas is for the sole purpose of off-loading stable patients with minor complaints off of the main ED where you have people actually trying to die.

    I have had a patient with a minor complaint that could have waited for an office visit with their family doctor come out of the room to complain about the wait, while the doctor was in another room trying to resuscitate a baby. And yet, I was still kind and professional toward the person.

    But back to the original topic, again I will state that most of the time, a headache is not an emergency; however, it could be. This is why we have the triage process.

    Here is a good article that I think sums up the situation from an ED staff member's point of view nicely:

    ER misuse in our instant gratification society

  • 0

    This may be slightly off topic, but you seem a bit surprised that the patient walked in, and did not come by ambulance.

    Some of the sickest people I've seen have been walk-ins. The sickest don't always come by ambulance. They can be walking and talking one moment, and coding the next.

    To answer your question, yes, heat stroke can lead to rhabdomyolysis, of which DIC is a late complication. It sounds to me like, for whatever reason, your patient waited too long before seeking treatment.

  • 5
    brownbook, Here.I.Stand, roser13, and 2 others like this.

    This is unacceptable and needs to stop now. This type of behavior undermines the primary nurse, reinforces attempts to split staff, and can result in medication errors or other mistakes because the nurse who is trying to "help" does not know the patient.

    The first step is for you to talk to this nurse face to face. Tell her that you appreciate her willingness to help, but that in the future, she needs to check in with you first. If speaking with her does not result in the desired change in behavior, then take it up the food chain to the charge nurse next time it happens, at the time that it happens. If the episode is repeated again, then take it to your manager in the form of a formal, written complaint documenting each episode using objective language and leaving any emotion out of of it.

    It's one thing to help one another as part of working as a team, and this is appropriate behavior. It's an entirely different thing to insert oneself into a situation without knowledge of the patient situation and without checking in with the primary nurse first to see if they even want/need assistance.

  • 10
    Ivygal36, Altra, canoehead, and 7 others like this.

    Quote from OrganizedChaos
    Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
    I'll let you in on a little secret. Lots of doctors just follow the path of least resistance. ;-)

  • 14
    Despareux, canoehead, becky1230, and 11 others like this.

    A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.

    I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
    Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.

    Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
    As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

  • 1
    WheresMyPen likes this.

    Disclaimer: I am chiming in late, and I have not read any of the previous responses. I am replying to the original post.

    All I will say is you are spot on!

  • 1
    knurse10 likes this.

    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.

  • 2
    Everline and Farawyn like this.

    In a word, no.

  • 2
    ScrappytheCoco and elkpark like this.

    You can ask anything you want. Whether you get it is a whole other question.

  • 2
    Maevish and calivianya like this.

    Quote from canigraduate
    Unacceptable: looking in every patient's chart on your unit as a floor nurse when there is no reasonable expectation that you will be providing some sort of care...
    I think this is the crux of the issue. In some small units, there is a reasonable expectation that you will provide care for any/all of the patients in your unit. For instance, in my ER, we provide care for one another's patients routinely, either because the primary RN is in another room, on a break, tied up on the phone coordinating a transfer, or any number of reasons- and we don't have a Charge, because we are so small. When a physician needs something done right this minute, and the primary RN is unavailable, whoever is available jumps in and provides the needed care. Whenever administering a medication or providing an intervention, understanding the rationale and any unique patient characteristics (i.e. whether the patient is opiate naive or on long term opioid therapy, whether the patient is unsteady on their feet at baseline, whether the patient has residual deficits from a previous CVA, etc) is pretty important, in my opinion as a professional ER RN.

    I've caught some medication errors before they happened, because the physician placed an order on the wrong patient (easy to do with Epic, if the physician has the wrong window open, is in a hurry, and does not double check), caught only because the order didn't make sense for that particular patient. Had I not known anything about that patient, the medication would have been administered.

    So, the question is whether this is the case in the original post- that RNs frequently provide care for one another's patients, and so knowing some basics about every patient in the unit is essential. It doesn't sound like this is the case, which I agree would make accessing the charts inappropriate.

    I still think it would behoove the original poster to ask the other RN why they are accessing charts for patients that are not under their care. Is it possible that there was an event in the past, such as a Code Blue that went bad, and this RN thinks it's important to keep tabs on all of the patients for safety purposes?

  • 0

    I think you need to get *all* the nurses trained in NIHSS, but start with the Charge Nurses. This way, you can transfer the pt to the gen med floor, freeing up the tele bed, and at least the CN can do the NIHSS until it is DCd.

  • 27

    I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.

    As House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.

    So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.

    Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

  • 5

    Yes, aside from getting what legal assistance you are able, were I in your situation, I would change my name, move to a different location, and eschew social media. Sorry you're going through this!

  • 0

    This is actually very puzzling to me. First, where in the world the nurse found 15 pillows, and second, what the rationale for this action could possibly be? The only thing I can think is that perhaps the nurse thought that the sensory perception of the pillows around the patient might help calm them, like swaddling a baby sort of? Just a thought.

  • 76
    RNHop, bbd613, Nurse Cookie Swirl, and 73 others like this.

    You're being thrown under the bus.


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