dewp_63

"When I took my PALS class it was taught by the PICU nurses and when I went in for my megacode the instructor said, "OK Mrs. ER nurse lets see how you deal with this one." He made me run the megacode for at least 35-40 minutes and tried everything in his power to stump me, and didn't stop until he did." I'm sorry that you had this experience. I remember from the old days of ACLS having this same problem when I was an ICU nurse. PALS/ACLS/NRP is geared to be a learning experience, with de-emphasis on the 'testing' of the skills learned. Please say something to the coordinator for the program about this instructor - they need remedial education in adult learning concepts...Keep you chin up and glorify that you are in an area of the hospital that has to keep up to date in EVERYTHING - ICU hold + 3 other patients, NO PROBLEM. (Ask an ICU nurse to do what we do and they would crumple...:chuckle

I work in an emergency department that recently went to a department specific uniform policy. Our team members wear navy blue scrubs - you may wear a white shirt under a navy lab jacket or a navy top under a white jacket. We can wear hospital t-shirts on Fridays. I like it, because it helps reinforce the "team effect". You don't join a bowling team, and say "I want to wear my own uniform" or get on a NFL team and say "well, I just don't feel like wearing that uniform". The navy colored theme is much more professional looking than some of the "scrubs" that some of the staff showed up in! :smackingf We don't have to wear a specific shoe (we can wear any color shoes we want), and most of us show our individuality in the funky socks we wear. The hospital recently addressed the issue of different color scrubs for different disciplines - but it got shot down, partially because we had just bought scrubs for OUR department! The current plan is to have color coded name tags for the different disciplines... guess the patient will have to have a decoder to find out who's who.....

It's amazing when you start looking at the pH of many of the drugs we routinely give. Morphine has a pH of around 4.0, if I remember right. I have had several patients c/o pain with Toradol IV - I now routinely dilute EVERYTHING in at least 10 cc NS, and patients have told me they can tell the difference... I agree that Phenergan would be my last choice for nausea, but it's very hard to change the doc's practice! Phenergan + order for po contrast for CT abdomen to r/o appy = very frustrated nurse!!!

I work in a 26 bed ER - 11 ER beds, 10 fast-track/clinic beds and 5 hold beds. We use Canadian Triage Assessment system (5 levels) for determining urgency and frequency of re-evaluation. We have really nice posters in triage with common complaints and their level of acuity. Ambulance patients are placed in a bed, if there is an empty one. Rarely are ambulance patients sent to waiting room and triage unless there are no empty beds, with no hope in sight for one clearing. That was common practice in our old ER - nurses said "don't reward the frequent fliers who abuse the ambulance system by making them think ambulance = automatic bed", but I noticed that this punitive system didn't slow them down - just made them (and us) adversaries... Hope this helps!

Our hospital uses a "short form" registration, allowing labels and face sheets to be quickly generated and available before pt is triaged. This does not include financial info unless the patient has been to hospital before and the info is already in the computer system. Pt's that come in by EMS are short-formed at the bedside (or at a registration desk in our main ER), with family members providing info when they are available. This does not delay screening by the medical practitioner, and allows us to start protocols when we have to send a patient back to the waiting room. Our policy is that if there is an empty bed, we will fill it - but sometimes we have to kick patients to chairs etc if an ambulance is on the way. We have 11 ER beds, 10 fast track beds and see >3000 month with a very low LWBS rate (~2%). All of our rooms have a computer, but we also have a computer on a rolling stand that they can use (we have a brand new ER, and corporate gave us all the bells and whistles - all beds have TV's, computers and all private rooms!) Hope this helps! :balloons:

techs are invaluable in our triage in assisting with vital signs, getting ekg's on chest pain patients (all get an ekg in triage - regardless of the bed status in the department) and in taking patients back to rooms. they do not elicit information regarding chief complaint or ever level a patient! :uhoh21: only rn's in our department can "triage" a patient (although a lvn can take report from ems/ambulance patients who are placed immediately in a room - they don't have to decide who will be brought back first). we have had a couple techs who wanted to do triage, started to ask the questions, and had to be reined in very quickly! these techs tended to also be the ones who didn't want to splint, ambulate or clean up patients - preferred to start iv's, ask about pain level, etc (nurse wanna-be stuff). i think techs are great, can make my job easier if they know their role - but can make my life difficult when they keep trying to do my job.....

We have had TV's at most of our bedsides for about a year now - when we move into our new ED, all the beds will have TV's (including the 10 fast-track beds). Noise has rarely been a problem, and visitors at the bedside has really not been an issue (not enough room at bedside! :chuckle ) Our patient complaints to administration have drastically decreased, patients aren't on their call light "can I have more pain med, water, time and attention...etc). Only once has it been an issue, and one little kid wanted to stay until the end of the program on NICK - told mom "we don't have cable at home! " Just had to laugh. Look at it as an opportunity to decrease the patients anxiety and stress, which in turn rolls downhill - less for you! :balloons:

Thanks for all your wonderful information. :) The prevailing thought seems to be that it is the neuro docs who are initiating (and thereby taking on the legal liability). Like I said, we can't get neuro here to do burr holes on young ICH patients, so I'm sure that we won't get a lot of response for CVA's. I'm not against the idea, I'm just hesitant without full back up (our ICU's are "medical" and "Surgical" - medical takes care of the usual ventilated long-term patients, and SICU is used primarily for our CABG patients. Because we have a interventional cath lab, we rarely give tPA to our MI patients, either!

Thanks for all your feedback. I don't doubt that the therapy can be advantageous for some patient groups, but we don't have a neurology floor in our hospital, and neuro coverage can be scanty. We have problems getting neuro docs to come to the ER to evaluate our documented ICB's, let alone a stroke patient. My experience with CVA patients when I worked ICU was that we pretty much just watched for any progression...hourly neuro checks, etc. Anyone doing q15 min neuro check outside of a stroke center? Anyone having the nurses do the NIH stroke scale??? It seems to me that it is a good idea to know what's on the scale, but that is the MD's responsibility.

We've been discussing the use of tPA in the ED for acute non-hemorrhagic stroke patients. I know that ACLS teaches this algorithm, but our MD's are hesitant to institute. Some of their hesitancy in the fact that the local neuro docs don't like it. I know this is happening in some of the "stroke centers" in the nation, but I haven't found a nurse in our area who has participated in this... I practice in a large urban area, with a medical center/med school/nursing school etc. in the same city. Just needed to know if this is just something the very elite do, or if it is something I should expect to see soon.

I have recently moved to the ER after 10 years of ICU work. I just finally burned out... The major difference I see in ER work is the variety, as others have pointed out. I finally came to realize that there are only so many ways to take care of a vent (or CHF, or MI, or GI bleed), and that much of what you do in ICU is just fill in the blanks. I became most frustrated with hourly UOP and VS that have been stable and normal for days on end. The charting in ICU is usually voluminous - and no one ever even looks at what you have written/typed. I sound bitter - BUT I feel that I could not function in the ER without the base I learned on the floors and ICU. My assessment skills were honed in the ICU's, as I could see a single patient (or two) over a longer period of time and compare assessments. In the ER, you see them for such a short time, and then they go home or go to the floor/unit/morgue. The assessment and problem solving skills I learned in the ICU makes it easier for me to anticipate the MD/PA's priorities, the patient needs and the ways to get the best outcomes in a timely manner. so, I guess the bottom line is : go where your heart tells you. ER is fun, but you have little continuity of care (unless they're "repeat offenders" as we call them). ICU is a major challenge and you WILL learn!!! Good luck!

our hospital is small also, and we have 24 hour pharmacy coverage only m-f. but - we do not keep kcl for infusion on the floors!!!!!!!!!! if we need an iv with k, we call the supervisor, who gets the bottle from pharmacy, watches us draw our dose (double check, there) and then the bottle either gets put in the sharps container or remainder squirted down the sink . . . if i find kcl in the med room, i throw it out ... once worked with a nurse who almost gave 4 cc kcl (40 meq) instead of 4cc lasix - the bottles don't even look anything alike!!!! we need to protect our patients from the others who are not as concientious as we are (just joking - we can all make mistakes! but this one is sure to kill - might as well give the patient a paralytic without a vent!)

Thank you so much for your reply, Jena. Hopefully, I can take this information back to the unit, where maybe we'll be able to write an appropriate policy addressing this.

I'm looking for information about standards ralated to manual wedging of PA caths and frequency of such. We are having a "war in our facility about frequency of wedging in absence of direct MD order. Some of the nurses feel that the PAWP should be obtained every 4 hours, while others of us seem to remember reading that PA cath balloons have a limited number of "safe" inflations, and that obtaining a PAWP is an invasive procedure. Our facilities policies and procedures are very vague, referring to a Manual of Nursing Practice (published) that we don't even have a copy of. I am concerned, especially as I work the night shift and we are often not using these numbers to direct treatment, we are just "filling in the blanks". Any feedback will be greatly appreciated!