thelema13 5,871 Views
Joined Jun 13, '11 - from 'Florida'.
thelema13 is a ED RN, CHARGE NURSE.
He has '3' year(s) of experience and specializes in 'ED'.
Posts: 287 (49% Liked)
I have filled out many risk masters with no action taken. I have gone to multiple meetings, requested by myself, to speak with the ED director or manager about a nurse/incident/labs lost/yadda yadda.
The sad thing about all of the previous posts is that it happens all too often. Under staffing, pressed for time, and increased patient loads make us cut corners from time to time. Yea, I have falsified a patients vitals that was in my ED for a toothache or a stubbed toe. I document estimated weights all the time because I cannot get every EMS or straight-back patient on the scale. I am supposed to do hourly rounding AND hourly clinical notes, but in all honesty, when does that happen? On a slow night perhaps. If I am lucky.
Some genius thought it would be a good idea to scan all meds when giving them. Yes, accurate charting and another fail-safe for patient safety, but also yes to time consuming, frustrating when the scanner/badge/med doesn't work properly and not really appropriate for the ED. And then I get chewed out for not complying with policy. How about some of the higher-ups come down and work a shift and scan ALL the meds? Half the time the COWS battery is dead from day shift.
Our scope of practice as nurses is continually widening, yet staffing seems to dwindle, tech positions disappear, and shifts feel like they get longer. There is always an exception to the rule, but knowingly fraudulently documenting that you did something when you did not is wrong. Slap my hand for documenting the tooth ache has a pulse ox of 100%, but I am not charting an assessment that I did not really do. I simply won't document, and if my charge or manager or director wants to ask questions or moan and complain, I will tell them the truth. Yes, the reason the Baker Act ran out of the ED is because the psych rooms were already full, the ED was full, and I had 7 patients to care for and I even pulled a CNA from the floor to be a sitter. I am not going to tackle a patient, that is what the sheriff's office is for. It is not my fault that we are understaffed and overworked. The truth hurts sometime.
To the LTC and nursing home nurses, I give you kudos for what you are able to do. That has to be a depressing job. I know you guys are so understaffed, it is ridiculous. Blame capitalism and greed for these situations. Just one request before you package up a patient and send them my way: an accurate, concise report would be nice, handwritten on paper even, and not 'the patient doesn't look good"; empty the foley bag! Vent over.
I say to each their own. After all, it is your name and license number that is on the line when the attorney's start sniffing.
Just to follow up, I got questioned by my manager about the pt And I stated I think we did everything we could have, save giving her dilaudid. I was backed up by coworkers and charge nurse. Good thing I did a risk master just to cover my butt. Pt never cam back later in day like she stated.
My wife is an MT in Florida, initial job was at a chiro office, he was charging clients $60/hr but my wife would receive $15/hr plus tips, and have to supply her own massage creams.
So we brainstormed, she got a small office on the highway out of an assisted living-type facility and does not pay rent, rather trades an hour massage per week to the building owner and his wife. Also, she chips in on utilities. Instead of charging $60/hr like everyone else in town, she charges $35/hr. She is booked solid and has built quite a reputation. With $60/hr rates, she was getting ~10-20 massages a week, now at $35/hr she does 20-40 massages a week, gets way better tips, and basically cannot accept any new clients due to a strong clientele.
Her rationale- "I would rather make $35/hr and be working full time than charge $60/hr and be worried about having work."
People see $35/hr and jump on it, I have let my nursing colleagues know and she still gets $60+/hr including tips, regularly.
Hope this helps.
Same old Ricky, fall due to drinking, off for his 10th CT this month.
Central FL, charge nurse in ED with 5 years experience. BSN, CEN. $28 base with 20% night diff, no diff for weekends. No bump in pay for BSN or CEN. I'm told compression raises due in April... but I'm not holding my breath.
Nonunion, not for profit hospital.
Mortgage is $650/mo with taxes and insurance included for 3/2 1800 sq ft house. Utilities 300/mo.
People expect competence. What they don't expect but hope for is kindness.
Sorry also forgot to mention 500cc NS bolus.
Pt denied HA or hx of migraine. Pt kept asking for dilaudid by name. I felt bad for her, it's not nice to vomit so much. I advocated pain medication but doc wouldnt give it. Pt was a frequent flyer, and husband known to be a di** to staff. He picked her up on discharge and demanded the medical directors name and number, screaming he wasnt going to pay the bill and that he was going to get us all fired.
In my opinion, there was some psychological aspect to her condition, which played into her symptoms making them worse. It sounded like after the initial vomiting after being brought back from triage, she was wretching, trying to make herself throw up. Just my opinion, and I did speak to my charge nurse a few times about the pt. What got me is that she was telling me to tell the doctor what to order, "i need at least 4 shots of phenergen and 2 shots of dilaudid, plus one of each before i leave for the ride home." Upon discharge, pt refused wheelchair and stormed out angrily, without any s/s witnessed before. And to leave our ED is quite a walk since we are renovating.
Thanks again for all the replies!
This happens EVERY DAY. When people come to the emergency department for sniffles, stubbed toes and lacerations that have stopped bleeding on the ride over, you can expect this to continue and get worse.
That is why I staple an information sheet on our local urgent care clinics onto all visits I deem trivial. I am the king of treat and street.
The RN (me) that turned around and punched the wall after a patient/bed combo rolled over right foot. Boxer's fx and great toe fx, and a worker's comp claim in the works. Wonder how that will go?
51 year old male with a very large metal cock ring that was purchased a few sizes too small. He put it on and had a solid erection for 4+ hours PTA. No other medical history.
This is what we did:
1: Ice packs
2: Ice bath for penis and testicles
3: Copious surgi-gel and digital manipulation
4: IV neosynephrine, 10mg in 500cc NS wide open, did not affect BP more than 10 points systolic but had little effect on diminishing his erection.
5: Patient urinated x3, minimal size reduction
6: IVP toradol, morphine, etomidate, versed and brought out the ring cutter, then the ring cutter broke.... the ring was surgical stainless steel 8mm thick
7: A whole lot more surgi-gel and I sent a nurse home to grab his Dremel.
8: Used the Dremel on and off for 1.5 hours, allowing time to allow the metal ring to cool (iced surgi-gel helped here) We used tongue depressors as a barrier/guard in between the penis and ring.
9: Ring pried open with some monstrosity tool from the OR.
10: Patient took a cold shower for 30 minutes, then ended up going home with a urology consult, percocet and a lesson well learned....
He had the ring on and a solid erection for approximately 7 hours. He was a retired firefighter/EMT and was cracking jokes left and right. It was a very sensitive, delicate, dangerous situation.
What did you just learn???????? Buy a rubber ring, and invest in a Dremel for your ED!
I have a lady that dislocates her shoulder to get some moderate sedation and a RX for percocet.
Just the other day, I had a 75 year old male come in with chest pain. Poor guy was on the way out of town with his wife to go on a cruise. I triaged, got an EKG, started a line, drew labs and informed the doctor. Grabbed a 250cc bolus, aspirin and on his 2nd nitro pill, he bottomed out and coded. Got him back shortly after doing some compressions, dumped 3,500cc of saline into him, BP ~40/20s. During my triage he told me he took viagra, but not for 3 weeks. After we stablized him, I started asking him more questions, and he admitted he took a viagra before they left the house. This guy was in his 80's and was going to try and get his vacation started on the drive to the ship!
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