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Lev <3, BSN, RN 43,381 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,657 (52% Liked) Likes: 4,912

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  • Dec 4

    Quote from Ruas61
    Everyone who has an occasional, or even every day glass of wine or an ounce or two of liquor, is not an alcoholic. They are not going to go into DT's. You might want to look into alcohol and addiction.
    LOL..I was about to post that just because you drink daily does not mean you will go into DTs a couple days later from withdrawal..

  • Dec 3

    Quote from Ruas61
    Everyone who has an occasional, or even every day glass of wine or an ounce or two of liquor, is not an alcoholic. They are not going to go into DT's. You might want to look into alcohol and addiction.
    LOL..I was about to post that just because you drink daily does not mean you will go into DTs a couple days later from withdrawal..

  • Dec 3

    My bag has motrin, pens, trauma shears, my lunch, and nursing references. My locker has an extra stethoscope and random education stuff from work. My car has
    a full change of scrubs including underwear.

  • Dec 2

    I think practices vary from hospital to hospital. I can speak for my ER.

    I think a gram of vanc is a pretty typical dose. Sometimes I see 1.2 g but usually the patients just get a gram.

    I have never cosigned potassium...but I can understand why they cosign it.

    We also mix our drips (that we don't stock premixed in the pyxis and when pharmacy is slow) with a needle and syringe. The antibiotics are either premixed by pharmacy or for common ones like rocephin or zosyn (stocked in the pyxis) we use the 50 or 100ml saline bags with adapters to spike the vial of powdered antibiotic.

    I have seen the use of both the safety transfer device and the blunt filter needle to transfer blood from a syringe into a specimen tube.

    Ok that last bit is just scary.

  • Nov 29

    One thing that I would love to see our volunteers do is to make sure that the room is stocked with enough blankets and gowns. And to make sure supplies are stocked in general.

  • Nov 29

    Quote from lnvitale

    In short, these are the things that happened that I struggle with:

    1. A general and open disdain for psych patients.
    Some depends on the culture of the particular ER. However, psych patients (especially those in crisis) are often not very nice people to be around and interact with.


    Quote from lnvitale
    2. A nurse told me to discharge a patient AMA even though the patient told me she had changed her mind and would like to stay. I refused to discharge her, by the way. That did not go well, but I survived. (this I attribute to the bad nurse). In addition to this, there was a general rush to clear the beds, especially during busy times.
    The proper thing to do in this situation would be to check and see if there was a discharge AMA order in the computer instead of arguing with the patient's nurse.


    Quote from lnvitale
    3. I was told that we do not address problems that weren't "what the patient came in for." I also attribute this to the bad nurse, because the charts suggest that we do in fact do that, or we are supposed to.
    The emergency department addresses the patient's chief complaint and/or any emergent needs of the patient. If they want to see a dentist or a podiatrist - they need outpatient referral. Busy EDs don't have time to address every single need of every patient.


    Quote from lnvitale
    4. A disregard for all things not immediately life threatening. For example, a physician removed an unconscious patient's leg dressings, then just threw the bandages back on without tape saying, "Ok, that's done." When I addressed this problem with the nurse and asked if I could redress the wounds she said "No, we don't do that. The ICU will take care of it." But the ICU did not have a bed for the patient for the rest of the 12 hour shift.
    I have seen the ED doctors I work with do the same thing. The ED is not focused on wound care. The focus of the ED is stabilizing patients. Once you stabilize your patients and have a moment to breathe, then you can take a couple minutes to do some wound care.

    Quote from lnvitale
    ***On a side note, I am noticing most of my issues have to do with one nurse whom I feel gave poor care. ***
    Maybe because you don't like her you are nitpicking, perhaps too harshly?


    Quote from lnvitale
    5. In general, I heard a lot of "we don't do that." in response to my questions about interventions.

    One thing that I feel may make me ill suited to the ED in general is that I prefer to address all the issues with the patient., rather than just the emergent ones.
    This can be overcome.


    Quote from lnvitale
    I would like to think about the future for the patient and not just their present needs. If a psych patient keeps bouncing to the ED, for example, I would like to help address this problem rather than send him out without referrals knowing he'll be back tomorrow. Is there any ED that works this way? Does this mean I should go to psych inpatient instead?
    We have counselors in our ED for people who have used drugs or overdosed. Not all people want help despite our best efforts. Especially the homeless population. You will discover this with time. There are people who deal with this problem, but they are not ED nurses.

  • Nov 28

    I would give a copy of your printed and signed resignation letter to one of the HR people and then I would visit your boss and hand the same to her directly. The letter should be addressed to your boss and include that day's date and your last day of employment. Then I would email a copy of the letter to your manager and cc the HR person. This is what I did when I resigned.

  • Nov 28

    I would give a copy of your printed and signed resignation letter to one of the HR people and then I would visit your boss and hand the same to her directly. The letter should be addressed to your boss and include that day's date and your last day of employment. Then I would email a copy of the letter to your manager and cc the HR person. This is what I did when I resigned.

  • Nov 27

    I would give a copy of your printed and signed resignation letter to one of the HR people and then I would visit your boss and hand the same to her directly. The letter should be addressed to your boss and include that day's date and your last day of employment. Then I would email a copy of the letter to your manager and cc the HR person. This is what I did when I resigned.

  • Nov 27

    Could any registered nurse answer these 5 simple questions for my school project please? Also if you could please state what floor/unit you work/worked on.

    1. What made you choose nursing?

    I chose nursing because it was a solid career choice, was interesting and stimulating, required contact with people, and seemed to be in demand (well it was easier to get a job before the recession)

    2. Is nursing rewarding? What has been your most rewarding experience?

    Nursing is rewarding when people appreciate what you do and when you can make a difference, which doesn't happen all the time. I don't have a specific example.

    3. What type of issues have you experienced that are a conflict to nursing?

    The issues I have experienced are managers who are out of touch with their staff, staff feeling out of touch with upper management aka the big wigs, supplies not being stocked, and chronic staff turnover with high patient acuity.

    4. What do you see as the future of nursing?

    In the future of nursing I see more RNs getting graduate degrees and less RNs wanting to stay at the bedside for long. I do not see national set staffing ratios for decades to come.

    5. What duties are included in your job description?

    Assess patients and implement the plan of care. Triage patients. Maintain a safe patient environment. Document in the medical record. Administer medications. Lift heavy loads. Be on feet for extended periods of time (not joking these are in the job descriptions).

  • Nov 26

    Maybe honesty is something you are lacking. Charting that you left on time when in reality you left early and charting that you gave that treatment when in reality you did not. Soon it will be the IV cardiac meds that you charted as given but then did not, and whoops patient is dead.

    Look for some local ethics classes.....

  • Nov 26

    Certain classes will require the level of memorization that you experienced during A&P. However, other classes will be more hands on and practical. Expect to be challenged.

    You will learn to build up the stamina. You may find some specialties with 8 hour shifts.

  • Nov 26

    Maybe honesty is something you are lacking. Charting that you left on time when in reality you left early and charting that you gave that treatment when in reality you did not. Soon it will be the IV cardiac meds that you charted as given but then did not, and whoops patient is dead.

    Look for some local ethics classes.....

  • Nov 25

    Maybe honesty is something you are lacking. Charting that you left on time when in reality you left early and charting that you gave that treatment when in reality you did not. Soon it will be the IV cardiac meds that you charted as given but then did not, and whoops patient is dead.

    Look for some local ethics classes.....

  • Nov 24

    3 PVCs in a row is Vtach. It really depends on the patient scenario. Is this patient throwing a lot of PVCs and then has a 3 beat run of vtach? Is this new onset? Was the patient symptomatic? It's always better to be safe than sorry and notify. However, most physicians will not get excited unless it is more than 5-6 beats which is enough for a patient to lose consciousness.


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