DawnJ 8,844 Views
Joined: Jun 12, '11;
Posts: 322 (45% Liked)
; Likes: 404
Many nursing hats
2 year(s) of experience
Get ready for ongoing pay cuts and general penny-pinching in the workplace. What do you think those insurance and medicare/medicaid tax dollars pay for? US!
Let's be honest, insurance premiums were rising long before Trump announced he was even running. While the ACA made health insurance easier to get, it did not address the issue of the bloated costs of equipment, medications, etc. I've had people tell me that they hesitated to get life saving treatments and medications, because their insurance companies refused to pay it and it was too expensive to cover out of pocket. Trump isn't even in power yet and people across the board have noticed their premiums and deductibles skyrocketing and that honestly has nothing to do with Trump and everything to do with the fact that insurance companies have no incentive to offer us affordable premiums. There is little competition in the current market. Insurance companies know they will retain their customers regardless, because there is really nowhere else to go. Most people have insurance through their employers, but those who don't really don't have many options and don't qualify for federal aid, because they make too much money. Many of them are self employed or are small business owners. So they are stuck with crappy Market Place insurance that really doesn't cover much outside of preventative care and health care in the event of something catastrophic and even then you are still responsible for thousands before the plan even kicks in.
Call your local Domestic Violence Hotline immediately. They can help you get to a safe place. Do it NOW!
National Domestic Violence Hotline
The patient is not a "drug addict", the patient has a history of drug abuse. Medicating the patient for an acute condition is the same as medicating any other patient.
GET THEIR PAIN UNDER CONTROL. Give any ordered pain rx, if it is not effective get another order. The nurse that gave Tylenol needs to be educated and written up.
I felt really bad about my needle skills too. I started in an ER and let me tell you, the techs were NOT subtle or gentle in letting me know that my skills were sub-par.
At first I got maybe 20% of my attempts. Now, 8 weeks of practice later, I notice I can get all the easy ones and a surprise moderate one now and again. Eventually I hope to be able to get 75% of my attempts. It is just getting the feel of it and building the muscle memory.
One of my first mistakes was not laying out all my supplies in the order I'd need them, all ready to go: INT flushed and ready, tegaderm peeled and waiting, blood tubes standing by, gauze and tape ready. Once I knew exactly where to reach for my supplies once I got that flash, I was better able to concentrate on getting that vein
You've done it FIVE times... in other words, hardly at all.
If your classmates are proclaiming comfort and competence after a similarly scant number of sticks, they are either deluding themselves or lying to you.
It probably took me 25-50 attempts to feel marginally competent, another hundred or so to feel competent, and a few hundred more to be an expert.
Give yourself a break; you'll get there, you just need practice.
Try making out a flowsheet or checklist of everything you need to give in report, in order. This way, if you follow your checklist, you know you have covered everything - and if someone else wants intimate details, they can LOOK IT UP. I can't know everything about a patient, and I'm not spending my time looking up something for someone else (unless it's something I should have known in the first place!)
Example (sort of how I give report)
Complaint (Mr brown is here with CP which started while he was at work yesterday. His EKG and Tropis have been negative so far, the last tropi is at 2200. He hasn't had any more CP since admission)
Brief Hx (He has had stents in the past, the last heart cath being 2 years ago. Hx of diabetes, takes insulin. He has HTN.)
Assessment - abnormal only (monitor shows SR with occasional PVCs in the 70s, BP has been running 140s-150s/70s., he has +1 pedal edema, he is on 2L O2 per protocol, he gets up well with minimal help)
Meds - new or changed ( we have started him on ntg paste every 6 hours, and he is taking all his regular home meds. We also started him on metoprolol today and stopped his lisinopril)
IV (he has a SL to the left hand)
Labs (His sodium was low on admission, but that was the only abn value. He has a CBC, Chem 7 and fasting lipids ordered for morning. And don't forget the tropi at 2200 He gets AC/HS accuchecks. He's been running under 200)
Plans (It looks like the plan is to watch him overnight. If he has any more problems, or elev. tropis, they my do a stress test tomorrow.)
Nice Things To Know (he is VERY HOH and legally blind. He also gets confused at night according to his wife)
Other things to consider : Procedures done or pending, consults, specific problems encountered with this patient etc..
I'm sure I left something out, but you get the picture!
16 yo male with a stubbed toe. Triaged and sat in the waiting room for 2 hours. He got angry and went home. Upon arrival at home he immediately called 911. EMS brought him back only to sit for 4 more hours. Thought that he would get back sooner. LOL!
It sounds like you may have been the topic of conversation and she was letting you know in a slightly roundabout way. Make a point to engage - even something as simple as "I have to take care of some education modules. If you need anything I'll be at
Pain killer seekers clog up the waiting rooms, and forces those who truly need care to wait longer for treatment. In stead of being given pain killers they should be getting psych consults. When they ask for a certain pain killer, and you tell them the hospital ran out of it but you got plenty of ibuprofen, they usually get up and leave pissed off.
I had a man once claiming his leg hurt so bad, the pain was a 10, he couldn't even walk on his leg. I told him he could have ibuprofen, and it would be some time for a doctor to view his charts before he would even be considered for the drug he requested. After I told him that, he was able to walk on the leg that hurt so bad and then told me he would just go to the other hospital in town. That other hospital was informed about his planed visit.
I have even requested psych consults for patients who's pain was so bad they could not get out of bed, nothing medically could explain the pain. After they were informed a psych consult was requested, they were healed, able to get out of bed and no longer in pain. Another patient that claimed he could not get out of bed and would pee all over the bed, was informed that the doctor ordered a Foley catheter to help with the incontinence, that was the fastest I had ever seen a person run out of the hospital still in a gown.
Several of the hospitals I work for have a place to document the patient's behavior next to their stated pain level. One even asks for the nurse's "total pain impression."
OOOHHHH she didn't say it!! Emergent, other nurses don't like what us ER nurses say about that kind of foolishness! just kidding. As we (well not me anymore) are frontlines, our exposure to pain seekers is exponentially high compared to floors and units that get the "weeded out" numbers that can by all means be very pain seeking.
I think the whole system from top had very poor management on pain management, and it's interwebbed from those who make the policies, satisfaction scores, HCAPS, reimbursement rates, fact that business people run patient care, to addictive behaviors and us enabling them for that behavior.
I frankly think all ERs should ban use of heavy duty narcotics especially dilaudid, demerol, fentanyl and such until either the physician absolutely has very reasonable rational for use prior to confirmation via radiology or only use after such confirmation is made. No dilaudid just becase they are "rocking back and forth" and dry-heaving and obvious frequent flyer! Of course, that doesn't help with scores, so, yeah let's just keep em high
I am not even remotely good at IVs but a few tricks I've learned:
sit down. Especially in an outpatient surgery setting, you have time to sit down, get comfortable, get all your supplies arranged, and talk yourself down (if you are like me and could benefit from that kind of thing).
Dangle the patient's hand down below their body if needed, to help the veins plump up.
Look at the hands first. If there's a vein that splits into a Y, go right in the middle of the Y. It is almost impossible to miss those, I am awful with IVs and I have never missed one of those (although I now am sure I will next time).
Pick a landmark - a freckle, scar, etc. Use your fingernail to make an indentation in the pt's skin (gently) above the vein if there is nothing else. Make it a half inch or so from where you plan to insert the needle, so you have something to aim for.
Bevel up, loosen the catheter from the needle before you start, and keep your supplies handy.
I painted the metal part with glitter nail polish while in nursing school, still have the same one (among others). I guess it could be removed if someone really wanted to but I don't necessarily think these things are done on purpose most of the time.
You WILL survive in here.
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