Content That Lev <3 Likes

Lev <3, BSN, RN 47,484 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: 2,852 (53% Liked) Likes: 5,281

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  • Jul 20

    I personally don't think the Ed is an effective way to counter the ever increasing demands to solve a myriad of social problems that we are being asked to address during a triage. I really think this type of outreach belongs in a different setting.

    The ED triage is supposed to be a focused assessment to deal with the problem at hand. Often there are people accompanying the patient, which makes it impossible to ask the very personal questions that we are supposed to ask. The blue dot idea is clever, but word of this will spread like wildfire. It will hardly be a secret.

    I find, the more questions I'm forced to asked during triage that aren't relevant to the case at hand, the less effective the whole thing becomes.

    If a woman (or man) comes in with signs of abuse, the protocol should be that no other person is allowed in the room, and a very frank, real discussion should be had. This is a commonsense approached that, unfortunately, is lacking today. Instead we like to cast a wide net, by asking everyone a bunch of screening questions, but we rarely catch any fish that way...

  • Jul 20

    OMG - that is brilliant. That blue dot idea really should win someone a Noble Peace prize. God bless the ED staff everywhere. You all really make a huge difference (for my part in telephone triage I attempt to keep every patient or parent out of the ED for colds, rashes, constipation, and all other non emergent illness better managed by primary care or urgent care). You all have your hands full.

  • Jul 20

    That's a very personal decision that only you can make. One thing to consider is that you will likely not be able to miss any clinical or only a tiny portion of clinical- the BON requires students to complete a certain number of hours of clinical in various specialties. Have women been able to give birth and be right back in class? Some have. Others elected to take off the semester when they were due and pick things up a semester later.

  • Jul 17

    Quote from KindaBack
    Walk-in pt: 55 YO guy with a history of chronic problems controlled by meds (htn, dm, etc) arrives saying, "I need a new scrip for Norco. I lost mine and I can't get another one for 8 days. I have chronic back pain and it's killing me." The pt lost the meds 3 days ago.

    The patient denies everything else including saddle paresthesia and urinary/fecal retention/incontinence. A&Ox4, abdomen is soft and nontender, no discernible work of breathing, no CVA tenderness, skin PWD.

    VS: 171/105, p153, r18, t36.8

    Prior to ESI, the patient again denies cp, sob, palpitations, dizziness, blurry vision, fevers, chills, n/v/d, dysuria, and abd pain. Explicitly repeats, "I just need a new scrip."
    I hate these! lol. Not because it's probably opiate withdrawal, but because they have a 5-worthy complaint with bad vitals. I agree with JKL33. The HR and BP (though asymptomatic with that BP) are concerning. He's going to be at least a 3.

  • Jun 25

    Depends what kind of changes you want to make.

    There are some changes that you can make without management's help. For example, you and your colleagues could decide to treat each other better -- and succeed in doing that without anybody's help. But other types of changes are virtually impossible to make without management support. So, pick your battles carefully.

  • Jun 25

    Quote from Lev <3
    How do you make changes in your work environment when management has a reputation for being resistant to staff input?
    Quote from llg
    There are some changes that you can make without management's help. For example, you and your colleagues could decide to treat each other better -- and succeed in doing that without anybody's help.
    Amen. Administration at Wrongway Regional Medical Center are a bunch of parochial-sighted pencil necked bureaucratic money grubbing geeks who, in action, don't give a flying care about staff.

    Co-worker cohesiveness is what gets us through.

  • Jun 22

    Hi Lev! Thanks so much for your reply. I apologize for the late response; didn't think anyone would respond haha! I appreciate your positivity. I've learned to settle in this new place, and I've accepted that even if I'm far from home, this opportunity will be worth it in the long run. Thank you again, I will definitely enjoy and learn as much as I can!

  • Jun 22

    How comfortable are you with unpredictability?
    In ICU there is an underlying structure. You will get 1 or 2 patients with a certain diagnosis, depending on the unit you are working in. After report comes assessments, meds, turns, rounds with the doctors, etc. The patients all are in a specific age group- adults or peds and are grouped according to diagnosis- burns go to one unit, trauma to another.
    ED takes all ages, all diagnoses, all levels of care from not ill at all to DOA, the numbers of people fluctuate widely. The diagnosis is often unclear and changes happen quickly.

  • Jun 22

    Quote from hawaiicarl
    If you like focused cases with autonomy, then ICU. If you like task based nursing with rapid turnover, ER.

    Cheers
    Giving you the benefit of the doubt that you've actually worked as a Registered Nurse in an ED: If you operated in task-based mode and had no autonomy, you didn't do it right.

  • Jun 22

    Quote from nurse4life4ever
    Thank you!
    Something to consider, even if it's "only" urgent care and fast track you plan on doing, that's the thing, you have to be able to differentiate between the two and that's where experience comes into play. You surely can't expect patients to know. Example, middle age woman comes in with some neck and jaw pain, you look her over and think maybe she pulled a muscle, or how weird her teeth are hurting on one side out of the blue with no obvious reason. She should see a dentist or lets give her some motrin. Maybe we will x-ray her arm and shoulder.

    Experience will tell you to do an EKG. that woman present with bizarre MI symptoms sometimes. Men can too, but you will learn that a good amount of people that truly need to go to the ER go to urgent care and a lot of people that can go to UC go to the ER. You have to be able to pick up on the sick from not sick and that comes from experience and specialized training.

    I and others here can list hundreds of examples of the woman above. So my post is no knock on you, but anyone that would allow a nurse to be a nurse practioner without any acute care experience is an idiot IMO. Any Urgent care or ER (even to fill the fast track roll) that would hire a FNP without any acute care experience is an idiot as well. If they aren't going to require any experience than they dang sure better be requiring specialized training,. I would also make sure your malpractice insurance is on point.

    Again, not a knock on you. You don't know what you don't know.

  • Jun 21

    Sad to hear yet another story of inadequate new grad orientation and generally unethical treatment. I believe you're on the right track with your intention to resign.

    I agree with the above poster - type a pleasant and short/to-the-point resignation letter. You mention talking with your manager in addition to turning in a resignation letter - - while it may be very awkward and/or seem cowardly not to say something, I advise caution. It is very natural to perhaps fantasize about a conversation where you are able to sort of vindicate yourself, or a conversation in which your manager somehow admits her own/her department's shortcomings and you will have your sense of dignity restored. I hate to be Debbie Downer, but I feel nearly 100% certain in advising you that that is not going to happen, or at least not the way that you imagine. These people have not dealt ethically with you up to this point and they aren't going to start now. You will become "whole again" by learning from this experience and moving forward....not by having a conversation after the damage has been done. If, after careful consideration, you really feel compelled to do more than just slip your letter under her door:

    "I've prepared my resignation but I thought it would be right to let you know in person. Thank you for my first opportunity as an RN."

    She'll probably say something back, while you smile and say...as little else as possible. Avoid platitudes, compliments that are lies, attempts to justify yourself, etc. Stay calm. Smile and nod. Exit as quickly as possible.

    Best wishes to you. I'm sorry this was your first experience.

    PS - even if by some strange twist she DOES take this opportunity to either apologize or acknowledge your poor treatment, RESIST the urge to engage too much - it's a day late at this point. Just say "I appreciate hearing that".

  • Jun 16

    I will say this....culture is EVERYTHING when it comes to a work place. I would move mountains personally for a good fit work-wise. Life is miserable without that. It bears weighing in. You may want to shadow for a shift to see if it plays out across the board or if they just talk a good game when hiring....

  • Jun 15

    She was also pointing out the error on your part in a less than gracious way for a reason. It is a roundabout way of letting you know that she does not appreciate it when people don't pay attention to detail. I would not expect that people who make mistakes in the application process are given second chances by this hiring manager. Hope that all of us are surprised, but I would not expect the best if I were you.

  • Jun 13

    Quote from AliNajaCat
    Oh. My. God.

    Please tell me that she at least made a decimal error and only gave the poor SOB 3 cc ...

    (trying to work out in my head what IM Milk of Mag would do to muscle ...)
    Nope, gave the whole 30cc. It was a really ugly abcess . . . .

  • Jun 13

    When I was working Med/Surg, one of the diploma students gave MOM 30 cc to her patient "in the butt" because she was NPO for the OR. Envisioning a Milk of Magnesia enema, I was wondering aloud whether we needed to give a tap water enema to wash that stuff out of there, when the student said "Don't worry. We gave it IM." Oh, for the love of . . . .
    Oh. My. God.

    Please tell me that she at least made a decimal error and only gave the poor SOB 3 cc ...

    (trying to work out in my head what IM Milk of Mag would do to muscle ...)


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