Tell me if this is the norm in your er! - page 3

Hi everyone...we had an er visit last night, and I don't work ER full time anymore (moved on to another specialty) although I do work agency in the ER now and then. I am a trav nurse, currently in... Read More

  1. by   GilaRRT
    Quote from nigerianmalenurse
    do you seriously want to know the norm in my er?
    lets go back to when you got to the er (my er), first you would have to come with a referral leta since it is a "teaching hospital' according to them,if you dont have that you would be advised to go seek help from somewhere else,even if u do hav a referral leta, you would hav to wait in line and mark my words "wait in line in your car in the parking lot" till theres a bed space since we have only 36 beds in our er,so it doesnt matter that you got to the hospital,u still may not get help. lets assume u beat all these hurdles,every lac, no mater how small are sutured in the "theatre" by the doctors,we dont have techs here (who eva they),u dont wana know the payment protocol. the is no prefence for dead,living,partially living or dying patients. compare this to what you have over there...............
    True; however, we cannot hold you to the same standard as the USA. You most certainly are attempting to improve the healthcare environment; however, comparing this suture situation to your situation is difficult if not impossible given the profound differences between the health care environment of our two countries.
  2. by   catshowlady
    GilaRN - Thanks, that was interesting. When hubby wakes up, I'll have to ask him about the training levels. This was 30+ years ago, during the Viet Nam war. He worked on a base hospital in the ER at night.
  3. by   missnurse01
    wow thanks everyone for the replies-and i see that i wasn't off in thinking that techs suturing wasn't the norm. yes it was at pres hosp. they said they were the only ones in the area that still did it.

    so everyone is only cleaning with saline now? not even hibiclens or something? i thought the doc would at least swab the wound with something, but nope, just the ns irrigation the tech did. i haven't seen this in practice yet, everywhere i have been has been betadine or hibiclens at least after the ns irrigation.

    i think in my head like so many other items in the medical field, that we becoming task masters, and like a new grad or whatever, don't really realize the full scope of our actions...i understand that suturing is generally a tactile skill, but i worry about the assessment portion of it, as well as the running into problems. yes i have seen tons of suturing occur without incident, but i was fairly confident that when problems arouse the docs knew what to do. does this make sense?

    once again, thanks to all!!!

    anyone doing dermabond over dissolvable sutures? i am starting to think that might have been a good fit for my son's toe, as a portion did not take the suture (read it tore through and couldnt be resutured in that spot) and i have had a time trying to get the wound edges decently together for him to not lose a wound edge. i know, it's only the underside of a tiny toe really...
  4. by   nolabarkeep
    We have a tech in our ED who does all of the splinting of limbs. He actually knows as much, if not more than the physicians regarding orthopedics. I guess its possible to thoroughly train staff to suture wounds. I can't imagine a hospital spending that amount of time and money to do this. I also have never known a physician that would trust a tech to suture a patient. I believe this person(s) were making this up. What if there is a lac to the lip? This is a delicate procedure that needs a professional trained hand.
  5. by   navvet
    So what's the problem. One can buy a suture kit on the internet, and then watch how to do it on Youtube. Simple sutures are not that complex. If the doc assesed the pt and then gave the go ahead for the tech/RN to suture, well there you go. I beleive that RN's should learn how to suture in school. I believe that all RN's should be trained as field medics as well. Why not? If in any small town or big city where a catastrophic situation arises, and hundreds or thousands have to be triaged and treated, then we as a society with the medical knowledge should be ready and capable to handle those situations. Where would one get the practice to be prepared? When one is handling everyday problems.
  6. by   navvet
    Why do RN's sell themselves so short? One needs a professional hand, Bull Malarky !!! If a Doctor can be trained to suture a lip, hip, or hand so can an RN.
    My Father used to say " I can't, never could." It is the skill they don't want RN's to have so the RN can't bill fo the skill !!!
  7. by   GilaRRT
    Quote from navvet
    So what's the problem. One can buy a suture kit on the internet, and then watch how to do it on Youtube. Simple sutures are not that complex. If the doc assesed the pt and then gave the go ahead for the tech/RN to suture, well there you go. I beleive that RN's should learn how to suture in school. I believe that all RN's should be trained as field medics as well. Why not? If in any small town or big city where a catastrophic situation arises, and hundreds or thousands have to be triaged and treated, then we as a society with the medical knowledge should be ready and capable to handle those situations. Where would one get the practice to be prepared? When one is handling everyday problems.
    I think you are missing the point. "Field medic" is not really the role of a nurse. Hence, the fact that nurses spend a significant portion of their education learning to work in "backbone" areas of medicine. You must understand, nursing is a highly diversified field. Therefore, entry level education is focused on the common jobs and tasks required of a nurse.

    Additionally, we can train every RN as a field medic, and these RN's will promptly forget all of this knowledge within a few years of practice because only a few would actually work in such a role. Would you expect an emergency room nurse to perform a comprehensive in-patient psychological assessment and interpret GAS scores on a patient with schitzoaffective disorder?

    In addition, I guarantee you that if such a scenario occurred (doomsday/field medic), our ability to do any meaningful care to critically injured patients would be minimal at best. This is from somebody who has worked in urban and remote areas of the world where the health care system is all but non-existent. If a nurse wishes to learn "remote medicine" there are a multitude of ways to obtain such knowledge after they master the fundamental concepts of nursing.

    You see, we need to focus on the commonly encountered scenarios and do the most good for the most amount of people, not train for a doomsday scenario. In the big picture, suturing is not an important part of our overall job. I simply cannot see wasting precious time teaching nurses to do this when that time could be spent working in the clinical environment as a floor nurse. In my final note, I would like to point out one fact. RN's do learn laceration repair. Most nurse practitioners are taught wound repair techniques as part of their advanced education.
  8. by   ernursen
    Quote from I_LOVE_TRAUMA
    I would only let an NP, PA, or MD suture up my kid. Even though I have closely watched 1000s of people get sutured and could probably do it , (I guess I'll see how good I am soon enough since I'm doing the ACNP now). I even once gave my husband 6 stiches across his eyebrow-there's hardly any scar at all. But when it comes to my kid, I would always want the most highly qualified and experienced person available. I agree that it is probably very varied by state.

    Funny.....the people most qualified and most experienced to suture in my ER are the medics. I would trust them with my life.
  9. by   ayla2004
    Quote from missnurse01

    anyone doing dermabond over dissolvable sutures? i am starting to think that might have been a good fit for my son's toe, as a portion did not take the suture (read it tore through and couldnt be resutured in that spot) and i have had a time trying to get the wound edges decently together for him to not lose a wound edge. i know, it's only the underside of a tiny toe really...
    In ther uk np can suture. whilst a nursing student in the er
    i ahve seen simple lac on a patients finger not sutured but secrued by sterstrips and dermabond and worked really well. the pt was an older adult with tissure papter skin and the lac was skin deep only to suture it would not have held. The rn was ex army nursing services and really knew what he was doing.
  10. by   mmutk
    I would also assume laws vary by state, In TN it is the norm for the MD to do the cleaning and closure, although at busy times I have seen an RN or two do it all. I do believe this is out of their scope of practice though.

    Not sure about your state.
  11. by   mommy2boysaz
    Quote from Vito Andolini
    Maybe the laws vary by state.

    Medics suture in combat. Some places, RN's sew episiotomies, don't they?

    Unlicensed personnel give meds, I guess they can suture, too, with proper training. Not saying I would like it.

    I've never heard of RNs suturing episiotomies! CNMs do, but then they also deliver the baby!

    Just because someone has been "trained" in something doesn't make it within their scope of practice. I'm sure that some RN's could be taught the procedure for initiating and maintaining general anesthesia, but that doesn't mean that it's within their scope, and they certainly shouldn't be doing it! (Nurse Anesthetists aside.)
    Just my opinion.
  12. by   GilaRRT
    Medics do not typically suture in combat. The priorities of care in a combat situation revolve around achieving tactical superiority, extricating the patient from the environment, and hemorrhage control if possible. Even further along the continuum in the Medical Evacuation care phase, suturing is not a priority.
  13. by   ewgrantham
    I found this thread trying to research USA hospital ERs using RNs to suture. I have been charged with this research for my ER. If anyone knows of any EDs employing this practice, please let me know.

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