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Floor nurse to ER nurse. Help please!

Emergency   (7,400 Views 20 Comments)
by BrayaRN BrayaRN (New Member) New Member

BrayaRN has 2 years experience and specializes in Cardiac, NICU, ED.

3,659 Visitors; 78 Posts

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You are reading page 2 of Floor nurse to ER nurse. Help please!. If you want to start from the beginning Go to First Page.

BrnEyedGirl has 18 years experience and specializes in Cardiac, ER.

18,574 Visitors; 1,235 Posts

System seems to be broke don't ya think?

It is,..not sure how to fix it.

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MassED has 15 years experience as a BSN and specializes in ER.

1 Article; 20,154 Visitors; 2,636 Posts

System seems to be broke don't ya think?

It is,..not sure how to fix it.

less patients?

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BrnEyedGirl has 18 years experience and specializes in Cardiac, ER.

18,574 Visitors; 1,235 Posts

It is,..not sure how to fix it.

less patients?

If we could only figure out a way to see only the emergencies!!

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BrayaRN has 2 years experience and specializes in Cardiac, NICU, ED.

3,659 Visitors; 78 Posts

Thank you everyone for your constructive feedback.

To clarify:

I certainly am seeing my patients more than every 4 hours, or 2 for the Level IIs. In fact, like I previously posted, sometimes I spend to much time. My initial assessment is always on time and the most thorough. Everytime I enter a room, I am reassessing just not necessarily charting at the time. My problem is being late with the charting, even though the assessing was certainly occurring on time.

I have yet to understand why there needs to be people who lay into you especially for an innocent post. I do not post frequently on this site. However, when I do it is always where I feel I have knowledge that would be especially beneficial. I answer the question that is asked to the best of my ability. I have never entered on in a post to belittle somebody or start some kind of war of words. I believe my initial post was asking about improving my skills in the ER. I would assume that posts that would follow would answer that initial question. Sure I could get on my high-horse and judge somebody not asking for it just to "improve" my self-esteem and to create some drama. Thankfully, I have better things to do than hide behind a computer screen and make negative comments about people who actually exist behind these screens and come here for advice.

I would ask:

A physician is able to determine the patient is faking a seizure in front of him. However, I am to believe it, because heck it's the right thing to do. How about the fact that the patient was in fact being treated as a seizure patient until the physician determined otherwise.

A gentleman comes in with a sore wrist. The physician orders some ice and an x-ray. The x-ray shows nothing. Computer records, however, show that this patient has travelled to at least 8 other ERs in the vicinity in the last month with the same complaint. During this month he has received Lortab prescriptions on nearly every visit. Sometimes filling a bottle of 6 one night and going back to fill another bottle of 20 the next night. So clearly this patient is not faking pain, this time it is true, and I had better advocate for this patient to make sure that he has another 20 Lortabs to hold him over in case he already used up his other 100?

How about the patient faking somnolence? Hmmm.... nothing is found in the blood work and she is stable to go home. She will not wake up. Then ammonia is held under her nose by my preceptor. Not only does she wake up, but she walks out the door and even apologizes on her way out.

:uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3:

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BrnEyedGirl has 18 years experience and specializes in Cardiac, ER.

18,574 Visitors; 1,235 Posts

Braya,...you will notice on this site that there are many folks who haven't been in your shoes,.have never been in a position to see the same pt over and over for c/o that never have a diagnosis. People who think we as ER nurses are exaggerating when we say Mr Jones has been in our ER 65 times over the last 6 months. He is always c/o of some form of pain, we do the million dollar work up, treat his pain while he's in the ER and send him home with a RX for Lortab, and he walks out of the ER, leaves with friends talking about hightailing it to the nearest Waffle House because "they were trying to starve me to death in here!"

After 40 of those visits, Mr Jones phones the ER to explain how he lost his RX, can I call it in for him,..or someone broke into his apartment and stole his meds,.can I call it in for him,..or the pharmacy calls to inform us that Mr Jones just picked up 20 Lortab the night before, do we want them to fill the RX?

There are many on this site that have never been in the position to try to be at least civil to Mr Jones only to have him swear at you, and spit in your face.

I agree with you,.it is very frustrating to have people like that suck all your time and energy when you have 3 other pts that are really sick and need you.

I am not above telling Mr Jones,.."look,.you've been here enough, you know the routine,..it takes hours to get back all the labs, Xrays, CT's etc. I have other pts to take care of,..sick pts that might just die right here, tonight in my ER if I don't help them. Please be patient with me,..you'll get what you came for,...just not this second." Some of my frequent flyers will chill a bit and I might get 30 min of peace,...others I just call security and have them deal with it.

There will be those on this site that call me cold, and a bad nurse. How do I know Mr Jones isn't really sick/injured etc? I fully expect Mr Jones to show up one night with an actual emergency,...his lifestyle puts him at a very high risk. I also believe that when he does show up with a real emergency I will know it. I have been educated and trained and am quite good at my job and when that chest pain is the big MI I will recognize it and treat it accordingly!

Unless you've walked a mile in my shoes,.....please don't assume I don't know how to do my job. It is vital that I can tell the difference between someone who is sick and someone who isn't. It is my job to triage and treat those who are really sick first,...that's what I was trained to do and what I get paid to do. I have a license, and a family to think about,...would I really blow off a pt that is truly ill just because he's a pain in the butt? Of course not! But it is my responsibility to care for all of my pts and since I can't be at 4 places at once I have to be sharp enough to recognize a true emergency when I see one!

Hang in there girl,...you'll figure out a way to do this. Sometimes people will be angry,....but imagine how angry folks would be if you allowed there child/grandmother/wife to die while you were busy with Mr Jones who again left with a diagnosis of "drug seeking behavior".

Edited by BrnEyedGirl

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WonderRN has 5 years experience and specializes in ED.

3,855 Visitors; 91 Posts

How do you know anyone is "faking" anything? Especially pain? While patients may not always manifest pain the same way I'd be hard pressed to know someone if definitely faking it. Also I hope by back dating you don't mean that you are charting your assessment done two hours late as being done on time...

Not constructive or helpful, really.

You've never had a patient that moaned and groaned when she saw you in her line of site, but was then talking, laughing on the phone, ambulating around the room without difficulty the next minute, when she thought no one was looking?

Seriously.

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sixpack7us has 16 years experience and specializes in cardiac, ER, Peds, Med surg, ICU, CCU.

532 Visitors; 5 Posts

I write everything down in my own shorthand.

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MassED has 15 years experience as a BSN and specializes in ER.

1 Article; 20,154 Visitors; 2,636 Posts

thank you everyone for your constructive feedback.

to clarify:

i certainly am seeing my patients more than every 4 hours, or 2 for the level iis. in fact, like i previously posted, sometimes i spend to much time. my initial assessment is always on time and the most thorough. everytime i enter a room, i am reassessing just not necessarily charting at the time. my problem is being late with the charting, even though the assessing was certainly occurring on time.

i think most of us have to edit our times of our assessments because we're in the middle of something else to take time to document. it's the nature of er nursing! are you computerized? do you have computers in patient rooms? you might try to document then, even a brief note, and go back and edit if you need to add anything after the fact.

i have yet to understand why there needs to be people who lay into you especially for an innocent post. i do not post frequently on this site. however, when i do it is always where i feel i have knowledge that would be especially beneficial. i answer the question that is asked to the best of my ability. i have never entered on in a post to belittle somebody or start some kind of war of words. i believe my initial post was asking about improving my skills in the er. i would assume that posts that would follow would answer that initial question. sure i could get on my high-horse and judge somebody not asking for it just to "improve" my self-esteem and to create some drama. thankfully, i have better things to do than hide behind a computer screen and make negative comments about people who actually exist behind these screens and come here for advice.

hallelujah! you said it! there are more than a few people who love to get on their high horse and post things to prove (maybe to themselves) how relevant (and super nurses) they are.... don't let it get you down. your post was great. :yeah:

i would ask:

a physician is able to determine the patient is faking a seizure in front of him. however, i am to believe it, because heck it's the right thing to do. how about the fact that the patient was in fact being treated as a seizure patient until the physician determined otherwise.

a gentleman comes in with a sore wrist. the physician orders some ice and an x-ray. the x-ray shows nothing. computer records, however, show that this patient has travelled to at least 8 other ers in the vicinity in the last month with the same complaint. during this month he has received lortab prescriptions on nearly every visit. sometimes filling a bottle of 6 one night and going back to fill another bottle of 20 the next night. so clearly this patient is not faking pain, this time it is true, and i had better advocate for this patient to make sure that he has another 20 lortabs to hold him over in case he already used up his other 100?

how about the patient faking somnolence? hmmm.... nothing is found in the blood work and she is stable to go home. she will not wake up. then ammonia is held under her nose by my preceptor. not only does she wake up, but she walks out the door and even apologizes on her way out.

:uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3::uhoh3:

again, most of us that work in the ed (or have long enough to have experienced these types of patients) know that you are correct.

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