Okay, I have just been wondering here who else is confused with this. First a little background I am a mommy, wife and have 4 kids ranging from 19(on Thursday) to 21 Months with 2 in the middle.
Okay, when I go out, I make sure the kids have what they need for my little one an ample supply of diapers, wipes, a change of clothes, snackies, drinks, diaper cream, and whatever else I need. If we're going somewhere boring the older 3 take books, gameboys, Ipods etc to keep them occupied. My oldest (the 19 year old) has Autism. WE went t hrough some BAD times, but my work is paying off. (his official dx is Autism, Bipolar, they recently dropped ADHD)
Okay, I'm a little more tolerant because of this. I understand that one day you pack 2 changes and the baby gets diarrhea and bam your out of clothes and can't get home quick enough. I understand things happen.
Why do you come to the ED with a 6 month old with NO formula, NO diapers, No extra clothes etc? Really Why? We stock size 3 and 5 diapers sometimes, if we're lucky we get newborn. We carry 1 type of formula. That might NOT be the formula your baby is on, we don't stock soy.
Than you get in the room and you want a cup of ice, 9 packs of graham crackers, peanut butter and Cranberry juice/Gingerale with SEPARATE cups of ice for those.
It's not the marriott folks! Than the warm blanket request for the patient, the parent, the parent's best friend, and grandma who is on way oh and they want drinks and ice too.
While all this is going on the 3 year old decides it's okay to try and pull the SHARPS box off the wall and grind the graham crackers in the floor. The parent is wrapped up in the blanket on the bed trying to sleep (by now the friends/family have left) and starts to SCREAM at the 3 year old.
Okay, I will be the FIRST to say I'm So not perfect, I dont' yell for 1 reason, it overstimulates my Autistic one so I rarely scream, yell raise my voice. I'm not saying i'm perfect because I am so not. but, really if you act like that in ER I'm scared as to what goes on at home.
Than you stick your head in the room and say "is everything okay?" and the mom says "oh yeah he just got add"
Well I understand ADD, some of those kids are off the wall but there is a DEFINANT difference between ADD and bad.
Am I the only one this bothers? (I had this happen yesterday with 2 crit patients) I was just wondering if i'm the only one
Specializes in Emergency Dept. Trauma. Pediatrics.
I know this is not directed at me, but overuse of analgesics for headaches leads to rebound headaches, and can even lead to chronic daily headaches. Also, evidence demonstrates that 1L NS bolus and Compazine IV are the most effective in relieving migraine symptoms.
If a patient presents to the ED with new onset headache, or with symptoms that are more severe or different in nature from their normal headaches, there are a host of neurological conditions that they could be experiencing. A full neurological exam is indicated for these people.
I frequently find myself having to explain that I cannot give them anything for their pain until after the doctor has seen them, because the effects of medication can interfere with a sound neurological exam. This means waiting for medication until after a doctor has been in the room, which on a good night is within an hour, and on a bad night, can take up to two hours or longer.
The best I can do for them prior to being examined by the physician is to start a line and give them a fluid bolus, dim the lights, give them a cool compress and maybe some O2.
Once the physician has completed the neurological exam and orders the Compazine/Benadryl cocktail, I can give it. If the patient requests a narcotic and the doctor has not ordered one, I then explain to them that narcotics can actually worsen migraines, or that the narcotic might temporarily make them feel better, but that they will most likely experience a rebound headache after discharge, and that the Compazine/Benadryl cocktail is the most effective remedy we have in the ED.
I am completely aware of how things need to work. That is not what the poster said though. She said she tells Migraine patients that narcotics are contraindicated in Migraines. Big difference between that and a nurse not being able to give a narcotic without a doctors order and having a protocol they need to follow first and so on.
Not all people respond to the migraine meds the same. Not all people get the rebound headaches. For me the migraine medication didn't work. I have been to Urgent Care three times since I started getting migraines 8 years ago. (I avoid ED at all costs). My first migraine I got I didn't realize what it was and I dealt with it for 9 days before finally going in. (I had no Ins so I held off and finally went to UC and did a payment plan) They gave me a shot of a narcotic which I don't remember what it was now and it worked. 9 days I was in excruciating pain trying to function and take care of my kids and in a matter of 20 mins it was over with no adverse effects.
Second time they gave a narcotic as well and it worked. I tried treating it myself first with migraine meds and when that didn't work I tried a percocet and that didn't work and I tried motrin and that didn't work. 3 days I finally went in.
The last time I didn't have a ride so they tried an IM injection of Toradol and that worked after 40 mins.
Not all people respond the same but it's not the nurses job to lie to the patient about medications and decide what they can and can not have. It's the Doctors job to decide what the patient can have. My husband gets migraines and he did the immitrex sp? Nasal years ago and it worked and he didn't get another migraine for years.
Maybe the poster didn't mean it the way they typed it. But I can only go off what they put in their post which was a general statement of what they tell migraine patients.
I do tell patients NArcotics are contraindicated for migraines. When? After the doc/PA has already said NO NO NO BAD BAD BAD. THey always want to "sweet talk" the nurse because they think we can pull some magical string and get the doc to do what they want!
Okay also, the parent who is the 1st time parent and panics. I'm cool with those. It's the parent who has the baby who has had a rash for 4 weeks that comes without supplies. THat I have an issue with. The kid who's face is split open and the mom is a nervous wreck, the nursemaid's baby, I'm generally lenient on those. Why? because they are REAL. They are not trying to get something for nothing.
Now as to NOT giving the ice/drinks/crackers.
We have Customer Satisfaction Surveys. YEs,, I said it the CSS's UGH! They want us to have a score of greater than 97%!
We also have areas for "comments" on these and quarterly they are published in a nice little booklet for us to review. The majority of complaints are "no ice, no juice, no warm blanket, no blanket for my 8 family members, not being allowed to bring the mc d's bag in and feed it to the patient with abdominal pain, Waiting more than 30 mn for service. waiting more that 30 min for treatment and discharge"
I think my fav was "They manhandled my son to make his shoulder 'pop', while he was sedated, I felt I should have been offered a sedative as this was traumatic to watch"
YEs, the patient's family member wanted to be sedated *****
Unfortunately, CSS are becoming a more common occurance and they need to be handled as such, we have a huge push on customer service. Not always cool but it's what's happening now.
Neither one of my boys had it but it was more convenient for the teacher to suggest every boy get medicated so they can sit in their seats and be good students. I wouldn't budge with my first and he outgrew the social butterfly syndrome. My second I took him to the recommended psych doc at the request of the teacher.
The doc asked my son a couple questions as my son quietly sat in his seat perfectly still and then the doc wrote me out a Rx for ritalin. After that I gave my son a vitamin every morning before he went to school just to see what would happen (I threw the Rx away!).
6 months later I was at the recess watching the kids play. The teacher came up to me with this huge smile on her face ... exclaiming how much better my son is now that he's medicated. She went on and on and I finally stopped her and told her I never gave him the Rx and that it was just her perception that had changed. I thought she was going to come unglued.
I know this is off-topic, but I just have to respond to this.
THE SAME THING HAPPENED TO ME AND MY SON!
When my son was in fourth grade, I was called into a conference with his three teachers and the asst. principal. They were concerned about his behavior. He needed to move around a lot in his seat. All of these teachers had about five years of experience among them. His previous teachers had much, much more experience, and they mentioned his moving behavior, but stopped short of recommending medical evaluation and told me that they would try some different things in the classroom. After the conference in fourth grade, I became paranoid that something was really wrong and got a referral from his pediatrician and all. He had an EEG, neuropsych testing, the works. I refused to medicate him.
About four months later, one of his inexperienced teachers came up to me and said how much his behavior improved. I told her we went through testing, but we chose to not medicate him. She didn't say anything, and I walked away.
He's now 13, and no other teacher has ever said anything about his behavior. He simply matured and has more self-control.
I do tell patients NArcotics are contraindicated for migraines. When? After the doc/PA has already said NO NO NO BAD BAD BAD. THey always want to "sweet talk" the nurse because they think we can pull some magical string and get the doc to do what they want!
No worries, I figured you meant something along those lines. Some behaviors and situations we deal with in the ED seem to be universal, and the different ways in which we respond to them are valuable information to exchange, one ED nurse to another.
I feel your pain. I do what I can but some days I say that I will "try" to get to their (severely nonurgent) request but I cannot guarantee that third cup of ice because I have some very sick patients that I am helping that require my attention. I hope they understand. Has worked so far.
I feel your pain. I do what I can but some days I say that I will "try" to get to their (severely nonurgent) request but I cannot guarantee that third cup of ice because I have some very sick patients that I am helping that require my attention. I hope they understand. Has worked so far.
We say that here and than you get all the screaming and yelling as we are VERY sick too, and I need that cup of ice and it just blows up.. it's bad. We have a culture of patients who are aware of the customer service requirements and milk it. that's my frustration. Certain things shouldn't have a customer service requirement.
I'm all for people being treated with dignity/respect and "going the extra mile" but unfortunately, there are nights where that just CANT happen. and that's the frustration point on this.
Correct, there are some nights when that can't happen, and you can't allow the patients to dictate your priorities. YOU are the nurse, and you are there to use your judgment to set appropriate priorities. They can ***** and scream all they want because you're not getting them another cup of ice, but the STEMI, stroke alert, or trauma is your priority from any logical or ethical vantage point. Let them scream all they want. I'll just close the sliding glass door to their room so the other patients in the hallway don't have to listen to it.
You can say just about anything to anyone if you say it the right way. But sometimes, no matter how you say it, some people don't want to hear "No". That is no fault of yours, and it's not your responsibility to satisfy someone that will not be satisfied, especially at the expense of the well being of others.
Most of the time, I take the time to schmooze and explain politely and with a smile why a cup of ice, an extra pillow, a meal tray, a diaper, some formula, etc., are not going to be immediately forthcoming. Other times, like when I'm prepping for a trauma, I go into "ignore" mode.
Call light? Ignore. Family member hovering in doorway trying to make eye contact? Ignore. LOL calling out "NURSE!!!!!" for the seven gazillionth time in the last hour? Ignore. Unless I see an immediate threat to life or limb, ignore.
Cause when that helicopter lands, I can't be caught up in another room dealing with something relatively unimportant. Let them be ****** that they're being ignored. I'll bet that if they were that trauma patient, they wouldn't want it any other way.
In the absence of any critical patients that need my undivided attention, you bet I'm responsive to reasonable requests and work very hard to make every patient feel comfortable and cared for. But I have no problem going into hardass mode when I have to. It's called "nursing judgment", and it's what we are there for.
Anyway, after thoroughly hijacking your thread, I'd say that there are concerned parents who run out the door in a panic and just don't think to grab the diaper bag, there are people who just aren't very bright, and there are people who seem to expect the rest of the world to do for them.
The first group are typically embarrassed and sheepish, and don't really want to ask for anything. They don't bother me because stuff just happens sometimes, and I don't want to make them feel any more foolish than they already do.
The second group, well.....you meet them in every walk of life, and since there isn't a cure for stupid, I'm only slightly annoyed when they interrupt me in the middle of delivering analgesia to a LOL with a fractured hip or grabbing the crash cart to do a cardioversion; really it's not the baby's fault they were born to an idiot, so if it won't be detrimental to my other patients to take a second to run to the supply room and grab what they need, it's no skin off my nose.
The third group ticks me off, because not only do they expect me to fetch every little thing they didn't bother to bring, but they're also typically the ones hovering in the doorway repeatedly asking how long it's going to be before X,Y, or Z happens, "threatening" to go to the other hospital if X,Y, or Z doesn't happen quickly enough, or any number of annoying time wasting/psychic energy draining behaviors that leave me wondering why I became a nurse. These are often the same people that have learned that if you yell loud enough and stomp your feet hard enough for long enough, you will eventually get what you want. I feel sad because I know all of this kind of behavior is going to be passed right down to the baby, and the baby's baby, and that baby's baby, all a familial cycle that will repeat through the generations.
This is all my purely unscientific opinion, of course.
My Father subscribes to the notion that the primary function of school isn't so much to impart knowledge but to reinforce (and where lacking, instill) parental discipline. "Discipline is the foundation for a successful and happy life", was his mantra.
I'll admit that growing up wasn't 'easy' with parents who were sticklers for discipline, curfew, grades and manners - but the older I get, the more thankful I am that my parents stuck to their guns.
There is a school of thought that says that a good chunk of the 'behavioral issues' we are seeing in children today has to do with the cumulative and steady erosion of parental authority over their children. Can't do this/can't say that/self-esteem this/don't show that etc. Parent's aren't "allowed" to 'parent their children' anymore. And children aren't allowed to learn from the two most important "teachers" in life - Success and Failure.
As for the rest, here is an article y'all probably can appreciate.
Reminds me of [NB: Mild language/content warning] this episode of "That 70s Show" (the part @ 6:10 is particularly funny). But I'd be lying if I said that it didn't remind me of my childhood and teenage years - my worst fear wasn't the cops, it was my parents finding out!
As a grown adult today, my Father's words still echo in my mind: "When you do well, the world praises you. But if you do something bad, the world blames your parents saying 'the child wasn't raised right'". Fair or unfair, right or wrong - Father's got a point. And I try to be mindful of that in my everyday living...
Specializes in Cardiac Telemetry, Emergency, SAFE.
I think my fav was "They manhandled my son to make his shoulder 'pop', while he was sedated, I felt I should have been offered a sedative as this was traumatic to watch"
YEs, the patient's family member wanted to be sedated *****
That may be the best thing ive ever read.... Wow. :yeah:I thought it was bad when family members asked for tylenol or to look at this "lump" theyve had for 2.4 yrs.
~Mi Vida Loca~RN, ASN, RN
5,259 Posts
I am completely aware of how things need to work. That is not what the poster said though. She said she tells Migraine patients that narcotics are contraindicated in Migraines. Big difference between that and a nurse not being able to give a narcotic without a doctors order and having a protocol they need to follow first and so on.
Not all people respond to the migraine meds the same. Not all people get the rebound headaches. For me the migraine medication didn't work. I have been to Urgent Care three times since I started getting migraines 8 years ago. (I avoid ED at all costs). My first migraine I got I didn't realize what it was and I dealt with it for 9 days before finally going in. (I had no Ins so I held off and finally went to UC and did a payment plan) They gave me a shot of a narcotic which I don't remember what it was now and it worked. 9 days I was in excruciating pain trying to function and take care of my kids and in a matter of 20 mins it was over with no adverse effects.
Second time they gave a narcotic as well and it worked. I tried treating it myself first with migraine meds and when that didn't work I tried a percocet and that didn't work and I tried motrin and that didn't work. 3 days I finally went in.
The last time I didn't have a ride so they tried an IM injection of Toradol and that worked after 40 mins.
Not all people respond the same but it's not the nurses job to lie to the patient about medications and decide what they can and can not have. It's the Doctors job to decide what the patient can have. My husband gets migraines and he did the immitrex sp? Nasal years ago and it worked and he didn't get another migraine for years.
Maybe the poster didn't mean it the way they typed it. But I can only go off what they put in their post which was a general statement of what they tell migraine patients.