Latest Comments by Northernlights

Northernlights 958 Views

Joined Feb 1, '05. Posts: 10 (10% Liked) Likes: 3

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    In the state of WI we have an implied consent law which states that drivers have implied that they give consent for chemical testing when they receive their licenses. However WI also has a law protecting professionals that do blood draws saying that they do not have criminal or civil liability when they draw blood in such cases except for criminal negligence in the act. Our facility has two different forms which are used: one for a patient who gives consent and one for a patient that refuses to consent. In both cases the officer fills out a section which cites the law used to demand a sample. In our state if the driver has already had one DUI offense or if there is an accident with fatality, the blood draw is mandatory.
    I disagree with the poster who want to make a legal blood draw wait for many hours before drawing them. In some cases if the draw is done more than 3 hours after an incident it is inadmissable as evidence.
    We all see the devastating effects of alcohol and driving. As nurses we should be willing to assist law enforcement to curb this problem. ER managers and law enforcement should work together to educate ER staff in their role.
    Northernlights

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    Hi, I would be interested to know if there are VA outpatient clinic nurses out there willing to share their opinions. What functions does the registered nurse do in outpatient clinics? Do you like your job?
    Thank you.

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    Dear Val,
    Sometimes I think of my heart as a patchwork quilt--the patches are those patients that I've been with that died. A part of them lives in my heart forever and when a new patch is added I often think about the ones that are already there just like when you look at the patches in a quilt.
    A little boy died in our ED because he wasn't in his seatbelt. His mother wasn't aware that he had taken it off. I cried for them over and over for months. Even now I get a lump in my throat, but it's better.
    The mom you helped with her son's death was lucky to have you there...
    Northernlights

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    I'm curious about how other small hospitals staff when census goes through the roof.
    I'm an ER nurse in a 25 bed hospital that has a 24-hr ER. The hospital does OB, med-surg and takes a few rehab type patients (swing bed or transitional care). My concern is not the ER, but the med-surg area. This past weekend I was turning patients over to the floor nurses who already had 7 or 8 patients. I felt awful knowing they were in over their heads, but we were backed up in ER and couldn't keep them.
    My question is, how do other small hospitals deal with large shifts in patient census. We don't seem to have a contingency plan. When we talk to our director, she says staffing is based on average census, which is averaged over a year's time and is 12 patients. However when we are at top census, our patient number is 25. And we seem to be hitting our top numbers much more often lately. We have never refused admissions due to nursing staff availability, but I wonder if we should sometimes. (Our next available hospital is 60 miles away).

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    I work in an ER of similar size and also without 24-hr pharmacy availability. Our hospital pharmacy has pre-packaged medications that we dispense for take home. They are labeled and we keep a log of what is dispensed. We keep it to a minimum: for example a packet would contain 3 vicodin or one antibiotic. We also have a limited number of types of medications available. Anything that could be purchased at a 24-hr store, ie ibuprofen, benadryl is not dispensed. It works well for us and I have to believe it must meet the requirements of emergency dispensing since our pharmacists are knowlegable and conscientious.

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    Is any one out there doing a "walking rounds" report where you go into each patient's room and do a report on that patient? We initiated this at our hospital last year and I thought it worked very well. There are benefits for the patient:he meets his "new" nurse and is present to hear the plan, goals, etc. and is reassured that the transition of care is communicated. As the oncoming nurse, I am able to have my first look at the patient right at the beginning of my shift--no surprises as I've had sometimes when the report on the patient and the actual patient appearance are very different. As the nurse giving report, I like it because I don't have to detail the obvious, the oncoming nurse can see that the patient is on oxygen and iv's, etc. and I hit the highlights of what happened my shift, what expectations there are for the next shift, and other pertinents. Report took about the same length of time or less time than traditional methods.
    There are times when all of the report can not take place at bedside: night shift perhaps, if there are visitors, or if there is information the patient for some reason can not hear (we found very little information that we couldn't share in front of the patient).
    Unfortunately, walking rounds did not continue, and our managers didn't pursue the reasons it stopped. I think it had to do with nurses that have done a verbal report for decades and were not willing to try something new; there was opposition from them at the outset. I find that those same nurses give very long verbal reports giving me unnecessary information that is a repeat of the computerized printouts we receive on each patient. It is a waste of time to tell me pt's age, room #, DR, IVF, etc.etc that is all printed in front of me. But it is the style they've used for years and can't seem to change.
    Northern Lights

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    An additional comment to the good comments I've read: the nurse giving you the narcan should have told you what she was giving you and why prior to you receiving the medication. You should not have had to ask.

  • 0

    Canoehead,
    I'm curious--will you need to work with this nurse again? Often? Was this an isolated incident or has she been "on your case?"
    You obviously gave good nursing care and met standards of practice. You can be proud that you stood up for your patient's best interests in the face of your co-workers' rantings.
    I would guess that she was alleging that your anger was out of control and that is why admin reacted the way they did. Did she feel threatened? Or was it a manipulation to get you into hot water? Either way, what's done is done and I would be concerned about how to move forward if you need to relate to her in the work setting in the future.
    By the way, the suggestion to agree to counselling, etc was good; but she should also need to receive some education about burn treatment. I've been a nurse for years like her; but unlike her, I realize that things I learned 5, 10, 20 years ago are no longer the accepted best practice.
    Best of luck to you in this difficult situation. Let us know how it goes.
    Northern Lights

  • 3

    My favorite--a woman brought her elderly father in because his hands turned blue. Cyanotic? No, the color was kind of royal blue and ended at the wrist. I took an alcohol wipe and wiped away a streak of the blue color. Diagnosis: new blue gloves! The patient, his daughter and I all had a good laugh. (By the way, he never made it all the way into ER thank goodness!)

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    I often say that the chest pain pt. coming into the ER by EMS saying "I'm having a heart attack" is more like not an acute coronory; and the patient walking in the front door of the hospital with chest pain that says, "I'm having chest pain, but I'm sure it's not my heart" probably is having an MI.
    In my experience, there is either denial or a true sense of dread with MI patients.



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