rjflyn 6,851 Views
Joined: Apr 10, '04;
Posts: 1,320 (15% Liked)
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Most are looking for a certain personality type but anyone can BS at test. What you can't is a first impression. Can tell if someone is going to fit you mix with in the first 5 mins or not. The questions you ask are just because you have to.
But doesnt ACLS also say a pt with chest pain and a heart rate in excess of 150 is by definition unstable and waiting around for a hour and a half for a test probably isn't the greatest course either. I for one want to know what the cardiologist he talked to said.
Am I clear. Everyone in the ED will hate you. My last place had Plusechek and its great noiw I'm at a place that has Cerners First net and its slow and bulky.
I dont know how much work up "ankle pain" requires. At my facility thats a complaint that typically if its during the hours its open goes through our express care area, if not its treated as such and they are in and out as fast as they can be seen and x-rayed if required. I we have one an its needed they get a bus pass and sent on their way, we provide them with the hotline number for shelter placement if they request it.
The standard of care for PCI is 90 mins. Though if there is no in house cath lab, then the standard is thrombolytics within 60 mins of arrival. I even know of some EMS systems that carry Retavase as they have transport times that cant exceed an hour and time is muscle.
May have given you Morphine because if that ED was like mine they may have not had any IV Toradol to give. We have be without for the last couple months. When we do have it pharmacy has be limiting it to 15mg and then only one time dosages and admitted NPO patients.
As far as skipping the CT, its not unusual as it sounds for persons with known history. No use dosing with radiation if there are no signs of obstruction. Though renal labs general help back up this decision.
Well, thats quite a conundrum. From a supervisory stand point most of the problems a department has is due to attendance. HR erred by even letting your file get to the interview stage, so now they are kind of stuck. What I would personally do, would be to allow you to come onboard with the condition that you not miss any days of work for set period of time, maybe in excess of the standard attendance policy. Now I would be reasonable, if you were somehow were to be injured or exposed on the job that would be the one exception. Once you have shown that the past discretion is not likely to repeat, I would treat you like any other staff, as a valued member of the team.
Generally 2G hour on pump is the limit unless its 1) OB for pregnancy induced hypertension/ and its complications, 2) asthma. On Zosyn our facility too has gone to the hour time frame save for the ED we still do 30 minutes because ED doctors generally order more than one antibiotic. To meet the standard, for example in the case of pneumonia all the antibiotics have to be given and if there is a miss you miss the indicator and we are not going to keep a pt in the ED an extra 4 hours just to start a second med, as the floors have a tendency to miss them for us.
Well since i work as a supervisor and deal with complaints. I give my two cents. When I get a pt who complains that " the doctor didn't give me anything for pain". But then I check the chart and more often than not there is clearly Tylenol or Motrin ordered, I generally explain to them that these are in fact pain medications and that it appears from the documentation that you have refused them. I further go on to state that the ED physician's are independent practitioners and I cannot tell them how to practice medicine. I generally go on to explain that if they have a license and privileges at my hospital I will be more than glad to get them anything they want.
But as it is I think we are finally actually treating pts pain
Though we do work in the ED and on occasion a person will be unconscious, unresponsive, have massive blood loss and they will get O negative. At the time we had no idea as to what their religious preferences were. It is something that we all have as emergency nurses have to reconcile.
Kind of thin as far as suicidal goes. Though most doctors and facilities wouldnt let a patient whom has received narcotics leave that soon after receiving them though there are exceptions. Personally I know the kind, the providers I work with would let them go without a second thought, as we have too many patients who actually want to be taken care of. I myself also am not going to beg someone to stay, I just make sure they are making an informed, competent decision.
I can say its about universal everyone has a STEMI box. Paperwork, we catch up later- ours is computerized as is the orders. Consent is the MDs to get, if the need a witness the are required to ask us for it. As for all the stuff we do to the patient himself- thats streamlined too- lines 2 IV's generally, Nitro drip, hardly ever because "we just stop it as soon as we get them in the lab", same goes for the heparin drip so we just give the bolus. ASA, Plavix or Effiuient and Morphine is about all thats left along with O2- the EKG was done at triage though sometimes we have the machine attached and are doing serial.
What the OP describes would be something that would fall under my facilities fitness for duty policy. She describe abnormal behavior that if I as a supervisor would have observed I would have most likely needed a UDS- of with the policy requires to be observed. That said like a prior commenter has noted pts coming to the ED with mental heath complaints get a drug screen, though in my experience these are never collected observed. There reasoning for the negative could be as simple as the med not being take frequently enough to keep a level to be detected- it happens. That said the only drug screens commonly observed are federal ones for truck drivers post accident.
I don't believe new grads belong in any speciality. It may be an unpopular belief, but that is how I feel. It takes at least a year to learn how to be a nurse after graduation. Nursing school teaches only the basics, life teaches you the more valuable lessons, such as critical thinking, prioritization and time management. It is difficult to learn how to be a nurse and learn a speciality at the same time. I think a year or two on a med/surg floor is a great way to learn these skills. Once you have learned how to be a nurse, then move on to the ED or whatever speciality you choose. I say all this with experience. Following graduation, I went to L&D. I had a hard time learning both how to be a nurse, and all the nuances of L&D. I then moved to a med/surg floor and honed my skills in prioritization, time management and critical thinking. I am now in the ED after 16 years of other experience and I love every minute of it. But it still took me some time to learn the ways of the ED. After 2 years there, I can honestly say I finally got the hang of it, but still have much to learn. So my advice, is go work med/surg for awhile, then come back down.
I wanna work where you can afford/have cab vouchers, I as the supervisor would spend my whole night writing them.
Having said that there is even liability in putting someone in a cab after narcs. Whats to say once said cab leaves the guy just doesn't get out around the corner. A bus is no better option- he could get hit as he steps off. Worse is " oh I just withhold narcs if they dont have a ride", is that policy or is that you now practicing without a license.
The best option is a comprehensive policy that allows for prompt care, puts the decision in the hands of the practitioner and gives you an options if the patient breaks the rules. When in doubt, ask the provider, your charge person and goodness talk to your patients.
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