Latest Comments by Anna Flaxis

Latest Comments by Anna Flaxis

Anna Flaxis, ASN 21,534 Views

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

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  • 0

    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.

  • 3

    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.

  • 2
    cayenne06 and klone like this.

    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!

  • 1
    RN-Doula likes this.

    Quote from relusanmi
    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.
    Can you define "rude"?

  • 1
    NotAllWhoWandeRN likes this.

    Yeah, no. Of all the potential precipitating events, the fentanyl is the least likely.

  • 1
    Pixie.RN likes this.

    Let her vent without offering your opinion. And foot rubs. Lots of foot rubs.

  • 0

    ...as little as possible.

  • 2
    brownbook and sallyrnrrt like this.

    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.

  • 1
    AutumnApple likes this.

    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.

  • 0

    Quote from elkpark
    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.
    Really? The OP stated:

    I understand that you are probably compassionate, good people in heart. But I am also certain that you all are not dumb either
    I see the original rant as being more about how the business of healthcare in the USA is being conducted. I see a lot of truth here, that we, as an industry, enable poor health choices in order to turn a profit.

    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.
    The bolded above is what many believe to be at the core of nursing- I certainly do, and to go into nursing in today's healthcare industry only to realize that it's all about the bottom line is understandably disillusioning- that has been my experience.

    I'm certainly in agreement that it's probably for the best that the OP is no longer working at the bedside, but just because I am able to reconcile my moral distress over what I feel nursing should be compared to what it is, does not compel me to take the moral high ground over someone who wasn't able to make that leap.

  • 1
    psu_213 likes this.

    Quote from rubyagnes
    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"
    Although I'm not certain that it's all that critical whether you use the word "ambulatory" rather than "walking", I tend to use language such as: "Pt ambulatory with steady gait to rm XX", or "Up to BR independently, urine spec collected", or "Ambulatory to BR with stand by assist", simply because "ambulate" is the technically correct term.

    I try to avoid language such as "Pt sleeping", "MD aware", "Call light in place, pt knows how to use it", or language that speaks to what others are aware of or know. Instead, I'll state "Resting quietly with eyes closed, respirations even and unlabored", "MD informed", "Call light within reach, pt instructed in use, verbalizes understanding". I don't have any way of knowing what someone else knows or is aware of- it's an assumption. I only know whether I've informed someone of something and what their response was.

    When writing a triage note, I try to avoid language such as "Pt hit head on door jamb", instead saying "Pt reports he hit his head on the door jamb". Even better is using quotes, such as Pt states "I hit my head on the door jamb". I don't know that the patient hit his head on the door jamb, I wasn't there. I only know what the patient is telling me.

    Make sense?

  • 0

    Quote from Horseshoe
    Because it's oozing with misanthropy, hyperbole, superiority, judgment, bitterness, overgeneralizing, indifference to suffering, and victim mentality.
    And this is exactly why many of those suffering burnout/compassion fatigue don't feel safe coming forward. This saddens me.

  • 0

    Quote from macawake
    So you have to be an ER nurse to "get it"?
    No, that's not what I'm saying at all. I think that ER nurses are more likely to be able to relate to the feelings expressed by the OP, for reasons that I think are pretty obvious, so I won't elaborate. You certainly don't have to be an ER nurse to get it, though.

    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.
    I tend to agree with this- but I don't see this as a reason to place a negative value judgment on the character of the OP. Every nurse is a human being, and every human being has biases. As nurses, we are obligated to have insight into our biases and set them aside and care for the person in front of us with empathy and compassion. One of the hallmarks of burnout is when we struggle- or are unable- to do that.

    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?
    I'm looking beyond the specific words, and more at the feelings behind them. To me, this sounds like a person who put their heart into their work thinking they were going to make a difference, who has been disillusioned and is hurting, and I think they deserve as much compassion as I would give to anyone who came to me in pain.

  • 3

    Quote from whichone'spink
    Why isn't this post more popular?
    Because it was posted in the General Nursing Discussion forum, not the Emergency Nursing forum.

    OP, I feel you- and I guarantee there are many, many other ED nurses who feel you, too.

    Just as we're asked to understand the intertwined environmental and psychosocial factors that drive patient behaviors such as "non-compliance", drug seeking, ED and EMS abuse, etc, and recognize these behaviors as symptoms of larger societal problems, I see ED staff burnout as a symptom of these same societal problems, and I will not judge you for it.

    Understanding these things and providing compassionate care to people in need is not synonymous with enabling irresponsibility, learned helplessness, and lack of any personal accountability. It is a difficult line to walk, and can exact a heavy price when your defenses are down because you put your heart into your work.

    Thank you for giving of yourself to help others in need. I'm sorry the personal cost was so great, and I hope that you are able to find peace in the future, knowing that you did make a difference to someone. I know you did.

    Take care!

  • 0

    Quote from amandakay24
    Quoted on accident thanks buhbye

    Sent from my LGL33L using Tapatalk
    Alrighty then!


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