medteleER

this is what bothers me. my rationale was "it's ONLY 1 mg". i've been in similar situations with schedule acetaminophen and prn norco, antibiotics being scheduled incorrectly by pharmacy (receiving a q8, q12, or qday dose too early because patient was a direct admission and received whatever it may be already at other facility), and meds that are synergists of each other, ie; the "seeker" type patients. and i was able intervene. can anybody else answer below? i need to keep myself out of trouble. any assistance is appreciate it. please and thanks.

i'm not sure if there were adverse effects, but according to allnurses.com there might have been or was. believe it or not, the patient dropped off a daisy award nomination for me.

and i'd add some dilaudid for pain and benadryl for the itch. lol. believe it or not we have patients here that receive all of that. maybe it's just where i'm working. anyway. thanks everybody for the posts.

how exactly would you approach this? i am asking, not being contentious. we care of patients like these frequently, with "patient advocates" who somehow manipulate (maybe that isn't the correct word) the MDs into prescribing meds like dilaudid, benedryl, trazodone, xanax, ativan, librium, phenergan, seroquel, gabapentin, amitriptyline, restoril in 1 sitting. most are scheduled and cleverly labeled PRN. i once questioned some orders being "not safe" and was grilled by the an MD and charge nurse. roughly, "if the vitals are stable, you have no reason to deny a patient their medication." even if i spread medication out an hour apart, some do not metabolize out in an 1 hour. and i'll get terminated for time management issues. any ideas?

all i wanted to do was help my patient sleep and not wig out. the patient told me "the MD ordered 1mg of xanax for me", but the orders didn't reflect this. so i took their word for it and got creative. i figured 0.5mg+0.5mg = 1mg, so let's try that. since 1 was for sleep, and 1 was for anxiety, it would be OK, i thought. i did take into consideration 1mg of xanax isn't going to kill the person. but now i'm not so sure. i actually feel bad about this.

The oncoming shift charge nurse got on me about "double dosing" a patient. MD had (2) specific orders PRN: 1) xanax 0.5 mg for sleep 2) xanax 0.5 mg q8h for anxiety I gave BOTH of them because the patient claimed being anxious and wanted something to sleep. My charge nurse pulled me to the side afterward and stated she was going to write it up. The patient was VSS in the morning. I'm not sure how I should be feeling about this.

it IS NOT the policy to spend time on the tele unit, prior to transferring to the ER. though it IS POLICY that I have to spend 6 months there if I do transfer... meaning I will be stuck there for 6 months. I am going to make contact with the managers as soon as I can. I would definitely want to shadow somebody in the ED, if I can.

Thanks in advance for reading. Just wondering if this is a good idea. I’ve made some posts regarding transferring to the emergency room, but my educator said it is necessary I spend some time on the telemetry unit prior. I am a med/surg nurse with 5 years under my belt. The nursing supervisor said I DO NOT have to do this and recommend I request to be floated there (telemetry) while I stay in med/surg. And I believe she also said, I could even request to be floated to the emergency overflow, occasionally (if I had all the certifications) So…. Should I transfer to the telemetry unit and stay for 6 months (policy) before going into the ER? If there isn't a position, it might take longer than 6 months. Or... do what my supervisor says about this floating to telemetry and ED overflow? I only feel like I can jump straight into the ER because they do hire new graduates. But I also want to be completely prepared (tele experience) before I do.

she is the educator for the ENTIRE hospital. there are a number of them, but they are not department specific. my ACLS is expired. i need to renew. and i can take a basic dysrhythmia course whenever. somebody in the ER told me she started out as a new grad there. i'm not sure what "telemetry unit skills" i would need in the emergency room that i cannot learn on the fly... that is why i'm asking here. if it is necessary to work on a telemetry unit before hand. worse case scenario, i will do a year on the tele unit and then transfer.

been a med/surg nurse for about 5 years. i wanted to get into my critical care (ER) department. my nurse educator told me it would be necessary to get some telemetry experience before i transition. i'm not sure if that is just hospital specific because i know new graduates jump right in there. n i work at a level 3 facility. i want to be as prepared as possible, so i wouldn't mind... but i am hating the floor, right now.

Not sure if this is going to make any sense, but the ICU is where I (being a med/surg nurse) transfers/transferred all of my patients requiring a higher level of care...other than the telemetry. Sometimes, I want to be the receiving end of that. Personal growth.

not a new grad, but helpful thread for me possibly transitioning to the ER

well, i been a medical/surgical nurse for about 5 years now... looking for a change. my volunteer experience in the emergency room brought me into the nursing field, so i want to spend the rest of my years there... or maybe the ICU. but moreso the ER. what do i do next? move to the telemetry unit? go straight into ER? what classes do i/should i take? i'm not too great with IV starts. the place is a level 3 trauma. any advice is appreciated. thanks all~!