HiddencatBSN

I work in the ED and we override ALL the time because we need the med before pharmacy can profile it. Usually by the time I get to a room it’s been profiled and I can scan it but especially for stuff that’s very urgent it might not be. Overrides are blocked on non-emergency meds but not on emergency meds so there’s a built in allowance for the overrides to happen given the way patient care works in the ED.

I just read about this and headed right on over here to talk about it. It sounds like the hospital, faced with losing money, threw her under the bus. How many patients did she have? How many shifts in a row had she worked? Was she on her regular unit? Was she properly trained? How was the vecuronium labeled? What distractions did she face while getting the medication, and do they profile meds to patients there (so you’re selecting from a med-list and not all available meds)? If the hospital was in danger of losing Medicaid money over this why is the nurse taking all the blame legally? Did she have a pattern of risky practice or negligence?

I just tell them with a smile that they are not the boss of me. But I’ve been pretty lucky that most of the physicians I’ve worked with respect the relationship as a collaborative one.

Nurses switch specialties all the time. What does your cover letter look like? How are you networking? Some employers will want someone already having the specific experience for their unit but many will be open to training the right person and that will be 100% the attitude you project. If you share with us the details on how you are presenting yourself (like specifically what phrases are you using, how do you introduce yourself, what’s your “pitch”, etc) I think we can probably help you adjust and identify ways to be more successful.

Having a psych background is a huge asset in the ED as it’s the point of entry for many Acute psych patients and the deescalation skills are helpful with the ones who have an underlying psych condition as well as patients and family who are just plain assholes. Are you open to looking outside of California? I know my current hospital is fine with skills training nurses to the ed and would lurve a psych background and I know they’re not alone. I think some self reflection is important too tho. You do not have to love your job and it doesn’t have to be your identity, but you might be projecting a ton of negativity in interviews and networking that are hindering you rather than a general disinterest in nurses with psych backgrounds. How do you present your interest in the job? How do you discuss your reasons for wanting to leave your current one? You shouldn’t lie but there are ways to present things in a way that is positive and excited about the new opportunity while being reflective about the current one not being the right fit. And I love therapy, wish I had time right now for it. I think going to therapy can be suggested in a way that is ableist and intentionally judgmental, but it really is a present to yourself to do that kind of self care.

Ooof, a nurse who claims to never have made an error or mistake makes me really worried because they're either not aware of their errors or they're hiding them. No way have 54% of nurses never made an error.

When leaving a job, I've always made a point to go in person and verbally give notice and then hand a letter with the same information (statement that I am giving notice, last day I will work, and a thank you for the opportunity provided). But it seems like a benefit to giving notice by email is that I can ultimately give a couple days longer notice, copy all supervisors directly instead of picking one to start with, and avoid being present for their initial reaction. So what do you all do and why?

Or if you are taking care of peds in a no-peds specific unit, they're going to order a 100ml bag. Most pumps I've used allow tenths of an ml for volume but not rate.

Our main reason for switching to high flow is for the PEEP. So we'll often do it for a patient satting well on the regular nasal cannula but still having respiratory distress. So sometimes they end up getting less oxygen but more pressure through the cannula than from the regular nasal cannula.I've had patients effectively on room air but on the high flow set up to give them just a little boost of pressure when they don't quite need CPAP.

You'll probably see fewer male nurses in pediatrics compared to other specialties but not so few that it's surprising to see them. And honestly in my experience it's actually pretty similar to the overall percentage of nurses who are men if not higher. Most of my coworkers, even the female ones, wouldn't be able to help with a difficult latch regardless, and the main time I've seen a patient request a same-gender nurse is if there's going to be a GU exam (usually they're more concerned about the provider's gender) or EKGs on a teen girl, and usually a female PCA or nurse can step in briefly to do that if the patient is uncomfortable.

Yeahhhhhh as a peds ED nurse I get a lot of parents assuming their kid is the sickest and them being angry it's taking so long to see them. Once I had a parent start yelling about how "someone" could be dying while we take forever to see them and I told them that we see the dying people right away which is why he is waiting. But the parents and the Hot Dog Disney junior song are totally prices worth paying to work in pediatrics.

Adding that for pediatrics you need to internalize the DOSE ORDERED / AMOUNT ON HAND x QUANTITY formula. So for children's Tylenol, if you need to give 250mg, that would be 250mg / 160mg * 5ml = 7.8 ml.

I've never seen multi-use bottles anyway, so the excess is waste regardless. I think I always empty my first vial because if I take 50% of the dose from each that's one more calculation that isn't necessary when you're visually just getting to whatever the calculated ml are.

Every place I've worked with has a calculated medication code book at the code cart, so you open the book to the patient's weight and the emergency meds are calculated by dose and by the ml you draw up based on the concentration we stock in the cart. I've seen it be pretty standard to post code meds above the patient's bed- this is usually calculated with every patient weight by the RN taking care of the patient and double checked by a second RN. I'm pretty sure code books are delegated tasks but then checked by pharmacy (I think at one place the unit educator compiled the book with pharmacy, at my current place I believe it was the hospital's medication safety committee and then checked by pharmacy.

is when they tell you "oh, the job doesn't specify that they cohort pediatric patients in a particular section in the ED, but it requires PALS so there MUST be a lot of pediatrics." This is at an adult hospital in a city with 2 children's hospitals and 3 children's emergency departments.