CTFD_RN

No.

Let it go. Not worth bringing it up to your manager and it would make you seem unadaptable.

Our standard foley is not latex free but does have nitrile gloves. We have to order a latex-free catheter and switch it.

10 pts is INSANE. I don’t have anything to offer on how to manage that many. Just do the best you can. The ER is really task-oriented. The more you see, do and hear about the more you understand and can anticipate. Good luck!

An example of a 3V would be flu like symptoms, NV, pelvic pain, UTI symptoms in a generally healthy adult ect. A 3H would be ABD pain, generalized weakness in elderly without CP, cellulitis with failed outpatient treatment ect. Stuff that would generally require/receive an admission for further testing or monitoring.

This is what I am talking about. We have some providers that order a head CT, IV fluids and IV meds (migraine cocktail) for every HA pt. Management seems to think it is a nursing problem when it is more complex than that. They keep trying different "systems" in order to speed up the process with no real results. Their current 'solution' is to have a zone for these pts whereas the pt is pulled to a room, triaged (if needed, we also triage up front), provider sees, orders in, orders and meds carried out and then pt back to lobby to await results. It sounds do-able but it is often not the case. Pts are coming back 3, 4, 5+ at a time and we (providers and nursing) can't keep up the flow. Or they are more complex than their CC made it seem. Or not appropriate to send back to lobby ect ect. Next thing you know we have 1/2 the zone filled/clogged. It just feels like an assembly line. Do other places do it this way too?

I am asking what process you use to get these type of pts seen and dispo’ed. Our current process leaves them in the lobby for a long time and/or they take up rooms for longer than our goal time.

We get a lot of ESI level 3 pts at my ER. We splint into 3Hs (for likely admits) and 3Vs (for treat & street). We have a FastTrack for level 4s&5s but our level 3s are clogging up the ER. What system does your ER use to see these pts? We keep trying new ways to get these pts seen quickly but nothing seems to be the solution. We are a 80 bed Level 1 Trauma ER.

Ditto to all of the above. The only time I use paper is either for an SBAR printed on my admitted pts that I use to stay organized on admitting orders or the paper towel I write VS on in my pts room so I don't have to log on to the computer.

TN doesn't pay well, at all. $19/hr is spot on. I don't think KY does either unless you work at a rural hospital.

We are assigned 4 rooms and if it gets bad then we also have a hall pt. Ideally we would be 3:1. We have a flow system where we "pull to full" and then start triaging and protocoling out of the lobby.

Handoff to the next shift should be pretty easy. There are 3 basic things I want to know: 1) Are they with it (A&Ox3?) ? 2) Can they walk? 3) Do they have an IV and does it work (draws blood)? Those are my top 3 things for standard ER pts anything else is just the cherry on top ?. If they are admitted and are bed holds then a little more info is nice but I can also print off the H&P and read that. An example would be like "Room 1 is standard CPer. He's alert, can walk, has an 18g that works great, vitals have been stable the 2nd trop is due at 1300." You don't need to tell me about his bowel sounds or if he and a T&A at age 5. There are your co-workwers! You should not feel uncomfortable giving report.