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A&Ox6, BSN, RN 13,979 Views

Joined Apr 16, '12 - from 'Starbucks'. A&Ox6 is a Psychiatric Nurse/Student Advisor/Writer/Speaker. She has '2' year(s) of experience. Posts: 603 (51% Liked) Likes: 908

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  • Nov 25

    I was watching old episodes of Scrubs, which is awesome if you ignore anything medical. So much to write about, but my favorite is that JD keeps his car door in the radiology/MRI room.

  • Sep 17

    I would probably say that it is a great thing to have. Just make sure that you have a protocol that allows you to use it in an emergency even without a patient specific order.

  • Aug 8

    Quote from Farawyn
    Again, I don't get this "legit" psych patient stuff.
    Humor me, and please explain the difference between a homeless guy with a hot urine and a court date as opposed to a "legit" psych patient.
    Far, as a former school nurse, this may help...

    You know the difference between the student who comes to you for a headache because they were cutting class and want a note to avoid an unexcused late/absent and a student who has 103 fever and is upset that he is being sent home?

    So I think that it is similar to the frustration we feel when a patient knows the magic words to be admitted in order to avoid being arrested or even a fight at home.

    I think that both can be seen in psych/mental illness. The difference is that inpatient psych admission is really for acute stabilization and safety. If someone has a need for treatment, I'm all for IOP/outpatient/group therapy/job coaching/ACT team etc. However, these patients are being admitted to psych because they say the magic S word even though all we can do for them is 3 hits and a cot.

  • Aug 7

    Quote from RN543
    I have to chime in here. I've worked in psych for 6 years now and it's my passion. But psych isn't for everyone. If you don't love psych nursing, then you aren't doing yourself or your patients any favors by continuing in the specialty. When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started. It's a wonderful thing to pursue this career because you want to make a difference. If that's you then it shows you are a caring person with a desire to help people. The problem is that some people have not accepted the fact that we aren't going to save or cure EVERYONE. It's likely that only a small percentage of our patients will improve and go on to lead productive lives. But I'm not going to stop trying. We need to remember that first of all, we don't always hear or see the success stories (b/c our successful pts may avoid readmission and we might never see them again)... So it's hard not to focus on the negative things we see and hear. But also remember that even the little things u do make a difference to that patient... Even if you're not a miracle worker...

    For example, a new patient comes in (depressed and suicidal) that is scared, embarrassed, ashamed... But you show compassion... You listen to them without judgment... You offer a meal to that patient that hasn't eaten in days. U put them at ease and make them feel a little better about what they are going through. You praise them for the choice they made by seeking help. So maybe this patient doesn't make a miraculous recovery... But it doesn't mean u didn't make a difference. Maybe a year from now when they are standing on that bridge about to end it all... They will remember you and how you made them feel about seeking help. Maybe you will be the reason they won't feel too ashamed to ask for help. You may have saved someone's life and never even know it.

    I just try not to judge. Someone who has BPD may be a little annoying but I won't let that show... And they are just as deserving of my time and my compassion. And at least in my area, the majority of my patients also have addiction issues. There is no easy fix for mental health disorders and addiction. And then you throw in external factors like homelessness, unemployment, legal issues, relationship/family problems... And the odds are hard for anyone to beat. The truth is we don't have the community resources (at least in my area) for these people to get back on their feet. Even when our facility's case manager finds a halfway house or other placement for one of my patients, they typically don't have the money to afford it. When I have a patient that is readmitted... Of course it saddens me that they are not doing well and had to return... But the only other negative thought I have is how we as a facility failed that patient. Was the patient discharged too soon? Did we not plan appropriately for their discharge? Is their something we can learn from this rather than being negative and judgmental toward the patient? Why would I get annoyed that my admission was a patient that was just here a month ago? Because he's abusing the system? Because he's taking a bed from someone else that really needs it? Oh please! Who are we to decide who is more deserving or who needs our help more than others? Sometimes it's nice to have the same patient again because I already know them... Maybe my assessment will be quicker... I may already have a good rapport with them, etc. And maybe they don't quite "get it" the 1st time, the 2nd time, or even the 20th time. But maybe on the 21st time you admit that patient they will come with a new perspective and insight and will follow up with their aftercare plans. You just never know. I learned my best lessons not from lectures... But from my own screw-ups. Sometimes our patients need to fall before they can pick themselves back up.

    In my opinion, there is a lot of discrimination and a lack of compassion for mental health and addiction. But how is this issue (non-compliance, readmissions, etc.) any different than any other nursing specialty? What if you take care of a patient that had a massive MI and goes back to eating cheeseburgers and has a 2nd heart attack within a few months? Or you have a diabetic patient that refuses to follow their recommended diet or take their medications consistently? Would you feel the same disdain for them? Are they just abusing the system too?

    Listen... I look at nurses that work in ICU or nursing homes or oncology or just about any other specialty... And I think how do the do it? But I'm sure a lot of them look at psych nursing and think the same. If it's not your thing then it's all good. But even if u think ur negativity is not being noticed by ur patients or co-workers... You're probably wrong. I decide what kind of day I'm going to have each day by my own attitude I walk in with. If you're attitude is negative, your negativity will likely be contagious.

    You would be surprised at how much of a difference it makes to carry a smile and a positive attitude... Your positivity will be contagious too. And pretty soon you will be impressed with the difference you are making around you.
    You make some great points, and I agree overall with what you say. However, some hospitals are so desperate to stay full that they admit individuals who will be much better served seeing a therapist or psychiatrist on an outpatient basis.

    Just because an individual is competent to sign for a voluntary admission, doesn't mean that inpatient treatment is appropriate.

  • Aug 4

    Quote from Rose_Queen
    Never a school nurse, and I'm rocking the pink today.
    Thanks. I was feeling a little lonely

  • Aug 4

    Rebooting an oldy, but I am missing y'all. Repping my school nurse pride in pink.

    (No, I am not back in school nursing, but once a school nurse always a school nurse.)

  • Aug 2

    Quote from OnOn2RN
    If I am reading this correctly, the school is not accredited and has had less than 25% NCLEX pass rate. That is really scary.

  • Jul 20

    Quote from

    Just to be clear - I'm NOT accusing you or anyone else of anything. I'm merely stating the situation as is. Because this isn't limited to migraineurs - sickle cell, fibromyalgia, chronic back pain, RSD, neuralgia... you name it. ALL manner of [I
    chronic[/I] conditions are sent to the ED - the place least equipped to manage it appropriately.

    Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency.

    cheers,
    I appreciate your response, but I think there are some errors in what you are saying.

    First of all, I work with children with sickle cell disease on a regular basis to help keep them out of the hospital. We focus on self management and the like. However, as pain can be a sign of VOC (vaso occlusive crisis), we do need our clients to get emergent care for this pain. While the hematologist should see the child at regular intervals and soon after an episode, it it's unrealistic to expect that they see the patient within the needed timeframe if this occurs at night or on weekends. My clients do tell me that they avoid emergency rooms, even in an emergency because they are often labeled as drug seeking or not requiring emergent care.

    Going back to other chronic conditions. Every condition had signs of am emergency. As an example, I have chiari I malformation. I am well managed, and not yet a candidate for surgery. However, I know that if I experience certain symptoms such as severe headache with stiff neck, hemiparesis and new symptoms, it could be a sign of an acute herniation.

    I understand that emergency nurses are stressed and often have too many patients too deal with. In a past job I was often floated to the emergency room. I just want to remind you that individuals with chronic conditions may or may not seem to need emergent care, but oftenthey are following a treatment plan. Also, remember that providers who see clients on an outpatient basis need to send individuals to emergency rooms because of the nature of office hours. Lastly, some clients go to am emergency room because they have poor health management.

    Finally, I will agree that not everyone who goes to the emergency room needs to go, but please don't take it out on those with legitimate chronic diagnoses. Why should sickle cell and migraines be treated any differently than diabetes and hypertension. All for can be managed in an outpatient basis but may have specific symptoms that necessitate emergency room visits.

  • Jul 15

    Quote from Nalon1 RN/EMT-P
    They are not dealing with your clients, they are dealing with their patients.
    So you're foster care? All your clients are under 18? All are wards of the state? Not what is being talked about. These kids do not come into the ER ranting and raving that they are in pain and need Dilaudid now. They are minors and need consent to treat, so they will have an adult with them and will be treated as they need to be. They will not refuse treatment. They will not leave one ER and go to another to get more meds. They will be treated appropriately for their condition.

    Your taking personal offense to something that is not directed at you or your clients. I do not see anyone saying the ED/ICU is better than any other area of nursing, you brought that up. No, I probably could not do (do not want) your job, and you state you float to the ER but can't do it? Why accept that assignment?


    As for this entire post, some people can't read a simple sentence. Tho OP (probably a troll) said a simple headache. Not a migraine, not a bleed, not a six month long headache, not the worst headache they ever had, just a headache. If you work in the ER you have had these patients. The patient that comes in saying "I have a headache that started an hour ago". No nausea or vomiting. No weakness or deficit. No visual problems. No speech problems. Just a regular headache that they have not taken anything for and just wants something for the pain, but for whatever reason has not even attempted OTC self treatment.

    Not every headache is an emergency.
    The x-ray above, we have no information about. The migraine sufferers, nothing to do with simple headache. Still trying to figure out how sickle cell got into this discussion.
    I am not really sure why you are upset about my post. I responded to a poster who bolded my use of client stating that she doesn't have clients. I responded stating that she may not have clients, but I do because of my work.

    While I currently work in foster care for medically and emotionally fragile persons, I have had experience in school, acute psych, and urgent care. I also was crosstrained to ED and med surg so that I could float. Therefore, I have worked with adult patients and individuals who come to the ED on a nightly basis for the turkey sandwich. I stated that I cannot do what ED/ICU nurses do as a way of recognizing that this is not my area of expertise. There has bewn a long history of elitism of some "designer" specialties in nursing. My statement was a preemptive attempt at explaining that just like I don't do what you do (because I don't) you don't do what I do.

    I don't really understand your statement regarding foster kids and ED. I understand that foster care is different in every state, but my clients are not all "wards of the state" from a medical perspective. Some biological parents remain as medical consenters. As such, a child in foster care is not always brought by a guardian to the ED. In fact, some of our foster parents are also ineffective in this manner. It may not be good, but it is reality.

    While I know that this OP referred to a simple headache, this thread has evolved, and many other examples have been addressed. Some of those examples included migraines, back pain and sickle cell. In general, many clients with SCD are labeled in EDs as med seeking. this actually does affect my child and adolescent clients because they receive mixed messages regarding treatment of a vasooclusive crisis.

    Regarding you not wanting to work in foster care, I will just say that very few nurses like to work in foster care for many reasons including low pay, limited appreciation and sometimes stigmata that rub off on us. However, I truly believe that I am doing important work, which can potentially improve the outcomes for our clients. Therefore I am glad I do what I do.

  • Jul 11

    Quote from Roy Fokker
    Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"

    If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!

    I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(

    In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:

    "Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.

    So yeah, I know that "headaches can be serious!""

    I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.

    What does this have to do with the price of tea in China?!!

    NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!

    People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
    And last I checked - pain did not kill anyone.

    Nobody is "taking it out on" anyone.

    ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
    More than half refuse, because "that s*** don't work!"

    It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
    Again: not saying that everyone lies...

    As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
    Et cetera

    Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?

    That sounds very much like an ED appropriate patient.

    Emergency Department overcrowding is a serious problem!
    Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
    Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!


    For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
    I reiterate the point I made in my original post - "would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?"

    Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"

    PS: "clients"???
    *** happened to "patients"??!!! Yes, it is why I highlighted the term!
    I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients.

    Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care.

    Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions.

    If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

  • Jul 11

    Quote from

    Just to be clear - I'm NOT accusing you or anyone else of anything. I'm merely stating the situation as is. Because this isn't limited to migraineurs - sickle cell, fibromyalgia, chronic back pain, RSD, neuralgia... you name it. ALL manner of [I
    chronic[/I] conditions are sent to the ED - the place least equipped to manage it appropriately.

    Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency.

    cheers,
    I appreciate your response, but I think there are some errors in what you are saying.

    First of all, I work with children with sickle cell disease on a regular basis to help keep them out of the hospital. We focus on self management and the like. However, as pain can be a sign of VOC (vaso occlusive crisis), we do need our clients to get emergent care for this pain. While the hematologist should see the child at regular intervals and soon after an episode, it it's unrealistic to expect that they see the patient within the needed timeframe if this occurs at night or on weekends. My clients do tell me that they avoid emergency rooms, even in an emergency because they are often labeled as drug seeking or not requiring emergent care.

    Going back to other chronic conditions. Every condition had signs of am emergency. As an example, I have chiari I malformation. I am well managed, and not yet a candidate for surgery. However, I know that if I experience certain symptoms such as severe headache with stiff neck, hemiparesis and new symptoms, it could be a sign of an acute herniation.

    I understand that emergency nurses are stressed and often have too many patients too deal with. In a past job I was often floated to the emergency room. I just want to remind you that individuals with chronic conditions may or may not seem to need emergent care, but oftenthey are following a treatment plan. Also, remember that providers who see clients on an outpatient basis need to send individuals to emergency rooms because of the nature of office hours. Lastly, some clients go to am emergency room because they have poor health management.

    Finally, I will agree that not everyone who goes to the emergency room needs to go, but please don't take it out on those with legitimate chronic diagnoses. Why should sickle cell and migraines be treated any differently than diabetes and hypertension. All for can be managed in an outpatient basis but may have specific symptoms that necessitate emergency room visits.

  • Jul 11

    Quote from Roy Fokker
    Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"

    If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!

    I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(

    In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:

    "Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.

    So yeah, I know that "headaches can be serious!""

    I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.

    What does this have to do with the price of tea in China?!!

    NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!

    People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
    And last I checked - pain did not kill anyone.

    Nobody is "taking it out on" anyone.

    ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
    More than half refuse, because "that s*** don't work!"

    It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
    Again: not saying that everyone lies...

    As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
    Et cetera

    Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?

    That sounds very much like an ED appropriate patient.

    Emergency Department overcrowding is a serious problem!
    Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
    Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!


    For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
    I reiterate the point I made in my original post - "would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?"

    Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"

    PS: "clients"???
    *** happened to "patients"??!!! Yes, it is why I highlighted the term!
    I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients.

    Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care.

    Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions.

    If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

  • Jul 11

    Quote from Roy Fokker
    Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"

    If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!

    I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(

    In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:

    "Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.

    So yeah, I know that "headaches can be serious!""

    I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.

    What does this have to do with the price of tea in China?!!

    NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!

    People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
    And last I checked - pain did not kill anyone.

    Nobody is "taking it out on" anyone.

    ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
    More than half refuse, because "that s*** don't work!"

    It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
    Again: not saying that everyone lies...

    As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
    Et cetera

    Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?

    That sounds very much like an ED appropriate patient.

    Emergency Department overcrowding is a serious problem!
    Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
    Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!


    For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
    I reiterate the point I made in my original post - "would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?"

    Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"

    PS: "clients"???
    *** happened to "patients"??!!! Yes, it is why I highlighted the term!
    I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients.

    Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care.

    Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions.

    If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

  • Jul 7

    I am honored to be filling in for our beloved ixchel's WILTW thread once again.

    As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons.

    Brain Development

    I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.

    The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.

    Standardized Patients

    As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P
    program I thought I knew what to expect. The experience was good overall.

    However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas?

    Female Condoms

    This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.

    What did YOU learn this week?

  • Jul 7

    Quote from

    Just to be clear - I'm NOT accusing you or anyone else of anything. I'm merely stating the situation as is. Because this isn't limited to migraineurs - sickle cell, fibromyalgia, chronic back pain, RSD, neuralgia... you name it. ALL manner of [I
    chronic[/I] conditions are sent to the ED - the place least equipped to manage it appropriately.

    Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency.

    cheers,
    I appreciate your response, but I think there are some errors in what you are saying.

    First of all, I work with children with sickle cell disease on a regular basis to help keep them out of the hospital. We focus on self management and the like. However, as pain can be a sign of VOC (vaso occlusive crisis), we do need our clients to get emergent care for this pain. While the hematologist should see the child at regular intervals and soon after an episode, it it's unrealistic to expect that they see the patient within the needed timeframe if this occurs at night or on weekends. My clients do tell me that they avoid emergency rooms, even in an emergency because they are often labeled as drug seeking or not requiring emergent care.

    Going back to other chronic conditions. Every condition had signs of am emergency. As an example, I have chiari I malformation. I am well managed, and not yet a candidate for surgery. However, I know that if I experience certain symptoms such as severe headache with stiff neck, hemiparesis and new symptoms, it could be a sign of an acute herniation.

    I understand that emergency nurses are stressed and often have too many patients too deal with. In a past job I was often floated to the emergency room. I just want to remind you that individuals with chronic conditions may or may not seem to need emergent care, but oftenthey are following a treatment plan. Also, remember that providers who see clients on an outpatient basis need to send individuals to emergency rooms because of the nature of office hours. Lastly, some clients go to am emergency room because they have poor health management.

    Finally, I will agree that not everyone who goes to the emergency room needs to go, but please don't take it out on those with legitimate chronic diagnoses. Why should sickle cell and migraines be treated any differently than diabetes and hypertension. All for can be managed in an outpatient basis but may have specific symptoms that necessitate emergency room visits.


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