rnwaller

Hi Everybody, We need to distinguish here between an LTAC (Long Term Acute Care HOSPITAL) and LTC ie. long term care or a SNF - Skilled Nursing Facility/Nursing Home LTAC is a hospital (and licensed as one) some even have ICU level of care. Per Medicare guidelines (thats what everybody uses as their standard) the goal length of stay is 20-30 days (you do not keep patients in an LTAC long term - although some stay a few months). Patients are seen by physicians daily and respiratory therapists are an integral part of the system. An LTAC is designated for "medically complex" patients requiring extended recovery times from an ACUTE illness. The most common LTAC patient is a complicated ventilator wean or complicated wound patients. What is mentioned as a 1 to 5 nursing ratio is common although ICU does remain at 1:2. SNF - Skilled nursing facility What is commonly know as a nursing home. Both short term medically stable recovery patients and chronic conditions. Licensed as a SNF not as a hospital. Nursing ratio's can range from 1:20 to 1:26 and I agree they are a challenge to work in. They are accepting sicker and sicker patients (some that meet the criteria to go to the LTAC hospital.) God bless the SNF nurses! FYI Acute Rehab - Patients with acute medical condition, stabilized, that can tolerate 3 hours of rehab per day. Most common stroke and trauma ie. Senator Gabrial Gifford. Hope this helps!

I continue to monitor the patient (which would include transfusion reaction) just as if I hung any other medication. That is, in essence, a nurses job. Keep up the great work everbody.

I am hopeful that you have enough repore with your manager that this discussion should not be a big deal. In my opinion, no need to tell your personal story, just express an interest in moving to day shift. Is there a day shift position posted? Is it your hospitals policy to post in house positions to employees first? Where are these postings? Day shift usually has a different 'flavor' than evenings or nights - be sure you want to make the move, and remember you may also loose evening differential.

Thanks for choosing ER Nursing (although this could change) 1. Ask your guidance counseler to 'shadow' and ER nurse. 2. Sign up to get your nursing degree - I highly recommend a BSN program while you're young!! 3. Graduate and taking the nursing boards, preferable in a compact state, find us what this is before you take the boards. 4. Spend one year in med/surg/telemetry and one year in ICU 5. Get a great job in any ER (with this background they will love you!) 6. See you in six years, we'll be waiting with bells on!

I am concerned with the posts I see here. I seem to be reading a lot of one person 'against' another. I agree there are some bullish/bossy people out there - but my guess is they are fewer in nursing. Most nursing enviornments require teamwork, so being bossy doesn't work. Recently, I was perceived as being "bossy". It is a new job and lots of personalities in the mix - as well as recent management changes. The end of the matter was - I was folllowing direction from the charge nurse and my colleagues thought I was being "bossy". I was doing what I was told - my colleagues perceived it as "bossy" because it was creating more work for the team. My thoughts to this group, when someone is being "bossy" take a moment to step back and ask, is it possible they are just doing what they have been told to do (and you don't like what their telling you) or does this person function differently than you? I am an assertive person (I admit it) and I have a 'get 'r done' philosophy. So, I want to do what has to be done and get it done. Others have a more layed back approach. I'm not bossy and their not lazy. We work differently. I try me best to recognize the strengths and weaknesses of my self and my colleagues every day. I hope you all will, too. In the end we are all nurses.

I am agreeing with Liverpool Jane, as an RN and a JW I try to avoid hanging blood. In the US it is always two nurses who hang blood (so I am never doing it 'solo'), and after the blood is hanging it is my job to monitor the patient (as nurses do all the time.) The Bible also states that free will is a choice (not always the right choice) so if the patient with his/her physician has consented to have blood, it is not my place to impose my religious beliefs on them. I hope this helps. - Michelle

Hello again, You mention this patient had chronic anemia. Is she getting the full follow up? Does she have a hematologist, is she getting Epogen? Iron? May be this is all true but I do sometimes find that a patient will refuse a transfusion, then no aggressive follow up is made. She is in my prayers. Michelle

I have been working ED for 9 years now. Lately, I am feeling like a taskmaster - I start the IV, give the meds, dip the urine, give the contrast etc .... What I don't seem to have is any input/interaction with the diagnosis process. The best example of this is I walked out of a patients room the other day and the clerk says - OR is on the phone for report on Mr. 'A', I didn't even know Mr. 'A' was a positive appy (the doc never bothered to tell me.) In my opinion its a severe lack of respect for the nurse as a part of the team. I feel professionally stifled. Anyone else experiencing this?

My hospital is just looking at uniforms and I expect a decision this year about a single scrub color. I too have been at a facility that went all white. I agree with several posts - looks good but is impractical at times (I work ER). I can say that with 17 years of experience including travel to six states, white gets two thumbs up because it makes you immediately identified as a nurse and seems to come with respect from patients and families - I can live with this. So get out the bleach and be proud to be identified as a nurse!!!

Your already on the right track. The system we used was two (or three) triage nurses. One continued traige and one started workups, including sending labs, ekg etc. (an ED tech can also be helpful) We had a chart rack and a specimen holder and this nurse followed results for these patients (had to show EKG to someone watch for critical labs etc.) For that busy an ED you need a doc/mid-level assigned as the "go to" person for triage. If I felt an IV was necessary I used the hallway near triage - I did not let IVs go to waiting room. We used Zofran ODT for quick relief. The charge nurse (or whoever assigns beds) would work with the triage team to know who needed the bed next. I have had a normal EKG with positive cardiac enzymes results sitting in the waiting room so the mention of follow through for results is important. Some people will still leave, even though you are getting thi ngs done for them, so a call back system has to be developed if you get abnormal results requiring follow up. We did urine dips/upreg etc.. but I never told patients results if they were going back to the waiting room - if they have the answer they were more likely to leave. Motivated as we all are, sometimes there is just plain waiting.

You sound very stressed at your current position. I hope you can clear up these change of shift procedures or you may need to move on. Think about suggesting some solutions, get a group involved in making it better, hopefully you can gain some administrative support.

re: pregnancy test Answer - Please call your PCP on Monday for your test results. The result is not an Emergency! I have actually been able to do this once!

Maisy, You did not say how busy an ER you where in or if its a one or two nurse triage system. I spent a year on committee of this very question. Some quick answers. We initiate standing orders in triage including Xrays and bloodwork - IV starts are held off as who is responsible to monitor an IV in the waiting room and what if the patient leaves? It is imperative to have the medical director behind this. It does progress to some more aggressive ordering for experienced staff with established relationships with the doc (ie. head CT, U/S for DVT etc..). I hope this helps - feel free to ask me more.

ED and Breaks, tough words in the same sentence. Scheduling - not a part of the ED language. I have just returned to a regular ED job after a few years of traveling. My experience is a system where you have a 'buddy' assigned is best. You and your buddy schedule breaks with each other based on census and acuity in your zone (your buddy should have an assignment physically close to yours). I try not to leave urgent undone tasks for my buddy. Charge and Triage are usually buddies. When my buddy is at lunch I do my best to follow through on whatever happens with all of our patients, if I need help I try to get it. If its falling apart or somebody goes downhill and I feel patients are at risk I let Charge know and I call my buddy back from lunch. Sometimes, a stable patient has to wait for something because we are people and we do need an occasional break. The ED is far from a scheduled world, but its the only way for me!

If your relief has not arrived, report off to oncoming charge RN, if he/she cannot accept report then have your OT sheet in hand and let him/her know gently but firmly that you expect to be paid if you cannot report off in a timely manner. On the flip side I worked for two years with a nurse who hardly charted anything during her shift and spent 40-90 minutes OT on a DAILY basis charting after giving report (tough to follow her as she took all the charts for the first hour of your shift). This was addressed with her on several occasions but only after she was finally told no overtime did it stop.