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ER charge nurse

dewp_63's Latest Activity

  1. dewp_63

    ER Nurses Treated Different in my Hospital!

    "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
  2. dewp_63

    Nursing Uniform Policy

    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.....
  3. dewp_63

    IV Phenergan and Toradol "Push"

    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!!!
  4. dewp_63

    Triage protocols. what does your ER use?

    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!
  5. dewp_63

    EMTALA and pt registration

    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:
  6. dewp_63

    Techs Triaging

    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.....
  7. dewp_63

    TV in the ED

    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:
  8. 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!
  9. 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.
  10. 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.
  11. dewp_63

    triage reassessment

    I work in a suburban hospital ER - we have 10 beds, 3 fast track beds and 2 hallway beds (just don't tell jchao!). We see 70-90 patients a day. Our nurse manager wants us to retriage/touch base with all patients in the waiting room every hour. We have 1 triage nurse (at least until 11pm - then everyone catches triages), and often you cannot get out of triage to get an ice bag without having 4 more patients lined up to triage! The NM not only wants us to go out to the waiting room, but she expects us to write a note on every chart... Our usual staffing pattern is: 1 MD, 3 RN's from 7p-7a (I work nights - not sure about day staffing), 1 RN 11a-11p, and we're supposed to have an LVN/LPN 5p-3:30a (don't have enough hired, so we often have to do without! ) Our fast track is open noon to midnight, so we have a PA during those hours. We are strongly discouraged from going on diversion to EMS- even when there are NO BEDS in the hospital (which seems to be the case more and more!) The NM thinks this will help with patient satisfaction and decrease our number of "left without being seen" patients. I know when I'm in triage, there just isn't time. When I'm on the floor - I'm doing good to keep up with my patients! HELP! Anyone have any suggestions to facilitate this? By the way - we get a new nurse manager next month - maybe she'll be more realistic. Our current manager is responsible for 2 ED's in two different hospitals 15 miles apart - we never see her except for staff meeting...
  12. dewp_63

    ER Care or lack of

    Sorry to hear about your tough night. I work in a small (10-15 bed, depending on who you ask) ER, and understand your frustration. A lot of what goes on after you get to a bed is dependent on how the MD works. We have some that will order all kinds of labs, IV's and meds before seeing the patient, and others who want to work through each patient at a time, and gets very upset if we try to get him to multi-task. The nurses' confidence and working relationship with the MD's will also affect your stay. I feel comfortable with some of the docs to ask for appropriate treatment (IV, labs, meds, etc), while others are not so receptive... Although I hate for anyone to get a complaint letter, I know that I'm more on my toes after someone complains - so I suggest letting someone in administration (either ER or hosp) know. Please be sure and send compliments (if any) and not just complaints... It's hard to be any nurse these days, with lowered staff/patient ratios and sicker patients. We are the only area in the hospital who cannot stop patients from coming in - and many of the ones who consume the most time are people who abuse the ER for minor/clinic complaints... Guess the bottom line is: 1.) please let someone know. Maybe it's the doc and not the nurses.... 2.)remember nurses are human too...
  13. I've worked nights most of my nursing career - always by choice! I love the people who work nights, and my body just won't function at 6:45 in the morning unless I've been up all night! I've rarely had problems sleeping - can pretty much lay my head on the pillow and I'm out like a baby... can't sleep with the TV on - don't really need the white noise... been blessed with good genes I guess! The thing that's really been chapping my hide is all the telemarketer calls... Yesterday, I got 4 calls between 11:30 and 1pm!!!!!!!!! Bought the telezapper - but still have to hear the phone ring. Turned off the ringer - but would still hear the answering machine click on. Can't turn off both the phones - the school has needed to call several times. Can we dump all the telemarketing companies in the sea?:chuckle Does anyone really buy anything from someone who calls? Thanks for the opportunity to vent... I can really relate to some of these posts. p.s. I have slept through having my roofing replaced, my carpeting replaced and a new driveway being put in - so I don't know why the phone is so bad for me...
  14. dewp_63

    False Nails (Does it promote infection?)

    It was explained to me that clear polish is allowed, because it allows everyone to see what your nails look like. With colored nail polish, you could have fungal infections, crud under your nails, etc. and no one would be the wiser... My gripe about all of this is it is targeted to nurses. I don't know how many times I see a Resp. Tech or Radiology tech with false, long nails. And they rarely wear gloves for their usual procedures... But, I am glad that nurses are trying to address this very important topic. I had an interesting experience a couple of weeks ago. The infection control nurse had her booth set up, with the black light and flourescent cream to educate you about the numbers of germs that remain on your hands after hand washing. Well, I scrubbed the heck out of my hands (more than a regular washing), but didn't have a nail brush or hand brush. After I came back, the glow around my nail beds amazed me! The other eye-opener came related to the nail polish I was wearing (freshly applied). It was some fancy stuff for Halloween, with glitter, and the glitter caught all the flourescent stuff, so you could see every minute crack in the nail polish. Like I said, I'm leaning more toward no nail polish after that!
  15. dewp_63

    Co-pays in the ER

    Our hospital also wants the nurse to escort the patient to the registration/cashier's area for "financial" checkout after the discharge paperwork is signed. We have increased our collection of debt - which may not directly impact my paycheck - but with hospitals going belly up because of finances... at least I have a job and a place to work. Another thing they have started doing is showing the bill for services to self-pay (read: no insurance or funding) patients, and giving them 48 hours to make an offer to pay something (priceline.com in the ER !). My understanding is that any amount of money is preferable to nothing... Haven't heard whether this has worked yet or not. I'll let you know. I don't have a problem escorting any one to the registration, and I have had only 1 patient's family get nasty (told me "Bill me, they always just bill me!")
  16. dewp_63

    ER or ICU?

    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!